Evaluation of an interprofessional active learning session on acute pain and opioid use disorder using the interprofessional collaborative competency attainment scale

Improving Self-Reported Person-centered Care Competency in Nursing Students: A Pilot Study Using Interactive Case Studies

BACKGROUND

To prepare nursing students to deliver high-quality care, educators need strategies to foster person-centered care (PCC).

PURPOSE

This pilot study evaluated an intervention with interactive case studies on undergraduate nursing students' PCC competency.

METHODS

We conducted a pilot study with sophomore undergraduate nursing students ( n = 39) from a Midwestern US university. We developed a 90-minute class seminar with interactive case studies highlighting how patient preferences, values, and circumstances could influence fall risk. We assessed PCC using the Patient-Centered Care Competency Scale.

RESULTS

Although there was no statistically significant change in overall PCC competency before and after the intervention, we noted a small to medium effect size on PCC competency per Cohen's d standards ( d = 0.35). Content analysis of students' open-ended responses reflected PCC and clustered into 5 themes.

CONCLUSIONS

Findings suggest that educators may use interactive case studies to foster nursing student PCC competency.

First-year health professions students' interprofessional identity development following participation in a brief introductory interprofessional activity: a qualitative study

Healthcare providers need to simultaneously identify with their own profession and the broader interprofessional group to improve interprofessional team functioning and collaboration. The purpose of this study was to explore firstyear healthcare students' interprofessional identity development following a brief introductory interprofessional activity. The Extended Professional Identity Theory (EPIT) served as the framework for this qualitative study. The sample included 1,047 students from 19 different health professions at one institution in the first semester of their professional program. Deductive content analysis was used to analyze students' reflections from two reflective questions in a mandatory course evaluation survey. The 24-item version of the Extended Professional Identity Scale was used as a structured categorization matrix for deductive coding of student reflections to the three EPIT constructs: interprofessional belonging, commitment, and beliefs. Participant responses, spanning all three EPIT constructs, support the ability of early health professions learners to demonstrate the development of an emerging interprofessional identity. Future research is needed to assess IPI at various points across the curriculum and to explore between profession differences and the implications for foundational IPE design and learning along the continuum into practice.

Pharmacy Student Education Related to Opioids: A Scoping Review of the Literature

OBJECTIVES

This scoping review explores and assesses the extent of the literature on the current state of opioid-related training and education of student pharmacists and identifies areas for further research to improve the preparedness of future pharmacists in managing care for patients using opioid medications. This review also examines and maps the literature as it relates to the 4 substance misuse educational content areas (legal/ethical issues; screening, treatment, and stigma; pharmacology and toxicology; and psychosocial aspects) recommended by the 2020 American Association of Colleges of Pharmacy Special Committee on Substance Use and Pharmacy Education.

FINDINGS

A systematic literature search was conducted to identify articles reporting opioid-related educational and training initiatives for student pharmacists in the United States through May 2023. A total of 52 articles were included in the review. Nearly 40% of the included studies reported content that addressed all 4 recommended content areas, with only 8 addressing only 1 or 2 content areas. The majority of studies included students in the third year of their pharmacy program, with many reporting interprofessional educational initiatives. Assessments of opioid-related knowledge and attitudes, satisfaction with the activity, and interprofessional attitudes and competencies were reported.

SUMMARY

Most of the reported activities addressed at least 3 of the recommended educational content areas. However, relatively few reported sufficient details to support the replication of the activities and there is a need to evaluate the effectiveness of these educational initiatives with more vigorous research methodology to determine their potential effectiveness.

An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients

Introduction

Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, we developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction.

Methods

The SP case highlighted a patient on opioids for chronic low back pain resulting from a car accident. Despite no improvement in pain or function, the patient continued taking opioids and developed behaviors that could represent opioid misuse. During the synchronous, online session, interprofessional teams of students interviewed an SP and collaborated to develop a holistic care plan to address the patient's pain and potential opioid misuse. The session evaluation included pre- and postsession surveys.

Results

Over 750 students from medicine, pharmacy, nursing, and social work programs participated in the virtual IPE sessions during a single year. Students rated the session positively. Matched survey responses suggested improved confidence in knowledge and skills, and learning through Zoom was rated favorably.

Discussion

We successfully implemented a synchronous online IPE session involving SP interactions that allowed students to practice team-based care of a patient with chronic pain who was taking opioids. Based on the success of this IPE session, including the success of the online delivery model, future IPE sessions will continue virtually.

Interprofessional Active Learning for Chronic Pain: Transforming Student Learning From Recall to Application

Chronic pain (CP) affects over 50 million Americans daily and represents a unique challenge for healthcare professionals due to its complexity. Across all health professions, only a small percentage of the curriculum is devoted to treating patients with CP. Unfortunately, much of the content is delivered passively via lecture without giving students an opportunity to practice the communication skills to effectively treat patients in the clinic. An interprofessional team of health educators identified 5 essential messages that students frequently struggle to convey to patients with CP. Those messages were based on interprofessional and profession-specific competencies to treat patients with CP from the International Association for the Study of Pain. The 5 messages highlighted the importance of (1) therapeutic alliance, (2) consistent interdisciplinary language, (3) patient prognosis, (4) evidence for pain medicine, surgery, and imaging, and (5) early referral to the interprofessional team. For each message, the team summarized relevant research supporting the importance of each individual message that could serve as a foundation for didactic content. The team then developed active learning educational activities that educators could use to have students practice the skills tied to each message. Each learning activity was designed to be delivered in an interprofessional manner.

Interprofessional education focused on medication safety: a systematic review

Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.

Short and medium-term effects of different teaching strategies for interprofessional education in health professional students: A randomized controlled trial

BACKGROUND

Interprofessional education (IPE) is recognized as important for teaching in healthcare. However, few studies comparing active versus traditional strategies for this teaching approach have been conducted.

OBJECTIVES

This study aims to compare the use of different educational strategies (i.e. active learning versus formal lectures) for teaching interprofessional geriatric competencies in health professional students from different healthcare courses.

DESIGN

Randomized controlled trial.

SETTINGS

Public university.

PARTICIPANTS

Health professional students (nursing, physiotherapy, medicine, nutrition and psychology courses).

METHODS

Different theoretical educational strategies (active learning in intervention group versus formal lectures in control group) were associated with case-based group discussions. The RIPLS (Readiness for Interprofessional Learning Scale), IEPS (Interdisciplinary Education Perception Scale) and TSS (Team Skills Scale) instruments were applied at 3 timepoints: on first day of class, on last day of class and at 6 months post-intervention.

RESULTS

Of 151 eligible students, 99 concluded all stages of the study and were subsequently included in the analysis. A significant increase in scores on the RIPLS, IEPS and TSS was measured on the last day of class and this performance gain persisted after 6 months for both strategies. However, no significant performance difference between the two strategies was found. Similarly, although student satisfaction was very good, no difference in ratings between the strategies was evident.

CONCLUSIONS

The results of this project, besides developing and fostering important discussion on IPE, can add to the literature and aid researchers in IPE by furthering knowledge on how different teaching strategies can impact future health professionals.

Implementing a Dutch Physical Therapy Intervention Into a U.S. Health System: Selecting Strategies Using Implementation Mapping

Background

Coach2Move is a person-centered physical therapy intervention that has demonstrated success in changing physical activity behaviors among older adults in the Netherlands. In this manuscript, we describe how we developed an implementation plan for Coach2move in a U.S. population and healthcare system using Implementation Mapping.

Methods

We established an implementation planning team of researchers, patients, and clinicians. The Consolidated Framework for Implementation Research provided an overall structure for consideration of the context for implementation. Implementation Mapping guided the planning process. The implementation planning team worked sequentially through the five tasks of Implementation Mapping (1) Identify needs, program adopters and implementers; (2) Identify adoption and implementation outcomes, performance objectives, determinants, and matrices of change; (3) Choose theoretical models and implementation strategies; (4) Produce implementation protocols; (5) Evaluate implementation outcomes. In this manuscript, we identify our evaluation plan but not results as data collection is ongoing.

Results

Clinic managers and physical therapists were identified as program adopters and implementors. Performance objectives necessary steps to achieving implementation outcomes were linked to Coach2Move fidelity indicators with implementation by the physical therapist. These included delivery of person-centered care, motivational interviewing, meaningful goal setting, shared decision-making in planning, and systematic monitoring and follow-up. Determinants linked to these performance objectives included knowledge, outcome expectations, skills and self-efficacy, and perceived norms. Implementation strategies were selected based on a review of methods effective for influencing these determinants. This resulted in four primary strategies (1) educational meetings and dynamic training, (2) peer-assessment meetings, (3) changing the electronic health record template, and (4) reminders and prompts. Measures of intervention acceptability, appropriateness, and feasibility will be collected after training and early in implementation. Fidelity and effectiveness measures will be collected over the next 12-months.

Conclusion

Implementation mapping provided a systematic process for identifying what physical therapists would need to implement Coach2Move with fidelity. The result was a matrix linking behavioral determinants and performance objectives. These matrices of change allowed for systematic identification and tailoring of implementation strategies to the needs of our population and setting. The process was acceptable to diverse stakeholders, facilitated communication across stakeholders.

Identifying contributing factors influencing pediatric nurses' and health professionals' self-reported collaborative practice behaviors

PURPOSE

In this study, we examined the influence of interprofessional American Heart Association (AHA) resuscitation courses on pediatric health care professionals' (N = 218) self- reported collaborative practice behaviors (CPBs) and examined differences in CPBs between nursing, medicine, and respiratory therapy.

DESIGN AND METHODS

A mixed methods explanatory design was utilized with a sample of pediatric nurses, nurse practitioners, physicians, and respiratory therapists. Data were collected using the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and two open-ended questions. Data analysis included: exploratory factor analysis, paired t-tests, mixed effects modeling and directed content analysis. Inferences were made across quantitative and qualitative data.

RESULTS

Statistically significant improvement in mean CPB scores was demonstrated by all professions (t (208) = -12.76; ρ < 0.001) immediately after the AHA courses. Qualitative responses indicated physicians identified roles and responsibilities (94%, n = 17) as the most important CPB. Communication was identified by nurses (78%, n = 76), nurse practitioners (100%, n = 11) and respiratory therapists (71%, n = 5) as most important.

CONCLUSIONS

Participation in an interprofessional AHA course significantly increased mean self-reported CPB scores. Changes in mean CPB scores were sustained over 6 weeks upon return to clinical practice.

PRACTICE IMPLICATIONS

Future research focused on CPBs of front-line health care professionals can provide an accurate portrayal of an interprofessional team and can inform how collaborative practice is established in everyday clinical practice.

Results of a Team Objective Structured Clinical Examination (OSCE) in a Patient with Pain

PURPOSE

As rates of chronic pain and opioid use disorder continue to rise, improved pain education is essential. Using an interprofessional team objective structured clinical examination (OSCE) simulation, this study evaluates whether prior exposure to a case-based learning module improves students' assessment and treatment planning of a standardized patient prescribed chronic opioids presenting with acute pain.

METHODS

A quasi-experimental mixed method approach using convenience sampling was employed to evaluate student performance and the impact of the educational intervention.

RESULTS

Fourteen (intervention) and 16 (control) nurse practitioner, physician assistant, medical, pharmacy, and dental students in the final pre-licensure program years completed the team OSCE. Demographics, OSCE learning scores, Interprofessional Attitudes Scale scores, and pain management plans did not differ between groups. All students evaluated the activity highly. Qualitative analysis did not demonstrate differences between groups, but did identify similar themes: students missed opportunities to establish patient-provider rapport and educate across disciplines; opioid use disorder was assumed with chronic opioid therapy; team discussions improved treatment plans; moderators variably influenced team discussion.

CONCLUSION

This novel approach to interprofessional training in pain management using a team OSCE is promising, with modifications suggested. A case-based learning module without structured education prior to the OSCE did not improve students' assessment and pain management skills compared to a control group. Nonetheless, important themes emerged including biases towards the standardized patient. Additional research is needed to develop effective curricular initiatives to foster and improve interprofessional collaboration in assessing and managing a standardized patient with acute and chronic pain.

Interprofessional education on opioid use and pain identifies team-based learning needs

BACKGROUND

An interprofessional education (IPE) activity was designed for health professional students in pharmacy, medicine, nursing, social work, and addiction studies. The goals were to practice team-based collaboration for patients who are prescribed opioids for chronic pain and to evaluate student responses to the activity.

INTERPROFESSIONAL EDUCATION ACTIVITY

Student teams were guided through an unfolding patient case that included evaluating the patient's history, screening tool results, morphine equivalent dose, prescription monitoring program report, and videos of a patient-provider interaction. The two-hour, in-person IPE activity culminated in creation of a patient-centered treatment plan. Surveys were administered to compare pre- and post-course opioid knowledge and post-course IPE attitudes among the healthcare professions.

DISCUSSION

Pharmacy students' baseline opioid knowledge scores were similar to nursing students, significantly lower than medical students, and significantly higher than social work students. Pharmacy students reported significantly higher gains in opioid knowledge than medical students. Nursing and social work students showed significantly higher levels of agreement that the course enhanced attitudes toward interprofessional collaboration compared to medicine and pharmacy students. Students most frequently noted working with other professions as the most valuable aspect of the IPE activity.

IMPLICATIONS

Training gaps can be met using novel IPE activities specific to chronic pain and opioid use. Depending on profession, students demonstrated varied baseline knowledge regarding opioid use for chronic pain. Comparing knowledge gains and attitudes on IPE collaboration among professions can detect areas for program refinement to address each professions' unique needs.

Evidence of validity for the Norwegian version of the interprofessional collaborative competency attainment survey (ICCAS)

This was a validation study of the Norwegian version of The Interprofessional Collaborative Competency Attainment Survey (ICCAS). ICCAS consists of 20 retrospective pre- and post-questions, where respondents rate their agreement with regard to self-assessed competencies after participating in interprofessional education courses. It has been validated across various settings. The questionnaire was translated using the back-translation technique. We investigated evidence of validity regarding content, response process, and internal structure. Data were obtained from health and social care students (n = 1440, response rate 42.8%) participating in 12 different interprofessional courses in seven education institutions in Norway using a cross-sectional design. Exploratory factor analysis indicated one retracted factor for pre-scores and one retracted factor for post-scores. High McDonald's omega values indicated good internal consistency. Item deletion did not improve the scale's overall consistency on pre- or post-scores. We observed higher mean post-scores than pre-scores with moderate-to-large effect sizes, indicating a positive change in self-assessed interprofessional capabilities after training. Our findings indicate that the Norwegian version of ICCAS is a valid tool that may be implemented across a wide range of interprofessional education courses. Finally, our findings support earlier recommendations that ICCAS should be analyzed at an overall level to address change in interprofessional capabilities.