Heath care students learn to learn from one another
In the 1980s, health care educators began to rethink how health sciences students, including future doctors, nurses, physical therapists and their allied health peers, should learn their jobs. Interprofessional education, the name that eventually stuck, was simple, but revolutionary: what if students from different disciplines worked together in classrooms and clinical simulation spaces before they graduate and have to work as members of a team caring for patients whose health and wellbeing wasn’t an example in a textbook, but a life and death responsibility?
ECU health sciences and social work students discuss the film “Keepers of the House” at an interprofessional education event in September. (Photo by Ty Huff)
For years, the interprofessional education concept had percolated on East Carolina University’s health sciences campus, but since the return of students to campus following the COVID-19 pandemic, faculty have turbocharged efforts to have students learn with, and from, one another through a kaleidoscope of IPE opportunities.
In late September, nearly 400 students from across ECU’s health sciences and main campuses — from the Colleges of Allied Health Sciences, Nursing, School of Social Work, and the Brody School of Medicine and School of Dental Medicine — gathered to learn from one another how different health care teams work together to elicit the best outcomes for their patients.
The assembled students and faculty mentors watched the film “Keepers of the House” which gives voice to members of hospital housekeeping staffs who are often overlooked as critical members of the health care team. Dr. Neil Prose, a faculty member from the Duke University School of Medicine, spoke before students were broken into small groups to discuss the film’s message and how it might impact their future practice.
Dr. Chris Lysaght, a clinical professor of physical therapy and the director of interprofessional education for the College of Allied Health Sciences, said efforts to integrate the college’s diverse programs began in 2017 and continue to expand across the university.
“In our college, we have a foundational curriculum, where students in all the programs complete integrated IPE assignments within each of their respective coursework. These activities are embedded in all of the programs,” Lysaght said.
Recently, students from the Department of Physical Therapy and Department of Addictions and Rehabilitation Studies at the College of Allied Health Sciences, and the Brody School of Medicine, participated in a clinical simulation in which they were challenged to conduct a physical examination of a patient and share their individual assessment skills with one another. During the scenario, the patient showed signs of being the victim of domestic violence, prompting the students to formulate plans together, on the fly, to determine how best to seek out long-term care and protection for the patient.
Lysaght said one of the benefits of IPE events is to get health care professionals from different disciplines in the same room to learn that they are all people with different skills sets working toward the same goal. But just being in the same room isn’t enough.
“They have to actually do something together, experience something together. At minimum we need to ask and answer some questions and collaborate on something,” Lysaght said.
Organizing a First
Medical students observe Rachel Golden, a physical therapy student, as she conducts a physical exam with a role player during an interprofessional education event at the Brody School of Medicine.
Lysaght said this was the first interprofessional education experience that was planned enough in advance to incorporate the afternoon’s activities into coursework from multiple colleges across the campus. Requiring the film and follow-up discussion ensured students would have interprofessional interactions.
“First, we had to identify the appropriate courses that could be required in, and then the course managers had to decide if they wanted to require it or not,” Lysaght said.
“We wanted them to consider, respect and value all members of the team, but then to do that they also had to communicate,” Lysaght said.
An added challenge to the event was forcing students out of their comfort zones, and to understand that while interprofessional education is an accreditation requirement for the university’s programs, working with their peers will be non-negotiable after graduation.
“People who have treated patients, faculty who have been boots on the ground and really understand patient care, have always been advocates for interprofessional education because they know the difference it makes,” Lysaght said. “They’d rather be working on a team that gets each other and collaborates. There is research that shows there’s less burnout, there’s better morale and better patient outcomes.”
Shifting Relationships
Dr. Chris Lysaght is a clinical professor of physical therapy and the director of interprofessional education for the College of Allied Health Sciences
Lysaght and Kelli Jones, a clinical assistant professor of nursing and the college’s clinical placement coordinator, agree that the sense of a hierarchy in health care — doctors in charge with nurses and other members of the health care team playing supporting roles — is starting to collapse under the gravity of the team approach that is driving modern health care delivery.
“That’s changing. People are sicker and living longer, and there aren’t enough doctors to go around,” Lysaght said. “They can’t fully punch out at the end of a shift.”
Professional education requires participants to walk before they run, and Lysaght said they do that by starting with foundational events like watching and discussing the “Keepers of the House” film, and then progressing on to case studies and hands-on simulations.
“The final step is clinical care on the ground,” Lysaght said.
The participants from the College of Nursing at the film event were third semester seniors and Jones said she jumps on any opportunity to get students into scenarios that will prepare them for life after graduation.
“Even to just have them understand what a lab sciences or PA student does is important,” Jones said. “We all have to make decisions together, so nursing students having the confidence to being able to communicate with a medical student or a PA student is key.”
Jones has been a nurse for three decades and said she never had the opportunity to engage with medical and allied health peers when she was a student. Seeing her students developing experience and confidence before entering the workforce gives her hope for the future of her profession.
“It was intimidating the first time I had to call a doctor to get an order,” Jones said. “We work in silos, but our goal is to help patient outcomes. That comes through communication and understanding what everyone else does.”
A lack of understanding of roles and responsibilities extends to all future members of the health care team, Jones said.
“Medical students have no idea what nurses do until they get on the unit, doing their residency, and we in nursing don’t have a clear concept of speech therapy,” Jones said.
Recently Jones’ students showed second year medical students how to don sterile gloves and give injections, and both groups were surprised at the skill levels of the other.
“The nursing students were like, ‘Oh my, they don’t even know how to sterile glove and I learned that freshman year,’ and then the med students said, ‘I haven’t even stepped foot in a hospital yet, and you know how to do this already,’” Jones remembered. “So it’s a level playing field and I think they both take something away from the experience.”
Non-traditional Health Team Members
Dr. Kelley Reinsmith-Jones, the director of ECU’s Master of Social Work program.
Dr. Kelley Reinsmith-Jones, the director of ECU’s Master of Social Work program, has long made efforts to give social workers opportunities to train with health care students to practice being part of a health care team before graduation. Social workers, said Reinsmith-Jones, are a critical part of the patient care team, oftentimes being the advocate for the human being in the hospital bed.
“Being sick has a lot of humanness attached to it, which sometimes becomes less recognized during a medical encounter. People are stuck and prodded, and they have to get undressed — it’s a very dehumanizing experience, especially for older people,” Reinsmith-Jones said.
By having social work students integrated into IPE events, Reinsmith-Jones hopes the medical, nursing and allied health students will remember to consider the whole person they are treating and integrate the extended team fully into the patient’s care plan.
Casey Gerard, a first-year social work student from the College of Health and Human Performance, said she has participated in several IPE events and is heartened by members of the student medical community acknowledging social work as a vital aspect of the care team.
In turn, spending time with health sciences students has broadened Gerard’s understanding of the incredible demands levied on them all, but especially future doctors.
“It’s really beneficial for us to spend time with them because I did not know what residency looks like, how intense it is and how much they have to do before they can even get into a clinical setting,” Gerard said. “It gives us so much more understanding for when we hit the field.”
By their nature, social workers work from the heart, so when she discussed the “Keepers of the House” film with student peers, Gerard said she kept reminding them that the patient is a whole person, and to consider the needs of those who would care for the patient during recovery.
“What about the caregivers, the people who are going to take our patients home and follow up with the medical plan?” Gerard said. “They’re brilliant individuals, these medical students, but we need to learn how much more grace to give them.”
Because she is re-entering the university somewhat older than her peers, Gerard said the wisdom gained from having lived life, and raising two children, gives her added perspectives in IPE events that the other students likely don’t share.
“It’s beneficial if I can sit in a space vulnerably and tell them about a lesson I learned that was painful and help them to not have to learn that lesson the hard way,” Gerard said. “Everybody may be taking it a little too seriously. It’s stressful, but we are not performing brain surgery or landing a rocket on the moon — we’re good.”