Interdisciplinary Service-Learning: An institutionalized strategy for interprofessional education

Angela L. Hinzey

Physical Therapy student at Marie Reed School, Community of Hope

Now What Next Steps: Fit and Capacity

Background

What How ISCOPES learns and serves

Medical student at Deanwood Community Center

ISCOPES achieves outcomes. In FY11 and prior to adopting IPEC Competencies, 130 students (96%) completed retrospective pre-tests and post-tests formulated around 34 core sub-competencies defined by the National Commission for Health Education Credentialing, Inc. (NCHEC) for Master Certified Health Education Specialists (MCHES).

The measurement of positive movement in self-reported ability from “Not At All Able” to “Fairly Able” to “Able” to “Very Able” was the primary outcome variable. See Table 1 for most significant impact (below).

This study and several others, as well as strategic planning, have resulted in ISCOPES alignment with IPEC competencies. Continued evaluation will demonstrate how shifts in program design and content toward these competencies not only enable standardization across teams and disciplines, but ensure continued achievement of measurable outcomes among students, coaches, consumers, and beyond.

We are guided by our Five-Year Strategic Plan

We prioritize and promote the use of Best Practices:

We equally emphasize Learning and Serving:

Nurse Practitioner student at Girard Street, Community of Hope

So What Why YOU should care

*ISCOPES – Interdisciplinary Student Community-Oriented Prevention Enhancement Service

Acknowledgments: ISCOPES would not exist without the commitment of the students, University faculty, community leaders, DC residents, and leadership team who serve with and learn from each other every year.

Thanks to The George Washington University’s Schools of Medicine and Health Sciences, Public Health and Health Services for making the ISCOPES program possible. Thanks to the DC Dept on Disability Services Healthcare Quality Initiative for supporting this presentation

Service-Learning is an experiential education method that simultaneously promotes the pursuit of learning objectives and achievement of meaningful community outcomes. Few service-learning programs subsist at a professional educational level and fewer still are interprofessional, a crucial emerging trend in professional development. The ISCOPES* program at The George Washington University is one such program, involving graduate-level, health sciences students, faculty, community leaders, and consumers in interprofessional health education activities.

For sixteen years, ISCOPES students have developed their skills in interprofessional teamwork; culturally competent care; and project planning, implementation, and evaluation with the guidance of faculty and community coaches. In FY2011, 140 students, 19 faculty coaches, 22 community coaches, and two full time staff completed ISCOPES. See student breakdown (right).

Table 1: Top 10 Positive Competency Changes in FY2011 All

Students (%)

PT MD MPH HSML MS PA & PA/

MPH NP

Plan a Needs and Resources Assessment with Key Stakeholders (#1) 53% 44% 48% 63% 80% 80% 43% 46%

Address Factors That [Help and Hinder Health Promotion Services] Implementation (#12)

50% 31% 67% 58% 80% 60% 29% 49%

Examine Factors That Enhance or Compromise the Process of Health [Promotion Services] (#6)

50% 31% 59% 74% 60% 80% 71% 38%

Develop [Health Promotion Services] Goals (#9) 50% 25% 54% 74% 60% 100% 57% 49%

Infer Needs for Health [Promotion Services at Your Site] Based on Assessment Findings (#7)

49% 41% 58% 58% 80% 60% 43% 41%

Involve Priority Populations and Other Stakeholders in the [Health Promotion Services] Planning Process (#8)

48% 25% 50% 53% 60% 80% 71% 54%

Implement a [Health Promotion Service] (#13) 47% 31% 49% 63% 60% 80% 71% 41%

Engage in Health [Promotion Services] Advocacy (#32) 47% 25% 50% 63% 100% 80% 71% 41%

Select or Design [Culturally Appropriate Health Promotion Services] Strategies and Interventions (#10)

47% 25% 58% 53% 60% 60% 57% 51%

Develop an Evaluation Plan [for a Health Promotion Service] (#16) 45% 31% 50% 53% 80% 60% 43% 43%

• Universal health care access • Authentic collaboration

between University and Community

• Service-Learning as a core strategy

• Research-informed resources + culturally appropriate adaptations

• Interprofessional teamwork • Culturally competent health

services • Sustainable, outcomes-driven

project development, management, and evaluation

We Value:

• GW students effectively engage in intensive, health promotion experiences

• GW faculty/staff effectively serve as community health promotion coaches

• Community leaders facilitate capacity building through university-community health promotion partnerships

• High priority target populations in the DC Metro area participate in health promotion experiences

• University-Community partnerships are strengthened

Our Goals:

3.9

17.8

0.8

14.7

3.9 28.7

4.7

0.8

24.8

Academic Program - % of Total Student Enrollment in ISCOPES FY2011

Health Sciences Management and Leadership (3.9%)

MD Yr 1 (17.8%)

MD Yr 2 (0.8%)

Master of Public Health (14.7%)

Master of Science (3.9%)

Nurse Practitioner (28.7%)

Physician Assistant/Master of Public Health (4.7%)

Physician Assistant (0.8%)

Physical Therapy (24.8%)

Students share/rotate leadership responsibilities on teams to encourage a collaborative model of practice; to prioritize person–centered care and outcomes; and to focus more on scope of practice than hierarchy. Students and Coaches are equals.

Collaboration across teams is encouraged through facilitated neighborhood-specific debriefs and cross promotion of team projects. This process decreases duplication of services and increases effectiveness across departments, organizations, and disciplines.

Students practice handover techniques in January, May, and September each year. These activities reinforce with students the importance of jargon-less communication, accurate record keeping, continuous quality improvement, and peer education.

Our goals, curriculum, and program evaluation tools reflect the IPEC Competencies1. IPE competence builds the capacity of our students, faculty, and neighborhood practitioners to engage in effective interprofessional practice.

Team service projects are constructed around the Getting to Outcomes2 community health model, an evidence-based, ten-component framework promoted by The Centers for Disease Control and Prevention and widely used in public health practice.

1. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. 2. Chinman M, Hunter S, Ebener P, Paddock S, Stillman L, Imm P, and Wandersman A (2008). The Getting to Outcomes Demonstration and Evaluation: An Illustration of the Prevention Support System. American Journal of Community Psychology, 41, 206 – 224.

• Phase I: Relationship-building and increasing readiness to effectively serve

• During this phase, students spend 4 hrs/mth in team meetings, 2 hrs/mth in training, and 2 hrs/mth in project planning

• Team meetings are student-led and include faculty and community coaching

• Training occurs through small and large group seminars; team blogging; and online learning

• Project Planning involves research and relationship-building with partner sites

Learn and Serve

• Phase II: Team-building; increasing cultural awareness, appreciation, and value; team project implementation and evaluation (PIE)

• During this phase, students and coaches spend 4 hrs/mth in team meetings, 1 hr/mth in continued training, and 3 hrs/mth minimum in PIE

• PIE prioritizes culturally appropriate adaptations, ongoing reflections, and preparing for handovers to new teams (Phase III)

Learn and

Serve

• Identify, recruit, and/or educate diversified champions who value IPE/IPP and have decision-making power or influence within the academic institution AND community.

• Select at least two disciplines of students and faculty, particularly with differing philosophical views of health and health care, that can participate. What incentives might be needed (accreditation, tenure/promotion, stipends, course credit)?

• Consider the impact of geographical location. How might physical proximity or lack thereof (distance programs, rural health programs) affect learning and serving?

• Explore institutional support necessary for changing potentially rigid class schedules. • Examine local relationships between academia and the community. Does more relationship-

building need to happen before entering into formal partnership?

Consider Fit

• Funding: Institutional, grant-related, both • Staff: sufficient credentials, diverse skill sets, and committed • Space: accessible to both academic participants and community, neutral departmental

alignment, storage of team materials

Determine and Build Capacity