Strengthening Capacity Through Interdisciplinary Work: Experience-Based Education
Janice K. Smith, M.D., M.P.H. Clinical Associate Professor Department of Family Medicine Director, PAHO/WHO Collaborating Center for Training in International Heath University of Texas Medical Branch Galveston, Texas
Collaborators
UTMB Janice K. Smith, MD, MPH School of Medicine Kathy A. Nash, RN, FNP, PhD School of Nursing Gretchen Stone, OT, PhD School of Allied Health Sciences Ann Frye, PhD School of Medicine Janet Grobe-Hood, DDS UT Dental Branch
Primary Health Care in Developing Countries Elective
3 days of lectures, workshops at UTMB in Galveston
Travel to Mulukuku, Nicaragua
Maria Luisa Ortiz Centro de Mujeres
Work together as part of interdisciplinary team
Team Members
Visiting Delegation
MLO Clinic Staff
Advanced NP‟s Dentists Nurses Occupational Therapists Physicians Medical students Nursing students Dental students Lay volunteers
Clinic Director- RN Physician Nurse Health promoters Social promoter Naturopathic practitioner
Activities
Pharmacy Vital Signs and Triage Insert photo of sam And amy w/ baby
History and Physicals
Night Call Laboratory
Interdisciplinary Teams
Overall, past findings suggest:
a lack of cooperation among nurses and physicians When students are part of the team, the lack of cooperation is more pronounced
In a previous study of students‟ attitudes after participating in this elective, teamwork was a strong theme.
“How to work well with others and how much more can be accomplished as a team.” “ The importance of „team work‟ can never be over stressed”
Assumptions
Working in resource poor area drives the need for more effective and efficient care Capacity to provide primary health care can be increased by working in interdisciplinary teams
However: There are few studies on how students of different health professions view each other‟s value and abilities
Research Questions
Do students who work with members of other disciplines in an international education clinical setting report a
change in their perceptions of
Their own competence & autonomy The need to cooperate with others Actual cooperation Their understanding of the value of other team members’ contributions to the care of the patient
Study Design
Mixed Method
Quantitative measures –
Used to capture students‟ perceptions and changes in perceptions (pre and post survey)
Qualitative methodology
Used to explore why changes in perception, if any, may have occurred.
Interdisciplinary Education Perception Scale (IEPS)
an 18-item self report perceptual /attitudinal inventory using a Likert scale 4 subscales measure: 1. competence and autonomy 2. perceived need for cooperation 3. actual cooperation 4. understanding others‟ value
(Leucht, 1990)
Subjects
8 pre-clinical medical students 6 nursing students 5 dental students
Procedure
IEPS administered to students before the course/trip and again at end of trip to measure pre-post change T-tests were conducted on differences of mean scores between pre and post test IEPS subscale scores. Differences in scores were compared across disciplines and across measures
Qualitative Methods
After 11-13 days on site, each subject participated in one 10-20 minute recorded interview with the primary researcher Subjects were asked questions about their experiences:
with people from their own discipline with people from other disciplines their overall experience
Qualitative Methods
Primary researcher kept journal of observations of team members both in clinic setting, & in other interactions (e.g. meals, off-duty activities) Interviews were transcribed and analyzed by graduate students who were blinded to the study questions
to enhance their understanding of the context of the study, graduate students analyzing data were given description of clinical setting access to journal and photographs opportunity to meet clinic director
Results
Using the IEPS, actual cooperation was the only difference that reached statistical significance (p<.005) All students across all disciplines had a positive change
Medical Student Scores
Decrease in perception of their own competence and autonomy Increase in perceived need for cooperation Increase in actual cooperation Increase in understanding of others‟ value to the team
Nursing students Positive change in all 4 measures Dental students: Negative change in own perceived competence and autonomy Slight positive change in other 3 measures
Why is cooperation related to increased capacity as a team?
Subjects reported that cooperation enables different members of a team to work together toward a common goal.
How is Cooperation Realized?
through interactions with other team members who have a similar level of expertise. through transactions with team members who had considerably more expertise. In these situations students reported learning new technical skills and learning to reason and question.
Final Questions
Is student education enhanced by working in interdisciplinary teams? Does working in interdisciplinary teams strengthen capacity to provide health care in resource poor settings?
Conclusions
Working in a team with persons from other disciplines
helps students to form their own personal and professional identity increases students‟ awareness of what they don‟t know increases actual cooperation between team members increases their perception of the value of other health professionals