Breaking Down Silos: Impact of an Interprofessional Curriculum to Teach Health Professions Students Oncology Palliative Care

Nursing students must be prepared for collaborative interdisciplinary practice if they are to succeed in today’s healthcare environment. Preparing baccalaureate nursing students to be effective members of interprofessional teams is a challenge facing undergraduate nursing programs. The need to meet this challenge is evident. Interprofessional communication and collaboration for improving health outcomes is an essential component of baccalaureate education (American Association of Colleges of Nursing, 2008). Team work and collaboration is a core pre-licensure competency according to the Quality and Safety Education for Nurses (QSEN) initiative (Cronenwett, et al, 2007). The key to preparing nursing students for interprofessional communication, collaboration, and team work may lie in interdisciplinary educational experiences in the undergraduate program. Although the need for interprofessional education (IPE) is apparent, there are few published models and fewer still that have been examined for their effectiveness. The purpose of this study was to examine the effect of a mandatory, interdisciplinary oncology palliative care curriculum on nursing, medical, social work and chaplaincy students’ self-perceived comfort with palliative care skills, self-efficacy related to interprofessional learning, and interprofessional palliative care knowledge. The Interdisciplinary Curriculum for Oncology Palliative Care Education (ICOPE) consisted of four components: on-line case-based didactics, an interprofessional case management exercise, clinical rotations, and critical reflection writing exercises. Nursing students in the final semester of a BSN program, fourth year medical students, masters-level social work students specializing in healthcare, and chaplain residents completing Clinical Pastoral Education were required to complete all components of the curriculum. A pre-post mixed-methods design was used to examine the impact of the ICOPE curriculum. Pre-post measures included the End-of-Life Professional Caregiver Survey to measure palliative care specific educational needs and the Self-Efficacy for Interprofessional Experiential Learning Scale to measure student self-efficacy perceptions related to learning collaboratively in interprofessional teams. A survey developed by the research team measured interdisciplinary palliative care knowledge. All data were collected via on-line surveys. Although all students were required to complete the ICOPE curriculum as part of their educational experience, participation in the study was optional. Only data from students providing informed consent were analyzed. A total of 527 students completed the curriculum. Pre and post measures were completed by 373 students, the majority of whom were female (75%) nursing (64%) students. Following completion of the curriculum, students across all disciplines demonstrated significant increases in comfort with palliative care skills. All disciplines, except chaplaincy residents, demonstrated significant increases in self-perceived efficacy related to learning collaboratively in interprofessional teams and palliative care knowledge. The lack of significant changes in the chaplain group was possibly due to the small sample size of chaplains as the effect size on all scales were notable (Cohen’s d = > 0.60). All students rated the ICOPE curriculum highly with 11 of 14 items on the evaluation at 4.0 or greater on a 5 point scale.  Themes identified in the open-ended responses on student evaluations included: students most valued the opportunity to observe palliative teams at work and practice team-based skills with other learners; the clinical experience positively affected them professionally and personally; they increased their understanding of and respect for other disciplines; and, they perceived improved ability to function on a team. This mandatory, multimodal, experiential, interdisciplinary oncology palliative care curriculum increased students’ comfort with palliative care skills, self-efficacy in interprofessional learning, and palliative care knowledge. Success will ultimately be determined by long term outcomes, an area for future research. While many obstacles to IPE exist, the value of such experiences to the learners justifies efforts to initiate and continue similar programs.  Interprofessional practice plays a key role in the success of health care reform (National Academies of Practice, 2012). No longer can nursing and other health professional students be educated in silos and be expected to function as effective interdisciplinary team members in today’s complex health care environment. Nurse educators are ideally suited to develop and lead IPE initiatives.