The World Health Organization (WHO) supports interprofessional collaboration and education (ICE) to strengthen efficiency and performance of healthcare teams resulting in improved outcomes for patients, team members, and organizations (2010). This recommendation has been validated by studies demonstrating the benefits of ICE including improved role definition, identification of factors influencing the team environment, improved attitudes of team members, and improved communication (Aase, Hansen, & Aase, 2014; Park, Hawkins, Hamlin, & Hawkins, 2014; Shafran, Richardson, & Bonita, 2015). The Medical Student Collaborative began in 2016 after medical faculty approached the hospital’s critical care outreach team with a desire to expose fourth year medical students to high acuity situations. Initial feedback from medical students participating in the Collaborative indicated benefits extending beyond the program’s intent. These incidental observations reflected the value of ICE as identified by the WHO and the studies cited. Consequently, the Collaborative has evolved to encompass both the care of high acuity patients and phenomena pertaining to interdisciplinary teamwork.
Project Description & Goals
The critical care outreach team is composed of highly skilled, experienced critical care nurses who possess keen operational knowledge and are empowered to practice to the full extent of their license. They provide critical care consultation, emergency response, staff education, and advocacy to 14 acute care units in a 697 bed academic medical center. This dynamic environment requires the critical care outreach nurse to autonomously triage and expedite multiple requests during a given shift. The nurses’ breadth and depth of critical care experience, accompanied by their operational expertise and exuberance for teaching, rendered them opportune partners in this Collaborative.
Fourth year medical students are scheduled to work with a critical care outreach nurse for a single seven hour shift from 1700 to 0000 when the team receives its highest volume of calls. Collaborative objectives are clearly written and shared among all participants to provide direction and justification for the experience (Woermann, Weltsch, Kunz, Stricker, & Guttormsen, 2016). Revised objectives based on feedback from early participants include: enhance critical thinking and confidence in the recognition and management of decompensating patients; collaborate in interdisciplinary planning and facilitation of patient care; engage in interdisciplinary opportunities for teaching/learning to improve patient and nurse outcomes; gain experience obtaining arterial blood specimens and establishing intravenous access in patients with compromised vasculature utilizing ultrasound guidance as needed.
The vision for this Collaborative is to provide an exemplar framework for healthcare and education systems to work together in actualizing ICE thus addressing the WHO’s call to action (WHO, 2010).
Process
The medical student performs proactive rounding and surveillance with the critical care outreach nurse and responds to all emergencies and requests for consultation, procedural assistance, and staff education needs. Throughout the shift, the medical student and nurse engage in purposeful debriefing regarding the patients they encounter and discuss interdisciplinary experiences pertaining to communication, flow of patient care, and role clarification. Students have the opportunity to ask numerous questions ranging from patient management during a crisis situation to educational preparation of an acute care bedside nurse. The Collaborative experience further affords medical students the opportunity to establish intravenous access and obtain arterial blood specimens utilizing ultrasound guidance. During periods of downtime, the critical care outreach nurse reviews evidence-based unfolding case studies with the student that address interdisciplinary management of unstable, decompensating patients.
Following their experience with the critical care outreach nurse, medical students are asked to complete an electronic, anonymous survey. Questions are answered using a numerical rating scale and with open response. Data collection began in May, 2017 and is ongoing with each monthly cohort of medical students. Since the Medical Student Collaborative began in 2016, critical care outreach nurses and medical students have shared over 500 hours of ICE.
Outcomes
Preliminary survey results indicate working with the critical care outreach nurse increases medical students’ confidence in the recognition and management of decompensating patients while offering a better understanding of interdisciplinary communication as it pertains to the continuum of care. Medical students report the experience was worth their time and it improved their understanding of how collaborative teaching/learning experiences impact nurse and patient outcomes. They further indicate the experience increased their knowledge in establishing intravenous access and obtaining arterial blood specimens. Individual comments include, “it helped me understand the responsibilities of nurses and the functions of different ancillary staff in the hospital. I think it was a tremendous experience in fostering interdisciplinary understanding;” “…it made me feel less timid to ask RNs about various thoughts/questions I have in the future. Specifically, I found it encouraging that my interest in learning how to gain IV access, perform blood draws, learn how to care for port sites, learn how the monitors work in the room, and learn how to position the bed for a code would be well-received;” and “I wish there were more sessions/opportunities for medical students to be involved with learning about the day-to-day lives/activities of RNs. It would be helpful to see exactly what happens when we place orders in [the computer] and then things are ‘magically’ completed (e.g. blood draws, accessing a port, initiating tube feeds, initiating IVF, etc.”
Conclusion
The outcomes of the Medical Student Collaborative demonstrate alignment with the core competencies defined by the Interprofessional Education Collaborative (2016). Students speak of experiencing a respectful environment that facilitates interdisciplinary understanding and delivery of patient-centered care. Through increased understanding of the nurse’s role, students identify how their communication and actions directly affect patient care. Although the original intent of the Collaborative involved managing patients in high acuity situations, the findings of this Collaborative thus far suggest that ICE facilitates effective clinical care in high acuity situations by establishing a trusting environment that allows for open communication and interdisciplinary understanding. As the Collaborative continues to evolve it is necessary to identify objective measures pertaining to short and long-term effects of ICE on patient, nurse, and medical student outcomes.