What programs in communication sciences and disorders (CSD) are implementing interprofessional education models?
The Rockcastle Project: A Model for Interprofessional Clinical Education in a Rural Medical Center
by Judith L. Page
This report describes one collaborative, interprofessional, and interinstitutional project developed to provide clinical educational experiences specifically designed to familiarize students with other disciplines and to teach the teamwork skills necessary for practice in a rural setting. The impetus to begin the program was an outgrowth of discussions within the college about the necessity for improving our students’ skills in interprofessional service delivery. We were able to build an effective, collaborative team with the OT faculty at Eastern Kentucky University (EKU) because they are partners with us in another project, UK’s interinstitutional, interprofessional rehabilitation sciences doctoral program.
Description of the Project
The setting for this experience was Rockcastle Regional Hospital and Respiratory Care Center, a medical center located in rural central Kentucky. Rockcastle offers a full spectrum of services across the life span, including inpatient and outpatient rehabilitation, home health, and specialized services such as long-term care for clients who are ventilator dependent, work hardening, cardiac care, and oncology.
Participants from three academic programs at two institutions (communication disorders and physical therapy at the UK, and occupational therapy at EKU were involved in designing the experience as well as scheduling and supervising the students’ clinical training. From Rockcastle, the directors of OT, PT, and speech-language pathology were involved in designing the experience and in supervising the student participants. Representatives from Area Health Education Centers (AHECs) were instrumental in planning the experience and providing support to the students. AHECs are federally funded academic and community partnerships that provide health career recruitment programs for K–12 students and increase access to health care in medically underserved areas. AHECs address health care workforce issues by exposing students to health care career opportunities that they otherwise would not have encountered, establishing community-based training sites for students in service-learning and clinical capacities, providing continuing education programs for health care professionals, and evaluating the needs of underserved communities.
For the first pilot, one student from each of the three disciplines was recruited to participate in the project. All three participants were on site for the 4 weeks of planned project activities.
Project Objectives and Student Learning Outcomes
The project objectives and learning outcomes were originally articulated in an article by Barr (1998); Oandasan & Reeves (2005). The goals of this project were to provide an interprofessional, evidence-based learning experience for students from up to three disciplines and also develop a clinical learning environment that enhances and enables interprofessional education and practice. Helping students to work together on an interprofessional team and increase their knowledge of roles, responsibilities, contributions and expertise of various healthcare professionals was a major project goal. At the end of this learning experience, students were to demonstrate knowledge of the roles and responsibilities of other health care professions, as well as to work with other professionals to assess, plan and provide care for individual patients.
Required Student Activities
Students participated in a 4-week program (January 5–30, 2009) that included weekly interprofessional learning activities. Week 1 focused on orientation activities and observation of an interprofessional examination of a patient. During Week 2, the students participated as a team in an interprofessional examination of a person on the long-term care unit and worked together to evaluate the findings and to develop an interprofessional plan of care. During Week 3, the students presented the plan of care at a rehabilitation team meeting. In Week 4, they participated in a community education activity, facilitated by AHEC, which required them to work as a team and educate others about their role on the health care team. Throughout the entire experience, the students were required to locate evidence from professional literature and participate in weekly discussions with the team and with experienced clinicians. Students were also given a checklist of activities to complete individually during the 4-week period. These activities were designed to ensure that students observed or participated in aspects of care provided by all three of the disciplines at Rockcastle (see below).
Examples of Required Individual Student Activities
The student will observe the following:
- modified barium swallow study
- client using an alternative communication system
- client using a speaking valve
- a work screen of one client
- discipline-specific evaluations
The student will actively participate in the following meetings:
- care plan
- rehabilitation staff
- discharge planning
The student will observe the following therapy sessions:
- occupational therapy
- physical therapy
- speech-language pathology
- co-treatment between PT and OT
- co-treatment between OT and SLP
The student will interact and communicate effectively with the following disciplines regarding a client on his or her caseload:
- social worker
- discharge planner
- respiratory therapist
Each student completed the Interdisciplinary Education Perception Scale (IEPS) (McFadyen, Maclaren, & Webster, 2007) at the start and conclusion of the 4 weeks. Total mean scores on the 18-item IEPS increased for all three students by the end of the experience. It was noted that while each of the three students began the interprofessional experience with positive perceptions of their own discipline, there was an overall increase of positive perceptions of the other disciplines by the end of the experience. In addition to the IEPS, qualitative feedback was solicited from the Rockcastle clinical supervisors and the students. The on-site supervisors noted that the students seemed initially overwhelmed by their perceptions of the added interprofessional assignments, but ultimately successfully managed the workload. The students reported to their clinical faculty that they enjoyed the experience and felt they had increased their knowledge of interprofessional practice, including their understanding of the roles of the other disciplines. As a result, the students were able to practice interprofessional team skills, articulate their own scope of practice, learn the roles of other professions, discuss community resources, and communicate with other health care professionals.
The project resulted in an interprofessional framework that will be continued at Rockcastle and replicated elsewhere. There are plans to expand the number of participating disciplines to include medical and physician assistant students. To increase the quality time spent with the other disciplines, AHEC is exploring shared housing options for participating students. To expose more students to the interprofessional experience, use of a technology system that allows linking of university classrooms is being considered, where project participants could demonstrate interprofessional examination to those in the classroom. In addition, a second hospital in the state is currently working with members of the original core work group to replicate the project.
Judith L. Page is Associate Professor and Director, Division of Communication Disorders at University of Kentucky
Barr, H. (1998). Competent to collaborate: Towards a competency-based model for McFadyen, A. K., Maclaren, W. M., & Webster, V. S. (2007). The Interprofessional Education Perception Scale (IEPS): An alternative remodeled sub-scale structure and its reliability. Journal of Interprofessional Care, 21, 433–443.
Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator, and the learning context. Journal of Interprofessional Care, 19, 21–38.
This article first appeared in the June 2010 issue of Access Academics and Research.