- Email: [email protected]
Novel partnerships for interprofessional education: A pilot education program in 3D technologies for human centered computing students and physical therapy students
Journal of Interprofessional Education & Practice 15 (2019) 15–18
Contents lists available at ScienceDirect
Journal of Interprofessional Education & Practice journal homepage: www.elsevier.com/locate/jiep
Novel partnerships for interprofessional education: A pilot education program in 3D technologies for human centered computing students and physical therapy students
T
Karen L. Gordes∗, Sandy McCombe Waller University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD, 21201, United States
A R T I C LE I N FO
A B S T R A C T
Keywords: 3D printing Rehabilitation Adaptive equipment
The role of emerging technologies in the rehabilitative care of patients continues to grow. In order to effectively provide care in a complex medical system, rehabilitative specialists need to be fluent in how technology can enhance the delivery of patient care. In concert, technology experts need to understand how patients are affected by their technological designs. Currently, there is an absence of data to evaluate the impact of combining these two professional groups (physical therapy and human centered computing) to serve the needs of rehabilitative patients. The purpose of this project was to enhance the ability for both rehabilitative professionals and human centered computing specialists to address the healthcare needs of individuals requiring adaptive equipment. An interprofessional educational series was developed to integrate the knowledge and skills of Doctor of Physical Therapy students with students from a human centered computing program to develop adaptive equipment personalized to individual patients using 3D printing. The pilot program was evaluated using survey data and interviews collected from both student and patient perspectives. This paper contributes to the understanding of challenges to unique interprofessional collaborations and provides suggestions to foster more effective educational training for both disciplines. Strategies for improving the development of patient-centered 3D printed adaptive equipment as well as the practical application of using 3D printed assistive technology (AT) in the delivery of client care are discussed.
1. Format This pilot program was an interprofessional collaboration between Doctor of Physical Therapy students at the University of Maryland Baltimore and the Human Centered Computing students at the University of Maryland Baltimore County. Faculty from both institutions partnered to offer team-based classroom training in the use of 3D printing for personalizing adaptive equipment to improve health care outcomes for medically complex patients. The same core faculty, who had formal Interprofessional Education (IPE) training participated for the duration of this pilot program. 2. Target audience Doctor of Physical Therapy Students (DPT) (n = 58), Human Centered Computing Student (HCC) (n = 1), High School Interns from Digital Harbor Foundation (the company contracted to provide the 3D printing services) (n = 3), and medically complex outpatient volunteers
∗
(n = 12). This pilot program occurred during the first and second year clinical courses of a three-year program for the DPT students. The HCC student is a doctoral candidate working on their doctoral dissertation. The high school interns are students from the Baltimore community receiving advanced training in 3D technologies. The outpatient volunteers are individuals with medically complex diagnoses (e.g. stroke, diabetes, other neuromuscular pathologies) from the Baltimore community who volunteer for classroom education laboratory sessions. 3. Objectives The overall objectives for this pilot program were based on the Interprofessional Education Collaborative© (IPEC) Core Competencies and are as follows: 1. Competency Domain I – Values and Ethics for Interprofessional Practice: Students from each discipline will be able to respect the contributions each can make within the healthcare system, 2. Competency Domain 2 – Roles and Responsibilities: Students from each discipline will understand how their disciplines can complement each
Corresponding author. E-mail addresses: [email protected] (K.L. Gordes), [email protected] (S. McCombe Waller).
https://doi.org/10.1016/j.xjep.2019.01.003 Received 13 July 2018; Received in revised form 16 November 2018; Accepted 4 January 2019 2405-4526/ © 2019 Elsevier Inc. All rights reserved.
Journal of Interprofessional Education & Practice 15 (2019) 15–18
K.L. Gordes, S. McCombe Waller
the 3D printed adaptive device for their simulated cases including benefits and pitfalls of the generated product and recommendations for modifications from a clinical perspective. In addition, for each case, the HCC student and the high school interns discussed the difficulties and ease of generating the 3D AT and recommendations for modifications from a 3D printing perspective. At the conclusion of session three, the student groups generated an updated order request reflective of the combined recommendations reviewed during the classroom session. Between session three and four, updated 3D printed AT were generated for each simulated patient case by the HCC student and the high school interns. Session 4: At session four, each student group provided a presentation on the transition from initial to final product, again including perspectives on the benefits and pitfalls relative to clinical application and ease of generating via 3D printing. 4.3. Actual patient cases Fig. 1. Schematic of the six interprofessional classroom sessions.
Classroom sessions five and six included direct access to 12 outpatient volunteers with medically complex rehabilitation issues. Session 5: At session five, the DPT students were divided into 12 patient groups with the HCC student and high school interns rotating among the 12 patient groups. Faculty from both disciplines facilitated team interaction. Student interprofessional teams worked collaboratively to develop clay molds for an adaptive piece designed to meet an individual patient's needs. The needs of the volunteer patients were similar to the simulated patient cases. Between classroom five and six, the HCC student and the high school interns generated 3D printed AT from the clay molds. After the 3D printed product was generated, the HCC student along with a DPT faculty member met with each DPT student group to review the 3D printed AT to determine if modifications or additional supplies were necessary to make the product functional prior to delivering to the outpatient volunteer. Adjustments were made as needed by the HCC student and high school interns. Session 6: At session six, the DPT student groups presented their 3D printed product to the outpatient volunteers. The interprofessional student teams made real-time modifications, as able, to the AT to improve fit and function for their specific patient. Each student group as well as the outpatient volunteers presented their perspective on the 3D printed adaptive product to the full cohort. At classroom six, five of the original twelve patients did not show for the classroom session; one of the five was able to meet at a later date in which the assigned DPT students and a DPT faculty member evaluated the fit and function of the 3D generated AT.
other to better address rehabilitation needs of patients requiring the use of assistive equipment. 3. Competency Domain 3 – Interprofessional Communication: Student teams will effectively share information using understandable terminology and provide respectable, constructive feedback. 4. Competency Domain 4 – Teams and Teamwork: The outpatient volunteers will be able to identify the benefits of an interprofessional team inclusive of engineers and physical therapists in meeting their healthcare needs, 5. Competency Domain 4 – Teams and Teamwork: The outpatient volunteers will report positive feedback about their experience in working with the interprofessional teams [1]. 4. Activity description 4.1. Introduction The interprofessional students participated in six classroom sessions each session. Session 1 was 1.5 h, and sessions 3–6 were each three hours in length (See Fig. 1). Session 1: At the first session, the HCC student provided a lecture presentation on the field of HCC along with instruction on how 3D printing is utilized to develop AT. The lecture was followed by an open session discussion between the HCC student and DPT students on the role of physical therapy (PT) in developing rehabilitative adaptive equipment.
5. Assessment 4.2. Simulated patient cases Online surveys were distributed prior to the first classroom session and following each of the six classroom sessions to the DPT students using www.surveymonkey.com (SurveyMonkey, Inc. San Mateo, CA) to assess perceptions of the use of 3D printed AT. Paper based surveys were distributed to the patient participants after classroom session five and six to assess level of satisfaction with their patient care experience. All students and patients participated in debriefing interviews after each session to collect information about their individual experiences and perspectives at each phase of the pilot program.
Session 2: During classroom session two, the DPT students engaged with the HCC student and the high school interns to generate playdough molds for adapting assistive device equipment for simulated patient scenarios. There were five patient-based cases (see Appendix A). The PT students were divided into five groups and assigned a case with the HCC student and high school interns rotating among the five groups. Faculty from both disciplines facilitated team interaction. DPT student and faculty utilized their knowledge of human anatomy, movement and biomechanics while the HCC students and faculty contributed their knowledge of modeling design and 3D printing materials. Discussions between the professional student groups included implications for functional movement patterns, pros and cons of various 3D printing materials and how materials would impact functional use of the outputted product. Between classroom session two and three, the HCC student and the high school interns used the playdough molds to produce a 3D printed AT. The 3D printed product was based on the playdough mold along with an order sheet completed by the DPT students with descriptors inclusive of size, dimensions, and requested material. Session 3: At session three, a DPT student representative from each group presented
6. Evaluation 6.1. DPT student surveys, volunteer surveys The DPT student surveys indicate that at onset, the DPT students were familiar with the existence of 3D AT but had little to no experience with creating 3D AT or using a 3D printer. Out of 58 DPT students, only 7 students reported having experience with 3D AT and only 3 DPT students had ever used a 3D printer (See Table 1). At the start of the pilot program, an equivalent number of DPT students felt they would be involved in modifying existing adaptive 16
Journal of Interprofessional Education & Practice 15 (2019) 15–18
K.L. Gordes, S. McCombe Waller
communication when interfacing for the development of adaptive equipment for patients using 3D printing technology.
Table 1 Survey data pre-classroom session one. Pre-Class One (# of students)
6.3. Student performance Experience with creating 3D Assistive Technology (AT)? Ever seen a 3D printer? Ever used a 3D printer? Do you know where to access a 3D printer?
Yes = 7
No = 51
Yes = 58 Yes = 3 Yes = 54
No = 0 No = 55 No = 4
While facilitating the classroom sessions, faculty, both DPT and HCC, qualitatively assessed students through observation during the classroom sessions to determine if the pilot program objectives were met. Faculty from both professional groups agreed the student objectives as outlined for Competency Domains 1–3 were achieved.
equipment as they would be in generating new AT in their role as a PT. As the DPT students moved through the educational series their beliefs changed, with the majority of students believing they would be more likely to modify existing adaptive equipment (See Tables 1 and 2). In addition, at the onset of the pilot program, the majority of the DPT cohort expressed interest in learning about 3D printing, however, at the conclusion of the pilot program, DPT student interest in learning about 3D printing declined as well as DPT student belief that 3D printing would be useful in their future careers as PT professionals. (See Table 2 and 3). The outpatient volunteer surveys indicated they felt the students respected them, understood their issues and each volunteer felt they had learned something from being a part of the pilot program and felt the composition of the interprofessional student groups worked well to meet their needs. All of the volunteers indicated they would be willing to participate in future laboratory experiences involving 3D printing of adaptive equipment based upon their positive experience.
6.4. Activity performance After sessions 4 and 6, faculty with formal IPE debriefing training met openly as a group to discuss their observational assessments along with their analysis of the compiled survey data to determine if the pilot program objectives were met. Faculty from both professional groups agreed the pilot program objectives as outlined for Competency Domains 1–4 were achieved. Following this pilot program, the faculty identified the need to use a formal interprofessional team assessment tool. 6.5. Barriers There were two barriers encountered in the implementation of this interprofessional educational series that are likely unique to this pilot program. The DPT student participants expressed a lack of confidence in using 3D technologies from the start to the end of the classroom sessions. Given the general availability and early introduction to technologies for this generation of students prior to entering a Doctoral program, this was not an anticipated issue thus, the pilot program was not designed to overcome the perceived inadequacy. This perception interfered with DPT student initiative to take a lead role in the development of the adaptive equipment and may have impacted the students’ evaluation of the experience. The utilization of high school interns negatively impacted the timing of the classroom sessions. The high school interns were only available for a limited number of work hours during the week which then resulted in an increase in the number of weeks required to produce the 3D printed adaptive equipment for both the simulated and actual patient cases. This required a rescheduling of the original dates set for classroom sessions 3, 4, and 6. Due to the rescheduling of the final classroom session, 4 of the 12 volunteer patient participants were unable to return for the review of their 3D printed adaptive equipment.
6.2. Debriefing interviews During the debriefing interviews, it was identified that the changes in DPT student perception regarding the value of generating and modifying adaptive equipment via 3D printing as well as their interest in learning the skill to generate 3D assistive technology was strongly tied to perceived limitations in the functional application of the 3D AT for the simulated and actual patients. Despite this perception, the majority of students at the end of the educational series still felt that 3D printing of AT would likely expand within the field of PT. Consistent across the student groups there were comments indicating that the lack of continuous communication between the classroom sessions created challenges in decision making in generating the 3D products for both the simulated and actual patient cases. Students reported the need for ongoing communication to ensure the final product generated was useful and felt the lack of contact between the professional groups between the classroom sessions was a major limitation and affected the quality of the product. The high school interns and HCC student often had to make independent decisions regarding adjustments to material, design, sizing, etc. during the 3D printing process and could have benefited from the PT perspective. All student groups (DPT, HCC, interns) strongly recommended that in the professional setting these two disciplines should have ongoing
7. Impact: implications for education and clinical practice 7.1. Education implications This pilot program demonstrates interprofessional educational training experiences do not require a one to one ratio between
Table 2 Survey data post-classroom sessions one to four, simulated patient cases. Simulated Cases (# of students) Post Class One Do you believe 3D printing is important PT? Do you think 3D printing will grow in PT?
Yes = 55 Yes = 57
No = 3 No = 0
Do you think 3D printing will be useful in your PT work? Are you interested in learning about 3D printing? Are you interested in gaining skill to generate 3D AT? Do you think you are more likely to modify (mod) or generate (gen) AT as a PT? Were you satisfied with your group's 3D printed AT?
Yes = 56 Yes = 56 Yes = 56 Mod = 29
No = 2 No = 1 Question skipped = 1 No = 2 Gen = 29
Question Skipped = 1
17
Post Class Two
Post Class Three
Post Class Four
Yes = 54 Yes = 57
No = 4 No = 1
Yes = 54 Yes = 55
No = 4 No = 3
Yes = 54 Yes = 54
No = 4 No = 4
Yes = 53 Yes = 51 Yes = 47 Mod = 46
No = 5 No = 7 No = 11 Gen = 12
Yes = 50 Yes = 44 Yes = 43 Mod = 45
No = 8 No = 14 No = 15 Gen = 13
Yes = 47 Yes = 47 Yes = 45 Mod = 45
No = 11 No = 11 No = 13 Gen = 13
Yes = 53
No = 5
Yes = 42
No = 16
Yes = 50
No = 8
Journal of Interprofessional Education & Practice 15 (2019) 15–18
K.L. Gordes, S. McCombe Waller
Table 3 Survey data post-classroom sessions five and six, actual patient cases. Actual Cases (# of students)
Do you believe 3D printing is important in PT? Do you think 3D printing will grow in PT? Do you think 3D printing will be useful in your PT work? Are you interested in learning about 3D printing? Are you interested in gaining skill to generate 3D AT? Do you think you are more likely to modify (mod) or generate (gen) AT as a PT? Were you satisfied with your group's 3D printed AT?
Post Class Five
Post Class Six (students whose patient did return)
Post Class Six (students whose patient did not return)
Yes = 49 Yes = 49 Yes = 43 Yes = 42 Yes = 37 Mod = 45
No = 9 No = 9 No = 15 No = 16 No = 21 Gen = 13
Yes = 28 Yes = 29 Yes = 26 Yes = 18 Yes = 18 Mod = 31
No = 11 No = 10 No = 13 No = 21 No = 21 Gen = 8
Yes = 15 Yes = 14 Yes = 14 Yes = 8 Yes = 6 Mod = 17
No = 4 No = 5 No = 5 No = 11 No = 13 Gen = 2
Yes = 46
No = 12
Yes = 22
No = 17
Yes = 9
No = 10
facilitators from both the DPT and HCC program.
professional student groups. This educational series was able to deliver the necessary content with an unequal number of students, i.e. 68 DPT and 1 HCC student. When implementing an interprofessional program with professions that are disparate, such as technology and healthcare, additional interactions between student groups inside and outside of the classroom setting may be required to facilitate the greatest gains in meeting the IPEC Core Competencies. In addition, there is a definite need to consider where in the curriculum the interprofessional experience is placed relative to content students are learning within their own discipline. For the DPT students, the students were more resourceful and creative for generating a 3D product for the simulated patient cases than the actual patient cases. This could have been due to the limited experience the DPT students had with direct patient care at the time of the pilot program. For this particular educational series, it may have been better located later in the curriculum to provide a backdrop of more direct clinical experience with patients.
Appendix A. Simulated patient cases
• Case 1: Pt. is a 62-year-old (y.o.) male after left hemorrhagic stroke, • • • •
7.2. Clinical practice implications
requires use of hemiwalker, limited ability to grasp with his left hand. Case 2: Pt. is a 45 y.o. female after traumatic brain injury, requires use of right quad cane, limited by right wrist flexor synergy. Case 3: Pt. is a 32 y.o. male after right humeroradial fracture, requires use of axillary crutches for recent ankle sprain, limited by right elbow flexion range (AROM/PROM 0–10°). Case 4: Pt. is a 60 y.o. female with right adhesive capsulitis, requires use of straight cane for balance issues, limited by shoulder flexion range (AROM/PROM 0–10°). Case 5: Pt. is an 8 y.o. male with scoliotic curve, requires use of walker for Cerebral Palsy related balance issues, limited by fixed trunk flexion to 20°, fixed trunk right sidebend/rotation to 10°.
Grants or other financial assistance
Based upon the experiences between these two student groups, it is recommended that healthcare professionals and experts in the production of 3D AT have ongoing communication when interfacing to develop adaptive equipment for direct patient users. Ongoing communication is necessary to ensure the rehabilitative needs are met within the confines of the capabilities of 3D printing.
The work was supported by the University of Maryland Baltimore Center for Interprofessional Education Seed Grant and an NSF grant to support the payment of services completed by the 3D printing high school interns.
8. Required materials
References
Three large laboratory rooms, 3D printers, 3D printing materials, adaptive equipment (straight cane, quad cane, axillary crutches, hemiwalker, standard walker), supplementary materials for adaptive equipment (foam, Velcro© hook and loop, scissors, epoxy) and faculty
1. Interprofessional Education Collaborative. Core Competencies for Interprofessional Collaborative Practice: 2016 Update. Washington, DC: Interprofessional Education; 2016https://optometriceducation.org/wp-content/uploads/2017/01/IPEC-2016Updated-Core-Competencies-Report__final_release_.pdf.
18
Contents lists available at ScienceDirect
Journal of Interprofessional Education & Practice journal homepage: www.elsevier.com/locate/jiep
Novel partnerships for interprofessional education: A pilot education program in 3D technologies for human centered computing students and physical therapy students
T
Karen L. Gordes∗, Sandy McCombe Waller University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD, 21201, United States
A R T I C LE I N FO
A B S T R A C T
Keywords: 3D printing Rehabilitation Adaptive equipment
The role of emerging technologies in the rehabilitative care of patients continues to grow. In order to effectively provide care in a complex medical system, rehabilitative specialists need to be fluent in how technology can enhance the delivery of patient care. In concert, technology experts need to understand how patients are affected by their technological designs. Currently, there is an absence of data to evaluate the impact of combining these two professional groups (physical therapy and human centered computing) to serve the needs of rehabilitative patients. The purpose of this project was to enhance the ability for both rehabilitative professionals and human centered computing specialists to address the healthcare needs of individuals requiring adaptive equipment. An interprofessional educational series was developed to integrate the knowledge and skills of Doctor of Physical Therapy students with students from a human centered computing program to develop adaptive equipment personalized to individual patients using 3D printing. The pilot program was evaluated using survey data and interviews collected from both student and patient perspectives. This paper contributes to the understanding of challenges to unique interprofessional collaborations and provides suggestions to foster more effective educational training for both disciplines. Strategies for improving the development of patient-centered 3D printed adaptive equipment as well as the practical application of using 3D printed assistive technology (AT) in the delivery of client care are discussed.
1. Format This pilot program was an interprofessional collaboration between Doctor of Physical Therapy students at the University of Maryland Baltimore and the Human Centered Computing students at the University of Maryland Baltimore County. Faculty from both institutions partnered to offer team-based classroom training in the use of 3D printing for personalizing adaptive equipment to improve health care outcomes for medically complex patients. The same core faculty, who had formal Interprofessional Education (IPE) training participated for the duration of this pilot program. 2. Target audience Doctor of Physical Therapy Students (DPT) (n = 58), Human Centered Computing Student (HCC) (n = 1), High School Interns from Digital Harbor Foundation (the company contracted to provide the 3D printing services) (n = 3), and medically complex outpatient volunteers
∗
(n = 12). This pilot program occurred during the first and second year clinical courses of a three-year program for the DPT students. The HCC student is a doctoral candidate working on their doctoral dissertation. The high school interns are students from the Baltimore community receiving advanced training in 3D technologies. The outpatient volunteers are individuals with medically complex diagnoses (e.g. stroke, diabetes, other neuromuscular pathologies) from the Baltimore community who volunteer for classroom education laboratory sessions. 3. Objectives The overall objectives for this pilot program were based on the Interprofessional Education Collaborative© (IPEC) Core Competencies and are as follows: 1. Competency Domain I – Values and Ethics for Interprofessional Practice: Students from each discipline will be able to respect the contributions each can make within the healthcare system, 2. Competency Domain 2 – Roles and Responsibilities: Students from each discipline will understand how their disciplines can complement each
Corresponding author. E-mail addresses: [email protected] (K.L. Gordes), [email protected] (S. McCombe Waller).
https://doi.org/10.1016/j.xjep.2019.01.003 Received 13 July 2018; Received in revised form 16 November 2018; Accepted 4 January 2019 2405-4526/ © 2019 Elsevier Inc. All rights reserved.
Journal of Interprofessional Education & Practice 15 (2019) 15–18
K.L. Gordes, S. McCombe Waller
the 3D printed adaptive device for their simulated cases including benefits and pitfalls of the generated product and recommendations for modifications from a clinical perspective. In addition, for each case, the HCC student and the high school interns discussed the difficulties and ease of generating the 3D AT and recommendations for modifications from a 3D printing perspective. At the conclusion of session three, the student groups generated an updated order request reflective of the combined recommendations reviewed during the classroom session. Between session three and four, updated 3D printed AT were generated for each simulated patient case by the HCC student and the high school interns. Session 4: At session four, each student group provided a presentation on the transition from initial to final product, again including perspectives on the benefits and pitfalls relative to clinical application and ease of generating via 3D printing. 4.3. Actual patient cases Fig. 1. Schematic of the six interprofessional classroom sessions.
Classroom sessions five and six included direct access to 12 outpatient volunteers with medically complex rehabilitation issues. Session 5: At session five, the DPT students were divided into 12 patient groups with the HCC student and high school interns rotating among the 12 patient groups. Faculty from both disciplines facilitated team interaction. Student interprofessional teams worked collaboratively to develop clay molds for an adaptive piece designed to meet an individual patient's needs. The needs of the volunteer patients were similar to the simulated patient cases. Between classroom five and six, the HCC student and the high school interns generated 3D printed AT from the clay molds. After the 3D printed product was generated, the HCC student along with a DPT faculty member met with each DPT student group to review the 3D printed AT to determine if modifications or additional supplies were necessary to make the product functional prior to delivering to the outpatient volunteer. Adjustments were made as needed by the HCC student and high school interns. Session 6: At session six, the DPT student groups presented their 3D printed product to the outpatient volunteers. The interprofessional student teams made real-time modifications, as able, to the AT to improve fit and function for their specific patient. Each student group as well as the outpatient volunteers presented their perspective on the 3D printed adaptive product to the full cohort. At classroom six, five of the original twelve patients did not show for the classroom session; one of the five was able to meet at a later date in which the assigned DPT students and a DPT faculty member evaluated the fit and function of the 3D generated AT.
other to better address rehabilitation needs of patients requiring the use of assistive equipment. 3. Competency Domain 3 – Interprofessional Communication: Student teams will effectively share information using understandable terminology and provide respectable, constructive feedback. 4. Competency Domain 4 – Teams and Teamwork: The outpatient volunteers will be able to identify the benefits of an interprofessional team inclusive of engineers and physical therapists in meeting their healthcare needs, 5. Competency Domain 4 – Teams and Teamwork: The outpatient volunteers will report positive feedback about their experience in working with the interprofessional teams [1]. 4. Activity description 4.1. Introduction The interprofessional students participated in six classroom sessions each session. Session 1 was 1.5 h, and sessions 3–6 were each three hours in length (See Fig. 1). Session 1: At the first session, the HCC student provided a lecture presentation on the field of HCC along with instruction on how 3D printing is utilized to develop AT. The lecture was followed by an open session discussion between the HCC student and DPT students on the role of physical therapy (PT) in developing rehabilitative adaptive equipment.
5. Assessment 4.2. Simulated patient cases Online surveys were distributed prior to the first classroom session and following each of the six classroom sessions to the DPT students using www.surveymonkey.com (SurveyMonkey, Inc. San Mateo, CA) to assess perceptions of the use of 3D printed AT. Paper based surveys were distributed to the patient participants after classroom session five and six to assess level of satisfaction with their patient care experience. All students and patients participated in debriefing interviews after each session to collect information about their individual experiences and perspectives at each phase of the pilot program.
Session 2: During classroom session two, the DPT students engaged with the HCC student and the high school interns to generate playdough molds for adapting assistive device equipment for simulated patient scenarios. There were five patient-based cases (see Appendix A). The PT students were divided into five groups and assigned a case with the HCC student and high school interns rotating among the five groups. Faculty from both disciplines facilitated team interaction. DPT student and faculty utilized their knowledge of human anatomy, movement and biomechanics while the HCC students and faculty contributed their knowledge of modeling design and 3D printing materials. Discussions between the professional student groups included implications for functional movement patterns, pros and cons of various 3D printing materials and how materials would impact functional use of the outputted product. Between classroom session two and three, the HCC student and the high school interns used the playdough molds to produce a 3D printed AT. The 3D printed product was based on the playdough mold along with an order sheet completed by the DPT students with descriptors inclusive of size, dimensions, and requested material. Session 3: At session three, a DPT student representative from each group presented
6. Evaluation 6.1. DPT student surveys, volunteer surveys The DPT student surveys indicate that at onset, the DPT students were familiar with the existence of 3D AT but had little to no experience with creating 3D AT or using a 3D printer. Out of 58 DPT students, only 7 students reported having experience with 3D AT and only 3 DPT students had ever used a 3D printer (See Table 1). At the start of the pilot program, an equivalent number of DPT students felt they would be involved in modifying existing adaptive 16
Journal of Interprofessional Education & Practice 15 (2019) 15–18
K.L. Gordes, S. McCombe Waller
communication when interfacing for the development of adaptive equipment for patients using 3D printing technology.
Table 1 Survey data pre-classroom session one. Pre-Class One (# of students)
6.3. Student performance Experience with creating 3D Assistive Technology (AT)? Ever seen a 3D printer? Ever used a 3D printer? Do you know where to access a 3D printer?
Yes = 7
No = 51
Yes = 58 Yes = 3 Yes = 54
No = 0 No = 55 No = 4
While facilitating the classroom sessions, faculty, both DPT and HCC, qualitatively assessed students through observation during the classroom sessions to determine if the pilot program objectives were met. Faculty from both professional groups agreed the student objectives as outlined for Competency Domains 1–3 were achieved.
equipment as they would be in generating new AT in their role as a PT. As the DPT students moved through the educational series their beliefs changed, with the majority of students believing they would be more likely to modify existing adaptive equipment (See Tables 1 and 2). In addition, at the onset of the pilot program, the majority of the DPT cohort expressed interest in learning about 3D printing, however, at the conclusion of the pilot program, DPT student interest in learning about 3D printing declined as well as DPT student belief that 3D printing would be useful in their future careers as PT professionals. (See Table 2 and 3). The outpatient volunteer surveys indicated they felt the students respected them, understood their issues and each volunteer felt they had learned something from being a part of the pilot program and felt the composition of the interprofessional student groups worked well to meet their needs. All of the volunteers indicated they would be willing to participate in future laboratory experiences involving 3D printing of adaptive equipment based upon their positive experience.
6.4. Activity performance After sessions 4 and 6, faculty with formal IPE debriefing training met openly as a group to discuss their observational assessments along with their analysis of the compiled survey data to determine if the pilot program objectives were met. Faculty from both professional groups agreed the pilot program objectives as outlined for Competency Domains 1–4 were achieved. Following this pilot program, the faculty identified the need to use a formal interprofessional team assessment tool. 6.5. Barriers There were two barriers encountered in the implementation of this interprofessional educational series that are likely unique to this pilot program. The DPT student participants expressed a lack of confidence in using 3D technologies from the start to the end of the classroom sessions. Given the general availability and early introduction to technologies for this generation of students prior to entering a Doctoral program, this was not an anticipated issue thus, the pilot program was not designed to overcome the perceived inadequacy. This perception interfered with DPT student initiative to take a lead role in the development of the adaptive equipment and may have impacted the students’ evaluation of the experience. The utilization of high school interns negatively impacted the timing of the classroom sessions. The high school interns were only available for a limited number of work hours during the week which then resulted in an increase in the number of weeks required to produce the 3D printed adaptive equipment for both the simulated and actual patient cases. This required a rescheduling of the original dates set for classroom sessions 3, 4, and 6. Due to the rescheduling of the final classroom session, 4 of the 12 volunteer patient participants were unable to return for the review of their 3D printed adaptive equipment.
6.2. Debriefing interviews During the debriefing interviews, it was identified that the changes in DPT student perception regarding the value of generating and modifying adaptive equipment via 3D printing as well as their interest in learning the skill to generate 3D assistive technology was strongly tied to perceived limitations in the functional application of the 3D AT for the simulated and actual patients. Despite this perception, the majority of students at the end of the educational series still felt that 3D printing of AT would likely expand within the field of PT. Consistent across the student groups there were comments indicating that the lack of continuous communication between the classroom sessions created challenges in decision making in generating the 3D products for both the simulated and actual patient cases. Students reported the need for ongoing communication to ensure the final product generated was useful and felt the lack of contact between the professional groups between the classroom sessions was a major limitation and affected the quality of the product. The high school interns and HCC student often had to make independent decisions regarding adjustments to material, design, sizing, etc. during the 3D printing process and could have benefited from the PT perspective. All student groups (DPT, HCC, interns) strongly recommended that in the professional setting these two disciplines should have ongoing
7. Impact: implications for education and clinical practice 7.1. Education implications This pilot program demonstrates interprofessional educational training experiences do not require a one to one ratio between
Table 2 Survey data post-classroom sessions one to four, simulated patient cases. Simulated Cases (# of students) Post Class One Do you believe 3D printing is important PT? Do you think 3D printing will grow in PT?
Yes = 55 Yes = 57
No = 3 No = 0
Do you think 3D printing will be useful in your PT work? Are you interested in learning about 3D printing? Are you interested in gaining skill to generate 3D AT? Do you think you are more likely to modify (mod) or generate (gen) AT as a PT? Were you satisfied with your group's 3D printed AT?
Yes = 56 Yes = 56 Yes = 56 Mod = 29
No = 2 No = 1 Question skipped = 1 No = 2 Gen = 29
Question Skipped = 1
17
Post Class Two
Post Class Three
Post Class Four
Yes = 54 Yes = 57
No = 4 No = 1
Yes = 54 Yes = 55
No = 4 No = 3
Yes = 54 Yes = 54
No = 4 No = 4
Yes = 53 Yes = 51 Yes = 47 Mod = 46
No = 5 No = 7 No = 11 Gen = 12
Yes = 50 Yes = 44 Yes = 43 Mod = 45
No = 8 No = 14 No = 15 Gen = 13
Yes = 47 Yes = 47 Yes = 45 Mod = 45
No = 11 No = 11 No = 13 Gen = 13
Yes = 53
No = 5
Yes = 42
No = 16
Yes = 50
No = 8
Journal of Interprofessional Education & Practice 15 (2019) 15–18
K.L. Gordes, S. McCombe Waller
Table 3 Survey data post-classroom sessions five and six, actual patient cases. Actual Cases (# of students)
Do you believe 3D printing is important in PT? Do you think 3D printing will grow in PT? Do you think 3D printing will be useful in your PT work? Are you interested in learning about 3D printing? Are you interested in gaining skill to generate 3D AT? Do you think you are more likely to modify (mod) or generate (gen) AT as a PT? Were you satisfied with your group's 3D printed AT?
Post Class Five
Post Class Six (students whose patient did return)
Post Class Six (students whose patient did not return)
Yes = 49 Yes = 49 Yes = 43 Yes = 42 Yes = 37 Mod = 45
No = 9 No = 9 No = 15 No = 16 No = 21 Gen = 13
Yes = 28 Yes = 29 Yes = 26 Yes = 18 Yes = 18 Mod = 31
No = 11 No = 10 No = 13 No = 21 No = 21 Gen = 8
Yes = 15 Yes = 14 Yes = 14 Yes = 8 Yes = 6 Mod = 17
No = 4 No = 5 No = 5 No = 11 No = 13 Gen = 2
Yes = 46
No = 12
Yes = 22
No = 17
Yes = 9
No = 10
facilitators from both the DPT and HCC program.
professional student groups. This educational series was able to deliver the necessary content with an unequal number of students, i.e. 68 DPT and 1 HCC student. When implementing an interprofessional program with professions that are disparate, such as technology and healthcare, additional interactions between student groups inside and outside of the classroom setting may be required to facilitate the greatest gains in meeting the IPEC Core Competencies. In addition, there is a definite need to consider where in the curriculum the interprofessional experience is placed relative to content students are learning within their own discipline. For the DPT students, the students were more resourceful and creative for generating a 3D product for the simulated patient cases than the actual patient cases. This could have been due to the limited experience the DPT students had with direct patient care at the time of the pilot program. For this particular educational series, it may have been better located later in the curriculum to provide a backdrop of more direct clinical experience with patients.
Appendix A. Simulated patient cases
• Case 1: Pt. is a 62-year-old (y.o.) male after left hemorrhagic stroke, • • • •
7.2. Clinical practice implications
requires use of hemiwalker, limited ability to grasp with his left hand. Case 2: Pt. is a 45 y.o. female after traumatic brain injury, requires use of right quad cane, limited by right wrist flexor synergy. Case 3: Pt. is a 32 y.o. male after right humeroradial fracture, requires use of axillary crutches for recent ankle sprain, limited by right elbow flexion range (AROM/PROM 0–10°). Case 4: Pt. is a 60 y.o. female with right adhesive capsulitis, requires use of straight cane for balance issues, limited by shoulder flexion range (AROM/PROM 0–10°). Case 5: Pt. is an 8 y.o. male with scoliotic curve, requires use of walker for Cerebral Palsy related balance issues, limited by fixed trunk flexion to 20°, fixed trunk right sidebend/rotation to 10°.
Grants or other financial assistance
Based upon the experiences between these two student groups, it is recommended that healthcare professionals and experts in the production of 3D AT have ongoing communication when interfacing to develop adaptive equipment for direct patient users. Ongoing communication is necessary to ensure the rehabilitative needs are met within the confines of the capabilities of 3D printing.
The work was supported by the University of Maryland Baltimore Center for Interprofessional Education Seed Grant and an NSF grant to support the payment of services completed by the 3D printing high school interns.
8. Required materials
References
Three large laboratory rooms, 3D printers, 3D printing materials, adaptive equipment (straight cane, quad cane, axillary crutches, hemiwalker, standard walker), supplementary materials for adaptive equipment (foam, Velcro© hook and loop, scissors, epoxy) and faculty
1. Interprofessional Education Collaborative. Core Competencies for Interprofessional Collaborative Practice: 2016 Update. Washington, DC: Interprofessional Education; 2016https://optometriceducation.org/wp-content/uploads/2017/01/IPEC-2016Updated-Core-Competencies-Report__final_release_.pdf.
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