- Email: [email protected]
Interprofessional education to foster communication and resilience among health professional students
Journal of Interprofessional Education & Practice 7 (2017) 1e3
Contents lists available at ScienceDirect
Journal of Interprofessional Education & Practice journal homepage: http://www.jieponline.com
Interprofessional education to foster communication and resilience among health professional students Jane Anthony Peterson, PhD, FNP-C, FAANP *, Margaret Brommelsiek, PhD University of Missouri Kansas City, School of Nursing, 2464 Charlotte St., Kansas City, MO 64108, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 21 March 2016 Received in revised form 12 December 2016 Accepted 3 January 2017
An 8-week interprofessional education (IPE) immersion classroom experience was developed to prepare advanced practice nursing, pharmacy, social work and clinical psychology students for delivering care as interprofessional clinical practice (IPCP) teams at a Veterans Administration primary care clinic. The course was designed to assist students in building resilience for negotiating challenges in the healthcare environment, to transition from autonomous novices to interprofessional practitioners, and to fortify knowledge and attitudes around veteran healthcare. Using case studies and standardized patients, student teams learned to negotiate challenging patient and interprofessional conflicts that can arise around moral dilemmas, cultural differences, and the hierarchy within the healthcare system. Students learned to anticipate and manage challenging situations through increased problem-solving skills, effective coping strategies, and improved confidence in managing negative emotions. © 2017 Elsevier Inc. All rights reserved.
Keywords: Interprofessional education Resilience Health professions students Veterans
Format
Objectives
An 8-week interprofessional education (IPE) immersion classroom experience used case studies, patient scenarios, and standardized patients to foster students' humanistic values and beliefs to build effective patient and interprofessional relationships. Interprofessional communication strategies were used to develop creative solutions to moral and ethical conflicts to develop resilience and self-confidence while functioning in interprofessional clinical practice (IPCP) teams. The skills developed in the classroom setting were applied during the clinical practicum at a Veterans Administration (VA) primary care clinic and assisted students in transitioning from autonomous novices to interprofessional practitioners.
Project objectives include: 1) facilitate relationship-building with patients and other healthcare providers through collaborative teamwork; 2) develop students' confidence to cross professional boundaries through enhanced interpersonal communication; 3) build individual and team resilience; and 4) develop students' commitment to quality patient-centered care.
Target audience Advanced practice nursing (nurse practitioner), pharmacy, clinical psychology, and social work students in an IPE immersion course with clinical practicum at a VA primary care clinic were provided with opportunities to build resilience while working in interprofessional teams. Funding: This work was supported by grant #09HP26956 from the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services. * Corresponding author. Fax: þ1 816 235 1701. E-mail address: [email protected] (J.A. Peterson). http://dx.doi.org/10.1016/j.xjep.2017.01.001 2405-4526/© 2017 Elsevier Inc. All rights reserved.
Background A vast majority of current health professions students grew up in meritocratic environments when even minor accomplishments were garnered with instantaneous rewards, but as health professionals, an individual's day-to-day contributions often go unrecognized.1 In a study examining generational differences in the characteristics of medical students, millennials scored lower in the areas associated with resilience, including self-reliance, ambiguity, and stress management.2 Because resilience is time-bound and situational in nature,3 many of today's health professions students may have limited experience with overcoming adversity. To be successful in stressful and demanding clinical practices, health professionals should learn the necessary skills to tolerate and recover from adverse situations during their educational training. This project sought to develop health professional students' resilience using strategies from previous research.4 The training sessions were designed to increase student confidence (self-efficacy),
2
J.A. Peterson, M. Brommelsiek / Journal of Interprofessional Education & Practice 7 (2017) 1e3
coordination (planning), control and composure (anxiety reduction), and commitment (persistence) in support of quality patientcentered care as identified by Martin and Marsh.4 Each of these characteristics has been identified as attributes of resilience5 and helps students to perceive that they can have a positive impact, even in situations that are predominantly negative. Course content was also designed to assist students in transitioning from the role of student learner to professional practitioner.5 Additionally, utilizing IPE for building resilience within the health professions has shown some impact in reducing the effects of moral injury, negative psychological responses, and employment attrition rates.6 While there is minimal research on the topic, the social environment does appears to impact one's resilience and ability to cope in social situations.7 Social resilience is contingent on a group's mutual trust and ability to maintain communication and stabilization. Yet, many health professionals have been educated in “silos” and have not had the opportunity to collaborate and interact within healthcare teams. As healthcare professionals are increasingly required to work collaboratively in providing care to complex patients, developing one's social resilience will be essential. Activity description In building resilience, an IPE course was offered as an 8-week immersion experience. Course content was designed to teach health professions students to communicate and collaborate as members of IPCP teams serving veterans. Curriculum content was developed around the Interprofessional Education Collaborative [IPEC] core competencies, Values/Ethics, Roles/Responsibilities, Interprofessional Communication, and Teams/Teamwork8 to improve individual provider and team communication, ethical reasoning, and coordinated care delivery for the patient population. Health professionals who believe they can control some aspects of a given situation, their emotional responses in that situation, and realize that clinical challenges or setbacks are inevitable, will be less likely to perceive themselves as inadequate or failing. Therefore, resilience can be fostered in a positive manner even in stressful situations. Using case studies, patient scenarios, and standardized patients, interprofessional student teams learned to expect and negotiate challenging patient and interprofessional conflicts that can arise around moral dilemmas, cultural differences, and the hierarchy within the healthcare system. In learning to anticipate and cope with adverse and challenging situations, students were able to gradually increase their problem-solving skills and coping mechanisms, gain confidence in managing negative emotions and stress, and to reflect on their learning. Faculty teaching the IPE course provided students with immediate constructive feedback following each of the case study discussions, reinforcing the key points, providing positive comments, and focusing on the most effective evidence-based approaches to manage the various situations encountered in the learning experience. Challenging the health professional students' values and beliefs through the case scenarios served to elicit interprofessional interactions and to stimulate creative solutions for overcoming moral and ethical conflicts while developing the students' skills and self-confidence in a safe, supportive learning environment. An important aspect of IPE is assisting health professional students to function as interdependent professionals by facilitating communication to promote the quality and safety of patient care. In this IPE course, students are encouraged to function as interprofessional teams from the onset and are required to solve patient and clinical problems by working together through a team approach. This IPE approach fosters collaboration prior to responding to case scenarios by utilizing the diversity of ideas and points-of-view offered by the healthcare team. The case scenarios used in the
trainings are designed to become more challenging as the course progressed and required students to seek guidance and support from their team members to actively engage in creative and collaborative problem-solving. Additionally, students engaged in reflective practice in order to assist them in understanding their own personal and professional needs as healthcare providers and to gain important insights into their actions. The use of reflective journals provided a method for capturing students' perspectives regarding their clinical practice experience as members of IPCP teams and the private interactions with their patients. An IPE clinical practicum experience within the VA was provided to students in tandem with the 8-week IPE immersion course and continued throughout the remainder of the semester. The clinical experience allowed students to gain first-hand knowledge working with a veteran patient population and as members of IPCP teams in the delivery of care. Teams consisted of two to three students with at least two different professions represented on each team. Patient case load varied and was dependent upon the case load of each individual preceptor. Because the Veterans Administration has established PACT (Patient Aligned Care Teams) teams, students were able to easily transition from their IPCP teams in the classroom setting to their clinical practicum. This transition was captured through students' reflective journals. Assessment Increased resilience among student participants was measured using qualitative data from two different methods. Students' reflected weekly by responding briefly to structured questions during the course and their clinical practicum at the VA. The journals helped to gain an understanding of students' perceptions related to working with veterans and their experiences as members of interprofessional care teams. A secure online data entry program, Survey Monkey™ (https://www.surveymonkey.com/) was utilized to gather student reflections. Data was also collected through endof-course focus groups with student participants using guided semi-structured interviews and detailed discussions of their attitudes and perceptions regarding the course and the VA clinical practice immersion. During this session, students were queried regarding barriers and facilitators to IPE and IPCP along with what specific lessons were learned from the course content and the clinical practicum experiences. Evaluation Colaizzi's method was the seven-step process9 utilized to analyze student reflections and focus group data to identify meaningful information, categorize, and identify major themes.10 The evaluator employed content analysis,11 followed by data review from three experts to further code and categorize themes until consensus was derived. Evaluation findings showed that students increased knowledge, confidence, and attitudes in relation to working on interprofessional teams. Students increased knowledge and confidence in providing appropriate healthcare services to a complex set of patients (veterans), skill sets directly related to professionalism, and social resilience. Themes that emerged include: 1) increased self-confidence (self-efficacy); 2) increased knowledge and collaboration on interprofessional teamwork (planning); 3) comfort and situational control (anxiety reduction); and 4) commitment (persistence) to provide optimal patient care. Students commented that interprofessional interaction during the immersion course helped them to understand and articulate the roles and expertise of each respective health professional and that this has served to increase their own confidence during interprofessional interactions. Additionally, the students learned to seek
J.A. Peterson, M. Brommelsiek / Journal of Interprofessional Education & Practice 7 (2017) 1e3
support and to collaborate with their team members and the teaching faculty within the structured classroom and clinical setting and reported that working on patient case studies in interprofessional groups helped them improve their confidence and ability to work interactively with other health professionals. To support the four major themes, exemplar student comments include: “I feel comforted (anxiety reduction) knowing that inside of our academic institution we are learning to interact with one another so when we do get into our professional setting we are more comfortable. It is an important part of giving patients the best care (persistence).” “The training made me more aware not to place a hierarchy among the disciplines (planning). We all work hand in hand.” “I feel more confident (self-efficacy) knowing that I have a team … as long as everyone is collaborative, I feel happy (anxiety reduction) about the way that healthcare is going” (persistence). “I feel more confident (self-efficacy) knowing that I have a team of providers to back me up in a specific way” (planning). “More respect. I have gained more respect” (anxiety reduction). “I feel like I get better at my job every single time I interact with other people” (self-efficacy). Increased knowledge and positive attitudes toward veterans' healthcare was stimulated by the observations of students' in both the post-course focus groups and through the reflective journaling. A majority of the students had little prior knowledge about healthcare issues related to veterans. The inclusion of a Veterans Panel proved to be a particularly powerful tool for the students in understanding the range of veteran experiences. For example, students noted: “I was completely unaware how different that population is. I hadn't considered that a veteran might want a structured care plan with very specific instructions … basically give them an order for their healthcare, give them specific guidelines” (planning). As a result of the knowledge gained by participating in the immersion course, the students reported a resolve to alter their approach to veterans in their respective professions: “I know it is difficult when you have multiple people taking care of your health. After listening about all the hoops they have to jump through made me more aware of what I can do in my setting to take away some of these hoops. This is something I am able to change” (persistence). “I have taken care of veterans before. But moving forward, I'm going to have a different approach to taking care of veterans” (persistence and planning). Students also expressed in their journals and during the focus group sessions how they have used their knowledge of military culture and veterans when communicating with their patients during the practicum experience: “Understanding when the patient was in service has an effect on the patient's behavior.” “I had the opportunity to use military language when communicating. We all have stories, but I love listening to veterans. It's an incomparable, humble, moving, emotional, and influential experience.” “I have found it is important to speak up to veterans clearly and to be upfront with them.” “I feel competent interacting with a veteran when I was able to discuss their trauma and how it impacted their ability to serve.” Impact As healthcare evolves it will be important to prepare future health professionals to cope with multiple stressors within the workplace and to become more resilient. Goals of this IPE project helped build resiliency among health professional students by improving communication, strengthening team work, clarifying roles and responsibilities, and providing situations that challenged values and ethical decision-making. The IPE training sessions and
3
resulting themes indicated that IPE increased student confidence (self-efficacy), coordination (planning), control and composure (anxiety reduction), and commitment (persistence) in support of patient-centered care. Through utilizing case scenarios and standardized patients, health professional students were able to practice and negotiate complex health conditions, patient ambiguity, and conflicts among the health professions. Students learned to evaluate and refocus their individual strengths and weaknesses and those of the healthcare team to provide evidence-based, patientcentered care. With the increasing responsibilities of all health professionals, particularly advanced practice nurses,12 educating all health professions students how to effectively cope and manage inherent stressors in the workplace will be important skills to develop. Implementing evidence-based educational strategies for resilience training and providing advanced practice nurses with the opportunities to interact with other health professional students is one viable option to increase resiliency. Although resilience was not specifically included as a quantitative measure in the evaluation for the original course session, the authors plan to objectively measure this outcome in future course evaluations. Required materials Web-based course format, such as Blackboard™; Survey Monkey™ or another online data entry program for surveys. Classrooms and clinical facilities for student experiences. Acknowledgment Project evaluators, Sarah Knopf-Amelung, MA-R and Tracy Graybill, Research Assistant, for their dedication to this project. References 1. Myers KK, Sadaghiani K. Millennials in the workplace a communication perspective on millennials' organizational relationship and performance. J Bus Psychol. 2010;25(2):225e238. http://dx.doi.org/10.1007/s10869-010-9172. 2. Borges NJ, Manuel RS, Elam CL, Jones BJ. Comparing millennial and generation x medical students at one medical school. Acad Med. 2006;81(6):571e576. http://www.meded.umn.edu/meds/documents/150112_Borgesetal-Comparing MillennialGenX_000.pdf. 3. Luther SS. Resilience in development: a synthesis of research across five decades. In: Cicchetti DD, Cohen DJ, eds. Developmental Psychopathology: Risk Disorder, and Adaptation. 2nd ed, Vol 3. Hoboken, NJ: John Wiley & Sons Inc.; 2006:739e795. 4. Martin AJ, Marsh HW. Academic resilience and its psychological and educational correlates: a construct validity approach. Psychol Sch. 2006;43(3): 267e281. http://dx.doi.org/10.1002/pits.20149. 5. Howe A, Smajdor A, Stockl A. Towards an understanding of resilience and its relevance to medical training. Med Educ. 2012;46:349e356. http://dx.doi.org/ 10.1111/j.1365-2923.2011.04188.x. 6. Bates MJ, Bowles S, Hammermeister J, et al. Psychological fitness. Mil Med. 2010;175(8S):21e38. http://dx.doi.org/10.7205/MILMED-D-10-00073. 7. Adger WN. Social and ecological resilience: are they related? Prog Hum Geogr. 2000;24(3):347e364. http://dx.doi.org/10.1191/030913200701540465. 8. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative; 2011. 9. Sanders C. Application of Colaizzi's method: interpretation of an auditable decision trail by a novice researcher. Contemp Nurse J. 2003;14(3):292e302. 10. Edward KL, Welch T. The extension of Colaizzi's method of phenomenological enquiry. Contemp Nurse. 2011;39(2):163e171. http://dx.doi.org/10.5172/ conu.2011.39.2.163. 11. Hsich HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277e1288. http://dx.doi.org/10.1177/10497732.302276687. 12. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2011.
Contents lists available at ScienceDirect
Journal of Interprofessional Education & Practice journal homepage: http://www.jieponline.com
Interprofessional education to foster communication and resilience among health professional students Jane Anthony Peterson, PhD, FNP-C, FAANP *, Margaret Brommelsiek, PhD University of Missouri Kansas City, School of Nursing, 2464 Charlotte St., Kansas City, MO 64108, USA
a r t i c l e i n f o
a b s t r a c t
Article history: Received 21 March 2016 Received in revised form 12 December 2016 Accepted 3 January 2017
An 8-week interprofessional education (IPE) immersion classroom experience was developed to prepare advanced practice nursing, pharmacy, social work and clinical psychology students for delivering care as interprofessional clinical practice (IPCP) teams at a Veterans Administration primary care clinic. The course was designed to assist students in building resilience for negotiating challenges in the healthcare environment, to transition from autonomous novices to interprofessional practitioners, and to fortify knowledge and attitudes around veteran healthcare. Using case studies and standardized patients, student teams learned to negotiate challenging patient and interprofessional conflicts that can arise around moral dilemmas, cultural differences, and the hierarchy within the healthcare system. Students learned to anticipate and manage challenging situations through increased problem-solving skills, effective coping strategies, and improved confidence in managing negative emotions. © 2017 Elsevier Inc. All rights reserved.
Keywords: Interprofessional education Resilience Health professions students Veterans
Format
Objectives
An 8-week interprofessional education (IPE) immersion classroom experience used case studies, patient scenarios, and standardized patients to foster students' humanistic values and beliefs to build effective patient and interprofessional relationships. Interprofessional communication strategies were used to develop creative solutions to moral and ethical conflicts to develop resilience and self-confidence while functioning in interprofessional clinical practice (IPCP) teams. The skills developed in the classroom setting were applied during the clinical practicum at a Veterans Administration (VA) primary care clinic and assisted students in transitioning from autonomous novices to interprofessional practitioners.
Project objectives include: 1) facilitate relationship-building with patients and other healthcare providers through collaborative teamwork; 2) develop students' confidence to cross professional boundaries through enhanced interpersonal communication; 3) build individual and team resilience; and 4) develop students' commitment to quality patient-centered care.
Target audience Advanced practice nursing (nurse practitioner), pharmacy, clinical psychology, and social work students in an IPE immersion course with clinical practicum at a VA primary care clinic were provided with opportunities to build resilience while working in interprofessional teams. Funding: This work was supported by grant #09HP26956 from the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services. * Corresponding author. Fax: þ1 816 235 1701. E-mail address: [email protected] (J.A. Peterson). http://dx.doi.org/10.1016/j.xjep.2017.01.001 2405-4526/© 2017 Elsevier Inc. All rights reserved.
Background A vast majority of current health professions students grew up in meritocratic environments when even minor accomplishments were garnered with instantaneous rewards, but as health professionals, an individual's day-to-day contributions often go unrecognized.1 In a study examining generational differences in the characteristics of medical students, millennials scored lower in the areas associated with resilience, including self-reliance, ambiguity, and stress management.2 Because resilience is time-bound and situational in nature,3 many of today's health professions students may have limited experience with overcoming adversity. To be successful in stressful and demanding clinical practices, health professionals should learn the necessary skills to tolerate and recover from adverse situations during their educational training. This project sought to develop health professional students' resilience using strategies from previous research.4 The training sessions were designed to increase student confidence (self-efficacy),
2
J.A. Peterson, M. Brommelsiek / Journal of Interprofessional Education & Practice 7 (2017) 1e3
coordination (planning), control and composure (anxiety reduction), and commitment (persistence) in support of quality patientcentered care as identified by Martin and Marsh.4 Each of these characteristics has been identified as attributes of resilience5 and helps students to perceive that they can have a positive impact, even in situations that are predominantly negative. Course content was also designed to assist students in transitioning from the role of student learner to professional practitioner.5 Additionally, utilizing IPE for building resilience within the health professions has shown some impact in reducing the effects of moral injury, negative psychological responses, and employment attrition rates.6 While there is minimal research on the topic, the social environment does appears to impact one's resilience and ability to cope in social situations.7 Social resilience is contingent on a group's mutual trust and ability to maintain communication and stabilization. Yet, many health professionals have been educated in “silos” and have not had the opportunity to collaborate and interact within healthcare teams. As healthcare professionals are increasingly required to work collaboratively in providing care to complex patients, developing one's social resilience will be essential. Activity description In building resilience, an IPE course was offered as an 8-week immersion experience. Course content was designed to teach health professions students to communicate and collaborate as members of IPCP teams serving veterans. Curriculum content was developed around the Interprofessional Education Collaborative [IPEC] core competencies, Values/Ethics, Roles/Responsibilities, Interprofessional Communication, and Teams/Teamwork8 to improve individual provider and team communication, ethical reasoning, and coordinated care delivery for the patient population. Health professionals who believe they can control some aspects of a given situation, their emotional responses in that situation, and realize that clinical challenges or setbacks are inevitable, will be less likely to perceive themselves as inadequate or failing. Therefore, resilience can be fostered in a positive manner even in stressful situations. Using case studies, patient scenarios, and standardized patients, interprofessional student teams learned to expect and negotiate challenging patient and interprofessional conflicts that can arise around moral dilemmas, cultural differences, and the hierarchy within the healthcare system. In learning to anticipate and cope with adverse and challenging situations, students were able to gradually increase their problem-solving skills and coping mechanisms, gain confidence in managing negative emotions and stress, and to reflect on their learning. Faculty teaching the IPE course provided students with immediate constructive feedback following each of the case study discussions, reinforcing the key points, providing positive comments, and focusing on the most effective evidence-based approaches to manage the various situations encountered in the learning experience. Challenging the health professional students' values and beliefs through the case scenarios served to elicit interprofessional interactions and to stimulate creative solutions for overcoming moral and ethical conflicts while developing the students' skills and self-confidence in a safe, supportive learning environment. An important aspect of IPE is assisting health professional students to function as interdependent professionals by facilitating communication to promote the quality and safety of patient care. In this IPE course, students are encouraged to function as interprofessional teams from the onset and are required to solve patient and clinical problems by working together through a team approach. This IPE approach fosters collaboration prior to responding to case scenarios by utilizing the diversity of ideas and points-of-view offered by the healthcare team. The case scenarios used in the
trainings are designed to become more challenging as the course progressed and required students to seek guidance and support from their team members to actively engage in creative and collaborative problem-solving. Additionally, students engaged in reflective practice in order to assist them in understanding their own personal and professional needs as healthcare providers and to gain important insights into their actions. The use of reflective journals provided a method for capturing students' perspectives regarding their clinical practice experience as members of IPCP teams and the private interactions with their patients. An IPE clinical practicum experience within the VA was provided to students in tandem with the 8-week IPE immersion course and continued throughout the remainder of the semester. The clinical experience allowed students to gain first-hand knowledge working with a veteran patient population and as members of IPCP teams in the delivery of care. Teams consisted of two to three students with at least two different professions represented on each team. Patient case load varied and was dependent upon the case load of each individual preceptor. Because the Veterans Administration has established PACT (Patient Aligned Care Teams) teams, students were able to easily transition from their IPCP teams in the classroom setting to their clinical practicum. This transition was captured through students' reflective journals. Assessment Increased resilience among student participants was measured using qualitative data from two different methods. Students' reflected weekly by responding briefly to structured questions during the course and their clinical practicum at the VA. The journals helped to gain an understanding of students' perceptions related to working with veterans and their experiences as members of interprofessional care teams. A secure online data entry program, Survey Monkey™ (https://www.surveymonkey.com/) was utilized to gather student reflections. Data was also collected through endof-course focus groups with student participants using guided semi-structured interviews and detailed discussions of their attitudes and perceptions regarding the course and the VA clinical practice immersion. During this session, students were queried regarding barriers and facilitators to IPE and IPCP along with what specific lessons were learned from the course content and the clinical practicum experiences. Evaluation Colaizzi's method was the seven-step process9 utilized to analyze student reflections and focus group data to identify meaningful information, categorize, and identify major themes.10 The evaluator employed content analysis,11 followed by data review from three experts to further code and categorize themes until consensus was derived. Evaluation findings showed that students increased knowledge, confidence, and attitudes in relation to working on interprofessional teams. Students increased knowledge and confidence in providing appropriate healthcare services to a complex set of patients (veterans), skill sets directly related to professionalism, and social resilience. Themes that emerged include: 1) increased self-confidence (self-efficacy); 2) increased knowledge and collaboration on interprofessional teamwork (planning); 3) comfort and situational control (anxiety reduction); and 4) commitment (persistence) to provide optimal patient care. Students commented that interprofessional interaction during the immersion course helped them to understand and articulate the roles and expertise of each respective health professional and that this has served to increase their own confidence during interprofessional interactions. Additionally, the students learned to seek
J.A. Peterson, M. Brommelsiek / Journal of Interprofessional Education & Practice 7 (2017) 1e3
support and to collaborate with their team members and the teaching faculty within the structured classroom and clinical setting and reported that working on patient case studies in interprofessional groups helped them improve their confidence and ability to work interactively with other health professionals. To support the four major themes, exemplar student comments include: “I feel comforted (anxiety reduction) knowing that inside of our academic institution we are learning to interact with one another so when we do get into our professional setting we are more comfortable. It is an important part of giving patients the best care (persistence).” “The training made me more aware not to place a hierarchy among the disciplines (planning). We all work hand in hand.” “I feel more confident (self-efficacy) knowing that I have a team … as long as everyone is collaborative, I feel happy (anxiety reduction) about the way that healthcare is going” (persistence). “I feel more confident (self-efficacy) knowing that I have a team of providers to back me up in a specific way” (planning). “More respect. I have gained more respect” (anxiety reduction). “I feel like I get better at my job every single time I interact with other people” (self-efficacy). Increased knowledge and positive attitudes toward veterans' healthcare was stimulated by the observations of students' in both the post-course focus groups and through the reflective journaling. A majority of the students had little prior knowledge about healthcare issues related to veterans. The inclusion of a Veterans Panel proved to be a particularly powerful tool for the students in understanding the range of veteran experiences. For example, students noted: “I was completely unaware how different that population is. I hadn't considered that a veteran might want a structured care plan with very specific instructions … basically give them an order for their healthcare, give them specific guidelines” (planning). As a result of the knowledge gained by participating in the immersion course, the students reported a resolve to alter their approach to veterans in their respective professions: “I know it is difficult when you have multiple people taking care of your health. After listening about all the hoops they have to jump through made me more aware of what I can do in my setting to take away some of these hoops. This is something I am able to change” (persistence). “I have taken care of veterans before. But moving forward, I'm going to have a different approach to taking care of veterans” (persistence and planning). Students also expressed in their journals and during the focus group sessions how they have used their knowledge of military culture and veterans when communicating with their patients during the practicum experience: “Understanding when the patient was in service has an effect on the patient's behavior.” “I had the opportunity to use military language when communicating. We all have stories, but I love listening to veterans. It's an incomparable, humble, moving, emotional, and influential experience.” “I have found it is important to speak up to veterans clearly and to be upfront with them.” “I feel competent interacting with a veteran when I was able to discuss their trauma and how it impacted their ability to serve.” Impact As healthcare evolves it will be important to prepare future health professionals to cope with multiple stressors within the workplace and to become more resilient. Goals of this IPE project helped build resiliency among health professional students by improving communication, strengthening team work, clarifying roles and responsibilities, and providing situations that challenged values and ethical decision-making. The IPE training sessions and
3
resulting themes indicated that IPE increased student confidence (self-efficacy), coordination (planning), control and composure (anxiety reduction), and commitment (persistence) in support of patient-centered care. Through utilizing case scenarios and standardized patients, health professional students were able to practice and negotiate complex health conditions, patient ambiguity, and conflicts among the health professions. Students learned to evaluate and refocus their individual strengths and weaknesses and those of the healthcare team to provide evidence-based, patientcentered care. With the increasing responsibilities of all health professionals, particularly advanced practice nurses,12 educating all health professions students how to effectively cope and manage inherent stressors in the workplace will be important skills to develop. Implementing evidence-based educational strategies for resilience training and providing advanced practice nurses with the opportunities to interact with other health professional students is one viable option to increase resiliency. Although resilience was not specifically included as a quantitative measure in the evaluation for the original course session, the authors plan to objectively measure this outcome in future course evaluations. Required materials Web-based course format, such as Blackboard™; Survey Monkey™ or another online data entry program for surveys. Classrooms and clinical facilities for student experiences. Acknowledgment Project evaluators, Sarah Knopf-Amelung, MA-R and Tracy Graybill, Research Assistant, for their dedication to this project. References 1. Myers KK, Sadaghiani K. Millennials in the workplace a communication perspective on millennials' organizational relationship and performance. J Bus Psychol. 2010;25(2):225e238. http://dx.doi.org/10.1007/s10869-010-9172. 2. Borges NJ, Manuel RS, Elam CL, Jones BJ. Comparing millennial and generation x medical students at one medical school. Acad Med. 2006;81(6):571e576. http://www.meded.umn.edu/meds/documents/150112_Borgesetal-Comparing MillennialGenX_000.pdf. 3. Luther SS. Resilience in development: a synthesis of research across five decades. In: Cicchetti DD, Cohen DJ, eds. Developmental Psychopathology: Risk Disorder, and Adaptation. 2nd ed, Vol 3. Hoboken, NJ: John Wiley & Sons Inc.; 2006:739e795. 4. Martin AJ, Marsh HW. Academic resilience and its psychological and educational correlates: a construct validity approach. Psychol Sch. 2006;43(3): 267e281. http://dx.doi.org/10.1002/pits.20149. 5. Howe A, Smajdor A, Stockl A. Towards an understanding of resilience and its relevance to medical training. Med Educ. 2012;46:349e356. http://dx.doi.org/ 10.1111/j.1365-2923.2011.04188.x. 6. Bates MJ, Bowles S, Hammermeister J, et al. Psychological fitness. Mil Med. 2010;175(8S):21e38. http://dx.doi.org/10.7205/MILMED-D-10-00073. 7. Adger WN. Social and ecological resilience: are they related? Prog Hum Geogr. 2000;24(3):347e364. http://dx.doi.org/10.1191/030913200701540465. 8. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative; 2011. 9. Sanders C. Application of Colaizzi's method: interpretation of an auditable decision trail by a novice researcher. Contemp Nurse J. 2003;14(3):292e302. 10. Edward KL, Welch T. The extension of Colaizzi's method of phenomenological enquiry. Contemp Nurse. 2011;39(2):163e171. http://dx.doi.org/10.5172/ conu.2011.39.2.163. 11. Hsich HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277e1288. http://dx.doi.org/10.1177/10497732.302276687. 12. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2011.