Rutgers, The State University of New Jersey Joining Forces Collaboration An Interprofessional...

Rutgers, The State University of New Jersey

Joining Forces CollaborationAn Interprofessional Learning Activity

Carol A. Terregino, M.D.

Senior Associate Dean for Education (interim)

Master Educators’ Guild Symposium

Rutgers Biomedical and Health Sciences

March 17, 2014.

Robert Wood Johnson Medical School

SERVICE


A LABOR OF LOVE

“To colleagues whose tireless activities to get the message out to the nation—you have inspired me. I think I am a better person because I have learned from you.”

Special thanks to Robert Like for his collaboration, Chris Molloy and Joe Barone for believing in Me and supporting the endeavor, The JF Kennedy Hospital, and Peter Amenta for signing on to the AAMC initiative and charging me to get it Done.


• White House initiative to serve military personnel and families in employment, education and wellness

• Charge from the Association of American Medical Colleges• RWJMS joined over 100 medical schools in pledging to

participate • The contribution: A transformative educational program to

train cohorts of learners in the health professions each year


Why is this initiative important?

• 15 million of the 23 million US veterans seek care in the community rather than VA system

• In NJ, 443,200 veterans, 73% are wartime veterans

• Impact factor of these veterans’ service: – 1,329,600 connected and impacted by war and/or service

The Stories


INTERPROFESSIONAL INNOVATIVE COLLABORATION FOR LEARNERS ACROSS EDUCATIONAL SPECTRUM • Learner collaboration: medical students, pharm d

students, nursing students, graduate students in social work and psychology, residents in psychiatry, primary care, and physical medicine and rehabilitation

Beyond RBHS, Beyond RWJUH

• Faculty collaboration: MD/DO in family medicine, psychiatry, physical medicine and rehabilitation, acute care surgery, emergency medicine, pharm d, doctoral trained nurses, psychologists, social workers

• Facilitators: including orthotics, physical and occupational therapy, behavioral health, veterans and family members, students


What is innovative? INTERPROFESSIONAL INNOVATIVE COLLABORATION FOR LEARNERS ACROSS EDUCATIONAL SPECTRUM• Warrior-Centric Healthcare (WCHT)TM by The Steptoe Group

BASED UPON RECOMMENDATIONS FROM

• Rand Report: Invisible wounds of War• DoD Prevention of Suicide by Members of the Armed

Services• DoD Recovering Warrior Task Force Report

“immediate and unabated need for the implementation of warrior-centric evidence-based assessment and training” of health providers

First time such a program was used in an academic environment with interprofessional health professions students


Joining Forces with The Steptoe Group


What is our Vision for Educational Collaboration?

Annual interprofessional training of a cohort of learners to meet the total health and healthcare needs of our service members, veterans, their families and communities

Outcomes:

Enhanced awareness

Improved communication

Warrior-centric care

Collaborative care plans


Implementation

• Collaboration with the Steptoe Group to tailor the learning to interprofessional students***

• Train the Trainer-full day session (40 trainers)– 20 faculty with terminal degrees– 20 facilitators with military/veteran experience/family member

contact/clinical contact with veteran

• Training of students and residents-full day session (400 students/residents)– Facilitated small groups, interactive– Online avatar case studies and assessments at 3,6,and 9 months for all

learners

***significant modifications


What are the Learning Modules?

• Military and veteran culture in the clinical setting• Cultural competency in the military and veteran communities• Neurobiology of post-traumatic stress disorder and traumatic

brain injury• Provider communication in the military and veteran

communities

• RWJMS Modifications based upon training– More engaged learning– Role play– CAT scans, Drugs and Brains– Practical strategies


Specifics of the Educational Program

1. technology – videos and avatars

2. adult learning principles in large and small groupsInteractive

Reflection and sharing

Impact factor

Personal connection

3. target the knowledge and performance of healthcare providers, allied health team members, and service support personnel

4. Durable solutions: approach to complex patient scenarios and knowing where to access help for veterans


Joining Forces in the Patient Centered Medicine Curriculum


400 Strong, impacted by an evocative video of voices of warriors, now students at Rutgers


Panel of warriors and family members


Small Group Interaction

• Each room had a faculty facilitator from one of the professional schools as well as a veteran, significant other or family member of the veteran– Ground rules– Ice breakers

• Time for reflection• Interdisciplinary groups of 4 for role play• Development of a collaborative care plan for a veteran form

the perspective of the various professions


Dr. Prescott lending his expertise in small group


Role playing in interprofessional scenarios


Teaching with Role Play

• An E7 warrior presents to the emergency department at 5:30 am with severe jaw pain. He is in the reserves, awaiting deployment but not yet called up. He needs to be at training at 7:00 am.

• Why you never call an enlisted serviceman SIR?• Four Acts

– The Triage Nurse– The Physician/Physician Assistant/Nurse Practitioner– The Mental Health Provider– The Community Pharmacist


Warriors lending their perspective to the collaborative care plan


Outcomes-based upon 167 pre and post test matched data


Pre and Post Test Unmatched Preliminary Data – Survey by Kevin Parks, MD candidate

Pre – test n=151 Post – test n=205 Sig.

“I feel uncomfortable screening / history taking a veteran of the Armed Forces.”

2.2 (0.8) 1.9 (0.8)P=.001

“When I gather patient histories, I ask (will ask) about veteran status.”

2.1 (1.1) 4.2 (0.7) P=.001

“I am aware of resources available to veterans to help meet their healthcare needs.

2.5 (0.9) 3.7 (0.8) P=.001


More outcomes


Lessons Learned

• Power of Stories • Power of the Patient as a player in “interprofessional”

education• Power of health professions student as “faculty”• Time for reflection• Limit didactics• Avatars?


Questions, Comments, Future Directions

• Invitation to attend the June 23, 2014 event?• Invitation to Joining Forces with RWJMS to become the

Regional Training Site for Warrior-Centric Care?• Rutgers National Center for Educating Health Professionals,

Welcoming veterans and families who receive care outside of the VA system, Educating Rutgers Veterans, Treating PTSD Traumatic Brain Injury

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