Interprofessional Longitudinal Student Geriatric Clinic to Enhance Collaborative Practice
INTERPROFESSIONAL LONGITUDINAL STUDENT GERIATRIC CLINIC TO ENHANCE COLLABORATIVE PRACTICE Gwendolen Buhr, MD, MHS, MEd, CMD; Duke University Department of Medicine Mary Lou Affronti, DNP, MHSc, APRN, ANP; Duke University School of Nursing James E. Herndon II, PhD; Duke Department of Biostatistics & Informatics Liza Genao, MD; Duke University Department of Medicine Milta Little, MD; Duke University Department of Medicine Alicia Bolden, DMSc, MPH, PA-C; Duke Physician Assistant Program Blanca Iris Padilla, PhD, MSN, APRN, FNP-BC; Duke University School of Nursing Jody Feld, PT, DPT, PhD; Duke Doctor of Physical Therapy Background: The complexity in caring for older adults necessitates interprofessional collaborative practice (IPCP). Most practicing providers [physicians (MD), nurse practitioners (NP), physician assistants (PA), and physical therapists (DPT)] care for older adults and are required to collaborate with many other health professionals. However, students of different professions train largely in silos making the mastery of IPCP challenging. Furthermore, many IP experiences are short, hindering the ability to develop relationships and content mastery. In addition to the need to increase IPCP, there is a pressing need to apply it to care for older adults. The National Academy of Medicine called for the enhancement of geriatric training for the entire workforce - including exposure to settings of training outside of the hospital - while also calling for improved recruitment of geriatric specialists. During the COVID-19 pandemic, telehealth became a tool to that was widely applied to reduce staff and patient exposures. Moving forward, telehealth will be a core element of medical training. Consequently, it will be essential to develop effective telehealth training experiences for a wide variety of medical audiences. Objectives: The goal of this study was to determine the effectiveness of a longitudinal hybrid telehealth/ in-person experience in enhancing competence in geriatrics and IPCP among MD, NP, PA, and DPT students. Methods: To enhance competence in geriatrics and IPCP, a team of MD, NP, PA, and DPT students provided annual wellness and follow-up visits for older adults in a half-day hybrid telehealth/ in-person clinic over 4-to-21-week blocks with direct IP faculty observation. There was a focus on mobility, mentation, medications, multi-complexity, and what matters most to patients (the 5Ms). Student evaluation tools included: (1) pre-post self-assessed readiness for IPCP (ISVS-21), (2) pre-post confidence in the 5M’s, (3) post IP teamwork behaviors (ITOFT) and (4) self-assessment of telehealth experiences. In addition, post faculty assessment of student’s telemedicine proficiency and patient perspectives on team communication (CAT-T) were completed. Results/Outcomes/Improvements: Eleven IP students and 5 IP faculty have participated in the 33-week study. Forty-three patients were seen for AWVs and 14 for follow-up visits. CAT-T survey (scale of 1-5 where 1 is poor and 5 is excellent) (N=23) results were uniformly high (range 4.3 to 4.7), highest ratings included treating patients with respect, greeting patients in a way that made them feel comfortable, and spending right amount of time. Lowest ratings included giving as much information as they wanted, involving the patient in decisions as much as they wanted, and discussing next steps. The CAT-T scores improved as the year progressed. Students improved with respect to ISVS-21 (mean pre 4.5 to post 5.8 on a scale of 1-7) and 5Ms concepts (mean pre 2.6 to post 3.8 on a scale of 1 to 5). All students felt competent in telehealth after the experience. Significance/Implications/Relevance: The IP telehealth clinic was feasible and increased students’ readiness for IPCP, confidence in the 5Ms, and telehealth skills. These experiences will likely improve the transition of students to practice and endow healthcare leadership.
- 2022