Creating opportunities for nursing students and medical students to collaborate during their training can be tricky. Still, research suggests doing so can yield massive payoffs for post-graduation practice: facilitating smoother transitions to interdisciplinary care, enhancing teamwork, reducing preventable errors, and improving patient safety.
These benefits are precisely what interprofessional education (IPE) aims to accomplish and why more universities and medical centers are fostering these experiences by building them into curricula and clinical rotations.
For example, this past fall, 12 third-year nursing students from New York University Rory Meyers College of Nursing were paired with medical students from NYU Long Island School of Medicine in a newly launched IPE initiative. The medical students were entering year 2 of an accelerated 3-year primary care program designed to bridge projected physician shortages.
"A lot of institutions have IPE experiences, but they're usually just a one-off, one-day simulation or clinical," says Selena Gilles, DNP, ANP-BC, associate dean of NYU's undergraduate nursing program. "We wanted a program in which students, over a year, could work together every week. That's really what makes our program so unique."
For the fall and spring semesters, the dyads met one day a week for clinical rotations at NYU Langone Hospital-Long Island, where they jointly assessed patients and created care plans. They also evaluated the social determinants of health affecting each patient's optimal treatment and recovery, then presented their findings to residents, social workers, and floor nurses during interdisciplinary rounds.
In the spring, the duos joined pharmacy students to work on a case study for a complex patient, where they were able to "identify what their role is as a member of the team and how they all can work together to take care of that patient," says Gilles.
The interactions were impactful.
"In medical school, there's a lot that you don't get the chance to learn or experience until you become a resident," says Moise Romano, a medical student in the program. "Working with nurses feels like one of those things. That's such a big part of what goes on in the hospital, so getting nurses' perspectives, seeing what they do daily, and the detail they need to know about their patients was very rewarding."
When nursing student Salma Santos realized a patient didn't fully understand her diabetes diagnosis and had no transportation home, she and her medical student counterpart shared the information during rounds so that additional resources, like a consultation with a nutritionist, could be arranged.
"The program cemented how important collaboration and bouncing [information] off each other is," says Santos. There were certain subjects that might not have been addressed if nursing or pharmacy students weren’t part of the discussion because "we are all looking at different things to make sure this patient is thoroughly cared for."
Rise of Interprofessional Initiatives
Interdisciplinary education first garnered national attention in 1972, following a report by the Institute of Medicine. However, it wasn't until 2011 that the first standardized set of IPE core competencies and skills was released by the Interprofessional Education Collaborative (IEC), formed 2 years earlier to promote team-based care and advance the inclusion of IPE in curricula.
Initially, the organization had six members representing the professions of medicine, nursing, pharmacy, dentistry, and public health, including the American Association of Colleges of Osteopathic Medicine (AACOM), the Association of American Medical Colleges (AAMC), and the American Association of Colleges of Nursing (AACN).
Today, IPEC encompasses 21 national health profession associations and is expected to release an updated set of core competencies next year.
Once schools realized the importance of IPE, they tried to squeeze it into their existing curriculum, which led to single-day events highlighting the skills needed for interprofessional care, says Mark Speicher, PhD, MHA, senior vice president for medical education and research at AACOM.
But programs have evolved as the benefits of interprofessional collaboration have become more apparent, particularly a propensity to reduce burnout among providers, he says.
"In osteopathic medical students, our research has shown that an affinity for teamwork and interprofessional care is related to lower burnout scores. These findings, while not entirely consistent across professions, have been replicated in nursing as well."
Subsequently, many IPE offerings are now much longer than a single day, he adds.
"The average program length is one-and-a-half academic years," says Speicher, citing preliminary data from a recent IPC survey of IPE participants. "Fifteen percent of programs are shorter than one semester, 27% are one semester, and 36% are longer than one semester."
IPE Takes Many Forms
Interprofessional collaborations can take many forms, though the successful implementation may require detailed planning, Gilles says.
"There are so many challenges in developing a program like this," she says, adding that NYU's program can run for at least 5 years because of a generous $7 million gift made to the school. "You have to have the resources, buy-in, and figure out where nursing and medical curricula meet and how they match."
Undeterred, many schools have found ways to forge ahead and offer meaningful interdisciplinary opportunities.
In January, HealthPartners Institute introduced an IPE initiative for advanced practice providers. With enrollment limited to four nurse practitioner or physician assistant students, participants complete up to 12 months of clinical rotations where they collaborate with their peers under the guidance of a preceptor.
Similarly, the Interprofessional Student Hotspotting Learning Collaborative, supported by the AAMC and AACN, is an annual 6-month program that establishes diverse healthcare teams to engage with high-utilizing patients who have complex medical and social needs. Each team participates in monthly case conferencing for up to four adult patients and may include students of medicine, nursing, psychology, and audiology, among others.
Since 2017, pairs of first-year medical students at the University of Chicago's Pritzker School of Medicine have been partnered with a practicing nurse on a "high-performing nursing unit," like pediatrics or surgery, says Tia Kostas, MD, a geriatrician at UChicago Medicine who directs IPE efforts at Pritzker.
The yearly event, called Understanding Nursing Interprofessional Team Experiences, or UNITE, lasts 4 hours but allows students to observe and participate in medication administration, health record documentation, physician–nurse communication, patient education, handoffs, and patient admissions and discharges, Kostas says.
"Then when medical students are on clinical rotations later in their training, they tap into these prior experiences to better function as an interprofessional team leader to optimize patient care."
Although the medical students tend to slow the productivity of the nurses, participants report feeling a sense of deepened engagement and satisfaction, she says.
"They also generally agreed that UNITE improved their understanding of the roles of nurses and how nurses and physicians communicate and work together on a team," Kostas says. "One thing that students found interesting was how nurses have so much more patient contact than doctors, and so [they] have a huge role in patient education and a significant impact on patient care."
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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Image 1: NYU Rory Meyers College of Nursing
Image 2: American Association of Colleges of Osteopathic Medicine
Image 3: University of Chicago Medicine
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Cite this: Interprofessional Education Benefits Nursing, Medical Students - Medscape - Jun 10, 2022.