1. Linda K. Daley PhD, RN, ANEF, Professor Emerita of Clinical Nursing
An Interdisciplinary Course Focused on Case Management of Patients from Underserved Populations
Jacqueline M. Loversidge, PhD, RNC-AWHC, Assistant Professor of Clinical Nursing
Linda K. Daley PhD, RN, ANEF, Professor Emerita of Clinical Nursing

2. Background . . .
Why an Interdisciplinary Course for Health Professions Students?
Why a focus on Case Management for the Underserved?

3. The Call for Health Professions Educators to Prepare Students for Interprofessional Collaboration
IOM (now Academy of Medicine) Reports
Starting with To Err is Human (2000)
Health Professions Education: A Bridge to Quality (2003)
Measuring the Impact of Interprofessional Education on Collaborative Practice & Patient Outcomes (2015)
QSEN Competencies
Teamwork & Collaboration
Both Prelicensure & Graduate
IPEC Competencies (2011)
IPEC 2016 Update
Accreditation Standards

4. Interprofessional Education (IPE) Interprofessional Collaborative Practice (IPCP)
IPE: ‘When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.’ (WHO, 2010)
IPCP: ‘When multiple health workers from different professional background work together with patients, families And communities to deliver the highest quality of care.’ (WHO, 2010)

5. Interprofessional Education Collaborative (IPEC) Intent
Overall goal is to meet the demands of health care including expected workforce shortages
Interdisciplinary teams can improve the management of chronic illnesses, decrease in-hospital length of stay and hospital costs, and help to avoid medical errors resulting from poor communication.
Needed d/t increased complexity in patients with chronic conditions
E.g. diabetes; asthma

6. IPEC Core Competency Domains
Values / Ethics – mutual respect; shared values
Roles / Responsibilities – recognize role, knowledge, skills, limitations of own and other’s professions
Teamwork – integrate knowledge and experiences of other professions to inform decisions
Communication – responsive; responsible; supports a team approach

7. IPEC 2016 Update: Purpose
Reaffirm value & impact of core competencies and core competencies
Organize the competencies within the singular domain of Interprofessional Collaboration
Broaden the interprofessional competencies to better achieve the Triple Aim:
Improve patient experience of care;
Improve the health of populations; and
Reduce the per capita cost of care.

8. Complex Patients – Underserved Populations
Many of the most complex patients come from underserved populations:
Most difficulty with non-adherence;
experience the greatest recidivism, up to 10% r/t non-adherence; and
Use most health care dollars, estimated between $100 and $300 billion in health care costs annually
Iuga, A. O. & McGuire, M. J. (2014)

9. Context The Ohio State University: About Us
7 Health Sciences on campus
>12,000 courses
>200 UG majors >100 Master’s programs >90 Doctoral programs
>58,000 students (main campus)
~800 Grad Nursing students >675 UG ~500 RN/BSN

10. Student course-work occurs in interdisciplinary teams
The Course: Interdisciplinary Case Management for Working with Underserved Populations
HRSA Grant funded Interprofessional Education and Collaboration Project
Interdisciplinary Case Management Course one “aim” of project/study with multiple aims
Nursing, Medicine, Health & Rehabilitation Sciences, Social Work, Pharmacy, Dentistry
Focuses on community-based populations, living in poverty, with complex healthcare needs
14 weeks; 2 credits
Student course-work occurs in interdisciplinary teams
Faculty interdisciplinary – team taught

11. Course Objectives
Provide an understanding of the implications of poverty on health and healthcare access
Foster an understanding of the roles and scope of practice of different professions
Clarify attributes different trainees can bring to situations
Enhance communication skills
Identify when consulting other professions is beneficial and appropriate
Foster an understanding of the impact of the “team” on patient care
Identify dynamics of effectively functioning teams and employ learned strategies.
Increase competence in team-based health care in community health settings, especially with residents living in poverty.

12. Student Learning Objectives
Communicate effectively with all members of the healthcare team;
Communicate effectively with community residents living in poverty;
Work together to solve clinically relevant complex case studies;
Demonstrate an understanding of the impact of poverty on health and healthcare provision;
Demonstrate an understanding of the healthcare team in medical and health homes.

13. Teaching Strategies (Essential Behaviors)
Case studies (2 ways) (roles/responsibilities; engage others; patient centered)
Take on “community citizen” role
Health professional role
Simulation (communication, teamwork)
Standardized patients (patient centered; values/ethics; recognizing limitations; teamwork, communication, shared accountability)
Apply profession-specific assessment & critical thinking skills to their teamwork
Over two weeks
Also explores pre-conceived notions about gender identity
Panel presentations (teamwork; values/ethics)

14. Teaching Strategies (Essential Behaviors)
Poverty projects (teamwork; shared values/ethics)
Professional presentations (communication; recognizing uniqueness)
Presentation of their group’s semester-long family poverty project
Debrief on assigned readings/activities (shared values/ethics)
Lecture is limited
In-class focused discussion
Expert guest speakers

15. Nursing UG and Grad NP students Med, Pharm and RT Students
IPE Simulation
Led by NP’s, MD’s,
Nursing UG and Grad NP students
Med, Pharm and RT Students

16. Student Outcomes: Focus on Nursing Consistent with QSEN Teamwork & Collaboration
Selected “Skills”
Satisfactory Performance in Course Context
Act with integrity, consistency & respect for differing views
Cooperates in IP team to develop:
Plan of care for standardized patients
Plan to manage their “family” in context of semester-long case simulation
In-class discussions, e.g. “When the Nurse wants to be Called Doctor”
Assume role of team member or leader based on the situation
Exemplar -discussion of standardized patient’s discharge planning:
Takes on leadership role in discussion regarding adaptations of nursing-related care to home setting, e.g. dressing changes/wound monitoring, medication adherence, ambulation challenges;
However takes on member collaborative role (primarily sharing necessary information) in discussions with SW regarding HC financing; with RD & Speech regarding calories/swallowing; etc.

17. Student Outcomes: Focus on Nursing Consistent with QSEN Teamwork & Collaboration
Selected “Skills”
Satisfactory Performance in Course Context
Integrate the contributions of others who play a role in helping patient/family achieve health goals
Exemplar - discussion of standardized patient’s medication management:
Nurse has a breadth of understanding regarding uses, interactions (this patient overusing an OTC drug to manage cough), administration, and pharmacokinetics/dynamics . . .
However collaborates with both medical and pharmacy students for expertise on differential diagnosis, and appropriate prescribing/drug choices.
Choose communication styles that diminish the risks associated with authority gradients among team members
Prelicensure nursing students reach a level of comfort asserting themselves and their knowledge/ understanding of patients and nursing care;
Compare to – majority of students in the course are graduate students; including many medical students

18. Student Outcomes Across Professions: IPEC Competencies
Competency Domain
Observable Student Outcomes that align w/ IPEC Competencies (paraphrased)
Domain 1: Values/Ethics for Interprofessional Practice
Develop respect for dignity/cultural diversity/individual; differences characterizing patients, populations, & health care team; and
Act with honesty & integrity in their teams.
Domain 2: Roles/Responsibilities
Communicate their own roles responsibilities;
Recognize their own role limitations; and
Appreciate & use the full scope of KSAs of the entire team to best advantage to enhance patient care.
Domain 3: Interprofessional Communication
Express own knowledge/opinions to team confidently, clearly, and respectfully to assure common understanding.
Recognize one’s own uniqueness in the culture/heirarchy.
Domain 4:
Teams & Teamwork
Develop consensus on ethical practices to guide teamwork;
Share accountability with team for work required across the semester.

19. Student Feedback
‘Would love to do this again! 3 hr blocks or more meeting times would be necessary’
‘Great experience! It put at least student knowledge into perspective and reaffirmed my importance on the team’
‘I think we will all be a little more comfortable when it comes time to put these skills into practice’
“. . . I found [this course] to be extremely relevant to the career path I hope to form through nursing.”
‘I can’t believe this isn’t a required course!’

20. Successful IPE Required attendance PBL – Problem Based Learning
Part of accountability to team: show up!
PBL – Problem Based Learning
Learning methods that reflect real-world practice (authentic context)
Continuous interaction among students of different disciplines

21. IPE Challenges Ideal Space to support experiences
Advertising/incentive
Faculty commitment
Mutual time for planning, course offering
Coordination of efforts
Administrative/curricular support
Registration from within own major/dept.
GTAs essential

22. Don’t Sweat the Small Stuff
Right mix - knowledge, experience, profession– doesn’t matter
Right size of groups – doesn’t matter; one size doesn’t fill all
Student’s need to ‘be right’ – need to talk, need to listen, need to share
Right grading scheme – let attendance determine the pass/fail
Right format – mix it up but focus on IPEC recommendations
What is important thoughtful, respectful facilitation

23. Oval
The Oval – no cows

24. Selected References
Iuga, A. O. & McGuire, M. J. (2014). Adherence and health care costs. Risk Management and Healthcare Policy, 7:
QSEN Prelicensure Competencies. Retrieved from
Interprofessional Education collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D. C.: Interprofessional Education Collaborative.