Yale PA Online Leads Innovative Virtual Interprofessional Education Event

Coordinating physician assistants, nurse practitioners, occupational therapists, physical therapists, social workers, speech therapists, public health experts, and other members of a health care team to ensure a patient receives the best care possible can be challenging. This is also true for students in online programs who need to learn about the other disciplines and gain experience collaborating. Mary Showstark, MS, PA-C, a faculty member in Yale School of Medicine’s Physician Assistant (PA) Online Program, had an idea to meet this need: organize a Virtual Interprofessional Education (VIPE) event.

As a result of Showstark’s innovative initiative and significant collaboration with faculty and staff from six online programs at four other top universities, about 200 students and 20 faculty members from these schools participated in a 2.5-hour VIPE event centered around health care on November 19, 2018.

In addition to all 41 of the Yale PA Online students, the participating students, faculty, and staff were from:

Virtual training was familiar to the participants because the curriculum of each of these degree programs combines interactive online didactic learning with in-person clinical or practicum training. Therefore, Showstark was readily able to recruit faculty and staff from the other programs to help with this effort, including:

2U, Inc., which collaborates year-round to deliver these degree programs online, helped facilitate the VIPE using an online platform that fosters connection and collaboration.

Showstark’s aim was to ensure students had the opportunity to obtain an interprofessional orientation and training experience in the care of patients across the continuum of care (family practice, emergency department, hospital admission, sub-acute care, and home), with an emphasis on promoting the patients’ physical, psychological, social, and spiritual well-being through collaborative health care practices.

As Showstark shared in introductory remarks to all VIPE participants, she was inspired to create this course based on a personal experience.

On her first day at work after PA school, her supervisor asked her to discharge a patient. After thinking, “Ok, how hard could this be?” and getting advice from the nurses on the floor to “make sure the patient is ready to be discharged and then write DC IV/DC Home,” she spoke with the patient and asked, “Are you ready to go home?”

When the patient responded yes, she wrote up the DC IV/DC Home.

Showstark said, “I can still hear my boss yelling at me ‘DC IV/DC Home – what? Has the patient worked with nutrition and speech and language pathology after having a tracheotomy? Have they been cleared by Physical Therapy (PT) and Occupational Therapy (OT) after being in a car accident? Have case management and social work made sure the patient has home health and is safe at home yet?  Do you even know the role of public health in this setting?’” 

“I sat there in awe that here I was going to let a patient out on the street without considering any of these things. That is when I learned medicine is not only an art, it’s logistics and team work.”

Today there is broad recognition of the importance of team-based and collaborative care models, both to ensure the highest quality of care and to reduce costs. The World Health Organization, in its Framework for Action on Interprofessional Education & Collaborative Practice states “interprofessional education is a necessary step in preparing a ‘collaborative practice-ready’ health workforce that is better prepared to respond to local health needs.” The accreditation requirements of some programs, including some who participated on November 19, now include interprofessional education.

Prior to the VIPE, students were assigned to read background material on a case study patient, a 72-year-old woman in Kentucky. The materials included information about her symptoms when she arrived at a primary care office on an urgent basis, and other data such as her past medical history, family medical history, psychosocial/personal history, and lab results.

After Showstark’s introductory remarks in a virtual seminar room, the VIPE participants separated into 18 virtual break out rooms, each including a faculty mentor and, to the extent possible, a representation of students from the different programs. Each group spent an hour analyzing the patient’s case and preparing a presentation on an assigned question for the broader group, which took place over the final hour of the VIPE.

In reviewing the case, the students discussed the roles of different team members, including what patient issues they would focus on at each of the following levels of care: primary care/emergency department; inpatient hospital setting; discharge planning; and causes, prevention and preventive measures. They also noted where there is overlap and similarities among the different professions.

The students were prompted to consider numerous questions, ranging from “What are barriers to communicating with other professions?,” to “What data could be collected from this patient and others encountering stroke (the patient’s diagnosis) that could support individual and community prevention efforts?”

Joosten-Hagye complimented the preparation and performance of the students in her breakout room. “They knew the case, were very professional in how to respond and triage the case in the different settings, and were very knowledgeable about their specific role in each setting.”

She added, “the three PA students from Yale really understood their role as a PA and how to bring in other disciplines to assist with treatment across the settings. I really enjoyed hearing one PA note towards the end of our session ‘While we have focused on the patient, we cannot forget the family.’ As a social worker I appreciated hearing that so much.”

Showstark added, “All the students who participated were impressive.”

For Rebecca Preston, a Yale PA Online student located in rural Montana, the VIPE was her first interprofessional classroom experience.  She was fascinated to “piece it all together as we worked through the case” and see the shift in focus among the professions, with the PAs and nursing FNP students weighing in the most as they were diagnosing the situation and thinking about immediate steps, and then, as they progressed to continuing care, professions such as OT and PT becoming more vocal.

Preston appreciated “learning more about the role of OT, where they overlap with PT, and when and how their thought process differs from PT” because that was the profession she was least familiar with going into the VIPE. She found “communication was key, with different professions having different concerns and coming from different perspectives.” 

As for working through a case with students she had not met before, Preston said, “It was brand new for all of us, but it didn’t take long to get rolling and understand the dynamic of the group.”

One advantage of a virtual exercise: it enabled programs that are not co-located, and individuals within programs such as Yale PA Online who are not co-located, to participate, expanding its breadth. Additionally, a virtual exercise has a lower cost barrier because there are no travel or room rental expenses. Moreover, in practice, medical professionals will not always be face-to-face, so remote coordination is a valuable skill to develop.

Joosten-Hagye did not see challenges to conducting the exercise virtually, but saw it as “an opportunity to create a very unique IPE experience,” praising Showstark’s leadership as “pivotal to the success of the implementation.”

Showstark is grateful for her colleagues from the other participating schools, and 2U, for meeting monthly, and often more frequently, over nine months to organize the exercise.

For Showstark, the most positive outcome of the VIPE was seeing students from all over the country working together and the strong engagement of all participants. She was surprised by the high level of “collaboration between everyone, like they knew each other for ages.”

Showstark and colleagues are already planning future exercises, adding more professions including programs in justice and public policy, child life, law, police, and theology. Joosten-Hagye, based in part on student feedback, wants to add more client context to future exercises, such as issues of community, social economic status, education, culture, spirituality, and diversity.

Yale PA Online Director James Van Rhee also is thinking about the future. “The VIPE not only allowed students from various health professions to work together during an online case discussion, but to talk about how they will work together in the future when they are in clinical practice together. Discussing now how they will work together in the future will improve their collaboration in clinical practice and improve patient care.”

Citation for this content: Yale School of Medicine Physician Assistant Online Program