Preparing Students for Collaborative Practice:

An Overview of the 2012 Jefferson Health Mentors Program

Instructor’s Guide

List of Resources Files:

  • HMP Year One Orientation Materials – Part 1, 2, and 3
  • HMP Year Two Orientation Materials
  • HMP Module 1 - Obtaining a Comprehensive Life and Health History
  • HMP Module 2 - Preparing a Wellness Plan
  • HMP Module 3 - Assessing Patient Safety
  • HMP Module 4 - Self Management Support and Healthy Behavior
  • HMP Self and Peer Evaluation Form
  • Team Performance Scale (TPS)
  • HMP References

Explanation of when, how, and the order in which to use each resource file:

The two-yearJefferson Health Mentor Program (HMP) curriculum consists of four key modules, plus orientation sessions at the beginning of each academic year. The timeline for our program is as follows:

  • Year One:
  • Orientation (Fall)
  • Module 1 (Fall)
  • Self and Peer Evaluation Form (mid year)
  • Module 2 (Spring)
  • Team Performance Scale (TPS)/course evaluations (end of year)
  • Year Two:
  • Orientation (Fall)
  • Module 3 (Fall)
  • Self and Peer Evaluation Form (mid year)
  • Module 4 (Spring)
  • Team Performance Scale (TPS)/course evaluations (end of year)

The Jefferson Health Mentors Program (HMP) is required for all first and second year medical, physical therapy, occupational therapy, couples and family therapy, nursing, and pharmacy students. As part of this curriculum, interprofessional teams of five to six students meet a Health Mentor to complete a series of four modules centered on team-based, person-centered care. The student team members and Health Mentor remain the same throughout this longitudinal two-year IPE curriculum. The Health Mentor is identified as a teacher as well as a team member; each Health Mentor is a community-dwelling adult with one or more chronic conditions or impairments who is interested in sharing his/her personal narrative with a team of health professional students.

In Year One of the HMP, all students from the 6 professional programs participate in a half day orientation where they meet with their new team members, discuss group process, set team ground rules, and participate in a problem-based learning exercise. For Module 1, each of these student teams meets on campus with their Health Mentor toobtain a comprehensive life and health history. For Module 2, each team interviews their Health Mentor about his/her wellness practices (e.g. spiritual, occupational, emotional, physical, etc.). In Year Two, all student teams participate in one hour orientation where they reconnect with their team members, practice and discuss home safety assessment, and take time to prepare for Module 3. For Module 3, student teams go into their Health Mentor’s home for the first time and perform a comprehensive home and medication safety assessment. For Module 4, student teams interview their Health Mentor about health behaviors, evaluating stage of change, readiness for change,confidencelevels and assessing strengths, weaknesses, opportunities and threats (SWOT analysis).The meetings with the Health Mentors are scheduled on campus by our HMP staff in Year One of the program. However, in Year Two of the program, student teams work with their Health Mentors and assume scheduling responsibilities for the final two modules.

Concepts of teamwork and professionalism are interwoven throughout each component of the two-year curriculum. A multifaceted educational design was used in the development of each of the four new team-based modules. Each module concludes with a50-minutefaculty-facilitated interprofessional small group session (IPE session), where groups of four to five teams are brought together to share experiences from Health Mentor visits and present/discuss materials from their assignments. Module assignments evaluate achievement of module-specific objectives and program goals. Individual reflection papers assess what students’ value and personally learn from their participation. Mid year self- and peer-evaluations assist in measuring professionalism and year-end surveys (including the Team Performance Scale1and course evaluations) are administered to assess student attitudes toward teamwork, collaborative care and understanding of discipline-specific roles as well as opportunities for ongoing continuous quality improvement.

The HMP at Thomas Jefferson University is unique both in its scale (with over 1200 students participating each academic year) and the profound support from the institution and the volunteer faculty who have helped to implement this program and who facilitate the IPE small group sessions. However, our intention in sharing this program through MedEd PORTAL is to make these resources available to individuals and institutions of all shapes and sizes with varying degrees of experience in IPE and varying professions on campus. We have numerous resources from the development of this program and have paired these down to a list of what we believe are the key resource files for each orientation and module. In our opinion, each module can be used as a standalone IPE curriculartool and adapted for use at a particular institution. However, additional information is available upon request fora more detailed perspective of the “behind the scenes” logistics and program support, grading guidelines, recruitment and training of our health mentors, and program evaluation.

Purpose/Goals of the Resource:

There are three overarching HMP goals:

1)Students will understand and value the roles and contributions of various members of the interprofessional healthcare team.

2)Students will understand the perspective of the patient and value patient-centered care.

3)Students will appreciate how a person’s health conditions and/or impairments interact with personal and environmental factors.

Additional Module specific goals, objectives, and measurement strategies are embedded within each of the Orientations and the four HMP modules attached.

Conceptual Background:

The impetus for creating the Jefferson Health Mentor Program (HMP)is rooted in the new vision of health care delivery proposed byInstitute of Medicine, World Health Organization, and Healthy People 2020goals. 2-6 The HMP is designed specifically to increase health professions student competencies in interprofessionalism and collaborative practice, a goal further supported by the recent Interprofessional Educational Collaborative Practice (IPEC) report.7 Interprofessional education (IPE) is widely advocated as a key element to promote an effective, redesigned healthcare system. The IOM has stated that “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.”3 Educators and national organizations such as the American Association of Colleges of Nursing (AACN), the Association of American Medical Colleges (AAMC), and others are increasingly advocating IPE and some professions, like pharmacy, physical therapy (PT) and occupational therapy (OT), now include IPE in their accreditation standards.8-12

In 2006, Jefferson Medical College (JMC) of Thomas Jefferson University (TJU) was the recipient ofThe Association of American Medical Colleges (AAMC)/ Josiah Macy Foundation Grant for Chronic Illness Care Education. Recognizing the need to train health professions students in team-based care, an interprofessional team of faculty representing six clinical professions trained at Jefferson assembled to create a new curriculum. This team developed the original Jefferson Health Mentor Program (HMP), a longitudinal patient-centered team-based curriculum,using the Wagner Chronic Care Model as the conceptual framework.

Initially conceived by a representative team of faculty and student champions in 2007, the HMP gained approval from the Curriculum Committees of each profession. Content is currently embedded within a specified course for each discipline, a total of 22 courses over the two year period. Each year, an interprofessional faculty and student advisory committee participates in a process of continuous quality improvement, evaluating and revising curricular content. Monthly interprofessional faculty and student liaison meetings are held to approve curricular revisions and develop appropriate implementation strategies.To date, nearly 3000 students from six disciplines have completed this longitudinal program and an additional 600 new students will be enrolled this fall.

Effectiveness and Significance

Course evaluation data has been increasingly positive over the last five years with each round of quality improvement. With the implementation of the updated and revised curriculum this academic year, the HMP has received its highest rated student course evaluations to date; the majority of students from all six disciplines agreed that the IPE modules helped in their achievement of program goals (ratings ranged by discpline from 78-99% agreement, with lowest rating of 78% from Medicine and highest rating of 99% from Couples and Family Therapy; survey response rate from all six disciplines was greater than 50%).Additional qualitative analysis of student reflection essays has demonstrated an even more marked effect of the program on students appreciation for the challenges and benefits of team-based, person-centered care. One observed benefit of this program is the shift in student values regarding the provision of health care. In the written reflections, faculty have noted a culture change from wanting to “fix” a patient’s chronic condition to attempting to better understand the context of the person’s life experiences before and after diagnosis of one or more chronic conditions. Students describe adopting a new perspective of caring for patients with chronic conditions.

Another major benefit of the HMP is the collaboration that has naturally developed within interprofessional student teams. By bringing students from the various programs together to complete HMP visits and assignments, they establish relationships with peers and across disciplines that rarely occurred in previous years. Written reflections reveal emergent awareness of and respect for the scope, rigor and demands of their fellow team members’ training, practice, and expertise. A 2012 study on student attitudes toward health care teams demonstrated a significant improvement in attitudes comparing baseline to the end of the two year HMP scores. A noticeable shift in campus culture has resulted in students now expecting to work with peers from other professional programs, where three years ago most students might never even meet colleagues from other training programs on campus. Graduating students who have completed the HMP are including this experience in their resumes and personal statements as a highlight of their education.

An unexpected benefit observed at TJU has been collaboration among faculty from the four schools/college and six departments. Indeed, HMP faculty have adopted the principles of collaborative practice in their work, and role model the benefits of this behavior for students and other faculty. Frequently, interprofessional faculty working groups form and volunteer to complete requested tasks related to new IPE activities. These collaborations have led to increased faculty satisfaction and tremendous scholarly activity, with 39 peer reviewed presentations and 7 peer reviewed publications stemming directly from the HMP.

Lessons Learned

The success of the HMP requires coordination, recruitment and training of health mentors, and evaluation and assessment of HMP program goals/objectives. Implementing HMP across the University requires coordination among 22 individual courses within six complex and crowded professional curricula. Further, coordination occurs between the varying academic calendars. Key to success has been the willingness of faculty from each discipline to learn together and from each other. Communication, mutual respect, flexibility, and an unwavering commitment to the ideal of interprofessional person-centered education have become the hallmarks of HMP.

Health Mentors are community volunteers, adults living with one or more chronic health conditions or impairments. They are recruited from diverse sites including physician practices, senior centers, rehabilitation programs, and community-based organizations. Potential Health Mentors receive one-hour of training that includes a detailed description of HMP logistics, makeup of the student teams, role of the Health Mentor as teacher, as well as an overview of HMP goals and objectives. After recruitment, Health Mentors complete an application andHealth Mentors receive regular communication from HMPstaff including details of team visits as well as a student-edited bi-annual newsletter.

An important lesson learned in introducing the HMP is the value of engaging student course liaisons from each discipline to provide feedback and serve as leaders. Students continue to play a key role in re-engineering the HMP by encouraging increased use of technology, such as adoption of Team Wiki sites for posting module instructions and completing team assignments, along with gaining support for an optional online small discussion group.

Program objectives drive HMP evaluation. Process and outcome evaluation has been ongoing since program initiation. Process evaluation occurs through regular formal course evaluations, student focus groups, and informal feedback from student liaisons and health mentor faculty. Outcome evaluation includes both quantitative and qualitative methods. Quantitative evaluation tools are used to gather data at baseline and at the end of the two-year program. Data analysis leads to both identification of program successes and needs for future improvements.

Jefferson InterProfessional Education Center (JCIPE), which was founded in 2007, serves as the academic “home” for the Health Mentors Program. JCIPE provides both coordination and convening home for the HMP faculty team, course coordinator and student liaisons, as well as evaluation support in collaboration with existing evaluation teams at JMC and other schools.Ultimately, the success of this program rests on institutional support from Thomas Jefferson University, the collaboration of six disciplines (including 22 courses, over 30 faculty, and approximately 1200 students), the 250 volunteer Health Mentors, and assistance from more than 10 community organizations, including public health agencies, local senior centers, senior housing facilities, and retirement communities who help to recruit volunteer Health Mentors.

Special Implementation Guidelines and Reflective Critique

Particular challenges with implementing a broad IPE curriculum like the HMP include programmatic and scheduling logistics, student perceptions, and the Health Mentors themselves. During the quality improvement phase of this curriculum, it was critical that HMP modules did not contribute to curriculum overload or repetitiveness in any particular program. Module content was designed to meet curricular objectives for all participating disciplines and was integrated into the existing discipline specific courses.

Logistics of coordinating each discipline’s academic and examination schedules with scheduling dates for orientation, mentor visits, assignment due dates and interprofessional team debriefing sessions are an ongoing challenge. Aninterprofessional faculty steering committee now begins the scheduling process 6 to 12 months before the start of the academic year. In addition, use of “university time,” a two-hour time block during which no classes are scheduled, for hosting health mentor visits and for interprofessional small group (IPE) sessions emphasizes to students and faculty the value placed on HMP by our university.

A primary challenge for IPE curricularinnovations is the lack of a common language across health professions’ regarding health and wellness. This challenge was addressed in 2010 by incorporating the International Classification of Functioning, Disability and Health framework (ICF) throughout the two year HMP curriculum. Students now use the ICF framework to communicate more effectively as a team and to better understand the interaction of a patient with his/her health conditions, social roles, and environment.

Since process and outcome evaluations are incorporated as key elements of the overall HMP assessment plan, the HMP team has been able to ensure continuous quality improvement over the last five years and meet new IPE recommendations and accreditation standards across disciplines.

Tips for Practical Implementation

  • Involve all disciplines and students in the planning phase. It is important to have everyone at the table in the beginning rather than bringing disciplines on at a later date.
  • Have the modules replace existing curriculum in each discipline rather than adding to the curriculum. This will help to prevent curriculum overload and help with buy in of the program.
  • Strategize about how to receive approval by the curriculum committees of each discipline. Have faculty members present the curriculum to discipline-specific curriculum committees who are knowledgeable about the modules and passionate about IPE.
  • Involve administration in the discussion of how the program fits into faculty workload. Work with your institution and administration to gain buy in and support for faculty time and effort.
  • Health Mentor recruitment is an ongoing process. Each year a few Health Mentors must drop out of the program, usually due to illness. By recruiting Health Mentors throughout the year, we maintain a waitlist of Health Mentors who can fill in for student teams in these instances.
  • Retention of good Health Mentors is key. Approximately 80% of our Health Mentors return after completing their initial two years with a team, and many Health Mentors will take on more than one team each year.Saying thanks to our Health Mentors is important; each year, student teams write a “thank you” note to their Health Mentors at the end of the program, and HMP staff send“certificates of participation” to each of our Health Mentors to recognize their significant volunteer effort.
  • Recruit Health Mentors with disabilities. Originally we only recruited mentors with chronic conditions. Mentors with disabilities have enriched our program and provided students with a unique perspective.
  • Remind both students and Health Mentors that the students are not YET licensed professionals and cannot provide treatment or interventions. In this program, Health Mentors are “teachers” and not patients/clients. Students are told not to provide interventions or treatments, and they are encouraged to refer Health Mentors back to his/her health care team if specific issues or questions arise. Students are also advised that they can contact the HMP coordinator and director of the program in an emergency or if they have a concern about a Health Mentor.
  • Incorporating new technologiesallows for greater flexibility in completion of team-based assignments. Given students’ busy schedules, new technologies that allow for asynchronous work, such as Wikis and online discussion boards, have eased the burden on students.
  • Consider need and plan for faculty development activities around IPE competencies, teamwork and module-specific topics. In person and online training sessions have met our needs.

References