RESEARCH ARTICLES Pharmacy Student Participation in an ...archive.ajpe.org/aj6702/aj670245/aj670245.pdf · mented an interdisciplinary curriculum within a 2-week rural health program

American Journal of Pharmaceutical Education 2003; 67 (2) Article 45.

RESEARCH ARTICLES Pharmacy Student Participation in an Interdisciplinary Case Conference

Pamela U. Joyner, EdD,a Carol P. Tresolini, PhD,b Donna H. Harward, BA,b W. Ashley Davis, BAb aSchool of Pharmacy, University of North Carolina at Chapel Hill bSchool of Medicine, University of North Carolina at Chapel Hill

Objectives. An emphasis on pharmaceutical care has made interdisciplinary teamwork increasingly important. However, required interdisciplinary education is rare in pharmacy education. The purpose of this paper is to discuss pharmacy student participation in a required interdisciplinary case confer-ence designed and implemented for health professional students. Methods. At the University of North Carolina at Chapel Hill, 439 health professional students, includ-ing 113 doctor of pharmacy students, participated in a required series of 2 simulated interdisciplinary case conferences. Evaluation focused on changes in knowledge and attitudes of both students and fa-cilitators and included preconference and postconference surveys of students and postconference sur-veys of facilitators. Results. In general, students’ knowledge of other health care professionals increased. With regard to pharmacy students’ attitudes toward interdisciplinary care, students reported generally positive atti-tudes, with a greater improvement in their attitudes preconference to postconference in pharmacy stu-dents than in other students. Conclusions. Results show that interdisciplinary experiences can assist students in developing appre-ciation for the expertise that each health profession offers. Keywords: interdisciplinary education, pharmacy curriculum, standardized patients

Interdisciplinary experiences during a pharmacy student’s education can assist students in gaining an ap-preciation for what other disciplines offer. If students do not have the opportunity to interact with other health professional students, it may be difficult for them to col-laborate and interact effectively once they enter profes-sional practice.3 According to Leininger, “many of our health care problems are related to a lack of understand-ing of and appreciation for the actual and potential con-tributions of different health disciplines.”4

INTRODUCTION With the emphasis on pharmaceutical care, the

role of the pharmacist has become more patient cen-tered and outcome oriented. Pharmacists are expected to work with the patient and other health professionals in designing, implementing, and monitoring a thera-peutic plan that will produce specific therapeutic out-comes for the patient.1 Furthermore, according to the doctor of pharmacy (PharmD) accreditation guide-lines developed by the American Council on Pharma-ceutical Education,2 collaborating with other health professionals is one of the professional competencies that should be achieved through a school of pharmacy curriculum.

Interdisciplinary experiences need to be relevant and useful to real life practice.5 The National Research Council has stated the importance of active learning to increase learners' retention and understanding, and their ability to transfer learning to novel contexts.6 Real or simulated experiences are necessary to develop stu-dents’ understanding of the roles and responsibilities and most effective use of health professional team members. Students must also know how to work col-laboratively with other disciplines.7

Corresponding Author: Pamela U. Joyner, EdD.Mailing Address: UNC-CH School of Pharmacy, Cam-pus Box #7360, Beard Hall, Chapel Hill, NC 27599-7360. Tel: 919-962-0030. Fax: 919-966-9428. E-mail:[email protected]

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. Previous reports have described interdisciplinary

education experiences that have been implemented for pharmacy students. Popovich and colleagues8 de-scribed the development, implementation, and evalua-tion of an elective, interdisciplinary case studies course involving pharmacy, nursing, dietetic, and health promotion education students at Purdue Uni-versity. The involved faculty members had known each other through other campus activities and had established the goal of developing and implementing an interdisciplinary case studies course. The faculty members believed that students enrolled in this inter-disciplinary experience should have completed a sig-nificant amount of their course work in order for the students to effectively contribute their professional viewpoint and insights to the patient case discussions. Therefore, the five students from each discipline who were enrolled in this course were in the last profes-sional year of their curricula at Purdue University. Each student wrote a reflective paper addressing their self-learning and team-learning experiences. In addi-tion, each student completed a 10-question self-assessment evaluation. Results demonstrated stu-dents’ ability to work effectively in teams and achieve interdisciplinary consensus in solving patient prob-lems.

Borrego and colleagues9 implemented pharmacy student participation in a rural interdisciplinary health care training program. The New Mexico Interdisci-plinary Health Care for Rural Areas Training Program at the University of New Mexico Health Sciences Center was established on the belief that the health of the public, primary care development, public coopera-tives, and university-community partnerships are bet-ter served by training students in interdisciplinary set-tings. The basis is that the recruitment and retention of providers can be improved if experiences in rural communities can demonstrate and foster professional interdisciplinary relationships in rural practice. A grant from the Health Resources and Service Admini-stration (HRSA) helped begin this interdisciplinary program during 1990. The curriculum consisted of an on-campus phase followed by a rural community phase conducted during the summer. Participation was voluntary, and 65 pharmacy students were in-volved in this program from 1990 through 1999. Pro-gram evaluation demonstrated positive changes in student confidence and attitudes concerning interdis-ciplinary concepts.

Duerst and colleagues10 developed and imple-mented an interdisciplinary curriculum within a 2-week rural health program. The summer institute was

developed to enable health professional students within the University of Wisconsin system to have an interdis-ciplinary educational experience. The Wisconsin Con-sortium for Interdisciplinary Training for Rural Areas, the Southwest Wisconsin Area Health Education Center (AHEC) and a rural, underserved community in south-western Wisconsin developed the summer institute. The Wisconsin Consortium for Interdisciplinary Training in Rural Areas was a part of a 3-year training grant sup-ported by the Interdisciplinary Training for Rural Areas Grant Program in the Health Resources Service Admini-stration (HRSA). The purpose of the Interdisciplinary Training Grant was to prepare health care providers to function as an interdisciplinary team in order to improve access and advance the quality of primary care delivery in rural, medically underserved communities. Nine stu-dents from pharmacy, social work, and nursing were a part of this experience. Students perceived increased knowledge and a greater appreciation for the roles of their discipline and other disciplines involved in the program as a result of participating in this program.

Although the type of interdisciplinary initiatives de-scribed in the literature help address the need for inter-disciplinary training, examples of successful interdisci-plinary experiences for pharmacy students that are a re-quired part of the curriculum and that offer “real life” practice are limited. The interdisciplinary experiences that pharmacy students receive during clerkships are incidental and most often are not planned or structured. The purpose of this paper is to discuss pharmacy student participation in a required interdisciplinary case confer-ence designed and implemented for health professional students at the University of North Carolina at Chapel Hill (UNC-Chapel Hill). A particularly innovative as-pect of this project was the use of standardized patients (actors highly trained to authentically portray real pa-tients) to provide students with the opportunity to elicit the medical and psychosocial history necessary to de-velop a patient-centered management plan. In addition, the standardized patients provided a learning experience that more closely replicated the challenges encountered in a professional setting and promoted an interactive learning experience.

METHODS

Program Development An interdisciplinary planning group composed of

faculty members and administrators from the various health professional schools and programs at UNC-Chapel Hill was responsible for planning and imple-menting the simulated case conference activity. The 13-member Health Affairs Interdisciplinary Grant (HAIG)

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. Committee was made up of representatives from the schools of pharmacy, medicine, nursing, and social work, and from programs in the Department of Allied Health Sciences (physical therapy, occupational ther-apy, and speech and hearing sciences). The School of Pharmacy’s Associate Dean for Professional Educa-tion served as a member of this committee and repre-sented pharmacy.

The committee began meeting during February 1999 and developed the following program goals and their accompanying student learning objectives: Goal 1. Understand and appreciate the professional knowledge and roles of various health care profes-sionals. Each student will be able to: • Use a holistic model of health and function

(WHO ICIDH-2) to identify the appropriate health professionals to manage a patient with multiple problems.

• Describe the contributions of his/her discipline and 3 other professions in the evaluation of the patient.

Goal 2. Effectively share responsibility for interdisci-plinary team health care delivery. Each student will be able to: • Use interdisciplinary team management principles

to ensure quality health care provision to a spe-cific patient.

• Describe how a health professional collaborates to effectively share responsibility for patient care.

• Identify 3 challenges to interdisciplinary patient care and describe strategies to address the chal-lenges.

Goal 3. Describe a rationale for an interdisciplinary team approach to patient care. Each student will be able to: • Articulate 2 professional benefits of working with

an interdisciplinary group. • Articulate 2 benefits for patients when services

are provided through an interdisciplinary team. • Describe the role of the interdisciplinary team in

addressing ethical dilemmas. Once student learning objectives were estab-lished, the committee began the challenging task of planning and scheduling the sessions. At UNC-Chapel Hill, differences in scheduling and profes-sional degree requirements across health affairs schools make it difficult to create interdisciplinary learning experiences. To circumvent these difficul-ties, the committee decided to develop the interdisci-

plinary case conference activity as a mandatory part of an already-existing required course in each of the par-ticipating schools and programs. In pharmacy, the in-terdisciplinary experience was included as part of the third-year “Problems in Pharmacotherapy” course, which is a required intermediate-level pharmacotherapy course for PharmD students. It uses a problem-based learning format centered on clinically based scenarios or cases. In medicine, the experience was incorporated into the second year “Introduction to Clinical Medicine” course. With the exception of nurse practitioners, all other students were at an intermediate level of their edu-cation. Student participation in the exercise contributed to students’ respective course grades. A 2-session case conference activity, using stan-dardized patients, was designed for the interdisciplinary experience. To ensure that students from each of the 7 health professions had the opportunity to contribute to the management of an individual patient, 3 clinical sce-narios were developed. Each patient presented a unique medical and social history that warranted the involve-ment of a specific combination of health professionals. For example, one patient was a 19-year-old college stu-dent who comes to the clinic requesting another pre-scription of Percocet for back pain. The rising junior has dropped classes this semester because the pain from a car accident is debilitating. The student’s social activities have diminished because of discomfort and difficulty walking. Further history reveals an excessive use of alcohol recently to “help ease the back pain.” Additional inquiry reveals a supportive family, but friends are frustrated and not providing as much camaraderie as they had immediately after the accident. The patient has also developed a stutter, about which the patient is quite sensitive. This seems to occur when speaking about a recent breakup of a long-term relationship and when asked about alcohol use. This patient’s care would benefit from the involvement of the following health professionals: pharmacist, social worker, physical therapist, physician, nurse, and speech pathologist. A second scenario focused on a patient in his mid-70s who is caring for a disabled spouse, has a hearing loss, and complains of fatigue. The third clinical scenario involved a 55-year-old patient who comes to the clinic complaining of persistent chest pain. Individuals of specific ages, appearance, and ethnicities were trained to portray the previously described cases. The standardized patient training protocol, in use by the School of Medicine Standardized Patient Program at UNC-Chapel Hill since the early 1990s, includes multi-ple training sessions that total 4 to 5 hours of instruction, role play, and rehearsal, directed by the standardized

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. patient trainer, for each case. Standardized patients for each case are taught the appropriate physical pres-entation a particular patient would have (eg, posture relative to physical condition, stuttering technique, and the issues that prompt the stutter), as well as ap-propriate responses to questions about psychosocial issues. Since these case conferences do not include conducting a physical examination, these patients are not required to learn the physical responses to specific examination procedures. By standardizing the clinical presentation, medical history, social issues, and pa-tient affect and appearance through multiple training sessions, the patients provided each interdisciplinary group with identical opening comments and equiva-lent opportunities to elicit information pertinent to developing a patient-centered management plan. Through eliciting information from their respective patients during a 30-minute interview, students could model their professions’ unique contributions to a patient’s care, interact with other health professionals in an authentic encounter, and engage in developing a specific interdisciplinary patient management plan. By assigning students to small groups according to their professional discipline, the committee ensured that each small group included representatives from at least 4 different health professions. Pharmacy stu-dents, along with nursing, medical, and social work students, were assigned across all 3 cases. Speech pathology, audiology, and physical and occupational therapy students were assigned to patients with perti-nent medical and social histories (eg, stuttering, hear-ing loss, impaired mobility). Each interdisciplinary small group was assigned to 1 of the 3 cases based on the group’s composition. As indicated in Table 1, the number of participating students varied across disci-plines. Since there were fewer students in the social work, speech, and audiology courses, these profes-sions were not represented in each small group. To ensure a high level of interaction within the groups, each group comprised only 8 or 9 students. The World Health Organization’s International Classification of Function and Disability,11 which merges medical and social models for a more holistic understanding of the patient and their environment, was selected to give structure to the collaboration and discussion. This model provides a framework for thinking about multiple influences on health and ill-ness and provides a unified, standard language for describing human functioning and disability as a component of health. One of its purposes is to pro-vide a scientific basis for understanding, studying, and

describing functional states associated with health con-ditions. The model focuses on human functioning and disturbance in functioning across 3 interdependent di-mensions: (1) body structure and function and impair-ments, (2) individual activities and limitations on activi-ties, and (3) participation in society and restrictions on participation. The model focuses attention on improv-ing contextual factors (personal and environmental), health promotion, and social participation by removing societal hindrances and encouraging the use of social supports. In addition, the model addresses the complex relationships and interactions between an individual’s health condition and the unique circumstances present within their life that facilitates or restricts their partici-pation, satisfaction, enjoyment, and fulfillment. The World Health Organization updated the model in 2000; further information can be found at http://www.who.ch/icidh.12 Since faculty from social work and allied health were the only facilitators with previous experience in using the WHO model, all facili-tators received training about the model.

Facilitators for the small groups were recruited from the 7 participating disciplines proportionate to the num-ber of participating students from each discipline. Each facilitator was asked to attend a 1-hour training session that had 3 components: (1) discuss the schedule and pur-pose of the case conference and review strategies for small group facilitators (eg, listen, observe, allow for pauses and silence, post and verify what students say, request examples or illustrations, encourage and recog-nize student contributions, test consensus, and summa-rize the group’s decisions/management plan); (2) ex-plain the ICIDH-2 Model that serves as a framework for assessing the patient’s needs and developing an interdis-ciplinary management plan; and (3) describe the instru-ments to be completed by both students and faculty as part of the evaluation protocol. Description of Case Conference Sessions The case conference sessions were held in March and April 2000. In 54 interdisciplinary groups of 8 or 9, with each group guided by a faculty facilitator, students interviewed standardized patients to explore the pa-tients’ problems and develop a management plan. Fa-cilitators had been trained to encourage full participation by all students.

To maintain consistency, each session was 2 hours in duration, with each student, facilitator, and standard-ized patient attending the same small group for each ses-

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Table 1. Disciplines participating in interdisciplinary case conference activities (N=439)

Discipline Number

of Students Pharmacy 113 Medicine 160 Nursing 58 Physical therapy 39 Speech and Hearing 36 Occupational therapy 23 Social work 10

sion. The goal for the first 2-hour session was to de-scribe a patient's health status and needs from an in-terdisciplinary perspective using the World Health Organization model.11

At the first session, each group began with an ex-ercise intended to “break the ice,” during which stu-dents described myths to be debunked about their par-ticular professions and reviewed learning objectives. The students in each group then conducted a 30-minute interview with an assigned standardized pa-tient. Each group then used a worksheet to organize information about the patient (see Appendix 1). Fi-nally, each group identified 2 potential interventions and additional information needed from the patient, and ended with a brief assessment of the group proc-ess.

The goal for the second session was to develop a management plan in collaboration with the patient. Participants began by reviewing the first session’s work and developing a tentative management plan. Each group then met again with the same standard-ized patient with whom it had worked in the first ses-sion to further develop the management plan. Each group then discussed the plan, identified the benefits of an interdisciplinary approach to care, and ended with a debriefing on the group’s process. Evaluation Evaluation of the interdisciplinary experience in-cluded preconference and postconference surveys of students and postconference surveys of facilitators. The student preconference and postconference sur-veys were sent via e-mail to each participating stu-dent. Questions, based on the student learning objec-tives, addressed knowledge of the training, skills, and roles of various health professionals as well as atti-tudes toward interdisciplinary care. The response

scale for items related to student knowledge of the train-ing and skills of various health care professionals ranged from 1, indicating “know almost nothing,” to 5, indicat-ing “know a great deal.” Items concerning student atti-tude toward interdisciplinary care had a response scale ranging from 1, indicating “strongly disagree,” to 5, in-dicating “strongly agree.” Knowledge of the roles of various professions was tested with open-ended ques-tions about a case scenario related to identifying the ap-propriate disciplines to be involved with a particular case. Students who returned a completed form by the deadline were entered in a drawing to win 1 of 2 gift certificates to the UNC-Chapel Hill student stores. The postconference survey of the facilitators asked them to rate the effectiveness of various aspects of the confer-ence (training, logistics, groups, student performance, etc), as well as to indicate prior experience with inter-disciplinary and case-based education and standardized patients. Analysis of student and facilitator surveys in-volved computing frequencies for each item.

RESULTS Student Participation

As shown in Table 1, 439 students, representing 7 health professions participated in the interdisciplinary case conference activities. One hundred thirteen third-year pharmacy students enrolled in the “Problems in Pharmacotherapy” course were participants. Preconference and Postconference Student Survey Results

Fifty percent (218) of the 439 students who partici-pated in the activity returned their preconference survey. Among those, 63 pharmacy students (56%) completed and returned the preconference survey. The postconfer-ence survey was distributed to 439 students and returned

American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. Table 2. Changes in pharmacy students versus other students’ self-assessment of knowledge about training and skills of health professionals

Response

No knowledge

A great deal of knowledge

Knowledge of training and skills of…

Student discipline n

1 %

2%

3%

4%

5%

Audiologists Pharmacy 63 Preconference 56 35 8 2 0 59 Postconference 39 31 20 8 2 Change -17 -4 +12 +6 +2 Other 155 Preconference 42 30 15 10 3 156 Postconference 33 24 26 10 7 Change -9 -6 +11 0 +4Nurse practitioners Pharmacy 62 Preconference 5 21 39 35 0 56 Postconference 0 11 30 50 9 Change -5 -10 -9 +15 +9 Other 152 Preconference 10 23 26 18 23 155 Postconference 4 14 29 28 26 Change -6 -9 +3 +10 +3Occupational therapists Pharmacy 62 Preconference 18 50 29 3 0 58 Postconference 5 21 40 24 10 Change -13 -29 +11 +21 +10 Other 153 Preconference 9 26 33 21 11 154 Postconference 3 15 29 33 19 Change -6 -11 -4 +12 +8Pharmacists Pharmacy 63 Preconference 0 0 0 2 98 58 Postconference 0 0 0 5 95 Change 0 0 0 +3 -3 Other 153 Preconference 7 16 37 30 10 153 Postconference 1 7 20 54 19 Change -6 -9 -17 +24 +9Physical therapists Pharmacy 62 Preconference 3 18 50 24 5 56 Postconference 0 9 29 46 16 Change -3 -9 -21 +22 +11 Other 155 Preconference 3 13 31 35 18 155 Postconference 0 6 25 38 31 Change -3 -7 -6 +3 +13Physicians Pharmacy 62 Preconference 0 3 15 58 24 57 Postconference 0 2 5 49 44 Change 0 -1 -10 -9 +20 Other 152 Preconference 1 6 11 36 46 156 Postconference 0 1 7 22 69 Change -1 -5 -4 -14 +23

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. Table 2 Cont. Changes in pharmacy students versus other students’ self-assessment of knowledge about train-ing and skills of health professionals

Response

No knowledge

A great deal of knowledge

Knowledge of training and skills of…

Student discipline n

1 %

2%

3%

4%

5%

Registered nurses Pharmacy 63 Preconference 2 11 25 48 14 57 Postconference 0 4 23 46 28 Change -2 -7 -2 -2 +14 Other 151 Preconference 6 15 22 22 36 156 Postconference 3 10 20 35 33 Change -3 -5 -2 +13 -3Social workers Pharmacy 63 Preconference 11 30 44 14 0 58 Postconference 5 26 41 22 5 Change -6 -4 -3 +8 +5 Other 152 Preconference 6 22 39 22 11 154 Postconference 8 13 29 38 12 Change +2 -9 -10 +16 +1Speech pathologists Pharmacy 62 Preconference 29 52 11 6 2 57 Postconference 16 18 47 18 2 Change -13 -34 +36 +12 0 Other 153 Preconference 22 32 24 11 11 153 Postconference 17 18 26 25 13 Change -5 -14 +2 +14 +2

by 210 (48% response). Fifty-nine pharmacy students (52%) completed and returned the postconference survey. Overall, 94 students (20 pharmacy students and 74 other students) returned both the preconfer-ence and postconference surveys.

For both pharmacy students and all other students, preconference and postconference survey responses were compared to determine changes in knowledge and attitudes. Tables 2 and 3 summarize these find-ings. In general, students’ knowledge of other health care professionals increased, with fewer students re-porting they had almost no knowledge after the con-ference than before the conference, and more students reporting they had a great deal of knowledge. An ex-ception to this was the knowledge of pharmacists’ training and skills reported by pharmacy students. The percent of pharmacy students reporting a great deal of knowledge about pharmacists’ training and skills dropped from 98% on the preconference survey to

95% on the postconference survey. Pharmacy students reported generally positive attitudes toward interdisci-plinary care and showed a greater improvement in their attitude than did students in other disciplines when pre-conference survey responses were compared with post-conference survey responses.

Overall, students were consistently positive about their participation in this exercise. Narrative comments indicated that students enjoyed interacting with students and facilitators from other disciplines. For example, one student noted, “I feel we all gained a better sense of what other professions know and have to contribute.” Others wrote, “This experience provided valuable in-sight to the way in which other disciplines approach pa-tient problems,” and “I enjoyed getting the opportunity to talk with other future health professionals and discov-ering that we have many of the same thoughts.” As

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. Table 3. Changes in pharmacy students versus other students’ attitudes toward interdisciplinary teamwork

Strongly Disagree

StronglyAgree

Student 1 2 3 4 5 Item Discipline n % % % % % Working in teams unnecessarily compli-cates things most of the time*

Pharmacy 63 57

Preconference Postconference Change

32 42

+10

48 40 -8

17 7

-10

2 7

+5

2 4

+2

Other 153 Preconference 46 39 9 5 1 153 Postconference 44 44 8 2 2 Change -2 +5 -1 -3 +1 The team approach improves the quality of care to patients

Pharmacy 63 58


2 0

-2

0 2

+2

5 3

-2

41 22

-19

52 72

+20 Other 155 Preconference 3 2 5 28 61 153 Postconference 7 2 5 28 58 Change +4 0 0 0 -3 Patients receiving interdisciplinary team care are more likely than other patients to be treated as a whole person

Pharmacy 63 59


2 0

-2

6 3

-3

8 3

-5

49 25

-24

35 68

+33

Other 155 Preconference 3 6 12 31 48 154 Postconference 7 5 9 32 46 Change +4 -1 -3 +1 -2 Working on a team keeps most health professionals enthusi-astic and interested in their jobs

Pharmacy 61 58


3 0

-3

5 3

-2

20 12 -8

52 50 -2

20 34

+14

Other 153 Preconference 1 6 36 40 17 152 Postconference 1 5 34 38 22 Change 0 -1 -2 -2 +5 Physicians are most likely to be team leaders

Pharmacy 62 58


3 5

+2

10 17 +7

26 29 +3

45 33

-12

16 16

0 Other 151 Preconference 7 16 34 27 16 153 Postconference 9 12 30 26 23 Change +2 -4 -4 -1 +7*negatively worded item

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. Table 4. Comparison of pharmacy facilitators to other facilitators participating in interdisciplinary case conference activities Not at all Completely

Item n 1

% 2

% 3

% 4

% 5

% Training and logistics To what extent did the training

adequately prepare you to facili-tate the sessions?

Pharmacy facilitators Other facilitators

12 34

0 0

16.67 8.82

25.00 23.53

41.67 55.88

16.6711.76

To what extent were the adminis-trative aspects of this activity ef-fective (eg, scheduling, notifica-tion,materials, etc.)?


12 34

0 0

0 0

33.33 8.82

16.67 35.29

50.0055.88

The interdisciplinary sessions To what extent was the mix of

disciplines represented in your group adequate to achieve the goals of the sessions?


12 33

8.33 0

0 3.03

8.33 18.18

50.00 57.58

33.3321.21

To what extent did the use of standardized patients enhance the learning process?


11 33

0 0

0 0

27.27 6.06

27.27 30.30

45.4563.64

To what extent was the WHO model useful in organizing the work of your group?


12 34

8.33 0

16.67 11.76

41.67 32.35

33.33 50.00

0 5.88

To what extent was the group size appropriate for interdisciplinary learning?


12 34

0 0

5.88 0

2.94 0

32.35 16.67

58.8283.33

Student performance To what extent was there partici-

pation from all group members? Pharmacy facilitators Other facilitators

12 34

0 0

0 2.94

8.33 20.59

50.00 41.18

41.6735.29

To what extent did students dem-onstrate professional behavior during their interactions with other students and the patient?


12 32

0 0

0 0

8.33 3.13

16.67 31.25

75.0065.63

To what extent did all group members participate in sharing their particular expertise?


12 34

0 0

8.33 0

16.67 8.82

41.67 52.94

33.3338.24

shown by the students’ preconference and postconfer-ence survey results, the narrative comments reinforce the overwhelmingly positive changes brought about by participation in this activity. Facilitator Surveys

The facilitator questionnaire was sent to 51 facili-tators representing all disciplines and 46 (90%) were

returned. Twelve (100%) of the pharmacy faculty facili-tators completed and returned the evaluation instrument. Tables 4 and 5 summarize findings from the facilitator questionnaire, with pharmacy facilitators’ responses contrasted with the responses from all other facilitators (medicine, nursing, physical therapy, speech and hear-ing, occupational therapy, and social work) combined. Facilitators in general gave high ratings to the training

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Table 5. Facilitators’ prior experience compared to other facilitators participating in interdisciplinary case conference activities Facilitator Experience

Yes, n (%)

No, n (%)

Prior to this activity, had you been a facilitator for an in-terdisciplinary group of stu-dents?


2 11

(16.67) (33.33)

10 22

(83.33) (66.67)

Do you have experience prac-ticing as a part of an inter-disciplinary team?


11 34

(91.67) (100.00)

1 0

(8.33)

Have you taught or directed an interdisciplinary course?


3 9

(25.00) (28.13)

9 23

(75.00) (71.88)

Prior to this activity, have you had the opportunity to work with a standardized patient?


7 16

(58.33) (47.06)

5 18

(41.67) (52.94)

Do you have experience using case-based learning?


12 26

(100.00) (78.79)

0 7

(21.21)

and logistics provided to them, to the sessions them-selves, and to student performance. Pharmacy facili-tators, however, were less satisfied than other facilita-tors with the usefulness of the WHO model as an or-ganizing framework, the appropriateness of group size, and the use of standardized patients. Compared with other facilitators, pharmacy facilitators reported more frequently that there was participation from all group members in their small groups. Eighty-three percent of the pharmacy facilitators reported that they had not served previously as a facilitator for an inter-disciplinary group, compared with 67% of other fa-cilitators. Approximately 92% of pharmacy facilita-tors indicated prior experience as part of an interdis-ciplinary team. Twenty-five percent had taught or directed an interdisciplinary course, and 58% had prior experience interacting with standardized pa-tients. All of the pharmacy facilitators had prior ex-perience using case-based learning while only 79% of other facilitators had such experience.

Several facilitators offered narrative comments focused on the domination of some groups by nurse practitioner or medical students and the confusion or complexity surrounding the use of the WHO model. However, the majority of comments expressed facili-tators’ enjoyment of the sessions and their satisfaction with having the opportunity to interact with students from various disciplines. One of the pharmacy facili-tators remarked that, “Exchange of ideas and team

concepts keeps everything working towards the goal of optimizing patient care. I found it interesting to see how each discipline’s ear is tuned to something different in what they hear from patients. Everyone has valuable information to add to the care of patients.” Limitations

Faculty and administrators planning the case confer-ence activity quickly discovered how difficult it is to identify a mutual time during the academic schedule when students from 7 disciplines can meet. Another limitation concerned the compatibility between the aca-demic levels of the students in various disciplines. For example, the advanced-level family nurse practitioners sometimes intimidated the other students in their groups. Other students were at an intermediate level of educa-tion within their discipline. In other small groups, medical students dominated the patient interviews and discussions, most likely because of traditional percep-tions of professional roles that assume physicians will exert clinical leadership. The World Health Organiza-tion’s International Classification of Function and Dis-ability11 was used to give structure to the discussions within the small interdisciplinary groups. Unfortu-nately, some groups focused too much of their time on attempting to understand and successfully navigate the model. Only social work and allied health faculty members and students had previous experience using this fairly complex model. Finally, since so few stu-dents completed both the preconference and postconfer-

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. ence surveys, we were unable to determine within-subject changes in knowledge and attitude and can report only aggregate data.

DISCUSSION The inaugural year of the Interdisciplinary Case

Conference taught us a great deal about both the value of the activity and how the experience could be im-proved. Students gained knowledge, attitudes, and skills. Specifically with regard to Goal 1, students’ knowledge of the training and skills of other health professionals increased overall as shown in Table 2. With respect to Goal 2, facilitators reported that stu-dents used interdisciplinary team management princi-ples in deciding on the appropriate plan of action for the patient (Tables 4 and 5). In accordance with Goal 3, students’ understanding of the value of interdisci-plinary teamwork apparently increased, as shown in Table 3.

Analysis of numerical and narrative survey re-sponses guided further development of the case con-ference activity. Based on what was learned, the fol-lowing changes have been made to the activity: 1. The WHO model has been modified to make it

less complex for facilitators who do not have pre-vious experience in using the model. In the initial activity, only social work and allied health faculty members had previous experience with the model, and the brief, 1-hour training provided for the other facilitators on using the model was appar-ently insufficient. As a result, simpler confer-ence materials have been developed to facilitate the groups’ use of the model.

2. The activity is now conducted in one 3-hour ses-sion, rather than two 2-hour sessions, to reduce the administrative and logistical burden to faculty members.

3. Dental students and rehabilitation counseling stu-dents have been added to expand students’ expo-sure to additional health professionals.

4. Nurse practitioner students, who tended to domi-nate the discussions within their small groups, have been replaced with baccalaureate nursing students to better match the educational skill lev-els of students from the nursing profession with those of the other students.

5. To circumvent the tendency for medical students to dominate patient interviews and small group discussions, explicit discussion of strategies for preventing this has been added to the training ses-sion for facilitators.

6. Permanent funding for the activity has been ob-tained from the university as a result of the overall positive response from students and facilitators. The procedures for administering evaluation instru-

ments have been changed to ensure greater response rates and to enable greater precision of within-subject comparisons. Evaluation instruments are now adminis-tered during the session, and bar codes are used on sur-veys to allow comparison between individual students’ preconference and postconference responses.

Our experience in having pharmacy students par-

ticipate in a required interdisciplinary experience has been rewarding. More importantly, results show that the goals and learning objectives for this project were ac-complished. Pharmacy students’ knowledge of other health care professional roles increased, and students recognized that each health profession has an area of expertise to contribute to patient care.

CONCLUSIONS Barriers to establishing interdisciplinary learning

experiences for health professional students often seem overwhelming in number and insurmountable in magni-tude. Even when faculty are interested and dedicated to providing such experiences, logistical and practical is-sues sometimes intervene to prevent their implementa-tion.

We have described one strategy for overcoming bar-riers to interdisciplinary teaching and learning--a strat-egy that has provided a rich experience for pharmacy students as well as students from medicine, nursing, physical therapy, speech and hearing sciences, occupa-tional therapy, and social work. The gains that were realized in student knowledge and attitudes and the pro-fessional satisfaction that faculty facilitators derived from the experience and from their observation of en-thusiastic student participation have inspired us to make the activity an ongoing part of the required curricula across the health professional schools.

Although faculty members will encounter chal-lenges when planning and implementing interdiscipli-nary experiences, such as identifying funding sources, matching academic levels of students, and finding a time when students from multiple disciplines can convene, the importance of giving health professional students the opportunity to participate in interdisciplinary experi-ences cannot be overemphasized. As Ray13 reminds us, professional students need to learn from each other, and they need to understand the professional roles of others. This is especially true now as we strive to make phar-

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American Journal of Pharmaceutical Education 2003; 67 (2) Article 45. maceutical care giving the new standard for our profession.

ACKNOWLEDGMENTS The authors thank their colleagues who have been

part of the interdisciplinary project planning group: Marco Aleman, Stacia Carone, Susan Coppola, Celia Hooper, Anne Meier, Judy Miller, Martha Mundy, Amy Pomeranz, Sharon Ringwalt, Kathleen Rounds, Jackson Roush, Anne Skelly, Florence Soltys, Margot Stein, Beat Steiner, Judy White, Crystal Wilson, and Kim Wilson. Further, the authors are grateful for the financial support received for the project from the Office of the Provost, UNC-Chapel Hill, through the Health Affairs Interdisciplinary Education Commit-tee.

REFERENCES 1. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533-43. 2. American Council on Pharmaceutical Education. Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Chicago, Ill: American Council on Pharmaceutical Education Inc; 1997. 3. Plake KS, Wolfgang AP. Impact of experiential education on pharmacy students’ perceptions of health roles. Am J Pharm Educ. 1996;60:13-9.

4. Leininger M. This I believe about interdisciplinary health education for the future. Nurs Outlook. 1971;19:25-9. 5. Manasse HR. The need for health team education. US Phar-macist. 1997;22:57-77. 6. Learning and transfer. In: Bransford JD, Brown AL, Cocking RC, eds. How People Learn: Brain, Mind, Experience and School. Washington, DC: National Academy Press; 2000: 51-78. 7. Shepard K, Yeo G, McGann L. Successful components of interdisciplinary education. J Allied Hlth. 1985;14:297-303. 8. Popovich NG, Wood OB, Brooks JS, Black DR. An elective, interdisciplinary health care case studies course. Am J Pharm Educ. 2000;64:363-71. 9. Borrego ME, Rhyne R, Hansbarger LC, Geller Z, Edwards P, Griffin B, McClain L, Scaletti JV. Pharmacy student participation in rural interdisciplinary education using problem based learning (PBL) case tutorials. Am J Pharm Educ 2000; 64:355-363. 10. Duerst B, Boh L, Rosowski P, Elvers L, Geurkink E, Han-son J. Fostering interdisciplinary education for students in a rural health care setting. Am J Pharm Educ. 1997;61:371-4. 11. World Health Organization. ICIDH-2: International classifi-cation of functioning and disability. Geneva: World Health Or-ganization, 1999. 12. World Health Organization (2000). International classifica-tion of functioning, disability, and health. Geneva: World Health Organization, 2000. Available at: http://www.who.ch/icidh. Ac-cessed on: November 7, 2002. 13. Ray MD. Shared borders: achieving the goals of interdisci-plinary patient care. Am J Health-Syst Pharm. 1998;55:1369-74.

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Appendix 1. Worksheet for ICIDH-2 classification of function and disability (WHO, 1999)

Dimension Strengths Problems Interventions/ Preventions

Additional Infor-mation

Health Condition:

Disease or Disorder of the Body Body Structure & Function: Anatomical & physiological aspects of the body. Activity: The nature and extent of functioning at the level of the person. These range from simple to complex tasks. Participation: Involvement in life situations in relation to health conditions, activities & body functions & structures, and the context. Context in-cludes physical, social and cultural environment. Lived experience of illness or dis-ability. Personal factors: Individual background and personal features. Reprinted with permission of the World Health Organization (WHO). All rights are reserved by WHO.

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