Interdisciplinary Student Health Teams: Combining Medical Education and Service in a Rural Community-based Experience

Several initiatives have been introduced over the years to address the maldistribution of health care professionals and to improve access to care for underserved rural populations. One of these is the sponsorship of community-based, service-oriented teams comprised of students from various health disciplines. This study investigated extramural training as a complement to traditional hospital-based experiences. The specific objective of the study was to determine the extent to which the nation's medical schools combine training with a rural community-based experience in the form of an interdisciplinary student health team program. In the fall of 1994, a 32-item questionnaire was mailed to the chief academic or clinical affairs administrators of the nation's 126 allopathic medical schools. A total of 104 (82.5%) medical schools responded to the survey. Eighty-six of the respondents (82.7%) reported some type of rural training or public service activity; 22 (21.2%) acknowledged the sponsorship of an interdisciplinary student health team program. Small rural communities, those with populations of 5,000 or fewer, were the focus of 76 percent of the reporting programs. Nearly two-thirds of the reporting programs were located in the South, the region with the nation's lowest physician-to-population ratio. The nursing and medical professions were most frequently represented, although a wide range of disciplines were identified as participating on the student health teams. Activities of the teams included both ambulatory care and community outreach services. The majority of the programs used team-building exercises to enhance team effectiveness. Extramural training programs offer students a realistic examination of the social, cultural, economic, and political forces that influence both individual and community health. Rural community-based programs, such as interdisciplinary student health teams, should be valued because they can strengthen the link between the sponsoring institution's educational mission and its public service obligation.     

The Rural Elderly Assessment Project: A Model for Interdisciplinary Team Training

SUMMARY

The Rural Elderly Assessment Project (REAP) was designed to train occupational therapy, physical therapy, physician assistant, and public health faculty and students to conduct interdisciplinary team health assessments with rural, community-dwelling older adults. This article highlights key features of the project's design and implementation and presents preliminary evaluation data from the 25 students who participated in the project. Students completed several pre- and post-test measures. Statistically significant improvements were observed in all but one of the knowledge, skill, and attitude domains that were specifically targeted by the project. Students identified a variety of benefits they received from participating in the project, and all students indicated that they would recommend the project to another student. Implications for project replication and interdisciplinary team training of allied health students are discussed.     

Multidisciplinary team dynamics in the production of problem-based-learning cases in issues related to older adults

Two important goals in allied health education are to prepare future allied health professionals to function as members of interdisciplinary teams and to increase their awareness of issues related to the growing older adult population. The responsibility for achieving these goals rests on the faculty and administrators of allied health education programs, who may not themselves be proficient in either of these domains. A multidisciplinary team of health educators and administrators was brought together to produce six problem-based learning (PBL) cases related to older adults. Members of the team represented a variety of disciplines in health care, diverse philosophies of educational development, a variety of roles in allied health education, and differing levels of knowledge of issues related to older adults--parameters similar to those found in the members of an interdisciplinary healthcare team. The methods by which this multidisciplinary group functioned and the dynamics in attaining the goals of the project are presented.     

A rural service-learning model for health administration education

Service learning for students in the health professions can best be described as an educational methodology based on the collaboration between an academic discipline and a community agency to link student learning with community-based service. This paper describes a service-learning model in rural and medically underserved communities used in a master in health administration program in a rural Southern state. It presents the process, components, outcomes, and challenges. Over the past five years, 56 students completed 116 experiences involving internships, field projects, or special projects in rural and medically underserved communities. A total of 27 percent of our graduates who completed rural and medically underserved experiences accepted job positions in rural health care entities. Strategies utilized by this rural service-learning model include interdisciplinary team training, partnerships among rural and medically underserved community health care entities and academic institutions, faculty-preceptor retreats, and involvement in local community initiatives. These experiences prepare future health administrators to contribute in a meaningful way toward building an effective rural health care delivery system.     

Making sustainable water and sanitation in the Peruvian Andes: an intervention model

Sustainability of water supplies in remote rural communities is problematic and resource consuming. CARE has a long history of working hand in hand with remote rural communities and devising programs tailored to their needs. We present here an intervention that integrates development of water supplies and sanitation, with operation and maintenance skills development and training of health promoters that can educate from within the community that ensures the sustainability of drinking water supply systems in rural communities. The training used is innovative in that it uses a series of video-workshops which are found to be particularly useful in communities with high illiteracy rates.     

Investigating the health of rural communities: toward framework development

How healthy are the residents of rural Canada? How healthy are Canada's rural communities? Members of an interdisciplinary research team at the Brandon University Rural Development Institute, Manitoba, Canada, formed a partnership with rural stakeholders in an attempt to strengthen and build capacity in rural communities. One component of this research was the development of a framework to assist residents of rural communities to assess the health and sustainability of their community. Through dialogue with partners and review of the literature, a preliminary framework can be generated. This article formed the first step in the creation of such a framework. The article begins with common term and concept development, extends to a critical analysis of framework literature and culminates with consideration of steps to be taken next in the establishment of a framework and indicators that are both meaningful and useful for rural residents and their communities.     

Making sustainable water and sanitation in the Peruvian Andes: an intervention model

Sustainability of water supplies in remote rural communities is problematic and resource consuming. CARE has a long history of working hand in hand with remote rural communities and devising programs tailored to their needs. We present here an intervention that integrates development of water supplies and sanitation, with operation and maintenance skills development and training of health promoters that can educate from within the community that ensures the sustainability of drinking water supply systems in rural communities. The training used is innovative in that it uses a series of video-workshops which are found to be particularly useful in communities with high illiteracy rates.     

Partnering with public health: a model for baccalaureate nursing education

This article discusses the implementation of a one-year project developed to increase and improve the quality of public health nursing experiences for baccalaureate nursing students at one state-assisted university. The partnership model involved collaboration with public health departments, the academic nursing programs, and community agencies and leaders. The project led to the development of increased student skills related to interdisciplinary team work, program development, and cultural competency skills. A needs assessment questionnaire of the public health department partner staff supported a need to develop public health work force skills. The project provided opportunities for nursing faculty development. The project results support the need for service-academic partnerships to develop the public health nursing workforce.     

RURAL INTERDISCIPLINARY HEALTHCARE TRAINING IN HAWAII: A CROSS-CULTURAL PROJECT

ABSTRACT: In 1993, a federally funded project began at the University of Hawaii to educate students from a variety of health professions (nursing, medicine, dental hygiene, psychology, public health, and social work) about the challenges of working as an interdisciplinary team in rural health settings. After nine months of study, this education culminated in students participating in interdisciplinary team projects in rural areas of Hawaii. The development and funding of interdisciplinary rural health projects across the United States reflects the growing awareness that limited resources and access to health in rural areas requires resource sharing, both physical and non-physical. Exposing students to information about rural health care, and then providing hands-on opportunities for teamwork with fellow students in a rural setting, can serve an additional and critical function: to recruit to rural areas healthcare workers who are already aware of the challenges and rewards of this type of practice.     

Rural Health Professions Education at East Tennessee State University: Survey of Graduates From the First Decade of the Community Partnership Program

CONTEXT: To help meet rural Appalachian needs, and with initial support from the W.K. Kellogg Foundation, East Tennessee State University partnered with 2 counties to implement a health curriculum for nursing, public health, and medical students in a rural setting. The Community Partnerships Program 3-year longitudinal curriculum included theoretical, conceptual, and practice elements of the 3 disciplines incorporated into an experiential, inquiry-based, service-learning program. Interdisciplinary learning, problem solving, and reinforcement of career choices in medically underserved rural communities were emphasized. PURPOSE: To compare career choices, attitudes, and practice locations of Community Partnerships Program graduates with traditional graduates. METHODS: Surveys were mailed to Community Partnerships Program and traditional program graduates matriculating from 1992 to 2002 (response rates 58/84 and 72/168, respectively). FINDINGS: Community Partnerships Program graduates indicated a significantly greater interest in rural primary care, care for the underserved and interdisciplinary group collaboration, and were more likely to practice in rural locations than did their traditionally educated peers. Family, personal factors, and the availability of employment were major influences in determining the decision to choose a career in a rural location. Community Partnerships Program graduates indicated they were better prepared to work in interdisciplinary teams and were more likely to work in community-based programs and activities than did the traditional graduates. CONCLUSION: A program that enrolls students interested in rural health care and provides training in rural communities produces graduates who will practice in rural areas.     

An Interdisciplinary Health Team Training Program for School Staff in Minnesota

ABSTRACT: This paper describes an interdisciplinary health team training program for school-based clinic staff in Minnesota. The project sought to improve team functioning, level of practice, and health care services at the school sites. Participants were interdisciplinary staff members from clinics in senior high, middle, and elementary schools. The program consisted of further development in team training knowledge and skills and educational sessions on issues identified by participants. Evaluations indicated participants reported greater knowledge and improved team functioning experiences from the team training. Gains also were shown in knowledge and skills in specific school topic areas such as violence, resiliency, working with resistant families, and self-care. The program could serve as a model for other interdisciplinary school health team training.     

The pillars of health management education: lessons from the CEE experience.

AUPHA faculty members have had the opportunity to provide health care executive training and to work in partnership with academic institutions in Central and Eastern Europe and in the New Independent States of the former Soviet Union. This article presents some observations on health management education that demonstrate the similarity in issues faced by programs in the U.S. and in CEE. The health management educational partnership program was designed to provide technical assistance to emerging health management programs in the CEE. The partnership program has been mutually beneficial for several reasons. The role of physicians in leadership and the management educational needs that result provide one example of an issue that health management educational programs must address. The emergence of the roles of other health professions and growing contribution that they will make has its parallel in the American ascendance of the role of interdisciplinary team in clinical decision making. The partnership and executive training experiences have caused U.S. partners to focus consciously on pedagogical methods. The nature of the issues faced by emerging CEE health management programs suggests that mutual support among programs in the region after the partnership program is necessary in order to provide a forum for debate. The focus of the debate should continue to be on the role of management in health reform, content of curriculum, research focus and pedagogical methods appropriate for health care management undergraduate and graduate programs. The result will be a strengthening of the health management academic discipline in the region. The future of the AUPHA should predicated on the same principles, the roots from which it has grown.     

Developing interdisciplinary courses for allied health students: a retrospective view

Innovative interdisciplinary education in allied health has been developed in order to give students insight into role competencies of other professionals, improve the quality of health care while reducing costs, and facilitate the interdependent functioning of allied health care providers in meeting patient or client needs. The process of interdisciplinary course development requires the same communication and needs identification by faculty as is necessary for the provision of team care by practitioners. A retrospective account of interdisciplinary course development in a major health sciences center, together with materials developed for class presentation, may serve to encourage this type of activity elsewhere.     

A developing country's university oriented toward strengthening health systems: challenges and results.

OBJECTIVES. The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity. METHODS. Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula. RESULTS. The university has developed equity-based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district-level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, community health sciences as 20% of the medical and nursing undergraduate curriculum. CONCLUSIONS. The mission and experience of the Aga Khan University in population-based health systems design and health sciences education can guide universities in both developing and developed countries.     

A Strategy to Increase the Number of Urban Family Practice Resident Physicians Who Enter Rural Practice

Physician geographic maldistribution is a problem in the United States health care system. Innovative strategies are needed to entice resident family physicians training in the larger, more numerous suburban and urban training programs to practice in rural areas upon completing their training. This paper describes a strategy used at St. Elizabeth Medical Center Family Practice Residency Program, Dayton, OH, to encourage rural practice. In the St. Elizabeth plan, the interested family practice resident moonlights in a rural practice provided by the local county hospital. The county medical staff covers the resident physician's practice during the frequent absences. The residency program faculty provide on-site supervision, telephone back-up coverage, and practice consultation. The county hospital provides billing services; the resident physician retains 100 percent of collections. The resident physician gains exposure to the knowledge, skills, and attitudes needed in rural practice. Upon completion of residency training, the physician remains in practice and is not required to pay back any expenses incurred by the hospital. Two resident physicians participate currently; three others have expressed interest in practicing in the community. A similar plan might work in parts of the United States where, like Ohio, training programs and rural communities are not far apart.     

The Role of Occupational Therapy in Back School

Multidisciplinary faculty collaboration within the health professions educational system is explored. The definitions for the concepts of intradisciplinary, multidisciplinary, interdisciplinary and transdisciplinary faculty teams are provided along with the strengths and weaknesses of collaborative teaching and course development across various health profession programs. Examples of these teaching models are described using case studies to illustrate collaborative course development by faculty from Occupational Therapy, Nursing, Physician Assistant, Social Work and Dental Hygiene, Nurse Anesthesia, and Health Services Management programs offered at the University of New England in Portland, Maine, United States of America.     

A Community Development Approach to Rural Recruitment

ABSTRACT: Programs designed to empower rural communities for health care provider recruitment have usually focused on the health care sector without aggressively addressing broader community development issues. The Recruitable Community Project (RCP) in West Virginia includes community education on recruiting and also assessments of and recommendations to rural communities on broad-based community development, aiming to enhance communities' recruiting potential. The project provides multidisciplinary university-based planning assistance programs for small communities, involving collaborative community visits. The project also uses a project manager as a "community encourager" who participates in community education and in the formulation of sustained community recruiting efforts. From August 1999 through August 2001, 7 underserved rural communities completed the RCP organizational processes and hosted planning assistance teams. Members of community recruitment boards gave high marks to the RCP process, its planning assistance teams, and its usefulness in establishing community ties to state and academic agencies. Since working with the RCP, the 7 communities have recruited 27 providers, success possibly stimulated by their RCP involvement (data current as of September 2002). This model of community training and development to empower rural communities to better recruit health professionals shows early promise. This model could be broadened to include more collaboration of community development and health science disciplines programs for recruitment and retention efforts.     

Rural and remote oral health, problems and models for improvement: a Western Australian perspective

Oral healthcare in rural communities shares many of the dilemmas faced by medicine in providing services to large geographical areas with dispersed populations. This study examined the population data and service provision data relevant to the geographical distribution of oral health care in Western Australia (WA). Of the 1.7 million people resident in WA, 72% were resident in the five major urban centres with only 13% in rural and remote regions. Of the 320 postcode regions, 186 had a population of less than 2500, 31 had a population from 2500 to 5000, 42 from 5000 to 10 000, 37 from 10 000 to 20 000, and 24 had a population greater that 20 000. Almost 80% of postcode regions with a population less than 2500 are in non-urban regions. Of the total of 690 dentists who were analysed in this study, it was found that the vast majority (greater than 85%) worked in practices in postcode regions within metropolitan Perth or the major urban centres. A total of 43 postcode regions did not have a dental practice within their bounds. In order to address this disparity in service availability, strategies including the development of training for medical practitioners and auxiliaries, the use of modern technology, school-based programs and the development of interdisciplinary links should be implemented. These strategies would also facilitate the development of closer links between medical and dental practitioners and the development of skills within the medical fraternity that would facilitate improved oral health in rural and remote communities.     

How we built our team: collaborating with partners to strengthen skills in pregnancy, delivery, and newborn care

We describe how collaboration with outpatient community health centers and other disciplines resulted in the creation of a novel interdisciplinary inpatient maternal child health system that focuses on safety and collaboration. Our maternal child health faculty team includes a mix of fellowship- and non-fellowship-trained, inpatient- and outpatient-based family physicians. Our team provides a sustainable framework for faculty to practice both inpatient and outpatient maternity care and provides strong role models for our trainees.     

Barriers and solutions to implementing a new curriculum: lessons from the women's health education program at MCP Hahnemann School of Medicine

The integration of new knowledge into the medical school curriculum is a difficult process. This article proposes effective strategies for overcoming obstacles to curricular integration of women's health and sex and gender topics. Some techniques developed to overcome barriers to the integration of new material into an existing curriculum include faculty development, faculty rewards, development of competencies and assessment tools, interdisciplinary team teaching, standardized patients, and reference resources. An interdisciplinary approach to implementing women's health education, as with most new curricular material, is endorsed for integration of the new field into the medical school curriculum. This proposed model results in general institutional participation and support, especially from senior level leadership. The outlined process enables students and faculty to learn techniques for incorporating emerging information in all disciplines, helping them to become "life-long learners."