Amy is a fourth year emergency medicine resident, who has recently started supervising medical students while on shift. She meets Jim, a third year medical student, who will be working with her for the shift. Over the course of the shift, it becomes apparent that Jim is struggling with understanding a charge nurse’s role in the emergency department. Amy wishes there was a way for medical students like Jim to gain more insight into the role of other team members in the emergency department.
This Feature Educational Innovation (FEI), titled, “The Nursing Shift: Measuring the Effect of Inter-professional Education (IPE) On Medical Students in the Emergency Department” was originally posted by the CAEP EWG FEI Team in 2018 and answers the question: “How can we improve inter-professional education of medical students in the emergency department?” A PDF version is available.
Description of Innovation
Inter-professional education (IPE) involves “occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care”.1 Current literature has found IPE to increase knowledge and skills,2 improve attitudes towards other professions,3 and to promote superior clinical outcomes.4 Health Canada has collaborated to form accreditation standards to support IPE in Canadian medical schools.5 The proposed educational innovation termed the ‘nursing shift,’ is currently based out of Kelowna General Hospital’s Department of Emergency Medicine, in partnership with UBC’s Southern and Island Medical Programs. The “nursing shift” endeavours to enhance IPE in these institutions.
This nursing shift pilot was first trialed with 32 third year medical students from Feb 2016 until May 2017. Students were asked to evaluate the educational intervention by providing narrative feedback including the pros, cons, and overall impression of the shift. Narrative feedback was then assessed using an informal thematic analysis.
Curriculum, Tool, or Material
The innovative educational concept consists of an 8-hour nursing shift with a 30-minute break. Medical students spent 4 hours at triage with a nurse learning about patient intake. The remaining 3.5 hours were spent in the emergency department collaborating with a nurse on several tasks including preparing and administering medications, starting intravenous lines, and inserting Foley catheters.
Students provided overwhelmingly positive narrative feedback in response to the nursing shifts. Some quotes included:
- “I think that this shift will help me to more successfully move into the ER rotation with a greater understanding and appreciation of the members of the healthcare team other than physicians and for the organization of the ER.”
- “This shift was very humbling. The nurses I worked with were kind and competent – Can’t really imagine a better combination.”
- “The chance to work with nursing staff directly is unique and extremely valuable.”
A formal rotation will be implemented in the form of a prospective cohort study with 24 medical students from two UBC sites including Kelowna and Victoria. The Kelowna group will attend a nursing shift, while the Victoria group will complete the standard emergency medicine rotation without the nursing shift. Impact will be measured over two years using a mixed-methods analysis.
Healthcare systems are shifting to a more collaborative team oriented approach, and IPE has been shown to prepare students for this changing workplace. 67 Building upon the early success with a nursing shift pilot, we seek to understand third year medical students’ experience of the 8-hour nursing shift integrated into a standard emergency medicine rotation, and to evaluate any changes in attitudes towards inter-professional collaboration after engaging in this intervention. Evaluation of this novel implementation will enable further assessment and optimization of the nursing shift, and if it is well received, encourage widespread adoption.
Current literature shows multiple benefits of IPE,5 so it is imperative that medical schools structure their curriculums to maximize collaborative education. We are building on a successful pilot project to further study the impact of the educational intervention termed the ‘nursing shift.’ This study will not only assess this unique educational opportunity for continued application at our institution, but it will also inform educators and other professionals if other medical schools would benefit from a similar nursing shift. Furthermore, this project will add to the growing literature on how novel educational approaches can positively influence team-based practice in healthcare settings.
Is inter-professional education a part of your institution’s curriculum for medical students?
Are there other ways that your institution promotes inter-professional education?
More about CAEP FEI
This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Feature Educational Innovations project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive FEI each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.