1. science
2. medicine

Joining Forces Collaboration
An Interprofessional Learning Activity
Carol A. Terregino, M.D.
Senior Associate Dean for Education (interim)
Master Educators’ Guild Symposium
Rutgers Biomedical and Health Sciences
March 17, 2014.
Rutgers, The State University of New Jersey
Robert Wood Johnson Medical School
SERVICE
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“To colleagues whose tireless
activities to get the message out to the
nation—you have inspired me. I think I
am a better person because I have
learned from you.”
A LABOR OF LOVE
Special thanks to Robert Like for his collaboration, Chris Molloy and Joe Barone
for believing in Me and supporting the endeavor, The JF Kennedy Hospital, and
Peter Amenta for signing on to the AAMC initiative and charging me to get it
Done.
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• White House initiative to serve military personnel and families
in employment, education and wellness
• Charge from the Association of American Medical Colleges
• RWJMS joined over 100 medical schools in pledging to
participate
• The contribution: A transformative educational program to
train cohorts of learners in the health professions each
year
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Why is this initiative important?
• 15 million of the 23 million US veterans seek care in the
community rather than VA system
• In NJ, 443,200 veterans, 73% are wartime veterans
• Impact factor of these veterans’ service:
– 1,329,600 connected and impacted by war and/or service
The Stories
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INTERPROFESSIONAL INNOVATIVE COLLABORATION FOR
LEARNERS ACROSS EDUCATIONAL SPECTRUM
• Learner collaboration: medical students, pharm d
students, nursing students, graduate students in social
work and psychology, residents in psychiatry, primary
care, and physical medicine and rehabilitation
Beyond RBHS, Beyond RWJUH
• Faculty collaboration: MD/DO in family medicine,
psychiatry, physical medicine and rehabilitation, acute
care surgery, emergency medicine, pharm d, doctoral
trained nurses, psychologists, social workers
• Facilitators: including orthotics, physical and
occupational therapy, behavioral health, veterans and
family members, students
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What is innovative?
INTERPROFESSIONAL INNOVATIVE COLLABORATION FOR
LEARNERS ACROSS EDUCATIONAL SPECTRUM
• Warrior-Centric Healthcare (WCHT)TM by The Steptoe Group
BASED UPON RECOMMENDATIONS FROM
• Rand Report: Invisible wounds of War
• DoD Prevention of Suicide by Members of the Armed
Services
• DoD Recovering Warrior Task Force Report
“immediate and unabated need for the implementation of
warrior-centric evidence-based assessment and training”
of health providers
First time such a program was used in an academic
environment with interprofessional health professions
students
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Joining Forces with The Steptoe Group
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What is our Vision for Educational
Collaboration?
Annual interprofessional training of a cohort of learners to meet
the total health and healthcare needs of our service members,
veterans, their families and communities
Outcomes:
Enhanced awareness
Improved communication
Warrior-centric care
Collaborative care plans
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Implementation
• Collaboration with the Steptoe Group to tailor the learning to
interprofessional students***
• Train the Trainer-full day session (40 trainers)
– 20 faculty with terminal degrees
– 20 facilitators with military/veteran experience/family member
contact/clinical contact with veteran
• Training of students and residents-full day session (400
students/residents)
– Facilitated small groups, interactive
– Online avatar case studies and assessments at 3,6,and 9 months for all
learners
***significant modifications
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What are the Learning Modules?
• Military and veteran culture in the clinical setting
• Cultural competency in the military and veteran communities
• Neurobiology of post-traumatic stress disorder and traumatic
brain injury
• Provider communication in the military and veteran
communities
• RWJMS Modifications based upon training
–
–
–
–
More engaged learning
Role play
CAT scans, Drugs and Brains
Practical strategies
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Specifics of the Educational Program
1. technology – videos and avatars
2. adult learning principles in large and small groups
Interactive
Reflection and sharing
Impact factor
Personal connection
3. target the knowledge and performance of healthcare
providers, allied health team members, and service support
personnel
4. Durable solutions: approach to complex patient scenarios
and knowing where to access help for veterans
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Joining Forces in the Patient Centered
Medicine Curriculum
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400 Strong, impacted by an evocative video of
voices of warriors, now students at Rutgers
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Panel of warriors and family members
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Small Group Interaction
• Each room had a faculty facilitator from one of the
professional schools as well as a veteran, significant other or
family member of the veteran
– Ground rules
– Ice breakers
• Time for reflection
• Interdisciplinary groups of 4 for role play
• Development of a collaborative care plan for a veteran form
the perspective of the various professions
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Dr. Prescott lending his expertise in small group
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Role playing in interprofessional scenarios
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Teaching with Role Play
• An E7 warrior presents to the emergency department at
5:30 am with severe jaw pain. He is in the reserves,
awaiting deployment but not yet called up. He needs to
be at training at 7:00 am.
• Why you never call an enlisted serviceman SIR?
• Four Acts
–
–
–
–
The Triage Nurse
The Physician/Physician Assistant/Nurse Practitioner
The Mental Health Provider
The Community Pharmacist
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Warriors lending their perspective to the
collaborative care plan
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Outcomes-based upon 167 pre and
post test matched data
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Pre and Post Test Unmatched Preliminary
Data – Survey by Kevin Parks, MD candidate
Pre – test n=151
“I feel
uncomfortable
screening / history
taking a veteran
of the Armed
Forces.”
Post – test n=205 Sig.
2.2 (0.8)
1.9 (0.8)
“When I gather
patient histories,
I ask (will ask)
about veteran
status.”
2.1 (1.1)
4.2 (0.7)
P=.001
“I am aware of
resources
available to
veterans to help
meet their
healthcare needs.
2.5 (0.9)
3.7 (0.8)
P=.001
P=.001
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More outcomes
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Lessons Learned
• Power of Stories
• Power of the Patient as a player in “interprofessional”
education
• Power of health professions student as “faculty”
• Time for reflection
• Limit didactics
• Avatars?
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Questions, Comments, Future Directions
• Invitation to attend the June 23, 2014 event?
• Invitation to Joining Forces with RWJMS to become the
Regional Training Site for Warrior-Centric Care?
• Rutgers National Center for Educating Health Professionals,
Welcoming veterans and families who receive care outside of
the VA system, Educating Rutgers Veterans, Treating PTSD
Traumatic Brain Injury