Mar 08, 2016
By Mildred Nicol, RN, BSN , Holly Mansell, BSP, PharmD

An interprofessional education pilot at the Saskatchewan Transplant Program

A transplant coordinator and a pharmacy educator bring students in two health disciplines together

The Saskatchewan Transplant Program (STP) provides care to solid organ transplant recipients in our province. The clients require lifelong monitoring and medication management to maintain the delicate balance between avoiding organ rejection and preventing drug toxicity. Interprofessional teams, consisting of nurses (the transplant coordinators), pharmacists, physicians and a social worker, are dedicated to improving the health outcomes and quality of life for clients. Having successfully operated under this practice model for more than 20 years, the members of the team at the Saskatoon site have been pioneers in collaborative practice. We felt ours was an ideal site to trial an interprofessional clinical practice experience for students, in collaboration with the University of Saskatchewan.

Interprofessional education (IPE) is essential to the development of a “collaborative practice-ready” health-care workforce, which in turn optimizes health services, strengthens health systems and improves health outcomes (World Health Organization, 2010). While IPE opportunities currently exist for health sciences students at the University of Saskatchewan, feedback from students has indicated that these initiatives sometimes feel forced and disjointed. Further, opportunities for students to experience collaboration first-hand in health-care practice settings in Saskatoon are few. In August 2014, we proposed a pilot IPE experience for a nursing student and a pharmacy student to the university’s colleges in these two disciplines. We received approval, and the university placement coordinators promoted the pilot and identified candidates.

Working together in one office, nurses and pharmacists at the STP manage a shared patient caseload. Although the nurses’ expertise lies in patient assessment and the pharmacists’ is in medication management, close working relationships have developed and have led to mutual learning and enhancement of the roles. With the opportunity to expand their scope of practice, these team members have learned to troubleshoot problems in new ways — allowing them to deliver quality care more quickly, consistently and efficiently.

Our goal was to present this model for the selected students. We hoped that by way of introduction to interprofessional practice, they would develop an understanding of the strength of collaboration in providing optimal patient care.

We were the co-preceptors for the fourth-year nursing student and fourth-year pharmacy student who were selected for the pilot. During the first week of this five-week practicum, we focused on orientation and had the students shadow the program team members. As time progressed, the students were given opportunities to put their skills and observations about collaboration into practice. Various team members were generous with their time and took the lead in educating them about each of the professional roles. For example, the pharmacists mentored the nursing student on medication management topics. The nurses educated the pharmacy student about their roles in physical assessments, organ retrievals and donor selection. The physicians guided the students through in-depth discussions on specific transplant topics.

The hands-on clinical activities took place in transplant outpatient clinics. The students learned to work as a team while conducting systems assessments and medication reviews, developing care plans and educating patients on healthy lifestyle choices and the importance of medication adherence.

One of our main objectives was to have the students team up on a project. They opted to design a selection of teaching materials for transplant patients with limited health literacy, a task they handled confidently and collaboratively. The practicum concluded with the students giving a formal presentation on their project to all program staff.

Lessons learned
In our one-on-one interviews with the students afterward, they made it clear they perceived the experience as extremely beneficial. As their preceptors, we had observed their interprofessional growth. Initially, they were more comfortable shadowing the team and learning side by side. By the end of the rotation, however, they were asking questions and providing input as a team. Their informed feedback and the quality of their presentation demonstrated the benefits of having them work with members of each profession. Although the two of us had worked together before as colleagues, planning the pilot and the student learning opportunities and doing team teaching allowed us to pool professional resources in a new way.

Although we consider this pilot a success, several challenges deserve discussion. From our perspective, the experience was time and labour intensive and sometimes logistically complicated because of the involvement of two health disciplines. It is obviously ideal to involve a preceptor from each profession in such projects, but this adds yet another layer of complexity to schedule planning. We would not have been able to successfully facilitate the pilot if we had included students from other disciplines.

We became acutely aware that each discipline had its own expectations and goals for students involved in clinical practice experiences. It was soon clear that the nursing student would be able to spend only three days a week with us because of competing program commitments. On the other two days of the week, the pharmacy student worked on an independent assignment comparing teamwork in sports with that in health care.

Both students noted that they would have liked to have had more time to dedicate to direct patient care. Unfortunately, two factors limited what we were able to offer. Transplantation is a highly specialized field, and we needed to spend more time than anticipated to orient the students to the outpatient clinic routine before we felt comfortable providing opportunities for them to interact with patients. The second factor was related to infrastructure. Because of the lack of space in the STP office, the students had to work out of a separate conference room. This meant they weren’t involved in the regular phone call inquiries from patients and team discussions, which provide real-time clinical learning opportunities.

Next steps
Despite the challenges in arranging the pilot, we felt this project was a worthwhile endeavour. In fact, we have embarked on a similar project with another two students in nursing and pharmacy. Having had the experience of the pilot, we were able to streamline the planning process. Another project we are trying to find time to work on is the development of a structured introductory learning module for future student participants. The purpose is to provide essential transplant knowledge that will boost participants’ confidence in their ability to take on clinical activities early on. We plan to include actual patient cases for the students to work on together along with expanded information on the roles of physicians and social workers on the STP team. By providing this introductory material, we could then make the actual reviewing of cases the focus for our meetings with the students.

To address the problem of not having space in the office for the students and to provide additional opportunities to hone clinical skills, we proposed to the team members that non-urgent patient questions and concerns could be triaged to the students, who could assess them, review the findings with the team and follow through with the patients.

Overall, the nursing/pharmacy IPE pilot was an excellent learning opportunity for all of us. The importance of teamwork in health care has been proven, and the value of IPE cannot be overstated. We encourage others to try to incorporate IPE into student clinical practice experiences whenever possible.

The authors thank former students Lauren Gamble, RN, and Brennan Bosch, BSP, for their enthusiasm and their willingness to participate in the pilot.

World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice.

Mildred Nicol, RN, BSN, is a transplant coordinator at the Saskatchewan Transplant Program, St. Paul’s Hospital, Saskatoon.

Holly Mansell, BSP, PharmD, is a faculty member in the college of pharmacy and nutrition at the University of Saskatchewan. She maintains a practice site at the Saskatchewan Transplant Program.

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