Accelerating Change in Medical Education

These med students learn teamwork from practicing nurses

Familiarizing medical students with all elements of the health care process—including those that go beyond a physician’s responsibilities—is rapidly becoming a point of emphasis in medical education. Typically, this is done through interprofessional education programs that pair medical students with trainees, such as nurses in training or pharmaceutical residents, from allied schools of health within a university setting.

As a stand-alone medical school—one that has no allied schools of health—the University of Chicago Pritzker School of Medicine (U. of C.) did not have that option. Instead, the med school turned to its practicing nurses to offer students an understanding of their profession and how it works in tandem with physicians in a variety of settings.

“The idea of trying to expose med students specifically to other members of the health care team is critically important,” said Jeanne Farnan, MD, associate professor of medicine and assistant dean of curricular innovation and evaluation at U. of C. “Providing those opportunities to get that lens and understanding from someone else’s point of view is really important before that solidification of the ‘I’m the doctor role’ sets in.”

Training with professionals

In 2017, U. of C. piloted an interprofessional practice experience pairing 88 first-year medical students with practicing nurses for a clinical experience. The program, known as UNITE (Understanding Nursing: Interprofessional Team-Based Experience), seeks to break down the interprofessional silos that often exist in medical education.

Through the program, students are given the opportunity to select from 11 high-performing nursing units with which they would like to work—those units included pediatrics, emergency medicine and surgery. Once they are given an overview of the nursing profession, students participate in weekly four-hour nursing shifts with their nursing partner. During that shift, students have a checklist of activities in which they may participate, such as the nursing huddle, medication reconciliation, a nurse hand-off or an intake. Following the shift, students write a reflection of their experiences.

“Medical students love being in the hospital and seeing patients,” Dr. Farnan said. “For the majority of the time, the students are active participants. We were very reluctant to even bill it as a shadowing experience because we really wanted the students to feel like they were involved in any activity that fell within their identified scope of practice.”

Nurses prove to be willing partners

For the UNITE program to work, the medical school found willing partners across U. of C.’s nursing staff. Those partners participated on a volunteer basis.

U. of C.’s nurses are familiar with working with learners, generally nurse trainees. Familiarizing them with physician trainees who have yet to enter the clinical setting required a few debriefing sessions during nursing grand rounds.

In terms of their work with med students, there was both an instruction and evaluation component for nurses. After shifts, nurses evaluated medical students on a number of aspects of their performance, including professionalism, communication skills and level of engagement.

The nurses who participated in the program generally found it rewarding.

“Interestingly enough while the nurses felt [the students] added more work to their shift, they felt more satisfied with their shift,” said Dr. Farnan. “We actually saw that nurses felt more engaged than they would have felt without the medical students there and we thought that was a lovely value add of the medical students.”

The nurses weren’t the only satisfied party. In a survey of students following the completion of the UNITE program, an overwhelming majority found the program to be beneficial. In light of those results, U. of C. will continue the UNITE program with its first-year medical students in 2018.

Dr. Farnan hopes UNITE can serve as a template for other medical schools facing similar challenges.

“I would encourage schools that are in similar positions as ours, maybe who don’t have a nursing or pharmacy school, instead of spending energy spinning the wheels how to make the stars align and getting nursing and medical students together in the same space, really think about how to leverage your staff providers who are already done with their training,” she said. “The experience was just as valuable for our students because they were able to see the nurses in practice at the end of the journey of nursing school.”

The University of Chicago is one of 32 schools in the AMA’s Accelerating Change in Medical Education Consortium. The AMA awarded each consortium member a grant for its transformative medical education projects in key innovation areas.

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