Implementing interprofessional, graduate level, geriatric primary care education: Reflections on year 1 of a new program

BACKGROUND: Preparing and deploying a primary care workforce ready to care for the aging global population requires increasing efficiency in graduate level health professions education while ensuring competence in interprofessional practice. Training programs need to meet population health needs while also addressing the challenges of coordinating training schedules of diverse professionals, many of whom are practicing professionals. This study reports on the first year program evaluation of a unique nurse practitioner and physician training program focused on improving geriatric interprofessional care in the primary care setting. The program intervention included a week long joint educational program with physicians and nurse practitioners, online learning modules, and follow up learning exercises. Faculty designing the program included experienced geriatric nurse practitioners, primary care graduate level physician educators, an instructional technologist, and a behavioral scientist. METHODS: Evaluation data for the study drew from multiple sources including pre and post intervention focus group interviews with 10 student participants (8 MD, 2 NP), performance reports from the online learning modules, surveys about perceptions about interprofessional teamwork and practices, course evaluations, and faculty reflections. We conducted general descriptive analyses appropriate for the data type. The small sample size limited statistical comparison for significant differences between respondents. RESULTS: In the interviews participants emphasized how program training sites negatively limit the ability to deliver quality geriatric primary care and apply classroom content in the "real world". Participants also reported feeling uncomfortable providing feedback about other professions when in the same room. Issues around leadership also emerged as power dynamics between professions influenced perceived roles and responsibilities. Perceptions of quality of interprofessional collaboration at the current site of clinical practice remained nearly the same before (6.56/10) and after (6.2/10) the intervention. Perceptions of team leadership and serving as an equal contributor trended upward after the intervention. Overall perceptions of interprofessional collaboration on existing teams at their training sites, however, trended largely downward. Participants, in short answer questions, felt least comfortable addressing geriatric care issues related to patient safety, end of life care situations, communication, and work allocation. Synthesizing all the results suggest that this type of program may be effective in improving geriatric content overall but in an interprofessional education context, may sensitize learners to broader issues around geriatric primary care delivery, such as appropriate use of different roles on the healthcare team. CONCLUSIONS: Rich data from this first year of a 3 year study is informing the development of interprofessional geriatric primary care training programs, which could help health professions schools reinforce and address interprofessional care delivery issues that may predictably arise after this type of intensive educational intervention. It is also noteworthy that the role of the training site in reinforcing or undermining appropriate delivery of geriatric specific care cannot be ignored.