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Grant Summary
An
innovative, three year interdisciplinary
training project for the Quentin N.
Burdick grant competition, building upon
the established eight-year
academic-community partnership between
the Omaha and Winnebago American Indian
nations of northeastern Nebraska and
Creighton University Medical Center is
proposed, responding to priority needs
identified by the reservation
communities. New initiatives will be
undertaken by the current project,
including faculty and student training
in foundational skills related to
cultural competence and
interdisciplinary, community-based
primary care. As foundational training
is completed, additional innovative
training will be implemented to
systematically improve evidence-based
primary care services in the target
areas of diabetes, geriatrics and mental
health services in the reservation
communities.
In
the Omaha and Winnebago communities, the
concept of service provision in a stand
alone, ambulatory care clinic, visited
by an interdisciplinary team primarily
during summer months, does not match the
cultural or service needs. Thus, the
current project is predicated upon novel
notions of the community clinical sites
serving as “classrooms” in which
services and student training occur, and
that such service and training is
ongoing, continuous, and integrated into
the community for each month of the
year. In this manner, clinical services
and student training are uniquely
embedded into the fabric of community
life. The project “Circles of Learning”
is a concrete, sustainable response to
the legislative purposes outlined in the
Quentin N. Burdick Grants competition.
The project directly targets Section 754
of the Public Health Service Act
priorities as it: (1) Uses innovative
methods for training rural health care
practitioners, (2) Demonstrates and
evaluates innovative interdisciplinary
methods and models for access to
cost-effective comprehensive health
care; (3) Delivers health care services
to individuals in rural areas; (4)
Enhances relevant research considering
rural health care issues; and (5)
Increases recruitment and retention of
rural health care practitioners.
The
proposed project blends well with the
mission of Creighton University, a
Jesuit school nationally recognized for
its strong commitment to social justice
and service to others. The project is
also consistent with the graduate
outcome goals of Creighton University’s
Health Science programs in occupational
therapy, physical therapy, pharmacy,
nursing and medicine. The project
builds on a successful nine-year history
of developing self-sufficient clinical
service delivery to the Omaha and
Winnebago communities and will be
implemented by a seasoned project team
representing both academic and community
sites.
Training will occur at multiple levels:
1) Advanced Faculty, 2) Short-Terms
Student Training, 3) Student Clinical
Internship/Mini-Residency, (all
addressed under Goals 1 and 2) 4)
Educational and community leaders
involved in interdisciplinary,
underserved practice settings (Addressed
under goals 3 and 4)
Advanced faculty development will
consist of “Foundational Team Skills”
related to: collaborative and
profession-specific roles in
community-based primary care; cultural
communications for appropriate
interactions with the Omaha and
Winnebago tribal communities; and
principles of evidenced-based practice.
“Specialty Practice” training for
project team members will follow in the
areas of diabetes (yr 1), geriatrics (yr
2) and mental health (yr 3). Following
training, the interdisciplinary team
will be actively engaged in
community-based primary care, providing
an infrastructure for student training.
Short-term student training
will be implemented based on evaluation
data from previous short term student
training experiences, which revealed a
highly significant effect for short-term
training (n=111, p=.000) in pre and post
test measures. Prior to on-site
practice training, students will
complete online modules for
“Foundational Team Skills” training
(topics previously described above), and
training in one of the respective
“Specialty Practice” areas of diabetes,
geriatrics or mental health. The cohort
of students trained each year will
include 8 occupational therapy, 8
physical therapy, 8 pharmacy (all of
whom are enrolled in entry level
doctoral programs) and 8 nursing
(graduate level); and 2 medical
students.
Clinical Internship/Mini-residency:
A different cohort of students
(groups of 3 including 1 PT, 1 OT and 1
pharmacy student) will participate in
training of longer duration in years 1,
2 and 3. After completing the online
“Foundational Team Skills” modules and
training for one of the “Specialty
Practice” areas, students will engage in
an 8-week pre-graduate clinical
internship, returning after graduation
to complete a 4-week mini-residency.
Based upon success and failures in our
past work, this model is designed to
enhance recruitment for the residency
phase while maximizing impact of the
immersions experience and skills
developed during the clinical internship
phase. The mini-residents will have
prior experience on the reservation,
thereby allowing advanced training
opportunities in developing culturally
appropriate evidenced-based clinical
pathways and participate in
interdisciplinary grand rounds. There
are four primary goals related to this
project:
Project Goals
Goal 1: Innovative training:
Implement two types of interdisciplinary
training; faculty/project personnel
training as well as professional and
post-professional student training. Each
level of training addresses
community-identified needs in diabetes,
geriatrics and mental health. Goal
1: Outcomes: Training in year 1
= 27 faculty/project personnel will be
trained. In addition, the total number
of students trained in year 1 = 37
students. Student training includes
short-term experiences and long-term
clinical internships in year 1. For the
short-term experiences, 34 students
include 8 OT, 8 PT, 8 Pharmacy, 8
Nursing and 2 Medicine. For the 3
clinical internships (long-term 8-week
clinical rotation), participants
include: 1 PT, 1 OT, and 1 Pharmacy
student. Training in year 2 = 27
faculty/project personnel will be
trained: The total number of students
trained in year 2 = 40 students. For
the short-term experiences, 34
participants include 8 OT, 8 PT, 8
Pharmacy, 8 Nursing and 2 Medicine; the
3 clinical internships, participants
include: 1 OT, 1 PT, and 1 Pharmacy; and
the 3 post-graduate mini-residency
participants include 1 OT, 1 PT and 1
Pharmacy. Training in year 3 =
27 faculty/project personnel will be
trained: The total number of students
trained in year 3 = 40 students. For
the 34 short-term experiences,
participants include 8 OT, 8 PT, 8
Pharmacy, 8 Nursing and 2 Medicine. For
the 3 clinical internship, participants
include 1 OT, 1 PT, and 1 Pharmacy; and
for the 3 post-graduate mini-residency,
participants include 1 OT, 1 PT and 1
Pharmacy.
Goal 2: Clinical Service Delivery:
Deliver and assess evidence-based care
in community sites in the practice areas
of diabetes, geriatrics and mental
health. Goal 2: Outcomes:
Develop and implement culturally
sensitive clinical pathways. Year 1
addresses diabetes; year 2 –
geriatrics; & year 3 - mental
health. Implement interdisciplinary
grand rounds integrating clinical cases
and clinical pathways across three
health science schools (School of
Pharmacy and Health Professions, Nursing
and Medicine) and two sites (Creighton
University and Omaha /Winnebago
Nations). (Total number of participants:
50 at community site and 200 at
university site).
Goal 3: Leadership Institute:
Macro-level training will occur
through the interdisciplinary Leadership
Institute. 1) Twenty clinical and
academic leaders involved in managing
health disparities in rural, Native
American communities will be identified
to participate in an interdisciplinary
Leadership Institute. Participants will
develop papers describing “best
practices” for preparing health
practitioners’ to enter into
interdisciplinary practice in rural,
underserved communities. Institute
proceedings will be disseminated
nationally. Goal 3: Outcomes:
Year 1 = Needs assessment:
Identify a database of academicians and
practitioners who are actively
addressing community health needs in
rural, underserved Native American
communities. From database, invite a
total of 20 interdisciplinary
educational or clinical leaders from OT,
PT, pharmacy, nursing and medicine to
participate in a Leadership Institute.
The outcome of the Institute is targeted
to describe best practices and
strategies for preparing health
professions students for
interdisciplinary, rural-community based
practice. Year 2 = Leadership
Institute: Convene a meeting of
national leaders in interdisciplinary
health professions education addressing
health disparities common to practice in
rural, Native American communities.
Year 3 = Proceedings: Based upon
work in years 1 & 2, publish proceedings
of the Institute and garner book
contract sharing papers or proceedings
that address innovative educational
models for interdisciplinary, health
professions education for preparing
practice in rural, underserved
communities.
Goal 4: Dissemination Research:
Additional macro-level training
occurs through analysis of outcomes of
previously funded Quentin N. Burdick
projects. The case study approach will
be used to develop recommendations for
effective recruitment and retention of
health practitioners in rural,
underserved communities. Goal 4:
Outcomes: Recruitment &
Retention research: Years 1-2:
Across the Quentin N. Burdick projects,
use case study approach to explore
recruitment and retention of health care
practitioners to rural practice.
Year 3: Develop a set of
recommendations for effective
recruitment and retention of rural
health care practitioners. Goal 4:
Outcomes: Project Dissemination:
Years 1 & 2: Target professional
presentations in respective health
professions organizations, rural
practice and Indian Health Service.
Year 3: Submit manuscripts to
journals that address interdisciplinary
education, rural health and Indian
Health Service. |
