A collaborative curriculum for medical and nursing students

Abstract

Context and setting The US health care system has undergone a series of changes over the past decade, including the emergence of managed care organisations, disease management, clinical practice guidelines and continuous quality improvement. These changes require interdisciplinary team practice to function efficiently. The health professions must educate students to function in this health care delivery system. However, medical and nursing curricular content and structure have followed strict disciplinary lines in the past. Students of this traditional education are often ill-prepared for the reality of professional teamwork. Why the idea was necessary An interdisciplinary educational paradigm will improve and expand current interaction between medical and nursing students that will lead to greater trust and more effective interactions in the clinical arena. Both medical and nursing educators use simulation to teach these requisite clinical skills in separate forums. Our objective with this new curriculum is to bring the 2 groups of students together and educate them to function as a collaborative team in this high-risk, high-stress environment. What was done The curricular intervention was piloted with 11 3rd- and 4th-year medical students and 9 4th-year nursing students. The scenario created was a mock code using a simulated mannequin who undergoes a cardiac arrest. The student doctors and nurses were sent in as a team to initiate a code and to administer lifesaving clinical skills. After the ‘unsuccessful’ code, the student doctors and nurses subsequently had to pronounce the death of the patient and inform the patient's wife (a standardised patient). To examine students' attitudes, we administered 2 survey instruments: the Jefferson scale of attitudes towards doctor–nurse collaboration pre- and post-intervention and 10 4-point Likert scale items to evaluate the perceptions of the 20 participants. Evaluation of the results and impact The students, before and after our pilot curriculum, agreed strongly that doctors should be educated to establish collaborative relationships with nurses [mean 3·8 on a scale of 1 (strongly disagree) to 4 (strongly agree)]. The students also agreed strongly that interprofessional relationships between doctors and nurses should be included in their educational programmes (mean 3·9) and that during their education, medical and nursing students should be involved in teamwork in order to understand their respective roles (mean 3·9). The students' qualitative perceptions of the curriculum were overwhelmingly positive. This type of collaborative teaching will begin to address directly the ‘tacit’ curriculum, the difficult and most crucial times for communication between doctors, nurses and patients. Our experience with this pilot has shown that both medical and nursing students perceive a need for interprofessional teaching. This area of medical communication is a valuable and necessary skill.