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UWHC,

Nursing,

UW Health,Ambulatory Education,Educational Opportunities,Grand Rounds,Nursing Grand Round Presentation Video Archive 2012,Clinical Grand Rounds 2012,08/28/2012 - Interdisciplinary Collaboration: Medical Students Shadowing Nurses,Resources

Evaluation Form

Evaluation Form - UW Health, Ambulatory Education, Educational Opportunities, Grand Rounds, Nursing Grand Round Presentation Video Archive 2012, Clinical Grand Rounds 2012, 08/28/2012 - Interdisciplinary Collaboration: Medical Students Shadowing Nurses, Resources


SUCCESSFUL COMPLETION
To receive contact hours, participants must sign in on the attendance form, attend the entire program and complete an
evaluation for each presentation attended. Please return your completed evaluation form to a staff member of
Education & Development for Nursing & Patient Care Services at the end of the program.

CONFLICTS OF INTEREST
All activity planners for this program have reported no financial relationships with commercial interest.
All presenters for this program have reported no conflicts of interest related to their presentation

NON-ENDORSEMENT OF PRODUCTS
The presence of commercial exhibits during this program does not imply endorsements by the University of Wisconsin
Hospital and Clinics, Wisconsin Nurses Association for the American Nurses Credentialing Center’s Commission on
Accreditation.

SPONSORSHIP & COMMERCIAL SUPPORT
There is no sponsorship or commercial support for this program

OFF-LABEL USE
All program presenters have agreed to disclose to participants prior to their presentations if off-label (or unlabeled uses)
of commercial products will be discussed during their presentation (s).

Interdisciplinary Collaboration:
Medical Students
Shadowing Nurses

Megan LeClair, BSN, RN
Nurse Clinician
Trauma and Life Support Center
Nursing Grand Rounds
August 2012


UWHC Nurse Residency Program
• A 12-month program designed to help
nurses move confidently into practice
following graduation from a baccalaureate
program.

• Expected to complete an Evidence-Based
Practice Project.


Project Selection
• Media image and portrayal of nursing
o Dean May; School of Nursing Presentation
o Saving Lives: Why the Media's Portrayal of
Nursing Puts Us All at Risk by Sandy Summers,
RN, MSN, MPH and Harry Jacob Summers

• Personal experience



PICO Question
• Population: Among medical students,
• Intervention: how does partnering with a nurse,
• Comparison: compared with no partnering,
• Outcome: influence attitude towards nursing
practice and the profession of nursing?

Literature Search
• Comprehensive literature search
conducted:
o PubMed
o CINAHL
o Nursing Consult
• 14 articles used in final synthesis
o 11 qualitative studies, 2 single group pre-post
cohort studies and 1 systematic review

Evidence Reveals…
• How medical students view nurses

o Medical students consider nurses to be “inferior with
respect to status, competence, and academic
ability”. (Rudland & Mires, 2005)

o Students consistently rate ‘reliability’, ‘sensitivity and
compassion,’ and ‘friendly and courteous’ among
nurses’ top three skills and abilities (Anvaripour, Jacobson,
Schweiger & Weissman, 1991).

o Medical students felt they have no opportunity to
develop a relationship with nurses during their
medical education (Anvaripour, Jacobson, Schweiger & Weissman, 1991)

Evidence Reveals…
• Poor RN/MD communication = poor patient
outcomes
o Poor communication between physicians and nurses
was more significantly correlated with increased
hospital mortality than any other factor the authors
investigated (Knaus et al., 1986).
o Mitchell and colleagues found lower mortality ratios were
related to high nurse-physician collaboration. (Mitchell et al.,
1989).
o In a qualitative study, Weinberg and colleagues found that
19 of 20 residents reported instances of poor
communication or problematic relationships with nurses.

Evidence Reveals…
• Partnering interventions
o A study by Barrere & Ellis (2002) partnered 3rd year medical
students with nurses for an 8 hour session and showed a
statistically significant trend toward improved attitudes about
collaboration.

o Helmich et al.(2010) demonstrated that first year medical students
thought nurses had more competencies and responsibilities than
they had expected after shadowing with a nurse over the
course of four weeks.

o Jain et al. (2012) partnered 1st year medical students with nurses
for a 4 hour shadow program which revealed that medical
students’ attitudes toward nurses improved and their knowledge
of the profession increased.

Shadow Programs
• Dartmouth Medical School
– 2-4 hour elective shadowing for first and
second year students with up to six
experiences
• University of Vermont Medical School
– 2 hours shadowing plus discussion for all first
year students
• University of Michigan Medical School
– 4 hour shadowing for all first year students

Recommendation for Practice
• Partnering/shadowing experience with a
registered nurse

Pilot the Practice
• A 4-hour “partnering” experience for first or
second year medical students from UWSMPH
with an RN on the Trauma and Life Support
Center (Medical/Surgical ICU) at UW Hospital.

Timeline



January
2012
Early
March
2012
June
2012
April
2012
July
2012
Late
March
2012
Began
collaboration!
UWSMPH approval,
present to TLC
Unit Council
IRB
exemption
Students
shadow
Data
analyzed
Results shared
with UWSMPH
and SoN

Sample
• 11 first or second year medical students
from UWSMPH participated in the
experience
o A survey was completed pre- and post-
experience along with four open-ended
questions

• 12 first or second year students completed
the survey once, without the experience


Panel
Sherry McMullan, RN,
BSN, CCRN
David Burke, RN, MSN Mick Kelly, MD Candidate
Class of 2015

Outcome Measures
• 15-item validated survey
o The Jefferson Survey of Attitudes Toward
Physician-Nurse Collaboration (Hojat, 1999)
o 4-point Likert-type scale
o (1 =“strongly disagree” to 4=“strongly agree”)

• Items categorized into four factors
o Shares education & collaboration
o Caring vs. curing
o Nurse's autonomy
o Physician's authority






1. A nurse should be viewed as a collaborator and colleague with a physician rather than his/her assistant…. 4 3 2 1
2. Nurses are qualified to assess and respond to psychological aspects of patients’ needs……………………. 4 3 2 1
3. During their education, medical and nursing students should be involved in teamwork in order to
understand their respective roles……………………………………………………………………………..

4

3

2

1
4. Nurses should be involved in making policy decisions affecting their working conditions……………….. 4 3 2 1
5. Nurses should be accountable to patients for the nursing care they provide……………………………….. 4 3 2 1
6. There are many overlapping areas of responsibility between physicians and nurses……………………….. 4 3 2 1

7. Nurses have special expertise in patient education and psychological counseling………………………….. 4 3 2 1
8. Doctors should be the dominant authority in all health care matters……………………………………….. 4 3 2 1

9. Physicians and nurses should contribute to decisions regarding the hospital discharge of patients……….. 4 3 2 1

10. The primary function of the nurse is to carry out the physician’s orders…………………………………… 4 3 2 1
11. Nurses should be involved in making policy decisions concerning the hospital support services upon
which their work depends…………………………………………………………………………………….

4

3

2

1
12. Nurses should also have responsibility for monitoring the effects of medical treatment…………………… 4 3 2 1
13. Nurses should clarify a physician’s order when they feel that it might have the potential for detrimental
effects on the patient…………………………………………………………………………………………

4

3

2

1

14. Physicians should be educated to establish collaborative relationships with nurses……………………….. 4 3 2 1
15. Interprofessional relationships between physicians and nurses should be included in their educational
programs……………………………………………………………………………………………………...

4

3

2

1


© Jefferson Medical College, 2001. All rights reserved. Reprinted by permission from Mohammadreza Hojat, Ph.D.

Method of Analysis
• Data ran through Statistical Analysis System
(SAS) in groups and pair comparisons
o To compare the 3 groups: Kruskal-Wallis Test

o To compare a pair: Signed Rank Test

Review of Outcomes
• No difference between no-experience and pre-
experience (p=0.11)

• Statistically significant change of attitude
(p=0.04) toward positive nurse-physician
collaboration when comparing pre-experience
and post-experience total scores

• Statistically significant change in attitude
between the no experience group and the post-
experience group (p<0.01)

Review of Outcomes
541
614
0
100
200
300
400
500
600
700
Pre-experience Post-experience
The change in
score reflects a
statistically
significant
improvement
(p = 0.04)

32%
97%
79%
79%
76%
9%
88%
61%
56%
57%
0% 20% 40% 60% 80% 100%
Physician's
Authority
Nurse Autonomy
Caring vs Curing
Shares Education
and Collaboration
All
Pre-experience
Post-experience
Percentage of “Strongly Agree” with Survey Statements

0%
0%
0%
0%
0%
0%
18.2%
36.4%
66.7%
81.8%
63.6%
33.3%
0% 20% 40% 60% 80% 100%
Post-experience
Pre-experience
No experience
# 3: During their education, medical and nursing students should be
involved in teamwork in order to understand their respective roles.
Strongly Agree
Agree
Disagree
Strongly Disagree

#8 Doctors should be the dominant authority in all health care matters.
27.3%
9.1%
0%
72.7%
81.8%
41.7%
0%
9.1%
50%
0%
0%
8.3%
0% 20% 40% 60% 80% 100%
Post-experience
Pre-experience
No experience
Strongly Agree
Agree
Disagree
Strongly Disagree

0%
0%
0%
0%
0%
0%
9.1%
54.5%
58.3%
90.9%
45.5%
41.7%
0% 20% 40% 60% 80% 100%
Post-experience
Pre-experience
No experience
#12: Nurses should also have responsibility for monitoring
the effects of medical treatment.
Strongly Agree
Agree
Disagree
Strongly Disagree

Open Ended Question Responses
• What parts of this experience did you find valuable?

• What parts of this experience were less valuable to
you?

• If this experience was to be repeated what changes
would make the experience most beneficial?

• How do you anticipate this experience influencing
your role as a medical student and as a future
physician?




Implications from this project
• Increase inter-professional educational
opportunities

• In conversations with UWSMPH, there is a
possibility for implementing this
experience into their curriculum




Next Steps…
• Poster presentation at WNA Annual
Conference in October 2012 in Steven’s
Point, WI
• Opportunities to complete a research
study or complete another EBP project
with different objectives
• Consider publication and more
poster presentations

Special Thanks
• Thank you to all those who contributed to
and supported this project…
o Élise Arsenault Knudsen, MS, RN, ACNS-BC
o Kim McPhee, MS, RN-BC
o TLC Nurses and Leadership
o UWSMPH Medical Students
o Dean Patrick McBride of UWSMPH
o Dean Katharyn May of UW SoN
o Rosa Mak

Questions


References
• Anvaripour, P. L., Jacobson, L., Schweiger, J., & Weissman, G. K. (1991, January). Physician-nurse collegiality in
the medical school curriculum: exploratory workshop and student questionnaire. The Mount Sinai journal of
medicine, 58(1), 91-94. Retrieved March 6, 2012, from PubMed.
• Foley, M., Jacobson, L., & Anvaripour, P. L. (1995, June). Second-Year Medical Students' Perceptions of the
Professional Nurse's Role. Journal of the New York State Nurses Association, 26(2), 15-19. Retrieved December
4, 2011, from PubMed.
• Hojat, M., Fields, S. K., Veloski, J. J., Griffiths, M., Cohen, M. J., & Plumb, J. D. (1999, June). Psychometric
Properties of an Attitude Scale Measuring Physician-Nurse Collaboration. Evaluation & the Health Professions,
22(2), 208-219. Retrieved January 20, 2012, from PubMed.
• Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1986). An Evaluation of Outcome from Intensive
Care in Major Medical Centers. Annals Of Internal Medicine, 986(104), 410-418. Retrieved December 7, 2011,
from PubMed.
• Jain, A., Luo, E., Yang, J., Purkiss, J., & White, C. (2012, September). Implementing a Nurse-Shadowing Program
for First-Year Medical Students to Improve Interprofessional Collaborations on Health Care Teams. Academic
Medicine, 87(9), 1-4. doi:10.1097/ACM.0b013e31826216d0.
• Marcinowicz, L., Foley, M., Zarzycka, D., Chlabicz, S., Windak, A., & Buczkowski, K. (2009). Polish medical
students' perceptions of the nursing profession: a cross-sectional study. Scandinavian Journal of Caring Sciences,
23, 438-445. Retrieved December 7, 2011, from CINHAL.
• Mitchell, P. H., Armstrong, S., & Simpson, T. F. (1989). American Association of Critical-Care Nurses
Demonstration Project: profile of excellence in critical care nursing. Heart & lung, 18(3), 219-237. Retrieved
December 23, 2011.
• Nadolski, G. J., Bell, M. A., Brewer, B. B., Frankel, R. M., Cushing, H. E., & Brokaw, J. J. (2006, April 25).
Evaluating the quality of interaction between medical students and nurses in a large teaching hospital. BMC
Medical Education, 6(23), 1-6. Retrieved December 6, 2011, from CINHAL.
• Rudland, J. R., & Mires, G. J. (2005). Characteristics of doctors and nurses as perceived by students entering
medical school: implications for shared teaching. Medical Education, 39, 448-455. Retrieved November 14, 2011,
from PubMed.
• Summers, S., & Summers, H. J. (2009). Saving Lives; Why the Media's Portrayal of Nurses puts us all at Risk.
New York City: Kaplan Publishing.