Category Archives: A Closer Look at Health Professions Education

Nov 7 2012
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Education Progression: We Need Mentorship and Support for all Nurses to Become Lifelong Learners

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Linda Dedo, RN, MSN/MHA, medical center manager, University of Virginia, and co-lead of the Virginia Action Coalition Education Progression Workgroup.

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Education progression is an important objective for today’s nursing workforce. I have been a nurse for 40 years and, as I reflect, my career has been an exercise in progression. I first became interested in nursing as a young teen when my mother helped me become a Red Cross candy striper. I did volunteer work at several local nursing homes until my senior year in high school when I enrolled in a vocational practical nursing program.

I graduated from this program at age 19 and began my formal nursing career. I worked in acute care hospital settings for 20 years and I always thought I was a good nurse. I was well-respected by my peers and well-liked by my patients. I collaborated well with the physicians and other health care leaders in my organization, but I was beginning to realize that I would need to return to school if I expected to continue to grow in my bedside nursing role in a large academic medical center.

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Oct 12 2012
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Reflective Practice: Narrative Pedagogy Can Transform the Educational Paradigm

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Gwen Sherwood, PhD, RN, FAAN, professor and associate dean for Academic Affairs at the University of North Carolina at Chapel Hill School of Nursing, and co-investigator for RWJF’s Quality and Safety Education for Nursing (QSEN).

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Never have so many forces converged to compel transformation in nursing education. The revealing reports in the Institute of Medicine (IOM) Quality Chasm series identified serious gaps in patient safety and quality-of-care outcomes and fueled a debate on changes required in health care professions education if we are to improve. Changes in health care delivery systems and financing, advancements in knowledge, and breakthrough reports on the future of nursing ignite discussions on implementing changes in nursing education necessary to change patient care outcomes.

In the forefront of transforming the paradigm of nursing education, the Quality and Safety Education for Nurses (QSEN) project defined the competencies for integrating a quality and safety framework for nursing (Cronenwett et al, 2007; Cronenwett et al, 2009). Funded by the Robert Wood Johnson Foundation (RWJF), QSEN identified the knowledge, skills and attitudes for the six competencies identified by the IOM: All health professionals must be able to deliver patient-centered care using teamwork and collaboration, within a framework of evidence-based practice, quality improvement, and safety using informatics.

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Oct 8 2012
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Improving Medical Education to Focus on Delivering Value to Patients

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation Clinical Scholar and senior fellow at the Leonard Davis Institute for Health Economics at the University of Pennsylvania, a member of the AAIM-ACP High-Value, Cost-Conscious Care Curriculum Development Committee, and a practicing physician at the Philadelphia Veteran Affairs Medical Center.  He is also the author of Clinical Wards Secrets, a guide for medical students transitioning from the classroom to hospital wards.

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Health care costs continue to escalate.  Concurrently, the amount of published medical research has increased 10-fold over the last decade.  Each of these changes combined with recent health care reform has led to a rapidly evolving health care system.  Unfortunately, medical education has been unable to keep pace with these changes. 

Health care professionals find themselves searching for ways to deliver better value for their patients.  They are looking for an opportunity to become a part of the solution to stemming the rising costs while still providing high-quality, evidence-based care.

The American College of Physicians (ACP), the Accreditation Council for Graduate Medical Education (ACGME), and the Medicare Payment Advisory Commission (MedPAC) have each recognized these deficits among the health care workforce.  They’ve called for a restructuring of medical education to address these issues.  However, teaching hospitals and medical educators lack a common strategy to accomplish this daunting task.  To address these issues, my research team and I studied approaches to transforming medical education to help prepare providers to assess and deliver value-based care for their patients.

To better prepare a high-functioning health and health care workforce, we must start by gaining a better understanding of the problem.  In 2009, we published the first study that shed light on this issue on a national scale.  We found that among U.S. medical students, less than half felt they were appropriately trained in topics relating to the practice of medicine such as medical economics.  In addition, we found that a higher intensity curriculum in health care systems resulted in a payoff, not a tradeoff.

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Sep 28 2012
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Nursing Education Isn't What It Used to Be!

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Kate Driscoll Malliarakis, PhD, CNP, MAC, assistant professor and program coordinator, Nursing Leadership and Management at the George Washington University School of Nursing. Malliarakis is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (ENF) and president-elect of the RWJF ENF Alumni Association.

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Nursing has afforded me the opportunity to serve in numerous non-traditional positions. Now as an academic, I work to provide my students with a broad view of health care. Today, nurses enjoy a variety of educational opportunities that differ from the old one-size-fits-all approach. Thanks to technological advances in education, hybrid formats enable nurses to experience new educational opportunities through online course work and flexible, asynchronous learning.  

Online education encourages diversity as students hail from a variety of geographic locations and experiences. Unlike the standard classroom where a student can sit in the last row and not participate, online discussions demand the student’s involvement not only with the faculty but with each other. The result is a richer interaction and learning experience.

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Sep 24 2012
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Transforming Nursing Education to Meet Emerging Health Care Needs

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Judith Halstead, PhD, RN, FAAN, ANEF, president of the National League for Nursing and executive associate dean for Academic Affairs at the Indiana University School of Nursing.

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The changes proposed by health care reform have the potential to significantly alter the environment in which nurses and other health care professionals will practice. The emerging emphasis on primary care, transition care, and accountable care organizations underscores a fundamental shift in how the US health care delivery system is envisioned to function in the future. This future health care environment is very different from the one that many of us in academia currently prepare our students to practice in, i.e., an environment that has been predominately focused on preparing students for practice in the acute care setting. The IOM’s Future of Nursing: Leading Change, Advancing Health (2011) clearly identifies changes that need to occur in nursing education if we hope to prepare nurses with the competencies and skills required to practice in a redesigned health care system.

What is the role of nursing education in realizing a transformed health care system? The role can be a significant one, but only if we are willing to re-examine our current nursing education models. To produce nurses prepared to practice in reformed health care environments, we can no longer educate our nursing students using the traditional educational practices that we have long embraced. There exists no substantive evidence to suggest that our traditional means of clinical education in nursing and other health professions are particularly effective in developing clinical reasoning, so it is an opportune time to closely examine our educational practices and create new learning paradigms that are grounded in evidence. I believe we need to focus on four priority areas in order to achieve meaningful transformation in our nursing education models: 1) building faculty capacity; 2) designing new models of clinical education; 3) developing innovative models of academic/practice collaboration; and 4) advancing the science of nursing education through research.

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Sep 21 2012
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How Much Should Individuals Entering Health Professions Know About Health Policy?

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Miriam Laugesen, PhD, an assistant professor of Health Policy and Management at Columbia University's Mailman School of Public Health and the recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research for a study of Medicare physician payment policies.

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When people apply to a program to study health policy, their admissions essay sometimes begins "I always wanted to be a physician, but I realized I wanted to impact more people." Health policy students think in terms of systems, and they are therefore different from front-line health care providers. Whereas a nurse may see the uninsured person with uncontrolled diabetes, the health policy student will connect this to failures of public policy; the patient is nested within clinical, social or organizational environments.

To understand that systemic context, our health policy students first need various 'hard' or technical skills such as program evaluation, epidemiology, and health economics, and it's these skills that employers often look for when hiring our graduates. Without a doubt, technical skills are always valuable.

However, one or two years out, and over the long-term, many of our policy students appreciate the 'soft' skills, such as solving problems, lobbying policy-makers, or building new coalitions. Our policy students learn larger lessons about why things happen, and why policies also fail. They become highly attuned to the framing of advocacy messages. They understand how and why Congress punishes federal agency heads when health policies threaten interests such as tobacco farmers, or why Congress enacts unpopular policies even though legislators want to be re-elected.

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Sep 17 2012
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Improving Nurse Education Matters to Businesses, Too

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Dana Egreczky, BS, MBA, senior vice president of workforce development at the New Jersey Chamber of Commerce, and president and CEO of the New Jersey Chamber of Commerce Foundation.

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As head of workforce development at the New Jersey Chamber of Commerce, I’ve seen a vast shift in the education levels employers expect in their employees, and nurses are no exception. It makes good sense: Nurses have more responsibilities than ever, and are caring for an increasing, and increasingly complex, patient population. They need to understand vast amounts of medical knowledge and be able to make quick, sound decisions that affect the lives of their patients.

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Certainly, all nurses play a valuable role in our health care system, but we need more nurses with baccalaureate degrees and higher to meet increasing demands and to provide higher quality, more complex care. Studies show a clear link between nurse education levels and patient outcomes.

We also need more nurses with advanced degrees to fill faculty vacancies. Our population is aging, and in increasing need of nursing services, but there aren’t enough nurse educators to train the next generation of nurses. And that does not bode well for our health—or our economy.

At the New Jersey Chamber of Commerce Foundation, we are doing our part to solve this problem. We have teamed up with the Robert Wood Johnson Foundation (RWJF) to create the New Jersey Nursing Initiative (NJNI), which is working to transform nursing education and address the nurse faculty shortage in our state.

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Sep 14 2012
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The Need for Pluralism

The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? This post is by RWJF Investigator Award in Health Policy Research recipients Robert L. Wears, MD, PhD, a professor in the Department of Emergency Medicine at the University of Florida, and Kathleen M. Sutcliffe, PhD, The Gilbert and Ruth Whitaker Professor of Business Administration at the University of Michigan’s Ross School of Business.

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There are many aspects to the problem of what is or is not working in health professionals’ education today, and the changes needed to address them.  From our view as researchers studying issues of safety, resilience, and managing for the unexpected, some of the more important are that health professionals’ education is seriously deficient in the social sciences; is limited almost exclusively to largely positivist ideas about what counts as scientific activity; and is almost totally devoid of the humanities. 

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None of these deficiencies are new, and that is what concerns us.  The lack of engagement with the sciences of safety, and of human and organizational performance, has implications for practice, for safety, and for understanding and creating actionable knowledge.

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With respect to practice, for example, without sufficient exposure to humanities and social sciences we risk socializing people to become authoritative but inhuman techno-nerds, even if they didn’t start out that way.  

With respect to safety, we risk training people in positivistic methods and research approaches that oversimplify and even miss local contextual specifics that create real threats to safety. 

With respect to understanding and knowledge creation, we risk training people to revere scientific and technical rationality and ‘objectivity’ at the expense or even denial of any sort of constructivist or interpretive understanding.

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Sep 12 2012
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Learning to Lead Through Experience

The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Lindsey J. Cardwell, MSN, RN, clinical educator in the Professional Development Department at Centra Health in Lynchburg, Virginia and co-lead of the Virginia Action Coalition’s Leadership Workgroup.

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I am passionate about the importance of nurses being involved in their professional organizations and contributing to the evolution of the profession of nursing and the nation’s health care delivery system.

The Institute of Medicine’s 2010 report, The Future of Nursing: Leading Change, Advancing Health, affirmed that nurses must be prepared to serve as leaders at the bedside and in the boardroom. It said that nurses have the expertise to reform our health care system and we must ensure that they feel confident in their ability to contribute to this change.

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The Virginia Action Coalition’s Leadership Workgroup is working with Virginia schools of nursing to ensure that leadership development is incorporated throughout nursing curricula and to identify the best practices for teaching nurses how to lead. The University of Virginia School of Nursing has utilized one of our country’s innovative leadership development programs, the National Student Nurses Association’s Leadership University (Leadership U), to develop student nurse leaders through experiential learning.

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Sep 10 2012
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Give Students a Voice in Their Education

As students settle back into school and the nation finishes its Labor Day celebration, the Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Joseph Potts, president of the National Student Nurses Association.

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One of the many privileges of being elected president of the National Student Nurses Association (NSNA) is that I get the opportunity to meet with nurses and nursing students from all walks of life. A question I try to always ask when these situations arise is: “What would you most like to change about nursing and or nursing school.” The answers that I get range from uniforms, bullying, and autonomy to issues with working hours and pay.

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The thing that I most consistently hear, though, is the answer to my follow-up question: “Why do you think this problem persists?” Almost always, the response to this question is a form of: “Well, that is how it’s always been.”

I hate this answer! Why does a profession that believes whole-heartedly in evidence-based practice for its patients not apply the same principle to its social and cultural structure? Why do so many of us still refuse to examine, with the same vigor that we examine the quality of a patient’s life, the quality of life of a nurse or even a nursing student? Perhaps the extent to which this mentality puzzles and irritates me is because at the main community I have been involved with as a nursing student, the University of North Florida (UNF), this is not an issue.

In my opinion, there is one reason UNF has been able to avoid, or at least move beyond, this issue of complacency and evolve with the rapidly changing face of nursing, nurses, and nursing students. Simply put, the faculty at UNF isn’t just willing to listen to feedback from their students.  They intentionally seek it. A great example of this is our School of Nursing committees.

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