Title:Bridging disciplines and distance

Virtual interprofessional program highlights the School of Nursing’s trailblazing role in online learning

On a telehealth visit, family nurse practitioner Elke Zschaebitz performs an intake interview with a patient named Paula, currently pregnant with her fourth child. Paula, recently arrived in Virginia’s Shenandoah Valley as a migrant worker, speaks only Spanish, so the two women converse through an interpreter.

Paula has not seen a health care practitioner since coming to the U.S. three months earlier. She is suffering from throbbing tooth pain in her left molar and has gestational diabetes. Her blood sugar testing and insulin dosing are irregular. She also has been taking medication for depression, but only sporadically. Near the end of the interview, she discloses that her youngest child, a 3-year-old, has stopped communicating.

Paula and her husband do not own a car and have no health insurance. Given these barriers, what is the most effective treatment plan?

In a virtual meeting room, 12 students vigorously debate the answer to this question, guided by a facilitator. They come from institutions across the U.S. and represent a range of disciplines—nursing, social work, occupational therapy, speech therapy, dentistry, and more.

The students are enrolled in an innovative interprofessional training program called VIPE (Virtual Interprofessional Education), launched in 2017. Designed to promote collaborative problem-solving, VIPE is built around complex cases such as Paula’s. Although they are simulations, the cases are based on real-life examples.

As one of seven founding members of the VIPE Consortium, the Georgetown School of Nursing has played a pivotal role in the development of the program, which has grown to include more than 60 universities in 30 countries.

In November, three School of Nursing faculty members—Pamela Biernacki, Lois Wessel, and Elke Zschaebitz—were honored with the Georgetown Provost’s Innovation in Teaching Award for their work in advancing the VIPE program.

“Within the larger Georgetown community, we’ve been trailblazers in hybrid learning and remote learning,” says School of Nursing Dean Roberta Waite. “It’s awesome to see our faculty leveraging their expertise within this dynamic learning environment, where they can teach and support others in a myriad of ways.

“I’m very proud to see their skill set and their knowledge valued and recognized in a larger domain.”

‘A snowball effect’

The World Health Organization and leading professional groups have long recognized that interprofessional education (IPE) is a critical element in health care training.

“IPE prepares students from different disciplines to work collaboratively in teams,” says Biernacki, associate professor of nursing and assistant dean for innovation and program development. “According to the National Academy of Medicine, it improves the quality of patient care, lowers health care costs, and ensures we’re not redundant in how we use our resources.”

Because of its benefits, Biernacki notes, IPE is now an accreditation requirement in most health care educational institutions in the U.S., as well as internationally.

However, there are roadblocks to the delivery of effective interprofessional education. Faculty members in rural settings, for example, may not be able to gather students from a variety of specialties in the same physical space. On the other hand, students in more urban settings can miss out on learning about the particular issues faced by providers in underserved areas that are sparsely populated.

Overcoming these obstacles was the impetus for the creation of VIPE. At a time when the word “zoom” was commonly accepted to mean moving fast, the original VIPE consortium members envisioned online learning as a powerful tool for team-building and collaborative problem-solving.

“We develop cases that students don’t typically get to see during their education, and they certainly don’t get to sit at the table with people from all these disciplines,” Biernacki says. “So they dig deep to come up with a variety of solutions. We try really hard to make them realize there’s not one answer.”

Biernacki and Zschaebitz credit Mary Showstark, a faculty member in Yale University’s physician assistant program, for getting VIPE off the ground. “I want to give kudos to Mary—this was her brainchild,” says Zschaebitz, assistant professor of nursing. “After that, it was kind of a snowball effect.”

In addition to the rapid growth of consortium partners in the U.S., VIPE has expanded overseas, most notably with the AfriVIPE program, centered in South Africa and including programs in Zimbabwe and Kenya as well.

‘The magic of the tiny room’

The VIPE curriculum, used by all member universities in the consortium, includes asynchronous and synchronous elements. Students first engage in asynchronous learning activities, including reading through case study materials and viewing the case simulation, as well as watching video interviews with professionals from different disciplines describing their roles and responsibilities.

VIPE coordinators then stage a one-day synchronous event with approximately 200 students. They first meet in a large online space for introductions, then break out into small groups of 12–15 to discuss the assigned case study and come up with a treatment plan. After an hour, everyone reconvenes to present their small-group findings to the entire class.

Zschaebitz has taken the lead on developing a number of the VIPE case simulations, drawing on her professional experience using storytelling and first-person narratives to advance diversity, equity, and inclusion principles in the patient-provider relationship.

“The process is very collaborative,” Zschaebitz emphasizes. “We all get together and hash out the details.”

Working within a limited budget, Zschaebitz often uses non-actors, recruiting colleagues and even family members. “In one case, my dad played an elderly person in a rural area afraid to go out because of COVID.” Surprisingly, she says, the non-actors generally come across as more realistic. “When we used actors, it wasn’t as authentic as I thought it would be. They were more focused on reading the lines, rather than just being organic and telling the story.”

Built on actual cases, the VIPE scenarios incorporate the social determinants of health as well as layering in specific issues that involve different specialties. In one simulation, for example, Zschaebitz used a case involving a child with autism whose family had moved to a rural, underserved area in West Virginia.

“We added aspects for disciplines that we needed to pull in, like dentistry—there was a question about whether the child’s teeth should be bonded because they didn’t brush them that well,” she says.

“When the students enter the breakout room, they’re all strangers. The facilitator is there to draw out the students and get them talking about their experiences,” she explains. “We’ll get some profound statements, like we did discussing a case concerning opioid addiction, when a student who was a veteran revealed that he had once struggled with substance abuse. Once it gets very real, the students become even more engaged.

“That’s the magic of the tiny room,” Zschaebitz continues. “At the end of the session, we have an individualized plan of care that every provider would want—it’s so comprehensive and detailed—from all these students learning from each other and thinking outside the box.”

‘It becomes a mindset’

At Georgetown School of Nursing, VIPE is required for all advanced practice nursing students. Beginning in Fall 2024, VIPE will also be a requirement in the undergraduate nursing program.

More than a thousand Georgetown students have participated in VIPE thus far, and evidence gathered through course evaluations and student comments clearly demonstrates the program’s effectiveness.

“I absolutely loved VIPE,” says Jillian Murphy Deaton (G’22), an inaugural Johnson/Turpin fellow in the Family Nurse Practitioner program. “It was so great to meet students from other schools and other specialties, learn their capabilities and see how they would approach a case from their end. The virtual aspect allowed us all to be together even though we’re far apart.”

Deaton’s small group encompassed a variety of disciplines—including students training as social workers, case managers, physician assistants, and nurses. Their case involved a student who played sports, suffered an injury, and subsequently became addicted to opioids. The young woman’s mother brought her to the emergency room after she overdosed.

“The PAs were more like hospitalists, talking about inpatient treatment, while the social work students were already thinking about resources for family counseling and how to prevent the situation in the future,” Deaton says.

“When we first started dissecting this case together, we didn’t fully understand each other’s roles. I was a few terms away from graduating, and I thought, ‘I know what social workers do.’ But no, I didn’t—I had no idea about all they’re trained to do, how they fit into the clinical picture, and the vast magnitude of resources they have.

“It’s more than a one-day experience, it becomes a mindset,” Deaton continues. “If we don’t have a collaborative and interprofessional view, we truly isolate ourselves and think nursing is the be all, end all.

“There’s a lot we can do—everything can be permissible, but is it beneficial? Is it beneficial for me to take on the social worker aspect of a case and find the resources, or is it more beneficial for me to bring people in? For people who are very Type A like me, it’s easy to think, ‘Oh, I’m passing my patient on,’ but you’re not. You’re bringing someone else in to help.”

Deaton gives special praise to the VIPE small-group facilitators, faculty members from consortium universities who volunteer their time. “The facilitator makes sure that all voices are heard and we’re working on a level playing field,” she says. “It was a great experience learning not to just jump into the conversation, but to step back to really listen to those around us.”

Optimizing health

Biernacki and Zschaebitz both emphasize that VIPE has proven to be an invaluable educational opportunity for faculty as well.

“It’s amazing how much I have learned from having dental students in the room, for example, and I believe it’s reciprocal,” Biernacki says. “I remember one of the dental students assigned to a case involving the pregnant migrant worker hadn’t ever thought about the link between depression and poor hygiene, and how that could affect dental care.”

In developing VIPE case studies, Zschaebitz has intentionally introduced care management issues that many faculty may have little experience with. “My clinical expertise is working with people who are gender diverse. When I began creating my first VIPE case, I thought, ‘This is a very vulnerable population that a lot of people probably don’t know much about.’” She went on to produce a case study involving an 18-year-old woman, assigned male at birth, who was being abused by her mother’s boyfriend.

“The students learned a lot,” she says. “And I think the faculty learned even more.”

Georgetown’s pioneering role in VIPE reflects the broader educational mission of the School of Nursing and its fundamental commitment to promoting health equity.

“Nursing is about optimizing health, looking at the totality of the person—physically, emotionally, mentally, and spiritually,” says Dean Waite. “At Georgetown that’s amplified because we infuse our educational processes with our core Jesuit values.

“It’s amplified in how we engage, how we deliver content, how we think about people, how we think about communities. It’s the framing that we use when we’re providing education—it’s really foundational,” she says.

VIPE is especially powerful, Waite says, because the program examines not just an individual patient’s situation, but the larger social structures that affect health.

“So much of health is focused on the individual, and that’s important,” she notes. “But the individual does not live in a vacuum. What the individual experiences depends upon the context they live in. It shapes and informs how they respond based on the tools that they have.

“So the structures we create—the resources, opportunities, policies—have a major impact on the trajectory of a person’s health.”

Beyond the Zoom room

Although VIPE is relatively new, there is already a wealth of anecdotal evidence about its impact for students graduating and entering practice.

Even before graduation, Jillian Deaton was able to apply lessons learned in a clinical situation. “I was in my last term—my integration term—and my preceptor had me see a patient that she knew was difficult.

“I walked in and the patient said, ‘I don’t know you and I don’t like you.’ What she was really telling me, without realizing it, was that she’d lost trust in medical providers because they hadn’t treated her correctly.”

Working with a pharmacist and a social worker, Deaton and her fellow providers were able to build some trust back by considering her whole situation, not just the problem she presented with on the day Deaton saw her. They were able to cut the cost of the patient’s medications from hundreds of dollars each month—which she couldn’t afford—to just 15 dollars a month. “Bringing in the pharmacy team was vital. VIPE helped me realize the external resources that I do have access to—before that I truly didn’t know what I didn’t know.”

More recently, Deaton was working with a clinic in an underserved area that decided to hire a social worker. “People in the clinic were saying, ‘I really don’t know how to work with her,’” Deaton remembers.

Deaton organized a medical provider meeting where the social worker could describe her role in detail. “I feel like I wouldn’t have known to do that if I hadn’t gone through VIPE,” she says.

“The social worker was amazing,” Deaton continues. “She had access to all kinds of medication programs, and taught us how to code appropriately for insurance. She was also great at end-of-life care planning, explaining DNRs. And she could have an hour slot with a patient, when I know I only have 15 to 20 minutes on a good day.”

Now living in Texas, Deaton has also joined the Georgetown School of Nursing faculty as an adjunct, teaching remotely. In the future she hopes to become a VIPE facilitator herself, giving back to the program she has found indispensable. “I still use VIPE to this day—it’s like lightbulbs going off all the time,” Deaton says. “And I know it’s something that each student will use, whether they do so consciously or unconsciously.”

‘Juggernaut problems’

Building on its success, the VIPE program is now expanding beyond health professions, including emergency management and security personnel. “We’re working on an AfriVIPE case now involving flooding and disaster planning,” says Biernacki. “What are the real-world issues? For example, if you have a flood, how do people in wheelchairs get out? Health professionals want to know how to develop an evacuation plan.”

Parallel with VIPE’s expansion nationally and internationally, the Georgetown School of Nursing is currently engaging in discussion with other schools and programs within the university—particularly the School of Medicine, but also including law, business, and public policy— to create trans-disciplinary learning opportunities based on the VIPE model.

“There are elements of that already—such as the work of Vicki Gerard with the Health Justice Alliance and Michelle Roett with the new Center for Health Equity,” Waite says.

“It’s a great opportunity, and it needs to be leveraged in as many spaces as possible, from undergraduate to graduate learning,” she continues.

“Because of our structured education system, quite often we teach in silos,” says Waite. “But if we want to transform health, it’s important to bring together different disciplines, as VIPE does.

“Students are bringing their disciplinary lens and sharing how they might tackle a problem. What draws them to perform that action first? How do we learn from each other?

“We’re one of the richer countries in the world, yet we have some of the poorest health outcomes,” she says. “We all have to work together to solve these juggernaut problems we face today.”