Interprofessional education: Using an interdisciplinary team to teach graduate students to manage low income clients with metabolic syndrome

Background: The IOM/AACN recently recommended increasing the emphasis on interdisciplinary education. Graduate students have limited opportunities to participate in interdisciplinary teams. Since 2008, students in nursing/nutrition have functioned as collaborative team members with medicine to deliver nonpharmacologic therapy to low income clients with Metabolic Syndrome (MS).

Methods: The team includes physicians, faculty, and students in nursing/nutrition. The clinic is housed within a family medicine center, is open 9am-3pm on Fridays and is staffed by an RD student coordinator, FNP students and undergraduate students. The clinic’s electronic medical records are used to identify clients with risk factors for MS. Clients meeting criteria are called to determine if they are interested in participating in the clinic. Those agreeing receive personalized care by students consisting of 4-1 hour nutrition and 2-1 hour fitness sessions aimed at: 1) reducing risk factors; 2) improving adherence to healthy nutrition behaviors; and 3) improving fitness through exercise prescriptions.

Results: To date the team has screened ~1000 clients and referred 150 clients to the clinic for evaluation. Interim analysis of clinical outcomes on those completing the sessions revealed that pre/post differences (BMI, waist circumference, triglycerides, HDL, cholesterol, BP, fasting glucose) are improving with a few of the clients achieving goals (weight loss, improved nutrition, normalized lab values). Although the service is complimentary, there is a 70% combined drop out/no show rate primarily related to transportation or work issues. Outcomes for interprofessional education include improved skills in: 1) performing histories/physicals; 2) interpreting lab values; 3) determining fitness parameters; 4) using outpatient electronic medical records to identify clients with MS (usually not listed as a diagnosis). Exit interviews indicate that students report satisfaction with the experience and an increased awareness of each professions role. Nutrition students report greater understanding of medications (name, uses, interactions). NP students report greater knowledge related to nutrition and improved skill in writing exercise prescriptions.  

Conclusion: The measurement of clinical outcomes has been hindered by a high no show/drop out rate and limited hours of operation. The interprofessional education model shows promise as team members report a high level of satisfaction with the approach.