Academics

First Year Education and Collaborative Education

International background and basic approach to the introduction of inter-professional education (IPE)

The educational philosophy of this university from the time it was established has been to develop QOL supporters." Education specialized in healthcare and welfare has traditionally advocated the training of human resources in the support of human lives, and at the same time to improve the "quality of life (QOL)" of clients, patients and the elderly.

NUHW has implemented inter-professional education (IPE) which incorporates into the educational method a paradigm of healthcare and welfare professionals with multiple occupations collaborating and sharing goals aimed at extending healthy life expectancy and realizing independent life and a society of harmonious coexistence. The basic composition of the current collaborative education during the four years when students study at this university is shown in the figure and table below.

First half of the first year Basic Seminar Compulsory
Second half of the first year Core curriculum Compulsory (3 of 8 subjects)
First half of the second year Core curriculum Compulsory (1 of 6 subjects)
Second half of the second year Basic Seminar on Collaboration Compulsory
First half of the third year Studies in healthcare and welfare collaboration Compulsory (3 fields in studies in collaboration, and 1 subject from risk management theory and international health theory)
Second half of the fourth year Integrated General Seminar on Collaboration Elective (can also be taken in the second half of the third year)

IPE has emerged and was developed in the United Kingdom as a new educational method in which people in multiple occupations learn the value of collaboration and experience collaboration for themselves while studying their professions. It emerged in response to incidents such as the harm caused by an experimental medical treatment used by a heart surgeon in the United Kingdom in 2000 and the death of an abused child due to a lack of collaboration among professions in 2001. Students aiming to be various kinds of professionals study together about each other, in order to deepen their understanding of the healthcare and welfare fields, know about each other's professions, and improve their own specialist skills as professionals. Collaborative education has developed in the United Kingdom because of its multiethnic state and because obtaining course credits in collaborative education has been made compulsory for obtaining qualifications as a therapist.

Japan is seen as a society with a falling birth rate and aging population. In addition as the number of people receiving services and care increases, so does the amount of work in healthcare and welfare workplaces. Therefore, it is necessary for healthcare and welfare students to collaborate with other related occupations in clinical practice after graduation. Also it is important to develop professionals who can act with a good understanding of the meaning of collaboration, when they are in the process of forming their characters.


Fig.1. Educational goals of interprofessional education and the corresponding subjects for each academic year (First, Second, Third, Fourth) during 2005-2008.
The degree of collaboration is also indicated QOL, quality of life

In the healthcare and welfare fields, in order to improve the QOL of the people who receive care, it is necessary to produce high-quality graduates equipped with the skills of the team approach in mind. This will be realized by getting the students who aim to become doctors, dental practitioners, nurses, public health nurses, physical therapists, occupational therapists, prosthetists and orthotists, speech, language and hearing therapists, pharmacists, dental hygienists, social workers, and many other professionals that provide care.

Since the founding of the university we have been aiming to establish IPE in healthcare and welfare based on this idea. We commenced collaborative education to foster basic collaboration abilities by having the students from each department mix together to carry out research, debates, and presentations. We thought of a concept for actual collaborative education over the four years at university and developed methods of practice in which case review meetings like those held in clinical practice are simulated in a seminar format. Students prepare for the case review meetings, participate in them, engage in debates and discussions as members of the team, form a consensus about the goals with other students, and provide medical and other interventions for the users. After a series of trials and improvements, in fiscal year 2005 the "Integrated General seminar" was established, and in fiscal year 2008 we officially started the "Integrated General seminar" class as an elective subject in the second half of the fourth year, which takes 15 hours and is worth one credit. This developed into the Integrated General Seminar on Collaboration in the current curriculum.

Process of on-campus consensus formation regarding the introduction of inter-professional education

When the university was founded in 2001 the IPE-related subjects in the curriculum included Basic Seminar II that was compulsory for all the students in the second half of the first year. And as basic subjects dealing with medicine and welfare in the first and second year, the Theory of Collaboration between Medicine and Welfare, the Theory of Communication between Medicine and Welfare, and Special Theory of Healthcare and Welfare (elective) were also included.

However, the healthcare and welfare curriculum (core curriculum) at the time of the founding of the university, and in fiscal year 2005 had some problems as well. One problem was that there was a gap in the collaborative education in the semesters from the second half of the second year to the second half of the third year. This reduced the connectedness between collaborative education and specialist education and was a problem with regard to the preparations for the Integrated General Seminar on Collaboration. Moreover, because Basic Seminar II in the second half of the first year as part of specialist education had not yet begun, the knowledge of the students themselves as professionals was insufficient. In response to this problem, in the fiscal year 2009 curriculum revision, Basic Seminar II was renamed as "Basic Seminar on Collaboration" in the second year. This clarified the major concept of the core curriculum is "collaborative education" and placed collaborative education subjects in an unbroken sequence from the first year to the fourth year.

The IPE for the "Integrated General Seminar" for fourth year students commenced for all enrolled in the university in its first year as a voluntary seminar. The purpose of this seminar was for both students and teachers to participate equally. Initially only a few teachers and students practiced in the seminar, but year by year the number of people interested in the seminar grew and as a result of the 2009 curriculum revision the seminar became a subject with recognition for credit.

From that time IPE became a part of the core curriculum, and the Basic Seminar on Collaboration was placed in the second year, Studies in Healthcare and Welfare Collaboration I (Practice of Medicine), II (Practice of Welfare), and III (Health and Community), and Healthcare and Welfare Risk Management Theory in the third year, and the Integrated General Seminar on Collaboration in the fourth year, creating a healthcare and welfare core curriculum that organically proceeds from one academic year to the next.

Process of promotion of inter-professional education

IPE was commenced at this university from the time of the founding of the university, but for the IPE practice "Integrated General seminar" in the final academic year we performed repeated trials and established the style of practices in a case-centered format. We have taken an approach that utilized the advantages of both face-to-face learning with clients and non-face-to-face learning using virtual cases. The collaborative education of this university has included many lecturers from Japan and overseas. On the other hand teachers from this university have been visiting domestic and overseas universities. With the launch of the Japan Association for Inter-professional Education (JAIPE) in November 2008, the development of educational content and methods by many universities in Japan, explanations of the theory of collaborative education and evaluations of the results of collaborative education are publicly released, and exchanges of information are promoted among related international organizations and at the academic society level.

From 2009 to 2011 joint development of module study materials for use in collaborative education was started under the inter-university collaboration support program run through cooperation among five universities in Japan. Mechanisms were constructed for use of the module study materials on-line, enabling students to participate in remote learning between different universities, and we have come to the stage of practical use and public release.

Organizations and systems running inter-professional education

Sub-committees including the Integrated General Seminar Executive Sub-Committee, the Core Curriculum Review Sub-Committee, the Basic Seminar on Collaboration Sub-Committee, and the Collaborative Education Evaluation Sub-Committee have been organized within the Collaborative Education Promotion Committee. These implementation plans receive approval in the General Affairs Council, and are implemented after obtaining the understanding and cooperation of all of the teaching staff in the university.

The fiscal year 2009 strategic inter-university cooperation support program to enhance university education "Co-development and Practice of modules-centered Inter-professional Education to improve Quality of Life" was adopted so the "Strategy 21 Promotion Meeting" was organized and works in coordination with the Collaborative Education Promotion Committee. It can also offer university-wide facilitator training with the cooperation of the FD Committee.

The specific content of current inter-professional education classes

(1) Basic Seminar (run by the Education Development Committee)
Since the time of the founding of the university we have offered the first year education subject Basic Seminar I (currently the Basic Seminar) for a small number of students in the first half of the first year, and commenced introductory education providing guidelines for student life, improving communication skills, reading, listening, writing and speaking skills, and teaching how to make friends. The Basic Seminar, which carries out practice activities based on themes, has the objective of achieving a smooth introduction to university life. One of the objectives is for all of the students to establish relationships of trust with their supervising teachers, so that the teachers give guidance about how to lead a university life and become the number one "safety net" for the students to live their student life and graduate safely.

The Japanese language skills and interpersonal communication skills of university students have been declining due to the "pressure-free education" which has been reconsidered in recent years, and due to the declining birth rate and trend toward nuclear families. In such background, another objective of the seminar is to improve essential skills such as communication with users (and their families) of healthcare and welfare institutions and facilities, and also among professionals. For this reason, it has the objective of teaching an introductory-level of Japanese language in order to obtain the Japanese language skills needed for smoothly participating in university life. The students master skills such as how to attend lectures and take notes, how to listen, read, write, and speak. We also tried creating Japanese language study materials at the university. Currently we give tests of the students' ability to express themselves in Japanese, and the students who do not attain a certain level have to take classes in methods of expression in Japanese at a later date.

Regarding how the classes run, all of the students attend the seminars given by the teachers in the departments to which they belong. In the first semester, each teacher builds relationships of trust with their seminar students. This is achieved by doing research and presentation with those students. By addressing the problems that have occurred to the students, the teachers aim to bring out best education results.

(2) Basic Seminar on Collaboration
Since the founding of the university, various kinds of collaborative education had started. From fiscal year 2009, the Basic Seminar II, which was previously in the second half of the first year was integrated into the healthcare and welfare core curriculum as the Basic Seminar on Collaboration. Then the subject was moved to the second half of the second year. By setting it in the second half of the second year we aimed to implement collaboration education and improve communication skills. This was because we wanted our students to be conscious of the profession they were aiming for.

Students from many academic disciplines gather in the laboratories of all teachers in order to choose themes related to healthcare and welfare. By talking about their majors students learn about each other's specialty. The research outcomes are debated at the research presentation sessions in each academic department. These methods of running the classes are currently going through a process of trial and error.

(3) First year and second year core curriculum
From fiscal year 2005 interprofessional education was enhanced, and "QOL Theory" and ''Theory of Collaboration between Medicine and Welfare" were established as first and second year subjects. Four years later these subjects were enhanced further. Now students select at least three credits from among eight subjects in the first year, and select one credit or more from among six subjects in the second year. These include "World of Disability," "World of QOL," "Healthcare and Welfare Special Lecture," "World of Healthcare and Welfare Equipment," "Healthcare and Welfare Mechanisms," "Healthcare and Welfare Law," and many other collaborative education-related subjects.

(4) Third year core curriculum about collaboration
Under the 2009 fiscal year revision, compulsory collaborative education subjects were established in the third year. Currently all of the third-year students take these subjects on a large-scale. The subjects are compulsory from which the students have to select one credit point or more: Studies in Healthcare and Welfare Collaboration I (Medical Field), Studies in Healthcare and Welfare Collaboration II (Welfare Field), Studies in Healthcare and Welfare Collaboration III (Health and Community), Healthcare and Welfare Risk Management Theory. Four large classrooms are actually used simultaneously. Group A holds the lecture in one classroom and Group B is divided into the other three to carry out group work and debates. For students who do not attend the Integrated General Seminar on Collaboration, these subjects complete their collaborative education.

(5) Integrated General Seminar on Collaboration (second half elective subjects worth one credit point, intensive course during the summer vacation period, five days)
The objective of the "Integrated General Seminar" is for students to master the basic methods and content for collaborating with other professionals. In the seminars the students apply the specialist skills of the academic disciplines to which they themselves belong while at the same time gaining understanding of the specialist skills and directions in other academic disciplines.

Approximately 200 students (including ten pharmacy faculty students from Niigata University of Pharmacy and Applied Life Sciences and three students from the Nippon Dental University) and 45 teachers (including other universities' teachers) from all academic disciplines will participate. They form 20 student groups. The case-based study group uses videos, virtual cases and actual patients. The orientation is held at the beginning of the summer vacation, and the objectives over the five-day schedule of the integrated general seminar are explained. In the teaching method we apply modules of study materials and create groups that use a web conferencing system.

The seminar is implemented over five days in the final week of the summer vacation.

On the first day we hold an orientation, confirm the prior learning, and formulate plans for future activities. The facilitator reviews the issues together with the students. Based on the prior learning, the students give presentations in their specialist area. Both the students and the facilitator reflect on what they have learned from each other.

On the second and third day we gather information in accordance with the action plan from the previous day. Then we again present and discuss various issues together. In order to know the cases more deeply, some groups carried out further gathering of materials, listened to lectures by specialists, visited hospitals and other facilities, interviewed clients, observed the spheres of life of the clients, and watched videos.

On the fourth day we present materials from each specialist area and hold debates with all the members. After presentations we identify the problems common to all of us. Then we formulate solutions and support measures. On the last day we prepare for the presentation.

Collaborative education with other universities

Under the "Inter-University Collaborative Education in Niigata Prefecture" project, this university took the lead in advancing inter-university collaborative education in 2009 and 2010. Compared with other universities we train a large number of healthcare- and welfare-related professionals. But we lack departments such as the faculties of medicine, dentistry, and pharmaceutical sciences for our collaboration.


Fig.2

This seminar was held for three days during the summer vacation. The participants in this seminar in 2010 were 62 students and 21 teachers from seven universities. The institutions that accepted these practices included nine medical and welfare facilities in the prefecture. On the first day of the program, we were taught about the philosophy of collaborative education of the United Kingdom. Later we performed a group work from the perspective of collaboration. Students who were aiming for multiple occupations were divided into groups of five or six. On the following day facilitators overviewed the cases they planned to work on at the hospital. On the second day the students and teachers visited the hospitals and talked with the staff and patients, and thought about what QOL was for them. In addition, the student groups met and talked with the patients and people recuperating at home, learned about what the people receiving care thought about their illnesses. From their dialogue with the staff students learned about what the actual implementation of the team approach was. Based on their learning over the first two days, the next day students held debates about what QOL was for care clients, and the ideal form of assistance with regards to collaboration with multiple occupations. Later students presented in front of everyone their future directions.

Making collaborative education compulsory

This university currently has ten departments and about 700 students in one academic year, but further efforts are necessary to develop an effective healthcare and welfare system so that many students can receive collaborative education. What is under discussion is to what extent collaborative education should be made compulsory. This course is important not only for students who will work in future healthcare and welfare-related workplaces but also for those who will work in general companies. However, securing locations and teachers and time slots is not easy.

Even in the United Kingdom in the fourth year Collaborative Education is not always a compulsory subject. However, in Japan, there are some universities which send students to many clinical facilities and provide collaborative education to them, but they are exceptions.

It would be ideal for as many students as possible to participate in this type of education. In order to study the basic theory and implementation of IPE in the United Kingdom, this university sends volunteer teachers to several universities in UK. Furthermore, in the United Kingdom online database of cases talked about by patients" is widespread. Also many universities use virtual and actual cases on the web as a module study materials.

As one method of solving these cases, in the past, one group in the Integrated General Seminar presented its own case over the Internet. Participants used a video conferencing system, and attempted to receive instruction from an external facilitator in a remote area. The presentations by the students were broadcast through the Internet to the chairperson of the Onomichi City Medical Association, and as a result we succeeded in the experiment of actually receiving instruction from him.

We are developing a system to construct a database of module study materials about virtual cases on the web. This will enable us to present and debate the cases necessary for collaborative education through the Internet. In 2009, the "Co-development and Practice of module-centered Interprofessional Education to improve Quality of Life" initiative was implemented. Through the collaboration of five universities nationwide we adopted a "support program for strategic university collaborations to enhance university education". This was done under the university reform promotion project of the Ministry of Education, Culture, Sports, Science and Technology. The actual development of modules is currently under way. They are based on scenarios provided by multiple universities and can be replayed with illustrations and audio for each scene.


Fig.3

At the current time the modules registered in the on-demand lecture system are "prevention and treatment of bone fractures and living support for elderly people," "food intake and swallowing disorder arising from Wilson's disease," "for improvement of the activities and participation' of spinocerebellar degeneration patient," "care of home senile dementia patient," "improvement of the metabolic syndrome of middle aged and older people," "home support for end of life cancer patient," "living support for elderly people living alone," "elderly people with cerebral infarction aftereffects and cancer," "maternity," "administration of medications to elderly people," "return to home, house renovation, and redesign of lifestyle for severely disabled person," "the distress of elderly wife providing long-term care to husband with cerebrovascular disease," "support for the growth and development of mentally retarded children as a result of child abuse." These modules were developed for the purpose of students in all occupations so that they do not become biased toward any field.