Integrative Health Curriculum
CU graduate physician assistant (PA), physical therapy (PT), and occupational therapy (OT) students engaged in a 12-month integrative health (IH) curriculum through completion of the “Foundations in Integrative Health” course, a 31.6-hour online curriculum from the National Center for Integrative Primary Healthcare (NCIPH).19 The NCIPH curriculum consists of six units which focus on the development of a core set of IH competencies and resources for healthcare providers in primary care. NCIPH unit titles and content summary can be found in Table 1. One hundred and twenty first-year graduate students (20 PA, 73 PT, and 27 OT) completed the “Foundations in Integrative Health” curriculum during their first professional year (three semesters – summer, fall, and spring).
Units 1-3 were assigned as part of the first semester (summer) of professional didactic courses for each program.20 The 73 PT students also completed unit 4 during the first semester. In the second semester (fall) of professional didactic courses, PA and OT students completed unit 4 and all students completed unit 5. The final unit of the NCIPH course, unit 6, was covered in the final semester (spring) of the first professional didactic year for each program. The curriculum was intentionally distributed across three semesters to prepare students for the concurrent interprofessional (IP) practice experience (Table 1) and was aligned with existing program material.
Interprofessional Practice Experience
Following the first semester (summer) of the integrative health curriculum, all 120 CU health sciences graduate students began a two-semester interprofessional case development experience with a senior client from a Hispanic community center in a medically underserved area using an IH-focused case study template. The template, developed in collaboration with the University of Minnesota Center for Health IP Programs, is based on the IH framework and the social determinants of health, and provides a strategy for the IP team to gather information on their client’s health and wellbeing, socioeconomic status, and physical environment, as well as other community-level data.21
Students were randomly placed in 15 interprofessional teams consisting of 7-8 students each (1-2 PA, 1-2 OT, and 4-5 PT) and remained with the same team for both semesters of the experience. Fifteen community-dwelling Hispanic seniors who participate in United Community Center (UCC) Senior Center activities were recruited for voluntary participation by UCC personnel during regular programming. CU Spanish program students were identified as interpreters to facilitate bilingual communication.
In the first semester of the experience (second semester of the year), the interprofessional teams and clients met biweekly face-to-face for 4-6 one-hour sessions to develop an IH case study about the UCC Hispanic senior client using the provided template. Each team also identified and outlined opportunities to enhance their client’s health based on the social determinants of health. In the second semester of the experience (third semester of the year), student teams implemented an IP IH intervention with their Hispanic senior client based on their completed IP IH case study. Table 1 provides a visual outline of the integrative health curriculum, when it was offered to students, and how it relates to the concurrent IP experience.
Integrative Health Data Collection
Students’ integrative health knowledge and self-perceptions were assessed upon entrance to their program prior to curriculum access and following each semester of curriculum completion using two NCIPH knowledge and self-perception evaluations.19 The knowledge assessment reflects information presented in the six “Foundations in Integrative Health” units and consists of 30 multiple choice questions. The self-perception evaluation is a 35-item tool which assesses confidence related to application of IH concepts in IP practice on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Pre-test evaluations were administered to all students prior to NCIPH curriculum enrollment and post-test evaluations were administered online at the end of each semester of the didactic year.
Interprofessional Practice Experience Data Collection
PA, PT and OT students’ self-perceptions related to IP practice were gathered prior to the initiation of interprofessional activities and following each semester of the two-semester collaborative experience using two valid and reliable assessment tools. The Readiness for Interprofessional Learning Scale (RIPLS) assessed three areas of students’ values of and attitudes toward IP learning on a 5-point scale (1 = Strongly Disagree and 5 = Strongly Agree).22 The Interprofessional Collaborative Competencies Attainment Scale (ICCAS) was used to assess students’ perceived skills and abilities in six domains on a 7-point scale (1 = Strongly Disagree and 7 = Strongly Agree).23
All quantitative data analysis was performed using the program R.24 Comparison of pre-test and post-test data across the three disciplines was analyzed using Kruskall-Wallis, Welch’s Anova, Dunn’s Post-hoc, and Games-Howell tests. Differences from pre- to post-test scores between the three disciplines were analyzed using paired T-tests. Significant differences between groups was defined as p = <0.05.