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Rural Interprofessional Health Care Education: a Study of Student Perspectives Portland State University PDXScholar Dissertations and Theses Dissertations and Theses Spring 6-5-2017 Rural Interprofessional Health Care Education: a Study of Student Perspectives Curt Carlton Stilp Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/open_access_etds Part of the Educational Leadership Commons, Interprofessional Education Commons, and the Rural Sociology Commons Let us know how access to this document benefits ou.y Recommended Citation Stilp, Curt Carlton, "Rural Interprofessional Health Care Education: a Study of Student Perspectives" (2017). Dissertations and Theses. Paper 3624. https://doi.org/10.15760/etd.5516 This Dissertation is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. Rural Interprofessional Health Care Education: A Study of Student Perspectives by Curt Carlton Stilp A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Education in Educational Leadership: Postsecondary Education Dissertation Committee: Candyce Reynolds, Chair Becky Boesch Andy Job Leslie McBride Portland State University 2017 © 2017 Curt Carlton Stilp i Abstract As the cost for health care delivery increases, so does the demand for access to care. However, individuals in a rural community often do not have access to the care they need. Shortages of rural health care professionals are an ever-increasing problem. The Affordable Care Act of 2010 sought to increase health care access by focusing on team- based care delivery. Thus, the need to educate health care students in the fundamentals of team-based practice has led to an increased emphasis on Interprofessional Education (IPE). While past research focused on urban IPE, a literature gap exists for the effects of a rural team-based educational experience on practice location decisions. This study examined how rural IPE influenced health profession students’ perspectives of what it means to be a member of a rural health care team and explored what factors go into making decisions of where to live and provide care. Motivational Theory provided the framework for a mixed methods approach with data from student reflective journaling and a post-experience Q sort. Analysis yielded important understandings about the impact of rural IPE. Accordingly, having a rural IPE experience provided positive motivation for returning after graduation. Further, the time spent in rural IPE generated understandings of what it means to live and provide care to a rural community. One important new discovery gained is the clinical setting is not where most IPE took place. As a result, social interactions with fellow students and community members achieved the goals of rural IPE. Despite these influential findings, noted barriers to genuine rural IPE persisted. In the end, students, educators, and rural health care professionals need to be aware of the multiple factors that guide decisions of where to live and provide care. ii Acknowledgements I would first and foremost like to thank God for his continual strength and provision for my family and me. He sustained us by his grace during the past three years, so that we did not wear out. I would also like to thank my wife, Jodi Stilp, for supporting me before, during, and after this endeavor. She stepped in when I could not and made it possible for life to continue on, without much of a wrinkle. Her love for me and belief that I could finish this program meant everything. I love you! I want to thank my four children, Grant, Katie, Alli, and Paige Stilp. They went into this process knowing that it would require adjustments from them as well. They handled it all with maturity and grew in their knowledge of education right alongside of me. Their understanding was what I needed when sleep was short and I could not always be there to reciprocate the encouragement. Thank you to my friends who began this journey with me, prayed, listened, and cheered all of us on to completion. Thank you for being part of our lives. A big thank you to my dissertation chair, Dr. Candyce Reynolds. Her feedback and suggestions were invaluable. The advice for how to approach a topic or structure an explanation was exactly what I needed to be successful. I also want to thank my dissertation committee. Their recommendations for how to improve my study made this such a better paper in the end. Thank you for reading my entire dissertation in just two weeks. Finally, I want to thank my doctoral classmates who walked this road right along with me. Their support and understanding of what this program takes meant I had an ally in the trenches with me. It was a privilege and honor getting to know you and I cannot wait to see where we all go next. iii Table of Contents Page Abstract ............................................................................................................................... .i Acknowledgements ............................................................................................................. ii List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Chapter 1: Introduction ........................................................................................................1 Chapter 2: Literature Review .............................................................................................17 Chapter 3: Method .............................................................................................................66 Chapter 4: Results ............................................................................................................106 Chapter 5: Summary and Discussion ...............................................................................147 References ........................................................................................................................187 Appendices Appendix A Informed Consent and Study Information Sheet ............................198 Appendix B The Q-Set Used for the Study ........................................................202 Appendix C Journal Coding Table .....................................................................205 Appendix D Values Coding Categorization Table .............................................226 Appendix E Example of Completed Q Sort and Corresponding Email..............232 Appendix F The Un-Rotated Factor Matrix........................................................234 Appendix G Group A Factor Loadings ...............................................................236 Appendix H The Complete Factor Array for the Q Sort ....................................238 iv List of Tables Table 3.1 Sample of the Q-Set ...........................................................................................91 Table 4.1 Descriptive Coding With Examples ................................................................108 Table 4.2 Descriptive Coding Themes .............................................................................110 Table 4.3 Values Coding With Examples ........................................................................114 Table 4.4 Values Coding Categories ...............................................................................116 Table 4.5 Q Sort Demographic Data ................................................................................122 v List of Figures Figure 3.1 Workflow Design Model for the Study ............................................................70 Figure 3.2 The Q Sort ........................................................................................................82 Figure 4.1 Representative Q Sort for Team-Oriented Rural Optimist Perspective .........131 Figure 4.2 Representative Q Sort for Independent Rural Impartial Perspective .............136 Figure 4.3 Representative Q Sort for Team-Willingness Rural Skeptic Perspective ......140 1 CHAPTER 1 INTRODUCTION This dissertation is a study of a health science university’s attempt to improve the health of rural communities by increasing the numbers of health care professionals living and working in rural communities through a rural Interprofessional Education (IPE) program. Chapter 1 gives a brief overview of the subsequent chapters as well as introduces the problem in practice, theoretical framework, and methods for the study. Chapter 2 is a literature review exploring aspects of rural health care, traditional medical education, team-based learning, and how motivation is influenced through experience. Chapter 3 describes the methods used in the study for data collection and analysis, concluding with some considerations on the implications for rural team-based health care education and delivery. Chapter 4 represents data collected from students who experienced rural IPE as part of their health care training and the respective analysis. Chapter 5 provides interpretation of the data and implications for current and future health care education. Rural Health Care Good health care is a common need shared by every member of society. Individuals encounter illnesses and diseases that require the expertise of medical providers to care for their needs. Therefore, the demand
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