Dr. Ellen Fahey, DNP, MSN, FNP-C
Assistant Professor of Nursing at Columbia University School of Nursing; Program Director, Family Nurse Practitioner Program
Dr. Ellen Fahey serves as the Director of the Family Nurse Practitioner (FNP) program, which enrolls about 80+ students. The shift to remote teaching in Spring 2020 brought with it the shutdown of the program’s clinical sites. With these closures, Dr. Fahey had to consider how students could engage in the clinical experience outside of the sites. Dr. Fahey met the moment by leveraging online resources to support student learning, developing simulation-based learning experiences, and engaging students in reflection. Read on to learn more about what Dr. Fahey did in her course, what lessons and experiences she’s carrying forward, and the advice she has for other instructors at Columbia.
Leverage Online Resources to Support Student Learning
To provide non-direct clinical experiences, I used a lot of resources within our online community. This included a database of cases that students could work through and then have a discussion about. The tools used included Aquifer, a case-based system, and ReelDx that provides videotaped clinician-patient interactions and clinical questions students can answer. ReelDx allowed our students to observe a real interaction between a clinician and a patient and then make decisions based on what is present in the interview and what is not present in the interview and physical.
Develop Simulation-Based Learning Experiences
We had to get creative to find ways to engage these students with clinical decision-making experiences outside of the clinical arena; this included the use of standardized patients via telemedicine to simulate clinical experiences for our students. Utilizing the resources in CUSON simulation lab, I developed standardized patient simulation scenarios, where students used a telemedicine platform to meet virtually with a patient who had both a medical and a psychological problem. Together with the Psych Mental Health Nurse Practitioner (PMHNP) program, FNP students saw a 32 year-old Orthodox Jewish woman who was recently diagnosed with BRCA1+ breast cancer with recommendation for bilateral mastectomy and ovary removal. CourseWorks (Canvas) was set up to mimic an electronic medical record where students had access to the patient’s chart and the ability to communicate with the assigned PMHNP. The FNP students saw the patient first, completed a history and physical exam, then referred the patient via CourseWorks (Canvas) to the PMHNP. The PMHNP saw the patient at a different time and then communicated via CourseWorks (Canvas) their findings. This experience allowed the student to practice how to work collaboratively with other healthcare providers, how to convey difficult information to a patient, how to provide culturally sensitive care all in a non-threatening environment.
I have continued to use the standardized patient simulations with the students even when clinical sites opened up because students find it to be a valuable learning experience. We have even broadened it to the Doctorate program – the CUSON FNP program prepares the student with a Doctorate Degree; the Doctorate degree requires that the FNP student meet specific clinical competencies. This past summer we expanded our standardized patient simulation scenarios to assist students in meeting their clinical competencies. We developed a case that required the student to present information to a patient using the tools of shared decision making. Students were videotaped performing their visit and reviewed using a grading rubric to demonstrate proficiency. After the scenario, students were provided feedback on their performance.
Engage Students in Reflection
We asked the students to write a clinical reflection, to talk about what it felt like to be engaged with the patient and consider culture in regards to clinical practice. The students wrote so many interesting things about culture, from a traditional cultural expert perspective to pop culture, with one student mentioning the case of Angelina Jolie who was diagnosed with the breast cancer gene and made the decision to have a bilateral mastectomy. It was really interesting to see each student’s perspective on the experience afterwards.
And we received a lot of positive feedback. The students found that they benefited from having structured expectations of how they need to behave. They were given the steps and the tools to be able to translate that into practice, and that’s the goal. We all might have patients sometimes that have a different belief system or a different perspective, and we need to figure out how to address their needs. We can take the time to say, “let me do a little research. Let me figure this out and follow-up.” The students learned about the patient, the patient’s experiences, we gave them this diagnosis, and then the students had to do the research to be able to best address the patient’s concerns; this case learning will translate well to the clinic.
Advice for Instructors and the Future of Teaching at Columbia
Use technology to support student learning and develop their digital skills.
Don’t shy away from the technology, even if it’s outside your comfort zone. There’s a lot of good technology out there and students benefit from developing digital skills that will serve them in their work lives. The pandemic required us to think outside of the box. We managed to use Zoom to do virtual simulations with our students and prepare them for virtual practice. Telemedicine became more common during Covid, so we turned our scenario via Zoom into a telemedicine experience, preparing students for their future work. The students explored how to do an assessment via telemedicine, how to get a good patient history, and considered what you can and cannot do virtually.
Leverage collaborations across professions.
In Spring 2022, I received a Provost Interdisciplinary Teaching Award in collaboration with the Dental School. Our project is to do Interprofessional Education (IPE) across our schools using Storyline Articulate to engage in collaborative practice. I can see how there’s a lot more opportunity for us to be working across specialties. The pandemic helped many realize that we’re not in a silo and that we need to be collaborating more. I would like to see that happen more and for us to utilize technology to make these opportunities accessible to all of our students. This would mean students can engage in these activities from anywhere; they would not have to be on campus in order to be involved.
I’m hoping that we’ll have more interprofessional education amongst the schools. This is something that the Family Nurse Practitioner program is working on now with the Dental School, in that our Nursing students are matched with Dental students to go into the dental clinic together and do assessments.
With our grant we are working to develop an interactive virtual clinical experience for FNP and Dental students to use prior to going into the clinical arena together that will simulate the in person clinical experience. This collaboration will also include social work. If there is anything I learned from our time teaching during the pandemic is that we aren’t alone. Digital technology has allowed us to connect easier with our colleagues and peers, allowing for more interprofessional education for our students and faculty.