Developing Interprofessional Education

1. Developing Interprofessional Education Irma Ruebling, M.A., P.T., Director Interprofessional Education Program Saint Louis University Medical Center

2. Plan for the day • Presentation followed by discussion of possible IPE at Midwestern • Background on why IPE is gaining such emphasis and definitions, goals, competencies • Content and learning experiences • Faculty development and program assessment • Wrap-up – challenges and opportunities, organizational capacity

3. Objectives • Discuss the role of IPE in improving the delivery of health care services. • Use the terminology of IPE appropriately. • Identify appropriate competencies for CHS. • Identify possible learning experiences for CHS. • Identify faculty development needs to assist in successfully implementing IPE. • Discuss the outcomes to be measured of IPE program. • Discuss opportunities IPE provides. • Describe possible means of overcoming challenges for implementing IPE.

4. Why IPE? • Health care system is not providing we need and deserve – to many medical errors and unsafe conditions • To provide health care that leads to optimal patient outcomes. • IPE is considered one mechanism to accomplish this goal.

5. National Reports • Medical errors resulted from poor communication and processes of care • Institute of Medicine, To Err is Human(1999) A redesign of the health care system to include six aims: safety, patient-centered, effective, timely, efficient, and equitable Address the processes of care • Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century(2001)

6. “All health professionals should be educated to deliver client-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Institute of Medicine, Health Professions Education: A Bridge to Quality(2003).

7. Josiah Macy Foundation • “All health professions schools have an obligation to educate future practitioners who are prepared both to assess and to meet the health needs of the public. This obligation entails…fostering greater inter-professional teamwork and collaboration.” Macy Foundation, “Revisiting the Medical School Education Mission at a time of Expansion, 2009 

8. Morrison, G. Goldfarb, S, Lanken, PN. (2010 )Team Training of Medical Students in the 21st Century: Would Flexner Approve? Academic Medicine 85 (2), 254-259. • In the 20th Century, team members were resources for the physician as the decision maker. • In the 21st Century – team members are responsible for key decisions in the patient’s care together with the physician. • This shift demands a change in how all providers are prepared to practice. Health professionals must understand the roles and expertise of colleagues, and be able to communicate well between professions. • Health professionals must realize that the collective knowledge of the group far exceeds that of an individual.

9. Paradigm Shift Physician Centered practice to Patient Centered practice Practitioner autonomy to Team collaboration Focus on illness & cure to Focus on health promotion Passive patient role to Involved patients & families Acute, episodic care to Care for chronic conditions Aschenbrener CA, Clearning a Path Ahead for IPE Presentation: Collaborating Across Borders II, Halifax, 2007 Institute of Medicine, Crossing the Quality Chasm (2001)

10. What is IPE? • Definitions • Goal/Purpose • Competencies

11. Definitions • Professional – under the same general educational governing association • Disciplinary – can be specialty within an identified profession

12. Interprofessional Shared experiences Interaction/joint decision making Shared responsibility/ accountability for decisions Multiprofessional Shared experiences No expectation of interaction or participative decision-making Definitions, cont

13. Interprofessional Education defined • IPE occurs when 2 or more professions learn with, from, and about each other to improve collaboration and the quality of care. • Center for Advancement of Interprofessional Education, 2008 • WHO, Framework for IPE, 2011

14. Interprofessional Education Occurs when there is • Interaction between students and faculty of different professions AND • Goals and learning experiences lead to achieving • Performance of skills required for collaborative patient/client-centered teamwork • Understanding of and respect for the role and unique contributions of the health professions

15. Interprofessional Practice Health care activity which requires: collaborative, interdependent use of shared expertise directed toward a unified purpose of delivering optimal patient care

16. Collaborative – includes concepts of shared responsibilities, shared decision-making, shared values, shared planning and intervention, and sharing of professional perspectives • Interdependent - mutual dependence rather than autonomous – arises out of common desire to address patient’s needs • D'Amour, D., M. Ferrada-Videla, et al. (2005). "The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks." Journal of Interprofessional CareSupplement 1: 116-131.

17. Shared expertise - combined knowledge and skills of the team • Optimal patient care - achieving the highest level of function and self-efficacy

18. Goal/Purpose • Based on the basic premise or value of the program • For example: • Conviction that IPE promotes better patient/client care and IP practice is best practice

19. Example • The purpose of Interprofessional Education is to prepare students with knowledge, attitudes and skills of interprofessional practice which lead to: • Interprofessional patient/client-centered care • Optimal individual patient health outcomes • Improvements in community level (population) health • Effective and efficient delivery of health care services • Advocacy for improvement of health and health services SLU-IPE

20. IP Competencies in Health Care • “Integrate the enactment of knowledge, skills, and values/attitudes that define working together across the professions, with other health care workers, and with patients, along with families and communities, as appropriate to improve health outcomes in specific care contexts.” • Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative

21. Domains & General Competency Statements • Values/Ethics for IP Practice • Work with individuals of other professions to maintain a climate of mutual respect and shared values. • Roles and Responsibilities • Use knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative

22. Domains & General Competency statements • Interprofessional Communication • Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of diseases. • Teams and Teamwork • Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-/populations centered care that is safe, timely, efficient, effective and equitable. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative

23. Developing Competencies • Useful to identify core themes around which to develop competencies for IPE • Based on concepts and values of IPE, mission of institution and professional programs • Identify specific competencies. • May be iterative – a continuing working document

24. Develop IPE Competencies Based on 5 domains of SLU-IPE core curriculum • Interprofessional Practice • Patient-Centered Care • Wellness • Patient Safety and Quality Care • Social Justice

25. Example: Interprofessional Practice • Competency: Participate in effective collaboration with health professionals in developing and implementing plans of care to achieve optimal health outcomes. • Objective: Discuss unique contributions of each health professional for care of patient • Learning Activity: Study one page description of each profession. Group interview of member of profession. Reflect on professional contributions in case discussions including IP Grand Rounds. Also reflect on how the team working together impacted the patient’s care. SLU-IPE

26. Example: Wellness • Competency:Recognize a population health perspective that encompasses the ability to assess the health needs of a specific population, implement and evaluate interventions to improve the health of that population. • Objective: Identify and recommend clinical prevention services based upon a patient’s age, gender, and risk factor status. • Learning activity:IP team projects and presentations on health promotion/education activity for specific populations including how each professional contributes. SLU-IPE

27. Stop – Think – Reflect • How does IPE fit with the mission of the college and University? • What areas are covered in your programs that could benefit from becoming part of the IPE program? • What student competencies would you see as important outcomes of IPE?

28. Development • Learning experiences • Teaching methods

29. Types of IPE Programs • An IPE day or workshop • IPE Seminar • IPE Clinical Experience • IPE didactic course • IPE embedded throughout program

30. Formative Concept • Interprofessionality: • An approach to care and education where educators and practitioners collaborate synergistically to provide an integrated and cohesive answer to the needs of the client/family/population IPE to enhance learner outcomes Interdependent with Collaborative practice to enhance patient care outcomes D'Amour, D. and I. Oandasan (2005). "Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept." Journal of Interprofessional Care Supplement 1: 8-20. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative

31. Statement of Premises/Principles • Statements based on definitions, purpose, competences. • Statements of values and beliefs about IPE

32. Premises/Values of Beliefs Examples • IPE should occur as early as possible in the professional curriculum • Embedding IPE experiences within and throughout existing curricula allows aspects of patient-centered care and IP team practice to be an expected part of professional practice • IP collaborative practice occurs with deliberate planning and implementation of learning and practice, not by good will, intent, desire, or chance alone • IPE must have interactive learning experiences, didactic and experiential, that include critical reflection SLU-IPE

33. Operationalizing Concepts and Values The development of IPE curriculum, courses, and other learning activities is a collaboration between faculty of various health professions • designing and implementing activities for IP student learning • retaining joint responsibility and accountability for IP student learning outcomes

34. Operationalizing Concepts and Values Student learning in IPE is defined as occurring when courses and other learning experiences meet criteria of interaction leading to achievement of the IP learning outcomes.

35. Criteria for IPE Learning Experiences • Students and faculty represent multiple health professions • Objectives include demonstrating a level of achievement related to interprofessional competencies • Content relating to interprofessional competencies is included • Assignment includes interprofessional team work • Student evaluation includes an assessment of growth in interprofessional competence SLU-IPE

36. Selecting Content for IPE • Identify topics that are best covered with an IP approach as IPE has been defined. • Currently in professional curricula • Not in professional curricula but should or would be good to be cover • Would benefit for interprofessional discussions and actions

37. Selected Content • Examples: • Roles and responsibilities of various health professionals • Principles and development of teamwork • Health care system • Health promotion • Health care ethics • Evidenced-based practice • Interprofessional practicum • Interprofessional grand rounds

38. Interprofessional Team Seminar • Introduction to communication and patient safety • Discussion of IP teams and professional training & roles and responsibilities in patient care • Case-based discussion including standardized patient simulations • Contributions of each profession • Discussion of priorities for assessment and care plan • Imbedding in the cases issues of cultural differences, health literacy, patient safety, socioeconomic concerns, ethical issues in the cases, social determinants of health SLU-IPE

39. Teaching Methods • Lecture combined with team and small group discussion in break-out sessions • Small group discussion sessions of 20-30 students • Students are divided into IP teams of 4-5 for in-class discussions and out-of class projects • Students produce team reports of in-class discussions • Critical reflection assignments on Grand Rounds, certain readings and videos

40. Stop – Think – Reflect • What do you see as curricular and teaching/ learning issues for IPE? • How would teaching in IPE differ from teaching now in single professional courses? • What teaching strategies do you think should be used in IPE experiences?

41. Your Thoughts • What do you think are your faculty development needs for implementing and sustaining an IPE program? • What is the best way for you to engage in these faculty development activities?

42. Faculty Development Possible topics: Commitment to the value of IPE and IP collaborative practice Knowledge of scope of practice of the professions Effective teamwork skills Teaching and managing large classes Interactive learning Small–group facilitating Use of critical reflection

43. Faculty Development • Methods: • Do and reflect • Self-directed learning • Facilitated workshops • Conferences • Mentors and consultants • In-house formal and informal discussions • Steinert, Y. (2005). "Learning Together to Teach Together: Interprofessional Education and Faculty Development." Journal of Interprofessional Care1(Supplement): 60-75.

44. Assessment Plan Assumptions • Assessment is based on learning outcomes and objectives • Include assessment of knowledge, attitudes, and skills • Student learning outcomes or competencies drive the research questions • Research is multi-method • Research is longitudinal SLU-IPE

45. Curriculum Management • Interprofessional Teaching & Learning Team • Determines student learning outcomes • Oversees course development through course teams • Develops flow chart linking outcome with objectives and learning activities • Evaluates results of assessments for curricular changes SLU- IPE

46. Assessment Management • Assessment Team • Oversees the assessment process to assure student learning outcomes are included • Identifies preliminary research questions based on student development of attitudes, knowledge, and skills related to the student learning outcomes • Continuously monitors development of new and on-going research questions SLU-IPE

47. Assessment Implementation • Assessment Project Teams • Refine specific research purpose and questions related to a project • Determine the type of assessment: quantitative, qualitative • Develop the research protocol • Conduct reliability and validity testing • Participate in data collection, analysis procedures and dissemination of results SLU-IPE

48. SLU-IPE Assessment Blueprint

49. Attitudes Learning Outcomes • Value (or significance) of the IP team in providing patient care. • Demonstrate how to contribute effectively to the development of care plans which are responsive to the clients’ needs and diverse needs of the community at large. Research purpose • To assess changes in students’ attitudes and perceptions about learning with students in various health professions and about working in collaborative teams SLU-IPE

50. Attitudes: Research questions • What are the attitudes and perceptions about IP learning and teamwork of students with no formal education in IPE? • What changes occur in student attitudes and perceptions about IP learning and teamwork from: • prior to and after the first IPE course; • after their last IPE practicum course; • and after one year of professional experience in their chosen health career? SLU-IPE