Developing Interprofessional Education

Irma Ruebling, M.A., P.T., DirectorInterprofessional Education Program

Saint Louis UniversityMedical Center

Plan for the day

• Presentation followed by discussion of possible IPE at Midwestern

1. Background on why IPE is gaining such emphasis and definitions, goals, competencies

2. Content and learning experiences 3. Faculty development and program assessment4. Wrap-up – challenges and opportunities, organizational

capacity

Objectives1. Discuss the role of IPE in improving the delivery of health

care services.2. Use the terminology of IPE appropriately.3. Identify appropriate competencies for CHS.4. Identify possible learning experiences for CHS.5. Identify faculty development needs to assist in successfully

implementing IPE.6. Discuss the outcomes to be measured of IPE program.7. Discuss opportunities IPE provides.8. Describe possible means of overcoming challenges for

implementing IPE.

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.

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)

• “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).

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

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.

Paradigm ShiftPhysician 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 IPEPresentation: Collaborating Across Borders II, Halifax, 2007

Institute of Medicine, Crossing the Quality Chasm (2001)

What is IPE?

• Definitions

• Goal/Purpose

• Competencies

Definitions

• Professional – under the same general educational governing association

• Disciplinary – can be specialty within an identified profession

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

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

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

Interprofessional Practice

Health care activity which requires:

collaborative, interdependent use of shared expertise directed toward a unified purpose of delivering optimal patient care

• 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 Care Supplement 1: 116-131.

• Shared expertise - combined knowledge and skills of the team

• Optimal patient care - achieving the highest level of function and self-efficacy

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

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

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

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

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

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

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

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

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

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?

Development

• Learning experiences

• Teaching methods

Types of IPE Programs

• An IPE day or workshop

• IPE Seminar

• IPE Clinical Experience

• IPE didactic course

• IPE embedded throughout program

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 outcomesInterdependent 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

Statement of Premises/Principles

• Statements based on definitions, purpose, competences.

• Statements of values and beliefs about IPE

Premises/Values of BeliefsExamples

• 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

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

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.

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 competenceSLU-IPE

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

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

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

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

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?

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?

Faculty Development

Possible topics:

Commitment to the value of IPE and IP collaborative practiceKnowledge of scope of practice of the professionsEffective teamwork skillsTeaching and managing large classesInteractive learningSmall–group facilitatingUse of critical reflection

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 Care 1(Supplement): 60-75.

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

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

changesSLU- IPE

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

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 resultsSLU-IPE

SLU-IPE Assessment Blueprint

Learning outcomes

Research purpose

Research question(s)

Research Methods

Evaluation of results

Attitudes

Knowledge

Skills

Attitudes

Learning Outcomes1. Value (or significance) of the IP team in providing patient care. 2. 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

Attitudes: Research questions

1.What are the attitudes and perceptions about IP learning and teamwork of students with no formal education in IPE?

2.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

Attitudes: Research Methods

• Questionnaire: Readiness for IP Learning Scale (Parsell, McFayden) and University of West England IP Questionnaire (Pollard) followed by focus group concerning inconsistent items and confirmation of results

• Analysis: Remark scan, SPSS, descriptive and interferential statistics, factor analysis, followed by qualitative analysis identifying themes.

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Knowledge

Learning Outcomes1. Discuss the unique contribution of each health care profession

for the care of clients.2. Refer the care of the patient to appropriate health professional

based on the scope of practice and unique expertise of the profession.

Research Purpose– To assess changes in students’ ability to identify the best choice

health professional to implement a procedure or intervention in the patient’s care plan.

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Knowledge: Research questions

Does the student’s ability to identify the most appropriate health professional to provide a particular service needed in a specific case improve 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

Knowledge: Research Methods

• Questionnaire consisting of case and questions regarding the most appropriate health professional to provide needed services followed by focus groups to clarify discrepancies in responses.

• Analysis: Remark scan, SPSS, descriptive and interferential statistics, followed by qualitative analysis identifying themes.

SLU-IPE

Summary• The focus of the evaluation is on outcomes assessment

throughout the education program including post-graduation components.

• This assessment process allows for multiple projects in various stages.

• Projects may build off of each other.• As a comprehensive program the assessment

– is longitudinal,– includes quantitative and qualitative studies, and – encompasses assessment of attitudes, knowledge, and skills.

Organizational Capacity

• Leadership AND Grassroots Commitment

• Centralized coordination – Infrastructure– Creation of designated Program or Center– Existence of a general plan – mandate

• Funding and facilities

Faculty & Staff Engagement Across Health Professions

Faculty and clinical staff from different professions who value IP collaboration and share a vision and common goals work together to – Co-create curriculum and clinical programs– Develop knowledge and skills of IP interaction – Take an active role in the scholarship agenda– Focus on patient-centered care

Leadership Commitment

• Centralized operation, coordination and support• Infrastructure fosters time to develop IP

activities, incentives to engage in IP endeavors, and integration across professions

• Find solutions to issues of scheduling as well as faculty and staff recruitment

• Provide appropriate physical facilities, technology and other resources

Interprofessional Education (IPE) Program Organization

Updated 6/1/11

Assistant VP, Health Sciences

Executive Advisory Committee

IPE Director

IPE Assistant Director IPE Assistant Director IPE Teaching and Learning Team

IPE Practicum Team

IPE Practicum Community Sites

Interprofessional Grand Rounds

IPE Post-Baccalaureate Curriculum Track

Interprofessional Team Seminars (IPTS)

IPE Course Faculty Teams

IPE Fr-Entry Course Coordinator(s)

IPE Assessment Team

IPE AssessmentProject Teams

IPE 110: Intro IP Health Care

IPE 350: HC Systems/Health Promo

IPE 420: App Decision Making in IP Practice

IPE 460: Evidence Based Practice

IPE 490: Integrated IP Practicum

IPE Program Coordinator

Existence of a Plan

• Strategic Plan for development, evaluation, and sustainability– Shared vision of IPE and IPP– Explicit philosophy of IPE that permeates the

organization – Existence of a plan for implementing goals of IPE

IPE Policies

• Examples:

– Faculty participation– Use of funds– Student enrollment– Student academic policies

Funding and Facilities

• Space for teaching – large group, small group

• Administrative space

• Funding for Faculty and Staff

Shared Challenges of the faculty

• Faculty development – Learning to communicate as a teaching team

• Large class size – new to all faculty• Scheduling of classes and teaching team

meetings• Engaging new faculty

Opportunities for Faculty Involved in IPE

• IP collaboration amongst faculty• Learning more about other professions• Shared research • New & strengthened friendships• Newer faculty learn from more experienced

faculty with whom they team teach

Opportunities for Students Involved in IPE

• Opportunity for students to experience best practice– Modeling of IP teamwork– Enhanced collaboration– Improved student awareness of IP teams

• Enhanced focus on patient/client centered care & improved health outcomes

• Increased student comfort level with IP teams

Development of Culture of IPE or IPP

• Indicators:– Vision of IP endeavor is commonly understood– Faculty members across professions are engaged– Administrative support – funding, facilities as well as staff,

faculty and student recognition– Full integration in professional education and practice– Included in recruitment activities for faculty, students, and

clinical staff– Incorporated into uni-professional courses including

clinical experiences

Challenges

• State-of-the-art for research in IPE and IP practice outcomes is limited and considered weak in methodology.

• Uncertainty regarding potential for reimbursement model for interprofessional collaborative practice

The Opportunity of Interprofessional Health Care

• Health professionals working at the top of their knowledge and skill– Enhanced staff motivation and satisfaction

• Working as team providing the right care for the patient when it is needed– Enhanced patient motivation and satisfaction

• Being part of change in delivery of care that can accomplish optimal health outcomes

IPE Best Practices

• Begin IPE early in the health professional program

• Experiences occur throughout the health professional program

• Include interaction among students and working in teams

• Include didactic, practical and clinical experiences

Always keep the vision in the forefront.

It is about improving patient care.