Co-Teaching Interprofessional Care

at the Graduate School Level

Brian D. Carpenter, Ph.D.

Associate Professor

Objectives

1) Review a curricular model for introducing

graduate students to disciplinary perspectives

and interdisciplinary teamwork

2) Related course objectives to geropsychology

and primary care competencies

3) Recount administrative and logistical

challenges in course implementation

4) Summarize indicators of student development

5) Discuss future adjustments

• Provost’s Cross-School Interdisciplinary

Teaching Grants

Origins of our course

• Growing interest in interprofessional care

• APA Presidential Task Force on Integrated

Healthcare (2007)

• WHO Framework for Action on Interprofessional

Education and Collaborative Practice (2010)

• Interprofessional Education Coalition Core

Competencies for Interprofessional Collaboration

(2011)

Goals guiding course development

• Provide basic education about aging that

students complete before semester

• Expose students to guest lecturers from

different disciplines and practice settings

• Interweave interdisciplinary team dynamics &

communication

• Focus on understanding and appreciating other

disciplines (i.e., how to practice with other

disciplines, not how to practice within other

disciplines)

Format for each disciplinary lecture

• History of profession

• Training requirements

• Major theories/evidence-based practice

• Settings of practice

• Assessments & interventions

• Reimbursement

• Your discipline’s presence on teams

• Psychology

• Social Work

• Occupational Therapy

• Physical Therapy

• Speech and Language Pathology

• Chaplaincy

• Nursing

• Medicine

• Pharmacy

Team functioning & communication

• Didactic readings

• Hartford GITT video cases

• National League of Nursing written case

studies

• Western Health Sciences written case studies

• University of Missouri – Columbia Virtual

Health Care Team written case studies

• Experiential exercises

Site visits to observe teams in action

• Inpatient rehabilitation hospital, long-term

dementia care residence, community-based

outpatient screening and referral clinic,

outpatient multi-service clinic (PACE)

• Attended two interdisciplinary team meetings

• Recorded observations of team features and

team process

• Delivered in-class, interdisciplinary group

report on shared observations and

evaluations

Geropsychology competencies addressed

Foundational - Skills

Recognize Importance of Teams

a. Understand the theory and science of geriatric team

building

b. Value the role that other providers play in the

assessment and treatment of older clients

c. Demonstrate awareness, appreciation, and respect

for team experiences, values, and discipline-specific

conceptual models

d. Understand the importance of teamwork in geriatric

settings to address the varied biopsychosocial needs

of older adults

Geropsychology competencies addressed

Consultation - Knowledge

Interdisciplinary Collaboration

a. The distinction between types of treatment teams

(e.g., multidisciplinary and interdisciplinary)

b. The roles, and potential contributions, of a wide

range of healthcare professionals in the assessment

and treatment of older adult with mental disorders

c. How team composition and functioning may differ

across settings of care

Geropsychology competencies addressed

Consultation - Skills

Participate in Interprofessional Teams a. Work with professionals in other disciplines to incorporate

geropsychological information into team treatment planning and

implementation

b. Communicate psychological conceptualizations clearly and

respectfully to other providers

c. Appreciate and integrate feedback from interdisciplinary team

members into case conceptualizations

d. Work to build consensus on treatment plans and goals of care,

to invite various perspectives, and to negotiate conflict

constructively

e. Demonstrate ability to work with diverse team structures (e.g.,

hierarchical, lateral, virtual) and team members (e.g., including

the ethics board, chaplains, and families in palliative care

teams)

Primary care competencies addressed

1A. Science

1A.1 Scientific mindedness: Values a scientific foundation in the

practice of PC psychology

1A.9 Knowledge and understanding of evidence-based practice and its

application to the practice of PC psychology

1B. Research/Evaluation

1B.4 Ability to conduct research within the context of an

interdisciplinary team

2C. Advocacy 2C.1 Demonstrates knowledge of health care policy and its influence

on health and illness and PC services

3A. Professional values and attitudes 3A.1 Consolidates professional identity as a PC psychologist

3D. Reflective practice/self-assessment/self-care 3D.1 Supports importance of reflective practice in PC

3D.2 Understands importance of self-assessment in PC settings

3D.3 Understands importance of health professional self-care in PC

Primary care competencies addressed

4A. Interprofessionalism

4A.1 Values interprofessional team approach to care

4A.2 Appreciates the unique contributions that different health care

professionals bring to the PC team

4A.3 Develops collaborative relationships to promote healthy

interprofessional team functioning that is characterized by

mutual respect and shared values

4A.4 Assesses team dynamics and coaches teams to improve

functioning

4A.5 Demonstrates awareness, sensitivity, and skills in working

professionally with diverse individuals

4B. Building and sustaining relationships in PC 4B.1 Understands the importance of communicating clearly,

concisely, and respectfully in a manner that is understandable

and meaningful to various audiences (e.g., clinicians, patients,

staff)

Primary care competencies addressed

5A. Practice Management 5A.4 Can co-interview, co-assess, and co-intervene with other PC

providers

5D. Clinical Consultation 5D.3 Helps PC team conceptualize challenging patients in a manner

that enhances patient care

5D.5 Follows up with other PC clinicians as indicated

6A. Teaching 6A.2 Completes needs assessment and understands teaching

approaches used by other health professions about

behavioral health issues

6A.6 Participates in the education and training of multiple

stakeholders in the larger health care system about PC

psychology

Trainees involved

Year 1 (2012)

• OT – 4

• Psychology – 5

• Public Health – 3

• Social Work – 7

• Medicine – 1

Year 2 (2014)

• OT – 4

• Psychology – 2

• Public Health – 4

• Social Work – 11

• Medicine – 1

• Applied Health

Behavior – 3

Enrollment challenges

• Physical Therapy class schedule

• Medicine rotations only 7 weeks long

• Administrative resistance from Nursing

• Pharmacy program not affiliated with our

university

• Uncertainty with Registrar regarding tuition

Logistical challenges

• Scheduling a class time

• Different spring breaks

• Location – parking permits? rotate? classroom?

• Dinner

• Academic culture differs across schools

• expectations about availability of syllabi and

reading lists

• sanctity of reading period

Learning outcomes

Change in attitudes/beliefs

40

60

80

100

Attitude Toward Teams Ability To Do Team Work

Score

Pre-Semester Post-Semester

* t = -6.18(41), p < .001

** t = -12.01(41), p < .001

*

**

Change in attitudes/beliefs

120

140

160

180

Attitude Toward Older Adults

Sco

re

Pre-Semester Post-Semester

* t = -4.12(40), p < .001

*

Attitudes toward working with teams

1

2

3

4

5

Attitude toward otherdisciplines

Providing care forelderly

Practicing in teamenvironment

Sco

re

Pre-Semester Post-Semester

* t = -5.74(40), p < .001

** t = -3.95(40), p < .001

*** t = -6.10(40), p < .001

* *** **

Working as a team less threatening

“I have to admit that as I learned about various

disciplines, I had to actively prevent myself from becoming

defensive of [my profession] and our expertise and skeptical

of other professions purported competencies.

I was initially resentful at the idea of other disciplines

conducting brief [versions of assessments I was trained to

conduct]. I now acknowledge the global benefits of various

professionals having [that skill]…

Had I not been given interdisciplinary training exposure,

my openness to other disciplines would still be limited.”

How will they practice

“XYZ program was a good example of cultural

silos—the group thought they were acting as a team

when they were really functioning as autonomous

units managed by a staff person.

There was a total lack of common understanding

and communication—each professional documented

their results and it was only viewed by 1 staff

member. What could have been great

interdisciplinary care turned out to be very similar to

the traditional model.”

Early professionals with the “big picture”

Reflecting on reimbursement for geriatrics:

“Professionals would hesitate to choose geriatrics

and/or gerontology if their effort to care for older clients

(patients) is not well compensated in the system or

valued in society, and this will eventually lead to the

shortage of geriatric professionals. ..Therefore, it is

important and necessary to either improve the existing

reimbursement policy or introduce a brand-new policy

to support geriatric professionals and their

interdisciplinary teams better than now.”

Future development

• More disciplines represented

• More contemporary scholarly resources

• More sophisticated and longitudinal student

outcome assessment

• Faculty sustainability issues

• Budgetary sustainability issues

Brian D. Carpenter

Department of Psychology

Washington University

St. Louis, MO 63130

bcarpenter@wustl.edu

(314) 935-8212