interprofessional education jchs/vtc/carilion clinic · discuss the impetus of interprofessional...

Interprofessional EducationJCHS/VTC/Carilion Clinic

November 27th, 2017

Objectives

1. Discuss the impetus of interprofessional education in the US

2. Describe the key structure of IPE programs at VTC and JCHS

3. Identify lessons learned and future directions in achieving IPE/IPL goals

4. Review 22 tasty leftover Thanksgiving recipes

2

Disclosure

3

Sit in interprofessional teams

• Seating according to avatar sticker signs on wall

• Colored round stickers for your name badge based on disciple and “Avatar Element”

• “Earth”– Green

• “Fire” – Red

• “Water” – Blue

• “Air” – Yellow

4

Definition IPE• “Occasions when two or more professions

learn with, from and about each other to improve collaboration and the quality of care.”

5

A brief history..IPE

• 1910 William Mayo, “Union of Forces”

• 1972 – IOM “Interdisciplinary teams”

• 1999 – “To Err is Human” IOM

• 2001 “Crossing the Quality Chiasm”

At the same time..

• Quality Enhancements

• Cost constraints

• New, expanding professions, scopes of practice

• Patient Centered Medical Home

• Accountable Care Organizations

• Etc…

• 1970: 2.5 vs 2010

IPE Collaborative

8

• Six national healthcare organizations:– AACN (Nursing)– AACP (Pharmacy)– ADEA (Dental Medicine)– AAMC (Allopathic Medicine)– AACOM (Osteopathic Medicine)– ASPH (Public Health)

• Convened “Expert Panel” in 2009• Developed Core Competencies• Funding• MedED portal , Accreditation Standards

Core Competencies :Domains

9

– Values/ethics for interprofessional practice

– Roles/responsibilitiesfor collaborative practice

– Interprofessional communication

– Interprofessional Teamwork and team-based care

Traditional Education

10

Jefferson College of health Sciences

• Quality Enhancement Project for SACS

• Graduate and Undergraduate IPE Courses

• IPE Day partnership

Development of an Interprofessional Evidence-based

Practice (EBP) CourseAllison-Jones, L., Clark, W., Hadley, R., Haynes, D., Kennedy, W., Price, J., Southard, D., & Vari, P.

1. Glasziou, P., DelMar, C., & Salisbury, J. (2007) Evidence-based Practice Workbook (2nd ed.). Malden, MA: Blackwell.

2. Institute of Medicine. (2001). Health Professions Education: A Bridge to Quality. Washington, D.C.: National Academies Press.

3. Melnyk, B. M & Fineout-Overholt, E. (2005). Evidence-based Practice in Nursing & Healthcare. Philadelphia: Lippincott,

Williams, & Wilkins.

References*

Jefferson College of Health Sciences

prepares, within a scholarly environment, ethical,

knowledgeable, competent, and caring healthcare

professionals.

Three graduate programs with approximately 80

students

Occupational Therapy, Physician Assistant, Nursing

Goal: To develop content-specific courses that also

prepare graduates for interprofessional (IPE) teamwork.

First Course Implemented Spring 2009

IPE 509-Research & Evidence-based Practice

Background1

Challenges2

Solutions3

Adoption of “Evidence-based Practice”

terminology

Case scenarios encompassing each

discipline’s practice and requiring students to

articulate different roles.

Textbooks addressing multiple disciplines.

15-week schedule, primarily distance but with four 3-hour

classroom sessions

Block scheduling into 4 course sections, subdivided into

assigned groups with representation from each discipline

Required orientation to database research with JCHS

research librarian

Assignments a mix of individual and group work

Faculty from each discipline available

as consultants

EBP group posters presented to

College community

Conclusions &

Recommendations

Comments from JCHS Student Evaluations

“I really enjoyed this class and learned a lot which has flowed over into

my professional life assisting me to assist other RNs in Evidence-based practice.”

“I learned a lot about how to work with people that are different from myself. I also

learned a lot about researching topics and the research process.

I was dreading this class at first, but in the end I learned a lot.”

Conclusions

Techniques of IPE can be used to facilitate achievement of objectives not related to IPE.

Essential to provide adequate “face time” to facilitate student group

interaction

Faculty must stress importance of group work and roles

of different disciplines

Majority of negative comments on evaluations related to

perceptions of “busy work”

5

4 Evaluation

Course evaluations completed as a QA project

indicate student satisfaction with course, with

means ranging from 3.48 to 4.62

How can IPE course meet needs of

professions using different terms and practices?

evidence-based medicine vs. evidence-based

nursing

population based, patient based, policy based

How can IPE course provide value for

unlicensed, inexperienced OT & PA students and

experienced RN students?

How can IPE course meet competing scheduling

needs?

primarily on campus vs. distance

5 week, 10 week & 15 week schedules

What type of assignments facilitate

OT, PA, NSG students working

together to learn EBP?

Then along came VTC SOM RI

Thought exerciseIf you could design a curriculum to

achieve the goals of the IPEC competencies, what would you do?

14

IPL Curriculum Overview First Year

Block I

Team 1 Team 8 Team 2 Team 9 Team 3 Team 10 Team 4 Team 11 Team 5 Team 12 Team 6 Team 13 Team 7 Team 14

Aug. 21

Aug. 28

Sept. 11

Sept. 18

Block II


Oct. 9

Oct. 16

Oct. 23

Oct. 30

Nov. 6

Nov. 13 Off OSCE Off OSCE Off OSCE Off OSCE

Nov. 20 OSCE Off OSCE Off OSCE Off OSCE Off

Nov. 27

Block III


Jan. 22

Jan. 29

Feb. 5

Feb. 12 Feeding America Open

Feb. 19 Open Feeding America

Block IV


Mar. 12

Mar. 19 OSCE Off OSCE Off OSCE Off

Mar. 26 Off OSCE Off OSCE Off OSCE Feeding America Open

Apr. 2 Open Feeding America

Apr. 9

Apr. 16

Apr. 23

Lab 1

Lab 2/Community Meals

Culinary Track Wrap-Up (M106)

Feeding America Market

Open


Open


Open


Open

Lab 1

Nutrition Lecture (LeClair)

Open


Open

Lab 1


Feeding America Market Nutrition Lecture (LeClair)

Debrief (TAG)

Open

Feeding America MarketVTC/JCHS Programs of Study – Academic Differences & Similarities (TAG)

Culinary Track Section B

Introduction to Roles & Scopes (M203 Auditorium)

Roles and Scopes Track Section A

Into to Culinary Track Lecture (M106)

Lab 1


Communication & SBAR/CUS (TAG) Feeding America Market


Open

HCTC (M203, TAG Rooms, etc.)

TAG Debrief (TAG)

Roles, Scopes & Patient Voice - Family Advisory Council (TAG)

Open

Roles and Scopes Track Section A Cont. Culinary Track Section B Cont.

Healthcare Roles and Responsibilities & Professional Controversies/Challenges (TAG)

Debrief (TAG)


Open

Open

Open

Open

Lab 1


Intro to Culinary Track Lecture (M106)

Lab 1



Culinary Track Wrap-Up (M106)

Open






Lab 1


Open



Intro to Interprofessional Learning

Culinary Track Section A Roles and Scopes Track Section B

IPL Course Orientation, Intro to Team Contracts & Team Formation (Lecture M203) START at 3:00

Personal Journey, Goal Setting & Team Contracts (TAG)

Teamwork Concepts & TeamSTEPPS (Lecture M203)

This I Believe (TAG)

Communication & SBAR/CUS (TAG)

Introduction to Roles & Scopes (M203 Auditorium)

VTC/JCHS Programs of Study – Academic Differences & Similarities (TAG)

Roles, Scopes & Patient Voice - Family Advisory Council (TAG)

Healthcare Roles and Responsibilities & Professional Controversies/Challenges (TAG)

Ethics and Legal Issues in Practice:

Welcome! • Curriculum is delivered in small IP teams with stable, consistent faculty

• Faculty /TAG Facilitators:

– Judy Cusumano, PhD

– Randy Howell, PA-C, DHSc.

– Jennifer Slusher, PhD, LPC

– Kim Whiter, MS-Ed, MLS

– Richard Brown, MDiv., BCC, ACPE

– Mark Derbyshire, LCSW

– Laurie Seidel, MSN,RN

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RESEAR CH POSTER PRESENTATION DESIGN © 2015

www.PosterPresentations.co

m

• The Core Competencies for Interprofessional

Collaborative Practice address interprofessional

competencies that are critical for safe, high quality

patient care

• Diversity in the implementation and assessment of

the core competencies has made it difficult to

determine evaluation methods

• Purpose: Longitudinally evaluate an Interprofessional

Leadership (IPL) curriculum on students’ perceived

confidence in interprofessional skills

Background

Methods• Participants. Nursing, medical, physician assistant

(PA) students

• Study Design. With-in subjects study, pre- test, post-

test

• Intervention. In a year long course, counselors facilitate

self assessment in small IP groups. Knowledge & skills

are operationalized in community service learning

projects

• Instrumentation. Team Skill Scales Adjusted

• Data Collection. Self assessment in collaborative

teamwork skills

• Data Analysis. Descriptive and inferential statistics

Paired t-tests.

DemographicsPA: 206 (37%); Nursing: 145 (26%); Medical 206 (37%)

Female 376 (68%); Male 181 (32%)

Total students: 557

Descriptive ResultsA team skills composite was created as the average of all six items for T1 and T2. The overall average scores for each of the fivecohorts in each academic program was compared for T1 and T2. As displayed by the slope-graphs below, on average, almost allcohorts in all three programs scored their team skills significantly higher (p < 0.05) at T2 than at T1.

•Although no causal inferences can be made, students in all three educational programs consistently rate their team skills higher on average following the interprofessional course than before the course.

Patty Vari, PhD, RN; Sara Brown, DNP, RN; Ava Porter, DNP, RN; Judy Lash, PhD; David Trinkle, MD; Jeannie Garber, DNP, RN;

Wilton Kennedy, DHSc, PA; Brock Mutcheson, PhD; Richard Vari, PhD Acknowledgement: Ellen Rachel Lockhart

Results from an Ongoing Early Interprofessional Education Course for Health Professions

Students

Cohort 3,3.5Cohort 6,3.5Cohort 7,3.5

Cohort 5,3.4Cohort 4,3.4

Cohort 6,4.1

Cohort 4,3.9

Cohort 7,3.9

Cohort 3,3.9

Cohort 5,3.7

Post (T2)

Cohort 3 Cohort 4 Cohort 5 Cohort 6 Cohort 7

5 =Excellent

4 = Very Good

3 =Good

2 =Fair

1 = Poor

Pre (T1)

Cohort 4,3.6


Cohort 3,3.8

Cohort 7,4.1

Pre (T1) Post (T2)

Cohort 3 Cohort 4 Cohort 5 Cohort 6 Cohort 7

5 =Excellent

4 = VeryGood

Cohort 4,3.5


Cohort 5,3.3

Cohort 7,3.3

3 =Good

2 =Fair

1 =Poor

Cohort 4,3.4

Cohort 6,3.9

Cohort 3,3.8

Cohort 5,3.8

Cohort 7,4.0

Pre (T1)

Cohort 3 Cohort 4 Cohort 5

Post (T2)

Cohort 6 Cohort 7

5 =Excellent

4 = Very Good

Cohort 3,3.6

Cohort 4,3.4

Cohort 7,3.4Cohort 5,3.4Cohort 6,3.3

3 = Good

2 =Fair

1 =Poor

Physician Assistant Program Medical Program

At T2, students completed a second short survey with the samesix items asking them to indicate whether they were “moreskilled,” “less skilled” or whether they experienced “no changein skills” as a result of the interprofessional course. The resultsof this scale were significantly correlated (p < 0.05) with thechange in self rating from T1 to T2 for most items. Moreover, ingeneral, a higher proportion of students indicated they were“more skilled” as a result of the course, supporting the findingsfrom above.

across all threeThe same two particular team skills/items were rated the highest on average ( mean > 3.9) for all programs and one particular team skill/item was rated the lowest (mean < 3.5) in all three programs.

Medicine Program

Nursing Program

Physician Assistant

0% 20% 40%

Excellent Very Good Good

60% 80% 100%

Fair Poor

Team Skill/ Item: Help draw out team members who are not participating actively in meetings

100%

Medicine Program

Nursing Program

Physician Assistant

0% 20% 40%


60% 80%

Fair Poor

Team Skill/Item: Recognize when your team is not functioningwell.

Medicine Program

Nursing Program

Physician Assistant

0% 20% 40%


60% 80% 100%

Fair Poor

Team Skill/Item: Function effectively in an interprofessional team

-36%

-34%

-36%

-43%

-32%

-27%

64%

66%

64%

57%

68%

73%

-80% -60% -40% -20% 40% 60% 80%0%20

%

No Increase Increase

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Nursing Program

Discussion•Students in all three programs rated items similarly. Students indicated they were skilled at recognizing effective interprofessional team functioning and at functioning well within an interprofessional team. However, they indicated they were not as skilled at drawing out inactive team members.

Conclusions•Over 5 Cohorts, Team Skills Scale Adjusted survey has provided valuable evaluation data on student perceptions of their IPE skills after completing a year long required Interprofessional Leadership (IPL) course.

Follow-Up•As additional data is collected, the research team will investigate the degree to which student perceptions of their team skills vary as a function of experience in the health professions and experience in interacting with interprofessionalteams.

ReferencesInterprofessional Education Collaborative Expert Panel, (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel.Washington, D.C.: Interprofessional Education Collaborative.

Hepburn, K., Tsukuda, R., & Fasser, C., (1996), Team Skills Scale, In Heineman, Zeiss (Eds.), Team Performance in Health Care: Assessment and Development (pp. 159- 163). New York: Kluwer Academic/ Plenum Publishers

http://www.PosterPresentations.com/

Evaluation: Survey of Programs

22

Assessment Tools

0

10

20

30

40

50

60

1

Student reflection

Preceptor

evaluationsAttitudinal surveys

Simulation exams

Written

examinationsOSCE

Peer evals

Issue with Assessments

Interprofessional Collaboration Competency Domain

24

Development of an Interprofessional Evidence-based

Practice (EBP) CourseAllison-Jones, L., Clark, W., Hadley, R., Haynes, D., Kennedy, W., Price, J., Southard, D., & Vari, P.

1. Glasziou, P., DelMar, C., & Salisbury, J. (2007) Evidence-based Practice Workbook (2nd ed.). Malden, MA: Blackwell.

2. Institute of Medicine. (2001). Health Professions Education: A Bridge to Quality. Washington, D.C.: National Academies Press.

3. Melnyk, B. M & Fineout-Overholt, E. (2005). Evidence-based Practice in Nursing & Healthcare. Philadelphia: Lippincott,

Williams, & Wilkins.

References*

Jefferson College of Health Sciences

prepares, within a scholarly environment, ethical,

knowledgeable, competent, and caring healthcare

professionals.

Three graduate programs with approximately 80

students

Occupational Therapy, Physician Assistant, Nursing

Goal: To develop content-specific courses that also

prepare graduates for interprofessional (IPE) teamwork.

First Course Implemented Spring 2009

IPE 509-Research & Evidence-based Practice

Background1

Challenges2

Solutions3

Adoption of “Evidence-based Practice”

terminology

Case scenarios encompassing each

discipline’s practice and requiring students to

articulate different roles.

Textbooks addressing multiple disciplines.

15-week schedule, primarily distance but with four 3-hour

classroom sessions

Block scheduling into 4 course sections, subdivided into

assigned groups with representation from each discipline

Required orientation to database research with JCHS

research librarian

Assignments a mix of individual and group work

Faculty from each discipline available

as consultants

EBP group posters presented to

College community

Conclusions &

Recommendations

Comments from JCHS Student Evaluations

“I really enjoyed this class and learned a lot which has flowed over into

my professional life assisting me to assist other RNs in Evidence-based practice.”

“I learned a lot about how to work with people that are different from myself. I also

learned a lot about researching topics and the research process.

I was dreading this class at first, but in the end I learned a lot.”

Conclusions

Techniques of IPE can be used to facilitate achievement of objectives not related to IPE.

Essential to provide adequate “face time” to facilitate student group

interaction

Faculty must stress importance of group work and roles

of different disciplines

Majority of negative comments on evaluations related to

perceptions of “busy work”

5

4 Evaluation

Course evaluations completed as a QA project

indicate student satisfaction with course, with

means ranging from 3.48 to 4.62

How can IPE course meet needs of

professions using different terms and practices?

evidence-based medicine vs. evidence-based

nursing

population based, patient based, policy based

How can IPE course provide value for

unlicensed, inexperienced OT & PA students and

experienced RN students?

How can IPE course meet competing scheduling

needs?

primarily on campus vs. distance

5 week, 10 week & 15 week schedules

What type of assignments facilitate

OT, PA, NSG students working

together to learn EBP?

Carlion Clinic IP

• ACP Fellowships:

– Emergency medicine

– Orthopedics

– Rural health/Urgent care

– Surgery

Interprofessional Issues

• Teams are dynamic, complex and change

• Roles often overlap

• Authority is negotiated

• Sum > Parts

• Values may differ

• Authority is negotiated , autonomy is negotiated

• Competing goals and motivations

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interprofessional education jchs/vtc/carilion clinic · discuss the impetus of interprofessional...

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