Sharon Decker, RN, Ph.D., ANEF, FAANProfessor and Endowed Chair

Director TTUHSC QEP Director, The F. Marie Hall SimLife Center

Interprofessional Learning: Development, Implementing and Evaluating a Program

� Discuss the state of the science related to Interprofessional Education (IPE).

� Discuss the role of simulation in interprofessional education.

Current learning environments lacked sympathy for interprofessional education and its concomitant of learning and working together.

(1993)

2000 – Institute of Medicine (IOM)� Most care delivered is done by teams of people, yet training remains focused

2003 – IOM� Core Competency – “Work in interdisciplinary teams”

2011 – IOM� The Future of Nursing – Transform education

2011 Core Competenciesfor Interprofessional Collaborative Practice

WHO, 2010 definition of interpfrofessional education and collaborative practice

two of more professionals, work together with patient and family

� Patient Safety and Quality of Care� Teamwork impacts patient care

� Effective teamwork linked to:

� positive patient outcomes

� increase in staff satisfaction

� No one can learn “everything”

� Demands shared accountability

� Complexity of care

� Computer technology

� Collaboration

� Shared accountability

� Coordination of care (patient-centered)

� Acquire and use knowledge

� Theory and practice related to teamwork

� Research support R/T Function as a team-member

� Accreditation

Include Interprofessional (Interdisciplinary)Team Work

� Clinical Laboratory Sciences � Graduate Medical Education � Collegiate Nursing Education � Pharmaceutical Education � Health-System Pharmacists � Physician Assistant � Occupational Therapy� Audiology� Physical Therapy� Athletic Trainer

MultidisciplinaryDisciplines participate in an independent, discipline-specific team/s

InterdisciplinaryMultiple disciplines utilizing collaborative communication rather then shared communication.

Interprofessionalindicates a group of individuals from different disciplines working and communicating (shared) with each other.

TransdisciplinaryShared knowledge, skills, and responsibilities across traditional disciplinary boundaries.

Interprofessional Education (IPE)

“when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (WHO, 2010).

Teamwork

The interaction and relationships between two or more health professional who work interdependently to provide safe, quality patient care.

Goals of Interprofessional Education (IPE)

To improve health, health care and education of the health professions through the use of continuous improvement methods.

“All health professional should be educated to deliver patient-centered care as members of an interdisciplinary(interprofessional) team…”

IOM, 2003a, pg.3

� Most health care delivery by teams, yet education & training is focused on the individual

IOM (2001)

� Is simulation an appropriate pedagogy to teach and assess IP competencies?

� Recognized as a pedagogy to teach and assess

� Professional Organizations

� Interprofessional – international organizations –SSH, INACSL

� National Organizations / Endeavors

� Unprepared and unenthusiastic faculty

� Philosophical difference

� Academic policy differences

� Reward structure

� Differences in recognition

� Turfism

� Financial structures

� Sustainability

� Over-crowded curricula (Time)

� Academic calendars

� Different points of entry

� Various geographic locations

� Variations in learner age, education levels, and clinical

� Language and/or communication

� Varying professional practice acts

� Varying professional accreditation

� Scheduling

� Complete SWOT

� How can we accomplish this?� What activities?

� Who do you need to partner with?

When should IPE be initiated?

What type of methodologies could you use?

What types of experiences could be integrated into the process?

Are you ready – what KSA’s are needed ?

� If faculty across disciplines teach together would this strategy promote collaboration across disciplines?

� But, faculty have not been trained through Interprofessional approaches (including simulation) and therefore, may have difficulty to teach that way.

IOM , 2001, 2004

� Learning through simulation is enhanced through:

� Feedback

� Repetitive practice

� Total curriculum integration

� Learning that increases in difficulty

� Multiple learning strategies

How does IPE “fit”?

� Commitment from the institution

� Appropriate resources (including funding)

� Faculty-Buy-In

� Competent and trained educators

� Curricular Institutionalization

� So, what actions would you recommend r/t integrating interprofessional simulations?

� Topics, concepts,

� Matching of learners

� What are the knowledge, skills, and attitudes related to

� Scenario Development

� What scenarios

� Debriefing

� How do we integrate into our curricula?

� What should be learned and when?

� How do we include “others” – how to make connections?

� How can we overcome scheduling issues?

It will not be magical and will be achieved only through change in our current system of education.

How will outcomes be measured?

� Objectives � 2 to 3

� Roles� Required active engagement

� Fidelity

� Problem-solving/Decision-making� Challenge but be attainable

� Support� Cueing

� Questioning

� Clarify the objectives of the debrief specific to team performance

� Maintain the discussion “team-centered”

� Vary the facilitation to meet the needs of the various team members

� Allow team members to speak. Don’t interrupt.

� Promote team self-discovery

� Use Socratic Questioning to promote discussion

� Redirect questions back to the team. Encourage team members to discover their own answers.

� Involve quiet team members

� Encourage team members to talk among themselves

� Ask the team to discuss factors that promoted or impeded their success

� Promote transfer of the activity’s objectives to patient care

� Use active listening

� Include video strategically to stimulate discussion

� Briefly summarize the debrief highlighting the objectives

� (McDonnell, Jobe, & Dismukes, 1997)

� Different Technique – and/or combinations

National Patient Safety Education Framework - Australiahttp://www.agedcarecrisis.com

Health Professions Education Collaborative http://www.ihi.org/IHI/Topics/HealthProfessionsEducationhttp://www.improvementskills.org/

University of MinnesotaUniversity of Washington “cultural change”Medical University of South CarolinaSaint Louis UniversityUniversity of California, San FranciscoEast Carolina University

Simulation Training, Research, and Technology Utilization System Clinical Performance Pyramid.

Cognitive Basis

Requires Knowledge, Recognition, Assessment, Prioritization, & Application of Experience & Judgment.

Overview of the Simulation Module for Assessment of Resident Targeted Event Responses (SMARTER) processes for training teamwork in EM.

Shapiro, M. J., Gardner, R., Godwin, S. A., Jay, G. D., Lindquist, D. G., Salisbury, M. L., et al. (2008). Defining team performance for simulation-based training: methodology, metrics, and opportunities for emergency medicine. Academic Emergency Medicine, 15, 1088-1097.

Overview of event-based approach to training (EBAT) process for teamwork training in emergency medicine (EM). KSA = knowledge, skills, and attitudes.

Rosen, M. A., Salas, E., Wu, T. S., Salvatore, S., Lazzara, E. H., Lyons, R., et al. (2008). Promoting teamwork: An event-based approach to simulation-based teamwork training for emergency medicine residents. Academic Emergency Medicine, 15, 1190-1198.

The result has been learning environments that lack sympathy for interprofessional education and its concomitant of learning and working together.

Identify critical competencies (KSA)

Emphasize teamwork over tasks

Desired outcomes should guide the process

Provide guided active learning

Mirror the work environment (simulation)

Feedback – relevant and timely

Debrief

Evaluate the outcomes

Reinforce

� Health professions tend to forget -

they are one of many serving patients.

� Cultural change – in small step –

understand and communication shared roles and responsibilities among health providers

Mychaskiw G. COM accreditation:

The Flexner Report revisited.

J Am Osteopath Assoc. 2007;107~7!:246–247.

� Sites to assist

� TeamSTEPPS

� Training Guide: Using Simulation in TeamSTEPPSTraining

http://www.ahrq.gov/teamsteppstools/simulation/index.html

� TeamSTEPPS Rapid Response System

http://www.ahrq.gov/teamsteppstools/rrs/rrsspecscen.htm

� QSEN

http://www.qsen.org/view_strategies.php