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DEFINING NEW FIELDS: INFORMATICS AS INTERDISCIPLINARY EDUCATION

Jesús Ibarra, MD, MMEd, MS Doctoral Student

October 3, 2012

School of Biomedical Informatics

2 Biography

MEDICAL DOCTOR • 1979 - 1986

PEDIATRICIAN • 1986 - 1990

MASTER OF MEDICAL EDUCATION • 2001 - 2005

DOCTORAL STUDENT HEALTH INFORMATICS • 2009 – current

Practice in the field of transdisciplinary

knowledge acquisition and health care

Leader

Researcher

Physician

University teacher

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Physician

B. S. Biomedical Engineering

(2003)

B.S. Nutrition and well being

(2004)

B.S. Nursing (2006)

B. A. Management. Health Syst.

(2007)

Dentistry (2008)

MdPhD (2008)

M.D. (1976)

Patient, family &

community

Example: Development of an interdisciplinary health care team

5 Why is this important to Biomedical Informatics?

“Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, driven by efforts to improve human health.”

“Faculty should design BMI graduate programs so that every student works collaboratively:

Team effectively with partners within and across disciplines”

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Goals 6

To understand changes in fields as they integrate

To establish differences in multi, inter and trans disciplinary fields

To understand how integrated teams function and means to improve them

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Outline

1.  Education and teams formed of multiple disciplines

2.  How disciplines integrate

3.  Team processes including barriers and promoters

4.  Conceptual framework

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8 Real life situations are complex and require teams educated across disciplines

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9 The case for transdisciplinary team work • Growing emphasis in health research,

services, education and policy (Choi, 2007)

•  Funding agencies call for research involving multiple disciplines (NIH)

• Hospitals establish multiple disciplinary teams to provide care (Kessler, 2006)

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Education occurs in silos

MDs Nurses Respiratory Therapists Managers

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Problem

•  There is a mismatch between education and practice.

• Students learn their professional domains in a mode of silos, but are expected to approach complex problems in real world in a collaborative transdisciplinary fashion.

• Education is being pursued with disciplines apart from each other.

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Problem of terminology

• Common terms: multidisciplinary, interdisciplinary, transdisciplinary (Grossman, 2005)

• Ambiguous definition, interchangeable use (Whitfield, 2004)

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Levels of Integration

•  Terms not equal

• Different terms for different integration

• Progression

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A comparison (Choi, 2006)

Multidisciplinary Interdisciplinary Transdisciplinary Keyword Additive Interactive Holistic Mathematical example

2+2 = 4 2+2=5 2+2=yellow

Food example a salad bowl a melting pot a cake

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Integration Ladder (Harden, 2000)

1.  Isolation

2.  Awareness

3.  Harmonisation

4.  Nesting

5.  Temporal coordination

6.  Sharing

7.  Correlation

8.  Complementary programme

9.  Multi-disciplinary

10.  Inter-disciplinary

11.  Trans-disciplinary

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Isolation

•  Departments or subject specialists organize their teaching without consideration of other subjects or disciplines

•  Each discipline looks, from the perspective of own discipline, in terms of areas to be covered, depth of coverage, sequence and timing.

•  No attention is paid to other, or related contributing subjects

•  Each subject is seen as an entity in itself. •  Traditional curriculum

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(Harden, 2000)

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Integration Ladder (Harden, 2000)

1.  Isolation

2.  Awareness

3.  Harmonisation

4.  Nesting

5.  Temporal coordination

6.  Sharing

7.  Correlation

8.  Complementary programme

9.  Multi-disciplinary

10.  Inter-disciplinary

11.  Trans-disciplinary

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What happens steps 2-8

•  Faculty become aware of the contents from other disciplines

•  Faculty harmonize the contents of the courses

•  There appear nests of contents within the disciplines, coming from other disciplines

•  There is coordination in time

•  There is sharing of contents

•  There is correlation of contents

• Programs become complementary

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Multidisciplinarity

• Draws on knowledge from different disciplines but stays within the boundaries of those fields

(NSCERC, 2004)

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Interdisciplinarity

• Analyzes, synthesizes and harmonizes links between disciplines into a coordinated and coherent whole

(Choi, 2006)

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Transdisciplinarity

•  Integrates the natural, social, and health sciences in a humanities context, and in so doing transcends each of their traditional boundaries

(Soskolne, 2000)

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Isolation Transdisciplinarity

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Transdisciplinary Education

Shifts in:

• Goals

•  Identity

• Products

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So where is informatics?

•  Interdisciplinary

• What does that mean? ▫  New identity

▫  New problems to solve

▫  New language

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Moving from education to teams

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Teams not Groups

•  A small number of consistent people committed to a relevant shared purpose,

•  With common performance goals,

•  Complementary and overlapping skills, and

•  A common approach to their work

(Loimer and Manion, 1996)

26 Challenge (Barr, 2005) Some factors which involve relations among professions and affect service to clients

Poor communications

Proliferating professions

Coping with complexity

Collaborating more widely Resolving rivalry Improving

quality

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Poor communications (Pietroni, 1992)

Each profession

• develops own language, only insiders know

•  uses different words with same meaning

▫  cognitive risks

•  uses a range of languages

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28 Bridging disciplines requires reconciling differences in •  basic assumptions about the nature of the

world,

•  beliefs about what constitutes an interesting question for study,

• methods for generating and analyzing information,

•  and rules about what constitutes evidence or "proof".

(Seipel, 2009)

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Conceptual framework

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Dimensions of a team

•  Identification

•  Formation

•  Adaptation

(Lei, 2007)

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Identification

•  Team members do a self-assessment to know if they are ready for teamwork, and to approach the problem,

•  They seek information,

•  Set their personal goals,

•  Do strategic planning, and

•  Do self-monitoring.

(Lei, 2007)

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Formation •  Team members set goals for the team,

•  A leadership is established,

•  Roles are identified,

•  Trust is built,

•  Members give each other support, •  There is feedback from peers, clients or experts,

•  Communication and collaboration tools are used,

•  Information tools are incorporated,

•  Cognitive and knowledge creation tools are used,

•  There is awareness, and

•  There is appreciation for each other. (Lei, 2007)

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Adaptation

•  Goals are aligned,

•  A shared mental model is built,

•  There is understanding, creativity, and innovation.

(Lei, 2007)

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Identification 1.  Self Assessment 2.  Information Seeking 3.  Personal Goal Setting 4.  Strategic Planning 5.  Self-Monitoring

Formation 1.  Team Goal Setting 2.  Leadership 3.  Role Identification 4.  Trust 5.  Interdependence 6.  Social Support 7.  Peer Feedback 8.  Client Feedback 9.  Expert Feedback 10. Communication &

Collaboration Tools 11. Information Tools 12. Cognitive &

Knowledge Creation Tools

13. Awareness 14. Appreciation

Adaptation 1.  Goal Alignment 2.  Shared Mental Model 3.  Understanding 4.  Creativity 5.  Innovation

Collective-Efficacy Team-Outcome

Indi

vidu

al L

earn

er

Tran

s-di

scip

linar

y Te

am

Teacher

Self-Efficacy Individual-Process

Dimensions of a team

Adapted from Lei, 2007

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Strategies to enhance teamwork

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T •  Team

E •  Enthusiasm

A •  Accessibility

M •  Motivation

W •  Workplace

O •  Objectives

R •  Role

K •  Kinship

(Choi 2007)

36 Promoters to enhance teamwork

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(Choi, 2007)

Strategy Promoting the promoters (P)

Team P1. good selection of team members P2. good team leaders P3. maturity and flexibility of team members

Enthusiasm P4. personal commitment of team members

Accessibility P5. physical proximity of team members P6. the Internet and email as a supporting platform

Motivation P7. incentives

Workplace P8. institutional support and changes in the workplace

Objectives P9. a common goal and shared vision

Role P10. clarity and rotation of roles

Kinship P11. communication among team members P12. constructive comment among team members

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Dealing with barriers Strategy Barring the barriers (B)

Team B1. avoid poor selection of disciplines and team members B2. avoid poor process of team functioning

Enthusiasm B3. avoid lack of proper measures to evaluate success of interdisciplinary work B4. avoid lack of guidelines for multiple authorship in research publications

Accessibility B5. avoid language problems Motivation B6. avoid insufficient time for the project

B7. avoid insufficient funding for the project Workplace B8. avoid institutional constraint

Objectives B9. avoid discipline conflicts

Role B10. avoid team conflicts

Kinship B11. avoid lack of communication between disciplines B12. avoid unequal power among disciplines

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(Choi, 2007)

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Summary

• Understanding multiple discipline teams is relevant for biomedical informaticians

• Some issues of learning in transdisciplinary teams have been identified

• A baseline understanding of how transdisciplinary teams function has been established

• Promoters and detractors for teamwork have been discussed

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Take home message

•  Informaticians are trained in an integrated way, but they are called to work in teams of professionals that have been trained in silos

•  There are strategies to overcome obstacles and barriers

•  There is a conceptual framework that can help us to understand teamwork

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Acknowledgements •  Amy Franklin, PhD

•  James P. Turley, RN, PhD

•  Juliana Brixley , RN, PhD

•  Craig W. Johnson, PhD

•  Joan Engebretson DrPH, AHN-BC, RN

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Questions?