p iloting an interprofessional e ducation w orkshop: teaching others palliative care...

Piloting an Interprofessional Education Workshop:

Teaching others palliative care communication skills

Neha J. Darrah, MDDiane Hadley, PharmD BCACP

Amy Corcoran MD CMD FAAHPM

Geriatrics Grand RoundsApril 4, 2014

Disclosures

• We have no relevant financial disclosures; however, a portion of this project was supported by funds from the Health Resources and Services Administration (HRSA) under Geriatric Academic Career Award K01HP20493 and the GEC grant UB4HP19214.

• The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the DHHS, HRSA, BHPR, or the U.S.

Learning Objectives

To describe the main objective for an effective interprofessional, education workshop

To list the essential elements for a successful interprofessional, education workshop

Overview• IPE BACKGROUND

• IPE and palliative care

• Workshop history

• Workshop description

• Results

• Study limitations

• Future implications

What is IPE?

Interprofessional Education (IPE)

• Defined as students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010)

Goal of IPE

• Prepare health professional students for deliberately working together

• Provide high quality, patient-centered care

Barriers to IPE

Logistics

Professional hierarchies/stereotypes

Institutional resistance

Strategies for IPE

Classroom didactics

Practice based interventions

Experiential Strategies

• Role play

• Simulation exercises

Interprofessional Education Collborative (IPEC)

• Organizations involved– American Association of Colleges of Nursing– American Association of College of Osteopathic

Medicine– Association of schools of Public Health– American Association of Colleges of Pharmacy– American Dental Education Association – Association of American Medical Colleges

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed April 1, 2014.

Interprofessional Collaborative Practice Domains from Interprofessional Education Collaborative

(IPEC) 2011

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed April 1, 2014.

Overview• IPE Background

• IPE AND PALLIATIVE CARE



• Results



Why is IPE Relevant to Palliative Care?

Palliative care is specialized medical care for people with serious illnesses. Palliative care is provided by a TEAM of doctors, nurses, and other specialists (social work, chaplaincy, pharmacy) who work together with a patient’s other doctors to provide an extra layer of support.

Past IPE Palliative Care Workshops

Palliative care: A suitable setting for undergraduate interprofessional education

• Description: Interprofessional student workshops with family care providers

• Recruited Learners: Medical, nursing, social work, physiotherapy, and occupational therapy students

• Results: Students value and enjoy opportunity to work together and find the experience moving, informative, and interesting

Wee B, Hillier R, Coles C, et al. Palliative care: a suitable setting for undergraduate interprofessional education. Palliat Med. 2001 Nov; 15 (6) 487-92.


Using simulated patients in a multiprofessional communication skills programme: reflections from the

programme facilitators

• Description: Multiprofessional, 4-day communication skills program with standardized patients

• Recruited learners: Predominantly nursing with some physiotherapist, dieticians, and radiographers

• Results: No formal evaluation but feedback was positiveDonovan T, Hutchinson T, and Kelly A. Using simulated patients in a

multiprofessional communication skills programme: reflections from the programme facilitators. Eur J Cancer Care. 2003 Jun; 12(2): 123-8


Enhancing interprofessional education in end-of-life care: An interdisciplinary exploration of death and dying in literature

• Description: 12-week elective focused on reflections of dying depicted in the literature

• Recruited learners: medical, nursing, bachelor of health science, and chaplaincy students

• Results: All students met learning objectives based on qualitative analysis of written assignments and highly rated by participants

Brajtman S, Hall P, and Barnes P. Enhancing interprofessional education in end-of-life care: an interdisciplinary exploration of death and dying in literature. J

Palliat Care. 2009 Summer; 25(2): 125-31


Interdisciplinary education in end-of-life care: Creating new opportunities for social work, nursing, and clinical pastoral

education students

• Description: Interprofessional case simulations with volunteer actors

• Recruited learners: Social work, nursing, and chaplain students

• Results: All students found it valuable and most cohorts demonstrated significant improvement in pre-determined outcomes

Forrest C and Derrick C. Interdisciplinary education in end-of-life care: creating new opportunities for social work, nursing, and clinical pastoral education

students. J Soc Work End Life Palliat Care. 2010; 6(1-2): 91-116.


Using Online Learning and Interactive Simulation To Teach Spiritual and Cultural Aspects of Palliative Care to

Interprofessional Students

• Description: Combined online learning with interactive simulation

• Recruited learners: Social work, nursing, medicine, and chaplain

• Results: Successfully met five learning objectives and highly rated by participants

Ellman MS, Schulman-Green D, Bratt L, et al. Using Online Learning and Interactive Simulation to Teach Spiritual and Cultural Aspects of Palliative Care to

Interprofessional Students. J Palliat Med. 2012; 15(11); 1240-

Past IPE Palliative Care WorkshopsEffect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients with

Serious Illness: A Randomized Trial

• Description: Randomized participants to 8-session, simulation-based, communication skills intervention vs usual education

• Recruited learners: Medicine, nurse practitioners

• Results: Simulation-based communication training did NOT improve quality of communication but was associated with small increase in patients’ depressive symptoms

Curtis JR, Back AL Ford DW et al. Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication with Patients with Serious Illness: A Randomized Trial. JAMA. 2013 Dec 4; 310 (21): 2271-81

Overall Conclusions

• IPE is generally well received by students

• Number of disciplines in workshops ranged from two to five

• Simulation-based training did NOT translate into improved quality of communication



• WORKSHOP HISTORY


• Results



Workshop History

2011-2012

• Piloted first interprofessional, communication workshop with advanced practice nursing students and physician fellows

• Developed as three-station palliative care Observed Structured Clinical Examination (OSCEs)

Corcoran AM, Lysaght S, Lamarra D, Ersek M. Pilot test of a three-station palliative care observed structured clinical examination for multidisciplinary trainees.

J Nurs Educ. 2013 May;52(5):294-8.

http://www.ncbi.nlm.nih.gov/pubmed/23550548

http://www.ncbi.nlm.nih.gov/pubmed/23550548

Workshop History2012-2013

• Expanded workshop to include learners from nursing (undergraduate and advanced practice), medicine (fellows), physical therapy, occupational therapy, pharmacy, chaplaincy, and social work (masters students)

• Recruited learners from BOTH University of Pennsylvania and University of Sciences

• Demonstrated statistically significant improvement in learner preparedness for interprofessional team and communication skills

Lessons Learned from Past Workshops

Learners appreciated the opportunity to work in interdisciplinary teams

Rated the topic as good to excellent

Learners need to be matched based on training level• i.e. Physician fellows are not well matched with

undergraduate nursing students




• WORKSHOP DESCRIPTION

• Results



Workshop Goals

Introduce palliative care communication and interprofessional team skills to learners

Determine effectiveness of interprofessional workshop on improving these self-reported skills

Recruited Learners

University of Pennsylvania• Medicine (fourth year medical students)• Social Work• Nursing (undergraduate, advanced practice)• Chaplaincy

University of Sciences• Physical therapy• Occupational therapy• Pharmacy

Key Components of WorkshopWorkshop Basics• Pre-workshop preparation• Two-hour simulation-based workshops with STANDARDIZED

PATIENTS• Four sessions offered over two days in October

Participants and Observers• Nursing and social work students were assigned to be either

participants or observers at the discretion of their faculty• All participants were assigned to pre-determined

interprofessional teams

Recruited diverse, interprofessional faculty facilitators

Case DescriptionPatient is a 72 y/o female with dementia admitted from a nursing home to the ICU three days ago for aspiration pneumonia. She is now doing better and transferred to the floor.

At baseline, she requires assistance in her all of her ADLs. She is noted to have signs of aspiration

Goal of meeting is to discuss goals of care (resuscitation, discharge plan) with patient’s daughter or son

Workshop Schedule4:00-4:15

Orientation

4:15-5:15

Participant group 1

meets with SP 1

Participant group 2

meets with SP 2

Participant group 3

meets with SP 3

Participant group 4

meets with SP 4

Observer group 1

observes

Observer group 2

observers5:15-5:45

Debrief

Evaluations

Participants were given both pre and post-workshop evaluations

Asked participants to rate their confidence in multiple domains on 5 point Likert scale

• Communication Skills

• Interprofessional team skills (Based on IPEC competencies)



• Workshop History

• Workshop Description

• RESULTS



Learner Assignments

Recruited 109 learners

73 assigned to participant

group

Divided into 16 groups of 4-5

each

36 assigned to observer group

Divided into 7 groups of 5-6

each

Learner DemographicsParticipant Observer Total

Sex

Female 57 (78%) 35 (97%) 92 (84%)

Male 16 (22%) 1 (3%) 17 (16%)

Race

Caucasian 43 (59%) 29 (81%) 72 (66%)

Asian 20 (27%) 4 (10%) 24 (22%)

African American 5 (7%) 3 (8%) 8 (7%)

Hispanic 2 (3%) 0 (0%) 2 (2%)

Mixed heritage 1 (1%) 0 (0%) 1 (1%)

No answer 2 (3%) 0 (0%) 2 (2%)

Age (mean) 27 28

Learner DemographicsParticipant Observer Total

Profession

Nursing 17 (23%) 34 (94%) 51 (47%)

Advanced 16 (22%) 28 (78%) 44 (40%)

Undergrad 1 (1%) 6 (17%) 7 (6%)

PT 15 (21%) 0 (0%) 15 (14%)

Pharmacy 12 (16%) 0 (0%) 12 (11%)

Medicine 11 (15%) 0 (0%) 11 (10%)

Social Work 8 (11%) 2 (5%) 10 (9%)

OT 6 (8 %) 0 (0%) 6 (6%)

Chaplaincy 4 (5%) 0 (0%) 4 (4%)

Years Training (mean) 3.28 (0-13) 3.66 (0-15)

Importance of IPE Not at all (1-2)

Somewhat (3)

Very (4-5)

How important is communicating with other health care professionals for you to be effective in your profession? Participant 70 (96%)

Observer 1 (3%) 34 (94%)

How committed are you to work on interprofessional communication skills during your training? Participant 1 (1%) 1 (1%) 68 (93%)

Observer 1 (3%) 34 (94%)

Prior ExperienceYes No Don’t Know Missing

Work with individuals of other professions to create plan of care

Didactic 68 (62%) 29 (27%) 5 (5%) 7 (6%)

Bedside 67 (62%) 31 (28%) 2 (2%) 9 (8%)

Apply knowledge of my profession to appropriately assess and address health care needs of a patient Didactic 76 (70%) 15 (14%) 11 (10%) 7 (6%)

Bedside 55 (51%) 34 (31%) 8 (7%) 12 (11)

Explain the role other professionals play in an interprofessional team

Didactic 67 (62%) 29 (27%) 8 (7%) 5 (5%)

Bedside 52 (48%) 39 (36%) 5 (5%) 13 (12%)

Prior ExperienceYes No Don’t Know Missing

Communicate with other healthcare professions, patients and caregivers

Didactic 63 (58%) 31 (28%) 8 (7%) 7 (6%)

Bedside 64 (59%) 32 (29%) 2 (2%) 11 (10%)

Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care Didactic 60 (55%) 29 (27%) 13 (12%) 7 (6%)

Bedside 49 (45%) 39 (36%) 11 (10%) 10 (9%)

Facilitate and/or participate in a family conference

Didactic 43 (39%) 46 (42%) 11 (10%) 9 (8%)

Bedside 40 (37%) 52 (48%) 6 (6%) 11 (10%)

Comparison of Pre and Post-Workshop Evaluations

Pre-Workshop Mean Score

Post-Workshop Mean Score

Sig. (2-tailed)

Work with individuals of other professions to create plan of care

Participant 3.60 4.11 0.000

Observer 3.83 4.00 0.226

Apply knowledge of my profession to appropriately assess and address health care needs of a patient Participant 3.55 4.04 0.000

Observer 3.91 4.06 0.282

Explain the role other professionals play in an interprofessional team


Observer 3.77 4.17 0.017

Comparison of Pre and Post-Workshop Evaluations

Pre-Workshop Mean Score

Post-Workshop Mean Score

Sig. (2-tailed)

Communicate with other healthcare professions, patients and caregivers


Observer 3.69 4.14 0.014

Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care Participant 3.48 4.08 0.000

Observer 3.46 4.09 0.002

Facilitate and/or participate in a family conference


Observer 3.31 3.89 0.001

Curriculum/Workshop ContentPoor-Fair(1-2)

Good (3)

Very good – Excellent (4-5)

Relevance of topic content to my discipline

4 (4%) 10 (9%) 92 (84%)

Utility of pre-reading 9 (8%) 19 (17%) 77 (71%)

Utility of pre-workshop video 23 (21%) 22 (20%) 55 (50%)

Utility of pre-workshop profession specific lecture

15 (14%) 20 (18%) 62 (57%)

Workshop SessionsPoor-Fair(1-2)

Good (3)


Usefulness of small group orientation

14 (13%) 23 (21%) 69 (63%)

Usefulness of communication exercise with standardized surrogates

1 (1%) 6 (6%) 98 (90%)

Usefulness of SPs 1 (1%) 3 (3%) 101 (93%)

Effectiveness of small group faculty facilitators

2 (2%) 4 (4%) 100 (92%)

Usefulness of post exercise debriefing

1 (1%) 4 (4%) 101 (93%)

Overall EvaluationPoor-Fair(1-2)

Good (3)


Overall, how would you rate the educational quality of the workshop?

Participant 1 (1%) 5 (7%) 65 (89%)

Observer 6 (17%) 28 (81%)

Yes No Not sure

Would you be interested in participating in a follow-up session to practice family meetings? Participant 60 (82%) 4 (5%) 8 (11%)

Observer 26 (72%) 5 (14%) 5 (14%)

Overall ConclusionsPre vs Post Workshop Assessments• Participant Group: Significantly more confident in ALL

domains after the workshop• Observer Group: Significantly more confident in most

domains after the workshop

Majority of participants rated the workshop as very good to excellent

Majority of participants would be interested in participating in another workshop





• Results

• STUDY LIMITATIONS

• Future Directions

Study Limitations

Variability in student representation

Evaluations Used

• Used non-validated survey tool

• Evaluation of effectiveness was limited to students’ self-reports and did not assess higher level learning outcomes as acquisition of knowledge or behavior change





• Results

• Study Limitations

• FUTURE DIRECTIONS

Future Directions

Workshop Structure• Offer workshop multiple times during the year• Offer workshop multiple times for the same group of

learners

Evaluations• Use validated survey tool• Create OSCE for learners to test behavior changes

Thank you!Dr. MaryAnn Foricea Dr. Mary ErsekDr. Cathy Poon Eunhae KimDr. Christine Bradway Dr. Zvi GellisDr. Lora Packel Dr. Varleisha GibbsDr. Claudia Pravanta Dr. Valerie CotterDr. Carrie Ann Doherty Denise LaMarraJohn Seman

QUESTIONS?

p iloting an interprofessional e ducation w orkshop: teaching others palliative care...

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