QUIPPED

Queen’s University Inter-Professional Patient-Centred Education Direction

Queen’s University Inter-Professional Patient-Centred Education DirectionJ. Medves, C. Schroder, M. Paterson, S. Verma, T. Broers, C. Chapman, A. O’Riordan, C. Poth, N. Haun

QUIPPED Team: Principal Investigators: Jennifer Medves, RN, PhD; Margo Paterson, OT Reg. (Ont), MSc, PhD; Cori Schroder, MD, MEd, CCFP, FCFP; and Sarita Verma, LLB, MD, CCFP, FCFP; Program Manager: Teresa Broers, MSc; Education Coordinator: Christine Chapman, MEd; Clinical Educator: Anne O’Riordan BSc (OT) Administrative Assistant: Noreen Haun

MethodologyThe primary methodology for QUIPPED is Critical Action Research.

The key attributes of Critical Action Research are that it

• generates knowledge to inform practice, • involves participants in the process, • takes place in a naturalistic setting, • co-creates knowledge for local situations, and • develops cooperative, collaborative, and interactive relationships.

November 2006

In Year One, the QUIPPED project team evaluated several existing inter-professional initiatives in order to assess their effectiveness for increasing awareness and understanding of scopes of practice of different professionals, and improving communication and collaboration. Three examples of the initiatives include:

• Intimate Partner Violence workshop• Core Academic Days for medical residents• Faculty Development Workshop in Loss and Bereavement

Intimate Partner Violence - Pre-licensure• The Intimate Partner Violence (IPV) Workshop is a unique one-day inter-professional workshop for pre-licensure

students that has been taking place at Queen’s University since 1998. In 2005, QUIPPED evaluated its effectiveness. • Approximately 330 participants from Medicine (100 – 2nd year), Nursing (120 – 3rd year), Occupational Therapy (45 –

3rd year, BSc program), Physical Therapy (45 – 3rd year, BSc program), X-Ray Technology (13 –3rd year), and Law (10) attended the workshop.

• Results, all of which were shared with the workshop planners, determined that learners overall found the workshop content useful, but indicated a need for more practical skills and an opportunity to practice these skills.

• As a result, the Intimate Partner Violence (IPV) Half-Day Workshop was developed by QUIPPED, in collaboration with the faculty members who developed the full-day workshop. It was a skills-based interactive follow-up of the full-day inter-professional workshop, offered to 30 students in the winter of 2005. It was developed to test the effectiveness of an interactive approach to teaching IPV issues. The objective of this workshop was to develop the communication and perception skills needed to encourage victims of intimate partner violence to disclose their situations to members of a health care team.

• Results of this half-day workshop were overwhelmingly positive, both from the content-specific perspective of having the opportunity to learn practical skills for IPV, but also from the inter-professional perspective, particularly learning about different scopes of practice and the shared responsibility to encourage disclosure about IPV, as well as how to collaborate with other team members to facilitate IPV disclosure.

Intimate Partner Violence - Pre-licensure• Results from the first Intimate Partner Violence (IPV) Workshop suggested the need to make it less didactic and more

interactive. The ½ day skills based session was one response to that. • An additional response was the inclusion of an interactive session to the full-day workshop in 2006. An inter-

professional case study on IPV was developed and the small group exercise was evaluated by QUIPPED. Preliminary findings suggest the case study was crucial in highlighting the need for effective communication and team work in order to facilitate disclosure by a victim of abuse.

• Qualitative findings revealed that learners overwhelmingly recognized the need to improve inter-professional communication and collaboration for the benefit of the patient and also agreed that there was a good focus on all health care and other professionals during the workshop, which helped to put the patient/client in better perspective. The majority of students also agreed that the inter-professional case study was good for building respect and understanding of what other professionals do.

• Post-workshop reflection suggested the need for better collaboration between the content experts and IPE experts in the planning of the entire event.

Key Findings and Ongoing Challenges of IPE• Through planning and development of a common learning module, IP clinical placements and IP simulation activities,

it has become apparent that IP is not the only domain that requires coordination. We, on the QUIPPED team, have had the opportunity to identify significant overlapping in curricular and clinical placement planning by the various schools in the Faculty of Health Sciences that may benefit from a new vision in health education.

• Faculty members in Health Sciences Programs strive to ensure that learners have opportunities to develop as health care professionals and scientists to provide excellence in health care. Faculty are therefore committed to teaching, service and research. However, research is usually focused on their substantive clinical or discipline specific area, not on teaching. There is a growing understanding that research in teaching is required if we are going to ensure excellence in pedagogy, both inter-professionally and discipline-specific.

• As a result, the vision at Queen’s University for IPE has been broadened to promote scholarship for all health sciences teaching and learning.

Patient-Centred

Care

Vision for an Office of Health Sciences EducationPromoting excellence in teaching and learning through Scholarship and Best Practices

SimulationLaboratory

Clinical Education Centre

Classroom Learning

Clinical Placements

Inter-ProfessionalEducation

Discipline-Specific Professional Practice

Scope of Project – QUIPPED Project Matrix• The vertical lines of the project matrix, below, illustrate the health

care disciplines at Queen’s, including both academic and clinical practice disciplines.

• The many levels of influence for the planned inter-professional learning initiatives are represented in the horizontal lines.

Underlying Value: Improving Patient-Centred Care

Goal: To create an inter-professional educational environment at Queen’s University that enhances the ability of learners, faculty, and health care providers to provide patient-centred care that recognizes the contribution of the health care team within a respectful and collaborative framework.

Objectives:1. To promote and demonstrate the benefits of inter-professional education for collaborative patient-centred practice2. To increase the number of educators prepared to teach from an inter-professional collaborative patient-centred perspective3. To increase the number of health professionals trained for collaborative patient-centred practice before and after entry-to-practice4. To stimulate networking and scholarship regarding best educational approaches for collaborative patient-centred practice5. To facilitate inter-professional collaborative care in both the education and practice settings

Research MeasuresFor pre- and post-licensure educational initiatives, the research instruments combine open and close-ended questions, using two validated measures for the close-ended questions: “The Interdisciplinary Education Perception Scale” (IEPS) by Luecht et al., 1990 and the “Readiness for Interprofessional Learning Scale” (RIPLS) by Parsell and Bligh, 1999. In order for learners to be tracked through multiple initiatives, learners begin all questionnaires by creating a “personal code” that becomes their unique identifier. For faculty development and some pre-licensure initiatives, focus group interviews and key informant interviews are being conducted.

Project ParticipantsThe total number of learners who haveparticipated in one or more of the

activities:Pre-licensure learners• Approximately 420 students, from

three different academic years from Medicine, Nursing, Occupational Therapy, Physical Therapy, and X-Ray participated in various initiatives in year one. This number has already been surpassed in year two.

Post-licensure learners• 90 first-year medical residents were

evaluated in year one during their core academic days. In year two, 70 medical residents took part in an inter-professional communication session with 80 other students from OT, PT, pharmacy, and nursing.

Faculty learners• 60 faculty members participated in

the first Faculty Development workshop in May 2006.

Planning faculty• Over 30 faculty have been involved

in planning or teaching the various IP sessions at Queen’s University.

The three key themes from the qualitative responses for those who agreed suggest thatIPE would:• Offer an opportunity to learn to work together and

better communicate to optimize patient care• Increase knowledge about the scope of practice of

other professionals• Provide an opportunity to socialize which leads to

better cooperation

The following is a representative quotation: Inter-professional education “provides an opportunity to get to know colleagues in other disciplines – creates greater sense of community and will help facilitate better cooperation.”

Year One: A Sample of Activities and Findings

Project Overview

Loss and Bereavement - Faculty Development• This one-day inter-professional workshop was developed by QUIPPED to position faculty, preceptors, and teaching

assistants to provide current and future learners with opportunities to develop knowledge and skills concerning loss and bereavement. One objective was to highlight the diverse perspectives and strengths that various health care professions bring to the issues. Effective pedagogical approaches to teaching about loss and bereavement were also discussed and modeled.

• The workshop limited participation to 60 practitioners and faculty members from medicine, nursing, OT, PT, psychology, social work, and chaplaincy services. It used a small-group format in order to encourage interactive teaching strategies that highlighted the inter-professional issues related to loss and bereavement.

• The planning committee for this workshop was also inter-professional, and included students, consumers, faculty, and QUIPPED staff.

Workshop Survey and Focus Group Findings• Evaluation results were overwhelmingly positive in terms of content about loss and bereavement and practical skills

for addressing it with patients, family members, as well as with themselves (in order to prevent compassion fatigue).• An analysis of data from a survey of participants and a focus group discussion with planning committee members,

indicated that although the workshop was inter-professional in participation, even the small-group sessions did not encourage participants to share loss and bereavement issues from the perspective of their profession. Although the planning group was inter-professional and discussed the inter-professional issues that needed to be highlighted, there was a tendency for pairs of facilitators to revert back to their area of expertise and their uni-professional perspectives when they developed their session.

• It highlighted the need to integrate specific inter-professional objectives and content into sessions, and reinforced the need for inter-professional teams of planners/presenters to work together throughout the entire session development, rather than sub-divide development responsibilities to individuals.

• Faculty development and appropriate preparation is absolutely crucial before implementing IPE if one hopes to enhance the ability to deliver IPE which translates into collaborative inter-professional care.

Core Academic Days - Post-licensure• Core Academic Days are required educational sessions for all first-year medical residents at Queen’s, offering topics

that include Communication Skills, Professionalism, Ethics, and Health Advocacy. Although this was not inter-professional, it was evaluated by QUIPPED with a view to making it inter-professional in year two (see follow-up).

• The QUIPPED team conducted a survey of 90 medical residents to evaluate their attitudes towards inter-professionalism and willingness to include participation by students from other health science degrees in specific sessions of the Core Academic Days.

• There was overwhelming agreement that health care professionals need to collaborate in the workplace (98%). • However, responses regarding whether its beneficial to learn together with students of other professions, garnered an

almost 50% split in agreement.

The three key themes from the qualitative responses for those who disagreed suggest

that:• IPE is better learnt in hospital or clinic setting

than in a classroom• Students need to understand one’s own

professional responsibilities before trying tounderstand those of other professionals.

• IPE takes time away from valuable uni-professional learning

The following is representative quotation: “There would simply be too many people in class. We have to fully appreciate/understand our own professional responsibilities before embarking on understanding those of other professions.”

• The results indicate that first-year medical residents do not embrace the concept that learning together would create more effective team work. This may point to the need to start IPE earlier in the health science education of students since stereotypes develop early.

• Since additional research suggests that IPE should be done at various stages, the Post-Graduate Dean who coordinates the academic days is still committed to introducing the concept of IPE to post-licensure learners in year two (see follow-up).

Year Two: Reviewing Findings, Modifying Activities, and Learning New Lessons

The Steering Committee, composed of students, faculty, and consumers, meets bi-monthly.

COMPETENCIESProfessional – Expert – Scholar – Manager – Communicator – Collaborator – Advocate

An inter-professional group of students and faculty worked together at the Community Outreach Day.

Certificate Program in Inter-Professional Teaching and Learning - Faculty Development• The lessons learned from the Loss and Bereavement Workshop are informing the development of a Certificate Program

in Inter-Professional Teaching and Learning for educators in the Faculty of Health Sciences at Queen’s University. It aims to develop a group of educators who are prepared to teach to inter-professional groups of students or from a more inter-professional perspective.

• Through the development process of this program, it is clear that requiring faculty to work in inter-professional teams for session development is not without major challenges. In particular, for some, it is a challenge to move between different teams (e.g. from a clinical team to an educational team) and work equally towards the goals for both teams.

• It is also a challenge for some, despite a commitment to IPE, to look beyond one’s uni-professional responsibilities and consider those of other health care professionals. These challenges encourage us to explore creative solutions as we plan faculty development.

Core Academic Days - Post-licensure• The two-hour communication skills session that is part of the Core Academic

Days was developed into an inter-professional activity, with 70 first-year medical residents along with 80 invited OTs, PTs, pharmacy residents, and Nursing students participating.

• The 150 students were divided into 16 small groups, facilitated by an inter-professional team of faculty members. The two-hour session included small group discussion as well as a case study discussion from a video.

• Results of the inter-professional session were positive and highlighted the recognition of the importance of communication in health care team work and patient-centred care. An additional benefit of the activity itself was that learners recognized, as one student said, that “other professions have more respect for us then I first thought”. This element of inter-professional education is critical.

• Overall, all participants agreed that “team-working skills are essential for all health care learners” and that “patients would ultimately benefit if health care learners worked together to solve patient problems”.

Inter-professional small group work during the Core Academic Days