Interprofessional Education JCHS/VTC/Carilion Clinic · IPE 509-Research & Evidence-based Practice...
Transcript of Interprofessional Education JCHS/VTC/Carilion Clinic · IPE 509-Research & Evidence-based Practice...
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
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Disclosure
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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
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Definition IPE• “Occasions when two or more professions
learn with, from and about each other to improve collaboration and the quality of care.”
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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
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• 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
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– Values/ethics for interprofessional practice
– Roles/responsibilitiesfor collaborative practice
– Interprofessional communication
– Interprofessional Teamwork and team-based care
Traditional Education
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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”
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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?
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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
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
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
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
Jan. 22
Jan. 29
Feb. 5
Feb. 12 Feeding America Open
Feb. 19 Open Feeding America
Block IV
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
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
Feeding America Market
Open
Feeding America Market
Open
Feeding America Market
Open
Lab 1
Nutrition Lecture (LeClair)
Open
Nutrition Lecture (LeClair)
Open
Lab 1
Lab 2/Community Meals
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
Lab 2/Community Meals
Communication & SBAR/CUS (TAG) Feeding America Market
Nutrition Lecture (LeClair)
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)
Nutrition Lecture (LeClair)
Open
Open
Open
Open
Lab 1
Lab 2/Community Meals
Intro to Culinary Track Lecture (M106)
Lab 1
Lab 2/Community Meals
Feeding America Market
Culinary Track Wrap-Up (M106)
Open
Feeding America Market
Feeding America Market
Feeding America Market
Nutrition Lecture (LeClair)
Lab 2/Community Meals
Lab 1
Nutrition Lecture (LeClair)
Open
Feeding America Market
Lab 2/Community Meals
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 5,4.0Cohort 6,3.8
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 6,3.5Cohort 3,3.4
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%
Excellent Very Good Good
60% 80%
Fair Poor
Team Skill/Item: Recognize when your team is not functioningwell.
Medicine Program
Nursing Program
Physician Assistant
0% 20% 40%
Excellent Very Good Good
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
Evaluation: Survey of Programs
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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
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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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Comments/Questions/Discussions