Moving toward the Development of Interprofessional E-Cases

N. Posel, S. Faremo & D. Fleiszer

Good things, when short, are twice as good. 

Baltasar Gracian, The Art of Worldly Wisdom

Presentation Overview

1.Interprofessionalism in healthcare2.Relevant learning theories and the

development of interprofessional e-cases

3.Design features of the e-case model currently in development at McGill university

4.The process of utilization

Interprofessional Practice

“The healthcare system is in need of reform…...improvements will come when health care providers work more effectively in teams and when they have the competencies to practice in increasingly accountable and technological environments.” (Stephenson, 2002)

Interprofessionalism in Healthcare

Sometimes…….

Gaps and Overlaps

Gaps:

Can impact on safety and quality of care

Overlaps or redundancies:

Can impact on access, efficient use of resources and consistencies among professionals

Interprofessionalism in Healthcare

Interprofessional Practice

“Health professionals must work interdependently in carrying out their roles and responsibilities….with an appreciation of each professions unique contributions to health care.” (O’Neil and the Pew Health Professions Commission, 1998)

Interprofessionalism in Healthcare

Professionalism in the Current Clinical Setting

Uni - professional socialization has already occurred

Competencies and expertise are defined and in use

Professional boundaries have generally been determined and refinedInterprofessionalism in Healthcare

Interprofessionalism in the Clinical Setting

Attitudes & Perceptions – Building Trust and Respect

Skills & Areas of Expertise – Redefining Boundaries

Interprofessionalism in Healthcare

Knowledge – Transfer & Sharing

Practitioners, learners, patients, their families & the environment

Interprofessionalism in the Clinical Setting

Interprofessionalism in Healthcare

Develop common, complementary and collaborative competencies

Theoretical Framework

Learning Theories

1.Adult learning: Autonomous, active and self-directed

Motivated by the relevant and the practical

2. Professional socialization; Domain specific knowledge

Reflective practice

Zones of proximal development

Learning Theories

3.Communities of learning and practice Cooperative learning within a

collaborative environment

Situated and experiential learning4. Cognitive Apprenticeship

Knowledge transfer

Modeling

Coaching, scaffolding, fading and reflection

Theoretical Framework

Interprofessional e-Cases

Learning Theories & Design Features

1. Approximate actual situations in which interprofessional teams practice within a ‘real-life’, clinically meaningful

environment (D’Eon. 2005)

2. Be sufficiently complex that they cannot be done alone, thus reinforcing collaborative competencies (Steinert, 2005)

3. Allow participants to move towards interdependent collaboration using the case scenario to accent teamwork, communication and enriched quality of

patient and family care (Barr, 2005)

Design Features

e-Case Model in Development at McGill

1. Flexibility The case scenario allows the team determine

who leads each case and which professionals are included

2. Virtual but ‘real’ environment Realistic and meaningful environment Multimedia (including audio and video) Hyperlinks, prompts and access to teaching

modules Ability to archive, reuse and repurpose

3. Teaching & Learning Access to expert summaries and rationales

Design Features

e-Case Model in Development at McGill

4. Initial uniprofessional approach Highlight existing attitudes and perceptions Reinforces unique professional knowledge Permits sequencing

5. Integration of individual care plans into an interprofessional care plan or ‘blueprint’

Highlights group dynamic

6. Synthesis Identification of gaps and overlaps

3. Integrated Interprofessional Care Plan Review of the e-case computer generated ‘Blueprint’/interprofessional care plan

Group analysis of gaps and overlaps

Group revision to interprofessional care plan

Refine action items, mandates and outcomes measures (to determine efficacy)

Delegate roles and responsibilities & support

Formalize care plan as an ongoing document

4. Summary & EvaluationEvaluation of patient and professional progress

Treatment, post treatment, discharge planning and follow-up

Outcome measurement & efficacy review Plan archived for patient and student education

1. Presentation of Clinical Scenario Presentation of e-case

Group discussion about the professions and case leader(s) required for the specific case scenario with associated rationales

Review of professional perceptions, attitudes and beliefs specific to the case scenario

Initial uni-professional assessment, determination of action items, rationales, timeframes & sequencing

2. Group Discussion Formalization of the initial interprofessional group, (professions and case leader)

Interprofessional meeting(s) to review uniprofessional care plans

Inclusion of the patient’s voice

Assignment of roles and responsibilities

Input of uni-professional plans into the computer model for the e-case ‘Blueprint’

The Process for e-Case Development: Clinical Setting

The Process for e-Case Development: Academic Setting

1. Presentation of the Case to the LearnersSmall uni-professional student groups study the e-case scenario

Each group develops a uniprofessional care plan

2. Roundtable Students participate in an interprofessional group to review the case. For each group:

a) A case leader(s) is chosen

b) Uniprofessional care plans & rationales are reviewed & integrated into interprofessional care plan c) The e-case generates an interprofessional blueprint

3. Evaluation Students access, review & compare:

a. The uniprofessional ‘expert’ care plan and rationales with their own

b. The interprofessional ‘expert’ care plans and rationales with their own

Presentation of the Clinical Scenario

Development of Uni-professional Care Plan

An Example of Uni-professional Care Plan:

e-Case Blueprint

Nancy PoselNancy.posel@mcgill.ca

Moving toward the Development of Interprofessional E-Cases