BEST PRACTICES/LESSONS LEARNED: USING CORE COMPETENCIES TO BUILD A PROGRAM Alan Dow, MD, MSHA Assistant Vice President of Health Sciences for Interprofessional Education & Collaborative Care Virginia Commonwealth University Richmond, VA IPEC INSTITUTE MONDAY, JANUARY 13, 2014 © 2014 IPEC. May not be reproduced without permission. OBJECTIVES • To discuss how the IPEC competencies shape interprofessional education at an institutional level • To provide a framework to link behavioral objectives for teamwork with the IPEC competencies • To describe several educational programs that meet competency and behavioral objectives © 2014 IPEC. May not be reproduced without permission. VIRGINIA COMMONWEALTH UNIVERSITY • 53 acre Health Science campus • 5 health professional schools: allied health, dentistry, medicine, nursing, pharmacy • Tertiary academic medical center • 3200 clinical learners • Monroe Park campus • School of social work, departments of psychology and health & human performance • Distant training sites: • Inova-Fairfax (70 miles north) • UVA (70 miles west) © 2014 IPEC. May not be reproduced without permission. THE CENTER FOR INTERPROFESSIONAL EDUCATION AND COLLABORATIVE CARE • • • Official center at VCU in January of 2013 >2,000 learners have participated in Center programs Students and faculty from all five health science Schools, the School of Social Work, & Dept of Psychology 4 © 2014 IPEC. May not be reproduced without permission. © 2014 IPEC. May not be reproduced without permission. Interprofessional Collaborative Practice Competencies Values/ Ethics (n = 10) Roles/ Responsibilities (n = 9) Interprofessional Communication (n = 8) Teams and Teamwork (n = 11) IPEC INSTITUTE MONDAY, JANUARY 13, 2014 Interprofessional Education Collaborative Expert Panel. (2011). 6 © 2014 IPEC. May not be reproduced without permission. The IPEC Competencies were created to: create a coordinated effort for IPE guide curriculum provide a foundation for learning structure research promote dialogue between health professions shape accreditation, licensing, and credentialing IPEC INSTITUTE MONDAY, JANUARY 13, 2014 © 2014 IPEC. May not be reproduced without permission. TOOL AND SURVEY METHODS 38 original IPEC competencies 1 competency omitted 32 competencies converted directly into items 5 items split into 10 items 42 items comprise the final questionnaire all items given stem and assigned to 5-point Likert scale Assesses student selfefficacy using a Likert scale Administered as an online survey with invitation email Sent to students by program leader IPEC INSTITUTE MONDAY, JANUARY 13, 2014 Dow AW et al. 2014. JIC © 2014 IPEC. May not be reproduced without permission. SURVEY POPULATION All students enrolled in clinical degree programs on VCU’s Health Science Campus Allied Health Nine Departments Medicine MD and non-MD students Dentistry DDS and Dental Hygiene Nursing BSN, MSN, PhD Pharmacy IPEC INSTITUTE MONDAY, JANUARY 13, 2014 Dow AW et al. 2014. JIC 9 © 2014 IPEC. May not be reproduced without permission. RESULTS: 2012 481 completed surveys Overall response rate: 14.9% Response rate by School: Allied Health – 4.1% Dentistry – 7.0% Medicine – 25.4% Nursing – 7.8% Pharmacy – 26.3% IPEC INSTITUTE MONDAY, JANUARY 13, 2014 Dow AW et al. 2014. JIC 10 © 2014 IPEC. May not be reproduced without permission. FACTOR ANALYSIS AND RELIABILITY Four forced domains: accounted for 79% of the variance in responses aligned with four IPEC domains Overall scale reliability: α=.99 Reliability by domain-associated factor Values and Ethics: α =.98 Roles: α = .95 Communication: α = .95 Teamwork: α = .97 IPEC INSTITUTE MONDAY, JANUARY 13, 2014 Dow AW et al. 2014. JIC 11 © 2014 IPEC. May not be reproduced without permission. Dow AW et al. 2014. JIC 12 © 2014 IPEC. May not be reproduced without permission. Center for Interprofessional Education and Collaborative Care Early Learners Advanced Learners Practitioners Effective, efficient, appropriate collaborative practice Maintain high attitudes (Value & Ethics) Build core knowledge (Roles & Responsibilities, Communication, Teams) Collaboration skills (Communication, Teams & Teamwork) © 2014 IPEC. May not be reproduced without permission. © 2014 IPEC. May not be reproduced without permission. PARTICIPATING INSTITUTIONS Institution 1: large southern public university with a comprehensive health science campus Institution 2: large midwestern public university with a college of health professions (dentistry, nursing, PA, allied health) Institution 3: smaller health system-associated health professional school (nursing, allied health) Institution 4: large midwestern public university with a comprehensive health science campus IPEC INSTITUTE MONDAY, JANUARY 13, 2014 © 2014 IPEC. May not be reproduced without permission. RESULTS: DEMOGRAPHICS Students by Institution Students by Profession N % N % Institution 1 624 71% Allied Health 256 29% Institution 2 94 11% Dentistry 74 8% Institution 3 85 10% Medicine 190 22% Institution 4 80 9% Nursing 159 18% Pharmacy 15 2% Public Health 28 3% Unknown 161 18% Students by Gender N % Male 242 27% Female 641 73% Age Range: 19 - 65 (M=28, SD = 8) © 2014 IPEC. May not be reproduced without permission. RESULTS: DOMAIN SCORES BY INSTITUTION, 2013 4.8 Comparisons between institutions: • Values and Ethics (p=.014) • Teams and Teamwork (p=0.18) • Roles and Responsibilities (p=0.69) • Interprofessional Communication (p=0.69) 4.59 4.6 4.43 4.4 4.46 4.37 4.32 4.31 4.31 4.23 4.21 4.2 4.14 4.12 4.21 4.16 4.06 4.02 4 3.96 3.8 3.6 Values and Ethics Institution 1 Roles and Responsibilities Institution 2 Interprofessional Communication Institution 3 Teams and Teamwork Institution 4 IPEC INSTITUTE MONDAY, JANUARY 13, 2014 © 2014 IPEC. May not be reproduced without permission. RESULTS: DOMAIN SCORES BY PROFESSION Allied Health Dentistry Medicine Nursing Pharmacy Public Health Unknown No significant differences between professions Values and Ethics 4.37 4.23 4.37 4.45 4.25 4.59 4.31 Roles and Responsibilities 4.13 4.01 4.13 4.19 4.06 4.34 4.13 Interprofessional Communication 4.21 4.15 4.21 4.25 4.37 4.38 4.13 Teams and Teamwork 4.05 3.93 4.03 4.12 4.32 4.21 4.03 4.8 4.6 Allied Health 4.4 Dentistry 4.2 Medicine Nursing 4 3.8 Pharmacy 3.6 Public Health Values and Ethics Roles and Interprofessional Responsibilities Communication Teams and Teamwork Unknown IPEC INSTITUTE MONDAY, JANUARY 13, 2014 © 2014 IPEC. May not be reproduced without permission. Center for Interprofessional Education and Collaborative Care Early Learners Advanced Learners Practitioners Effective, efficient, appropriate collaborative practice Maintain high attitudes (Value & Ethics) Build core knowledge (Roles & Responsibilities, Communication, Teams) Collaboration skills (Communication, Teams & Teamwork) © 2014 IPEC. May not be reproduced without permission. © 2014 IPEC. May not be reproduced without permission. Inputs Activities Outputs Mediumterm Goal Long-term Goal Increased Interprofessional Competency Improved patient outcomes and community health Engage in Shared Problem Solving Students Communicate in Context Faculty Resources Sequence of Learning Activities Resolve Conflict Enhance Team Performance Be a Change Agent 21 © 2014 IPEC. May not be reproduced without permission. Engage in Shared Problem Solving Context-Specific Experiences Solve Healthcare Problems Interprofessionally Profession-Specific Experiences Experience Interprofessional Problem Solving Foundational Health Professions Experiences Be Exposed to Interprofessional Problem Solving Pre-Curricular Experiences 22 © 2014 IPEC. May not be reproduced without permission. Pre-Curricular Experiences IPEC INSTITUTE MONDAY, JANUARY 13, 2014 © 2014 IPEC. May not be reproduced without permission. Inter Health Professional Alliance (IHPA) • • • • Student-initiated and student-run group 4 years old Over 200 members A number of peer-reviewed publications and national presentations •School of Allied Health Professions •School of Dentistry •School of Medicine •School of Nursing •School of Pharmacy •School of Social Work •School of Engineering •VCU Dietetics Internship program © 2014 IPEC. May not be reproduced without permission. © 2014 IPEC. May not be reproduced without permission. FOUNDATIONAL HEALTH PROFESSIONS EXPERIENCES Interprofessional Case Series • >600 students • Pericurricular sessions full 1credit course • Student feedback: more! Foundations of Quality and Safety • ~500 students • Full 1-credit course 26 © 2014 IPEC. May not be reproduced without permission. 2012-2013 Extracurricular Interprofessional Case Series • Meet your peers • Learn something (roles) • Encouraged but not required • Pizza • Positive evaluations with suggestions © 2014 IPEC. May not be reproduced without permission. 2012-2013 2013-2014 Extracurricular Interprofessional Case Series • Meet your peers • Learn something (roles) • Encouraged but not required • Pizza • Positive evaluations with suggestions Pericurricular Interprofessional Case Series • Meet your peers • Learn something (roles, teams) • Required* • Positive evaluations with suggestions © 2014 IPEC. May not be reproduced without permission. Sample item: I am able to respect the unique cultures, values, roles/responsibilities, and expertise of other health professions. 5 4.5 4 3.5 3 Retrospective PreAssessment Post-Assessment 2.5 2 1.5 1 0.5 0 VE VE RR VE RR RR TT TT TT RR © 2014 IPEC. May not be reproduced without permission. 2012-2013 2013-2015 2015-2016 Extracurricular Interprofessional Case Series • Meet your peers • Learn something (roles) • Encouraged but not required • Pizza • Positive evaluations with suggestions Pericurricular Interprofessional Case Series • Meet your peers • Learn something (roles, teams) • Required* • Positive evaluations with suggestions Curricular Foundations Course • Meet your peers • Learn something (roles, teams, systems) • Required 1credit course © 2014 IPEC. May not be reproduced without permission. PROFESSION-SPECIFIC EXPERIENCES Interprofessional Critical Care Simulations • All N4s and M4s (320 students) • Three two-hour sessions around simulators: how do you manage a patient with an acute clinical deterioration? • Student feedback: more! 31 © 2014 IPEC. May not be reproduced without permission. Effect Sizes between Retrospective Pre and Post Ratings by Item 2 1.8 1.6 All comparisons significantly different at p < 0.01. Cohen’s d Effect Size: Small: 0.2-0.49 Medium: 0.5-0.79 Large: ≥0.8 = interprofessional objectives = critical care objectives 1.4 1.2 1 0.8 0.6 0.4 0.2 0 © 2014 IPEC. May not be reproduced without permission. PROFESSION-SPECIFIC EXPERIENCES Interprofessional Virtual Case • Homegrown case system for asynchronous collaboration • ~600 participants annually (SOM, SON, SOP, SOSW) • Now being used at several other institutions 33 © 2014 IPEC. May not be reproduced without permission. Receive case information Complete peer evaluations Highvalue learning Answer group questions Summarize case data in EHR Answer individual questions © 2014 IPEC. May not be reproduced without permission. 35 © 2014 IPEC. May not be reproduced without permission. 36 © 2014 IPEC. May not be reproduced without permission. CASE ACTIVITY MEASURES Case activity measures Logins EHR entries Message board posts and replies Message board posts viewed Social Medical Nursing Pharmacy Work Students Students Students Students (n=194) (n=146) (n=60) (n=122) 21 (2-98) 28 (5-197) 25 (2-86) 22 (1-114) 11 (0-44) 14 (2-53) 5 (0-19) 7 (0-43) 8 8.5 9.5 5 (0-157) (0-131) (0-81) (0-108) 24 27 36.5 17.5 (0-659) (0-675) (0-335) (0-460) © 2014 IPEC. May not be reproduced without permission. CORRELATIONS BETWEEN CASE ACTIVITY MEASURES AND SCORES 1 2 3 4 5 6 1. Individual Score — 2. Individual Logins 0.32* — 3. Individual EHR Entries 0.33* 0.32* — 4. Individual Message Board Posts/Replies 0.39* 0.50* 0.28* — 5. Individual Message Board Views 0.35* 0.46* 0.25* 0.80* — 6. Team Score 0.18* 0.23* 0.07 0.34* 0.27* — 7. Team Size -0.03 -0.01 -0.10 -0.12 -0.03 0.02 7 — © 2014 IPEC. May not be reproduced without permission. CONTEXT-SPECIFIC EXPERIENCES Richmond Health and Wellness Program • Nursing, Pharmacy, Social Work, Medicine, Psychology • HRSA-funded • Community-focused care coordination in an indigent setting • Patient and student impact • “Hotspotting” 39 © 2014 IPEC. May not be reproduced without permission. Engage in Shared Problem Solving Context-Specific Experiences Solve Healthcare Problems Interprofessionally Profession-Specific Experiences Experience Interprofessional Problem Solving Foundational Health Professions Experiences Be Exposed to Interprofessional Problem Solving Pre-Curricular Experiences 40 © 2014 IPEC. May not be reproduced without permission. SCHOLARSHIP AND DISSEMINATION Emswiller Symposium • Regional interprofessional symposium • >150 attendees past two years Interprofessional Virtual Case • Patent pending • Licensing to UNT, UNM, KU RHWP • Dissemination to other institutions Grant funding • HRSA • Macy Foundation • Reynolds Foundation National Presentations or Manuscripts (*=student/trainee) • • • • • • • • • • • • • • • • • • Melissa Abell Nital Appelbaum* Nathaniel Arnold* Peter Boling Antoinette Coe Ann-Marie Conlon Steve Crossman Jeff Delafuente Deborah DiazGranados Alan Dow Alex Enurah* Jessica Evans* Moshe Feldman Cheryl Garland Sarah Hobgood Susan Johnson Tanya Huff Sharon Lanning • • • • • • • • • • • • • • Kelly Lockeman Paul Mazmanian Natalie Nguyen* Kelechi Ogbonna Shelley Orr Darshan Pandya* Pamela Parsons Sheldon Retchin Andrew Rock* Lana Sargent Lyubov Slashcheva* Stephanie Umphlette* Lynn VanderWeilen* Jean Ellen Zavertnik 41 © 2014 IPEC. May not be reproduced without permission. Questions and Discussion Alan Dow awdow@vcu.edu © 2014 IPEC. May not be reproduced without permission.