Developing Interprofessional
Education
Irma Ruebling, M.A., P.T., Director
Interprofessional Education Program
Saint Louis University
Medical Center
Plan for the day
• Presentation followed by discussion of possible IPE at
Midwestern
1. Background on why IPE is gaining such emphasis and
definitions, goals, competencies
2. Content and learning experiences
3. Faculty development and program assessment
4. Wrap-up – challenges and opportunities, organizational
capacity
Objectives
1. Discuss the role of IPE in improving the delivery of health
care services.
2. Use the terminology of IPE appropriately.
3. Identify appropriate competencies for CHS.
4. Identify possible learning experiences for CHS.
5. Identify faculty development needs to assist in successfully
implementing IPE.
6. Discuss the outcomes to be measured of IPE program.
7. Discuss opportunities IPE provides.
8. Describe possible means of overcoming challenges for
implementing IPE.
Why IPE?
• Health care system is not providing we need
and deserve – to many medical errors and
unsafe conditions
• To provide health care that leads to optimal
patient outcomes.
• IPE is considered one mechanism to
accomplish this goal.
National Reports
• Medical errors resulted from poor communication
and processes of care
– Institute of Medicine, To Err is Human (1999)
A redesign of the health care system to include six
aims: safety, patient-centered, effective, timely,
efficient, and equitable
Address the processes of care
– Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st
Century (2001)
• “All health professionals should be educated
to deliver client-centered care as members of
an interdisciplinary team, emphasizing
evidence-based practice, quality improvement
approaches, and informatics.”
Institute of Medicine, Health Professions Education: A Bridge to Quality (2003).
Josiah Macy Foundation
• “All health professions schools have an
obligation to educate future practitioners who
are prepared both to assess and to meet the
health needs of the public. This obligation
entails…fostering greater inter-professional
teamwork and collaboration.”
Macy Foundation, “Revisiting the Medical School Education Mission at a time of Expansion, 2009
Morrison, G. Goldfarb, S, Lanken, PN. (2010 )Team Training of Medical
Students in the 21st Century: Would Flexner Approve? Academic
Medicine 85 (2), 254-259.
• In the 20th Century, team members were resources for the physician
as the decision maker.
• In the 21st Century – team members are responsible for key
decisions in the patient’s care together with the physician.
• This shift demands a change in how all providers are prepared to
practice. Health professionals must understand the roles and
expertise of colleagues, and be able to communicate well between
professions.
• Health professionals must realize that the collective knowledge of
the group far exceeds that of an individual.
Paradigm Shift
Physician Centered practice
to Patient Centered practice
Practitioner autonomy
to
Team collaboration
Focus on illness & cure
to
Focus on health promotion
Passive patient role
to
Involved patients & families
Acute, episodic care
to
Care for chronic conditions
Aschenbrener CA, Clearning a Path Ahead for IPE
Presentation: Collaborating Across Borders II, Halifax, 2007
Institute of Medicine, Crossing the Quality Chasm (2001)
What is IPE?
• Definitions
• Goal/Purpose
• Competencies
Definitions
• Professional – under the same general
educational governing association
• Disciplinary – can be specialty within an
identified profession
Definitions
, cont
Interprofessional
Multiprofessional
• Shared experiences
• Shared experiences
• Interaction/joint
decision making
• No expectation of
interaction or
participative decisionmaking
• Shared responsibility/
accountability for
decisions
Interprofessional Education defined
• IPE occurs when 2 or more professions learn
with, from, and about each other to improve
collaboration and the quality of care.
•
Center for Advancement of Interprofessional Education, 2008
•
WHO, Framework for IPE, 2011
Interprofessional Education
Occurs when there is
• Interaction between students and faculty of
different professions AND
• Goals and learning experiences lead to
achieving
– Performance of skills required for collaborative
patient/client-centered teamwork
– Understanding of and respect for the role and
unique contributions of the health professions
Interprofessional Practice
Health care activity which requires:
collaborative, interdependent use of
shared expertise directed toward a unified
purpose of delivering optimal patient care
• Collaborative – includes concepts of shared
responsibilities, shared decision-making, shared values,
shared planning and intervention, and sharing of professional
perspectives
• Interdependent - mutual dependence rather than
autonomous – arises out of common desire to address
patient’s needs
•
D'Amour, D., M. Ferrada-Videla, et al. (2005). "The conceptual basis for interprofessional collaboration:
Core concepts and theoretical frameworks." Journal of Interprofessional Care Supplement 1: 116-131.
• Shared expertise - combined knowledge and skills of
the team
• Optimal patient care - achieving the highest level of
function and self-efficacy
Goal/Purpose
• Based on the basic premise or value of the
program
• For example:
– Conviction that IPE promotes better patient/client
care and IP practice is best practice
Example
• The purpose of Interprofessional Education is to
prepare students with knowledge, attitudes and
skills of interprofessional practice which lead to:
–
–
–
–
–
Interprofessional patient/client-centered care
Optimal individual patient health outcomes
Improvements in community level (population) health
Effective and efficient delivery of health care services
Advocacy for improvement of health and health
services
SLU-IPE
IP Competencies in Health Care
• “Integrate the enactment of knowledge, skills,
and values/attitudes that define working
together across the professions, with other
health care workers, and with patients, along
with families and communities, as appropriate
to improve health outcomes in specific care
contexts.”
•
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional
collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education
Collaborative
Domains & General Competency Statements
• Values/Ethics for IP Practice
– Work with individuals of other professions to maintain a climate
of mutual respect and shared values.
•
Roles and Responsibilities
–
Use knowledge of one’s own role and those of other
professions to appropriately assess and address the healthcare
needs of the patients and populations served.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional
collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative
Domains & General Competency statements
• Interprofessional Communication
– Communicate with patients, families, communities, and other
health professionals in a responsive and responsible manner
that supports a team approach to the maintenance of health
and the treatment of diseases.
• Teams and Teamwork
– Apply relationship-building values and the principles of team
dynamics to perform effectively in different team roles to plan
and deliver patient-/populations centered care that is safe,
timely, efficient, effective and equitable.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional
collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative
Developing Competencies
• Useful to identify core themes around which
to develop competencies for IPE
– Based on concepts and values of IPE, mission of institution
and professional programs
• Identify specific competencies.
– May be iterative – a continuing working document
Develop IPE Competencies
Based on 5 domains of SLU-IPE core curriculum
•
•
•
•
•
Interprofessional Practice
Patient-Centered Care
Wellness
Patient Safety and Quality Care
Social Justice
Example: Interprofessional Practice
• Competency:
Participate in effective collaboration with health
professionals in developing and implementing plans of care to
achieve optimal health outcomes.
• Objective: Discuss unique contributions of each health
professional for care of patient
• Learning Activity: Study one page description of each
profession. Group interview of member of profession. Reflect on
professional contributions in case discussions including IP Grand
Rounds. Also reflect on how the team working together impacted
the patient’s care.
SLU-IPE
Example: Wellness
• Competency: Recognize a population health perspective
that encompasses the ability to assess the health needs of a
specific population, implement and evaluate interventions to
improve the health of that population.
• Objective: Identify and recommend clinical prevention
services based upon a patient’s age, gender, and risk factor
status.
• Learning activity: IP team projects and presentations on
health promotion/education activity for specific populations
including how each professional contributes.
SLU-IPE
Stop – Think – Reflect
• How does IPE fit with the mission of the college and
University?
• What areas are covered in your programs that could
benefit from becoming part of the IPE program?
• What student competencies would you see as
important outcomes of IPE?
Development
• Learning experiences
• Teaching methods
Types of IPE Programs
• An IPE day or workshop
• IPE Seminar
• IPE Clinical Experience
• IPE didactic course
• IPE embedded throughout program
Formative Concept
• Interprofessionality:
– An approach to care and education where educators and
practitioners collaborate synergistically to provide an integrated
and cohesive answer to the needs of the
client/family/population
IPE to enhance learner outcomes
Interdependent with
Collaborative practice to enhance patient care outcomes
D'Amour, D. and I. Oandasan (2005). "Interprofessionality as the field of interprofessional practice and interprofessional
education: An emerging concept." Journal of Interprofessional Care Supplement 1: 8-20.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative
practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative
Statement of Premises/Principles
• Statements based on definitions, purpose,
competences.
• Statements of values and beliefs about IPE
Premises/Values of Beliefs
•
•
•
•
Examples
IPE should occur as early as possible in the professional
curriculum
Embedding IPE experiences within and throughout existing
curricula allows aspects of patient-centered care and IP team
practice to be an expected part of professional practice
IP collaborative practice occurs with deliberate planning and
implementation of learning and practice, not by good will,
intent, desire, or chance alone
IPE must have interactive learning experiences, didactic and
experiential, that include critical reflection
SLU-IPE
Operationalizing Concepts and Values
The development of IPE curriculum, courses,
and other learning activities is a collaboration
between faculty of various health professions
• designing and implementing activities for IP
student learning
• retaining joint responsibility and accountability
for IP student learning outcomes
Operationalizing Concepts and Values
Student learning in IPE is defined as occurring
when courses and other learning experiences
meet criteria of interaction leading to
achievement of the IP learning outcomes.
Criteria for IPE Learning Experiences
• Students and faculty represent multiple health
professions
• Objectives include demonstrating a level of
achievement related to interprofessional
competencies
• Content relating to interprofessional competencies is
included
• Assignment includes interprofessional team work
• Student evaluation includes an assessment of growth
in interprofessional competence
SLU-IPE
Selecting Content for IPE
• Identify topics that are best covered with an IP
approach as IPE has been defined.
– Currently in professional curricula
– Not in professional curricula but should or would
be good to be cover
– Would benefit for interprofessional discussions
and actions
Selected Content
• Examples:
– Roles and responsibilities of various health
professionals
– Principles and development of teamwork
– Health care system
– Health promotion
– Health care ethics
– Evidenced-based practice
– Interprofessional practicum
– Interprofessional grand rounds
Interprofessional Team Seminar
• Introduction to communication and patient safety
• Discussion of IP teams and professional training &
roles and responsibilities in patient care
• Case-based discussion including standardized patient
simulations
– Contributions of each profession
– Discussion of priorities for assessment and care plan
– Imbedding in the cases issues of cultural differences,
health literacy, patient safety, socioeconomic concerns,
ethical issues in the cases, social determinants of health
SLU-IPE
Teaching Methods
• Lecture combined with team and small group
discussion in break-out sessions
• Small group discussion sessions of 20-30 students
• Students are divided into IP teams of 4-5 for in-class
discussions and out-of class projects
• Students produce team reports of in-class
discussions
• Critical reflection assignments on Grand Rounds,
certain readings and videos
Stop – Think – Reflect
• What do you see as curricular and teaching/
learning issues for IPE?
• How would teaching in IPE differ from
teaching now in single professional courses?
• What teaching strategies do you think should
be used in IPE experiences?
Your Thoughts
• What do you think are your faculty
development needs for implementing and
sustaining an IPE program?
• What is the best way for you to engage in
these faculty development activities?
Faculty Development
Possible topics:
Commitment to the value of IPE and IP collaborative practice
Knowledge of scope of practice of the professions
Effective teamwork skills
Teaching and managing large classes
Interactive learning
Small–group facilitating
Use of critical reflection
Faculty Development
• Methods:
– Do and reflect
– Self-directed learning
– Facilitated workshops
– Conferences
– Mentors and consultants
– In-house formal and informal discussions
• Steinert, Y. (2005). "Learning Together to Teach Together:
Interprofessional Education and Faculty Development." Journal of
Interprofessional Care 1(Supplement): 60-75.
Assessment Plan
•
•
•
•
•
Assumptions
Assessment is based on learning outcomes and
objectives
Include assessment of knowledge, attitudes, and
skills
Student learning outcomes or competencies drive
the research questions
Research is multi-method
Research is longitudinal
SLU-IPE
Curriculum Management
• Interprofessional Teaching & Learning Team
– Determines student learning outcomes
– Oversees course development through course
teams
– Develops flow chart linking outcome with
objectives and learning activities
– Evaluates results of assessments for curricular
changes
SLU- IPE
Assessment Management
• Assessment Team
– Oversees the assessment process to assure
student learning outcomes are included
– Identifies preliminary research questions based on
student development of attitudes, knowledge,
and skills related to the student learning
outcomes
– Continuously monitors development of new and
on-going research questions
SLU-IPE
Assessment Implementation
• Assessment Project Teams
– Refine specific research purpose and questions
related to a project
– Determine the type of assessment: quantitative,
qualitative
– Develop the research protocol
– Conduct reliability and validity testing
– Participate in data collection, analysis procedures
and dissemination of results
SLU-IPE
SLU-IPE Assessment Blueprint
Learning
outcomes
Attitudes
Knowledge
Skills
Research
purpose
Research
Research
question(s) Methods
Evaluation
of results
Attitudes
Learning Outcomes
1. Value (or significance) of the IP team in providing patient care.
2. Demonstrate how to contribute effectively to the development of
care plans which are responsive to the clients’ needs and
diverse needs of the community at large.
Research purpose
– To assess changes in students’ attitudes and perceptions about
learning with students in various health professions and about
working in collaborative teams
SLU-IPE
Attitudes: Research questions
1. What are the attitudes and perceptions about IP
learning and teamwork of students with no
formal education in IPE?
2. What changes occur in student attitudes and
perceptions about IP learning and teamwork
from:
– prior to and after the first IPE course;
– after their last IPE practicum course;
– and after one year of professional experience in their
chosen health career?
SLU-IPE
Attitudes: Research Methods
• Questionnaire: Readiness for IP Learning Scale
(Parsell, McFayden) and University of West
England IP Questionnaire (Pollard) followed by
focus group concerning inconsistent items and
confirmation of results
• Analysis: Remark scan, SPSS, descriptive and
interferential statistics, factor analysis, followed
by qualitative analysis identifying themes.
SLU-IPE
Knowledge
Learning Outcomes
1.
2.
Discuss the unique contribution of each health care profession
for the care of clients.
Refer the care of the patient to appropriate health professional
based on the scope of practice and unique expertise of the
profession.
Research Purpose
– To assess changes in students’ ability to identify the best choice
health professional to implement a procedure or intervention in
the patient’s care plan.
SLU-IPE
Knowledge: Research questions
Does the student’s ability to identify the most
appropriate health professional to provide a
particular service needed in a specific case
improve from prior to and after the first IPE
course; after their last IPE practicum course; and
after one year of professional experience in their
chosen health career?
SLU-IPE
Knowledge: Research Methods
• Questionnaire consisting of case and
questions regarding the most appropriate
health professional to provide needed services
followed by focus groups to clarify
discrepancies in responses.
• Analysis: Remark scan, SPSS, descriptive and
interferential statistics, followed by qualitative
analysis identifying themes.
SLU-IPE
Summary
• The focus of the evaluation is on outcomes assessment
throughout the education program including postgraduation components.
• This assessment process allows for multiple projects in
various stages.
• Projects may build off of each other.
• As a comprehensive program the assessment
– is longitudinal,
– includes quantitative and qualitative studies, and
– encompasses assessment of attitudes, knowledge, and skills.
Organizational Capacity
• Leadership AND Grassroots Commitment
• Centralized coordination – Infrastructure
– Creation of designated Program or Center
– Existence of a general plan – mandate
• Funding and facilities
Faculty & Staff Engagement Across
Health Professions
Faculty and clinical staff from different
professions who value IP collaboration and
share a vision and common goals work
together to
– Co-create curriculum and clinical programs
– Develop knowledge and skills of IP interaction
– Take an active role in the scholarship agenda
– Focus on patient-centered care
Leadership Commitment
• Centralized operation, coordination and
support
• Infrastructure fosters time to develop IP
activities, incentives to engage in IP
endeavors, and integration across professions
• Find solutions to issues of scheduling as well
as faculty and staff recruitment
• Provide appropriate physical facilities,
technology and other resources
Interprofessional Education (IPE) Program Organization
Assistant VP, Health Sciences
Executive Advisory Committee
IPE Director
IPE Program Coordinator
IPE Assistant Director
IPE Assistant Director
IPE Practicum Team
IPE Post-Baccalaureate
Curriculum Track
IPE Practicum
Community Sites
Interprofessional Team
Seminars (IPTS)
Interprofessional
Grand Rounds
IPE Teaching and
Learning Team
IPE Fr-Entry Course
Coordinator(s)
IPE Course Faculty
Teams
IPE 110:
Intro IP Health Care
IPE Assessment Team
IPE 350:
HC Systems/Health Promo
IPE Assessment
Project Teams
IPE 420: App Decision
Making in IP Practice
IPE 460:
Evidence Based Practice
Updated 6/1/11
IPE 490:
Integrated IP Practicum
Existence of a Plan
• Strategic Plan for development, evaluation,
and sustainability
– Shared vision of IPE and IPP
– Explicit philosophy of IPE that permeates the
organization
– Existence of a plan for implementing goals of IPE
IPE Policies
• Examples:
–
–
–
–
Faculty participation
Use of funds
Student enrollment
Student academic policies
Funding and Facilities
• Space for teaching – large group, small group
• Administrative space
• Funding for Faculty and Staff
Shared Challenges of the faculty
• Faculty development
– Learning to communicate as a teaching team
• Large class size – new to all faculty
• Scheduling of classes and teaching team
meetings
• Engaging new faculty
Opportunities for Faculty Involved in IPE
•
•
•
•
•
IP collaboration amongst faculty
Learning more about other professions
Shared research
New & strengthened friendships
Newer faculty learn from more experienced
faculty with whom they team teach
Opportunities for Students Involved in IPE
• Opportunity for students to experience best
practice
– Modeling of IP teamwork
– Enhanced collaboration
– Improved student awareness of IP teams
• Enhanced focus on patient/client centered
care & improved health outcomes
• Increased student comfort level with IP
teams
Development of Culture of IPE or IPP
• Indicators:
– Vision of IP endeavor is commonly understood
– Faculty members across professions are engaged
– Administrative support – funding, facilities as well as staff,
faculty and student recognition
– Full integration in professional education and practice
– Included in recruitment activities for faculty, students, and
clinical staff
– Incorporated into uni-professional courses including
clinical experiences
Challenges
• State-of-the-art for research in IPE and IP
practice outcomes is limited and considered
weak in methodology.
• Uncertainty regarding potential for
reimbursement model for interprofessional
collaborative practice
The Opportunity of Interprofessional
Health Care
• Health professionals working at the top of
their knowledge and skill
– Enhanced staff motivation and satisfaction
• Working as team providing the right care for
the patient when it is needed
– Enhanced patient motivation and
satisfaction
• Being part of change in delivery of care that
can accomplish optimal health outcomes
IPE Best Practices
• Begin IPE early in the health professional
program
• Experiences occur throughout the health
professional program
• Include interaction among students and
working in teams
• Include didactic, practical and clinical
experiences
Always keep the vision in the forefront.
It is about improving patient care.