Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Title:
Interprofessional Education for Collaborative Patient-Centered Chronic Disease Care
An application to the Interprofessional Education for Collaborative Patient Centred
Practice Initiative of the Health Human Resources Strategy, Health Canada
Principal Applicant: University of New Brunswick
Partner Organizations: Atlantic Health Sciences Corporation
Dalhousie University Faculty of Medicine
New Brunswick Community College
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Table of Contents
Overview (from section 5.2)
3
1.
Principal Applicant Organization
5
2.
Partner Organizations
6
3.
Patients and Learners
7
4.
Steering Committee
Co-Chair : Keith De’Bell
Co-Chair : Barbara McGill
9
10
11
5.
Project description
5.1 Title
5.2 Overview
5.3 Context
5.4 Conceptual Framework
5.5 Change in Culture and Attitude
5.6 Barriers and Challenges
5.7 Primary Target Audience
5.8 Integration of the Learning into Educational and
Clinical Settings
5.9 Bibliography
12
12
12
13
14
17
17
18
6.
Project Objectives
20
7.
Tentative Timelines
21
8.
Evaluation
23
9.
Knowledge Transfer, Networking and Dissemination
27
10. Sustainability
18
19
28
Appendix: Project Summary
29
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Overview
Four partners have come together on this project:
 University of New Brunswick (UNB) that offers a Bachelor of Nursing, a
Bachelor of Nursing for Registered Nurses and Bachelor of Health Sciences
degree programs at its Saint John Campus;
 New Brunswick Community College (NBCC) that offers Practical Nurse program
and parts of BHS programs at its Saint John Campus;
 Atlantic Health Sciences Corporation (AHSC) that is a practice setting including a
tertiary care hospital and a primary care Community Health Center;
 Dalhousie University that offers medical education practice through distributive
learning experiences to Family Medicine residents through the St. Joseph’s
Community Health Centre (SJCHC) of AHSC and undergraduate clinical
clerkships in Saint John through the AHSC facilities.
Each partner has varying degrees of experience with Interprofessional Education (IPE).
This concept is new to faculty and students in the education programs at UNB Saint John
and NBCC Saint John. Interdisciplinary teams can be found at AHSC, but need to be
developed to a higher level. SJCHC is on the cutting edge of interprofessional primary
care and provides workshops based on the “Building a Better Tomorrow Initiative”
(BBTI) to education health care providers in interprofessional care. Dalhousie University
Faculty of Medicine is a partner in the Tri-faculty Interprofessional Program that includes
mandatory seminars for students in all health disciplines on this important new concept
(Cycle I of IPEPCC).
This project will provide three facilitators (1 affiliated with UNB Saint John, 1 with
NBCC-SJ, 1 with AHSC) who will function as an implementation team to facilitate
meeting of the project objectives:




Increase the capacity of health educators to promote IPE with pre-licensure
students through faculty development and strengthening liaison with partners
already engaged in IPE. Faculty development will include both workshops to
familiarize educators with IPECPCP concepts and benefits and active engagement
in the curriculum development;
Increase the capacity of pre-licensure students and post-licensure professionals to
deliver interprofessional care through curriculum development including
interprofessional experience leading to participation in a “capstone” workshop on
chronic care, and practice experience in clinical settings at AHSC and CHC;
Strengthen the functioning of post-licensure interprofessional teams across
medical-surgical units of AHSC to ensure that pre-licensure students have
opportunities to participate in high functioning teams in practice for the benefit of
patients receiving integrated clinical care;
Evaluate each component of the program for its effect on educators, pre-licensure
students, post-licensure professionals, and patient care.
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
The work already done at the SJCHC with the BBTI will be used as a starting point for
the project. BBTI is a modular program developed in Atlantic Canada through the
PHCTF, addressing the various aspects of IPE. Facilitators have been trained to deliver
the program components to primary care providers at AHSC working in CHC, public
health, and community mental health. Currently BBTI is being offered for these groups
through AHSC. We will build on this work including preparation of other clinical areas
for IPECPCP, and develop complimentary new tools for IPECPCP delivery and
evaluation.
As noted above curriculum development forms both part of the faculty development
component of this project and prepares for delivery to the learners. A capstone workshop
on chronic disease component is an innovation that will be developed specifically for this
project. BN, BN/RN, BHS, PN, and MD students will engage with post-licensure health
professionals representing other disciplines to address case studies/simulations related to
chronic illness (e.g., diabetes) across the disease trajectory. This will provide a unique
opportunity to build on previous course work and to engage in interprofessional practice
to address common patient problems.
The Steering Committee will be made up of
 The three facilitators;
 Representatives from the faculty/educators and pre-licensure students of each
partner;
 Representatives from the practice partners and post-licensure professionals;
 Patients with chronic illness (e.g., Diabetes).
 Administrative representatives of the partners
The unique features of this program are:
 The provision of IPECPCP in the unique health/medical education environment of
New Brunswick;
 The inclusion of PN students with BN, and Medical students in an IPECPCP
initiative;
 The development of a “capstone” workshop/simulation of interprofessional
management of chronic illness patients.
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
1. Primary Applicant Organization
Primary Applicant: University of New Brunswick (UNB)
Incorporation number: 23-7103810
Project Lead: K. De’Bell
Street/Mailing Address: PO Box 5050,
Tucker Park Rd,
Saint John,
New Brunswick. E2L 4L5
Telephone: (506) 648 5577
FAX: (506) 648 5784
E-Mail: kdb@unbsj.ca
Organization mission, goals and objectives
The University of New Brunswick is a national comprehensive university providing high
quality and innovative programmes in both education and research. Its mission includes
both

Serving New Brunswick, the Atlantic Region and Canada through the provision
of broadly educated graduates and through the development of applied
programmes,

Co-operating with governments and post-secondary institutions in developing a
coherent system of advanced education (University Mission Statement, UNB
Calendar).
and
The University’s commitment to applied programmes in health care education and to
innovative partnerships with other institutions are reflections of its goal of carrying out its
fundamental role in the economic, social and cultural well being of the province and of
Atlantic Canada, as a national university and as a learning institution (UNB President’s
report 2003-4, p.3).
The University offers Nursing programmes through its Nursing Faculty (Fredericton,
Moncton, and Bathurst) and through its Department of Nursing (Saint John). These
programmes include undergraduate B.N. programmes for new Nursing students, postdiploma B.N. programmes for in-practice RNs who have a diploma education, and post
graduate M.N. programmes including advanced practitioner and nurse practitioner
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
programmes. Students in these programmes obtain experience in both urban and rural
clinical settings through the University’s agreements with Regional Health Authorities.
Involvement of the University’s Faculty of Education will provide expertise on the use
and evaluation of education models. A key part of the proposal, in addition to curriculum
and materials development for both pre and post-licensure students, is the faculty
development component. Expertise on faculty development and best practice in the
Faculty of Education will assist in the construction of this component of the programme.
The University has an established record of developing health education strategies with
education and practice setting partners, and supports initiatives such as its Bachelor of
Health Sciences programmes, with its highly integrated partnership approach, as part of
its innovation strategy (UNB President’s Report 2003-4 p.5). Through the establishment
of these partnerships it has formed a strong working relation with the Atlantic Health
Sciences Corporation (AHSC), and the New Brunswick Community College (NBCC)
which are also partners in this proposal.
In addition to its principal purpose of demonstrating a model of interprofessional
education for collaborative patient centred practice and evaluating the model as described
below, this project will be an important further step in attaining UNB’s objective of
sustainable multi-institutional health care education programmes. As well as building on
the foundation of the working relationship between UNB, AHSC and NBCC, it will
facilitate a stronger working relationship with the faculty of Dalhousie Medical School,
particularly in the case of those faculty based in New Brunswick.
No other grants or contracts are being used to fund this pilot project. However an in-kind
contribution will be made by the primary applicant and partner institutions. This is
detailed in the budget section (section 11)
2. Partner Organizations
In addition to the primary applicant, UNB, the partner organizations will be
Atlantic Health Sciences Corporation (Region 2 Health Authority) (AHSC)
Dalhousie University Faculty of Medicine (Dal)
New Brunswick Community College (NBCC)
The partners have a history of working together and maintaining communication both
formally and informally. Previous formal agreements have typically been either bilateral
(e.g. AHSC and Dalhousie University for the family practice residents programme at the
St. Joseph’s Community Health Centre) or trilateral (e.g. AHSC, UNB, and NBCC for
the Nuclear Medicine Stream of the BHS programme). To the best of our knowledge this
will be the first formal multi-institutional education programme agreement that all of the
partners have been involved in. It reflects the shared vision of the institutions involved in
this proposal of increased capacity in health education through multi-institutional
collaboration.
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
The working relationships amongst the partners have demonstrated their ability to work
collaboratively while maintaining their separate governance structures. In particular,
curriculum changes and new courses referred to in this document will be developed
subject to the normal approval processes of the appropriate partner institution.
3. Patients and Learners
Patients: This programme will be constructed around a patient-centered approach to care
for patients with a chronic disease. One of the advantages of building the programme
around a chronic disease is that it will allow us to examine and discuss interprofessional
interaction in the continuum of care along the illness trajectory. This will involve
consulting with patients at different stages of the disease to inform curriculum
development. Patients with a chronic disease will be involved throughout the construction
of the pre-licensure and post-licensure (including continuing education) curriculum and
faculty development programme, and throughout the running of the project. (Details are
given in the project description below). Patients will also contribute to the evaluation
component by providing feedback on the degree to which the interprofessional training
has addressed patient needs.
Regarding the recruitment of patients, an obvious choice would be persons with
diabetes. Opportunities for involvement in the programme will be advertised to the client
population of the diabetic teaching programme of the St. Joseph’s Community Health
Centre. As we wish to include interprofessional issues that may arise for patients in rural
settings, patients living in rural southwest New Brunswick (Health Region 2- from
Sussex to St. Stephen including the Fundy Isles), as well as those living in urban settings
will be included.
Learners
In keeping with the objectives of the programme stated below (Section 6) the principal
learner groups will include faculty/health educators, pre-licensure students, and postlicensure health professionals.
Faculty/Health Educators
Faculty development to increase the number of health educators able to facilitate
IPECPCP is a core aim of this programme. Faculty in the Department of Nursing UNB
Saint John, Faculty in the Faculty of Health Sciences, NBCC, and Faculty affiliated with
Dalhousie University Medical Faculty will have access to this training. However it is
understood that changing the attitudes and education strategies of all health care
educators, including those who may act as preceptors or mentors for students in a clinical
setting, to include interprofessional team work and patient centred practice is necessary.
Therefore the faculty development stage of the programme will include workshops on
interprofessional approaches and patient centred practice open for participation to all
health care professionals having a role in clinical site education.
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Students
The pre-licensure core learners groups include pre RN Bachelor of Nursing (BN) students
(UNB Saint John), and practical nurse (PN) students (NBCC). (See proposal description
below). Approximately 40 students per year in each of the PN and pre RN BN
programmes will take the IPECPCP programme. Pre-licensure students will typically
take the course in the upper years of their programme.
The core learners will also include 10 post graduate family medicine residents from
SJCHC. At present, residents at the SJCHC are students in the Dalhousie Medical School
postgraduate programme however they will have taken their undergraduate medical
training at medical faculties across Canada and in some cases outside Canada.
Consequently not all residents will have received the same IPE as undergraduates and in
some cases may not have received any IPE. We believe this reinforces the need for an
IPE programme at the postgraduate level immediately prior to licensure.
The core learner groups as identified above reflect the education qualification which each
group has before licensure (i.e. certificate for LPNs, Bachelors degree for RNs, and
postgraduate training for MDs). It is therefore appropriate to develop interprofessional
experiences that bring together these core groups as outlined in this proposal. At present,
undergraduate MD students from New Brunswick are primarily educated at Dalhousie
University (Halifax, Nova Scotia) and Memorial University (St. John’s, Newfoundland).
Undergraduate MD students may return to New Brunswick for part of their clinical
rotation however the numbers and areas of specialization are difficult to predict under the
current system. However, it is also recognized that this programme provides an
opportunity to provide undergraduate MD students with IPECPCP during their clinical
rotation at AHSC. For the purposes of this pilot study we have focused on the students in
the internal medicine clinical rotation and there is agreement in principle to develop an
IPECPCP component for these students. Because of the nature of the clinical rotation this
will, in general, be asynchronous with the other core learner groups however it will be
designed to build on the other IPE components that these students receive as part of their
undergraduate training at Dalhousie Medical School. We will also attempt to establish
links with those programmes that undergraduate New Brunswick MD students enter to
establish better integration of IPECPCP at all levels of the MD education path.
Similarly IPECPCP training will also be made available to social work, dietician,
pharmacy and other health profession students placed at SJCHC.
This pilot project will also provide opportunities for the integration of IPECPCP into
other health care programmes shared by the partners including the BHS/diploma
programmes for Nuclear Medicine, Radiography, Radiation Therapy, and Respiratory
Therapy.
Within the AHSC system an interdisciplinary team environment has been developed in
units such as the SJCHC. However few of the AHSC staff have had formal IPECPCP
training currently. AHSC staff will be provided with access to IPECPC through a
continuing education programme. This component of the pilot project is intended to
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
effect the workplace environment for interprofessional patient centred practice (see
section 5).
For the purposes of the pilot project the language of instruction will be English
(following the normal practice of the educational institution partners) and both patients
and learners will be communicated with in English. However, the final report will be
translated into French and disseminated in both official languages. We expect to develop
Faculty Development packages and Curriculum packages in both official languages.
4. Steering Committee
The steering committee will ensure continued communication between the partner
institutions at the appropriate level, will continue to monitor the programme is matching
the model of IPECPCP, and will ensure that appropriate and sustained evaluation is in
place.
Co-chairs (one page descriptions follow this section): Keith De’Bell (Special Advisor to
the President and Vice President (Saint John), UNB) and Barbara McGill (Vice President
(Community) and Chief Nursing Officer, AHSC).
The steering committee membership has been chosen to address the various roles
necessary within the Committee to ensure a sustainable programme consistent with the
IPECPCP model. These include ensuring on-going support of the programme and liaison
from the education institutions and practice sites. The Steering Committee composition
has also been chosen to reflect the interactions between groups within the IPECPCP
model and therefore includes representatives of patients, educators, and learners. The
Steering Committee composition is also consistent with our view that interprofessional
education should reflect the continuum of care throughout the illness trajectory required
for patient centred care as well as the interdisciplinary team approach for specific
interventions.
Nine members of the Steering Committee are persons with administrative responsibilities
such that they will be able to ensure the required attention to liaison between the partners
and regard for sustainability occurs. The representative from the Faculty of Education
will be able to advise the Committee on education models and best practice and will
ensure the Committee has access to other members of the Education Faculty when
specific expertise is required. The current Education Faculty representative has
considerable expertise in evaluation practice.
The remaining members of the Steering Committee will ensure that the programme
development is guided by input from the core centres of the education and practice areas
of the IPECPCP model and the interaction between them.
The three facilitators will be appointed following approval of the proposal. They will be
drawn from front line educators/practitioners and their roles within the project will
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
include IPECPCP curriculum development and integration (see below for a detailed
description). Within the steering committee they will provide an essential connection
between the administrative oversight and the “on the ground” practice of the programme.
The patient representatives will normally be drawn from the population of knowledgeable
chronic disease patients and these interact in the practice setting with post-licensure
professionals which are also represented in the Committee. (We use ‘practice setting’
here in the broadest sense of where health care is delivered). We recognize that the
learner at the centre of the interdisciplinary education system may be a pre-licensure
student or a post-licensure professional whose interdisciplinary education is a response to
the need for collaborative care in patient centred practice; thus there is an interaction
through the post-licensure professionals between the patient centred professional system
and the learner centred education system. Both pre and post-licensure groups of learners
are represented. The Committee also has representation from the educators who facilitate
the enculturation of the learners in their professional beliefs and attitudes. The
representatives of the learners, in-practice professionals and educators will be chosen to
ensure a broad representation of the professions in the Committee.
Co-Chair: Keith De’Bell
Institution: University of New Brunswick
Position: Special Advisor to the President and Vice-President (Saint John), Health Care
Education and Research
Education: B.Sc. (Physics, London, 1976), M.Sc. (Solid State Physics, London 1977),
Ph.D. (Mathematics, London, 1980)
Experience
 Teaching: Range of teaching experience in statistics, mathematics and physics
including the development of innovative curricula for the teaching of physics to
elementary school teacher candidates and for in-service development of
elementary school teachers.
 Research : Funded by Natural Sciences and Engineering Council of Canada since
1985, published articles in refereed journals 78
 Administrative Experience : Associate Dean of Arts and Science (Trent
University, 1993-1998), Dean of Science, Applied Science and Engineering
(University of New Brunswick in Saint John, 1999-2004), Special Advisor to the
President and Vice President (Saint John), (University of New Brunswick 2004-)
 Other recent relevant experience Member (1999-) and Chair (2005-) of the
Atlantic Science Council (APICS), Member, Management Board, Canadian
Rivers Institute (2001-2004), Chair, Evaluation Subcommittee, and member,
Implementation Committee, St. Joseph’s Community Health Centre (2002-3),
Chair, Research and Evaluation Committee, and member, Leadership Roundtable,
Vibrant Communities Saint John (2005).
Comments: As Dean of Science, Applied Science and Engineering (1999-2004), Keith
De’Bell had Faculty level responsibility for the Department of Nursing at UNB Saint
John. He was also responsible for the Bachelor of Health Science programmes which
report directly to the Dean. As Dean of the Faculty and Chair of the Bachelor of Health
10
Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Sciences Advisory Committee he developed a strong working relationship with partners
in the BHS programme, i.e. a community college and two regional health authorities. He
was closely involved in developing the formal agreements, which underpin the BHS
partnerships and in developing the “integrated programme” model of the BHS degree.
He has also developed a health research partnership between the University, the New
Brunswick Community College, the National Research Council Institute for Information
Technology and the Atlantic Health Sciences Corporation. His present position of Special
Advisor includes building collaborative partnerships amongst educational institutions,
health care authorities, government departments, and NGOs to increase the University’s
capacity to deliver innovative health care education programmes and national standard
research.
Co-Chair:
Barbara J. McGill
Institution: Atlantic Health Sciences Corporation, (Region Health Authority 2, NB)
Position: Vice-President, Community Programs and Chief Nursing Officer
Education: MN (Dalhousie University, Halifax, NS) 1983. BN (University of New
Brunswick) Fredericton, NB, 1984, RN (St. Joseph’s Hospital School of Nursing) Saint
John, NB, 1969
Experience:
 Research: Site Coordinator, Atlantic Health Sciences Corporation, Understanding
the Costs and Outcomes of Nurses Turnover in Canadian Hospitals (in progress)
2005 - 2006. Nursing Effectiveness, Utilization and Outcomes Research Unit,
University of Toronto (CHSRF funded) 2005 - 2006, Nursing Environments:
Knowledge to Action ñ The Centre for Organization Research and Development,
Acadia University, Wolfville, NS (in progress, Health Canada funded),
Evaluating Implementation and Integration of the Nurse Practitioner Role in BC
and NB. (Letter of intent approved - awaiting funding in August, CIHR funded),
2005, Effective mechanisms for establishing, monitoring and predicting the needs
for Nursing services in the Atlantic Provinces, Atlantic Consortium on Research
Utilization for Nursing, (CHSRF funded), 2003, Communaute vertielle de
pratique en sante du coeur – L’ordre des infirmire, et infirmiers du Quebec, 2003,
Evidence-based standards for measuring nurse staffing and Performance ñ
Nursing Effectiveness, Utilization and Outcomes Research Unit, University of
Toronto, (CHSRF funded), 2003
 Administration: Vice-President, Community Programs and Chief Nursing Officer,
Atlantic Health Sciences Corporation, Saint John, NB, 2003- present, VicePresident, Planning and Chief Nursing Officer, Atlantic Health Sciences
Corporation, Saint John, NB, 2000 ñ 2003, Adjunct Professor, Nursing, UNBSJ,
1998-present, etc
 Other Recent Relevant Experience: President, Academy of Canadian Executive
Nurses, 2005 - 2006, Chair, Nursing Resources Advisory Committee to the
Minister of Health and Wellness, NB, 2001 ñ present, Chair, Integration and
Coordination of Care and Services Committee, Region 2, NB, 1999-present,
Surveyor, Canadian Council on Health Services Accreditation, 1995-present,
Member, NB Steering Committee ñ Transition of Community Mental Health /
Public Health to RHAs, 2004-present
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Comments: Barbara McGill brings a progressive perspective to the integration and
coordination of care and services to patients and clients between AHSC and the health
and community sectors of Region 2. This perspective is honed through active
involvement in the development, implementation and evaluation of patient care delivery
efforts at the local, provincial, and national levels. The challenges of regionalization
provided her the opportunity to explore the application of an integrated interdisciplinary
patient-centred, outcome-oriented approach to care delivery within a program
management context. Ms. McGill has been providing nursing professional practice
leadership to Atlantic Health Sciences Corporation since 1993.
5. Project description
5.1 Title: Interprofessional Education for Collaborative Patient-Centered Chronic Disease
Care
5.2 Overview.
The benefits of interprofessional teams in patient centred practice have multiple potential
benefits:



for the patient (increased coordination of services, integration of health care for a
wide range of health needs, empowerment as an active partner in care),
for health care delivery professionals (increased professional satisfaction, (where
appropriate) shifts emphasis to long term preventative care, allows professionals
to focus on individual areas of expertise),
and for the health care delivery system (more efficient delivery of care, decreased
burden on acute facilities as a result of increased prevention and patient education
interventions)[1].
In order to ensure that these potential benefits of this model of health care are realized it
is necessary to ensure that the education model reflects the practice model.
The complex interactions described in the interprofessional education for patient centred
practice (IPECPCP) model of D’Amour and Oandasan [2] require a multifaceted
approach which affects the education system, the learner, and the workplace.
Education system: The proposed project will increase the capacity for IPECPCP through
a faculty development programme for university and community college faculty, and for
in-practice health care providers (health educators) who act as mentors for students
during their practice experience. A component of this faculty development programme
will be joint development of the interprofessional experience for students.
Students: Integration of IPECPCP materials into the curricula of the partner institutions
and provision of common experiences which reflect the interprofessional environment
will provide students with opportunities to learn about each others distinct professional
roles while developing experience with interprofessional team work in a patient centred
12
Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
practice context.
Workplace: In addition to providing a development programme for health educators, the
proposed project will develop a programme of training for in-practice health
professionals who have not previously received formal IPECPCP.
Evaluation: An effective evaluation programme is essential to assess the effectiveness of
the programme both in terms of process and outcome, and to inform further development
for a sustainable IPECPCP programme. The programme will build on existing evaluation
tools including those that have been developed for the BBTI programme, to assess the
effectiveness of the workshops employed. New evaluation tools designed to assess
changes in approaches to practice will also be developed.
While the pilot project is intended to provide experience that may be useful in other
regions of Canada, the details of the proposal reflect some of the context of the particular
model of health care education used in New Brunswick. This context is described in the
following subsection. A detailed description of the proposal is then provided.
5.3 Context
At the present time no medical school exists in New Brunswick however components of
the medical education programmes are provided in Saint John through clinical rotations
for undergraduate MD students and residencies for postgraduate students (see below).
This places limitations on the opportunities for IPECPCP including MD students
however these opportunities will be utilized as described below.
New Brunswick uses a variety of inter-provincial agreements and in-province programs
to provide education for health professionals. There are a number of excellent programs
providing education to health professionals here in the province. The University of New
Brunswick Saint John offers a four-year Bachelor of Nursing degree, a part-time
Bachelor of Nursing degree program for Registered Nurses, and a Bachelor of Health
Sciences degree (Radiography, Respiratory Therapy, Nuclear Medicine, and Radiation
Therapy). The New Brunswick Community College at Saint John offers a Practical
Nurse (PN) Programme, a Respiratory Therapy program, a Nuclear Medicine Technology
programme, a Medical Laboratory Technology programme and a number of health care
support worker programs. The Atlantic Health Sciences Corporation also provides
programs for health disciplines such as Radiography and Radiation Therapy.
The Region 2 Health Authority (AHSC) serves south western New Brunswick from St.
Stephen to Sussex, including the Fundy Isles. The Saint John Regional Hospital is a large
tertiary care hospital which provides cardiac services to the province and is one of two
centres in New Brunswick for neuroscience and oncology. The region also includes a
number of smaller hospital and health centers, the Extramural Hospital program, and an
urban Community Health Center. Public Health Services and Community Mental Health
Services are being incorporated into the Health Authority. A full range of patient/client
services are provided by health care professionals from various disciplines within the
Region. The Health Authority accepts students for clinical placements from the Nursing
13
Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
programs at UNB Saint John, from the PN and health programs at NBCC-SJ, and from a
variety of other professional education programs from other parts of Canada. The
Medical Faculties of Dalhousie University and Memorial University are affiliated with
the Health Authority for clinical placements of medical students and residents and many
of the medical staff at AHSC have academic appointments with these universities. The
Health Authority also hosts students from other disciplines for clinical placements such
as physiotherapy, occupational therapy, psychology, social work, and clinical dietetics.
Clinical placements for students from UNB Saint John and NBCC-SJ are coordinated so
as not to overwhelm clinical areas, but each educational program functions
independently.
Currently the students in these programs may receive some content related to team
function and/or development of skills essential to effective team membership. In addition
some of the B.N. students obtain multi-disciplinary points of view through classes shared
with other health care professionals in classes such as “Health Ethics” and “Health
Research”. Students have varying degrees of exposure to teamwork among health care
professionals within clinical placements, e.g., some attend team conferences or rounds
while a few may prepare a patient assignment for colleagues. However, there are
currently few opportunities to examine roles and responsibilities, explore differences in
care frameworks or philosophies, or develop advanced skills for effective
interprofessional practice. The proposed IPECPC programme will provide a systematic
and comprehensive approach to interprofessional education for all of the learner groups
identified in this proposal.
5.4 Conceptual Framework: The conceptual framework for this pilot study incorporates
key features of the interprofessional education for collaborative patient centred practice
model of D’Amour and Oandasan [2]. In particular it reflects the fact that to be effective
as an education programme for patient centred care the interprofessional education must
be informed by the patient’s view of the trajectory of the illness. Therefore we have
structured the programme development so that it will be informed by articulate patients at
various stages of the chronic disease, moreover patients will be involved in the steering
committee and their assessments will be used as part of the evaluation process. For the
purposes of this pilot study, patients can be invited to participate through the SJCHC
diabetes management programme.
The framework also notes that the work of D’Amour and Oandasan [2] identifies the role
of the workplace culture in making interprofessional education either effective or
ineffective. Moreover, it takes into account the role of faculty within the student centred
education component, in the enculturation of students in their discipline. Therefore we
will develop both an interprofessional education component of the AHSC continuing
education programme, for in-practice professionals who have not previously had
exposure to (formal) interprofessional education for patient centred care, and a faculty
development package for educators both within the education institutions and within the
clinical setting. Our proposal includes design and implementation of interprofessional
experience for students and practitioners in the examination of professional roles and
barriers to collaboration, and in development of advanced skills to enhance effective
14
Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
teamwork.
The conceptual framework outlined above has lead to the project being developed as four
phases:
I.
II.
III.
IV.
Resource Identification
Faculty Development
 Orientation and Awareness
 Joint Curriculum Development
 Curriculum Materials and Reports
IPECPCP Implementation
Final Report and Evaluation
A more detailed description and tentative timelines are given below (sections 7 & 8).
Each phase develops a foundation for the following phase and concurrent with these
phases an evaluation process which interacts with the phase and informs the development
of the next phase, is carried out.
While the project will include interprofessional team experience in the practice setting it
will also provide simulations to facilitate understanding of interprofessional practice
including the distinct but interacting roles of the team members. The evaluation process
will also use simulations to assess the effect of the programme.
Simulations can take a variety of forms, such as computer programs, physical models,
and problem-solving exercises on CD-ROM or DVD. Nursing faculty at UNB Saint John
use situational simulations of case studies, as well as interviews of patients and families,
and actors taking on roles. Simulations are also used in upper year medical programmes
although traditionally the use of simulated patients by actors is primarily used for the
final assessment process and does not include a collaborative care team of students. For
the purpose of this project, we are proposing a combination of all three of these methods.
Simulation experiences can be used to explore student attitudes and values as well as to
practice decision-making and communication skills. Simulations have the advantages of
being repeatable, predictable and schedulable. In addition, the ability to tailor the
simulation provides an opportunity to explore different health care issues in the rural and
urban settings.
A “capstone” simulation is to be delivered in a workshop format with the core audience
being BN and PN Students in the later parts of their programs, as well as family practice
MDs in the residency component of their programme where possible. In a patient-centred
continuum of care model, after graduating from their respective programs, these students
will work together in patient care delivery teams in the workplace. These are chosen as
the core professions for the study as the numbers of students is predictable and large
enough to allow some quantitative analysis. Within the New Brunswick model of health
care education provision the numbers and specializations of other students may vary;
however, this model has the advantage that over time many different professions and
specializations will be involved in the programme. Inclusion of post-licensure health
professionals in the workshops will be through the AHSC continuing education
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programme.
We expect the workshop to take 1.5 days with all students brought to a single site for the
duration of the workshop. The workshop will include an orientation session, interviews
and practice setting simulations with students in small interdisciplinary groups
(maximum of eight students per group), post practice setting simulation discussion and
analysis in small interdisciplinary groups, large group comparison and discussion
including comparative analysis by groups working at different stages in the trajectory of
illness. (For the interviews and practice setting simulations actual patients and simulated
patients will be used depending on the availability and appropriateness of actual patients).
Simulated practice setting situations have been used previously for inter-disciplinary
education [3] [4] [5] [6]. Generally speaking these have shown that this education model
is effective for identifying differences in perception of issues through, for example,
differences in approaches to ethical issues in the cultures of different disciplines. It is also
effective for enhancing students’ awareness of differences in roles and scope of practice.
The proposed programme specifically incorporates the model of interprofessional
education for collaborative patient centred practice by looking at the interaction of the
patient view of the illness trajectory and the practice setting culture, with the
interprofessional education model.
In preparation for the simulation workshops, students will participate in learning
experiences that will be integrated into their existing course work at their own institutions
and which will include interprofessional workshops. They will then come together for a
planned simulation experience to work in teams to address patient case studies. To create
the interprofessional experience, students from other professional disciplines involved in
clinical placements in the Health Authority will be invited to participate in the simulation
as they are available. When students are not available, then practicing members of the
professional group will be invited in to provide additional professional perspectives. As
described below, health care practitioners who have not previously had access to formal
health care education will take part in the simulation exercises and as part of their formal
preparation prior to the simulation exercises will be provided with learning materials on
collaborative team practice relevant to in-practice professionals.
The case studies used in the preparatory work and simulation exercise will be based on
chronic illness experiences and management. This is supported by the fact that population
health studies indicate that there are high rates of many chronic illnesses in the local
area[7], and complex chronic illness or multiple co-morbidities lend themselves to team
interventions. For the purposes of the pilot project discussed here we anticipate using
diabetes as the main chronic illness on which to base the case studies. Centering the case
studies used in the realization of the education model on a chronic illness, such as
diabetes, is informed by the interaction between the education model and patient centred
care model identified by D’Amour and Oandasson[2]. In particular, this provides access
to a substantial number of patients whose experience in managing their disease and in
interacting with health care professionals, will inform the development of the
programme.
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
The simulations will be based on a combination of stimuli, including written case
descriptions related to chronic illness, actors who will take on the role of patients with
this condition, and/or interviews with patients and families who are experiencing a
complex chronic health challenge. Patients experiencing the specific conditions under
discussion in the simulation will be consulted as a part of the planning process. The
theory component of the programme will be packaged into an independent study that will
be completed in preparation for participation in a simulation.
A programme for practicing professionals in collaborative care and interprofessional
practice will be established. This is consistent with the observation by D’Amour and
Oandasan [2] that “it is important to have clinical settings where collaborative practice is
modeled” and that “institutional factors (meso level) can influence the professional
beliefs and attitudes of faculty and learners towards interprofessional ways of learning
and practicing”. Existing practitioners in the profession may be either formal or informal
mentors to new practitioners in the workplace and, in particular, may either reinforce or
diminish the role of interprofessional practice and collaborative care as part of the
workplace culture. We hypothesise that new recruits will be either positively or
negatively influenced by in-practice individuals in their profession according to their
degree of developed interprofessional education and practice of professionals already
established in the workplace. A study of this will require a longer period of research than
can be incorporated in the two year pilot programme and, therefore, will form part of the
long term evaluative research for the interprofessional programme beyond the term of
this pilot project. However during the pilot project we shall be able to assess the role of
in-practice professionals in the groups and to assess models for the inclusion of such
professionals in the full programme (see Section 6.8 below). The senior administration of
AHSC has given its support to developing such a programme as part of its continuing
education programme.
5.5 Change in culture and attitude
As noted above the programme will address IPECPCP both for pre-licensure students and
post-licensure in-practice health care workers. In doing so it will effect both the education
setting centred on the student and the practice setting centred on the patient. This
recognizes the point made by D’Amour and Oandasan [2] that interprofessional
education will not be effective in changing the model of patient care if it is not supported
by the practice setting culture.
5.6 Barriers and Challenges
Implicit assumptions of hierarchy. The core learner groups in this programme are PN
students, BN Students and MD residents. These groups have different types of education
experience (certificate, undergraduate degree, and post-graduate training) and this is often
accompanied by different types of life experience (typical ages may vary significantly
among the groups). Historically health care has used a hierarchical structure amongst
health professions and even within professions. However effective teamwork has been
17
Interprofessional Education for Collaborative Patient-Centered
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shown to positively affect health care practice and outcomes and has been associated with
trust and mutual attunement in shared time and space even in stressful healthcare
situations [8]. We will address any implicit assumptions of hierarchy that may be
associated with the differences in educational experience by placing emphasis on mutual
respect for the distinct but interacting roles of team members.
Limited number of full health education programmes. We deliver full education programs
for only a small number of health care disciplines in our geographic area, so in order to
create a true interprofessional education experience we are proposing an innovative
collaboration to overcome this barrier. A particular difficulty in this context is that
undergraduate MD students receive most of their undergraduate training outside New
Brunswick. At present undergraduate students are present in Saint John only during
certain of their clinical rotations and therefore both the exact number and area in which
they work is unpredictable. We intend to liaise with the Dalhousie University and
Memorial University programmes so as to understand and build on the IPE that they
provide for undergraduate MD students.
Faculty Experience with IPECPCP. While some of the faculty who will be involved with
this project have experience with multi-disciplinary programmes and there is some
experience with simulations within specific discipline contexts, there is a need for a
larger number of faculty who can integrate inter-disciplinary team patient centred health
care into their classes and who can facilitate the inter-disciplinary workshop. This will be
addressed through a faculty development package as described above.
Student Assessment. The issue of student assessment may prove difficult because of
different methodologies in the different programmes. However, experience with multiinstitution programmes such as the Bachelor of Health Sciences programme indicates that
this can be addressed through the steering committee.
Limited numbers of students in some disciplines For some disciplines the numbers of
students may be very small even after the programme has been run several times. For this
reason, quantitative analysis will be used primarily in the case of the core groups of
learners as identified above however qualitative data will be collected from all groups
including facilitators and patients. (See section 8).
5.7 Primary Target Audience: The primary target audience is those entering or in-practice
in the professions of practical nurse, registered nurse and MD. These have been chosen as
they form core components of the interdisciplinary teams for patient centred practice.
Secondary audiences are undergraduate MD students during clinical rotation, other health
professions and, through the faculty development package, health educators.
5.8 Integration of the Learning into educational and clinical settings
As described above the integration into the educational setting will be by weaving the
interdisciplinary team for patient centred care approach into the curriculum of existing
courses (PN, BN, and post graduate MD). Students in the PN and RN groups are
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
provided with clinical experience during the course of their programme therefore they
will have an opportunity to apply education in interdisciplinary team patient centred care
in the clinical sites used for this clinical experience. The SJCHC environment in which
the MD residents work is based on patient centred practice through interdisciplinary
teams. Residents will receive orientation and workshops (BBTI based) which provide
IPECPCP. Depending on where the resident previously studied, this will either
supplement and reinforce previous IPECPCP training or introduce this training to the
resident. A specific objective of this proposal is the integration of interprofessional team
experience into the practice setting placements of students (objective 3 see section 6).
Atlantic Health Science Corporation is the main practice setting provider for the PN and
BN programmes and is committed to interdisciplinary practice to support patient centred
care. The health educator component of the faculty development phase and continuing
education programme described above will accelerate the integration of this model into
the practice settings where the BN and PN students receive their clinical training.
5.9 Bibliography
[1] Grant RW, Finnocchio LJ, and the California Primary Care Consortium
Subcommittee on Interdisciplinary Collaboration. Interdisciplinary Collaborative Teams
in Primary Care: A Model Curriculum and Resource Guide. San Francisco, CA: Pew
Health Professions Commission, 1995. (As quoted in Building a Better Tomorrow
materials).
[2] D. D’Amour and I Oandasan, Interprofessional Education for Collaborative PatientCentred Practice : an evolving framework, Interprofessional Education for Collaborative
Patient-Centred Practice, Chapter 10 (Health Canada 2004)
[3] O. Wahlstrom and I. Sanden, Multiprofessional training ward at Linkoping
University: Early Experience, Education for Health: Change in Learning & Practice v.11
p231-236 (1998)
[4] G.J. Mires et al., Multiprofessional Education in Undergraduate Curricula can work,
Medical Teacher v.21 281-285 (1999)
[5] J. Ker, L. Mole, and P. Bradley, Early Introduction to Interprofessional Learning: A
Simulated Ward Environment, Medical Education v.37 248-255 (2003)
[6] C. Edward and P. E. Preece, Shared Teaching in Health Care Ethics: A Report on the
Beginning of an Idea, Nursing Ethics v.6 299-307 (1999)
[7] K. Hayward and R. Colman, The Tides of Change: Addressing Inequity and Chronic
Disease in Atlantic Canada. A Discussion Paper. prepared for the Population and Public
Health Branch (Health Canada 2003)
[8] H. Menzies, Nurses and Health Care (Chapter 5); No Time: Stress and the Crisis of
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Modern Life (2005 Pub Douglas and McIntyre, Vancouver)
6. Project Objectives
The overall objective of the project is to develop a sustainable model of health care
education which will equip students to work in interprofessional teams in patient centred
practice, through simulated care experiences for patients with chronic disease in various
stages of the disease, and practicum experience. This will provide students with valuable
experience in how interdisciplinary teams interact along the continuum of care, as well as
how such teams work at a specific point in the illness trajectory.
In order to achieve this overall objective the programme is structured to increase capacity
for delivery of IPECPCP, provide students with exposure to concepts of interprofessional
practice and with experience of patient centred practice through interdisciplinary teams.
Specific Objectives are
Objective # 1: To facilitate and increase the capacity for health educators to deliver the
interprofessional education model (IPECPCP).
Objective # 2: To increase the competencies of students and health professionals across
disciplines to deliver interprofessional health care
Objective # 3: To provide opportunities for students and health professionals across
disciplines to apply their IPECPCP program on interprofessional team work.
Objective # 4: Evaluation of strategies for an effective IPECPCP programme and
identification of better practices
Specifically, in terms of the objectives of the Health Canada IPECPCP initiative:
The project will promote and demonstrate the benefits of interprofessional education for
collaborative patient centred care by demonstrating the change in self-efficacy, attitude
towards the patient’s role, and perception of professional roles by students. The
continuing education programme will directly promote the benefits of collaborative
practice in the health practice setting place.
The programme will stimulate networking and sharing of best practices through
publications in scholarly journals and conference presentations, and constructing faculty
development and curricula packages which may be used by other sites.
The programme will increase the number of health professionals trained in collaborative
patient centred practice by integration of this material into upper year undergraduate and
college education programmes and through a post-licensure continuing education
programme for in-practice professionals who have not previously had access to this type
of education. All students will take part in the workshop simulation described in section
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Interprofessional Education for Collaborative Patient-Centered
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5.
The programme will increase the number of educators prepared to teach from an
interprofessional, collaborative practice patient centred care perspective through a faculty
development programme. This will be developed into a training package for educators at
other sites following the completion and assessment of the pilot offering of the
programme.
The programme will facilitate interprofessional collaboration in both education and
practice by modeling this in the structure of the programme. This will be achieved, for
example, by including students from at least three core programmes, and pre and postlicensure professionals from other disciplines; by using college instructors, university
faculty, and clinical instructors as educators; and through the structure of its steering
committee (section 6.4).
7. Tentative Timelines
The following provides tentative timelines for the broad phases of the programme.
Detailed timelines for activities related to the specific objectives described above (section
6) are given in the work plans attached as an appendix to this application.
May 2006 to August 2006 Phase I: Resource Identification
Research on best practices
Hiring of Facilitators
Establish steering committee
Consultation with patients and IPECPCP programmes
September 2006 to December 2006: Phase II Pt 1: Faculty Development, orientation and
awareness
Development and Implementation of the Evaluation Framework for Faculty/Educator
Development
Introduction to IPECPCP Concepts and Benefits for Faculty and Educators (Workshops)
Identification of learning objectives
Identification of working groups
January 2007 to April 2007: Phase II Pt 2: Faculty development, joint curriculum
development
Interdisciplinary working group curriculum development
Working group development of interdisciplinary practice scenarios
Consultation with patients
May 2007 to August 2007 Phase II Pt3: Faculty Development, Curriculum materials and
reports
Finalization of curriculum and schedule, and curriculum materials production
Summary of results for phase II evaluation
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Interprofessional Education for Collaborative Patient-Centered
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September 2007 to December 2007: Phase III, IPECPCP implementation
Logic model and evaluation materials for IPECPCP implementation
Pilot delivery of the IPECPCP curriculum including interdisciplinary cross-links and
capstone workshop
January 2008 to June 2008: Phase IV, Final report and Evaluation
Data analysis and evaluation.
Refinement of the curricula materials and workshop materials for incorporation into the
partners’ education and training programmes
Preparation of professional development and curriculum packages for delivery at other
sites.
Presentation of findings to patient, educator and learner groups
Dissemination of findings through conference presentations and article submission to
scholarly journals
Completion and submission of the final report
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8. Evaluation
Evaluation Phase I: Identification of Better Practices to Inform the Program Design and
Evaluation Framework (May 2006- August 2006)
The initial project phase will involve identification of promising practices related to the
development, delivery and review of interprofessional educational programs within the
health sector. The outcomes of the proposed data-gathering activities will assist in
refining the design and evaluation framework for the IPECPCP sponsored by Health
Canada. This aspect of the endeavour involves the completion of five key components: a
Literature Scan, Key Expert Interviews, Formulation of Promising Practice Statements,
Creation of a Project Logic Model and Elaboration of the Evaluation Framework, and
Development of Evaluation Instruments.
a) Literature Scan (May-June 2006)
Members of the project team will undertake a scan of the literature to identify evidencebased-practices related to the design, implementation and evaluation of interprofessional
educational health programs. A minimum of five databases will be used (e.g. PsycInfo,
EMBASE, Pubmed or Medline, CINAHL, ERIC, Social Sciences Index, and CDSR –
Cochrane Database of Systematic Reviews) to complete this scan. Bibliographies of
relevant documents and articles will also be searched. Journals that are frequent sources
of articles will be hand-searched. Research documents retrieved as a result of such
searches will include peer-reviewed journal articles and research monographs. Gray
literature, including government reports, public reports, and contract research reports,
will be retrieved through searches of departmental websites. The outcomes of this scan
will provide the basis from which to complete a concise literature summary. It is
anticipated that this document will be approximately 8 to 10 pages in length.
b) Key Expert Interviews (May-June 2006)
In conjunction with the literature review, interviews will be conducted to seek the advice
of key provincial and national experts who have had background experience and direct
involvement in the development, delivery and evaluation of interprofessional educational
health programs. For this evaluation activity University and Regional Health Authority
Ethics forms will be completed outlining the specific data collection and ethics
procedures required to meet the standards defined by the Tri-Council Policy Statements
on Ethical Conduct for Research Involving Humans. Once ethics clearance has been
granted, then data collection will proceed.
For this evaluation activity, key experts may represent practitioners, policy makers and
researchers. Expert experience will ideally provide plausible advice and serve to confirm
conclusions reached through the literature review. Key experts will be identified through
consultation with Health Canada and other provincial and national groups currently
involved in the delivery of interprofessional educational programs. It is anticipated that
approximately 15 in-depth phone interviews will be completed with key experts,
representing perspectives from researchers, practitioners and policy-makers. Initial
contact will be made with the key experts to review the purpose of the research program
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Interprofessional Education for Collaborative Patient-Centered
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and their potential participation in this aspect of the project. Upon obtaining their
consent, individual interview times will be arranged.
Interviews will be conducted by telephone in either French or English, given the
preference and regional considerations of the interviewee. A semi-structured interview
will be undertaken with a range of open-ended, as well as more focused questions.
Interviews with key experts will be recorded. Upon transcription of relevant interview
data, the responses for each area of inquiry will be merged, and content analysis will be
used to analyze the main themes emerging from the outcomes of the interviews. Relevant
documentation identified by the key experts will also be examined and used to elaborate
upon the key informant interview data. The results of this data-gathering effort will
provide the basis from which to complete a research summary of the key expert interview
outcomes. This summary should be approximately 5 to 7 pages in length.
c) Formulation of Promising Practice Statements (June 2006)
This aspect of this pre-project phase will involve an analysis of the key practices and
lessons learned from the literature scan and expert interviews. Areas of convergence from
these two data-gathering efforts will be documented and form the basis for the
development of concise statements outlining promising practice related to the
development, delivery and evaluation of interprofessional educational health programs.
The outcomes of this research effort will facilitate the completion of a final document
incorporating the literature scan, key expert outcomes and a list of promising practice
statements. The final document will be approximately 20 pages in length.
d) Creation of a Project Logic Model and Elaboration of the Evaluation Framework
(July-August 2006)
The promising practices identified in this will provide the basis from which to review the
IPECPCP implementation and evaluation plan. Once key insights from the better
practices perspectives have been incorporated into the project plan, a logic model for this
initiative will be created. The logic model will provide a schematic overview of the key
components of the proposed project plan, including: theoretical assumptions, goals,
resources (inputs), participants, outputs, and outcomes (immediate, short-term and longterm). Upon completion of the logic model, it will be submitted to project authorities for
their consideration and review. Feedback will then be incorporated and the logic model
will be finalized.
The accepted framework will subsequently be used to structure and elaborate the planned
implementation and evaluation activities of the proposed project. It is anticipated that the
finalized evaluation framework will examine three key areas related to the program’s
development, delivery and outcomes. These include evaluation of the stakeholder training
and capacity-building phase, the evaluation of the effectiveness of the actual project
implementation, as well as evaluation of the outcomes realized as a result of the delivery
of the interprofessional educational initiative.
e) Development of Evaluation Instruments (July-August 2006)
During the later part of this phase, work will also be undertaken to design the datacollection instruments that will be used in the various evaluation phases of this initiative.
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Interprofessional Education for Collaborative Patient-Centered
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Identified better practices related to the evaluation of interprofessional programs gleaned
from the literature scan and key experts will assist in guiding both the format and content
of the evaluation instruments and data-collection protocols. Ongoing deliberations with
Project Authorities will be undertaken to ensure that approaches to data-collection and
inquiry are ethical and sensitive to the needs of students and faculty members who will
participate in the implementation of this educational initiative. Evaluation instruments
will be developed for the three evaluation components of this initiative: the faculty
development evaluation, the process evaluation, and the outcome evaluation. The final
deliverable for this phase will entail submission of the various evaluation tools to Project
Authorities for their consideration. Feedback from this review will be subsequently
incorporated, and the final evaluation instruments and methods will be finalized.
At the close of this phase, University and Regional Health Authority Ethics forms will be
completed for the remaining evaluation phases. This will also entail outlining the
specific data-collection and ethics procedures required to meet the standards defined by
the Tri-Council Policy Statements on Ethical Conduct for Research Involving Humans.
Once ethics clearance has been received, then the subsequent evaluation phases will be
undertaken.
Evaluation Phase II: Faculty Development Evaluation (September 2006 to August 2007)
From September 2006 to December 2007 faculty members and health educators from
participating universities and colleges will attend a series of orientation sessions related
to the development and delivery of interprofessional educational programs. These
training workshops will be designed not only to acquaint participants with current
practise related to interprofessional training approaches, but also to prepare them for
engagement in subsequent curriculum planning/development activities to be carried out
between January 2007 and August 2007. Overall, the purposes of training and eliciting
the participation of faculty participants are to enhance their professional capacity and
readiness to implement effectively the proposed interprofessional educational program in
the fall of 2007.
It is anticipated that a pre-post survey approach will be employed to evaluate
participants’ perspectives regarding the impact of the training and curriculum
development sessions on enhancing their readiness to implement the proposed
interprofessional educational program. Areas of inquiry will include investigation of
knowledge of essential content, skills acquired or strengthened, the nature of professional
attitudes and working relationships, and perceived confidence. In addition, participants’
satisfaction with the training and curriculum development process will be examined,
including lessons learned as a result of their involvement in this aspect of the initiative.
The outcomes of the pre-post surveys will be coded and entered into the project database.
Basic statistical analyses and content methods will be used to investigate potential
changes in faculty capacity/readiness (knowledge, skills, attitudes, and working
relationships, confidence) to implement the interprofessional educational program. Upon
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Interprofessional Education for Collaborative Patient-Centered
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completion of these analyses, a concise summary report of the findings will be submitted
to Project Authorities.
Evaluation Phase III: Process Evaluation (September 2007 – December 2007)
This aspect of the evaluation will examine the effectiveness of the implementation of the
initiative. Key areas of inquiry might include, but would not be limited to:
 Was there consistency between the project’s intent and the activities of the
initiative?
 Did the initiative effectively reach and engage student and faculty partipcants?
 Did participants perceive that the objectives of the project were met?
 Were participants satisfied with the implemented activities of the project?
 What were participants’ perceptions regarding the overall impact of this
initiative?
 What specific challenges were encountered in the implementation of the program?
How were these addressed and how did this impact program delivery?
 What lessons learned were identified as a result of the implementation of this
initiative?
 What specific developments might be considered to enhance the effectiveness of
subsequent applications of this capacity-building model in other jurisdictions?
It is anticipated that an evaluation questionnaire will be administered to participants at the
close of each educational session. Questions will include a range of rating scale and
open-ended items, designed to examine participants’ perspectives regarding the
implementation of the various initiative activities. For this aspect of the evaluation, two
process evaluation questionnaires will be developed, one for use with students and the
other to be administered to faculty members/health educators. In addition to the session
evaluation questionnaires, four focus groups will also be carried out with project
participants towards the end of the project implementation period. Two of these sessions
will be carried out with students, whereas the remaining ones will involve faculty
members/health educators. Areas of inquiry will be similar to those used in the
questionnaires; however, these group sessions will focus on gathering perspectives
related to the overall/global implementation of the initiative.
Consistent with the previous phase, the results of the post-session questionnaires and
focus group sessions will be coded and entered into the project database. Basic statistical
analyses and content methods will be undertaken to investigate data related to the
implementation of the interprofessional educational program. Upon completion of these
analyses, a concise summary report of the findings of this aspect of the evaluation will be
submitted to Project Authorities.
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Interprofessional Education for Collaborative Patient-Centered
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Evaluation Phase IV: Outcome Evaluation (September 2007-June 2008)
This aspect of the evaluation will examine the accomplishments and outcomes resulting
from the implemented interprofessional education program. Particular attention will be
given to documenting potential changes in students’ knowledge of essential content,
acquired skills, professional attitudes, working relationships, and confidence related to
interprofessioanl team efforts and delivery of patient-centred healthcare. It is envisioned
that baseline data for these areas of professional functioning will be gathered at the outset
of the program. Subsequent data-collection periods will be undertaken at mid-point in
the program, at the close of the implementation phase, and three month following the
termination of the program. It is anticipated that a range of data-collection methods will
be employed for this evaluation phase, including administration of baseline and follow-up
self-report surveys and problem-solving test situations that incorporate scenarios relating
to interprofessional health team efforts and delivery of patient-centred health care. The
possibility of identifying a suitable comparison group for this aspect of the evaluation
will also be explored. If it is deemed feasible to include a comparison group, then the
data-collection activities completed with the treatment group will also be carried out with
the participants from the comparison group during the same time period.
The results of the self-report surveys and the problem-solving test situations will be
coded and entered into the project database. Inferential statistical analyses and content
methods will be undertaken to investigate the data associated with the outcomes of the
interprofessional educational program. Upon completion of these analyses, a concise
summary report of the findings of this aspect of the evaluation will be submitted to
Project Authorities.
Throughout the curriculum delivery component of the project, each of the partner
organizations will apply their normal evaluation procedures for instruction quality
assurance.
9. Knowledge transfer, networking and dissemination
Information about the project and its outcomes will be disseminated through publication
in scholarly journals and through national (e.g. CASN, ACCC) and international (e.g.
Congress of Health Professions Educators) conferences. Conferences play a particularly
important role in dissemination of the results as this provides an opportunity to network
with others working on interprofessional education for patient centred care.
In addition the partners will seek to develop curriculum and faculty development
materials which may be transferred to another site. Training in the use of these materials
will also be developed. It is anticipated that this will occur after the assessment of the
pilot project proposed here has been completed.
As previously described, a continuing education programme will form part of this project
and this will provide direct knowledge transfer into the sites where undergraduate
students receive clinical experience.
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Interprofessional Education for Collaborative Patient-Centered
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10. Sustainability
The components of the program once established will create a sustainable education
experience that can be built into our current curriculums. With planning it will be
possible to cycle all of our students through the program. It is very difficult to organize
team experiences that truly represent the practice environment. Well-designed
simulations and workshops with multiple perspectives brought into the discussions will
provide valuable learning experiences for students. The simulations and the descriptions
of our experience will be available to the many other health care education programs that
are in similar settings.
Following assessment of the pilot project we anticipate that the interprofessional
education experiences and related preparation will be integrated into the curriculum of
the partner programmes in a manner similar to that of the pilot project proposed here. All
programmes would require students to take the interprofessional simulations and
workshops to complete the interprofessional education component. We also anticipate
that the interprofessional education simulations and workshops will become a regular part
of the programme for other allied health profession students through the Bachelor of
Health Sciences (BHS) programme (UNB). MD undergraduate students and residents
will access the programme as part of their interprofessional education programme. AHSC
will maintain the programme for in-practice professionals as part of their continuing
education programme.
Principal increased costs will be those directly involved with the capstone workshop and
will include the costs of including patients (simulated and real) in the simulation and
costs of using in-practice professionals with interprofessional education experience as
facilitators. As a sustainable alternative, web based simulations and provision of
workshop materials will be investigated as to cost effectiveness and pedagogical value.
Certain web based components are outlined in the work plans and include simulated
interaction with the electronic health record system that supports interprofessional team
approaches (see objective 3).
Atlantic Health Science Corporation is committed to the patient centred care model and
sees the recruitment of staff with experience in inter-disciplinary health care as a key
component in its human resources strategy. Institutional commitment to collaborative
practice for patient centred care must be supported by an appropriate education
programme for staff who have not received training in this area.
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Appendix: Project Summary
Project Title: Interprofessional Education for Collaborative Patient-Centred Chronic
Disease Care
Please provide a brief description of the proposed project (maximum 350 words) in the
space below or on a separate sheet. (If the latter, order the description according to the
following.)
1. Mandate of the primary applicant organization
The University of New Brunswick (UNB) is a national comprehensive university
providing high quality and innovative programmes in both education, including health
education programmes.
2. List of partners with whom the organization will work on this project and their roles
The educational partners (Dalhousie University Faculty of Medicine, New Brunswick
Community College (NBCC) will provide core groups of learners from their health
education programmes as well as providing additional expertise in curriculum
development and evaluation.
The practice site partner, Atlantic Health Sciences Corporation (AHSC) through the St.
Joseph’s Community Health Centre, will provide access to health care professionals
working in a Collaborative Practice model. Other areas within AHSC where students
receive practice setting experience will be prepared for IPECPCP. In addition, patients
with diabetes will be recruited from the diabetes teaching unit for initial consultations on
chronic disease health care.
3. Objectives of the project
The overall objective of the project is to develop a model of health care education which
will equip students to work in interprofessional teams in patient-centred practice, through
simulated care experiences for patients with chronic disease in various stages of the
disease.
Specific objectives are (see the following work plans):
Objective # 1: To facilitate and increase the capacity for health educators to deliver the
interprofessional education model (IPECPCP).
Objective # 2: To increase the competencies of students and health professionals across
disciplines to deliver interprofessional health care.
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
Objective # 3: To provide opportunities for students and health professionals across
disciplines to apply their IPECPCP program on interprofessional team work.
Objective # 4: Evaluation of strategies for an effective IPECPCP programme and
identification of better practices
4. Major activities required to achieve these objectives are indicated in the following
work plans
5. Expected results of the project
The project is expected to demonstrate the benefits of IPECPCP and to increase the
numbers of professionals trained in collaborative patient centred practice, with emphasis
on the benefits of collaborative practice along the continuum of care along the trajectory
of chronic disease.
For specific indicators of success see the following work plans.
6. Methods that will be used to evaluate both the process and the outcomes of the project
Qualitative and quantitative data will be collected from learners, patients, and educators.
For specific evaluation methods see the following work plan for objective 4
7. List of the project deliverables with timelines
Deliverables include






IPECPCP literature survey (Phase I August 2006)
Faculty Development workshop materials and evaluation framework (Phase II.1
December 2006)
Interdisciplinary practice scenarios (Phase II.2 April 2007)
Curriculum schedule and materials for implementation, and summary of
evaluation results for phase II (Phase II.3 August 2007)
Logic model and evaluation materials for IPECPCP implementation (Phase III
December 2007)
Professional Development and Curriculum Packages, presentation of findings to
stakeholder groups, conference presentations, and final report (Phase IV June
2008)
Timelines and deliverables for the objectives and actions are indicated in the attached
work plans.
8. Dissemination plan (including to whom, when and how the information will be
disseminated).
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Interprofessional Education for Collaborative Patient-Centered
Chronic Disease Care
The findings from this pilot project will be disseminated through the following:
Presentation of findings to patient, educator and learner groups, and to senior
administration of the partner institutions.
National and international Conference presentations and submission of articles to
scholarly journals.
Dissemination of the final report, including posting of the report on the websites of the
partner institutions.
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