CLINICAL SKILLS
Managed Educational Network
Excellent skills for excellent care
Assessing Interprofessional Teamwork
Competence Through A Team Observed
Structured Clinical Assessment (TOSCA)
Funded CSMEN PROJECT 2012-13
Keith Stevenson,
Evelyn McElhinney
Liz Simpson,
Kay Currie
Jacqueline McCallum
School of Health and Life Sciences
Glasgow Caledonian University
Quality Education for a Healthier Scotland
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Statutory Requirement
Standards for Pre Reg. Nursing Education (NMC 2010)
R5.7 Programme providers must ensure that students have the
opportunity to learn with, and from, other health and social care
professionals. (NMC 2010 p75)
HCPC Standards of education and training p7 (2012)
4.9 When there is interprofessional learning the profession-specific
skills and knowledge of each professional group must be
adequately addressed.
SSSC Council (23 Jul 2009)
to encourage and promote collaborative working: cross sector,
interagency, interprofessional and academic/practice.
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Scottish Perspective (NES)
The concept of IPL is not new and over the past ten years it
has become an integral part of many pre- and postregistration health and social care professional programmes
throughout the United Kingdom.
The driver for this rapid growth in IPL activity is the
requirement for health and social care graduates to be
competent regarding interprofessional collaboration and team
working in a variety of settings.
http://www.nes.scot.nhs.uk/education-and-training/educationaldevelopment/initiatives/
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Making it Real at GCU
IPE Modules should be designed to include
simulated authentic interprofessional activity:
Authentic interprofessional team working,
Authentic interprofessional communication,
Provide real experience of leading an interprofessional team,
Provide opportunities for students to reflect on their leadership
and subsequent team success
• Provide Psycho-Sociological Perspective on IPP at each level
•
•
•
•
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Agreed IPP Skills
(Thistlethwaite and Moran2010)
• Effective TEAMWORK
• Understanding TEAM ROLES and RESPONSIBILITIES
• Effective COMMUNICATION
• Effective SHARED DECISION MAKING
• Involving an understanding of THE SERVICE USER
• Revisiting ETHICS and ATTITUDES
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Example of a McMaster TOSCA Scenario Briefing
Use:Nursing, OT, Physio, Podiatry, Social Work, Dietetics, Paramed
You have 20 minutes to discuss the case and suggest a care plan
and you will be assessed on your contribution to the discussion.
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•
•
•
•
Alan Kettle, 37 yrs old, is morbidly obese and has low self-esteem and social
phobia.
He fell last week getting out of the shower and his elderly parents had trouble
getting him up so called 999. He is asking for a motorized scooter as he has been
having increasing trouble walking due to weight, OA (knee and hip) and SOB.
He previously requested a scooter 1 year ago but was declined. The Occupational
Therapist thought the scooter would decrease his functional status.
Alan is coming in for his appointment next week to once again request a scooter.
The clinician, with whom he has booked his time, has requested that he be
reviewed by the team to develop a response and an approach, prior to his visit.
Alan’s Medical History is attached (see next page)
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Medical History
DOB: April 13, 1977 /Weight: 325lbs/ Height: 5’10”/ BMI: 46.6 (> 90th percentile for age)
Obesity onset: Childhood
Diabetes- Type 2 medication dependant since 2005
Oral weight loss meds and various diets have failed
Social anxiety: (has prevented follow-up with obesity clinic)
OA (knees and hips) Sleep apnea (intermittently compliant with CPAP)
Most Recent Investigations
HbA1c 0.088 BP 149/92 BMI 46.6
Renal function: Sodium 137; Potassium 3.6; Urea 8.7; Creatinine 128
Medications
Celeoxib 60mg po od (for pain)
Orlistat (Xenical) 120mg po tid with each main meal (anti-obesity)
Metformin 500mg tid (for diabetes) Clonazepam 0.5mg tid prn (for anxiety)
Ramipril 2.5mg po od (for blood pressure and kidney care)
Social History
College –courses x2 Writing literature; Introduction to Journalism; online
Employment- occasionally publishes fiction stories via people watching at shopping malls etc.
Social phobia
Caffeine/cola dependency - diet counselling in 2001, 2005, 2007
Non smoker; Non drinker
Parents- Mabel and Patrick Kettle- did counselling course 2006 “ Food and Enabling”
Sisters –older- Alicia-healthcare admin; Cindy- nurse; Stephanie; pharmaceutical rep
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Suggested Scoring Template
1-2
Well Below
3-4
Below Expected
Name
Student A
5
6-7
Expected
Above Expected
Student B
Student C
8-9
Well Above
Student D
Communication
Collaboration
Roles +
Responsibilities
Collaborative
Approach
Conflict
management
Team functioning
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TOSCA GROUP 1
(in action)
Social Work
Student
Mental Health
Nursing Student
Physiotherapy Student
Occupational Therapy
Student
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Combined Scoring Template
Group 1
1-2
Well Below
3-4
Below Expected
5
6-7
Expected
Above Expected
8-9
Well Above
Name
Student A
Student B
Student C
Student D
Communication
6 7 7
7 7 8
6 7 6
7 8 7
Collaboration
7 7 6
7 7 8
7 7 7
8 8 8
Roles +
Responsibilities
5 5 6
7 7 8
5 6 6
7 7 7
Collaborative
Approach
7 7 7
6 6 7
6 6 6
7 7 8
Conflict
management
n/a
n/a
n/a
n/a
Team functioning
7 7 7
7 8 8
7 7 7
8 8 8
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TOSCA Group 2
(in action)
Mental Health
Nursing Student
Occupational Therapy Student
Social Work Student
Physiotherapy Student
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Combined Scoring Template
(Group 2)
1-2
Well Below
3-4
Below Expected
5
6-7
Expected
Above Expected
8-9
Well Above
Name
Student A
Student B
Student C
Student D
Communication
6 6 6
7 7 7
7 7 7
7 7 6
Collaboration
5 6 6
6 7 7
6 7 7
7 6 7
Roles +
Responsibilities
7 7 5
7 7 7
7 7 6
7 7 7
Collaborative
Approach
6 7 6
7 7 6
6 7 6
7 6 7
Conflict
management
n/a
n/a
n/a
n/a
Team functioning
7 6 5
7 7 6
7 7 6
7 7 7
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TOSCE STUDY
WHICH GROUP?
BRIEF QUESTIONNAIRE
1
2
Strongly
Agree
(Please circle)
Agree
Unsure
Disagree
Strongly
Disagree
Place a x in the column that best describes your feeling about the experience
Q1. The Assessment was explained I knew what I was supposed to do
Q2. The Assessment room was appropriate to the task
Q3. The other students seemed to know what to do better than me
Q4. It was difficult to know who was leading the group
Q5. I found it difficult to get my point across to the rest of the group
Q6. It was interesting to hear the other professions’ viewpoints on the
case we were discussing
Q7. I felt uncomfortable that I had to say stuff when I didn’t really have
anything to say.
Q8. I can see why this type of assessment would be useful to us in our
professional lives
Q9. I didn’t like the experience of being assessed in this way
Q10. I think being taught and then assessed in interprofessional activities
by simulations like this is a good idea.
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Agreement
with Positive
Questions
Qs1,2,6,8,10 Response
31 Strongly
9
Agree
Agree
77.5%
22.5%
Total
40
100%
Response
32
Disagree
5 Strongly Disagree
80%
12.5%
Disagreement
with Negative
Questions
Qs 3,4,5,7 9
Neutral
Total
3
7.5%
40
100%
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Consistency of Scoring
• Independent Observers A,B and C marked from the film
• Consistency of agreement very strong
• Two levels of agreement
68% of scoring between A and B were identical
66% of scoring between B and C were identical
66% of scoring between A and C were identical
Cohens Kappa = 0.52
= 0.50
= 0.50
A and B
B and C
A and C
Anything above 0.5 =Very strong reliable agreement
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Conclusions
• TOSPA is a feasible method of students experiencing and
being assessed in interprofessional communication
• The mechanism of filming did not interfere with the process
• The filming is important in providing a standard record for
independent marking
• The TOSPA experience would seem to be valued by students
as a truly useful exercise making interprofessional sense.
• TOSPA can be used as a formative teaching aid as well as a
summative exercise.
• The TOSPA used in this project was thought to be successful
because the case was accessible and important to all four
participants.
• More meaningful and authentic TOSPA cases are needed.
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