interprofessional education: a bridge to the future · with health systems for interprofessional...

INTERPROFESSIONAL EDUCATION: A BRIDGE TO THE FUTURE

Moderator: April D. Newton, PT, DPT, FNAP

Jim Carlson, PhD, PA-C, CHSE Sandra Larson, PhD, CRNA, APN, FNAP

April D. Newton, PT, DPT, FNAP Nancy L. Parsley, DPM, MHPE

Wendy Rheault, PT, PhD, FASAHP, FNAP

1. To discuss the current state of Interprofessionalism at RFUMS

2. To discuss approaches to develop relationships and partnerships with health systems for interprofessional clinical education opportunities

3. To describe the use of simulation strategies for students’ clinical experiences

4. To explore two innovative models for interprofessional clinical experiences

5. To review a study investigating the impact of the interprofessional clinical education models in a simulated environment

S E S S I O N O B J EC T I V E S

• Welcome & Panelist Introductions

• Interprofessionalism at Rosalind Franklin University (RFU)

• Health System Benefits & Partnerships

• Bridging the Gap to Interprofessional Collaborative Practice

• Interprofessional Collaborative Practice: Clinical Education Models

• Question and Answer

S E S S I O N OV E R V I E W

I n t e r p r o f e s s i o n a l i s m

a t R o s a l i n d F r a n k l i n U n i v e r s i t y

o f M e d i c i n e a n d S c i e n c e

WENDY RHEAULT PROVOST

To serve the population through the interprofessional education of health and biomedical professionals and the discovery of knowledge dedicated to improving the wellness of its people.

M I S S I O N

V I S I O N To achieve national recognition as the premier interprofessional health sciences University.

R F U A T A G L A N C E

2,214 students

30+ academic programs 5 schools

1 university ROSALIND FRANKLIN

UNIVERSITY

Chicago Medical School

College of Health

Professions

Scholl

College of Podiatric Medicine

Graduate

and Postdoctoral

Studies

College of Pharmacy

Improved Profile of Entering Students (Admissions)

Improved Student Achievement (Outcomes)

Improved Employee and Student Experience (Satisfaction)

Reduced Cost (Affordability)

Q U A D R U P L E A I M O F H I G H E R E D U C A T I O N

I N T E R P R O F E S S I O N A L E D U C A T I O N T I M E L I N E

Interprofessional Curriculum Committee (university wide)

FIRST YEAR IP EXPERIENCE Foundations for Interprofessional Practice Course Service Learning

Project Clinical

Experience

INSTITUTE FOR INTERPROFESSIONAL EDUCATION

Research Education Clinical

Simulation

INSTITUTIONAL CULTURE OF

INTERPROFESSIONALISM

Governance Admissions Orientation IP Seminars

MP to IP Committee Strategic Plan

IP TEAMS

COURSE

VISION Strategic

Plan Budget Buy-in

Recognition Assessment Evaluation Recognition

Assessment Evaluation

Space Resources Mentors Logistics

Space Resources

Space Resources Mentors Logistics

Champions

More Champions

Department of Interprofessional

Healthcare Studies

More Students

RFUMS IP Student

Outcomes University Calendar

Adopted IPEC IP Competencies

Y E A R S 0 - 1 Y E A R S 1 - 4 Y E A R S 5 - 1 5

D E V E L O P I N G A C U L T U R E O F I N T E R P R O F E S S I O N A L I S M

STRATEGIC PLAN STUDENT

ENVIRONMENT Interprofessional Student Council IP Community

Activities IP Student-Run

Clinic

FACULTY Interprofessional

Academic Committee Promotion and Tenure for IP

Activities All Committees

Interprofessional Faculty Education

Universal Calendar

Programs Physically Close Together

EDUCATIONAL PROGRAMS

First Year Course IP Courses

Clinical Experiences Simulation

IP Degree Programs

TIME AND SPACE

T H E D E W I T T C . B A L D W I N I N S T I T U T E F O R I N T E R P R O F E S S I O N A L E D U C A T I O N

THE HUB OF INTERPROFESSIONAL ACTIVITIES

• Education – to identify, develop, manage, and evaluate IPE activities

• Clinical Experiences – to develop and implement strategies; to educate students, faculty, and preceptors for interprofessional clinical experiences

• Simulation – to promote and facilitate interprofessional simulation-based research; develop and evaluate simulation-models linked to interprofessional clinical training models

• Research and Scholarship – to assess didactic and clinical IPE at RFUMS; disseminate results through publications and presentations

• Community Engagement – to promote collaboration among all university constituents and increase IP service within the community

H e a l t h S y s t e m B e n e f i t s & P a r t n e r s h i p s

Nancy L. Parsley Vice President for Academic Affairs

Dean, Dr. William M. Scholl College of Podiatric Medicine

H E A L T H C A R E C O N C E R N S

• Increasing chronic disease

• Limited access

• Acuity LOS

• Increasing costs

• Continuing unacceptable rate of error

• Global influence

HEALTHCARE CONCERNS

N E W S T R A T E G I E S F O R H E A L T H C A R E

WHAT NEW WAYS HAVE WE APPROACHED THE HEALTHCARE ISSUES:

• Accountable Care Organizations

• Population health point of view

• Big data analysis/analytics

• Clinical care networks/telehealth

• Patient-centered care coordination

O U T C O M E S O F I P C P → T R I P L E A I M

Quadruple Aim • Improving Patient Care Experiences • Improving the Health of Populations • Reducing the Per Capita Healthcare Cost + Improving Provider Satisfaction

POPULATION HEALTH

REFERENCES Brandt, B. Lutfiyya, N, King, J, Chioreso. A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim. Journal of Interprofessional Care. 2014; 28(5): 393-399. Berwick, DM, Nolan, TW, Whittington. The triple aim: Care, health, and cost. Health Affairs. 2008; 27, 759-769.

TRIPLE AIM

PATIENT EXPERIENCE

PER CAPITA COSTS

Quality • Cost • Experiences

I N T E R P R O F E S S I O N A L C O L L A B O R A T I V E P R A C T I C E E V I D E N C E

REFERENCES Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy of Sciences. 2011. Institute of Medicine. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academy of Sciences. 2011. Hepp, SL, Suter, E, Jackson, K, et al. Using an interprofessional competency framework to examine collaborative practice. Journal of Interprofessional Care. 2015; 29(2): 131-137. Morgan, S, Pullon, S, McKinlay, E. Observation of interprofessional collaborative practice in primary care teams: An integrative literature review. International Journal of Nursing Studies. 2015; 52: 1217-1230.

P O S S E S S E S P O T E N T I A L T O : • Increase access to care • Maintain quality of care with improved efficiency • Improve quality of care • Improve patient outcomes • Make the best use of health professionals’ time and expertise • Increase job satisfaction

I N T E R P R O F E S S I O N A L C O L L A B O R A T I V E P R A C T I C E B E N E F I T S

T E N D E N C Y T O D E C R E A S E : • Length of hospitalization • Staff turnover • Hospital admissions • Medical errors

REFERENCES Lemieux-Charles, L, et al. What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review, 2006; 63: 263-300. Yeatts, D, Seward, R. Reducing turnover and improving health care in nursing homes: The potential effects of self-managed work teams. The Gerontologist. 2000; 40:358-363. Morey, JC et al. Error reduction and performance improvements in the emergency department through formal teamwork training: Evaluation results of the Med Teams project. Health Services Research. 2002; 37:1553-1581.

VALUE

Student

RFU

Patient

Clinical Partner

Strategic Relationships

Add VALUE

Why C R E A T E A M U T U A L L Y B E N E F I C I A L R E L A T I O N S H I P

W E C O L L A B O R A T E T O A C H I E V E S H A R E D G O A L S T H A T A D V A N C E V A L U E I N T H E S T U D E N T L E A R N I N G & P A T I E N T C A R E E X P E R I E N C E

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C O L L A B O R A T I O N E M B R A C E S A T E A M A P P R O A C H

Clinical Sites Desire… • Safety • Work force Training

Opportunities • Recruit • Retain • Retrain

RFUMS Desires… • Sustainable Clinical Training • IPCP Training Opportunities • Student Debt Reduction • Advance IP Competencies in

Clinical Settings

TRIPLE AIM Increase Patient Satisfaction Improve Population Health

Reduce Healthcare Cost

QUADRUPLE AIM Maintain a Work/Life Balance

Decrease Provider Burnout Improve Clinician and Staff Satisfaction

ACADEMIC PARTNER

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CLINICAL PARTNER

B r i d g i n g t h e Ga p t o I N T E R P R O F E S S I O N A L C O L L A B O R A T I V E

P R A C T I C E

Jim Carlson Vice President for Interprofessional Education and Simulation

S I M U L A T I O N I N H E A L T H C A R E E D U C A T I O N

Simulation is a technique – not a technology – to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real word in a fully interactive manner.

REFERENCE

Gaba DM. The future vision of simulation in healthcare. Qual Saf Health Care 2004;13i2-i10

W H Y W E S I M U L A T E F l i g h t 1 5 4 9

Mastery of the day to day

Competency in common tasks / knowledge

Fluency in the less common or unique

W H Y W E S I M U L A T E

High reliability Quality and Safety Team-working Problem Solving Automation

W H Y W E S I M U L A T E – A D U L T L E A R N I N G

• Adult learners need to understand WHY they are learning, SOLVE problems, connect PRIOR experiences, and be ACTIVELY INVOLVED (Kolb)

• This is what we do at WORK (work-based learning)

P R O F E S S I O N S P E C I F I C S I M U L A T I O N S

• Allopathic Medicine • Nurse Anesthesia • Nursing (RN) • Pathologists’ Assistant • Podiatric Medicine • Pharmacy • Physical Therapy • Physician Assistant • Psychology / Clinical Counseling

M O D A L I T I E S A N D C O R E C O M P E T E N C I E S

• History and Physical Examination Skills • Interpersonal Communication • Patient Education and Counseling • Diagnostic Reasoning & Clinical

Reasoning • Procedure Training • Patient Safety • Documentation and informatics

MANNEQUIN- BASED

SIMULATION

STANDARDIZED PATIENTS (SP)

VIRTUAL / WEB-BASED

SIMULATION

O P P O R T U N I T I E S F O R I N T E R P R O F E S S I O N A L S I M U L A T I O N

• Values and Ethics

Work with individuals of other professions to maintain a climate of mutual respect and shared values.

• Roles and Responsibilities

Use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.

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O P P O R T U N I T I E S F O R I N T E R P R O F E S S I O N A L S I M U L A T I O N

• Interprofessional Communication

Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.

• Teams and Team Working

Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.

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T E A M T R A I N I N G W O R K S H O P

• Role and Responsibilities (RR7): Forge interdependent relationships with other professions within and outside of the health system to improve care and advance learning.

• Teams and Teamwork (TT4): Integrate the knowledge and experience of health and other professions to inform health and care decisions, while respecting patient and community values and priorities/preferences for care.

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T E A M T R A I N I N G W O R K S H O P – L E S S O N S L E A R N E D

• Highly valued by participants ( >95% note significant value and relevance to practice and that the workshop helped them improve their ability to coordinate with other members of the healthcare team)

• Methods of team assessment are challenging but possible: ◆ Expertise ◆ Coordinating behaviors ◆ Trust

• Faculty development around appropriate debriefing is critical. TeamSTEPPS

scaffolds learning from pre-clinical years and provides a framework to guide post encounter reflection

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P A T I E N T S A F E T Y uniprofessional simulation involving interprofessional competencies

• Values and Ethics (VE8): Manage ethical dilemmas specific to interprofessional patient/population centered care situations.

• Values and Ethics (VE9): Act with honesty and integrity in relationships with patients, families, communities, and other team members.

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P A T I E N T S A F E T Y – L E S S O N S L E A R N E D

• Feedback from learners confirmed that they rarely if ever feel empowered to ARCC though they frequently see actual patient scenarios or circumstances where it is relevant.

• The majority of learns ( >90%) indicate that the case scenario better prepared them/ made them feel more confident when addressing team conflict in future practice

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P A T I E N T S A F E T Y A N D D I A G N O S T I C E R R O R

• Interprofessional Communication CC1: Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function.

• Teams & Teamwork (TT10): Use available evidence to inform effective teamwork and team-based practices.

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P A T I E N T S A F E T Y A N D D I A G N O S T I C E R R O R

Incorporation of interprofessional collaboration and diagnostic decision support to improve patient safety.

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66 PAS-1 students participate in a four case

SP-based exercise

CONTROL

Document initial diagnostic hypotheses

and plan for further testing for each case

Treatment #1: PA-resident Discussion of

four cases

Submit final diagnostic hypotheses and plan for

further testing

Treatment #2

Use informatics to guide decision making (ISABEL)

Submit final diagnostic hypotheses and plan for

further testing

O U T C O M E S

• PA students that coordinated with the resident did not improve accuracy and were overconfident in their decisions.

• PA students that used a self-directed support system (ISABEL) significantly improved accuracy and were more appropriately calibrated in terms of confidence.

• Video analysis of PA-Resident discussions revealed communication behaviors that promoted anchoring and confirmation bias.

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PATIENT SAFETY AND DIAGNOSTIC ERROR - LESSONS LEARNED

• Communication and team working alone are not a remedy to improve diagnostic error and decision making.

• IP teams / team leaders may wish to employ specific communication behaviors around decision making ◆ Be aware of framing effect ◆ Invite alternative information into the discussion ◆ Consult decision support tools/ information systems prior to final

decision making.

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D E B R I E F I N G F O R L E A R N I N G A N D R E T E N T I O N O F I P H A N D O F F C O M M U N I C A T I O N A N D T E A M S K I L L S

• Test the effect of two

debriefing strategies (F2F and self-directed) on student learning of interprofessional handoff communication and team skills.

• Julie Ronnenbaum, PT, DPT, PhD

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• TT9: Use process improvement to

increase effectiveness of interprofessional teamwork and team-based services, programs, and policies.

• CC1: Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function.

D E B R I E F I N G F O R L E A R N I N G A N D R E T E N T I O N O F I P H A N D O F F C O M M U N I C A T I O N A N D T E A M S K I L L S

• 52 DPT3 students participated in a series of three simulations

involving a hand-off.

• Each simulation was followed by either face to face or self-directed (computer-based).

• Handoffs were assessed after Sim 1 (baseline), Sim 2, and Sim 3.

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H A N D O F F S – O U T C O M E S L E S S O N S L E A R N E D

• Handoff accuracy improved in both groups

• Handoff accuracy improved more in the face to face group

• Learners also valued the face to face debriefing more than self-directed / computer based. There was greater perceived value in the group discussion.

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MEANINGFUL INTERPROFESSSIONAL SIMULATION THE VIRTUAL HOSPITAL

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R F U M S - C E N T E G R A S I M U L A T I O N C E N T E R

E M E R G E N C Y D E P A R T M E N T

E M E R G E N C Y D E P A R T M E N T

E M E R G E N C Y D E P A R T M E N T

A M B U L A T O R Y C A R E / O U T P A T I E N T

A M B U L A T O R Y C A R E / O U T P A T I E N T

I N P A T I E N T U N I T

I N P A T I E N T U N I T

O P E R A T I N G R O O M / P R O C E D U R E U N I T

I n t e r p r o f e s s i o n a l C o l l a b o r a t i v e P r a c t i c e

C l i n i c a l R o t a t i o n M o d e l s T r a d i t i o n a l • T r a n s i t i o n a l • P r o g r e s s i v e

April D. Newton

Interprofessional Clinical Specialist DeWitt C. Baldwin Institute for Interprofessional Education

R E S E A R C H D E V E L O P M E N T F O R M O D E L S

D R I V E R S F O R T H E M O D E L S ’ C O N C E P T I O N :

PATIENT CARE & PROVIDER CARE • Measurement of IPCP in the context of chronic disease management for older adults1

• Chronic diseases are responsible for 7 of 10 deaths each year2

• Treating people with chronic diseases accounts for 86% of national healthcare costs2

• Integrated Primary Care (IPC) teams are evolving to include physicians and behavioral health clinicians, e.g. licensed professional counselors and psychologists,3pharmacists,4 and nurse practitioners.5

• Quadruple Aim – goal of improving work life of healthcare providers, clinicians and staff6

REFERENCES 1Bookey-Bassett, A, Markle-Reid, M, McKey, C, Akhtar-Danesh, N. Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. The Journal of Advanced Nursing. 2016;73(1):71-84. 2Trotter, BS, Lobelo, F, John Heather, A. Managing value-based risk: Chronic disease is health care’s “rising risk.” Group Practice Journal. 2016;42-45 at amga.org. 3Glueck, BP. Roles, attitudes, and training needs of behavioral health clinicians in integrated primary care. Journal of Mental Health Counseling, 2015;37(2): 175-188. 4Price-Haywood, EG, Amering, S, Luo, Q, Lefante, J. Clinical pharmacist team-based care in a safety net medical home: facilitators and barriers to chronic care management. Population Health Management. 2017;20(2):123-131. 5Laderman, M. Behavioral health integration: a key component of the Triple Aim. Population Health Management. 2015;18(5):320-322. 6Bodenheimer, T, Sinsky, C. From Triple Aim to Quadruple Aim: care of the patient requires care of the provider. Annals of Family Medicine. 2014;12(6):573-576.

T H E O R E T I C A L F R A M E W O R K

Social Practice Theory (Wegner)

REFERENCES Wegner, E. Communities of Practice learning, meaning, and identity. Cambridge MA: Cambridge University Press, 1998.

T H E O R E T I C A L F R A M E W O R K

If you want to truly understand something, try to change it. - Kurt Lewin Field Theory (Lewin)

• Learning is a change in cognitive structure. • Learning is a change in motivation. • Learning is acquisition of skills. • Learning is a change in group belonging. • Learning of all types involves change in perception.

P O P U L A T I O N H E A L T H M A N A G E M E N T M O D E L

REFERENCE Trotter, BS, Lobelo, F, John Heather, A. Managing value-based risk: Chronic disease is health care’s “rising risk.” Group Practice Journal. 2016;42-45 at amga.org.

F R A M E W O R K F O R I N T E R P R O F E S S I O N A L I T Y

REFERENCE D’Amour D, Oandasan I. Interprofessionality as the field of interprofessional practice and interprofessional education an emerging concept. Journal of Interprofessional Care. May 2005; (Supplement 1), 8-20.

C l i n i c a l R o t a t i o n M o d e l s

T r a d i t i o n a l • i T r a n s i t i o n a l • i P r o g r e s s i v e

T R A D I T I O N A L C L I N I C A L E D U C A T I O N M O D E L

C H A R A C T E R I S T I C S • 1:1 Model (1 Student to ≥ 1 Clinical Educator)

• Share patient caseload

• Collaborate solely with Clinical Educator

• “Siloed” patient interaction

• Intraprofessional (Student and Clinical Educator)

• Requires excellent communication skills between Students and Clinical Educators

PATIENT

Nurse Anesthesia

Clinical

Educator

Psychology

Clinical

Educator

Pathologists' Assistant

Clinical Educator

Physical Therapy

Clinical

Educator

Podiatric Medicine

Physician Assistant Patient

Medicine

Clinical

Educator

I N T E R P R O F E S S I O N A L T R A N S I T I O N A L C L I N I C A L E D U C A T I O N M O D E L

C H A R A C T E R I S T I C S • Requires excellent communication skills between

students and preceptors • Share patient caseload • ≥ 2: 1 Model (≥ 2 Students to 1 Clinical Educator*)

*able to supervise all students • Clinical Educator supervises all students • Students are exposed to other health professions

students • Students work intra- and inter-professionally • Expands knowledge of health professions students’

roles and responsibilities • Enhances learning through interprofessional

patient interactions • Develops students’ teamwork skills

Podiatric Medicine

Pharmacy Medicine

Patient

I N T E R P R O F E S S I O N A L P R O G R E S S I V E C L I N I C A L E D U C A T I O N M O D E L

C H A R A C T E R I S T I C S • 3:3 Model (≥ 3 Students of different disciplines to ≥3

Clinical Educators of different disciplines) • Students are exposed to other health professions

students • Students work intra- and inter-professionally • Expands knowledge of health professions students’

roles and responsibilities • Enhances learning through interprofessional patient

interactions • Develops students’ teamwork skills • Students and Clinical Educators value and respect

team leads changing depending on the patients’ conditions

• Profession- and interprofessional-centric • Students and Clinical Educators work

interprofessionally • Clinical Educators assume role of “facilitator” of

students

Clinical Educator

Clinical Educator

Clinical Educator

Team Lead

O V E R C O M I N G B A R R I E R S / C H A L L E N G E S T O I P C P

Field Theory(Lewin) FORCE FIELD ANALYSIS FOR IPCP

THANK YOU!

Q & A ♦ DISCUSSION

Contact: April D. Newton, PT, DPT, FNAP Interprofessional Clinical Specialist

DeWitt C. Baldwin Institute for Interprofessional Practice april.newton@rosalindfranklin.edu 847-578-8696