facilitating small group learning in the ipe classroom
TRANSCRIPT
Lynne SinclairInnovative Program and External Development Lead at the
Centre for Interprofessional Education University of Toronto Educational ConsultantAssistant Professor –
Department of Physical TherapyUniversity of Toronto
Who is in the room?
Table introductions◦
What are your hopes for the day?
Share your top hope for the day from your table
By the end of this interactive workshop, participants will be able to: describe effective strategies for facilitating
small interprofessional groups of learnersuse approaches to enable interprofessional
learning for a single studentdifferentiate between uniprofessional and
interprofessional learning discuss the challenges and benefits of utilizing
simulation for IPE
3
8:00 - 12:00 – Small Interprofessional Group FacilitationInterprofessional IcebreakersWhat is a student IPE learning activity?What is interprofessional facilitation?IP facilitation in action –
DVD discussions and Group theoryThe Rules of Engagement of IPE facilitation 12:00– 1:00 – Lunch1:00 – 3:00 – Simulations in IPEWhat are the synergies between IPE and simulation?How can IPE competencies be used in simulation?What are the challenges/benefits of utilizing simulation for IPE?Your turn! Role play!3:00 – 4:00 – Lessons Learned: Strategies and Enablers Where does IPE already happen in your settings?Sharing of activities, approaches and successes4:00- 4:30 – Next steps/Wrap Up/Q and A
Occurs when multiple health workers from different
professional backgrounds provide comprehensive health services by
working with patients, their families, carers and communities to deliver the highest quality of
care
across settings. Framework for Action on Interprofessional Education & Collaborative Practice WHO, 2010
Patient
Health Care Assessment
Individual Professionals
© University of Toronto 2010
Patient/ family
Health Care Assessment
Integrated Care Plan
Interprofessional Practice
Shared care plan
Individual Professionals
© University of Toronto 2010
www.cihc.ca
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“It is believed by many that if we train competentcollaborative practitioners, more collaborative practice settings will be developed over time…Hence practice is linked with education.”
D’Amour & Oandasan, 2005
© University of Toronto 2010
Multiprofessional education?
Interprofessional education?
Ongoing learning for professions together
Barr, 2009
Ongoing learning with, from and about other professions to improve collaboration and the quality of care
Barr 2009
What is most prevalent today?
We occasionally formally learn “with” each other (e.g. in parallel about a new approach), we rarely learn “from” and “about” each other – Sargeant, 2009
Interprofessional education occurs when (learners) from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.
WHO, 2010
principles of adult learning are used(e.g. problem-based learning, learning by doing, building on experience)learning methods reflect the real world practice experiences interaction occurs between learners (i.e. learning about, from and with)
WHO, 2010
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Create a relaxed, safe learning environment – socializing as a start for building relationshipsBuild trust, respect & supportEnhances professional identity – adapted for IPCreates inclusion & honours diversityEncourages leadership & self-directionFosters cooperation & teamworkBuilds a foundation for collaboration
Have fun!
Unique about ….?
(this is for six people –divide into as many areas as people in your group)
In common?
1.
Interprofessional students placed together in a shared practice area at same time
2.
Two introductory tutorials3.
Four weekly, patient-themed group discussion tutorials
4.
Shared preparation and delivery of a formal group presentation
IPE Co-Facilitators
PsychologyPT
OT
SW
RN
Pharmacy
MDRPN
JanDecNov Feb
4-week IPE Student Placement
Lumague, M., Morgan, A., Mak, D., Hanna, M., Kwong, J., Cameron, C., Zener, D., & Sinclair, L. (2006). Interprofessional education: The student perspective. Journal of Interprofessional Care, 20 (3): 246-253.
http://www.ipe.utoronto.ca/docs/TRIWeb%20Manual.pdfhttp://www.ipe.utoronto.ca/docs/TRIWeb%20Manual.pdf
• IPE Component in a Clinical Placement
“None (of the students) described education in the skills required for collaborative practice... They appeared not to have reflected upon the contexts and skills necessary for true interprofessional practice. While they all seemed to feel that team practice was a good thing … their concept of appropriate team behavior was rudimentary—being a ‘nice person’. They seem to have a relatively superficial and concrete conceptualization of interprofessional attitudes and behavior.”
Russell et al, 2006 p. 37
Activity 1 – Participation in IP Team EducationActivity 2 – Interview and Shadow Two Team
MembersActivity 3 - Participation in Team Meetings
Can be used with as few as one learnerUsed across settingsCritical elements remain reflection and facilitated discussion
© University of Toronto 2010
TIPsTeachingInter-Professionally
© University of Toronto 2010
How did you decide to enter your profession? On this team, what does your assessment & intervention usually involve? Who do you collaborate most closely with on this team? Why? Can you provide a specific example/patient/client story to illustrate?How do you work to establish and maintain relationships on this team?
What did you learn about the roles on this team that you did not know previously?What are the similarities & differences between the roles (including yours)?What else do you want to learn about the team and its members? What new learning objectives have now emerged for you?How will this experience influence your role as a professional and team member?
TIPsTeachingInter-Professionally
© University of Toronto 2010
What would you highlight as strengths for how this team worked together in the meetings you observed? What opportunities may enable this team to further build on their ability to collaborate? What structures and processes enabled team collaboration? What structures and processes hindered team collaboration? How might these be addressed?How would you describe the relationship between how the team functions in the meeting and the impact on patient/client care and team member satisfaction?
© University of Toronto 2010
TIPsTeachingInter-Professionally
Who participated?Who facilitated/educated?What was the format of the session? (e.g. lecture, small group discussion, etc.)What were the learning objectives?
What about that session might make it an ‘interprofessional team education’ session?
Are 2 or more professions involved?Does significant interactivity between participants occur?Are there opportunities to learn about, from and with one another?Are interprofessional teaching/learning moments discussed/addressed? ◦
E.g. Are important contributions of different team members highlighted? ◦
E.g. Is learning about how team members work together discussed?◦
E.g. Are strategies that enable interprofessional communication discussed?
© University of Toronto 2010
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◦
“A learner-centred approach which invites learners
to take full responsibility for decisions, actions and consequences.”
-
Sinclair, Barker & Moaveni, 2005
Centre for IPE, University of Toronto
“expert teacher” needs to be replaced by that of a “facilitator” Fox 1994 or “coach” Schön, 1987
Instead of 'teaching' to participants, facilitators need to 'work with' participants. This approach is advocated within adult learning theory (Knowles, 1980)
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Students’ perceptions of effective small group tutors (Steinert, 2004)
◦
Promote thinking and problem solving◦
Non threatening◦
Encourages interaction◦
Does not lecture◦
Highlighted clinical relevance◦
Wants to be there◦
Understands the goals of small group teaching, uses the cases well, outlines the small group objectives and remembers to summarize the discussion◦
Expand on the case or generalizing issues to another clinical situation
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IP Facilitator◦
“…someone who embraces the notion of dialogue, is self-aware, learns with the group, but is able to provide the appropriate learning resources and create an environment for effective interprofessional education.”
-
Howkins & Bray, 2008
Faculty play a key role in creating an environment that is supportive of the goals for IPC and indeed can act as role models (lit review by Oandasan & Reeves 2005: Gill & Ling, 1995, Waugaman 1994; Parsell & Bligh 1998)
The perceived status or importance of an interprofessional initiative can be negatively affected if faculty do not ‘walk the talk’
(lit review by Oandasan & Reeves: Falconer et al., 1993; Mathias & Thompson, 1997; Graham & Wealthall, 1999)
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“…facilitation of interprofessional learning is a complex and
demanding activity”-
Lindqvist & Reeves, 2007
What is happening in the scenario? Who is involved?How would you describe the facilitation? How else might you have intervened as an effective facilitator?How is this group functioning? What role is the facilitator playing at this stage of group development?How might this session impact future group function?
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Ensure introductions (consider ice breaker)Establish ground rules with group (norms)Role model – be open, genuine, reflective, trustworthySet clear expectations Establish learning climate (including acceptance of limitations – “it is ok not to know”, respect, comfort, stimulating, promote participation)Build confidence
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Observe and clarify group processListenQuestion (ex. jargon)Focus the group (sort issues, determine main issue)Address conflictsSummarizeGive and receive feedback
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Jargon and clarificationNumber of members - Numbers from each professionCharacteristics:◦
Interaction occurs among members◦
Task to be achieved◦
Opportunity to reflect on learning
Common groundGroups are more than the sum of their parts Is skilled in optimizing IP learning opportunities
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What is happening in the scenario? Who is involved?How is the facilitator effective in his role? How else may you have intervened as facilitator?What are the interprofessional issues in this clip? How are they addressed or how might they be addressed?
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Stereotypical beliefs about professions (e.g. gender, status, caring, power, etc.)
Students may have range of educational experiences (ex. first placement to last)
Jargon and clarification of acronyms
Work with students to recognize and capitalize on opportunities for collaboration
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Link between effective team collaboration and client care (e.g. balancing task and process)
Approaches to team decision making
Facilitator understands issues of power and hierarchy
Celebrate diversity – understand no one profession has all the answers for a client
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1) Facilitator observation of group behaviour2) Ask for group self-assessment (consider
providing your feedback to team)3) Desired behaviour is described4) Ascertain the team understands the difference
between current and desired behaviours5) A plan to close the gap is developed6) Debrief by the group7) Follow-up on improvement
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Provide your feedback to group - CORBS
• Clear• Observed (and Owned)• Regular• Balanced• Specific
“He who can take advice is sometimes superior to he who can give it”
Karl vonKnebel
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What is happening in the group? How would you describe it?
How might you provide feedback to the group if they struggled with self-assessment?
What strategies would you have used as the IP facilitator?
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Is attuned to the dynamics of interprofessional learning-
Barr, 1996 in Oandasan & Reeves, 2005
Is skilled in optimizing learning opportunities-
Barr, 1996 in Oandasan & Reeves, 2005
Values the distinctive experience and expertise which each of the participating professions brings-
Barr, 1996 in Oandasan & Reeves, 2005
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Is ready to encounter interprofessional friction between participants when they are working together -
Hammick 1998; in Oandasan & Reeves, 2005Understands issues of power and hierarchy -
Thomas, 1995; Miller et al., 1999 in Oandasan & Reeves, 2005Has knowledge and experience of facilitating small groups and working in an interprofessional fashion -
Perkins & Tryssenaar, 1994; Funnell, 1995; Lary et al., 1997
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What is happening in the scenario? Who is involved?What strategies did the IP facilitator use well? How else may you have intervened as facilitator?What are the interprofessional issues in this clip? How are they addressed or how might they be addressed? How might the facilitator’s actions impact future sessions?
ProcessProcessTaskTask
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Establish ground rules with group (interprofessional norms)Role model – be open, genuine, reflective, trustworthyEstablish learning climate (including acceptance of
limitations – “it is ok not to know”, respect, comfort, stimulating, promote participation)Look for common ground for team (e.g. decision
making)Is skilled in optimizing IP learning opportunities
Role modeling is key◦
Co-facilitation from different professions◦
Collaborative learning environments◦
Need opportunity for joint reflection
Enables effective facilitation ◦
Sharing of responsibilities◦
Observing and intervening related to task and process
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Shadow experienced IP facilitators◦
e.g. observe, make implicit explicit, evaluate and debrief together
Co-facilitate◦
Includes coordinated, purposeful, shared preparation and planning◦
Opportunities graded to support novice facilitator
- Howkins & Bray, 2008
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Engage in formative IPE evaluation◦
Promotes critical thinking re: process and effect of IPE
Seek mentorship re: IPE Participate in a peer group of IP facilitators◦
Opportunity to pool resources and for collaborative learning
Participate in IP program planning teams◦
Additional IP learning experience and opportunity to influence how IPE occurs
- Howkins & Bray, 2008
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Role model reflectionPrompt students’ analysis re: IP issues and opportunitiesProvide opportunities for self-assessment related to interprofessionalismMake interprofessional learning explicitBroad concept of team (e.g. research, ethics etc.)Varying levels of student/schools - focus on IPECo-facilitation model best (shared and consistent)Preparation/faculty development is critical
Share your reflections about interprofessional issues◦
E.g. consider how your expectations about how your misperceptions about other professions challenged in the past
Ask students to discuss how their expectations re: interprofessionalism compares to reality◦
E.g. what surprised them most, what they are most curious about, what do they want to learn more about, etc.
Help the student to reflect using questions that enable analytical thinking, e.g.◦
How is this similar to what you know about other roles?◦
What enabled interprofessional communication in both of these situations? (e.g. reduced use of jargon, etc)◦
Reflect on factors that enable collaboration related to personal, roles, team, organization, etc.
Self-assessment of collaborative competencies, e.g.◦
Ask the student about own collaborative strengths◦
Share your own collaborative competencies (such as role understanding, IP communication, reflection, understanding of team function, shared values and goals, coordination, etc.)◦
Help the student to identify learning priorities and plan how to address (including use of resources that exist within the team broadly –
who else can the
student learn from?)
3. Stimulate Self-Assessment related to Interprofessional Issues
Many IP teachable moments may not be appreciated◦
Consider what IP learning opportunities exist in your own day to day work?
Consider how to raise issues specifically re: roles and collaboration ◦
e.g. What is the impact of collaboration on patients? What is a team? What can I learn from that team member and the team as a whole?
4. Make Interprofessional Learning Explicit
© University of Toronto 2011 72
Enjoy and network!
Ability to practice in a safe environment
Mimics a real-life environment so HCP’s can act and
perform as they normally would◦
More effective (more realistic) than uni-professional
simulations
◦
requires team work and consultation with other HCP’s
Increases the opportunities to practice in a team-
based environment
Teaching strategies are more effective when learners see the direct relevance between the interprofessional educational experience and their future/current practice
Simulation provides a realistic simulated clinical situation Kolb – experiential learning theory
IPE is facilitated when learners from different health care professions come together to learn by responding to a realistic simulated clinical situation
Learning WITH:– a shared goal of enabling effective collaboration
and improving health outcomes should inform any IPE planning
– consider the shared and unique learning needs of
different professions/roles in planning the
simulation
Set clear learning objectives that relate to your IPE needsE.g. teamwork, leadership, communicationUse IPE competencies guidelines for scenario developmentDefine competencies and associated learning objectives
Develop scenarios with these learning objectives in mindContent is important but CONTEXT imperative!Keep it simple: Learning about IPE is often inherent in most interprofessional simulations
Create a safe learning environment for participantsStress level must be managed effectively in order for participants to learn in a simulated environment
Debriefing is key to facilitating learningDebriefing questions should be targeted at IPE objectives of scenarioOften need to refocus the debrief on your objectives
OK: Describe the learning objective of this scenario?Better: Describe the interprofessional learning objective of this scenario?
Please see handout “IPE Debriefing Guideline for Facilitators”
Adapted from Instructor Development: Simulation-Based Education Design and Debriefing Workshop Notes (Mayo Clinic, March 2009)
Adapted from Mayo Clinic(2009)
Don’ts Don'ts
Make the simulation too
stressful or set the participants
up to fail
Be worried if the simulation
does not go according to plan!
Role play profession other than
your own
Forget your objective is IPE
FORGET TO HAVE FUN!
Do’s Do’s
Enjoy this learning experience
Have clear IPE learning
objectives
Create a safe learning
environment
Be aware of your participants
Be aware of your own strengths
& weaknesses
Co-facilitation
Be aware of your learners’
differing experience and
needs
Refocus the debrief on your
IPE objectives
As an educator, be
prepared (practice, practice,
practice!)
HAVE FUN!
MasterTrainInc: Pediatric Arrest Simulation◦
simulationhttp://www.youtube.com/watch?v=4EWlNp
KrCucACLS MegaCode 2010 Guidelines◦
http://www.youtube.com/watch?v=tVHJq9op5cw&fea
ture=relatedWorking As A Team (Interprofessional Problem Solving)◦
http://www.youtube.com/watch?v=hvTOSnadrcU&pla
ynext=1&list=PL0CCA8B7945620CC4Queens University◦
https://meds.queensu.ca/central/community/maryfe
rguson:a_slip_and_fall
Mikkelsen KyrkjebØ, J., BrattebØ, G. & Smith-StrØm, H. (2006). Improving patient safety by using interprofessional simulation training in health professional education. Journal of Interprofessional Care, 20(5): 507 – 516Raun, C. (2004). Simulation as a teaching strategy for nursing education and orientation in cardiac surgery. Critical Care nurse, 24 (3), 46-51Sargeant, J. (2009). Theories to aid understanding and implementation of interprofessional Education. Journal of Continuing Education in the Health Professions, 29(3):178–184Zhang, C., Thompson, S. & Miller, C. (2010). A review of simulation based interprofessional education. Clinical Simulation in Nursing, Vol (X), 000-00. doi: 10.1016/j.ecns.2010.02.008 Ziv, A., Wolpe, P.R., Small, S.D., Glick, S. (2003). Simulation-Based Medical Education: An Ethical Imperative. Academic Medicine, 78 (8): 783 - 788
Your chance to practice!
Recognize and describe specific IP group dynamics that occurredIdentify and describe (or practice) specific IP
facilitation strategiesContribute to (or lead) IP simulation debriefing
1. Read case description 2. Everyone: Name tags – choose a character/alias name 3. For the first role play, choose:
– One facilitator– One observer
4. Remaining group members each select a “profession role” from handout
5. “Professionals” ONLY pick “process role” from envelope (do not share this information)
6. Role play for 5 mins max followed by debriefing (refer to next slide)7. Switch roles and repeat (total of 2 role plays and discussions). Use
envelope #2 for second role play.Respond to facilitation
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Debriefing ◦
Led by observer◦
Facilitator first, team members next, observer reflections last
QUESTIONS for discussion – Refer to Debriefing Guidelines:◦
Elicit emotion e.g. “How did that feel for everyone?”◦
Review the facts of the scenario e.g. “How would you describe what happened in terms of IP group dynamics?”
◦
Advocacy/Inquiry Strategy e.g. “That was a challenging scenario – why do think things played out the way they did?
◦
Make link to real life e.g. “How does this compare to your own experiences?”
◦
So what, Now What? e.g. based on this, what is your one KEY lesson?
At least two different professions/roles amongst participants and amongst faculty/educators –
consider numbers across groups
Opportunities to ‘get to know one another’
are critical (e.g., introductions, brief icebreaker)
Discussions about roles, responsibilities and scopes of practice (e.g., similarities and differences) may be helpful as a focus
96
There should be interactivity
where participants can actually speak directly to one another
Time and space considerations lay foundations for more effective interactions
Effective facilitation
is critical for enabling rich and interprofessionally focused dialogue
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A shared goal of enabling effective collaboration and improving health outcomes should inform IPE planning
Consider shared and unique learning needs and perspectives of different professions/roles
Interprofessional learning should be made explicit (e.g., Instead of asking, ‘What did you find most valuable about this session?’, ask ‘What was that value of learning about, from and with other professions?’)
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As an IP facilitator:Be mindful of your own verbal and nonverbal communication Address use of jargonAttend to group processBe authentic/role model IPEPlan simulation with your IPE objectives in mindKnow your group/team (be prepared)
What are you inspired to do to advance IPE in your own
classrooms?
What first step can you take?
8:00 - 12:00 – Small Interprofessional Group FacilitationInterprofessional IcebreakersWhat is a student IPE learning activity?What is interprofessional facilitation?IP facilitation in action –
DVD discussions and Group theoryThe Rules of Engagement of IPE facilitation 12:00– 1:00 – Lunch1:00 – 3:00 – Simulations in IPEWhat are the synergies between IPE and simulation?How can IPE competencies be used in simulation?What are the challenges/benefits of utilizing simulation for IPE?Your turn! Role play!3:00 – 4:00 – Lessons Learned: Strategies and Enablers Where does IPE already happen in your settings?Sharing of activities, approaches and successes4:00- 4:30 – Next steps/Wrap Up/Q and A
By the end of this interactive workshop, participants will be able to: describe effective strategies for facilitating
small interprofessional groups of learnersuse approaches to enable interprofessional
learning for a single studentdifferentiate between uniprofessional and
interprofessional learning discuss the challenges and benefits of utilizing
simulation for IPE
1
0
106
www.ipe.utoronto.ca
–
Centre for IPE, University of Toronto
www.cihc.ca
–
Canadian Interprofessional Health Collaborative
www.healthforceontario.ca/IPCProject
http://www.chsrf.ca/research_themes/workplace_e.php
www.health-human-resources.ca
http://informahealthcare.com/loi/jic
-Journal of Interprofessional Care
107
Davoli, G. W., & Fine, L. (2004). Stacking the deck for success in interprofessional collaboration. Health Promotion Practice, 5(3), 266-270.Howkins, E. & Bray, J. (2008). Preparing for interprofessional teaching: Theory and practice. New York, New York: Radcliffe Publishing.Lindqvist, S.M. & Reeves, S. (2007) Facilitators' perceptions ofdelivering interprofessional education: a qualitative study, Medical Teacher, 29:4, 403 – 405.Oandasan, I. & Barker, K. (2005) Interprofessional Education forCollaboration Patient-Centred Care Canada as a Case Study. Journal of Interprofessional Care, 19 (Suppl. 1).Oandasan, I. et al. (2005) Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in Canada, CHSRFRussell, L. et al. (2006). An exploratory analysis of an interprofessional learning environment in two hospital clinical teaching units. Journal of Interprofessional Care, 20(1):29-39.World Health Organization (2010). Framework for Action on Interprofessional Education & Collaborative Practice Available at: http://www.who.int/hrh/nursing_midwifery/en/
