teaching the pt-pta relationship: “teaming” with possibilities! · 2020. 6. 15. · potential...

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Teaching the PT-PTA Relationship: “Teaming” with Possibilities!

Kathy Volkman: UNMC

Andreia Nebel: Clarkson College

Karen Abboud: Clarkson College

Daniel Aksamit: Clarkson College

Non-Disclosure Statement

Presenters have no financial disclosures that would be a potential conflict of interest with this presentation.

Setting Sail: Discovering a New World of Opportunities

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Objectives

Upon completion of this session, attendees will be able to:• Describe results of a multi-year, multi-institutional quality

improvement scholarly project about student perceptions and attitudes toward the PT-PTA relationship.

• Identify and relate how to meet IPEC and CAPTE standards related to interprofessional education in PT and PTA curricula.

• Develop strategies to implement a PT/PTA interprofessional experience to meet accreditation standards.

Welcome!

Kathy Volkman, PT, MS, [email protected]

Andreia Nebel, PT, DPT, [email protected]

Karen Abboud, PTA, MHA, [email protected]

Daniel Aksamit, [email protected]

mailto:[email protected]




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Getting to Know You….

• How many PT programs?

• How many PTA programs?

• How many are currently involved in PT/PTA collaboration within your curriculums?

• How many of you have formalized Team Training (i.e. TeamStepps)?

• How many of you are familiar with the Interprofessional Education (IPE) Collaborative (IPEC) standards?

Background: Journey

2007-Collaborative

Lab

2009- IPEC Framework

2011- UNMC TeamSTEPPS

Training

2013-Clarkson

TeamSTEPPS Training

Fall 2014-Began Quality Improvement

(QI) Study

2017-CAPTE

Standards

Revised

Spring 2018-

Completed QI Study (n= 108)

CAPTE revisions validated importance of IPE, patient safety, and PT/PTA team

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Interprofessional Education Collaborative (IPEC)Framework for the development of IPE education values and core competencies (https://www.ipecollaborative.org/about-ipec.html)

#1

• Values/Ethics for Interprofessional Practice

#2• Roles/Responsibilities

#3• Interprofessional Communication

#4• Teams and Teamwork

IPEC IPE CoreCompetencyDomains

TeamSTEPPS-“Strategies & Tools to Enhance Performance and Patient Safety”

Agency for Healthcare Research and Quality www.ahrq.gov

• Shared mental model• Role clarity• Situation monitoring and mutual

support to facilitate problem solving • Feedback and communication • Respect for each team member’s

knowledge and potential to be a situational leader

KNOW the PLAN, SHARE the PLAN, REVIEW the RISKS

https://www.ipecollaborative.org/about-ipec.html

http://www.ahrq.gov/

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Commission on Accreditation in Physical Therapy Education (CAPTE): Standards

• Jan 2016- New standards in effect for PT and PTA programs

• Jan 2018- Revised areas in effect, including IPE standards

• PT and PTA standards have overlap in areas of:• Communication• Ethics• IPE expectations

• http://www.capteonline.org/AccreditationHandbook/

Purpose of Study

1. Identify PT and PTA students knowledge, attitudes, and perceptions of the use of interprofessional team skills in the context of the PT/PTA relationship.

2. Use data to drive quality improvement of this learning activity for PT and PTA interactions.

http://www.capteonline.org/AccreditationHandbook/

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Literature Background

• Colgrove (2017): Importance of exploring the impact of affective learning through meeting with the “other,” use of role play and immersion in a case, DPT perceptions on PTA role.

• Our study: was an extension of our case-based learning and team-based care approaches which were already integrated into our curricula; the affective domain requires different teaching methods and our experience allows for that learning

• Jelley (2013): Importance of teaching competencies in communication and collaboration for intraprofessional practice in PT and PTA curricula; research based on PT and PTA practitioner perceptions.

• Our study: assessed perceptions of PT and PTA students and importance of teamwork according to IPEC competencies plus we added values and ethics into our learning experience

• Plack (2006): Timing of PT and PTA lab experiences to build relationships is important, attitudes of 1st year PT students were negative and were defensive of their role when paired with 2nd year PTA students.

• Our study: included 2nd year PT students and 2nd year PTA students

Population and Methods

Population

• Demographics:

• DPT students (n= 81)

• PTA students (n= 37)

• Typical class size:• DPT= 50

• PTA= 44 (2 programs; Traditional and Transfer)

• Age and gender typical of PT/PTA programs nationwide

Methods/Data Collection

• Pre-survey

• 1st year/semester one

• Prior to TeamSTEPPS training

• Knowledge-based

• Post-survey

• 2nd year curriculum (SPTs/SPTAs)

• After TeamSTEPPS training

• After PT/PTA Learning Experience

• Knowledge-based + behaviors and attitudes

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Instruments

• Knowledge• Pre- and post-test of team skills

• Developed by faculty

• Attitudes and Perceptions• Teamwork Attitudes Questionnaire• Interdisciplinary Education Perception Scale (IEPS) (McFadyen

et al., 2007)• Completed retrospectively for pre/post attitudes and

perceptions

Analysis: Did the students improve in their knowledge of teamwork?... YES!

• Knowledge pre- and post-tests analyzed by Chi-square• Examine proportion of questions answered correctly before and

after the learning experience

• All three groups (2014/2016, 2015/2017, 2016/2018) improved on proportion of questions answered correctly

• TeamSTEPPS training increases knowledge of collaborative practice

• Consistent with IPEC competencies; knowledge is important and students need early exposure

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0%

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Group 1 Group 2 Group 3

% A

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% Correct Pre % Correct Post

** ***

Figure 1 Q1. Which one of the following skills allows team members to assign roles, establish expectations, and discuss contingency plans for unusual circumstances? *p<.01. **p<.001.

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Figure 2 Q3. Which one of the following skills allows any team member to speak up to those with more authority without provoking a conflict or confrontation? *p<.01. **p<.001.

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80%

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Figure 3 Q8. Use of team tools and strategies is intended to improve patient safety by overcoming barriers to individual effectiveness. *p<.01. **p<.001.

Analysis of Behaviors and Attitudes of Students: Descriptive Statistics• A gap persists in the perception of PTAs and the relations with PTs

• PTs claim to think highly of PTAs, but PTAs are less certain

• PTs claim to have strong relations with PTAs, but PTAs are less confident

• PTs are less convinced that they need to depend upon or cooperate with PTAs

• PTAs are far less assured that PTs are willing to share information with them

• PTs are convinced they share information with PTAs

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“Physical therapists think highly of physical therapist assistants”

Physical therapists think highly of physical therapist assistants.

TotalDISAGREE NEUTRAL AGREE STRONGLY AGREE

PTAs Combined Count 5 13 12 4 34

% within Combined PTAs and

the PTs

14.7% 38.2% 35.3% 11.8% 100.0%

PTs Count 2 13 47 17 79


the PTs

2.5% 16.5% 59.5% 21.5% 100.0%

Total Count 7 26 59 21 113


the PTs

6.2% 23.0% 52.2% 18.6% 100.0%

“Physical therapists need to cooperate with physical therapist assistants”

Physical therapists need to cooperate with physical therapist assistants.

TotalNEUTRAL AGREE STRONGLY AGREE

PTAs Combined Count 1 4 28 33

% within Combined PTAs and the

PTs

3.0% 12.1% 84.8% 100.0%

PTs Count 1 31 47 79


PTs

1.3% 39.2% 59.5% 100.0%

Total Count 2 35 75 112


PTs

1.8% 31.3% 67.0% 100.0%

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“Physical therapists must depend upon the work of physical therapist assistants”

Physical therapists must depend upon the work of physical therapist assistants.

TotalDISAGREE NEUTRAL AGREE STRONGLY AGREE

PTAs Combined Count 1 7 8 18 34


the PTs

2.9% 20.6% 23.5% 52.9% 100.0%

PTs Count 5 19 38 17 79


the PTs

6.3% 24.1% 48.1% 21.5% 100.0%

Total Count 6 26 46 35 113


the PTs

5.3% 23.0% 40.7% 31.0% 100.0%

“Physical therapists are willing to share information and resources with physical therapist assistants”

Physical therapists are willing to share information and resources with physical therapist assistants.

TotalNEUTRAL AGREE STRONGLY AGREE

PTAs Combined Count 7 18 9 34


PTs

20.6% 52.9% 26.5% 100.0%

PTs Count 2 35 42 79


PTs

2.5% 44.3% 53.2% 100.0%

Total Count 9 53 51 113


PTs

8.0% 46.9% 45.1% 100.0%

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Analysis: Did attitudes toward teamwork and perception of the other team member change?... YES!

• Wilcoxon Signed Ranks tests

• Established all three cohorts showed a shift in attitudes in the intended direction

• Supported TeamSTEPPS training and interprofessional collaboration

0.0

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NEUTRAL AGREE STRONGLY AGREE

% A

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ECTL

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Before After

Figure 4 Q28. It is important to monitor the emotional and physical status of other team members. Z = -3.068 , p <.01.

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0.0

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Before After

Figure 5 Q31. To be effective, team members should understand the work of their fellow team members. Z = -3.468 , p <.001.

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STRONGLY DISAGREE DISAGREE NEUTRAL AGREE STRONGLY AGREE

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Before After

Figure 6 Q32. Asking for assistance from a team member is a sign that an individual does not know how to do his/her job effectively. Z = -3.432 , p <.001.

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Before After

Figure 7 Q41. It is important to have a standardized method for sharing information when handing off patients. Z = -3.300 , p <.001.

Student Feedback

105 out of 108 students (97.2%)…

Were in agreement that the team training learning experience from the team skills curriculum and the collaborative learning experience was effective

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Question #47

“From your PT/PTA lab experience, please tell us the most important thing you learned, specifically about working with PT/PTA, to care for patients in any rehabilitation setting.”

#47: From your PT/PTA lab experience, please tell us the most important thing you learned, specifically about working with PT/PTA, to care for patients in any rehabilitation setting.

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#47 (cont’d): From your PT/PTA lab experience, please tell us the most important thing you learned, specifically about working with PT/PTA, to care for patients in any rehabilitation setting.

Question #48

“From your PT/PTA lab experience, please tell us the most important thing you learned, specifically about

the role of teamwork, to improve the safety and quality of care in any rehabilitation setting.”

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#47: From your PT/PTA lab experience, please tell us the most important thing you learned, specifically about working with PT/PTA, to care for patients in any rehabilitation setting.

“The use of teamwork skills between PTs and PTAs can lead to the best outcomes for patients. For example using a brief at the start of the day, or before each new patient will allow for both PT and PTA to have a shared mental model of what the goals for the patient are.” (SPT SP 2016)

“I learned that communication is

paramount in delivering a consistent and effective

tx regiment.”(SPTA SU 2015)

#47 (cont’d): From your PT/PTA lab experience, please tell us the most important thing you learned, specifically about working with PT/PTA, to care for patients in any rehabilitation setting.

“It is important to listen and respect what the other team member has to say and contribute.

Even if it is something that you don’t agree with, ultimately conveying that the safety and quality of care of patients is the number one

priority, should help in resolving conflict momentarily.” (SPTA SP 17)

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Why is This Important & How Can it Be Implemented?

Guiding Documents:• IPEC competencies •CAPTE Standards

Curricular Ideas:• TeamSTEPPS tools and

training•Case study across

settings • Ethics case•Role-play• Large group discussion

IPEC Domains / Constructs*Centre for Interprofessional Education, University of Toronto;Refer to handout

#1

• Values/Ethics for Interprofessional Practice

#2• Roles/Responsibilities

#3• Interprofessional Communication

#4• Teams and Teamwork


#1• Collaboration

#2• Communication

#3• Values and Ethics

* Framework for the Development of Interprofessional Education Values and Core Competencies, ©2009 University of Toronto, Centre for Interprofessional Education. Used with permission from University of Toronto.

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PT & PTA CAPTE Standards(IPE, Teamwork, Communication)

PT (IPE/Communication)

• 6F- didactic/clinical curriculum includes IPE; learning activities are directed toward development of interprofessional competencies (effective 1/1/18)

• 6L3- involvement in interprofessional practice

• 7D7- communicate effectively with all stakeholders (i.e., patients/clients/family members, caregivers, interprofessional team members, payers, and policymakers, etc.)

• 7D29- delineate, communicate, and supervise those areas of the plan of care that will be directed to the PTA

PTA (IPE/Teamwork)

• 6J3- involvement in interprofessional practice

• 6J4- participation as a member of PT/PTA team

• 7D7- communicate effectively with all stakeholders (i.e., patients/clients/family members, caregivers, interprofessional team members, payers, and policymakers, etc.)

• 7D28- participate in provision of patient-centered interprofessional collaborative care

PT & PTA CAPTE Standards(Ethics)

PT

• 7D6- implement, in response to an ethical situation, a plan of action that demonstrates sound moral reasoning congruent with core professional ethics and values

PTA

• 7D6- implement, in response to an ethical situation, a plan of action that demonstrates sound moral reasoning congruent with core professional ethics and values

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Putting it All Together

The following information will review how PT/PTA programs can implement the IPEC IPE Core Competency Domains and the Centre for Interprofessional Education Constructs, as applied to the PT/PTA team, for IP collaborative practice

• Reviewed in this section will be:• Examples of Competency Statements• Application Ideas• Curricular Considerations• UNMC/Clarkson College Experience Teaching Examples

Construct 1: Collaboration(IPEC Domains #2: Roles and Responsibility; #4: Teamwork)

Exemplar Competency Statements• Clearly communicate role/responsibilities to patients, families, and other professionals• Recognize limitations in skills, knowledge, and abilities• Apply leadership practices that support collaborative practice and team effectiveness• Share accountability with others for outcomes• Reflect on individual/team performance for improvement

Application• Safe and effective care demands clearly defined roles and responsibilities• Stereotypes and inaccurate perceptions erode mutual respect and interferes with

effective teamwork• Practice leadership skills by dealing with conflict openly and constructively through

communication skills and shared problem solving

Core Competencies for Interprofessional Collaborative Practice, 2011

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Curricular Considerations• Provide curricular and co-curricular opportunities for PT/PTA

students to interact • Students practice describing their role and education to others• Students reflect on how PTs or PTAs can be situational leaders• PT students understand and practice delegation of care to PTAs• Teach team tools


UNMC/Clarkson College Experience Teaching Examples

• PT/PTA students describe their roles in case studies (various care settings)

• PT students learn to delegate care to PTAs in case studies

• Students practice applying tools which facilitate teamwork in role play situations (various care settings)

• Brief• Huddle

• Debrief

• Students reflect on how PTs and/or PTAs can be situational leaders using TeamSTEPPS during case studies


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Construct 2: Interprofessional Communication(IPEC Domain #3)

Exemplar Competency Statements

• Choose effective communication tools/techniques that enhance team function

• Express knowledge/opinions to team members with confidence, clarity, and respect

• Listen actively and encourage ideas/opinions of other team members

• Give timely, sensitive, instructive feedback and respond respectfully to feedback

Application

• Students should develop dual competency in clinical skills and team skills

• Create effective patterns that promote teamwork (not dysfunctional patterns)

• Use communication strategies that facilitate understanding (e.g., TeamSTEPPS SBAR)


Curricular Considerations• Practice giving/receiving feedback from team

members• Teach communication tools that facilitate

teamwork and conflict resolution• Practice applying these communication tools

in role play situations


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UNMC/Clarkson College Experience Examples• Ice-breaker question• Students collaborate on patient case in variety of settings (acute, SNF,

OP) to create interventions and answer setting-specific questions• Students learn various TeamSTEPPS communication strategies:

• SBAR• CUS (role play ethics case)• 2-Challenge Rule

• Small/large group discussion questions about ethics case• “What communication strategies can you use to defuse this

situation?”


Construct 3: Values/Ethics for IP Practice(IPEC Domain #1)

Exemplar Competency Statements

• Respect unique cultures, values, roles/responsibilities, and expertise of others

• Work in cooperation with those who…provide care…or support the delivery of prevention and health services

• Manage ethical dilemmas specific to IP patient/population care situations

• Act with honesty and integrity in relationships with patients, families and other team members.

Application

• Mutual respect/trust are foundational values for the PT-PTA and patient relationship

• Behaviors should reflect a shared commitment to safe, efficient, effective systems of care, grounded in shared values and ethics (APTA code of ethics)


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Curricular Considerations• Apply discussions using Code of Ethics (PT) and Standards of

Ethical Conduct (PTA) to include PT-PTA team examples• Clinical frameworks with consistent modeling of ethical

practice• Content on ethics in coursework


UNMC/Clarkson College Experience Examples

• Emphasis of team training in individual curricula reflects value of teamwork

• Faculty from each program model IP values and behavior in class

• Integration of ethics case into experience with large group discussion:

• “Are the interventions within the scope of work of the PTA? • “What are the possible consequences of the actions of the PT or PTA?”

• “How could this situation be resolved to benefit all stakeholders?”

• “How could this situation be prevented?”


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UNMC/Clarkson Teaching Example: Ethics Case

Background: PT and PTA students pair up on a paper case; each has their part of the case and does not know the whole story; the case puts the PTA in a difficult position of being asked to do something beyond their scope of practice

Learning Experience: The pairs role play a phone conversation between the PT and PTA and are asked to reflect on some potential ethical problems, consequences of actions, communication strategies to defuse this situation, and solutions to resolve or prevent it

Large Group Discussion: Follows role play to probe students’ thoughts, strategies, solutions and questions

Breakout Session for Small Groups

1. Reference handout: “Framework for Development of IPE Values and Core Competencies” (used with permission, University of Toronto, Centre for Interprofessional Education)

2. Self-assess your current curricular content using CAPTE standards and IPEC constructs (Collaboration, Communication, and Values & Ethics)

3. Look for opportunities (e.g., face-to-face classroom, clinical, and distance) in your own curriculum for enhancing PT-PTA learning experiences

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Sharing Time

•Best idea from the table

•Biggest barrier to solve

Future Plans

• Student feedback (Question #49)• “Your feedback is very important because it allows us to continually

improve the PT/PTA lab experience for students. If you have suggestions as to how we can improve this interprofessional (IPE) experience, please describe below.”

• Based on student feedback, updated experience in 2019 (did not change during the study)

• Review of literature re-emphasized value in continuing this IPE PT/PTA team learning experience (Chen et al., 2017; Chhabria, Black, Giordano, & Blue, 2019; Madigosky, Franson, Glover, & Earnest, 2019; Shortridge et al., 2019)

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Feedback

“Maybe multiple labs because I don't think there was enough time to get to know the PTA students as well as collaborating with

them in 1.5 hours.” (SPT SP 2016)

Feedback (cont’d)

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Improvements to Our Experience

• Increased lab time to two hours

• Added more time for students to discuss curriculum content

• Revised patient case to include SBAR role play

• Revised ethics case to add additional healthcare provider (DON)

• Expanded collaboration with other institutions

Conclusion- Tips for IP Educational Needs Assessment(University of Toronto, Centre for IP Education, 2017)

• Build an IP planning team• Be purposeful about modeling IP collaboration within the team • Identify shared learning needs across professions and roles• Consider resources that enabled past IP initiatives to be successful• Recognize the generative potential of needs assessments to initiate

change and begin your experience• Be open to the possibility that emerging needs may become

apparent during the design, implementation, and program evaluation

• Reflect on key learning points from your analysis (QI)

https://ipe.utoronto.ca/sites/default/files/12%20Tips%20for%20Education%20Needs%20Assessments%20Through%20An%20Interprofessional%20Lens_Aug%202017.pdf


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Questions?

Thank you!

Please contact us if you would like more information from our experience.

References• Bondoc, S., & Wall, T. (2015) Interprofessional educational experience to assist in student readiness toward

neurorehabilitation. Occupational Therapy Health Care, 29(2),153-164.

• CAPTE Standards capte.org http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTStandardsEvidence.pdf

• http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTAStandardsEvidence.pdf

• Chen, A., Dennehy, C., Fitzsimmons, A., Hyde, S., Lee, K., Rivera, J., Shunk, R., Wamsley, M. (2017). Teaching interprofessional collaborative care skills using a blended learning approach. Journal of Interprofessional Education and Practice, 8, 86-90. http://dx.doi.rog/10.1016/j.xjep.2017.07.002

• Chhabria, K., Black, E., Giordano, C., & Blue, A. (2019). Measuring health professions students’ teamwork behavior using peer assessment: Validation of an online tool. Journal of Interprofessional Education and Practice, 16, 1-6. http://dx.doi.rog/10.1016/j.xjep.2019.100271

• Colgrove Y.M. & VanHoose, L.D. (2017). DPT students perceptions of the physical therapist assistant’s role: Effect of collaborative case-based learning compare to traditional content delivery and clinical experience. Journal of Allied Health, 46(1)1-9.

• Greiner, A.C., Knebel, E., eds. (2003). Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press.

• Interprofessional Education Collaborative Expert Panel (2011). Core competencies for interprofessional collaborative practice: Report of expert panel. Washington, D.C.: Interprofessional Education Collaborative. https://www.ipecollaborative.org/about-ipec.html

• Interprofessional Education Collaborative. (2016).Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative. https://www.ipecollaborative.org/about-ipec.html

http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTStandardsEvidence.pdf

http://www.capteonline.org/uploadedFiles/CAPTEorg/About_CAPTE/Resources/Accreditation_Handbook/CAPTE_PTAStandardsEvidence.pdf



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References• Jelley, W., Larocque, N., & Borghese, M. (2013). Perceptions on the essential competencies for

intraprofessional practice. Physiotherapy Canada, 65(2), 148–51.

• Madigosky, W.S., Franson, K.L., Glover, J.J., & Earnest, M. (2019). Interprofessional education and development (IPED): A longitudinal team-based learning course introducing teamwork/collaborartion, values/ethics, and safety/quality to health professional students. Journal of Interprofessional Education and Practice,16, 1-5. http://dx.doi.rog/10.1016/j.xjep.2018.12.001

• McFadyen, A.K., Maclaren, W.M., & Webster, V.S. (2007). The interdisciplinary education perception scale (IEPS): an alternative remodeled sub-scale and its reliability. Journal of Interprofessional Care 21(4), 433-43.

• Plack, M., Williams, S., Miller, D., Malik, F., Sniffen, J., McKenna, R., et al. (2006). Collaboration between physical therapists and physical therapist assistants: Fostering the development of the preferred relationship within a classroom setting. Journal Physical Therapy Education, 20, 3–13.

• Shortridge, A., Steinheider, B., Bender, D.G., Hoffmeister, V.E., Ciro, C.A., Ross, H.M., Randall, K., & Loving, G. (2019). Teaching and evaluating interprofessional teamwork using sequenced instruction and TeamSTEPPS team performance observation tool (TPOT). Journal of Interprofessional Education and Practice, 16, 1-4. http://dx.doi.rog/10.1016/j.xjep.2019.01.009

• TeamSTEPPS 2.0, Agency for Health Research and Quality, www.ahrq.gov/teamstepps/index.html

References• Indiana University (2016). Teach 2.0 (Team Education Advancing Collaboration in

Healthcare), Interprofessional Practice and Education Center, accessed August 5, 2019 from https://ipe.iu.edu/wp-content/uploads/2017/01/TEACH-2.0-Competencies.pdf

• University of Toronto (2008). Advancing the interprofessional education curriculum 2009. Curriculum overview. Competency framework. Toronto: University of Toronto, Office of Interprofessional Education. https://ipe.utoronto.ca/sites/default/files/12%20Tips%20for%20Education%20Needs%20Assessments%20Through%20An%20Interprofessional%20Lens_Aug%202017.pdf

• University of Toronto (2017), Tips for IP Educational Needs Assessment. Toronto: University of Toronto, Office of Interprofessional Education. https://ipe.utoronto.ca/sites/default/files/12%20Tips%20for%20Education%20Needs%20Assessments%20Through%20An%20Interprofessional%20Lens_Aug%202017.pdf

• Wellmon, R., Gilin, B., Knauss, L., Inman, & Linn, M. (2012). Changes in student attitudes toward interprofessional learning and collaboration arising from a case-based educational experience. Journal of Allied Health, 41(1):26-34.

http://www.ahrq.gov/teamstepps/index.html

https://ipe.iu.edu/wp-content/uploads/2017/01/TEACH-2.0-Competencies.pdf

