university of virginia: creation of clinically-relevant ... · university of virginia: creation of...

University of Virginia: Creation of Clinically-Relevant IPE

Simulations and Objective Assessment Tools

Valentina Brashers MD, FACP, FNAP Professor of Nursing and Woodard Clinical Scholar

Attending Physician in Internal Medicine Founding Co-Director, Center for ASPIRE

University of Virginia

Objectives of this Presentation

After viewing this webinar, participants will be better able to:

• Discuss the UVA method for creating IPE simulations based on Collaborative Care Best Practice Models

• Describe the implementation of these IPE simulations during clinicals/clerkships for all medical and nursing students

• Describe the development and implementation of objective tools for longitudinal assessment of IPE competencies

• Identify potential benefits and challenges for implementing these methods at their own institutions

Need for more clinically relevant IPE experiences and objective tools

• Rapidly accumulating evidence that teamwork is essential to achieving the Triple Aim

• Link between IPE and measurable changes in teamwork behaviors less well documented

• New tools needed for developing clinically-relevant IPE activities and for measuring teamwork behaviors

The UVA Approach to IPE

Learners come to us with many preconceived notions

• About what is really important for them to learn (= low tolerance for “fuzzy fringe stuff”)

• About IPE (= fuzzy fringe stuff)

• About working with other professions (= know what they are “supposed” to say…)

Conceptual Framework for UVA IPE

• Clinically-relevant IPE moves teamwork from fringe to core:

– Learning occurs most effectively when it is reinforced by real-life clinical experiences

– Important to bridge the gap between the academic and clinical “silos” by aligning educational goals with Health System priorities for care delivery

– Faculty/clinician development is key component – students will model what they see

– Essential to integrate IPE skills with profession-specific skills and embed teamwork into traditional curricula across the learning continuum

• Fully integrated into the programs of study

Conceptual Framework for UVA IPE

• Experiential learning

– Hands-on IPE skills learning creates the greatest likelihood for enduring changes in practice behaviors

– Changes in attitudes follow good IPE experiences

• Competency-based assessments used as both formative and summative evaluation tools

– Students tend to value most those things on which they are evaluated/tested

– Support observable and measurable changes in skill application to patient care

– Self-assessment and feedback make learning objectives more tangible and “owned” by the learner

Conceptual Framework for UVA IPE (cont)

Competency Framework for UVA IPE

Prior to 2011 Now: IPEC Competencies

Communication Professionalism Shared Problem Solving Shared Decision Making Conflict Resolution

“Bridging the Gap” Developing, Implementing, and Assessing the

Impact of Innovative Undergraduate Interprofessional Education (IPE) Experiences Based

on Collaborative Care Best Practice Models

(Blackhall, Brashers, Erickson, Owen, Shannon Thomas

+ 13 other coinvestigators)

Bridging the Gap Program Description - This program for expanding

interprofessional education at the University of Virginia is designed to

1) develop innovative clinically relevant undergraduate interprofessional experiences,

2) fully integrate these experiences throughout the clinical/clerkship year, and

3) assess the impact of these experiences on students’ achievement of defined interprofessional competencies.

Step 1: Identify area of practice and associated guideline

Step 3: Using a case study, identify critical collaborative behaviors for effective guideline step implementation

Step 2: Provide Training for IPE facilitation

Create collaborative care best practice model (CCBPM) videos

Create collaborative care best practice model behaviors checklists

Step 4: Create final CCBPM and associated validated Collaborative Behaviors Observational Assessment Tool (CBOAT) appropriate for target learners

Step 5: Design IPE experiences that reflect learning objectives derived from the CCBPM and CBOAT

Pilot simulations

Step 6: Implement IPE didactic and simulation experiences during clerkship/clinical year

Process Template to Develop, Implement, and Assess Simulation IPE Experiences

Recruit expert panels

Step 7: Develop and implement validated Interprofessional Team Objective Structured Clinical Examinations (ITOSCEs)

Participatory action research (review and refine)


Goals of Care/ End of Life

Rapid Response/ Critical Illness

Chronic Progressive Illness

Transitions in care for the cognitively impaired

Illness Cancer Sepsis Muscular dystrophy Alzheimer’s disease

Guidelines

http://www.guideline.gov/content.aspx?id=15531&search=palliative+care#Section4

20

http://www.guideline.gov/content.aspx?id=12231&se

arch=surviving+sepsis

http://www.guideline.gov/content.aspx?id=15645&search=muscu

lar+dystrophy

http://www.guideline.gov/syntheses/synthesis.aspx?id=16414&search=alzhei

mer

Patient population

Adult Adult Pediatric Geriatric

Care setting Inpatient unit ICU Outpatient Hospital to home then home to assisted living

Learners (n=260)

3rd year 3rd year 3rd year 3rd year

IP Competencies

Communication Professionalism Shared problem

solving Shared decision

making

Communication Professionalism Shared problem

solving

Communication Professionalism

Shared problem solving Shared decision making

Conflict Resolution

Communication Professionalism

Shared problem solving Shared decision making

Conflict Resolution

http://www.guideline.gov/content.aspx?id=15531&search=palliative+care




http://www.guideline.gov/content.aspx?id=12231&search=surviving+sepsis



http://www.guideline.gov/content.aspx?id=15645&search=muscular+dystrophy



http://www.guideline.gov/syntheses/synthesis.aspx?id=16414&search=alzheimer





• Project Team Meetings

• Expert Panel Meetings

• Faculty development for IPE facilitation

• Continuing interprofessional education (CIPE) for clinicians

• Participation in conferences (Macy, CAB, etc)

• Consultants (Schmitt, Reeves)

• Website resources (in progress)

Collaborative Care Best Practice Model (CCBPM)

• Expert panels meet to discuss a case scenario

• Identify specific professional and interprofessional behaviors needed for “gold standard” team-based care

• View videotaped scenarios

• Participatory Action Research →several rounds to refine checklist

• Come to consensus on final list = CCBPM

Collaborative Behaviors Observational Assessment Tools (CBOATS)

• Very explicit observable/measurable behaviors

• Inter-rater reliability established

• Adaptable to any target learner – novice to expert (eg. simplified for students, gold standard for clinicians)

• Basis for learning objectives for IPE simulations and for formative and summative evaluation (see ITOSCEs)


Pilot simulations


Bridging the Gap: The Student Experience

Introduction to Collaborative Care

After participating in this experience, learners will be able to:

• Define “Interprofessional Practice”

• Explain to peers the educational preparation and role contributions of doctors and nurses in acute care settings

• Explain to peers four specific behaviors required for successful interprofessional collaboration.

• Use the SBAR tool in clinical settings.

Intro to Collab Care 2012 + 2013

0

50

100

150

200

250

300

UnderstandRoles

Value Teams BetterOutcomes

SA

A

D

SD

Difficult Discussions at the End of Life

Blackhall, Erickson, Goeke

Rapid Response: Surviving Sepsis

Littlewood, Tullmann, Wright

Chronic Progressive Illness in Pediatrics (Muscular Dystrophy)

Haizlip, Epstein, Crain

Transitions From Hospital to Home for Cognitively Impaired Elderly

(Alzheimer Dz)

Rose, Balogun, Fletcher

Interprofessional Teamwork Objective Structured Clinical Examinations (ITOSCEs)

• Derived from CCBPM, videos, and CBOATs

• Multiple pilot sessions

• Ran 12 ITOSCES simultaneously while project team provided quality control/feedback from control room

• Designed for both formative and summative assessments ⁻ Students rated themselves ⁻ Standardized patients and providers rate students

Sample Results for Nursing Students

0 20 40 60 80 100 120 140 160

15. Works with MD to encourage patient to take the breathing…

14. Maintains patient-focus.

13. Communicates RECOMMENDATIONS to MD.

12. Communicates ASSESSMENT to MD.

11. Communicates BACKGROUND to MD.

10. Communicates SITUATION to MD.

9. Introduces self to MD.

8. Recognizes need for assistance

7. Reassesses after intervention

6. Intervenes in response to assessment.

5. Completes an organized, focused assessment.

4. Intervenes in response to patient’s concern/physiologic state.

3. Reassures patient

2. Elicits patient’s concerns

1. Introduces self to patient.

SON Rapid Response: PreITOSCE vs. PostITOSCE (SP Scores)

Pre_RR_Total Item Score

Post_RR_Total Item Score

0 50 100 150 200 250 300

11. Offers alternative treatments or comfort measures for providingthe treatment.

10. Works with RN to encourage patient to take the breathingtreatment.

9. Actively listens to RN’s response to recommendations.

8. Discusses recommendations with RN.

7. Communicates Assessment with RN.

6. Performs brief physical examination.

5. Actively listens to RN’s report of events.

4. Elicits information about the background from the nurse.

3. Elicits information about current situation from nurse.

2. Attempts to take a brief history from the patient.

1. Introduces self to RN and the patient.

SOM Rapid Response: PreITOSCE vs. PostITOSCE (SP Scores)

Pre_RR_Total ItemScore

Post_RR_Total ItemScore

Sample Results for Medical Students








Pilot simulations


Process Template to Develop, Implement, and Assess Simulation IPE Experiences




Lessons Learned • Identifying specific intraprofessional and IPE behaviors helps create

measurable learning objectives

• Integrating IPE with profession-specific clinical learning moves IPE from the “fringe” to the “core” of student learning

• Every step of IPE development can be used as an opportunity for faculty development

• Implementing ITOSCEs helps students take ownership of their own strengths and learning gaps

Barriers • Scheduling challenges for faculty, clinicians, and students

• Time needed for development of IPE experiences and validated assessment tools was greater than anticipated.

• Competition for the availability of simulation/standardized patient center time and space

Summary • Implementing IPE experiences, CBOATS, and

ITOSCEs based on Collaborative Care Best Practice Models

– Embeds IPE into the learning of all students – fringe to core

– Includes powerful opportunities for faculty development

– Emphasizes experiential and reflective learning toward enduring changes in skills and attitudes

– Creates high-impact formative as well as summative competency-based evaluation tools that can be used for learners at all levels (novice to expert)

Questions and Discussion

university of virginia: creation of clinically-relevant ... · university of virginia: creation of...

Documents