A Model for Interprofessional Education Through Case Study Roles

Dianne Cameron, PhD

Collaborative Health Initiatives

Faculty of Science & Engineering

Northern Health Research Conference

Timmins, June 4-6, 2015

Conflict of Interest Declaration: Nothing to Disclose

Presenter: Dianne CameronTitle of Presentation:

A Model for Interprofessional EducationThrough Case Study Roles

I have no financial or personal relationships to disclose

Nothing to Hide

Introduction• IECPCP:

“interprofessional education for collaborative patient-centred care”(Health Canada. Interprofessional Education for Collaborative, Patient-Centred Practice. Discussion Paper & Research Report Request for Proposal. October 2003)

• Interprofessional Education:“occasions when two or more professions learn from and about each other to improve collaboration and the quality of care”(Centre for Advancement of Interprofessional Education (CAIPE), 1977, revised)

• Collaboration:“an interprofessional process of communication and decision-making that enables the separate and shared knowledge and skills of health care providers to synergistically influence the client/patient care provided”(Way & Jones, 2000)

Introduction … Interprofessional education (IPE) leads to interprofessional care (IPC)

How do we get there?

Many valid ideas: short courses, seminars, workshops, focus groups, …

• A quick search on Health Canada finds >10,000 references on IPE/IPC

• How to prepare large numbers of students in many educational programs/disciplines for fulfillment of interprofessional practice in their professions ???

Relevant IPE/IPC issues:excerpts from IECPCP report

• Little literature for educators on facilitating IPE: urgent need for faculty development

• Evaluation methods for program and student assessments relevant to IPE are needed

• Most successful collaborative practice initiatives were in service or mixed settings (92%), rarely in higher education settings (7%)

• Opportunities for IPE in transcultural perspectives are lacking or inadequate in most professional programs and do not address how to provide culturally sensitive care

• Learners entering their training programs already have pre-existing stereotypes developed about other health professionals

IPE/IPC issues from IECPCP report…

• Professional schools should include clinical experiences where students from different professions work collaboratively in teams providing care to culturally diverse populations.

• Students in health care need to be aware of the contributions of all health care providers, particularly non-traditional health care providers, and how to work more collaboratively with them.

• An interprofessional collaborative approach among professionals, health care providers (traditional/non-traditional) and the community is desirable and possibly the only feasible way in which health care can be delivered in Canada's northern native communities and remote settings

• Successful implementation of interprofessional education will require both individual and collective learning

Challenges for undergrad IPE

Incorporation of IPE into undergraduate curricula has been slow, and faces numerous challenges:

• Professional programs need to focus on discipline specific education

• Little room in busy timetables for IP courses

• “Silos” remain intact in many institutionsAdministrative support is lacking

• Courses not shareable across disciplines

• Faculty assigned to one department or one program, one instructor per course

• Class times & clinical time across programs conflict

• No “credit” for extra-curricular IPE

Examples: PossibleInterdisciplinary Courses

Interdisciplinary Pathophysiology

Clinical Research Methods in Interdisciplinary Practice

Interprofessional Practice and Cultural Competency

Interprofessional Practice and Patient Care

Common Elements:• Team taught – instructors from various disciplines, faculties,

institutions• Case based, patient centred• Combination of individual learner and team projects• Students from different disciplines• Health care role exploration and role play

Pathophysiology- Interdisciplinary Practice

• Uses the vehicle of common subject material in pathophysiology, illustrated in patient case studies

• Stresses a team approach to patient care to integrate learners from different professional disciplines

• Case studies explore a variety of episodic and complex health challenges from an individual, family and community perspective, cultivating an understanding of interprofessional practice

• Team taught by faculty from radiation therapy, oncology, midwifery, neuroscience, human biology, radiology, nursing, forensic science… some from Laurentian, some from Hôpital régional de Sudbury Regional Hospital

Pathophysiology - Interdisciplinary Practice…

Example Learner Activities (individual and team work):• Each student is assigned a preliminary case study patient

and a health care role NOT matching his/her discipline• Stage I case study report includes researching the role,

scope of practice, licensure, interaction with patient, case based questions on pathophysiology, patient background

• Stage II case study – identifies classmates with different health care roles sharing same patient; team must pool information and submit joint case report

• Stage III case study – includes pathophysiology lab with tests/exploration related to each case

• Final Health Care Team report & oral presentation

Case Studies & Roles

Patient 1 Patient 2 Patient 3

Nurse Practitioner Paramedic Optometrist

Pathologist Radiologist Respiratory Therapist

Parasitologist Emergency Physician Chiropodist

Laboratory Technician Dietician Pharmacist

Social Worker X-ray Technician Family Physician

Nurse Home Care Worker Clinical Dietician

Aboriginal Elder Physiotherapist Lab Technician

Case Studies & Roles…

Patient 1, Mr. Minto Patients 2, Gauthier brothers

Patient 3, Annie Armstrong

Aboriginal Cree trapper near Hornepayne, pain in right side below the rib cage, dark coloured urine, reluctant to seek medical help

Fragile elderly bachelor brothers on farm near Verner, attacked by rabid cow & trapped on shed roof, speak no English

Morbidly obese former logging camp cook with skin & visual problems, sleep disturbance, always hungry & thirsty

Case Studies & Roles…

Patient 4 Patient 5 Patient 6

Nurse Practitioner Oncologist Obstetrician /Gynecologist

Social Worker Radiation Therapist Genetic Counsellor

Endocronologist Naturopath Spouse

Bariatric Surgeon Clinical Psychologist Midwife

Psychiatrist Oncology Nurse Ultrasound Technician

Nurse Health Care Chaplin

Dietician

Case Studies & Roles…

Patient 4, Annie Armstrong (2)

Patients 5, Mike Periera Patient 6, Janet Simmons

Enters program for bariatric surgery for weight loss

Heavy smoker with emphysema, now terminal lung cancer; palliative case

Pregnant in an isolated rural area, lost previous child to genetic disorder; healthy but fearful

Measuring Effectiveness• Each course uses an entry/exit assessment tool to

evaluate changes in knowledge and awareness of IPE/IPC by students who have completed the course

• Participating course instructors are asked for input before, during, and after course completion

• Students complete a course evaluation at the end of each course

• Final team case reports includes students’ evaluation of pros/cons of IPC, IPE & what they learned

• Still needed: longer term tracking to evaluate effect of undergraduate IPE on patient outcomes in professional practice

Measuring Effectiveness…Student questionnaire responses on entry / exit

Measuring Effectiveness…Three most changed responses from entry to exit

Measuring Effectiveness…Sample from one team’s final report..

“We have learned that having a patient-centered health care team is essential in the diagnosis and treatment of a patient. Each part of the team, whether or not they actually interacted with the patient, played a part in Mr. Minto’s care and if one was missing we could not have made our diagnosis. Working as a team allows each person to focus on their job and be an expert in their field so that the patient receives the best care possible. Health care team members whether they are nurse practitioners, experts, or social workers seek out, and rely upon collaborative interaction with each other to ensure that their patients receive effective and seamless care. Care that is truly patient-centered considers patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient and their loved ones part of the care team. Overall, using a team health care approach allowed for the best possible care for Mr. Minto.”

References1. Barr, H., Koppel, I., Reeves, S., Hammick, M., & Freeth, D. (2005). Effective interprofessional education -

Argument, assumption and evidence. CAIPE London, United Kingdom: Blackwell Publishing.

2. Commission on the Future of Health Care in Canada. (2002). Building on values: The future of health care in Canada: Final report. Commissioner: Roy J. Romanow. Ottawa: Queen's Printer.

3. Health Canada (2004). Interprofessional education for collaborative patient-centred care (IECPCP)

4. Health Force Ontario (2007). Interprofessional Care: A Blueprint for Action in Ontario. www.healthforceontario.ca/IPCProject

5. Martin-Rodriguez, L., Beaulieu, M., D'Amour, M., & Ferrada-Videla, M. (2005). The determinants of successful collaboration: A review of theoretical and empirical studies. Journal of Interprofessional Care, 19(1 Suppl), 132-147.

6. McNair, R., Brown, R., Stone, N., & Sims, J. (2001). Rural interprofessional education: Promoting teamwork in primary health care education and practice. Australian Journal of Rural Health, 9(Suppl), S19-S26.

7. Oandasan, I., Baker, G.R., Barker, K., Bosco, C., D'Amour D., et al. (2006). Teamwork in healthcare: Promoting effective teamwork in healthcare in Canada. Policy synthesis andrecommendations. Ottawa: Canadian Health Services Research Foundation.

8. Parsell, G., & Bligh, J. (1999). Interprofessional learning. Postgraduate Medical Journal, 74, 89-95.

9. Parsell, G., Spalding, R., & Bligh, J. (1998). Shared goals, shared learning: Evaluation of a multiprofessional course for undergraduate students. Medical Education, 32, 304-311.

10. Purden, M. (2005). Cultural consideration in interprofessional education and practice. Journal of Interprofessional Care, 19(1 Suppl), 224-234.

11. Zwarenstein, M., Reeves, S., & Perrier, L. (2005). Effectiveness of pre-licensure interprofessional education and post-licensure interprofessional collaboration interventions. Journal of Interprofessional Care, 19(1 Suppl), 148-165.

A Model for Interprofessional Education Through Case Study Roles

Dianne Cameron, PhD

Collaborative Health Initiatives

Faculty of Science & Engineering

Northern Health Research Conference

Timmins, June 4-6, 2015