Welcome! Before We Begin...

Today’s Presentation will include 2 audience interactive exercises….

Please be sure to sit with NEW friends!

Interprofessional Team Immersion: Cultivating the “Ah-Ha” Moment

Presented by:Jim Cavanaugh

Dawne-Marie DunbarKris Hall

Shelley Cohen Konrad Kira Rodriguez

Why, What, How• Theoretically framed rationale • Co-designed programming • Rapid cycle evaluation• Replicable, streamlined implementation• Assessment

How we plan to use your time today

Brief interactive team activityProject Background & Supporting Theory Case Building Brief interactive team activitySimulation Design & ImplementationAssessment Design & ResultsOther OutcomesQuestions/Comments

Orientation:Team Identity

What just happened?

ConstructivismMultiple Perspectives

Reflective/Reflexive Learning

Relational-CulturalLearning in Relationship “A foot in both worlds”

Active Producers of Knowledge

Team-based ModelsCommunities of

Interest

Learning Theories

Planning for Patient Interaction:Roles, Responsibilities, Teamwork

Team Activity

• As Individual Team Members (5 minutes): – Share personal and professional reactions to the case. – What can each team member contribute to help Lori

with her stated needs?

• As a Team (5 minutes):– Identify and discuss potential barriers and

opportunities to providing Lori with effective care.

What just happened?

Case Construction By Design

Steps Lori & Ryan1. Identify a “Difficult Conversation” that could

occur anywhere in patient careIssues of sexuality and intimacy

2. Add complicating medical factors Paralysis; chronic pain

3. Add complicating psychosocial factors Sudden onset catastrophic disability; altered family dynamics

4. Add complicating social determinants of health

Access to care; financial stressors

5. Use multiple stakeholders to inform and integrate case elements into realistic narrative

Individual with spinal cord injury; health professions faculty;

Tactics: 1. Create opportunities for input from multiple members of the health care team2. Create sufficient case complexity so that the team must set priorities, address

dilemmas, and identify sociocultural factors that affect the patient care plan

Goal of Case ConstructionGood cases foster healthy team behaviors:

1. Understanding individual roles & responsibilities

2. Practicing the blending of diverse professional skills into effective team behavior

3. Evaluating impacts of social determinants and health inequities on health

4. Discovering flexible approaches to team leadership

Add still image of Lori and Ryan from 30 second film providing the

team with feedback. “The people made all the

difference.”

• Two simulation days; 2 patient visits per session • Team Debrief between sessions; -Faculty Advisor Focus: clinical content

• Large Group Debrief after second session: – Patient and family member feedback– Faculty Focus:

• Teamwork• Roles & Responsibilities

Simulation Overview

Simulation Design Considerations

• Professional Actors vs. High Fidelity Simulators vs. Standardized Patients

• Individual Team Care Plans

• Faculty Debriefing Skills

• Scheduling challenges

Simulation Lessons Learned

• Faculty Debriefing – IP Faculty Teamwork Role Modeling & New Collaborations– Recruiting Champions: proven strategy– Trusting the Pedagogy– Start Small, Repeat, Share

• Student’s Response Themes:– The importance of teamwork– Appreciation of “shared knowledge” and of roles &

responsibilities– Sim helps practice difficult conversations & communication– More sim please!

Evaluation Design

• Multiple theoretical frameworks – Utilization-focused evaluation (Patton 2008)

– Rapid feedback cycle evaluation (e.g. Zakoc 2015 Data-to-Action)

– Modified Kirkpatrick learning outcomes (Freeth et al 2002)

– Canadian (CIHC 2010) & American (IPEC 2011, 2016) Interprofessional Core Competencies

• Mixed methods– Quantitative: pre-post student surveys • 12 item version of the IP Education Perceptions Scale (IEPS) - McFayden,

Maclaren, & Webster, 2007• 11 selected items from the IP Collaborative Care Coordination – Global Rating

Scale (ICCC-GRS) - Hunter et al, 2015– Qualitative: feedback cards & post survey with open-ended questions

Survey ParticipantsHealth Profession Enrolled Pre Post Matched Pre-

Post# % # % # % # %

Social Work 5 12% 2 7% 4 13% 2 9%Occupational Therapy 6 14% 3 10% 5 16% 3 13%Nursing 4 10% 3 10% 1 3% 1 4%Physical Therapy 6 14% 4 13% 6 19% 3 13%Osteopathic Medicine 6 14% 6 20% 4 13% 4 17%Dental 5 12% 5 17% 5 16% 4 17%Pharmacy 3 7% 2 7% 2 6% 2 9%Physician Assistant 1 2% 1 3% 0 0% 0 0%Dental Hygiene 6 14% 4 13% 5 16% 4 13%

TOTAL 42 100% 30 71% 32 76% 23 55%

Survey Quantitative Results

Interprofessional Education Perceptions Scale (IEPS) Subscales & Summative Score

Median of Summed Ratings

Wilcoxon Sign Rank Test (related samples)

Pre Post p-value

  Perceived Need for Cooperation Subscale 11 11 0.353  Perception of Actual Cooperation Subscale 25 25 0.220  Competency and Autonomy Subscale 25 25 0.023*  IEPS Summed Score 60 62 0.046*

Global Rating Scale (GRS)Competency Areas & Summed Score

Median of Summed Rating

Wilcoxon Sign Rank Test (related samples)

Pre Post p-value

GRS Collaboration Competency Items 20 21 0.019*GRS Communication Competency Items 20 20 0.014*GRS Summed Score 44 45 0.009*

Survey Qualitative Results 1What surprised or challenged your previous perceptions?

• “I was surprised to learn just how little I knew about what every other profession does and has to offer their patients. It was a bit challenging for me to accept this …[it] made me realize how little I actually knew about those professions.”

Lack of knowledge about others’ scope of

practice

• “I was surprised at how much we focused not only on our own field but also on others. I thought each member would be focused on their field, but it seemed that we all pitched in for every aspect of our patients care.”

Appreciation for knowledge of other health professions

• “Many professions overlap and complement one another, and it can be challenging to fit all of the pieces together.”

Unanticipated “professional overlap”

• “I was amazed at how well we all worked together…the dental medicine student didn't overpower every aspect of the oral health situation and actually was interested in what I had to say and what I wanted for the patient …”

Ease of collaboration

Survey Qualitative Results 2How influence your health care practice in the future?

“I have a better understanding about what each profession does, and how each profession is interrelated. I feel more confident in my ability to reach out to other professions in order to treat clients as a whole. “

Increased likelihood of referring/consulting with other health professionals in practice

Increased confidence in ability to actively participate in collaborative teamwork

Increased knowledge about other health providers’ roles and scopes of practice

Other Outcomes

University of New England326/7 Hersey HallPortland, Maine USA 04103207/221-4114 ipec@une.edu

Facebook: Interprofessional Education CollaborativeTwitter: @UNEIPE or #IPEUNE

Resources: Access support materials for Team Immersionhttp://bit.ly/2b8ggNE

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