Shriners Hospital for Children

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Shriners Hospital for Children
Liliane Asseraf-Pasin Elaine Laflamme The
McGill Educational Initiative on
Interprofessional Collaboration Partnership for
Patient and Family Centered Practice Faculty of
Medicine McGill University
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Overview

• Definitions
• Why Interprofessional Education?
• Literature Review (Freeth et al., 2005)
• How To?
• Discussion

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Definitions

• Multiprofessional Education
• Is when members (or students) of two or more
  professions learn alongside one another parallel
  rather than interactive learning.
• (Freeth et al., 2005)
• Students learn by tackling together a common
  problem, but from the perspective of their own
  discipline.
• (Areskog, 1994)

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Definitions

• Interprofessional Education
• Learning arising from interaction between members
  (or students) of two or more professions. This
  may be a product of interprofessional education,
  happen spontaneously in the workplace, or in
  educational settings.
• (Freeth et al., 2005)
• Students from each profession look at the subject
  from the perspective of other professions as well
  as their own.
• (Harden, 1998)

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Interprofessional Patient-Centered Practice

• Active participation of different professional
  groups in decision making delivery of patient
  family-centered care
• Responsive to patient family goals, opens
  mechanisms for continuous communication fosters
  mutual respect among professionals

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The Nature of Collaboration
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Why Interprofessional Education?

• Mounting evidence that Collaborative Practice
  improves outcomes in a number of patient
  populations studied to date
• Geriatrics, ER care for abused women, STD
  Screening, Adult Immunization, fractured hips and
  neonatal ICU care, depression care, and in
  simplifying medications
• (Zwarenstein et al., 2004)

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Why Interprofessional Education?

• Modify negative attitudes perceptions
  (Carpenter, 1995)
• Remedy failures in trust communication between
  professions (Carpenter, 1995)
• Reinforce collaborative competence (Barr, 1998)
• Secure collaboration
• implement policies (Department of Health, 2001)
• improve services (Wilcock and Headrick, 2000)
• effect change (Engel, 2000)
• Cope with problems that exceed the capacity of
  any one profession (Casto Julia, 1994)
• Enhance job satisfaction ease stress (Barr et
  al., 1998 McGrath, 1991)
• Create a more flexible workforce (Department of
  Health, 2000)

(as cited in Barr, 2002)
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Why Interprofessional Education?

• Complexity of care
• Rising expectations
• Professional proliferation
• Students want to know
• Community based care
• Teamwork
• Interprofessional conflict
• New models of practice
• Legislation redefinition of professional roles
• Effectiveness of interprofessional practice

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Literature Review

• Studies that EVALUATED Interprofessional
  Education
• 10, 495 abstracts
• 884 papers
• 373 studies
• 107 robust evaluations 3 on quality criteria

(Freeth et al., 2005)
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Literature Review

• Inclusion criteria for studies
• Evaluation design was appropriate to the research
  aims/questions
• Selection of participants was based on clear
  criteria
• Validity reliability or authenticity
  trustworthiness well considered
• Results and context clearly described

(Freeth et al., 2005)
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Literature Review

• Quality reported information
• Clear rationale
• Good contextual information
• Sufficient information on sampling, ethics and
  possible bias
• Analysis described in sufficient detail

(Freeth et al., 2005)
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Literature Review
Profession Number of Studies
Nurses 95 (89)
Doctors 88 (82)
Others (e.g. administrators, school teachers) 58 (54)
Social Workers 39 (36)
Allied Health Professionals (unspecified) 32 (30)
Occupational therapists 22 (21)
Physiotherapists 18 (17)
Psychologists 16 (15)
Pharmacists 13 (12)
Dentists 5 (5)
Midwives 6 (6)
(Freeth et al., 2005)
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• Findings by Outcome collapsed

Education lead Outcomes University Service Joint Total
1) Responses 26 (4) 16 (1) 0 (3) 50
2a) Perceptions attitudes 12 (8) 9 (2) 1 (1) 32
2b) Knowledge skills 27 (2) 11 (0) 0 (0) 50
3) Behaviour 6 (5) 12 (1) 3 (0) 26
4a) Practice 2 (3) 31 (6) 4 (0) 46
4b) Patients 5 (1) 14 (8) 1 (3) 32
(Freeth et al., 2005)
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Literature Review

• Key messages with examples
• Wide range of positive outcomes associated with
  IPE
• Richardson, Montemuro, Cripps, Mohide,
  Macpherson (1997)
• Mixed, neutral and negative reactions provide
  useful lessons
• Clinebell Stecher (2003)
• McCallin (2001)

(Freeth et al., 2005)
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Literature Review

• Key messages

High Profile Low Profile
Work-Based Initiatives Team Development
Undergraduate IPE University Service Partnership
In-service IPE Learning with Credit
(Freeth et al., 2005)
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Effective Collaborative Interventions implemented
in Pediatrics
Purpose of Study Source Intervention
To evaluate the frequency and referral patterns, need for continuing education, and information given to parents of children with cleft lip and palate by local primary care physicians. Grow, J. L. Lehman, J.A., Jr. Cleft Palate-Craniofacial Journal. 2002 Sep 39(5)535-40. (13 ref) Particular aspects of care evaluated included protocols of care, information for parents, referral patterns, conferences attended, and literature read.
To assess the educational impact of a block rotation designed to familiarize pediatric residents with community resources for medically and developmentally complex children. Zenni, E.A., Fiallos, Y. Ambulatory Child Health. 1999 5(2) 142-50. (11 ref) Residents spent 4 weeks in a variety of community sites engaged in observational activities. Developed self-perceived increased knowledge of services available to children with special needs, and self-perceived increased ability to work with allied health professionals and to coordinate care for complex patients.
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Effective Collaborative Interventions implemented
in Pediatrics
Purpose of Study Source Intervention
To describe the evaluation of an educational experience for third-year medical students concerning children with developmental disabilities, and parental psychosocial issues. Andrew, N.R.,  Siegel B.S.,  Politch, L., Coulter D. Ambulatory Child Health. 1998 4(3) 307-16. (19 ref) Students spent 2-4 h in a home visit interviewing family members about their experiences with a child who had a developmental disability, observed family interactions.
By following their patients from the time their patients were in the hospital and back to their homes and community, the students are able to understand in depth the problems faced by patients, the importance of communication skills in educating patients on their illness and the importance of good communication between primary, secondary and tertiary care.  Sherina, M.S., Azhar, M.Z., Mohd Yunus, A.,  Azlan Hamzah, S.A. Medical Journal of Malaysia. 60 Suppl D54-7, 2005 Aug. The students do a series of home visits and also accompany their patients for some of their follow-ups at the hospital, government clinics, general practitioners' clinics even to the palliative care or social welfare centres.
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Effective Collaborative Interventions implemented
in Pediatrics
Purpose of Study Source Intervention
The authors sought to evaluate the accuracy of medical student self-assessment of their performance in the paediatric clerkship OSCE and thus obtain preliminary data for use in programme strengthening. Pierre, R. B., Wierenga, A., Barton, M., Thame, K., Branday, J. M., Christie, C. D. C. West Indian Medical Journal.  54(2)144-8, 2005 Mar. The objective structured clinical examination (OSCE) has been recognized not only as a useful assessment tool but also as a valuable method of promoting student learning.
To compare the effects of two teaching methods (written case analyses and written case analyses with group discussion) on students' recognition and assessment of common ethical dilemmas. Smith S., Fryer-Edwards, K., Diekema D.S., Braddock, C. H. 3rd. Academic Medicine.  79(3)265-71, 2004 Mar. Four components of the case analyses were evaluated ability to identify ethical issues, see multiple viewpoints, formulate an action plan, and justify their actions.
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Effective Collaborative Interventions implemented
in Pediatrics
Purpose of Study Source Intervention
The authors sought third-year medical students' perceptions of ambulatory preceptors' teaching effectiveness across primary care disciplines. Elnicki D.M., Kolarik R., Bardella I. Academic Medicine.  78(8)815-9, 2003 Aug. Students anonymously evaluated the full-time volunteer preceptors using a 5-point Likert-type evaluation that had 8 items addressing preceptor teaching behaviors, 6 items on attaining clerkship goals and 1 assessment of overall teaching effectiveness.
This paper documents the rhetorical features of certainty and uncertainty in novice case presentations, considering their pragmatic and problematic implications for students' professional socialization. Lingard, L., Garwood, K., Schryer, C.F., Spafford, M. M. Social Science Medicine.  56(3)603-16, 2003 Feb. Five thematic categories emerged, two of which this paper considers in detail "Thinking as a Student" "Thinking as a Doctor". Within these categories, the management portrayal of uncertainty was a recurrent issue.
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Take Home Message

• Team Building is important
• Team Development is necessary
• Regular Interdisciplinary Rounds
• Interdisciplinary Assessments
• Maintain Collaborative Quality
• Design Improvements to your Practice
• Practice by Reviewing Performance Data

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How To Teach IPP to Students

• Foster IPP Skills, Attitudes and Behaviors within
  your team and Model to Mentor Students.
• Provide didactic information package to students
  prior to their clinical placement.
• Orient students to Spina Bifida Team Members
  early on in the rotation
• Set clear, achievable measurable goals
• Have students Identify Roles Tasks of each
  professional involved in the team and compare
  them to actual R T. i.e.
• what do you think is the role of the Social
  Worker/Nurse on this team?
• Where do you see their intervention within this
  clients plan of care?
• What do you see as your role on this team?

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How To Teach IPP to Students

• Use Simulation to present a typical case to all
  students as a group exercise.
• Map out process from admission to discharge
• Allow them to practice as an IP team come up
  with a plan
• Facilitate their discussion and redirect if
  necessary
• Prepare a list of typical questions and answers
  (Q A) parents may have about your team
  functioning, process and expected outcomes.
• Have students pretend to be another professional
  and prepare a Mock Team Meeting.

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Sample Methods

• Shadowing (walking through the day of another
  professional)
• Scaffolding (breaking-up tasks into smaller
  parts)
• Situated Learning Principles (beginning at the
  edge moving towards the center)
• Peer Coaching/Enhancing Metacognition
  (K/KDK/DKDK)
• Simulation
• Real Case Studies
• Small Group Discussions (IP)
• Peer discussions (intra)
• Videotaping sessions
• Provide time for students to meet prior to next
  clinic to share discuss issues

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Summary

• Definitions
• Why Interprofessional Education?
• Literature Review (Freeth et al., 2005)
• How To?
• Discussion

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References

• Areskog, N. H. (1994). Multiprofessional
  education at the undergraduate level. In K.
  Soothill, L. Machay, C. Webb (Eds.), Working
  together? Interprofessional relations in health
  care. London Edward Arnold.
• Barr, H. (March, 2002). Interprofessional
  Education Today, Yesterday and Tomorrow.
  Published as Occasional Paper No1, The UK Centre
  for the Advancement of Interprofessional
  Education (CAIPE).
• Freeth, D., Hammick, M., Reeves, S., Koppel, I.,
  Barr, H., Ashcroft, J. (2005). Effective
  interprofessional education Development,
  delivery evaluation. Malden, MA Blackwell
  Publishing Inc.
• Harden, R. M. (1998). Effective multiprofessional
  education a three-dimensional perspective.
  Medical Teacher 20, 5, 402-408.
• Zwarenstein et al., (2004) http//www.ktp.utoronto
  .ca/aboutTheKTP/projects/

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For a copy of any article please email
us elaine.laflamme_at_mcgill.ca liliane.asseraf.pasi
n_at_mcgill.ca