Collaboration in Action – EFPPEC at Queen’s Dr. Cori Schroder MD MEd CCFP FCFP Dr. Joshua Shadd...

Collaboration in Action

– EFPPEC at Queen’s

Dr. Cori Schroder MD MEd CCFP

FCFP

Dr. Joshua Shadd MD CCFP

EFPPEC Videoconference

March 14, 2007

Objectives

This videoconference will provide participants with the opportunity to:

• hear about successful collaborative educational initiatives at the undergraduate, post-graduate and faculty development levels

• appreciate the benefits of jumping on someone else’s bandwagon

• discuss the pros and cons of EFPPEC ‘branding’ in the curriculum

• think more flexibly about ways of advancing EFPPEC competencies in their home institutions

Outline

• Introduction – A Bit of History

• Collaborative Initiatives– Undergraduate– Postgraduate– Faculty Development

• Summary & Conclusions

Break for Questions

A Bit of History

Working within the Queen’s Environment

• Faculty of Health Sciences – Medicine, Nursing, Rehabilitation Therapy

• Palliative Care Medicine Program – Departments of Oncology, Family Medicine, Medicine

“Queen’s … on the cutting edge of tradition…”

A Bit of History

Getting the ‘word’ out.. Developing the Local Team..• Palliative Care Medicine Program• Undergraduate – Medicine in Society,

Associate Dean UG Program• Postgraduate – PGME, Assistant Dean PG

Program• Associate Dean Medical Education

A Bit of History

QUIPPED• Queen’s University Inter-Professional

Patient-Centred Education Direction• $1.2 million for qualitative research

(action research in the critical paradigm) • 33 months to change the culture of

teaching and learning at Queen’s (June 2005 – March 2008)

A Bit of History

The Goal of QUIPPED

To create an inter-professional educational environment at Queen’s University that enhances the ability of learners, faculty, and health care providers to provide patient-centred care that recognizes the contribution of the health care team within a respectful and collaborative framework.

Web page: http://meds.queensu.ca/quipped

A Bit of History

The Inter-Professional Matrix at Queen’s (QUIPPED)

A Bit of History

Commonalities: QUIPPED and EFPPEC

• Education initiatives• Need to change ‘culture’ of institution• Various levels of learners• Promote patient-centred care• Promote collaboration• Inter-professional

A Bit of History

EFPPEC could offer QUIPPED• Competencies and content ideal for IPE• Committed educators

QUIPPED could offer EFPPEC• Stronger ‘lobby’ within institution• Assistance with development of education

initiatives• Broader representation on EFPPEC local

team

Undergraduate

The Current Picture

Phase I Phase IIA Phase IIB Phase IIE ClerkshipPhase IIC

Year 1 Year 2 Year 3 Year 4

The Current Picture

• 3hr PC lecture• 2hr pain lecture• 1hr pain small group• 2hr multidisciplinary pain lecture• 3hr PC patient home visit (inter-

professional facilitators)

• Total contact: 11 hours



The Current Picture

• 2hr multidisciplinary pain lecture• 1hr PC dyspnea lecture• 1hr PC GI lecture• 3hr PC cases (small groups)

• Total contact: 7 hours



The Current Picture

• 1hr tutorial



The Current Picture

1.1 I – Comm/Clin SkillsIIA - MSK Block IIA - Pain in PC IIIA - Pain symposiumIIB – Pain in PC II

1.2 IIA – Intro to painIIB – Pain in PC IIIIE – PC Cases

1.3 IIA – Pain in PC IIIB – Pain in PC II

1.4 IIA – Final hoursIIC – DyspneaIIE – GI Problems IIE – PC Cases IIB – PsychiatryIIC – GU (nausea)IIC – Resp (dyspnea)IIE – GI (nausea)IIE – Fatigue

1.5 IIB – Pain in PC II


2.1 I – Comm/Clin SkillsIIC – Ethics: EOL

2.2 IIB – PC CasesIIC – Ethics: EOL

2.3 IIA – Intro to PCIIA – PC home visits

2.4 I – Comm/Clin SkillsIIA – Moose FactoryIIA – X-Culture EthicsIIC – Ethics: EOLIIE – Native Culture

3.1 IIB – Law: DeathIIB – Ethics: Adv DirIIC – Ethics: EOL


3.3 IIA – Intro to PC

3.4 IIB – Law: DeathIIB – Ethics: EuthanIIC – Ethics: EOL



4.1 I – MD/Pt RelationshipI – Comm/Clin SkillsIIA – Psycho OncIIC – Ethics: EOL

4.2

4.3 IIA – Psycho Onc

4.4 I – Comm/Clin Skills

5.1 IIA – Intro to PCIIA - NursingIIA – Hospital Outcomes

5.2 I – Med Sci RoundsI – Continuity of CareIIA – PC home visitsIIA – Wellness Symposium

6.1 IIA – PC home visitsIIA – Psycho Onc


6.3 I – MD/Pt Relationship IIA – PC home visits

The Current Picture

Challenges• distributed, but not integrated• minimal presence in clerkship

Strengths• We have time (and time is territory)• We are not alone

Agents of Change

EFPPEC

QUIPPED

Office of Health Science Education

New electronic learning resources

Accreditation-inspired re-evaluation of curriculum & pedagogy

EFPPEC +

Office of Health Sciences Education Innovation Fund

=The Progressive, Integrated, Collaborative Pain Curriculum

Project

PIC Pain Project

Our challenge:• Numerous instructors from multiple

disciplines/departments• Difficult to know what students already know• Diverse ideas about what students need to know• “Everybody’s problem, but no one’s responsibility.”

Our team:• Palliative Care Medicine• Pharmacology & Toxicology• Orthopedic Surgery• Family Medicine• Health Science Education

PIC Pain Project

Our aim:

To reassess and redevelop a curriculum intended to equip pre-clerkship students with the knowledge, attitudes and skills required to assess and manage the symptom of pain appropriate to the level of a beginning clinical clerk.

Get everyone on the same page, moving effectively in the same direction in a coordinated fashion.

PIC Pain Project

• Consensus-based

• Distinct • Progressive • Integrated

• Collaborative• Relevant• Measurable • Mappable

Our goals:

1. Develop a Phase II pain curriculum

PIC Pain Project

Our goals:

2. Develop learning opportunities• relevant & engaging• pedagogically sound• workload & time neutral

3. Evaluate• student outcomes• the curricular development process

PIC Pain Project

• Consensus-based

• Distinct • Progressive • Integrated

• Collaborative• Relevant• Measurable • Mappable

So where are we?

1. Develop a Phase II pain curriculum

Here!

PIC Pain Project

Building Consensus

• Literature search: pain curricula

• Stakeholder survey: What topics are appropriate for pre-clerkship?

• Survey outcomes:»Awareness»Dialogue»Buy-in

• Lay groundwork for inter-professional initiative

EFPPEC +

Oncology curricular renewal+

collaborativecurriculum.ca=

Oncology e-Curriculum

Oncology e-Curriculum

• Proposed online oncology learning resource

• Outgrowth of online learning project funded jointly by 5 Ontario faculties

• Initial target will be undergraduate medicine, but content will address needs of learners from different professions at different levels

• Anticipated content will address multiple EFPPEC competencies

EFPPEC +

QUIPPED=

Advance Care Planning IP Student Workshop

ACP IP Student Workshop

• Initiated, designed & implemented by inter-professional group of graduate students (OT, theology, medicine) through QUIPPED stipends

• Half-day elective workshop for pre-licensure students in medicine, nursing, occupational therapy & physiotherapy

• Pedagogical guidance & logistical support from QUIPPED

• Several members of EFPPEC local team served as consultants to students

EFPPEC +

QUIPPED=

Suffering: Responding as Professionals

Suffering Curriculum

• Inter-professional exploration of the concept of suffering and our response as health care professionals

• Multifaceted-approach aimed at pre-licensure students

EFPPEC alone

↓Palliative Care Patient home visits for

first year medical students

First-Year Patient Visits

EFPPECOT “Lived Experience”

Geriatrics

QUIPPED

Postgraduate

Associate Medical Service, Inc.Fellowship in End-of-life Care

• Fellowships awarded in 2005 for 5 years to 6 teaching sites in Ontario

• Education initiative• To develop interdisciplinary models of

exemplary EOL care• Enhance postgraduate medical trainees’

care and management of patients at the end of life

EFPPEC +

AMS=

Educational Strategies for IM

Residents

Education Strategies for IM Residents

• Evaluation of residents involves self-assessment (level of competence/priority for learning) based on generic EFPPEC competencies

• Knowledge test mapped to EFPPEC competencies• Evaluation data will inform as to IM resident needs

and effective educational strategies

Current Benefits:• All IM residents now have a mandatory 1-month PC

rotation• Queen’s AMS Fellows and co-investigator on

evaluation are members of the Local EFPPEC team

Faculty Development

EFPPEC +

QUIPPED=

Loss and Bereavement Faculty Development

Workshop

Loss & Bereavement Faculty Development Workshop

• Focus on faculty• Enhance content expertise (EFPPEC

competencies considered)• Develop skills to enhance collaborative

practice in loss & bereavement• Develop skills to enhance ability to teach

topic from an IPE perspective• 60 faculty (13 nursing, 10 psychology, 10

social work, 7 OT, 6 MD, 3 theology, 2 PT, 9 other)

Loss & Bereavement Faculty Development Workshop

Sessions related to EFPPEC competencies

• Key note address: “At a loss: Professional and Personal Responses to Grief, Mourning, and Bereavement”

• Workshops:“Spirituality of Loss and Bereavement: Awareness and Assessment”“Cross cultural Factors in Loss and Bereavement”“What about my grief? The Health Care Provider’s Grief”“What should I say and how should I say it: Interviewing and Counseling the Bereaved”

Inter-professional Teaching and Learning (IPTL) Certificate Program

• 3 Modules– Developing Effective Inter-Professional Collaborative

Teams– Creating an Inter-professional learning environment– Developing an Inter-Professional Applied Project

• Opportunity for inter-professional educators to enhance skills to enable them to ‘teach from an IPE perspective’

• Foster inter-professional partnerships

• 17 participants (medicine, OT, nursing, psychology, PT)

EFPPEC +

QUIPPED+

IPTL=

Suffering: Responding as Professionals

&Oncology e-Curriculum

EFPPEC ‘Branding’

Is it important to ‘brand’ EFPPEC competencies in our curricula?

Consider…• branding can be a barrier to collaboration• the twin risks of too much or too little

responsibility (creating a new silo or provoking a turf war)

• value of the brand• EFPPEC is a finite entity

Why Collaborate?

Cons:• Loss of control• Dilution of respect• Hassle factor

Pros:• Helps break down silos• Increase student/faculty buy-in• Leverage influence outside your dedicated

hours• Reflects the real world• Only realistic way of achieving objectives!

Today



1.3 IIA – Pain in PC IIIB – Pain in PC II

1.4 IIA – Final hoursIIC – DyspneaIIE – GI Problems IIE – PC Cases IIB – PsychiatryIIC – GU (nausea)IIC – Resp (dyspnea)IIE – GI (nausea)IIE – Fatigue



2.1 I – Comm/Clin SkillsIIC – Ethics: EOL

2.2 IIB – PC CasesIIC – Ethics: EOL

2.3 IIA – Intro to PCIIA – PC home visits






4.1 I – MD/Pt RelationshipI – Comm/Clin SkillsIIA – Psycho OncIIC – Ethics: EOL

4.2



5.1 IIA – Intro to PCIIA - NursingIIA – Hospital Outcomes

5.2 I – Med Sci RoundsI – Continuity of CareIIA – PC home visitsIIA – Wellness Symposium

6.1 IIA – PC home visitsIIA – Psycho Onc


6.3 I – MD/Pt Relationship IIA – PC home visits

The Future



1.3 IIA – Pain in PC IIIB – Pain in PC II Oncology e-Curriculum

1.4 IIA – Final hoursIIC – DyspneaIIE – GI Problems IIE – PC Cases IIB – PsychiatryIIC – GU (nausea)IIC – Resp (dyspnea)IIE – GI (nausea)IIE – Fatigue Oncology e-Curriculum



2.1 I – Comm/Clin SkillsIIC – Ethics: EOL Suffering Curriculum

2.2 IIB – PC CasesIIC – Ethics: EOL Suffering Curriculum

2.3 IIA – Intro to PCIIA – PC home visits Suffering Curriculum






4.1 I – MD/Pt RelationshipI – Comm/Clin SkillsIIA – Psycho OncIIC – Ethics: EOLACP Module

4.3 IIA – Psycho Onc ACP Module


5.1 IIA – Intro to PCIIA - NursingIIA – Hospital Outcomes Suffering CurriculumOncology e-Curriculum

5.2 I – Med Sci RoundsI – Continuity of CareIIA – PC home visitsIIA – Wellness Symposium Suffering CurriculumOncology e-Curriculum

6.1 IIA – PC home visitsIIA – Psycho Onc Suffering Curriculum

6.2 IIA – Psycho Onc Suffering Curriculum

6.3 I – MD/Pt Relationship IIA – PC home visits Suffering Curriculum

Summary – Lessons We’ve Learned

• Build a broad local team

• Look around for what is already happening – and see if you can join in!

• It is easier to adjust the direction of a moving object than create momentum from scratch

• Sometimes it is better to be a shotgun than a rifle

Thank you!

Collaboration in Action – EFPPEC at Queen’s Dr. Cori Schroder MD MEd CCFP FCFP Dr. Joshua Shadd...

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