Interprofessional Education in Practice: Teaching and Evaluating Collaborative Practice Among...
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Interprofessional Education in Practice: Teaching and Evaluating Collaborative
Practice Among Interprofessional Learners at a Family Medicine Residency Program
Jason Ricco, MD, MPH, Assistant ProfessorJerica Berge, PhD, MPH, Associate Professor
University of Minnesota North Memorial Family Medicine Residency Program
Collaborative Family Healthcare Association 17th Annual ConferenceOctober 15-17, 2015 Portland, Oregon U.S.A.
Session # A4aOctober 17, 2015
Faculty Disclosure
The presenters of this session• have NOT had any relevant financial
relationships during the past 12 months.
Learning Objectives
At the conclusion of this session, the participant will be able to:
• Describe how interprofessional education (IPE) is integral to helping the healthcare workforce achieve the Triple Aim through collaborative care
• Discuss various interprofessional education approaches within a family medicine residency program
• Identify the role for more robust evaluation of interprofessional education activities by focusing more on assessment of IPE competencies to measure preparedness for collaborative practice
Bibliography / References
1. Brandt B, Lutfiyya MN, King JA, Chioreso C. A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim. J Interprof Care. 2014; 28(5):393-99.
2. Chong WW, Aslani P, Chen TF. Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators. J Interprof Care. 2013;27(5):373–379.
3. Farrell B, Pottie K, Woodend K, et al. Shifts in expectations: Evaluating physicians’ perceptions as pharmacists become integrated into family practice. J Interprof Care. 2010;24(1):80-89.
4. Hughes L, Tuggy M, Pugno P, Peterson L, Brungardt S, Hoekzema G, Jones S, Weida J, Bazemore A. Transforming training to build the family medicine workforce our country needs. Fam Med. 2015;47(8):620-7.
5. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: report of an expert panel. Washington, DC: Interprofessional Education Collaborative, 2011. http://www.aacn.nche.edu/education-resources/ipecreport.pdf. Accessed June 20, 2011.
6. World Health Organization. Framework for action on interprofessional education & collaborative practice. Geneva, 2010.
Learning Assessment
• A learning assessment is required for CE credit.
• A question and answer period will be conducted at the end of this presentation.
UMN North Memorial Family Medicine Residency
Introduction/Terms Increasing emphasis on interprofessional
collaboration for improving health care quality
Interprofessional education (IPE) is a means to prepare professionals to engage in such collaboration
WHO definition of IPE: “Two or more professions learning with, from and about each other to improve collaboration and quality of care.”
UMN North Memorial Family Medicine Residency
Background IOM’s 2001 Report- “Crossing the Quality Chasm: A New
Health System for the 21st Century” Health care redesign Preparing the workforce
Interdisciplinary training among health professions
WHO 2010- “Framework for Action on Interprofessional Education and Collaborative Practice” WHO recognizes “interprofessional collaboration in
education and practice as an innovative strategy that will play an important role in mitigating the global health workforce crisis.”
Nearly universal support from professional organizations for IPE
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World Health Organization, 2010. Framework for Action on Interprofessional Education & Collaborative Practice. WHO. Geneva, p. 9.
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Background IPE Collaborative practice Optimizes health services and
improves health outcomes Evidence for improved:
Access to health services Chronic disease outcomes Patient safety Appropriate use of clinical resources
Also a decrease in: Hospital admissions, length of stay, hospital complications Clinical error rates Mortality1-5
1. Reeves S et al. Interprofessional education:effects on professional practice and health care outcomes. Cochrane Database of SystematicReviews, 2008, Issue 1.
2. Reeves S. A systematic review of the effects of interprofessional education on staff involved in the care of adults with mental health problems. Journal of Psychiatric Mental Health Nursing, 2001, 8:533–542.
3. McAlister FA et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission. Journalof the American College of Cardiology, 2004, 44:810–819.
4. Mickan SM. Evaluating the effectiveness of health care teams. Australian Health Review, 2005, 29(2):211-217. 5. Lemieux-Charles L et al. What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review, 2006, 63:263–300.
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Collaborative Practice and the Triple Aim Healthcare Triple Aim1 as the overarching
framework to fix the U.S. healthcare system: Quality Cost Experience
IPE/Collaborative practice interwoven in all three aims
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Problem
Widespread, systematic implementation of IPE has not yet occurred in the U.S. “A quick scan of most health professions schools
today reveals a collection of siloed educational structures, working in parallel with little dialogue, integration, or collaboration between them.”
-B. Brandt and M. Earnest
More success in other countries
Previously documented structural, cultural, organizational, and interactional barriers to IPE
Earnest M, Brandt B. Aligning practice redesign and interprofessional education to advance triple aim outcomes. J Interprof Care. 2014 Nov;28(6):497-500
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The challenges Integration of longitudinal IPE activities
within primary care training sites
Evaluating IPE curriculum effectiveness to prepare professionals to engage in collaborative practice
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Evolution of IPE Evaluation IPE concepts around since 1970s
Linked to healthcare delivery and outcome improvement processes
Resurgence of IPE initiatives in response to the Affordable Care Act
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Evolution of IPE Evaluation Prior evaluation of IPE activities largely
based on learner self-assessment of:
Attitudes towards other professions and IPE activities
Readiness to work collaboratively in a healthcare team
Intent to practice in an interprofessional setting
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IPE Competencies
2011 IPE Collaborative Core Competencies Based on WHO definitions of collaborative
practice 38 competencies within 4 domains of IPE
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The Age of Milestones ACGME Family Medicine Milestone Project
Developmentally-based assessment of demonstrable attributes and behaviors throughout residency training
Linked to domains essential for family medicine physician competency
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Our Story Who we are
Our IPE Curriculum
Our evaluation methods
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North Memorial Family Medicine Residency Program
A University of Minnesota residency program, 10-10-10
Affiliated with a community hospital Broadway Family Medicine, our clinic, is
located in North Minneapolis Patient-Centered Medical Home Longstanding interprofessional culture
preceding the era of IPE initiatives
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Staff Faculty
MD and DO physicians Clinical pharmacists Behavioral medicine (LMFT) NP
Residents MD/DO PharmD Behavioral health interns
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Other Staff Care coordinators (LICSW, RN) Triage RN
Various students from different health professions programs
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IPE Initiatives Team meetings Care plans Student pairings Resident pairings Video recording
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Interprofessional Team Meetings:A venue for multidisciplinary input on the integrated physical and mental health needs of complex patients.
Purpose:1. Learn and practice a biopsychosocial approach to patient care2. Increase learner ability to provide interprofessional care to increase quality and continuity of care3. Provide opportunities to practice new skills:
Conducting a family meeting
Motivational interviewing or counseling skills
Structuring a medical visit
4. Provide time for substantive case discussions:
Increase understanding of “whole person” in context
Assess relationship with patient
Develop treatment/interactive approaches
Evaluate treatment effectiveness
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Participants in Team Meetings Include:
4 Resident teams (7-8 residents per team) 1-2 MD faculty 3 Behavioral health (mental health) faculty (LMFT,
LICSW) or Intern 1 PharmD faculty and/or resident 1 Triage nurse (occasionally) 1 Care coordinator 1 Patient advocate 1 Front desk staff (occasionally) Patient Family Community support (PHN, social worker, etc.) Observers (students)
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Who are “Team Patients”? Team members bring patients that are
“complex”: Multimorbidity Mental Health diagnoses Any combination (biopsychosocial) Communication problems “Dreaded” patient Uncertain diagnosis or treatment plan “Practice” interactions Need for collaborative care between
multiple providers
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Team Meetings Logistics:
Each team meets one morning per week from 8-8:40 am followed by team clinic until noon 30-45 minutes: Case discussion and
consultation with team members; debrief/updates from last team patient visits
3 hours: Patients seen by any combination of team members (each resident given one 40 minute slot for a “team” patient)
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Care Plan Team
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Interprofessional Paired Visits Designed as a developmental step to prepare
learners to collaborate effectively as a team Ultimately, this will happen asynchronously
(warm hand-offs, etc.) in the real world First learners need orientation to the other
professions’ strengths and assets First step is a paired visit with 2 learners from
different professions learning “from, about, and with” each other during real patient encounters
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Student Interprofessional Pairings Started in 2009 Pair students on 2 half days a week Previously evaluated change in attitudes
towards IPE with pre and post questionnaire Readiness for Interprofessional Learning
Scale Validated questionnaire Overall, positive attitudes towards IPE both
before and after paired visits
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Resident Interprofessional Pairings Started in 2010 Pair residents on 1 half day a week Initially MD and PharmD residents, now including
behavioral health interns Previously evaluated:
Individual feedback and perception of value Amount of contribution to patient care tasks by
each team member as viewed by other member
Shared decision-making by team during visit11. Lounsbery JL, Moon JY, Prasad S. Assessing collaboration between family medicine residents and pharmacy residents during an interprofessional paired visit. Fam Med. 2015;47(5):397-400.
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Video Review A/V capabilities in clinic to capture patient
encounters Used originally to assess individual family
medicine resident communication and exam skills during quarterly video review with faculty
Videos captured of paired interprofessional (IP) visits to evaluate both team and individual performance in IPE competencies
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Current Evaluation Process Development of an evaluation tool to assess
IPE competencies during video review Ideal tool attributes:
To have demonstrable behavioral anchors for assessment of IPE competencies within each domain
Can assess both individual and team performance in relation to IPE competencies
Can be used both for formative team feedback and longitudinal tracking of an individual learner’s progress with IPE competencies
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Example Video of a Paired IP Visit Assess effectiveness of visit, team
dynamic, patient-centeredness, IPE competencies: Values/ethics for interprofessional practice Roles/responsibilities Interprofessional communication Teams and teamwork
During video think about evaluation strategy Team and individual evaluation? Formative and summative evaluation
capabilities?
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Discussion What do you think of the paired visits? Comments on IPE curriculum? Suggestions or challenges in evaluating
IPE competencies during video review process?
Next steps
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Questions?
Session Evaluation
Please complete and return theevaluation form to the classroom
monitor before leaving this session.
Thank you!