Clinton Adams, DO, MPA, FACHESusan Mackintosh, DO, MPH

Lessons Learned and Accolades Earned

Objectives Describe highlights of the IPE implementation process at

WesternU

Discuss program barriers and pitfalls discovered in the implementation of the IPE curriculum at WesternU

Discuss areas of success noted in the implementation of the IPE curriculum at WesternU

Describe how osteopathic practice and philosophy may aid in the implementation of an IPE program

Objectives Discuss how WesternU’s lessons learned and accolades earned

might apply to different institutions represented in the audience

Analyze how early recognition of potential barriers and threats and early identification of potential program successes might improve the implementation process for represented institutions aspiring to begin or augment existing IPE curriculum

* Full Implementation Anticipated 2012

Didactic Simulation Clinical Care

Snap-Shot of WesternU IPE Program

Nine Health Care Disciplines

•Osteopathic Medicine

•Physician Assistant•Physical Therapy•Pharmacy•Graduate Nursing•Veterinary Medicine•Optometry•Dental Medicine•Podiatric Medicine

● Case-based small group course

●TeamSTEPPS•Patient Safety•Disaster Preparedness•Future•TOSCE•Virtual Community•Etc.

● IP Diagnostic

Suite● Grand Rounds● Off Campus

Rotations (IP portfolio)

Collaborative Patient

Centered Focus

Evaluation of all Activities

Didactic Teamwork Clinical Care

Update at a Glance Phase I launched January of 2010 One semester only

Phase I full-year course began Fall of 2010 Phase II launched Fall of 2010 Planning for Phase III began January 2011 Anticipate rolling out one to two pilot programs in

2011-2012 academic year

Case-Based CoursePhase I

Description of course: Required course for all entry-level health care professional students Year-long course Students receive fundamental knowledge on

non-technical/non-clinical competencies Apply that knowledge to five cases over the course of the year (all cases

based on real medical cases) Divided into interprofessional groups of nine students with one faculty

facilitator for group discussions

Case-Based CoursePhase I Competencies for the course: Communication and collaboration Knowledge of health professions Interprofessional collaborative care Quality of life Culture of safety One Health Ethical and legal environment of health care

Case-Based CoursePhase I Accolades earned: Extremely successful initial implementation year with 849

students and 151 facilitators participating in the three cases 100% of students passed course Overall, students and faculty felt the interaction was very

positive, and they learned about, with and from each other (the very definition of IPE)

Case-Based CoursePhase I

Lessons learned: Foundation information is needed Why IPE? Communication Scope of practice Etc.

Orientation on case-based learning and expectations Threshold of one absence was used as an excuse to miss class

Case-Based CoursePhase I Lessons learned: Grading Grading was too subjective

Difficulty monitoring all competencies and participation Faculty perceived course was artificially geared toward a B grade

(competent) Lacked inter-rater reliability

Different grading systems in colleges made grading challenging All students awarded grade of A or equivalent

Case-Based CoursePhase I Lessons learned: Cases Students rapidly acclimated to case format Imbedded discussion questions were repetitive and did not necessarily

drive toward competencies (for evaluation purposes)

Students wanted closure of case and interprofessional synopsis, but not in Grand Rounds format

Case-Based CoursePhase I

Course revisions based on lessons learned: Orientation provided information on IPE and more clearly defined

expectations of student roles Provided foundation lectures for competencies (Semester one):

Communication/Collaboration

Scope of practice (roles and responsibilities)

(Semester two): Patient safety/CDC quality of life indicators

One Health

Ethical/legal environment of health care

Case summary in lieu of grand rounds

Case-Based CoursePhase I Course Revisions based on lessons learned

• Grading– Objective quizzes to assess competencies (lectures and independent study

project to prepare for cases)– Facilitators will evaluate students on “participation” only– Grading will be 80% objective and 20% subjective– Threshold absence removed, and 100% participation expected (students

with EXCUSED absence will be given make-up opportunity)– Credit/No Credit grading proposed for all 2011-2012 IPE courses

Case-Based CoursePhase I Course Revisions based on lessons learned Cases First semester cases will be simplified and focus on one major

competency each case Cases will be in three-week cycles

Week one will be independent study to prep for case and competency Week two will be case discussion and assignment of learning issues Week three will be reporting back on learning issues, case summary,

debriefing and evaluation

Case-Based CoursePhase I Course Revisions based on lessons learned Cases For semester two, cases will advance in topics and content Final case will include a virtual component Anticipated competencies will include quality of life issues/culture of

safety; one health; ethical-legal environment of healthcare Topics such as cultural awareness and some limited scientific knowledge

will be considered more “collateral learning” Hope to incorporate element of virtual community in last case

Case-Based CoursePhase I Course Revisions based on lessons learned Cases No Grand Rounds, but students will be provided with both a case

summary from the primary author as well as an interprofessional perspective that will be viewed in small groups

Students will be provided more real-time opportunity to evaluate course, cases, and facilitators instead of end of course only

Case-Based CoursePhase I Early indications for 2011-2012 course revisions Early feedback course is very successful Pre-course reading assignments not well received Considering condensed lectures for students on competency topics

Considering folding team training course (TeamSTEPPS) into first-year case-based course

Case-Based CoursePhase I Early indications for 2011-2012 course revisions Unresolved issues continue to be: Timeslot (trying to coordinate uniform timeslot including awareness of

examination schedules with all nine colleges) Different policies for different colleges Absolute standardization of facilitator evaluation process

Team Training CoursePhase II For phase II course challenges include: Duplicating intensive faculty and facility demand for small

group face to face course, Could not provide common time in second year curricula

Students worked independently on team training modules with assignments and group capstone activities

Team Training CoursePhase II

Description of course: Used TeamSTEPPS® For semester one students did: Independent module work on TeamSTEPPS® material Reflective essays Live group capstone activity on patient safety exercise

Team Training CoursePhase II Description of course (cont.) For semester two: Students did independent module work on TeamSTEPPS® material Did joint group activity applying TeamSTEPPS® principles to analysis of

disaster after action reports Health care professional team building in emergency management course Live capstone activity disaster tabletop exercise

Team Training CoursePhase II Accolades earned: Successfully completed TeamSTEPPS® training for all second

year students in six professions Not all students could participate in phase II due to length of program and

other curricular restrictions

Instilled principles of team mentality Students learned how poor performance of one member of team could

negatively affect the entire team Students developed knowledge of asynchronous team communication

Team Training CoursePhase II Lessons learned: In general, students felt the content of this course was a “back

step” from what was done last year Students did not like going from working in teams to working

independently Semester two was changed based on this to adapt to asynchronous

teamwork using a group Wiki

From semester one, needed to make the capstone activity more challenging

Team Training CoursePhase II

Anticipated revisions for course Move TeamSTEPPS® curriculum to case-based phase I course. Develop more asynchronous and complex scenarios where students

can apply knowledge focusing on their skills in asynchronous communication Virtual community? Other technology options?

Team Training CoursePhase II

Future possibilities for phase II course Team Based OSCE Service Learning Health mentor program

Targeted grouping of profession specific training courses Eg, One Health, etc.

Electives Eg, Ethics, medical Spanish, cultural competency, etc

Collaborative Care Training (Clinical)Phase III Planning phase just beginning: One clinical faculty member from each college Planning for one on campus and one off campus pilot for next

year Considerations for activities: Portfolio IPE grand rounds/journal club Team care conferences Interprofessional diagnostic suite

Group Activity Discuss how the WesternU lessons learned and accolades

earned might apply to your institution Describe how early recognition of identified issues might be

utilized in your institution to help mitigate potential barriers and obstacles that might impede development and implementation of an IPE curriculum.

Discussion For additional information contact: Susan Mackintosh, DO, MPH smackintosh@westernu.edu

Clinton Adams, DO, MPA, FACHE cadams@westernu.edu