1. Improving Teaching and Learning in the Primary Care Setting Through an Interprofessional Teamwork Curriculum Caroline LeClair, DO Assistant Professor Yvonne Skoretz, EdD Senior Instructor Department of Family Medicine University of Colorado School of Medicine

2. Disclosures None

3. Objectives Introduction Background Curriculum Pre-Post Survey Successes/Opportunities Discussion

4. Interprofessional Teamwork Curriculum SOM Enhancing Education Grant Grant goals: –Stimulate Educational Innovation –Improve quality of Educational Programs –Focus on IPE in the clinical setting –Address LCME Standard 7.9 Ensuring that core curriculum prepares students to function collaboratively on interdisciplinary health care teams that include professionals from other disciplines

5. Overarching Grant Objective Develop and implement an outpatient based program to train students how to best work in interprofessional teams in order to maximize ambulatory education and interprofessional collaboration

6. Interprofessional Teamwork and Team-based care WHO 2010 Framework IPEC 2011 Core Competencies IOM Healthcare Reform PCMH

7. Teamwork in Primary Care Offices: Improved Health Outcomes Research indicates that teamwork in primary care results in: –better continuity of patient care, better access to care, and greater patient satisfaction (Stevenson, et al., 2001). –patients perceive that they are receiving higher quality healthcare (Campbell et al, 2001). –superior care for diabetes patients (Bower et al, 2003)

8. Teamwork in Primary Care Offices: Improved Team Outcomes Significant improvement in communication and supportive behavior Significantly increased perceptions of teamwork after training (Weaver, et al., 2010) Increases in employee satisfaction (Leonard, Graham, & Bonacum, 2004). Improved job satisfaction, autonomy, staff support, percieved quality of teaching by faculty (Roth et al, 2009)

9. Ambulatory Care Block Structure Orientation Intra-session Final Exam Community IM Rural FM Community IM 4-week clinical experience

10. Student Curriculum Orientation 1.Teamwork curriculum 2.Structured clinical curriculum 3.MBTI facilitated program Orientation 1.Teamwork curriculum 2.Structured clinical curriculum 3.MBTI facilitated program Clinical Experience 1.Observe & apply skills 2.Apply MBTI knowledge to team integration 3.Obtain 2 multisource feedback 4.Perform 1 self- evaluation Clinical Experience 1.Observe & apply skills 2.Apply MBTI knowledge to team integration 3.Obtain 2 multisource feedback 4.Perform 1 self- evaluation Intra-session 1.Small group team-based care ppt 2.Written teamwork reflection 3.Large group MBTI debrief 4.Goal Setting Intra-session 1.Small group team-based care ppt 2.Written teamwork reflection 3.Large group MBTI debrief 4.Goal Setting Clinical Experience 1.Observe & apply skills 2.Work toward goals 3.Obtain 2 multisource feedback 4.Perform 1 self- evaluation Clinical Experience 1.Observe & apply skills 2.Work toward goals 3.Obtain 2 multisource feedback 4.Perform 1 self- evaluation Administer teamwork pretest Administer teamwork posttest

11. Teamwork Curriculum Build from current IPE CurriculumConnect to PCMH Teach about teams and dysfunction Watch and analyze videos of teams

12. Teamwork Skills TeamSTEPPS® Primary Care Videos. August 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/primarycare/video/index.html

13. Small Group TeamSTEPPS Video Reflection: Teamwork Skills Discuss in small groups: –What went wrong? Identify observed breakdowns in teamwork. –How was quality of patient care affected? –How could the situation have been better handled? –List strategies that could have been used in this situation?

14. Teamwork BARRIERS Hierarchical Culture Lack of Resources or Information Ineffective Communication Conflict Time Distractions Workload Fatigue Misinterpretation of Data Failure To Share Information Defensiveness Conventional Thinking TOOLS and STRATEGIES Brief Huddle Debrief STEP Cross-Monitoring Feedback Advocacy and Assertion Two-Challenge Rule CUS DESC Script Collaboration OUTCOMES Shared Mental Model Adaptability Team Orientation Mutual Trust Team Performance Patient Safety! TeamSTEPPS Primary Care Version. February 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/primarycare/index.html

15. Structured clinical curriculum Elderly patient case study Tips for success in clinic Potential student roles

16. Small Group Case-based Learning: Team Member Roles Elderly couple case Students divide into 3 groups and discuss: Group 1: Identify medical problems Group 2: Identify potential student roles Group 3: Identify necessary office attributes Present discussion points to large group

17. Meyers Briggs Type Indicator Four MBTI Dichotomies Where do we get our energy? ExtraversionIntroversion How do we take in information? SensingIntuition How do we make decisions? ThinkingFeeling How do we organize our world? JudgingPerceiving

18. Clinical Experiences Learning Contract; clinical learning & teamwork goals Direct Observation Forms Multisource Feedback & Self-assessment

19. Multisource feedback Students required to ask for feedback from office providers other than preceptor Students required to do self- evaluation

20. Intrasession Small group oral presentation describing: –Their team, their own role on the team –Team processes that were in place which enhance care –Make a recommendation for improvement Debriefing –Reflective writing assignment –Teamwork goal setting –MBTI as it relates to teamwork skills

21. Additional Curriculum Incorporated PCMH Learning Modules –PCMH intro –Patient Centeredness –Team Approach –Population Management Attend weekly didactics Palliative Care Day Preventive medicine project Community Service Learning Project

22. Pre-Post Survey Developed Interdisciplinary Teamwork Curriculum in Ambulatory Education Survey 13 item Likert scale survey Independent samples t-test ANOVA

24. Validity and Reliability Factor Analysis Factor 1 – eigenvalue = 6.335 (48.36%) Factor 2 – eigenvalue = 2.782 (21.77%) Cronbach Alpha =.889

25. Major Findings Pretest (n=66) Posttest (n=72) MSDM t valuep 22 Overall Total3.91.3574.06.618-1.64.103 Factor One - Teamwork4.06.4224.27.695-2.17.031*.034 Factor Two- MBTI3.42.6933.32.845.760.449 *p<.05. Pre-Post Differences in Mean Scores

26. Block 2 (n=43) Block 3 (n=47) Block 4 (n=48) MSDM M Overall Total Pretest Posttest F(2,137)=1.165, p=.315 3.92 3.94.376.653 3.90 4.23.346.365 3.93 4.01.370.732 Factor One – Teamwork Pretest Posttest F(2,137)=.802, p=.451 4.11 4.20.494.799 4.03 4.42.409.391 4.05 4.22.378.794 Factor Two- MBTI Pretest Posttest F(2,137)=.773, p=.464 3.30 3.11.801.640 3.45 3.59.644.782 3.52 3.29.654 1.00 Differences in Mean Scores Based on Block Completion

27. Team Members

28. Roles Medical Student/Learner Interviewer/Data Gatherer Coordinator of Care Advocate Educator Assistant Patient Coach

29. Successes Students’ confidence level in interprofessional teamwork skills increased MBTI knowledge useful for team integration/collaboration not significant Students are working with other disciplines Students are taking an active role on teams Students felt like an integral part of the team (4.3/5) Students increased their appreciation of team- based care and the PCMH as care model (4.5/5)

30. Opportunities MBTI was rated as not useful to learning (2.3/5) Determine why the MBTI is not perceived as useful to learning Faculty development to support teamwork curriculum Methods to evaluate interprofessional teamwork skills

31. Questions? Caroline LeClair, DO caroline.leclair@ucdenver.edu caroline.leclair@ucdenver.edu Yvonne Skoretz, EdD yvonne.skoretz@ucdenver.edu

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