Presentation on theme: "Piloting an Interprofessional Education Workshop: Teaching others palliative care communication skills Neha J. Darrah, MD Diane Hadley, PharmD BCACP Amy."— Presentation transcript:
1 Piloting an Interprofessional Education Workshop: Teaching others palliative care communication skillsNeha J. Darrah, MDDiane Hadley, PharmD BCACPAmy Corcoran MD CMD FAAHPMGeriatrics Grand RoundsApril 4, 2014
2 DisclosuresWe have no relevant financial disclosures; however, a portion of this project was supported by funds from the Health Resources and Services Administration (HRSA) under Geriatric Academic Career Award K01HP20493 and the GEC grant UB4HP19214.The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the DHHS, HRSA, BHPR, or the U.S.
3 Learning ObjectivesTo describe the main objective for an effective interprofessional, education workshopTo list the essential elements for a successful interprofessional, education workshop
4 Overview IPE BACKGROUND IPE and palliative care Workshop history Workshop descriptionResultsStudy limitationsFuture implications
5 What is IPE? Interprofessional Education (IPE) Goal of IPE Defined as students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010)Goal of IPEPrepare health professional students for deliberately working togetherProvide high quality, patient-centered careInterest in promoting IPE is not new. At the first IOM conference in 1972, 120 leaders from allied health, medicine, pharmacy, dentistry, and nursing discussed key questions about IPE, particularly how to use the health force effectively to meet the needs to the patients and families. In 2003, the IOM identified learning how to work in interprofessional teams as one of the core competencies central to the education of all health care professionls
6 Barriers to IPELogistics Professional hierarchies/stereotypes Institutional resistanceDespite the interest in promoting IPE, there are significant barriers to providing IPE. Traditionally, education of health professions has occurred in silos. Because of this, there is little infrastructure in undergraduate and graduate medical curricula to provide IPE. The most significant barriers are as follows:Logistics – difficult to schedule students across disciplines, varying schedules most significantProfessional hierarchies/stereotypes:
7 Strategies for IPE Classroom didactics Practice based interventions Experiential StrategiesRole playSimulation exercisesDespite these barriers, numerous groups have created IPE initiatives. Mounting evidence that experiential strategies are most effective. Principles of adult learning apply – giving learners flexbility/choice and enhancing the authenticity of the experience improves the effectiveness of the initiative
8 Interprofessional Education Collborative (IPEC) Organizations involvedAmerican Association of Colleges of NursingAmerican Association of College of Osteopathic MedicineAssociation of schools of Public HealthAmerican Association of Colleges of PharmacyAmerican Dental Education AssociationAssociation of American Medical CollegesInterprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at: Accessed April 1, 2014.
9 Interprofessional Collaborative Practice Domains from Interprofessional Education Collaborative (IPEC) 2011IPE is aimed at meeting these four domainsValues/Ethics: Work with individuals of other professions to maintain a climate of mutual respect and shared valuesRoles/Responsibilities: Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations servedInterprofessional communication: Communicate with patients, families, communities, and other health professionals in responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of diseaseInterprofessional teamwork: Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population centered care that is safe, timely, efficient, effective, and equitableInterprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at: Accessed April 1, 2014.
10 Overview IPE AND PALLIATIVE CARE IPE Background Workshop history Workshop descriptionResultsStudy limitationsFuture implications
11 Why is IPE Relevant to Palliative Care? Palliative care is specialized medical care for people with serious illnesses. Palliative care is provided by a TEAM of doctors, nurses, and other specialists (social work, chaplaincy, pharmacy) who work together with a patient’s other doctors to provide an extra layer of support.Palliative care is provided by interprofessional teams. In order to provide effective palliative care, health professionals must learn how to work effectively in interprofessional teams
12 Past IPE Palliative Care Workshops Palliative care: A suitable setting for undergraduate interprofessional educationDescription: Interprofessional student workshops with family care providersRecruited Learners: Medical, nursing, social work, physiotherapy, and occupational therapy studentsResults: Students value and enjoy opportunity to work together and find the experience moving, informative, and interestingHalf day interprofessional workshopFirst half: students meet in interprofessional teams and learn about each other’s courses and explore each person’s backgroundSecond half: Students joined by a family carer. Goal of interprofessional team is to listen to and reflect on carer’s expereinceWee B, Hillier R, Coles C, et al. Palliative care: a suitable setting for undergraduate interprofessional education. Palliat Med Nov; 15 (6)
13 Past IPE Palliative Care Workshops Using simulated patients in a multiprofessional communication skills programme: reflections from the programme facilitatorsDescription: Multiprofessional, 4-day communication skills program with standardized patientsRecruited learners: Predominantly nursing with some physiotherapist, dieticians, and radiographersResults: No formal evaluation but feedback was positiveWorkshop componentsReflection on communication and psychological issuesGraduated introduction to role play with simulated patientsDonovan T, Hutchinson T, and Kelly A. Using simulated patients in a multiprofessional communication skills programme: reflections from the programme facilitators. Eur J Cancer Care Jun; 12(2): 123-8
14 Past IPE Palliative Care Workshops Enhancing interprofessional education in end-of-life care: An interdisciplinary exploration of death and dying in literatureDescription: 12-week elective focused on reflections of dying depicted in the literatureRecruited learners: medical, nursing, bachelor of health science, and chaplaincy studentsResults: All students met learning objectives based on qualitative analysis of written assignments and highly rated by participantsStudents assigned to interprofessional groups that are maintained throughout the courseInvolves combination of individual, small group, and large-group workObjectives:Recognize ethical dilemmas raised in the literature that are relevant to the care of the dying in our societyIdentify professional qualities and professional culture as reflected in the literatureIdentify examples of conflict and collaboration between professions reflected in the literatureRecognize the significant physical, psychosocial, and spiritual issues experienced by persons with a terminal illness as well as by their familiesIdentify the terminally ill person’s perspective on end of life issues as well as the perspectives of his/her family member(s)Reflect on personal values and their impact on caring for terminally ill patients and their familiesDemonstrate elements of collaborative interaction when participating in the interdisciplinary classBrajtman S, Hall P, and Barnes P. Enhancing interprofessional education in end-of-life care: an interdisciplinary exploration of death and dying in literature. J Palliat Care Summer; 25(2):
15 Past IPE Palliative Care Workshops Interdisciplinary education in end-of-life care: Creating new opportunities for social work, nursing, and clinical pastoral education studentsDescription: Interprofessional case simulations with volunteer actorsRecruited learners: Social work, nursing, and chaplain studentsResults: All students found it valuable and most cohorts demonstrated significant improvement in pre-determined outcomesDescribes interdisciplinary, interuniversity program that prepares social work, nursing, and chaplaincy students for competent practice when working with individuals and families facing end-of-life circumstancesOutcomesIncreased levels of knowledge in competencies related to practice in end of life careIncreased skills in competencies related to effectively assessing biopsychosocial end of life concerns or needsDemonstrate skills related to recognizing and responding to ethical concerns and decisions and in serving as advocates for clients who are dealing with end-of-life mattersIncreased skill development related to recognizing and responding to ethical concerns and decisions, and those related to serving as advocatesComponents of intervention:Out of department elective: students required to audit or take for credit one course outside academic home departmentSeminar: monthly seminars that alternate between discipline-specific (knowledge building) and interdisciplinary (skill building) instruction for total of 8 seminars over academic yearDiscipline specific: 3-5 hours, provide universal contentInterdisciplinary seminars: involve all program students + program faculty, day-long, case simulations built around content module for the period, recruit local actorsForrest C and Derrick C. Interdisciplinary education in end-of-life care: creating new opportunities for social work, nursing, and clinical pastoral education students. J Soc Work End Life Palliat Care. 2010; 6(1-2):
16 Past IPE Palliative Care Workshops Using Online Learning and Interactive Simulation To Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional StudentsDescription: Combined online learning with interactive simulationRecruited learners: Social work, nursing, medicine, and chaplainResults: Successfully met five learning objectives and highly rated by participantsWorkshop DescriptionOnline, interactive multimedia case module structured around clinical course of a 68 year old AA woman with end-stage metastatic breast cancer90-minute interprofessional workshop: Students assigned to to one of four interprofessional teams compromised of 6 to 8 students and complete following two tasksGroup discusses one of several palliative care challenges20-minute simulation of interprofessional team meeting in which students assume role of professions to develop plan for new palliative care case (woman of Muslim faith who has carcinomatosis with bowel obstruction)3. Learning Objectives1. Understand basic precepts and goals of palliative care2. Recognize and address common misconceptios about opioids3. Identify spiritual and cultural needs of patients and understand how to meet those needs4. Understand clinical features of imminent death and how to help help patient/family5. To recognize contributions of all health care professionals and understand the importance of the IDTEllman MS, Schulman-Green D, Bratt L, et al. Using Online Learning and Interactive Simulation to Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students. J Palliat Med. 2012; 15(11); 1240-
17 Past IPE Palliative Care Workshops Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients with Serious Illness: A Randomized TrialDescription: Randomized participants to 8-session, simulation-based, communication skills intervention vs usual educationRecruited learners: Medicine, nurse practitionersResults: Simulation-based communication training did NOT improve quality of communication but was associated with small increase in patients’ depressive symptomsInterventionEight four-hour sessions led by two facultyEach session included following and focused on specific topicBrief didactic overview, including demonstration role-play by facultySkills practice using simulation (simulated patient, family, clinicians)Reflective discussionsCurtis JR, Back AL Ford DW et al. Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication with Patients with Serious Illness: A Randomized Trial. JAMA Dec 4; 310 (21):
18 Overall Conclusions IPE is generally well received by students Number of disciplines in workshops ranged from two to fiveSimulation-based training did NOT translate into improved quality of communication
19 Overview WORKSHOP HISTORY IPE Background IPE and palliative care Workshop descriptionResultsStudy limitationsFuture implications
20 Workshop HistoryPiloted first interprofessional, communication workshop with advanced practice nursing students and physician fellowsDeveloped as three-station palliative care Observed Structured Clinical Examination (OSCEs)Developing effective communication and symptom assessment skills is an important component of palliative care training for advance practice nurses (APNs) and other health care providers. The purpose of this project was to develop and pilot test a three-station palliative care Observed Structured Clinical Examination (OSCE) for APN students and physician fellows. Three stations included discussing goals of care, breaking bad news, and assessing delirium. Measures included the Interpersonal Skills Tool, Station Checklists, the OSCE Evaluation Tool, and a focus group to solicit learners' perspectives about the experience. Findings showed that learners evaluated the exercise as appropriate for their level of training and that standardized patients were convincing and provided helpful feedback. Learner self-evaluation means were significantly lower than those of standardized patient or faculty, and faculty raters demonstrated low interrater reliability. Initial evaluation suggests a three-station palliative care OSCE exercise is effective for multidisciplinary learners, although additional refinement is necessary.Corcoran AM, Lysaght S, Lamarra D, Ersek M. Pilot test of a three-station palliative care observed structured clinical examination for multidisciplinary trainees. J Nurs Educ May;52(5):294-8.
21 Workshop HistoryExpanded workshop to include learners from nursing (undergraduate and advanced practice), medicine (fellows), physical therapy, occupational therapy, pharmacy, chaplaincy, and social work (masters students)Recruited learners from BOTH University of Pennsylvania and University of SciencesDemonstrated statistically significant improvement in learner preparedness for interprofessional team and communication skills
22 Lessons Learned from Past Workshops Learners appreciated the opportunity to work in interdisciplinary teamsRated the topic as good to excellentLearners need to be matched based on training leveli.e. Physician fellows are not well matched with undergraduate nursing studentsWhat are other lessons?
23 Overview WORKSHOP DESCRIPTION IPE Background IPE and palliative care Workshop historyWORKSHOP DESCRIPTIONResultsStudy limitationsFuture implications
24 Workshop GoalsIntroduce palliative care communication and interprofessional team skills to learners Determine effectiveness of interprofessional workshop on improving these self-reported skills
25 Recruited Learners University of Pennsylvania University of Sciences Medicine (fourth year medical students)Social WorkNursing (undergraduate, advanced practice)ChaplaincyUniversity of SciencesPhysical therapyOccupational therapyPharmacy
26 Key Components of Workshop Workshop BasicsPre-workshop preparationTwo-hour simulation-based workshops with STANDARDIZED PATIENTSFour sessions offered over two days in OctoberParticipants and ObserversNursing and social work students were assigned to be either participants or observers at the discretion of their facultyAll participants were assigned to pre-determined interprofessional teamsRecruited diverse, interprofessional faculty facilitatorsPre-workshopView video illustrating the roles of other health care professionalsRead assigned materialsAttend professional specific lectureComplete pre-workshop evaluation
27 Case DescriptionPatient is a 72 y/o female with dementia admitted from a nursing home to the ICU three days ago for aspiration pneumonia. She is now doing better and transferred to the floor.At baseline, she requires assistance in her all of her ADLs. She is noted to have signs of aspirationGoal of meeting is to discuss goals of care (resuscitation, discharge plan) with patient’s daughter or sonDeveloped case that would involve all disciplines
28 Workshop Schedule 4:00-4:15 Orientation 4:15- 5:15 Participant group 1 meets with SP 1Participant group 2 meets with SP 2Participant group 3 meets with SP 3Participant group 4 meets with SP 4Observer group 1 observesObserver group 2 observers5:15-5:45DebriefParticipants or facilitator had the ability to call a time out at any point during the caseFeedbackStructured feedback from standardized patient
29 EvaluationsParticipants were given both pre and post-workshop evaluationsAsked participants to rate their confidence in multiple domains on 5 point Likert scaleCommunication SkillsInterprofessional team skills (Based on IPEC competencies)Communication SkillsFacilitate and/or participate in a family confernceInterprofessional team skills (Based on IPEC competencies)Work with individuals of other professionsApply the knowledge of my profession to appropriately assess and address health care needs of a patientExplain the role other professionals play in an interprofessional teamCommunicate with other healthcare professionalsApply relationship-building values and principles of team dynamics
30 Overview RESULTS IPE Background IPE and palliative care Workshop HistoryWorkshop DescriptionRESULTSStudy limitationsFuture implications
31 Learner Assignments Recruited 109 learners 73 assigned to participant groupDivided into 16 groups of 4-5 each36 assigned to observer groupDivided into 7 groups of 5-6 eachEach participant group had at least 4 different disciplines represented. No discipline was duplicated in a given team
34 Importance of IPE Not at all (1-2) Somewhat (3) Very (4-5) How important is communicating with other health care professionals for you to be effective in your profession?Participant70 (96%)Observer1 (3%)34 (94%)How committed are you to work on interprofessional communication skills during your training?1 (1%)68 (93%)
35 Prior Experience Yes No Don’t Know Missing Work with individuals of other professions to create plan of careDidactic68 (62%)29 (27%)5 (5%)7 (6%)Bedside67 (62%)31 (28%)2 (2%)9 (8%)Apply knowledge of my profession to appropriately assess and address health care needs of a patient76 (70%)15 (14%)11 (10%)55 (51%)34 (31%)8 (7%)12 (11)Explain the role other professionals play in an interprofessional team52 (48%)39 (36%)13 (12%)
36 Prior Experience Yes No Don’t Know Missing Communicate with other healthcare professions, patients and caregiversDidactic63 (58%)31 (28%)8 (7%)7 (6%)Bedside64 (59%)32 (29%)2 (2%)11 (10%)Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care60 (55%)29 (27%)13 (12%)49 (45%)39 (36%)10 (9%)Facilitate and/or participate in a family conference43 (39%)46 (42%)9 (8%)40 (37%)52 (48%)6 (6%)
37 Comparison of Pre and Post-Workshop Evaluations Pre-Workshop Mean ScorePost-Workshop Mean ScoreSig. (2-tailed)Work with individuals of other professions to create plan of careParticipant3.604.110.000Observer3.834.000.226Apply knowledge of my profession to appropriately assess and address health care needs of a patient3.554.043.914.060.282Explain the role other professionals play in an interprofessional team3.384.013.774.170.017Used paired sample t-test
38 Comparison of Pre and Post-Workshop Evaluations Pre-Workshop Mean ScorePost-Workshop Mean ScoreSig. (2-tailed)Communicate with other healthcare professions, patients and caregiversParticipant3.544.110.000Observer3.694.140.014Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care3.484.083.464.090.002Facilitate and/or participate in a family conference3.213.313.890.001
39 Curriculum/Workshop Content Poor-Fair(1-2)Good(3)Very good – Excellent (4-5)Relevance of topic content to my discipline4 (4%)10 (9%)92 (84%)Utility of pre-reading9 (8%)19 (17%)77 (71%)Utility of pre-workshop video23 (21%)22 (20%)55 (50%)Utility of pre-workshop profession specific lecture15 (14%)20 (18%)62 (57%)
40 Workshop Sessions Poor-Fair (1-2) Good (3) Very good – Excellent (4-5) Usefulness of small group orientation14 (13%)23 (21%)69 (63%)Usefulness of communication exercise with standardized surrogates1 (1%)6 (6%)98 (90%)Usefulness of SPs3 (3%)101 (93%)Effectiveness of small group faculty facilitators2 (2%)4 (4%)100 (92%)Usefulness of post exercise debriefing
41 Overall Evaluation Poor-Fair (1-2) Good (3) Very good – Excellent (4-5)Overall, how would you rate the educational quality of the workshop?Participant1 (1%)5 (7%)65 (89%)Observer6 (17%)28 (81%)YesNoNot sureWould you be interested in participating in a follow-up session to practice family meetings?Participant60 (82%)4 (5%)8 (11%)Observer26 (72%)5 (14%)
42 Overall Conclusions Pre vs Post Workshop Assessments Participant Group: Significantly more confident in ALL domains after the workshopObserver Group: Significantly more confident in most domains after the workshopMajority of participants rated the workshop as very good to excellentMajority of participants would be interested in participating in another workshop
43 Overview STUDY LIMITATIONS IPE Background IPE and palliative care Workshop HistoryWorkshop DescriptionResultsSTUDY LIMITATIONSFuture Directions
44 Study Limitations Variability in student representation Evaluations UsedUsed non-validated survey toolEvaluation of effectiveness was limited to students’ self-reports and did not assess higher level learning outcomes as acquisition of knowledge or behavior change
45 Overview FUTURE DIRECTIONS IPE Background IPE and palliative care Workshop HistoryWorkshop DescriptionResultsStudy LimitationsFUTURE DIRECTIONS
46 Future Directions Workshop Structure Evaluations Offer workshop multiple times during the yearOffer workshop multiple times for the same group of learnersEvaluationsUse validated survey toolCreate OSCE for learners to test behavior changes
47 Thank you!Dr. MaryAnn Foricea Dr. Mary Ersek Dr. Cathy Poon Eunhae Kim Dr. Christine Bradway Dr. Zvi Gellis Dr. Lora Packel Dr. Varleisha Gibbs Dr. Claudia Pravanta Dr. Valerie Cotter Dr. Carrie Ann Doherty Denise LaMarra John SemanHRSA funding, Amy’s GACA, GEC
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