1. Piloting an Interprofessional Education Workshop: Teaching others palliative care communication skills
Neha J. Darrah, MD
Diane Hadley, PharmD BCACP
Amy Corcoran MD CMD FAAHPM
Geriatrics Grand Rounds
April 4, 2014

2. Disclosures
We 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 Objectives
To describe the main objective for an effective interprofessional, education workshop
To list the essential elements for a successful interprofessional, education workshop

4. Overview IPE BACKGROUND IPE and palliative care Workshop history
Workshop description
Results
Study limitations
Future 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 IPE
Prepare health professional students for deliberately working together
Provide high quality, patient-centered care
Interest 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 IPE
Logistics Professional hierarchies/stereotypes Institutional resistance
Despite 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 significant
Professional hierarchies/stereotypes:

7. Strategies for IPE Classroom didactics Practice based interventions
Experiential Strategies
Role play
Simulation exercises
Despite 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 involved
American Association of Colleges of Nursing
American Association of College of Osteopathic Medicine
Association of schools of Public Health
American Association of Colleges of Pharmacy
American Dental Education Association
Association of American Medical Colleges
Interprofessional 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) 2011
IPE is aimed at meeting these four domains
Values/Ethics: Work with individuals of other professions to maintain a climate of mutual respect and shared values
Roles/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 served
Interprofessional 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 disease
Interprofessional 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 equitable
Interprofessional 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 description
Results
Study limitations
Future 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 education
Description: Interprofessional student workshops with family care providers
Recruited Learners: Medical, nursing, social work, physiotherapy, and occupational therapy students
Results: Students value and enjoy opportunity to work together and find the experience moving, informative, and interesting
Half day interprofessional workshop
First half: students meet in interprofessional teams and learn about each other’s courses and explore each person’s background
Second half: Students joined by a family carer. Goal of interprofessional team is to listen to and reflect on carer’s expereince
Wee 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 facilitators
Description: Multiprofessional, 4-day communication skills program with standardized patients
Recruited learners: Predominantly nursing with some physiotherapist, dieticians, and radiographers
Results: No formal evaluation but feedback was positive
Workshop components
Reflection on communication and psychological issues
Graduated introduction to role play with simulated patients
Donovan 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 literature
Description: 12-week elective focused on reflections of dying depicted in the literature
Recruited learners: medical, nursing, bachelor of health science, and chaplaincy students
Results: All students met learning objectives based on qualitative analysis of written assignments and highly rated by participants
Students assigned to interprofessional groups that are maintained throughout the course
Involves combination of individual, small group, and large-group work
Objectives:
Recognize ethical dilemmas raised in the literature that are relevant to the care of the dying in our society
Identify professional qualities and professional culture as reflected in the literature
Identify examples of conflict and collaboration between professions reflected in the literature
Recognize the significant physical, psychosocial, and spiritual issues experienced by persons with a terminal illness as well as by their families
Identify 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 families
Demonstrate elements of collaborative interaction when participating in the interdisciplinary class
Brajtman 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 students
Description: Interprofessional case simulations with volunteer actors
Recruited learners: Social work, nursing, and chaplain students
Results: All students found it valuable and most cohorts demonstrated significant improvement in pre-determined outcomes
Describes interdisciplinary, interuniversity program that prepares social work, nursing, and chaplaincy students for competent practice when working with individuals and families facing end-of-life circumstances
Outcomes
Increased levels of knowledge in competencies related to practice in end of life care
Increased skills in competencies related to effectively assessing biopsychosocial end of life concerns or needs
Demonstrate 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 matters
Increased skill development related to recognizing and responding to ethical concerns and decisions, and those related to serving as advocates
Components of intervention:
Out of department elective: students required to audit or take for credit one course outside academic home department
Seminar: monthly seminars that alternate between discipline-specific (knowledge building) and interdisciplinary (skill building) instruction for total of 8 seminars over academic year
Discipline specific: 3-5 hours, provide universal content
Interdisciplinary seminars: involve all program students + program faculty, day-long, case simulations built around content module for the period, recruit local actors
Forrest 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 Students
Description: Combined online learning with interactive simulation
Recruited learners: Social work, nursing, medicine, and chaplain
Results: Successfully met five learning objectives and highly rated by participants
Workshop Description
Online, interactive multimedia case module structured around clinical course of a 68 year old AA woman with end-stage metastatic breast cancer
90-minute interprofessional workshop: Students assigned to to one of four interprofessional teams compromised of 6 to 8 students and complete following two tasks
Group discusses one of several palliative care challenges
20-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 Objectives
1. Understand basic precepts and goals of palliative care
2. Recognize and address common misconceptios about opioids
3. Identify spiritual and cultural needs of patients and understand how to meet those needs
4. Understand clinical features of imminent death and how to help help patient/family
5. To recognize contributions of all health care professionals and understand the importance of the IDT
Ellman 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 Trial
Description: Randomized participants to 8-session, simulation-based, communication skills intervention vs usual education
Recruited learners: Medicine, nurse practitioners
Results: Simulation-based communication training did NOT improve quality of communication but was associated with small increase in patients’ depressive symptoms
Intervention
Eight four-hour sessions led by two faculty
Each session included following and focused on specific topic
Brief didactic overview, including demonstration role-play by faculty
Skills practice using simulation (simulated patient, family, clinicians)
Reflective discussions
Curtis 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 five
Simulation-based training did NOT translate into improved quality of communication

19. Overview WORKSHOP HISTORY IPE Background IPE and palliative care
Workshop description
Results
Study limitations
Future implications

20. Workshop History
Piloted first interprofessional, communication workshop with advanced practice nursing students and physician fellows
Developed 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 History
Expanded 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 Sciences
Demonstrated 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 teams
Rated the topic as good to excellent
Learners need to be matched based on training level
i.e. Physician fellows are not well matched with undergraduate nursing students
What are other lessons?

23. Overview WORKSHOP DESCRIPTION IPE Background IPE and palliative care
Workshop history
WORKSHOP DESCRIPTION
Results
Study limitations
Future implications

24. Workshop Goals
Introduce 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 Work
Nursing (undergraduate, advanced practice)
Chaplaincy
University of Sciences
Physical therapy
Occupational therapy
Pharmacy

26. Key Components of Workshop
Workshop Basics
Pre-workshop preparation
Two-hour simulation-based workshops with STANDARDIZED PATIENTS
Four sessions offered over two days in October
Participants and Observers
Nursing and social work students were assigned to be either participants or observers at the discretion of their faculty
All participants were assigned to pre-determined interprofessional teams
Recruited diverse, interprofessional faculty facilitators
Pre-workshop
View video illustrating the roles of other health care professionals
Read assigned materials
Attend professional specific lecture
Complete pre-workshop evaluation

27. Case Description
Patient 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 aspiration
Goal of meeting is to discuss goals of care (resuscitation, discharge plan) with patient’s daughter or son
Developed case that would involve all disciplines

28. Workshop Schedule 4:00-4:15 Orientation 4:15- 5:15
Participant group 1 meets with SP 1
Participant group 2 meets with SP 2
Participant group 3 meets with SP 3
Participant group 4 meets with SP 4
Observer group 1 observes
Observer group 2 observers
5:15-
5:45
Debrief
Participants or facilitator had the ability to call a time out at any point during the case
Feedback
Structured feedback from standardized patient

29. Evaluations
Participants were given both pre and post-workshop evaluations
Asked participants to rate their confidence in multiple domains on 5 point Likert scale
Communication Skills
Interprofessional team skills (Based on IPEC competencies)
Communication Skills
Facilitate and/or participate in a family confernce
Interprofessional team skills (Based on IPEC competencies)
Work with individuals of other professions
Apply the knowledge of my profession to appropriately assess and address health care needs of a patient
Explain the role other professionals play in an interprofessional team
Communicate with other healthcare professionals
Apply relationship-building values and principles of team dynamics

30. Overview RESULTS IPE Background IPE and palliative care
Workshop History
Workshop Description
RESULTS
Study limitations
Future implications

31. Learner Assignments Recruited 109 learners
73 assigned to participant group
Divided into 16 groups of 4-5 each
36 assigned to observer group
Divided into 7 groups of 5-6 each
Each participant group had at least 4 different disciplines represented. No discipline was duplicated in a given team

32. Learner Demographics Participant Observer Total Sex Female 57 (78%)
35 (97%)
92 (84%)
Male
16 (22%)
1 (3%)
17 (16%)
Race
Caucasian
43 (59%)
29 (81%)
72 (66%)
Asian
20 (27%)
4 (10%)
24 (22%)
African American
5 (7%)
3 (8%)
8 (7%)
Hispanic
2 (3%)
0 (0%)
2 (2%)
Mixed heritage
1 (1%)
No answer
Age (mean) 27 28
Predominantly white females participated

33. Learner Demographics Participant Observer Total Profession Nursing
17 (23%)
34 (94%)
51 (47%)
Advanced
16 (22%)
28 (78%)
44 (40%)
Undergrad
1 (1%)
6 (17%)
7 (6%) PT
15 (21%)
0 (0%)
15 (14%)
Pharmacy
12 (16%)
12 (11%)
Medicine
11 (15%)
11 (10%)
Social Work
8 (11%)
2 (5%)
10 (9%) OT
6 (8 %)
6 (6%)
Chaplaincy
4 (5%)
4 (4%)
Years Training (mean)
3.28 (0-13)
3.66 (0-15)

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?
Participant
70 (96%)
Observer
1 (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 care
Didactic
68 (62%)
29 (27%)
5 (5%)
7 (6%)
Bedside
67 (62%)
31 (28%)
2 (2%)
9 (8%)
Apply knowledge of my profession to appropriately assess and address health care needs of a patient
76 (70%)
15 (14%)
11 (10%)
55 (51%)
34 (31%)
8 (7%)
12 (11)
Explain the role other professionals play in an interprofessional team
52 (48%)
39 (36%)
13 (12%)

36. Prior Experience Yes No Don’t Know Missing
Communicate with other healthcare professions, patients and caregivers
Didactic
63 (58%)
31 (28%)
8 (7%)
7 (6%)
Bedside
64 (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 care
60 (55%)
29 (27%)
13 (12%)
49 (45%)
39 (36%)
10 (9%)
Facilitate and/or participate in a family conference
43 (39%)
46 (42%)
9 (8%)
40 (37%)
52 (48%)
6 (6%)

37. Comparison of Pre and Post-Workshop Evaluations
Pre-Workshop Mean Score
Post-Workshop Mean Score
Sig. (2-tailed)
Work with individuals of other professions to create plan of care
Participant
3.60
4.11
0.000
Observer
3.83
4.00
0.226
Apply knowledge of my profession to appropriately assess and address health care needs of a patient
3.55
4.04
3.91
4.06
0.282
Explain the role other professionals play in an interprofessional team
3.38
4.01
3.77
4.17
0.017
Used paired sample t-test

38. Comparison of Pre and Post-Workshop Evaluations
Pre-Workshop Mean Score
Post-Workshop Mean Score
Sig. (2-tailed)
Communicate with other healthcare professions, patients and caregivers
Participant
3.54
4.11
0.000
Observer
3.69
4.14
0.014
Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care
3.48
4.08
3.46
4.09
0.002
Facilitate and/or participate in a family conference
3.21
3.31
3.89
0.001

39. Curriculum/Workshop Content
Poor-Fair
(1-2)
Good
(3)
Very good – Excellent (4-5)
Relevance of topic content to my discipline
4 (4%)
10 (9%)
92 (84%)
Utility of pre-reading
9 (8%)
19 (17%)
77 (71%)
Utility of pre-workshop video
23 (21%)
22 (20%)
55 (50%)
Utility of pre-workshop profession specific lecture
15 (14%)
20 (18%)
62 (57%)

40. Workshop Sessions Poor-Fair (1-2) Good (3) Very good – Excellent (4-5)
Usefulness of small group orientation
14 (13%)
23 (21%)
69 (63%)
Usefulness of communication exercise with standardized surrogates
1 (1%)
6 (6%)
98 (90%)
Usefulness of SPs
3 (3%)
101 (93%)
Effectiveness of small group faculty facilitators
2 (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?
Participant
1 (1%)
5 (7%)
65 (89%)
Observer
6 (17%)
28 (81%)
Yes No
Not sure
Would you be interested in participating in a follow-up session to practice family meetings?
Participant
60 (82%)
4 (5%)
8 (11%)
Observer
26 (72%)
5 (14%)

42. Overall Conclusions Pre vs Post Workshop Assessments
Participant Group: Significantly more confident in ALL domains after the workshop
Observer Group: Significantly more confident in most domains after the workshop
Majority of participants rated the workshop as very good to excellent
Majority of participants would be interested in participating in another workshop

43. Overview STUDY LIMITATIONS IPE Background IPE and palliative care
Workshop History
Workshop Description
Results
STUDY LIMITATIONS
Future Directions

44. Study Limitations Variability in student representation
Evaluations Used
Used non-validated survey tool
Evaluation 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 History
Workshop Description
Results
Study Limitations
FUTURE DIRECTIONS

46. Future Directions Workshop Structure Evaluations
Offer workshop multiple times during the year
Offer workshop multiple times for the same group of learners
Evaluations
Use validated survey tool
Create 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 Seman
HRSA funding, Amy’s GACA, GEC

48. QUESTIONS?