1. Interdisciplinary Teaching and Learning: Out Of The Silos And Into The Fields David A. Brechtelsbauer, MD, CMD Associate Professor of Family Medicine USD Sanford School of Medicine, Sioux Falls, SD Jodi R. Heins, PharmD Professor of Pharmacy Practice South Dakota State University, Brookings, SD Clinical Pharmacy Specialist Sioux Falls VA Health Care System, Sioux Falls, SD

2. Objectives Participants will, through critical analysis of a well-developed interdisciplinary team (IDT) seminar: Identify barriers and techniques for overcoming barriers to IDT education. Discuss the relevance of adult learning principles to IDT education and clinical practice. Participate in and/or critique IDT involvement in this lecture-discussion.

3. Representing: Medicine Nursing Pharmacy Social Work Chaplaincy

4. Barriers Lack of student interaction in education due to distance separation of specialties Coordination of multiple institutions Time commitment for faculty “Good” patients Representation of all groups in each small group Limitation on size

5. Interdisciplinary Palliative Care Seminar Seminar History

7. Academic Work Group A subgroup of LifeCircle SD, formed in 2000 Goal: Education of health care professionals in Hospice and Palliative Care

8. Participating Academic Institutions Augustana College Department of Nursing Avera Clinical Pastoral Education Mount Marty College Department of Nursing Presentation College USD Sanford School of Medicine SDSU College of Pharmacy Sioux Falls Seminary USD School of Nursing USD Social Work Program

9. Participating Clinical Institutions Avera McKennan University Health Center and Hospice Dougherty Hospice House Avera Sacred Heart Hospital and Hospice Rapid City Regional Hospital and Hospice Sanford USD Medical Center and Hospice Sanford Hospice Cottage Sioux Falls VA Medical Center Asera Care Hospice Compassionate Care Hospice

10. Participating Clinical Sites: Nursing Homes & Retirement Communities Bethany Lutheran Home Avera Prince of Peace Good Samaritan skilled nursing facilities Luther Manor, Center, Village Southridge Healthcare Golden Living-Covington Heights Inn on Westport Dow Rummel Village Waterford at All Saints

11. Interdisciplinary PC Seminar Goals: Facilitate improved care at the end of life through interdisciplinary education Generate mutual recognition and valuing of interdisciplinary roles Introduce the students to home visits.

12. Interdisciplinary PC Seminar Five Consecutive Tuesday Afternoons Pre-seminar orientation: overview, pretest Sessions I-V: Discussion of “Elizabeth” Sessions II-V: Home Visits in student pairs Session II: IDT Role Play Sessions III-V: Small Groups work as IDTs

13. Session Structure Session I: 1-5:00 pm Sessions II-V 1:00 - 2:00 pm Make Home Visit 2:30 - 4:00 pm Lecture and Discussion 4:00 - 5:00 pm Small Group Discussion

14. Seminar Requirements Attendance Professional Behavior Active Engagement Completion of Home Visits and assignment Journal (to be handed in at the completion of the seminar) Test (medical students)

15. Seminar on Moodle Introductory Section Sessions I – V Objectives Questions for Group Discussion Required Readings Suggested Readings

16. Home Visit Goals Model professionalism Establish rapport with a patient at EOL and his/her family Understand the IDT approach Personal reflection on student’s attitudes and fears about dying Strengthen skills in communication, assessment, and understanding of person’s social context Meet one’s individual goals for Home Visit

17. Types of Activities/Assessments for Students by Discipline MEDICINE See “big picture” Observe team Notice environment Do Karnofsky Discuss symptom management Do physical assessment NURSING Do family assessment Participate in “hands on” caregiving Interact with client and/or family Do physical assessment Do some charting or share documentation

18. Types of Activities/Assessments for Students by Discipline PHARMACY Do med review Look up meds and think about why they’re used Discuss symptom management SOCIAL WORK Assess emotional needs of client and/or family Explore advance directives Assess family dynamics Explore resources Provide life review Identify cultural factors

19. Types of Activities/Assessments for Students by Discipline CHAPLAINCY Help interpret religious/spiritual issues in light of illness Explore person’s meaning, hopes, fears, anxiety, doubts and spiritual coping Offer appropriate religious rituals as determined by the context

20. Home Visit Canons Complete Home Visit Form and share with Home Visit Coordinator and your Partner during first visit Identify your own personal goals Share contact info (name/phone) with partner and coordinator Honor confidentiality in home visit and small group Recognize that… Your client may not be “actively dying” (in palliative care) and may be cognitively compromised “Best laid plans…” –be flexible and resourceful Establish rapport with client before you address your own agenda

21. More Home Visit Canons Return on time! Didactic session starts at 2:30 pm Complete home visit assignment over the four weeks (medical students) Wear your student name tag or the IPC Seminar name tag

22. Research Data 88 South Dakota students in medicine, nursing, pharmacy, social work, and chaplaincy Main Outcome Measure: students will have greater familiarity with their role in a team, more understanding of the roles of other disciplines in palliative care, will identify positive contributions to professional practice and patient care using the team approach

23. Perceptions of Interdisciplinary Education Conducted 2009-2010 27 Medical Students 58 Other students 30 Nursing 10 Social Work 10 Chaplain 8 Pharmacy

24. I am confident that I can resolve conflict with professionals outside of my discipline: Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Strongly agree/ Agree 24 (89%)46 (82%)22 (81%)54 (100%) Neutral 2 (7%)9 (16%)4 (15%)0 Disagree/ Strongly disagree 1 (4%)1 (2%)1 (4%)0

25. I would prefer to work in an interdisciplinary team rather than practice independently or only with members of my discipline Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Strongly agree/ Agree 12 (44%)37 (64%)15 (56%)40 (77%) Neutral 15 (56%)19 (33%)7 (26%)11 (21%) Disagree/ Strongly disagree 02 (3%)5 (19%)1 (3%)

26. In your opinion, how might the IDT approach impact… Creative problem solving Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 20 (74%)54 (93%)24 (89%)51 (94%) Team has no effect 6 (22%)4 (7%)3 (11%)3 (6%) Team makes worse 1 (4%)000

27. My perception of “interdisciplinary team” is…. Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Negative 002 (7%)0 Neutral 6 (22%)9 (16%)3 (11%)2 (4%) Positive 20 (74%)33 (58%)19 (70%)23 (43%) Very positive 1 (4%)15 (26%)3 (11%)28 (53%)

28. In your opinion, how might the IDT approach impact… Patient care Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 26 (96%)57 (98%)27 (100%)54 (100%) Team has no effect 1 (4%)000 Team makes worse 01 (2%)00

29. In your opinion, how might the IDT approach impact… Respect for my discipline Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 16 (59%)50 (86%)17 (63%)45 (83%) Team has no effect 11 (41%)7 (12%)6 (22%)7 (13%) Team makes worse 01 (2%)4 (15%)2 (4%)

30. In your opinion, how might the IDT approach impact… Willingness to be held accountable for outcomes over which I may not have complete control Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 8 (30%)34 (60%)6 (23%)37 (69%) Team has no effect 12 (44%)19 (33%)18 (69%)14 (26%) Team makes worse 7 (26%)4 (7 %)2 (8%)3 (6%)

31. In your opinion, how might the IDT approach impact… Understanding other disciplines’ scope of practice. Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 26 (100%)56 (97%)25 (93%)54 (100%) Team has no effect 02 (7%) 0 Team makes worse 000

32. In your opinion, how might the IDT approach impact… Cost of patient care Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 9 (33%)23 (40%)7 (26%)33 (61%) Team has no effect 8 (30%)26 (46%)9 (33%)15 (28%) Team makes worse 10 (37%)8 (14%)11 (41%)6 (11%)

33. In your opinion, how might the IDT approach impact… Wisely using my time and the time of other professionals Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 12 (46%)49 (85%)12 (44%)43 (81%) Team has no effect 9 (35%)8 (14%)9 (33%)6 (11%) Team makes worse 5 (19%)1 (2%)6 (22%)4 (8%)

34. In your opinion, how might the IDT approach impact… Willingness to share information and resources with other professionals Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Team enhances 22 (82%)56 (97%)22 (82%)53 (98%) Team has no effect 5 (19%)2 (3%)5 (19%)1 (2%) Team makes worse 0000

35. My impression of the IPC Seminar is … Pre-SeminarPost-Seminar Medical Students Other Disciplines Medical Students Other Disciplines Very negative 1 (4%)0 0 Negative 1 (4%)06 (22%)0 Neutral 16 (62%)8 (14%)5 (19%)5 (9%) Positive 7 (27%)36 (62%)13 (48%)28 (52%) Very Positive 1 (4%)14 (24%)2 (7%)21 (39%)

36. Research Data - Summary Results Quantitative data suggest that interdisciplinary education enhances students’ understanding of their discipline and the work of other disciplines. Students perceive the team approach enhancing patient outcomes, goal setting, and communication among colleagues. Qualitative data reinforced the importance of interdisciplinary education while revealing strains among disciplines in hierarchy and valuing.

37. Research Data - Summary Conclusions Playing one’s part in the team strengthens students’ confidence and comfort interdisciplinary settings. Experiencing the limitations of teamwork in action must be acknowledged for some.

38. Volunteer IDT Panel Discussion

40. Acknowlegements Susan L. Schrader, PhD. Department of Sociology, Augustana College (Sioux Falls, SD) and Chair, LifeCircle South Dakota: Partners Improving End-of-Life Care Peter Holland, DMin. Clinical Pastoral Education, Avera Health (Sioux Falls, SD) Pam Schroeder, RN, MEd, MS. Department of Nursing, Augustana College (Sioux Falls, SD)

41. Access the Moodle Course http://www.usd.edu/med/neurosciences/partne rship.cfm or http://www.LifeCircleSD.orghttp://www.usd.edu/med/neurosciences/partne rship.cfmhttp://www.LifeCircleSD.org Choose “Moodle” from left hand menu Click “login” USERNAME: takers PASSWORD: Takers#2011 Guest password available until May 15 th