1. Implementing an Integrated Curriculum Model: Lessons Learned
Christie newton presenting on behalf of
Lynda Eccott, Victoria Wood & Salimah Valiani
It is my pleasure to present the approach we have used at UBC to successfully integrate interprofessional learning into the health professional programs at UBC.

2. Acknowledgements Lesley Bainbridge, College of health disciplines
Leandra best, faculty of dentistry
Michael burgess, centre for applied ethics
Philip crowell, faculty of medicine
Donna drynan, department of occupational science and occupational therapy
Bethan everell, school of physical therapy
Judy Gillespie, school of social work
Elizabeth joes, school of social work
Patricia Marck, school of nursing
Claudia Ruitenberg, faculty of education
Patricia Rodney, school of nursing
Sheila Epp, School of nursing
Carol andersOn, Community Member
Ubc Teaching and learning enhancement fund
I would also like to acknowledge:
the contributions of our interdisciplinary working group of content experts who developed the integrated ethics curriculum model
and funding from the UBC Teaching and Learning Enhancement Fund.

3. Disclosure I have no conflicts to declare
As noted I am a full time employee of UBC and I have not received any funding.

4. Objectives Describe UBC’s integrated curriculum model
Identify complex areas of healthcare that benefit from an integrated approach
Discuss the integrated curriculum development process
Evaluate the benefit of an integrated approach to health professional education
My objectives for this presentation are to
Describe the integrated curriculum model at UBC
Outline the selection of topics using the complex area of healthcare – ethics to demonstrate the benefits provided by an integrated curriculum
Review the integrated curriculum development process
Provide an evaluation of the perceived benefits of an integrated approach to health professional education.

5. IPE for IPc
My assumption for this presentation is that your attendance at this conference indicates your buy in to the evidence for IPE supporting collaborative practice

6. Focus on clinical knowledge
IPE
Extra-curricular
Focus on competencies
Challenges
Focus on clinical knowledge
Seen as an add-on
Finding common time
My second assumption is that you have experienced within your teaching context challenges with implementing IPE
At UBC, we have 12 health professional programs distributed across 5 faculties and four regions of the province.
Each year, we graduate over 1,000 health professional students from these programs and at any time throughout the year we have over 3000 health professional students distributed across the province. Briefly, challenges faced include:
Finding common times to bring students together for common learning – as a result we frequently hold activities in extracurricular time
Frequently extracurricular IPE is seen as an add-on
Focus of the formal curricula on discipline specific clinical knowledge and skills
Difficult to shift discipline specific focus to broad / cross cutting competencies for collaborative practice - Communication; Patient-Centred Care; Role Clarification; Team Functioning; Conflict Management; Collaborative Leadership

7. The Integrated Approach
content common across programs
complex areas of health care that require a collaborative approach
learning that is unique to each profession
economies of scale for foundational knowledge common to all programs
relevant opportunities for interprofessional learning
meaningful integration of interprofessional learning
To address these challenges to IPE we decided to shift the focus from IPE to curriculum integration. We engaged all of the health and human service programs at UBC, with the guidance and administrative support of the Office of UBC Health (formerly the College of Health Disciplines)with the intention to collaboratively developed and implement an integrated curricular approach.
The aims of an integrated curriculum are to:
Address content common across health professional programs
Focus on complex content areas such as health care topics that require a collaborative approach
Support learning that is unique to each profession
Seek economies of scale for foundational knowledge common to all programs
Create opportunities for interprofessional learning in these complex areas of healthcare
Support the meaningful integration of interprofessional learning into curricula to enhance uni-professional curricular content

8. UBC Health Integrated Curricula Other Topics of Interest
Content Areas
What topics are common across health professional programs and benefit from a collaborative approach?
UBC Health Integrated Curricula
Ethics
E-Health
Indigenous Cultural Safety
Other Topics of Interest
Pain Management
Professionalism
Nutrition
Ask participants to name topics that they think would benefit from an integrated approach – then share our topics [slide is animated]. The UBC Health integrated curriculum topics were identified by our UBC Health Council (Deans and Directors). We used ethics as the exemplar and are now working on an e-health curriculum using this model.

9. Partnerships UBC Health Council Instructional Designer Faculty Lead
Education Coordinator
Instructional Designer
Curriculum Committee
Working Group
Curriculum Manager
As noted - Development and implementation of the integrated curriculum is the result of contributions from a committed interdisciplinary group of faculty and funding from the UBC Teaching and Learning Enhancement Fund. Other key collaborators and supporters included:
UBC Health Council – Deans and directors from the health professional programs at UBC. Chose topics of the integrated curricula and made a commitment to integrate the curricula as a required component of programs.
Faculty Lead - Provided direction for the project, drafted curriculum documents, proposed content for learning activities, communicated with UBC health council and curriculum committee, and external stakeholders.
Integrated Curriculum Working Group – Interdisciplinary group of content experts. Reviewed and revised curriculum documents, amended content for learning activities, approved curriculum documents, developed content for learning activities, identified evaluation mechanism, and identified internal and external collaborators.
UBC Health Curriculum Committee – Comprised of curriculum coordinators from each of the health professional programs at UBC. Identified time for interprofessional components, and recruited facilitators.
Curriculum Manager - Developed content for learning activities, facilitated meetings and recorded meeting outcomes, compiled funding progress reports, communicated with stakeholders, produced knowledge dissemination material, liaised with instructional design personnel for content development and migration, and developed instructional resources.
Instructional Designer – Created innovative, flexible, and engaging online materials to support each component of the curriculum. Includes: online preparatory modules; self-directed learning; and facilitator training.
Educational Coordinator – Manages logistics such a room bookings, facilitator recruitment, organizing students into interprofessional groups, and administering evaluation surveys.
* Made possible with a grant from the UBC Teaching and Learning Enhancement Fund

10. Assessment Strategies
Development Process
Step 1
Environmental Scan
Step 2
Competency Profile
Step 3
Identify Activities
Step 4
Content Development
Step 5
Assessment Strategies
Step 6
Implementation
The development of the integrated ethics curriculum took 3 years. However, it was time well spent as we now have a process framework for development of other integrated curricula. I will briefly go through each of these steps.

11. Step 1 – Environmental Scan
Brainstorm and develop questions
Deploy via Program Heads, analyze and summarize results
Compile literature, curriculum resources, and external course syllabi
Key deliverables: Identify needs, opportunities and useful resources
The environmental scan allowed us to identify needs, opportunities, and most importantly useful resources related to the content area.
We did not want to reinvent the wheel, we wanted to enhance existing curricula within programs, introduce curriculum should it not exist and replace curriculum only when absolutely necessary.

12. Step 2 – Identify Common Competencies
guiding principles, exit competencies, milestones, and learning outcomes
Map exit competencies to course syllabi
literature review to inform curriculum approach
Key deliverables: competency profile
This part took the most time but has now set us up for a more streamlined approach for future topics.
It was important to ensure the competencies and objectives chosen for the integrated curriculum aligned with profession specific needs and were common across professions. In this way programming would not be perceived as an add on.

13. Step 3 – Identify Activities
number, scope, and anticipated resources based on milestones and quartiles
Determine implementation schedule for programs with differing lengths
Develop learning objectives based on exit competencies and milestones
Key deliverables: curriculum outline
Logistics were listed in the challenges at the outset – to manage the numbers and distribution of health professional learners at UBC, the curriculum model needed to be flexible, modular and technology enhanced which would allow it to:
Span from classroom to practice-setting,
Build on or spiral in complexity
Meet the needs of programs differing in length ex. Medicine 4 years and Occupational Therapy 2 years. .
The integrated model therefore used a quartile approach with most of the content presented online with follow up face to face interprofessional sessions used for more interactive learning.

14. Step 4 – content development
Develop cases
Identify supporting materials
Develop online modules and other resources
Pilot activities
refine activities based on student and facilitator feedback
Develop facilitator training module and webinar
Key Deliverables: curriculum activities
We used an iterative development approach that allowed us to launch the curriculum as later components were still under development.
Each component was piloted and refined before final launch.
Here are the steps involved in creating each module
Of note, the case-based framework was used because it was a common curricular approach in the health professions at UBC and also because of the evidence for case based learning to promote interprofessional collaboration during face-to-face sessions.

15. Step 5 – Assessment Strategies
environmental scan of assessment tools and strategies
Develop online resource to host resources
Key Deliverables: Inventory of assessment tools and strategies
Assessment was left as the responsibility of the individual programs, this was done because each program had different assessment needs based on profession specific accreditation criteria.
However, we felt it important to provide recommendations for assessment based on best IPE practices (e.g. debrief to consolidate learning during self-directed online module).
We developed an inventory of assessment tools and strategies

16. Step 6 – Implementation MEt individually with programs
Map delivery options
Schedule activities
Book rooms and recruit facilitators
Set up online components
Track activity completion
Report activity completion back to programs
Key Deliverables: Delivery schedule
We started by working individually with each program to identify common times for activities.
This was time consuming.
Once we identified times within each program we needed to match times with other programs while ensuring an appropriate disciplinary mix for each time slot.
The first year, we struggled to match programs and ended up offering 13 sessions. The second year, we we were more successful and now programs have dedicated two-hours, one day per week, during a single month for each year of their program for the interprofessional components of the curricula.
This fall we have 3 integrated curricula running for the first time, with a total of 4 interprofessional components thus far.

17. 2017 Integrated Curriculum Schedule

18. 2018 Integrated Curriculum Schedule

19. This is the model.
As you can see, the integrated curricula address uni, multi and interprofessional learning.
Activities increase in complexity and are integrated at different points throughout the curriculum.
Most online activities are about 1 hour and generally serve as preparation for face to face sessions
The face to face interprofessional components are 2-hour case based workshops.

20. evaluation the development process (Working group)
January 2015
Online Survey and focus group
N=11
program engagement (Curriculum coordinators)
Online survey
N=8
Implementation (curriculum coordinators)
August 2016
Focus Group
N=15
In addition to evaluations of student satisfaction and learning, it was important to evaluate effectiveness of the development process and how the curricula have been integrated into programs. We conducted a number of surveys and focus groups to find this out.

21. Success Factors
Topic Choice – Perceived as adding value and addressing a need
Commitment – Bi-directional (top-down; curriculum coordinators up)
Collaboration – Engagement from the beginning in development process through supported partnerships (Committees)
Resources – Funding; content experts; curriculum developer; instructional designer
Flexibility – Use of online technology; quartiles; modular approach
Protected Time – Needed to support multiple integrated curricula
According to these evaluations, we identified the following success factors that have facilitated development and implementation of the curriculum.

22. Outcomes
a required component of 12 health professional programs at UBC
Allows programs to replace existing content with common learning
Enhances uni-disciplinary Programming
Implements interprofessional learning as a required component
For decades, interprofessional education (IPE) has been relegated to the domain of extracurricular learning at many post-secondary institutions, including UBC.
In 2015 a new integrated curriculum approach was introduced and provided a way to implement interprofessional learning as a required component of its health professional programs.
By focusing on the specific yet common learning of each health profession and achieving economies of scale for foundational knowledge the integrated curriculum model allows for the introduction of interprofessional learning as a required component within the different curricula, allowing students to develop competencies for collaborative practice as identified in the Canadian National Interprofessional Competency Framework.

23. UBC Health – www.health.ubc.ca
Questions?
UBC Health –
Victoria Wood –
If you have any questions about the curriculum, I can try and answer them. Otherwise, I will direct you to our Curriculum Manager who will be able to follow-up.