1. Interprofessional Team Seminar: Folding Medical Students into the Mix
Fred Rottnek, MD, MAHCM
David Pole, MPH
Saint Louis University
Department of Family and Community Medicine
STFM 36th Annual Predoctoral Education Conference
January, 2010

2. Fred Rottnek, MD, MAHCM David Pole, MPH
Medical Director, Area Health Education Center
Medical Director, Corrections Medicine: Saint Louis County Department of Health
David Pole, MPH
Deputy Director, Area Health Education Center
Medical School Liaison for Interprofessional Education
1/29/2010
IPTS: Folding Medical Students into the Mix

3. Objectives
Understand the developmental process leading to the Interprofessional Team Seminars (IPTS)
Introduce the curriculum and didactic methods and structure of IPTS
Appreciate the structural and cultural barriers to meaningful Interprofessional Education
Appreciate the role of administrative support
There is a paper in progress…
1/29/2010
IPTS: Folding Medical Students into the Mix

4. Why Interprofessional Education?
To practice interprofessional health care, we must develop new ways to train students in interprofessional health care
Finding data to support intuition
Correlation of IP practice to Quality and Safety
Cochrane Database of Systematic Reviews
Conclusion: We know the outcomes we want; we don’t know how to get there
1/29/2010
IPTS: Folding Medical Students into the Mix

5. IPE at Saint Louis University
Task Force on Interprofessional Education (1995)
Center for Interprofessional Education and Research (CIER)
Core IPE Curriculum (2006)
Doisy College of Health Sciences
School of Nursing
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IPTS: Folding Medical Students into the Mix

6. First Attempts of IPE at SLU SOM
AHEC Elective (2002 – 2006)
IP Care of Medically Underserved Pop’s
Tuesday evenings 5:00-7:00 PM, 12 weeks
MS1, Nursing, PT, Social Work, Public Health
PPS-1 (AY: ) “Critical Issues in HC”
Students had no clinical context; no buy-in
Large group not conducive to IP themes
Not all faculty had skills to facilitate IP discussions
IPE requires more that sitting in a room together and hearing same message
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IPTS: Folding Medical Students into the Mix

7. Elements Needed for Redesign
Place course in MS’s clinical years
Must match student learning style (Millennial)
Build curriculum around patient case studies--embed IPE themes vs. Issue driven
Minimize lecture and large group activities
Emphasize fast-paced, flexible small group discussions with faculty facilitator
Maintain group and faculty continuity
1/29/2010
IPTS: Folding Medical Students into the Mix

8. Interprofessional Team Seminars
Objectives:
Develop a greater understanding of issues and skills to improve patient and IP team communications
Increase awareness of the scope and practice of multiple health disciplines
Practice skills at IP team communication in small-groups using patient cases that include themes: patient-centered care, safety, health care systems, cultural competency, health literacy, system/personal bias impact on care
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IPTS: Folding Medical Students into the Mix

9. IPTS Course Pilot (AY 2008-2009)
Participants: PA, PT, OT, MSW, Accelerated Nursing and Medical Students (220 students)
Logistics to fold in the medical students:
Two-hour block; one time a month for months
Elective for third year medical students (one week of credit for their fourth year)
Minimize disruption of the med. students’ clerkships: IPTS scheduled prior to Basic Science Clinical Correlation required course
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IPTS: Folding Medical Students into the Mix

10. IPTS: Curriculum and Methods
Methods: Computer assisted instruction, large group lectures, small group discussions and presentations, independent reading
14 Small groups: Mix of IP students (~15) to one faculty facilitator. Faculty were briefed on topics and didactic format prior to class (30 min)
Content of small group sessions: FR/DP-designed case studies embedding themes of IP care, review with IP planning team
Out-of-class activities: Google blog respond to question/discussion treads; reading assignments
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IPTS: Folding Medical Students into the Mix

11. IPTS: Faculty Development
Content
Preview of case and didactic methods
Facilitators lead discussions using their experience, professional training and professional values
Focus on IP discussion and team process vs. details of clinical care
Process
Provided facilitators with case orientation and confidence to lead groups for professional students that they normally would not teach
Facilitators worked as an interprofessional team in developing and delivering the course
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IPTS: Folding Medical Students into the Mix

12. IPTS: Formal Feedback Evaluation methods: Results:
Student post-assessment, facilitator post-assessment, qualitative feedback on group discussion, threaded on-line discussions, and facilitator feedback during faculty development sessions
Results:
High majority of medical students reported the seven sessions very satisfactory or satisfactory (5 point Likert scale) for useful to their practice.
High majority of the students reported the course to be very satisfactory or satisfactory (5 point Likert scale) for increasing knowledge, skills and understanding of IP care & team communication.
1/29/2010
IPTS: Folding Medical Students into the Mix

13. IPTS: Informal Feedback
Faculty: reported format provided a means for students to understand each other’s unique and shared experiences in training.
Discovered shared experiences
Hospital politics, disparaging instructors, and cost of education, wanting to care for patients
Topics particular to medical education
Forum to process: patient care experiences, burden of debt, sacrifice of personal and family time due to professional pressures and responsibilities, and challenges of taking on increasing responsibilities over course of training.
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IPTS: Folding Medical Students into the Mix

14. IPTS: Revisions Year 2 (AY 2009-2010)
More focused cases
No blog/threaded discussions between classes
Access to online learning with TeamSTEPPS™
Increased faculty development, e.g., working with standardized patients, trajectory discussions (what if…)
Added students and facilitators including Saint Louis College of Pharmacy (310 students)
Expand research to include new professions
1/29/2010
IPTS: Folding Medical Students into the Mix

15. IPTS: Proposed Additions Year 3 (AY 2010-2011)
Mandatory course for MS-3’s (180) - mandate from SOM Dean (SLU VP for Health Sciences)
College of Pharmacy wants required for 5th year (150 students)
Will need additional faculty to facilitate
Will need to split sessions to accommodate over 600 students in IPTS
1/29/2010
IPTS: Folding Medical Students into the Mix

16. Barriers/Challenges to IPE
Structural
Training: student’s schedules/clinical rotations differ in time, location, duration of training and integration of theory and practice (concomitant or sequentially)
Faculty skills, ability to embrace innovation – new teaching methods, ability to reflect and evaluate program and self, incentives, and definitions of successful experience for both faculty and students
Logistics – team assignments, rooms, course times
Cultural:
Jargon, philosophy of provider-patient/client relationship, definition of clinical outcomes, problem-solving approach, professional stereo types/socialization
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IPTS: Folding Medical Students into the Mix

17. IPE Programming: Folding Medical Students into the Mix
Identify the barriers
Identify administrative support, faculty champion
Pilot course as an elective
Build on successful programs
Build on working relationships – IP faculty plan course experience together, share facilitator roles
Embed IP principles and values into patient cases
Engage in IP faculty development
“Explicitate”
1/29/2010
IPTS: Folding Medical Students into the Mix

18. References
Institute of Medicine (2001). Crossing the Quality Chasm. Washington, D.C., National Academy of Sciences. Pp
Journal of Interprofessional Care, (May 2005) Supplement 1
Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I. Interprofessional education: effects on professional practice and health care outcomes. The Cochrane Database of Systematic Reviews Draft (2005 ) Most Recent Substantive Amendment: 12 November 2007
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IPTS: Folding Medical Students into the Mix

19. Questions and Comments
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IPTS: Folding Medical Students into the Mix 19