1. Orientation to the Geriatric Interprofessional Assessment Clinic (GIAC)

2. World Health Organization defines Interprofessional Education (IPE):
What is IPE?
World Health Organization defines
Interprofessional Education (IPE):
“When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”1
1 World Health Organization (WHO). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization

3. Interprofessional Collaborative Practice Competencies
Values and Ethics
Roles and Responsibilities
Interprofessional Communication
Teams and Teamwork
Link to Competency Document
IPEC Report 2011, Updated 2016

4. Silo’d Approach to Healthcare
Medicine
Physical Therapy
Social Work
Occupational Therapy
Pharmacy
Dietetics

5. Interprofessional Collaborative Practice
Medicine
Physical Therapy
Nursing
Occupational Therapy
Pharmacy
Shared Leadership
Team Huddles
Alternative Presentation Styles
Patient Partnership
Transparency

6. We are a collaborating site with the National Center for Interprofessional Practice and Education

7. Geriatric Interprofessional Assessment Clinic is a unique interprofessional clinic in which you will be introduced to interprofessional team care of older adults. The clinic involves students from Schools of Medicine, Pharmacy, Social Welfare and Health Professions.

8. In the GIAC
Students care for complex, older adult patients as an interprofessional team and are supervised by interprofessional faculty members.
Students build upon their own professional training to work and learn together as a team.
Students gain an understanding of the roles of other health professions and how they can work collaboratively to optimize patient care.

9. GIAC Orientation
The GIAC runs one half-day per week on Wednesday afternoons.
In the Fall and Spring semesters we have:
Medicine SW OT
Pharmacy
Dietetics and Nutrition
In the Summer we have Medicine and PT.

10. Where is the clinic located?
The clinic is located in the Landon Center on Aging Rainbow. (NE corner of 36th and Rainbow)
For your first clinic date, be in clinic by 12:30pm for orientation.
After the first day, plan to be in the clinic by 12:45pm.

11. What should we wear? Please wear typical outpatient clinic attire.
Please wear your name badge or name tag.

12. GIAC Orientation Faculty
Medicine: Shelley Bhattacharya DO, MPH and Denise Zwahlen MD
Physical Therapy: Laura Hughes Zahner PT
Pharmacy: Crystal Burkhardt PharmD
Dietetics and Nutrition: Nick Marchello MS, RD, LD
Occupational Therapy: Jane Hughes OTD, OTR/L
Social Work – Myra Hyatt LSCSW, LCSW

13. GIAC Orientation
Prior to coming to GIAC each week, please review Dr. Bhattacharya’s and Dr. Zwahlen’s patient schedules for the session. The domain name for the GIAC is UKP-LCOA FAM MED.
Not all students have familiarity with O2 , so you may need to help guide them through the electronic chart.

14. GIAC Orientation
There is a white board with patient names listed on it. Each student will sign up for 1-2 patients.
Learners from other professions will also sign up to see these patients. Learner sign-ups should be based on the needs of the patients for that encounter.
There will typically be no more than 3 learners in the room for each patient encounter. One of the learners needs to be a medical student, with the other learners chosen based on the patient needs.

15. GIAC Orientation
Prior to interviewing your patient visit, perform a 5 – 10 minute “pre-huddle” with the team. During your pre-huddle, be specific as to who will do what part of the history and exam.
There are dry erase boards hanging on the wall near the schedule for your use/convenience.
You will have 30 minutes to see the patient including obtaining the history and review of systems, as well as performing a goal-directed physical exam. Please structure your interview so that the ideas and goals of the team are integrated together during your “pre-huddle”.

16. GIAC Orientation (cont.)
At 30 minutes, you will hear a knock on the door. This signifies that you need to wrap up and move into “post huddle.” Please finish what you are doing and exit the room. If you haven’t begun the physical exam, go ahead and exit. The physical exam can be done with the faculty after your presentation to them.
Med students: for your review of systems, most of it should be gained from your history. So, you should not need to go through each system during that part of the interview. That can be a big time-saver!
If you feel like you need orthostatic blood pressures, point of care tests (A1c, BS) or a urinalysis, as you identify this, inform nursing so that they can get started. You don’t have to wait for the official order from us. This will save time.

17. GIAC Orientation (cont.)
After coming out of the room, “post-huddle” with your team for a few minutes and decide how you are going to share the patient presentation with your preceptor team.
If you have extra time, as when the Attending is not out of the previous patient’s room, consider needed testing such as TUG (Get Up and Go), GDS or SLUMS.
After discussion with the preceptor team, Dr. Bhattacharya or Dr. Zwahlen and the learner team will enter the room together, summarize the plan, answer questions and end visit.
Total time per patient should take no more than 60 – 75 minutes.

18. Standardized Patient Encounter Evaluation Rubric (SPEER)
Students may be observed via a live video-feed while in the patient room to allow reflective feedback of the team’s patient and interprofessional interaction.
This will help facilitate growth as interprofessional providers and ultimately provide better patient outcomes.
Please watch video below to learn more:

19. General flow in the GIAC…
IPTC Workflow
General flow in the GIAC…
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief

20. Form an IP team, and assign yourselves to a patient.
IPTC Workflow
START HERE
Form an IP team, and assign yourselves to a patient.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief

21. IPTC Workflow START HERE IP Team Doc and Debrief IP Team Huddle
Students form an IP team, and assign yourselves to a patient.
Students review chart TOGETHER and determine roles/
responsibilities.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief

22. IPTC Workflow START HERE IP Team Doc and Debrief IP Team Huddle
Form an IP team, and assign yourselves to a patient.
Review chart TOGETHER and determine roles/
responsibilities.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief
Communicate in a patient-centered manner as a team.

23. Before the Patient Encounter
All students will be given access to the patients’ charts in the electronic health record system (O2), for the purposes of GIAC only.
Although you have access to the charts, it is important to huddle with your IP team prior to seeing the patients, to define your contribution to the visit and to determine the team’s plan when in the patient room.
When reviewing the chart:
Click on the patient’s name on the provider schedule and choose ‘Review’ from the toolbar directly above the schedule
The faculty or prior GIAC students will walk you through this on the first day of the clinic or beforehand

24. During the Patient Encounter
Upon entering the patient room, the team should introduce themselves or designate one member to introduce the team members, their professions, and provide an ‘elevator speech’ about the team-based approach.
‘Elevator Speech’ example:
Hello, Mr. Smith. Welcome to the Geriatric Interprofessional Assessment Clinic or the GIAC. (Introduce yourselves and your profession.) Are you familiar with the GIAC ? We provide team-based care. Along with your input, each one of us is here to provide expertise and to come up with a care plan that suits you and your wellbeing.
Ask patient to share reason for visit, limit to 3 problems for that visit; match to reason for appt.

25. IPTC Workflow START HERE IP Team Doc and Debrief IP Team Huddle
Form an IP team, and assign yourselves to a patient.
Review chart TOGETHER and determine roles/
responsibilities.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief
Communicate in a patient-centered manner as a team.
Develop Assessment and Plan as a team.

26. IP Team Huddle
These patients are coming in to see a geriatric physician but know they will be working with an IP team.
Use the huddle time as a team to determine the plan for what each team member will do in the room as it seems appropriate for the patient.
There may be shared roles and responsibilities, and that’s ok.
Sometimes though, the plan changes or needs to adjust organically during the actual patient encounter. You will learn to adapt quickly.
It is important to engage as fully as possible to provide the best patient care, and to benefit optimally from this opportunity.

27. IPTC Workflow START HERE IP Team Doc and Debrief IP Team Huddle
Form an IP team, and assign yourselves to a patient.
Review chart TOGETHER and determine roles/
responsibilities.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief
Communicate in a patient-centered manner as a team.
Develop Assessment and Plan as a team.
Involve all professions in the presentation,
if possible.

28. Patient Presentation
Use SBAR as your communication tool within your team in the post-huddle
When you present to the faculty, present the recommendations first, supported by why your team chose this approach
All team members should participate in the patient presentation, including those that don’t identify any concerns from their professional stand point.

29. IPTC Workflow START HERE IP Team Doc and Debrief IP Team Huddle
Form an IP team, and assign yourselves to a patient.
Review chart TOGETHER and determine roles/
responsibilities.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief
Communicate in a patient-centered manner as a team.
Develop Assessment and Plan as a team.
Return to the patient’s room with team and preceptor(s)
Involve all professions in the presentation,
if possible.

30. IPTC Workflow START HERE IP Team Doc and Debrief IP Team Huddle
Form an IP team, and assign yourselves to a patient.
Review chart TOGETHER and determine roles/
responsibilities.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief
Each profession should be represented in the patient note as is appropriate.
Communicate in a patient-centered manner as a team.
Student or preceptor-initiated debriefing may take place at any point during the clinic. ALL students will debrief with the preceptors at the end of clinic every week.
Develop Assessment and Plan as a team.
Return to the patient’s room with team and preceptor(s)
Involve all professions in the presentation,
if possible.

31. Interprofessional Debriefing Expectations
During the clinic day, there will be opportunities to dialogue intentionally about the interprofessional aspects of your GIAC experience.
It is ideal to have these conversations with your interprofessional team.
You can initiate these conversations or they may be initiated by preceptors from any of the professions.
Why? These conversations and related reflections help to make explicit what might be implicit, actualize the learning and assist with translation to future practice experiences. Students have found greater satisfaction with their GIAC experience when they participated in intentional debriefing around interprofessional concepts.
We expect that students spend some time each day they are in the GIAC debriefing about concepts or experiences with interprofessional collaboration and/or teamwork. Again, this may be preceptor-initiated or student-initiated.

32. When to Debrief?
Opportunities for these conversations in the clinic work flow could include:
After the IP Team Huddle regarding a patient who has not yet been roomed.
After the patient encounter and IP Team Huddle but before reporting out to preceptors.
After the patient visit has ended during the Doc and Debrief, but before you select a new patient.
Whenever seems appropriate.
All students will debrief together at the end of clinic.
IP Team Huddle
IP Patient Encounter
IP Team
Huddle
Present to
IP Preceptor(s)
IP Team Doc and Debrief
Possible Debrief
Possible Debrief
Possible Debrief

33. Interprofessional Collaborative Practice
How did that feel?
What went well?
What could be improved?
Values and Ethics
What were the benefits or challenges of working in an interprofessional team?
How has working together influenced your respect for one another?
What values related to patient care do you share with your interprofessional colleagues?
Roles and Responsibilities
What surprised you (or what did you learn) about the role of another team member today?
What instances of role blurring or shared competency between professions have you observed?
Interprofessional Communication
How was the openness and inclusivity of the team to all professions and the patient/family voices?
In what ways could communication have been improved during the visit?
Teamwork
What promoted or discouraged teamwork today?
What TeamSTEPPS® principles or tools were used or could have been helpful?
(Situation Monitoring, Mutual Support, SBAR, CUS, Briefs, Huddles, etc.)
What did you notice about leadership today? How did it influence interactions or outcomes?
Summary
How does what you are learning about interprofessional collaboration affect patient care?
How are your perceptions of interprofessional collaboration changing or staying the same?
What is a take-home point that you can apply to your future interprofessional collaborations?

34. A team is a small number of people with complimentary skills who are committed to a common purpose, performance goals and approach for which they hold themselves mutually accountable.

35. What should we expect from your team?
Because these are Family Medicine patients, they come in for a variety of reasons.
Common reasons for patient visits:
Chronic Disease Management
Emergency Room Follow-up
Hospital follow-up
Geriatric consult
Establish care
Many times, these patients face multiple health challenges (and often psychosocial challenges). Having an IP team can address more issues.
Always consider what you and the other team members can recommend given each patient’s priorities and circumstances; their context is important.
Learn about other professions’ roles and responsibilities related to patient care
Learn about other individuals’ approaches to patient care and communication
Actively engage throughout the visit, with your interprofessional peers, as a team contributing through your professional lens.

36. Physical Therapy Student Expectations
As a PT student in this clinic, Laura Hughes Zahner will schedule a meeting with you prior to the GIAC to:
Answer any questions you might have after reviewing this Orientation
Orient you to O2 (electronic health record) and ensure you have access
Discuss Day One, more specifically relevant to you
Many times, the PT student can perform parts of the Subjective exam (called “history” by medical students) and the Objective exam (or “physical exam”), as it seems appropriate for the patient, and is decided upon before going into the patient’s room with your IP colleagues.

37. Other PT roles These visits are a great opportunity to:
Ask PT-related subjective exam questions, as is helpful for the team/patient
Perform PT-related objective examination, as is helpful for the team/patient
Educate patients as might be helpful to them
Give simple tips and/or exercises as needed
Determine whether or not a patient could benefit from a referral to PT (e.g. JaySTART program) or other related services
Assist with documentation related to the PT component of the patient’s visit that day

38. Occupational Therapy Student Expectations
As an Occupational Therapy Student in this clinic your role is to engage the patient in an occupational profile to determine if there is a disruption in their daily life as it pertains to the visit that day.
Review the EHR in O2 for each patient assigned to you and identify OT needs in preparation for meeting with your team and the patient.
Provide onsite OT recommendations to the team which can range from referral for services, consultation or specific intervention recommendations.

39. Medical Student Expectations
As a Medical student in this clinic, you will be responsible for charting in the room while seeing the patient. Use the Notewriter template in O2. Talk to your IP team about anything they would like to add to the note.
Don’t expect to give the typical SOAP format presentation. It will change based on your team.
Learn about other professions’ roles and responsibilities related to patient care. It’s OK if another profession takes the lead.
Learn about other individuals’ approaches to patient care and communication.

40. Dietetics Student Expectations
As a Dietetics intern in this clinic, you should assess the patient’s EMR (prior to GIAC clinic) for PMH regarding aspects of medical nutrition therapy.
Dietetic interns should actively participate in all interprofessional activities, including
A) sharing info derived from prior EMR evaluation
B) devising a plan with teammates for the interview
C) asking pertinent questions during the interview process
D) actively contributing to the post-huddle plan development
E) contributing to the physician debrief
F) actively participating in the planned intervention
G) actively contributing to the post-round debriefing session.

41. Social Work Student Expectations
The Social Work student will call each patient prior to their visit to complete a social history
TEAM: Please review their note prior to seeing each new patient
Social Work student will complete or help you complete a GDS and SLUMS/MOCA when deemed necessary
Social work student will identify resources

42. Pharmacy Student Expectations
Serve as the medication expert for the team and patient
Prior to the visit, complete a comprehensive medication history through review of the patient’s chart and reconcile outside medication information
During the visit they will…
Identify the medication management system in place
Understand high risk medications used
Identify medication-related problems and contribute to medication and non-medication treatment plan development
Provide education to team and patient/caregiver on medications (starts, adjustment, discontinuation, etc.)
Assist in documentation related to Pharmacy components of the visit (current medication & Patient Instructions)

43. GIAC Ground Rules for All Professions
Faculty and students are responsible for creating
A safe and supportive environment for learning
A patient-centered environment whereby patients are treated with respect inside and outside the patient room.
A collegial environment within which we speak to one another with mutual respect and have the courage to resolve conflict.

44. GIAC Ground Rules for All Professions
We’d like for every student to be able to –
Contribute to patient encounter as determined by pre-huddle discussion
Present the patient to the team and preceptor(s)
Receive feedback from interprofessional preceptors
Participate in interprofessional debriefing opportunities

45. GIAC Ground Rules for All Professions
We encourage every student team to –
Seek learning from all preceptors
Check in with the interprofessional preceptors while formulating your plan
Determine not only what your plan is, but how the plan will be communicated to the preceptor and patient

46. GIAC Survey
You will receive a survey at the end of your time in GIAC about your Interprofessional experiences.
Thank you in advance for taking the time to complete these surveys. Your feedback is greatly appreciated!

47. Questions?

48. Thank you for your attention!

49. References
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
TeamSTEPPS®: Strategies and Tools to Enhance Performance and Patient Safety. Agency for Healthcare Research and Quality. U.S. Department of Health and Human Services.
General Interprofessional Debriefing Questions Facilitator Guide. University of Kansas Medical Center. Josiah Macy Jr. Foundation. Interprofessional Learning in Practice: