PREPARING CLINICIANS TO BE EFFECTIVE INTERPROFESSIONAL PRACTICE INSTRUCTORS: The MGH and MGH Institute Experience Mary Knab, DPT, PhD Director, IMPACT Practice, MGH Institute of Health Professions Ann Jampel, MS, PT Physical Therapy Center Coordinator of Clinical Education, Massachusetts General Hospital Carmen Vega-Barachowitz, MS, CCC-SLP, FASHA Director, Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital Collaborating Across Borders VI October 3, 2017 1
Presentation Overview BACKGROUND: METHODS: IMPLEMENTATION: RESULTS: CONCLUSION: Context for work being presented IPI training and development Program development Program evaluation Program description Program evaluation Scale of program Potential application to varied settings Next steps for our work 2
BACKGROUND 3
Underlying Assumptions IPE essential to preparing a collaboration ready workforce Translating IPE into practice challenging for learners Meaningful IPE in the practice setting is critical Clinician instructors need support to translate uni-professional teaching skills into IPE 4
Massachusetts General Hospital (MGH) 1,050 bed medical center in Boston Teaching hospital affiliated with Harvard Medical School Committed to interprofessional patient-centered care 5
MGH Institute of Health Professions (IHP) School of Health and Rehabilitation Sciences Communication Sciences and Disorders Occupational Therapy Physical Therapy Physician Assistant PhD in Rehabilitation Sciences School of Nursing BSN (post-baccalaureate) MS (NP) RN to MS Doctor of Nursing Practice 6
Interprofessional Education at IHP School of Health and Rehabilitation Sciences School of Nursing Communication Sciences and Disorders Occupational Therapy BSN (post-baccalaureate) MS (NP) Physical Therapy Physician Assistant PhD in Rehabilitation Sciences RN to MS Doctor of Nursing Practice 7
Interprofessional Dedicated Education Unit (IPDEU) Adapted from nursing DEU model Unit clinicians (Nurse, PT, OT, SLP) serve as Interprofessional Practice Instructors (IPIs) Clinical Faculty Coordinators (CFC) coordinate, support IPIs, facilitate learning Focus on interprofessional aspects of care delivery 8
Interprofessional Clinical Experience (IPCE) Student dyads join IPIs on the IPDEU Two half-day sessions (consecutive weeks) Focus on interprofessional aspects of care delivery, not discipline-specific clinical skills IPIs maintain patient care responsibilities Teaching model requires IPI development 9
Supporting IPI Development Disclosures: Funded in part by grant from MGH Executive Committee on Teaching and Education (ECOTE) Authors supported as employees of MGH and MGH Institute of Health Professions 10
Aims of the IPI Development Program Enable clinician IPIs to: Effectively engage interprofessional student dyads Integrate dyads into the clinical day Facilitate learning focused on competencies for collaborative practice. Support broader goal of interprofessional clinical education model that is: Cost-effective Scalable 11
METHODS: Program Development Needs assessment via focus groups with former IPDEU instructors Working team developed resource toolkit and 90-minute training session CFCs implemented IPIs training and supported IPIs during student visits Piloted, evaluated, revised 12
METHODS: Program Evaluation Quantitative and qualitative data gathered IPI Survey: Pre-training, post-training, postexperience Knowledge items Self-efficacy items Scenarios How would you handle? Post-experience only: Narratives (i.e. brief story from IPI experience) Student Survey: Feedback on experiences with IPIs IPI focus groups: Post experience 13
PROGRAM DESCRIPTION 14
Needs Assessment Am I providing a valuable educational experience? Teaching tasks vs. teaching concepts Discipline-specific goals vs. IPP/IPE goals Teaching own discipline vs. teaching with other disciplines Dual role: clinician at bedside and IPP educator Retrieved 7/13/16: https://frrl.wordpress.com/2012/03/09/a-leaders-role-in-clearing-the-path-for-innovation/ 15
IPI Toolkit & Training: Key elements Intentionality: Explicitly and knowingly teach collaborative aspects of care delivery What does IPP look like in my everyday practice? Where? When? How? How can I make it visible? 16 16
IPI Toolkit & Training: Key elements Clinical teaching strategies Active observation Facilitated debriefing 17 17
Teaching Strategy: Active observation Observation as A PASSIVE PROCESS Creates potential for: Divided attention Missed opportunities Heightened anxiety At worst, a total shut down of the learner. [Clare Morris (2003). Teaching and learning through active observation. http://www.faculty.londondeanery.ac.uk/elearning/feedback/files/t-l_through_active_observation.pdf] Observation as an ACTIVE, PURPOSEFUL TASK Greater potential to: Engage learner s attention on desired elements Stimulate deep learning Develop professional know-how. 18
Teaching Strategy: Debriefing, Continuous and Summative OT Stud. Nurse Student SLP IPI 19
Post experience debriefing What? Structured period at end of session with CFC, IPIs, and all students CFC facilitated Students bring unanswered questions, observations of communication and team work, insights into roles and impact on patient care Why? Opportunity to reflect individually and collectively, expanding meaning making Promote critical thinking & deep learning Makes IPP visible to the learners 20
Toolkit Resources Booklet IPI copy, Unit copy Pocket cards Learning Objectives Setting the Stage script Active Observation: Steps and examples Sample facilitative quesitons: Pre- and post- encounter, Sample questions: Reflective 21
RESULTS 22
Results: IPI Demographics Age Years of Clinical Exp IPI # and Profession Prior CI in discipline? # Previous Students N= 14 Mean 28 4.21 Max 41 17 Min 24 1 Age and Clinical Experience N=14 4 Yes 18-21 2 OT 2 Yes 6-9 2 SLP 1 Yes 10 2 PT 0 0 8 RN 1 Yes 2 Profession and Clinical Teaching Experience 23 23
Results: IPI Self-Efficacy 5.5 5 4.5 4 3.5 3 X = 4.07 X = 4. 70 X = 4. 56 Pre Post 1 Post 2 Ability to facilitate IPE learning Provide effective learning and care Identify IPE opportunities Develop active observation questions Apply active observation Manage student activities Facilitate student reflection Make IPE visible to students Articulate decision making Facilitate learning across disciplines Self-efficacy scores at pretest, first posttest (after training) and second posttest (after clinical experience). 24 24
Results: Key qualitative findings Focus Group: Four themes emerged 1. Balancing Dual Role IPI s felt high degree of accountability to both their patients and students. 2. Sense of Effectiveness Implementing strategies from training Self-generated strategies Looking for more opportunities to develop 25 25
Results: Key qualitative findings Focus Group themes continued 3. AHA Moments Large degree of IP collaboration in their daily practice Students learned more than I taught Importance of making IPP visible to all students 4. Evolution of Role Identity Member of interprofessional team Interprofessional Practice Instructor 26 26
CONCLUDING COMMENTS Consistent and intentional IPI development is important and improves outcomes Training related to awareness of the IP aspects of care delivery is an asset. Further investigation: It is challenging to measure IPE s impact on care delivery might we be able to look at an intermediary such as unit culture? Changed IPI practice based on translating IPEC domains into own behaviors 28
THANK YOU Mary Knab mknab@mghihp.edu Ann Jampel ajampel@partners.org Carmen Vega-Barachowitz cvegabarachowitz@mghihp.edu 29