The Interprofessional Standardized Patient Encounter: Preparing Medical, Nursing and Pharmacy Students to Join Forces! Jana K. Zaudke MD, MA University of Kansas Medical Center

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

Background Interprofessional Teaching Clinic (IPTC) –Interprofessional student teams see patients in a live outpatient primary care setting. MondayTuesdayWednesdayThursdayFriday 8AM-12PMIPTC: M/P/HIMIPTC: M/P/NIPTC: M/P/N/PsyIPTC: M/P/PsyIPTC: M/P/PT 1PM-5PMNO IPTCStudio PopIPTC: M/P/OT/PsyNO IPTC

Background Studio Pop – Our educational adjunct to IPTC MondayTuesdayWednesdayThursdayFriday 8AM-12PMIPTC: M/P/HIMIPTC: M/P/NIPTC: M/P/N/PsyIPTC: M/P/PsyIPTC: M/P/PT 1PM-5PMNO IPTCStudio PopIPTC: M/P/OT/PsyNO IPTC

Background Studio -- a workshop environment –Design studio teaches critical thinking and creates an environment where students are taught to question all things in order to better designs. 1 Pop -- population health management –Attention to health disparities –Aim to improve health of population 1 AIAS Studio Culture Task Force. The Redesign of Studio Culture. Washington, DC: American Institute of Architecture Students; 2002.

Background Studio Pop activities transform education and practice simultaneously. –‘Pop Tarts’ Reflection and Debriefing exercises ‘Hot Spotting’ Low and High Fidelity Simulations Practice Improvement

Background Studio Pop activities transform education and practice simultaneously. –‘Pop Tarts’ Reflection and Debriefing exercises ‘Hot Spotting’ Low and High Fidelity Simulations Practice Improvement

Background Low and High Fidelity Simulations –Crucial Conversations and Conflict Resolution –Interprofessional Medical Error Disclosure –Interprofessional Standardized Patient (SP) Encounter

Background Low and High Fidelity Simulations –Crucial Conversations and Conflict Resolution –Interprofessional Medical Error Disclosure –Interprofessional Standardized Patient (SP) Encounter

Activity Objectives Roles/Responsibilities –Understand the roles of each primary care team member involved in the patient visit. –Value the unique contribution of each member of the primary care team. Interprofessional Communication –Develop a collaborative patient care plan as an interprofessional primary care team. –Listen actively, and encourage ideas and opinions of other team members. –Provide constructive feedback to other team members, responding respectfully as a team member to feedback from others.

Activity Description Learners –The learners are at various levels in their education based on the program length. –However, all learners are more advanced in their skills and have some experiential clinical learning. In our activity, participants are: –3 rd year Medicine –6 th year Pharmacy –4 th year Nursing

Activity Description IPE SP Visit #1 –Simulation is BEFORE students see patients together in IPTC. IPE SP Visit #2 –Simulation is AFTER completion of their rotation.

Case Description Mr. Newman is a 54 year old male who presents to establish care at a primary care clinic with acute complaint of polyuria and polydipsia. –History of HTN, Type 2 DM, Hyperlipidemia, Smoking, Obesity

Case Description: Visit #1 Each team will need to prioritize problem list, and decide how to address: –Elevated blood sugar and blood pressure Each team will need to decide whether to address: –Weight loss –Diet –Exercise –Smoking cessation –Preventive recommendations We expect students to address barriers to adherence and self-management. –Hidden Problem: Literacy He knows his medications, but refers to them by first initial. He appears motivated but health literacy is low.

Case Description: Visit #2 Each team will need to prioritize problem list, and decide how to address: –Discrepancies in patient’s reported blood sugars in the context of intensification of therapies Each team will need to decide whether to address: –Weight loss –Diet –Exercise –Smoking cessation –Preventive recommendations We expect students to address barriers to adherence and self-management. –Hidden Problem: Cost of prescription medication He cannot afford Januvia now that coupon has expired. He chose to pay for it anyway, but did not pay for insulin. –Insulin injection is just as expensive, and painful to inject.

Event Timeline Group #1Group #3 Huddle 15 min Encounter 30 min Huddle 10 min Presentation 10 min Patient Wrap up 15 min Debrief 10 min Total Time90 min Group #2: OBSERVES GROUP #1 AND COMPLETES evaluation tool Group #4: OBSERVES GROUP #3 AND COMPLETES evaluation tool Huddle 15 min Encounter 30 min Huddle 10 min Presentation 10 min Patient Wrap up 15 min Debrief 10 min Total Time90 min

Event Timeline Group #2Group #4 Huddle 15 min Encounter 30 min Huddle 10 min Presentation 10 min Patient Wrap up 15 min Debrief 10 min Total Time90 min Group #1: OBSERVES GROUP #2 AND COMPLETES evaluation tool Group #3: OBSERVES GROUP #4 AND COMPLETES evaluation tool Huddle 15 min Encounter 30 min Huddle 10 min Presentation 10 min Patient Wrap up 15 min Debrief 10 min Total Time90 min

Event Timeline After the ‘do over’, all groups gather to debrief at the end of the afternoon. –1. What surprised you, or in other words, what did you learn about the other professions and their contribution to the patient simulation? –2. What are the pros/cons of caring for the patient as an interprofessional team? –3. What are your key take home points from this simulation and how will you use this in the Interprofessional Teaching Clinic?

Evaluation iTOSCE rubric completed for Visits #1 and #2 –Subscales IP Patient-Centered Communication IP Team-Based Communication Interview and History Collaborative Patient Care Plan –Scale is 0= ‘not observed’ or 1= ‘observed’. iTOSCE completed by: –Students, faculty and SP

Evaluation Interprofessional Patient-Centered Communication Each team member introduced self to patient. Each team member explained professional role to patient. The team explained the “team-based” visit. The team set expectations at the beginning of the visit with the patient. The team elicited the patient’s perspective throughout the visit. The team demonstrated empathy to the patient. The team negotiated a treatment plan with the patient. The team communicated to the patient in terms they could understand. Interprofessional Team-Based Communication During the Huddle before the encounter, the team pre- determined roles/tasks for each team member. Everyone on the team contributed to the patient interview. The team was organized in their approach during the patient encounter. During the Huddle after the encounter, everyone on team contributed to developing patient care plan. Everyone on the team contributed to communicating the plan (including education) to the patient. The team was respectful to all profession’s ideas. If needed, the team utilized conflict resolution to achieve team consensus with patient care plan.

Evaluation Interview and History Interview addressed 1. Chief Complaint 1.History of Present Illness 1.Past Medical History 1.Family History 1.Social History 1.Review of Systems Patient Interviewed regarding medication reconciliation. Patient interviewed regarding health maintenance (e.g., smoking status, immunizations). Patient interviewed regarding self-care of chronic diseases (e.g., home blood glucose/pressure monitoring, diet, exercise). Patient assessed for adherence to treatment plan (e.g., meds, lifestyle changes). Physical exam was performed.

Evaluation Collaborative Patient Care Plan Team addressed concern for health literacy. Team addressed need for patient education. Team developed appropriate clinical care plan (e.g., labs, diagnostic tests, medications, referrals).

Evaluation Video and transcription review –Utilization of the huddles –Team formation and roles –Agenda setting –Conflict resolution

Evaluation Reflections –Describe one thing you learned from the SP experience in Studio Pop and discuss how you will utilize the new knowledge and skills in the IPTC. Participating in this program has increased my understanding of what other health professionals know and go through to complete their program…I know that I can rely on [them] for help. – M3 Understanding that one person does not have to know everything in order to have a successful encounter is the key to working well as a team. – M3

Conclusions Triumphs –Students are more likely to form teams on their own. –Students are more likely to huddle before and after the encounter. –Students report increased efficiency. Students and preceptors actively work to balance educational needs of our IP teams, patient complexity, and patient satisfaction.

Conclusion Challenges –The ‘do over’ effect –Faculty development We need preceptors who are the nexus for interprofessional practice and education. –IPE and IPP Assessment

Thank you to my interprofessional colleagues: Dr. Sarah Shrader PharmD Dr. Jim Kleoppel PharmD Dr. Chris Phillips DNP Dr. Sarah Marks MD Thank you to the Medical Alumni Innovative Teaching Fund at KUMC for funding!