Interprofessional Standardized Patient Exercise Orientation

What is the ISPE? During the ISPE you will work with a team of 3-4 health professional students and a standardized patient (SP) The ISPE is designed to give you: An opportunity to work with an interprofessional team to care for a patient Knowledge of the roles of other healthcare professionals in chronic illness care Experience in developing an interprofessional team care plan Feedback from an SP and your team about your communication skills

ISPE Team Members During the ISPE your team may include the following members: 3rd year medical student 3rd year dental student 3rd or 4th year pharmacy student 2nd year nurse practitioner student 3rd year physical therapy student Interns from the dietician program 2nd year social work student You may have encountered some of these SPs (standardized patients) in the past in other programs playing different roles. Please treat each patient as is this is the first time you have met this patient and disregard any memory of previous encounters.

On some teams there may be 2 students from the same profession On some teams there may be 2 students from the same profession. If this is the case, we recommend that you focus on different aspects of the case Team members may have differing levels of experience with SPs and with providing care in a clinical setting.

It’s all about the process… It is about working in a team with the patient to come to a clinical understanding of what might be going on with the patient and formulating a team plan.

ISPE Format – Initial Huddle You will have a 15 min “team huddle” to review the Patient Presenting Information, which you will find on 2 Clipboards that your team will share in your assigned Huddle Room. During your Huddle, your team will: Determine the student order for the interviews Consider the unique skills that each team member brings to the encounter Strategize and divide up tasks The case is sufficiently complex that you should think about dividing up tasks during the visit so that you have adequate time to address all the issues in the case.

ISPE Format: Patient Encounter For the patient encounter, each team member will have 15 minutes to perform: A focused history and physical exam, appropriate for your profession Information sharing/education with the patient of your preliminary assessment and plan Team members observe the encounter quietly in the room (they are “invisible” to you and the SP). ISPE faculty observe remotely. Team huddles and all encounters are recorded

Encounter Timing Listen to the intercom announcements and the Hall Proctor about when to start your encounters. You will hear a warning when there are 5 minutes remaining At 15 minutes, you will be notified that “time is up”; you and your observers must promptly leave the room If you decide to leave the room before the end of 15 minutes, you may not re-enter There will be a 5 minute break near the end of the encounters When you are told to leave the room you must leave the room immediately.

Between Encounters Your team will have ~5 minutes between each encounter to further discuss the case quietly in the hallway Did you forget or not have time to cover an issue that the next team member can address? Is there an issue that the next team member should cover? What is the team uncovering about the health issues of this SP? You will be notified when the next team member should begin their encounter.

Keep in mind…. The SP is aware that s(he) is being seen by a team of providers Treat the encounter like a real patient encounter in the outpatient setting You can refer to and build on information that your team member/SP discussed You do not need to repeat portions of the Hx or PE unless you feel that your profession’s approach is unique The standardized patient is aware that s(he) is being seen by a team of providers. All patient encounters should be dealt with as if they were being seen in an outpatient clinic. We recognize that the encounter and room set-up may be different than how you would typically practice. The goal of this exercise isn’t to perfectly recreate how you see patients in your setting, but to provide you with as authentic experience as possible, working in an interprofessional team. Treat the standardized patient as a real patient and the encounter as real clinical encounter. You may use information gathered from watching previous students interact with this patient. You do not need to repeat portions of the history or physical exam performed by other team members unless you need additional information or if you believe your profession’s approach is unique.

Team Care Plan/Team Huddle After the entire team has completed their encounters, your team have 18 min to huddle to discuss the case and develop a written Interprofessional Team Care Plan (you will not share this Plan with the SP) You will be given a blank form on which to write the plan, which you be handing in at the debrief session. Identify a spokesperson for your team to present elements of the Care Plan at the debrief session There is not sufficient time for your team to share the team plan with the patient at the end of the exercise. The hall proctor will direct you to a clinic room for your post-encounters team huddle.

Debrief Session 2-3 teams will join together for a 40 minute Debrief Session 1-2 faculty members will facilitate the session Students teams will first share elements of their Team Care Plan Teams will then discuss their ISPE experience The hall proctor will guide you to the room for the debrief session.

To Recap… Team Huddle to strategize Team Encounters Team Huddle for Team Care Plan Debrief Session with Faculty

Exam logistics: Find computer terminal for your room

Encounter Sign In Process Please sign in before your encounter on the computer associated with the room that you will enter. Your Username = “My Access” ID (i.e. SFXXXXXX). Your Password = Your UCSF Email password. (Any problems with the computers? Ask the hall proctor for help.)

On the hallway computer… Once your name appears on the screen… The exam room camera begins recording & you can enter the room Please click “Stop encounter” when you leave the room at the end of the encounter The exam room camera turns off and then the SPs are allowed to begin their evaluation

No invasive procedures There will be NO PELVIC, GENITAL, BREAST, OR RECTAL EXAMS PERFORMED on the SP For dental students, there will be no intraoral examination or periodontal probing. When you are ready to do this portion of the exam, please inform the patient “Now I’d like to do an intraoral exam.” The SP will provide you with a folder of the examination results. You may take this out of the room to review in more detail if you need to. Please give to the Hall Proctor to return the Exam Room when you have finished your review.

Please use the equipment in the exam room BP cuff Otoscope Ophthalmoscope Small equipment Supplies

Follow diagram on Controller to raise & lower portions of the table.

Please put the Controller back when you are done. Step here to rotate the table.

All you need is…. Your stethoscope (if you normally use one in your profession) and a pen or pencil Your white coat and name badge; dress professionally as you would with a real patient All equipment and supplies are provided in each exam room DO NOT take any personal props into the rooms including eye charts, crib sheets, etc. Leave pagers, cell phones, laptops, etc., in the provided location. For taking notes, please use the blank paper on one of your team’s Patient Presenting information clip boards. Turn in clipboards and notes before your debrief session. During the hallway team discussions between each encounter, you may elect to use information databases on your smart phone. (Faculty, this has been a bit inconsistent during the encounters; we should reach consensus on this)

Evaluation The SP will evaluate your patient-provider communication skills You to complete a brief written survey about the ISPE experience in an online Survey. A link to your SP evaluation, and the digitally recorded video of your patient encounter will be emailed to you within 1 month of the ISPE. Please access your UCSF EMAIL account directly. If you are forwarding your UCSF email account to another email service (including g-mail) the reporting system will not forward your scores. We recommend that you review your video with a faculty member from your profession to get the maximum value from this experience. Any of the ISPE faculty present at your session would be happy to review your video with you at a later date.

After Your ISPE Experience You will also be able to access a referenced sample team plan to review medical issues in the case We recommend that you review your SP encounter with a faculty member from your profession and that you review the Team huddle focusing on your teamwork skills.

Relax…have fun and enjoy the process. Final Words We hope that this is a positive interprofessional learning experience for you. Relax…have fun and enjoy the process.