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

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

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

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

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 1/29/2010 IPTS: Folding Medical Students into the Mix

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: 2007-2008) “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 1/29/2010 IPTS: Folding Medical Students into the Mix

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

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 1/29/2010 IPTS: Folding Medical Students into the Mix

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 7 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 1/29/2010 IPTS: Folding Medical Students into the Mix

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 1/29/2010 IPTS: Folding Medical Students into the Mix

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 1/29/2010 IPTS: Folding Medical Students into the Mix

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

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. 1/29/2010 IPTS: Folding Medical Students into the Mix

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

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

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 1/29/2010 IPTS: Folding Medical Students into the Mix

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

References Institute of Medicine (2001). Crossing the Quality Chasm. Washington, D.C., National Academy of Sciences. Pp 48-51. 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 1/29/2010 IPTS: Folding Medical Students into the Mix

Questions and Comments 1/29/2010 IPTS: Folding Medical Students into the Mix 19