Interprofessional Asthma Education: Development of a Comprehensive Asthma Rotation in a Pediatric Residency Carolyn C Robinson 4/30/2014 xxx00.#####.ppt 11/10/2018

Problem Identification 1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach 1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach Importance of asthma Over 6 million children 4.7 million office visits yearly 700,000 visits to an emergency room; 200,000 hospitalizations Lack competency in asthma management Knowledge Meter Dosed Inhaler (MDI) technique 6. Evaluation and Feedback - Individual Learners - Program 6. Evaluation and Feedback - Individual Learners - Program 2. Targeted Needs Assessment - Learners - Learning Environment 2. Targeted Needs Assessment - Learners - Learning Environment * * Pre-test Post-test * 5. Implementation - Obtaining Political Support - Securing Resources - Addressing Barriers - Introducing the Curriculum - Administering the Curriculum 5. Implementation - Obtaining Political Support - Securing Resources - Addressing Barriers - Introducing the Curriculum - Administering the Curriculum 3. Goals and Objectives - Broad Goals - Specific Measurable Objectives 3. Goals and Objectives - Broad Goals - Specific Measurable Objectives Pre-Test Post-Test * Percent Correct Percent of Residents * * 4. Educational Strategies - Content - Methods 4. Educational Strategies - Content - Methods Changes in knowledge after online didactic. p<0.05 Overall assessment before and after instruction. p<0.001 Kim. Journal of Asthma 2009 Hemnes. Journal of Asthma 2009 Kern’s Six Step Approach to Curriculum Development Kern’s Six Step Approach to Curriculum Development xxx00.#####.ppt 11/10/2018

Needs Assessment Kern’s Six Step Approach to Curriculum Development 1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach 6. Evaluation and Feedback - Individual Learners - Program 2. Targeted Needs Assessment - Learners - Learning Environment Resident n=54 Faculty n=34 Resident n=54 Faculty n=28 5. Implementation - Obtaining Political Support - Securing Resources - Addressing Barriers - Introducing the Curriculum - Administering the Curriculum 3. Goals and Objectives - Broad Goals - Specific Measurable Objectives Percent of responses Rating 4. Educational Strategies - Content - Methods Faculty and resident response to need for curriculum Faculty and resident response on location of training Rating on a Likert Scale 1=Least Needed to 4=Most Needed Kern’s Six Step Approach to Curriculum Development xxx00.#####.ppt 11/10/2018

Kern’s Six Step Approach to Curriculum Development Goals and Objectives 1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach Goal Understand key aspects of outpatient asthma care in children. Objectives Obtain a comprehensive history of an asthmatic patient Accurately classify severity based on NHLBI guidelines Describe the control status according to NHLBI guidelines Recognize characteristics for increased risk of ICU hospitalization Recognize indications for referral to pulmonary medicine Teach the proper MDI and aerochamber technique Develop a plan for optimal asthma control 6. Evaluation and Feedback - Individual Learners - Program 2. Targeted Needs Assessment - Learners - Learning Environment 5. Implementation - Obtaining Political Support - Securing Resources - Addressing Barriers - Introducing the Curriculum - Administering the Curriculum 3. Goals and Objectives - Broad Goals - Specific Measurable Objectives 4. Educational Strategies - Content - Methods Kern’s Six Step Approach to Curriculum Development xxx00.#####.ppt 11/10/2018

Educational Strategies 1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach Interprofessional Education Asthma Educator, Clinical Pharmacist, Respiratory Therapists Comprehensive Approach All aspects of asthma care Variety of Educational Methods Different learning styles Condensed Short one week block 6. Evaluation and Feedback - Individual Learners - Program 2. Targeted Needs Assessment - Learners - Learning Environment 5. Implementation - Obtaining Political Support - Securing Resources - Addressing Barriers - Introducing the Curriculum - Administering the Curriculum 3. Goals and Objectives - Broad Goals - Specific Measurable Objectives 4. Educational Strategies - Content - Methods Kern’s Six Step Approach to Curriculum Development xxx00.#####.ppt 11/10/2018

Educational Methods Lecture Self Directed Learning Direct Observation “Empty Outlines” “Instructor Storytelling” “Pop culture” Self Directed Learning Syllabus of articles Online asthma modules Scavenger hunt Direct Observation Reflection “Muddiest Point” “Harvesting” “One minute papers” Patient Interaction Counseling Interpretation of Spirometry Evaluation Skills instruction www.notonemorelife.org

Kern’s Six Step Approach to Curriculum Development Implementation 1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach Support Residency program leadership, chief residents, and medical educators Pulmonologists, pulmonary fellowship program Resources Interprofessional collaborators Authors of online material Syllabus of articles Barriers Scheduling Standardization Curriculum introduced July 2013 6. Evaluation and Feedback - Individual Learners - Program 2. Targeted Needs Assessment - Learners - Learning Environment 5. Implementation - Obtaining Political Support - Securing Resources - Addressing Barriers - Introducing the Curriculum - Administering the Curriculum 3. Goals and Objectives - Broad Goals - Specific Measurable Objectives 4. Educational Strategies - Content - Methods www.notonemorelife.org Kern’s Six Step Approach to Curriculum Development xxx00.#####.ppt 11/10/2018

Weekly Schedule Interprofessional Activities Educational Activities Day 1 Introduction Didactic Lecture with pulmonary fellow Online Modules Reading of Articles Pre-assessment of asthma knowledge and Meter Dose Inhaler (MDI) skills Taste testing with clinical pharmacist Day 2 Direct Patient Care and Physician Modeling with pulmonary attending in After Hospital Asthma and Life Threatening Asthma Clinics Day 3 Direct Patient Care and Physician Modeling at Health Centers with pulmonary attending Day 4 Participate with asthma educator Participate with Pulmonary Diagnostic Lab and respiratory therapists Day 5 Wrap up lecture with questions Post-assessment of asthma knowledge and MDI skills Evaluation Day 1 Introduction Didactic Lecture with pulmonary fellow Online Modules Reading of Articles Pre-assessment of asthma knowledge and Meter Dose Inhaler (MDI) skills Taste testing with clinical pharmacist Day 2 Direct Patient Care and Physician Modeling with pulmonary attending at After Hospital Asthma and Life Threatening Asthma Clinics Day 3 Direct Patient Care and Physician Modeling at Health Centers with pulmonary attending Day 4 Participate with asthma educator Participate with Pulmonary Diagnostic Lab and respiratory therapists Day 5 Wrap up lecture with questions Post-assessment of asthma knowledge and MDI skills Evaluation Day 1 Introduction Didactic Lecture with pulmonary fellow Online Modules Reading of Articles Pre-assessment of asthma knowledge and Meter Dose Inhaler (MDI) skills Taste testing with clinical pharmacist Day 2 Direct Patient Care and Physician Modeling with pulmonary attending at After Hospital Asthma and Life Threatening Asthma Clinics Day 3 Direct Patient Care and Physician Modeling at Health Centers with pulmonary attending Day 4 Participate with asthma educator Participate with Pulmonary Diagnostic Lab and respiratory therapists Day 5 Wrap up lecture with questions Post-assessment of asthma knowledge and MDI skills Evaluation Interprofessional Activities Educational Activities xxx00.#####.ppt 11/10/2018

Improvement in Knowledge: Written Test 1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach Objective Before After p value n Obtaining a comprehensive history of an asthmatic patient 2.8 4.48 <0.001 25 Indications for the use of different inhaler devices 1.96 4.28 Being able to teach the proper inhaler technique 1.56 4.56 Classifying the severity of asthma per NHLBI guidelines 2.36 4.08 Determining asthma control status per NHLBI guidelines 2.16 4.04 Recognizing patients at risk for ICU hospitalization 2.52 Indications for referral to Pulmonary 2.24 3.92 Developing an outpatient plan for optimal asthma control 4.36 6. Evaluation and Feedback - Individual Learners - Program p=0.001 n=26 2. Targeted Needs Assessment - Learners - Learning Environment p<0.001 n=26 n=24 5. Implementation - Obtaining Political Support - Securing Resources - Addressing Barriers - Introducing the Curriculum - Administering the Curriculum 3. Goals and Objectives - Broad Goals - Specific Measurable Objectives 4. Educational Strategies - Content - Methods (at end of rotation) (did not take rotation) Self perceived knowledge before and after the rotation. Likert Scale 1=Not knowledgeable to 5=very knowledgeable Kern’s Six Step Approach to Curriculum Development xxx00.#####.ppt 11/10/2018

Improvement in Skill: MDI Technique (at end of rotation) (did not take rotation) Based on checklist of items necessary to perform the skill proficiently xxx00.#####.ppt 11/10/2018

Satisfaction 100% of residents Rating Rotation should be offered again Rotation should be required Would recommend the rotation to a colleague Plan to implement what they learned in their future career Satisfaction with Rotation Components Rating Rating on a Likert Scale of usefulness (n=25). 1=Not useful 5=Most useful. xxx00.#####.ppt 11/10/2018

Conclusions Positive learning experience on outpatient asthma care Benefits of using a structured framework Uses an innovative, comprehensive approach to teaching of asthma IPE is an excellent tool Significant improvement Written test scores and MDI technique Framework for other departments Future Directions: Sustainability and Retainability xxx00.#####.ppt 11/10/2018

Acknowledgements Dr. Jen Rama Dr. Mark Ward Dr. Siby Moonnumakal Dr. Robert Moore Dr. Julie Katkin Pulmonary Diagnostic Lab Kai Sanders xxx00.#####.ppt 11/10/2018