Interprofessional learning and teaching in evidence-based practice Arlene Smaldone, PhD, RN

Interprofessional Education

Interdependence of health professions’ education and practice needs

Learning within professional silos

Interprofessional teamwork, an IOM Core Competency

Teaching and learning evidence-based practice skills 2007 IOM convened Roundtable on Evidence Based Medicine To help transform the way evidence on clinical effectiveness is generated and used to improve health and health care Goal – by 2020, 90% of clinical decisions will be supported by accurate, timely and up to date clinical information reflecting best available evidence Institute of Medicine (US). Evidence-Based Medicine and the Changing Nature of Healthcare: 2007 IOM Annual Meeting Summary. Washington (DC): National Academies Press; 2008. Appendix C

Evidence-based practice is ideal for interprofessional education approach Content and skills consistent across disciplines Good practice for professional environment

EBP Education has been well studied Synthesis of 16 systematic reviews that examined effects of teaching evidence based health care (Young et al. 2014, PLOS ONE) 10 SRs: Undergraduate and postgraduate 6 SRs: Postgraduate and continuing professional development Only 6 studies examined interprofessional EBP education

Interprofessional EBP studies 6 studies (1998 and 2014) Canada, UK, Hong Kong Variety of study designs All reported attendees from ≥2 disciplines None reported EBP faculty by discipline Program intensity Most one day or less

Interprofessional EBP content Formulating PICO questions (2) Searching the literature (3) Critical appraisal skills (3) Appraisal of systematic reviews (1) Apply evidence to decision-making (1) Identify strategies to implement evidence in local context (1)

Training programs in EBP Focus on a narrow spectrum of knowledge and skills Curriculum related to development, implementation and evaluation of evidence based clinical practices and policies and their implementation in clinical settings is often omitted Most EBP education delivered in discipline specific silos Few utilize interprofessional education approaches Of these, most examined only immediate outcomes Only one study examined longer term outcomes at 6 months Knowledge and EBP core skill retention No change in decision-making behaviors

Teaching Evidence Assimilation for Collaborative Health Care Unusual regarding Broad scope Level 1: acquisition of EBP skills with focus on care of individual patients Level 2: how EBP skills are applied to development of national policies and learn how to adapt for use in local settings Level 3: knowledge translation to maximize value of research in system wide improvement initiatives Interprofessional learning environment Simulate the practice setting

TEACH: Interprofessional evolution over time Data extracted from 2009-2016 workshop registrations, small group enrollments, assigned tutors and plenary sessions by disciplines 2015 – added questions regarding interprofessional experience to workshop evaluation survey Analyzed data Descriptive statistics Qualitative content analysis

TEACH participants 2009-2016 * *2009 Nurses and librarians included in “other”

Greater diversity in TEACH attendees over time Year Attendees Other Disciplines 2009 19.0% Includes nurses and librarians 2010 6.0% Researchers; medical and library science students 2011 82 18.3% Researchers; medical student; Physical therapist; Pharmacist; Administrators; Epidemiologists 2012 45 24.4% Researcher; medical student; Administrators; Epidemiologists; Dentist; Nutritionist; Social worker 2013 74 31.1% Researchers; graduate students; Pharmacists; Administrators; Dentist; Nutritionist; Social worker 2014 59 28.8% Researchers; Administrators; Nutritionist; Social worker; Genetic counselor; Physician assistants; Social worker

TEACH enrollment track by year (2009-2016)

TEACH small group facilitators (2009-2016)

TEACH Plenary Sessions (2009-2016)

2015 what conference attendees said….. While the majority of 2015 participants had received prior education in EBP, less than half had received this education with interdisciplinary educators (35%) or with attendees from other professions (45%) Majority reported improved knowledge (94%), competence (90%) and performance (90%) as a result of TEACH participation What attendees reported liking best “the interdisciplinary interaction and ideas shared” “problem focused, patient-centered and multidisciplinary…”

Conclusions Interprofessional EBP education not common Having participants and faculty from several disciplines doesn’t make education interprofessional Environment conducive to sharing of perspectives and mutual trust Acquisition of skills doesn’t guarantee implementation of evidence into practice

What you should expect

Implementation of projects sparked during TEACH Location Type Project Leader Project Type Outcomes 1 NYC Community hospital Clinical leadership Reducing heart failure readmission Initiated protocol; heart failure readmission reduced in year 1 2 Canada Pediatric diabetes care Pediatric sepsis Emergency care protocols Protocols developed and disseminated 3 Philadelphia Academic medial center Nursing (CNS) CAUTI

What will your long term outcomes be?