Moving toward the Development of Interprofessional E-Cases N. Posel, S. Faremo & D. Fleiszer

Good things, when short, are twice as good. Baltasar Gracian, The Art of Worldly Wisdom

Presentation Overview 1.Interprofessionalism in healthcare 2.Relevant learning theories and the development of interprofessional e-cases 3.Design features of the e-case model currently in development at McGill university 4.The process of utilization

Interprofessional Practice “The healthcare system is in need of reform…...improvements will come when health care providers work more effectively in teams and when they have the competencies to practice in increasingly accountable and technological environments.” (Stephenson, 2002) Interprofessionalism in Healthcare

Sometimes…….

Gaps and Overlaps  Gaps:  Can impact on safety and quality of care  Overlaps or redundancies:  Can impact on access, efficient use of resources and consistencies among professionals Interprofessionalism in Healthcare

Interprofessional Practice “Health professionals must work interdependently in carrying out their roles and responsibilities….with an appreciation of each professions unique contributions to health care.” (O’Neil and the Pew Health Professions Commission, 1998) Interprofessionalism in Healthcare

Professionalism in the Current Clinical Setting  Uni - professional socialization has already occurred  Competencies and expertise are defined and in use  Professional boundaries have generally been determined and refined Interprofessionalism in Healthcare

Interprofessionalism in the Clinical Setting Attitudes & Perceptions – Building Trust and Respect Skills & Areas of Expertise – Redefining Boundaries Interprofessionalism in Healthcare Knowledge – Transfer & Sharing

 Practitioners, learners, patients, their families & the environment Interprofessionalism in the Clinical Setting Interprofessionalism in Healthcare  Develop common, complementary and collaborative competencies

Theoretical Framework Learning Theories 1.Adult learning:  Autonomous, active and self-directed  Motivated by the relevant and the practical 2. Professional socialization;  Domain specific knowledge  Reflective practice  Zones of proximal development

Learning Theories 3.Communities of learning and practice  Cooperative learning within a collaborative environment  Situated and experiential learning 4. Cognitive Apprenticeship  Knowledge transfer  Modeling  Coaching, scaffolding, fading and reflection Theoretical Framework

Interprofessional e-Cases Learning Theories & Design Features 1.Approximate actual situations in which interprofessional teams practice within a ‘real-life’, clinically meaningful environment (D’Eon. 2005) 2.Be sufficiently complex that they cannot be done alone, thus reinforcing collaborative competencies (Steinert, 2005) 3.Allow participants to move towards interdependent collaboration using the case scenario to accent teamwork, communication and enriched quality of patient and family care (Barr, 2005)

Design Features e-Case Model in Development at McGill 1.Flexibility  The case scenario allows the team determine who leads each case and which professionals are included 2.Virtual but ‘real’ environment  Realistic and meaningful environment  Multimedia (including audio and video)  Hyperlinks, prompts and access to teaching modules  Ability to archive, reuse and repurpose 3.Teaching & Learning  Access to expert summaries and rationales

Design Features e-Case Model in Development at McGill 4.Initial uniprofessional approach  Highlight existing attitudes and perceptions  Reinforces unique professional knowledge  Permits sequencing 5.Integration of individual care plans into an interprofessional care plan or ‘blueprint’  Highlights group dynamic 6.Synthesis  Identification of gaps and overlaps

3. Integrated Interprofessional Care Plan Review of the e-case computer generated ‘Blueprint’/interprofessional care plan Group analysis of gaps and overlaps Group revision to interprofessional care plan Refine action items, mandates and outcomes measures (to determine efficacy) Delegate roles and responsibilities & support Formalize care plan as an ongoing document 4. Summary & Evaluation Evaluation of patient and professional progress Treatment, post treatment, discharge planning and follow-up Outcome measurement & efficacy review Plan archived for patient and student education 1. Presentation of Clinical Scenario Presentation of e-case Group discussion about the professions and case leader(s) required for the specific case scenario with associated rationales Review of professional perceptions, attitudes and beliefs specific to the case scenario Initial uni-professional assessment, determination of action items, rationales, timeframes & sequencing 2. Group Discussion Formalization of the initial interprofessional group, (professions and case leader) Interprofessional meeting(s) to review uniprofessional care plans Inclusion of the patient’s voice Assignment of roles and responsibilities Input of uni-professional plans into the computer model for the e-case ‘Blueprint’ The Process for e-Case Development: Clinical Setting

The Process for e-Case Development: Academic Setting 1. Presentation of the Case to the Learners Small uni-professional student groups study the e-case scenario Each group develops a uniprofessional care plan 2. Roundtable Students participate in an interprofessional group to review the case. For each group: a) A case leader(s) is chosen b) Uniprofessional care plans & rationales are reviewed & integrated into interprofessional care plan c) The e-case generates an interprofessional blueprint 3. Evaluation Students access, review & compare: a. The uniprofessional ‘expert’ care plan and rationales with their own b. The interprofessional ‘expert’ care plans and rationales with their own

Presentation of the Clinical Scenario

Development of Uni-professional Care Plan

An Example of Uni-professional Care Plan:

e-Case Blueprint

Nancy Posel Moving toward the Development of Interprofessional E-Cases