1. Introduction to Interprofessional Education
Providing Safe and Effective Care for Patients
with Limited English Proficiency
Classroom Session 1:
Introduction to Interprofessional Education
Introductory remarks – 2 min. (1 min. on clinical quality & safety and limited English proficiency; 1 min. on Interprofessional Education)
Course Instructor 1 Welcome. I am ____________. This is an innovative curriculum that addresses an increasingly relevant issue in health care delivery: improving safety and effectiveness of care for patients with Limited English Proficiency (LEP).
Course Instructor 2
I would like to welcome you as well. I am ____________. In addition to addressing safety for Limited English Proficient patients, we have designed the course to provide an interprofessional learning experience.
This course was developed with the support of the Josiah Macy Jr. Foundation. These slides may be reproduced and adapted provided that attribution to the Disparities Solutions Center at Massachusetts General Hospital and the MGH Institute of Health Professions is clearly stated on any resulting materials and it is used for non-commercial, educational, or professional development purposes.

2. Class Overview Introductions (15 min) PowerPoint (15 min)
Interprofessional Icebreaker (30 min)
Reflective Exercise (20 min)
Video Case Study and Team Exercise (30 min)
Wrap up (5 min)
Explanation of Online Assignment (5 min)
Course Instructor 1
Walk students through the agenda for the class.
Introductions (15 min)
Welcome any participants or observers (e.g., faculty facilitators, interpreters, etc), and ask them to introduce themselves briefly
Ask students to introduce themselves by providing: name, program, and reason for enrolling in the class

3. Curriculum Map
Module 1 Learning Goal: Understand the evidence for disparities and high rate of medical errors, particularly for patients with limited English proficiency.
Module 2 Learning Goal: Work effectively with interpreters and other care team members to ensure safe, high-quality care for patients with limited English proficiency.
Module 3 Learning Goal: Explore the ways that systems of care can be improved to ensure quality and safety for patients with limited English proficiency in a team environment.
E-learning Module 1
(20-30 min)
Classroom Session 1
(2 hrs)
Online Group Assignment 1
(20 min)
E-learning Module 2
Classroom Session 2
Online Group Assignment 2
(30 min)
E-learning Module 3
Classroom Session 3
Online Group Assignment 3
15 min to present PowerPoint slides 3-8.
Course Instructor 1
Review logistics for the course:
There are 3 modules: You have completed the e-learning section of Module 1, are here for this class (today/ tonight), and will complete the online group assignment after this class by _____________ (provide due date).
The next two weeks will repeat the sequence of e-learning, classroom sessions, and online assignments.

4. Learning Objectives Module 1 Learning Goal
Understand the evidence for disparities and high rate of medical errors, particularly for patients with limited English proficiency.
Module 1 Learning Objectives
Recognize gaps in knowledge and skills regarding safe care for patients with LEP
Recognize value of interprofessional collaboration, communication, and teamwork to improve safety for patients with LEP
Describe core competencies for interprofessional collaboration
Develop interprofessional team-based strategies for working effectively with medical interpreters to prevent adverse events for patients with LEP
Course Instructor 1
The overall goal is to create a culture of excellent care for patients with LEP through individual and team based practice provided in health care systems that are responsive and inclusive to all patients and populations. We hope that this experience will help improve safety and quality and reduce risks of accepting inadequate language and interpretation processes. We hope to refine medical and nursing education for patient safety and interprofessional care.
There are specific objectives (note on slide).
We would like each of you to become champions for safe and effective care for patients with limited English proficiency as future health care leaders. We value your opinions and perspectives. We hope to create a student-centered experience: that you become engaged, and speak up when you feel that there may be different viewpoints, approaches, or other aspects of the curriculum that may be improved.

5. Why Safety for Patients with LEP?
Higher rate of medical errors
Effective intervention (interpretation)
Need to change culture within health care organizations
Course Instructor 1
Our main purpose is to create a culture of safe and effective care for patients with LEP, to change the current culture as needed.
This is driven by these factors:
Patients with LEP experience higher rates of errors and those errors lead to more harm and worse consequences than for those who speak English as their native language. Examples include: higher rates of falls, medication errors, and readmissions.
Professional interpretation has been shown to be effective in decreasing the rates of errors.
We believe that changing the health care culture for patients with LEP will improve their health outcomes.

6. Interprofessional Education
“When students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”
Course Instructor 2
As you proceed through your professional education, you may have noted the complexity of your patient’s needs for care, and, indeed, the complexity of caring for vulnerable populations.
Medical and nursing students seldom share clinical learning experiences although, in reality, practice is shared. Creating interprofessional learning opportunities fosters collaboration, trust, and open communication with the potential to remove barriers between nurses and physicians not only in training but in actual practice.

7. Interprofessional Team-Based Care
Intentionally created
Small work groups
Collective identity
Shared responsibility
Particular group of patients
Course Instructor 2
We have created teams based on the information you gave us, making each team as diverse as possible. We have teamed equal numbers of medical and nursing students, some with experience working with diverse populations, others with less so, and some with language proficiencies other than English. The teams are small (4-6 people). You will have both individual and shared responsibility to speak up, identify issues, and solve problems and complete assignments.
You may be able to integrate this experience into many practice settings. This course will also give you opportunities to reflect on the learning experiences through team discussions and activities.
Reference: Core competencies for interprofessional collaborative practice. Report of an expert panel. (2011). Retrieved on May 7, 2013 from

8. Core Competencies for Interprofessional Collaborative Practice
Collaboration
Communication
Values and ethics
Course Instructor 2
We are focusing on the development of Knowledge, Skills, and Attitudes across a learning continuum. Some of you have been exposed to the experiences of patients with limited English proficiency either through personal experience, clinical rotations, or other work settings.
This course is an immersion experience that should develop your competency in two areas: collaborating among professions as team members and working effectively with interpreters and health care systems to improve care for those with limited English proficiency.

9. Interprofessional Icebreaker
Students:
Describe the training and education you receive as a medical or nursing student. How does your training differ from your colleagues in the other profession?
Describe your experience (if any) working with interpreters. This can be professional interpreters or ad hoc interpreters (e.g., patient’s family/friend or staff who speak the language but have not been trained as medical interpreters).
Interpreters:
Describe your day-to-day work. What is a typical day like for you? How do you get assigned to interpret for a patient? What is your schedule like?
Students have 30 min. for this discussion.
Course Instructor 2
In order to work effectively in a team-based environment, it is essential that students in the health professions get to know one another and understand each others’ training and roles, as well as the roles of other members of the care team that they will be working with, such as professional interpreters.
Use this time in your groups to have a discussion addressing the questions on this slide. We’ll leave this up for you to refer to throughout your discussion. Feel free to ask the interpreter additional questions about his/her role as well.

10. Reflective Exercise: Hospital in Laos
Begin reflective exercise. There is 20 min. total for this activity.
First 10 min of exercise:
Course Instructor 1
Describe the activity to students. Ask students to close their eyes and listen to the scenario as it is read aloud. (5 min.)
Give students 5 min. for their team to consider how they feel about the inability to speak directly to the doctors and nurses taking care of them.
The above photo is courtesy of Trip Advisor < >.

11. Reflective Exercise: Hospital in Laos
Large group discussion (10 minutes)
Course Instructor 2
How might an experience such as the one described in this scenario influence your practice with patients with Limited English Proficiency?
The above photo is courtesy of Jim Harris from We Help War Victims

12. Video Case Study & Team Exercise
TeamSTEPPS “Opportunity” Video
30 minutes for this exercise
Introduce & Show Video (5 min.)
Course Instructor 1
You will be watching a video case study of a middle aged Latino man with limited English proficiency who is seen by a nurse and a physician in the emergency room. In this case the patient experiences a delay in appropriate intervention, as well as a poor outcome. As you watch the scenario unfold, consider the questions on the handout for this exercise in your team folder.
Team Discussion (10 min.)
Course Instructor 2
The team facilitators will guide a brief discussion. There is a flip chart for each team. Please select one person to record and report back to the larger group.
Large Group Debriefing (15 min.) Course Instructor 2
Let’s quickly hear from each team about their groups discussion.
What problems did you note about communications among doctor, nurse, interpreter, patient, and patient’s wife? (go through each team)
Now let’s hear about your discussion about responsibility for improving communication, (go through each team)
How could the team have worked better to prevent any adverse events?
Think about collaboration: is there a difference between collaboration and communication?
Were their differences between individual vs team values and ethics?
Were their differences on how you perceived individual roles and responsibilities?

13. Wrap Up Key take-home messages from today’s class
Additional questions, comments, or observations?
10 min. to wrap up the class
Course Instructor 1 (5 min.)
Ask students to reflect on the key take-home messages from the class
Invite any final questions, comments, or observations
Course Instructor 2 (5 min.)
Describe the online assignment:
Please refer to the online assignment instructions in your folder. The purpose of this assignment is to reinforce material covered in e-learning and tonight’s session and link to Module 2. Please read the case study and respond to the question via the online discussion board.