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University of Virginia: Creation of Clinically-Relevant IPE
Simulations and Objective Assessment Tools
Valentina Brashers MD, FACP, FNAP Professor of Nursing and Woodard Clinical Scholar
Attending Physician in Internal Medicine Founding Co-Director, Center for ASPIRE
University of Virginia
Objectives of this Presentation
After viewing this webinar, participants will be better able to:
• Discuss the UVA method for creating IPE simulations based on Collaborative Care Best Practice Models
• Describe the implementation of these IPE simulations during clinicals/clerkships for all medical and nursing students
• Describe the development and implementation of objective tools for longitudinal assessment of IPE competencies
• Identify potential benefits and challenges for implementing these methods at their own institutions
Need for more clinically relevant IPE experiences and objective tools
• Rapidly accumulating evidence that teamwork is essential to achieving the Triple Aim
• Link between IPE and measurable changes in teamwork behaviors less well documented
• New tools needed for developing clinically-relevant IPE activities and for measuring teamwork behaviors
The UVA Approach to IPE
Learners come to us with many preconceived notions
• About what is really important for them to learn (= low tolerance for “fuzzy fringe stuff”)
• About IPE (= fuzzy fringe stuff)
• About working with other professions (= know what they are “supposed” to say…)
Conceptual Framework for UVA IPE
• Clinically-relevant IPE moves teamwork from fringe to core:
– Learning occurs most effectively when it is reinforced by real-life clinical experiences
– Important to bridge the gap between the academic and clinical “silos” by aligning educational goals with Health System priorities for care delivery
– Faculty/clinician development is key component – students will model what they see
– Essential to integrate IPE skills with profession-specific skills and embed teamwork into traditional curricula across the learning continuum
• Fully integrated into the programs of study
Conceptual Framework for UVA IPE
• Experiential learning
– Hands-on IPE skills learning creates the greatest likelihood for enduring changes in practice behaviors
– Changes in attitudes follow good IPE experiences
• Competency-based assessments used as both formative and summative evaluation tools
– Students tend to value most those things on which they are evaluated/tested
– Support observable and measurable changes in skill application to patient care
– Self-assessment and feedback make learning objectives more tangible and “owned” by the learner
Conceptual Framework for UVA IPE (cont)
Competency Framework for UVA IPE
Prior to 2011 Now: IPEC Competencies
Communication Professionalism Shared Problem Solving Shared Decision Making Conflict Resolution
“Bridging the Gap” Developing, Implementing, and Assessing the
Impact of Innovative Undergraduate Interprofessional Education (IPE) Experiences Based
on Collaborative Care Best Practice Models
(Blackhall, Brashers, Erickson, Owen, Shannon Thomas
+ 13 other coinvestigators)
Bridging the Gap Program Description - This program for expanding
interprofessional education at the University of Virginia is designed to
1) develop innovative clinically relevant undergraduate interprofessional experiences,
2) fully integrate these experiences throughout the clinical/clerkship year, and
3) assess the impact of these experiences on students’ achievement of defined interprofessional competencies.
Step 1: Identify area of practice and associated guideline
Step 3: Using a case study, identify critical collaborative behaviors for effective guideline step implementation
Step 2: Provide Training for IPE facilitation
Create collaborative care best practice model (CCBPM) videos
Create collaborative care best practice model behaviors checklists
Step 4: Create final CCBPM and associated validated Collaborative Behaviors Observational Assessment Tool (CBOAT) appropriate for target learners
Step 5: Design IPE experiences that reflect learning objectives derived from the CCBPM and CBOAT
Pilot simulations
Step 6: Implement IPE didactic and simulation experiences during clerkship/clinical year
Process Template to Develop, Implement, and Assess Simulation IPE Experiences
Recruit expert panels
Step 7: Develop and implement validated Interprofessional Team Objective Structured Clinical Examinations (ITOSCEs)
Participatory action research (review and refine)
Step 1: Identify area of practice and associated guideline
Goals of Care/ End of Life
Rapid Response/ Critical Illness
Chronic Progressive Illness
Transitions in care for the cognitively impaired
Illness Cancer Sepsis Muscular dystrophy Alzheimer’s disease
Guidelines
http://www.guideline.gov/content.aspx?id=15531&search=palliative+care#Section4
20
http://www.guideline.gov/content.aspx?id=12231&se
arch=surviving+sepsis
http://www.guideline.gov/content.aspx?id=15645&search=muscu
lar+dystrophy
http://www.guideline.gov/syntheses/synthesis.aspx?id=16414&search=alzhei
mer
Patient population
Adult Adult Pediatric Geriatric
Care setting Inpatient unit ICU Outpatient Hospital to home then home to assisted living
Learners (n=260)
3rd year 3rd year 3rd year 3rd year
IP Competencies
Communication Professionalism Shared problem
solving Shared decision
making
Communication Professionalism Shared problem
solving
Communication Professionalism
Shared problem solving Shared decision making
Conflict Resolution
Communication Professionalism
Shared problem solving Shared decision making
Conflict Resolution
Step 2: Provide Training for IPE facilitation
Recruit expert panels
• Project Team Meetings
• Expert Panel Meetings
• Faculty development for IPE facilitation
• Continuing interprofessional education (CIPE) for clinicians
• Participation in conferences (Macy, CAB, etc)
• Consultants (Schmitt, Reeves)
• Website resources (in progress)
Step 3: Using a case study, identify critical collaborative behaviors for effective guideline step implementation
Create collaborative care best practice model (CCBPM) videos
Create collaborative care best practice model behaviors checklists
Step 4: Create final CCBPM and associated validated Collaborative Behaviors Observational Assessment Tool (CBOAT) appropriate for target learners
Participatory action research (review and refine)
Collaborative Care Best Practice Model (CCBPM)
• Expert panels meet to discuss a case scenario
• Identify specific professional and interprofessional behaviors needed for “gold standard” team-based care
• View videotaped scenarios
• Participatory Action Research →several rounds to refine checklist
• Come to consensus on final list = CCBPM
Collaborative Behaviors Observational Assessment Tools (CBOATS)
• Very explicit observable/measurable behaviors
• Inter-rater reliability established
• Adaptable to any target learner – novice to expert (eg. simplified for students, gold standard for clinicians)
• Basis for learning objectives for IPE simulations and for formative and summative evaluation (see ITOSCEs)
Step 5: Design IPE experiences that reflect learning objectives derived from the CCBPM and CBOAT
Pilot simulations
Step 6: Implement IPE didactic and simulation experiences during clerkship/clinical year
Bridging the Gap: The Student Experience
Introduction to Collaborative Care
After participating in this experience, learners will be able to:
• Define “Interprofessional Practice”
• Explain to peers the educational preparation and role contributions of doctors and nurses in acute care settings
• Explain to peers four specific behaviors required for successful interprofessional collaboration.
• Use the SBAR tool in clinical settings.
Intro to Collab Care 2012 + 2013
0
50
100
150
200
250
300
UnderstandRoles
Value Teams BetterOutcomes
SA
A
D
SD
Difficult Discussions at the End of Life
Blackhall, Erickson, Goeke
Rapid Response: Surviving Sepsis
Littlewood, Tullmann, Wright
Chronic Progressive Illness in Pediatrics (Muscular Dystrophy)
Haizlip, Epstein, Crain
Transitions From Hospital to Home for Cognitively Impaired Elderly
(Alzheimer Dz)
Rose, Balogun, Fletcher
Step 7: Develop and implement validated Interprofessional Team Objective Structured Clinical Examinations (ITOSCEs)
Interprofessional Teamwork Objective Structured Clinical Examinations (ITOSCEs)
• Derived from CCBPM, videos, and CBOATs
• Multiple pilot sessions
• Ran 12 ITOSCES simultaneously while project team provided quality control/feedback from control room
• Designed for both formative and summative assessments ⁻ Students rated themselves ⁻ Standardized patients and providers rate students
Sample Results for Nursing Students
0 20 40 60 80 100 120 140 160
15. Works with MD to encourage patient to take the breathing…
14. Maintains patient-focus.
13. Communicates RECOMMENDATIONS to MD.
12. Communicates ASSESSMENT to MD.
11. Communicates BACKGROUND to MD.
10. Communicates SITUATION to MD.
9. Introduces self to MD.
8. Recognizes need for assistance
7. Reassesses after intervention
6. Intervenes in response to assessment.
5. Completes an organized, focused assessment.
4. Intervenes in response to patient’s concern/physiologic state.
3. Reassures patient
2. Elicits patient’s concerns
1. Introduces self to patient.
SON Rapid Response: PreITOSCE vs. PostITOSCE (SP Scores)
Pre_RR_Total Item Score
Post_RR_Total Item Score
0 50 100 150 200 250 300
11. Offers alternative treatments or comfort measures for providingthe treatment.
10. Works with RN to encourage patient to take the breathingtreatment.
9. Actively listens to RN’s response to recommendations.
8. Discusses recommendations with RN.
7. Communicates Assessment with RN.
6. Performs brief physical examination.
5. Actively listens to RN’s report of events.
4. Elicits information about the background from the nurse.
3. Elicits information about current situation from nurse.
2. Attempts to take a brief history from the patient.
1. Introduces self to RN and the patient.
SOM Rapid Response: PreITOSCE vs. PostITOSCE (SP Scores)
Pre_RR_Total ItemScore
Post_RR_Total ItemScore
Sample Results for Medical Students
Step 1: Identify area of practice and associated guideline
Step 3: Using a case study, identify critical collaborative behaviors for effective guideline step implementation
Step 2: Provide Training for IPE facilitation
Create collaborative care best practice model (CCBPM) videos
Create collaborative care best practice model behaviors checklists
Step 4: Create final CCBPM and associated validated Collaborative Behaviors Observational Assessment Tool (CBOAT) appropriate for target learners
Step 5: Design IPE experiences that reflect learning objectives derived from the CCBPM and CBOAT
Pilot simulations
Step 6: Implement IPE didactic and simulation experiences during clerkship/clinical year
Process Template to Develop, Implement, and Assess Simulation IPE Experiences
Recruit expert panels
Step 7: Develop and implement validated Interprofessional Team Objective Structured Clinical Examinations (ITOSCEs)
Participatory action research (review and refine)
Lessons Learned • Identifying specific intraprofessional and IPE behaviors helps create
measurable learning objectives
• Integrating IPE with profession-specific clinical learning moves IPE from the “fringe” to the “core” of student learning
• Every step of IPE development can be used as an opportunity for faculty development
• Implementing ITOSCEs helps students take ownership of their own strengths and learning gaps
Barriers • Scheduling challenges for faculty, clinicians, and students
• Time needed for development of IPE experiences and validated assessment tools was greater than anticipated.
• Competition for the availability of simulation/standardized patient center time and space
Summary • Implementing IPE experiences, CBOATS, and
ITOSCEs based on Collaborative Care Best Practice Models
– Embeds IPE into the learning of all students – fringe to core
– Includes powerful opportunities for faculty development
– Emphasizes experiential and reflective learning toward enduring changes in skills and attitudes
– Creates high-impact formative as well as summative competency-based evaluation tools that can be used for learners at all levels (novice to expert)
Questions and Discussion
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