preparing a workforce for interprofessional collaborative care · 2014-11-17 · ipe collaborative...
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Preparing a Workforce
for Interprofessional
Collaborative Care
Carol A. Aschenbrener, M.D.
AAMC
SACME, November 5, 2014
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Long recognized need to change physician education
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“There is growing realization that it is unrealistic to assume that effectively articulated education, progressing in logical sequence from the rudiments to mastery, can be provided through fragmented programs under different jurisdictions…medical education should, in the future, be planned and provided as a continuum – a continuous process with all the elements carefully integrated and under coordinated leadership.”
AAMC Commission on Medical Education 1932
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“The concept of medicine as a single discipline concerned with only the restoration of individual health from the diseased state should be replaced by the concept of ‘health professions’ working in concert to maintain and increase the health of society as well as the individual.”
Coggeshall Report 1965, AAMC
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“Faculty members should define and agree on the required competencies for graduating students and, in so doing, define the purpose of their medical students’ education in terms that have a similar meaning for all students and faculty members in all disciplines and all specialties.”
ACME-TRI 1992
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Drivers to Transform Care
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Access for Diverse Population
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Behavior Undermines Health
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IPE Collaborative
Agreement January 2009 to work together to:
• Foster a common vision for team-based care
• Promote efforts to reform health care delivery and financing consonant with that vision
• Contribute to development of leaders and resources for substantive interprofessional learning
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Every medical, nursing, dental, pharmacy, and public health graduate is proficient in the core competencies for interprofessional, team-based care, including preventive, acute, chronic and catastrophic care.
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IPE Collaborative Action Plan
Promoting a common language and shared
competencies
Facilitating effective faculty development
Fostering shared learning resources
Identifying effective organizational
models
Facilitating linkage with clinical and
translational research
Promoting inter-professional
collaboration with policy-makers
Help our member institutions advance the field by:
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Four competencies, 38 behavioral expectations
Values and ethics
Roles and
responsibilities
Interprofessional
communications
Teams and
teamwork
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IP Collaborative
Practice
IP Team-based Care
Care delivered
by intentionally
created, usually
relatively small
work
groups,…having
a collective
identity and
shared
responsibility for
a patient or
group of
patients.
When multiple
health workers
from different
professional
backgrounds
work together
with patients,
families, carers
and
communities to
deliver the
highest quality
of care. WHO
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Meaningful interprofessional learning
• Should begin early, before professional identity set
• Be reinforced over time
• Be focused on patients, real or simulated
• Include a meaningful role for the learner
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IPEC, HRSA, FOUNDATIONS PARTNER
TO RELEASE COMPETENCIES IN 2011
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10/14 Council on Social Work
Education
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Resources for Learning and Assessment
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www.mededportal.org/ipe
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Publications Homepage
www.mededportal.org
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Faculty Development
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Faculty Development Institutes
Seven institutes May 2012-October 2014
249 Institutional teams
1074 Individuals
Majority of medicine attendees from UME
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Diffusion is Happening in Medicine
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LCME Standard 10/2012
The core curriculum of a medical education program must prepare medical students to function collaboratively on health care teams that include other health professionals. Members of the health care teams from other health professions may be either students or practitioners.
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A True Continuum of
Medical Education
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2014 GQ: Participation in Any
Required IPE Activities
60
62
64
66
68
70
72
74
2011 2012 2013
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2014 GQ: Other Professions in
Required IPE Activities
0 10 20 30 40 50 60 70 80 90
Psychology
Social Work
Public Health
Osteopathic Medicine
Occupational Therapy
Physical Therapists
Dentistry
Pharmacy
Physicians Assistants
Nursing
Percentage
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2014 GQ: Type of Learning
Experience in Required IPE
0
50
100
150
200
250
2011 2012 2013 2014
Lecture only, clinical subject Patient-centered case problemsClinical Simulations Active engagement with PatientsTeam Skills Training
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IPE Collaborative Action Plan
Promoting a common language and shared
competencies
Facilitating effective faculty development
Fostering shared learning resources
Identifying effective organizational
models
Facilitating linkage with clinical and
translational research
Promoting inter-professional
collaboration with policy-makers
Help our member institutions advance the field by:
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We want to know:
• Which assessments – including guided professional judgment – will give us confidence that learners are at least proficient in the competencies for IP collaborative practice?
• How resilient is team readiness when tested by work stress?
• Which learning experiences are most effective?
• What faculty behaviors correlate with student perception of good role models and mentors?
• Long term: are there learner attributes that predict strong collaborative and team skills?
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Related Work Reinforcing IPE
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Source: Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. 2013. “Toward a
Common Taxonomy of Competency Domains for the Health Professions and Competencies for
Physicians.” Acad Med 88(8): 1088-1094.
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Patient
Care
Knowledge for Practice
Interprofessional Collaboration
Personal & Professional Development
Systems-based
Practice
Practice-based Learning &
Improvement
Professionalism
Interpersonal and
Communication
Skills
The Physician
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“The members of the Coalition endorse a framework for professional competence that contains six general but essential domains of competence: Professionalism, Medical Knowledge, Patient Care and Procedural Skills, Interpersonal and Communication Skills, Practice-based Learning and Improvement, and System-based Practice.
The Coalition member organizations are committed to ongoing, meaningful processes for assessment and evolution of the competencies to ensure that students and physicians have the knowledge and skills to provide excellent patient care as social and delivery system needs change.”
Consensus Statement on Framework for Professional Competence by the Coalition for Physician Accountability
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www.aamc.org/cepaer
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EPA 9: Collaborate as a member of an
interprofessional team
Expected behaviors of an entrustable learner (indirect supervision):
• Acts as an active and integrated member of team who in most situations prioritizes team goals over one’s own.
• Understands roles of other team members, seeks their counsel, actively listens to their recommendation and incorporates them.
• Typically communicates in bidirectional manner and keeps all team members informed and up to date.
• Modifies and adapts communication content and style based on audience, venue, receiver preference, type of message.
• Usually able to read one’s own emotions and anticipate those of others.
• Maintains professional demeanor in all but most trying situations
• Actively engages with patient and team for seamless transitions.
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What Role for CE in Advancing Interprofessional Collaboration?
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Change is difficult
People always have the same three questions:
• What exactly do you want me to do?
• What do I have to give up?
• What’s in it for me?
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The Habit Loop
Motivation
Routine
Cue Reward
Source: Charles Duhigg: The Power of Habit, 2012
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IPE can help create the future
Enhance interprofessional dialogue on broad scale
Increase awareness of unconscious bias
Consider single standard of competency for specific services
Stimulate creation of fluid learning pathways across health professions
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