E ducation W orkshop Teaching others palliative care communication skills Neha J Darrah MD Diane Hadley PharmD BCACP Amy Corcoran MD CMD FAAHPM Geriatrics Grand Rounds April 4 2014 ID: 651301
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Piloting an Interprofessional Education Workshop: Teaching others palliative care communication skills
Neha J. Darrah, MD
Diane Hadley,
PharmD
BCACP
Amy Corcoran MD CMD FAAHPM
Geriatrics Grand Rounds
April 4, 2014Slide2
DisclosuresWe have no relevant financial disclosures; however, a portion of this project was supported by funds from the Health Resources and Services Administration (HRSA) under Geriatric Academic Career Award K01HP20493 and the GEC grant UB4HP19214.The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the DHHS, HRSA, BHPR, or the U.S.Slide3
Learning ObjectivesTo describe the main objective for an effective interprofessional, education workshopTo list the essential elements for a successful interprofessional, education workshopSlide4
Overview
IPE BACKGROUND
IPE and palliative care
Workshop history
Workshop description
Results
Study limitations
Future implicationsSlide5
What is IPE?Interprofessional Education (IPE)Defined as students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010)
Goal of IPE
Prepare health professional students for deliberately working together
Provide high quality, patient-centered careSlide6
Barriers to IPELogisticsProfessional hierarchies/stereotypes
Institutional resistanceSlide7
Strategies for IPEClassroom didacticsPractice based interventions
Experiential Strategies
Role play
Simulation exercisesSlide8
Interprofessional Education Collborative (IPEC)Organizations involvedAmerican Association of Colleges of Nursing
American Association of College of Osteopathic Medicine
Association of schools of Public Health
American Association of Colleges of Pharmacy
American Dental Education Association
Association of American Medical Colleges
Interprofessional
Education Collaborative Expert Panel. (2011). Core competencies for
interprofessional
collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed April 1, 2014.Slide9
Interprofessional Collaborative Practice Domains from Interprofessional Education Collaborative (IPEC) 2011
Interprofessional
Education Collaborative Expert Panel. (2011). Core competencies for
interprofessional
collaborative practice: Report of an expert panel. Washington, D.C.:
Interprofessional
Education Collaborative. Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed
April 1,
2014.Slide10
Overview
IPE Background
IPE AND PALLIATIVE CARE
Workshop history
Workshop description
Results
Study limitations
Future implicationsSlide11
Why is IPE Relevant to Palliative Care?Palliative care is specialized medical care for people with serious illnesses. Palliative care is provided by a TEAM of doctors, nurses, and other specialists (social work, chaplaincy, pharmacy) who work together with a patient’s other doctors to provide an extra layer of support.Slide12
Past IPE Palliative Care WorkshopsPalliative care: A suitable setting for undergraduate interprofessional educationDescription
: Interprofessional student workshops with family care providers
Recruited Learners
:
M
edical, nursing, social work, physiotherapy, and occupational therapy students
Results:
Students value and enjoy opportunity to work together and find the experience moving, informative, and interesting
Wee B, Hillier R, Coles C, et al. Palliative care: a suitable setting for undergraduate interprofessional education.
Palliat Med. 2001 Nov; 15 (6) 487-92.Slide13
Past IPE Palliative Care WorkshopsUsing simulated patients in a multiprofessional communication skills programme: reflections from the
programme
facilitators
Description:
Multiprofessional
, 4-day communication skills program with standardized patients
Recruited learners
: Predominantly nursing with some physiotherapist, dieticians, and radiographers
Results: No formal evaluation but feedback was positiveDonovan T, Hutchinson T, and Kelly A. Using simulated patients in a multiprofessional communication skills programme: reflections from the programme facilitators. Eur J Cancer Care. 2003 Jun; 12(2): 123-8Slide14
Past IPE Palliative Care WorkshopsEnhancing interprofessional education in end-of-life care: An interdisciplinary exploration of death and dying in literature
Description
: 12-week elective focused on reflections of dying depicted in the
literature
Recruited
learners:
medical, nursing, bachelor of health science, and chaplaincy
students
Results:
All students met learning objectives based on qualitative analysis of written assignments and highly rated by participantsBrajtman S, Hall P, and Barnes P. Enhancing interprofessional education in end-of-life care: an interdisciplinary exploration of death and dying in literature. J Palliat Care. 2009 Summer; 25(2): 125-31Slide15
Past IPE Palliative Care WorkshopsInterdisciplinary education in end-of-life care: Creating new opportunities for social work, nursing, and clinical pastoral education students
Description
:
Interprofessional
case simulations with volunteer actors
Recruited
learners
: Social work, nursing, and chaplain
students
Results: All students found it valuable and most cohorts demonstrated significant improvement in pre-determined outcomesForrest C and Derrick C. Interdisciplinary education in end-of-life care: creating new opportunities for social work, nursing, and clinical pastoral education students. J Soc Work End Life Palliat Care. 2010; 6(1-2): 91-116. Slide16
Past IPE Palliative Care WorkshopsUsing Online Learning and Interactive Simulation To Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students
Description
: Combined online learning with interactive
simulation
Recruited
learners
: Social work, nursing, medicine, and
chaplain
Results:
Successfully met five learning objectives and highly rated by participantsEllman MS, Schulman-Green D, Bratt L, et al. Using Online Learning and Interactive Simulation to Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students. J Palliat Med. 2012; 15(11); 1240-Slide17
Past IPE Palliative Care WorkshopsEffect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients with Serious Illness: A Randomized Trial
Description
:
Randomized participants to 8-session, simulation-based, communication skills intervention
vs
usual education
Recruited
learners
:
Medicine, nurse practitionersResults: Simulation-based communication training did NOT improve quality of communication but was associated with small increase in patients’ depressive symptomsCurtis JR, Back AL Ford DW et al. Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication with Patients with Serious Illness: A Randomized Trial. JAMA. 2013 Dec 4; 310 (21): 2271-81Slide18
Overall ConclusionsIPE is generally well received by studentsNumber of disciplines in workshops ranged from two to fiveSimulation-based training did NOT translate into improved quality of communicationSlide19
Overview
IPE Background
IPE and palliative care
WORKSHOP HISTORY
Workshop description
Results
Study limitations
Future implicationsSlide20
Workshop History2011-2012Piloted first interprofessional, communication workshop with advanced practice nursing students and physician fellows
Developed as three-station palliative care Observed Structured Clinical Examination (OSCEs)
Corcoran AM, Lysaght S, Lamarra D, Ersek M.
Pilot test of a three-station palliative care observed structured clinical examination for multidisciplinary trainees.
J
Nurs
Educ. 2013 May;52(5):294-8. Slide21
Workshop History2012-2013Expanded workshop to include learners from nursing (undergraduate and advanced practice), medicine (fellows), physical therapy, occupational therapy, pharmacy,
chaplaincy
, and social work (masters students
)
Recruited
learners from BOTH University of Pennsylvania and University of
Sciences
Demonstrated
statistically significant improvement in learner preparedness for interprofessional team and communication skillsSlide22
Lessons Learned from Past WorkshopsLearners appreciated the opportunity to work in interdisciplinary teamsRated the topic as good to excellent
Learners need to be matched based on training level
i.e. Physician fellows are not well matched with undergraduate nursing studentsSlide23
Overview
IPE Background
IPE and palliative care
Workshop history
WORKSHOP DESCRIPTION
Results
Study limitations
Future implicationsSlide24
Workshop GoalsIntroduce palliative care communication and interprofessional team skills to learnersDetermine effectiveness of interprofessional workshop on improving these self-reported skills
Slide25
Recruited LearnersUniversity of PennsylvaniaMedicine (fourth year medical students
)
Social Work
Nursing
(undergraduate, advanced practice
)
Chaplaincy
University of Sciences
Physical therapy
Occupational therapyPharmacy Slide26
Key Components of WorkshopWorkshop BasicsPre-workshop preparation
Two-hour simulation-based workshops with
STANDARDIZED PATIENTS
Four
sessions offered over two days in October
Participants and Observers
Nursing and social work students were assigned to be either participants or observers at the discretion of their faculty
All participants were assigned to pre-determined interprofessional teams
Recruited
diverse, interprofessional faculty facilitators Slide27
Case DescriptionPatient is a 72 y/o female with dementia admitted from a nursing home to the ICU three days ago for aspiration pneumonia. She is now doing better and transferred to the floor. At baseline, she requires assistance in her all of her ADLs. She is noted to have signs of aspiration
Goal of meeting is to discuss goals of care (resuscitation, discharge plan) with patient’s daughter or sonSlide28
Workshop Schedule
4:00-4:15
Orientation
4:15-
5:15
Participant group 1 meets with SP 1
Participant group
2 meets with SP 2
Participant group 3 meets
with SP 3Participant group 4 meets with SP 4Observer group 1 observes Observer group 2 observers5:15-5:45 DebriefSlide29
EvaluationsParticipants were given both pre and post-workshop evaluationsAsked participants to rate their confidence in multiple domains on 5 point Likert
scale
Communication Skills
Interprofessional team skills (Based on IPEC competencies)Slide30
Overview
IPE Background
IPE and palliative care
Workshop History
Workshop Description
RESULTS
Study limitations
Future implicationsSlide31
Learner AssignmentsSlide32
Learner Demographics
Participant
Observer
Total
Sex
Female
57
(78%)
35 (97%)
92 (84%) Male16 (22%)1 (3%)17 (16%)Race Caucasian43 (59%)29 (81%)72 (66%) Asian20 (27%)4 (10%)24 (22%) African American5 (7%)3 (8%)8 (7%) Hispanic2 (3%)
0 (0%)2 (2%)
Mixed heritage
1 (1%)
0 (0%)
1 (1%)
N
o answer
2 (3%)
0 (0%)
2 (2%)
Age (mean)
27
28Slide33
Learner Demographics
Participant
Observer
Total
Profession
Nursing
17 (23%)
34 (94%)
51 (47%) Advanced16 (22%)28 (78%)44 (40%) Undergrad1 (1%)6 (17%)7 (6%) PT15 (21%)0 (0%)15 (14%) Pharmacy12 (16%)0 (0%)12 (11%) Medicine11 (15%)0 (0%)11 (10%) Social Work8 (11%)2 (5%)
10 (9%) OT
6 (8 %)
0 (0%)
6 (6%)
Chaplaincy
4 (5%)
0 (0%)
4 (4%)
Years Training (mean)
3.28 (0-13)
3.66 (0-15)Slide34
Importance of IPE
Not at all
(1-2)
Somewhat
(3)
Very
(4-5)
How important is communicating with other health care professionals for you to be effective in your profession?
Participant70 (96%) Observer1 (3%)34 (94%)How committed are you to work on interprofessional communication skills during your training? Participant1 (1%)1 (1%)68 (93%) Observer1 (3%)34 (94%)Slide35
Prior Experience
Yes
No
Don’t Know
Missing
Work with individuals of other professions to create plan of care
Didactic
68 (62%)
29 (27%)
5 (5%)7 (6%) Bedside67 (62%)31 (28%)2 (2%)9 (8%)Apply knowledge of my profession to appropriately assess and address health care needs of a patient Didactic76 (70%)15 (14%)11 (10%)7 (6%) Bedside55 (51%)34 (31%)8 (7%)12 (11)Explain the role other professionals play in an interprofessional team Didactic 67 (62%)
29 (27%)8 (7%)
5 (5%)
Bedside
52 (48%)
39 (36%)
5 (5%)
13 (12%)Slide36
Prior Experience
Yes
No
Don’t Know
Missing
Communicate
with other healthcare professions, patients and caregivers
Didactic
63 (58%)
31 (28%)8 (7%)7 (6%) Bedside64 (59%)32 (29%)2 (2%)11 (10%)Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care Didactic60 (55%)29 (27%)13 (12%)7 (6%) Bedside49 (45%)39 (36%)11 (10%)10 (9%)Facilitate and/or participate in a family conference Didactic 43 (39%)
46 (42%)11 (10%)
9 (8%)
Bedside
40 (37%)
52 (48%)
6 (6%)
11 (10%)Slide37
Comparison of Pre and Post-Workshop Evaluations
Pre-Workshop
Mean Score
Post-Workshop Mean Score
Sig. (2-tailed)
Work with individuals of other professions to create plan of care
Participant
3.60
4.110.000 Observer3.834.000.226Apply knowledge of my profession to appropriately assess and address health care needs of a patient Participant3.554.040.000 Observer3.914.060.282Explain the role other professionals play in an interprofessional team Participant3.384.01
0.000 Observer
3.77
4.17
0.017Slide38
Comparison of Pre and Post-Workshop Evaluations
Pre-Workshop
Mean Score
Post-Workshop Mean Score
Sig. (2-tailed)
Communicate
with other healthcare professions, patients and caregivers
Participant
3.544.110.000 Observer3.694.140.014Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care Participant3.484.080.000 Observer3.464.090.002Facilitate and/or participate in a family conference Participant3.214.080.000 Observer3.31
3.890.001Slide39
Curriculum/Workshop Content
Poor-Fair
(1-2)
Good
(3)
Very good – Excellent
(4-5)
Relevance
of topic content to my discipline
4 (4%)10 (9%)92 (84%)Utility of pre-reading9 (8%)19 (17%)77 (71%)Utility of pre-workshop video23 (21%)22 (20%)55 (50%)Utility of pre-workshop profession specific lecture15 (14%)20 (18%)62 (57%)Slide40
Workshop Sessions
Poor-Fair
(1-2)
Good
(3)
Very good – Excellent
(4-5)
Usefulness of small group orientation
14 (13%)
23 (21%)69 (63%)Usefulness of communication exercise with standardized surrogates1 (1%)6 (6%)98 (90%)Usefulness of SPs1 (1%)3 (3%)101 (93%)Effectiveness of small group faculty facilitators2 (2%)4 (4%)100 (92%)Usefulness of post exercise debriefing1 (1%)4 (4%)101 (93%)Slide41
Overall Evaluation
Poor-Fair
(1-2)
Good
(3)
Very good – Excellent
(4-5)
Overall, how would you rate
the educational quality of the workshop?
Participant1 (1%)5 (7%)65 (89%) Observer6 (17%)28 (81%)YesNoNot sureWould you be interested in participating in a follow-up session to practice family meetings? Participant60 (82%)4 (5%)8 (11%) Observer26 (72%)5 (14%)
5 (14%)Slide42
Overall ConclusionsPre vs Post Workshop AssessmentsParticipant Group: Significantly more confident in ALL domains after the workshop
Observer Group: Significantly more confident
in
most
domains after
the workshop
Majority of participants rated the workshop as very good to excellent
Majority of participants would be interested in participating in another workshopSlide43
Overview
IPE Background
IPE and palliative care
Workshop History
Workshop Description
Results
STUDY LIMITATIONS
Future DirectionsSlide44
Study LimitationsVariability in student representationEvaluations Used
Used non-validated survey tool
Evaluation of effectiveness was limited to students’ self-reports and did not assess higher level learning outcomes as acquisition of knowledge or behavior changeSlide45
Overview
IPE Background
IPE and palliative care
Workshop History
Workshop Description
Results
Study Limitations
FUTURE DIRECTIONSSlide46
Future DirectionsWorkshop StructureOffer workshop multiple times during the yearOffer workshop multiple times for the same group of learners
Evaluations
Use validated survey tool
Create OSCE for learners to test behavior changesSlide47
Thank you!
Dr. MaryAnn
Foricea
Dr. Mary
Ersek
Dr. Cathy Poon
Eunhae
Kim
Dr. Christine
Bradway Dr. Zvi GellisDr. Lora Packel Dr. Varleisha Gibbs Dr. Claudia Pravanta Dr. Valerie CotterDr. Carrie Ann Doherty Denise LaMarraJohn SemanSlide48
QUESTIONS?