E12iii: A Geriatric Standardized Patient Exercise Teaches - PDF document

E12iii: A Geriatric Standardized Patient Exercise Teaches Interprofessional Teamwork Skills Maria A Wamsley ISPE Geriatric Case Team • Maria A. Wamsley, MD • Michi Yukawa, MD • Josette Rivera, MD A Geriatric Standardized • Susan Hyde, DDS, MPH, PhD Patient Exercise Teaches • Janelle Christman, MSG Interprofessional • Amber Fitzsimmons, MS Teamwork Skills • Alice Gahbauer, MS • Alison Scheid, PT, DPT, OCS, NCS Maria A. Wamsley, MD Funding support from UCSF Instructional Grants UCSF School of Medicine Program Roadmap Background • Background • IPE interventions that are authentic and reflect settings and roles of participants are • Interprofessional SP Exercise (ISPE) most effective • Results • Simulation provides opportunities for learners to practice patient care and team • Lessons learned communication skills • Conclusions • Geriatrics includes interprofessional care teams and geriatric competencies are an area of increased focus for many professions Hammick et al. Medical Teacher 2007 Wamsley et al. J Interprof Care 2012 Leipzig et al. Acad Med 2009; Partnership for Health in Aging 2009. Background - ISPE ISPE Curricular Goals  Increase awareness of roles of other • Improves attitudes towards working in interprofessional teams (ATHCT) healthcare professionals – Team Efficiency  Develop communication and – Team Value collaboration skills in the context of – NOT Physician’s Shared Role an interprofessional team • Perceived outcomes  Develop a comprehensive care plan – Learning about roles of other healthcare professionals (HCPs) in collaboration with interprofessional – Educating other HCPs about their professions roles healthcare team – Increased comfort working collaboratively on IP teams Hyer et al. J Interprof Care 2000. Wamsley et. al. J Interprof Care 2012. Collaborating Across Borders IV: Transformative Change from the Classroom to Practice June 12 – 14, 2013 | Vancouver, BC

E12iii: A Geriatric Standardized Patient Exercise Teaches Interprofessional Teamwork Skills Maria A Wamsley ISPE Format ISPE Format • Teams of 4 professional students • Team brief with patient presenting information (Med, NP, PT, Pharm, Dent, SW, • Sequential patient interviews while team Nutrition) members observe • Year 2 or 3 of training • Team huddles between interviews • Required part of the curricular • Collaborative team care plan experience • Faculty-led debriefing session • Complex chronic illness SP case • SP evaluation of communication/professionalism skills • Faculty facilitators from all • Written feedback from IP team members on professions patient communication and teamwork skills ISPE Team Brief ISPE Team Huddle ISPE Team Debrief “Elsie Smith” • Multiple chronic conditions: – Diabetes – Hypertension – Hyperlipidemia – Recurrent falls – Peripheral neuropathy – Osteoarthritis – Xerostomia/Periodontitis/Pulpitis – Glaucoma – Anxiety – Social isolation Collaborating Across Borders IV: Transformative Change from the Classroom to Practice June 12 – 14, 2013 | Vancouver, BC

E12iii: A Geriatric Standardized Patient Exercise Teaches Interprofessional Teamwork Skills Maria A Wamsley Participants in the ISPE 2012-2013 ISPE Student Evaluation Total number of participants = 345 Item n Mean (SD) I learned about the patient care roles of other 261 5.22 Medicine healthcare professionals during this exercise (0.96) Pharmacy This standardized patient exercise increased my 261 4.99 Dentistry comfort in working collaboratively in an IP team (1.04) Nursing to develop a patient care plan Nutrition I found the debriefing session to be helpful to 261 5.08 Social work process my group's experience during the (1.01) PT interprofessional exercise I would recommend this interprofessional 261 5.09 standardized patient exercise to a fellow student (1.05) in my profession (1=strongly disagree, 6=strongly agree ) ISPE Student Evaluation by Student Comments Profession • “Having the ability to observe others interview the patient live was extremely valuable in learning how different professions approach the same case. It was eye-opening and great to see how we so easily fall into the trap of the medical model culture.” • “Able to learn about other disciplines and how to interact with them and work together to formulate a cohesive plan of care. The exercise could be improved by being introduced a little earlier in our education.” (1=strongly disagree, 6=strongly agree ) ISPE Faculty Evaluation ISPE Challenges Item Mean (SD) • Scheduling N=47 • Targeting the right learners The ISPE enhances student understanding of the 5.81 (0.40) patient care roles of different health professionals. • Disparate numbers of learners from The ISPE fosters communication between 5.83 (0.38) programs participating health professional students. • Developing a case that is compelling The ISPE increases collaboration between 5.64 (0.57) for the different professions participating health professional students. • SP Training time requirements for I would recommend participation in the ISPE for 5.96 (0.20) learners in my profession. complex case (1=strongly disagree, 6=strongly agree ) Collaborating Across Borders IV: Transformative Change from the Classroom to Practice June 12 – 14, 2013 | Vancouver, BC

E12iii: A Geriatric Standardized Patient Exercise Teaches Interprofessional Teamwork Skills Maria A Wamsley ISPE Summary Future directions…. • Well-received by student and faculty • Incorporating additional professions • Improves attitudes toward working in • Integrating this exercise with other interprofessional teams IPE curricula • Geriatric case provides model for • Building in reflection collaborative care • Faculty development • Learning roles • IPE skills assessment • Communication and collaboration skills Attitudes Towards Healthcare Questions Teams (ATHCT) • 21 item validated instrument • 3 subscales – Team value • Ex: “ The team approach improves the quality of care to patients ” – Team efficiency • Ex: “ Working in teams unnecessarily complicates things most of the time ” – Physician ’ s shared role • Ex: “ A team ’ s primary purpose is to assist physicians in achieving treatment goals for patients ” Pre-Post ISPE Participants Attitudes Focus Group - Outcomes Toward Healthcare Teams • Learning roles of other professionals 6 “It was one of those things that just really opens your 5.5 * eyes and just gives you a little more insight into what * other people do.” 5 4.5 • Educating others about your profession 4 “I think a lot of the students in my group were confused 3.5 Pre-ISPE as to what an NP would do in that situation…they were 3 like – Oh, okay, that’s what you would do.” Post-ISPE 2.5 • Increased confidence in working with other 2 professionals 1.5 “I’m a little more comfortable talking to the 1 physician…it’s not so intimidating to go up to the Value Efficiency MD physician and say, hey, this is what I feel should Shared * p<.001 happen to this patient” Role Wamsley et al. Journal of Interprofessional Care 2012. Collaborating Across Borders IV: Transformative Change from the Classroom to Practice June 12 – 14, 2013 | Vancouver, BC