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Kim Dunleavy PT, Ph.D , OCS Clinical Associate Professor

Department of Physical Therapy University of Florida

Sujay Galen PT, PhD, Kristine Reid PT, MPT, Rozanne Dizzazzo Miller DOT, OTLR

Wayne State University Detroit MI

Preparation of future health care professionals for collaborative practice requires an understanding of both individual professional roles and responsibilities and those of other team members.

IPE Collaborative 2011

Experiences where “students from two or more professions learn with, from and about, each other to enable effective collaboration and improve health outcomes”.

Center for Advancement of Interprofessional Education (2002)

Values & ethics for interprofessional practice Roles and responsibilities for collaborative

practice Interprofessional communication Interprofessional teamwork

IPEC 2011

Logistics Scheduling Timing within curricular sequences Priorities for professional curriculum needs

Learning activities should be appropriate for the learning stage

Integrated throughout curriculum

IPEC 2011

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Instructional methods reported: shared formal classroom learning workshops problem-based learning case-based simulations participation in health fairs integrative clinical experiences

Most research has reported attitudes towards potential for collaboration and teamwork

Kenaszchuk 2012, Eccott 2012, Wellmon 2012.

Short activities within

structured presentation

Case –based or problem-based

experience

Experiential training

Improved satisfaction Allows students to practice assimilation and

analysis Allows instructor to determine understanding

of content Some tasks and content are suited to active

learning strategies - interview techniques, interpersonal communication

Prunuske 2012, Lupu 2012, Morreale 2012

Personality differences can influence group activities

Time Some content not suited for less structured

active learning Weaker, more reserved students or those

who require structure may not benefit maximally (Minhas 2012)

The extent of motivation can be used to reflect impact of teaching methods. Keller’s ARCS Model for motivation was used as part of the theoretical foundations for this study.

Attention Relevance Confidence Satisfaction

Visser & Keller 1990

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This study aimed to examine Physical Therapy and Occupational Therapy student’s perceptions of a student IPE peer teaching active learning experience

Retrospective qualitative study of student reflections after a peer teaching experience

Study qualified for exemption as part of routine educational practices with de-identified data analysis

Clinic Day scheduled as par t of the Connective Tissue disorders section of a Pathophysiology course (medical school).

300 Medical Students rotated through stations including PT & OT

30 Medical students per group First year PT (n=34) and OT (n=14) students

participated in small groups, interacting with approximately 20-30 medical students

Short faculty led powerpoint presentation 7-10 mins Scope of practice Referral systems Context of referrals Areas of practice

Student interactive demonstrations and participation (20-25 minutes)

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Medical students:• Develop an awareness of the roles and

responsibilities for PT & OT • Understand the professional scope of practice

and referral mechanisms for PT & OT• Experience selected interventions

PT & OT students:• Develop teaching and communication skills in an

interprofessional setting• Articulate elements of their own professional

roles and responsibilities

Preparation prior to session Peer teaching 2 hours (4 sets medical students)

• PT – ambulation techniques, use of assistive devices for gait, weightbearing precautions, balance testing and training

• OT – hand function assessments, splinting, types of assistive technology available for patients with rheumatological diagnoses

PT students submitted 5 bullet point comments reflecting on the experience

OT students commented on experience using the DEAL model (Describe, Examine, Articulate Learning)

Ash & Clayton 2009

Reflections were de-identified prior to analysis Initial open coding was conducted using IBM

SPSS text analytics for Surveys to extract codes and initial categories.

Follow- up directed content analysis was completed by 2 investigators using line-by-line coding until agreement

Confirmatory analysis was conducted for consensus by 2 additional investigators (no agreement)

Directed content analysis explored concepts related to interprofessional competencies and motivation.

Data was searched for terms consistent with: Interprofessional communication Professional role identity Motivation (attention, relevance, confidence,

satisfaction)

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Professional roles and identityo Gaps in knowledge (audience)o Preparation to teach peerso Importance of advocacyo Individual professional roles

Communication/Teaching

PT and OT students indicated increasing awareness of: Gaps in medical student’s knowledge of PT &

OT professional scope and roles Preparation to teach others about their

professions. The importance of advocacy Their own roles.

“Finding a way to incorporate what they are currently

learning with what we are currently learning, so they

get a better understanding of where PT falls in their

future working with patients. Many of them didn’t

realize just how much assessment and evaluating of

the patients we do." (PT student)

“This experience started to prepare me for when I must answer

the questions that many people will have about my

profession. I was able to articulate the purpose of occupational

therapy in terms that are understandable, and gained

experience with answering such questions. In my future

practice, I will be able to use some of the descriptions that I

used during this experience to explain the profession,

equipment, and areas of expertise.” (OT Student)

“Even though the purpose of going to the medical school was to

educate second year medical students about occupational

therapy, for me, it was also a learning experience. One major

factor I learned was that many individuals are naïve to what

occupational therapy is, and how it helps patients. I generally

talk about occupational therapy to individuals that are informed

about the field and did not realize the wide variety of

assumptions others has about the field.” (OT student)

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“The majority of medical school students had no

knowledge of occupational therapy except that it is

related to physical therapy. It was an eye-opener for just

how much we need to advocate for our profession in

other professional arenas.” (OT student)

Both groups commented on the growing awareness of their own professional roles –often linked to the realization of the limited understanding of the medical students in this area.

Growing sense of identity and pride

“I think that I gained more passion for my profession after

helping out with this project.” (OT student)

Three of the four constructs of the ARCS model were supported:

Relevance, Confidence & Satisfaction

Both groups of students commented on the importance of teaching medical students first hand about their professions and development of communication skills.

There were also comments about the learning benefits of teaching others:

“There is no doubt that project brought a solidification of assisted device uses, contraindications, and gait patterns. This knowledge became ingrained in my mental bank due to the teaching aspect of this exercise. I had no idea teaching others helped my retention of material at this level.”

The demonstrations and repetition promoted confidence as well as the realization that they were being seen as the experts and that the medical students were receptive.

“I think the demos helped give us PT students more confidence in demonstrating our knowledge of PT”“I felt professional and knowledgeable – made me feel more comfortable”

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“My specific task was to run the adaptive equipment station.

I noticed that most of the students who approached our

table were afraid to ask us what different equipment was, so

I took the initiative to make them feel comfortable by

explaining different items. Once they felt comfortable asking

questions, most of them really seemed intrigued by all that

occupational therapy could do for patients.” (OT student)

Some students were nervous and found the initial interactions stressful, but commented on their increasing comfort level:

“As time progressed I feel like I got more comfortable speaking and presenting this information, so the event became less stressful and more fun. “

There were a few students who were withdrawn and uncomfortable and needed faculty encouragement to initiate discussion and to adjust non-verbal communication.

“I found it difficult to gauge the interest and understand the students which made me unsure if I was doing a good job”

“It was nerve racking to have people staring at you, waiting for you to teach them something”

Most students found the experience satisfying and enjoyable:

“I enjoyed teaching the students, especially when I was able to make sense of things for them; helping them to their “Ahha” light bulb moment”

Engaging students who were not focused or conversing among themselves

Some questions beyond students level of knowledge (compliance with PT, insurance limits)

Some students would have preferred to rotate stations

“The sequential learner in me did have frustrating moments, primarily due to lack of equipment as we were sharing”

“My partner did a lot of talking and was a little more aggressive than I was. Teamwork is exciting but also stressful because you want to contribute but also give others their 2 cents worth”

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“The concept of this interdisciplinary approach is amazing. Unfortunately, this may be the only

exposure medical students get exposure to PT/OT. More events and workshops should take place

amongst interdisciplinary health professionals. I believe communication amongst health professionals

would improve health care efficiency. “

“We listened to the professor talk about things they think are important for aspiring physicians to know about their field and then the students demonstrated techniques they use in practice on patients. It was a very cool experience and my favorite thing so far this year. “

“It also really opened my eyes to the different health professional fields. I learned about how Occupational Therapists develop new tools for patients, how Physical Therapists quickly assess the abilities of the elderly and how nurses read bone density scans. I also learned a lot about how each of these fields work with doctors in the setting of health insurance billing which I thought was totally applicable and eye-opening.”

“Anyway, this was a really great environment to get "inter-professional" education and I think it would be a great set-up for the IPTV program. I think the clinic days met some of the objectives of the IPTV program in a very rewarding way.”

Improvements with practice and with reflection-in-action

Increased confidence by 2nd or 3rd set Some students took on leadership &

organizational roles Format allowed immediate feedback

Opportunity to develop:

teaching skills interprofessional communication skills preliminary awareness of understanding of

roles and responsibilities confidence

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IPE peer teaching active learning early in the curriculum promoted development of individual professional role identity for PT/OT studentsKhalili 2013

Early IPE experiences could dismantle misconceptions about scope of practice, knowledge base & roles at a stage when opinions are still forming.

The opportunity to participate in this type of experience was considered valuable by students. Pettigrew 1998.

The process of educating other students emphasized the need for advocacy and importance of teaching others, often with the realization that the medical students knowledge of their professions was limited.

For the PT & OT students this realization alone may set the stage for providing explanations about what they can do at a later point in their careers.

Student motivation is likely to be high using active learning IPE format with opportunity to develop confidence and satisfaction

Efficient method to provide exposure for a large number of students in a short timeframe.

Benefit of repetition to develop confidence High fidelity with low stakes

Support for Hoffman & Harnish (2007) suggesting that changes in student attitudes and confidence in their own skills within an IPE context is useful.

Khalili 2013 suggests that uniprofessionalidentity is the first step to wards interprofessional socialization.

Khalili 2013

SystematicFactors

Professional Education

Dual Identity

Personal

IPEIndividual

Identity

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Experience was positive and motivating, but additional opportunities would be needed to build team identity.

Requirement for Teaching & Learning class or Service Learning requirement which may have influenced commentary

Did not collect medical student’s perceptions

Different reflection methods did not allow comparison of PT & OT responses

Short term exposure early within curriculum, unable to determine influence of early timing

Peer teaching active learning IPE experience:

Provided an opportunity for PT/OT students to develop confidence and experience satisfaction while refining practical skills, communication and teaching strategies

Promoted development of individual professional role identity.

Further IPE experiences are likely to solidify communication and interprofessional skills and build team professional identity.

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