Embed Size (px)
Citation preview
Interprofessional (IP) Competencies in Geriatrics
Marilyn Luptak, PhD, MSWAssociate Professor and Director, Social Work in Aging Emphasis
Spafford Endowed Chair in Social Work
Hartford Geriatric Social Work Faculty Scholar
University of Utah College of Social Work
Webinar November 13, 2012
Acknowledgements
Adapted from
Interprofessional (IP) Competencies in Geriatrics,Prepared & Presented by:
Tim Farrell, MD & Marilyn Luptak, PhD, MSW
Western Regional Reynolds Meeting
July 13, 2012
Objectives
Introduce a paradigm for IP competencies. Define the “state of the art” in IP
competencies, including geriatrics. Discuss multiple perspectives on IP
competencies. Share lessons learned from IP curricular
implementation
TeamSTEPPS website:http://www.healthcaresafetysolutions.com/pg_teamtrain_sol_more.html
Traditionally, each member of the medical team…has trained in educational silos, perfecting his or her own skill set but with a limited understanding of each others’ roles…each individual having a vast amount of experience but the team itself being a complete novice.
/
“A team of experts does not make an expert team”
Swezey, Salas, eds. Teams: Their training and performance. 1992:3-29.
Why pursue Interprofessional Education (IPE)?
“…how care is delivered is as important as what care is delivered”*
Evidence supports effectiveness of IP care†
Gap between training and practice realities Need “collaborative practice-ready” graduates *
* Interprofessional Education Collaborative Expert Panel (2011) † Partnership for Health in Aging (PHA) Position Statement (2010)
Crew Resource Management
Crew Resource Management (CRM)CRM Characteristic 1980s 2000s
Team composition Pilots only Pilots, flight attendants, ground crew
Educational focus Team members’ personalities
Team members’ interactions
Training activities Unrelated to aviation Related to aviation
Duration of training One-time experience Longitudinal experience
Organizational features
-No “safety culture”-CRM imported from other airlines or countries
- “Safety culture” exists-CRM adapted to each airline’s needs
Attitude of pilots Often ridiculed Widespread acceptance
3 Types of Professional Competencies
Adapted from Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative (p. 19)
Spectrum of IP Care
IP collaborative practice
IP teamwork
IP team-based care
Increasingly intentional
team-based care
Key Aims of IPE
• Learning is interactive
• Improve interprofessional communication
• Enhance collaborative competencies
• Resolve interprofessional rivalries • Improve quality of care, relationships
Slide from J Rivera, Interprofessional Education and Assessment Presentation at Reynolds July 2012 Meeting
Back to the Future…
Historical Perspective: Geriatric Interdisciplinary Team Training (GITT)
In the mid-1990s the JA Hartford Foundation sought to improve care of older adults via GITT by:
Creating national training models of partnerships between "real world" providers of geriatric care and educational institutions
Improving academic responsiveness to the health care delivery system
Developing well-tested curricula for GITT Creating a cadre of well-trained professionals competent in
gerontology and interdisciplinary team skills Testing models of staff development training for practicing
health professionals
JA Hartford Foundation. (2001)
Geriatric Interdisciplinary Team Training (GITT) – State of the Art
Rush University GITT Program
16+ years of providing interdisciplinary education, training and applied practice programs in team based geriatric care in a variety of formats.
Has trained > 4000 advance practice students/professionals in > a dozen disciplines.
Piloting an online GITT course that includes learning competencies and knowledge from Core Competencies for Interprofessional Collaborative Practice document.
Rush University Medical Center GITT
(website accessed June 1 2012)
IPEC (Interprofessional Education Collaborative Expert Panel)
Multiple stakeholders convened in 2011 Adopted 2003 IOM competencies for
health professions education: Provide patient-centered care Apply quality improvement Employ evidence-based practice Utilize informatics Work in interdisciplinary teams
Not specific to geriatrics
IPEC Competency Domains
Domain 1: Values/Ethics for IP Practice Domain 2: Roles/Responsibilities Domain 3: IP Communication Domain 4: Teams and Teamwork
Partnership for Health in Aging (PHA)
Similarities to IPEC IP competencies Multiple stakeholders convened in 2008 Focus on competencies that should be
mastered upon completion of a health professions program
Differences from IPEC IP competencies Geriatrics-specific Based on 2008 (not 2003) IOM report
PHA “Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-
Level Health Professional Degree”
Domain 1: Health Promotion and Safety Domain 2: Evaluation and Assessment Domain 3: Care Planning and Coordination
Across the Care Spectrum (Including End-of-Life Care)
Domain 4: Interdisciplinary and Team Care Domain 5: Caregiver Support
PHA/IPEC Overlap
IPEC Domain PHA Domain PHA Subdomain
Values/Ethics Multiple 2.1, 3.1, 4.1, 4.2
Roles/Responsibilities Evaluation and Assessment
2.1
Communication Care Planning and Coordination Across the Care Spectrum
3.4
Teams and Teamwork Interdisciplinary and Team Care
4.1, 4.2
How to implement IPE competencies?
Exposure vs. context Simply exposing trainees to other disciplines is
probably insufficient Must ground IPE in a relevant clinical setting to
promote behavior change
Optimal approach is unclear Timing Duration Required vs. elective experiences Separate course vs. “thread”
Challenges in IPE
Developing its theoretical underpinning Engaging trainees from multiple disciplines Promoting contextual learning Overcoming barriers to instilling IP “culture” Scheduling Assessing trainees’ performance in IP
competencies*
IPE implementation status
Nursing Integrated into baccalaureate, master’s and doctoral
levels Medicine
ACGME: “Next Accreditation System” (Milestones) Osteopathic: Preliminary work under way
Dentistry: Pending within 2013 accreditation standards
Pharmacy: Part of current accreditation standards Public health: 10 master’s level IPE competencies Social work: In process….
IPE Competencies: Social Work
Since 1998, Hartford Social Work (SW) curriculum development projects have used a competency-based approach to infuse gerontological SW content in classroom and field curricula that: Focuses on student outcomes based in practice
behaviors Stipulates 10 competencies common to generalist
and advanced SW practice The gero competencies are linked to current
CSWE Educational Policy and Accreditation Standards practice behaviors.
Council on Social Work Education and the Social Work Leadership Institute. (2009)
Geriatric Social Work Competency Scale II With Life-Long Leadership Skills
Domains of geriatric social work with 10 skills
in each I. Values, ethics and theoretical perspectives II. Assessment III. Intervention IV. Aging services, programs and policies V. Leadership in the practice environment of
aging Rating on 5-point Likert scale 0 ----------------- 1 ------------------ 2 ------------------ 3 ---------------- 4 Not skilled at all - Beginning skill - Moderate skill - Advanced skill - Expert skill
Council on Social Work Education and the Social Work Leadership Institute. (2009)
Geriatric Social Work Competency Scale II… (cont)
Social Work Skills Related to Interprofessional Practice
Understand the perspective and values of SW in relation to working effectively w other disciplines in geriatric interdisciplinary practice.
Advocate on behalf of clients w agencies and other professionals to help elders obtain quality services.
Assess “self-in-relation” in order to motivate yourself and others including trainees, students, and staff toward mutual, meaningful achievement of a focused goal or committed standard of practice.
Create a shared organizational mission, vision, values and policies responding to ever changing service systems in order to promote coordinated, optimal services for older persons.
Build collaborations across disciplines and the service spectrum to assess access, continuity, and reduce gaps in services to older adults.
Manage individual (personal) and multi-stakeholder (interpersonal) processes at the community, interagency, and intra-agency levels in order to inspire, leverage power, and resources to optimize services for older adults.
Council on Social Work Education and the Social Work Leadership Institute. (2009)
University of Utah IPE and Geriatrics – Initial Steps
Feb 2011: Dr Farrell and I served together on a geriatrics conference steering committee.
Dec 2011: We reconnected to explore collaborating on a CMS grant proposal related to care transitions.
Jan 2012: Based on a shared commitment to geriatric interprofessional education, we began to identify strategies for including MSW students in Dr Farrell’s GACA OSVE project.
July 2012: We co-presented on IP Competencies for the Reynolds Western Regional meeting.
November 2012: OSVE pilot is underway; scheduling is challenging….
GT-OSVE (Geriatric Transitions Objective Structured Video Examination)*
IP trainees view a 10-minute video clip of a transition of care
Team leader (usually FM resident) formulates plan of care with assistance of IP team
Team leader presents plan of care to faculty Assessment instrument:
Transitions domains Team leadership domains
*Funded by HRSA Geriatric Academic Career Award (GACA) grant # K01HP20487
GT-OSVE
GT-OSVE
Relationship to IPE best practices Culture: Developed from the inside out Context: Delivered within clinical settings Scheduling: Eased by video format
Preliminary lessons learned Most team functioning assessment instruments
assume a long-standing team. Use of existing infrastructure eases
implementation. Engagement of non-resident learners is essential.
References
Council on Social Work Education (CSWE) & the Social Work Leadership Institute. (2009). Advanced gero social work practice. Alexandria, VA: CSWE.
Farrell T & Luptak M. (July 13, 2012). Interprofessional Competencies in Geriatrics. Presentation @ Western Regional Reynolds Meeting, Newport Beach, CA.
Helmreich RL, Merritt AC, Wilhelm JA. (1999). The evolution of crew resource management training in commercial aviation. International Journal of Aviation Psychology, 9(1): 19-32. Available at: http://homepage.psy.utexas.edu/homepage/group/helmreichlab/publications/pubfiles/Pub235.pdf. Accessed May 27, 2012.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.
References (cont)
JA Hartford Foundation. (2001). The John A Hartford Foundation geriatric inter-disciplinary team training (GITT) Program: Implementation manual. NY: Author.
Partnership for Health in Aging. (2008). Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-Level Health Professional Degree. Available at: http://www.americangeriatrics.org/files/documents/health_care_pros/PHA_Multidisc_Competencies.pdf. Accessed May 27, 2012.
Partnership for Health in Aging. (2010). Position Statement on Interdisciplinary Team Training . Available at: www.americangeriatrics.org/pha. Accessed May 27, 2012.
Reeves S, Lewin S, Espin S, & Zwarenstein M. (2010). Interprofessional Teamwork for Health and Social Care. Ames, IA: Blackwell Publishing Ltd.
Rush University Medical Center Geriatric Integrated Team Training. Available at: http://www.rush.edu/professionals/training/geriatrics/index.html. Accessed June 1, 2012.
