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Where Does InterprofessionalEducation (IPE) Fit Into Your

Program Curriculum?

Sandra Banas Joan Ward

Program Directors 101 Pando ™ Workshop

Objectives • Define interprofessi onal education.

• Discuss the concept interprofessional team based care.

• Define the interprofessional practice competency domains.

• Develop strategies to implement interprofessionalcurriculum

What Is Interprofessional Education (IPE) ?

When students from 2 or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.

WHO, Framework for IPE, 2011

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Why IPE?Medical errors result from poor communication and gaps in delivery of care

– Institute of Medicine, To Err is Human (1999)

Why IPE?

The Triple Aim• Safety• Efficiency• Patient Satisfaction

Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st

Century (2001)

Paradigm ShiftPhysician centered practice to Patient centered practice

Practitioner autonomy to Team collaboration

Focus on illness & cure to Focus on health promotion

Passive patient role to Involved patient & families

Acute, episodic care to Care for chronic conditions

Aschenbrener CA, Clearing a Path Ahead for IPE Presentation: Collaborating Across Borders I I , Halifax, 2007 Institute of Medicine, Crossing the Quality Chasm

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Goal of Interprofessional Education

• Prepare all health professions students for deliberatively working together with the common goal of building a safer and better patient-­centered and community-­population oriented U.S. health care system.

Interprofessional Team-­Based Care• Care delivered by intentionally created, usually relatively small work groups in health care, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients.– Rapid response teams– Palliative care teams– Primary care teams

– Operating room team

Interprofes s ional Educ ation Col laborativ e Ex pert Panel . Core c ompetenc ies for In terprofes s ional c o l laborativ e prac tic e: Report o f an ex pert panel. May 2011. Was hington, DC. In terporfes s ional Educ ation Col laborativ e.

Interprofessional Collaborative Practice

• Understanding of and respect for the role and contributions of each profession.

• Performance of skills required for collaborative patient/client-­centered teamwork .

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Teamwork • No elite sports team or marching band is successful without teamwork.

Collaborative Education

CollaborativePractice

PATIENT

Education Practice

How will IPE benefit students as future clinicians?

• Understanding of others• Fosters communication• Personal growth/humility• Decreased med errors• Increased career satisfaction

• Understanding place in health care system

• Improved patient care

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Institute of Medicine (IOM) Reports

• 1972 IOM Report-­”Educating for the Health Team”

• 1999 IOM Report – “To Err is Human: Building a Safer Health System”

• 2001 IOM Report – “Crossing the Quality Chasm: A New Health System for the 21st Century

• 2003 IOM Report-­ “Health Professions Education: A Bridge to Quality”

The Lancet Report

• “Instructional reforms should: adopt competency-­driven approaches to instructional design,…Promote interprofessionaleducation…that breaks down professional silos while enhancing collaborative and non-­hierarchical relationships in effective teams.”

Fran k J, Chen L, Bhu tta Z, et al . Heal th p ro fessionals fo r a n ew cen tu ry: tran sfo rmin g Edu cation to strengthen heal th systems in an in terdependen t wo rld . The Lan cet, 2 0 1 0 ; 3 7 6 : 1 9 2 3 -­‐1 9 5 8

Conferences

• All Together Better Health-­ 8th International Conference on InterprofessionalPractice in Education – Oxford

• Interprofessional Education Collaborative-­ Interprofessional Education: Building a Framework for CollaborationOctober 5-­7, 2016Herndon, VA

• Jefferson Center for InterprofessionalEducation-­ InterProfessional Care for the 21st Century -­ Redefining Education & Practice-­ October 28 to 29, 2016

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U.S.: Right Time for IPE

• U.S Healthcare Reform

• U.S. Health Professions Accreditation Organizations

• Interprofessional Education Collaborative (IPEC) Expert Panel

IPE Best Practices• Begin IPE early• Identify topics that are best covered with an IPE approach

• Experiences occur throughout the health professional program, didactic and clinical

• Include interactive learning experiences followed by critical reflection and feedback

US Healthcare Reform Examples • American Recovery and Reinvestment Act (2009)

– Allocates ~$19 billion to expand the use of health IT– Provide an integrated medical record and information system that is accessible to providers and patients

• Patient Protection and Affordable Care Act of 2010– Realign providers’ financial incentives– Encourages more efficient organization and delivery of health care

– Investment in preventive and population health• Expansion of health insurance coverage

– In 2010, adults up to age 26 are eligible for coverage under parents’ insurance plan

– Low to moderate income families were eligible for assistance in obtaining coverage in 2014

– Eliminate “pre-­existing” conditions that preclude coverage

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U.S. Health Professions Accreditation Organizations

Standards for the Curriculum• B1.08 The curriculum must include instruction to prepare students to work collaboratively in interprofessional patient centered teams.

• ANNOTATION: Such instruction includes content on the roles and responsibilities of various health care professionals, emphasizing the team approach to patient centered care beyond the traditional physician-­PA team approach. It assists students in learning the principles of interprofessional practice and includes opportunities for students to apply these principles in interprofessional teams within the curriculum.

Interprofessional Education Collaborative – Expert Panel

IPEC Report, May 2011 IPEC Competencies• Report provides core competencies

for interprofessional education • Includes:

– American Association of Colleges of Pharmacy (AACP)

– American Association of Colleges of Nursing (AACN)

– Association of American Medical Colleges (AAMC)

– American Dental Education Association (ADEA)

– American Association of Colleges of Osteopathic Medicine (AACOM)

– Association of Schools of Public Health (ASPH)

In terprofes s ional Educ ation Col laborativ e Ex pert Panel . Core c ompetenc ies for in terprofes s ional c o l laborativ e prac tic e: Report o f an ex pert panel . May 2011. Was hington, D.C. In terprofes s ional Educ ation Col laborativ e.

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Press Release – February 2016 • Nine new members join organization dedicated to improving patient care

The Interprofession al Education Collaborative (IPEC) has approved nine additional members through a new institutional membership category, expanding its representation of associations of schools of the health professions to 15. Established in 2009 by six organizations committed to advancing interprofessional learning experiences and promoting team-­based care, IPEC now includes the following national associations:

Founding members:• American Association of Colleges of Nursing (AACN)• American Association of Colleges of Osteopathic Medicine (AACOM)• American Association of Colleges of Pharmacy (AACP)• American Dental Education Association (ADEA)• Association of American Medical Colleges (AAMC)• Association of Schools and Programs of Public Health (ASPPH)

New institutional members:• American Association of Colleges of Podiatric Medicine (AACPM)• American Council of Academic Physical Therapy (ACAPT)• American Occupational Therapy Association (AOTA)• American Psychological Association (APA)• Association of American Veterinary Medical Colleges (AAVMC)• Association of Schools and Colleges of Optometry (ASCO)• Association of Schools of Allied Health Professions (ASAHP)• Council on Social Work Education (CSWE)• Physician Assistant Education Association (PAEA)

• Values/Ethics for Interprofessional Practice• Work with individuals of other profess ions to maintain a climate of mutual respect and shared values

Competency Domain 1

• Roles/Responsibilities• Use the knowledge of one’s own role and those of other profess ions to appropriately assess and address the healthcare needs of the patients and populations served

Competency Domain 2

• Interprofessional Communication• Communicate with patients , families , communities , and other health profess ionals in a respons ive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease.

Competency Domain 3

• Teams and Teamwork• Apply relationship building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-­‐/population centered care that is safe, timely, efficient, effective, and equitable

Competency Domain 4

Interprofessional Collaborative Practice Competency Domains

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Interprofessional Education at Nova Southeastern University

• First Semester– Intro to PA Profession course – Focus on healthcare team. • Lecture and Activity to interview other health professions

• Second & Third Semester– IPE Day – Scheduled day for DO, PT, OT, PA, Pharmacy and Nursing students• Lectures, Activities, Simulation exercises

• Fourth Semester– Students required to spend half day observing interprofessional team of PA, Social Worker and law enforcement managing care of homeless through Project H.O.P.E.

Interprofessional Education at Shenandoah University

• Co-­curricular activities• Brown-­Bag lunches• Simulation Exercises• Clarion Competition• Primary Care Progress• Interprofessional Service Learning Project

• Interprofessional Student Run Clinics

Interprofessional Education at Upstate Medical University

• White Coat Ceremony for students across

CHP

• Case-­Based Activity (PA, MD, NP, PT)

• Virtual Medical Error Room

• Service activities

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Interprofessional Education at University of the Sciences

• Initially– Transition of Care Exercise with PA, PT, OT and Pharmacy Students –

» Utiliz ing a Stroke Care » Done in the First Semester » Repeated in Second Year

– Interprofessional Roles

• Progressed to: – Acute Coronary Syndrome with Simulation

• University of Penn Nurse Practitioner Students – Sepsis Simulation

• University of Penn Nurse Practitioner Students – Pediatric Medication Safety Group Exercise – Geriatric Patient Pharmacology Simulation – Geriatric Interprofessional Activity

© 2012 Benita Epstein © BS Boston G lobe by Dan Wasserman

FROM INTERPROFESSIONAL EDUCATION…TO INTERPROFESSIONAL PRACTICE

Developing InterprofessionalPractice Models in Primary Care

• New models have been developed and designed to address previous/current primary care practice limitations:– The Patient-­Centered Medical Home (PCMH)

• Example care coordination model requiring coordination between multiple health care professionals

• A response to U.S. Healthcare Reform and a concept that appears in the Patient Protection and Affordable Care Act

• Widely-­accepted model• The Chronic Care Model (CCM)

• Multi-­pronged approach for improved chronic disease management• Productive interactions between patients and health care professionals with appropriate resources and expertise

• Foster high-­quality chronic disease care• Meets some criteria of the PCMH

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Principles of the PCMH • Building on the work of a large and growing community, the Agency for Healthcare Research and Quality (AHRQ) defines a medical home not simply as a place but as a model of the organization of primary care that delivers the core functions of primary health care.

• Five Functions/Attributes of the PCMH:– Comprehensive Care– Patient-­Centered– Coordinated Care– Accessible Services– Quality and Safety

How to Implement InterprofessionalEducation in Your Program

• First and foremost, we must be advocates of IPE and “walk the talk.”

• Incorporate innovative practice models into the curriculum and link these models to IPE and team-­based learning

• Engage other programs and Colleges (Medicine, Nursing, PT, Social Work, CSD, etc.) into the planning and implementation of IPE

• Consider holding an IPE Day

• Support a Primary Care Progress Student Chapter

• Take opportunities to learn from other interprofessional disciplines.

Summary • Interprofessional Collaboration improves patient outcomes

• Interprofessional Collaboration is expected and is reflected by US Healthcare Reform policies

• Interprofessional Education is necessary to prepare the healthcare workforce to work collaboratively

• Innovative U.S. primary care models are being developed that vastly incorporates interprofessional practice collaborations

• Despite the wealth evidence of pharmacists contributions and related improved outcomes, the pharmacist’s role in many IPPs is still being defined

• Newer models such as the PCMH and the CCM are ripe for pharmacists’ expertise and interprofessional integration

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References • 1. Institute of Medicine. Educating for the Health Team. October 3, 1972. Available at:

http://www.ipe.umn.edu/prod/groups/ahc/@pub/@ahc/@cipe/documents/asset/ahc_asset350123.pdf. Accessed June 2, 1013.

• 2. Barr H, Ross,F. Mainstreaming Interprofessional Education in the United Kingdom: A position paper. Journal of Interprofessional Care, 2006, Vol. 20, No. 2 , Pages 96-­104.

• 3. Institute of Medicine. Health Professions Education: A Bridge to Quality. April 18, 2003. Available at: http://www.iom.edu/Reports/2003/Health-­Professions-­Education-­A-­Bridge-­to-­Quality.aspx. Accessed June 2, 2013.

• 4. Frank J, Chen L, Bhutta Z, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet, 2010;; 376:1923-­1958.

• 5. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice: Report of an expert panel. May 2011. Washington, D.C. Interprofessional Education Collaborative Available at: http://www.aacn.nche.edu/education-­resources/ipecreport.pdf. Accessed June 2, 2013.

Acknowledgements

• Many thanks to: – Rachel Carlson and Melissa Coffman- from

their 2015 presentation.

Questions?