Collaboration in Action – EFPPEC at Queen’s Dr. Cori Schroder MD MEd CCFP FCFP

1. Collaboration in Action – EFPPEC at Queen’s Dr. Cori Schroder MD MEd CCFP FCFP Dr. Joshua Shadd MD CCFP EFPPEC Videoconference March 14, 2007

2. Objectives This videoconference will provide participants with the opportunity to: • hear about successful collaborative educational initiatives at the undergraduate, post-graduate and faculty development levels • appreciate the benefits of jumping on someone else’s bandwagon • discuss the pros and cons of EFPPEC ‘branding’ in the curriculum • think more flexibly about ways of advancing EFPPEC competencies in their home institutions

3. Outline • Introduction – A Bit of History • Collaborative Initiatives • Undergraduate • Postgraduate • Faculty Development • Summary & Conclusions Break for Questions

4. A Bit of History Working within the Queen’s Environment • Faculty of Health Sciences – Medicine, Nursing, Rehabilitation Therapy • Palliative Care Medicine Program – Departments of Oncology, Family Medicine, Medicine “Queen’s … on the cutting edge of tradition…”

5. A Bit of History Getting the ‘word’ out.. Developing the Local Team.. • Palliative Care Medicine Program • Undergraduate – Medicine in Society, Associate Dean UG Program • Postgraduate – PGME, Assistant Dean PG Program • Associate Dean Medical Education

6. A Bit of History QUIPPED • Queen’s University Inter-Professional Patient-Centred Education Direction • $1.2 million for qualitative research (action research in the critical paradigm) • 33 months to change the culture of teaching and learning at Queen’s (June 2005 – March 2008)

7. A Bit of History The Goal of QUIPPED To create an inter-professional educational environment at Queen’s University that enhances the ability of learners, faculty, and health care providers to provide patient-centred care that recognizes the contribution of the health care team within a respectful and collaborative framework. Web page: http://meds.queensu.ca/quipped

8. A Bit of History The Inter-Professional Matrix at Queen’s (QUIPPED)

9. A Bit of History Commonalities: QUIPPED and EFPPEC • Education initiatives • Need to change ‘culture’ of institution • Various levels of learners • Promote patient-centred care • Promote collaboration • Inter-professional

10. A Bit of History EFPPEC could offer QUIPPED • Competencies and content ideal for IPE • Committed educators QUIPPED could offer EFPPEC • Stronger ‘lobby’ within institution • Assistance with development of education initiatives • Broader representation on EFPPEC local team

11. Undergraduate

12. The Current Picture Year 1 Year 2 Year 3 Year 4 Phase I Phase IIA Phase IIB Phase IIC Phase IIE Clerkship

13. The Current Picture • 3hr PC lecture • 2hr pain lecture • 1hr pain small group • 2hr multidisciplinary pain lecture • 3hr PC patient home visit (inter-professional facilitators) • Total contact: 11 hours Year 1 Year 2 Year 3 Year 4 Phase I Phase IIA Phase IIB Phase IIC Phase IIE Clerkship

14. The Current Picture • 2hr multidisciplinary pain lecture • 1hr PC dyspnea lecture • 1hr PC GI lecture • 3hr PC cases (small groups) • Total contact: 7 hours Year 1 Year 2 Year 3 Year 4 Phase I Phase IIA Phase IIB Phase IIC Phase IIE Clerkship

15. The Current Picture • 1hr tutorial Year 1 Year 2 Year 3 Year 4 Phase I Phase IIA Phase IIB Phase IIC Phase IIE Clerkship

16. The Current Picture Year 1 Year 2 Year 3 Year 4 Phase I Phase IIA Phase IIB Phase IIC Phase IIE Clerkship

17. The Current Picture Challenges • distributed, but not integrated • minimal presence in clerkship Strengths • We have time (and time is territory) • We are not alone

18. Agents of Change EFPPEC Accreditation-inspired re-evaluation of curriculum & pedagogy Office of Health Science Education QUIPPED New electronic learning resources

19. EFPPEC + Office of Health Sciences Education Innovation Fund = The Progressive, Integrated, Collaborative Pain Curriculum Project

20. PIC Pain Project Our challenge: • Numerous instructors from multiple disciplines/departments • Difficult to know what students already know • Diverse ideas about what students need to know • “Everybody’s problem, but no one’s responsibility.” Our team: • Palliative Care Medicine • Pharmacology & Toxicology • Orthopedic Surgery • Family Medicine • Health Science Education

21. PIC Pain Project Our aim: To reassess and redevelop a curriculum intended to equip pre-clerkship students with the knowledge, attitudes and skills required to assess and manage the symptom of pain appropriate to the level of a beginning clinical clerk. Get everyone on the same page, moving effectively in the same direction in a coordinated fashion.

22. Consensus-based Distinct Progressive Integrated Collaborative Relevant Measurable Mappable PIC Pain Project • Our goals: • Develop a Phase II pain curriculum

23. PIC Pain Project Our goals: • Develop learning opportunities • relevant & engaging • pedagogically sound • workload & time neutral • Evaluate • student outcomes • the curricular development process

24. Consensus-based Distinct Progressive Integrated Collaborative Relevant Measurable Mappable PIC Pain Project • So where are we? • Develop a Phase II pain curriculum Here!

25. PIC Pain Project Building Consensus • Literature search: pain curricula • Stakeholder survey: What topics are appropriate for pre-clerkship? • Survey outcomes: • Awareness • Dialogue • Buy-in • Lay groundwork for inter-professional initiative

26. EFPPEC + Oncology curricular renewal + collaborativecurriculum.ca = Oncology e-Curriculum

27. Oncology e-Curriculum • Proposed online oncology learning resource • Outgrowth of online learning project funded jointly by 5 Ontario faculties • Initial target will be undergraduate medicine, but content will address needs of learners from different professions at different levels • Anticipated content will address multiple EFPPEC competencies

28. EFPPEC + QUIPPED = Advance Care Planning IP Student Workshop

29. ACP IP Student Workshop • Initiated, designed & implemented by inter-professional group of graduate students (OT, theology, medicine) through QUIPPED stipends • Half-day elective workshop for pre-licensure students in medicine, nursing, occupational therapy & physiotherapy • Pedagogical guidance & logistical support from QUIPPED • Several members of EFPPEC local team served as consultants to students

30. EFPPEC + QUIPPED = Suffering: Responding as Professionals

31. Suffering Curriculum • Inter-professional exploration of the concept of suffering and our response as health care professionals • Multifaceted-approach aimed at pre-licensure students

32. EFPPEC alone ↓ Palliative Care Patient home visits for first year medical students

33. First-Year Patient Visits EFPPEC OT “Lived Experience” QUIPPED Geriatrics

35. Postgraduate

36. Associate Medical Service, Inc.Fellowship in End-of-life Care • Fellowships awarded in 2005 for 5 years to 6 teaching sites in Ontario • Education initiative • To develop interdisciplinary models of exemplary EOL care • Enhance postgraduate medical trainees’ care and management of patients at the end of life

37. EFPPEC + AMS = Educational Strategies for IM Residents

38. Education Strategies for IM Residents • Evaluation of residents involves self-assessment (level of competence/priority for learning) based on generic EFPPEC competencies • Knowledge test mapped to EFPPEC competencies • Evaluation data will inform as to IM resident needs and effective educational strategies Current Benefits: • All IM residents now have a mandatory 1-month PC rotation • Queen’s AMS Fellows and co-investigator on evaluation are members of the Local EFPPEC team

39. Faculty Development

40. EFPPEC + QUIPPED = Loss and Bereavement Faculty Development Workshop

41. Loss & Bereavement Faculty Development Workshop • Focus on faculty • Enhance content expertise (EFPPEC competencies considered) • Develop skills to enhance collaborative practice in loss & bereavement • Develop skills to enhance ability to teach topic from an IPE perspective • 60 faculty (13 nursing, 10 psychology, 10 social work, 7 OT, 6 MD, 3 theology, 2 PT, 9 other)

42. Loss & Bereavement Faculty Development Workshop Sessions related to EFPPEC competencies • Key note address: “At a loss: Professional and Personal Responses to Grief, Mourning, and Bereavement” • Workshops: “Spirituality of Loss and Bereavement: Awareness and Assessment” “Cross cultural Factors in Loss and Bereavement” “What about my grief? The Health Care Provider’s Grief” “What should I say and how should I say it: Interviewing and Counseling the Bereaved”

43. Inter-professional Teaching and Learning (IPTL) Certificate Program • 3 Modules • Developing Effective Inter-Professional Collaborative Teams • Creating an Inter-professional learning environment • Developing an Inter-Professional Applied Project • Opportunity for inter-professional educators to enhance skills to enable them to ‘teach from an IPE perspective’ • Foster inter-professional partnerships • 17 participants (medicine, OT, nursing, psychology, PT)

44. EFPPEC + QUIPPED + IPTL = Suffering: Responding as Professionals & Oncology e-Curriculum

46. EFPPEC ‘Branding’ Is it important to ‘brand’ EFPPEC competencies in our curricula? Consider… • branding can be a barrier to collaboration • the twin risks of too much or too little responsibility (creating a new silo or provoking a turf war) • value of the brand • EFPPEC is a finite entity

47. Cons: Loss of control Dilution of respect Hassle factor Pros: Helps break down silos Increase student/faculty buy-in Leverage influence outside your dedicated hours Reflects the real world Only realistic way of achieving objectives! Why Collaborate?

48. Today

49. The Future

50. Summary – Lessons We’ve Learned • Build a broad local team • Look around for what is already happening – and see if you can join in! • It is easier to adjust the direction of a moving object than create momentum from scratch • Sometimes it is better to be a shotgun than a rifle