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P iloting an Interprofessional E ducation W orkshop: Teaching others palliative care communication skills

P iloting an Interprofessional E ducation W orkshop: Teaching others palliative care communication skills. Neha J. Darrah, MD Diane Hadley, PharmD BCACP Amy Corcoran MD CMD FAAHPM Geriatrics Grand Rounds April 4, 2014. Disclosures.

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P iloting an Interprofessional E ducation W orkshop: Teaching others palliative care communication skills

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  1. Piloting an Interprofessional Education Workshop: Teaching others palliative care communication skills Neha J. Darrah, MD Diane Hadley, PharmD BCACP Amy Corcoran MD CMD FAAHPM Geriatrics Grand Rounds April 4, 2014

  2. Disclosures • We have no relevant financial disclosures; however, a portion of this project was supported by funds from the Health Resources and Services Administration (HRSA) under Geriatric Academic Career Award K01HP20493 and the GEC grant UB4HP19214. • The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the DHHS, HRSA, BHPR, or the U.S.

  3. Learning Objectives To describe the main objective for an effective interprofessional, education workshop To list the essential elements for a successful interprofessional, education workshop

  4. Overview • IPE BACKGROUND • IPE and palliative care • Workshop history • Workshop description • Results • Study limitations • Future implications

  5. What is IPE? Interprofessional Education (IPE) • Defined as students from two or more professions learning about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010) Goal of IPE • Prepare health professional students for deliberately working together • Provide high quality, patient-centered care

  6. Barriers to IPE Logistics Professional hierarchies/stereotypes Institutional resistance

  7. Strategies for IPE Classroom didactics Practice based interventions Experiential Strategies • Role play • Simulation exercises

  8. Interprofessional Education Collborative (IPEC) • Organizations involved • American Association of Colleges of Nursing • American Association of College of Osteopathic Medicine • Association of schools of Public Health • American Association of Colleges of Pharmacy • American Dental Education Association • Association of American Medical Colleges Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed April 1, 2014.

  9. Interprofessional Collaborative Practice Domains from Interprofessional Education Collaborative (IPEC) 2011 Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Available at: http://www.aacn.nche.edu/education-resources/ipecreport. Accessed April 1, 2014.

  10. Overview • IPE Background • IPE AND PALLIATIVE CARE • Workshop history • Workshop description • Results • Study limitations • Future implications

  11. Why is IPE Relevant to Palliative Care? Palliative care is specialized medical care for people with serious illnesses. Palliative care is provided by a TEAM of doctors, nurses, and other specialists (social work, chaplaincy, pharmacy) who work together with a patient’s other doctors to provide an extra layer of support.

  12. Past IPE Palliative Care Workshops Palliative care: A suitable setting for undergraduate interprofessional education • Description: Interprofessional student workshops with family care providers • Recruited Learners: Medical, nursing, social work, physiotherapy, and occupational therapy students • Results: Students value and enjoy opportunity to work together and find the experience moving, informative, and interesting Wee B, Hillier R, Coles C, et al. Palliative care: a suitable setting for undergraduate interprofessional education. Palliat Med. 2001 Nov; 15 (6) 487-92.

  13. Past IPE Palliative Care Workshops Using simulated patients in a multiprofessional communication skills programme: reflections from the programme facilitators • Description:Multiprofessional, 4-day communication skills program with standardized patients • Recruited learners: Predominantly nursing with some physiotherapist, dieticians, and radiographers • Results: No formal evaluation but feedback was positive Donovan T, Hutchinson T, and Kelly A. Using simulated patients in a multiprofessional communication skills programme: reflections from the programme facilitators. Eur J Cancer Care. 2003 Jun; 12(2): 123-8

  14. Past IPE Palliative Care Workshops Enhancing interprofessional education in end-of-life care: An interdisciplinary exploration of death and dying in literature • Description: 12-week elective focused on reflections of dying depicted in the literature • Recruited learners: medical, nursing, bachelor of health science, and chaplaincy students • Results: All students met learning objectives based on qualitative analysis of written assignments and highly rated by participants Brajtman S, Hall P, and Barnes P. Enhancing interprofessional education in end-of-life care: an interdisciplinary exploration of death and dying in literature. J Palliat Care. 2009 Summer; 25(2): 125-31

  15. Past IPE Palliative Care Workshops Interdisciplinary education in end-of-life care: Creating new opportunities for social work, nursing, and clinical pastoral education students • Description: Interprofessional case simulations with volunteer actors • Recruited learners: Social work, nursing, and chaplain students • Results: All students found it valuable and most cohorts demonstrated significant improvement in pre-determined outcomes Forrest C and Derrick C. Interdisciplinary education in end-of-life care: creating new opportunities for social work, nursing, and clinical pastoral education students. J Soc Work End Life Palliat Care. 2010; 6(1-2): 91-116.

  16. Past IPE Palliative Care Workshops Using Online Learning and Interactive Simulation To Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students • Description: Combined online learning with interactive simulation • Recruited learners: Social work, nursing, medicine, and chaplain • Results: Successfully met five learning objectives and highly rated by participants Ellman MS, Schulman-Green D, Bratt L, et al. Using Online Learning and Interactive Simulation to Teach Spiritual and Cultural Aspects of Palliative Care to Interprofessional Students. J Palliat Med. 2012; 15(11); 1240-

  17. Past IPE Palliative Care Workshops Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication With Patients with Serious Illness: A Randomized Trial • Description: Randomized participants to 8-session, simulation-based, communication skills intervention vs usual education • Recruited learners: Medicine, nurse practitioners • Results: Simulation-based communication training did NOT improve quality of communication but was associated with small increase in patients’ depressive symptoms Curtis JR, Back AL Ford DW et al. Effect of Communication Skills Training for Residents and Nurse Practitioners on Quality of Communication with Patients with Serious Illness: A Randomized Trial. JAMA. 2013 Dec 4; 310 (21): 2271-81

  18. Overall Conclusions • IPE is generally well received by students • Number of disciplines in workshops ranged from two to five • Simulation-based training did NOT translate into improved quality of communication

  19. Overview • IPE Background • IPE and palliative care • WORKSHOP HISTORY • Workshop description • Results • Study limitations • Future implications

  20. Workshop History 2011-2012 • Piloted first interprofessional, communication workshop with advanced practice nursing students and physician fellows • Developed as three-station palliative care Observed Structured Clinical Examination (OSCEs) Corcoran AM, Lysaght S, Lamarra D, Ersek M. Pilot test of a three-station palliative care observed structured clinical examination for multidisciplinary trainees. J Nurs Educ. 2013 May;52(5):294-8.

  21. Workshop History 2012-2013 • Expanded workshop to include learners from nursing (undergraduate and advanced practice), medicine (fellows), physical therapy, occupational therapy, pharmacy, chaplaincy, and social work (masters students) • Recruited learners from BOTH University of Pennsylvania and University of Sciences • Demonstrated statistically significant improvement in learner preparedness for interprofessional team and communication skills

  22. Lessons Learned from Past Workshops Learners appreciated the opportunity to work in interdisciplinary teams Rated the topic as good to excellent Learners need to be matched based on training level • i.e. Physician fellows are not well matched with undergraduate nursing students

  23. Overview • IPE Background • IPE and palliative care • Workshop history • WORKSHOP DESCRIPTION • Results • Study limitations • Future implications

  24. Workshop Goals Introduce palliative care communication and interprofessional team skills to learners Determine effectiveness of interprofessional workshop on improving these self-reported skills

  25. Recruited Learners University of Pennsylvania • Medicine (fourth year medical students) • Social Work • Nursing (undergraduate, advanced practice) • Chaplaincy University of Sciences • Physical therapy • Occupational therapy • Pharmacy

  26. Key Components of Workshop Workshop Basics • Pre-workshop preparation • Two-hour simulation-based workshops with STANDARDIZED PATIENTS • Four sessions offered over two days in October Participants and Observers • Nursing and social work students were assigned to be either participants or observers at the discretion of their faculty • All participants were assigned to pre-determined interprofessional teams Recruited diverse, interprofessional faculty facilitators

  27. Case Description Patient is a 72 y/o female with dementia admitted from a nursing home to the ICU three days ago for aspiration pneumonia. She is now doing better and transferred to the floor. At baseline, she requires assistance in her all of her ADLs. She is noted to have signs of aspiration Goal of meeting is to discuss goals of care (resuscitation, discharge plan) with patient’s daughter or son

  28. Workshop Schedule

  29. Evaluations Participants were given both pre and post-workshop evaluations Asked participants to rate their confidence in multiple domains on 5 point Likert scale • Communication Skills • Interprofessional team skills (Based on IPEC competencies)

  30. Overview • IPE Background • IPE and palliative care • Workshop History • Workshop Description • RESULTS • Study limitations • Future implications

  31. Learner Assignments

  32. Learner Demographics

  33. Learner Demographics

  34. Importance of IPE

  35. Prior Experience

  36. Prior Experience

  37. Comparison of Pre and Post-Workshop Evaluations

  38. Comparison of Pre and Post-Workshop Evaluations

  39. Curriculum/Workshop Content

  40. Workshop Sessions

  41. Overall Evaluation

  42. Overall Conclusions Pre vs Post Workshop Assessments • Participant Group: Significantly more confident in ALL domains after the workshop • Observer Group: Significantly more confident in mostdomains after the workshop Majority of participants rated the workshop as very good to excellent Majority of participants would be interested in participating in another workshop

  43. Overview • IPE Background • IPE and palliative care • Workshop History • Workshop Description • Results • STUDY LIMITATIONS • Future Directions

  44. Study Limitations Variability in student representation Evaluations Used • Used non-validated survey tool • Evaluation of effectiveness was limited to students’ self-reports and did not assess higher level learning outcomes as acquisition of knowledge or behavior change

  45. Overview • IPE Background • IPE and palliative care • Workshop History • Workshop Description • Results • Study Limitations • FUTURE DIRECTIONS

  46. Future Directions Workshop Structure • Offer workshop multiple times during the year • Offer workshop multiple times for the same group of learners Evaluations • Use validated survey tool • Create OSCE for learners to test behavior changes

  47. Thank you! Dr. MaryAnn Foricea Dr. Mary Ersek Dr. Cathy Poon Eunhae Kim Dr. Christine Bradway Dr. ZviGellis Dr. Lora Packel Dr. Varleisha Gibbs Dr. Claudia Pravanta Dr. Valerie Cotter Dr. Carrie Ann Doherty Denise LaMarra John Seman

  48. QUESTIONS?

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