Putting It All Together: Clinical Placements and Facilitation Skills in Inteprofessional Education IPE

1. Putting It All Together: Clinical Placements and Facilitation Skills in Inteprofessional Education (IPE) What does success and sustainability mean?What does success and sustainability mean?

2. Susan J. Wagner Faculty Lead – Curriculum & Placements Office of Interprofessional Education andCoordinator of Clinical EducationDepartment of Speech-Language PathologyUniversity of TorontoMandy LoweInterprofessional Education LeaderToronto Rehabilitation Institute andFaculty Lead – Preceptor DevelopmentOffice of Interprofessional Education University of Toronto 

3. Agenda Self-Assessment of Facilitation Skills Getting To Know You Learning Objectives University of Toronto IPE Curriculum IPE Component in a Clinical Placement What is Facilitation? and IPE Facilitation? IPE Facilitation Principles IPE Facilitation Competencies Summary

4. Self-Assessment of Facilitation Skills

5. Getting To Know You

6. Getting To Know You Experience with IPE placements and learning Profession

7. Learning Objectives

8. Learning Objectives Describe the IPE component in a clinical placement for the new University of Toronto curriculum. Describe key principles and competencies of an IPE facilitator. Demonstrate reflection on the development of your facilitation skills.

9. University of Toronto IPE Curriculum

10. Definition –Interprofessional Education “Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care”

11. A New Vision “If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.” Commission on the Future of Health Care in Canada, 2002 Michener Centre is forward thinking in having developed the IPE curriculum that you are now taking In the RSS at U of T – OT/PT/SLP we have had an IPE curriculum for the past five years – offer over 20 sessions a year – from didactic to small group facilitated case-based discussions to structured IPE clinical placements Students find very rewardingMichener Centre is forward thinking in having developed the IPE curriculum that you are now taking In the RSS at U of T – OT/PT/SLP we have had an IPE curriculum for the past five years – offer over 20 sessions a year – from didactic to small group facilitated case-based discussions to structured IPE clinical placements Students find very rewarding

12. September 2009 Incoming first year students of the 10 health science professional programs will: Attain core competencies for interprofessional relational-centred collaborative team practice The Vision of the Council of Health Sciences Deans The Vision of the Council of Health Sciences Deans: University of Toronto health professional students will acquire core competencies needed for provision of relationship-centred care  in an interprofessional, collaborative team practice environment, both on campus and at experiential practice sites.The Vision of the Council of Health Sciences Deans: University of Toronto health professional students will acquire core competencies needed for provision of relationship-centred care  in an interprofessional, collaborative team practice environment, both on campus and at experiential practice sites.

13. Funding Ministry of Training, Colleges and Universities Government of Ontario

14. Dentistry Medical Radiation Sciences – Michener Institute Medicine Nursing Occupational Therapy Pharmacy Physical Education and Health Physical Therapy Social Work Speech-Language Pathology

15. Curriculum Overview Mandatory competency-based longitudinal curriculum Woven within each uniprofessional curricula

16. IPE Curriculum Components

17. Core Competencies

18. Key Features Foundational values Entry-to-practice focus Learning continuum Evidence-based Measurable

19. Levels Exposure – introduction – pre-placement Immersion – development - interprofessional placement component Competence – entry-to-practice

20. Hierarchy of constructs Values and Ethics Communication Collaboration

21. Specific competencies aligned with constructs Knowledge Skills/Behaviours Attitudes Within a larger educational and professional context

24. Values and Ethics Competence

25. Relational-Centred Care “captures the importance of the interaction among people as the foundation of any therapeutic or healing activity….relationships are critical to the care provided by nearly all practitioners (regardless of discipline or subspecialty) and a source of satisfaction and positive outcomes for patients and practitioners.” Pew-Fetzer Task Force, 2000

26. Four Dimensions of Relational-Centred Care- Pew-Fetzer Task Force (2000) Patient/Client – Practitioner Relationship Practitioner-Practitioner Relationship Community-Practitioner Relationship Clinician Relationship to Self

28. Communication Competence

29. Collaboration Competence

30. Learning Activities

31. Core Learning Activities Values/ethics: Year 1 session Roles: Case-based session (e.g., Pain Curriculum, Rehab Sciences) Communication: Conflict in Interprofessional Life Collaboration: IPE component in a clinical placement (e.g., Toronto Rehabilitation Institute) The learning activities affiliated with the competency-based curriculum will be integrated within the students’ uniprofessional curricula established by each Faculty/department. Learners will be required to satisfactorily participate in four core IPE learning activities and a certain number of IPE learning activity electives. The four core learning activities include: Introduction to the Values and Ethics related to IPC (e.g., Year 1 IPE Session already in existence) Introduction to health professional roles using IPE case-based sessions (e.g. Pain Curriculum cases already in existence) Interprofessional Communication/Conflict resolution (e.g., Conflict in Professional Life already in existence ) Interprofessional Collaboration - IPE learning within an already existing clinical placement (e.g., Toronto Rehabilitation Institute IPE placement) The learning activities affiliated with the competency-based curriculum will be integrated within the students’ uniprofessional curricula established by each Faculty/department. Learners will be required to satisfactorily participate in four core IPE learning activities and a certain number of IPE learning activity electives. The four core learning activities include: Introduction to the Values and Ethics related to IPC (e.g., Year 1 IPE Session already in existence) Introduction to health professional roles using IPE case-based sessions (e.g. Pain Curriculum cases already in existence) Interprofessional Communication/Conflict resolution (e.g., Conflict in Professional Life already in existence ) Interprofessional Collaboration - IPE learning within an already existing clinical placement (e.g., Toronto Rehabilitation Institute IPE placement)

32. Elective Learning Activities Menu of complementary IPE learning activities Identified in environmental scan The learning activities affiliated with the competency-based curriculum will be integrated within the students’ uniprofessional curricula established by each Faculty/department. Learners will be required to satisfactorily participate in four core IPE learning activities and a certain number of IPE learning activity electives. The IPE learning electives will include those that currently exist (for example the IPE Lunch and Learn sessions held by the Rehabilitation Sciences departments) and new ones that will be created. The learning activities affiliated with the competency-based curriculum will be integrated within the students’ uniprofessional curricula established by each Faculty/department. Learners will be required to satisfactorily participate in four core IPE learning activities and a certain number of IPE learning activity electives. The IPE learning electives will include those that currently exist (for example the IPE Lunch and Learn sessions held by the Rehabilitation Sciences departments) and new ones that will be created.

33. Complementary learning activities Build upon those in existence Emergency Preparedness Global Health Maternity Care Palliative Care Dying and Death Patient Safety Wellness and Prevention Rehabilitation Sciences IPE Curriculum

34. Assessment Evaluation

35. IPE Component in a Clinical Placement

36. Structured Model Alternate Model Four activities

37. Structured Model Four elements Common clinical area Introductory Tutorial Patient/Client/Family Themed Tutorials Shared Presentation

38. 4 Activities Introduction Learning objectives Most appropriate level Preparation Participation Reflection Discussion

39. Participation in IP Team Education With others (students/staff) from at least 2 other professions and provide opportunity to interact with at least one other person Reflective questions e.g. What was the value for you in learning with a group of other professionals?

40. Interviewing a Patient/Client interview and shadow a patient/client and then shadowing the patient/client as he/she interacts with at least 2 other team members Interview questions e.g. Who are all of the people you consider part of your team? How would you describe the teamwork on this team?

41. Interview and Shadow 2 Team Members learn with, from and about other team members through interviewing and shadowing at least 2 other team members Interview questions e.g. How do you in your professional role usually interact with mine on this team? What goals might our roles share?

42. Participation in Team Meetings with at least 2 other team members across 2 team interactions/meetings Reflective questions for discussion e.g. Describe the interprofessional collaboration you observed in these meetings. What structures and processes enabled team collaboration?

43. What is Facilitation? and IPE Facilitation?

44. Definitions Facilitation “A learner-centred approach which invites learners to take full responsibility for decisions, actions and consequences.” - Sinclair, Barker & Moaveni, 2005

45. What is the Difference Between Facilitation and IPE Facilitation?

46. Facilitator “…someone who embraces the notion of dialogue, is self-aware, learns with the group, but is able to provide the appropriate learning resources and create an environment for effective interprofessional education.” - Howkins & Bray, 2008

47. Why use small group learning? To promote: Understanding Critical thinking Problem-solving abilities Communication skills Why have you used small groups? What specifically is small group work good for? Small groups more effective for promoting favourable attitudes towards learning, increase comprehension and problem solving and transfer of knowledge to new situations and allow for working on non-cog issues (steinert, 1996) Learn more of what is taught and retain longer than when same content presented in other formats More satisfied David, 1993Why have you used small groups? What specifically is small group work good for? Small groups more effective for promoting favourable attitudes towards learning, increase comprehension and problem solving and transfer of knowledge to new situations and allow for working on non-cog issues (steinert, 1996) Learn more of what is taught and retain longer than when same content presented in other formats More satisfied David, 1993

48. Involvement in learning Self-directed learning Favourable attitudes towards learning Motivation and satisfaction with learning

49. Deep learning understand and make sense of material vs. memorizing and reproducing Application of ideas Teamwork Collaboration and cooperation Etc.

50. “…facilitation of interprofessional learning is a complex and demanding activity” - Lindqvist & Reeves, 2007

51. IP Facilitation is Critical Faculty play a key role in creating an environment that is supportive of the goals for IPC and indeed can act as role models - Oandasan & Reeves, 2005: Gill & Ling, 1995, Waugaman 1994; Parsell & Bligh 1998 The perceived status or importance of an interprofessional initiative can be negatively affected if faculty do not ‘walk the talk’ - Oandasan & Reeves, 2005: Falconer et al., 1993; Mathias & Thompson, 1997; Graham & Wealthall, 1999 IPE facilitation is important, yet….IPE facilitation is important, yet….

52. Medical residents picked up on mixed messages of supervisors involved in IPC & those not involved regarding the value of an interprofessional approach - Barker & Oandasan, 2005

53. IPE Facilitation Principles

54. Some IPE Facilitation Principles Recognize stereotypical beliefs about professions e.g., gender, status, caring, power, etc. Understand that students have a range of educational experiences e.g., first placement to last Work with students to recognize and capitalize on opportunities for collaboration MANDYMANDY

55. Be inclusiveness Celebrate diversity understand no one profession has all the answers for a patient/client Role model effectively Co-facilitation Collaborative learning environments Need opportunity for joint reflection

56. Link between effective team collaboration and patient/client care e.g., balancing task and process Able to encounter interprofessional friction and deal with conflict Understand issues of power and hierarchy Many of us have facil smalll groups – pts, own professions…build on exper and strengths in facil but some diff with ipeMany of us have facil smalll groups – pts, own professions…build on exper and strengths in facil but some diff with ipe

57. IPE Facilitation Resources Stepping Stones Workshop Centre for Faculty Development Facilitating Groups in IPE: Getting Started ehpic IPE Leadership Course June 22- 26, 2009 IPE Faculty/Staff Development Program

58. Mandy BKR success We have them here to show you if you want to come and look Add web linkMandy BKR success We have them here to show you if you want to come and look Add web link

59. IPE Facilitation Competencies

60. Facilitation Competencies for IPE Collaboration Create a positive and safe interprofessional learning environment. Identify and manage group dynamics in interprofessional learning. Manage issues around power and hierarchy.

61. Communication Enable effective interprofessional communication. Explain your facilitator philosophy.

62. Professionalism and Values Demonstrate life-long learning. Demonstrate respect and value difference. Demonstrate positive role modeling for interprofessional education and interprofessional collaboration.

63. Professionalism and Values Develop self-awareness. Demonstrate inner conviction and good humour in the face of difficulties. Demonstrate strategic preparation to anticipate the impact of specific contexts and issues in interprofessional education.

64. Think- Pair- Share Reflect on your self-assessment Strengths Areas for development Share some of your thoughts with your neighbour Share thoughts with the large group

65. Sample IPE Facilitation Opportunities Core Learning Activities: Year One Conflict in IP Life Pain Curriculum IPE Component in a Clinical Placement

66. Elective Learning Activities: Dying and Death Rehabilitation Sciences Sector IPE Curriculum Sessions

67. Summary Questions

68. References Barker, K.K., Bosco, C. & Oandasan, I. (2005). Factors in implementing interprofessional education and collaborative practice initiatives: Findings from key informant interviews. Journal of Interprofessional Care. 19(2 supp 1), 166 - 176. CAIPE (1997). Interprofessional education – A definition. London: Centre for the Advancement of Interprofessional Education. Commission on the Future of Health Care in Canada.(2002). Building on values: The future of health care in Canada. Ottawa: Health Canada. Howkins, E., & Bray, J. E. (2008). Preparing for interprofessional teaching: Theory and practice. Oxford: Radcliffe Publishing.

69. Lindqvist, S. M., & Reeves, S. (2007). Facilitators' perceptions of delivering interprofessional education: A qualitative study. Medical Teacher, 29(4), 403 - 405. Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal of Interprofessional Care, 19(2 supp 1), 21 - 38. Pew-Fetzer Task Force on Advancing Psychosocial Health Education. (2000). Health professions education and relationship-centred care. Pew Health Professions Commission and the Fetzer Institute. Sinclair, L., Barker, K. & Moaveni, A. (2005). ehpic IPE leadership course: Module 3. Unpublished document. University of Toronto.

70. www.ipe.utoronto.ca For more information: susan.wagner@utoronto.ca lowe.mandy@torontorehab.on.ca