Interprofessional Education and TeamSTEPPS

1. Interprofessional Education and TeamSTEPPS

2. The Imperative for Team Training in (Medical) Education Karyn Baum, MD, MSEd University of Minnesota

3. “Once in practice, health professionals are asked to work in interdisciplinary teams…yet they are not educated together or trained in team-based skills” • --IOM, Health Professions Education: A Bridge to Quality

4. “Effective teamwork in health-care delivery can have an immediate and positive impact on patient safety” • World Health Organization, Topic 4, Patient Safety Curriculum • “Our challenge…is not whether we will deliver care in teams but rather how well we will deliver care in teams” • Paul Schyce, SVP Joint Commission

5. Core Competencies for Interprofessional Collaborative Practice • Competency Domain 4: Teams and Teamwork • “Understanding how team developmental processes can affect team members, overall team functioning, and outcomes…is an important part of being an effective team member.”

6. ACGME New “Common” Program Requirements • Residents must care for patients in an environment the maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams

7. TeamSTEPPS in Medical Student Education N. Kevin Krane, M.D. Vice Dean for Academic Affairs Tulane University School of Medicine

8. REVIEWA Systematic Review of Teamwork Training Interventions in Medical Student and Resident EducationChakraborti, et al., J Gen Intern Med 23:846–53, 2008. • Thirteen studies met inclusion criteria. All curricula employed active learning methods ;the majority (77%) included multidisciplinary training. • Conclusions: • Appear to be modestly effective in the short term.  • Curricula may be more effective when they address more of the teamwork principles

9. Team Training of Medical Students in the 21st Century: Would Flexner Approve? Morrison et al. Acad Med. 2010; 85:254–259. • Penn: 2-day retreat during orientation, students in same teams of 6-7 for all four years, and embeds team learning activities for student teams throughout the four-year curriculum. • Team training must be embedded in medical school education.

10. The use of simulation and a modified TeamSTEPPS curriculum for medical and nursing student team training.Emory: Robertson, et al., SimulHealthc 2010;5:332-7. • METHODS: 213 students, 4-hour team training with lecture and small group exercises. Knowledge and attitudes assessed before/after. Recognition of team skills was assessed using videos. • CONCLUSIONS: Students improved their knowledge of vital team and communication skills, attitudes toward working as teams, and were able to identify effective team skills.

11. Atallah H, Kaplan B, Ander D, Robertson B. (Emory) Interprofessional Team Training Scenario. MedEdPORTAL; 2009. Available from: http://www.mededportal.org/publication/1713 Simulation Exercise: Educational Objectives • To be able to understand the impact of communication and coordination on efficiency and effectiveness of care implementation. • To be able to identify the performance of team skills in the area of leadership, communication, mutual support and situational monitoring. • To be able to perform team skills in the area of leadership, communication, mutual support and situational monitoring.

12. InterprofessionalTeamSTEPPS training: Comparing Peer Assessment to Expert Ratings. Brock et al., U of Washington, Seattle, Wa • Piloted an iP training program with simulators using mixed teams of medical, nursing, pharmacy and physician assist students to learn and practice TeamSTEPPS communications skills and Global assessments of I-P team performance • Methods: 49 students, assigned to 6 Teams,were trained on  TeamSTEPPS skills.   • 3 sims  (asthma, CHF and SVT). • Assessed Team Performance with experienced Observers for:  Team Structure, Leadership, Situation Monitoring, Mutual Support and Communication.  • Results:55% of peer assessments indicated team success with the Communication dimension but only 26% reported success for Mutual Support.   Peer assessments weren’t comparable to expert ratings.  

13. UNC and Duke • UNCHCS, UNC School of Medicine, UNC School of Nursing and Duke University Medical Center awarded GlaxoSmithKline funding for development of a collaborative patient safety educational program using TeamSTEPPS • The 2 year project focused on inter-disciplinary team training for students in the SON & SOM at each institution

14. University of North Dakota School of Medicine and Health Sciences • IPHC is required for MD, RN, PT, OT, and communication sciences and disorders students who have a clinical focus. Uses TeamSTEPPS concepts as a framework for application of team communication skills in small groups. • The course objectives include: • Demonstrate patient/client-centered approach in decision-making as an interdisciplinary team. • Demonstrate ability to reflect about team experiences and feedback.  • Identify sources of potential error and consequences to health care delivery.

15. St. Louis University • Required IP seminars for all 3rd year students with 7 health professional schools • Integrating principles of TeamSTEPPS with programs at their major teaching hospitals • Focus is on case-based discussions

16. Kirksville College of Ostepathic Medicine • TeamSTEPPS required of all students before clinical rotations • Must take quiz to demonstrate completeness • TeamSTEPPS modules available on-line (through St. Louis University) • LIJ-Hofstra: Also using TeamSTEPPS in curriculum for medical students

17. Tulane: TeamSTEPPS • Dean gives patient safety overview • Foundations in Medicine: First year MD and RN students • TeamSTEPPS presentation • Simulation activity • Interdisciplinary seminars using TeamSTEPPS: MD, RN, Rx students • Fall 2012: Team training for first year gross anatomy dissecting teams (randomized research protocol) using TeamSTEPPS teamwork module

18. Tulane: TeamSTEPPS for Clinical Students • As part of their third/fourth year, Tulane students must complete 5 “interdisciplinary” seminars from a menu of topics, one being Patient Safety using TeamSTEPPS™. • 6 MD, 6 RN and 6 Rx students from local schools (non-Tulane) volunteered to participate in each seminar which focuses on Patient Safety/TeamSTEPPS™ seminar, all taught by one individual (KK) • Almost all RN and Rx students had completed some clinical/ward training

19. Results: Data on 96 Students: TeamSTEPPS • Significant improvement pre/post student mean RIPLS scores (p<.01) • RN and Rx students: greater value on working with other healthcare professionals than MD students (p<.01). • Rx students felt more strongly than MD students that shared learning with others would help (p<.05). • Compared to RN’s, MD and Rx students more strongly viewed a nurse’s role as that of support for physicians (p<.01). • MD students felt they had to acquire more knowledge than pharmacy and nursing students (p<.01). • Overall rating = 4.69/5.00. Training with other healthcare professional students was the most valuable part of the seminar.

20. Summary • Several schools now using TeamSTEPPS in their curriculum: Emory, UNC, Duke, St. Louis U, U of North Dakota, Kirksville COM, U Wash, LIJ-Hofstra, Tulane, ? Others? • Typically part of Interprofessional Education • More likely to be first/second yr medical students • Variable amounts of simulation • Is there evidence it makes any difference?

21. Team STEPPS in GME:A Challenging Task Michael E. Barfield, M.D. General Surgery Resident Duke University

22. ACGME Common Program RequirementsEffective July 1, 2011 Teamwork Resident must care for patient in an environment that maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care in the specialty And… • The Joint Commission • Balanced Scorecard

23. Institutional Leadership • With the changing standards in education and accreditation agencies, institutional leadership has recognized the need for and are now seeing the value of GME trainee involvement.

24. Challenges Particular to Trainees • Resident Schedule • Duty Hour Restrictions • Daily Workflow • Mandatory Conferences • Off-site Rotations • Resident Complement • Perceptions of Just Culture • What do trainees see modeled?

25. What Has Been Done? • Literature reports of trainee involvement in Team STEPPS training • University of Washington • Four hours of Team STEPPS training is done with all incoming residents for 3 years • Combines didactic and breakouts sessions with trainees teaching each other the concepts • Duke University • Creation of GME Patient Safety & Quality Council • Patient Safety and Quality Concentration • GME has 5 Master Trainers • Team STEPPS Essentials has had 8 attendees • Resident exposure through unit and Peri-operative programs

26. Content Delivery • Team STEPPS Essentials • Webinars • Team STEPPS Series • “In-service” teaching models common for nurses on various clinical service units • App for iPhones, iPads, Droids,etc.

27. Changing Priorities • Institutional Initiatives • Prioritize trainee involvement in safety and quality initiatives • Introduction to Team STEPPS in UME • Delivering the tools and the language • Deliver Concepts Earlier? • Model the Concepts • Current providers and leaders • Behaviors, not decisions

28. Team training in interprofessional settings

29. Interprofessional Education • "Interprofessional Education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care" • Center for the Advancement of Interprofessional Education (CAIPE)

30. Why? • Social Learning Theory (Bandura et al.) • Situated Learning (Lave) • Cognitive Apprenticeships (Brandt et al.) • Learning, Generalizing • Andragogy (Knowles) • And they go on….

31. Does it work? • Immediate • Yes and no • Long-term….who knows?

32. Challenges/answers • Cultural • We don’t know/trust/value each other! • Different languages • History • Logistical • Schedules (hardest part) • Space • Political • Regulatory • Local • Accreditations---these are not only going way, but forcing issue

33. Some curricular resource sites • MedEdPortal • IHI Open School • QSEN • Academy for Healthcare Improvement

34. Please contact us! • Karyn Baum: kbaum@umn.edu • Michael Barfield: michael.barfield@duke.edu • Kevin Krane: kkrane@tulane.edu