co-teaching interprofessional care at the graduate school ......interdisciplinary collaboration a....
TRANSCRIPT
Co-Teaching Interprofessional Care
at the Graduate School Level
Brian D. Carpenter, Ph.D.
Associate Professor
Objectives
1) Review a curricular model for introducing
graduate students to disciplinary perspectives
and interdisciplinary teamwork
2) Related course objectives to geropsychology
and primary care competencies
3) Recount administrative and logistical
challenges in course implementation
4) Summarize indicators of student development
5) Discuss future adjustments
• Provost’s Cross-School Interdisciplinary
Teaching Grants
Origins of our course
• Growing interest in interprofessional care
• APA Presidential Task Force on Integrated
Healthcare (2007)
• WHO Framework for Action on Interprofessional
Education and Collaborative Practice (2010)
• Interprofessional Education Coalition Core
Competencies for Interprofessional Collaboration
(2011)
Goals guiding course development
• Provide basic education about aging that
students complete before semester
• Expose students to guest lecturers from
different disciplines and practice settings
• Interweave interdisciplinary team dynamics &
communication
• Focus on understanding and appreciating other
disciplines (i.e., how to practice with other
disciplines, not how to practice within other
disciplines)
Format for each disciplinary lecture
• History of profession
• Training requirements
• Major theories/evidence-based practice
• Settings of practice
• Assessments & interventions
• Reimbursement
• Your discipline’s presence on teams
• Psychology
• Social Work
• Occupational Therapy
• Physical Therapy
• Speech and Language Pathology
• Chaplaincy
• Nursing
• Medicine
• Pharmacy
Team functioning & communication
• Didactic readings
• Hartford GITT video cases
• National League of Nursing written case
studies
• Western Health Sciences written case studies
• University of Missouri – Columbia Virtual
Health Care Team written case studies
• Experiential exercises
Site visits to observe teams in action
• Inpatient rehabilitation hospital, long-term
dementia care residence, community-based
outpatient screening and referral clinic,
outpatient multi-service clinic (PACE)
• Attended two interdisciplinary team meetings
• Recorded observations of team features and
team process
• Delivered in-class, interdisciplinary group
report on shared observations and
evaluations
Geropsychology competencies addressed
Foundational - Skills
Recognize Importance of Teams
a. Understand the theory and science of geriatric team
building
b. Value the role that other providers play in the
assessment and treatment of older clients
c. Demonstrate awareness, appreciation, and respect
for team experiences, values, and discipline-specific
conceptual models
d. Understand the importance of teamwork in geriatric
settings to address the varied biopsychosocial needs
of older adults
Geropsychology competencies addressed
Consultation - Knowledge
Interdisciplinary Collaboration
a. The distinction between types of treatment teams
(e.g., multidisciplinary and interdisciplinary)
b. The roles, and potential contributions, of a wide
range of healthcare professionals in the assessment
and treatment of older adult with mental disorders
c. How team composition and functioning may differ
across settings of care
Geropsychology competencies addressed
Consultation - Skills
Participate in Interprofessional Teams a. Work with professionals in other disciplines to incorporate
geropsychological information into team treatment planning and
implementation
b. Communicate psychological conceptualizations clearly and
respectfully to other providers
c. Appreciate and integrate feedback from interdisciplinary team
members into case conceptualizations
d. Work to build consensus on treatment plans and goals of care,
to invite various perspectives, and to negotiate conflict
constructively
e. Demonstrate ability to work with diverse team structures (e.g.,
hierarchical, lateral, virtual) and team members (e.g., including
the ethics board, chaplains, and families in palliative care
teams)
Primary care competencies addressed
1A. Science
1A.1 Scientific mindedness: Values a scientific foundation in the
practice of PC psychology
1A.9 Knowledge and understanding of evidence-based practice and its
application to the practice of PC psychology
1B. Research/Evaluation
1B.4 Ability to conduct research within the context of an
interdisciplinary team
2C. Advocacy 2C.1 Demonstrates knowledge of health care policy and its influence
on health and illness and PC services
3A. Professional values and attitudes 3A.1 Consolidates professional identity as a PC psychologist
3D. Reflective practice/self-assessment/self-care 3D.1 Supports importance of reflective practice in PC
3D.2 Understands importance of self-assessment in PC settings
3D.3 Understands importance of health professional self-care in PC
Primary care competencies addressed
4A. Interprofessionalism
4A.1 Values interprofessional team approach to care
4A.2 Appreciates the unique contributions that different health care
professionals bring to the PC team
4A.3 Develops collaborative relationships to promote healthy
interprofessional team functioning that is characterized by
mutual respect and shared values
4A.4 Assesses team dynamics and coaches teams to improve
functioning
4A.5 Demonstrates awareness, sensitivity, and skills in working
professionally with diverse individuals
4B. Building and sustaining relationships in PC 4B.1 Understands the importance of communicating clearly,
concisely, and respectfully in a manner that is understandable
and meaningful to various audiences (e.g., clinicians, patients,
staff)
Primary care competencies addressed
5A. Practice Management 5A.4 Can co-interview, co-assess, and co-intervene with other PC
providers
5D. Clinical Consultation 5D.3 Helps PC team conceptualize challenging patients in a manner
that enhances patient care
5D.5 Follows up with other PC clinicians as indicated
6A. Teaching 6A.2 Completes needs assessment and understands teaching
approaches used by other health professions about
behavioral health issues
6A.6 Participates in the education and training of multiple
stakeholders in the larger health care system about PC
psychology
Trainees involved
Year 1 (2012)
• OT – 4
• Psychology – 5
• Public Health – 3
• Social Work – 7
• Medicine – 1
Year 2 (2014)
• OT – 4
• Psychology – 2
• Public Health – 4
• Social Work – 11
• Medicine – 1
• Applied Health
Behavior – 3
Enrollment challenges
• Physical Therapy class schedule
• Medicine rotations only 7 weeks long
• Administrative resistance from Nursing
• Pharmacy program not affiliated with our
university
• Uncertainty with Registrar regarding tuition
Logistical challenges
• Scheduling a class time
• Different spring breaks
• Location – parking permits? rotate? classroom?
• Dinner
• Academic culture differs across schools
• expectations about availability of syllabi and
reading lists
• sanctity of reading period
Learning outcomes
Change in attitudes/beliefs
40
60
80
100
Attitude Toward Teams Ability To Do Team Work
Score
Pre-Semester Post-Semester
* t = -6.18(41), p < .001
** t = -12.01(41), p < .001
*
**
Change in attitudes/beliefs
120
140
160
180
Attitude Toward Older Adults
Sco
re
Pre-Semester Post-Semester
* t = -4.12(40), p < .001
*
Attitudes toward working with teams
1
2
3
4
5
Attitude toward otherdisciplines
Providing care forelderly
Practicing in teamenvironment
Sco
re
Pre-Semester Post-Semester
* t = -5.74(40), p < .001
** t = -3.95(40), p < .001
*** t = -6.10(40), p < .001
* *** **
Working as a team less threatening
“I have to admit that as I learned about various
disciplines, I had to actively prevent myself from becoming
defensive of [my profession] and our expertise and skeptical
of other professions purported competencies.
I was initially resentful at the idea of other disciplines
conducting brief [versions of assessments I was trained to
conduct]. I now acknowledge the global benefits of various
professionals having [that skill]…
Had I not been given interdisciplinary training exposure,
my openness to other disciplines would still be limited.”
How will they practice
“XYZ program was a good example of cultural
silos—the group thought they were acting as a team
when they were really functioning as autonomous
units managed by a staff person.
There was a total lack of common understanding
and communication—each professional documented
their results and it was only viewed by 1 staff
member. What could have been great
interdisciplinary care turned out to be very similar to
the traditional model.”
Early professionals with the “big picture”
Reflecting on reimbursement for geriatrics:
“Professionals would hesitate to choose geriatrics
and/or gerontology if their effort to care for older clients
(patients) is not well compensated in the system or
valued in society, and this will eventually lead to the
shortage of geriatric professionals. ..Therefore, it is
important and necessary to either improve the existing
reimbursement policy or introduce a brand-new policy
to support geriatric professionals and their
interdisciplinary teams better than now.”
Future development
• More disciplines represented
• More contemporary scholarly resources
• More sophisticated and longitudinal student
outcome assessment
• Faculty sustainability issues
• Budgetary sustainability issues
Brian D. Carpenter
Department of Psychology
Washington University
St. Louis, MO 63130
(314) 935-8212