Piloting an Interprofessional Education Workshop: Teaching Palliative Care Communication Skills
In this workshop, the focus is on teaching palliative care communication skills through interprofessional education. The session covers the main objectives and essential elements for a successful workshop, delves into the background and history of interprofessional education (IPE) in palliative care, discusses barriers to IPE, strategies for effective implementation, and highlights organizations like IPEC involved in promoting collaborative practice.
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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
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.
Learning Objectives To describe the main objective for an effective interprofessional, education workshop To list the essential elements for a successful interprofessional, education workshop
Overview IPE BACKGROUND IPE and palliative care Workshop history Workshop description Results Study limitations Future implications
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
Barriers to IPE Logistics Professional hierarchies/stereotypes Institutional resistance
Strategies for IPE Classroom didactics Practice based interventions Experiential Strategies Role play Simulation exercises
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.
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.
Overview IPE Background IPE AND PALLIATIVE CARE Workshop history Workshop description Results Study limitations Future implications
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.
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.
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
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
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.
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-
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
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
Overview IPE Background IPE and palliative care WORKSHOP HISTORY Workshop description Results Study limitations Future implications
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.
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
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
Overview IPE Background IPE and palliative care Workshop history WORKSHOP DESCRIPTION Results Study limitations Future implications
Workshop Goals Introduce palliative care communication and interprofessional team skills to learners Determine effectiveness of interprofessional workshop on improving these self-reported skills
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
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
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
Workshop Schedule 4:00- 4:15 4:15- 5:15 Orientation Participant group 1 meets with SP 1 Observer group 1 observes Participant group 2 meets with SP 2 Participant group 3 meets with SP 3 Observer group 2 observers Participant group 4 meets with SP 4 5:15- 5:45 Debrief
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)
Overview IPE Background IPE and palliative care Workshop History Workshop Description RESULTS Study limitations Future implications
Learner Assignments Recruited 109 learners 73 assigned to participant group 36 assigned to observer group Divided into 16 groups of 4-5 each Divided into 7 groups of 5-6 each
Learner Demographics Participant Observer Total Sex Female 57 (78%) 35 (97%) 92 (84%) Male 16 (22%) 1 (3%) 17 (16%) Race Caucasian 43 (59%) 29 (81%) 72 (66%) Asian 20 (27%) 4 (10%) 24 (22%) African American 5 (7%) 3 (8%) 8 (7%) Hispanic 2 (3%) 0 (0%) 2 (2%) Mixed heritage 1 (1%) 0 (0%) 1 (1%) No answer 2 (3%) 0 (0%) 2 (2%) Age (mean) 27 28
Learner Demographics Participant Observer Total Profession Nursing 17 (23%) 34 (94%) 51 (47%) Advanced 16 (22%) 28 (78%) 44 (40%) Undergrad 1 (1%) 6 (17%) 7 (6%) PT 15 (21%) 0 (0%) 15 (14%) Pharmacy 12 (16%) 0 (0%) 12 (11%) Medicine 11 (15%) 0 (0%) 11 (10%) Social Work 8 (11%) 2 (5%) 10 (9%) OT 6 (8 %) 0 (0%) 6 (6%) Chaplaincy 4 (5%) 0 (0%) 4 (4%) Years Training (mean) 3.28 (0-13) 3.66 (0-15)
Importance of IPE Not at all (1-2) Somewhat (3) Very (4-5) How important is communicating with other health care professionals for you to be effective in your profession? Participant 70 (96%) Observer 1 (3%) 34 (94%) How committed are you to work on interprofessional communication skills during your training? Participant 1 (1%) 1 (1%) 68 (93%) Observer 1 (3%) 34 (94%)
Prior Experience Yes No Don t Know Missing Work with individuals of other professions to create plan of care Didactic 68 (62%) 29 (27%) 5 (5%) 7 (6%) Bedside 67 (62%) 31 (28%) 2 (2%) 9 (8%) Apply knowledge of my profession to appropriately assess and address health care needs of a patient Didactic 76 (70%) 15 (14%) 11 (10%) 7 (6%) Bedside 55 (51%) 34 (31%) 8 (7%) 12 (11) Explain the role other professionals play in an interprofessional team Didactic 67 (62%) 29 (27%) 8 (7%) 5 (5%) Bedside 52 (48%) 39 (36%) 5 (5%) 13 (12%)
Prior Experience Yes No Don t Know Missing Communicate with other healthcare professions, patients and caregivers Didactic 63 (58%) 31 (28%) 8 (7%) 7 (6%) Bedside 64 (59%) 32 (29%) 2 (2%) 11 (10%) Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care Didactic 60 (55%) 29 (27%) 13 (12%) 7 (6%) Bedside 49 (45%) 39 (36%) 11 (10%) 10 (9%) Facilitate and/or participate in a family conference Didactic 43 (39%) 46 (42%) 11 (10%) 9 (8%) Bedside 40 (37%) 52 (48%) 6 (6%) 11 (10%)
Comparison of Pre and Post- Workshop Evaluations Pre-Workshop Mean Score Post-Workshop Mean Score Sig. (2-tailed) Work with individuals of other professions to create plan of care Participant 3.60 4.11 0.000 Observer 3.83 4.00 0.226 Apply knowledge of my profession to appropriately assess and address health care needs of a patient Participant 3.55 4.04 0.000 Observer 3.91 4.06 0.282 Explain the role other professionals play in an interprofessional team Participant 3.38 4.01 0.000 Observer 3.77 4.17 0.017
Comparison of Pre and Post- Workshop Evaluations Pre-Workshop Mean Score Post-Workshop Mean Score Sig. (2-tailed) Communicate with other healthcare professions, patients and caregivers Participant 3.54 4.11 0.000 Observer 3.69 4.14 0.014 Apply relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care Participant 3.48 4.08 0.000 Observer 3.46 4.09 0.002 Facilitate and/or participate in a family conference Participant 3.21 4.08 0.000 Observer 3.31 3.89 0.001
Curriculum/Workshop Content Poor-Fair (1-2) Good (3) Very good Excellent (4-5) Relevance of topic content to my discipline 4 (4%) 10 (9%) 92 (84%) Utility of pre-reading 9 (8%) 19 (17%) 77 (71%) Utility of pre-workshop video 23 (21%) 22 (20%) 55 (50%) Utility of pre-workshop profession specific lecture 15 (14%) 20 (18%) 62 (57%)
Workshop Sessions Poor-Fair (1-2) Good (3) Very good Excellent (4-5) Usefulness of small group orientation 14 (13%) 23 (21%) 69 (63%) Usefulness of communication exercise with standardized surrogates 1 (1%) 6 (6%) 98 (90%) Usefulness of SPs 1 (1%) 3 (3%) 101 (93%) Effectiveness of small group faculty facilitators 2 (2%) 4 (4%) 100 (92%) Usefulness of post exercise debriefing 1 (1%) 4 (4%) 101 (93%)
Overall Evaluation Poor-Fair (1-2) Good (3) Very good Excellent (4-5) Overall, how would you rate the educational quality of the workshop? Participant 1 (1%) 5 (7%) 65 (89%) Observer 6 (17%) 28 (81%) Yes No Not sure Would you be interested in participating in a follow-up session to practice family meetings? Participant 60 (82%) 4 (5%) 8 (11%) Observer 26 (72%) 5 (14%) 5 (14%)
Overall Conclusions Pre vs Post Workshop Assessments Participant Group: Significantly more confident in ALL domains after the workshop Observer Group: Significantly more confident in most domains 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
Overview IPE Background IPE and palliative care Workshop History Workshop Description Results STUDY LIMITATIONS Future Directions
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
Overview IPE Background IPE and palliative care Workshop History Workshop Description Results Study Limitations FUTURE DIRECTIONS
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
Thank you! Dr. MaryAnn Foricea Dr. Cathy Poon Dr. Christine Bradway Dr. Lora Packel Dr. Claudia Pravanta Dr. Carrie Ann Doherty John Seman Dr. Mary Ersek Eunhae Kim Dr. Zvi Gellis Dr. Varleisha Gibbs Dr. Valerie Cotter Denise LaMarra
