Office of Interprofessional Education and Practice

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Office of Interprofessional Education and
Practice

Integrating Health Sciences Across the Continuum
Advancements in Interprofessional Education
C. Schroder, A. Aiken Health Sciences Education
Rounds March 6, 2008
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Overview of presentation

• Language definitions
• Linking education and practice
• Proposed benefits
• Historical context
• Theories grounding IP education and practice
• Implications for Queens

Office of Interprofessional Education and
Practice
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Language
SUFFIXES Professional, Disciplinary Discipline
subject that is taught, field of
study Profession a calling requiring
specialized knowledge and often long and
intensive academic preparation the use of
Professional makes it clear that individuals
from different health professions are included
Office of Interprofessional Education and
Practice
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Language
PREFIXES Multi, Inter, Trans Multi
partners working independently or in parallel
towards a purpose Inter partners from different
domains work collaboratively towards a common
purpose Trans role blurring/doing tasks outside
normal professional role OR IP teams functioning
at high level of synergy
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Practice
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Interprofessional Education (IPE)
DEFINITION occasions when two or more
professions learn with, from and about each other
to improve collaboration and the quality of
care (CAIPE, modified)
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Practice
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Interprofessional Education
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Continuum of learning

• UNI MULTI INTER
• (separate) (in parallel)
  (between)

Evolves toward integration of all components of
with, from and about into learning experience.
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Interprofessional Care (IPC)
DEFINITION The provision of comprehensive health
services to patients by multiple HCPs who are
trained to work collaboratively to deliver the
best quality of care in every health care
setting. (Summit Document, 2006)
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Practice
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Linking IPE and IPC

• Interprofessional Education for Collaborative
  Patient-Centred Practice (IECPCP) Framework
  (DAmour Oandasan, 2004)
• Two linked circles (2 CD model)
• Education factors that affect HCP learners
  capacity to become a competent collaborative
  practitioner
• Practice processes and factors that affect
  patient care outcomes in collaborative practice
  settings

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Practice
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Linking IPE and IPC
Distinction in the framework between the two
fields provides an opportunity for stakeholders
like the government, licensing bodies, hospital
and academic institutional leaders, educators,
learners, health professionals, and the public,
to examine the factors that influence specific
outcomes of both fields while acknowledging their
interdependence.
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Practice
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Proposed Benefits IPE IPC

• Improved patient care/outcomes/satisfaction
• More efficient work/practice environment
• Better health care resource utilization
• Reduction in clinical error
• Improved provider satisfaction
• Reduction in staff shortages

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Practice
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IPE Effects on professional practice and health
care outcomes

• Scott Reeves et al. 2007 Cochrane review
• Update to 1999 review
• 6 studies 4 RCT, 2 CBA
• 4 positive outcomes ER culture, patient
  satisfaction, collaborative team behavior,
  clinical error rate management care delivered to
  domestic violence victims mental HP competencies
  related to deliver patient care
• 2 mixed (positive neutral), 2 no impact

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Practice
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IPE Effects on professional practice and health
care outcomes

• CONCLUSIONS
• 6 studies compared to none in 1999
• Some positive outcomes but not possible to draw
  generalisable inferences because of small
  numbers, heterogeneity of interventions,
  methodological limitations
• Need more rigorous studies that include data
  collection strategies that provide insight into
  how IPE affects changes in health care processes
  and patient outcomes

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Practice
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IPE Historical Perspective

• INTERNATIONAL CONTEXT
• World Health Organization
• 1973 Expert Committee reviewing medical
  education
• IP and traditional programs complementary
• 1978 IPE entrenched in WHO strategy to promote
  Health for All by the year 2000

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Practice
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IPE Historical Perspective
INTERNATIONAL CONTEXT United Kingdom 1970s IPE
initiatives developed in response to emphasis
on community care and development collaborative
models of delivery 1987 Centre for the
Advancement of Interprofessional Education
(CAIPE) founded
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Practice
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IPE Historical Perspective
CANADIAN CONTEXT National 2001 Caring for
Medicare Sustaining a Quality System
(Fyke) 2002 Study on the State of the Health Care
System in Canada (Kirby) 2002 The Commission on
the Future of Health Care (Romanow)
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Practice
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IPE Historical Perspective
CANADIAN CONTEXT National 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

(Romanow)
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Practice
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IPE Historical Perspective

• CANADIAN CONTEXT National
• 2003 First Ministers Accord on Health Care
  Renewal
• 2003 Interprofessional Education for
  Collaborative Patient-Centred Practice (IEPCPC)
• National Expert Committee
• 20 million dollars in funding through Health
  Canada
• QUIPPED
• EFPPEC
• Canadian Interprofessional Health Collaborative
  (CIHC)

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Practice
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IPE Historical Perspective

• IECPCP Outcomes by March 31, 2008
• Increased understanding of IP collaborative
  practice
• Improved sharing of best practices
• Increased use well functioning IP teams
• Increased access to appropriate provider at
  appropriate time
• Decreased wait times in critical areas of health
  care system

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Practice
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IPE Historical Perspective

• CANADIAN CONTEXT Ontario
• 2006 Summit on Advancing IP Education and
  Practice
• Priorities and actions within health care and
  education systems to ensure ready access to
  quality health care services and protect
  sustainability of system and its workforce

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Practice
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IPE Historical Perspective
CANADIAN CONTEXT - Ontario We know that IP
collaboration is key to providing the best in
patient care. That means we need to ensure our
health and human services students gain the
knowledge and skills they need through IPE that
begins at the earliest stages of their schooling.
This is why Ontario has made IPE and IPC a
cornerstone of their new health human resources
plan. A cornerstone that will support health
providers and patient for years to come. (Dr.
Joshua Tepper , ADM MOHLTC)
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Practice
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IPE Historical Perspective

• CANADIAN CONTEXT Ontario
• 2006 Funding through MOHLTC and MTCU for IPE,
  Mentorship, Leadership, Preceptorship and
  Coaching Fund
• Mentoring MD/APN Dyads in PC
• Seed funding Mental Health
• Seed funding Ontario Collaborative
• AHSC infrastructure funding- OIPEP

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Practice
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IPE Historical Perspective

• CANADIAN CONTEXT Ontario
• 2007 Blueprint for Advancing IP Care in Ontario
  (MP)
• 2007 Combined funding MOHLTC/MTCU ICEF
• The Southeastern Interprofessional Collaborative
  Learning Environment (SEIPCLE)
• The Ontario Collaborative
• Mentoring IP Primary Health Care Teams in
  Collaborative Palliative Care Practice
• Centre for Interprofessional Mental Health
  Education and Care
• Primary Care Consulting Program (ID)

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Practice
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Theories relevant to IPE IPC

• Scott Reeves et al. 2007 Scoping Review
• Funded by QUIPPED and Calgary Health Regions
  IECPCP project
• Identified described 35 theories in literatures
  currently applied to IPE/C
• Identified presented 33 additional theories
  with potential to inform IPE/C not as yet
  employed in IP context

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Practice
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Theories used in IP literature

• Perspectives
• Social psychology (12)
• Sociology (7)
• Adult learning (4)
• Systems (5)
• Psychodynamic (3)
• Organizational (3)

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Practice
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Theories used in IP literature examples

• Social psychology
• Contact theory (Allport)
• Sociology
• Discourse, surveillance theories (Foucault)
• Adult Learning
• Reflective learning (Schön)
• Experiential learning (Kolb)

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Practice
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Theories used in IP literature examples

• Systems
• Complexity theory (Cooper)
• Psychodynamic
• Social defence (Menzies)
• Organizational
• Organizational learning (Argyris Schön)

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Practice
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Theories suggested as relevant

• Focus
• Individual (9)
• Team/group (13)
• Organizational/system (11)

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Practice
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Theories suggested as relevant examples

• Individual
• Active learning
• Team/group
• Collaborative/cooperative learning
• Organizational/system
• Unfreeze Change Refreeze

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Practice
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IPE Key questions to address
What? When? How? Where?
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Practice
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IPE involves collaboration in the learning
process to

• Socialize professionals in working together, in
  shared problem solving and decision making
  towards enhancing the benefit for patients, and
  other recipients of services
• Develop mutual understanding and respect for the
  contributions of various disciplines
• Instill the requisite competencies for
  collaborative practice (communication,
  negotiation, etc.)

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IPE What, when, how, where?

• Core Competencies for IPC
• Knowledge
• Roles, responsibilities
• Skills/Behaviours
• Communication, Reflection, Cooperation, Conflict
  Management
• Attitudes
• Mutual respect, trust, willingness to collaborate

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Practice
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IPE What, when, how, where?

• Pre-licensure, post-licensure
• Mandatory, elective
• Content IP objectives together or IP objectives
  alone
• Explicit, implicit
• Classroom, Simulation, Practice setting

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Practice
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IPE Barriers, Challenges, Opportunities

• MACRO Level - National/Political Organizational
• Need for senior management and government
  political support
• Accreditation, regulatory, and licensing bodies
• University funding flexibility of finances and
  HHR
• Professional associations - liability
• Compensation for educators/clinicians

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Practice
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Queens Enablers

• MACRO Level - National/Political Organizational
• Government support IECPCP, Blueprint,
  MOHLTC/MTCU
• QUIPPED, 5 ICEF grants, OIPEP
• Primary care reform (FHT)
• Organizations CIHC, NaHSSA, Ontario
  Collaborative
• Provincial work groups developing core
  competencies curriculum, accreditation

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Practice
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IPE Barriers, Challenges, Opportunities

• MESO Level University/Medical Organization
• Administrative challenges for learners and
  faculty that affect teaching environment and role
  of local leaders
• Scheduling e.g. timing of IPE approach (early,
  late)
• Logistical obstacles inequality number of
  learners divergent learning/assessment styles
  different curricular periods limited resources
  space considered an add-on lack of
  administrative support lack of value

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Practice
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Queens Enablers

• MESO Level University/Medical Organization
• FHS (Medicine, Nursing, Rehabilitation)
• QUIPPED initiatives (learner, faculty) - momentum
  
• OIPEP funded until March 2009
• Adoption OIPEP vision statement at FHS Faculty
  Board administrator support, leadership
• OIPEP management and steering committee broad
  stakeholder group - address logistical obstacles

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Practice
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IPE Barriers, Challenges, Opportunities

• MICRO Level Learner/Faculty
• Attitudinal/behavioural hidden curriculum
• Stereotypes
• Learning environment individual, cooperative
• Professional readiness for IPE

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Practice
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Queens Enablers

• MICRO Level Learner/Faculty
• Student advocates readiness
• Faculty champions
• Faculty development IPTL
• Model collaborative teams
• Learning environment CEC, IP placements,
  simulation hospital, community, local, regional

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Practice
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Implications for Queens

• Need to sustain momentum created by QUIPPED
  initiatives, faculty development
• Maintain infrastructure support for OIPEP to
  ensure its Vision is realized
• All health professional schools promote and
  support Interprofessional Education (IPE).
• Common IPE competencies have been identified for
  medicine, nursing and rehabilitation therapy.
• IPE is integrated throughout the core curriculum
  .
• All students have opportunities each year to
  participate in IPE activities through
  simulations, the Clinical Education Centre, or in
  clinical settings.

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Practice
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Implications for Queens

• Develop a IPE framework for Queens FHS that
  considers barriers, theories, and links education
  with practice
• Develop variety of IPE opportunities including
  classroom, CEC, simulation lab, placements for
  learners
• Develop variety of IPE opportunities for faculty
  specific to interests and education roles
• Support/develop IP teams in all settings to model
  IPC
• Highlight value of IPE space, student
  stipends, awards, faculty promotion, scholarship

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Practice
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Implications for Queens

• Support for Queens IPE leaders (students,
  patients, faculty) to continue their provincial
  national involvement on work groups, OC, CIHC,
  AHSC, NaHSSA
• Mandate to contribute to the literature, share
  lessons learned, disseminate best practices

Office of Interprofessional Education and
Practice