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BEST PRACTICES/LESSONS LEARNED: USING
CORE COMPETENCIES TO BUILD A PROGRAM
Alan Dow, MD, MSHA
Assistant Vice President of Health Sciences for
Interprofessional Education & Collaborative Care
Virginia Commonwealth University
Richmond, VA
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
© 2014 IPEC. May not be reproduced without permission.
OBJECTIVES
• To discuss how the IPEC competencies shape
interprofessional education at an institutional level
• To provide a framework to link behavioral objectives
for teamwork with the IPEC competencies
• To describe several educational programs that meet
competency and behavioral objectives
© 2014 IPEC. May not be reproduced without permission.
VIRGINIA COMMONWEALTH UNIVERSITY
• 53 acre Health Science
campus
• 5 health professional
schools: allied health,
dentistry, medicine, nursing,
pharmacy
• Tertiary academic medical
center
• 3200 clinical learners
• Monroe Park campus
• School of social work,
departments of psychology
and health & human
performance
• Distant training sites:
• Inova-Fairfax (70 miles
north)
• UVA (70 miles west)
© 2014 IPEC. May not be reproduced without permission.
THE CENTER FOR INTERPROFESSIONAL
EDUCATION AND COLLABORATIVE CARE
•
•
•
Official center at
VCU in January of
2013
>2,000 learners
have participated in
Center programs
Students and
faculty from all five
health science
Schools, the School
of Social Work, &
Dept of Psychology
4
© 2014 IPEC. May not be reproduced without permission.
© 2014 IPEC. May not be reproduced without permission.
Interprofessional Collaborative
Practice Competencies
Values/
Ethics
(n = 10)
Roles/
Responsibilities
(n = 9)
Interprofessional
Communication
(n = 8)
Teams and
Teamwork
(n = 11)
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
Interprofessional Education Collaborative Expert Panel. (2011).
6
© 2014 IPEC. May not be reproduced without permission.
The IPEC Competencies
were created to:
create a coordinated effort for IPE
guide curriculum
provide a foundation for learning
structure research
promote dialogue between health professions
shape accreditation, licensing, and credentialing
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
© 2014 IPEC. May not be reproduced without permission.
TOOL AND SURVEY METHODS
38 original IPEC
competencies
1 competency
omitted
32 competencies
converted directly into
items
5 items split into
10 items
42 items comprise the
final questionnaire
all items given stem and
assigned to 5-point Likert scale
Assesses student selfefficacy using a
Likert scale
Administered as an
online survey with
invitation email
Sent to students by
program leader
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
Dow AW et al. 2014. JIC
© 2014 IPEC. May not be reproduced without permission.
SURVEY POPULATION

All students enrolled in clinical degree
programs on VCU’s Health Science Campus
Allied Health
Nine Departments
Medicine
MD and non-MD
students
Dentistry
DDS and Dental
Hygiene
Nursing
BSN, MSN, PhD
Pharmacy
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
Dow AW et al. 2014. JIC
9
© 2014 IPEC. May not be reproduced without permission.
RESULTS: 2012
481 completed surveys
Overall response rate: 14.9%
Response rate by School:
Allied Health – 4.1%
Dentistry – 7.0%
Medicine – 25.4%
Nursing – 7.8%
Pharmacy – 26.3%
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
Dow AW et al. 2014. JIC
10
© 2014 IPEC. May not be reproduced without permission.
FACTOR ANALYSIS AND RELIABILITY
Four forced domains:
 accounted for 79% of the variance in responses
 aligned with four IPEC domains
Overall scale reliability: α=.99
Reliability by domain-associated factor
 Values and Ethics: α =.98
 Roles: α = .95
 Communication: α = .95
 Teamwork: α = .97
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
Dow AW et al. 2014. JIC
11
© 2014 IPEC. May not be reproduced without permission.
Dow AW et al. 2014. JIC
12
© 2014 IPEC. May not be reproduced without permission.
Center for Interprofessional Education and Collaborative Care
Early Learners
Advanced
Learners
Practitioners
Effective,
efficient,
appropriate
collaborative
practice
Maintain high attitudes (Value & Ethics)
Build core knowledge (Roles & Responsibilities, Communication,
Teams)
Collaboration skills (Communication, Teams &
Teamwork)
© 2014 IPEC. May not be reproduced without permission.
© 2014 IPEC. May not be reproduced without permission.
PARTICIPATING INSTITUTIONS
Institution 1: large southern public university with a
comprehensive health science campus
Institution 2: large midwestern public university with
a college of health professions (dentistry, nursing,
PA, allied health)
Institution 3: smaller health system-associated
health professional school (nursing, allied health)
Institution 4: large midwestern public university with
a comprehensive health science campus
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
© 2014 IPEC. May not be reproduced without permission.
RESULTS: DEMOGRAPHICS
Students by Institution
Students by Profession
N
%
N
%
Institution 1
624
71%
Allied Health
256
29%
Institution 2
94
11%
Dentistry
74
8%
Institution 3
85
10%
Medicine
190
22%
Institution 4
80
9%
Nursing
159
18%
Pharmacy
15
2%
Public Health
28
3%
Unknown
161
18%
Students by Gender
N
%
Male
242
27%
Female
641
73%
Age Range: 19 - 65 (M=28, SD = 8)
© 2014 IPEC. May not be reproduced without permission.
RESULTS: DOMAIN SCORES BY
INSTITUTION, 2013
4.8
Comparisons between
institutions:
• Values and Ethics
(p=.014)
• Teams and
Teamwork (p=0.18)
• Roles and
Responsibilities
(p=0.69)
• Interprofessional
Communication
(p=0.69)
4.59
4.6
4.43
4.4
4.46
4.37
4.32
4.31
4.31
4.23
4.21
4.2
4.14
4.12
4.21
4.16
4.06
4.02
4
3.96
3.8
3.6
Values and Ethics
Institution 1
Roles and
Responsibilities
Institution 2
Interprofessional
Communication
Institution 3
Teams and
Teamwork
Institution 4
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
© 2014 IPEC. May not be reproduced without permission.
RESULTS: DOMAIN SCORES BY
PROFESSION
Allied Health
Dentistry
Medicine
Nursing
Pharmacy
Public Health
Unknown
No
significant
differences
between
professions
Values and
Ethics
4.37
4.23
4.37
4.45
4.25
4.59
4.31
Roles and
Responsibilities
4.13
4.01
4.13
4.19
4.06
4.34
4.13
Interprofessional
Communication
4.21
4.15
4.21
4.25
4.37
4.38
4.13
Teams and
Teamwork
4.05
3.93
4.03
4.12
4.32
4.21
4.03
4.8
4.6
Allied Health
4.4
Dentistry
4.2
Medicine
Nursing
4
3.8
Pharmacy
3.6
Public Health
Values and
Ethics
Roles and
Interprofessional
Responsibilities Communication
Teams and
Teamwork
Unknown
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
© 2014 IPEC. May not be reproduced without permission.
Center for Interprofessional Education and Collaborative Care
Early Learners
Advanced
Learners
Practitioners
Effective,
efficient,
appropriate
collaborative
practice
Maintain high attitudes (Value & Ethics)
Build core knowledge (Roles & Responsibilities, Communication,
Teams)
Collaboration skills (Communication, Teams &
Teamwork)
© 2014 IPEC. May not be reproduced without permission.
© 2014 IPEC. May not be reproduced without permission.
Inputs
Activities
Outputs
Mediumterm Goal
Long-term
Goal
Increased
Interprofessional
Competency
Improved
patient
outcomes
and
community
health
Engage in
Shared
Problem
Solving
Students
Communicate
in Context
Faculty
Resources
Sequence
of
Learning
Activities
Resolve
Conflict
Enhance
Team
Performance
Be a Change
Agent
21
© 2014 IPEC. May not be reproduced without permission.
Engage in Shared
Problem Solving
Context-Specific
Experiences
Solve Healthcare
Problems
Interprofessionally
Profession-Specific
Experiences
Experience
Interprofessional
Problem Solving
Foundational Health
Professions Experiences
Be Exposed to
Interprofessional
Problem Solving
Pre-Curricular
Experiences
22
© 2014 IPEC. May not be reproduced without permission.
Pre-Curricular
Experiences
IPEC INSTITUTE
MONDAY, JANUARY 13, 2014
© 2014 IPEC. May not be reproduced without permission.
Inter Health Professional Alliance (IHPA)
•
•
•
•
Student-initiated and student-run group
4 years old
Over 200 members
A number of peer-reviewed publications and national
presentations
•School of Allied Health Professions
•School of Dentistry
•School of Medicine
•School of Nursing
•School of Pharmacy
•School of Social Work
•School of Engineering
•VCU Dietetics Internship program
© 2014 IPEC. May not be reproduced without permission.
© 2014 IPEC. May not be reproduced without permission.
FOUNDATIONAL HEALTH
PROFESSIONS EXPERIENCES
Interprofessional Case
Series
• >600 students
• Pericurricular
sessions  full 1credit course
• Student feedback:
more!
Foundations of Quality
and Safety
• ~500 students
• Full 1-credit course
26
© 2014 IPEC. May not be reproduced without permission.
2012-2013
Extracurricular
Interprofessional
Case Series
• Meet your
peers
• Learn
something
(roles)
• Encouraged but
not required
• Pizza
• Positive
evaluations
with
suggestions
© 2014 IPEC. May not be reproduced without permission.
2012-2013
2013-2014
Extracurricular
Interprofessional
Case Series
• Meet your
peers
• Learn
something
(roles)
• Encouraged but
not required
• Pizza
• Positive
evaluations
with
suggestions
Pericurricular
Interprofessional
Case Series
• Meet your
peers
• Learn
something
(roles, teams)
• Required*
• Positive
evaluations
with
suggestions
© 2014 IPEC. May not be reproduced without permission.
Sample item: I am able
to respect the unique
cultures, values,
roles/responsibilities,
and expertise of other
health professions.
5
4.5
4
3.5
3
Retrospective PreAssessment
Post-Assessment
2.5
2
1.5
1
0.5
0
VE
VE
RR
VE
RR
RR
TT
TT
TT
RR
© 2014 IPEC. May not be reproduced without permission.
2012-2013
2013-2015
2015-2016
Extracurricular
Interprofessional
Case Series
• Meet your
peers
• Learn
something
(roles)
• Encouraged but
not required
• Pizza
• Positive
evaluations
with
suggestions
Pericurricular
Interprofessional
Case Series
• Meet your
peers
• Learn
something
(roles, teams)
• Required*
• Positive
evaluations
with
suggestions
Curricular
Foundations
Course
• Meet your
peers
• Learn
something
(roles, teams,
systems)
• Required 1credit course
© 2014 IPEC. May not be reproduced without permission.
PROFESSION-SPECIFIC EXPERIENCES
Interprofessional Critical Care
Simulations
• All N4s and M4s (320
students)
• Three two-hour sessions
around simulators: how do
you manage a patient with
an acute clinical
deterioration?
• Student feedback: more!
31
© 2014 IPEC. May not be reproduced without permission.
Effect Sizes between Retrospective
Pre and Post Ratings by Item
2
1.8
1.6
All comparisons significantly different
at p < 0.01.
Cohen’s d Effect Size:
Small: 0.2-0.49
Medium: 0.5-0.79
Large: ≥0.8
= interprofessional objectives
= critical care objectives
1.4
1.2
1
0.8
0.6
0.4
0.2
0
© 2014 IPEC. May not be reproduced without permission.
PROFESSION-SPECIFIC EXPERIENCES
Interprofessional Virtual
Case
• Homegrown case
system for
asynchronous
collaboration
• ~600 participants
annually (SOM, SON,
SOP, SOSW)
• Now being used at
several other
institutions
33
© 2014 IPEC. May not be reproduced without permission.
Receive
case
information
Complete
peer
evaluations
Highvalue
learning
Answer
group
questions
Summarize
case data
in EHR
Answer
individual
questions
© 2014 IPEC. May not be reproduced without permission.
35
© 2014 IPEC. May not be reproduced without permission.
36
© 2014 IPEC. May not be reproduced without permission.
CASE ACTIVITY MEASURES
Case activity measures
Logins
EHR entries
Message board posts and
replies
Message board posts
viewed
Social
Medical
Nursing
Pharmacy
Work
Students Students Students Students
(n=194)
(n=146)
(n=60)
(n=122)
21 (2-98) 28 (5-197) 25 (2-86) 22 (1-114)
11 (0-44) 14 (2-53)
5 (0-19)
7 (0-43)
8
8.5
9.5
5
(0-157)
(0-131)
(0-81)
(0-108)
24
27
36.5
17.5
(0-659)
(0-675)
(0-335)
(0-460)
© 2014 IPEC. May not be reproduced without permission.
CORRELATIONS BETWEEN CASE ACTIVITY
MEASURES AND SCORES
1
2
3
4
5
6
1. Individual Score
—
2. Individual Logins
0.32*
—
3. Individual EHR
Entries
0.33*
0.32*
—
4. Individual Message
Board Posts/Replies
0.39*
0.50*
0.28*
—
5. Individual Message
Board Views
0.35*
0.46*
0.25*
0.80*
—
6. Team Score
0.18*
0.23*
0.07
0.34*
0.27*
—
7. Team Size
-0.03
-0.01
-0.10
-0.12
-0.03
0.02
7
—
© 2014 IPEC. May not be reproduced without permission.
CONTEXT-SPECIFIC EXPERIENCES
Richmond Health and
Wellness Program
• Nursing, Pharmacy,
Social Work,
Medicine,
Psychology
• HRSA-funded
• Community-focused
care coordination
in an indigent
setting
• Patient and student
impact
• “Hotspotting”
39
© 2014 IPEC. May not be reproduced without permission.
Engage in Shared
Problem Solving
Context-Specific
Experiences
Solve Healthcare
Problems
Interprofessionally
Profession-Specific
Experiences
Experience
Interprofessional
Problem Solving
Foundational Health
Professions Experiences
Be Exposed to
Interprofessional
Problem Solving
Pre-Curricular
Experiences
40
© 2014 IPEC. May not be reproduced without permission.
SCHOLARSHIP AND DISSEMINATION
Emswiller Symposium
• Regional interprofessional
symposium
• >150 attendees past two years
Interprofessional Virtual Case
• Patent pending
• Licensing to UNT, UNM, KU
RHWP
• Dissemination to other
institutions
Grant funding
• HRSA
• Macy Foundation
• Reynolds Foundation
National Presentations or Manuscripts
(*=student/trainee)
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Melissa Abell
Nital Appelbaum*
Nathaniel Arnold*
Peter Boling
Antoinette Coe
Ann-Marie Conlon
Steve Crossman
Jeff Delafuente
Deborah
DiazGranados
Alan Dow
Alex Enurah*
Jessica Evans*
Moshe Feldman
Cheryl Garland
Sarah Hobgood
Susan Johnson
Tanya Huff
Sharon Lanning
•
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Kelly Lockeman
Paul Mazmanian
Natalie Nguyen*
Kelechi Ogbonna
Shelley Orr
Darshan Pandya*
Pamela Parsons
Sheldon Retchin
Andrew Rock*
Lana Sargent
Lyubov
Slashcheva*
Stephanie
Umphlette*
Lynn
VanderWeilen*
Jean Ellen
Zavertnik
41
© 2014 IPEC. May not be reproduced without permission.
Questions and Discussion
Alan Dow
[email protected]
© 2014 IPEC. May not be reproduced without permission.