THEORY BURST #3: DESIGNING EFFECTIVE LEARNING EXPERIENCES Conan MacDougall, PharmD, MAS, BCPS Professor of Clinical Pharmacy University of California, San Francisco School of Pharmacy San Francisco, CA IPEC INSTITUTE MONDAY, JANUARY 13, 2014 What you (should) already know - How to build learning experiences upon IPEC s core competencies for collaboration What we will discuss today - Three principles of effective instruction that pose unique challenges for IPE and how to approach them - Briefly review an IPE framework at a health sciences institution and how an example IPE session met (or didn t) challenges discussed What you should be able to do after the session - Short term (after this session): - Outline learning activities for both faculty and students that will assist in designing strategies that support interprofessional educational goals - Long term (within 2 years): - Create and implement an effective IPE activity at your home institution 2017 IPEC 1
Take 5 minutes. With your group, design an INeffective Interprofessional learning experience. Be prepared to discuss & defend its badness! 2017 IPEC 2
2007; 29: 735 751 A best evidence systematic review of interprofessional education: BEME Guide no. 9 M. HAMMICK 1,D.FREETH 2, I. KOPPEL 3, S. REEVES 4 &H.BARR 5 1 UK, 2 City University, UK, 3 University of Westminster, UK, 4 University of Toronto, Canada, 5 University of Greenwich, UK MEDICAL TEACHER, 2016 VOL. 38, NO. 7, 656 668 http://dx.doi.org/10.3 109/0142159X.2016.1173663 BEME GUIDE A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39 Scott Reeves a, Simon Fletcher a, Hugh Barr b,ivanbirch c,sylvainboet d,nigeldavies e, Angus McFadyen f, Josette Rivera g and Simon Kitto d 2017 IPEC 3
EFFECTIVE LEARNING CONSIDERATION #1: MOTIVATION Jorge Cham www.phdcomics.com EFFECTIVE LEARNING CONSIDERATION #1: MOTIVATION Learner Priorities Interprofessional Education Collaborative Expert Panel. (2011). Washington, D.C.: Interprofessional Education Collaborative IPE Designer Priorities 2017 IPEC 4
EFFECTIVE LEARNING CONSIDERATION #1: MOTIVATION Medical students found it difficult to justify spending time on learning that was not being assessed, and nursing students found that the wards were often too busy for them to spend time with medical students. Morison S, et al. Learning in Health and Social Care (2003) EFFECTIVE LEARNING CONSIDERATION #1: MOTIVATION Lessons to consider 1. Explicitly design IPE as learner-facing objective AND assess and report performance Ideally link to a learner-required IPE milestone AND/OR 2. Carefully design content-focused experience where IP interaction clearly improves ability to achieve milestone Ideally linked with learner-required content milestone 2017 IPEC 5
EFFECTIVE LEARNING CONSIDERATION #2: PRIOR KNOWLEDGE & ATTITUDES Take 30 seconds and answer this question: Why are there seasons on Earth? Dunbar KN, et al. Do naïve theories ever go away? Using brain and behavior to understand changes in concepts (2007) Figure 1. How did the students describe doctors? Figure 2. How did the students describe nurses? Tunstall-Pedoe, et al. J Interprof Care (2003) DOI:10.1080.1356182031000081768 2017 IPEC 6
Figure 1. How did the students describe doctors? Figure 2. How did the students describe nurses? Tunstall-Pedoe, et al. J Interprof Care (2003) DOI:10.1080.1356182031000081768 Figure 1. How did the students describe doctors? Figure 2. How did the students describe nurses? Tunstall-Pedoe, et al. J Interprof Care (2003) DOI:10.1080.1356182031000081768 2017 IPEC 7
Tunstall-Pedoe, et al. J Interprof Care (2003) DOI:10.1080.1356182031000081768 Brown & Hewstone. Adv Experimental Social Psych (2005) DOI: 10.1016/S0065-2601(05)37005-5 There was considerable evidence of professional stereotyping but little evidence of change in these stereotypes during the programme. Positive stereotypes were not strengthened appreciably, nor were negative stereotypes reduced we found some evidence from the interviews that the students tended not to see fellow programme members as typical members of the other mental health professions and therefore did not generalize their positive experiences of fellow students to their professions as a whole. Carpenter J, et al. J Interprof Care (2006) DOI:10.1080/13561820600655653 2017 IPEC 8
Carpenter J, et al. J Interprof Care (2006) DOI:10.1080/13561820600655653 Level 1: Reaction Did they LIKE it? Level 2: Learning Did they LEARN it? Level 3: Behavior Do they DO it? Level 4: Results Did they IMPROVE something? IPEC INSTITUTE MONDAY, JANUARY 13, 2014 Reeves S, et al. Medical Teacher (2016) DOI: 10.3109/0142159X.2016.1173663 2017 IPEC 9
EFFECTIVE LEARNING CONSIDERATION #2: PRIOR KNOWLEDGE & ATTITUDES Lessons to consider 1. Many learners enter with deeply-held stereotypes of other professions 2. Such stereotypes may be very difficult to change BUT 3. Learners can learn to collaborative effectively and provide valuable care ANYWAY SO 4. Either focus carefully on conditions for positive attitude change OR 5. Focus on knowledge and skills and let attitudes fall as they may INTERACTION OF MOTIVATION WITH PRIOR KNOWLEDGE & ATTITUDES I definitely learned that pharm students have a different skill set when it comes to how to handle antimicrobials. However, I still have no idea how we will interact with one another in a professional settings. (SOM student eval of SOP/SOM small group activity) The discussion turned into a med school class where the medical students were the mainly responders to the questions from their MD professors. I felt that this was a great idea but in execution neglected the importance of pharmacy practice. It felt quite discouraging seeing the medical students dominating the discussions while we can contribute so little. One improvement I recommend is to wait until we are learning our therapeutics in Winter before making this workshop happen. (SOP student eval of SOP/SOM small group activity) As an experienced nurse for over 8 years, collaboration and effective communication is part of my work culture. I found this session to lack any vital learning opportunity for me, and many of my experienced colleagues felt the same. This module should be focused on those who are new to the medical field. They seem to be the ones who would benefit most from understanding the importance of collaboration and effective communication in a healthcare team setting. (SON student eval of campus-wide IPE small group activity) Ambrose SA, et al. How Learning Works, 1 st ed (2010) Opportunity to provide information and scenarios from my practice to students from other specialties with no or little clinical experience. I spent a lot of time in the last ten years at a teaching hospital where residents relied on some of their learning to come from Nurses. I like being in that role in the face to face sessions. (SON student eval of campus-wide IPE small group activity) 2017 IPEC 10
EFFECTIVE LEARNING CONSIDERATION #3: ASSESSMENT EFFECTIVE LEARNING CONSIDERATION #3: ASSESSMENT PRACTICE WITH FEEDBACK 2017 IPEC 11
EFFECTIVE LEARNING CONSIDERATION #3: PRACTICE WITH FEEDBACK Education Endowment Foundation. https://educationendowmentfoundation.org.uk/resources/teaching-learning-toolkit EFFECTIVE LEARNING CONSIDERATION #3: PRACTICE WITH FEEDBACK Mandal J, et al. J Interprof Ed Practice (2016) DOI: 10.1016/j.xjep.2016.10.005 2017 IPEC 12
Mandal J, et al. J Interprof Ed Practice (2016) DOI: 10.1016/j.xjep.2016.10.005 Vesel TP, et al. Teach Learn Medicine (2016) DOI: 10.1080/10401334.2016.1146609 2017 IPEC 13
EFFECTIVE LEARNING CONSIDERATION #3: PRACTICE WITH FEEDBACK Lessons to consider 1. Practice accompanied by appropriate feedback enhances likelihood of long-term knowledge/behavior BUT 2. Providing feedback on interprofessional skills is a challenge for instructors and learners SO 3. Make explicit what feedback you are looking for 4. Train feed-backers on how to provide feedback 5. Provide focused, bite-sized chunks QUESTIONS TO ASK AS YOU DEVELOP YOUR IPE: YOUR WORKSHEET Motivation -What are your learners motivations with respect to the IPE activity? -What value do they place on the IP vs profession-specific components? -What are your learners being held accountable for? -Is there anything your learners can STOP doing so that they can focus on IP components? Prior knowledge & attitudes -What practice-specific and IP-related knowledge and attitudes are your learners entering with? -Are you going to engage/challenge those attitudes? -How will you know whether you have impacted IP-related knowledge/attitudes? -Are you satisfied with changing knowledge and behavior without changing attitudes? Practice with feedback -How will you learners be able to apply/practice their knowledge and skills? -What form of feedback will they receive on their individual/team performance? -Who will provide the feedback and what training will they receive? 2017 IPEC 14
http://interprofessional.ucsf.edu 2017 IPEC 15
UCSF FRAMEWORK FOR IPE Disciplinary Expertise Competencies SOD SOM SON SOP PPT Common Competencies Interprofessional Collaborative Competencies Systems Thinking Continuous Improvement of Quality and Safety Patient Engagement Understanding Teams Knowledge of Roles and Responsibilities Effective Task Distribution Usual and Crisis Communication Conflict Management LOOK INSIDE *paid and volunteer clinical, basic science, and social science faculty at UCSF and affiliated institutions, as well as UCSF residents, fellows, and post-docs. QI/PS Develop faculty with teaching expertise in specific themes Increase the capacity and satisfaction of UCSF faculty as teachers Inter- Professional Teaching Improve the quality and depth of the teaching skills of UCSF faculty Simulation Teaching Teach for UCSF program goals: UCSF invites current and future faculty* to follow a path through the UCSF Educational Skills Workshops to develop their teaching skills and receive a certificate in recognition of their achievement. Clinical Teaching General Teaching Teach for UCSF Certificate Program Curriculum Development Clinical Teaching Small Group Teaching SOAP for Learner Professionalism Critical Reflection Teamwork and Communication in Interprofessional Education (online) IPE Strategies: Sustaining a Positive Interprofessional Environment IPE Strategies: Capitalizing on Teachable Moments in Interprofessional Education IPE Strategies: Engaging Learners Across the Health Professions IPE Strategies: Setting the Stage for IP Teaching The following workshop topics are required: Workshops 2017 IPEC 16
NATIONAL STRATEGY FOR COMBATING ANTIBIOTIC- RESISTANT BACTERIA Vision: The United States will work domestically and internationally to prevent, detect, and control illness and death related to infections caused by antibiotic- resistant bacteria by implementing measures to mitigate the emergence and spread of antibiotic resistance and ensuring the continued availability of therapeutics for the treatment of bacterial infections. September 2014 Discussion:%All%students%will%need%to%address%this%issue.%! This is a survey of attitudes What!organisms!cause!hospitalUacquired!pneumonia!and!what s!an! towards antimicrobial use and interprofessional teamwork. Your answers will remain confidential and appropriate!empiric!regimen?!did!ciprofloxacin!use!influence!the!empiric! will not affect your course grade, although completion of the survey is an regimen!chosen?! expectation.!! An) microbial*stewardship*programs:* Staphylococcus2aureus Pseudomonas2 aeruginosa Klebsiella E.2coli Acinetobacter Role*of*the*Pharmacist* Please indicate your level of agreement with each of the statements below 1. Antibiotic resistance is a major public health problem 2. Over-prescribing of antibiotics is a major cause of antibiotic resistance 3. Physicians should only consider the needs of the individual patient when prescribing an antibiotic 4. I am confident the development of new and effective drugs will keep pace with the growing rate of antibiotic resistance Monitor"an1bio1c"use"to* % Strongly Disagree find*opportuni) es*for* Pseudomonas.% improvement*! Enforce*the*an1bio1c" formulary"and"an1bio1c" use"restric1ons" Advise*prescribers*on* op1mal"an1bio1c"selec1on" and"dosing"! Assist*in*guideline" development" Collect*and*analyze*data"on" an1bio1c"use"and" outcomes" Disagree Discussion:%Some%students%will%experience%their%patient%having%MDR% What!are!risk!factors!for!infection!with!MDR!Pseudomonas!infection!?! Discussion:%Some%students%will%need%to%address%this%issue. % What%is%deNescalation%of%antibiotics%and%why%is%it%done?% 5. Patient demand is the major reason that physicians prescribe unnecessary antibiotics Clostridium2difficile Neither Agree nor Disagree Agree Strongly Agree! MacDougall C, et al. Open Forum Infect Dis 2017; DOI: 10.1093/o d/ofw225 2017 IPEC 17
MOTIVATION This was one of the best IPE sessions we had because it was actively engaging as opposed to our IPE last week on conflict which was two of the most boring hours of my education at UCSF and totally non-engaging. This session was directly applicable to our current coursework. More engagement and teamwork in these situations makes for better experiences, thanks for organizing. I think the key to making inter-professional learning a success is to make it relevant to what we are learning at the time. I had a positive experience and am glad we did it. PRIOR KNOWLEDGE & ATTITUDES This was great and the reason it was so different than the IPE exercises which are a lot less useful, is that in this session, we actually NEEDED each other. Neither medicine or pharmacy alone had enough information to completely do the exercise as well as we did together, so this was a great learning opportunity for each of us, in terms of material, but also in starting to work together in a very organic way. Thank you!! Wish more of our IPE activities were like this (and like the PE skills session with the PT students), with a natural reason for existing, rather than the forced grant-driven sessions that are pushed on us. MacDougall C, et al. Open Forum Infect Dis 2017; DOI: 10.1093/o d/ofw225 2017 IPEC 18
PRACTICE WITH FEEDBACK 2017 IPEC 19
UCSF Program in Interprofessional Education. Adapted from University of British Columbia. 2017 IPEC 20