Clinical capacity for teaching - Tairawhiti IPE experience A/Prof Sue Pullon IP Programme Director and HOD Dept of Primary Health Care & General Practice University of Otago Wellington Tolaga Bay Tairawhiti
In New Zealand Health professional degree programmes are Provided by wide range of tertiary institutions Even within same institution almost wholly uni-disciplinary Clinical placements often occur in same area, same providers, but different programmes Different programmes don t communicate, students don t learn together, don t communicate professionally Yet poor interdisciplinary communication is the single most common reason for reported complaints Koru
Health Workforce NZ Provided funding 2012-2014 for 3 year undergraduate rural IPE project Collaboration across institutions IP education in 2 high needs rural areas Rural, clinically-based, transition-to-practice clinical placement programme for final year students Dentistry, dietetics, medicine, nursing,, pharmacy, physiotherapy occupational therapy, social work
Tairawhiti-Whakatane Intended Learning Outcomes Eight Domains within a rural clinical context Communication Treaty of Waitangi Hauora Maori Collaboration Roles and responsibilities Patient/client/whanaucentred approach Team functioning Negotiating decisions Tolaga Bay wharf
UoO - EIT educational collaboration A 5 week rotational programme 1 designated region; 2 institutions; 5, then 6, disciplines University of Otago Dunedin
Host department - Primary health care and general practice UoO Wellington Already teaching IP with IP staff Proximity to local area Disciplines dentistry, dietetics, medicine, nursing, pharmacy, physiotherapy Teaching and learning site - Tairawhiti; Rural, isolated, high levels SE deprivation, high Maori population Many key stake holders, community providers
New Zealand Tairawhiti EIT University of Otago Christchurch Wellington Eastern Institute of Technology Dunedin main campus
2012, 2013 and 2014 2011 Set up 4 months 2012 Set up 5 more months May-June July Sept- Oct 2013 Jan-Feb Mar- April May-June July Sept-Oct 2014 Jan- Feb Mar-Apr May -June July Sept-Oct
2012 Students Dental Medicine Nursing Pharm Physio Totals Block 1 2 1 2 0 2 7 Block 2 2 3 0 4 2 11 Block 3 2 1 4 0 2 9 27
2012 + 2013 Stud. Dietet. Dental Med Nurs Pharm Physio Totals Block 1 0 2 1 2 0 2 7 Block 2 0 2 3 0 4 2 11 Block 3 0 2 1 4 0 2 9 Block 4 2 2 3 0 3 2 12 Block 5 2 0 2 3 3 2 12 Block 6 2 2 2 4 0 2 12 Block 7 2 2 3 0 3 2 12 Block 8 2 2 3 3 0 2 12 10 14 18 16 13 16 87
Evaluation Malatest Intl contracted to provide independent evaluation of TIPE to HWNZ since August 2012 Malatest Intl recently also contracted to provide independent evaluation from Whakatane to HWNZ Oct 2013 Evaluation framework developed Pre and post questionnaires for TIPE/whole class cohorts commenced 2013 Process of set up, running, resourcing the programme Dec 2012 formative evaluation report Mid year monitoring report July 2013 Summative evaluation report (to date) submitted Feb 2014 Ponga; silver fern
Comparison between year-start and year-end results compared to their peers who did not take part in TIPE, students demonstrated significantly increased: Agreement that an interprofessional approach permits health professionals to meet the needs of patients. Comfort working with and understanding of the roles of other health professionals. Self-assessed knowledge of aspects of rural healthcare.
Change in students agreement that with two statements about working with other health professionals between the year-start and year-end surveys for TIPE and non-tipe students
Change in knowledge for different aspects of rural healthcare between the year-start and year-end surveys for TIPE and non-tipe students
Comparison between year-start and year-end results compared to their peers who did not take part in TIPE, students demonstrated significantly increased: Knowledge across three areas: the impact of social and environmental conditions on the health and wellbeing of communities, the impact of family dynamics on healthcare decisions, and the impact of whānau ora on healthcare provision. Knowledge in two of the three areas of chronic condition management: knowledge of evidence based guidelines; and education resources.
Change in knowledge for different aspects of Māori and community healthcare between the year-start and year-end surveys for TIPE and non-tipe students
Student highlights 2013 I don t think I could have come into a warmer, friendlier, more welcoming community..i ve never ever been able to apply my concepts of Hauora Maori and things like that [before] that we get taught in our courses... They ve looked after us, they ve given us freedom to go off and like really develop as real world [practitioners] I think, and living in a little flat, we ve had so much fun, we ve done so much bonding.
The inter-professional stuff we did with the physio was awesome. I learnt so much about what they did, and it was really fun. I had a day with pharmacy, I learned heaps and with nursing this is easily the most beneficial course I ve ever done as part of my medical degree. I say this because it s the first time we have been able to integrate all the other professions. The quality of the s[local staff] is excellent. We are comfortable approaching them to raise concerns, and seek clarification. They are very, very supportive of us
IPE teaching and teachers Staff (PR+) achievements s have gone from strength to strength Changes of staff create new dynamics Planning works best when the team can get together and work together Shared negotiation (conflict resolution) is a learned skill Teachers are now modelling interprofessional behaviour Activities are challenging stereotypes Teachers are now representing a range of disciplines, adopting interdisciplinary identities
programme sustainability TIPE is in place as a sustainable programme that is achieving the intended outcomes and has the support of the local community. TIPE s achievements support the need for it to continue. Commitment of resources to developing governance and management structures, a curriculum agreed across participating disciplines, and to developing a locally based programme team has provided a strong foundation for continuing the programme. (Independent evaluation report to HWNZ, Jan 2014)
Organisational Challenges Co-ordinating Disciplines scheduling blocks Multiple organisational relationships and locations Student Timetables Clinical placement capacity
Governance infrastructure UoO + UoA liasion Tairawhiti Governance group IP leader UOW Admin UOW EOG - Education operations group nur; med; physio; dental; pharm Academic team UOW
UoO + UoA liasion Local staff Tairawhiti Governance group EOG - Education operations group nur; med; physio; dental; pharm MC + Educ UOW Admin UOW Academic leader Gisborne Admin Gis Hauora Maori nur med dent phy phar
Clinical placements EIT campus Hosp Community organisations Primary care clinical sites/ providers Academic leader Gisborne Admin Gis Hauora Maori nur med dent phy phar Maori providers
Students EIT campus Hosp Community organisations Primary care clinical sites/ providers Academic leader Gisborne Students Admin Gis Hauora Maori nur med dent phy phar Maori providers
Clinical providers Are clinical workplace providers - community; primary care; iwi; also DHB services Hosting final year students (transitioning to practice) Timetable of commitment block by block May provide a clinical home for one student But also may have differing groups of students 2-3 of different disciplines Support from local programme leader, programme administrator and the s Resources handbooks, information Payment proportional to commitment per block All helps with bringing students back to the area as health professionals
Clinical providers At this stage, students in the workplace need Room to undertake as much practice as possible Goldilocks supervision not too much, not too little, but just right Opportunity to learn with from and about their own discipline And to learn with from and about other disciplines - staff and peers (2+ students in the workplace) Mahunga
Not surprisingly, Small communities have small health workforces Clinical practice workflow is unpredictable Students still need to be made welcome and part of the team Organisation/communication within the practice workplace on the students behalf is key
Clinical Provider Capacity Mahia Maximised by good organisation of all the placements in the area A single point of contact works best Knowing well in advance that students are coming helps All (smaller?) providers need a rest at times Training, support and practice at having students all helps
In Tairawhiti In total, 11-12 students at any one time 2-4 students in any one discipline at any one time But some disciplines not available at every block (curriculum alignment issues) Limiting factors = clinical placement availability, accommodation, transport within the region Captain Cook memorial
Going south Wairoa Expanding to another area Close enough but very different A new community, particular context Small additional numbers of students Te Mahia
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