1 Lauren Collins, MD Shoshana Sicks, EdM Alicia Muratore, MSIIICreating a VERTICAL Interprofessional Education and Collaborative Practice Curriculum Lauren Collins, MD Shoshana Sicks, EdM Alicia Muratore, MSIII

2 Objectives: Describe a method for developing an integrated interprofessional education and collaborative practice (IPECP) curriculum Identify the benefits and challenges of implementing a longitudinal IPECP curriculum across previously siloed health professions training programs Apply an easy-to-use mobile application tool to assess teamwork and collaborative practice behaviors

3 Format and Agenda: Curriculum – 20 minutesTeamwork video demonstration – 5 minutes Competency-based evaluation of video – 5 minutes SWOT analysis – 5 minutes Large group discussion – 10 minutes During the first portion of this session, we will present a detailed overview of the development, implementation, evaluation and ongoing continuous quality improvement of our VERTICAL curriculum. Participants will have the opportunity to apply a competency-based assessment tool for evaluating new IPECP activities after watching a teamwork simulation scenario. Participants will then perform a SWOT analysis to identify strengths, weaknesses, opportunities and threats to IPECP implementation and evaluation at his/her own institution. Finally, session participants will engage in an interactive discussion of lessons learned, culminating in the development of a comprehensive list of practical tips for implementing curricular changes that embrace new IPECP curriculum and evaluation models. Participants will leave the session with a better understanding of the key stakeholders for advancing IPECP, new solutions to scheduling and logistical challenges, a menu of replicable models of IPECP innovation in the classroom, simulation and clinical practice settings, and an innovative mobile application assessment tool to assist in documenting achievement of core competencies in IPE and collaborative practice.

4 Where we were… As background, you may remember a time when medical and health professions students were trained in siloes. Students may have even been co-located but students, faculty and staff rarely trained together or had the opportunity to learn with, together and about one another and to fully appreciate and respect each other’s expertise and role on the care team

6 How can we get there? VERTICAL

7 What is VERTICAL? Value-driven, Ethical, Responsible, Team-based, Interprofessional, Collaborative Aligned Leaders Goal: Train, assess, and nurture a cohort of highly competent students who will represent the new face of healthcare, VERTICAL seeks to prepare students who are: Value-driven, Ethical, Responsible, Team-based, Interprofessional, Collaborative, Aligned Leaders. Integrated across six colleges at our University, including our medical college, VERTICAL students will achieve the IPEC Core Competencies (IPEC, 2011) and graduate equipped to deliver high quality, person-centered collaborative care.

8 Background: Need for Education Reform“Regardless of the number of health professional required in the future, all health professionals must be trained differently if they are to meet the needs of a changing patient population to thrive in a changed health care delivery system. All health professionals should be educated so that they can contribute to meeting the societal goals of better care, better health and lower cost for all – the Triple Aim.” - George E. Thibault, Health Affairs 32(11) 2013: Following a series of reports from the WHO and IOM and others, health professions educators began to see that were was a real need to train our students and provider “DIFFERENTLY” to achieve our common goal, the Triple Aim, to improve patient outcomes, improve patient satisfaction and to lower health care costs.

9 Background: Importance of IPEIPE is now part of most accreditation standards IPE Core Competencies developed in 2011 and updated in 2016 (IPEC) Teamwork Communication Roles/Responsibilities Values/Ethics Since JCIPE was founded in 2007, IPE has gained more and more attention as a central component of all health professions training. In 2011 and again in 2016, an expert panel with representation from most health professions was convened and laid out a set of core competencies that all health professionals should be equipped with to serve as part of a high functioning team. These competency domains include: Teamwork, Commmunication, Roles and Responsibilities, Values/Ethics

10 Importance of Collaborative PracticeImproved patient outcomes Interdisciplinary team training recommended to increase patient safety and quality health care (IOM,1999) Increased patient satisfaction Shown to increase patient satisfaction and improve culture (Reeves, et al., 2008) Decreased costs Shown to reduce errors in the ED (Reeves, et al., 2008) Increased provider satisfaction Acknowledge role of workforce, restoring joy and meaning to practice (Sinsky, et al., 2013) Addresses “Quadruple Aim” to improve health care quality through IN the last decade, we have also seen tremendous growth in the literature on the benefits of Collaborative Practice: We now have AMPLE evidence that a high functioning team can lead to improving health care quality, leading to better patient outcomes, improved patient satisfaction, lower costs, and improved provider satisfaction

11 VERTICAL: IPE/CP CurriculumStep 1: Informed Step 2: Knowledgeable Step 3: Competent Advanced IPC Near Miss RCA Hotspotting No One Dies Alone ESHP Advanced TeamSTEPPS IPE/CP Scholarship IPE/CP Facilitation Core IPC Collaborative care: team-based rounding, huddles, debriefs, Teach-Back TeamSTEPPS Virtual ESHP Clinical Discharge Scenario Teamwork training elective Year 2 HMP/Core IPE Step 4: Proficient *Adapted from Miller’s Pyramid of Clinical Competence Year 1 HMP/Core IPE First let’s start by discussing a method for developing an integrated interprofessional education and collaborative practice (IPECP) curriculum Education across the spectrum of health professions must evolve to keep pace with dynamic practice changes. As numerous recent reports have highlighted, there is an urgent need to bridge the gap between interprofessional education and clinical practice to prepare a workforce that is ready to achieve the Triple Aim.

12 VERTICAL: Educational Project GoalsDevelop a sustainable comprehensive IPECP curriculum that results in measurable achievement of IPE Core Competencies that can be replicated by other institutions Accurately measure health professional student attainment of IPE core competencies, using a novel mobile application platform, and disseminate outcomes locally, nationally and internationally The goal of this project is to develop, implement, evaluate and disseminate a new comprehensive, integrated interprofesional education and collaborative practice (IPECP) curriculum, VERTICAL, across the educational continuum at our institution

13 VERTICAL: IPECP CurriculumVERTICAL is built on JHMP as a foundation and now offers a robust menu of IPECP experiences for clinical (as well as some non-clinical) students Expanded our existing IPECP programming by: Adding innovative Core IPC Experiences Supporting and/or creating new Advanced IPC Electives Offering IPE Certification for students who pursue advanced training and demonstrate proficiency Developing a novel, accessible mobile application platform for standardized IPE/CP 360 degree assessment and tracking (JTOG) VERTICAL uses our Health Mentors Program as a foundation from which to build a robust menu of IPECP experiences for all clinical students. VERTICAL expands existing IPE content and enhances evaluation by: 1. Adding innovative core IPECP experiences 2. Creating advanced IPECP elective opportunities 3. Offering a new IPECP certificate program 4. Developing a novel mobile application platform for competency-based assessment

14 VERTICAL: Sample Programs“Core” Programs Jefferson Health Mentors Program TeamSTEPPS training “Advanced” Programs Interprofessional Student Hotspotting Program Enhancing Services to Homeless Populations Virtual World Training for Interprofessional Students Near Miss Root Cause Analysis

15 Jefferson Health Mentors Program

16 Jefferson HMP Students are partnered with an interprofessional student team and one health mentor, complete 4 modules over 2 years Mentors are community-based volunteers living and coping with one or more chronic health conditions or impairments. Each module is based around concepts of Social Determinants of Health and the Social-Ecological Model Students trained: >5700 Figures as of 10/13/16 To date, 4727 have graduated as of Spring 2016 and 5416 will graduate as of Spring 2017

17 TeamSTEPPS Training

18 TeamSTEPPS Workshops Evidence-based teamwork and communication framework to enhance patient safety Online interactive pre-work Small group (~15 students) 2-hour simulation-based workshops to: Impart principles of interprofessionalism Teach specific skills to enhance teamwork and communication Provide an opportunity to apply principles and skills Students trained: 780 12/4/2017

19 Advanced: Interprofessional Student Hotspotting Program

20 Interprofessional Student Hotspotting ProgramSmall interprofessional teams learn to work with superutilizers in their own communities Get early hands-on experience with caring for patients with complex health conditions by addressing root causes Learn about systemic barriers that cause repeated hospital admissions/ED visits and prevent patients from getting quality care and maintaining health Students trained to date: 18 Anticipated training in : 48

21 Enhancing Services to Homeless Populations: Virtual World Training for Interprofessional Students

22 Was working but lost job and benefits;ESHP Individual (3 characters) Age 35 Age 19 Age 59 Was working but lost job and benefits; has diabetes; very strong connections to local community of homeless persons Settings/Contexts Homeless after leaving an abusive relationship, 3 kids who now live with sister Interactions/Situations On street Dual DX, schizophrenia, heroin addition Transitional Apt. Key Issues Engagement Collaboration at all levels Resources Community clinic setting Paranoia, distrust of helpers; living on street Placed in transitional housing (apt.); trouble adapting; left; staff trying to locate and help Lack of medical/health follow-up; fell off wagon, no primary care provider helping

23 Near Miss Root Cause AnalysisSmall interprofessional teams composed of students, residents and staff work together to investigate a “near miss” over the course of 2 months Project culminates in presentation of findings and facilitation of a discussion with peers to avoid medical errors Students trained: 12 The purpose of this course is to engage interprofessional learners in the structured evaluation of a medical error, with the following objectives: Recognize the importance of analyzing and reporting Near Miss Events Demonstrate interprofessional teamwork skills Analysis a Near Miss Medical Error Event using a standardized structure Facilitate a discussion with peers regarding your Root Cause Analysis Recognize Near Miss Events in clinical practice Completion of this course will require: 1. Completion of prework and the precourse assessment 2. Active participation in the investigation phase. 3. Preparation for and co-facilitation of the final interprofessional work session 4. Submission of session slides, group fishbone, meeting minutes, and Final Summary with Action Plan 5. Completion of team member evaluations and post course assessment

24 VERTICAL: Lessons LearnedExtraordinary interest in IPE/CP expansion Faculty development is critical to success Stakeholder engagement across academic and clinical pillars is critical IPE champions must be recognized and rewarded Transcript designation for students who excel in CP should be offered Reconfigured committee structure needed to review IPC opportunities and designate IPE certification, created IPE inventory as well as application and tracking system underway Solutions: Ask Deans or other members to send representatives if unable to attend Changed meeting time after doodle poll sent to find a better meeting time for committee members Working with faculty to embed IPC programming into existing curricular requirements and to monitor and track success of IPC expansion with Jefferson Teamwork Observation Guide (JTOG) Have developed and are now offering more opportunities for Faculty Development re IPC program development and learner assessment, both on site and through CME/CE accredited Faculty Development workshops Have now developed a pilot for sustainability of IPC teamwork simulation training by charging a fee to reimburse faculty for effort to be paid for by SKMC funds, will use as a model to explore with other schools Solution: Continue to offer yearly TJU awards for IPE and IPC champions Have now developed a pilot for FD sustainability by charging a fee for on-site trainings, such as Whitemarsh CCRC pilot – charging a workshop fee will enable us to reimburse additional faculty for effort Plan to offer an enhanced multiday Faculty/Staff Development workshop open to national audience program using a similar fee structure Working with other JCIPE faculty and IPE champions to ensure that IPE/C remains at the forefront of the curricular changes Meeting regularly with Deans, institutional/hospital leadership, TJU students, community members and patients to explore as many opportunities for IPE/IPC expansion as possible Plan to work with curriculum committees to make sure that curricular changes help to align changes in education with changes in practice and healthcare delivery 10

25 VERTICAL: Next Steps Expand and refine VERTICAL curriculum and faculty development programs Expand menu of Core and Advanced IPECP electives Offer and track IPE/CP certification Finalize “native” app development and disseminate JTOG Refine, refine, refine…. Meet quarterly, refine curricula with CQI Implement IPC expansion to include 50% of Jefferson clinical students Host quarterly faculty development programs accompanied by follow up individual on-site training Begin tracking for transcript designation for all Jefferson students Host 4 interprofessional small group sessions at Jefferson, support faculty leaders at affiliates Implement Advanced IPC electives; plan 2 additional Advanced IPC electives Implement updated JTOG mobile platform with 50% of clinical students who have completed IPC experience Collect and analyze JTOG data; collect and analyze program evaluation; implement PELS data collection and Jefferson Longitudinal Survey/OIR survey of alumnae Report preliminary results at national meetings/publications 11

26 Teamwork Video https://www.youtube.com/watch?v=sKqo5qi2qVY :38 – 1:44  38 – 104

27 Based on the teamwork simulation scenario you just watched, please complete form to assess team behaviors.

28 VERTICAL: Assessment JTOG® App Competency based assessment Streamline all IPE, teamwork and collaborative practice evaluation for 360 degree assessment: Team (n >1750) Patient (n >400) Caregiver/Family (n >190) Individual (n > 10,500) This fall, we have gone through an iterative process of CQI as we pilot and refine all four versions (team, individual, patient and caregiver/family member) of the mobile “wrapped” version of the JTOG app before proceeding with converting this wrapped app into a “native” application. In addition, we have successfully recruited and trained a group of 10+ research assistants to help with administering the app on tablets with patients and caregivers (in inpatient and outpatient settings), as well as developed a handbook for RAs, which is continuously updated to improve consistency in administration of the tool. Our first validation study for the Team JTOG was published in JAH this summer, and we now have multiple additional pilots studies underway and planned to further look at the reliability and validity of this team tool in multiple settings, as well as the three new versions of the tool that we have now adapted and are utilizing across the institution. RAPID adoption of the tool which is now a part of at least three different TJU HRSA grants, as well as two applications (one for ACGME)….currently adopted by 15 different teams at TJU... And requested for use by over 40 other insitutions.

29 Team JTOG Roles and Responsibilities Teamwork Communication LeadershipTeam Characteristics IPEC Competency Members of the team came prepared to discuss the case/situation from their profession specific perspective. Roles and Responsibilities Members of the team appeared to understand the roles and responsibilities of other members of the team. Team members added other supporting pieces of information from their profession specific perspective regarding the case/situation. Team members sought out opportunities to work with others on specific tasks. Teamwork Team members engaged in friendly interaction with one another. Members of the team who were involved in the case/situation contributed to the discussion. Communication Discussion was distributed among all team members. Team members listened and paid attention to each other. Team members listened to and considered the input of others before pressing their own ideas. There appeared to be a team leader who coordinated the discussion. Leadership The team leader facilitated the discussion rather than dominated it. The opinions of team members were valued by other team members. Values and Ethics Team members appeared to have respect, confidence, and trust in one another. Team members appeared to feel free to disagree openly with each other’s ideas. Team JTOG VERTICAL’s development, implementation and assessment have demanded close collaboration with our institutional leaders, curriculum committees, patient safety institute, faculty, students, clinical affiliates, community organizations and patient partners.

30 Small Group Activity

31 SWOT Analysis 5 minutes: Identify strengths, weaknesses, opportunities and threats to IPECP implementation and evaluation at own institutions.

32 Large Group Discussion10 minutes - Development of a comprehensive list of practical tips for implementing curricular changes that embrace new IPECP curriculum and evaluation models

33 InterProfessional Education (JCIPE) Follow us on Twitter @JeffCIPEQuestions? Jefferson Center for InterProfessional Education (JCIPE) Follow us on

34 Sources: Interprofessional Education Collaborative Expert Panel, Core competencies for interprofessional collaborative practice: Report of an expert panel. Interprofessional Education Collaborative, Washington, DC. Retrieved from: ipecreport.pdf. American Association of Medical Colleges. The core entrustable professional activities for entering residency. https://www.aamc.org/initiatives/coreepas/. Accessed June 14, 2016. IOM (Institute of Medicine), Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Accessed June 14, 2016.