Key Elements to Consider When Developing Interprofessional Education Experiences

by Chase Board, Pharm.D., PGY1 Community Pharmacy Resident, University of Mississippi School of Pharmacy

My pharmacy school’s curriculum required each student to participate in one interprofessional education (IPE) training session and to write a self-reflection on the experience.  My IPE session occurred during my third year.  Working in a group with nursing and osteopathic students, we were tasked to provide an assessment and develop a treatment plan for a patient case scenario.  The instructors prefaced the activity to encourage us to focus our communication and teamwork skills.  For me, it seemed we struggled to find any purpose in learning how to work as a team.

The Joint Accreditation of Interprofessional Continuing Education defines IPE as events “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.”¹  Highly effective interprofessional teams can improve health outcomes by enhancing the quality of patient care, reducing medical errors, reducing the hospital length of stay, and lowering medical costs.²  In a crossover study evaluating the quality of written transition plans for patients within a healthcare delivery system, treatment plans written by healthcare professionals who collaborated as a team correlated to stronger work quality when compared to healthcare professionals who did not actively collaborate together.³

Thanks in part to this growing body of literature, many academic institutions are implementing IPE.  Indeed, the Accreditation Council for Pharmacy Education (ACPE) requires all colleges/schools of pharmacy to implement IPE in their curricula.  In a January 2018 update, the ACPE Board of Directors clarified guidance to schools of pharmacy curriculum to include IPE experiences involving prescribers, specifically physicians and medical students, in didactic and experiential courses.⁴

Preceptors at the University of Wisconsin-Madison School of Pharmacy implemented IPE with a “dual identity” design.5  Their program trains students to become traditional pharmacists, but they integrate interprofessional learning and socialization with other healthcare disciplines.  The program offers elective experiences allowing students to volunteer at a student-run clinic.  These opportunities allow students to learn and apply interprofessional skills such as cooperation, communication, and coaching.  The aim is to prepare students for their fourth-year Advanced Pharmacy Practice Experiences (APPE) and graduate “career-ready, collaborative pharmacists.”⁵

Preceptors should structure their IPE experiences based on the four core competencies outlined by the Interprofessional Education Collaborative (IPEC).  IPEC is composed of 21 national associations representing nearly all health professions educators, including the American Association of Colleges of Pharmacy (AACP).  IPEC serves to promote and advance the efforts of interprofessional learning experiences.  The recommendations provided by IPEC focus on four core competencies:⁶

1.   Values/Ethics for Interprofessional Practice

Team members should have mutual respect and shared values. This is a cornerstone of effective collaborative practice.

2. Roles/Responsibilities

Individuals should use their knowledge in collaboration with the other members of the team to address patient health care needs.

3. Interprofessional Communication

Team members should promote and maintain the health of their patients by engaging in effective team-based communication.  They should direct their dialogue towards the patient, the patient’s family, other members of the health care team, and the community.

4. Teams and Teamwork

Teams should discuss relationship-building values and team dynamic principles to plan, deliver, and evaluate patient care.

 

For example, during a fourth-year APPE, I served as a facilitator in a structured IPE experience.  Groups of pharmacy, nursing, and osteopathic medicine students were assigned to review a patient case, communicate electronically, and attend a face-to-face session.  The face-to-face activity was intended to simulate an actual patient encounter.  My role as an IPE facilitator was to observe each team during the simulation and record comments based on my observations. I was provided a rubric to assess IPEC core competencies such as communication, professionalism, roles/responsibilities assignments, and team cohesiveness.  At the end of the simulation experience, groups received feedback regarding the written progress notes and electronic communication.  They were asked to write self-assessments based on their individual and team-based performance. I believed this activity represents a good example of how to structure an IPE experience.

There are many assessment tools available to evaluate IPE experiences. When structuring an IPE experience, it is important to identify the type of tools available, as well as determine which tools are most effective.  The Committee on Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes suggests IPE experiences should utilize a mix of qualitative and quantitative assessment tools to evaluate outcomes.  Implementing only one methodology does not fully explore and capture the data that can be obtained by a mixed-methods approach.  A mixed-methods approach can provide insight into both the “what” and “how” of IPE interventions and outcomes.⁷

When selecting tools to use for IPE assessment, the assessment tools should measure attitude, behaviors, knowledge, and skills.⁸ This aligns with the IPEC four core competencies (values/ethics, roles/responsibilities, interprofessional communication, and teamwork).  The IPE experience I helped facilitate during my fourth-year APPE used three assessment tools to evaluate attitudes, perceptions, and behavior.⁸ Assessment tools like these can be found on the National Center for Interprofessional Practice and Education website.

Preceptors should role model effective interprofessional collaboration as a strategy to teach pharmacy students appropriate behavior to uphold during IPE experiences.  Including activities in a rotation whereby students observe and reflect properties can help them develop conscious behavior.⁹  Some strategies preceptors should use include being self-aware of being a role model, reserving time for discussion with students, facilitating reflection on the experiences, and explicitly communicating what is being modeled for the student.¹⁰

I’ve had the opportunity to role model for students at a local free clinic during my residency training.  A medical student was consulted to counsel a patient who was starting insulin therapy.  The medical student said they were struggling to remember subcutaneous injection technique.  I reviewed the proper insulin injection technique with her. Feeling more competent, the student counseled the patient and returned to me to reflect on her experience.

Functioning effectively on an interprofessional team is important.  Thus, we need to teach these skills to students while they are in school.  IPE experiences should be linked to the four IPEC core competencies. When developing IPE assessment, teachers should use quantitative and qualitative methods to evaluate student performances and experiences.  Role modeling can be used by facilitators and preceptors to demonstrate what effective behavior looks like in collaborative practice.

References

1. Definitions. Joint Accreditation Interprofessional Continuing Education website. 2019. Accessed May 15^th, 2019.
2. Buring SM, Bhushan A, Broeseker A, et al. Interprofessional education: definitions, student competencies, and guidelines for implementation. Am J Pharm Educ. 2009;73(4): Article 59.. Accessed May 15^th, 2019.
3. Farrell T, Supiano K, Wong B, Luptak M, Luther B, et. al. Individual versus interprofessional team performance in formulating care transition plans: A randomised study of trainees from five professional groups. J Interprof Care. 2018;32(3):313-320.
4. Clay Kirtley J., Vlasses P. ACPE Update – 2018. Oral Presentation at: American Pharmacists Association Annual Meeting; March, 2018. Nashville, TN. Accessed May 16^th, 2019.
5. Gerhards K. PharmD Program Strengthens Interprofessional Education. University of Wisconsin-Madison School of Pharmacy’s website. 2018. Accessed Mary 17^th, 2019.
6. Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: 2016 update. 2016. Washington, DC: Interprofessional Education Collaborative. Accessed May 19^th, 2019.
7. Chapter 5: Improving Research Methodologies. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington (DC): National Academies of Science. Published December 2015. Accessed May 19^th, 2019.
8. Shrader S, Farland M, Danielson J, Sicat B, Umland E. A Systematic Review of Assessment Tools Measuring Interprofessional Education Outcomes Relevant to Pharmacy Education. Am J Pharm Educ. 2017;81(6): Article 119. Accessed May 19^th, 2019.
9. Cruess S, Cruess R, Steinert Y. Role Modelling – making the most of a powerful teaching strategy. BMJ. 2008;336(7646):718-721.