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Shriners Hospital for Children
Liliane Asseraf-Pasin & Elaine Laflamme
The McGill Educational Initiative on Interprofessional Collaboration:
Partnership for Patient and Family Centered Practice
Faculty of Medicine
McGill University
Overview
 Definitions
 Why Interprofessional Education?
 Literature Review (Freeth et al., 2005)
 How To?
 Discussion
Definitions
 Multiprofessional Education:
 Is when members (or students) of two or more
professions learn alongside one another: parallel
rather than interactive learning.
(Freeth et al., 2005)
 Students learn by tackling together a common
problem, but from the perspective of their own
discipline.
(Areskog, 1994)
Definitions
 Interprofessional Education:
 Learning arising from interaction between members
(or students) of two or more professions. This may
be a product of interprofessional education, happen
spontaneously in the workplace, or in educational
settings.
(Freeth et al., 2005)
 Students from each profession look at the subject
from the perspective of other professions as well as
their own.
(Harden, 1998)
Interprofessional Patient-Centered Practice
 Active participation of different professional
groups in decision making; delivery of
patient & family-centered care
 Responsive to patient & family goals, opens
mechanisms for continuous communication
& fosters mutual respect among
professionals
The Nature of Collaboration
Why Interprofessional Education?
 Mounting evidence that Collaborative Practice
improves outcomes in a number of patient
populations studied to date:
 Geriatrics, ER care for abused women, STD
Screening, Adult Immunization, fractured hips
and neonatal ICU care, depression care, and
in simplifying medications
(Zwarenstein et al., 2004)
Why Interprofessional Education?
 Modify negative attitudes & perceptions (Carpenter, 1995)
 Remedy failures in trust & communication between professions
(Carpenter, 1995)
 Reinforce collaborative competence (Barr, 1998)
 Secure collaboration
 implement policies (Department of Health, 2001)
 improve services (Wilcock and Headrick, 2000)
 effect change (Engel, 2000)
 Cope with problems that exceed the capacity of any one
profession (Casto & Julia, 1994)
 Enhance job satisfaction & ease stress (Barr et al., 1998; McGrath, 1991)
 Create a more flexible workforce (Department of Health, 2000)
(as cited in Barr, 2002)
Why Interprofessional Education?
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Complexity of care
Rising expectations
Professional proliferation
Students want to know
Community based care
Teamwork
Interprofessional conflict
New models of practice
Legislation & redefinition of professional roles
Effectiveness of interprofessional practice
Literature Review
 Studies that EVALUATED Interprofessional
Education:
 10, 495 abstracts
 884 papers
 373 studies
 107 “robust” evaluations = 3+ on quality criteria
(Freeth et al., 2005)
Literature Review
 Inclusion criteria for studies:
 Evaluation design was appropriate to the
research aims/questions
 Selection of participants was based on clear
criteria
 Validity & reliability or authenticity &
trustworthiness well considered
 Results and context clearly described
(Freeth et al., 2005)
Literature Review
 Quality: reported information
 Clear rationale
 Good contextual information
 Sufficient information on sampling, ethics
and possible bias
 Analysis described in sufficient detail
(Freeth et al., 2005)
Literature Review
Profession
Number of Studies
Nurses
95 (89%)
Doctors
88 (82%)
Others (e.g. administrators, school
teachers)
58 (54%)
Social Workers
39 (36%)
Allied Health Professionals (unspecified)
32 (30%)
Occupational therapists
22 (21%)
Physiotherapists
18 (17%)
Psychologists
16 (15%)
Pharmacists
13 (12%)
Dentists
5 (5%)
Midwives
6 (6%)
(Freeth et al., 2005)
 Findings by Outcome – collapsed
Education lead
University
Service
Joint
Total
1) Responses
26 +
(4)
16 +
(1)
0+
(3)
50
2a) Perceptions & attitudes
12 +
(8)
9+
(2)
1+
(1)
32
2b) Knowledge & skills
27 +
(2)
11 +
(0)
0+
(0)
50
3) Behaviour
6+
(5)
12 +
(1)
3+
(0)
26
4a) Practice
2+
(3)
31 +
(6)
4+
(0)
46
4b) Patients
5+
(1)
14 +
(8)
1+
(3)
32
Outcomes
(Freeth et al., 2005)
Literature Review
 Key messages with examples:
 Wide range of positive outcomes associated
with IPE:
 Richardson, Montemuro, Cripps, Mohide, &
Macpherson (1997)
 Mixed, neutral and negative reactions provide
useful lessons
 Clinebell & Stecher (2003)
 McCallin (2001)
(Freeth et al., 2005)
Literature Review
 Key messages:
High Profile
Low Profile
Work-Based Initiatives
Team Development
Undergraduate IPE
University & Service
Partnership
In-service IPE
Learning with Credit
(Freeth et al., 2005)
Effective Collaborative Interventions
implemented in Pediatrics
Purpose of Study
Source
To evaluate the frequency and
referral patterns, need for
continuing education, and
information given to parents of
children with cleft lip and palate by
local primary care physicians.
Grow, J. L. &
Lehman, J.A., Jr.
To assess the educational impact of
a block rotation designed to
familiarize pediatric residents with
community resources for medically
and developmentally complex
children.
Zenni, E.A., &
Fiallos, Y.
Cleft PalateCraniofacial Journal.
2002 Sep; 39(5):53540. (13 ref)
Ambulatory Child
Health. 1999; 5(2):
142-50. (11 ref)
Intervention
Particular aspects of care
evaluated included protocols of
care, information for parents,
referral patterns, conferences
attended, and literature read.
Residents spent 4 weeks in a
variety of community sites
engaged in observational
activities. Developed selfperceived increased knowledge
of services available to children
with special needs, and selfperceived increased ability to
work with allied health
professionals and to coordinate
care for complex patients.
Effective Collaborative Interventions
implemented in Pediatrics
Purpose of Study
Source
Intervention
To describe the evaluation of an
educational experience for thirdyear medical students concerning
children with developmental
disabilities, and parental
psychosocial issues.
Andrew, N.R., Siegel Students spent 2-4 h in a home
B.S., Politch, L., &
visit interviewing family
Coulter D.
members about their
experiences with a child who
Ambulatory Child
had a developmental disability,
Health. 1998; 4(3):
& observed family interactions.
307-16. (19 ref)
By following their patients from the
time their patients were in the
hospital and back to their homes
and community, the students are
able to understand in depth the
problems faced by patients, the
importance of communication skills
in educating patients on their illness
and the importance of good
communication between primary,
secondary and tertiary care.
Sherina, M.S.,
Azhar, M.Z., Mohd
Yunus, A., & Azlan
Hamzah, S.A.
Medical Journal of
Malaysia. 60 Suppl
D:54-7, 2005 Aug.
The students do a series of
home visits and also
accompany their patients for
some of their follow-ups at the
hospital, government clinics,
general practitioners' clinics &
even to the palliative care or
social welfare centres.
Effective Collaborative Interventions
implemented in Pediatrics
Purpose of Study
Source
Intervention
The authors sought to evaluate the
accuracy of medical student selfassessment of their performance in
the paediatric clerkship OSCE and
thus obtain preliminary data for use
in programme strengthening.
Pierre, R. B.,
Wierenga, A., Barton,
M., Thame, K.,
Branday, J. M., &
Christie, C. D. C.
The objective structured clinical
examination (OSCE) has been
recognized not only as a useful
assessment tool but also as a
valuable method of promoting
student learning.
West Indian Medical
Journal. 54(2):144-8,
2005 Mar.
To compare the effects of two
teaching methods (written case
analyses and written case analyses
with group discussion) on students'
recognition and assessment of
common ethical dilemmas.
Smith S., FryerEdwards, K.,
Diekema D.S., &
Braddock, C. H. 3rd.
Academic
Medicine. 79(3):26571, 2004 Mar.
Four components of the case
analyses were evaluated: ability
to identify ethical issues, see
multiple viewpoints, formulate
an action plan, and justify their
actions.
Effective Collaborative Interventions
implemented in Pediatrics
Purpose of Study
Source
The authors sought third-year
medical students' perceptions of
ambulatory preceptors' teaching
effectiveness across primary care
disciplines.
Elnicki D.M., Kolarik
R., Bardella I.
This paper documents the
rhetorical features of certainty and
uncertainty in novice case
presentations, considering their
pragmatic and problematic
implications for students'
professional socialization.
Lingard, L.,
Garwood, K.,
Schryer, C.F., &
Spafford, M. M.
Academic
Medicine. 78(8):8159, 2003 Aug.
Social Science &
Medicine. 56(3):60316, 2003 Feb.
Intervention
Students anonymously
evaluated the full-time &
volunteer preceptors using a 5point Likert-type evaluation that
had 8 items addressing
preceptor teaching behaviors, 6
items on attaining clerkship
goals and 1 assessment of
overall teaching effectiveness.
Five thematic categories
emerged, two of which this
paper considers in detail:
"Thinking as a Student" &
"Thinking as a Doctor". Within
these categories, the
management & portrayal of
uncertainty was a recurrent
issue.
Take Home Message:
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Team Building is important
Team Development is necessary
Regular Interdisciplinary Rounds
Interdisciplinary Assessments
Maintain Collaborative Quality
Design Improvements to your Practice
Practice by Reviewing Performance Data
How To Teach IPP to Students
• Foster IPP Skills, Attitudes and Behaviors within your team and
Model to & Mentor Students.
• Provide didactic information package to students prior to their
clinical placement.
• Orient students to Spina Bifida Team Members early on in the
rotation
• Set clear, achievable & measurable goals
• Have students Identify Roles & Tasks of each professional involved
in the team and compare them to actual R & T. i.e.:
– what do you think is the role of the Social Worker/Nurse… on this team?
– Where do you see their intervention within this client’s plan of care?
– What do you see as your role on this team?
How To Teach IPP to Students
• Use Simulation to present a typical case to all students
as a group exercise.
– Map out process from admission to discharge
– Allow them to practice as an IP team & come up with a plan
– Facilitate their discussion and redirect if necessary
• Prepare a list of typical questions and answers (Q & A)
parents may have about your team functioning, process
and expected outcomes.
• Have students pretend to be another professional and
prepare a Mock Team Meeting.
Sample Methods
• Shadowing (walking through the day of another professional)
• Scaffolding (breaking-up tasks into smaller parts)
• Situated Learning Principles (beginning at the edge & moving
towards the center)
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Peer Coaching/Enhancing Metacognition (K/KDK/DKDK)
Simulation
Real Case Studies
Small Group Discussions (IP)
Peer discussions (intra)
Videotaping sessions
Provide time for students to meet prior to next clinic to
share & discuss issues
Summary
 Definitions
 Why Interprofessional Education?
 Literature Review (Freeth et al., 2005)
 How To?
 Discussion
References

Areskog, N. H. (1994). Multiprofessional education at the undergraduate
level. In K. Soothill, L. Machay, & C. Webb (Eds.), Working together?:
Interprofessional relations in health care. London: Edward Arnold.

Barr, H. (March, 2002). Interprofessional Education: Today, Yesterday and
Tomorrow. Published as Occasional Paper No1, The UK Centre for the
Advancement of Interprofessional Education (CAIPE).

Freeth, D., Hammick, M., Reeves, S., Koppel, I., Barr, H., & Ashcroft, J.
(2005). Effective interprofessional education: Development, delivery &
evaluation. Malden, MA: Blackwell Publishing Inc.

Harden, R. M. (1998). Effective multiprofessional education: a threedimensional perspective. Medical Teacher 20, 5, 402-408.

Zwarenstein et al., (2004)
http://www.ktp.utoronto.ca/aboutTheKTP/projects/
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