Wednesday, October 17, 2012

IPE Outcomes Evaluation

Another overarching theme at ATBH was systematic evaluation of educational outcomes from IPE. John Carpenter provided an excellent workshop where he not only provided a framework for understanding and implementing outcomes evaluation but also moved workshop participants step by step through the process (in an abbreviated format since the workshop was only 1.5 hours). Especially useful were a classification system for educational outcomes (based on an updated version of the Kirkpatrick-Barr framework of outcomes) and an annotated listing of frequently used tools for evaluating IPE.

Saturday, October 13, 2012

Systematic IPE Development

A second major theme of the ATBH conference experience was systematic IPE development. I found myself completely inspired by this workshop, Interprofessional collaboration on the run: A flexible curriculum for teaching collaborative practice to health and human service students in different educational settings, led by Christie Newton, a family practice physician; Donna Drynan, an occupational therapist, and Victoria Wood, project coordinator, all from the University of British Columbia. The authors described the systematic process through which they developed their Interprofessional Collaborative Learning series and demonstrated one of the videos used in the first module on Why will I need interprofessional collaboration in my practice? All modules have been carefully thought out and address key issues including role clarification, collaborative leadership and shared decision-making, team functioning, and conflict management. Core principles that characterize the modules are care processes, patient centered care, communication, complexity, and continuous quality improvement. And, amazingly enough, workshop leaders announced that the modules are available under  Creative Commons Licensing. I highly recommend that you take a look. You can get a taste of what the modules are like by entering Module 1 as a guest, then requesting access. There are other interesting materials on their site including information about their Passport system and the British Columbia Competency framework--a wealth of very useful resources, to be sure.

Thursday, October 11, 2012

ATBH Synthesis

themes from the All Together Better Health Conference in Kobe, Japan 2012
My experience of the All Together Better Health conference centered around 3 main themes: Global perspectives; systematic IPE development, and IPE outcomes evaluation. Presenters expounded on these themes with impressive breadth and depth. 
Patrick Kelley’s keynote on opening day set the stage by discussing global perspectives on IPE with reminders of the history of IPE and a compelling vision for the future. This global vision includes the need to better integrate healthcare and education and to foster learning as transformation by focusing on critical reflection and emphasizing socially responsible care. Dr. Kelley's keynote surveyed the territory and revealed multiple layers in these crucial areas while strongly emphasizing the need to bring ideas “from up in the clouds” to practical action. I heard these points emphasized again and again in presentations throughout the conference. 
Kelley drew heavily from the 2010 Lancet Commission Report, which I had not previously reviewed but now consider a "must read" for all health science educators and practitioners. A very interesting aspect of the Lancet report for educators is its discussion of where we've been, what is changing, and what must happen to reach the next levels of IPE. The authors assert that IPE has evolved from a transmission mode emphasizing information and skills, through a formative mode with socialization and values as key. Presently, there is a critical need for students to become leaders and change agents in the health professions. Many professional programs, including the clinical doctoral program in occupational therapy at Jefferson, have long emphasized this focus. But, are we doing all we can to foster an interprofessional focus in our graduates? To what extent can students in the health professions become leaders and change agents if they are not acutely aware of and skilled in communicating and negotiating as individuals and within interprofessional teams? A subsequent post will detail some practical actions ATBH presenters shared, to enable educators in the health professions to accomplish these aims.

Final Reflections

This time has gone by so very quickly! I am sad to leave, but glad to be taking home wonderful memories. I’ve learned so much in this time.

I’ve had so many neat “aha” moments about interprofessional education (IPE) through the ATBH VI conference, and I’d like to share my big take home messages with you:

IPE is a primary foundation of client-centered care, and each of us can become change agents to propel this movement forward. I now see the huge shift in skills, attitudes, and behaviors that needs to take place among professionals in order to bring about true interprofessional collaboration in practice. I intend to support this shift throughout my career, starting with my own interprofessional behavior while I am still a student.

IPE becomes even more powerful when we add a global perspective. By reaching across borders to care for our clients as a global community, we bring together not only the unique skills sets of various professions, but also join forces through our unique cultural backgrounds, ways of thinking, research evidence, practice tools, and education systems. My experience at ATBH VI is testament to the fact that when such an accomplished, creative international group comes together with international, interprofessional collaboration as their goal, we really can work toward better health for the world.

This experience has helped me identify interprofessional skills I need to develop. I need to increase my knowledge of the roles and expertise of other health professions so that I can partner with them more effectively. I need to model an attitude of openness and respect and develop skills in encouraging this attitude within the teams I am a part of. I need to further my communication and collaboration skills so that I can lend my OT expertise to team goals. I have a new vision for what this can look like: I want to be part of a team that utilizes every member’s unique knowledge and skills while looking toward our common team goals, so that we can present a unified plan of care and speak as if with a single voice to our clients.  

Going forward, I have several professional goals I want to achieve. I want to use critical observation skills and reflective practice to learn what makes for successful interprofessional collaboration. I want to seek mentors who demonstrate exemplary interprofessional skills. I want to become part of a work culture that supports interprofessional collaboration, and I want to create and support IPE opportunities in my practice setting.

At the very end of the ATBH conference, it was announced that the next ATBH conference will be held in Pittsburgh in 2014. I am certainly planning on attending if at all possible! It seems to me that once you’ve joined the IPE movement, you just have to keep going!

Wednesday, October 10, 2012

OT Lenses

As an occupational therapist in training, I cannot help but be interested in the physical as well as cultural environment of the places I travel. Through my OT lenses, I look around and think about the daily activities that people perform in their physical spaces. It may sound strange, but my OT brain has really got me thinking about the Japanese bathrooms I’ve been in. Let me explain…

During our web exchange with the students from Kitasato University last March, the Japanese OT students presented their plan of care for a 45 year-old woman with a traumatic brain injury. They explained that one of this woman’s primary goals would be to become independent in toileting as soon as possible. They said that a Japanese woman would feel extremely embarrassed about not being able to use the bathroom by herself, and that her lack of independence in this activity would even decrease her performance in her occupational roles because it would “cut in on her pride as a wife and mother”.

I was surprised to hear this from the Japanese students and tried to understand where they were coming from culturally, but I have to say I didn’t really understand the big deal about toileting until using a bathroom here myself.

Japanese bathrooms have complete privacy, with stall doors from the floor to ceiling. In many bathrooms there is a sensor on the wall that will make a loud, fake flushing sound when you use the toilet so that no one can hear you doing your business. All the toilets I saw in my travels have a bidet feature for washing after toileting. From what I have observed, cleanliness seems to be of primary importance in Japanese culture, and I imagine that it would be very embarrassing for a person to not be able to perform toilet hygiene independently. What’s more, many toilets are built into the ground, requiring the person to maintain balance as they squat to use them. If that is the only kind of toilet available to a person who has had an injury, I imagine they could need a great deal of help to use the bathroom.

No wonder my Japanese OT colleagues highlighted independence in toileting as an important goal! Toileting can be a sensitive issue for people regardless of cultural background, but I think I’ve seen a new level of sensitivity in the physical set up of Japanese bathrooms. Having seen the bathrooms here and the importance of maintaining privacy in toileting, I think I’d be extremely embarrassed to need help with this daily occupation here too.

For me, this brings home the importance of developing cultural competence in practice.  In order to be truly client-centered, I need to be aware of what my client’s goals are and understand how these goals fit with their cultural occupational performance patterns and roles. I need to be able to be aware of how I can best collaborate with my clients to develop culturally sensitive care. I think I have learned a lot about Japanese culture during my time here, and I hope I can carry this forward in my practice. 

Cultural Insights

This trip has been such a rich cultural experience. I’ve enjoyed soaking up the little moments of daily life that make this culture come alive for me- things like using a warm cloth or towel to clean my hands with every meal; seeing ladies carrying parasols to keep the sun off as they walk through town; tasting octopus and lotus root with breakfast; and smelling the earthy smell of the woods and incense burning at Kinkakuji temple. It’s been fun to soak it all in, and then step back to view the world through my OT lenses and think about how I can demonstrate understanding of Japanese culture in my future practice.

I’d like to share a few of these cultural experiences with you, to give you a feel for what I’ve learned.

It was amazing to visit Oaksa, Japan’s third largest city, on a Saturday night. The city was alive with young people bustling through the open-air gallery- shopping, meeting up with friends, going out to eat. It looked like the Japanese version of the boardwalk in a way, with bright lights, cheap eats, and arcade attractions.

We had a lovely visit to Kyoto. This picture shows the golden temple, Kinkakuji. I was amazed to see how a place could be designed to be so deeply serene. Feeling that sense of peace was a neat reminder that physical environments really can have an impact a person’s internal state. I think I will be visualizing this environment in my mind whenever I need to find that kind of internal peace again.

Our visit to Kyoto was a short one, but we had just enough time at the end of the day to visit another temple, Ginkakuji. We hiked up into the mountain nearby to catch a glorious view of the temple and surrounding Kyoto area just as the sun was setting.

I have been reflecting on how useful it is to navigate a cultural system that is not my own. It is strange to have the experience of being the only person who looks different for as far as you can see, and it can be overwhelming to feel so out of place. On this trip I’ve encountered the most significant language barrier I have ever faced, since I not only cannot speak the language, but I cannot easily recognize the names of places written in Japanese characters.

I am realizing that these are experiences many of my future clients may have. I have already worked with individuals on clinical fieldwork rotations who speak very little English, and who I imagine may face cultural as well as language barriers. For these clients, I hope to show empathy for the experience of feeling culturally out of place, and I hope to demonstrate understanding of the frustrations and fears that come with facing language barriers. 

Tuesday, October 9, 2012

Healthcare Team Challenge!

I am proud to be a member of a winning team in the ATBH VI healthcare team challenge!

This afternoon I joined a team of five students to compete in an interprofessional student event. The healthcare team challenge (link) is an event that was started by students (where). Teams get together to make a plan of care based on a case story. Then teams have 5 minutes to present their plan of care before a panel of experienced professionals who serve as judges. The winning team is decided based on the quality of the team’s plan of care and the team’s demonstration of interprofessional collaboration.

It was thrilling to be part of such a diverse team. I was excited to represent the USA and serve as the OT for my team. My team members hailed from New Zealand, Australia, and Indonesia, and represented the professions of medicine, dentistry, counseling psychology, and osteopathy. It was fun and challenging to work on a very complicated case story with them, and present our plan of care before the judges and audience.

One challenge we faced as a team was communication. Two of our team members did not speak English as their first language.  We also quickly realized that we needed to find common terminology across professions so that we could understand each other. We solved these challenges by establishing a ground rule of respect and a willingness to listen. We gave everyone a turn to speak in our discussions. We asked teammates to explain ideas and terms when we did not understand them. By creating a supportive environment for clear communication, we were able to develop a plan of care that included each profession’s input.

We weren’t chosen to come in first by the judges, but we had another chance when everyone in the room submitted a paper ballot to vote for the team they would most like to receive care from. We were excited to be winners in this part of the contest!

I thought the healthcare team challenge was a great way to engage students in IPE, We all had fun, and it was neat to see how students navigated challenges and found ways to collaborate across our professions and cultures. I especially liked seeing how the winning team demonstrated interprofessional collaboration skills. They presented a cohesive plan of care, had clear roles, demonstrated client-centered teamwork, and showed that they could communicate effectively with each other and with the audience.

I am excited to carry my insights and teamwork skills forward into my future practice. I hope to have the chance to participate in another healthcare team challenge soon! Maybe students at Thomas Jefferson University will host one of these events some time…