Navigating a PTA/OTA Interprofessional Collaboration Activity through the Polar Vortex
Purpose: The World Health Organization defines interprofessional education as a type of learning that occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. This type of training is a necessary step in preparing a “collaborative practice-ready” health workforce that is better prepared to respond to local health needs. In 2011 the Interprofessional Education Collaborative (IPEC) published the “Core Competencies for Interprofessional Collaborative Practice”. The core competencies are grouped into four domains: Values/Ethics, Roles/Responsibilities, Interprofessional Communication, and Teams/Teamwork. Developing effective teams through the acquisition of these core competencies has been shown to not only improve institutional quality but to also maximize safety, quality, and patient-centered care. (Interprofessional Education Collaborative Expert Panel, 2011). Both the Accreditation Council for Occupational Therapy Education (ACOTE) and the Commission on Accreditation in Physical Therapy Education (CAPTE) recognize the importance of these types of learning experiences and include standards that mandate participation in the provision of patient-centered interprofessional collaborative care (ACOTE Standard B.5.20 and B.5.21 and CAPTE Standard 7D28 and 7D7). The CAPTE accreditation standards that were revised in 2016 and became effective January 1, 2018 resulted in an increase in research related to interprofessional collaboration in physical therapy education (1-4). Other allied health disciplines have been involved in research activities for some time (5,6). Currently, there is little to no research specific to physical therapist assistant education programs. The purpose of this study was to assess the effectiveness of an interprofessional learning activity between Physical Therapist Assistant and Occupational Therapy Assistant students. The goal of the project was to expose both groups of students to intentional learning opportunities focused on the core competencies that used case-based learning to: increase confidence in working in an unfamiliar practice setting, improve team communication, improve understanding of roles and contributions of team members, and maximize team performance. Methods and/or Description of Project: In the Fall 2018 semester, 16 OTA students in OT 109 “Management and Ethics” and 8 PTA students in PT 290 “Professional Issues” met for a group learning activity. Prior to the start of the session, each student filled out 3 data collection tools: an Interprofessional Collaboration Pre-Survey, the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and the TeamSTEPPS Teamwork Attitudes Questionnaire. The Interprofessional Collaboration Pre-Survey was created by the program faculty. This survey gathered information about any previous experience the student had working with the other discipline, their understanding of the role of the other discipline, and their understanding on how the 2 disciplines work together to achieve the goals of the patient. It also investigated how well-prepared the students felt to work with the other discipline both in the classroom and in the clinic environments. The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) is a paper-and-pencil, self-report instrument designed to assess behaviors associated with patient-centered, team-based, collaborative care. It consists of 20 seven-point Likert-scale items with 1 representing strongly disagree and 7 representing strongly agree. The TeamSTEPPS Teamwork Attitudes Questionnaire is also a paper-and-pencil self-report instrument designed to assess attitudes towards the core components of teamwork in healthcare. It consists of 30 five-point Likert-scale items with 1 representing strongly disagree and 5 representing strongly agree. In addition to filling out these assessment tools, each group of students had to compile information describing the role of their discipline in clinical practice and then present their findings in a brief 5-10 minute overview in front of all students at the beginning of the face to face session. Then they applied Standards of Ethical Conduct for the PTA and the OT Code of Ethics to clinical scenarios with small and large group discussion. The second piece of this experience was completed in the Spring 2019 semester. This same group of students met during the OT 206 “Occupational Therapy for Physical Dysfunction” and the PT 201 “Licensure Preparation” courses. A pilot activity had previously been completed in the Spring 2017 and Spring 2018 semesters that had suggested a format that yielded beneficial results. The format had been adjusted each of the two times it had been offered based on faculty and student feedback. In this format, students were organized into four teams consisting of 2 PTA students and 4 OTA students per group. Each team was then assigned to one of four practice settings: acute care, inpatient rehab, home health, and outpatient. Students were given a case study scenario of a single patient, Ms. H, who had a diagnosis of CVA. The case outlined the patient’s medical and social history and included a full physical therapy and occupational therapy evaluation that included PT/OT goals and comprehensive plans of care for each discipline. Ms. H’s status changed from each setting scenario to reflect the recovery typically seen with this type of patient population. Each team completed a concept map related to the diagnosis which included the following categories: risk factors, signs and symptoms, pathophysiology, complications, medications, and diagnostic procedures. Each discipline then worked within the provided plan of care to create several treatment interventions that would be appropriate to address the provided goals within that particular setting. In this original course format, the students attended a 3 hour in-person session in which they would meet their team members and discuss the individual intervention plans for each discipline. They would then spend time planning and practicing a co-treatment session. After this meeting time within the individual team, each team would then demonstrate their individual interventions and their co-treatment to all students with course instructors serving as patient simulators. Each team would then lead group discussion to engage students in the different care areas and to solidify clinical reasoning concepts. At the conclusion of the event, each student was to complete post surveys for the tools that had originally been distributed. Unfortunately, the planned date of the in-person meeting coincided with the Polar Vortex of January, 2019. During this widespread weather phenomenon, extremely high winds and frigid temperatures stretched across the entire northeastern United States. As a result, the University had to be closed for 2 days. Due to previously-scheduled clinical education affiliations, the PTA students would not be able to attend an alternative class date without missing clinic days. With the prediction of the inclement weather and potential campus closure, the faculty opted to create an alternative course delivery format utilizing Zoom videoconferencing and an additional reflective learning video component. The team assignment, concept mapping, and pre-planning aspects of the experience remained the same. What differed was the discussion and format for the in-person demonstration of interventions. In the modified format, each team was invited to an individual Zoom conference in which the six team members assigned to each setting met with the 2 PTA and 2 OTA faculty members. Students discussed the patient findings and their planned interventions and discussed what a co-treatment would entail. They also discussed a detailed list of facilitation questions that had been created by the faculty members. Each videoconference lasted approximately 30 minutes. Because they were unable to demonstrate their interventions in person, each team was assigned the task of creating a video of a patient simulation scenario demonstrating their individual discipline interventions. The students then uploaded their videos to BOX, a file sharing platform utilized within the university. Each student was then charged with the task of completing an assignment that included watching each teams’ OTA video and PTA video, answering questions about the treatments demonstrated, and commenting on the content within the video. After submission of this assignment, students completed the three post-survey tools that they had filled out originally. Results/Outcomes: On the Pre-Survey, the Pearson Product-Moment Correlations found significant relationships at the = 0.05 level for the questions “Please rate your understanding of the role of the other discipline in patient care” and “Please rate your understanding of how a PTA and OTA work together to accomplish patient goals” (r = 0.606), and the questions “Please rate how well you feel prepared to participate in a classroom interdisciplinary activity” and “Please rate how well you feel prepared to work with other disciplines in your fieldwork/clinical affiliations” (r = 0.606) . This demonstrated that students who did not fully understand the role of the other discipline, were uncertain how the disciplines would work together to reach the patient’s goals. From the Post-Survey the questions “Please rate your understanding of the role of the other discipline in patient care” and “Please rate how well you feel prepared to work with other disciplines in your fieldwork/clinical affiliations” were significantly correlated at the = 0.05 level (r = 0.544). This showed that students who lacked confidence in interacting with interdisciplinary students were also unsure of interacting within the clinical environment. Paired samples t-tests conducted between the pre- and post-tests for all of the six subscale scores of the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) were found to be significantly different at the = 0.05 level, with higher average scores for each of the post-tests. Effect sizes, as calculated by Cohen’s d, were all large or medium for these differences. The largest effect sizes were found in the areas of communication, collaboration, roles and responsibilities, and collaborative approach. A medium effect size was found in the areas of conflict management and team functioning. When analyzing the TeamSTEPPS questionnaire, two of the five subscale scores (Team Structure and Communication) were significantly different at the = 0.05 level, with higher average scores for each of the post-tests than the pre-tests. Effect sizes for the two statistically significant differences, as calculated by Cohen’s d, were in the medium range for these differences. Means and standard deviations for two of the TeamSTEPPS subscales (Leadership and Situational Monitoring) were identical on both the pre- and post-test and therefore t-tests could not be performed on these subscale items. Paired samples t-tests on one of the TeamSTEPPS subscale (Mutual Support) produced no significant difference pre- and post-test. Overall qualitative comments from all participants were favorable with support for further events and integration of similar activities across the curriculum. The outcomes of this study suggest that participation in team case-based educational training is beneficial and it also infers that video teleconferencing is beneficial to promote interdisciplinary teamwork in order to develop a collaborative practice-ready health care workforce. Conclusions/Relevance to the conference theme: The current healthcare environment requires health professionals from different disciplines to work collaboratively in effective and efficient ways to improve patient outcomes and to maximize patient safety. It is imperative that educators prepare future health care professionals to contribute to this collaborative practice through ongoing interprofessional education opportunities. This presentation outlines some challenges that universities face when planning and delivering interprofessional education opportunities. It demonstrates that the benefits gained from IPE are not reserved for graduate-level students, but that associate-level PTA and OTA students can benefit greatly from these opportunities as well. Finally, it supports using creative technologies to assist student learning in these types of activities. In completing this study, we found that the benefits our Associate Degree students gleaned from IPE were similar to those already reported in the literature for graduate and professional students. During this session we would like to share the following outcomes that students at our university enjoyed: • Students’ understanding of the roles and responsibilities of each profession increased which will lead to improved teamwork. • Student confidence working in an unfamiliar practice setting increased which will translate to improved patient care. • Student comfort in working with other health care professionals increased. • Student understanding of their role in an interprofessional team and in collaborative practice was enhanced. • Students’ abilities to effectively communicate with IP Team members improved. We hope that this presentation and the accompanying discussion and networking it will cultivate will inspire educators to further refine current and develop future IPE opportunities. The challenge to discover a new way of doing IPE is there, accept it! “Years from now you will be more disappointed by the things that you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover”.- H. Jackson Brown, Jr.