Interprofessional Education in U.S. and Canadian Dental Schools: An ADEA Team Study Group Report

Association Report Interprofessional Education in U.S. and Canadian Dental Schools: An ADEA Team Study Group Report Allan J. Formicola, D.D.S., M.S.; Sandra C. Andrieu, Ph.D.; Judith A. Buchanan, Ph.D., D.M.D.; Gail Schneider Childs, R.D.H., M.P.H.; Micaela Gibbs, D.D.S.; Marita R. Inglehart, Dr. phil. habil.; Elsbeth Kalenderian, D.D.S., M.P.H.; Marsha A. Pyle, D.D.S., M.Ed.; Kim D Abreu, M.P.H.; Lauren Evans Abstract: - - - th Keywords: Trends in health professions education are often health care workforce needs, practice patterns of care provided, the cost-effectiveness of care, and the access to care. Over the past decade, the health - patients with chronic diseases. interprofessional education (IPE) and practice a health center schools as well as other health profes- - - 1250 Journal of Dental Education Volume 76, Number 9

1 - in their curricula. The four are values/ethics, roles/ structure IPE activities for their students. - content. The purpose of this report is to share the dental institutions in the United States and Canada Recent Thinking on IPE - - orative Practice conducted a review of the literature Background on the ADEA Team Study Group on Interprofessional Education Finding the correct balance among competing priorities in the curricula of health professions programs is difficult, given the explosion of scientific and technological advances. Faculty members face constant challenges to maintain a contemporary curriculum, especially in emerging areas. The ADEA Commission on Change and Innovation in Dental Education (ADEA CCI) (www.adea.org/adeacci/pages/default.aspx) and the ADEA Curriculum Resource Center (ADEA CRC) (www.adea.org/crc/pages/default.aspx) have many resources to help dental faculty members meet the challenges of continually improving their curricula. Beginning in 2006, the Macy project on New Models of Dental Education (with funding from the Josiah Macy Jr. Foundation and the National Institute of Dental and Craniofacial Research) brought together experts in content areas to produce a series of three reports aimed at assisting faculty in the process of updating their curricula. These reports, entitled New Opportunities for Dentistry in Diagnosis and Primary Health Care, Genetics and Its Implications for Clinical Practice and Education, and Curriculum and Clinical Training in Oral Health for Physicians and Dentists, are available at www.adea.org/publications/pages/newmodelsofdentaleducation.aspx. Adopting a similar organization as the Macy study, the ADEA Team Study Group on Interprofessional Education was formed to consider competencies needed for graduates of academic dental institutions that address interprofessional education (IPE), the theme of the 2011 ADEA Annual Session & Exhibition. Specifically, the study group had the following goals, to: 1. determine the competencies students need to develop to become members of interprofessional teams; 2. conduct a survey to assess the current state of interprofessional and intraprofessional education in dental schools in the United States and Canada; 3. describe the best practices of schools with exemplary programs; and 4. develop recommendations to assist dental schools with assessing and enhancing their efforts related to providing interprofessional and intraprofessional education. The study group developed a draft document on suggested competencies for dental students, surveyed the U.S. and Canadian dental schools about their current and planned curricular efforts in IPE, wrote case studies incorporating the best practices in six of the surveyed schools, and developed recommendations for schools as they plan and develop IPE course content and modes of instruction. The study group s report was reviewed during a meeting at the 2012 ADEA Annual Session & Exhibition and then finalized for distribution to all dental schools. September 2012 Journal of Dental Education 1251

- - - assistants). In that review, two studies found that the IPE intervention had no effect, two reported a Pre- and post-session The The Interprofes- sional Attitudes Questionnaire consists of fourteen has their profession. In these studies, the scales were students in IPE. - centers in the United States. The data showed that - - and leadership. IPE in Dental Education - 1252 Journal of Dental Education Volume 76, Number 9

- cians and other health professionals an essential part dochs/oralhealth/). The need for interprofessional - that these providers lack oral health-related knowl- childhood caries. 11 - Core Competencies for Interprofessional Collaborative Practice, 1 - Team-Based Competencies: Building a Shared Foundation for Education and Clinical Practice, - reports. - professional Practice General Competency Statement: Work with indi- General Competency Statement: Use the knowl- - care needs of the patients and populations served. - General Competency Statement: health professionals in a responsive and respon- General Competency Statement: - roles to plan and deliver patient/population-cen- - - Survey of U.S. and Canadian Dental Schools In addition to its review of relevant research, the - September 2012 Journal of Dental Education 1253

Table 1. Interprofessional education (IPE) competency domains, competencies, and examples of means of assessment 1 2 3 4 Competency Domain Competencies Means of Assessment Cross-Reference to IPEC Competencies Values/Ethics Work with individuals of other professions to maintain a climate of mutual respect and shared values. VE 1. Demonstrate high standards of ethical conduct and quality of care in one s contributions to team-based care. Develop norms and standards as a team. Measure adherence to norms and standards through 360 evaluations. VE7 2. Demonstrate sensitivity to and understanding of the diversity and cultural awareness of the roles of other health professions, the diversity of patients, and health care systems in order to provide competent patient-centered care. Development of concrete patient-centered approaches and questions to address care delivery in a culturally competent manner. VE3 3. Manage ethical dilemmas specific to interprofessional patient/ population-centered care situations. IPE group case studies outcome VE8 Roles and Responsibilities Use the knowledge of one s own role and those of other professions to appropriately assess and address the health care needs of the patients and populations served. RR 1. Demonstrate skills in working with a variety of health care providers to optimize patient care and learning. Implement a standardized feedback mechanism. TeamSTEPPS RIPLS IPE Perception Scale 2. Demonstrate self-assessment skills and know the limitations of one s own skills. Self-assess one s role response in IPE team clinical setting. 3. Demonstrate continual learning about one s roles and those of others in a variety of health care teams. Evaluate through 360 evaluations. TeamSTEPPS RIPLS IPE Perception Scale (pre- and post-assessment) 4. Develop care teams that use the full scope of unique and complementary skills, abilities, and knowledge of all team members available to optimize care. Evaluate team role-process after clinical experience. TeamSTEPPS RIPLS IPE Perception Scale (pre- and post-assessment) Communication Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance and promotion of health and treatment of disease. CC 1. Demonstrate effective skills in listening and communicating with patients, families, peers and communities: a. use effective communication tools/techniques and master new communication tools/techniques, including the use of informatics; Standardized patient communication evaluation. Role-play difficult conversations with peers or standardized patients. CC1 CC4 CC6 1254 Journal of Dental Education Volume 76, Number 9

b. learn to have a difficult conversation with confidence. 2. Provide constructive feedback to team members in a respectful manner, while accepting feedback from others to improve team effectiveness. 3. Recognize how one s own uniqueness, including experience level, expertise, culture, power, and hierarchy within the health care team, contributes to effective communication, conflict resolution, and positive interprofessional working relationships. Team/Teamwork Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient- and population-centered care that is safe, timely, efficient, effective, and equitable. 1. Demonstrate appropriate reflective skills to evaluate self and team roles and responsibilities in group activities. 2. Evaluate effective team processes and outcomes to optimize patient care and ensure quality improvement. 3. Assess team performance and progress on a continuous basis relative to attainment of goals, and self-correct using process improvement strategies. 4. Understand the stages of team development, and actively work toward becoming a high-performance team. Complete and discuss group process evaluation form; respond to evaluation by other team members. Implement 360 evaluations of team. TeamSTEPPS CC5 CC6 Reflective writing exercise evaluation TeamSTEPPS RIPLS IPE Perception Scale (pre- and post-assessment) CC7 TT Reflective writing exercise, possibly over time Engage in daily or weekly journaling. TeamSTEPPS RIPLS IPE Perception Scale (pre- and post-assessment) TT8 Evaluate process/patient care satisfaction or outcome during standardized patient team exercise. Implement quality improvement measures. TeamSTEPPS TT1 TT7 TT8 TT9 Reflective writing exercise after team clinical experience Use PDSA techniques to continuously measure and improve processes. TeamSTEPPS RIPLS IPE Perception Scale (pre- and post-assessment) TT9 Conduct writing exercise about team process. Set measurable goals. Assign roles and responsibilities according to skills and interests. Measure outcomes continuously. Develop and adhere to time frames. TeamSTEPPS RIPLS IPE Perception Scale (pre- and post-assessment) TT1 TT6 (See bottom of next page for sources and note) September 2012 Journal of Dental Education 1255

ten Canadian dental schools had responded. At this schools and four of the ten Canadian dental schools Current IPE Activities - schools. - - - Table 1. Interprofessional education (IPE) competency domains, competencies, and examples of means of assessment (continued) Sources: Column 1: Competency domains from Interprofessional Education Collaborative (IPEC) Expert Panel. Core competencies for interprofessional collaborative practice (www.aacn.nche.edu/education-resources/ipecreport.pdf). Column 2: Competencies suggested by the ADEA Team Study Group. Column 3: Means of assessment selected from the literature and recommended by the ADEA Team Study Group. For the IPE perception scale, see www.ncbi.nlm.nih.gov/pubmed/2365636; for the Readiness for Interprofessional Learning Scale (RIPLS), see www.ncbi.nlm. nih.gov/pubmed/10211258; and for TeamSTEPPS, see http://teamstepps.ahrq.gov/abouttoolsmaterials.htm. Column 4: Competencies cross-referenced by competency code to the IPEC document referenced for Column 1. Note: Suggested competencies in Column 2 are complementary to CODA Standards 1-9 and 2-19 (www.ada.org/sections/education- AndCareers/docs/pde_ssg_2013.doc): Standard 1: Institutional Effectiveness 1-9 The dental school must show evidence of interaction with other components of the higher education, health care education, and/or health care delivery systems. Standard 2: Educational Program Practice Management and Health Care Systems 2-19 Graduates must be competent in communicating and collaborating with other members of the health care team to facilitate the provision of health care. Team STEPPS=a training model designed to produce high-performing teams RIPLS=Readiness for Interprofessional Learning Scale 1256 Journal of Dental Education Volume 76, Number 9

Table 2. Respondents reports of other health professions programs on their campus and collaborations with other programs (on or off campus), by number and percentage of responding dental schools (N=62) Other Health Professions Program Other Program on Campus Collaborate with Other Program Medical school 51 (82%) 39 (63%) Nursing school 51 (82%) 29 (47%) Pharmacy school 40 (65%) 22 (36%) Physical therapy program 40 (65%) 21 (34%) Psychology department 40 (65%) 9 (15%) Social work program 34 (55%) 18 (29%) Dental hygiene program 31 (50%) 36 (58%) Other 21 (34%) 20 (32%) Other allied oral health program 9 (15%) 5 (8%) Dental assisting program 6 (10%) 11 (18%) Dental therapy program 1 (2%) 1 (2%) Table 3. Types of joint activities and numbers of schools involved in IPE reported in survey (N=62) Number of Schools Most Frequently Collaborating with Activity Involved Named Program >1 Program Joint volunteer activities 41 (66%) Medicine: 19 5 Clinical activities 37 (60%) Dental Hygiene: 11 3 Medicine: 10 Service-learning projects 32 (52%) Medicine: 10 4 Basic science courses 20 (32%) Medicine: 6 1 Communication training 19 (31%) Medicine: 5 8 Standardized patient programs 14 (23%) Medicine: 6 4 Medical emergency or patient safety interactions 13 (21%) Medicine: 5 2 Other activities 13 (21%) Medicine: 7 0 Ethics classes 9 (15%) Medicine: 3 5 Review of evidence-based practice activities 7 (11%) Medicine: 3 1 Evaluation of health systems across and delivery of care 6 (10%) Medicine: 4 1 - pain control, infection control, and CPR. their dental schools had encountered in the past, the - persons involved in these activities, such as a lack philosophical issues such as intra- and interprofes- for the future. New IPE-Related CODA Standards - September 2012 Journal of Dental Education 1257

- involved and such qualitative data as student course - - - - of these descriptions of clinical activities, however, - - - volunteer and outreach activities were reported as opportunities for activities related to this standard. When asked how the schools prepare for - - - - - - - - - 1258 Journal of Dental Education Volume 76, Number 9

Competencies Related to IPE - Dental Schools Best IPE Practices The dental schools were asked to provide in- drafted the case studies, and each school reviewed and approved its case. Western University of Health Sciences, College of Dental Medicine uni- - - - developed. This structure consists of an IPE Over- - of Interprofessional Education that is connected to - - Table 4. Survey responses on the importance of IPE competencies, by number of respondents and mean (SD) Mean Statement 1 2 3 4 (SD) Graduates must be competent to work with individuals of other 0 3 21 31 3.51 professions to maintain a climate of mutual respect and shared values. (0.605) Graduates must be competent to use the knowledge of their own roles 0 4 20 31 3.49 and those of other professions to appropriately assess and address the (0.635) health care needs of the patients and populations served. Graduates must be competent to communicate with patients, families, 0 2 17 35 3.61 communities, and other health professionals in a responsive and (0.564) responsible manner that supports a team approach to the maintenance of health and treatment of disease. Graduates must be competent in applying relationship-building values 0 10 19 26 3.29 and the principles of team dynamics to perform effectively in different (0.762) team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable. Note: Answer scale ranged from 1=not at all important to 4=extremely important. SD=standard deviation. September 2012 Journal of Dental Education 1259

- - showed that the students preferred case closure in - - activities will take place in the Patient Care Center portfolios. students are also involved in interprofessional clini- activities, have interprofessional clinic rotations in Medical University of South Carolina, James B. Edwards College of Dental Medicine - - - - twelve students in each section, and students respond - - - 1260 Journal of Dental Education Volume 76, Number 9

- student evaluations. - - - to seek opportunities for interprofessional clinical University of Colorado, School of Dental Medicine - - - - - - - transition for IPE into the clinical arena. Interprofes- Columbia University, College of Dental Medicine - - September 2012 Journal of Dental Education 1261

is hoped that one of the follow-up events of this - not attend the course. and ensure that people have the chance to live full of students who can participate in the course. - - workers in the dental school clinics. The hope is that oped for dental and social work students. The dental University of Minnesota, School of Dentistry - - the various health professionals in order to deliver 1262 Journal of Dental Education Volume 76, Number 9

- Health Center students are required to take this - - - - this course. Students are evaluated on their attendance and participation in discussions. The course for an additional session. - of value to their students. The students will then select interprofessional courses for Phase II. Phase III is - University of Florida, College of Dentistry - - - - - and twelve for ATTAC-IT. - - September 2012 Journal of Dental Education 1263

- the course evaluation. This course is in the process of - - - - positive overall. - there, which has the potential to increase their in- - with other pre-health professions students. In those Discussion deans of dental schools in the United States and - - health and health care is widespread. - - - 1264 Journal of Dental Education Volume 76, Number 9

- care at the individual and population levels cannot - - - course schedules, lack of leadership support in health - - - - - dental education. - schools. However, there were few opportunities to - other students in the allied dental health workforce. - report), the state of intraprofessional education needs work within the dental workforce. - - - - September 2012 Journal of Dental Education 1265

- - The dental schools also differ in the participants - - of the schools have volunteer efforts for students to - - - Study Group Recommendations various health professions, it appears that at- - the leadership of the health science center and to include all of the health care disciplines for such - 1266 Journal of Dental Education Volume 76, Number 9

- evaluation process. - - the silo approach to care and the education of to develop IPE coursework. Conclusions - interprofessional care. However, the responses to - - - - - Acknowledgments - - - - September 2012 Journal of Dental Education 1267

REFERENCES www.aacn.nche.edu/education-resources/ipecreport.pdf. - - - - - - 1268 Journal of Dental Education Volume 76, Number 9