The McGill Educational Initiative on Interprofessional Collaboration: Partnerships for Patient and Family-Centered Practice

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The McGill Educational Initiative on Interprofessional Collaboration:
Partnerships for Patient and Family
-
Centered

Practice





Margaret Purden N., PhD, Co
-
Lead,

David Fleiszer M.D. M.Sc., FRCS (C) Co
-
Lead

Helene Ezer, N., PhD

Jeffrey Wiseman M.D.,
M.Ed. FRCP (C)

Yvonne Steinert, PhD,

Bruce Shore, PhD

Aliki Thomas, O.T. (C) PhD(C)

Liliane, Asseraf Pasin P.T. PhD(C),







Kathryn Carnaghan
-
Sherrard, N., M.Sc.



Linda Snell M.D. FRCP (C)

Proposal Coordinator: Nancy Posel N., M.Ed.









Dec
ember 17, 2004








11502 McGill Educational Initiative on Interprofessional Collaboration

2

6.1 Primary Applicant Organization

Legal name: Faculty of Medicine, McGill University


Name of Project Leads: Dr. Margaret Purden and Dr. David Fleiszer Co
-
Leads


Street Address: 3655 Promenade Sir
-
William Osler, Montreal, Quebec H3G

1Y6


Mailing Address: 3506 University Street, Montreal, Quebec H3A 2A7


Telephone and facsimile number of leads: Purden: Telephone: (514) 398
-
2417








Fax: (514) 398
-
8455







Fleiszer: Telephone: (514) 934
-
1934
ext. 34014


Fax:


(514) 843
-
1623

e
-
mail addresses: Purden: margaret.purden@mcgill.ca




Fleiszer: david.fleiszer@mcgill.ca


McGill University was established

in 1821 when it was granted university powers by the
legislative council and a governing board was appointed. The Faculty of Medicine, established in
1821, was the first Faculty of Medicine in what is now Canada. Provision of exemplary medical
education h
as been part of its mission from the beginning. Research was started as early as 1848
and the Faculty has a strong international reputation for its strength in both clinical and basic
sciences research

Three other professional schools located in the Facul
ty are: The School of Nursing, The
School of Physical and Occupational Therapy, and the School of Communication Sciences and
Disorders.


The mission of McGill University is:
the advancement of learning through teaching,
scholarship and service to society:
by offering to outstanding undergraduate and graduate
students the best education available; by carrying out scholarly activities judged to be excellent
when measured against the highest international standards; and by providing service to society in
those

ways for which we are well
-
suited by virtue of our academic strengths.
The Faculty of
Medicine affirms the mission of McGill University.

Within this context, the mission of the Faculty of Medicine is to pursue internationally
significant scholarship and
to provide undergraduate, graduate and professional programmes of
the highest academic quality so that we may contribute to the well being of mankind.

We affirm the following objectives in order to accomplish our mission:

1.
Education

The health
-
care pro
fessionals who are graduates and trainees of the Faculty will be well
-
prepared to address the present and future health needs of the Canadian population. They will be
oriented to preserving health, technically competent, adept at solving problems, capable
of
functioning as part of a multi
-
disciplinary team and committed to life
-
long learning both for
themselves and their patients. They will exhibit ethical behaviour and compassion in dealing with
patients, restraint in using health resources, and an inquiri
ng attitude towards the mechanisms of
health and disease. Finally, our programs will be rooted in a scholarship of education designed to
the development and exploitation of modern pedagogical techniques.

2.
Research

The Faculty’s research programs will con
tribute to the understanding of the basic
mechanisms of health and disease and develop and evaluate clinical interventions to address
11502 McGill Educational Initiative on Interprofessional Collaboration

3

health care needs. The research will emphasize collaboration between basic and clinical sciences,
and between members of o
ur Faculty and researchers in other disciplines. The faculty will
encourage and support outstanding research trainees and research training programs. Our
research will encompass the scholarship of discovery and integration.

3.
Service

Members and trainees
of the Faculty will provide exemplary, scientifically based health
services to the McGill target population and will participate actively in national and international
professional organizations. Our stance will encompass a scholarship of application whose

aim is
to ensure that available and new knowledge are used to improve the care and well being of
society.

Suitability for proposed project
:

The four professions that are the focus of the proposal are housed within the one Faculty and
administrative struct
ure thus providing ease of communication and a shared network of hospital
and community health service facilities



Commitment by the Dean and senior administrators including the heads of the
professional schools and the heads of Undergraduate, Graduate and
Post
-
Graduate
education and Faculty Development, Executive Deanery



Reputation for rigour and quality of the programs across schools and the contribution of
program graduates on a national and international scale



Research productivity of the schools within
the Faculty of Medicine



State of the art learning resources housed within Molson Informatics and the new
Clinical Skills Laboratory available to all professional students



The close working relationships and exchanges between the departments of nursing at t
he
Sir Mortimer B. Davis
-
Jewish General Hospital (JGH) and the McGill University Health
Centre (MUHC) and the School of Nursing is unique in nursing in North America



Value placed on interprofessional education (IPE) and practice (IPP) by the major service
organizations


6.2 Partner Organizations

The project involves five partners: the School of Medicine, the School of Nursing, The
School of Physical and Occupational Therapy at McGill University and partners from the McGill
health care network namely, the MU
HC and the JGH.
The participation of faculty and students
from the School of Communication Sciences and Disorders will be included in the initiative as
clinical sites for IPP that include these students are enlisted in the project.
The discussion below
wil
l describe the partners and the nature of their relationship in this project.

Description

The educational programs within the Faculty of Medicine of McGill University address
undergraduate, graduate and the continuing education of health care professionals
. The MUHC
and the JGH, the two clinical sites chosen for this project are both quaternary care sites,
encompassing a wide scope of clinical activities, from community and ambulatory clinics to
intensive care and trauma. They include all clinical subspecia
lties and have a long standing
commitment to professional education programs, staff and professional development and to
research. The practice settings support patients and their families through complex clinical
situations, both as inpatients and outpatie
nts. In addition to focusing on both acute and chronic
situations, they are committed to health promotion and patient education
.

11502 McGill Educational Initiative on Interprofessional Collaboration

4

Nature of the Partnership

Due to the McGill system of cross appointments, faculty at the university often wear two
hats, that

of educator as well as that of clinician. The majority of the members of the Steering
Committee and the

Work Group reflect this reality. Happily this ‘dual citizenship’ encourages
greater understanding and cooperation and makes it easier to disseminate id
eas and information
across the academic and clinical settings.

A close relationship exists between the schools within the Faculty of Medicine and the
practice settings. The schools and the organizations share individuals; faculty assume clinical
appointmen
ts as well as teaching responsibilities; students move from academic to practice
settings throughout their professional education; and in postgraduate education clinicians look to
the school to further their academic careers, returning to the clinical sett
ings to apply theories to
practice. The schools and clinical settings have longstanding and established methods for
collaboration. This project will benefit from the experience gained in the many joint projects that
precede it. The ties between the setting
s will ensure support for the project and will facilitate the
sustainability of the project outcomes upon completion.

Commitment

The Dean of Medicine and the Directors of each of the schools are on board with the
project proposed. All have clearly indi
cated in their letters of support the importance of this
endeavour and have encouraged the active participation of senior academic leaders in their
respective departments. The continued involvement of senior level educational administrators on
the steering

committee will provide the group with the membership needed to advance and
support change in the system. This will further serve to ensure that the new directions for IPE and
IPP that emanate from the project are integrated and maintained within each scho
ol’s mainstream
curricula. A similar commitment has been made on the part of the chief
-
executive officers of the
McGill Teaching hospitals and division leaders in medicine and nursing. These leaders have
expressed enthusiastic support for the initiative, w
ith the recognition that resources will need to
be freed for project work and that a successful project will result in inevitable shifts in care
delivery models as IPP becomes a reality. Letters of support reflecting the willingness to sit on
the steering
committee have been received from leaders in practice and education from across the
disciplines and from the community at large.

Roles and Responsibilities

The three professional schools will play a critical role in every aspect of the project.
Members fro
m the schools currently participate on the project work group, each of the Schools
has chosen a representative to participate on the steering committee, and additional faculty from
the schools will be called on to become involved in particular aspects of t
he project as sub
-
committees of the work group are established (e.g., evaluation team).

Senior academic administrators from the three schools are taking active roles on the
project. The Director of the School of Nursing will co
-
chair the Steering Committe
e and the
Director of Curriculum Development (Undergraduate Medicine) will serve as a member on the
steering committee. The Associate Dean responsible for Faculty Development will work together
with the work group in its mandate to develop the university a
nd clinical educators for IPE.

Similarly, the clinical partners at the MUHC and the JGH have selected representatives
from across the four professions for the steering committee. Their advice is needed to shape the
process of developing and implementing I
PP. It is anticipated that additional clinical partners
from these institutions will become involved as the project takes shape and sub
-
committees of the
project work group get established. The clinical partners will focus on the integration of
11502 McGill Educational Initiative on Interprofessional Collaboration

5

interprofes
sional models of practice. Implementing IPP will take place with the support of the
Faculty Development Office and members of the work group.

The Partner Organization’s Project Leads

The McGill project is based on a co
-
leadership model. This decision is b
ased on the
following rational: 1) the interprofessional nature of the project should be reflected in the
organizational structure of the team, that is a partnership, 2) Nursing and Medicine were
identified as the necessary participants, therefore it would

be important that both would have
equal input in the executive decisions about the project, 3) as this is a complex undertaking, a
shared lead provides for greater continuity in leading the project in the face of competing
demands, 4) decisions are likely

to be more thoughtful and will take into account more factors as
a result of consultation between the co
-
leads, and 5) The leaders compliment each other in terms
of strengths and experience. One has considerable experience in developing and running projec
ts
on IPE and IPP initiatives and has previous funding from Health Canada. The second leader has
experience running large projects and managing the budgets associated with such initiatives.

Both are experienced educators within their disciplines and have a
ppointments in the
University
and

clinical settings.


Dr. Margaret Purden, co
-
leader on the project, an assistant professor in the School of
Nursing, has a strong background in IPE and IPP initiatives. Her previously funded work as
principal investigator
involved examining strategies to promote collaborative patient
-
centered

practice on an inpatient medical unit. A second project explored an educational program to
promote IPE with family medicine residents and nursing students. She has experience leading
i
nterprofessional research teams (physicians, psychologists, and nurses) and has participated on
several large project teams for previous Health Canada initiatives. The results from these projects
have been presented at national and international conference
s for nursing, medical and IPE. Her
most recent work included a systematic review of IPE for collaborative patient
-
centered

practice

that was conducted for Health Canada
1
. As well, her recent article,
Cultural considerations in
interprofessional education
and practice,

addresses important issues concerning cultural
competency in health care from the Canadian perspective
2
. She brings a broad perspective to
addressing the challenge of implementing an IPE /IPP framework. Dr. Purden’s faculty position
in the Sc
hool of Nursing and her appointment as Scientific Director of Nursing Research at the
JGH will enable her to anticipate and address the unique challenges faced by the academic and
clinical settings in making this fundamental shift. Furthermore, Dr. Purden’
s background in both
qualitative and quantitative methods will enable her to include a variety of strategies to evaluate
the project.

Dr. David Fleiszer, co
-
leader on the project, will co
-
chair of the Steering Committee. He
is an Associate Professor of Sur
gery at McGill, Director and senior member of the Cedar’s Breast
Center in the MUHC. Within the Health Center, Dr. Fleiszer has been involved on several
projects including the development of a comprehensive patient
-
centered breast center, and the
creation
of a surgical intensive care unit both of which include interprofessional teams. As
Director of the McGill Molson Informatics Project and former Associate Dean for Informatics, he
works closely with the Associate Dean for Undergraduate Medical Education an
d the Director for
Curriculum Development on McGill’s new medical curriculum. Dr. Fleiszer is the recipient of
four grants totaling $7, 500,000, including one from CANARIE Inc. (funded by Industry Canada)
specific to e
-
learning and the dissemination of edu
cational material across Canada. During this
time Dr. Fleiszer has managed the budgets and the teams responsible for these projects. Two
publications have emanated from this work,
Development
of an undergraduate medical
curriculum


The McGill experience
3

and
New directions in medical e
-
curricula and the use of
11502 McGill Educational Initiative on Interprofessional Collaboration

6

digital repositories
4
. At a national level Dr. Fleiszer is the current Chair of the Informatics
Resource Group of the Association of Faculties of Medicine of Canada. In this capacity, with
medical e
ducators from the 17 medical schools in Canada, he has supported communication,
sharing, collaboration, and the development of a Canadian Digital Library for healthcare teachers.
He brings to the project extensive experience in the development and integrat
ion of IPP within
clinical settings, in curriculum development at McGill, and in the use of informatics as a tool to
further teaching and learning at the Faculty.

Group trust, cohesiveness and communication

The project proposal work group contains members

from three of the four schools within
the Faculty of Medicine, participants from Faculty Development and from the Faculty of
Education, as well as clinical practitioners associated with the partner organization. A common
belief in the importance of IPP an
d responsibilities towards students has proven to be a strong
motivator in bringing these individuals together in a shared commitment to the project. They
bring to their work a common understanding of the principles of adult education, and long years
of ex
pertise as educators in the health professions. Their knowledge and experience have
facilitated their work as colleagues and partners in this project. This had made it possible to
quickly achieve consensus and to plan the scope of activities in this initia
tive.


Resolving conflict

The work group will rely on the same principles that allow for trust and communication to
be introduced as tools for conflict resolution. Active listening, openness to new ideas and respect
for differences in approach and prof
essional perspectives will serve as primary initial strategies
for conflict resolution. Wherever possible the group members will attempt to work towards
consensus. The rich nature and diverse expertise of the project members will serve to support this
appr
oach to conflict resolution. However, should irreconcilable differences occur among project
participants, the steering committee and the work group will help provide direction.


6.3 Patients and Learners

The students from the Schools within the Facu
lty of Medicine are actively involved in
McGill University and are very passionate in their desire to influence and shape their chosen
profession and the nature of the care they provide to their patients. Some of these initiatives will
be described in the
following section.

Learners

Throughout the planning, development, implementation and evaluation of this project,
undergraduate and graduate students (and medical residents) from the three schools within the
Faculty of Medicine will be actively involved. A
student representative from each of the Schools
will be on the steering committee and similarly, students will form part of the interprofessional
work group.

In each of the Schools, student representatives have been involved in curriculum
development and
revisions, taking active roles on committees as advisors for planning in the
Schools, assuming major positions in their respective student societies and in the university at
large. As well, students have been actively involved in planning and organizing lo
cal, provincial
and national conferences. One example is the Canadian Association of Nursing Students, a
national conference (CNSA) which was hosted by the McGill Nursing students January 2004.
Another major initiative was the first

Interprofessional Confe
rence, held March 2004
and

mounted

by the McGill students in the four schools. The second Interprofessional conference, is
planned for March, 2005. The students have also developed Mitabi (See Appendix G), a forum
for all students to come together. It prov
ides an on
-
line dialogue and face
-
to face discussions
11502 McGill Educational Initiative on Interprofessional Collaboration

7

around patient care issues, ethical issues and ways of interacting with patients to provide
humanistic care and healing. Interestingly, it is students in the first year of their professional
programs th
at first started this forum. This reflects their commitment to IPP and interest in having
their education and learning environments promote this idea.

In the course of the project, students from all the Schools in the Faculty will be included
in the develo
pment of Consensus Modules and will respond to the dynamic simulations that will
be prepared for IPE. They will also be represented in planning and will be active users of the new
McGill Skills Centre. In this shared learning

environment, students will be
able to interact, reflect
on each other’s roles and discover different perspectives on patient care. They will be able to
respond to patient/actors in the Centre in situations that require interprofessional interventions.
They will be asked to give feedbac
k about the learning materials and give their perspectives on
all the learning experiences with IPE during their educational programs. Their contributions will
be actively used to help build and refine the IPE program.

Patients and Families

Patient repre
sentatives will sit on the steering committee and will participate in all phases of
the project and will help ensure that the project activities will address and respect the cultural
diversity of the population in the Montreal area.

Patient representation

will also be very important in the evaluation of the outcomes of IPP
that is a consequence of this educational initiative. Patients and families, who are recipients of
care are directly and indirectly affected by the nature of students’ education and will

be able to
speak personally to the effectiveness of IPP endeavours of their student caregivers. In the Skills
Centre, people who may have been patients will learn to act out real patient scenarios for students
to learn the many skills they need. The scena
rios draw on both the experiences of patients and
clients in the community as well as the learners.


6.4 Steering Committee

The establishment of the steering committee is a result of the ongoing discussions that
ensued among the members of the work group.

In that process several inclusion criteria were
identified. Members of the Steering Committee need to be: 1) key stakeholders either in
education, practice, or in the use of health care services, 2) interested and committed to IPE, IPP
and approaches to c
ollaborative care, 3) unique in their perspective on the issues, 4) open to new
ideas in education and practice, 5) influential within their constituency, 6) broad in their
representation, and 6) change agents within their environments.



The role of the
Steering Committee is to: 1) become familiar with the project and the
current knowledge and perspectives on IPE and IPP, 2) act in an advisory capacity to make
suggestions and provide constructive feedback regarding the overall planning, implementation
and

evaluation of the project to the members of the project work group, 3) address the issues and
problems put forth by the work group and to make recommendations, 4) to review and approve
the quarterly progress reports of the work group to Health Canada, and

6) participate in process
recording of the evolution of the steering committee. Members of the Steering committee and
their letters of support are attached in Appendix G.

11502 McGill Educational Initiative on Interprofessional Collaboration

8

Experience Co
-
Chairs

Dr. David Fleiszer, will serve as one of the co
-
chairs of the s
teering committee and will
act as liaison between the steering committee and the project work group. This arrangement will
ensure open lines of communication between the two groups. A full description of Dr. Fleiszer’s
credentials and previous work with IP
E is described in section 6.2
The Partner Organization’s
Project Lead.



Dr Susan French, Director of the School of Nursing will serve as the other co
-
chair. Dr.
French has extensive experience in interprofessional work in her former role as Associate Dea
n
of Health Sciences (Nursing) and Director of Nursing at McMaster University. During her tenure
she advanced IPE within the Health Sciences Faculty. Dr. French’s scholarly work has focused
on professional development issues and collaborative patient
-
cent
red care. She has been a pioneer
in both of these areas and has presented at numerous national and international conferences. In
addition, Dr. French has a long history of leading interprofessional projects and task forces both
in Canada and abroad. As pro
ject director of CIDA
-
funded international programs since 1980,
she is familiar with the skills needed to work with numerous stakeholders and to bring projects to
fruition. She will bring her extensive knowledge of IPE and strong leadership skills to the r
ole of
co
-
chair of the steering committee.

Organizational Structure of the Project


The organizational chart below situates the groups involved in this project and specifies
the lines of communication that exist. It also indicates where personnel hired for

the project will
be positioned in this structure. The list of the work group members is in section 6.9.





11502 McGill Educational Initiative on Interprofessional Collaboration

9

6.5 Project Description

6.5.1
The McGill Educational Initiative on Interprofessional Collaboration: Partnerships for
Patient and fa
mily
-
Centered

Practice.

6.5.2 Project Overview

This project brings together four professional groups involved in educating health
professionals in medicine, nursing, physical therapy (PT) and occupational therapy (OT) at
McGill University whose goal is to

address the development of interprofessional education (IPE)
and practice (IPP) towards patient and family
-
centered

care. Active partners in this endeavour
are the MUHC and the JGH which provide a broad range of clinical learning environments
shared by t
hese students. Their strengths as teaching partners lie in a well
-
developed joint
appointment system where expert clinicians in medicine, nursing, PT and OT hold appointments
at both the hospital and university.

Within the McGill University health network

there are a number of clinical settings that
are exemplars of patient and family centered health care. These environments are the result of the
concerted efforts of competent and innovative people, many of whom are McGill graduates, who
move beyond system

barriers to actively seek the input of their colleagues and engage in a
mutually respectful partnership that leads to shared decision
-
making and shared responsibility for
patient and family
-
centred care. This project aims to turn these individual efforts
into the norm.

In order to lay the groundwork for the success of the IPE endeavour, activities that
develop commitment to the project and an open communication system among the partners will
be undertaken. Four major activities will be carried out to achie
ve the project goal. The first is to
develop the attitudes, knowledge and skills required to teach (IPP) among university and clinical
educators. A faculty development program will be mounted that is geared to understanding
professional roles, interprofess
ional communication, referral, and consultation, collegial
relationships, and developing students’ attitudes related to IPP. Such a program can be housed
within the Faculty of Medicine’s Faculty Development Office to which all professional schools
have acc
ess.

The second is to build a range of resources and tools that can facilitate the teaching of
IPP. Resources required for teaching and student learning, and tools that would assist health
professionals to engage patients and families in a collaborative re
lationship will be developed. In
order to do this, the project will take advantage of two facilities in the McGill system
-

an
existing and sophisticated informatics infrastructure (Molson Project), and a state of the art
Clinical Skills Centre that will b
e available to all professional schools in Fall 2005.

The third is to mount a comprehensive IPE program that is delivered within and across
student groups over the course of their programs. The IPE program will build and foster the
attitudes, values, knowl
edge and skills that will enable students to understand and draw on the
unique contributions of each discipline in the provision of patient and family centered health care.

The fourth is to develop clinical learning environments that enhance and enable I
PP, and
in which students are given the opportunity and the support to develop their skills. Two clinical
learning environments with the potential to model and sustain IPP have been identified. The
Cedars Breast Centre and 10 medical at the Royal Victoria
Hospital (RVH) site of the MUHC
will serve as the first designated settings for this project. This project will explore the factors that
sustain or impede the viability of clinical units as
centers

for IPP and IPE.

The project activities and the anticipate
d breadth of outcomes for learners, educators,
patients and families, as well as the study of clinical settings, suggest a wide variety of evaluation
strategies. Formative and summative evaluation approaches will be used to examine process and
outcomes. Me
thods of evaluation include questionnaires, focus groups, observational data,
11502 McGill Educational Initiative on Interprofessional Collaboration

10

computer
-
based simulations, case studies and an audio
-
visual prospective record of the processes
involved in the development and implementation of the IPE program. A tight link w
ill be made
between the objectives of the pedagogical activities and the evaluation methods.

A variety of approaches will be taken to address the question of sustainability. The
integration of IPE within existing organizational structures is an important
way of addressing
sustainability from the outset. Additional indicators of the sustainability of the project are: the
existence of IPE content over the course of the educational programs, ongoing dialogue between
different student groups during their progr
am, beliefs about the importance of IPP among the
graduating students, a cadre of clinical educators who model and facilitate the development of
IPP through small group work with students, and the existence of organizational structures in the
units and com
mittees that that go beyond the multi
-
disciplinary approach to reflect
interprofessional collaboration.

The project is based on a conceptual model that includes learners, patient
-
families and
educators in a set of collaborative exchanges that inform and ar
e informed by the four project
activities. This model, developed and approved by the working group reflects the collaborative
nature of the work that led to the development of this proposal. It serves as the organizing
framework on which this project will
be presented and is described below.

6.5.3 Conceptual Framework

The framework integrates ideas developed in the D’Amour and Oandasan model
1

with
beliefs about education and health care delivery within the McGill community and the unique
context of the Mc
Gill educational and clinical environments. D’Amour and Oandasan
1

highlight
the importance of the relationship between educators and learners in the development of
professional beliefs and attitudes. In their model, the students’ developing competencies in
teract
with organizational and interactional factors to influence patient care within the clinical
environment. The relationship between learner’s activities and patient’s outcomes is informed by
research about teaching and collaborative practice in situat
ed learning contexts.

The framework presented in Figure 1 introduces five new elements: 1) it expands the
view of the
learner
, 2) expands the unit of concern from the patient to include the family within
its sociocultural context, 3) it highlights the imp
ortance of partnerships between educators and
clinicians in teaching and modeling effective IPP, 4) it applies the concept of collaboration to the
interactions that occur between the learner, educator/clinician and patient/family groups, and 5)
it adds th
e educational infrastructure elements that are required to support and sustain IPE and
IPP initiatives

The discussion that follows addresses the student learners, the educators/clinicians, and
patient/families who are the human participants in the project

and the nature of the relationships
between them. It also describes resources available to develop an educational program that
fosters interprofessional collaborative patient and family
-
centered

practice.

Learners

At McGill, the professional Schools of M
edicine, Nursing, Physical and Occupational
Therapy and Communication Sciences and Disorders fall under the administrative structure of the
Faculty of Medicine. Despite the physical proximity between the student groups in both the
university and clinical s
ettings, students’ professional education has remained the exclusive
responsibility of the faculty within each professional school. Although PT and OT are different
professions, within their School, they share learning opportunities, pedagogical tools, fac
ulty
development and access to the clinical environment through which students acquire the attitudes,
knowledge and skills required to work effectively in professional teams. In nursing, IPE has
received a lesser

11502 McGill Educational Initiative on Interprofessional Collaboration

11





Figure 1. Conceptual framework for In
terprofessional Education and Practice


priority in the formal content of programs and is handled primarily in the clinical courses. In
medicine there has been no regular input from other professional groups in medical education.

Students, recognizing the

need to understand the role of other professional groups have
organized to come together as developing professionals. The first interprofessional conference
(March 25, 2004) attracted close to 100 individuals from across the student groups and Mitabi
re
flects a continuing interest among students to work together.

This project will bring students from three professional schools together in a systematic
way at critical points over the course of their professional development. Because a large
proportion of
the graduates of all disciplines stay within the McGill University health network,
facilitating understanding between these professional groups when they are still learners is likely
to have sustained and realizable benefits for practice and for patient ca
re in the McGill network.

Educators

Partnerships between educators and clinicians cut across both clinical and educational
environments within the McGill University teaching network. These partnerships include
practicing physicians who act as educators,
clinical nurse specialists who precept students and
participate in classroom teaching, as well as physical and occupational therapists who lecture in
the school and assume full responsibility for blocks of clinical education in their own practice. In
addit
ion, university faculty members have responsibilities for the ongoing development of
clinical staff within health care environments. In the case of medicine and nursing, these
11502 McGill Educational Initiative on Interprofessional Collaboration

12

partnerships have been formalized through a reciprocal joint appointment system,

and a system of
honorary appointments is in implementation in the School of Physical and Occupational Therapy.

While there is significant movement between academic and clinical environments within
each of the professional groups, there is little contact
between educators and clinicians across the
disciplines. This phenomenon is not unique to McGill and has been identified as an issue in
Steinert’s review
5

of the literature on faculty development for IPE. There have been attempts at
McGill to address IPE i
n courses on human sexuality and HIV. However, the focus was on
content and did not attempt to address the issue of working together around patient care, with the
result that these courses had little discernable impact on the development of IPP. To date, t
here
has been not been a systematic effort integrate specific knowledge related to IPE or to bring
students together in classroom or clinical environments.

The Patient and Family in an Environmental Context

One of the features of the McGill system has bee
n the value placed on understanding
patients and families’ responses to illness. Concepts of family and socio
-
cultural background are
particularly important within the McGill philosophy of health care and are shared by all the
project participants. Issues
of culture, poverty, literacy, previous experiences with illness, shared
family beliefs, family relationships and communication, as well as individuals’ needs for
information and control are considered important global determinants of health that must be
a
ddressed
2
. Disease as a major situational determinant of health brings other issues to be
addressed: prognosis, course of illness,
care
-
giving

and end of life issues and control of
multiple/severe symptoms among others. Health professionals bring shared an
d unique
knowledge about these issues. Interprofessional discussion groups and case presentations will
help students to recognize and value the knowledge and expertise that each professional brings to
helping patients and families manage these issues. In a
ddition, the organizational structures in the
environments in which care is delivered also has a major impact in how these issues are handled
and in patient outcomes.

Collaborative relationships


The human components in the model are related to each other
through collaborative
processes that are expressed differently in each relationship. These collaborative processes differ
from the traditional dyadic relationships of teacher and student, expert and novice, professional
and layperson.


Educator and Lear
ner
. The relationship between students and teachers in the respective
disciplines is viewed as one that enables professional socialization, incorporates student
feedback, facilitates a social constructivist approach to learning, and includes peer
-
peer and
near
peer approaches that enhance learning. It is viewed in the context of adult learning theory that
places importance on self
-
direction, builds on previous experiences, recognizes the experiential
component of adult learning, and is characterized by an e
nvironment of mutual planning,
negotiation, lack of formality, mutual trust and supportiveness
6
.


Educator/clinician and patient/family.

The importance of patient/family input to the
professional team has been stressed
7
, but the importance of the collabor
ative relationship between
patient/family and the care provider is a relatively new concept in the literature and is unevenly
applied in practice. The prevailing belief remains that the health professional is the expert and has
a responsibility to transmit

information, while collaboration suggests that the patient/family come
to the table as equal partners
8
. Several authors hold the opinion that clients who do participate in
the decision
-
making process have more positive outcomes
9, 10
.

The relationship be
tween clinician educators and patients and families can serve as a
model of collaboration between the professional and care recipients. This process is characterized
11502 McGill Educational Initiative on Interprofessional Collaboration

13

by respect and understanding, attention to messages, sharing of personal beliefs, knowledg
e and
expertise, and the exchange of information
11
. In the ideal situation, this kind of exchange
emanates from both the clinical/educator and the care recipients in their interactions. From the
professional’s perspective there is an attempt to model activ
e listening, attend to non
-
verbal cues,
make sense of the patient’s past experiences, appreciate the patient’s cultural differences and
understand the meaning of the situation for them, use open
-
ended questions and actively elicit the
patient’s point of vi
ew. The professional educator demonstrates sensitivity to the patient’s
moments of readiness for information, discussion and for control. From the patient/family
perspective, the willingness and capacity to engage as an active partner varies depending on
w
here they are in their illness trajectory and on the nature of the relationships they have with
health care providers.


Learner and Patient
. The relationship between students and their patients/families should
mirror that of the skilled clinician/educator
. All of the features in the relationship described above
are expressed with different levels of sophistication depending on where the learners are in their
professional development. These attributes are expectations for students regardless of their
profes
sional orientation. Attention must be given to the development of students’ abilities to
develop collaborative patient
-
family relationships. The development of a collaborative approach
in working with patients and families must begin early in the student’s

education and can be seen
as an upstream struggle. As students in all professions develop their knowledge base, their
temptation is to share this as it will surely help. Sensitivity to the timing, context and impact of
information on the individual patien
t/family situation requires more nuanced skills that develop
with time and under the guidance of skilled educators.

The IPE Program

There are four components to the IPE program, they are: the development of the faculty
skills required to mount and impleme
nt the program, the content to be addressed in educational
and institutional learning environments, the learning resources required to mount the program
and the exemplar settings in which IPP is featured and which can serve as learning environments
for stu
dents from each of the professions. Each of these elements will be discussed below.

Faculty Development

A first step in mounting the IPE program is the development of
faculty and clinical educators. This process will call on the resources of the Faculty D
evelopment
Office of the Faculty of Medicine whose goal is to promote excellence in teaching and
learning.

Faculty Development activities are designed to assist faculty members in their roles as
educators, researchers, and administrators, using a broad ran
ge of methods to achieve faculty
goals. The major activities include: 1) faculty
-
wide and departmental workshops and seminars, 2)
medical education rounds, 3) a Teaching Scholars Program for educators in the health sciences,
4) a Faculty Honour List for Ed
ucational Excellence, and 5) research activities in medical
education. This office is responsible for the development of medical educators and is also
available and used by educators from the other professional schools. It offers the human
resources and an

environment for the development of knowledge about learning and skill in
teaching among an interprofessional group of educators. It can bring together professional
educators to discuss the specific content of the IPE program, appropriate strategies for sh
aping
attitudes and delivering content to students, factors to consider in deciding the mix of learners
and approaches to the evaluation of student learning. It will assist in the mounting of workshops,
discussion groups, and conferences for educators in t
he project as well as presentations to larger
interested groups when appropriate. It can also assist educators to develop the leadership skills
required to initiate organizational change within practice environments. These skills are required
if clinician
educators are to be successful in integrating the IPP approach within units and larger
11502 McGill Educational Initiative on Interprofessional Collaboration

14

organizational structures. The Office has the possibility of building people’s expertise in a new
area and giving credibility and visibility to the IPE initiative.

Progr
am Content
Course content on effective communication in the patient
-
professional
relationship is a valued a part of educational content for all disciplines, with differing approaches
used to tackle it within each professional group. Content on professiona
l
-
professional
communication during first level education is addressed separately by each professional group in
part through the development of the professional values and attitudes, and also in the discussions
of patient care in clinical settings. However
, educators from the respective disciplines have not
yet systematically identified the possibilities and constraints involved in attempts to include
students and educators from all professional groups in an IPE initiative. A first step in this
direction ha
s been taken by the educational partners in the work group and a number of areas
have been identified where it could be particularly productive to bring students and educators
together. These include: professional identity
-
beliefs about self and others, co
mmunication skills
(verbal and written documentation of professional activities, sharing in the interprofessional
group context), listening skills, beliefs about health care, attitudes towards patient and family
(professional as expert, patriarchal versus
partnership approaches), professional boundaries,
professional accountability, the scope of professional practice, leadership skills, shared versus
unique knowledge, individual and collective responsibility, cultural issues in organizations,
organizatio
nal constraints on practice, ethical issues in care, conflict resolution, intra and
interprofessional consultations and referrals, and instituting change. Many of these ideas do not
lend themselves to didactic teaching methods and require different appro
aches and venues in
which they may be explored. In addition to these conceptual ideas, there is a substantial shared
knowledge base in the biological and medical sciences that can also serve as a starting point for
student discussions of the contributions
that each brings to patient and family
-
centered care.

Learning Resources

In relation to the how better to use the shared and unique knowledge
across disciplines, work group discussions have led to the conceptualization of two projects that
will expand th
e repertoire of resources to enhance teaching and learning. The first project brings
together students and expert practitioners in a working group to develop “consensus modules”
that reflect interprofessional best practice guidelines for common health/illn
ess situations. The
modules can be constructed in a flexible format so that professionals can use a portion of the
content as an adjunct in their approaches to teaching or providing information to patients and
families at the appropriate time in the course

of the trajectory of their illness. Modules can also be
used as a teaching tool in discussions with patients, as a point of departure for the professional
team in determining how to best work together to care for an individual patient/family situation,
or

as part of the patient’s record,.


The Consensus Modules can be used alone or in conjunction with the second project: the
web
-
based simulated case. This case is a comprehensive dynamic simulation that can be used as a
teaching tool for both undergraduate
and graduate or post
-
licensure learners. Cases are jointly
constructed with input of all professions and would provide a common clinical situation as the
point of departure for IPE and would form the basis of a Dynamic Case Inventory that deals with
a broa
d spectrum of disease and health/illness events. They can be used within and across
disciplines and would include content that lends itself to dialogue across professions such as: end
of life care, the management of chronic and intractable pain,
care
-
givin
g
, social support, cultural
sensitivity, managing conflict, informed consent, and referral and consultation processes across
disciplines. Flexibility in the structure and access to cases would enable us to use them with
beginning and advanced professional
learners. We envisage the creation of six Consensus
Modules and six Dynamic Cases over the course of the
project.

11502 McGill Educational Initiative on Interprofessional Collaboration

15

The existing curricula within the Schools offer a combination of approaches to the
delivery of content. These include web
-
based courses with l
inks to data sets, extensive library
and information retrieval resources on which we will draw
.
A number of additional resources that
exist at McGill can be used to develop the additional learning tools that are proposed for this
project.



The Molson Medic
al Informatics Project has a mandate within McGill to enhance medical
teaching and learning through the use of informatics. This is achieved through the integration
of multimedia methods (audio, video, images, interactive builds and animations) and the
dev
elopment of learning tools for medical students during their clerkship. The project also
contributes to the National Digital Library to permit wide availability of the multimedia and
the cases. The project offers technical expertise in developing tools tha
t can be used by
educators with students, and by students with patients and families. It offers the possibility of
linking and integrating the IPE initiative to the curricula across the professional schools and
to national initiatives in IPE.



The Clinica
l Skills Centre (available Fall 2005),
is one of the few centres to offer both low
tech and high tech learning tools for use by students (undergraduate and graduate) from all
schools within the Faculty of Medicine as well as to health care professionals in

institutions
affiliated with McGill University. It is intended to enhance existing pedagogy, and will
combine “low tech” approaches such as patient simulations to teach communication skills
with “high tech” electronic and computer based simulators and pro
ps that can assist health
professionals to work together to manage clinical situations. Part of its mission is to
contribute to new knowledge and establish “best clinical practices”. It is also intended for use
in the evaluation of learning.



Instructional
Multimedia Services (IMS) is McGill's central facility for the design,
development, and production of audiovisual materials as well as the loan, installation and
maintenance of equipment. IMS also provides television and film production services. Its
main
objective is to provide professional support to the McGill community and can be used to
document aspects of the processes involved in mounting the IPE initiative.



Together the faculty development initiatives and the development of these learning tools
w
ould help faculty to extend the modeling and apprenticeship approaches to education that are
currently the mainstay in the latter parts of the educational programs of the health professions.

Exemplar settings

Exemplar environments of IPP emerge and disapp
ear at different periods of time. An
examination of what makes IPP work shows that much of its success is related to the
constellation of the professional players in the setting and the way they interact
12
. In such
settings, all the players possess a profe
ssional self
-
esteem and are confident in their knowledge
and skills. They are not threatened by the opinions or actions of other health professionals. They
feel compelled to contribute to decisions about patient care and do so because their audience of
pee
rs is consistently receptive. While there are many such individuals in the McGill system, there
are risks inherent in relying on individuals as the sole drivers of IPP. When no formal criteria
exist or organizational structures are in place that can ensure

that IPP remains a part of the culture
of the units, the departure of individuals will remain a constant threat to its viability. The Project
aims to build on the IPP initiatives and the interest in participating in an IPE program that have
been identifie
d in two patient care settings. It will use these settings, and other settings that come
on board over the course of the project, to expand the IPE project. It will also examine the factors
and organizational structures that ensure the sustainability of IP
P in practice settings. The clinical
11502 McGill Educational Initiative on Interprofessional Collaboration

16

partners will be included in a move to build organizational structures that give formal recognition
for IPE and IPP initiatives. Such recognition is an important means of ensuring viability.


6.5.4 Context for the Proj
ect

Embarking on an IPE initiative at McGill is timely given the current developments in the
curricula of the professional schools. Medicine, Nursing, PT and OT are all in the process of
instituting change in their curricula at the undergraduate and gradua
te levels, and are thus
receptive to incorporating the concept of IPE into their programs. Concepts of professionalism,
collaboration and communication have taken on greater importance in medical education. In
nursing, curriculum changes to prepare nurses
to assume clinical nurse specialist and nurse
practitioner roles require that graduate programs address the question of overlapping
responsibilities among professions and the development of new partnerships. In the upcoming
master’s entry level programs fo
r PT/OT there are three courses designed to address complex
professional issues such as IPP and collaboration, communication, adult teaching and learning
models, patient and family dynamics and delivery of health care services in rehabilitation at local
a
nd global levels.

Internal and External Drivers

The drivers for the development of IPE and IPP in the current context include:



Introduction of CANMEDs roles of collaborator, professional, communicator, manager in
graduate medical education.



Medical schoo
l accreditation requires collaboration between professionals and with patients.



Institutional requirements for clinical nurse specialists with advanced preparation in areas of
medical specialization in order to deal with the complexity of the medical care.



Policy initiatives from the Ministry of Health and Social Services calling for nurse
practitioners in neonatology, cardiology, nephrology and soon in oncology, mental health.



Accreditation criteria for Schools of Physical and Occupational Therapy include
collaboration
between professionals across disciplines and clinical institutions as a core competency.



An increased scope of the practice domains and knowledge required for the education of all
professional groups.

Societal Drivers
:



RUIS (reseaux universi
taires integrées de santé) expectation that health professionals
collaborate across settings and institutions.



Bill 90 recognizes the changing nature of professional competence, the role of clinical
judgment and professional autonomy and calls for interdis
ciplinary approaches.



Increasing consumer involvement in health care decisions, and demands for access to
comprehensive health care across the trajectory of illness



Increasing age, chronic illness and multiplicity of problems, complex social issues and th
at
cannot be managed by any single professional group.

Opportunities

Opportunities for the development of IPE within the learning context in the McGill
University system include: changes within the curricula in each of the professional schools,
existing ex
pertise and an infrastructure for the development of advanced technology in education,
a demonstrated interest among learners for IPE, identified patient population and practice settings
that are amenable to collaborative approaches to care.

Curriculum Cha
nges

11502 McGill Educational Initiative on Interprofessional Collaboration

17



The introduction of physicianship, the physician as healer and professional, as a major
theme for the undergraduate curriculum



An anticipated shift of basic preparation of PT/OT to the master’s level and a move
towards new roles and community based p
ractice



Clinical nurse specialist & nurse practitioner study streams in the graduate program in
nursing



Clinical observations that new graduates have difficulty functioning effectively in the
interprofessional team.

Advanced Technology and Recognized Expe
rtise in Education



Availability of web
-
based delivery format that makes content more readily accessible to
multiple professional groups, helps to sustain information
-
based initiatives, and aids in
the broader dissemination of teaching materials.



The capaci
ty of the McGill Skills Centre to provide an opportunity for more effective use
of skills of educators and clinicians across the professions and open the possibility of
interprofessional collaboration in education.



A strong commitment and expertise in the
development of information technologies for
shared opportunities for learning across professional groups.



Availability of expertise in the Faculty Development Office to offer diverse programs that
foster collaboration across professions as people learn abo
ut teaching and learning

Motivated Learners



Ongoing student interest in the role of other health professionals and in the development
of IP initiatives (McGill interprofessional conference March 25, 2004)



Possibilities of determining an optimum mix of un
dergraduate and graduate learners from
different professional schools to ensure an effective IP learning group



Multiple formative periods over the course of their educational experience where IP can
be developed

Patient Population and Practice Settings



Two

settings have been identified by medicine as having a potential for becoming
exemplars of IPEP and in which individuals have committed to the IP concept. Medical
patients with multiple chronic illnesses or catastrophic illness at RVH site (10 Medicine
RVH

site,) patients in the initial psychosocial phase of illness (i.e. patients presenting for
breast surgery at the Cedars Breast Clinic RVH site). A third site will be selected at the
JGH where the four professional groups are working closely in the provisi
on of patient
care and in the teaching of students. Additional potential settings from the two clinical
partners have expressed interest and could be readily brought on board.

Contribution of project to a change in culture and attitude toward IPE

In orde
r for change in culture and attitude to be sustained, it is important that it is

incorporated within the existing structures of the organization, is accepted by a critical mass of
key players and is associated with useful outcomes. This will be achieved b
y incorporating IPE
and IPP activities into the mainstream in both the university and clinical environments. In the
university, IPE will be incorporated into the newly developed programs so that it is an integral
part of the curricula. Faculty Development
activities will cast a wide net and include educators in
the four professional groups, at the university and in the clinical settings, who are involved with
various levels of learners. The ‘train the trainers’ approach will allow for ongoing orientation of

new educators in the system as well as for the dissemination of the knowledge, attitudes and
skills. In the clinical setting, freestanding committees that monitor and support IPP within an
11502 McGill Educational Initiative on Interprofessional Collaboration

18

institution will be established and IPP will be assimilated within

the existing forums where
professionals come together around patient care issues. The lecture and conference series on IPP,
the accessibility of the web
-
based teaching/learning materials as well as new teaching and
learning tools for use in student educat
ion and in practice with patients and families will also
increase the profile of IPE and IPP within the academic and clinical communities.

Barriers and Challenges


Within Quebec, recent legislation on professional practice (Bill 90) has expanded the
roles
and responsibilities of the professional groups, resulting in a greater potential for overlap
among the professions. Working within this new structure will require ongoing dialogue and
discussion among the professional groups in order that health professio
nals see one another as
partners rather than adversaries. Similarly, the emergence of the nurse practitioner role will
challenge the current dynamics of the professional groups to rethink how professional
responsibility can be redistributed. Therefore it i
s critical that interprofessional collaboration
become part of the skill set of the new generation of graduates who will be entering this new
professional environment. Finally, national accrediting bodies for the various professional
schools are calling fo
r content in interprofessional collaboration and will be looking for evidence
of its presence in the curricula of the respective professional programs.

Primary Target Audience

Student learners across the four professions are the primary target group for t
he IPE
initiative. Secondary targets include the university and clinician educators who will be required to
find effective ways to deliver the content. Additional targets are the administrators in clinical
environments who have the capacity to create the o
rganizational climate and structures that are
essential to the success of an IPE program and to the delivery of patient and family centered care.

Description of how learning will be integrated into education and practice settings

IPE will be woven into t
he new curricula currently under development in the professional
schools. Close links will be made between project leaders and the curriculum committees of all
the professional Schools, the Faculty Development Office, the Molson Informatics group and the
M
cGill Skills Centre. The identification of the opportune moments for IPE, and the linking of
learners at the right time in the development of their professional identities will allow for IPE to
be introduced in a variety of courses both academic and clinic
al. Because IPE will be integrated
into the curricula at multiple points, it is more likely to become a stable part of the educational
program.

Within the practice settings, the identification and development of exemplar sites for IPP
and IPE will result
in clinician educators participating in faculty development initiatives.
Clinician educators will then serve as the resource people and IPP educators for the professional
staff in the clinical setting. The clinical educators, together with members of the w
orking group
and the continuing education departments in their respective settings, will also examine ways to
develop existing structures on the unit such as clinical rounds, into forums for interprofessional
collaboration.


6.6 Project Objectives

6.6.1
O
verall Goal

The overall goal for the project is to mount an IPE program that
builds interprofessional

collaborative patient and family centered practice. The educational program brings together
practicing clinicians, educators, and students from four profe
ssional groups with educators and
clinicians from their respective disciplines in a program that is delivered in both academic and
clinical environments. The program will build on the knowledge that each profession brings and
11502 McGill Educational Initiative on Interprofessional Collaboration

19

will develop the shared knowle
dge required to deliver collaborative patient and family
-
centered

practice.

Interprofessional collaborative patient and family
-
centered practice is defined as a group
of health professionals working together in a collegial relationship characterized by sha
red
values, beliefs, open communication, trust and respect to enable individuals and their families to
manage their illness and sustain their health. It includes the understanding of individual
professional responsibility, professional interdependence and
recognizes the patient and family as
partners in the decisions related to their health.

6.6.2
Specific Objectives and links to Initiative Objectives

1.

To develop strategies related to IPE that are based on shared beliefs within Medicine,
Nursing, Physical
& Occupational Therapy and the MUHC/ health services network about:



The nature of patient / family centered practice



Learners and learning process



Processes of professional socialization and acculturation



Respect for the knowledge and competencies of diffe
rent professional groups



The value of shared decisions and shared responsibilities for patient/family outcomes.
(see initiative objectives 1 & 5)

2.

To build on the existing strengths and unique features of the McGill professional schools and
the McGill hea
lth care network (see initiative objectives 1 & 5)

3.

To identify shared content relevant for IPE. (see initiative objective 2)

4.

To develop the learning resources required to teach students IPP for collaborative care. (see
initiative objective 5)

5.

To bring p
rofessionals, students and patients/families together to collaborate in the
development of learning resources that can be used in the delivery of care. (see initiative
objectives 1 & 5)

6.

To develop the skills of the university and clinician educators who w
ill be implementing
modalities of I[E. (see initiative objectives 3 & 4)

7.

To develop learning environments that are exemplars of IPP. (see initiative objectives 3 & 5)

8.

To identify opportune learning periods within the medical, nursing, physical and occupa
tional
therapy curricula at McGill where students are most receptive and able to work together over
interprofessional care issues. (see initiative objective 5)

9.

To mount and implement a program for IPE in the curricula of the three professional schools
tha
t develops patient and family
-
centered

practice (see initiative objective 1, 3, 5).

10.

To further understanding of the role of interprofessional consultation and collaboration in the
delivery of pt/family centered collaborative practice among the different pr
ofessional groups.
(see initiative objective 5)

11.

To evaluate the use of learning resources used in IPE from the perspective of students and
educators. (see initiative objective 1)

12.


To evaluate the use of learning resources used in the delivery of patient
-
centered

care from
the perspective of students, clinician educators and patients/families. (see initiative objective
1)

13.

To develop methods of evaluation of the faculty development initiative. (see initiative
objective 1 & 4)

14.

To identify the factors that co
nstrain and those that enhance the creation of exemplar learning
environments for IPE and IPP. (see initiative objective 5)

11502 McGill Educational Initiative on Interprofessional Collaboration

20

15.

To identify the learning resources, the teaching strategies, and the clinical care activities
within exemplar environments that fost
er IPP. (see initiative objective 4 &5)

16.

To increase the visibility and importance of interprofessional practice within the McGill
University teaching network. (see initiative objective 2)

17.

To develop methods of dissemination of knowledge related to IPE. (se
e initiative objective 2)


6.7 Work Plan and Timelines

The work plan below describes how we propose to lay the groundwork and proceed in the
planning and implementation of the IPE program A table will follow that provides an overview
of the activities and

time lines, related specific objectives, methods and tools, and the parties
responsible for each of these components of the project. The expected outcomes of the project are
described in the final segment.

Laying the groundwork

A number of activities have

been identified as critical to the success of the project. These
relate to clarifying the nature of IPP and communicating its value to a number of important
players. The first of these are the academic leaders within the respective programs and those
dire
ctly involved in the implementation of program content into the curriculum. The second
group includes the leaders of the institutions, departments and those responsible for unit level
decisions in all professional groups within the clinical practice enviro
nments. Work to achieve
“buy
-

in” and involvement from all these groups must begin early and be sustained through
discussions, workshops,
and the

dissemination of publicity material, conferences and the website.
Other key stakeholders are the recipients o
f care in IPP and the learners in IPE who must be
represented by articulate and thoughtful individuals working through the steering committee.

Planning/Implementation

In order to make a best fit for IPE in the curricula, each School will share their exis
ting
substantive knowledge/practice maps that together provide a basis for the identification of
common areas of interest for IPE and where they best fit within the formal and practice
components of their educational programs. Within the professional Schoo
ls, consensus needs to
be reached regarding the knowledge required for a comprehensive program in IPE, and some
areas in which there is agreement have already been described in the section 6.5.3. Additional
input will be sought from students about ideas th
at should be incorporated into the content of the
program, and it is expected that other ideas will emerge as the teaching approaches are
developed. Steering committee input on content areas will be actively sought and integrated.
While relevant content is

already in place to varying degrees within individual professional
programs, until now content has not been delivered within an interprofessional context. In
addition to content decisions, the questions of timing, level of the program and the mix of
stude
nts and faculty will be addressed as these issues have important pedagogical implications
from the perspective of each of the disciplines and equally important implications for the success
of IPE endeavours
13
.

Simultaneously, a faculty development program

will be organized to develop the human
resources required to implement IPE
as well as disseminate the knowledge, attitudes and skills
that are the focus of this initiative
. According to Steinert
5
, any faculty development initiative in
IPE must address att
itudes and beliefs as well as knowledge and skills. She suggests that topic
areas for discussions in the program should include: what is IPE, why IPE, the evidence for IPE,
barriers to IPE, models of IPE, models of collaborative practice, strategies for pr
omoting IPE and
collaborative patient
-
centered

practice, and team functioning and team building. The program
will address these issues as well as develop the pedagogical skills of faculty members in such
11502 McGill Educational Initiative on Interprofessional Collaboration

21

areas as working with students in small and large gr
oup discussions in the examination of the
content issues identified in the program. Although faculty members may be comfortable with
group discussions around clinical issues, they are less likely to have addressed the content
described above in an interpro
fessional context. These initiatives should take place in a variety of
settings and could include such formats as workshops, seminars and short courses, peer coaching,
self
-
directed learning, web
-
based learning and clinical teaching rounds.

Faculty members

must
also learn to take on leadership roles in bringing about change in the clinical environment to
promote collaboration.

Shortly after the steps above are underway, the development of the new learning tools
will begin. The development of the Consensus M
odules and the Dynamic Cases that are proposed
in the project will require joint efforts of experts, students and informatics personnel working
with a specific goal in mind. The identification of participants and the establishment of guidelines
that would
facilitate their work would help ensure that their work together will be focused and
productive and will produce results within an anticipated time frame. The very exercise of
developing these modules and cases constitutes an opportunity for these individu
als to engage in
IPP and provides them with “real life” experience in communication, resolving conflict, defining
professional boundaries and assuming shared responsibilities. Modules will be translated in order
that both patient/family and professional co
mponents are available in English and French. The
links for the professional components of the module to the e
-
curriculum, to accepted Best
Practice Guidelines, and to other reputable evidence
-
based sites will be made and maintained by
a health science lib
rarian.


The Clinical Skills Centre is expected to provide another learning resource that includes
multiple approaches to teaching IPP. In order to maximize the potential of this unique learning
environment for IPE, we will consult with a world
-
renowned

e
xpert in the use of case simulations
for teaching,

Dr Amitai Ziv, who has agreed to act as a consultant on the project. In keeping
with the case analysis theme we anticipate the need to train actors to act as patients who can
reflect care needs within si
mulated environments that require multiple interventions from a team
of different professionals. This will require active dialogue with the leaders in the Centre as it
becomes available in the fall of 2005.


In the designated settings, the project will wor
k toward developing the identified
professional leaders’ skills. Through their involvement in the faculty development program, they
will be able to demonstrate that the care of patients and families is a collective responsibility
within the practice on the

unit and in their work with students from across the disciplines, see
themselves as educators to all students from all the professional groups, serve as models for their
own students as well as those from the other professions, make concerted efforts to b
ring students
into the interprofessional discussions on the units and be proactive in finding the opportunities for
IP. They will be assisted to use existing opportunities
-

bedside rounds, discharge planning,
family case discussions, discussions about tre
atment decisions and symptom


and to develop
new approaches that work within the unique context of their own units in order to promote IPP.

Outcomes

The expectation of the groundwork activities are:



an increasing number of individuals aware and involved
in the IPE project



that IPP becomes a part of the goals and mission statement of the institution



the number of units that meet the criteria for IPP have moved beyond the start up units
chosen for the study.

Additional outcomes associated with the planning

and implementation activities are:

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A substantive knowledge/practice map for each professional group that identifies
common areas of interest and opportunities for IPE among the four professional groups

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Table 1: Proposed Work Plan


Activities

Time
-
line
s

Project
Objectives

Methods and Tools

Parties Responsible

Laying the
Groundwork

Getting the steering
cmtte (SC) on board






Raising the profile of
IPE and IPP



Sharing project goals
and objectives within
professional schools






Sharing project goals

and objectives within
the MUHC and the
potential exemplar
settings



0
-
3
months






0
-
3
months



0
-
6
months







0
-
6

months







1, 2, 16,








10, 16




1, 3, 8, 10,
16







1, 2, 7, 10,
14, 15, 16




Ongoing discussions with the SC
regarding the o
verview of the whole
project, establish roles of co
-
chairs for the
SC, and develop a schedule of regular
meetings identifying contributions of
individual members.


Preparation of educational materials for
publicity and the dissemination of
information pa
pers.


Work within professional culture using
workshops, open forums, & presentations
to provide evidence of the impact of IPP
on patient outcomes. Such sessions can
solicit ideas and willingness to be
involved in joint initiatives in IPE.



Work with e
xisting organizational
leadership to solicit interest and
involvement of individuals and clinical
settings (eg, inpatient units, ambulatory
services).

Identification of 4 professional leaders in
the exemplar settings.



work group

Co Chair






SC

Work g
roup

Project Coordinator


SC representatives from
the respective disciplines
and the work group
members.

Project Coordinator




SC and work group






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Activities

Time
-
lines

Specific
Objectives

Methods and Tools

Parties Responsible

Planning &
Implementa
tion


Begin the Prospective
Record










Developing the
human resources for
IPE













0
-
30
months










3months
-
ongoing














10, 13, 15,
16, 17










2, 4, 6,

















An audio
-
visual crew to document
critical meetings in whi
ch issues are
discussed and decisions are made across
all venues e.g., steering and working
group meetings, tool development
meetings with Molson Informatics,
faculty development initiatives,
interdisciplinary rounds and meetings in
clinical settings.



Fa
culty training Programs for university
and clinician educators as tutors in IPE
through the use of:

-
workshops on teaching and learning
(e.g. leading small group case
-
based
group discussions; leading
interprofessional group discussions).

-

train the traine
r workshops


with
educational leaders and key stakeholders
-

on IPE content and methods
-

-
site specific activities, academic
detailing and peer coaching to integrate
IPE into the clinical setting

-
incorporating web
-
based teaching in
IPE




ICC

Project Coo
rdinator

IMS

Work group

SC

Professional Leaders in
exemplar settings





Faculty Development
Office & members of the
work group


Departments of
Continuing Education in
clinical settings








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Activities

Time
-
lines

Specific
Objectives

Methods and Tool
s

Parties Responsible

Establishing vehicles
for communication of
IPE for practice








Mapping out a place
for IPE across the
curricula








Development of skills
in group work across
professional groups
of student learners


Development of
content an
d cases for
IPP

6months

18months

28months








3 months










6 months
-
ongoing




6months
-
ongoing


6, 7, 10, 14,
16









3, 8










8





3, 4, 5, 9, 10



IPE Workshop for educators with Dr.
Marilyn Hammick in April 2005

An annual all
-
day conf
erence

IPP: why, how, who and when

a.m. Plenary on IPP: Issues in
implementation

p.m. Discussion/Workshops: Tools that
include patients as partners in IPP

Tools for IPE for health professionals


Development of a substantive
knowledge map for each professi
onal
group to serve as a basis for the
identification of common areas across of
interest/opportunities for IPE


Identification of contact points, content
and level of student. Make these contact
points a part of the respective curricula.


Paired student h
ome visits, paired
student patient evaluations




Develop web
-
based Consensus Modules
for IPE and IPP that are linked to Best
Practice Guidelines, existing e
-
curriculum, and evidence
-
based sites.

Fac Dev Office

work group

Molson Informatics

Project Coo
rdinator








Work group

SC, Curr cmttee of the
professional schools







work group

Curr cmttee professional
schools


Work group, Steering
Cmttee, Curric cmttee
professional schools

Molson Informatics.

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Activities

Time
-
lines

Specific
Objectives

Meth
ods and Tools

Parties Responsible

Development of
content and cases for
IPP












Development of the
resources of the
Clinical Skills Centre
for IPE







The development of
clinical learning
environments

6months
-
ongoing













6months
-
ongoing








6 months
-
ongoing



3, 4, 5, 9, 10






5, 8








4, 5, 9





4, 7




4, 14, 15

Development of templates for dynamic
cases that can be used within and across
disciplines. These templates link to the
Consensus Modules, e
-
curriculum and
to other web
-
b
ased curricula materials.


Student driven projects that include