Why IP?

In 2010, the World Health Organization provided the following definition of Interprofessional Education:

“Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”

Sounds pretty straightforward, doesn’t it? Just need a large enough room, right? In reality, developing meaningful interprofessional educational events is, to say the very least, highly challenging.

There are a number of reasons for this, some logistical and others attitudinal.

The logistic challenges are formidable. Professional schools have separate and independently developed curricular content and scheduling. Finding common ground and common space within those busy and packed programs is akin trying to get a group of busy commuters to stop and pause as they rush for the train. Moreover, any changes have to be approved by three independent Curriculum Committees, all (very understandably) aware of any impact new programming may have on their overall program. They are also very cognizant of their accreditation responsibilities which require them to ensure “centralized and independent” control of their curricula.

As difficult as these logistic challenges may be, the attitudinal barriers are even more daunting. Many students fail to see the value, being understandably focused on their individual program objectives. Many faculty members, while conceding the value, feel it is something better learned passively within the clinical environment through role modeling, and that valuable dedicated classroom time is best spent delivering what they consider more essential “core content”. These attitudes undermine the commitment that is required to overcome the logistics. In the words of Nilofer Merchant, “Culture trumps strategy, every time”.  (Harvard Business Review: https://hbr.org/2011/03/culture-trumps-strategy-every)  

Certainly, history is littered with partial successes or abject failures. During my tenure, I have personally been involved or witnessed numerous enthusiastic, well-intentioned and carefully thought-out approaches that have not achieved sustained success. This has been the case whether the efforts were local, or at the provincial or national levels.

Most recently, Dr. Leslie Flynn has been chairing a group that has again taken up the formidable challenge of developing a program of interprofessional education for the three schools within the Faculty of Health Sciences (Medicine, Nursing, Rehabilitation Therapy). They have developed an innovative and attractive program of learning events intended to provide both educational relevance to students of all three schools, and an opportunity for them to engage interactively. Their initial program offering begins this week.

Given the rather checkered history and recognized challenges, many might be tempted to ask, “why bother?”

A cogent rationale is provided in the preamble to the description of objectives that constitute the Collaborator competency in the CanMEDS framework:

Collaboration is essential for safe, high-quality, patient-centred care, and involves patients and their families, physicians and other colleagues in the health care professions, community partners, and health system stakeholders.

Collaboration requires relationships based in trust, respect, and shared decision-making among a variety of individuals with complementary skills in multiple settings across the continuum of care. It involves sharing knowledge, perspectives, and responsibilities, and a willingness to learn together. This requires understanding the roles of others, pursuing common goals and outcomes, and managing differences.

(http://www.royalcollege.ca/rcsite/canmeds/framework/canmeds-role-collaborator-e)

The College of Family Physicians takes a very similar position in its “Undergraduate Competencies from a Family Medicine Perspective” document:

As Collaborators, family physicians work with patients, families, healthcare teams, other health professionals, and communities to achieve optimal patient care.

The College of Nurses of Ontario describes the following in Entrance to Practice Competencies for Registered Nurses:

Collaborates with other health care team members to develop health care plans that promote continuity for clients as they receive conventional, social, complementary and alternative health care.  

Physiotherapy Education Accreditation Canada (PEAC) is the organization responsible for accreditation of Rehabilitation Therapy programs in this country. In Essential Competency Profile for Physiotherapists in Canada, an essential Collaborator role is described as follows:

Physiotherapists work collaboratively and effectively to promote interprofessional practice and achieve optimal patient care.interprofessional practice and achieve optimal client care.

It seems then, that we all agree on the concept of Collaboration. But even more significant is the alignment about the “why bother” issue. It’s apparent from these statements that our mutual commitment is based on a shared acceptance of a fundamental truism – that collaboration provides for better patient care. Agreeing to Collaboration conceptually is not enough and, to borrow from Hamlet, “There’s the rub”.  Those noble objectives ring hollow unless followed by deliberate action. That action should consist largely of what we have come to recognize as Interprofessional Education, or “IP”. IP is basically the walk that makes the talk. It actualizes our commitment to promote patient care through collaborative effort of all professionals whose training allows them to positively impact our mutual patients. It requires that we understand what others have to contribute, respect those contributions, and find ways to communicate and work together effectively.

We don’t commit to these efforts simply because they’re “the right thing to do” (although they are), or because fairness demands it (which it does), or because we wish to achieve accreditation standards (which we do). We commit to IP because, first and foremost, it’s in the interests of our patients to do so.

And that should be reason enough.

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Recent lessons in the meaning of Community

What does it mean to be part of a community?

This past week, two widely reported events should cause us to consider the very nature and meaning of “community”.

The first such event, of course, is the crash of Ukraine International Airlines Flight 752 in which all 176 people on board perished, including a large number of Canadian citizens and others with close ties to Canada. Because many were involved in educational programs of various types, the Canadian university community was hard hit. The response was immediate, unified and sincere. Within my own community of undergraduate deans, there was a flurry of emails and texts expressing concern and offering support. Members of the medical student community came forward expressing concern for friends and colleagues across the country. Although some schools were more directly affected than others, all shared in the sense of loss.

Particularly revealing is that the concern and response to this disaster cut through any issues of cultural or religious background. The victims were remembered not as members of any particular group, but as people we came know as individuals, with personal traits and aspirations with which we could all identify. Obvious differences simply didn’t matter.

Later that same week, we learned of the death of Neil Peart, a member of the legendary Canadian rock band Rush and arguably one of the greatest drummers of all time. Although a member of my generation, Mr. Peart’s appeal was not confined to any age group. In fact, it was my children who drew my attention to his virtuosity and expansive lyrics. When news of his death was announced, tributes appeared on social media from diverse sources – everyone from lead singer and drummer of the Foo Fighters Dave Grohl to Prime Minister Justin Trudeau. Beyond his great talent, Peart was an iconoclast who always engaged life in his own way with an authenticity and integrity that inspired a community of admirers, young and old. From an interview with Rolling Stone in 2015,  “It’s about being your own hero. I set out to never betray the values that a 16-year-old had, to never sell out, to never bow to the man. A compromise is what I can never accept.” This spirit was a rallying call that held an ageless appeal.

The very word “community” has meaning beyond its reference to a group of people living in the same location. A deeper meaning, the one that came so vividly to light in the events of this past week is “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.”

Tragic and sad events are an inevitable aspect of the human condition. Physicians and all health providers accept as a professional responsibility the support and assistance of individual patients and their families through such events. We are prepared and trained to do so. But when tragedy impacts the communities in which we live, we share in the loss and struggle together to find meaning.

These two recent events teach us that the concept of community transcends barriers of culture and age and helps us find some such meaning.

They remind us that community is about the forces that bind us in common interest and intent. Community provides unconditional support and strength.

Community occurs when we choose to focus on what we share rather than what separates us.

In the end, community is a choice.

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I have my faculty evaluations, now what?

Did you teach last semester? If so, you likely have feedback from your faculty evaluation forms awaiting your attention. Parsing out feedback from evaluation questionnaires is an annual challenge for all university instructors.  It was the topic of a Faculty Focus article by Isis Artze-Vega, associate director of the Center for the Advancement of Teaching at Florida International University. She offered solid advice for those of who feel angst over student evaluations

Dr. Artze-Vega suggests seven key approaches to responding to student evaluations.

  1. First, she advises faculty to analyze the data. The Education Team routinely does this for course evaluations for course directors and the Course and Faculty Review Committee, but not for individual faculty evaluations. Analyzing comments is a great starting point; otherwise, human nature often has people hyper-focusing on the wrong things. Are you reading an outlier opinion, or is there a theme in multiple students’ comments? “Identifying themes will help you determine whether they warrant a response,” Artze-Vega writes.
  2. Ask any actor or director and they’ll tell you: negative feedback is easy to remember. American film director Peter Farrelly has said: “With all of my films, if I get one bad review and a bunch of good reviews the bad one is the only one that will stay with me.” Artze-Vega cautions to resist the lure of the negative. Don’t automatically dismiss a negative comment, but “consider: Am I focusing on this because it’s ‘louder,’ or because it’s a legitimate concern?”
  3. Considering feedback this way flows into Artze-Vega’s third key: Let your critics be your gurus. Citing a New York Times article, she points out that, “we often brood over negative comments because we suspect they may contain an element of truth.”
  4. A fourth approach is to find counter-evidence to negative comments. You can look for or remember comments that contradict the negative one. (If your faculty evaluation report is anything like some course evaluation reports, sometimes, you’ll find these comments in the same evaluation report from other students).
  5. Artze-Vega stresses that “we should devote at least as much time to students’ positive comments as their negative ones,” so her fifth key is dwell on the positive ones. If you hyper-focus on negative feedback, you can lose sight of the many things you are likely doing well – and that students appreciate.
  6. To aid in this, she further advises to read them with a friend. “A more objective party can help you make sense of or notice the absurdity of the comments because they’re not as personally invested in them.”
  7. Finally, Artze-Vega advises to be proactive. “If you don’t conduct this analysis yourself, you’ll be at the mercy of whomever is charged with your evaluation—and they probably won’t be as thorough,” she points out. “Also, take the time to provide explanations about any off-the-wall student complaints, so that your reviewers don’t draw their own conclusions.” 

To all of this, I’d add: having read through your feedback, what’s your plan? What will you keep doing? What will you change? How will you do that? If you teach in the Queen’s UGME program and would like some assistance in using student feedback to improve your teaching practice, I’m available to assist you with this. Drop me an email. Reach me at theresa.suart@queensu.ca

Because good advice is worth repeating, this is based on a post from January 12, 2015

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