Health Sciences Education and Research Commons
Strategic Plan 2011-2016
Health Sciences Education and Research Commons Health Sciences Council University of Alberta 218 TELUS Centre, 87 Ave, 111 Street Edmonton, Alberta, Canada T6G 2R1 Tel: 780.492.0110 Fax: 780.492.7123 firstname.lastname@example.org www.hserc.ualberta.ca twitter: @HSERC_UAlberta
table of contents
2 Executive Summary 3 Introduction 3 Partnerships and Opportunities for Growth 5 Planning Process 6 Vision, Mission and Values 7 Strategic Keys to Success 8 Key 1 – Innovative Curriculum 9 Key 2 – Focused Research 11 Key 3 – Integrated Technology 12 Key 4 – Dynamic Partnerships 13 Key 5 – Engaged Educators 14 Key 6 – Sustainability 16 Appendices 16 A Opportunities for Collaboration 17 B Communications Plan 21 C Definitions 22 D Strategic Planning Consultation List 24 E Review of Key Literature 32 E Edmonton Clinic Health Academy: Phase-in Plan of Activities & Equipment
Executive Summary The Health Sciences Education and Research Commons (HSERC) works with all university health professional programs to prepare professionals to deliver quality and safe care using team-based health science education; establish best practices in health sciences education and disseminate them widely; and make a meaningful contribution to the health of Alberta communities through optimized health team development and workforce preparation. HSERC projects and team collaborations, implemented largely in a 1,500 m2 space in the Edmonton Clinic Health Academy will achieve its goals through the successful implementation of six key strategies:
This Means â€Ś
1 Innovative Curriculum
Pursuing creative curriculum solutions to integrate development of team competencies into existing health science programs.
2 Focused Research
Making remarkable advancements in health science education that contribute to quality and safe care.
3 Integrated Technology
Investing in and integrating cutting-edge technologies and building capacity to create and adopt technology in health sciences teaching.
4 Dynamic Partnerships
Accelerating the transfer of proven practices and techniques into the workplace through mutually beneficial collaborations with health system and education entities.
5 Engaged Educators
Building a network of educators skilled in team learning and the use of simulation teaching tools.
Instituting a funding and resource management model that allows for sustained investment in research, technology and faculty development.
The HSERC strategic plan will be phased-in over a five year period. During the early years, the focus will be on putting in place the systems, structures, processes and plans to ensure long-term success. Simultaneously, advancements will be made in team-based education through research and development. HSERC will primarily provide service and support to University of Alberta health sciences faculties and professional programs including those in the faculties of Agricultural, Life and Environmental Sciences, Augustana, Medicine & Dentistry, Nursing, Pharmacy, Physical Education and Recreation, Public Health and Rehabilitation Medicine. In addition to internal partners, HSERC also works closely to cross-educate students and educators from other Alberta post-secondary institutions and to support continuous professional learning within Alberta Health Services.
The Health Sciences Education and Research Commons (HSERC) uses technology and good-sense to develop teams and tools that will deliver better health care in Alberta and beyond. Shaping the health professional of the future is HSERC’s business. With a focus on innovation and excellence, HSERC will research, create, test, implement and widely disseminate pioneering team-based and discipline-specific educational approaches in health sciences. The vision and mission of HSERC is aligned with and advances the vision and priorities of the University of Alberta as well as the Health Sciences Council and its members. In particular, HSERC is commited to outstanding achievement in learning, discovery and citizenship. International leadership, student engagement in health and the creation and transfer of knowledge about human health have been identified by the University as fundamental contributors to “uplifting the whole people.” Implementation of this Strategic Plan will contribute significantly to achieving this University promise. This Plan is designed to guide HSERC until 2016, however the strategies are likely to remain relevant for much longer. HSERC’s values guide its decisions, the behaviours of its employees and researchers, and how relationships with partners and stakeholders are approached and managed. Collaboration is fundamental to how HSERC operates and to the outcomes it strives to achieve. The primary desired outcome of HSERC’s work is that from end to end the individuals involved in the health continuum collaborate in all aspects of their work: • as builders of a safe and patient-centred health system; • as providers of quality, compassionate care; • as educators; • as researchers; and • as contributors to healthy communities. Throughout the summer and fall of 2009, HSERC consulted with all health science faculties; numerous academic, clinical and administrative staff; Chair of the Board of Governors; Provost; and Vice-Provost’s team. Input from these key stakeholders has led to a strong and thorough draft Plan.
Partnerships and Opportunities for Growth
HSERC is supported by the eight faculties that constitute the Health Sciences Council at the University of Alberta as well as the Faculty of Social Work at the University of Calgary, and Alberta Health Services. A number of Alberta post-secondary institutions collaborate with HSERC to maximize the impact of student learning across the care continuum and into rural Alberta. Early institutional partners include Grant MacEwan University, NorQuest College, Northern Alberta Institute of Technology (NAIT), and Grand Prairie Regional College. See Appendix A for a list of professional and research programs that work with HSERC to advance learning and discovery of health team competency and the use of technology in health education and patient care. Although it varies from year to year, approximately 8,000 students are enrolled in these programs and about 2,000 graduate and enter the workforce each year.
Evaluation and Measurement
Measuring HSERC’s success during the five years of this Plan, including the move into the Edmonton Clinic Health Academy, is critical. A collaborative process involving the Associate Deans (Academic) from each health science faculty and other key stakeholders (e.g. Alberta Health Services, Alberta Health and Wellness, Workforce Division and Federation of professional associations and accrediting bodies1) drives the activities within the Plan. Key performance indicators of HSERC’s success will be identified in 2011 in alignment with the goals and objectives of the Plan, the Human Health Initiative and other university-wide academic planning priorities.
Communicating to Build and Maintain Trust and Collaboration
A comprehensive Communications Plan for HSERC emphasizes the value of participants’ involvement in health simulation and pedagogical design and evaluation. The plan will include a brand that positions HSERC as a collaborative, engaging and trustworthy source of dialogue, support and guidance in health science education and research. The plan will be developed in consultation with the health sciences faculties and will reflect the strategic and integrated branding and communications model of the University of Alberta. (See Appendix B for an initial framework of the HSERC Communications Plan.) Throughout the Plan references are made to a number of terms that may not be familiar to all readers. Please see Appendix C for Definitions.
Accreditation Council of Canadian Physiotherapy Programs (2009); Alberta College of Medial Laboratory Technologists (2005); Alberta College of Occupational Therapists (2003); Alberta College of Pharmacy (2007); Canadian Association of Speech-Language Pathologists and Audiologists (2004); Canadian Council for Accreditation of Pharmacy Programs (2006); Canadian Medical Association (2008); Canadian Society for Medical Laboratory Science (2005); College and Association of Registered Nurses of Alberta (2005); College of Dietitians of Alberta (2008); College of Registered Dental Hygienists of Alberta (2007); College of Physical Therapists of Alberta (2005); College of Physicians & Surgeons of Alberta (2010); and Commission on Dental Accreditation of Canada
Planning Process This Strategic Plan is the outcome of a collaborative strategic planning process started in February 2009. The year-long consultation process led to a common understanding of the vision, mission, values, goals and objectives of HSERC in preparation for its 2011 launch in the Edmonton Clinic Health Academy as a shared educational resource for health scholars. HSERCâ€™s Plan is the culmination of discussions with, among others, University of Alberta leaders, the health sciences and affiliated faculties, Alberta Health Services, Alberta Health and Wellness, Alberta Advanced Education and Technology, Edmonton post-secondary institutions and HSERC employees. Individuals involved in the strategic planning process are listed in Appendix D. Under the guidance of the University of Alberta Health Sciences Council, HSERC will work with University and other partners to continue to shape its approach and offerings, and to ensure its activities remain relevant and its desired outcomes are achievable. Once finalized, the Plan will be reviewed and modified annually. HSERCâ€™s planning process recognizes and supports the unique, complex, consultative and collaborative personality of the University of Alberta and employs the principles of Collaborative Strategic Planning as outlined in the figure below (Sanaghan, More Hearts and Minds at the Table. 2009).
Pay Attention to the Sense of Community and Connection on Campus
Actively Seek External Perspective
Meaningful Engagement of Institutional Stakeholders
Principles of Collaborative Planning in Higher Learning
Include Reflection and Sense Making
Share the Information Gathered Throughout Process
Seek and Encourage Diversity and Multiplicity of Perspective
Use Resources, Skills and Knowledge of Institutional Stakeholders
Vision, Mission and Values Our Vision of the Future Health professionals collaborating to promote and deliver quality and safe care Our Mission Pioneering team-based health science educational approaches that empower individuals to flourish in an ever-evolving health system The Values that Guide Us • We have courage to lead and passion to innovate • We advance high quality in all we do • We embrace collaboration and teamwork, and • We believe reflection is vital to progress
The Business We’re In: Prepare professionals to deliver quality and safe care using teambased health science education
• Cultivate a culture of collaborative education • Integrate team competencies into health sciences education • Coordinate and facilitate educational experiences • Model collaboration and interprofessional work • Employ and integrate innovative technologies in teaching • Support continuing development for health professionals
• Research the effectiveness of current and original approaches to educating health professionals Establish best practices in health sciences education and disseminate • Use research outcomes to inform the education of health professionals • Establish a network of researchers and research supports them widely • Leverage partnerships to build evidence for pedagogical best practices Make a meaningful contribution to the health of Alberta communities
• Share new knowledge and understandings widely to accelerate the use of evidence based practices across the education and the health system • Prepare high-performing health professionals • Exhibit progressive health leadership
Strategic Keys to Success Key strategies for success have been recognized. Under each strategy, goals and objectives have been identified and are described on the following eight pages. An extensive international and local environmental scan has shown that there are explicit factors critical to creating and sustaining a successful long-term simulation and educational research centre. HSERCâ€™s five-year Strategic Plan identifies and is focused on six strategic keys to success. Significant progress in each of these areas will build a strong foundation upon which HSERC can excel. During the early years, the focus will be on putting in place the systems, structures, processes and plans to ensure long-term success. Simultaneously, advancements will be made in teambased education through research and development.
This Means â€Ś
1 Innovative Curriculum
Pursuing creative curriculum solutions to integrate development of team competencies into existing health science programs.
2 Focused Research
Making remarkable advancements in health science education that contribute to quality and safe care.
3 Integrated Technology
Investing in and integrating cutting-edge technologies and building capacity to create and adopt technology in health sciences teaching.
4 Dynamic Partnerships
Accelerating the transfer of proven practices and techniques into the workplace through mutually beneficial collaborations with health system and education entities.
5 Engaged Educators
Building a network of educators skilled in team learning and the use of simulation teaching tools.
Instituting a funding and resource management model that allows for sustained investment in research, technology and faculty development.
Key 1 Innovative Curriculum Pursuing creative curriculum solutions to integrate development of team competencies into existing health science programs.
A core set of team competencies are in place and integrated in health sciences curricula at the University of Alberta.
Objectives • • • •
Identify areas of greatest need in terms of team curricula. Construct programs and educational experiences aligned with team competencies. Engage students in education designed specifically to refine team competencies. Partner to develop and offer opportunities to enhance the team skills of current health professionals.
• The interfaculty HSERC Working Committee has developed an Interprofessional Learning Pathway based on four health team competencies. • HSERC has begun assessing existing university curricula to determine where students are currently achieving team competencies and to identify gaps in curricula. • HSERC and its partners have begun facilitating development of experiences or ‘boot camps’ in specific content areas that cross multiple disciplines. These after-hours boot camps provide learners with a high-intensity and realistic simulation experience that supplements existing learning and does not interfere with coursework. • A continued role of HSERC is to support faculty members and clinical instructors with the integration of team competencies, simulation or other health technologies into existing courses and learning experiences. HSERC is working with the University of Alberta Centre for Teaching and Learning to establish faculty development programming.
How Will We Know When We’re There • Team-based experiences will have higher prominence than courses. • Simulation, as a teaching strategy, will be integrated into health science programs. • Students will feel confident to transition into the workforce and will know how to function in teams.
Key 2 Focused Research Making remarkable advancements in health science education that contribute to quality and safe care.
HSERC is advancing evidence for best practices in health sciences disciplinary and team education
• Develop and implement a comprehensive research plan aligned with health sciences curricula and health system priorities. • Establish the resources, governance and structure that will support the research plan.
Starting Point • HSERC is promoting the use of existing best-practices in interprofessional education and collaborative practice, and is conducting original research in health team pedagogy and development of patient-centred competencies. • In order to fully research the impact and effectiveness of health educational tools and techniques, HSERC is first determining where development of team competencies and experiences within health curricula can make impact. • HSERC is establishing a research team to conduct research and evaluation of team communication and the impact of simulation within interdisciplinary student teams. Within the Faculty of Medicine & Dentistry, HSERC evaluated two learning experiences. In the first example, a tool is being developed to evaluate team communication in a simulated medical trauma environment. The second is a project to determine the impact of simulated pediatric cardiorespiratory emergencies on the function of interdisciplinary student teams. • Additionally, educational researchers working with HSERC are examining the development of team communication and collaborative skills within virtual environments (such as Second Life) in partnership with researchers and graduate students in the Faculty of Education and the Department of Computing Science. • The University of Alberta is building health education research capacity through the development of a Master of Education in Health Sciences Education. The program began accepting students in fall 2010 and is supported by HSERC in collaboration with the Faculty of Education and all University health sciences faculties.
How Will We Know When We’re There • The research governance structure will be in place. • The resources to support health team educational and simulation research will be secured. • HSERC with its partners will have secured a major national research or infrastructure grant, eg: CFI or CIHR grant.
Employing a collaborative process, the development of a comprehensive health educational research plan will occur. The framework will be adapted from Making an Impact, A Preferred Framework and Indicators to Measure Returns on Investment in Health Research. January 2009, Canadian Academy of Health Sciences Report of the Panel on the Return on Investments in Health Research. To ensure the research program is strong, the following three key components must be present: 1) Knowledge Sharing and Use (Advocacy and Promotion); 2) Research and Knowledge development (Learning); and 3) Research Infrastructure (Accountability). High level research strategies and goals shaping HSERCâ€™s research direction will be developed in 2010 and 2011, further to the initial framework laid out in the following table. Please refer to Appendix E for a review of key literature.
Advocacy & Promotion
(Knowledge Sharing & Use)
(Research & Knowledge Development)
Research clearly translated for professionals, administrators, educators, researchers and decision makers
Establish interdisciplinary research teams around areas strategic to advancing funding and grants
Identify strategies and priorities
Varied and broad-reaching knowledge sharing to local, national and international stakeholders
Build communities of practice to support research across disciplines and at multiple sites
Garner investments for capital equipment and capacity building of researchers and students
Tailor knowledge transfer to meet needs of researchers and improve the chances of practice improvement
Trained research teams within HSERC Communities of Practice conduct relevant research
Develop Knowledge Translation partnerships with other health science institutes and organizations including Alberta Health Services and Alberta Health & Wellness
Build tools for students, faculties and practitioners to use new knowledge
Peer reviews to maintain standards of scientific quality
Organizational culture shift to recognize team-based teaching, learning, and community practice
Implement changes in practice for students and practitioners based on research outcomes related to team-based and/or simulation teaching and learning
Share knowledge through publication, workshops, forums, conferences and websites
Align research and learning networks with strategic plans across U of A, Alberta Health Services and Alberta Health & Wellness
Demonstrate impact, effectiveness and positive outcomes of HSERC Research Program to support advocacy for HSERC initiatives
Key 3 Integrated Technology Investing in and integrating cutting edge technologies and building capacity to create and adopt technology in health sciences teaching
Innovative health and education technologies are integrated into teaching
• Implement mechanisms to keep informed about advances in technology that will support health sciences teaching, research and care delivery. • Pilot and evaluate promising technologies to support health sciences teaching and research. • Build or modify educational technologies to support health sciences education.
Starting Point • Virtual environments to deliver educational experiences are being developed by HSERC in collaboration with educators and researchers in the Faculty of Education and Department of Computing Science. • On-line delivery of a health team development course initiated in 2008 is being evaluated to determine its efficacy in developing team skills. • In partnership with the Faculty of Rehabilitation Medicine, HSERC is piloting an electronic charting system in a variety of learning experiences with diverse disciplines. • HSERC’s Demonstration Space offers a sophisticated audiovisual capture system to support instructors and students in multiple learning environments by enabling visual and auditory playback, review and reflection of learning experiences.
How Will We Know When We’re There • It will be the norm to use health technology in education. • Technologies used in teaching will model the cutting edge technologies students will encounter when they start practicing. • Students will graduate from University of Alberta health sciences programs adept in the use of modern day learning technologies.
Key 4 Dynamic Partnerships Accelerating the sharing of proven practices and techniques with the workplace through mutually beneficial collaborations with health system and education entities.
Relationships are shaped and nurtured to integrate evidence based practices in health sciences teaching and educational research
• Institute processes and approaches to develop and maintain meaningful stakeholder relationships. • Work with partners to develop and adopt evidence-based practices in health sciences teaching and educational research. • Provide students the opportunity to be architects of their own learning, through the development of meaningful and relevant learning modules.
• HSERC is working steadfastly to establish credibility and trust with learners, leaders and scholars of health education and simulation environments. • Formal processes are being established to link people, share information and solve problems and to create opportunities for dynamic partnerships. • Four primary shared tools have been created to ensure sustainable and embedded health team learning at the University of Alberta: 1) the health team learning pathway (or Interprofessional Learning Pathway); 2) physical infrastructure such as the HSERC simulation environments in the Edmonton Clinic Health Academy; 3) a hierarchy of champions, from early adopters through the HSERC working committee and the Provost’s office to the Interprofessional Health Collaborative for Alberta provincial committee; and 4) the creation and cultivation of environments that reward risk, collaboration, persistence and vision.
How Will We Know When We’re There • Faculties will meet accreditation standards related to interprofessional/team-based educational experiences, specifically related to communication and collaboration and integration of simulation learning experiences into curriculum. • HSERC and its partners have identified and presented a solution to a problem or challenge and are implementing it where relevant within the health continuum.
Key 5 Engaged Educators Building a network of educators skilled in team learning and the use of simulation teaching tools.
Educators create, implement and evaluate team learning experiences and simulation tools
• Develop capacity of educators to actively integrate team learning experiences into their curricula. • Develop and implement tools to assist educators in conducting team education research. • Develop capacity of educators to integrate and facilitate simulation.
Starting Point • HSERC is establishing a formal Health Sciences Faculty Development Program that will support faculty members and clinical instructors to integrate team competency development and/or simulation environments into student learning experiences. A needs assessment will be conducted to understand faculty and instructors’ needs. • A Standardized Patient Toolkit is being developed to assist faculty members and clinical instructors with integrating standardized patients into courses. • HSERC is helping faculty members and clinical instructors identify existing student team experiences and develop new ones through the use of an Interprofessional Team Competency package.
How Will We Know When We’re There • Faculty members will be supported to develop and deliver experiential learning experiences for both pre-licensure and continuing professional education. • Faculty instructors will use effective practices in health education and integrate them into curriculum. • HSERC and its partners demonstrate trust in everyone “at the table” in order to achieve an endpoint that all partners believe is worthwhile.
Key 6 Sustainability Instituting a funding and resource management model that allows for sustained investment in research, technology and faculty development.
HSERC is sustained by secure and prudently managed resources
• Diversify funding through philanthropy, research grants and other opportunities. • Secure a sustainable stream of annual operations funding. • Develop a centralized physical resource to provide learning opportunities and educational research opportunities.
• HSERC is developing a fund development strategy and philanthropic naming opportunities protocol in collaboration with the University of Alberta’s Central Development Office. • To maximize fund development success and philanthropic investment, a comprehensive communications strategy is being executed to establish HSERC’s value to the Alberta health system and to build awareness of and trust in HSERC’s mission, vision and directions. • Operating costs associated with potential service delivery models are being identified through a business model consultation process.
Health Academy Phase-In Plan
Educational and Research Environments See Appendix F for a proposed stage-by-stage graphic display of how infrastructure will be phased into the facility. In 2010, HSERC continues to consult to ensure that this plan meets the needs of its partners through to 2016. Activities, Equipment and Staffing HSERC continues to work with its partners to develop activity projections and to ensure that the appropriate equipment is in place to support its activities. The design process has been completed but HSERC continues to revisit the room-by-room design to ensure that each space will be used to the maximum capacity for which it was designed. A detailed plan is available on request from HSERC staff. Budgets (capital and operating) Equipment and operating budgets for HSERC from 2011 to 2016 have been prepared and are available on request from HSERC staff. HSERC is refining the budgets and further exploring revenue opportunities to identify ongoing sustainable and reliable funding. Among other things, during 2010 HSERC will: • work with UofA External Relations and Central Development to explore philanthropic revenue opportunities; • continue discussions with Alberta Health Services and other external stake holders to identify their interest in using the facility in the future; and • work with research facilitation officers in each faculty to assist in reflecting costs associated with using HSERC facilities in the Health Academy for research purposes.
Demonstration Space – 2008-2010
The need for a shared, central learning resource as part of the Edmonton Clinic Health Academy was agreed to by University of Alberta health sciences Deans and senior leadership team from the start. It was envisioned that this space would embody the new philosophy of interprofessionalism and would use innovative educational technology to support the evolution of a patient-centred health care system. Simulation and immersive learning were recognized as key. This central learning resource is HSERC. For HSERC to be successful as a shared resource, research and education programs must be active and make full use of its 1,500m2 space in Edmonton Clinic Health Academy. In preparation, educational pilot projects and experimentation with simulation environments began in 2008. Since May 2008 HSERC has been “making do” with converted offices and conference rooms in the TELUS Centre. While not ideal, it has allowed HSERC to create a physical Demonstration Space equipped with audio visual and information technology that researchers, students and professors from across campus use to deliver, debrief and evaluate interprofessional competency modules as part of their respective programs. The space includes a doctor’s office, a clinical consultation room, a debriefing room and Smart Condo.
How Will We Know When We’re There • • •
A major philanthropic gift has been secured. HSERC is fully operational when: ° a full staff cohort is in place; ° all rooms and areas within HSERC in the Health Academy are fully equipped and operational; and ° the Phase-In Plan has been executed. HSERC is operating at 80% capacity during peak hours (about 640 hours per year) and 60% capacity during off-peak hours (about 1,128 hours per year). • 25% of all hours of operation are used for interdisciplinary health sciences activity (about 442 hours per year).
Appendix A: Opportunities for Collaboration Program of Study and Research Anaesthesiology Biomedical Engineering Dental Hygiene* Dentistry* Health Promotion Studies Human Ecology Kinesiology Laboratory Medicine & Pathology Medical Laboratory Science Medicine* Nursing* Nutrition* and Food Science Obstetrics & Gynaecology Occupational Therapy* Oncology Paediatrics Pharmacology Pharmacy* Physical Education Physical Therapy* Population and International Health Psychiatry Public Health Sciences Public Health Recreation, Sport & Tourism Rehabilitation Science Social Work Speech Therapy* Surgery
Associated Faculty Medicine & Dentistry Medicine & Dentistry and Engineering Medicine & Dentistry Medicine & Dentistry Public Health Agricultural, Life & Environmental Sciences Physical Education & Recreation Medicine & Dentistry Medicine & Dentistry Medicine & Dentistry Nursing, Augustana Agricultural, Life & Environmental Sciences Medicine & Dentistry Rehabilitation Medicine Medicine & Dentistry Medicine & Dentistry Medicine & Dentistry Pharmacy and Pharmaceutical Sciences Physical Education & Recreation Rehabilitation Medicine and Augustana Public Health Medicine & Dentistry Public Health Public Health Physical Education & Recreation Rehabilitation Medicine University of Calgary Rehabilitation Medicine Medicine & Dentistry
* professionally accredited program
Once the infrastructure is in place, other programs may take advantage of research and educational opportunities with HSERC. These include, but are not limited to, a number of other health-related education and research programs in University of Alberta faculties outside of the traditional health sciences: • psychology (faculties of Arts, Science and Education); • health law (faculty of Law); • health organization studies (School of Business); • mathematical modeling in pharmaceutical development (faculty of Science); and • nanotechnology (faculties of Science and Engineering); • prion & protein-folding disease research (faculty of Science). • medical acupuncture (faculty of Extension); 16
Appendix B: Communications Plan Background
A health-team education and simulation centre is a new concept on the University of Alberta campus. Eight health science deans determined the need for a collaborative approach to interprofessional health team education in 2004. Since that time, the Health Sciences Council secretariat has been exploring the feasibility of the concept. With the construction of the Edmonton Clinic Health Academy, approximately 20,000ft2 were allocated as a shared commons area for health team training and simulation. The space was named the Health Sciences Education and Research Commons. In the past 2 years, HSERC has evolved from strictly a physical space in the Health Academy into a broader concept of collaborative, transparent and explorative partnerships committed to the development and testing of pedagogical practices and technological tools in health sciences education. HSERC is a body of partners from across the U of A campus – spanning 12 faculties – who are committed to through meaningful engagement of internal and external stakeholders to develop and promote quality and safe patient care. HSERC has and will continue to actively seek and encourage a diversity of ideas and perspectives to shape its future using an iterative process to reflect and refine concepts and directions, and the transparent sharing of information.
• Over 8,000 health sciences students per year have the potential to interact with HSERC • 8 of 18 health science faculties and an additional 4 non-health sciences faculties are actively engaged in HSERC scholarly activities • Over 10,000 academic staff members at the University of Alberta have the potential to interact with HSERC • There is the capacity for nearly 130,000 student experiences each year in the HSERC environments in the Edmonton Clinic Health Academy
Internal to University of Alberta • Health Sciences Clinical instructor • Health Sciences Deans • Senior Administration and Provostial Leadership Team
• Researchers with an interest in health promotion, care and delivery • IHEPG members (HSERC advisory committee of Associate Deans (Academic)) • Health sciences faculties clinical placement faculty and staff • Health sciences students • HSERC staff members • Government and Corporate Relations Office • University Chancellor and Senate • University Board of Governors • Communications Managers, Strategists and Advisors in Leadership Offices (Registrar’s Office, VP (Research), Provost’s Office, President’s Office) • External Relations Executive Committee • Health sciences faculties Administrative Professional Officers and administrative staff • Health sciences faculties communications staff • Health sciences faculties recruitment staff • Health Academy design and construction team • Health sciences alumni • Researchers and students from non-health sciences faculties with an interest in health education, simulation and technology innovation External to University of Alberta • Practicing health care professionals with an interest in health education • Health science instructors at other Alberta post-secondary institutions (specifically and especially NAIT, Norquest, and Grant MacEwan University) • Members of the Government of Alberta Health Workforce Action Plan (Advanced Education & Tech, Health & Wellness) • Alberta Health Services clinical simulation staff • Canadian Patient Safety Institute • Canadian Health Services Research Foundation • Other Canadian universities with simulation curricula (eg: University of Toronto, McGill University, University of Ontario Institute of Technology, University of British Columbia, McMaster University) • Other world universities with simulation curricula (Stanford, Iowa State University, University of Wollongong Australia) • Professional Associations and Accreditation Bodies (listed in footnote on page 3 of the HSERC Strategic Plan 2011-16) Issues • Limited awareness of HSERC’s capacity to support interprofessional research • Culture of mistrust of “central” projects; health science faculties 17
• • • • •
have a sense that central units or projects have a hidden agenda No direct accountability among health science faculties or their communications staff. Participation and buy-in of a central strategy is based on an individual honour system. Faculty communications accountability is directly to the respective Dean or department Chair. Economic environment (6% reduction in institutional funding for 2010-11 and an equal amount anticipated for 2011-12) increases competition for limited resources and energies Leadership team (deans and associate deans academic) is currently unstable (6 of 8 deans have less than 2 years experience on the Council) Inconsistent communications structures and resources within health sciences faculties Confusion over institutional priorities and questions about the 20112016 institutional academic planning cycle Lack of support and understanding from individual deans, chairs, and managers for centralization or integration of institutional messages, policies and practices
Internal • Build consensus among health science faculties around need for interprofessional health team education curricula • Raise awareness of HSERC demonstration space • Build momentum for HSERC activities in preparation for 2011 move into the Edmonton Clinic Health Academy • Build trust among stakeholders that HSERC is a shared educational resource rather than a separate “central” entity • Connect like-minded and complementary research leaders to advance interdisciplinary health research projects
External • Demonstrate the impact of team education on patient care and safety • Demonstrate HSERC capacity to deliver on research • Effectively meet the objectives set out by the Interdisciplinary Health Education Partnership investment from the Government of Alberta
Principles Guiding Communications Strategies and Tactics Be proactive. Be collaborative, trustworthy and engaging. Be responsive to needs. Be remarkable.
Internal Communications Tactics Demonstrate a desire to help faculties realize their priorities such as increasing simulation education, building interprofessional research team, and engaging students in health team experiences. Communication Coordination – chair quarterly dialogue with communicators from all health science faculties, Registrar’s Office, VP Research Office, VP Facilities and Operations, U-Hall Issues Manager, Public Affairs and VP External Relations • Leverage internal media such as Folio/Express News to advance simulation stories such as John Duff and Mark MacKenzie’s (FoMD) mannequin simulation, Smart Condo research and teaching success, or Theatre of Broken Bones piece on training excellent standardized patients for medice, nursing, pharmacy and Physio Therapy teaching and testing.
Stakeholder consultations revealed four primary needs that will be addressed within the HSERC communications strategy.
Edmonton Clinic Health Academy – • Communicate with faculty external relations staff (communications, development and alumni relations) to share key messaging, updates, issues and advances related to the facility. • Coordinate messaging and scripting of Health Academy video and virtual animations to be used for student recruitment and fund development. • Collaborate with the Central Development Office to develop an integrated fund development strategy for interprofessional priorities including (but not limited to) the Health Academy and HSERC space within it. • Be responsive to media relations, photo, interview, and video requests. • Partner with Alberta Health Services communications and UofA Vice President (External Relations), Associate Vice President (Government and Corporate Relations) and Director of Public Affairs to deliver integrated and strategic communications around the Health Academy with emphasis on supports for interdisciplinary collaboration in education and research. University Stakeholders – build an internal brand around which health science innovators can gather to develop, test and deliver
interprofessional health team education (for example, HSERC colour and key graphics, print materials, website, research posters). Coordinate key messaging and media relations at events such as Festival of Teaching, as they pertain to HSERC. Strategic Communications Advice – provide advice and communications insights to senior leadership and administration as well as to crossdisciplinary and cross-faculty projects. Supporting Strategic Decision of Health Sciences Deans – research and develop concepts that advance the University, Council and HSERC academic plan. External Communications Tactics Key messaging can be used in the context of stakeholder priorities to attain (or avoid) attention as needed. Government Relations – provide broad vision, description and specific action examples to government relations office to advance stakeholder relations and respond to need for direct government interaction through events such as the Deputy Ministers Dinner and Parliamentary staff tours 19
Community Relations – strategically engage the U of A Senate, provide stories and context about the community and global impact of interprofessional scholarship Knowledge Transfer – build and reinforce the University of Alberta brand promise through designing and producing abstracts, research posters, research presentations and print materials for international scholarly conferences (for example, national and international interprofessional education conferences, Festival of Teaching). Target specific, high profile academic journals Student Recruitment – provide key messaging and images to faculties to use in undergraduate student recruitment materials especially for the faculties of Nursing and Arts and the Registrar’s Office) Alumni Relations – provide relevant and strategic advice and key messaging to Alumni Relations via the New Trail advisory board and personal relationships with alumni communicators International Messaging – develop “health” content for verbal, print and on-line materials targeted to the culture, society and leadership of the Five Countries identified in the UofA International strategy (India, China, Mexico, Germany and USA) Media Relations – coordinate news coverage through simplification of broad and complex concepts, for example, health team development for patient centred care. Examples of past media stories are: • CTV National News – Smart Condo collaborative research (Rehabilitation Medicine, Industrial Design, Computing Science, Pharmacy) • Edmonton Journal proactive and Country Asides (rural paper) – coordination of writing, editing and publication of U of A research or activities that provide proactive advice to Albertans
A budget outlining the scope of communications annual activities has been developed. This communications budget reflects out-of-pocket expenses and does not include human resources costs associated with communications. A detailed work plan and associated budget has been developed and integrated in the overall HSERC Operations Budget.
Measurement and Evaluation
A detailed evaluation plan will be developed with the health sciences communications staff following the finalizing of the HSERC Strategic Plan 2011-2016.
Appendix C: Definitions
Interdisciplinary: An interactive process where researchers, educators and learners work jointly, each drawing from their own discipline to address a common problem.
Deliberate practice – individual focuses on a defined task, typically identified by a teacher, to improve particular aspects of performance, involves repeated practice along with coaching and immediate feedback on performance
Transdisciplinary: An integrative process where researchers, educators and learners work jointly to develop and use a shared conceptual framework that synthesizes and extends disciplinespecific theories, concepts, methods, or all three to create new models and language to address a common problem.
Fidelity – used to describe the accuracy of the system being used to accurately reproduce sound or images
Learner – the person, regardless of level of education or position that participates in an educational offering
High fidelity simulators –
- simulation technology that combines highly sophisticated, life-like mannequins with computer programs driven by complex models of respiratory and cardiovascular physiology and extensive pharmacological modeling of drugs (i.e. Human Patient Simulator
Simulator – a device that presents a simulated patient (or part of a patient) and interacts appropriately with the actions taken by the simulation learner (Gaba, 2007)
Crisis Resource Management (CRM) – set of non-medical skills including leadership, problem solving, situational awareness, communication skills, critical thinking, and resource management
- HPS). Also includes, highly specialized and expensive simulation technology to be used by a limited number of professional or trainees within the organization (i.e. endoscopic simulators, laparoscopic simulators, endovascular simulators)
Intermediate (moderate) fidelity simulators –
- simulation technology that combines life-like mannequins with computer programs driven by less complex models of respiratory and cardiovascular physiology and may include pharmacological modeling of drugs but only part of the environment, enabling restricted application to a specific subset of functionality
Low fidelity simulators –
- simulation that is static and lacks the detail and vitality of a living real situation, used in learning and practicing psychomotor skills (i.e. knot tying boards, IV arms)
Simulation – is a technique, not a technology, to replace or amplify real experience with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2007) Standardized patient (SP) – live human actors (or real patients) trained to accurately and consistently portray the history, physical findings, and emotional affect of real patients (or family/friends) Task Trainer – a device that replicates limited aspects of a task, but does not present an integrated experience (i.e. IV arm) Telehealth – is the use of communications and information technology to deliver health and health care services and information over large and small distances Virtual reality – a computer simulation of a real or imaginary system that enables a user to perform operations on the simulated system and shows the effects in real time
In-situ – simulation training that is physically integrated into the clinical environment using portable mannequins, standardized patients, task trainers, or other equipment Interprofessional education – occasions when two or more professions and/or pre-licensure students learn with, from, and about each other to improve collaboration and the quality of care
Multidisciplinary: A sequential process where researchers, educators and learners in different disciplines work independently from their discipline-specific perspective, with the goal of eventually combining efforts to address a common problem. 21
Appendix D: HSERC Strategic Planning Consultation List A thorough consultation among over 60 stakeholders took place throughout 2009. They included researchers, clinicians, students, administrators and leaders from within the University of Alberta. Consultations were also held with educators and researchers at other post-secondary institutions in Edmonton and with Alberta Health Services and various departments within the Government of Alberta. A complete list of individuals with whom consultations were held is below:
External Consultations Name Carl Amrhein Dan Birch Natalie Bishop Peter Blenis Pierre Boulanger Fraser Brenneis Peter Brindley Mike Carbonaro Chris Cheeseman Marcia Clark Jane Drummond Jon Duff Anna Farmer Marion Haggerty-France Mark Hall Doug Hedden Brian Heidecker Sara Houlihan Dan Huffman Christine Hughes Rob Lederer Lili Liu Penny Macdonald Lynne MacGillivray Mark Mackenzie Dave Magee Mike Mahon Dru Marshall 22
Title Provost and Vice-President (Academic) Associate Professor, Surgery Student Acting Associate Dean (Academic) Professor Vice Dean, Education Associate Professor, Critical Care, Medical Simulation Lead Professor, Educational Psychology Vice-Provost (Human Resources) Assistant Professor, Surgery Vice-Provost (Health Sciences Council) PICU, Pediatrics Assistant Professor, Community Nutrition University Secretary Assistant Professor and Clinical Coordinator Chair, Dept of Surgery Chair, Board of Governors Student Director Associate Professor Associate Professor Chair, Dept of Occupational Therapy Simulation Coordinator Manager of Capital Projects Medical Director Associate Dean (Professional Programs & Teaching) Chair, HSC and Dean Deputy Provost
Unit/Faculty University of Alberta Faculty of Medicine & Dentistry/Alberta Health Services Faculty of Rehabilitation Medicine Faculty of Agricultural, Life and Environmental Sciences Dept of Computing Science, Faculty of Science Faculty of Medicine & Dentistry Faculty of Medicine & Dentistry/Alberta Health Services Faculty of Education University of Alberta Faculty of Medicine & Dentistry/Alberta Health Services University of Alberta Faculty of Medicine & Dentistry/Alberta Health Services Dept of Agricultural, Food and Nutritional Science University of Alberta Faculty of Rehabilitation Medicine Faculty of Medicine & Dentistry University of Alberta Faculty of Medicine & Dentistry Alberta Health Services (Edmonton and Area) Regional Patient Simulation Program Faculty of Pharmacy Dept of Art and Design, Faculty of Arts Faculty of Rehabilitation Medicine Faculty of Nursing Faculty of Medicine & Dentistry STARS Air Ambulance Faculty of Rehabilitation Medicine Faculty of Physical Education & Recreation University of Alberta
Linda Mattern Bob Mc Kim Nadine Milos Joanne Olson Jane Potentier-Neal Joanne Profetto-McGrath Andrew Reid Frank Robinson Jonathan Schaeffer Fern Snart Tracy Stephens Kent Stobart Eleni Stroulia Dan Syrotiuk Norbert Werner Von Whiting Olive Yonge Linda Youell
Exec. Dir. Workforce Policy and Planning Director, Evaluation Chair, Dept of Dentistry Associate Dean Undergraduate Programs Associate Director, Office of Development Professor Simulation Specialist Dean of Students Vice- Provost (Information Technology) Dean Lab Coordinator and Faculty Lecturer Associate Dean, Undergraduate Medical Education Professor and iCORE Chair Vice Dean Clinical Simulation Specialist Senior Administrative Officer, Office of the Provost and Vice-President (Academic) Vice-Provost (Academic) Director of Undergraduate Services
Alberta Health & Wellness Data Integration, Measurement & Reporting, Alberta Health Services Faculty of Medicine & Dentistry Faculty of Nursing University of Alberta
Title Associate Director Standardized Patient Trainer Interprofessional Practice Manager Interprofessional Education Manager Director, HSERC and Assistant Professor Associate Director Exam Coordinator, Standardized Patient Program Administrative Coordinator Associate Director Associate Director Administrative Assistant, Standardized Patient Program Strategic Communications Manager Administrative Coordinator Associate Director
Unit/Faculty Health Sciences Council Health Sciences Education & Research Commons Health Sciences Education & Research Commons Health Sciences Education & Research Commons Faculty of Education Health Sciences Council Health Sciences Education & Research Commons
Faculty of Nursing Alberta Health Services University of Alberta University of Alberta Faculty of Education Faculty of Nursing Faculty of Medicine & Dentistry Dept of Computing Science, Faculty of Science Faculty of Physical Education & Recreation Northern Alberta Institute of Technology University of Alberta University of Alberta Faculty of Nursing
Internal Working Group Name Marni Devlin Moses Petra Duncan Tara Hatch Renate Kahlke Sharla King Kathy Kovacs Burns Judy Makarowski Lynne Moser Pam Rock Shirley Roozen Anna Schwandt Cynthia Strawson-Fawcett Marilyn Weiss Trish Whelan
Health Sciences Education & Research Commons Health Sciences Education & Research Commons Health Sciences Education & Research Commons Health Sciences Education & Research Commons Health Sciences Council Health Sciences Council Health Sciences Council 23
Appendix E: Review of Key Literature
Demonstrating effectiveness and searching for opportunities in simulation and team-based learning in Health Sciences Education:
A Review of Relevant Literature
Section 1: Demonstrated Need for Team-Based Teaching & Learning With or Without Simulation in Health Sciences Education It is evident from the literature that higher education institutions with health sciences programs partnered with health care organizations have been striving to develop innovative and effective approaches to teaching, learning, and evaluating the knowledge, skills and attitudes of students, faculty/staff and health professionals in practice settings. Trends in the 1990s and into this 21st century have focused more on interdisciplinary, interprofessional and team-based learning with and without simulation and creative learning environments (Thompson et al., 2007). The application of team-based education with the use of simulation is not new in health sciences education (Bradley, 2006). What has been transforming and evolving in both team-based and discipline-specific health sciences education is the diversity of opportunities and innovative approaches combining different types of simulation and learning environments to portray actual health care or clinical practice experiences as realistically as possible (Jeffries & McNelis, 2008; Pulman et al., 2008; Paige et al., 2009). There are many reasons for using team-based teaching with simulation for discipline-specific competencies and team-based collaborative patient care. First, there are ongoing concerns amongst health sciences faculties and health care employers that students’ skill capacity is less than adequate upon graduation (Bradley, 2003). Second, the track record concerning patient safety and reductions in errors or adverse events is a high concern for health care organizations. Not only are changes in attitudes and attention to skill competencies required, but also continuous practicing of these technical and related skills so that their confidence and comfort in appropriately clarifying and communicating with other health disciplines is attained (Bandali et al., 2008). And third, currently, with the shifting availability of appropriate faculty resources and clinical placements for health professional students, simulation and team-based learning strategies are becoming an essential psychomotor practice component (Bradley & Postlewaithe, 2003; Decker et al., 2008; Galloway, 2009). Not only is team-based teaching with simulation a practical approach to take with students 24
but there are many benefits as well (Bradley, 2003). Most importantly, this approach ensures they are capable of performing essential competency-based skills and communicating effectively with other disciplines before they actually get into the ‘real’ practice setting with ‘real’ patients, and as a result their confidence and decision making also improves dramatically (Paige et al., 2009; Allan & More, 2004; Lanning et al., 2008; Robins et al., 2008; Jacobsen & Lindqvist, 2009). There are many examples in the literature which demonstrate the effectiveness of clinical simulation to better enlighten and in some situations, better prepare health professional students (Baker et al., 2008). All of this translates into stronger practitioners, collaboration and shared responsibility for improved, quality and safe patient care (Jeffries & McNelis, 2008). Different theoretical frameworks have evolved which support the development of sustainable interprofessional and simulation models for health sciences teaching and learning around effective and safe patient-centred care (Mann et al., 2009). These and other reasons support team-based and simulation teaching and learning in the health sciences. It will be the identified benefits to these approaches which will continue to support initiatives moving forward. For example, there is support for these approaches in the Health Sciences across Canada as seen with the Canadian Network for Simulation in Healthcare which has the mission to “provide a platform for promotion and advancement of patient-centred simulation among health professionals, educators, administrators, regulators and policymakers across Canada” (http://www.patientsafetyinstitute.ca/English/ Initiatives/simulation/Pages/default.aspx?utm_source=CPSI&utm_ medium=HomePage&utm_content=Simulation&utm_ campaign=FeatureLinks). As part of many processes, the Canadian Patient Safety Institute (CPSI) has been encouraging more involvement in simulation training and interprofessional education to improve patient-safety practices. CPSI conducted a patient simulation needs assessment (2008) and have provided support for simulation initiatives. Alberta Health Services has also set up a Provincial Simulation Strategic Plan (2009) which promotes “best practice, prevent harm, and enhance quality of care” (p.4). They intend to develop alliances with those institutions such as the University of Alberta to create innovative and
sustainable simulation practice, education and research of benefit to all concerned. There are benefits to these broader alliances to support such things as accreditation of programs and health care institutions in providing optimal skills practice to students and health professionals in safe and non-threatening learning environments that include teambased and simulation exercises and that allow certification before exposure with patients (Lee et al., 2009). Simulation exercises provide a more accurate means to assess the skill competency of students and practitioners for an indication of actual performance (Brazil, 2008). Health professional associations use these types of training exercises and environments to assess competency of their members and provide certification based on actual performance (Grant & Davis, 2007). As simulation technologies expand and become more flexible in use some of the dependence on simulation centres may alter. Portable simulation in transitive settings provide the most opportunity to a wider range of student and professional teachers and learners in health sciences (Kobayashi et al., 2008). The use of portable manikins or access, and associated technologies and techniques, may increasingly complement established education and research programs at various locations. Knowledge translation is the goal and team-based and simulation teaching and learning facilitate this better than conventional means (Zwarenstein & Reeves, 2006; MacDonald & Archibald, 2008). Learners reported better outcomes in terms of their performance and their patient care. Collaboration in teaching and learning leads to better integration through education, communication, documentation, tool development, quality improvement and research (Dechairo-Marino et al., 2001).
Section 2: Demonstrated Effectiveness and Research Gaps Related to Team-based & Simulation Initiatives in Health Sciences Education The literature provides linkages to websites and programs which offer similar and/or other interprofessional and simulation-based initiatives compared to that offered through the Health Education and Research Commons (HSERC). Most programs emphasize collaborative patientcentred and quality health care, discipline-specific competencies (LeBlanc et al., 2008), interprofessional education and clinical practice skills (Miller et al., 2004; Philippon et al., 2005; Dechario-Marino et al., 2001), and the use of simulation in health care education ( Bandali et al., 2008; Nisbet et al., 2008; Pulman et al., 2008; CPSI, 2008; Gaba, 2004; Overstreet, 2008; Flynn & Shorten, 2009). The result is a model of health sciences education focused as much on studentsâ€™ ability to work together as it is on imparting the unique knowledge that doctors, nurses, pharmacists, therapists and other health professionals need to assume their professional roles and responsibilities as
individual practitioners and in patient-care teams (Miller et al., 2004, p.7). For example, HSERC includes Curriculum Development related to a Team-based Learning Pathway for Student Practitioners in preparation for Professional Development (Exposure/Introduction of students, Immersion/Development of students, and Competency/entry to practice) , Interprofessional Competencies (Collaboration, Reflection, Communication, and Professional Role Clarification), the Smart Condo demonstration site for interprofessional courses, Curriculum Modules ( Interdisciplinary courses for health sciences students, Surgical team-based learning, Bariatric education initiative, and Pediatric resuscitation â€˜mockâ€™ code), developing faculty capacity, and applying various simulation learning environments (desk top, Standardized Patients, and high fidelity manikins). The literature provides evidence in support of many of these initiatives and also provides some of the challenges that are or can be encountered. Research is essential for acquiring the evidence needed to support the different educational and teaching aspects of this rapidly expanding area. More specifically, research can be as simple as exploration of satisfaction of students or faculty from teaching and/or simulation, to evaluation research pertaining to achieving outcomes related to each initiative, to complex research determining the effectiveness of the processes applied and outcomes achieved as determined and assessed/measured through impact analysis on HSERC as well as on students, health sciences programs, health care organizations, health care providers/professionals or interdisciplinary teams, and of course, the patients (Kipp et al., 2007; Paige et al., 2009; Weller et al., 2009; Garside & Prescott, 2009; Misra et al., 2008; Lee et al., 2009; Banks, 2009; Morrison et al., 2009; Carlson et al., 2009). These different types of evidence are necessary to demonstrate justification
for the various team-based and/or simulation initiatives, to provide administrators and decision makers with the ‘proof’ they need to support these ongoing initiatives (Curran et al., 2005), and to become leaders in fostering effective innovative approaches to education, research and practice (Kipp et al., 2007). Collaborative practice models that embrace simulation as a vehicle for improving patient care are timely and necessary. Interdisciplinary education is critical to delivering safe and holistic patient care. Simulations that enhance collaborative practice models facilitate knowledge and appreciation of the contributions each discipline brings to the patient care arena. Moreover, understanding the expertise and abilities of each health care provider improves the likelihood that patients will receive comprehensive, quality care. Interdisciplinary simulations provide students and practicing professionals an opportunity to gather and synthesize information about the patient, about themselves, and about other members of the health care team. This valuable information then forms the basis for effective communication, critical thinking, and problem-solving that contributes to interdisciplinary collaboration and a safe practice environment (Jeffries & McNelis, 2008). There is still a need for more research in all aspects of health sciences team-based teaching and learning, particularly with the use of simulation. Studies have indicated that individual student practitioners claim the teaching experience helped them gain confidence with specific technical skills, and overall was an enjoyable educational experience and a good adjunct to their curriculum (Laschinger et al., 2008). Simulators have been shown to improve skill performances on OSCEs, but there is a diminishing effect over time. Continued practice is essential to maintain level of skill and maintain competency. As part of this learning, there needs to be appropriately trained instructors to ensure that students do not learn incorrectly with the simulators as they are not the ‘real’ thing and mistakes do not have the same consequences. The implications for research in these areas are evident (Laschinger et al., 2008; Bandali et al., 2008; Bradley, 2006). Galloway (2009) suggests that although more research is needed to confirm effectiveness in using simulation for teaching and learning, and support for the value of simulation use versus the costs related to simulation set up and use, there is little value in waiting for all the research to verify these. She recommends that the current research evidence showing the relationship between simulation and enhanced 26
overall patient safety warrants the use of more simulation in health sciences education, not less. The one obvious research gap identified across all the team-based and simulation learning experiences is the weak evidence of its impact or effectiveness on the overall outcomes for students as practitioners in the ‘real world’ healthcare and practice settings. A systematic review of the studies specifically focusing on the effectiveness of simulation used to prepare health science students for real-life experiences, shows inconclusive results (Laschinger et al., 2008). In addition, the team-based experiences have yet to be evaluated more rigorously for effectiveness and impact on patient care, or patient satisfaction generally (Cooper & Taqueti, 2009).The practice readiness model used in these contexts also needs further validation (Bandali et al., 2008). Evaluative education research by nature of its purpose is adequate for assessing some aspects of change observed or perceived as a result of team-based and simulation teaching and learning in health sciences, but it is not robust enough to indicate direct correlation between education and general safe, effective practice, or high-level efficacy and effectiveness outcomes for practitioners and patients (Bradley, 2006; Galloway, 2009). Practitioners in these settings are translating what they have learned in a controlled team-based and simulation environment to their practice with ‘real’ teams, ‘real’ patients suffering from ‘real’ acute trauma or disease conditions.
Section 3: Opportunities and Challenges for HSERC There are many different opportunities for team-based or interprofessional and simulation teaching and learning in the health sciences. In this review of the literature, specific focus has been given
to several designated areas being explored by the Health Sciences Education and Research Commons as opportunities that would fit within its mandate for pre-licensure training of health professional students and considerations for interprofessional practice. These areas include: Bariatrics or Chronic Disease Management which is currently an access and sustainability issue; team-based patient-centred care for management of chronic diseases in Primary Care Networks; Smart Condo for use in enhancing practices in continuing care management particularly for the elderly person; team-based higher order skills such as communication in critical care settings or operating theatres or patient safety practices; and Black Box Theatre and Immersive Lab to be used in management of disasters such as pandemics and crises resource management in critical incident situations. Chronic Disease Management (CDM) requires a range of health and other professionals, and that care be delivered in an integrated, collaborative and coordinated fashion for not only efficiency of service provision but also for addressing the multitude of needs which patients with chronic diseases often have. The team-based approach seems to work well for these patients in terms of treatment, healthcare access, patient satisfaction and outcomes (Willison, 2008). In addition, the team-based model has shown to be more cost effective than separate health provider visits (Litaker et al., 2003). The Primary Care Networks (PCN) are an example of a setting where team-based collaborative care for chronic diseases is more effective in terms of outcomes and costs, and especially where the teams are successful in helping patients to self-manage their disease (Bodenheimer et al., 2002; Mann et al., 2009). Collaborative Interprofessional Team Education (CITE) is one model which has shown to be effective and popular within PCNs or other rural primary care settings (Coleman et al., 2008). Patients are seeking PCNs, particularly as they have longer wait times or are unable to access specialists or appropriate care through regular clinics. This is particularly an issue for those residing in rural areas. Other opportunities exist in rural areas for innovative models of partnership and collaboration (Charles et al., 2006). Not only is training of interprofessional teams needed for PCNs and rural settings, but so is evaluation, to determine their effectiveness as teams, in meeting the patients’ needs and other aspects such as costs (Curran et al., 2007; Moaveni et al., 2008; Oandasan & Reeves, 2005). The focus is interprofessional education for collaborative patientcentred practice or care (Herbert, 2005). Applying simulation such as trained Standardized patients in the education of CDM teams has been shown to also work well as a model for chronic disease management and patient-centred collaborative care which includes the patient in the self-management goal (Davis et al., 2009; Baker et al., 2008). There are several challenges in trying to achieve what is proposed here. One
major hurdle is establishing seamless links between interprofessional learning and the actual application or practice of interprofessional competencies within PCNs or primary care settings where actual patients with real needs are engaged (Wilcock et al., 2009). Another consideration is sustaining these communities of collaboration as well as maintaining continuing interprofessional education (Egan-Lee et al.,2008). One suggestion is linking HSERC with other Health Sciences Council initiatives such as the Primary Health Care Initiative so that the practice side can be followed and researched. The aging population presents other challenges to interprofessional health care delivery than having complex health issues or chronic diseases. Their experience in continuing care or palliative care requires specially trained interprofessional teams. Such training has been proposed in HSERC’s Smart Condo which is a learning environment staging the ‘real’ world encounter. The literature concerning interprofessional education in palliative, long term, continuing and end-of-life care focuses on the specific training needed to address patient and team concerns as well as provide appropriate patient and family-centred care (Hall et al., 2006). There is also the training associated with role clarification amongst the health professionals involved with team-based care delivery in these settings (Lidskog et al., 2007). Students claim that their experiences in palliative care are invaluable for teaching them about interprofessional team-based care (Morris & Leonard, 2007). Where the interprofessional team experience does not work well is when challenges appear to block the opportunities for role clarification, for working jointly on tasks with patients, and when there is competition rather than cooperation. Good leadership is also needed in these settings (Cowley et al., 2002). Another area of interest is the collective of higher order skills needed for critical care settings, operating rooms, and emergency departments. The decision-making component of critical care deals with a different set of skills and cognition in a highly dynamic and intense environment such as the emergency department or trauma rooms, operating room, and intensive care units which has cardiac response teams (Gaba, 2001; Lighthall et al., 2003). One of the most critical sets of skills is communication at all levels but particularly amongst the members of interprofessional teams. The main issue regards the need to be open and transparent about all aspects of care delivery to prevent unforeseen mishaps compromising patient safety including drug administration, judgment calls, and team leadership and acknowledgement. The opportunities for team-based and simulation teaching and learning in these settings makes this area of particular interest to those working in critical care units or settings such as the operating room and cardiac arrest codes (Paige 27
et al., 2009; Mills et al., 2008; Merry et al., 2008; Gaba, 2001). Special training courses in these areas exist as ‘Critical Resource Management’. The curriculum involves highly realistic simulation scenarios requiring complex decisions and multiple levels of interaction. No one professional works alone in any capacity in these special areas of care, and particularly if ‘communities of practices’ create different opportunities to enhance quality of care and safety (White et al., 2008). Practicing decision-making and communication skills amongst interprofessional teams helps them as teams but also as individuals within the teams, to communicate more effectively and make appropriate decisions (Sibley & Parmelee, 2008; Priest et al., 2005). The team-based teaching and education approaches, along with simulation, particularly with high fidelity manikins or standardized patients, provides the appropriate learning environment. Regardless of the learning environment, it has become apparent that quality, safety, systems improvement and collaboration are no longer optional content in health professional curricula (Ladden et al., 2006). Patient safety has become a focal point of patient-centred care. As well, Howe (2006) suggests that patients should be involved in interprofessional team-based care for self-protection. Standardized patients can provide this interaction in a safe learning environment. Two quite different simulation learning environments, the Black Box Theatre and Immersive Lab, have been used in management training of disasters such as pandemics and Crisis Resource Management, amongst other clinical skills training. More specifically, Black Box Theatre is virtual reality as presented in a staged environment (theatre or classroom lab) used to train people in team and resource management 28
to be strategic and avoid mistakes (Clark & Mayer, 2003). Through this type of simulation training, roles and experiences are acted out and feedback is provided without judgment and real costs to patients’ lives. Numerous things in health care which can be analyzed in this environment include ‘near misses’, looking at how and why decisions are made for various scenarios including disasters, and helping to change the culture so that incident reporting happens without blame. Technical skills and performance can be assessed as can the impact of equipment technologies, surgical techniques and working practices. Theatre also has a strong use in dramatizing particular circumstances such as team communications in different health care settings, patients’ perceptions of care received or of adverse events and disclosure processes, experiences of persons with HIV or other chronic conditions, and many others (Rossiter et al., 2008). Videotaping the training scenario can be useful for debriefing with participants (Clark & Mayer, 2003). Another environment called the CAVE, or Cave Automatic Virtual Environments is a room with five walls, and in this environment the participants wear 3-D goggles. The participant feels immersed in the clinical scenario as a result of the 3-D surround projection of computer graphics displayed into the room. This approach has been used in operating room surgical procedures, dental training in the use of dental instruments, and psychological management of irrational behavior problems and phobias (Janzen & Saiedian, 2008). In crises management situations the interprofessional teams must be well coordinated in managing the various urgent aspects (Hallikainen et al., 2007). Communication once again becomes a high level skill which the team must be proficient at during a crises. The use of various types of simulation in such training is suggested, such as high fidelity manikins, standardized patients or others which provide the opportunity to the team to assess changes in individual and team behaviors (Hicks et al., 2008). Simulation assists teams in optimizing strategies for emergency mass disasters and vaccination parameters such as for the SARS outbreak (Asllani et al., 2007). Markers to determine what is effective teamwork in any type of disaster, are still lacking and need to be defined. The challenge is identifying all the team players who should be involved in comprehensive training for disaster preparedness. The team involves more than health care professionals as disasters have wider reaching impacts on communities
or areas. Transportation of traumatized, injured or deceased individuals is one of these critical areas (Sisiopiku, 2007). Leadership during stressful situations is critical and can also assessed and role-played through simulation to determine what communication and decision-making skills are most appropriate (Wisborg et al., 2006). Leadership in team-based patient care becomes especially critical in ‘Crisis Resource Management’ or ‘Critical Event Management’, such as disasters where there are numerous injured or massive casualties, and many uncertainties. Because these are not daily occurrences, health professionals do not get the experiences necessary to become proficient at being part of response teams with specific roles and responsibilities. Simulation-based training provides this experience in a safe and controlled environment. With the addition of debriefing, these exercises provide practitioners with a snapshot of their performance under stress, examining those things that went well and those that need more practice (Gaba, 2001; Lighthall et al., 2003; Reznek et al., 2003; Cooper & Taqueti, 2009). Where there are identified opportunities in team-based and simulation teaching and learning in health sciences, there are also challenges. Some of these are not new challenges but ones which are difficult to overcome in many situations. Others are common and can be managed if anticipated as part of the process. For example, the development, implementation and evaluation of team-based and simulation teaching and learning is more time intensive for all involved, and cannot accommodate as many learners at one time compared with conventional means (Jones & Hegge, 2008). There needs to be buy-in from all disciplines or faculties involved in preparing students for practice environments. However, not all faculty will be able to use simulation in their teaching as some may not have kept pace with the technology changes or have not had access to such technology, and may not have had a compelling reason to pursue simulation and technologies (Curran, 2008). Incentives for faculty need to include training and preparation, coordination of team-based and simulation that can easily fit into curricula and not need a lot of adjusting. There needs to be support from institutions to move in this direction and to invest in the technology and program changes. With HSERC moving into the Edmonton Clinic Health Academy facility and operating a ‘centre’ for team-based and simulation teaching and learning, there may be more support by faculties to utilize the expertise and benefit from this type of innovative teaching. Of course, there are financial and other costs involved in making the effort to incorporate simulation and to train teachers in simulation and team-based learning (Hansen et al., 2009). Team based collaboration also requires long-term nurturing and investment if interprofessional healthcare is to be a success (Kvarstrom, 2008).
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Appendix F: HSERC in Edmonton Clinic Health Academy: Phase-in Plan of Activities and Equipment