Inter-professional Education for Health Equity

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关超然David CY KwanSenior Consultant on

Medical EducationShantou University

Medical College, ChinaProfessor Emeritus

McMaster University, Canada

National Conference on Medical Education (Prince of Songkla, Hat Yai) 2015-0825

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IPL & IPP: PBL connection

1st APC-PBL & APA-PHS Joint PBL conferenceShanghai 2010-10-24

Prof. C.Y. Kwan 關超然教授China Medical University

• Faculty Development (since 2005)

• Univ. Hong Kong (1992-1996)

• McMaster University, Canada

• (1976-2008)

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IPL to IPP:PBL connection

(Student-centered) (Patient-centered)

2nd APJC-PBL2012-1027 (Shanghai)

Prof. C.Y. Kwan, Dorector

Ctr. Faculty Development

China Medical University(2005-2013)

University of Hong Kong(1992-1997)

McMaster University, Canada(1976-2008)

关超然David CY KwanCtr. Faculty Development and Education Assessment

Shantou UniversityProfessor Emeritus

McMaster University, Canada

3rd APJC-PBL(Phuket) 2014-1204

From PBL via IPL to IPP

Inter-professional Education for Health Equity

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关超然David CY KwanSenior Consultant on

Medical EducationShantou University

Medical College, ChinaProfessor Emeritus

McMaster University, Canada

National Conference on Medical Education (Prince of Songkla, Hat Yai) 2015-0825

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Health Equitycan only be achieved via

realization of social equity in

medical educationand

healthcare practice

What learning outcomes do we expect out of education in medical schools?

Critical thinking and integrating skillsCommunicative skillsSelf-directednessReflective & appraisal skillsTeam work spiritsProfessionalism Professional relevance

Same as above

What learning outcomes do we expect of professionals at workplaces?

PBLBorn in

1 9 6 9

Chang life

Education

Mindset

Problem-basedLearning via Internalization

Learning to cope with

life problems with the

use of scenarios/cases

that simulate life

situations

Learning attitude

Student-centered and

Self-directed learning

Learning format

Scenario-based

Small group discussion

Learning approach

Supportive facilitation

Self-reflection

6-S

Principle

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To Do(Psychomotorattributes)

To Know(Cognitive attributes)

Competencies(outcomes)

Education

To Be(Affectiveattributes)

Teachers

Students

Teaching

Assistants

TraditionalCurriculum

Tutors

Students

Resource

People

PBLCurriculum

Students

TutorCase problem

PBL教案

Case problem

PBL教案

自知自主自律團隊互助互輔專業人文素養人際溝通技巧

自知自主自律團隊互助互輔專業人文素養人際溝通技巧

Group dynamics

團隊動力

稱職

能力

Teacher-student interactions

Student-student interactions

Learners’ life context CompetencySelf-directedness

Team-work spirits

Professionalism

Communication

LBL

CBL

PBLEBL TBL

OBL

IPL

Case 1950Computer 1990Concept 2000Competence 2000

Problem 1960Project 1980

Team 1990Task 1990Technology 2010

BL

MOOC

Evidence 1990

Outcome 1990

•Flipped 2010

•Inter-professional 2010

•PBL

•Knowledge

•Comprehension

•Application

•Analysis

•Evaluation

•CreationBloom’s pyramid

To Be

PBL is a learning platform allowing

opportunity for high level outcomes

To Know To Do

Living/Life

Relevanceto humanity

Significanceto society

Population:family, communityglobal

Behavior:habit, ethics,attitudes

Living the life:life sciences. Living experiences

PBL has 3

dimensions

The concept of 3-

domains of PBL can

be further applied

and extended….

•Process

•Content

•Life-long

•learning

To be

PBL as general

education

•Process

•Content

•Dentistry

Professional

•Medicine•Nursing

•S & H

PBL as professional

education

Cardio-

vascular

Genito-

urinary

Gastro-

•intenstinal

Endocrine

Nerveous

Growth &

development

PBL as biomedical

education

Practice

Theory

Problem-based

learning

Holistic

Learning

PBL as an

education theory

Graduate Medical Education and Certification

Patient CareMedical

Knowledge

Practice-based Learning and Improvement

Interpersonal &

Communication Skills

Professionalism

Systems-based

Practice

•ACGME general competencies (adopted. 2007-02)

Dee Silverthorn 2013

Interprofessional

Cooperative

learning

Pre-licensure

clinical training

Collaborative

inter-professional

practice

Post-licensure

clinical practice

Need professional

attitude to equip

health professionals

with professional

competencies

Need educational

settings with health

professionals who

practice

collaboratively

Interdisciplinary

skills via

integrative

learning

Pre-clinical

education

Inter-dependent& inter-related

Need clinical context to

relate the collaborative

learning to the practice

of health professionals

PBL

IPL

IPP

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PBLMedicine

Nursing

IPLClin. Training

IPPClin. Practice

異質性

PBL

PBLMedicine

Nursing

教育同質性高

Homogenous

專業異質性高

Heterogeneous

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NursesPharmacists

Specilizedtherapists

Drugcompanies

Governmentregulators

Doctors

Socialworkers

Patients

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Mission and definition of

Interprofessional Learning

(IPL) & practice (IPP)

“ ..IPL occurs when two or more

professions learn with, from, and

about each other to improve

collaboration and the quality of

health care .”……………. (CAIPE, 1997)

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In any successful

professionPeople work as a team, in which several different professionals put together expertise for a commondeed with a strong senseof professionalism

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MPP IPP IPP2

IPP3

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Visions in an IPE program

To broaden the horizon of knowledge and skills of professional disciplines in favor of team-work in holistic delivery of health care.

To optimize staff ability in clinical reasoning as well as participation in & decision making with in and across disciplines.

To foster mutual respect for disciplinary contributions of all professionals.

To provide mechanisms for continuous communication among care-givers and health professionals.

To enhance active participation in care-givers in relevant professions in patient care.

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The goal of IPLTo change the way we educate healthcare providers to ensure

they have the necessary knowledge (Live), skills (People),

and attitudes (Behavior) to work effectively in inter-

professional teams within the evolving healthcare system.

Change

Attitudes

conservative:

Composite

Innovative:

Integration P

B

L

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Development of an IPE program

Effective use of multiple instructionalstrategies, including didactic lectures, field studies and case-based sessions.

Explicit attention to learning via group dynamics, including skills in interpersonal communication, and conflict resolution.

“Non-traditional” interprofessional problem-based learning strategies to effectuate learning via both professional integration and mutual respect.

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Learning strategies for IPL

To develop a context in which learning together in school becomes a vital part of working togetherat workplace.

To cultivate a platform for an early opportunityfor students from different professions to appreciate and tackle a variety of intertwining learning issuesin health care.

Being a superior contextual learning philosophy,

PBL is more suitable for IPL

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Conclusion

IPL approach is the same as PBL

An IPL case is the same as

a PBL case

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Promoting inter-professional education (IPE) through the

biennial Asia-Pacific Joint Conference on PBL (APJC-PBL)Francis I. Achike1, Meng-Chih Lee2, Hsian-Wen Lin3, Fremen Chih-Chen Chou 3, Dena Hsin-Chen Hsin3, & Chiu-Yin Kwan4

Trigger: Mr. Hypogly ChuckDr John Smith routinely does his daily ward rounds with resident doctors under his care. On this particular day he noticed that a diabetic patient Mr Hypogly Chuck he saw earlier hale and hearty was in a state of confusion, sweaty and had a rapid pulse. Dr Smith called the Nurse in charge (Ms Allison) and complained loudly about the state of the patient. Ms Allison calmly explained to Dr Smith that Hypo Chuck had been attended to by Nurse Emilia who in turn explained that she had “administered Hypo Chuck a jab of 100 units of insulin as prescribed by Dr Smith.” Just as she explained Mr Hypogly Chuck’s breakfast was arriving from the hospital’s kitchen. Dr Smith checked with the pharmacy about the prescription he had issued and found a simple instruction: “Treatment: Soluble insulin, 10.0U S.C. before meal”

Intended Students’ Learning Objectives (for the PBL facilitator)At the end of the class, the nursing and medical students would be able to:• -Discuss the characteristics of a proper prescription.

• -Identify the pitfalls in a prescription, especially from nursing, pharmacy, and medical perspectives.

• -Discuss the prescriber’s and the patient’s roles in a rational prescription-writing.

• -Discuss the consequences (dangers/ risks) of poor prescribing habits.

• -Experience collaborative decision making.

• -Discuss the communication inadequacy in this episode.

Inter-professional learning (IPL) enhances the learning of professional bioethics via PBL: A case study. Hsin HC, Chou JC, Kwan CY*

Trigger: When blood transfusion becomes an issue of life

and death: to treat or not to treat?Scenario 1：A 14 year-old girl, Maria, in respiratory distress, looking very pale, was brought by to ER her mother. Maria’s

mother claimed that her daughter had sustained dizziness and abdominal pain for several days. The symptoms were

progressively worsened and dyspnea developed in the morning of ER call. Due to low BP (60/40mmHg), high pulse rate

(130/min) and high respiratory rate (22/min), Maris’s condition was considered critical and she was sent to the

resuscitation room immediately. Urgent tests were arranged by the junior ER doctor and the results confirmed that this

girl has had massive intra-abdominal bleeding. Maria’s blood hemoglobin level was only 3.0 g/dL. The junior doctor

was worrisome and told the mother that emergency blood transfusion and surgical operation must be arranged without

delay to save Maria’s life. To this young doctor’s surprise, the mother firmly refused to let Maria go through blood

transfusion. It turned out that their entire family had been a faithful member of the Church of Jehovah‘s

Witnesses.…

In spite of the full effort of rescue without blood transfusion, the girl died of hypovolemic shock. The young resident

doctor was immensely frustrated, “As a surgeon, I find it ironic saddening to leave my patient bleed to death, while I know

I can save her life?” The senior doctor, however, comforted him and said that there was nothing they could do but to

respect patient’s autonomy. The young sobbing ER nurse mumbled emotionally: “We should sue her mother…..…..”.

Scenario 2: ` The young resident and ER nurse took this very much to her heart. What they could not accept was

that the senior doctor not only did not stand up for the patients’ rights, but also prevented them from attempting to

persuade the patient to accept the transfusion treatment.

The hospital Advisor commented on this case that imposed treatment in rescuing life or complying with patient’s

not-to-treat wish are both legally sound. The young resident argued, “But, what about ethics? What is the “actual duty” of

health care professional ?”. The advisor then told the young doctor and the ER nurse a similar episode he has

previously encountered. A father forced his seriously sick daughter to receive blood transfusion treatment

against her wish in order to her life. However, having realized that the spirit in her blood was “contaminated”

following transfusion, the young woman went plunging to her death from the top floor of the hospital. Has her

life really been saved? She sacrificed her physical life to save her spiritual life, instead.

Thank you for your attention

Be mindful ! Learning can

be deeper than you think !!

2015-0825