Interprofessional Education: Foundational Concepts and Creative Event Design

Which shows your commitment so much and I know that all of us remember us here from this organization really our golden interprofessional we teach we learn we work with a variety of other professions so I would also argue that we could probably today or Julie's we are honored to have after my new ward here too that reward is there a lot things within world I believe you can inside [Music] so that reward is Sunday the University of Arkansas for Medical Sciences director and professional faculty development soozee director faculty and parents professor and so the director for the Department of Theatre after war earned her bachelor's degree in psychology from the universe in clinical psychology from the University of our on every girl her residency at brush and completed her fellowship at the University of Arkansas thank you very much I'm excited to be here actually came in yesterday and a thirty-minute number of faculty focus talks and kinds of meetings in between and it's super exciting to hear how both have integrated by PE in from the beginning as one of your domains of focus in medical school and throughout the campus I'm from the University of Arkansas for Medical Sciences and I work in the office of IPE just housed in the academic affairs and thus not so they're college but therefore all 80 degree programs I hope to share with you today a little bit about how the corona and develop our eye PE program have a shared passion across both institutions but a little bit different implementation strategy and also a little bit about how we have focused on developing our faculty members you AMS requires us to show some disclosure slides and pause long enough for you to read them I'm assume you read quickly and the biggest point is the end point which is that this event just like all the others that our offices provide either faculty focused or student focused are all collaboratively derived that means that what you're about to hear is the perspective combined perspective of a number of our key leaders and IPE at UAMS now it's asked to do quite a bit in an hour so my plan is to touch lightly on these different subjects or the history of IP and the National Movement a lot about what our program looks like so that you think the next questions about implementation successes challenges that sort of thing also a little bit about how to engage faculty to help support the curriculum that we've developed so after I touch upon all of those points we'll have some time to discuss hopefully a little bit late start I think we can still have some time to have some rich discussion and share stories so I like to start out with the definition of IP it's a much misunderstood concept interprofessional education is defined as two or more learners with different Health Professions coming together to learn about from each other and actually talked about in some of the other meetings that I've had today is that that's really expanding into interdisciplinary education there's a lot of basic science or collaborative in it inside and outside healthcare professions training that is now happening to somebody even brought in that concept of who the learner groups are that should be involved in this but the public leaders of course to build collaboration skills and we know from Robert Wood Johnson and our own thoughtful reflection that teaching skills is best learned early particularly complicated skills like working well on a team and so our program starts from the first week or months that learners arrive and goes through until the end of their training both realize that sharing that focus mostly on through licensure today we can talk about residency and other advanced learner training in our conversation so naturally I pick collaborative different professional representatives came together to say we are as a health care system in the u.s. moving from four isolated Zobel practices to increasingly collaborative practices and there's some incentivization happening from our shift from fee-for-service to value-based outcomes that's pushing us in that direction and I'll give you an example of work with asthma patients you might find that percentage of your population is not adherent to their medications and therefore end up in the ER or the hospital which is a hypothesis the health system wants to promote better adherence and you learn the pulmonologist that just communicated what they need to do the scholars translated to behavioral change are lots and lots of examples about that across medicine so how many perhaps that we hear of change specialists such as the psychologist or adding a social or group had helped with access to medication or cost of medication or maybe a respiratory therapist to could help with the kinds of medications and how they're giving timely the day support might improve your appearance now from a budgetary perspective the institution specifically the clinic people have to increase their costs from salary for those individuals but the healthcare system is taking thousands of dollars even if you keep just a percentage of those non apparent ones out of the ER in a hospital and not for them to give you additional payments to report those added salaries so the vision of value-based outcome reimbursement that we are in the midst of transitioning to and how I ve really has some roots or some energy that's coming from that change promoting better collaboration because if we're all working together in the shared goal of improving patient care we need to work here in synergy I'm holding against each other now the iPad collaborative came together 2009 it started of charged all academic health centers to develop an ite curriculum didn't tell half just only needed to that was a little tricky and then this group spent about two years seriously considering what does it take in terms of skills to be able to work well together teamwork sounds like simplistic thing but it's really not in your stack of handouts you will find at the top I pick core competencies it's a brand back page flakes with black writing that is the list that the Ipek collaborative pulled together and it pulled it together with more different four domains within which 8 to 15 different specific skills how some of the skills are very rudimentary sort of novice little skills and those are the things that we are going to teach first and then some are more intermediate and then some are pretty sophisticated skills within the domain of roles and responsibilities you might see that play out most apparently so let me walk you through it in that series of skill sets the more rudimentary or novice level is to better understand who they are as individuals as they're creating their professional identity being able to say hi my name is Wendy were in a clinical psychologist silent expert in and to be able to talk about that succinctly to communicate that to new team members more sophisticated is how to go up to someone you've never met before and said higher interest rate their branch manager a specialist in genetics how do you work with this population I understand very much party says and then bleep on them when appropriate to make you're starting to have those conversations the more sophisticated level though navigating the role overlap so it used to be that we conceptualize ourselves as healthcare professionals this is what I do what else does this this is what you do no one else has that I will they know is that we do overlap in quite a few areas there are shared process that we all care about and all need to be experts in patient and family-centered care cultural competency understanding the importance of social determinants of health health literacy to name just a few so the roles and responsibilities you might have to navigate that role overlap specific example one of the first clinics that I integrated into is a weight management hardly PT myself in a position and the RT was asking questions about binge eating and I was asking questions about binge eating both of us needed to know because we would make recommendations based on the answers to those questions but we're duplicating effort and we had quite a long initial assessments two and a half hour too hard for patients to manage that so we haven't seen eating we started about the fact that we have an overlap in practice and instead of it becoming negative or territorial we said you know people can do some of those questions we want to get why didn't you do half a 95 do you want to do first women or open up them and then make sure that you communicate we come out really have a strong emphasis on that warm handoff and we decided in the end to do that louder although I worked in other clinics where we've chosen our former model where the Aspire needs to this person and the signings to this person knowing that we could have done different but it's a collegial conversation that are much more sophisticated right so the bin that domain for a novice rudimentary we're in immediate more advanced skills communication this is one that we feel very comfortable with of course communicating with patients need to be clear and science teach back kind of principles D jargon our language or working with people thinking about the peanuts will begin to make each of those written handouts innocent air keeping documents are readable and understandable authorization what this asks is having conversations amongst each other what does a sophisticated warm handoff in the midst of a chaotic busy clinic how do we make sure to simply get what we need to have an opportunity for questions back and forth and then be able to move forward with the if you think about it that deep sharpening that we do for our patients feature that's important for us to do it there are concepts that one professional cut one thin you know different so we're not careful or throwing around slang or radiations that are familiar to others we can our nomination process there's quite a bit in here about herbal medications there is some additional things about nonverbal communication making sure that we're doing warm handoff it isn't I'm climbing on the foot here I've got yep okay yeah yeah all right trying to cheer actually connecting with the person who's communicating with you showing that what they have to tell you is valuable comments and questions to deepen your understanding eh our documentation is also on that list making sure our written communications to each other are just as clear and concise and careful in its messaging verbally nonverbal the third strategy our domain of skills between values and si I get a lot of questions about this how do you develop a positive workplace will Germany what there's an easier today at home than I have today but the team functioning is a piece of having that positive work culture impact run - ah improve team process and measurement while the back end influencing stress or for funny the other thing is embedded in here is at first blush she might stay at simpler right us inside us and that may be true however if you look even offset as the heck about this and the ethical codes are a little bit different so in the psychology world which is my world if I receive a patient for therapeutic purposes who's in a clinic that patient happens to be 25 and happens to also be a medicine and once more left that would be part my other coat purple jeans do relationship and provides a new potential for fresh air or influence that there's no and so I don't have to withdraw from that research just actually came up and the end of the promotion your disciplinary research team did not appreciate the extra guidelines that my professional tax on that relationship as what we hadn't had as conversation so it's actually a party service to be able to those nuances in a way that doesn't nearly make your team members and doesn't another complication yeah started in the past was an Alan you're on the line please mutants are summing amplifier I don't know if you know that maybe if that's what it is there's somebody out there that has not uted themselves eating here you that's what they did you guys are taking first priority here we always said we always said you would take first priority here so that's what we're doing sorry that's where you go and the last donating is teamwork now social sciences for decades have done research on effective team process thinks it's real team process how to navigate the transition off of a valued member and a hold of that leaves on the team how to handle the transition on the new member and the cultural attitude routine and also means America needs us now in the corporate world they have that research for both of the decades I know that there are the team-building retreat team interventions and world is not until recently that we adopted some little bit of strategies in healthcare growth right and so you might view more about the impossible to which our offices their prized team-building skills okay so these are the collaborative skills created by iPad that we are being charged to develop in our learners across profession and it's true for all learners and it's going to impact their team skills not just in the clinical context all of that gets all the play right but it is also turning the research context we have a large current research faculty and a robust graduate school program biomedical sciences these are bench science folks who would never ever be in room so we have to make against they're designed to be relevant for those learners and teach team science right NIH funds to a greater degree those projects that have five or more this involved immigrants and I just also created a COPI I process which I navigated recently and it's time to get funding our deepest point of cofee on there we work together in the fourth grant process so NIH is appreciating this just as much so all of this means that IP is designed to prepare workforce to practice together to learn together to investigate work research together so what about just briefly about what you analyst says and it's helpful to know who we are the scope of the institution and the charts that we had the Chancellor the Provost created the office of IP and 2014 in Hana 1/2 time director and one administrator model at that time it's doubled in size now we have two directors I am the faculty focus 1 also clinical staff focus and then my partner dr. Neil who is a clinical pharmacist runs our student curriculum and then we have two program managers and we have to employ Department we're studying students who take our events and also work for us and give us very candid very candid feedback our event but we have almost 3,000 pre-licensure students we in addition had probably 1,500 or so and fast learners remember residents pharmacy residents dental residents etc based practice nursing EMPs etc problem is that not all student groups are easily identifiable in your accounting numbers so they're not all along his life we have about 1,500 maybe now 1,600 faculty members the students by colors are down below can't see the money which is nursing past the most followed by medicine health professions which has a number of different degrees pharmacy public health and then our graduate school and then we administrative the organizationally decided that we didn't want one person or two people the two directors to make all the decisions about the curriculum we needed to have an input from everyone so we very intentionally fill five interprofessional e derives or comprised pillar teens large committees the first is our student Greatland dr. Neil chairs this meeting I think frankly as well and she developed a work group for all the seven categories of events that we offer right multiple offerings are options within each category and then she also has a worker looking at assessment and evaluation in which we will look at later each of those events were then piloted with a small group of students we dated focus groups after much more intensive sort of assessment of it and tweeted then went live with our offerings we now doing I'm going once a year Qi process for each of those events look at the most latest feedback see where the problems are and twiki events annually this is my team the faculty focus tour now clinical staff focused team we also have a number of worker work groups doing specific targeted current workforce initiatives there might be seminars it might be quality improvement programs it might be our 101 which we did every faculty member live on every campus took us about 18 months but that was designed to tell everyone about why we are engaging in IPE show the literature to do that they be able to talk about why we made the curriculum the way we did answer questions and engage those who want to help us as facilitators we also have a collaborative practice arm is really working on their team consults or finding the exemplars those teams working really well together and we make sure shadowing experience has happened so you want your students to both see the best and best now we have research teams as well as clinical teams that could be shadowed we also have an internal Qi grant so not the student focus one separately we say to all the current workforce if you have a great idea and it's going to improve care patient outcomes patient experience reduce stress impact population health or reduced cost we would like to entertain that we do a call twice a year people submit to us we have an interprofessional team ranked than when we fund maybe $80,000 worth of grants from the corner price P in addition we have a scholarship group writing grants we have fortunate to be supported by quite a few grants we've had Renu Delta Dental several large person plans supporting the work that we're doing in the office kind of almost doubling what our institution is putting in we also have a number of us working on publication because we are literally swimming in data and we see our first time you'll see why and we need to get the word out about what we found and then in the middle we have developed in our community engagement making sure the community knows what we're doing we're linking our initiatives with their initiatives in many ways and then also looking for little funding which we've been able to secure as well so those are the five committees sort of driving the effort of the office both faculty focus and student curriculum focus this is what the curriculum looks like and we'll copy this in your handout there are seven elements on the far left is our novice workshop they're just come on campus they go there a training to be a something they haven't had classes yet it's usually the first day in the first week to canter in to the taste and say let's talk about this some night yeah they might want to do that sometimes they give us feedback they'd rather do a case something they're really not prepared to do that so we've spent in that workshop helping them get to know each other start building relationships start sharing with each other why they're interested in becoming the thing that they're there to turn to be and then where that overlap is patient family centered care ethics health equity social determinants of health health literacy and culture comments those kinds of things all of them in active learning so not for hours or we shorten it to three few years ago about three hours and bless you who needs that when you're orienting mini-tennis hoc active learning activity many set us off active so they're practicing storing those feet skills from that person in the next a little shoe fee down below our rich activity they have multiple choices here they can read a book you go to a discussion they can watch a public health community we do two a month a different ones all month each month is a different one you sort of attach it to what's the theme of that month is of its vaccination length repeal health awareness monitor whatever we'll have movies associated with that when they go to a discussion afterwards facilitated discussion questions and they write a reflection the reflection pulls in my competencies to the topic that they were involved in they then do Triple Aim project it's a Qi project design they don't have to do the project they just design it together so they're given a topic and it might be a room of 18 sown everyone's given the same topic and then they all each team comes together and have a faculty facilitator in each table talk about the topic design your own idea and then present them at the end of the workshop the best ones top rated ones please huh the nexus simulation of course it's a team-based simulation not a clinical skill simulation some are clinical scenarios but we have graduate students we have laboratory science students who are not in the room with patients we have health information students so we have to create a number of different simulations to better explore and improve the relevancy of that simulation for each of our student groups so we run simulations twice a month these various topics some of them have been so the few has been so great like our medical malpractice sandwich we do in an actual court of law with law students who are playing the roles of but that one has been so exciting that were on tonight's faculty [Music] we have nine different sins you can talk about that later that's sort of our intermediate phase where they're practicing and coming when you get to the final phase they're approaching graduation they should be able to engage in a team activity with fairly good competency maybe not perfect confident to do it so we expect a lot of them that we do at this pace workshop there and they have to work to provide additional assessment and treatment modalities don't have a couple different kinds great-granny workshop that they were burned they're trapped where for our research our myths things we've got an anatomy one there's a couple of different variations for their choice they also have to write a reflection about an existing practice activity they don't have to do an extra one you should people one they're going now they're on a clerkship or they're doing a clinical rotation they can write a reflection and say here's going to see see here's this one well here's what's not going well here are the things and this is specifically required here the things that I as a student on Steam can do to improve the team functioning bring awareness help build skills have inform the team sounds really important because when they get up in there Junior whatever is junior nurses on the team or maybe they're a fellow or an emergency emerging or a faculty member they have to feel everybody's voice is important to make a change everybody's voice can result in change so we specifically build that in there and then our student Decatur activity we build honestly for them to come and help us with events and that helps with education requirements teaching requirements having exposure to that but we also were training them a little bit in our facilitator skills what we found that they wanted to do much more than that so now one campus built ite grounds and they a team gets together they discuss a Turk certain topic or issue have a taste that they worked on together that is related to that topic or issue and it's so popular all the faculty or Canadians has very high rating so that's an example of people looking at our program in our in our own UAMS mirela and taking another idea that could be really good and adding it on and then we count it as credit in our curriculum so if you were to load in your handouts you would see a more complicated number of hours for each about 26 hours that they required to do now some programs are 18 months long summer for when it's five it's an attorney they have to do all of those things each program decides where in their trajectory are they considered novice where in the trajectory or leads to their intermediate and where in the trajectory are they consider emerging confidence they also tell us whether these events are embedded in class okay you're not putting the class today going to the since instead or whether it's on top of or in addition to their normal dip scheduling has been an issue I understand I've got this to here as everywhere we currently have most things Friday afternoons we did have them in evening for the wild that did not go over well people are tired and cranky and the faculty are not available they have families and children and lives and so it's been difficult to cover so we've moved them back to within the day since still happening with the same Center is available first Monday through Thursday but both of the rest of it is trying to have two hands so all that to say is what we do at UAMS is in the spirit of the original intent that interprofessional education is a method of teaching it's that active learning the practice the working through problems that coming together with collaborative solutions that is the intent and it doesn't really matter if it's related to the clinical harm of things if it's rated to the educational arm of things barça's related to the research so summary slide students faculty I would add removable staff and employees to this but it won't fit in my little diagram across all three of our missions utilize skill building in these four areas to move forward but on the Institute for Healthcare Improvement and 2011 call the quadruple aim patient care and experience reducing costs adding a charge for population health UNM s is in charge of our entire state we're ranked very poorly on several health indicators we're going to be paid between first four improving statewide indicators that means we're going to start doing a whole lot more public health focus next and then of course at the end provider satisfaction work burnout prevention or work satisfaction whatever terminology we'll use to try and not stress our people out with our changes make things better so our office provided the nike faculty facilitator training workshop it is four hours half on facilitator training how do you feel comfortable confident and prepared to facilitate an event that has nerves that are not your own probably feel great about working with your own learners but how do you know what a health information management training nodes are done that no they need at this point in their training how do you encourage those that are more tuned how to punch it down at once or they're taking over the conversation these are all facilitation skills how do you not teach when many of us have been taught over and over and over how to teach but to facilitate them learning what you want them to learn together them stuff's not what they learned it from you so happy workshop is on now and then half his own event design now have time to do the workshop freedom in ten minutes but I'm going to show you a few highlights so you know what we talked about there so one is each apartment has a tips and tricks a facilitation guide for how to make this event go well it's what kind of room works best what kind of arrangement of the room works best Tony silat ators you need what to say a pre huddle to gel your co-facilitators before you start things like how about you but they're on their phones constantly it's practically an appendage that doesn't detach when all their generation that's harder for me so in many of our but it's not quite all because some we use the phones for the activity but in many of our thoughts they make a big show of eternity going on and I say I admit to you I have someone on a call for me my kids are taken care of I'm turning off and I'm plugging time they are a hundred percent freedom if you meet me in that place that being engaged here we will have a wonderful experience this afternoon we'll probably get time for ugly and we do hold to that within about ten minutes for a legislative amendment if it goes well and I'll put it off to the side that is some kind of helpful there are other ground rules and things that we do and we're constantly watching our learners and their nonverbals to see if their own paths to see if they're off task so we can intervene appropriately during the event we ask a lot of questions we do very little teaching that's a skill and it usually if you've been educating a long time it's disability after we learn because we're we tend to be taught to be teachers before we were taught to be facilitators you know we're going cold facilitation if I'm working with someone new I have an offer free huddle we made at the break Sammy has a phone did you see how I kind of was looking at it this way did you know what I was meaning there because we don't know our nonverbals look at me when I do or we're not have to say anything we can read each other completely so that's a skill that gets developed over time with someone different skill with somebody else we deal with a model teamwork together we're pulling in different directions we're not showing the trainees what they need to see for modeling that teamwork and then we do often at the end of the sync everyone for coming has spent time they have been gauged with open hearts and what we wanted them to do we sent him for that that shows a marvelous respect for all and for the engagement and the time we make now there is a number of common problems they don't have it all the time but they do come up and so the facilitators have some eggs when we do if and then one of these might happen so we actually built some online modules to in addition to our workshop on one for small group so if you're working with a group of eight maybe on a Qi projects the other four large group so if you're working with a room of 120 with two other facilitators what are you going to do to manage any of these particular problems who haven't handout that summarizes what we say is white with black writing so a little bit if once you can take with you many of our facilitators having the clipboard in a room with them to remind them what to do until they start to feel comfortable we also have a separate training that's just for online facilitation that requires a lot of additional stuff for instance come to be really comfortable with the platform and play around with Facebook close to player Animas blackboard communities would have chat rooms that sort of thing in addition there's no non verbals online and they can talk each other pretty quickly if you're not on top of it so how to intervene and make sure people are I can intervene in that format to make sure that people aren't upsetting each other unintentionally now there's lots and lots of best practice dates for online facilitation and you guys have access to these slides I will not because Heritage Month that's the kind of stuff that we so the other half of the workshop is really to do a vent design people who have an idea they didn't have an existing event pajama club how could I make that my apini event well if you're going to invite other learners you can quickly make Annunaki event inviting other learners and we're making sure they're discussing with each other not just listening to present or something for tonight we have a way for people to obtain credit for whatever actively that currently that's the quick and simple to process so we can acknowledge that those things are happening across our institution oops what what I've talked about is resonating with you what questions you have but things are happening in each of your neck of the Kirlian woods that you think is really wonderful IP experience that you'd love to share with others or share with me we're always trying to get through ideas from others and share what we've learned with folks too so we now look forward in this emerging field yeah / - say what the challenges I think our society yeah so the question is about how to implement things in a protocol or [Music] many of our regional programs have a case based discussion that is complex pieces that happen in that clinic setting so it's there that those are all primary care but they have all the current workforce of ten and they have all the students attend so if you've got nursing trainees and medical students or residents and you've got your current workforce it's interprofessional and having those cakes discussions it might be we're stuck with this case I don't know what to do next who here has an idea you're told you know here's what our government plus problem-solver if you don't know when we consult but other team members we added this discussion to make things better and often it's creative from something that happens so that might be one thing many are already do something like that'd be one thing to pull an integer up those are in the living there frequently happening the bit with community professional trainees this so easy to avoid someone else who's interested in geriatrics or Pediatrics or developmental behavioral pediatrics to add more learners advertising and that would be a very much here professional discussion post our club those anytime you minute products on their currently existing and just tweaking you never ask me to do something more here's a little bit so that it was richer discussion more depth of comparison they were making sure to reference assignment many things like reflection rounds pulling for the joint interest and stress for me professional means so we have a workshop that's four hours but better attended is the manner in which among people minutes of it or a whole thing of it you know stress is up being like or literally just become a chair have some fellowship but like there's already looking for something [Music] it is so our Chancellor and provost and our Dean's of the five colleges and the graduate school came together in 2013 and said this is accreditation requirements across the board almost all of that time to come out at least what we're thinking about it we need to be ahead of this not behind this and they said it's a graduation requirement starting with 2015 those who started in 2015 the triple-eight event and forward so we have for almost four classes of pas quite a few classes of our ends we just finished our first class of medical students you know [Music] they're mandated to do 28 however we've got credits on so many different options they tend to do much more than that it's just that they happen to want to go to see something that would they were part to you [Music] yeah Malcolm this is pre-licensure so as and once you're in for you want super beautiful works right we do a little bit different with our residents first of all our office its first initiative was to get comprehensive according to our framework built and all of the students in it absolutely as possible so we focused pre-licensure first we are now focusing advanced learner that all the improvement program that's nine months long the teams don't just assignment we do it several PDSA cycle that we have our MOC accrediting people on murder so the facilitators working that can make that for accreditation ask an assembler presidents depending on the rules time you know for some of the Department of Pediatrics of Pediatrics presidents convention we also do the professional Wellness things and both of those initiatives were not because the Chancellor and provost and you have to have a curriculum make everybody do it the best what we did for the pre-licensure both of those happening is that residency director is four of them Amy talked to me and said I know you're doing other stuff we want to have something meaningful that's ite that also meets one of our other criteria here they are right now with struggling becoming a professional almost happen and how to do real cure so we've got a program for both will prime not stay there or Pikeville to other things how wonderful that they're not coming to us and asking for help as opposed to having a top level down and a lot of negativity in our leaders [Music] I'm sorry because it rings we go that far I think Morales are institutions as a whole other bigger conversation but we're going through a reduction workforce we have a number of things that would affect morale and nothing to do with us no I think we can leave show we can do it is 3,000 students we can accurately track who soon what is logistics are what this is all about logistics and I'm a program manager that detail-oriented she's on top of it all we have a faculty tracking database who was training in for a certification program which I'll mention in a minute what level are they what do they need to be asked to invited to do next to get finalized in that so we've shown we are can do so people in that part where they have speaker coming in they asked us to build an event around it and more people in that room more faculty and more students oh yeah if they are looking on a new workshop and they want to maximize impact we disseminate well we accurately counter data we share data quickly so College Medicine says framing LCME visited we need some mega boom so I think it's not costly and nobody's ever asked me that before I take that back nest and have a sheet minutes but yeah it means that we do [Music] with so around June when you try and make it a well you know [Music] to someone feel like that makes it you know nature we used to be mind and now it's Alison there's some of you that miss announcement or something yes I asked because it's impossible for us to attend everything right but I was feel like if we do you IP love this a small division of small specialty feel like they were lost out in his eye oh yeah so that has them up generally our offices we run illusion so we put reflection rounds but ask their role where the grounds were people said Tuesday noon was a good time right smack milk internal medicine the minute somebody told us hey there sir people are that's kind of like a Friday afternoon it's almost nobody does in here there's some classes there that had to be paused renew their things so there's educational things happening then not so much Grand Rounds a privately so we try to help people not do that like put it in places where it's not conflicting whatever possible true but yeah it's important the other thing is if you're combining an event what I thought maybe we're asking is it used to be my journal club and now all the other people are coming in or not my control I actually teach the incoming people to have a point faculty one person faculty member and they collaborate ahead that person who started it is losing control us or they're adding to program and that was puppies that we so Wallace so what yeah [Music] so we have a four hour and professionally facilitated workshops we've been giving it to faculty for two years now clinical staff got none of it now all new nursing hires have to take that workshop it's a initiative because in the nursing world the first year that engagement and institutional belongingness communal Iraqis to their likelihood of legal institution is usually there to to unify we have a nursing shortage and we need good trained people so retention why they wanted to improve that first-year incoming nurses so they have a number of events not just ours that first year but ours is one so now we're doing lots of now you're ready to heard about it so Kohaku led by lack of people is your part or than the new nurses so we've been doing that now the subtlest and the residents found out about it so now we're giving that to fellows and residents it's a half-day go so the reflection rounds are a little bit easier for more regular kind of touch points than a half they have to row the prearranged holy book I would do pre-licensure reflection around advanced learner so presidents and tell us and the life and then we do a faculty and they're all separate because they absolutely how does take place it's a great question because I'm a psychologist - I every one of our events we have a question that they discuss which is that you're working with this population we're richer sources of stress coming from and we're what kinds of things would you do to help keep that stress manageable so that was important to me a personal level that we were talking about that Paulo students all right there one question but it does provide a threat okay so two things else that I would let's talk about and we don't how much fun everyone in this evaluation and assessment every one of our events has multiple points of evaluation not every one of our events has all of these but at least one of our events has one of these that make sense so we have pre and post knowledge on some of our events but not all what satisfaction and perceived utility of the event that's pretty much on all of them we have attitudinal and perception changes we used to use the ripples for this purpose if you're familiar that's a highly vetted option in the last two years maybe three years now we've been going to IP conferences and people then bring out problems with the ripples so we switched over two years ago to the iPass which is a little bit different than similar in intent getting it those intangible how we feel about each other how we feel about teamwork perceptions and attitudes we do structured observation particularly in simulation we have feedback from patients or simulated patients and incorporated into some of our event we certainly ask them to rate themselves on skillet even when they rate themselves before in the event it tends to be super high and there in the event the law realistic if you say at the end what did you think you were there and what do you think you are now so it'll be lower they're better now don't have a ways to go and that isn't just something we've seen that's also a few literature we have peer report on one event it's the it's the turbulent project so qi project that they work on we have each of them rate each other on a number of team skills now that one is it will be very careful with that could cause hard families if we are implementing right so we haven't at this point share that data with them next year we're going to try and share it it will be aggregated my individual the teams are eight so it's fairly non revealing but it would be helpful to say my peers think I'd really didn't contribute at all and I thought I was doing fine that's an important moment to have we do have reflective essays that they write three times in a curriculum from the novice one in the intermediate and one in the advanced so we can do some qualitative analyses we also have a rubric that is quantitative so we can be both and then we hope to follow our students post graduation so we're in the midst of conversations with all the alumni associations who do regular surveys mostly annual and asking if they would put in some of our questions so they're not doing a separate survey but it's combined with something they're already pretty engaged with and see if we can find if what we're teaching them now was meaningful enough we know one you kind of never going to teach all these skills are we doing enough and the right thing down or up and we hope that that survey will help us will want long term impact the only other thing that I wanted to highlight is our certification training so I mentioned a little bit about this the 101 every faculty member all sixteen hundred got in-person by every site Co delivered took us about eighteen months it is now online all new hires can watch it so that they have that to then people will take that half-day workshop half facilitator skills half event design we those things that come out of the event designer super cool we have funded in now as part of our curriculum as well and give you some examples of that and then they pick because a facilitator skill for simulation a little bit different than our research project advisor a little bit different than a preceptor a little bit different than the workshop right and we had a seven categories plus online plus all the faculty facilitated events which are on here this is just an example so after the workshop they pick one let's say it's in one of these the one on the end has X's let's say they want to build their own event we're gonna horse certify them in there we help fund new IP events by the way we give them a certificate in your packet of handouts there in this language for the promotion and tenure packets across colleges all be Dean's in the previous is important valuable for the institution supporting their previous agreement that everyone all the students have to do it until there's language that you can use to talk about the certification process we have a few they've become master that's three or more categories of events that they're able to provide that last part of the process is three-step we give them all the material securing everything with the powerpoints watch a movie whatever they want to do they then come watch an event and I sit in the back with them explain hey we talked in the workshop about this that's why they're doing it this way kind of explain it as we go along and then they co-lead with an experienced facilitator I support them in the back of the room on the scales and do some qualitative stuff - all that to say is we're feeling life the people who finish this process are well qualified facilitate events we started with eight early adopters who were burning out very fast in our first year we now have 50 certified we have 22 horn master and we have another 50 in process so our role is to what we originally we're now we now have goal of 100 who can help us we do 300 student events a year and 100 faculty or clinical staff low estimates there so we can't hold that help and more say thank you so much for coming and hearing what we're doing and when we share that with you and I hope you can share with me so we do we do fun I mean that's pervert nation with our faculty they come up with a good idea what's getting in the way is funny but I hope you all have enjoyed the session and find ways to incorporate some of these and that word is spoken about which is day and your own as our own environment.