How to ... be a reflective practitioner.

The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.

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Health Professions Education: A Bridge to Quality

Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.

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Interprofessional teamwork: Professional cultures as barriers

E-Moderators are \"the new generation of teachers and trainers who work with learners online\" (p. viii) using Computer-Mediated Conferencing (CMC) as a learning tool, regardless of the subject they are teaching. They are the focus of E-Moderating, a recent book which provides both a theoretical framework for developing online learning using CMC (part one), and a wealth of practical advice (part two). The book is supported by a Web site. The author, Gilly Salmon, a distance education specialist with the Open University Business School in the UK, provides a five-step model of effective online education, along with copious examples of how the model relates to real-life online learning contexts. Salmon proposes that, by basing learning on a constructivist model, it is e-moderators that can make the difference in online education as they convene, direct, summarize, and archive synchronous and asynchronous discussions.

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E-Moderating: The Key to Teaching and Learning Online

Background: These recommendations have been developed to improve the care of intensive care unit (ICU) patients during the dying process. The recommendations build on those published in 2003 and highlight recent developments in the field from a U.S. perspective. They do not use an evidence grading system because most of the recommendations are based on ethical and legal principles that are not derived from empirically based evidence. Principal Findings: Family-centered care, which emphasizes the importance of the social structure within which patients are embedded, has emerged as a comprehensive ideal for managing end-of-life care in the ICU. ICU clinicians should be competent in all aspects of this care, including the practical and ethical aspects of withdrawing different modalities of life-sustaining treatment and the use of sedatives, analgesics, and nonpharmacologic approaches to easing the suffering of the dying process. Several key ethical concepts play a foundational role in guiding end-oflife care, including the distinctions between withholding and withdrawing treatments, between actions of killing and allowing to die, and between consequences that are intended vs. those that are merely foreseen (the doctrine of double effect). Improved communication with the family has been shown to improve patient care and family outcomes. Other knowledge unique to endof-life care includes principles for notifying families of a patient’s death and compassionate approaches to discussing options for organ donation. End-of-life care continues even after the death of the patient, and ICUs should consider developing comprehensive bereavement programs to support both families and the needs of the clinical staff. Finally, a comprehensive agenda for improving end-of-life care in the ICU has been developed to guide research, quality improvement efforts, and educational curricula. Conclusions: End-of-life care is emerging as a comprehensive area of expertise in the ICU and demands the same high level of knowledge and competence as all other areas of ICU practice. (Crit Care Med 2008; 36:953‐963)

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Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine

Purpose
This article examines literature on interdisciplinary education and teamwork in health care, to discover the major issues and best practices.

Methods
A literature review of mainly North American articles using search terms such as interdisciplinary, interprofessional, multidisciplinary with medical education.

Main findings
Two issues are emerging in health care as clinicians face the complexities of current patient care: the need for specialized health professionals, and the need for these professionals to collaborate. Interdisciplinary health care teams with members from many professions answer the call by working together, collaborating and communicating closely to optimize patient care. Education on how to function within a team is essential if the endeavour is to succeed. Two main categories of issues emerged: those related to the medical education system and those related to the content of the education.

Conclusions
Much of the literature pertained to programme evaluations of academic activities, and did not compare interdisciplinary education with traditional methods. Many questions about when to educate, who to educate and how to educate remain unanswered and open to future research.

https://onlinelibrary.wiley.com/doi/epdf/10.1046/j.1365-2923.2001.00919.x

Interdisciplinary education and teamwork: a long and winding road.

OBJECTIVES:
TAs a component of palliative care educational program development, the faculty at the University of Ottawa Institute of Palliative Care wished to assess end-of-life care for patients in long-term care (LTC) settings to develop an educational strategy for physicians.

DESIGN:
A chart audit, focusing on the last 48 hours of life of residents dying in LTC facilities.

SETTING:
Five LTC facilities in a city in Canada.

PARTICIPANTS:
Residents who died in the LTC facilities in a 12-month period. Those who died suddenly (i.e., with no palliation period) or in a hospital were excluded.

MEASUREMENTS:
Symptoms highlighted in the literature as commonly found in the terminally ill and the matching treatments were recorded on an audit form created by the authors. Included were pain, dyspnea, noisy breathing, delirium, dysphagia, fever, and myoclonus.

RESULTS:
One hundred eighty-five charts were reviewed. A large number of patients were cognitively impaired. Cancer was the final diagnosis in 14% of cases. Respiratory symptoms were the most prevalent symptom, with dyspnea being first and noisy breathing third. Pain was second, with a prevalence similar to that found in studies of cancer patients. Dyspnea was not treated in 23% of the patients with this symptom; opioids were used in only 27% of cases with dyspnea. Ninety-nine percent of patients who experienced pain were treated for it. Less than one-third of patients with noisy breathing were treated. Delirium was not treated in 38% of the cases, and no antidopaminergic medications were administered. Nurses were primarily responsible for documenting end-of-life issues, supporting the families of the dying residents, and communicating with other team members.

CONCLUSION:
The focused chart audit identified the high prevalence of cognitive impairment in the patient population, which complicates symptom management. Respiratory symptoms predominated in the last 48 hours of life. This symptom profile differs from that of cancer patients, who, according to the literature, have more pain and less respiratory trouble. Management of symptoms was variable. Nurses played a crucial role in the care of dying residents through their documentation and communication of end-of-life issues. Appropriate palliative care education can provide knowledge and skills to all healthcare professionals, including physicians, and assist them in the control of symptoms and improvement of quality of life for patients dying in LTC facilities. J Am Geriatr Soc 50:501–506, 2002.

The last 48 hours of life in long-term care: a focused chart audit.

Maximizing interprofessional collaborative patient-centred practice holds promise for improving patient care and creating satisfying work roles In Canada's evolving health care system, there are d

Developing collaborative person-centred practice: a pilot project on a palliative care unit.

In this article, we illustrate the application of a number of theoretical frameworks we have used to guide our work in interprofessional education (IPE) and collaborative interprofessional care (IPC). Although we do not claim to be experts in any one of these theories, each has offered important insights that have broadened our understanding of the complexities of interprofessional learning and practice. We have gained an appreciation for an increasing number of theories relevant to IPE and IPC, and, as a result, we have woven together more key principles from different theories to develop activities for all levels of interprofessional learners and clinicians. We pay particular attention to relational competencies, knotworking/idea dominance, targeted tension and situational awareness. We are now drawing on the arts and humanities and complexity theory to foster relationship-building learning. Evaluation of our endeavors will eventually follow these latter theories for methods that better match the human and social experiences that underpin learning. Our "theoretical toolbox" therefore may be of value to educators who develop and implement creative interprofessional learning activities, as well as clinicians interested in moving toward more effective collaboration.

Theories, relationships and interprofessionalism: Learning to weave

Background: The need for palliative and end-of-life care (PEOLC) education in prelicensure education has been identified. PEOLC requires effective collaborative teamwork. The competencies required for effective collaborative teamwork are only now emerging and methods to evaluate them must be developed. Objective: The adaptation of the traditional Objective Structured Clinical Examination (OSCE) for assessment of a student team addressing palliative care issues was undertaken. The McMaster-Ottawa Team Observed Structured Clinical Encounter (TOSCE) is intended as a formative evaluation tool for both competencies in interprofessional collaboration for patient-centered practice and PEOLC. Methods: Three stations based on palliative care scenarios were developed. From January 2007 to January 2008, a total of 141 students and 38 observers participated in the evaluation of three stations, with 6–7 students per group and two observers per station. Observers completed checklists for both PEOLC and interpr...

Lynda Weaver

Papers

Interdisciplinary education and teamwork: a long and winding road.

The last 48 hours of life in long-term care: a focused chart audit.

Developing collaborative person-centred practice: a pilot project on a palliative care unit.

Theories, relationships and interprofessionalism: Learning to weave

A method to enhance student teams in palliative care: piloting the McMaster-Ottawa Team Observed Structured Clinical Encounter.