From silos to teamwork: Adapting interprofessional education to online hybrid asynchronous and synchronous model for HKU – Fraide A. Ganotice, George L. Tipoe
Interprofessional education (IPE) is an increasingly popular medical education model designed to overcome the limitations inherent to disciplinary silos where students are trained within the confines of their own disciplines. Effective teamwork and collaboration, competencies closely linked to IPE, have been shown to significantly improve patient safety and reduce medical malpractice (Neily et al., 2010). Through IPE, students from diverse backgrounds are trained to be better collaborators by making use of relevant opportunities to learn with, about, and from each other (Barr et al., 2014). To narrow the gap between classroom training and clinical practice, medical curriculum must accommodate the shift from “silo” to team-based model (Long et al., 2014). This is an important step in rethinking healthcare delivery “from fragmentation to a position of strength” (WHO, 2010).
In this regard, the Li Ka Shing Faculty of Medicine promotes education for collaboration through its three-tier Interprofessional Education and Collaborative Practice (IPECP) programme (https://www.ipe.hku.hk/). This three-tier IPECP, with a slogan “Providing better care through the transformative power of collaboration” cuts across the curriculum in which learning activities are organised into continuum: Tier 1 (IPE literacy), Tier 2 (IPE pre-clinical simulation), and Tier 3 (Collaborative practice).This cross-faculty and cross-disciplinary programme involves students from six disciplines: Chinese medicine, education (speech and hearing), medicine, nursing, pharmacy, and social work from three collaborating faculties: Li Ka Shing Faculty of Medicine, Faculty of Education, and Faculty of Social Sciences. Through gamified modules (Anticoagulation therapy, Dementia, Developmental delay, Depression, Multiple drugs, Cancer), students in interprofessional teams are expected to develop essential teamwork skills including respectful communication, collaborative decision making, negotiation and respect for diversity, and teamwork and collaboration. The implementation of modules is facilitated by an interprofessional team of content experts.
Recently, the outbreak of coronavirus disease has resulted in the disruption of standard classroom practices. The disruption caused by the pandemic, which fuelled the need to creatively transition the face-to-face to e-learning model without jeopardizing the programme learning outcomes, led to the inception of a 10-day “Asynchronous and synchronous online IPE” (Figure 1). The gamified hybrid online model mitigates the potential health risks of large student gatherings. The asynchronous phase affords students with time flexibility to complete team-based tasks, while the synchronous phase provides them real-time interaction to foster social interaction and collaboration.
Figure 1. A 10-day asynchronous and synchronous online IPE model
The team-based activities are designed to tap deeper cognitive processing based on Revised Bloom’s Taxonomy (Figure 2, Krathwohl & Anderson, 2009). Through the various team-based activities, we promoted team cohesiveness within teams to enable members to work as a team and not just collection of individuals (Chapman, 2005).
Figure 2. Mapping the IPE learning outcomes with Revised Bloom’s Taxonomy
Using e-learning platforms (e.g. Learning Activity Management System, Zoom, and google slides), the students participated in the different stages of the team-based activities. During the “preparation”, we asked the teams to do the following: e-meet their teams, name their teams, and write multiple-choice questions. These were done to promote shared goals and “we-ness” in teams. During the “readiness assurance process”, to trigger the development of respectful communication and understanding of contributions of other disciplines in care management, we instructed the students to respond to well-written multiple-choice questions in best-item variety. Given the complexity of the MCQs, the appeal was designed to empower the teams to have an intellectual-challenging discussion with the content experts. The “application exercise” (Michaelsen & Richards 2005) was an important part to prepare the teams closer to clinical application through Interprofessional healthcare management planning (IHMP). Teams conducted independent meetings via Zoom to manage the case and to propose IHMP (Figure 3). The “enrichment activity” (synchronous phase) represented the culmination part where the content experts went live in a classroom while teams joined the class in the convenience of their homes (Figure 4). Gamification of IPE (Kahoot) helped maximize the participation of the students. Teachers attended to the team appeals when needed and facilitated discussion between teams. An important part of this enrichment activity was the teachers’ identification of three IHMPs which contained important discussion points. During the synchronous breakout session, teams reflected and revised their own IHMP based on the teachers’ feedback.
Figure 3. Sample Interprofessional healthcare management plan
Figure 4. The teachers and facilitators during the “enrichment activity” part of online IPE for the module on Cancer
Based on our experiences in running a large-scale online IPE, we identified interweaving factors critical in achieving online IPE outcomes: pedagogical design, electronic platform, and teacher facilitation. The design (including sequence, timing) of our online IPE is the output of careful planning with administrators and teachers. The e-platform and teacher support were very important to make the whole experience pleasant to the students who were geographically separated because of social distancing measures.
This IPE experience at HKU allowed us to help advance the IPE research agenda (https://www.ipe.hku.hk/research-publication) which focus on tearing down disciplinary silos through interprofessional education and collaborative practice (IPECP). Central to IPECP is untangling the basic instructional, motivational, and psychological principles that underpin its success in The University of Hong Kong. The positive comments of students and teachers were encouraging and the recommendations for areas for improvement were worth considering. In response to our metacognitive questions, an MBBS student wrote “I used to think that managing a clinical case only involves doctors and nurses. I realized that it also requires collaboration among pharmacologists, Chinese Medicine practitioners, health care assistants, and patient’s caregivers. In the future, I plan to manage a case with a broader view, try to understand patient’s needs, and set up specific goals and expected outcomes for different patients.”. A pharmacy student reflected that “I used to think that doctors would just take the lead and do everything and make all the decisions without asking for others’ consent. Now I realized that MBBS students would actually ask for our advice and opinion. In the future, I want to work closely and be more involved in clinical decision making”. These as well as the other students’ reflections provided initial validation of the collective effort of the organising committee in improving medical education.
References
- Barr, H., Helme, M., & D’Avray, L. (2014). Review of Interprofessional Education in the United Kingdom, 1997–2013. Centre for the Advancement of Interprofessional Education. Retrieved from: https://www.caipe.org/resources/publications/caipe-publications/caipe-2014-review-of-interprofessional-education-in-the-united-kingdom-1997-2013-in-brief-authored-by-barr-h-helme-m-davray-l
- Chapman, A. (2005). Bruce Tuckman’s 1965 Forming, Storming, Norming, Performing team development model. Businessballs. Retrieved from: https://www.businessballs.com/team-management/tuckman-forming-storming-norming-performing-model/
- Krathwohl, D. R., & Anderson, L. W. (2009). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s taxonomy of educational objectives. Longman.
- Long, T., Dann, S., Wolff, M. L., & Brienza, R. S. (2014). Moving from silos to teamwork: integration of interprofessional trainees into a medical home model. Journal of interprofessional care, 28(5), 473–474. https://doi.org/10.3109/13561820.2014.891575
- Michaelsen, L., & Richards, B. (2005). Commentary: drawing conclusions from the team-learning literature in health-sciences education: a commentary. Teaching and learning in medicine, 17(1), 85-88. https://doi.org/10.1207/s15328015tlm1701_15
- Neily, J., Mills, P., Young-Xu, Y., Carney, B., West, P., Berger, D. … Bagian, J. (2010). Association between implementation of a medical team training program and surgical mortality. Journal of the American Medical Association, 304, 1693–1700.
- World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Retrieved from: https://www.who.int/hrh/resources/framework_action/en/
