Design, Presentation, and Evaluation of an Interprofessional Case Conference on Fibromyalgia

This paper describes a case study presented to students and faculty in the health professions at an interprofessional case conference. The case described a fictional patient diagnosed with fibromyalgia syndrome as she progressed through six appointments with different healthcare providers, each of which was described as a case vignette and progressively presented to the audience. During each case vignette, students engaged in peer-level instruction regarding disciplinespecific content. Faculty facilitators provided a brief discussion about key elements within each vignette. In a postattendance survey, 92-96% of respondents agreed that they had productive interactions with students and faculty from other health professions and learned how these disciplines approached a patient with fibromyalgia. While 92% of the student respondents agreed that contributions from different healthcare providers was an effective therapeutic strategy for the case patient, 100% agreed that an interdisciplinary approach has advantages to solving a healthcare problem over a mono-professional approach. Our progressive case study model may be used or modified by other schools with multiple health professional programs to provide early experience learning collaboration within an interprofessional framework. Our preliminary results suggest that this approach can increase student appreciation for, and understanding of, the skills and scopes of practice of professional colleagues from other fields through interprofessional exchange. Future investigations should determine whether professional collaboration among healthcare providers improves when they participate in such activities during their professional education. Received: 04/09/2013 Accepted: 08/18/2013 Published: 10/07/2013 © 2013 Jobst et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Interprofessional Case Conference on Fibromyalgia EDUCATIONAL STRATEGY 2(1):eP1050 | 2 Introduction Effective patient care within our current healthcare delivery system requires communication between providers in various professions to initiate referrals, communicate patient progress, and produce the best possible patient outcomes. In order to achieve this, healthcare professionals need to understand the specific language, skills, and scopes of practice of professional colleagues from other fields. The ability to work with colleagues within interprofessional teams and to “cooperate, collaborate, communicate, and integrate care” has been defined as a core competency for healthcare professionals by the Institute of Medicine (Committee on the Health Professions Education Summit, Board on Healthcare Services, & Institute of Medicine of the National Academies, 2003). Despite this expectation, health professional educational programs do not consistently teach the skills necessary to operate interprofessionally (Garr, Evans, & Cashman, 2008; Barnsteiner, Disch, Hall, Mayer, & Moore, 2007). Further, it may still be common for students from different programs to rarely interact with each other until they begin practicing in clinical settings (Coster et al., 2008). Interprofessional education (IPE) improves interprofessional cooperation and communication, improves organizational practices, and benefits patients (Freeth et al., 2002; Barnsteiner et al., 2007). IPE generally takes the following forms: 1) shared learning, 2) simulation/case-based activities, or 3) post-graduate specialty courses and programs. Though disagreements exist regarding which of these forms is most useful, each offers some utility. The shared learning approach (also referred to as multiprofessional education) involves creation of an introductory curriculum in which core topics are taught using common lectures, seminar work, or group discussions within a multiprofessional school of health professions (Mazhindu, 2001). Difficulties implementing IPE using this model include: differences in prerequisites for admission, programmatic structure or organization, scheduling, and resource sharing across programs (Liaskos, 2009; Committee on the Health Professions Education Summit et al., 2003). While some educators and students describe these experiences as valuable (Cullen, Fraser, & Symonds, 2003), others suggest that simply learning common content without emphasis on collaborative practice skills does not facilitate interprofessionalism (Mazhindu, 2001) and may “detract from the differential application of knowledge and comparative curricula about respective roles and responsibilities”(Barr & Ross, 2006). Another approach to IPE includes simulation or case-based learning, which has been thoroughly described elsewhere (Committee on the Health Professions Education Summit et al., 2003; Freeth et al., 2002). Overall, approaches using small teams and group case work are consistently described as effective educational techniques (Coster et al., 2008; Barnsteiner et al., 2007; Fraser, Symonds, Cullen, & Symonds, 2000). Post-graduate and postprofessional specialty programs include a plethora of short-course/seminar type experiences (Freeth et al., 2002; Barnsteiner et al., 2007), but few examples of prelicensure experiences have been published. In 2009, the College of Health Professions (CHP) at Pacific University had seven schools and programs: Dental Health Science (DHS), Healthcare Administration, Occupational Therapy (OT), Physician Assistant Studies (PA), Pharmacy, Physical Therapy (PT), and Professional Psychology. In 2013, the CHP added four programs: Athletic Training, Audiology, Gerontology, and Healthcare Compliance. In a report to the Northwest Commission on Colleges and Universities, administrators within the CHP stated that one of its primary goals was to foster interprofessional practice (Pacific University, 2007). One measure to achieve this goal was the establishment of an Interprofessional Case Conference (IPCC) series. Initiated in 2005, the IPCC series brings students and faculty from each of the schools/programs together monthly throughout the academic year. Each conference is designed as an interactive forum to learn about selected health topics or to discuss regional interprofessional care programs. Common features of the IPCCs include collaborative preparation and presentation by faculty and clinicians in a style requiring student interactions, active learning strategies, and critical thinking skills. Conferences focus on teaching students how to understand and relate to their colleagues in the health professions by using small teams comprised of students in different health professions programs. In this manuscript, we describe an IPCC presented on September 11th, 2009 titled “Fibromyalgia: A Visit to the Interdisciplinary Clinic” Our IPE design followed the small-team and collaborative approach for optimal H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu.edu/hip 2(1):eP1050 | 3 interprofessional programs previously reviewed and modeled by Mazhindu, in that it emphasized inquirybased learning with a focus on a practical patient/ client-based scenario (Mazhindu, 2001). We presented a progressive case study format and outlined the path of a fictional patient experiencing ongoing symptoms of fibromyalgia. Students attending the conference followed the case patient as she progressed through a series of six healthcare appointments. Each of the case vignettes (i.e., a visit to one specific healthcare professional) was written and presented by a faculty member representing his/her respective program. The fictional patient initially visits the physician assistant and is referred to physical therapy, pharmacy, psychology, occupational therapy, and dental hygiene appointments. Each appointment was presented sequentially in a separate written case vignette. Small student groups representing more than one health profession were asked to discuss the vignette. Students from each health profession were asked to teach students and faculty within their groups how to understand and interpret the case material specific to their discipline. The main goals for this case study were for students to: 1) increase awareness of the roles that other health professionals play within a multidisciplinary treatment context; 2) learn about other professions’ terminology and goals related to patient care, and 3) gain appreciation for the value of interprofessional referral and treatment related to evidence-based patient outcomes. The purpose of this manuscript is to present an interprofessional progressive case study including participatory questions that may be used or adapted by other programs wishing to include IPE within their curricula. Student post-attendance survey data are included to assess our main goals for this progressive case study approach. Preparation of the Fibromyalgia Progressive Case Preparation of the case began with identifying faculty participants from the respective programs who had an interest or specialty practice related to fibromyalgia. Six faculty members (one from DHS, one from PA, two from Pharmacy, one from PT, one from Professional Psychology) and one community clinician (from OT) volunteered. The seven-member team collaboratively designed a fictional case patient with fibromyalgia and educated each other on discipline-specific concepts. Characteristics of the fictional patient, such as demographics and medical background, were collectively established and a basic structure for the progressive case was agreed upon. Each team member described evaluation and treatment services that clinicians in their profession would typically provide individuals with fibromyalgia. Following the initial meeting, each team member submitted via email a vignette with accompanying group discussion questions. These materials were peer-reviewed and t