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Summary of Updates Provided by Members of the Global Forum on Innovation in Health Professional Education’s Innovation Collaboratives

The Institute of Medicine’s (IOM’s) Global Forum on Innovation in Health Professional Education is complemented by the work of four university- or foundation-based collaborations in Canada, India, South Africa, and Uganda. Known as innovation collaboratives (ICs), these country-based collaborations characterize innovators in health professional education through their demonstration projects on how schools of nursing, public health, and medicine can work together toward a common goal. The four ICs were selected by IOM leadership through a competitive application process that provides for certain benefits on the Forum. These benefits include

•    the appointment of one innovation collaborative representative to the IOM Global Forum;

•    time on each workshop agenda to showcase and discuss the IC’s project with leading health interprofessional educators and funding organizations;

•    written documentation of each collaborative’s progress summarized in the Global Forum workshop reports published by the National Academies Press; and

•    remote participation in Global Forum workshops through a video feed to the collaborative’s home site.

Each collaborative is undertaking a different 2-year program of innovative curricular and institutional development that specifically responds to



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C Summary of Updates Provided by Members of the Global Forum on Innovation in Health Professional Education’s Innovation Collaboratives The Institute of Medicine’s (IOM’s) Global Forum on Innovation in Health Professional Education is complemented by the work of four university- or foundation-based collaborations in Canada, India, South Africa, and Uganda. Known as innovation collaboratives (ICs), these coun- try-based collaborations characterize innovators in health professional edu- cation through their demonstration projects on how schools of nursing, public health, and medicine can work together toward a common goal. The four ICs were selected by IOM leadership through a competitive ap- plication process that provides for certain benefits on the Forum. These benefits include • the appointment of one innovation collaborative representative to the IOM Global Forum; • time on each workshop agenda to showcase and discuss the IC’s project with leading health interprofessional educators and funding organizations; • written documentation of each collaborative’s progress summa- rized in the Global Forum workshop reports published by the National Academies Press; and • remote participation in Global Forum workshops through a video feed to the collaborative’s home site. Each collaborative is undertaking a different 2-year program of innova- tive curricular and institutional development that specifically responds to 129

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130 INTERPROFESSIONAL EDUCATION FOR COLLABORATION one of the recommendations in the Lancet Commission or the 2011 IOM The Future of Nursing report—reports that inspired the establishment of the Global Forum. These on-the-ground innovations involve a substantial and coordinated effort among at least the three partnered schools (a medi- cal school, a nursing school, and a public health school). As ad hoc activi- ties of the Global Forum, the innovation collaboratives are amplifying the process of revaluating health professional education globally so that it can be done more efficiently and more effectively and so that it will create in- creased capacity for task sharing, teamwork, and health systems leadership. The work of each of the collaboratives is detailed below. CANADA Maria Tassone, M.Sc., B.Sc.PT Sarita Verma, LLB, M.D., CCFP University of Toronto The Canadian Interprofessional Health Leadership Collaborative The Canadian Interprofessional Health Leadership Collaborative (CIHLC) is a multi-institutional and interprofessional partnership that in- cludes the faculties and schools of medicine, nursing, and public health and the programs of interprofessional education (IPE) at five universities. The collaborative, led by the University of Toronto, also contains the University of British Columbia, the Northern Ontario School of Medicine, Queen’s University, and Université Laval as regional leads, as well as these institu- tions’ affiliated networks with multiple sites in Canada, the United States, and the rest of the world (see Figure C-1). The goal of the CIHLC is to de- velop, implement, evaluate, and disseminate an evidence-based program for collaborative leadership in five phases over the next 3 years. The education program will be targeted to health care leaders, practitioners, and students. The first phase of the project included the identification of university leads, recruitment of staff, and the establishment of a national steering committee (NSC) and a secretariat to steer and support the project. The NSC has representation from each of the five universities. Through weekly telephone meetings, the leads, alternates, and research associates have been building synergies while delving into questions and discussion around the meaning of key project components. These have included defining what is meant by “collaborative leadership,” “collaborative leadership curricu- lum,” “community engagement,” “social accountability,” and “social re- sponsibility,” as well as exploring early ideas about evaluation frameworks for the program and project.

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APPENDIX C 131 IOM Global Health Forum Advisory Secretariat Co-Leads Groups National Steering Committee Designated collaborative representatives University University of Northern Ontario Queen’s Université of Toronto British Columbia School of Medicine University Laval - Medicine - Medicine - Medicine - Medicine - Medicine - Nursing - Nursing - IPE in Cultural (public health) - Nursing - IHPME - Public Health Diversity - Nursing - Pharmacy - Public Health - College of Health - Rehab (OT&PT) - Social Sciences - Centre for IPE Disciplines - Office of IPE - Office of IPE Regional Affiliated Networks FIGURE C-1  CIHLC structure. SOURCE: CIHLC. A CIHLC engagement plan calls for early engagement of stakeholders and communities to ensure New Figure C-1 and support for the project. successful uptake As such, the CIHLC leads have been building partnerships within their own universities which represent multiple health sciences faculties. They have also been using their established provincial and regional networks within Canada to inform and receive input on the CIHLC project and the potential opportunities provided by membership on the IOM Global Forum on In- novation in Health Professional Education. From a knowledge translation and scholarship perspective, the partners have presented this information at several relevant conferences and presented posters on the project at two international conferences in Thunder Bay, Canada, and Kobe, Japan, in October 2012. CIHLC partners have also been using their networks to stimulate discussion about the Lancet report and how recommendations could be applied to Canadian health education reform. The second phase, which is aimed at knowledge acquisition, is under way, by way of planning for and implementing phased literature reviews to identify what has been done in the peer-reviewed and grey literature and to identify gaps that have already begun to refine the objectives of the proj- ect. Several literature reviews are in various stages of implementation and are leading the evolution of the CIHLC program and its key components. Those key components are the definition and impact of collaborative lead- ership for health system change, the existing evidence base for collaborative

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132 INTERPROFESSIONAL EDUCATION FOR COLLABORATION leadership education, the principles of community engagement and social accountability, and the validity of potential evaluation frameworks. The first literature review that will serve as the foundation for the proj- ect has been completed. It was intended to establish the level and rigor of evidence related to collaborative leadership for health system change and, ultimately, to identify what type of collaborative leadership best enables the global transformation of the health care system. Once the broad framework for the literature review had been established, attention turned to schol- arly search engines. Initial search terms included “health care leadership,” “collaborative leadership,” “collaborative leadership” AND “healthcare,” “change leadership healthcare,” and “change management healthcare.” Initial databases consulted included Google Scholar, the Summon multi- disciplinary search engine at the University of Toronto, PubMed Health, Longwoods Publishing, and ProQuest. It became clear very early that the search strategy required targeting because the initial search on the term “collaborative leadership,” limited to scholarly journals in Summon, turned up more than 72,000 hits. With the basic field this enormous, the CIHLC’s working description of the “future collaborative change leader” was used as context and as a filter for the review. In total, 183 journal articles or reports and approximately two dozen theoretical books were reviewed. From this, it was clear that “collaborative leadership” is less a definable concept and that assessing the evidence is difficult because there is no single entity, model, or framework that leads to one definition. At this stage the literature review has led the project team to note that while the term “collaborative leadership” is ap- plied to diverse ways of practicing collaboration, it is generally aimed at the broad movement away from an “individual expert” model of leadership to drawing on multiple perspectives for richer responses to complex questions or needs. This movement from individual experts is broadly described as a necessity in a world of increasing complexity and rapid change, where no one person or perspective could possibly comprehend or influence the kinds of responses, thinking, and actions required for sustainability. Within this basic, shared perspective, the concept of “collaborative leadership” covers a huge range of discussions. At one end of the range, the concept is used to describe leaders with positional authority who are learn- ing to share power and decision making in different ways but who are not fundamentally changing traditional models of organization and structure. This literature tends to continue to focus on leaders as individuals. The term is also applied in various ways to the actions required to enable col- laborative action within and across systems, whether from formal leaders or among group members. The CIHLC’s current definition of collaborative leadership is as follows:

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APPENDIX C 133 Collaborative leadership is a way of being, reflected in attitudes, behav- iours, and actions that are enabled by individuals, teams, and/or orga- nizations and integrated within and across complex adaptive systems to transform health with people and communities, locally and globally. With the first literature review completed, the collaborative is now engaged in further refinement and validation on the definition of “collab- orative leadership” for health system change. Qualitative research is being undertaken through key informant interviews with up to 30 people. The subjects will include senior leaders in IPE; Canadian educators; govern- ment, hospital and student leaders; and international thought leaders. The results of this qualitative research, along with the literature review, will inform the leadership curriculum work that is under way. A systematic literature review of existing curricula in interprofessional collaborative leadership has been launched. Review questions have been formulated, key concepts have been identified, a search strategy format for key databases has been identified, and the search strategy has been tested for efficiency and effectiveness of journal article retrieval. The literature re- view will assess the impacts of leadership curricula on health care practices and on skills, attitudes, and behaviors of learners at pre-qualification, post- qualification, and executive levels. It will also inform which leadership com- petencies are addressed in existing curricula and what pedagogical methods are used. Based on the results, the CIHLC will adopt or adapt an existing leadership curriculum or else will develop something new. Ultimately, the goal is to produce a template or toolkit of collaborative leadership curricu- lums that will be culturally validated in both French and English languages and will be pilot tested among different groups of learners across Canada. At the same time, an evaluation framework is being developed that will include measurement indicators for systematic implementation. This product will support the pilot testing of the collaborative leadership cur- riculum. The CIHLC is also conducting a literature review of community engagement principles that includes an understanding of the competencies that underlie social responsibility and the principles that collaborative lead- ers should apply in their own or their organization’s social accountability. The work thus far confirms that the CIHLC’s initial model for the “future collaborative change leader” is consistent with the emerging focus on the need for health system influencers to be able to take meaningful ac- tion and to inspire positive movement in a world of multiple perspectives, ambiguity, and intricacy. The emphases in our emerging model on trans- formation, complexity, adaptation, learning, and distributive leadership all convey a context of transformative, systemic change. Our program will need to focus on the kind of leader who enables a more sustainable, equi-

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134 INTERPROFESSIONAL EDUCATION FOR COLLABORATION table, fair, and just way of harnessing existing resources and the creation of meaningful innovation across all health professions. INDIA Sanjay Zodpey, M.D., Ph.D. Public Health Institute of India Building Interdisciplinary Leadership Skills Among Health Professionals in the 21st Century: An Innovative Training Model Rationale for the Initiative Health professionals have made enormous contributions globally to health and development during the past century; complacency will only continue the ineffective application of 20th-century educational strategies that are unfit to tackle 21st-century challenges. The demand of 21st-century health professional education is mainly transformational, aiming to help the professionals strategically identify emerging health challenges and in- novatively address the needs of the population. As in many other countries, the need of the hour in India is to amalgamate the skills and knowledge of the medical, nursing, and public health professionals and to develop robust leadership competencies among them. This initiative proposes to identify the interdisciplinary leadership competencies among doctors, nurses and public health experts that are necessary to bring about a positive change in the health care system of the country. Once they are identified, an interdis- ciplinary training model will be conceptualized and piloted with an objec- tive to develop these leadership competencies and skills among the various health care professionals. Objectives of the Initiative 1. Identification of interdisciplinary health care leadership competen- cies relevant to the medical, nursing, and public health professional education in India. 2. Conceptualization of and piloting an interprofessional training model to develop physician, nursing, and public health leadership skills relevant for the 21st-century health system in India.

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APPENDIX C 135 Partners of the Proposed Regional Innovation Collaborative The proposed Regional Innovation Collaborative will be a partnership among three schools: the Public Health Foundation of India, New Delhi (public health institute); the Datta Meghe Institute of Medical Sciences, Sawangi (medical school); and the Symbiosis College of Nursing, Pune (nursing school). These schools will team up to further the objective of the collaborative. Proposed Workplan The three partner institutes will collaborate to address the major objec- tives of this initiative. The following activities, in chronological order, are proposed by the Regional Innovation Collaborative as part of the workplan following a formal approval of the proposal by the IOM: 1. Constitution of the collaborative: A team will be formed that includes members from all three partner institutes. The national program lead will represent the collaborative as a member of the Global Forum at the headquarters of the IOM. 2. Constitution of a Technical Advisory Group (TAG): The TAG will consist of renowned experts in the field of health professions education. The mandate of this group will be to oversee and provide guidance to the activities of the collaborative. The TAG will meet once in every 6 months to review the progress of the collaborative’s work and to discuss the further steps to be taken under the initiative. 3. Identification of interdisciplinary health care leadership compe- tencies: The initial activities to be undertaken by the collaborative would include an exhaustive literature search by the working group under the guidance of the program leads to understand the need for and genesis of leadership competencies as a part of education of health professionals. Pub- lished evidence, both global and Indian, shall be included in the literature search to look for key interdisciplinary leadership competencies, the need for an interdisciplinary training of health professionals, and the current scenarios in interprofessional health education. The literature search strate- gies will include the searching of journal articles from electronic databases, medical journals, grey literature, newspaper articles, and papers presented in conferences. A sensitive electronic search strategy will be used to locate the articles in Medline as well as other databases. The search will not be restricted by the period of publication or language. The electronic search will be

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136 INTERPROFESSIONAL EDUCATION FOR COLLABORATION complemented by hand searching for relevant publications and documents in their bibliographies. A process of snowballing will be used until no new articles are located. The Public Health Foundation of India (PHFI) is currently undertaking a project in India as part of the 5-C Network. Within this regional network of five countries in Southeast Asia, PHFI is involved in a situational analysis of the medical, nursing, and public health professions at a national level. The aim of this activity is to conduct a landscaping exercise to understand the current situation in these disciplines with regard to issues such as gover- nance, policy, and challenges encountered. As part of the situational analy- sis, PHFI will also carry out an institutional level assessment and evaluate the instructional processes being followed in these streams. Additionally, a graduate survey will be carried out with participation of current students as well as alumni in order to understand the framework of competencies. The findings of this national assessment will also be incorporated into the literature search activity. The collaborative shall hold regular meetings with participation from all three partner institutes. During these meetings, the group shall deliber- ate on the findings of the initial literature search and align the proposed activities within the broader context of the objectives of the collaborative. The proposed duration for this activity is 6 months. 4. Expert group meetings: Once the literature search is complete, the working group will summarize the findings of the search and prepare a formal report. The summary report will be circulated for detailed review by the senior members of the collaborative. The TAG will also review the report and guide the findings. Once the report and its findings are finalized, these will be shared with the Global Forum of the IOM. The duration for this activity will be 3 months. 5. Consultation: The next activity under the collaborative will be a consultation with experts from various disciplines of health professional education where the findings of the literature search will be presented. This would be a 2-day meeting in New Delhi hosted by PHFI and its partners. The agenda of the consultation would focus on the leadership issues in the fields of medicine, nursing, and public health in India. The agenda will include a discussion of the current situation in the fields of medical, nurs- ing, and public health leadership in India, followed by a presentation of the findings of the literature search. The second half of the agenda for the consultation would be devoted to group presentations where the expert group will deliberate on the strategies for the development of a standardized leadership competency framework for interprofessional health education across identified streams of health professionals.

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APPENDIX C 137 The proposed experts would include the following: representatives from various Indian institutions, such as the Ministry of Health and Family Welfare, the Indian Council of Medical Research, the Medical Council of India, the Indian Nursing Council, the National Board of Examinations, and the University Grants Commission; representatives from agencies such as the World Health Organization; academics from premier public health schools in India; and senior officials from associations such as the Indian Association of Preventive and Social Medicine (IAPSM), the Indian Public Health Association (IPHA), and the Indian Medical Association (IMA). They will all be invited to the 2-day consultation. The suggestions and recommendations of the consultation shall be incorporated by the collaborative’s partner institutes to line up with the ob- jectives. This will also form the basis for planning and piloting the interpro- fessional training model for physicians, nurses, and public health personnel. The proposed duration for this activity, including the groundwork for the consultation, its conduction, and the preparation of the report, would be 3 months. 6. Developing a training model: The next activity of the project will be the development of the training model for the pilot. Based on the find- ings of the literature search and the recommendations of the expert group at the consultation, a training model will be conceptualized. The design of this model will integrate the leadership skills of all three disciplines and will be adapted to suit the Indian health system scenario. A training manual will be developed for use in the trainings by the working group along with the team leaders. The training manual will in- corporate suggestions from TAG members as well. Learning objectives: At the end of the training, the participants would • Have an understanding of transformative learning, including the importance of health care leadership in the 21st century and the interdependence of health care education among health profession- als for the development of change agents. • Be trained to understand the application of leadership competen- cies in their local health care settings. • Have an understanding of how the application of these competen- cies would help them to tackle emerging health care challenges in their local health care settings. The training will be targeted at in-service professionals across the coun- try from the medical, nursing, and public health fields as well as students in these streams. Inculcating interdisciplinary leadership skills among medi-

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138 INTERPROFESSIONAL EDUCATION FOR COLLABORATION cal, nursing, and public health students will aim at transforming them into change agents at an early stage in their careers. The long-term objective of this training model would be its integration into the regular curriculum of the medical, nursing, and public health students with an aim to develop interdisciplinary leadership skills among them. The trainers will be faculty members from medical and nursing colleges and public health institutes. To achieve this goal, we will advocate the importance of this model through various national associations such as IAPSM, IPHA, etc. It is proposed that the training model will be implemented with the support of the state governments as well as of the central government. Before the trainings are implemented at various sites, this model will be pilot tested on some in-service professionals and students across the three streams. For this, a detailed agenda and the training material will be prepared based on the content of the training manual. 7. Piloting the training model: Participants—The pilot trainings will be conducted in four batches. For the first two batches the target group will be in-service doctors, nurses, and public health personnel from health care centers in and around New Delhi, Sawangi, and Pune. These would be personnel working at district hospitals, community health centers, private clinics and hospitals, and primary health centers. The size of the group for each training workshop will be about 15 to 20, with approximately 6 to 7 trainees from each stream. The next two batches will train students from all three disciplines. The number of trainees for each batch of students will be 15 to 20, with 6 to 7 students from each stream. The pilot model would, thus, aim to train approximately 30 to 40 in-service candidates and about 30 to 40 students belonging to medical, nursing, and public health professions. —Resource faculty from the three partner institutes as well Trainers­­ as experts from other organizations, such as the Ministry of Health and Family Welfare, the World Health Organization, academia (professors from the community medicine department at medical colleges), and professional medical, nursing and public health bodies, will be invited to participate as trainers and guest faculty. Contents and duration of the training—The proposed duration of the training is three days. This pilot training workshop will include both didac- tic sessions and group discussions. The didactic sessions will aim at giving the trainees an understanding of leadership skills and their importance in health care. The aim of the group discussions will be to train the trainees

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APPENDIX C 139 to innovatively apply interdisciplinary leadership competencies in their local health care settings. The first day of the training would focus on giving the trainees an overview of the concept of interdisciplinary leadership among health profes- sionals. This would be through didactic lectures. The trainees would also be given an opportunity to work in groups during the second half of the day and to present their views on the same. The second day of the training would focus on how these leadership skills can be applied by these profes- sionals in their own local health care settings. One to two didactic sessions will be followed by a group presentation on day 2 as well. The third day will consist of open sessions in which the trainees will have an opportunity to interact with the faculty and to give feedback about the training and will be evaluated on the basis of participation in group discussion, presenta- tions, and interaction. All four batches of pilot training will be conducted out of the three partner institutes. At the end of each training workshop, a formal report will be prepared and shared with the concerned stakeholders. The trainees will also be asked to fill out a feedback form, the responses to which will be incorporated in the report. Based on the feedback and the experience of each training workshop, certain amendments may be made to the subse- quent trainings to incorporate the suggestions. The pilot trainings will be conducted over a 6-month period. 8. Preparation and dissemination of findings: At the end of the pilot phase of training, a detailed final report will be prepared by members of the collaborative with inputs from the TAG. This report, in addition to interim reports about each activity, will be shared with all concerned national and international key stakeholders. The findings of the initiative will be pub- lished as a monograph and also in peer-reviewed journal. The collaborative will also present the findings of the initiative to the Global Forum on Health Professional Education. Parallel to the activities of the collaborative as part of this initiative, the national program lead will represent the collaborative in the semi-annual workshops of the IOM and will present the ongoing work of the collabora- tive to initiate discussion among global stakeholders and receive inputs and suggestions from the entire Global Forum community. Funding Support The Indian Council of Medical Research will be approached for fund- ing for this 2-year activity.

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140 INTERPROFESSIONAL EDUCATION FOR COLLABORATION SOUTH AFRICA Marietjie de Villiers, Ph.D., M.B.Ch.B., M.Fam.Med. Stefanus Snyman, M.B.Ch.B., DOM Stellenbosch University South African Partnership on Innovation in Health Professional Education The South African collaborative involves Stellenbosch University, the University of the Western Cape, and the University of the Free State col- laborating on two overlapping yet distinct projects in innovation in health professional education. Project 1: To identify the relevant competencies required for transfor- mational and shared leadership and design and to implement a suitable leadership program for health teams. The focus of this project is on leadership capacity building of health professional educators and young professionals. The principles of interde- pendence and transformative learning underpin the framework proposed by Frenk et al. (2010). In the proposed reforms that will result in interdepen- dence and transformative learning there is a recurring theme of leadership. This is anchored in the argument that transformative learning is about developing leadership attributes in order to produce enlightened change agents, which is then explicitly or implicitly woven into all the proposed instructional and institutional reforms. Leadership is therefore no longer the domain of the organizational leaders, but is shared. To optimize the potential for success of these reforms, the focus should be not only on the training of the new professionals, but also, especially in the initial stages, on capacity building of the existing teaching staff and practicing professionals, especially since role modeling is regarded as an integral part of the success (Interprofessional Education Collaborative Expert Panel, 2011). Components of the Project 1. Determine the leadership competencies that are valued as important and relevant in an interprofessional, multicultural environment, framed in the transformational (Bass, 1990), empowering (Albrecht and Andreetta, 2011), and shared leadership (Pearce et al., 2009) paradigms, also exploring aspects of positive (Cameron, 2008) and strengths-based (Rath and Conchie, 2008) leadership and posi- tioned within the concept of cultural dimensions (Hofstede, 2010).

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APPENDIX C 141 2. Design an interprofessional leadership competency framework. 3. Develop and implement: a.  leadership training programme with a multi-institutional, in- A terprofessional, team-based approach initially at the level of professional educators and young qualified professionals. This will take an interprofessional team-based approach. b. Appropriate assessment and evaluation tools. c. A system of continued and sustained support and development. Project 2: To design and implement competency-based interprofes- sional skills building for teamwork in community and primary health care settings. The aim of this project is to develop effective interprofessional col- laboration competencies in students and educators. It will contribute to the development of social accountability in graduates, institutional partners, and primary health care services. The patient- and community-centered approach of the project will foster interprofessional teamwork and also as- sist with restructuring health professions curricula in response to the health needs of society (Frenk et al., 2010; de Villiers and Naidoo, 2011). The collaboration between the various IPE units at the Faculty of Health Sciences, the Boland Nursing College in Worcester, and the Univer- sity of the Western Cape Faculty of Community and Health Sciences’ School of Nursing was started in 2010 by placing students together in community service learning projects. This IAP teamwork project was born out of these efforts. Encouraging progress has already been made in developing mobile applications for household and health systems surveys in a rural setting. Interprofessional training workshops with primary health care profes- sionals and community workers to strengthen patient- and community- centered care have also been conducted. This was further supported by the installation of video link facilities at rural clinical training sites. This project is designed to 1. Facilitate and coordinate appropriate curriculum renewal processes aiming to integrate interprofessional teamwork competencies lon- gitudinally throughout the curricula. These renewals could include, inter alia, signature leaning experiences at the beginning of the first year with student involvement in household and health systems surveys in a rural community, in partnership with local commu- nities. In consequent years IPE service learning activities will be developed using relevant interactive communicative technology approaches and equipment.

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142 INTERPROFESSIONAL EDUCATION FOR COLLABORATION 2. Develop an innovative formative and summative assessment model to longitudinally evaluate the development of teamwork competencies. 3. Build capacity for effective patient- and community-centered role models in interprofessional teamwork, in both a clinical and com- munity setting, among lecturers, clinical supervisors, and commu- nity partners (Interprofessional Education Collaborative Expert Panel, 2011). 4. Design and implement an appropriate evaluation of the above three areas to identify the good practice models, challenges, and oppor- tunities for such curriculum renewal processes for IPE. UGANDA Rose Chalo Nabirye, Ph.D., M.P.H. Nelson Sewankambo, M.B.Ch.B., M.Sc., M.D., F.R.C.P., L.L.D. (HC) Makerere University Defining competencies, developing and implementing an interprofessional training model to develop competencies and skills in the realm of health professions ethics and professionalism Innovation and Motivation for Selection of Innovation This project is a major innovation aimed at contributing to improve- ment in the quality of health service. Although there is a lot of discussion about the need to improve professional ethics and professionalism in low- and middle-income countries, there has been very little attempt to develop competence-based interprofessional education programs to address the challenges. Professionalism is defined in several different ways (Wilkinson et al., 2009). The Royal College of Physicians (2005) has defined profes- sionalism as “a set of values, behaviors, and relationships that underpin the trust the public has in doctors.” This definition can be extended to embrace all types of health workers. Overall Aim: To prepare a future workforce committed to practicing to a high degree of ethics and professionalism and performing effectively as part of an interprofessional health team with leadership skills. 1. To define competencies and develop a curriculum for interprofes- Specific Objectives sional education of health professional students (nursing, medicine,

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APPENDIX C 143 public health, dentistry, pharmacy, and radiography) in order to develop their skills in the realm of ethics and professionalism. 2. To pilot a curriculum for interprofessional education of health professional students (nursing, medicine, public health, dentistry, pharmacy, and radiography) to develop their skills in the realm of ethics and professionalism. 3. To develop curriculum for interprofessional education for health workers and tutors in ethics and professionalism and pilot its implementation in partnership with the regulatory professional councils. Approach to Implementation of the Project Instructional Reforms A critical element of this project will be the engagement of major stake- holders, including the Ministry of Health, patients, hospitals and health centers, private practitioners, professional councils, educators, students, alumni, and consumer rights groups nationally. This engagement will en- sure the participation of stakeholders in the implementation and the com- mitment of local resources to support this effort. Through this engagement the collaborative will define the extent of the problem (unethical and unpro- fessional practices among nurses, doctors, public health workers, and other health professionals) and identify the necessary interventions, including the required competences and interprofessional training approaches that will address the gaps as well as the necessary post-training support to ensure the institutionalization of ethics and professionalism among health profes- sionals in Uganda. Stakeholders will participate in the implementation of training and mentoring trainees at their respective places of work. Of par- ticular importance are the students who have initiated the formation of a student ethics and professionalism club. They are advanced in the planning process and will be supported through this project and contribute to the whole process of this project. Right from the beginning, the collaborative plans to align this educational project with the needs of Uganda’s popula- tion. Concerns have been raised about ethics and professionalism among health professionals in Uganda, largely by the media. There are, however, only limited brief reports in publications in the recent past in peer-reviewed literature on the issue of ethics and professionalism among health workers in Uganda (Hagopian et al., 2009; Kiguli et al., 2011; Kizza et al., 2011). Some national reports highlight the challenges in this area, but few formal studies have been conducted to document the extent of the problem, the contextual factors and possible interventions (UNHCO, 2003, 2010).

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144 INTERPROFESSIONAL EDUCATION FOR COLLABORATION Because of the lack of comprehensive evaluations and evidence the col- laborative plans to initiate this project with a systematic needs assessment. The needs assessment will involve the participation of representatives from several key partners mentioned previously. Data will be collected through an analysis of key documents from the professional councils, which are statutory units charged with the responsibility of investigating reports and cases of professional indiscipline among doctors, dentists, nurses, pharma- cists, and others. The collaborative shall undertake limited surveys and key informant interviews among the above-named groups. Development and Implementation of the Curriculum Results from the needs assessments will be used to inform the cur- riculum development process, which will employ the six-step approach (Kern et al., 2009). Prior to curriculum development, interprofessional competencies will be defined through stakeholder engagement and sugges- tions, building on the five competencies defined by the 2003 IOM report Health Professions Education: A Bridge to Quality. Trainees will learn not only competencies related to ethical practices and professionalism but also competencies of interprofessional collaboration and leadership (Interpro- fessional Education Collaborative Expert Panel, 2011). Stakeholder discus- sions will be held to get a clearer understanding of society’s needs and the challenges of ensuring high standards of ethics and professionalism. This will be followed by a consensus process to arrive at an agreed-upon set of competencies to be acquired during an interdisciplinary course for the students who are the next generation of leaders. A curriculum will be developed for students and for teachers based on the needs assessment results and the defined competencies. Institutional Reforms A number of institutional reforms will be needed as the instructional reforms are implemented. These include a careful review of the linkages and collaboration between the university and the aforementioned stakeholders, and the recognition and the reward system for excellence in demonstrat- ing the desired high standards of ethics and professionalism among both students and staff. REFERENCES Albrecht, S., and M. Andreetta. 2011. The influence of empowering leadership, empowerment and engagement on affective commitment and turnover intentions in community health service workers: Test of a model. Leadership in Health Services 24(3):228–237.

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