ASSESSING HEALTH
PROFESSIONAL EDUCATION

WORKSHOP SUMMARY

Patricia A. Cuff, Rapporteur

Global Forum on Innovation in Health Professional Education

Board on Global Health

INSTITUTE OF MEDICINE
               OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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G L O BA L F O RU M O N I N N OVAT I O N I N H E A LT H P RO F E S S I O NA L E D U C AT I O N ASSESSING HEALTH PROFESSIONAL EDUCATION WORKSHOP SUMMARY Patricia A. Cuff, Rapporteur Global Forum on Innovation in Health Professional Education Board on Global Health

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the coun- cils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the Academic Consortium for Complemen- tary and Alternative Health Care, the Academic Council of the American Physical Therapy Association, the Academy of Nutrition and Dietetics, the Accreditation Council for Gradu- ate Medical Education, the Aetna Foundation, the Alliance for Continuing Education in the Health Professions, the American Academy of Family Physicians, the American Academy of Nursing, the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Association of Nurse Anesthetists, the American Association of Nurse Practitioners, the American Board of Family Medicine, the American Board of Internal Medicine, the Ameri- can College of Nurse-Midwives, the American Congress of Obstetricians and Gynecologists/ ­ American Board of Obstetrics and Gynecology, the American Dental Education Associa- tion, the American Medical Association, the American Occupational Therapy Association, the American Psychological Association, the American Society for Nutrition, the American Speech-Language-Hearing Association, the Association of American Medical Colleges, the Association of American Veterinary Medical Colleges, the Association of Schools and Colleges of Optometry, the Association of Schools and Programs of Public Health, the Association of Schools of the Allied Health Professions, the Atlantic Philanthropies, the China Medical Board, the Council of Academic Programs in Communication Sciences and Disorders, the Council on Social Work Education, Ghent University, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation, Kaiser Permanente, the National Academies of Practice, the National Association of Social Workers, the National Board for Certified Counselors, Inc. and Affiliates, the National League for Nursing, the National Organization of Associate Degree Nursing, the Physician Assistant Education Association, the Robert Wood Johnson Foundation, the Society for Simulation in Healthcare, the Uniformed Services University of the Health Sciences, and the Veterans Health Administration. The views presented in this publication do not necessar- ily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13:  978-0-309-30253-1 International Standard Book Number-10:  0-309-30253-6 Additional copies of this workshop summary are available for sale from the National Acad- emies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www. iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2014. Assessing health professional educa- tion: Workshop summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR ASSESSING HEALTH PROFESSIONAL EDUCATION1 Darla Spence Coffey (Co-Chair), Council on Social Work Education Eric Holmboe (Co-Chair), American Board of Internal Medicine Carol Aschenbrener, Association of American Medical Colleges Martha (Meg) Gaines, University of Wisconsin, Madison Catherine L. Grus, American Psychological Association Lucy Mac Gabhann, Law Student, University of Maryland Lemmietta G. McNeilly, American Speech-Language-Hearing Association Patricia Hinton Walker, Uniformed Services University of the Health Sciences 1  Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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GLOBAL FORUM ON INNOVATION IN HEALTH PROFESSIONAL EDUCATION1,2 Jordan Cohen (Co-Chair), George Washington University Afaf Meleis (Co-Chair), University of Pennsylvania Kenn Apel, Council of Academic Programs in Communication Sciences and Disorders Carol Aschenbrener, Association of American Medical Colleges Gillian Barclay, Aetna Foundation Mary Barger, American College of Nurse-Midwives Timi Agar Barwick, Physician Assistant Education Association Geraldine Bednash, American Association of Colleges of Nursing Cynthia Belar, American Psychological Association Joanna Cain, University of Massachusetts School of Medicine Linda Casser, Association of Schools and Colleges of Optometry Lincoln Chen, China Medical Board Yuanfang Chen, Peking Union Medical College Marilyn Chow, Kaiser Permanente Elizabeth Clark, National Association of Social Workers Thomas Clawson, National Board for Certified Counselors, Inc. and Affiliates Darla Spence Coffey, Council on Social Work Education Malcolm Cox, Veterans Health Administration Jan De Maeseneer, Ghent University Marietjie de Villiers, Stellenbosch University James G. Fox, Association of American Veterinary Medical Colleges Roger Glass, John E. Fogarty International Center Elizabeth (Liza) Goldblatt, Academic Consortium for Complementary and Alternative Health Care Yuanzhi Guan, Peking Union Medical College Neil Harvison, American Occupational Therapy Association, Inc. Douglas Heimburger, American Society for Nutrition John Herbold, National Academies of Practice Eric Holmboe, American Board of Internal Medicine Pamela Jeffries, Johns Hopkins University School of Nursing Rick Kellerman, American Academy of Family Physicians Kathryn Kolasa, Academy of Nutrition and Dietetics 1  Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. 2  This is the list of Forum members as of October 10, 2013. vii

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John (Jack) Kues, Alliance for Continuing Education in the Health Professions Maryjoan Ladden, Robert Wood Johnson Foundation Lucinda Maine, American Association of Colleges of Pharmacy Beverly Malone, National League for Nursing Mary E. (Beth) Mancini, Society for Simulation in Healthcare Lemmietta G. McNeilly, American Speech-Language-Hearing Association Donna Meyer, National Organization of Associate Degree Nursing Fitzhugh Mullan, George Washington University Thomas Nasca, Accreditation Council for Graduate Medical Education Andre-Jacques Neusy, THEnet Warren Newton, American Board of Family Medicine Kelly Wiltse Nicely, American Association of Nurse Anesthetists Liana Orsolini, Bon Secours Health System, Inc. Rajata Rajatanavin, Mahidol University Scott Reeves, University of California, San Francisco Madeline Schmitt, American Academy of Nursing Nelson Sewankambo, Makerere University College of Health Sciences Stephen Shannon, American Association of Colleges of Osteopathic Medicine Susan Skochelak, American Medical Association Harrison Spencer, Association of Schools and Programs of Public Health Richard (Rick) Talbott, Association of Schools of the Allied Health Professions George Thibault, Josiah Macy Jr. Foundation Jan Towers, American Academy of Nurse Practitioners Richard (Rick) W. Valachovic, American Dental Education Association Sarita Verma, University of Toronto Patricia Hinton Walker, Uniformed Services University of the Health Sciences Shanita Williams, Health Resources and Services Administration, U.S. Department of Health and Human Services Holly Wise, Academic Council of the American Physical Therapy Association Brenda Zierler, University of Washington Sanjay Zodpey, Public Health Foundation of India viii

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IOM Staff Patricia A. Cuff, Senior Program Officer Rachel M. Taylor, Associate Program Officer (until December 2013) Megan M. Perez, Research Associate Samantha D. Brown, Senior Program Assistant (from February 2014) Hannah Press, Intern Julie Wiltshire, Financial Officer Patrick W. Kelley, Senior Board Director ix

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Reviewers This workshop summary has been reviewed in draft form by individu- als chosen for their diverse perspectives and technical expertise, in accor- dance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the summary meets institutional standards for objectivity, evidence, and respon- siveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Lesley Bainbridge, The University of British Columbia Lisa Conforti, American Board of Internal Medicine Jennifer R. Kogan, University of Pennsylvania School of Medicine Karen Anne Wolf, Samuel Merritt University School of Nursing Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Mary O’Neil Mundinger, Columbia University. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution. xi

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Acknowledgments After 2 short years of working together, our Global Forum is making its mark on health professional education. In 2013, the Interprofessional Education for Collaboration workshop summary report was among the top 10 most popular reports at the National Academies as noted by the National Academies Press. Webcast viewers of our workshops have ranged from 200 to 270 for our most recent workshop with viewers logging in from such countries as Japan, Pakistan, Sudan, Sweden, and Turkey. In addition, the activities of the Global Forum are regularly described on the Health Professionals for the 21st Century website; and the listserv of inter- ested individuals following the activities of the Global Forum now numbers more than 1,100 persons. Although interprofessional education remains high on the list of topics for many of our Forum members, we are now exploring other critical areas of health professional education such as innovative technologies for learn- ing across the education-to-workforce continuum, social accountability, health disparities, and community-based learning opportunities for health professional training. This workshop summary report, Assessing Health Professional Education, is an initial foray into many of these topics, and as Co-Chairs of the Forum, we are extremely grateful to all those who worked tirelessly to make this event a resounding success. Our sincere thanks go to the workshop planning committee co-chairs, Darla Spence Coffey and Eric Holmboe, along with the planning commit- tee members: Carol Aschenbrener, Meg Gaines, Catherine Grus, Lucy Mac Gabhann, Lemmie McNeilly, and Pat Hinton Walker. It goes without saying that the workshop would not have been possible without the adept skills of xiii

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xiv ACKNOWLEDGMENTS the Institute of Medicine (IOM) staff—Patricia Cuff, forum director; Rachel Taylor, associate program officer; and Megan Perez, research associate. And special thanks go to Patrick Kelley for his leadership in directing the IOM’s Board on Global Health, which oversees the Global Forum on Innovation in Health Professional Education. Finally, we would like to acknowledge our deep appreciation to the 45 sponsors and 61 members of the Global Forum that make it possible for us to host events like the workshop de- scribed in this report. Jordan Cohen, Forum Co-Chair Afaf Meleis, Forum Co-Chair

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Contents Acronyms and Abbreviations xvii Background 1 1 Setting the Stage 7 2 Practical Examples of Health Professional Education Assessment 21 3 Assessment as an Agent for Change 41 4 Technology and Innovation from Education to Practice 55 5 Strategies for Overcoming Challenges in Measuring Interprofessional Education 69 APPENDIXES A Workshop Agenda 85 B Models and Tools Discussed at the Workshop 91 C October 9, 2013, Poster Session: Abstracts 99 D Summary of Updates from the Innovation Collaboratives 125 E Speaker Biographical Sketches 147 xv

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Acronyms and Abbreviations AACN American Association of Colleges of Nursing  AAMC Association of American Medical Colleges ABIM American Board of Internal Medicine AHRQ Agency for Healthcare Research and Quality ANPF American Nurse Practitioner Foundation ASPPH Association of Schools and Programs of Public Health CAHPS Consumer Assessment of Healthcare Providers and Systems CIHLC Canadian Interprofessional Health Leadership Collaborative DMIC Dartmouth Microsystem Improvement Curriculum DoD U.S. Department of Defense FAIMER Foundation for Advancement of International Medical Education and Research HRO highly reliable organization IDCOP Idealized Design of Clinical Office Practices IHI Institute for Healthcare Improvement IHPE Innovation in Health Professional Education (the Forum) xvii

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xviii ACRONYMS AND ABBREVIATIONS IOM Institute of Medicine IPA interprofessional professionalism assessment IPC Interprofessional Professionalism Consortium IPE interprofessional education IPP interprofessional practice LIC longitudinal integrated clerkship MOOC massive open online course NCQA National Committee for Quality Assurance NLN National League for Nursing PCMH patient-centered medical home SYMLOG System for the Multiple Level Observation of Groups TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety THEnet Training for Health Equity Network T-TAQ TeamSTEPPS Teamwork Attitudes Questionnaire T-TPOT Trauma Team Performance Observation Tool VA U.S. Department of Veterans Affairs