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5 Strategies for Overcoming Challenges to Interprofessional Education Key Messages • By measuring what is valued, over time, what is measured will be valued because that is where the supportive data will be. (Coffey) • There is a lack of evidence-based approaches in IPE. (Aschenbrener, Hinton- Walker) • Patients and learners could be proactively involved in data collection that assesses teams, which could be used to guide learning in quality improvement. (Gaines) • Part of the learning process could involve clinicians and educators who work with patients to provide students with experiences that help them understand the patient experience. (Gaines) • Too often, assessment is thought of as a way of looking back rather than looking forward, and there is a potentially strong role for assessment as a tool for moving innovation forward. (Coffey) As co-chair of the workshop planning committee, Forum member Darla Coffey from the Council on Social Work Education began the reporting of the breakout groups by emphasizing an important theme that surfaced repeatedly throughout the workshop, which was how one might use assessment as a tool for changing culture. By measuring what is valued, she said that over time what is measured will be valued because that is where the supportive data will be. Coffey then introduced the speakers who led small breakout groups as noted in Box 5-1. The purpose of these breakout groups was to give the Forum members and the public participants a chance to discuss, in a highly interactive setting, what they individually value most about interprofessional education (IPE) and how this might be assessed. Each group looked at IPE in an environment (i.e., education to practice, health professional educational associations, communities, and health care) and considered various perspectives (such as that of student, educator, educational leadership, and health system user). The leaders organized their groups into four 35-minute rotations. Challenges to and opportunities for assessment in the different areas described above were looked at from policy (macro), institutional (meso), and individual (micro) levels during the first three rotations. In the fourth rotation, Forum members and public participants self- selected one of the groups to attend and discussed strategies on how to overcome previously identified challenges to assessing IPE (see Boxes 5-2, 5-3, 5-4, and 5-5, which appear later in this chapter). The groups then reconvened, and the group leaders gave presentations of what was covered in their breakout sessions, informed by the group discussions. 5-1 PREPUBLICATION COPY: UNCORRECTED PROOFS

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BOX 5-1 Breakout Groups: Topics and Leaders Group 1: Assessment of the interprofessional learner from education to workplace Leaders: Lucy Mac Gabhann, law student, and Catherine Grus, American Psychological Association Group 2: Assessment of the approaches to interprofessional learning: the role of professional associations in measuring the effectiveness of new technologies, methodologies, and pedagogy Leader: Carol Aschenbrener, Association of American Medical Colleges Group 3: Assessment of teams and collaborations in community-based activities and outpatient teams Leaders: Lemmietta McNeilly, American Speech-Language-Hearing Association, and Patricia Hinton Walker, Uniformed Services University of the Health Sciences Group 4: Role of health system users (sick and well persons) in assessment of education, community health interventions, and health care Leaders: Meg Gaines, University of Wisconsin, Madison, and Eric Holmboe, American Board of Internal Medicine The material presented was discussed by one or more workshop participants. During the workshop, all participants engaged in active discussions about opportunities. In some cases, participants expressed differing opinions. Because this is a summary of workshop comments and not meant to provide consensus recommendations, the workshop rapporteur endeavored to include all comments discussed by workshop participants as presented by the group leaders who were informed by the group discussions. The summaries of the breakout group reports should be attributed to the rapporteur of this summary as informed by the workshop. ASSESSING THE INTERPROFESSIONAL LEARNER FROM EDUCATION TO WORKPLACE Catherine Grus and Lucy Mac Gabhann focused on assessing the interprofessional learner from education to the workplace. In her remarks, Grus commented that several themes came up consistently across the three levels of opportunities noted in Table 5-1, but there were additional important points she wanted to mention. One was regarding the importance of data collection—in particular, the importance of longitudinal data collection, and how it could be helpful in formative assessments of individual learners and in overcoming obstacles to greater acceptance of IPE. But, she said, for high-quality assessments of the interprofessional learners to be developed and properly used, there would need to be a culture that embraces IPE. Grus said that this is a critical step for moving forward to more advanced discussions, such as how to assess the interface 5-2 PREPUBLICATION COPY: UNCORRECTED PROOFS

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TABLE 5-1 Opportunities for Assessing the Interprofessional Learner from Education to Workplace Outlined by Catherine Grus and Lucy Mac Gabhann (as informed by group discussions) Opportunities on a Policy Level (Macrolevel) • Integrate IPE in accreditation—drives hospitals. • Capitalize on the opportunities offered by health care reform. • Advocate for legislative policies for higher education. • Encourage institutional recognition of IPE (e.g., Magnet credential*). Opportunities on an Institutional Level (Mesolevel) • Recognize IPE in guidelines for faculty promotion, credentialing of providers, and human resource issues. • Use electronic health records as a means for collaboration. • Engage patients and families. • Mandate faculty development of IPE training and assessment skills. • Engage in comparative effectiveness and resource/data sharing—across institutions and across practice settings. • Identify best practices and retro-engineering education from practice. • Build or align regional centers across professions. • Collect and share best practices from a global perspective and from low-resource settings. Opportunities on an Individual Level (Microlevel) • Mandate faculty development of IPE training and assessment skills. • Achieve greater professional satisfaction from working collaboratively. • Develop longitudinal self-assessment skills. • Engage patients and families. NOTE: This table presents opportunities discussed by one or more workshop participants. During the workshop, all participants engaged in active discussions about opportunities. In some cases, participants expressed differing opinions. Because this is a summary of workshop comments and not meant to provide consensus recommendations, the workshop rapporteur endeavored to include all opportunities discussed by workshop participants as presented by the group leaders who were informed by the group discussions. This table and its content should be attributed to the rapporteur of this summary as informed by the workshop. * According to the American Nurses Credentialing Center, the Magnet Recognition Program is designed to identify health care organizations that provide high-quality patient care, nursing excellence, and innovations in professional nursing practice (American Nurses Credentialing Center, 2014). between education and practice. To do this, a more fluid connection between program- level faculty and practice sites would have to be established along with an understanding of the types of assessments being conducted at practice sites. Mac Gabhann followed up on Grus’ remarks by presenting a suggestion for overcoming one identified challenge: how best to assess collaboration on an individual level—along the continuum from training through practice—that is consistent with the triple aim. The ideas for her suggestion reflected many of the opportunities noted in Table 5- 1. Ideally, said Mac Gabhann, the design noted in Box 5-2 would start simultaneously at all levels (macro, meso, and micro); this might not be realistic, however, so she identified two areas for initial efforts at the policy level. The first is to bring IPE and 5-3 PREPUBLICATION COPY: UNCORRECTED PROOFS

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interprofessional practice (IPP) into the accreditation process for professions and for institutions, and the second is to design financial incentives that would encourage individual health professions to embrace IPE. Advocating for change in funding for interprofessional training and assessment could be the impetus for this to happen across the continuum from education to practice. The advocacy could come from health professionals but also from the users of the health system. Such consumers provide a potentially powerful voice for change and are an important source of information for assessing the adequacy of interprofessional collaborations. THE ROLE OF PROFESSIONAL ASSOCIATIONS IN MEASURING THE EFFECTIVENESS OF NEW TECHNOLOGIES, METHODOLOGIES, AND PEDAGOGY Carol Aschenbrener led the group looking at the role of professional associations in measuring the effectiveness of new technologies, methodologies, and pedagogy. Her presentation focused on ideas for assessing approaches to interprofessional learning. Many of the opportunities noted by the previous leaders were also pertinent to this topic. An overriding theme for her was the lack of evidence to support decision making. Generating evidence at the macrolevel begins by influencing accreditors to develop evidence-based regulations and to ease restrictions that limit innovation, she said. The result of this would be two-fold. First, evidence would be collected on the effectiveness BOX 5-2 Ideas Presented by Lucy Mac Gabhann and Catherine Grus (as informed by group discussions) Overcoming Challenges: Assessment of the Interprofessional Learner from Education to Workplace Challenge: Assessment of collaboration on an individual level—along the continuum from training through practice—that is consistent with the triple aim Mac Gabhann and Grus suggested starting at the policy level where accreditation might be addressed along with other high-level incentives for system change such as financing. Following these initial actions, one might then do the following: • Advocate for change in funding for interprofessional training and assessment. • Focus on continuing education and assessment of IPP in the current workforce in addition to students and faculty. • Use the media to engage health system users in partnership for improving IPE and the assessment of IPE. • Increase awareness of what each credentialing body requires through greater data sharing. • Train the workforce so opportunities at all levels can be advanced. 5-4 PREPUBLICATION COPY: UNCORRECTED PROOFS

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of various technologies; and second, the data would separate the most effective technologies from the most convenient ones. This same approach would apply for determining which pedagogies are most effective. In this regard, multiple associations could produce a joint proposal across professions for multisite research funding that would look at specific approaches to learning. This would fill an identified need for evidence-based approaches in IPE. However, it is very hard to obtain this kind of funding, and likely related to that difficulty, it is difficult to convince multiple associations to do research together—much less multiple professions across associations. But, said Aschenbrener, this could be something that members of the Global Forum could galvanize together. A second major theme Aschenbrener presented was the need for assessment approaches that do not rely on live clinical practice sites, due to the shortage of these. The most popular approach currently is simulation. Simulation encompasses a wide variety of approaches and technologies that range from high to very low fidelity. After discussing overarching issues, Aschenbrener suggested a way to advance opportunities for interprofessional learning and the assessment of such approaches. She included what she views as the most important opportunity at each of the policy, institutional, and individual levels (see Box 5-3). She focused on the mesolevel strategy, which would encourage professional associations to come together and jointly sponsor a massive open online course (MOOC). The MOOC would emphasize an area relevant to interprofessional learning. In her opinion, all of the content that does not require the social context of the classroom, the direct patient experience, or direct observation should be taught outside of the classroom where it can be accessed asynchronously. The MOOC would be sponsored and designed jointly, but the impact evaluation could be conducted by each individual profession. The results could then be compared to see whether the learning was as effective with one profession as with another. Developing the MOOC across health professional associations would in itself add to the collaboration of health professionals. For this to succeed, said Aschenbrener, each institution would have to engage faculty from different professions, which would likely BOX 5-3 Ideas Presented by Carol A. Aschenbrener (as informed by group discussions) Overcoming Challenges: The Role of Professional Associations in Measuring the Effectiveness of New Technologies, Methodologies, and Pedagogy Challenge: Assessment of the approaches to interprofessional earning To overcome this challenge, Aschenbrener suggested the following, multilevel approach: • Macrolevel: Develop joint proposals to secure funding for multisite research to explore the relationship between approaches to IPE and performance in practice and patient outcomes (e.g., NCSBN study). • Mesolevel: Jointly sponsor a MOOC in an area relevant to IPE, and evaluate the effects on different health professions. • Microlevel: Urge hospitals, health systems, and educational institutions to use simulation centers across all relevant health professions to foster interprofessional skills. 5-5 PREPUBLICATION COPY: UNCORRECTED PROOFS

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build even stronger collaborations. These collaborations could be used for discussion forums and other collaborative opportunities. ASSESSMENT OF TEAMS AND COLLABORATIONS IN COMMUNITY-BASED ACTIVITIES AND OUTPATIENT TEAMS Lemmietta McNeilly opened her presentation by acknowledging the large number of challenges there are to assessing teams and collaborations outside of the inpatient, hospital setting. The difficulty of knowing who to include in the assessment is one example. In outpatient settings, practitioners would almost certainly be included, but for education and training purposes, faculty and students would be part of the assessment, and under all circumstances, the community would be involved. Another challenge is how to actively engage the learner at the policy, institutional, and individual level in collaborative efforts—across the education-to-work continuum—that maintains the community as the focal point. Patricia Hinton Walker then addressed the microlevel opportunities (see Table 5-2) within this area of assessment, and offered suggestions for making the best use of those opportunities. TABLE 5-2 Opportunities for Assessing Teams and Collaborations in Community-Based Activities and Outpatient Teams, Outlined by Lemmietta McNeilly and Patricia Hinton Walker (as informed by group discussions) Opportunities on a Policy Level (Macrolevel) • Financial realignment focused on community-centered care. • Amended accreditation standards related to community members serving as faculty/mentors. • Support use of technology that engages persons, families, and communities. • Consider the individual’s personal health record (PHR) as the person’s electronic health record (EHR) —owned by the “person and family.” • Shift resources to legitimate community members as faculty with investment in faculty development. • Realignment of financial support for health professions education to more equally support IPE versus just a few disciplines. Opportunities on an Institutional Level (Mesolevel) • Consider adopting models such as the One-Health Model—linking caring for humans, animals, and the environment to health and health-professions education. • Facilitate citizen-learning models of education in communities instead of stop- in/stop-out visitor models for clinical learning experiences. • Legitimate service-learning projects with credit versus voluntary projects. • Engage community members in decision-making regarding such areas as admissions, curriculum, and design of community-centered learning activities. • Facilitate IPE teaching/learning with disciplines/providers and health workers beyond disciplines traditionally in health sciences centers. • Develop longer-term commitments to service learning in the community such as Penn Nursing LIFE (Living Independent for Elderly) and other longer-term community-centered longitudinal projects (Ghent University) and student-managed clinics. • Collaboratively address community needs beyond clinical care to addressing needs 5-6 PREPUBLICATION COPY: UNCORRECTED PROOFS

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such social determinants of health. • Realign financial incentives to assist community settings in fostering access to patients regularly. • Collaborate with other universities for development/validation of tools and metrics for team-based, community-based assessments. • Re-engage learners in social justice, civic responsibility, and reflective praxis. Opportunities on an Individual Level (Microlevel) • Provide opportunities and tools for leadership as change agents in the shift from acute to community-centered care. • Provide tools and remove barriers for learner’s commitment to leadership and social accountability. • Support student engagement in long-term community projects addressing not only health but also social determinants. • Design systems for continued input and participation from students in design of the curriculum and educational plans (Ghent University). • Provide credit for service-learning projects in communities (what has previously been volunteer service). • Encourage innovative projects using emerging technologies designed to improve health and continuity of care for individuals, families, and communities. NOTE: This table presents opportunities discussed by one or more workshop participants. During the workshop, all participants engaged in active discussions about opportunities. In some cases, participants expressed differing opinions. Because this is a summary of workshop comments and not meant to provide consensus recommendations, the workshop rapporteur endeavored to include all opportunities discussed by workshop participants as presented by the group leaders who were informed by the group discussions. This table and its content should be attributed to the rapporteur of this summary as informed by the workshop. The overall goal of McNeilly and Walker’s suggested approach to overcoming challenges to assessing community-based IPE (see Box 5-4) is to transform curricula and remove barriers so learners can pursue their passions. In doing, students and faculty facilitate change and provide leadership to address such issues as social justice, civic responsibility, and social accountability in communities. The definition of community could be local or global, but the essence of the curricula would remain the same: to provide opportunities and tools for developing leadership skills and agents for change. To create the envisioned change agents, said Walker, the experience would have to go beyond the brief clinical visits that often make up the experiences of health professional students and provide longitudinal, experiential learning opportunities. However, for this to be successful, systems that embrace continued input and participation of learners would need to be designed, said Walker. Letting students help shape the curriculum may be one way to actively engage them. Another way to engage students is to provide credit for service learning projects. These projects could involve clinical and community experiences as well as those at the policy level where accreditation issues could be addressed. And finally, making the most of emerging technologies could potentially drive the assessment process that ultimately improves health and continuity of care for individuals, families, and communities. Walker suggested this strategy can be successful, provided that educators and others allow such creative learning approaches to enter into health professional education. 5-7 PREPUBLICATION COPY: UNCORRECTED PROOFS

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BOX 5-4 Ideas Presented by Lemmietta G. McNeilly and Patricia Hinton Walker (as informed by group discussions) Overcoming Challenges: Assessing Teams and Collaborations in Community- Based Activities and Outpatient Teams Challenge: Assessing teams and collaborations outside of the inpatient, hospital setting McNeilly and Hinton-Walker presented the following ideas for overcoming this challenge: • Macro: Realign federal, state, accreditation, and private-sector policies to shift health professions education model(s) from acute inpatient care to care across the continuum that focuses on the community. • Meso: Systematically evolve to socially accountable health professions education by developing curricula, assessments, and activities that facilitate and encourage service orientation for faculty, practitioners, students, and communities. • Micro: Engage learners (students, faculty, and practitioners) in the transformation of curricula that removes barriers for addressing social justice, civic responsibility, and social accountability in communities. ROLE OF HEALTH SYSTEM USERS (SICK AND WELL PERSONS) IN ASSESSMENT OF EDUCATION, COMMUNITY HEALTH INTERVENTIONS, AND HEALTH CARE The fourth and final presenter of the small group strategies was Meg Gaines, who focused on working with patients to assess communication among health providers and health professional learners. The specific challenge she presented was to expand the role of patients in assessing communication of a health team. Macrolevel opportunities in this area (noted in Table 5-3) focused heavily on the Agency for Healthcare Research and Quality’s (AHRQ’s) Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. The CAHPS program uses surveys to assess consumers’ experiences with health care services in different settings (Agency for Healthcare Research and Quality, 2013). One major opportunity would be to develop a qualitative dimension to CAHPS. In this way, important patient narratives that do not fit easily into multiple choice surveys or Likert scales are not lost. Similarly, expanding the participant base for CAHPS to include family members, caregivers, and others would provide a more comprehensive picture of the patient experience. Another policy-level suggestion presented by Gaines was to add unconflicted patients to the certification system who could truly represent the patient voice and are from diverse populations. Gaines acknowledged that although this is a great opportunity to hear from patients, doing it well presents an enormous challenge. For example, engaging new populations, like patients, in assessments likely requires changes in the way the data is collected and analyzed, 5-8 PREPUBLICATION COPY: UNCORRECTED PROOFS

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TABLE 5-3 Opportunities for Expanding the Role of Patient Experience to Assess Team Communication Outlined by Meg Gaines and Eric Holmboe (as informed by group discussions) Opportunities on a Policy Level (Macrolevel) • Develop a qualitative dimension to CAHPS. • Develop an expanded participant base for CAHPS to include family members, caregivers, etc. • Add patients to the certification system. • Be sure that these added patients are not conflicted (e.g., retired hospital executives). • Be sure there is diverse representation. Opportunities on an Institutional Level (Mesolevel) • Explore use of electronic health records to get input from patients on their care experiences. • Bring patients together in groups so there is safety in numbers. • Consider greater use of patient advisory councils. • Ask clinic patients to assess their care experiences, which could include their perceptions of the workplace climate. Opportunities on an Individual Level (Microlevel) • Use the waiting room time to interactively educate patients about how to provide feedback so their responses are most useful to providers. • Explain to patients the value of sharing their feedback to improve quality, safety, and affordability of their care. • Use feedback to empower and motivate patients to want to provide accurate and honest information. • Ensure patient feedback is actually used, possibly for individual learner and system- level improvements. • Compensate patients for sharing their experience. NOTE: This table presents opportunities discussed by one or more workshop participants. During the workshop, all participants engaged in active discussions about opportunities. In some cases, participants expressed differing opinions. Because this is a summary of workshop comments and not meant to provide consensus recommendations, the workshop rapporteur endeavored to include all opportunities discussed by workshop participants as presented by the group leaders who were informed by the group discussions. This table and its content should be attributed to the rapporteur of this summary as informed by the workshop. adjusting how meetings are conducted so they are inclusive of patients’ thoughts and opinions, and rethinking how teams that include patients interact. Opportunities at the mesolevel could involve institutional changes around the use of health electronic records in order to get input from patients on their care experiences. Bringing patients together in groups may create a more comfortable and safe environment for individuals to express their true feelings. Another source of information at the mesolevel could be individual clinic patients for their input on their overall care experiences and perceptions of the workplace climate. On the microlevel, Gaines thought that waiting room time could be used to interactively educate patients about issues such as how to provide feedback in an assessment. Previous workshop discussions highlighted the crossover effect that engaging patients has on their health care. And likewise, engaging patients in their own health and health care could have a crossover effect of interesting them in how care is delivered, 5-9 PREPUBLICATION COPY: UNCORRECTED PROOFS

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which could be a way of reaching populations who are less engaged in their health and health care. Regardless of the patient engagement, Gaines felt it is necessary to compensate patients for their time although the actual compensation can vary. It can be a gift certificate, cash, a verbal expression of gratitude or publication of their suggestion in the organization’s newsletter. But most importantly, said Gaines, is to use the information extracted from the patients. There is tremendous exasperation when collected data is not used, so having a plan for using the information to improve the learners understanding of the health system from a patient perspective would be extremely important for current and future efforts in this area. The ideas Gaines presented—to overcome challenges associated with expanding the role of patients in assessing communication of a health team (see Box 5-5)—drew from the list of opportunities in Table 5-3. A possible starting place for overcoming the challenges could be at the macrolevel where participants of the workshop and members of the Global Forum might communicate to a wider audience a shared vision of the importance of engaging patients in assessment. These advocates of patient engagement could share examples of effective models that demonstrate how patients could be effectively involved. At the meso- and microlevels, patients and learners could be proactively involved in data collection that assesses teams, which could be used to guide learning in quality improvement, said Gaines. Part of the learning process could also involve clinicians and educators who work with patients to provide students with experiences that help them understand the patient experience. This could be done by observing health teams and then reflecting on the experience through group discussions and self-reflection. BOX 5-5 Ideas Presented by Meg Gaines (as informed by group discussions) Overcoming Challenges: Role of Health System Users (Sick and Well Persons) in Assessment of Education, Community Health Interventions, and Health Care Challenge: Expanding the role of patient experience to assess communication of the team A multilevel approach to overcoming this challenge was presented by Gaines and involved the following suggestions: • Macro: Charge the members of IOM’s Global Forum on Innovation in Health Professional Education to communicate to their constituency a shared vision of the importance of engaging patients in assessment and share some effective models. • Meso: Use data to proactively engage patients in assessments. Engage learners in data collection and analysis that improves the quality care. • Micro: Engage clinicians, who understand patients’ issues, to be observers, reporters, and interpreters of the “patient experience” in order to help learners understand it, and to guide them through self-reflection in a safe environment. 5-10 PREPUBLICATION COPY: UNCORRECTED PROOFS

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LOOKING FORWARD Following the presentations, a workshop participant wondered how the ideas presented by Gaines differ from those presented previously by other groups, and how assessment might actually be used as an agent of change? One way they differ, thought Holmboe, would be if the Global Forum members who represent multiple nations, professions, and sectors were to endorse the importance of involving patients in the assessment process. To his knowledge, that has not been done. Afaf Meleis who is the Dean of the School of Nursing at the University of Pennsylvania noted that the nurse’s Magnet Review Credentialing does involve patients in the assessment of organizations, so the process of involving patients in assessments does have a model to build upon. Forum member Malcolm Cox from U.S. Department of Veterans Affairs (VA) responded very positively to the notion of engaging patients in assessments. In his view, this would be well received by the patient community as well as the VA health system, which has already begun to move in this direction. Other health systems would similarly benefit from such a shift, he added. And although Walker agreed, she also expressed a fear of assessing the wrong aspects that could send the wrong messages about IPE. She echoed Aschenbrener’s call for establishing the evidence, but questioned whether it might be possible to assess while innovating? Can different ways of assessing be developed at the same time new methods of learning are created, like within the area of technology? In that same regard, Aschenbrener believed that assessing some aspect of simulation would be key because simulation is a very important tool for the health professions currently. Walker said that a number of tools and materials already exist, like TeamSTEPPS and social and emotional intelligence; the challenge is in figuring out how best to leverage these tools in terms of assessment, rather than trying to create something new. McNeilly built upon that idea using the 360-degree assessment as an example. This tool is well known to many and involves input and performance feedback from a full range of sources that could be used in formative assessments from IPE to practice, particularly if students are involved in all aspects of the assessment process. Coffey then closed the session by saying that too often, assessment is thought of as a way of looking back rather than looking forward, and there is a potentially strong role for assessment as a tool for moving innovation forward. IDEAS FOR FUTURE STEPS Eric Holmboe led the final session to develop ideas for future steps. To develop them, he instructed each of the small group leaders to speak with other Forum members seated at their table and come up with one important next step that would move one or more of their ideas forward. The small group leaders, whose presentations were noted earlier in this chapter, led table discussions and reported their ideas to the rest of the Forum members in the room. 5-11 PREPUBLICATION COPY: UNCORRECTED PROOFS

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Meg Gaines Meg Gaines spoke first. Her immediate next step involved leveraging the Forum membership to communicate to a wider audience—that includes regulatory organizations and community-based clinician educators—the importance of engaging patients in assessment in ways that have proven effective. The evidence for greater patient engagement in assessment would come from an environmental scan of best practices in this area that could be further expanded through commissioned studies of the topic. Carol Aschenbrener Carol Aschenbrener then expressed her thoughts. She wanted to create a MOOC as the first step to implementing the ideas she detailed in her presentation. The MOOC would be focused on core content linked to the interprofessional competencies for the beginning and advanced learner. Potential audiences could be students, faculty, and patients, and it could be used to educate governing boards and accrediting bodies who do not know what IPE is. It would be implemented by a set of motivated representatives from health and health education organizations. They would provide the needed expertise in such areas as faculty development, content, curriculum design, and pedagogic methodologies. Having a relationship with MOOC vendors like Coursera would be advantageous. It would also be crucial to have a lead organization driving the process and coordinating the relationship between the vender and the interprofessional advisory committee, said Aschenbrener. Because most of the efforts would be virtual and would not be dependent upon people coming together physically, there was no reason she could see for delaying the initiation of the activity. Patricia Hinton Walker Patricia Hinton Walker suggested a first step that drew ideas from her small group discussions as well as that of the previous two presenters. Like Gaines, Walker called upon the Forum members to publically announce that IPE is a priority, and like Aschenbrener, the message would be based on sound evidence possibly assembled through a future study. Ideally, the study would be informed by a wide array of stakeholders including patients, families, and communities, as well as learners across the education-to-practice continuum, said Walker. Accreditation bodies from different professions could also be targeted to explore how they identify assessment priorities. Results of the study could be taken forward by the Global Forum members to encourage institutional faculty and student leadership to become the implementers of innovation and change in IPE and training programs. Evaluation of interprofessional activities would be undertaken in order to identify and learn from the exemplars that emerge through the assessment process. With solid evidence demonstrating the value of interprofessional work and education, Walker believed the Global Forum members would then be in an excellent position to clearly articulate to their colleagues and others the value of interprofessional activities. 5-12 PREPUBLICATION COPY: UNCORRECTED PROOFS

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Catherine Grus Catherine Grus’ next steps were also quite similar to the other presenters. She started by suggesting a better use of the talent and expertise of the Global Forum members, who would be asked to conduct a gap analysis that identifies what has already been undertaken in the area of assessment of interprofessional activities, and what still needs to be addressed. The analysis would include how to obtain assessment data that is most useful to organizational boards and professional associations. In this way, high-level decisions about interprofessional activities are informed by the evidence and could feed into decisions made by curriculum committees. Lucy Mac Gabhann In a related next step, Lucy Mac Gabhann focused on how to drive an evidence- based accreditation process. Data and evidence would be generated by health research institutions on how health professional collaborations might lead to better outcomes. At the same time, Center for Medicare and Medicaid Innovation awardees and grantees would be producing assessment results that might inform those meta-analyses already underway, looking at linkages between IPE and improved interprofessional collaboration and patient care (Reeves et al., 2013). Analyzing all the available data would help identify higher-quality indicators related to teams and collaborations. Like others before her, Mac Gabhann felt the Global Forum members were in the best position to move this agenda forward while also involving the National Center for Interprofessional Practice and Education. This center was established in part to maximize the use of data in an effort to demonstrate the positive impact IPE and IPP can have on health, health care and costs. Building coalitions with the National Center and other more global partners around data collection and sharing knowledge of the effects of different types of collaborations could further expand the growing evidence base and lead to greater investment in assessment, as was noted by some of the workshop participants. And this investment in assessment, suggested Coffey, could be a tool for changing culture by measuring what is valued. Building Blocks for a Stronger Foundation In his closing remarks, Holmboe alluded to the workshop and the ideas put forth by individual Forum members as building blocks toward a stronger foundation. Each laid brick improves the base on which to build new and coalesced ideas within assessment of health professionals and the educational systems in which they operate. He challenged the Global Forum members to think of a specific activity that each could undertake individually or organizationally that would not just add to the foundation but also would increase each member’s sphere of influence. In that way, not only would the Global Forum be instrumental in building a house, but given each member’s reach, it could potentially be the spark for development of a whole community of houses. The bricks that built the community in Holmboe’s metaphor symbolize what can be accomplished when all stakeholders—educators, practitioners, students, patients, caregivers, and 5-13 PREPUBLICATION COPY: UNCORRECTED PROOFS

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others—work together in determining what is most valued and how to assess that so all critical goals are achieved. With that, the workshop was adjourned. REFERENCES AHRQ (Agency for Healthcare Research and Quality). 2013. CAHPS: Surveys and tools to advance patient-centered care, homepage. https://cahps.ahrq.gov (accessed January 6, 2014). American Nurses Credentialing Center. 2014. ANCC magnet recognition program. http://www.nursecredentialing.org/Magnet.aspx (accessed January 6, 2014). Reeves, S., L. Perrier, J. Goldman, D. Freeth, and M. Zwarenstein. 2013. Interprofessional education: Effects on professional practice and healthcare outcomes (update). Cochrane Database of Systematic Reviews 3:CD002213. 5-14 PREPUBLICATION COPY: UNCORRECTED PROOFS