Health Care Team Challenge: A Versatile Model for Interprofessional Education
|Case, Presentation, Video||9287||1||December 11, 2012|
The Health Care Team ChallengeTM (HCTC) is an innovative, versatile, low cost interprofessional (IP) learning activity that is used to simulate “real-life” team based problem solving. The HCTC model can easily be adapted to meet core competencies for collaborative care in all health professions programs. Key characteristics of a HCTC are described and one example of how the HCTC model has been successfully implemented is highlighted. The HCTC is a clinical cased-based competition between two or more interprofessional teams of students representing at least two health and social service disciplines (6-8 is ideal). Student participants receive the initial patient scenario at least one week, preferably 2 to 3 weeks, in advance of the live event.
Teams are instructed to work collaboratively to formulate a patient-centered plan of care. On the day of the event, the teams present their plan in front of a live audience of faculty, peers and community members. Then, teams are presented with additional information relevant to the case, challenging each team to adjust its management plan to incorporate the new information. Additionally, teams are asked to respond to “process questions” such as, “How did your team resolve conflicts?” and “What do you view as the strengths of your team?” Teams alternate in the presentation of the care plans and responses to team process questions. At the conclusion of the event, teams are evaluated by an IP panel of judges that may include the patient or family member, faculty, and / or a practicing community-based interprofessional care team. An “audience choice award” may also be presented. Teams are judged on both the quality of the management plan and the level of collaboration as illustrated by responses to the team process questions. All team participants, judges, and event sponsors receive recognition for their involvement. Winning team members may also receive prizes or scholarship funding.
Richardson B, Gersh M, Potter N. Health Care Team Challenge: A Versatile Model for Interprofessional Education. MedEdPORTAL; 2012. Available from: www.mededportal.org/publication/9287
Contains Information Suitable for Patient Education
- To work collaboratively with students from other health professions to maintain a climate of mutual respect and shared values.
- To place the interests of the patient / family at the center of their plan of care.
- To apply the knowledge of one’s own professional role and those of other team members to appropriately assess and address the health care needs of the patient / family.
- To communicate effectively with the patient / family and other members of the health care team.
- To listen actively and encourage ideas and opinions of other team members.
- To engage team members in shared patient-centered problem solving.
- To integrate the knowledge and experience of all team members to inform decisions, while respecting the patient’s values, priorities, and preferences for care.
- To constructively manage disagreements about values, roles, goals, and actions that may arise among team members.
- To practice leadership skills that support effective team work.
- Interprofessional Education Collaboration (IPEC), Multiprofessional Teamwork, HCTC
- Interpersonal & Communication Skills
- Interprofessional Collaboration
- Patient Care
- Practice-based Learning & Improvement
- Clinical Sciences
- Clinical Skills/Doctoring
- Communication Skills
- Cultural Diversity/Cultural Competency
- Health Education
- Instructional Materials/Methods
- Quality Improvement
- Professional School
- Allied Health Student
- Dental Student
- Medical Student
- Nursing Student
- Pharmacy Student
Authors & Co-Authors
Barbara Richardson, PhD, RN
Washington State University
Meryl Gersh, PT, PhD
Eastern Washington University
Nancy Potter, PhD
Washington State University
Sponsorship or Funding Source
INHCTC partially funded by the Canadian Institutes of Health Research #228167
Author partially funded by HRSA grant #1 D1DHP20355-01-00
Funded in part by the Josiah Macy Jr. Foundation in fulfillment of the AAMC/IPEC interprofessional education initiative.
Effectiveness and Significance
From the perspective of faculty and students, the HCTC successfully provides an interactive learning opportunity to develop the knowledge, skills, and attitudes outlined in the Interprofessional Education Collaborative (IPEC) core competencies. At the conclusion of the event, students completed an online evaluation for purposes of improving future HCTC events. 100% of students (n=54) stated that participating in the HCTC (at WSU/EWU/UW) was worth their time. Evaluations included the following comments:
“I was able to do as a student what I hope to do as a working professional. My team bonded and worked together very well. It gave me team experience with health care disciplines I have never even spoken to as a student. I have wanted this kind of experience since entering my program. Experiences rewire the brain, and this was a wonderfully positive experience that no book learning or same-discipline team projects can duplicate. I am really glad I got to do this!!”
“I became much more aware over these two weeks how much there is to know in health-care, and that I really can't know it all myself. Neither can anyone else, and it is in the patient's best interest to have multiple specialties putting their ideas together rather than working independently.”
“It was one of the best experiences of my educational career because it showed me where I fit in to the big picture of collaborative health care. It also taught me a lot about the other fields that I will have contact with once I graduate and begin working.”
“Participating in the HCTC gave me a huge appreciation for where my knowledge stops and other health care professionals starts. Knowing that will greatly help me to utilize them appropriately and seek out their expertise in the future.”
Participants were encouraged to complete the Readiness for Interprofessional Learning Survey (RIPLS) pre- and post participation in the HCTC (Appendix D). The 19 item questionnaire measures attitudes about teamwork, collaboration, professional identity and roles and responsibilities. Of the students (n=12) that completed the RIPLS both before and after the HCTC , significant differences in the paired t-test scores were detected for two questions. Following the HCTC, participants were more likely to agree (M = -.417, SD = .515) that shared learning with other health care students would help them communicate better with patients and other professionals (p = .017). Students were less likely to agree (M = . 583, SD = .900) that the function of nurses and therapists is mainly to provide support for doctors (p = .046). All students agreed (22%) or strongly agreed (78%) that team-working skills are essential for all health care students to learn and that patients would ultimately benefit if health care students worked together to solve patient problems. All students also agreed (44%) or strongly agreed (56%) that learning with other students would help them become a more effective member of a health care team and shared learning with other health care students would help them to communicate better with patients and other professionals.
In addition to asking participants to complete the RIPLS, we encourage students to complete an on-line evaluation for purposes of improving future HCTC events. The following are sample questions that may be used to solicit feedback:
What suggestions do you have for making the HCTC a better event next year?
Was participating in the HCTC worth your time? If yes, why? If no, why not?
If participation in the HCTC is required, faculty may wish to ask students to write a reflection on how the experience has changed their perception about providing collaborative patient centered care as a health care team.
Special Implementation Guidelines or Requirements
Using a modified Delphi technique, INHCTC participants identified and recommend inclusion of the following key features and operational considerations for every HCTC.
- Key Characteristics Operational Considerations
Integrated into curricula When possible, the HCTCTM event should be part of a larger interprofessional curriculum that engages students as part of their overall program.
Involves at least 2 teams Having more than one team in the HCTCTM supports the principle of a challenge, which is supported by social learning theory. The overall number of teams involved will be influenced by available resources. There is no maximum number of teams that can be involved.
Minimum of 2 professions on each team Based on the definition of interprofessional education, IPE involves two or more professions. Group theory suggests 6-8 people per team is ideal for small group learning (Johnson & Johnson, 1991). Team composition should be authentic, based on how a team would be composed in a “real” practice setting.
Students choose to participate as a team member While students may be invited to participate as a team member, they should not be required to do so.
Transparent recruitment process of team members As the event becomes more popular, more students than can be accommodated may volunteer to participate as a team member. Organizers should have a transparent process for deciding which students will be able to participate on a team.
Audience participation The HCTCTM should take place in front of an audience. Students may be required to attend as an audience member as part of a class activity or as an elective. Observing the HCTCTM is considered to be exposure to an interprofessional learning activity.
Educational/learning support Teams should have access to support for both content and process. This may be from: faculty mentors, practitioners, process resources, content resources, consumers (patient, community organizations, health care organization), and online resources.
Recognition for faculty Ongoing support from dedicated faculty is necessary for sustainability of the model; therefore, it is important to recognize the contributions faculty make. This can take the form of faculty performance and workload recognition; a certificate/letter; or verbal/public acknowledgement.
Recognition for students Ways in which students can be recognized for their participation include a certificate/letter, scholarships, academic credit, prizes, or meeting a required component of their program (i.e. IPE curriculum).
Case with assigned task(s) The HCTCTM is a case-based learning activity. Cases should have an appropriate level of complexity based on theories of team development, the level of the learners and the learning objectives. The content of the case should not be so complex that it distracts from the interprofessional process. The case should be authentic, grounded in reality. It is also important that the case be distributed to participants prior to the HCTCTM event. Participants should be asked to complete a task associated with the case (e.g. develop an interprofessional care or management plan).
Interprofessional team development over time Providing the case prior to the HCTCTM event enables students to develop as a team. This can be done face-to-face, virtually, synchronously or asynchronously.
Real-time team response to new information During the HCTC event, teams should be presented with new information they will process as a team. This could involve engaging in team work or answering questions from the audience and/or judges; being presented with case plot twist/extensions; or responding to provocateurs.
Tangible product/deliverable that can be assessed HCTC teams should be required to create a product such as an oral plan of care; a PowerPoint presentation; a written report; a video; or a role play.
Assessment of interprofessional teams Teams can be assessed on their process and/or the content (the deliverable). Evaluation can come from a panel of judges, the audience, and/or peer/self-assessment. Judges may include faculty, consumers, community members, practitioners, or students.
Opportunity for feedback to teams Verbal, written or online feedback can be provided to teams by the audience, judges, peers, and/or content and team process experts.
Program evaluation In order to continuously improve the delivery of the HCTC it is important to evaluate the model. Formal evaluation may include online/written surveys and/or focus groups. Informal evaluation may include debriefs and/or student feedback. Faculty may also choose to evaluate the HCTC as part of a program-wide evaluation.
- Strengths of the HCTC Model
A major strength of the model is the sound theoretical framework. From an educational theory perspective, the HCTC directly aligns with the World Health Organization’s (2010) principles of effective interprofessional education as the model is practice/problem-based and patient focused. As there is no universally accepted IPE theoretical framework, the HCTC is supported by elements of two established educational theories; social learning theory informs the structure of the HCTC model, and experiential learning theory for group process (Barr & Ross, 2006, Boduras, 2006, WHO, 2010). Additional strengths lie in the HCTC model’s versatility. Flexibility is achieved through potential involvement from multiple health professions, adjustable levels of clinical and /or IPE learning, and ‘extracurricular’ scheduling. Faculty can easily develop the case to involve students from multiple health and human service programs. For example, teams may be challenged to manage priorities for acute or chronic care, to handle role overlap in transitioning the patient from a hospital to assisted living, or create a plan for a potential natural disaster.
The focus of clinical and /or IPE learning can also be manipulated in a similar manner to match the educational level of participants. At UBC, the HCTC is designed to expose students to the concept of collaborative care. The event is held early in the academic year and serves to introduce students to topics such as culture, social determinants of health, and roles of healthcare colleagues. The goal is to stimulate student’s interest in learning more about both clinical content and collaborative care. The WSU/EWU/UW HCTC is held near the end of the academic year and serves to showcase IP collaboration skills and knowledge acquired in both classroom and clinical settings. The University of Minnesota’s Clarion competition focuses on a sentinel event in which teams complete a root cause analysis and propose potential systems based solutions to the identified problem. Some institutions have developed the HCTC as an immersion model for IPE with pre-readings, reflective questions, and on-line components; much like an interprofessional problem-based course integrated into the curricula of different disciplines. Another approach has been to develop content details for a particular clinical focus. If the goal is to increase understanding of collaborative care of a particular disease such as diabetes, HIV or breast cancer, or care of a patient with chronic pain or at the end of life, teams may be assigned to work with an expert consultant in the specific topic. Clinical specialists may serve as a mentor and resource to teams both before and during the HCTC; and also provide a brief summary of their role for the audience. The level of cases may be structured to provide educational exposure, immersion or competency.
One of the initial keys to success for the HCTC is the extracurricular format that allows for flexibility in scheduling. As such, it bypasses many of the logistical barriers faced by most IPE programs. The extracurricular format avoids the slow and costly formal process of implementing curricular change, as well as allowing IPE to gain momentum. With the Accreditation for Interprofessional Health Education (AIPHE) project well established in Canada, and the Interprofessional Education Collaborative (IPEC, 2011) core competency recommendations in the US, most health disciplines are now required to demonstrate evidence of IPE for accreditation. The HCTC can potentially provide a simple and successful IPE model that meets accreditation requirements.
Currently, the majority of HCTC events are held “in person.” However, the model may be expanded to include a greater number of teams and include teams from different regions with the use of digital media. At the University of Queensland’s Health Fusion Team Challenge, teams receive the initial case scenario via the web, and then create and submit a short (4-5 minute) video of their care management plan for evaluation by a panel of judges. The top 6 teams then meet (in person) for the second phase of the competition. In this way, student teams in remote locations may compete with colleagues in urban academic settings. Using digital media allows teams from across regions, states, or countries to compete against one another.
- Weaknesses of the HCTC Model
Holding a HCTC requires resources, both human and financial. At least a small group of faculty must be committed to ensure a successful event. Volunteering to organize a HCTC takes time and may not be recognized as a scholarly pursuit in some academic settings. The HCTC usually involves only a limited number of students from each health profession, with other students participating as members of the audience. Students that participate on a team have an opportunity to practice IP core competencies, but those sitting in the audience are not as engaged in IP learning. While student evaluations of their involvement in a HCTC event have been overwhelmingly positive, there is a lack of outcome data suggesting that participation eventually leads to better collaborative practitioners.
- Planning Guide / Practical Implementation Advice
The purpose of this guide is to help the Health Care Team Challenge planning committee get started by assigning responsibilities and implementing tasks in a timely manner. Your committee may wish to assign several people to each of the 3 general categories of tasks: (1) general logistics, (2) case development or recruiting a “real” patient and provider, and (3) recruiting student participants.
One person, either faculty or staff, should assume the role of HCTC event coordinator. It is helpful to have one person that oversees all planning and can be the “point person” for any questions. It is particularly important that all participants have just one person to whom all questions are directed. Consistent answers to frequently asked questions are one key to a successful event!
Use a real patient if possible. The most significant difference between the HCTC held at WSU and other places is the involvement of a real patient, rather than a paper-based scenario. We have found that interacting with a genuine person greatly increases motivation and buy-in from students. Patients are recruited through clinics staffed by faculty. Patients have enthusiastically volunteered to participate and at the conclusion of the event have expressed gratitude for the sincere interest and care provided by each IP team. Having the patient serve as a judge enforces the concept of patient-centered care. One of the most meaningful interactions came at the conclusion of a HCTC when the patient shared with students that while they were still novices, he would much prefer any one of their collaborative care plans than the current approach to his care, which includes multiple specialists who do not communicate well with one another, the patient, or his family / caregivers.
- If using a real patient, take care to observe HIPPA regulations. Do not distribute patient’s confidential information via the internet.
- Have one point of contact. It is important that all questions and concerns be answered in a timely and consistent manner. Identifying one “point person” decreases the potential for confusion.
- Make the recruitment process transparent. Participating in the HCTC has become very popular on our campus. Determine a clear process to recruit students, make sure it is “fair”, advertised well in advance of the sign-up date, and keep a list of alternates in case a student withdraws.
- Give recognition. Honor the patient who volunteered his / her time. Acknowledge faculty and community members that participate in planning or serving as a judge. Provide students with a certificate of participation and/or letter to include in their portfolio. Thank sponsors (if used) and recognize their contributions to the event.
- A HCTC creates IPE champions. A HCTC event clearly demonstrates how IPE can prepare students for collaborative practice. Faculty who previously were not enthusiastic about IP approaches to learning, became convinced of the importance of IPE as a direct result of their students’ participation on a HCTC team. Health care professionals from the community who attended the event commented that student presentations helped them better understand how the concept of collaborative patient centered care could be actualized in their practices.
- Celebrate success and have fun. Participating in the HCTC takes 8-10 hours of each student’s time outside of regularly scheduled classes. To increase motivation, all participants are given a HCTC T-shirt and water bottle, and extras are randomly given to people in the audience. Students raise additional funds (~$2000) from local professional organizations to purchase Kindles for the winning team and food for a reception following the event. Many student teams continue to be a resource for one another and meet (primarily for social purposes) long after the event takes place.
This information is made available under the Creative Commons license.
This publication has been formally peer reviewed elsewhere
April, 2012 Western Institute for Nursing
2012 International Meeting for Simulation in Healthcare
Publications, Presentations, and/or Citations for this Publication
- April, 2012 Western Institute for Nursing Symposium, “Overcoming the Barriers: Successful Models of Interprofessional Education”, Portland, OR.
- January, 2012 International Meeting for Simulation in Health Care expert panel, workshop, and poster presentation, “Health Care Team Challenge, A Versatile Interprofessional Simulation”, San Diego, CA.
- August, 2011 METI Regional Conference podium presentation, “Health Care Team Challenge; A Model for Interprofessional Education”.