The San Francisco VA Center of Excellence in Primary Care Education (SFVAMC COE-PCE) has developed several types of Interprofessional Case Conferences (ICCs) to teach and reinforce a culture of interprofessional collaboration in primary care through interactive, trainee- or faculty-led conferences. ICC’s occur in clinics that function as patient centered medical homes and teach clinical content, communication techniques, and a team-based approach to primary care. Health professions trainees include internal medicine and psychiatry residents, nurse practitioner and medical students, psychology and subspecialty fellows, and pharmacy, dietetic, social work and podiatry trainees.
This submission describes one of our ICC’s, entitled Collaborative Case Conference. CCC is a monthly hour-long case-based interprofessional case conference in which trainees from a variety of health professions facilitate and discuss medically and psychosocially complex patients from one trainee’s primary care panel with the goal of developing an improved plan of care for the patient. The reality of busy clinical practice is that communication between providers from different professions most often takes place through the medical record or through brief telephone consultations between individual providers. CCCs include upwards of twenty participants from wide-ranging backgrounds and allow face-to-face, interactive brainstorming of strategies and solutions that can ultimately be incorporated into a plan of care in real time.
The trainee facilitator works closely with a faculty mentor to prepare for and execute CCC, which includes selecting an appropriate patient, identifying clear learning objectives, inviting discussants involved in the patient’s care or with relevant expertise, writing up the case and discussion questions, selecting and summarizing two pertinent articles from the literature, and creating a facilitation plan to encourage participation and collaboration among all participants. The trainee also writes a post-conference care plan detailing the innovative ideas for the patient’s care that arose during CCC and completes a 3-month update on the status of the proposed interventions.
We support our trainees’ development of interprofessional facilitation skills by reinforcing the following guiding principles: clarifying the purpose and goals for the session, providing opportunities to observe, co-facilitate, and consult with effective facilitators, considering the potential contributions and perspectives of different professionals, and taking time to reflect on and debrief the session.
This submission includes a comprehensive Instructor’s Guide with documents and sample templates for conference preparation and follow-up.
CCC provides an effective opportunity for interprofessional collaboration. We used conference evaluation forms and trainee check-ins with faculty mentors to evaluate the following components of CCC: 1) Interprofessional trainee satisfaction with the organization, facilitation, educational value, and collaborative nature of the conference; 2) Interprofessional trainee self-assessment of knowledge, skills, and attitudes related to IPC; and 3) Participants’ achievement of learning objectives based on observed behaviors during CCC, documents generated for and subsequent to the conferences, and formative assessments by peers and faculty mentors.
Data regarding interprofessional trainees' rating of the conference and its impact on their IPC knowledge, skills and attitudes are provided in Table 2, “CCC Session Evaluations & Self-Assessments,” which is reported in Resource Files. Conference ratings were very high across the board, with scores above 4 (on 0-5 scale) for nearly all questions. In formal curricular feedback sessions held twice a year, trainees frequently request more such interprofessional case-based learning sessions.
In addition to supporting trainee's competency in IPC, CCC led to innovative developments in patients' treatment plans, which were documented in the Post Conference Care Plans and added to the patients' medical record. Trainees generated between 4 and 13 novel patient care interventions per CCC, which included both medical and psychosocial interventions in each case. In reflecting on her experience presenting a patient for CCC, one resident wrote "The CCC was extremely helpful in this case. I was able to bring multiple consultants together, and within one hour, accomplish what would otherwise have taken multiple days to weeks of emailing, paging, and calling." The experience of bringing a patient's many healthcare providers together in one room has, in many cases, led to new and lasting collaborations between individuals & departments. In one case of a patient with PTSD, decompensated alcoholic cirrhosis, and new diagnoses of both colon cancer and HCC, the patient's primary care provider, social worker, psychologist, hepatologist and palliative care team continue to exchange group emails coordinating his care a year after the conference first brought them all together. Following another CCC, nephrology and palliative care teams created a new joint educational conference for fellows discussing end-of-life care in end-stage renal disease patients.
In summary, the Collaborative Case Conference series has proven to be an effective tool in developing primary care trainees' competence in interprofessional collaboration and has helped to foster a culture of IPC within our program. The IPC skills that trainees develop through curricula such as CCC are expected to translate into enhanced interprofessional skills in future clinical settings beyond our training program. CCC has also had a positive impact on the individual patients discussed in the conferences, through the generation of new multidisciplinary strategies in the patients' care plans and the creation of lasting collaborations between their providers.
Target learners for this curricular innovation are Primary Care Internal Medicine residents and Nurse Practitioner trainees. CCC aims to promote two overarching goals central to our Primary Care training program:
- Support trainee competency in IPC.
- Foster a culture of interprofessional collaboration.
Specific learning objectives for Primary Care Internal Medicine residents and Nurse Practitioner trainees participating in CCC are as follows:
- Collaborate with interprofessional conference participants to develop innovative care plans that include perspectives and services beyond own profession.
- Identify and mobilize multidisciplinary resources available within one’s healthcare system to care for complex, challenging patients.
- Build professional relationships across multiple disciplines and use these ongoing relationships to enhance care of patients clinic-wide.
The trainee facilitator for each conference has the following additional important learning objective:
- Skilfully facilitate interprofessional case conferences.
Table 1, which is reported in Resource Files, also describes measurable learning outcomes and evaluation methods for each learning objective.
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Pearson M, O'Brien B, Shunk R. Development and evaluation of an interprofessional collaborative case conference series. Poster presented at: Society of General Internal Medicine Annual Meeting; 2013.
Pearson M, O'Brien B, Patel S, Bachhuber M, Kim C. Designing, delivering, and evaluating interprofessional case conferences (ICC) for health professions trainees. Workshop presented at: National Society of General Internal Medicine Annual Meeting; 2014.
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