Patent Application
20180233059
Various health professionals, such as medical doctors, nurses, psychiatrists, and the like interact with patients on a day-to-day basis. The quality of care that a health professional provides to a patient may depend on interactions between the health professional and the patient as well as on interactions between the health professional and other health professionals.
In order to improve the quality of care that a health professional provides to a patient, the health professional may become competent in patient-centered interprofessional collaborative practice. In order to facilitate this, a four-stage framework has been developed to define various competency domains. The four-stage framework may include competencies based on interprofessional values and ethics, roles and responsibilities, communication, and teams and teamwork. A health professional proficient in each of these competencies may be able to provide improved patient outcomes compared to a health professional that is not proficient in these competencies. Accordingly, disclosed herein are methods and systems for teaching these competencies to various health professionals and/or to students training to become health professionals.
In one aspect, a method for improving patient outcome is disclosed. The method includes (i) observing a first interview of a simulated patient, wherein, during the first interview, the simulated patient is in a first form; (ii) participating in a second interview of the simulated patient, wherein, during the second interview, the simulated patient is in a second form, and wherein participating in the second interview comprises interacting with the simulated patient; (iii) participating in a third interview of the simulated patient, wherein, during the third interview, the simulated patient is in the first form, and wherein participating in the third interview comprises interacting with the simulated patient; and (iv) based at least in part on the first, second, and third interviews, creating a plan of care for the simulated patient.
In another aspect, a system for improving patient outcome is disclosed. The system can include a user interface, a processor, and a computer readable medium storing program instructions that are executable by the processor to perform operations. The operations include (i) displaying, via the user interface, a first interview of a simulated patient, wherein, during the first interview, the simulated patient is displayed in a first form; (ii) displaying, via the user interface, a second interview of the simulated patient, wherein, during the second interview, the simulated patient is displayed in a second form; (iii) during the second interview, receiving, via the user interface, one or more inquiries for the simulated patient and outputting, via the user interface, one or more responses to the one or more inquiries; (iv) displaying, via the user interface, a third interview of the simulated patient, wherein, during the third interview, the simulated patient is displayed in the first form; (v) during the third interview, receiving, via the user interface, one or more inquiries for the simulated patient and outputting, via the user interface, one or more responses to the one or more inquiries; and (vi) receiving, via the user interface, a plan of care for the simulated patient, wherein the plan of care is based at least in part on the first, second, and third interviews.
In yet another aspect, a non-transitory computer readable medium is disclosed. The non-transitory computer readable medium stores executable instructions that, when executed by a processor of a computing device, cause the computing device to perform operations for improving patient outcome. Such operations include (i) displaying, via a user interface of the computing device, a first questionnaire including a first self-evaluation and receiving, via the user interface, one or more answers to the first questionnaire; (ii) displaying, via the user interface, a first interview of a simulated patient, wherein, during the first interview, the simulated patient is displayed in a first form; (iii) displaying, via the user interface, a second questionnaire including a second self-evaluation and receiving, via the user interface, one or more answers to the second questionnaire; (iv) displaying, via the user interface, a second interview of the simulated patient, wherein, during the second interview, the simulated patient is displayed in a second form; (v) during the second interview, receiving, via the user interface, one or more inquiries for the simulated patient and outputting, via the user interface, one or more responses to the one or more inquiries; (vi) displaying, via the user interface, a third questionnaire including a third self-evaluation and receiving, via the user interface, one or more answers to the third questionnaire; (vii) displaying, via the user interface, a third interview of the simulated patient, wherein, during the third interview, the simulated patient is displayed in the first form; (viii) during the third interview, receiving, via the user interface, one or more inquiries for the simulated patient and outputting, via the user interface, one or more responses to the one or more inquiries; (ix) receiving, via the user interface, a plan of care for the simulated patient, wherein the plan of care is based at least in part on information obtained during the first, second, and third interviews; and (x) displaying, via the user interface, a fourth questionnaire including a fourth self-evaluation and receiving, via the user interface, one or more answers to the fourth questionnaire.
These as well as other aspects, advantages, and alternatives, will become apparent to those of ordinary skill in the art by reading the following detailed description, with reference where appropriate to the accompanying drawings.
As noted above, a health professional may increase patient safety, reduce risk, and improve patient outcomes by embodying a number of skills including values of morality, altruism, and humanism, understanding roles and responsibilities within a patient care team, and communication, cooperation, and citizenship required for effective teamwork. These basic skills have been defined as the four Interprofessional Education Collaborative (IPEC) core competencies including (i) values and ethics for interprofessional practice, (ii) roles and responsibilities, (iii) interprofessional communication, and (iv) teams and teamwork. The four IPEC competencies are explained in more detail in I
The methods and systems described herein are designed to provide an educational model for enhancing a student's or health professional's learning and understanding of the IPEC core competencies. The student may be a student of one of various health fields such as a student of a medical school, dental school, pharmacy school, physical therapy school, physician assistant school, pathologist assistant school, nursing school, or psychology school. Similarly, the health professional may be a professional practicing in one of various health fields such as medicine, dentistry, pharmacology, physical therapy, pathology, nursing, or psychology. Other examples are possible as well.
The educational model may include the student or health professional observing and/or participating in a series of interviews with a simulated patient and creating a plan of care for the patient based on those interviews. Before and/or after each interview, the student or health professional may conduct a self-evaluation by answering various questions of a questionnaire. The questions may be chosen such that the student or health professional may be evaluated on their proficiencies of the four IPEC competencies. For instance, based on the student's or health professional's answers to the questionnaire, an instructor or some other evaluator may provide one or more evaluations of their proficiency in each of the four IPEC competencies. The evaluations may include written or verbal feedback and/or a letter grade or the like. The evaluations may be provided after the completion of each questionnaire or alternatively after the completion of all of the questionnaires.
When observing the interview, the student or health professional may merely observe without interacting with the simulated patient. As such, the interview may be carried out by a facilitator, such as an instructor or another scripted actor, who asks questions to the simulated patient for observation by the student or health professional.
In some examples, the substance of the first interview may focus on a family history and environmental history of the simulated patient.
At block 104, the method may include the student or health professional participating in a second interview of the simulated patient, wherein, during the second interview, the simulated patient is in a second form that is different from the first form. For instance, rather than being a real person, the simulated patient could take the form of a mechanical dummy, mannequin, or the like.
When participating in the second interview, the student or health professional may interact with the simulated patient rather than merely observing. As such, the student or health professional may submit various questions or inquiries to the simulated patient to obtain information about the patient. Because the simulated patient is not a real person in this example, the simulated patient may be remotely controlled to answer the questions posed by the student or health professional. For instance, the facilitator or some other person, such as the person who portrayed the patient during the first interview, may be located remotely (e.g., in an adjacent room) from the simulated patient. In some examples, the student or health professional may provide questions to the remotely located person via a remote audio system. For example, the questions may be spoken into a microphone (e.g., a microphone disposed on or near the simulated patient) that is connected wirelessly or via a wired connection to a speaker near the remotely located person. Similarly, the remotely located person may provide answers to the questions by speaking the answers into a microphone that is connected to a speaker disposed on or near the simulated patient. In this manner, the student or health professional can participate in an interview with a patient without engaging in any direct human contact with the patient.
In some examples, the substance of the second interview may focus on aspects of the simulated patient's environment and community. For instance, before the student or health professional interacts with the patient, the facilitator may interview the patient by asking questions such as those shown in the example script of
In addition to participating in the second interview to obtain information about the patient's environment and community, the student or health professional may conduct outside research, using the Internet for example, to obtain further information about the demographics and environment of the patient's community. The student or health professional can then reflect as an individual and/or discuss as a group with other students or health professionals to determine the impact that any obtained information may have on the patient's health and recovery.
At block 106, the method may include the student or health professional participating in a third interview of the simulated patient, wherein, during the third interview, the simulated patient is in the first form, and wherein participating in the third interview comprises interacting with the simulated patient. For instance, the patient may again take the form of a real person, and the interview could include the facilitator or some other person leading the interview. In particular, the facilitator and the simulated patient may be located remotely (e.g., in another room), and the student or health professional may observe the interview via a computing system displaying a live or delayed video and audio feed (e.g., a computing system executing IP-based video call software or the like).
Additionally, rather than merely observing the third interview, the student or health professional could ask the simulated patient various questions. For instance, the student or health professional could speak to the remotely located simulated patient via the computing system facilitating the video call. As such, the student or health professional may again participate in the interview of the patient without engaging in any direct human contact with the patient.
The simulated patient could be trained to steer the conversation of the third interview to focus on the socioeconomic status of the patient. For example, the simulated patient could indicate that he or she has concerns about paying for or obtaining medication, getting to and from appointments, living conditions, neighborhood safety, depression, lack of a support system, and the like.
At block 108, the method may include the student or health professional creating a plan of care for the simulated patient based at least in part on the first, second, and third interviews. For instance, the student or health professional may use any information obtained from the interviews of the simulated patient, from researching the demographics or community of the simulated patient, or from discussions with other students or health professionals. The created plan of care may include recommendations of external services for the simulated patient in terms of the patient's specific social determinants of health. Examples may include counseling, housing, social support groups, or the like. Further, the external services may be specific to the neighborhood of the simulated patient. For instance, during the interviews of the simulated patient, the student or health professional may ascertain the patient's neighborhood and may thus include recommendations for specific external services that are available in the patient's neighborhood.
At block 202, the method may include the student or health professional completing a self-evaluation regarding the core IPEC competencies—interprofessional values and ethics, roles and responsibilities, communication, and teams and teamwork. This evaluation may be referred to as the Stage One evaluation, which may be used to establish a baseline measurement of the student's or health professional's proficiencies in the IPEC competencies.
Because the Stage One evaluation is a preliminary evaluation, the student or health professional may not be expected to demonstrate proficiency in each of the IPEC competencies. For instance, at the time of the Stage One evaluation, the student or health professional may be merely expected to exhibit a basic understanding of the IPEC competencies. As such, the Stage One evaluation may act as a benchmark to provide concrete information, activate a background knowledge of the student or health professional, explain the educational model disclosed herein, and provide the student or health professional with expectations for the outcome of the educational model.
The Stage One evaluation may include providing the student of health professional with a self-evaluation questionnaire. The questionnaire may include questions for evaluating the student's or health professional's views on interprofessional values and ethics (e.g., morality, altruism, and humanism). Such questions may include questions for determining the student's or health professional's proclivity to comply with established rules, respect authority, or respect the concerns, needs, feelings, or privacy of others, and/or for determining the student's or health professional's societal views. Other types of questions for evaluating interprofessional values and ethics may be included as well.
The Stage One evaluation may further include questions for evaluating the student's or health professional's views on interprofessional roles and responsibilities. Such questions may include questions for measuring the awareness and acceptance of similarities and differences among people such as similarities and differences based on nationality, race, culture, disability, or beliefs. Other types of questions for evaluating interprofessional roles and responsibilities may be included as well.
The Stage One evaluation may further include questions for evaluating the student's or health professional's views on interprofessional teams and teamwork. Such questions may include questions for determining the student's or health professional's proclivity to seek conflict, value cooperation over competition, work alone or in a group, support other group members, and/or socialize with others. Other types of questions for evaluating interprofessional communication may be included as well.
In addition to providing questions to evaluate the student's and health professional's views on interprofessional values and ethics, roles and responsibilities, and teams and teamwork, the Stage One evaluation may further evaluate the student's or health professional's interprofessional communication skills. Such an evaluation may be performed by observing how the student or health professional interacts with others when performing the various steps of the method discussed herein.
Referring back to
At block 206, the method may include the student or health professional completing a second self-evaluation regarding the core IPEC competencies. This evaluation may be referred to as the Stage Two evaluation. The Stage Two evaluation may be designed to evaluate the student or health professional on the same or similar subjects as the Stage One evaluation and may include the same or similar questions (e.g., the questions depicted in
At block 208, after completing the Stage Two evaluation, the method may include participating in a second interview of the simulated patient, which may be carried out in the same or similar manner as described above with reference to block 104 of
At block 210, the method may include the student or health professional completing a third self-evaluation regarding the core IPEC competencies. This evaluation may be referred to as the Stage Three evaluation. The Stage Three evaluation may be designed to evaluate the student or health professional on the same or similar subjects as the Stage One and Two evaluations and may include the same or similar questions (e.g., the questions depicted in
At block 212, after completing the Stage Three evaluation, the method may include participating in a third interview of the simulated patient, which may be carried out in the same or similar manner as described above with reference to block 106 of
At block 216, the method may include the student or health professional completing a fourth self-evaluation regarding the core IPEC competencies. This evaluation may be referred to as the Stage Four evaluation. The Stage Four evaluation may be designed to evaluate the student or health professional on the same or similar subjects as the Stage One, Two, and Three evaluations (e.g., using the questions depicted in
During each of the Stage One, Two, Three, and Four evaluations, the student or health professional may be evaluated in various ways to determine their proficiency in the IPEC core competencies. For instance, in evaluations where the student or health professional completes a self-evaluation questionnaire, the student or health professional can be evaluated by applying a rubric to the completed questionnaire. Examples of such rubrics are included below in Tables 1-4 of the Appendix section.
As noted above and as demonstrated by the example rubrics, each subsequent stage of the evaluations holds the student or health professional to a higher standard. For instance, referring to the rubric of Table 4, a student or health professional may be evaluated in each stage on their ability to “demonstrate high standards of ethical conduct and quality of care in contributions to team-based care.” Specifically, in order to meet expectations of the Stage One evaluation, the student or health professional may be expected to “recognize ethical issues when presented in a complex, multi-layered context as well as cross-relationships among the issues.” In order to meet expectations of the Stage Two evaluation, the student or health professional may further be expected to “discuss how ethical issues may influence quality of team-based care.” In order to meet expectations of the Stage Three evaluation, the student or health professional may further be expected to “create best practices to influence and promote high quality team-based care.” And in order to meet expectations of the Stage Four evaluation, the student or health professional may further be expected to “apply, evaluate, and reassess best ethical practices within a patient's plan of care.” Other examples are also illustrated by the example rubrics in Tables 1-4.
In practice, the rubric in Table 1 may be applied during the Stage One evaluation, the rubric in Table 2 may be applied during the Stage Two evaluation, the rubric in Table 3 may be applied during the Stage Three evaluation, and the rubric in Table 4 may be applied during the Stage Four evaluation. In other examples, the evaluations of each of the stages may involve using more than one of the example rubrics, using metrics from multiple different example rubrics, and/or using metrics that are not shown by the example rubrics.
As noted above, the student or health professional may be provided with feedback regarding the Stage One, Two, Three, and Four evaluations at various times. For instance, the student or health professional could be provided with feedback after each individual evaluation or after the completion of all of the evaluations. The feedback may include an indication of whether each rubric metric has been satisfied for a particular stage. The feedback may include written or verbal feedback of how the student or health professional may improve. And in some examples, the feedback may include a letter or percentage grade based on how many rubric metrics were satisfied by the student or health professional. Further, if a student or health professional does not satisfy a sufficient number of metrics for a given stage evaluation, the student or health professional may be required to repeat one or more prior steps of the educational model before advancing to the next step. For instance, if the Stage Two evaluation indicates low proficiency by the student or health professional, then the student or health professional may be required to repeat the observation of the first interview before participating in the second interview. Other examples are possible as well.
By carrying out the methods disclosed herein, the student or health professional may become more aware and have a better understanding of interprofessional education and the IPEC competencies. This may help the student or health professional better understand and explore how the social determinants of health can affect patient health and outcomes, especially as related to underserved populations.
In some examples, some parts or all of the methods disclosed herein may be carried out by one or more computing devices. For instance, the first interview could be a pre-recorded interview or a live video feed of the interview displayed on a user interface of the computing device. The student or health professional could thus observe the first interview via the user interface of the computing device.
Similarly, the computing device may further facilitate the student's or health professional's participation in the second interview. For instance, the simulated patient may take the form of a virtual avatar displayed on the user interface of the computing device. The student or health professional may thus provide inquiries to the virtual avatar via the user interface of the computing device. For example, the student or health professional may input an inquiry via a keyboard or mouse input. Alternatively or additionally, the inquiries may be spoken into a microphone of the computing device and transmitted as audio or converted to text using voice-to-text software. The inquiries may then be transmitted over a network, such as the Internet to a remote computing device. And an operator of the remote computing device may provide answers to the inquiries in a similar manner (e.g., using voice or text input).
The computing device may also facilitate the student's or health professional's participation in the third interview. For instance, like the first interview, the third interview could be a pre-recorded interview or a live video feed of the interview displayed on a user interface of the computing device, thereby allowing the student or health professional to observe the third interview via the user interface of the computing device. Further, like the second interview, during the third interview the computing device could be configured to receive various inquiries from the student or health professional as well as provide answers to the inquiries via the user interface of the computing device.
Additionally, the computing device may facilitate some or all of the evaluations. For instance, for any or all of the Stage One, Two, Three, or Four evaluations, the computing device may display a questionnaire via the user interface of the computing device. The student or health professional may then perform a self-evaluation by inputting answers to the questionnaire via the user interface (e.g., using a keyboard or mouse).
Similarly, the computing device may facilitate completion of the plan of care for the simulated patient. For instance, the student or health professional may input their created plan of care into the user interface of the computing device, and the plan of care may then be transmitted via a network to a remote computing device. An operator of the remote computing device, such as an instructor, may receive the plan of care and input an evaluation of the plan of care into the remote computing device. The remote computing device may then transmit the evaluation back to the computing device for display to the student or health professional via the user interface of the computing device.
The data storage 504 can include or take the form of one or more computer-readable storage media that can be read or accessed by at least one of the one or more processors 502. The one or more computer-readable storage media can include volatile and/or non-volatile storage components, such as optical, magnetic, organic, or other memory or disc storage, which can be integrated in whole or in part with at least one of the one or more processors 502. In some embodiments, the data storage 504 can be implemented using a single physical device (e.g., one optical, magnetic, organic, or other memory or disc storage unit), while in other embodiments, the data storage 504 can be implemented using two or more physical devices.
The input/output unit 508 can include user input/output devices, network input/output devices, and/or other types of input/output devices. For example, input/output unit 508 can include user input/output devices, such as a touch screen, a keyboard, a keypad, a computer mouse, liquid crystal displays (LCD), light emitting diodes (LEDs), displays using digital light processing (DLP) technology, cathode ray tubes (CRT), light bulbs, and/or other similar devices. Network input/output devices can include wired network receivers and/or transceivers, such as an Ethernet transceiver, a Universal Serial Bus (USB) transceiver, or similar transceiver configurable to communicate via a twisted pair wire, a coaxial cable, a fiber-optic link, or a similar physical connection to a wireline network, and/or wireless network receivers and/or transceivers, such as a Bluetooth transceiver, a Zigbee transceiver, a Wi-Fi transceiver, a WiMAX transceiver, a wireless wide-area network (WWAN) transceiver and/or other similar types of wireless transceivers configurable to communicate via a wireless network.
In practice, the one or more processors 502 can be configured to execute computer-readable program instructions 506 that are stored in the data storage 504 and are executable to provide at least part of the functionality described herein. For instance, the one or more processors 502 may be configured to execute the computer-readable program instructions 506 in order to (i) display, via the input/output unit 504, a first interview of a simulated patient, wherein, during the first interview, the simulated patient is displayed in a first form; (ii) display, via the input/output unit 504, a second interview of the simulated patient, wherein, during the second interview, the simulated patient is displayed in a second form; (iii) during the second interview, receive, via the input/output unit 504, one or more inquiries for the simulated patient and output, via the input/output unit 504, one or more responses to the one or more inquiries; (iv) display, via the input/output unit 504, a third interview of the simulated patient, wherein, during the third interview, the simulated patient is displayed in the first form; (v) during the third interview, receive, via the input/output unit 504, one or more inquiries for the simulated patient and output, via the input/output unit 504, one or more responses to the one or more inquiries; and (vi) receive, via the input/output unit 504, a plan of care for the simulated patient, wherein the plan of care is based at least in part on the first, second, and third interviews.
The computing device 500 can be implemented in whole or in part in various devices, such as a smartphone, smartwatch, tablet, laptop, or personal computer. Generally, the manner in which the computing device 500 is implemented can vary, depending upon the particular application.
The particular arrangements shown in the Figures should not be viewed as limiting. It should be understood that other embodiments can include more or less of each element shown in a given Figure. Further, some of the illustrated elements can be combined or omitted. Yet further, an exemplary embodiment can include elements that are not illustrated in the Figures.
Additionally, while various aspects and embodiments have been disclosed herein, other aspects and embodiments will be apparent to those skilled in the art. The various aspects and embodiments disclosed herein are for purposes of illustration and are not intended to be limiting, with the true scope being indicated by the claims. Other embodiments can be utilized, and other changes can be made, without departing from the scope of the subject matter presented herein. It will be readily understood that the aspects of the present disclosure, as generally described herein, and illustrated in the figures, can be arranged, substituted, combined, separated, and designed in a wide variety of different configurations, all of which are contemplated herein.
