Table Facilitators ' Reflections Regarding their Interprofessional Core Competencies

Background: Providing students and practitioners opportunities to learn from other disciplines in a supportive environment has the potential to improve patient outcomes and practitioner job satisfaction. Purpose: The purpose of this study was to describe an annual Interprofessional Education Event offered in a university setting and explore participant views regarding their competencies based on the Interprofessional Education Collaborative’s four core competency domains: Values/ethics for interprofessional practice, roles/responsibilities, interprofessional communication, and teams and teamwork. Method: Twenty-six faculty and students participated in preparatory activities and served as table facilitators for a large case study event. After the session, twenty submitted survey responses reflecting on changes in their interprofessional competencies. Discussion: Table facilitators reported that their core competencies in all areas remained stable or improved as a result of their participation in the pre-planning stages and case study workshop. Participant comments indicated the importance of initiating interprofessional education during academic training and to continue it throughout an individual’s career. Future directions include pre-event competency assessments and longer-term follow-up with participants. Received: 04/24/2017 Accepted: 10/16/2017 © 2017 Morris et al. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Table Facilitators’ Reflections EDUCATIONAL STRATEGY 3(2):eP1133 | 2 Interprofessional Education Early on, healthcare professionals may have worked side by side but rarely worked as a team (Mellor, Hyer & Howe, 2002). Even with limited team interaction, patient outcomes improved making practitioners and researchers consider the impact of health care teams. The result was more formalized training in university settings and at professional development conferences. An early example of this occurred at the Purdue University School of Pharmacy and Pharmaceutical Science in 1968. Faculty developed a curriculum that directly connected pharmacy students with future healthcare team members through classes, medical rounds, and clinical placements (Tobbell, 2016). Similarly, curricula in nursing programs included effective ways to collaborate with physicians. The Student American Medical Association aided in creating collaborative educational opportunities and by 1975, around 5000 students had participated in voluntary Interprofessional Education (IPE) projects (see Baldwin, 2007 for review). Further, an interprofessional committee led the 1972 Institute of Medicine conference, where individuals from the fields of nursing, pharmacy, medicine, dentistry, and allied health developed a program to discuss the growing need for collaborative practice, surmounting medical costs, and overall scopes of practice (Pellegrino, 1972). As educational institutions plan to implement IPE opportunities, several university programs provide examples on ways to proceed. Rosalind Franklin University of Medicine and Science, University of Florida, University of Washington, and the University of Minnesota have interprofessional programs that require enrolled students to participate in various educational opportunities and meet minimum competencies related to interprofessional collaboration. Their programs range from one-credit courses to completely integrated curricula. The major focus is on demonstration of competencies in effective team membership rather than discipline specific scope of practice (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Rosalind Franklin University of Medicine and ScienceRFU], n.d.; WWAMI Institute for Simulation in Healthcare, 2016; University of Washington, 2002; University of Minnesota, n.d.). The overall goal is to train collaboration-ready healthcare professionals. Interprofessional Competency In 2011, the Interprofessional Education Collaborative (Interprofessional Education Collaborative Expert Panel, 2011) published a report outlining interprofessional competency development, concepts of interprofessionality, and core competencies for interprofessional collaborative practice. The development of the common core competencies were intended to provide overarching guidelines for the coordinated effort across health professions to direct integrated professional and institutional curricular development. Each of the four competency domains is defined by a general competency statement and multiple specific competencies. The first competency, values/ethics for interprofessional practice, has been an integral component of interprofessional teams described throughout the literature (Cooper, 1942; Silver, 1958; Baldwin, 2007; Slavkin, Sanchez-Lara, Yang, & Urata, 2014)and highlights the need to work in cooperation with patients and other team members to develop trusting relationships and provide high quality healthcare. It outlines the need for professionals to be honest, show integrity, and respect the dignity and privacy of patients while embracing cultural diversity and individual differences. All of these values are embraced while maintaining competence in one’s own profession. The second competency domain, roles/responsibilities, requires professionals to effectively communicate their own and other team members’ roles and responsibilities to patients, families, and other professionals. Healthcare professionals have a specific knowledge and skill set according to their Scope of Practice, however the approach to interprofessional knowledge should remain open and flexible (Bachrach, Robert, & Thomas, 2015). Medically complex patients often require more than one discipline to provide treatment and care, which increases the demand for health professionals to work synergistically. Understanding of each discipline’s roles, responsibilities, and strengths helps improve patient care. Team-based practice has been argued to provide not only improved comprehensive care but is also associated with cost savings and increased job satisfaction (Medves et al., 2010). By forging interdependent relationships with other professions, individuals must recognize their own limitations in skills, knowledge, and abilities. Teams that engage in continuous professional and interprofessional development will utilize the full scope of the team’s knowledge and skills to provide the best care possible. H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu.edu/hip 3(2):eP1133 | 3 The third competency domain, interprofessional communication, describes the importance of active listening, providing instructive feedback, and using respectful communication in healthcare settings. It is not only important for health care professionals to understand the rationale for their care but also be able to communicate that information to the patient and other professionals (Bachrach et al., 2015). Ineffective communication among healthcare professionals has been shown to be a common denominator behind many adverse events, medical errors, and delays in patient care. In fact, Kohn, Corrigan, and Donaldson (2000) reported 80% of errors were due to miscommunication (among colleagues, between patient and physician, inaccessible medical records, etc.) that led to physician reported patient-harm 43% of the time. These preventable medical errors, based on ineffective communication, costs billions of dollars each year and increase overall mistrust in the healthcare system (Kohn, Corrigan, & Donaldson, 2000). Therefore, consistent communication among team members, patients and family is imperative for this integrated, interdependent approach (Bridges et al., 2011). Professionals who are able to express their knowledge with confidence, clarity, and respect support the maintenance of health and the treatment of disease. The fourth competency domain, teams and teamwork, relates to an individual’s ability to integrate knowledge and experience from other professions as a way to effectively inform care. The goal of interprofessional collaboration is to develop and enhance one’s cooperation and leadership skills while working with professionals who have different content knowledge and skills as a means to understand and address health problems (Bachrach et al., 2015). Health care professionals must learn to communicate their knowledge in ways that others can understand and in turn, develop an appreciation and understanding of other discipline’s methods. This team approach can lead to improved relationships, increased trust, dispelling of stereotypes, and significantly improved attitudes towards other professionals (Parsell & Bligh, 1999). Individuals who share accountability and engage themselves and others in dialog regarding possible disagreements and develop consensus on ethical principles effectively demonstrate this competency.


Interprofessional Education
Early on, healthcare professionals may have worked side by side but rarely worked as a team (Mellor, Hyer & Howe, 2002).Even with limited team interaction, patient outcomes improved making practitioners and researchers consider the impact of health care teams.The result was more formalized training in university settings and at professional development conferences.An early example of this occurred at the Purdue University School of Pharmacy and Pharmaceutical Science in 1968.Faculty developed a curriculum that directly connected pharmacy students with future healthcare team members through classes, medical rounds, and clinical placements (Tobbell, 2016).
Similarly, curricula in nursing programs included effective ways to collaborate with physicians.The Student American Medical Association aided in creating collaborative educational opportunities and by 1975, around 5000 students had participated in voluntary Interprofessional Education (IPE) projects (see Baldwin, 2007 for review).Further, an interprofessional committee led the 1972 Institute of Medicine conference, where individuals from the fields of nursing, pharmacy, medicine, dentistry, and allied health developed a program to discuss the growing need for collaborative practice, surmounting medical costs, and overall scopes of practice (Pellegrino, 1972).
As educational institutions plan to implement IPE opportunities, several university programs provide examples on ways to proceed.Rosalind Franklin University of Medicine and Science, University of Florida, University of Washington, and the University of Minnesota have interprofessional programs that require enrolled students to participate in various educational opportunities and meet minimum competencies related to interprofessional collaboration.Their programs range from one-credit courses to completely integrated curricula.The major focus is on demonstration of competencies in effective team membership rather than discipline specific scope of practice (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Rosalind Franklin University of Medicine and ScienceRFU], n.d.; WWAMI Institute for Simulation in Healthcare, 2016; University of Washington, 2002;University of Minnesota, n.d.).The overall goal is to train collaboration-ready healthcare professionals.

Interprofessional Competency
In 2011, the Interprofessional Education Collaborative (Interprofessional Education Collaborative Expert Panel, 2011) published a report outlining interprofessional competency development, concepts of interprofessionality, and core competencies for interprofessional collaborative practice.The development of the common core competencies were intended to provide overarching guidelines for the coordinated effort across health professions to direct integrated professional and institutional curricular development.
Each of the four competency domains is defined by a general competency statement and multiple specific competencies.The first competency, values/ethics for interprofessional practice, has been an integral component of interprofessional teams described throughout the literature (Cooper, 1942;Silver, 1958;Baldwin, 2007;Slavkin, Sanchez-Lara, Yang, & Urata, 2014)and highlights the need to work in cooperation with patients and other team members to develop trusting relationships and provide high quality healthcare.It outlines the need for professionals to be honest, show integrity, and respect the dignity and privacy of patients while embracing cultural diversity and individual differences.All of these values are embraced while maintaining competence in one's own profession.
The second competency domain, roles/responsibilities, requires professionals to effectively communicate their own and other team members' roles and responsibilities to patients, families, and other professionals.Healthcare professionals have a specific knowledge and skill set according to their Scope of Practice, however the approach to interprofessional knowledge should remain open and flexible (Bachrach, Robert, & Thomas, 2015).Medically complex patients often require more than one discipline to provide treatment and care, which increases the demand for health professionals to work synergistically.Understanding of each discipline's roles, responsibilities, and strengths helps improve patient care.Team-based practice has been argued to provide not only improved comprehensive care but is also associated with cost savings and increased job satisfaction (Medves et al., 2010).By forging interdependent relationships with other professions, individuals must recognize their own limitations in skills, knowledge, and abilities.Teams that engage in continuous professional and interprofessional development will utilize the full scope of the team's knowledge and skills to provide the best care possible.
The third competency domain, interprofessional communication, describes the importance of active listening, providing instructive feedback, and using respectful communication in healthcare settings.It is not only important for health care professionals to understand the rationale for their care but also be able to communicate that information to the patient and other professionals (Bachrach et al., 2015).Ineffective communication among healthcare professionals has been shown to be a common denominator behind many adverse events, medical errors, and delays in patient care.In fact, Kohn, Corrigan, and Donaldson (2000) reported 80% of errors were due to miscommunication (among colleagues, between patient and physician, inaccessible medical records, etc.) that led to physician reported patient-harm 43% of the time.These preventable medical errors, based on ineffective communication, costs billions of dollars each year and increase overall mistrust in the healthcare system (Kohn, Corrigan, & Donaldson, 2000).Therefore, consistent communication among team members, patients and family is imperative for this integrated, interdependent approach (Bridges et al., 2011).Professionals who are able to express their knowledge with confidence, clarity, and respect support the maintenance of health and the treatment of disease.
The fourth competency domain, teams and teamwork, relates to an individual's ability to integrate knowledge and experience from other professions as a way to effectively inform care.The goal of interprofessional collaboration is to develop and enhance one's cooperation and leadership skills while working with professionals who have different content knowledge and skills as a means to understand and address health problems (Bachrach et al., 2015).Health care professionals must learn to communicate their knowledge in ways that others can understand and in turn, develop an appreciation and understanding of other discipline's methods.This team approach can lead to improved relationships, increased trust, dispelling of stereotypes, and significantly improved attitudes towards other professionals (Parsell & Bligh, 1999).Individuals who share accountability and engage themselves and others in dialog regarding possible disagreements and develop consensus on ethical principles effectively demonstrate this competency.

Research Question
Several years ago, Northern Illinois University began offering an annual case study workshop for faculty and students from six allied health disciplines to provide interprofessional education to their students.The purpose of this manuscript is to describe one of the events and answer the following research question: • Using the Core Competency Domains for Interprofessional Collaborative Practice (2011), do table facilitators' perceptions of their core competencies change as a result of the event?

Event Preparation
In preparation for the workshop, a 32 year old woman who sustained injuries after a rollover car accident met with faculty mentors from audiology, medical laboratory sciences, nutrition/dietetics, physical therapy, rehabilitation counseling, and speech-language pathology to discuss the incident and her medical conditions (see Appendix A for case summary).In addition to providing information about the case, this initial meeting served as an opportunity for faculty to develop and engage in collaborative practice, setting the stage for the integration of students.
Each discipline selected two students to be involved in future planning sessions, conduct research and complete assessments with the client.The faculty mentor met with their students multiple times to discuss the client's medical history, current living situation, physical abilities and limitations.Additionally, students administered the following testing: • hearing and central auditory processing disorders (audiology) • glucose levels and cholesterol levels (medical laboratory sciences) • dietary questionnaire, weight, BMI (nutrition/dietetics) • range of motion (physical therapy) • job potential analysis (rehabilitation counseling) • expressive language, word finding, and memory (speech-language pathology) Two additional large group meetings occurred with the client, faculty mentors, and student table facilita- tors from each discipline.An additional eight faculty joined the 12 students and six faculty mentors at these meetings, all of whom served as table facilitators at the workshop.At these meetings, scopes of practice were discussed as well as specific tests individual disciplines administered and the results obtained.Each discipline's team (faculty mentor and two students) created a onepage summary outlining the critical information relevant to this particular case study and what they wanted other professionals to know about their discipline.

Workshop Description
Approximately 180 students and 20 faculty from the six disciplines were seated seven to eight per table for small group discussions.Seating assignments were made so that as many fields as possible were represented at each table.Due to the number of dietetics and physical therapy students who participated, each table had three to four dietetics students and one physical therapy student.One speech-language pathology and one audiology student were seated at most tables.The smaller number of rehabilitation counseling and medical laboratory students meant each table was limited to one or the other discipline.Faculty from each discipline gave a brief overview of their scope of practice and the client provided her case history.Following this information, participants at each table shared information regarding their discipline's scope of practice.Table facilitators (12 students, six faculty mentors, and eight additional faculty) used the summary sheets peers had generated to aid in directing the conversation.
After twenty minutes of table discussion, the twelve student table facilitators who were most familiar with the case participated in a panel presentation where they expressed their concerns regarding the impact of the accident on the client's overall health, hearing, balance, communication, memory, future education and work opportunities, nutrition intake, and laboratory readings.Each discipline's summary included concerns and possible deficits, exams to be conducted, and possible referrals that could be made.Details were provided regarding the findings of individual tests that had been administered.Responses to a query to explain given rating • Working on a real case provided great insight for interdisciplinary services.
• I feel more able to understand a case as a whole rather than specific to my discipline.
• I see crossover in our professions.
• I never thought of allowing my students to see the point of view of other health care workers dealing with the same individual.
• I have a better understanding of how some of the different fields pertain to case management.
• I felt that I learned so much more about other professions and how we can collaborate when working with an individual.
• Learned more about others scope of practice.

Results
For each question, table facilitators reported that their competency increased or stayed the same as a result of the interprofessional case study workshop.As noted in Tables 1 through 4, no participant reported feeling less competent in any domain as a result of the work-shop.In addition to indicating if their competency levels changed, respondents were asked to explain their answers.Although all participants answered the multiple choice questions, not all participants answered the request to "Please explain your rating." All participant responses are reported in Tables 1 through 4. Responses to a query to explain given rating  Responses to a query to explain given rating • There is a lot of information that goes into the other professions, and one event in my opinion is not enough to become truly acquainted with these disciplines Although the event provided a great introduction to interdisciplinary services.• I learned more about how specifically my discipline could intervene with this case and what other disciplines I would work with most.• I am now aware of the roles of other professors in the health field.
• By informing other professionals about my role in the rehabilitation process, I was able to provide many of them with a potential referral to help their clients find or enhance their work experiences.• The panel discussion really had a lot of information that showed the distinction between professions in terms of roles.However, I can also see how when working with an individual who has an injury or a disability, they can benefit when seeing different health professionals.• I learned new things about the role of certain healthcare workers in an acute situation.
• I learned how my profession can better interact with other professions to more effectively serve the client.

Discussion
The case study event allowed university students and faculty in allied health fields to collaborate with each other in a supportive clinically relevant discussion regarding the treatment of one individual.While the event was limited to a 3½-hour session, the students who served as table facilitators received additional mentorship and opportunities for collaboration.Specifically, they met with the patient and their faculty mentor multiple times over the period of two months to plan, conduct patient evaluations, interpret test results, and develop information for the panel presentation.Further, all table facilitators met together several times to discuss the case.This study focused on the changes in interdisciplinary core competencies in values/ethics, roles/responsibilities, interprofessional communication, and teams and teamwork for the students and faculty who received the additional training opportunities.ments in participant knowledge of, skills in, and attitudes toward team leadership, mutual support and situation monitoring (King et al., 2008).
Alternatively, the majority of participants indicated their competency in communicating with patients and other practitioners did not improve.This result may have been due to the fact that communication skills are an important element for each of the disciplines.Thus, most table facilitators had already received discipline specific instruction and feedback on respectful and culturally competent communication, which they felt comfortable transferring to an interprofessional context.Comments that indicated an improvement in competency level presented increased confidence in their own scope of practice and ability to make appropriate referrals.
Given that accreditation agencies are adding interprofessional education criteria to their academic standards, programs must document student competency in interprofessional work.The described interprofessional case study event allowed students to be introduced to other disciplines and practice being spokespersons for their own profession.The seating arrangements at the event required students to meet new people who viewed a case from a different perspective.Discussions across the disciplines provided an opportunity for all participants to achieve a more holistic view of a patient.

Limitations and Future Research
Though this study provides similar results to those of other studies of interprofessional competency, it is important to point out some of the limitations of the study.This study asked participants if their competency changed after the event.Adding a pretest survey would allow for paired samples analyses.While this would increase the robustness of the study, it must be paired with an increased sample size.Even if pre-and posttest surveys had been completed, statistical analyses with only 20 participants will have a high risk of Type 1 (false positive) error.Ultimately, the goal is to add to growing evidence that demonstrates that when professionals collaborate, patient outcomes improve (Epstein, 2014;Zorek, et al., 2015).Thus, a longitudinal study assessing the outcomes of participants' future patients would be a worthy addition to the literature.
Event-based programming is one way universities can provide students and faculty the chance to meet each other and discuss a relevant case.At Northern Illinois University, these introductions have started discussions that have resulted in interprofessional clinical and research projects.As new relationships are forged, and curricula examined, integrated courses are being considered.Future research will focus on learner outcomes for all workshop attendees as well as additional interprofessional education programs.

Table Facilitators '
Reflections EDUCATIONAL STRATEGY3(2):eP1133 | 4 Table facilitators integrated the panel information in the hour-long table discussions that followed.Teams expanded on the concerns presented, providing their own thoughts and listening to each other regarding the case.A break from discussion allowed audience members to ask the client or table facilitators questions prior to returning to the final table discussion.

Table Facilitators '
Reflections • Being required to teach a large audience about the services my profession provides was a great experience and it helped me improve the skills of communicating with people who are unfamiliar with my terminology.•I have had limited experience working with patients, so working with a real case was helpful for my personal growth.•Helped with working with communities.• Better at referrals.• I felt more knowledgeable about some of the other fields, so that I feel more confident in explaining why various referrals or tests are necessary and appropriate.• Through my program, I have been learning from my instructors about how to communicate with clients, families, professionals, etc.They helped me and my cohort group learn how to develop effective counseling skills and practice cultural competency.Also, we learned about how we work with different health professionals.• Know more about the communication with the patient and those involved with the patient care.• I was reminded to ask about what other professionals my patients see.• Already feel competent in interdisciplinary care.
• Already well versed in this.•Due to my real-work clinical experience, my competency did not change.However, many great points were made that would have definitely helped students learning.Specifically, the point about the client being busy and we need to not overwhelm them with unnecessary recommendations was a good take home message.

Table 3 .
Competency Level Changes for Interprofessional Communication Domain 3

Table 2 .
Competency Level Changes for Roles/Responsibilities Domain 2

Table facilitators
I am better able to deduce relevant information form patient interviews.•Allhealthprofessionshaveanimportant role, helped to see how we can work together.•Planningforthiscasestudygave me a lot of experience in working with other professionals to prepare a mock rehabilitation plan and make mock referrals.•Thetablediscussionsreallyhelped!It was great hearing from students from various programs talk about their approaches andwhat issues they would address with their patients.We were all in agreement about how each specialty can help Catherine.•Itiseasy to get engaged in turf wars with other professions.This was a nice reminder that we are all on the same team.•Learnedallthe aspects described in this question.•Alreadyfeel competent in interdisciplinary care.•I teach teambuilding.
as future patients.This result is consistent with studies using TeamSTEPPS, a systematic approach to integrate teamwork into practice, which have shown improve-