Interprofessional Asthma Education Development of a Comprehensive Asthma

Interprofessional Asthma Education: Development of a Comprehensive Asthma Rotation in a Pediatric Residency Carolyn C Robinson 4/30/2014 Pediatrics

1. Problem Identification and General Needs Assessment Problem Identification - Health Care Problem - Current Approach - Ideal Approach • Importance of asthma ‐ Over 6 million children ‐ 4. 76. million officeand visits yearly Evaluation Feedback 2. Targeted Needs Assessment ‐ 700, 000 visits to Learners an emergency room; 200, 000 hospitalizations - Learners - Individual - Programin asthma management • Lack competency - Learning Environment ‐ Knowledge ‐ Meter Dosed Inhaler (MDI) technique Percent Correct 80 60 100 Deficiencies in Knowledge * * 5. Implementation Pre‐test Post‐test * Percent of Residents 100 Deficiencies in MDI Instruction 80 60 3. Goals and Objectives Pre‐Test * - Broad Goals Post‐Test - Obtaining Political - Specific Measurable Objectives Support 40 40 * - Securing Resources * - Addressing Barriers 20 20 - Introducing the Curriculum 4. Educational Strategies - Content 0 0 - Administering the Curriculum - Methods Pathophysiology Diagnosis Management Inadequate Adequate Good Changes in knowledge after online didactic. p<0. 05 Overall assessment before and after instruction. p<0. 001 Hemnes. Journal of Asthma Kim. Journal of Asthma 2009 Kern’s Six Step Approach to Curriculum Development Pediatrics Page 1 xxx 00. #####. ppt 9/24/2020 11: 21: 17 PM

1. Problem Identification and General Needs Assessment - Health Care Problem - Current Approach - Ideal Approach Percent of responses 80 6. Evaluation and Feedback for. Learners Curriculum - Need Individual - Program 20 0 3. 5 Resident n=54 Faculty n=34 60 40 4 2. Targeted Needs Assessment Location of Curriculum - Learners - Learning Environment Resident n=54 Faculty n=28 3 2. 5 5. Implementation Rating 100 3. Goals and Objectives 2 - Broad Goals - Obtaining Political - Specific Measurable Objectives Support - Securing Resources 1. 5 - Addressing Barriers - Introducing the Curriculum 4. Educational Strategies 1 Content Administering the Curriculum Outpatient Emergency Pediatric PICU Yes Maybe No - Methods Room Floor Faculty and resident response to need for curriculum Faculty and resident response on location of training Rating on a Likert Scale 1=Least Needed to 4=Most Needed Kern’s Six Step Approach to Curriculum Development Pediatrics Page 2 xxx 00. #####. ppt 9/24/2020 11: 28 PM

1. Problem Identification and General Needs Assessment Goals and Objectives - Health Care Problem - Current Approach - Ideal Approach • Goal 6. Evaluation and Feedback 2. Targeted Assessment ‐ Understand key aspects of outpatient asthma care Needs in children. - Individual Learners - Program - Learners - Learning Environment • Objectives ‐ Obtain a comprehensive history of an asthmatic patient ‐ Accurately classify severity based on NHLBI guidelines ‐ Describe the control status according to NHLBI guidelines 3. Goals and Objectives 5. Implementation - Broad Goals - Obtaining Political ‐ Recognize characteristics for increased risk of ICU hospitalization - Specific Measurable Objectives Support - Securing Resources ‐ Recognize for referral to pulmonary medicine - Addressingindications Barriers - Introducing the Curriculum 4. Educational Strategies ‐ Teach the proper MDI and- aerochamber technique Content - Administering the Curriculum ‐ Develop a plan for optimal- Methods asthma control Kern’s Six Step Approach to Curriculum Development Pediatrics Page 3 xxx 00. #####. ppt 9/24/2020 11: 21: 34 PM

1. Problem Identification and General Needs Assessment Educational Strategies - Health Care Problem - Current Approach - Ideal Approach • Interprofessional 6. Evaluation and Feedback. Education 2. Targeted Needs Assessment - Individual Learners - Learners Therapists ‐ Asthma Educator, Clinical Pharmacist, Respiratory - Program • Comprehensive Approach - Learning Environment ‐ All aspects of asthma care • Variety of Educational Methods ‐ 5. Different learning styles Implementation 3. Goals and Objectives - Obtaining Political • Condensed Support - Broad Goals - Specific Measurable Objectives - Securing ‐ Short one. Resources week block - Addressing Barriers - Introducing the Curriculum 4. Educational Strategies - Content - Administering the Curriculum - Methods Kern’s Six Step Approach to Curriculum Development Pediatrics Page 4 xxx 00. #####. ppt 9/24/2020 11: 21: 36 PM

Educational Methods • Lecture • Reflection • Self Directed Learning • Patient Interaction ‐ “Empty Outlines” ‐ “Instructor Storytelling” ‐ “Pop culture” ‐ Syllabus of articles ‐ Online asthma modules ‐ Scavenger hunt ‐ “Muddiest Point” ‐ “Harvesting” ‐ “One minute papers” ‐ Counseling ‐ Interpretation of Spirometry ‐ Evaluation ‐ Skills instruction • Direct Observation www. notonemorelife. org Pediatrics Page 5 xxx 00. #####. ppt 9/24/2020 11: 21: 37 PM

1. Problem Identification and General Needs Assessment Implementation - Health Care Problem - Current Approach - Ideal Approach • Support 6. Evaluation and Feedback 2. Targeted Needs Assessment ‐ Residency program medical educators - Individual Learners leadership, chief residents, and - Learners - Program ‐ Pulmonologists, pulmonary fellowship program - Learning Environment • Resources ‐ Interprofessional collaborators ‐ Authors of online material 5. Implementation ‐ Syllabus of articles 3. Goals and Objectives - Obtaining Political Support - Securing Resources Scheduling - Addressing Barriers - Introducing the Curriculum 4. Educational Strategies Standardization - Content - Administering the Curriculum - Methods • Barriers ‐ ‐ - Broad Goals - Specific Measurable Objectives • Curriculum introduced July 2013 www. notonemorelife. org Pediatrics Kern’s Six Step Approach to Curriculum Development Page 6 xxx 00. #####. ppt 9/24/2020 11: 21: 39 PM

Weekly Schedule Day 1 • Introduction • Didactic Lecture with pulmonary fellow • Online Modules • Reading of Articles • Pre‐assessment of asthma knowledge and Meter Dose Inhaler (MDI) skills • Taste testing with clinical pharmacist Pediatrics Day 2 • Direct Patient Care and Physician Modeling with pulmonary attending at in After Hospital Asthma and Life Threatening Asthma Clinics Day 4 Day 3 Day 5 • Participate • Wrap up with asthma • Direct Patient lecture with educator Care and questions Physician • Participate • Post‐ Modeling at with assessment of Health Centers Pulmonary asthma with Diagnostic Lab knowledge pulmonary and MDI skills attending respiratory • Activities Evaluation therapists Interprofessional Educational Activities Page 7 xxx 00. #####. ppt 9/24/2020 11: 21: 41 PM

1. Problem Identification and General Needs Assessment Improvement in Knowledge: Written Test Objective - Health Care Problem - Current Approach - Ideal Approach Before Obtaining a comprehensive history of an asthmatic patient 6. Evaluation and Feedback p=0. 001 n=26 - Individual Learners Indications for the use of different inhaler devices - Program 2. 8 After p value 4. 48 Needs Assessment <0. 001 2. Targeted p<0. 001 - Learners n 25 1. 96 n=26 - Learning 4. 28 Environment <0. 001 25 Being able to teach the proper inhaler technique 1. 56 4. 56 n=24 <0. 001 25 Classifying the severity of asthma per NHLBI guidelines 2. 36 4. 08 <0. 001 25 Determining 5. asthma control status per NHLBI guidelines Implementation 2. 16 4. 04 <0. 001 3. Goals and Objectives 25 - Broad Goals - Obtaining Political Recognizing patients at risk for ICU hospitalization 2. 52 4. 04 Measurable <0. 001 - Specific Objectives 25 Support - Securing Resources Indications for referral to Pulmonary 2. 24 3. 92 <0. 001 25 - Addressing Barriers 4. Educational Strategies - Introducing the Curriculum - Content - Administering Developing an outpatient planthe for. Curriculum optimal asthma control 4. 36 (did not<0. 001 25 (at 2. 36 end of rotation) take rotation) - Methods Self perceived knowledge before and after the rotation. Likert Scale 1=Not knowledgeable to 5=very knowledgeable Kern’s Six Step Approach to Curriculum Development Pediatrics Page 8 xxx 00. #####. ppt 9/24/2020 11: 21: 48 PM

Improvement in Skill: MDI Technique p<0. 001 n=24 (at end of rotation) Based on checklist of items necessary to perform the skill proficiently Pediatrics Page 9 xxx 00. #####. ppt 9/24/2020 11: 21: 52 PM (did not take rotation)

Satisfaction • 100% of residents ‐ Rotation should be offered again ‐ Rotation should be required ‐ Would recommend the rotation to a colleague ‐ Plan to implement what they learned in their future career Satisfaction with Rotation Components Rating 5 4 3 2 1 Clinic Asthma Didactic Rotating in Reading Online Education Lecture PDL Syllabus Modules Rating on a Likert Scale of usefulness (n=25). 1=Not useful 5=Most useful. Pediatrics Page 10 xxx 00. #####. ppt 9/24/2020 11: 21: 54 PM

Conclusions • Positive learning experience on outpatient asthma care • Benefits of using a structured framework • Uses an innovative, comprehensive approach to teaching of asthma ‐ IPE is an excellent tool • Significant improvement ‐ Written test scores and MDI technique • Framework for other departments • Future Directions: Sustainability and Retainability Pediatrics Page 11 xxx 00. #####. ppt 9/24/2020 11: 21: 57 PM

Acknowledgements • Dr. Jen Rama • Dr. Mark Ward • Dr. Siby Moonnumakal • Dr. Robert Moore • Dr. Julie Katkin • Pulmonary Diagnostic Lab • Kai Sanders Pediatrics Page 12 xxx 00. #####. ppt 9/24/2020 11: 21: 58 PM