• At-a-Glance
• Instructor’s Guide
• Instructor’s Notes

Authors: Kathy Lituri, RDH, MPH, Oral Health Promotion Director, Clinical Instructor; Michelle Henshaw, DDS, MPH, Associate Dean for Global and Population Health; and Sheree Norquist, MS, Program Administrator, Boston University Henry M. Goldman School of Dental Medicine.

At-a-Glance

Topic	Interprofessional team-based care
Target Audience	Social Work, Medicine, Occupational Therapy, Nutrition and Dietetics, Dentistry
Academic Focus	Clinical skills
Target IPEC Competencies	Domain: Values/Ethics Work in cooperation with those who receive care, those who provide care, and others who contribute to or support the delivery of prevention and health services. Domain: Teams and Teamwork Engage other health professionals—appropriate to the specific care situation—in shared patient-centered problem-solving.
Target HRSA Competencies	Domain: Interprofessional Collaborative Practice Exchange meaningful information among health care providers to identify and implement appropriate, high quality care for patients, based on comprehensive evaluations and options available within the local health delivery and referral system. Apply interprofessional practice principles that lead to safe, timely, efficient, effective, equitable planning and delivery of patient and population-centered oral health care.
Learning Objectives	Discuss with team members each profession’s role in assessing, addressing, and improving a patient’s overall health. Develop an interprofessional plan of care including, but not limited to, a referral for preventive and restorative dental services.

Instructor’s Guide

Overview for instructors. The purpose of this didactic session is to provide students with the opportunity to learn about the roles and responsibilities of colleagues from other health professions. During the session, students will break into groups and teams to develop a plan of care for the case study patient, Terry.

Terry’s case integrates oral health with overall health, so if possible, instructors should incorporate dental, dental hygiene, or dental therapy students into each group to assist with oral health content.

Materials provided in this toolkit.

• Instructor’s Copy, Geriatric Oral Health Case Study: Terry
• Student handouts:
  • Geriatric Oral Health Case Study: Terry
  • Intraprofessional Group Questions
  • Interprofessional Team Questions

Additional materials needed.

• Index cards, two per student

Instructor preparation.

• Ask a faculty member from each of the participating programs to locate or draft a short description of the roles and responsibilities for his or her respective profession. Compile these descriptions in a single document and make it available to students through email, your preferred learning management system, or your website.
• Review the Instructor’s Copy, Geriatric Oral Health Case Study: Terry before the start of the classroom session. Note that highlighted areas flag important details.
• Review the Intraprofessional Group Questions and Interprofessional Team Questions and make notes according to the professions represented in the session.

Student preparation. Before the start of the didactic session, students must:

• Register for and complete the following Smiles for Life courses:
  • Course 1: The Relationship of Oral to Systemic Health
  • Course 7: The Oral Examination
  • Course 8: Geriatric Oral Health
• Review the roles and responsibilities document provided by the instructor.

Schedule.

• Introduction (10 minutes)
• Review the case study (10 minutes)
• Intraprofessional groups (15 minutes)
• Interprofessional teams (15 minutes)
• Discussion (20 minutes)

Instructor’s Notes

This didactic session will take an hour or more, depending on the number of participants.

Introduction (10 minutes). Review the learning objectives and purpose of the session. Ask students to identify themselves by hand as you note which professions are represented in the class. Then ask a student volunteer from each profession to read his or her roles and responsibilities aloud.

Review the case study (10 minutes). Break students into groups by profession. Each group should have no more than five or six members. Then ask all students to read the case study for Terry silently.

Note: If you prefer to review the case study as a full class, paste key points in PowerPoint slides for reference.

Intraprofessional groups (15 minutes). After everyone has reviewed the case study, ask students to take 15 minutes to work with the other members of their profession to answer the questions on the handout, Intraprofessional Group Questions. Each group should select one member to record the group’s answers.

Once all groups have completed the handout, ask the students to use an index card to comment anonymously on the following statement.

I felt my contributions to my professional group were valued.

In their comments, students should:

• Agree or disagree with the statement.
• Explain why they feel the way they do.
• Indicate their profession.

When all students have completed this exercise, collect the index cards and disband the groups.

Interprofessional teams (15 minutes). Ask students to reorganize themselves into interprofessional teams and assign each team a letter name (e.g., Team A, Team B, Team C). If possible, each team should consist of at least one representative from each profession participating in the session.

Now, ask the students to work with their new team members to answer the questions on the handout Interprofessional Team Questions. Each team should select one member to record the team’s answers.

Once all groups have completed the handout, ask the students to use an index card to comment anonymously on the following statement.

I felt my contributions to the interprofessional team were valued.

In their comments, students should:

• Agree or disagree with the statement.
• Explain why they feel the way they do.
• Indicate their profession and team.

When the students have completed this exercise, collect the index cards and disband the teams.

Explain to students that you will review their index cards to help plan future interprofessional education activities.

Discussion (20 minutes). Encourage students to share their care plans and their reactions to the exercise.To prompt discussion, ask the following questions.

1. How did the experience of working with the group differ from that of working with the team?
2. What did you learn about the contributions students outside your profession could make to Terry’s case?
3. Did you perceive barriers to caring for Terry as an interprofessional team? If so, what were they?
4. Were there also barriers or benefits to working intraprofessionally?
5. Did working with students from other professions make you aware of aspects of Terry’s health that you might not have considered before?
6. How will you apply what you learned today about interprofessional team-based care to your future education and practice?

At a Glance

Topic	Teamwork and Communication in Health Care
Target Audience	Pharmacy, Nursing, Speech-Language Pathology and Audiology
Academic Focus	Clinical skills
Target IPEC Competencies	Domain: Teams and Teamwork Describe the process of team development and the roles and practices of effective teams. Reflect on individual and team performance for individual, as well as team, performance improvement.
Target HRSA Competencies	Domain: Interprofessional Collaborative Practice Exchange meaningful information among health care providers to identify and implement appropriate, high quality care for patients, based on comprehensive evaluations and options available within the local health delivery and referral system.
Learning Objectives	Understand the terminology and concepts of interprofessional education and collaborative practice. Consider how collaborative practice can increase provision of comprehensive oral health services.

Instructor’s Guide

Overview for instructors. The purpose of this didactic session is to introduce students to the concepts of interprofessional education and collaborative practice. Instructors will use two case studies to highlight the specific teamwork and communication skills individuals need to work effectively on an interprofessional health care team. Each case study uses little to no medical or dental terminology to embed oral health. As a result, this session is ideal for pre-licensure health sciences students with no clinical training.

Materials provided in this toolkit.

• Pre- and Post-Session Assessment Questionnaire
• Instructor’s Copy, Case Study: Jill
• Instructor’s Copy, Case Study: Mr. Jones
• Student handouts:
  • Case Study: Jill
  • Case Study: Mr. Jones

Instructor Preparation.

• Download slides 30–34 and the accompanying speaker notes from Smiles for Life Course 1: The Relationship of Oral to Systemic Health

• Ask a faculty member from each of the participating programs to locate or draft a short description of the roles and responsibilities for his or her respective profession. Compile these descriptions into one Word document and make it available to your students through email, your preferred learning management system, or your website.
• Review the following materials prior to the classroom session.
  • Pre-Session Assignment: Teamwork and Communication in Health Care
  • Pre- and Post-Session Assessment Questionnaire
  • Case Study: Jill
  • Case Study: Mr. Jones

 Student preparation. Before the start of the didactic session, students must:

• Complete the Pre- and Post-Session Assignment: Teamwork and Communication in Health Care.
• Review the roles and responsibilities document provided by the instructor.

 Schedule.

• Pre-assessment (2–5 minutes)
• Introduction (5 minutes)
• Discussion of the pre-session assignment (10 minutes)
• Smiles for Life Course 1: The Relationship of Oral to Systemic Health PowerPoint slides 30–34 (10 minutes)
• Case study for Jill (10 minutes)
• Case study for Mr. Jones (10 minutes)
• Wrap-up (5 minutes)
• Post-assessment (2–5 minutes)

Instructor’s Notes

This session will take approximately one hour, depending on the number of participants.

Pre-assessment (2–5 minutes). Ask students to complete the pre-session portion of the Pre- and Post-Session Assessment Questionnaire as they arrive.

Introduction (5 minutes). Review the learning objectives and purpose of the session. Ask students to identify themselves by hand as you note the professions represented in class. Then, ask a student volunteer from each profession to read the roles and responsibilities for his or her profession aloud.

Discussion of pre-session assignment (10 minutes). The purpose of this assignment is to provide students with a real-world example of substandard health care delivery.

Ask student volunteers to share their answers to the questions in the Pre-Session Assignment: Teamwork and Communication in Health Care. Use the following notes to enhance discussion for each question.

1. Describe a time when you were part of a team (e.g., playing sports, class project, etc.).
   • The purpose of this question is to prompt students to think about their personal experiences with teamwork. Allow a few students to share their answers.
2. Write down at least two characteristics of the team that made it particularly effective or ineffective. As student volunteers share their examples, write them in two columns (effective and ineffective) on a dry-erase board or other visible place in the room.
   • The purpose of this question is to prompt students to identify specific examples of effective or ineffective teamwork.
3. Were you surprised by anything in the Washington Post article? If so, what surprised you and why?
   • This question should prompt students to reflect on the consequences of poor health care delivery (i.e., what happens when teamwork, collaboration, and good communication are absent).
4. How do you think Deamonte’s death could have been avoided?
   • This question asks students to contemplate what went wrong with Deamonte’s health care delivery.

If necessary, guide students toward an understanding of the ways better communication and teamwork could have resulted in the more timely care needed to save Deamonte’s life.

Smiles for Life Course 1: The Relationship of Oral to Systemic Health PowerPoint slides 30–34 (10 minutes). This portion of Smiles for Life Course 1: The Relationship of Oral to Systemic Health introduces the concepts of interprofessional education and collaborative practice. Take time to read the definition of each and point out that the purpose of this didactic session is to prepare students for collaborative practice.

Case study for Jill (10 minutes). Break students into interprofessional teams of five or six. If possible, place one student from each profession on each team.

Instruct students to read Jill’s case study silently, then answer the questions as a team. One student should take notes and be prepared to discuss the team’s answers.

Use the following notes to enhance discussion generated by the questions.

1. Do you think Jill’s health care providers collaborated effectively?
   • Yes. Although Jill’s school nurse could have taken action earlier, the dentist, physician, and school nurse communicated in a positive manner that reflects collaborative practice.
2. Are all health care providers required to report suspicion of abuse or neglect? Why or why not?
   • Yes. All U.S. states and territories have laws that mandate the reporting of suspected abuse by specified individuals. These typically include physicians, nurses, and other health professionals. The need to be alert to nonmedical issues also highlights a potentially overlooked aspect of patient-centered care delivery. All health care providers should be concerned about a patient’s overall health and wellbeing, including those conditions whose treatment extends beyond the provider’s training.
3.  What characteristics of an effective team are present in Jill’s case?
   • Jill’s health care team exhibited effective communication, mutual respect, and concern for comprehensive care.
   • The physician addressed Jill’s oral health concerns and provided a dental referral. This illustrates patient-centered, comprehensive care.
   • The dentist followed up with Jill’s physician and also consulted with her school nurse. This illustrates effective communication and collaboration.
4. How can you prepare to collaborate with other health care providers once you are in practice?
   • Participate in interprofessional education opportunities such as this one.
   • Learn about the roles and responsibilities of other health care providers.
   • Contact local health care providers once in practice to facilitate collaboration.

Case study for Mr. Jones (10 minutes).

Option 1
Ask students to form new teams with at least one person from each profession present on each team. Teams should designate one person to take notes and report on team findings. After the students have formed teams, direct them to read the case study for Mr. Jones silently, then answer the questions as a team.

Option 2
Ask students to remain with their present teams but designate a new person to take notes and report findings. Direct students to read the case study for Mr. Jones silently, then answer the questions as a team.

Use the following notes to enhance discussion generated by the questions.

1. Why do you think Mr. Jones’s condition progressed to such an extreme?
   • The primary care provider (PCP) prescribed oral medication—a poor choice for patients with difficulty swallowing—and failed to refer Mr. Jones to a dentist for further evaluation.
   • The speech language pathologist (SLP) did not perform an adequate oral examination, even after noticing Mr. Jones’s bad breath and food accumulation.
   • The pharmacist filled the prescription for oral antibiotics in pill form without questioning the patient’s ability to swallow, even though the pharmacist recognized his facial paralysis and difficulty speaking.
2. What characteristics of an effective team are missing in Mr. Jones’s case?
   • Mr. Jones’s health care team members did not communicate or collaborate with one another regarding his health care delivery.
3. What could the primary care provider have done differently?
   • The PCP could have spoken to the SLP over the phone and explained that he prescribed Mr. Jones antibiotics and pain medication for an infected tooth. This may have prompted the SLP to point out the need for liquid antibiotics to ensure patient compliance. It may also have prompted the SLP to follow up with Mr. Jones regarding his oral condition at his appointment.
   • Even without a call from the PCP, the SLP could have performed a comprehensive oral examination as part of Mr. Jones’s appointment and noted the infected tooth, which should have prompted an immediate dental referral.
   • The pharmacist could have questioned Mr. Jones about his facial paralysis and ability to swallow. This would have prompted a change in prescription from pill to liquid form, enabling Mr. Jones to take the oral antibiotics more easily.
4. Could the PCP have involved any other health professional earlier in Jones’s care?
   • Yes, the PCP could have referred Mr. Jones to a dental provider when the oral antibiotics were prescribed.
5. Aside from health outcomes, were there additional consequences of Mr. Jones’s treatment?
   • Yes, cost and unnecessary pain and stress for the patient.

Wrap-up (5 minutes).

To facilitate a wrap-up discussion, ask students the following questions.

1. Did working with students from other professions highlight aspects of health care delivery that you had not considered before?
2. How will you apply what you learned today about teamwork and communication in health care to your education and in practice?

To close the session, summarize the following points for your students.

• Patient-centered health care requires all health care providers to communicate and collaborate effectively.
• A lack of communication and teamwork has been shown to negatively impact patient health outcomes.
• Patient health and safety is at risk when health care providers do not work together.

Post-assessment (2–5 minutes). Ask students to complete the post-session portion of the Pre- and Post-Session Assessment Questionnaire before they leave. Impress upon them the value of their feedback in helping you hone the session for future students.

Note: This didactic session was pilot tested with an interprofessional group of first-year pharmacy, nursing, and speech-language pathology and audiology students. Accordingly, the case study and questions used in this session were tailored for these professions. Feel free to adapt this session to meet the needs of students from a different mix of professions.

• Session 1, Geriatric Oral Health Case Study: Terry
• Session 1, Instructor’s Copy, Geriatric Oral Health Case Study: Terry
• Session 1, Interprofessional Team Questions
• Session 1, Intraprofessional Group Questions
• Session 2, Case Study: Jill
• Session 2, Case Study Questions: Jill
• Session 2, Case Study: Mr. Jones
• Session 2, Case Study Questions: Mr. Jones
• Session 2, Pre- and Post-Session Assessment Questionnaire
• Session 2, Pre-Session Assignment Teamwork and Communication in Health Care