Clark mun presentation ppt - Faculty of Medicine

Best Practices and Models of GeriatricInterprofessional Education and Teamwork:

Implications for Newfoundland and Labrador

Phillip G. Clark, ScDPhillip G. Clark, ScDUniversity of Rhode IslandUniversity of Rhode Island

Presentation sponsored by the Presentation sponsored by the Centre Centre for Collaborativefor CollaborativeHealth Professional Education, Memorial University,Health Professional Education, Memorial University,

St. JohnSt. John’’s, Newfoundland, 14 May, 2010s, Newfoundland, 14 May, 2010

Outline of Presentation ExamineExamine

Context for Context for interprofessional interprofessional education (IPE) ineducation (IPE) inthe USthe US

ReviewReview Selected historical programsSelected historical programs

SummarizeSummarize Lessons from history for the presentLessons from history for the present

DevelopDevelop Some guidelines for IPE program contentSome guidelines for IPE program content

ProposePropose Implications and recommendations forImplications and recommendations for

Newfoundland and LabradorNewfoundland and Labrador

Some Good News Recent Institute of Medicine (IoM) reportsRecent Institute of Medicine (IoM) reports

in the US supporting in the US supporting interprofessionalinterprofessionaleducation (IPE) and practice (IPP) in healtheducation (IPE) and practice (IPP) in health Health Professions Education: A Bridge toHealth Professions Education: A Bridge to

QualityQuality (2003) (2003) Retooling for an Aging America: Building theRetooling for an Aging America: Building the

Health Care WorkforceHealth Care Workforce (2008) (2008)

Primary focus is on quality improvement toPrimary focus is on quality improvement toavoid medical errors and mistakesavoid medical errors and mistakes

Some Bad News Since the 1940s, the US has had a roller-Since the 1940s, the US has had a roller-

coaster history of developing IPE and IPPcoaster history of developing IPE and IPP ““As with the mythical Sisyphus, each forwardAs with the mythical Sisyphus, each forward

push seems to end with a return to the point ofpush seems to end with a return to the point oforigin, with little tangible evidence of impactorigin, with little tangible evidence of impactor permanence . . . [E]ach new generationor permanence . . . [E]ach new generationseems to have to repeat the experiences andseems to have to repeat the experiences andfrustrations of the pastfrustrations of the past”” (Baldwin, 1996, p. (Baldwin, 1996, p.182).182).

Challenges with combining IPE and work withChallenges with combining IPE and work witholder adults (older adults (““double jeopardydouble jeopardy””))

Understanding Differences in the USBackground

Different historiesDifferent histories ““Life, liberty, and the pursuit of happinessLife, liberty, and the pursuit of happiness””

US Declaration of Independence (1776)US Declaration of Independence (1776)

““Peace, order, and good governmentPeace, order, and good government”” Canadian Constitution Act (1867)Canadian Constitution Act (1867)

Different social valuesDifferent social values Independence and personal autonomyIndependence and personal autonomy Collectivism and communityCollectivism and community

Understanding the US Background(cont’d.)

Emphasis onEmphasis on Developing models, not on fundamentallyDeveloping models, not on fundamentally

changing the contextchanging the context US as the US as the ““land of the demonstrationland of the demonstration

projectproject””

Implications for Health Care Health care systemsHealth care systems

Universal health care (Canada)Universal health care (Canada) Fragmented care (US)Fragmented care (US) Change is more deliberate (Change is more deliberate (RomanowRomanow

report in Canada) vs. more incrementalreport in Canada) vs. more incremental(divisive debate in US)(divisive debate in US)

Health professions educationHealth professions education Lack of support external to educationalLack of support external to educational

settings for IPEsettings for IPE Lack of clear link between IPE and IPPLack of clear link between IPE and IPP

Some Major Models from the Pastand the Present Veterans Administration Medical CentersVeterans Administration Medical Centers

Interdisciplinary Team Training (in Geriatrics)Interdisciplinary Team Training (in Geriatrics)Programs (ITTG/P)Programs (ITTG/P)

Geriatric Education CentersGeriatric Education Centers US Bureau of Health ProfessionsUS Bureau of Health Professions

Rural Interdisciplinary Training ProgramsRural Interdisciplinary Training Programs US Bureau of Health ProfessionsUS Bureau of Health Professions

Hartford FoundationHartford Foundation (New York) (New York) Geriatric Interdisciplinary Team TrainingGeriatric Interdisciplinary Team Training

(GITT) Program(GITT) Program

Veterans Administration ITTP

Embedded in clinical education settings at 12Embedded in clinical education settings at 12VA Medical Centers across the USVA Medical Centers across the US

Trained a whole generation of clinicians andTrained a whole generation of clinicians andleaders in IPE and IPPleaders in IPE and IPP

One of longest-lived programs, eventuallyOne of longest-lived programs, eventuallyfalling victim to VA budget cuts in the latefalling victim to VA budget cuts in the late1990s1990s

Recent major initiative in developing primaryRecent major initiative in developing primarycare teams within the VAcare teams within the VA

Geriatric Education Centers Program in existence since 1983Program in existence since 1983 Currently, 48 Currently, 48 GECs GECs nationallynationally Required to offer interdisciplinary educationRequired to offer interdisciplinary education

and training in geriatricsand training in geriatrics Academic programsAcademic programs Continuing educationContinuing education

Significant variabilitySignificant variability Little in-depthLittle in-depth interprofessional interprofessional teamwork teamwork

trainingtraining Increasing emphasis on evaluation of programIncreasing emphasis on evaluation of program

impacts on clinician behavior and patientimpacts on clinician behavior and patientoutcomesoutcomes

Rural Interdisciplinary Training Program started in 1990 (no longer funded)Program started in 1990 (no longer funded) Focus on unique context of ruralFocus on unique context of rural

environment for IPEenvironment for IPE Broader definition of healthBroader definition of health

More psychosocial and health promotion basedMore psychosocial and health promotion based

Need for community focus on problemsNeed for community focus on problems Blurring of traditional roles and responsibilitiesBlurring of traditional roles and responsibilities

among professionsamong professions Wider array of team membersWider array of team members

Paraprofessionals from communityParaprofessionals from community

Hartford GITT Demonstration projects in 8 academic healthDemonstration projects in 8 academic health

science centers, linked to provider settingsscience centers, linked to provider settings Successful inSuccessful in

Developing curricula and materials to be implementedDeveloping curricula and materials to be implementedin other settings (in other settings (““GITT KitGITT Kit””))

Modestly successful inModestly successful in Making measurable impacts on trainee attitudes andMaking measurable impacts on trainee attitudes and

skills in IPPskills in IPP

Not so successful inNot so successful in Long-term maintenance or program sustainabilityLong-term maintenance or program sustainability

Discussion of Implications Sometimes we can learn as much, or more,Sometimes we can learn as much, or more,

from failures as from successesfrom failures as from successes If youIf you’’ve seen one ve seen one interprofessional interprofessional program,program,

youyou’’ve seen one ve seen one interprofessional interprofessional programprogram Context matters!Context matters!

Acute careAcute care Long term careLong term care Community careCommunity care Health promotionHealth promotion UrbanUrban RuralRural

Discussion of Implications (cont’d.)

Some based on specific evaluationsSome based on specific evaluations Hartford GITTHartford GITT

Leipzig et al. (2002)Leipzig et al. (2002) Reuben et al. (2004)Reuben et al. (2004)

Others on general patterns andOthers on general patterns andobservationsobservations Baldwin (1996)Baldwin (1996) Satin (1987)Satin (1987)

Hartford GITT Findings(Leipzig et al., 2002)

Attitudes toward working on IP teamsAttitudes toward working on IP teams Medical residents, advanced practiceMedical residents, advanced practice

nursing students, and MSW students allnursing students, and MSW students allsupport IPP as benefiting geriatric patientssupport IPP as benefiting geriatric patients

Significant differences between MDs andSignificant differences between MDs andNPs/NPs/MSWs MSWs with regard to leadership andwith regard to leadership andresponsibility on teamsresponsibility on teams

Is earlier teamwork intervention neededIs earlier teamwork intervention neededfor MDs before attitudes are set?for MDs before attitudes are set?

Hartford GITT Findings (cont’d.) (Reuben et al., 2004)

Concept of Concept of ““disciplinary splitdisciplinary split”” Attitudinal and cultural traditions of theAttitudinal and cultural traditions of the

different health professions faculty anddifferent health professions faculty andstudents are important obstacles to creatingstudents are important obstacles to creatingan optimal interdisciplinary team-trainingan optimal interdisciplinary team-trainingexperienceexperience

In most cases, these obstacles impedeIn most cases, these obstacles impedeplanned operation or effectiveness of aplanned operation or effectiveness of aprogramprogram


Attitudes and experienceAttitudes and experience Differing histories of collaboration vs. independenceDiffering histories of collaboration vs. independence

Regulatory requirementsRegulatory requirements Limitations on preceptor qualifications/experiencesLimitations on preceptor qualifications/experiences

for certificationfor certification

Faculty supportFaculty support Generally, low level of medical supportGenerally, low level of medical support

Participation of traineesParticipation of trainees Variability in duration and dose of trainingVariability in duration and dose of training


Level of trainingLevel of training More vs. lessMore vs. less

Trainee expectationsTrainee expectations Based on model of care in the professionBased on model of care in the profession

Hierarchy within systemHierarchy within system Hierarchy/egalitarian tensionHierarchy/egalitarian tension

Faculty and trainee roles in clinicalFaculty and trainee roles in clinicalexperiencesexperiences Hospital settings reinforce hierarchyHospital settings reinforce hierarchy Home care settings attenuate itHome care settings attenuate it

Lessons Learned (Baldwin, 1996)

Understanding and achievementUnderstanding and achievement Interdisciplinary concepts are not easy toInterdisciplinary concepts are not easy to

understand and even more difficult to achieve inunderstand and even more difficult to achieve inpracticepractice

Challenges to sustainabilityChallenges to sustainability Few programs are able to sustain their efforts inFew programs are able to sustain their efforts in

the absence of prolonged sponsorship and fundingthe absence of prolonged sponsorship and funding MeasurementMeasurement

This same problem has hampered efforts toThis same problem has hampered efforts tomeasure the true educational and clinical potentialmeasure the true educational and clinical potentialof IPE and IPPof IPE and IPP

Lessons Learned (Satin, 1987)

High priorityHigh priority IPE itself must be the highest priority of theIPE itself must be the highest priority of the

programprogram Participants must be conscious and supportive ofParticipants must be conscious and supportive of

thisthis

PowerPower The power controlling the educational programThe power controlling the educational program

must understand and be committed to IPEmust understand and be committed to IPE

LocationLocation Successful IPE may have to be located outside ofSuccessful IPE may have to be located outside of

traditional academic structurestraditional academic structures

Lessons Learned (cont’d.)

VirtuesVirtues There must be honesty, trust, and respect amongThere must be honesty, trust, and respect among

key participantskey participants

ResourcesResources Resources must be provided to support theResources must be provided to support the

goals and objectives of IPEgoals and objectives of IPE

Lessons Learned (Baldwin, 1996)

““The issue is not The issue is not ‘‘team vs. no team,team vs. no team,’’ but butrather what kind of team, for what purpose,rather what kind of team, for what purpose,and under what conditions.and under what conditions.

““Interdisciplinary health care teams are notInterdisciplinary health care teams are notan end in themselves, but a means for morean end in themselves, but a means for moreeffective communication and cooperationeffective communication and cooperationamong health professionals in the service ofamong health professionals in the service ofpatient needs.patient needs.””

Some Guidelines for IPE ContentAreas

Essential knowledge and skills for IPPEssential knowledge and skills for IPP Cognitive mapsCognitive maps Normative mapsNormative maps ReflectionReflection ToolkitsToolkits Goal-based health careGoal-based health care

Some Quotations for Consideration

““We donWe don’’t see things as they are; we seet see things as they are; we seethings as we arethings as we are”” AnaAnaïïs Nins Nin

““The real voyage of discovery consists notThe real voyage of discovery consists notin seeking new landscapes, but in havingin seeking new landscapes, but in havingnew eyes.new eyes.”” Marcel Marcel ProustProust

Epistemology of Interdisciplinary Inquiry(Petrie, 1976)

““Cognitive mapCognitive map”” of a profession of a profession Basic conceptsBasic concepts Modes of inquiry and observational categoriesModes of inquiry and observational categories Representational techniquesRepresentational techniques Standards of proofStandards of proof Types of explanationTypes of explanation What counts as a problemWhat counts as a problem General idea of what constitutes the disciplineGeneral idea of what constitutes the discipline

Ontology of Interdisciplinary Inquiry(Clark, 2006; Drinka & Clark, 2000)

““Normative mapNormative map”” of a profession of a profession Basic valuesBasic values Modes of moral reasoningModes of moral reasoning Methods of resolving ethical dilemmasMethods of resolving ethical dilemmas Related to oneRelated to one’’s core identity as a persons core identity as a person

and as a professionaland as a professional

Need for Reflection (Clark, 2009)

Focus on knowledgeFocus on knowledge Concept of Concept of ““decenteringdecentering,,”” of becoming of becoming

aware of viewpoints different from oneaware of viewpoints different from one’’ssownown

Notion of Notion of ““metacognitivemetacognitive competence competence”” One is able to One is able to ““think about onethink about one’’s owns own

thinkingthinking”” as well as that of others as well as that of others Encouraging reflectionEncouraging reflection

JournalingJournaling Self-assessmentsSelf-assessments

Contents of Professional Toolkit Maps of a professionMaps of a profession

Cognitive mapCognitive map Normative mapNormative map

Models of professional functioningModels of professional functioning(Qualls & Czirr, 1988)(Qualls & Czirr, 1988) Logic of assessmentLogic of assessment

““Ruling inRuling in”” and and ““ruling outruling out”” Focus of professional effortsFocus of professional efforts

Acute medical vs. social and functionalAcute medical vs. social and functional Locus of responsibility for changeLocus of responsibility for change Pace of actionPace of action

Contents of Teamwork Toolkit

Teamwork skillsTeamwork skills (Clark, 2009; (Clark, 2009; Hyer Hyer et al.,et al.,2001; Long & Wilson, 2001)2001; Long & Wilson, 2001)

CommunicationCommunication Conflict managementConflict management LeadershipLeadership Role negotiationRole negotiation Problem-solvingProblem-solving Decision makingDecision making

Contents of Teamwork Toolkit(cont’d.)

Teamwork expectations and beliefsTeamwork expectations and beliefs(Qualls &(Qualls & Czirr Czirr, 1988), 1988)

Focus of groupFocus of group’’s attentions attention Outcome vs. processOutcome vs. process

Expectations about decision-makingExpectations about decision-making Beliefs about interdisciplinary practiceBeliefs about interdisciplinary practice

Two Different Models or Paradigmsof Health Care (Mold, 1995; Mold et al., 1991)

Disease- or problem-basedDisease- or problem-based Goal-basedGoal-based

Disease or Problem-Based Model Basic assumptionsBasic assumptions

Ideal health defined by absence of health-relatedIdeal health defined by absence of health-relatedproblemsproblems

Purpose of health care is to prevent or eradicatePurpose of health care is to prevent or eradicatethese problemsthese problems

CharacteristicsCharacteristics All health problems are undesirableAll health problems are undesirable Diseases are distinct from the individualDiseases are distinct from the individual Depersonalization and fragmentation of careDepersonalization and fragmentation of care Health care professionals are experts in definingHealth care professionals are experts in defining

problems and their solutionsproblems and their solutions

Application of Model to Older Persons

LimitsLimits Does not take into account the normal agingDoes not take into account the normal aging

processprocess Does not provide a model for achievable healthDoes not provide a model for achievable health

Need more open-ended modelNeed more open-ended model Sees Sees ““problemsproblems”” as as ““challengeschallenges”” Admits of the positive effects of challengesAdmits of the positive effects of challenges Emphasizes personal growth and developmentEmphasizes personal growth and development

Goal-Oriented Model of Health CharacteristicsCharacteristics

Health is defined by each individual andHealth is defined by each individual andmay be different at different timesmay be different at different times

Individual health goals should beIndividual health goals should bedetermined by both individual and providerdetermined by both individual and provider

Decisions regarding priority of individualDecisions regarding priority of individual’’sshealth-related goals rest with the individualhealth-related goals rest with the individual

Success is measured by whether theSuccess is measured by whether theindividual feels progress is being made inindividual feels progress is being made inachieving goalsachieving goals

Goal-Oriented Model of Health Requires assessment ofRequires assessment of

Individual strengths and resourcesIndividual strengths and resources Interests and needsInterests and needs Personal valuesPersonal values Real and potential obstacles and challengesReal and potential obstacles and challenges

Implications for Implications for interprofessional interprofessional teamworkteamwork Supports collaboration with other disciplines toSupports collaboration with other disciplines to

achieve individualachieve individual’’s goalss goals Provides overarching Provides overarching ““missionmission”” for the team to for the team to

unite all disciplinesunite all disciplines Makes team members become consultants to theMakes team members become consultants to the

individualindividual

Implications for Newfoundland andLabrador

Aging and chronic diseaseAging and chronic disease Healthy agingHealthy aging Rural contextRural context Team composition and focusTeam composition and focus

Implications for Newfoundland andLabrador (cont’d.)

Aging and chronic diseaseAging and chronic disease Rapid aging of provinceRapid aging of province Greater chronic disease burdenGreater chronic disease burden

Healthy agingHealthy aging Multifactorial Multifactorial determinants of healthdeterminants of health Health promotion at any health statusHealth promotion at any health status


Context of rural practiceContext of rural practice (Hunter, 1998; Jensen(Hunter, 1998; Jensen&& Royeen Royeen, 2002; Kelley & , 2002; Kelley & MacLearnMacLearn, 1997; , 1997; Minore Minore &&Boone, 2002; Slack et al., 2002)Boone, 2002; Slack et al., 2002) Large numbers of older adultsLarge numbers of older adults Need to emphasize primary, secondary, andNeed to emphasize primary, secondary, and

tertiary preventiontertiary prevention Role of culture, health beliefs, and practicesRole of culture, health beliefs, and practices Broader definition of health, health care, andBroader definition of health, health care, and

roles of professionalsroles of professionals Serving the underserved and disadvantagedServing the underserved and disadvantaged


Community focusCommunity focus Determine needs of communitiesDetermine needs of communities Work with local populations on needsWork with local populations on needs

Team composition and focusTeam composition and focus Blurring of traditional roles and responsibilitiesBlurring of traditional roles and responsibilities

among professionsamong professions Wider array of team members (includingWider array of team members (including

paraprofessionals from community)paraprofessionals from community) Members may be on more than one teamMembers may be on more than one team Need to address geographic separationNeed to address geographic separation Use of technology to create Use of technology to create ““virtual teamsvirtual teams””

Some Reflections and Recommendations Development of combined IPE focusDevelopment of combined IPE focus

InterdisciplinaryInterdisciplinary Older adultsOlder adults Health promotionHealth promotion RuralRural

Potential structuresPotential structures Clinical teamworkClinical teamwork Research/interventionResearch/intervention

Some Reflections and Recommendations Potential benefitsPotential benefits

StudentsStudents Change traditional roles and expectationsChange traditional roles and expectations Increased interest in careers inIncreased interest in careers in

geriatrics/gerontology and rural/remotegeriatrics/gerontology and rural/remote

Older adultsOlder adults Improved active agingImproved active aging Enhanced quality of lifeEnhanced quality of life

ProvinceProvince Community-government-academic partnershipCommunity-government-academic partnership

Some Reflections and Recommendations

Potential challengesPotential challenges Connecting IPP and IPEConnecting IPP and IPE Triple jeopardy problemTriple jeopardy problem

TeamworkTeamwork Older adultsOlder adults RuralRural

SustainabilitySustainability

Some Final Questions to Ponder ““How can we more effectively linkHow can we more effectively link

academic IPE with health care systemacademic IPE with health care systemIPP in a way that mutually sustainsIPP in a way that mutually sustainsthem?them?””

““What are the reciprocal What are the reciprocal ‘‘levers oflevers ofchangechange’’ that can be employed to create that can be employed to createsynergistic and positive changes in bothsynergistic and positive changes in bothIPE and IPP?IPE and IPP?””

References Baldwin, D. C. (1996). Some historical notes on inter-Baldwin, D. C. (1996). Some historical notes on inter-

disciplinary and disciplinary and interprofessional interprofessional education and practice ineducation and practice inhealth care in the USA. health care in the USA. Journal of Journal of Interprofessional Interprofessional CareCare,,1010, 173-187., 173-187.

Clark, P. G. (2004). Institutionalizing interdisciplinaryClark, P. G. (2004). Institutionalizing interdisciplinaryhealth professions programs in higher education: Thehealth professions programs in higher education: Theimplications of one story and two laws. implications of one story and two laws. Journal ofJournal ofInterprofessional CareInterprofessional Care, , 1818, 251-261., 251-261.

Clark, P. G. (2006). What would a theory of inter-Clark, P. G. (2006). What would a theory of inter-professional education look like? Some suggestions forprofessional education look like? Some suggestions fordeveloping a theoretical framework for teamwork training.developing a theoretical framework for teamwork training.Journal of Journal of Interprofessional Interprofessional CareCare, , 2020, 577-589., 577-589.

References (cont’d.) Clark, P. G. (2009). Reflecting on reflection inClark, P. G. (2009). Reflecting on reflection in

interprofessional interprofessional education: Implications for theory andeducation: Implications for theory andpractice. practice. Journal of Journal of Interprofessional Interprofessional CareCare, , 2323, 213-223., 213-223.

DrinkaDrinka, T. J. K., & Clark, P. G. (2000). , T. J. K., & Clark, P. G. (2000). Health careHealth careteamwork: Interdisciplinary practice and teachingteamwork: Interdisciplinary practice and teaching..Westport, CT: Auburn House/Greenwood.Westport, CT: Auburn House/Greenwood.

Hunter, R. (1998). Challenges of rural sites. In E. L.Hunter, R. (1998). Challenges of rural sites. In E. L.SieglerSiegler, K., K. Hyer Hyer, T. Fulmer, & M., T. Fulmer, & M. Mezey Mezey (Eds.), (Eds.),Geriatric interdisciplinary team trainingGeriatric interdisciplinary team training (pp. 193-209). (pp. 193-209).New York: Springer.New York: Springer.

HyerHyer, K., Flaherty, E., Fairchild, S., , K., Flaherty, E., Fairchild, S., BottrellBottrell, M., , M., MezeyMezey,,M., & Fulmer, T. (2001). M., & Fulmer, T. (2001). Geriatric interdisciplinaryGeriatric interdisciplinaryteam training (GITT) curriculum kitteam training (GITT) curriculum kit. New York: GITT. New York: GITTResource Center, Division of Nursing, New YorkResource Center, Division of Nursing, New YorkUniversity.University.

References (cont’d.)

Jensen, G. M., &Jensen, G. M., & Royeen Royeen, C. B. (2002). Improved rural, C. B. (2002). Improved ruralaccess to care: Dimensions of best practice. access to care: Dimensions of best practice. Journal ofJournal ofInterprofessionalInterprofessional Care Care, , 1616, 117-128., 117-128.

Kelley, M. L., & MacLean, M. J. (1997). InterdisciplinaryKelley, M. L., & MacLean, M. J. (1997). Interdisciplinarycontinuing education in a rural and remote area: Thecontinuing education in a rural and remote area: Theapproach of the Northern Educationalapproach of the Northern Educational Centre Centre for Aging for Agingand Health. and Health. Educational GerontologyEducational Gerontology, , 2323, 631-649., 631-649.

LeipzeigLeipzeig, R. M.,, R. M., Hyer Hyer, K.,, K., Ek Ek, K.,, K., Wallenstein Wallenstein, S.,, S.,VezinaVezina, M. L., Fairchild, S.,, M. L., Fairchild, S., Cassel Cassel, C., & Howe, J. L., C., & Howe, J. L.(2002). Attitudes toward working on interdisciplinary(2002). Attitudes toward working on interdisciplinaryhealthcare teams: A comparison by discipline. healthcare teams: A comparison by discipline. Journal ofJournal ofthe American Geriatrics Societythe American Geriatrics Society, , 5050, 1141-1148., 1141-1148.

Mold, J. W. (1995). An alternative conceptualization ofMold, J. W. (1995). An alternative conceptualization ofhealth and health care: Its implications for geriatrics andhealth and health care: Its implications for geriatrics andgerontology. gerontology. Educational GerontologyEducational Gerontology, , 2121, 85-101., 85-101.


Mold, J. W., Blake, G. H., & Becker, L. A. (1991).Mold, J. W., Blake, G. H., & Becker, L. A. (1991).Goal-oriented medical care. Goal-oriented medical care. Family MedicineFamily Medicine, , 2323, 46-51., 46-51.

MinoreMinore, B., & Boone, M. (2002). Realizing potential:, B., & Boone, M. (2002). Realizing potential:Improving interdisciplinary professional/Improving interdisciplinary professional/paraprofessional teams in Canadaparaprofessional teams in Canada’’s northerns northerncommunities through education. communities through education. Journal ofJournal ofInterprofessionalInterprofessional Care Care, , 1616, 139-147., 139-147.

Reuben, D. B., Levy-Storms, L., Yee, M., Lee, M.,Reuben, D. B., Levy-Storms, L., Yee, M., Lee, M.,Cole, K., Waite, M., Nichols, L., & Frank, J. C. (2004).Cole, K., Waite, M., Nichols, L., & Frank, J. C. (2004).Disciplinary split: A threat to geriatrics interdisciplinaryDisciplinary split: A threat to geriatrics interdisciplinaryteam training. team training. Journal of the American GeriatricsJournal of the American GeriatricsSocietySociety, , 5252, 1000-1006., 1000-1006.


Satin, D. G. (1987). The difficulties of interdisciplinarySatin, D. G. (1987). The difficulties of interdisciplinaryeducation: Lessons from three failures and a success.education: Lessons from three failures and a success.Educational GerontologyEducational Gerontology, , 1313, 53-69., 53-69.

Slack, M. K., Cummings, D. M., Borrego, M. E., Fuller,Slack, M. K., Cummings, D. M., Borrego, M. E., Fuller,K., & Cook, S. (2002). Strategies used byK., & Cook, S. (2002). Strategies used byinterdisciplinary rural health training programs tointerdisciplinary rural health training programs toassure community responsiveness and recruitassure community responsiveness and recruitpractitioners. practitioners. Journal ofJournal of Interprofessional Interprofessional Care Care, , 1616,,129-138.129-138.

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