CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care

Quality Education for a Healthier Scotland

CLINICAL SKILLSManaged Educational Network Excellent skills for excellent care

Assessing Interprofessional Teamwork Competence Through A Team Observed Structured Clinical Assessment (TOSCA)Funded CSMEN PROJECT 2012-13

Keith Stevenson, Evelyn McElhinney Liz Simpson,Kay CurrieJacqueline McCallum

School of Health and Life SciencesGlasgow Caledonian University



Statutory RequirementStandards for Pre Reg. Nursing Education (NMC

2010)R5.7 Programme providers must ensure that students have the

opportunity to learn with, and from, other health and social care professionals. (NMC 2010 p75)

HCPC Standards of education and training p7 (2012)

4.9 When there is interprofessional learning the profession-specific skills and knowledge of each professional group must be adequately addressed.

SSSC Council (23 Jul 2009) to encourage and promote collaborative working: cross

sector, interagency, interprofessional and academic/practice.


Scottish Perspective (NES)

The concept of IPL is not new and over the past ten years ithas become an integral part of many pre- and post-registration health and social care professional programmesthroughout the United Kingdom.

The driver for this rapid growth in IPL activity is therequirement for health and social care graduates to becompetent regarding interprofessional collaboration and teamworking in a variety of settings.

http://www.nes.scot.nhs.uk/education-and-training/educational-development/initiatives/




Making it Real at GCU

IPE Modules should be designed to include simulated authentic interprofessional activity:

• Authentic interprofessional team working, • Authentic interprofessional communication, • Provide real experience of leading an interprofessional

team, • Provide opportunities for students to reflect on their

leadership and subsequent team success• Provide Psycho-Sociological Perspective on IPP at each level


Agreed IPP Skills (Thistlethwaite and Moran2010)

• Effective TEAMWORK

• Understanding TEAM ROLES and RESPONSIBILITIES

• Effective COMMUNICATION

• Effective SHARED DECISION MAKING

• Involving an understanding of THE SERVICE USER

• Revisiting ETHICS and ATTITUDES


Example of a McMaster TOSCA Scenario Briefing Use:Nursing, OT, Physio, Podiatry, Social Work, Dietetics, Paramed

You have 20 minutes to discuss the case and suggest a care plan and you will be assessed on your contribution to the discussion.

• Alan Kettle, 37 yrs old, is morbidly obese and has low self-esteem and social phobia.

• He fell last week getting out of the shower and his elderly parents had trouble getting him up so called 999. He is asking for a motorized scooter as he has been having increasing trouble walking due to weight, OA (knee and hip) and SOB.

• He previously requested a scooter 1 year ago but was declined. The Occupational Therapist thought the scooter would decrease his functional status.

• Alan is coming in for his appointment next week to once again request a scooter. The clinician, with whom he has booked his time, has requested that he be reviewed by the team to develop a response and an approach, prior to his visit.

• Alan’s Medical History is attached (see next page)


Medical HistoryDOB: April 13, 1977 /Weight: 325lbs/ Height: 5’10”/ BMI: 46.6 (> 90th percentile for age)

Obesity onset: Childhood Diabetes- Type 2 medication dependant since 2005Oral weight loss meds and various diets have failed Social anxiety: (has prevented follow-up with obesity clinic)OA (knees and hips) Sleep apnea (intermittently compliant with CPAP)

Most Recent Investigations HbA1c 0.088 BP 149/92 BMI 46.6Renal function: Sodium 137; Potassium 3.6; Urea 8.7; Creatinine 128Medications

Celeoxib 60mg po od (for pain)Orlistat (Xenical) 120mg po tid with each main meal (anti-obesity)Metformin 500mg tid (for diabetes) Clonazepam 0.5mg tid prn (for anxiety)Ramipril 2.5mg po od (for blood pressure and kidney care)

Social HistoryCollege –courses x2 Writing literature; Introduction to Journalism; onlineEmployment- occasionally publishes fiction stories via people watching at shopping malls etc.

Social phobia Caffeine/cola dependency - diet counselling in 2001, 2005, 2007 Non smoker; Non drinkerParents- Mabel and Patrick Kettle- did counselling course 2006 “ Food and Enabling”Sisters –older- Alicia-healthcare admin; Cindy- nurse; Stephanie; pharmaceutical rep


Suggested Scoring Template

Name Student A Student B Student C Student DCommunicationCollaborationRoles + Responsibilities

Collaborative Approach

Conflict management

Team functioning

1-2 3-4 5 6-7 8-9

Well Below Below Expected Expected Above Expected Well Above


TOSCA GROUP 1 (in action)

Mental Health Nursing Student

Social Work Student

Physiotherapy Student

Occupational Therapy Student


Combined Scoring Template Group 1

Name Student A Student B Student C Student DCommunication 6 7 7 7 7 8 6 7 6 7 8 7Collaboration 7 7 6 7 7 8 7 7 7 8 8 8Roles + Responsibilities

5 5 6 7 7 8 5 6 6 7 7 7


7 7 7 6 6 7 6 6 6 7 7 8

Conflict management

n/a n/a n/a n/a

Team functioning 7 7 7 7 8 8 7 7 7 8 8 8

1-2 3-4 5 6-7 8-9



TOSCA Group 2 (in action)

Social Work Student

Mental Health Nursing Student Occupational Therapy Student

Physiotherapy Student


Combined Scoring Template (Group 2)

Name Student A Student B Student C Student DCommunication 6 6 6 7 7 7 7 7 7 7 7 6Collaboration 5 6 6 6 7 7 6 7 7 7 6 7Roles + Responsibilities

7 7 5 7 7 7 7 7 6 7 7 7


6 7 6 7 7 6 6 7 6 7 6 7

Conflict management

n/a n/a n/a n/a

Team functioning 7 6 5 7 7 6 7 7 6 7 7 7

1-2 3-4 5 6-7 8-9



BRIEF QUESTIONNAIRE

StronglyAgree

Agree Unsure Disagree Strongly Disagree

TOSCE STUDYWHICH GROUP? 1 2 (Please circle)Place a x in the column that best describes your feeling about the experience

Q1. The Assessment was explained I knew what I was supposed to doQ2. The Assessment room was appropriate to the taskQ3. The other students seemed to know what to do better than meQ4. It was difficult to know who was leading the groupQ5. I found it difficult to get my point across to the rest of the groupQ6. It was interesting to hear the other professions’ viewpoints on the case we were discussingQ7. I felt uncomfortable that I had to say stuff when I didn’t really have anything to say.Q8. I can see why this type of assessment would be useful to us in our professional livesQ9. I didn’t like the experience of being assessed in this wayQ10. I think being taught and then assessed in interprofessional activities by simulations like this is a good idea.


Agreement with Positive QuestionsQs1,2,6,8,10 Response 31 Strongly Agree 77.5%

9 Agree 22.5%

Total 40 100%

Disagreement with Negative Questions

Qs 3,4,5,7 9 Response 32 Disagree 80%5 Strongly Disagree 12.5%

Neutral 3 7.5%

Total 40 100%


Consistency of Scoring

• Independent Observers A,B and C marked from the film• Consistency of agreement very strong • Two levels of agreement 68% of scoring between A and B were identical 66% of scoring between B and C were identical 66% of scoring between A and C were identical

Cohens Kappa = 0.52 A and B = 0.50 B and C = 0.50 A and C

Anything above 0.5 =Very strong reliable agreement


Conclusions• TOSPA is a feasible method of students experiencing and

being assessed in interprofessional communication• The mechanism of filming did not interfere with the process• The filming is important in providing a standard record for

independent marking• The TOSPA experience would seem to be valued by students

as a truly useful exercise making interprofessional sense.• TOSPA can be used as a formative teaching aid as well as a

summative exercise.• The TOSPA used in this project was thought to be successful

because the case was accessible and important to all four participants.

• More meaningful and authentic TOSPA cases are needed.

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CLINICAL SKILLS Managed Educational Network Excellent skills for excellent care