Was born in Cirebon, Jawa BaratMedical Doctor (MD), UNIVERSITAS INDONESIAMaster of Public Health (MPH), HARVARD-USADoctor of Science (ScD): JOHNS HOPKINS-USAPost Doctoral in Statistics: UNIV of MICHIGAN-USACurrent Activities:

Indonesian Public Health Assoc, PresidentDept of Health Policy & Administration, UI, ChairNational Team for Poverty Reduction Acceleration, Vice

President Office (TNP2K), Human Resource SpecialistExpert Committee on TB - MoH, Health Policy SpecialistMoH National NCD Roadmap, Lead ConsultantCountry Coordination & Facilitation (CCF Indonesia) for

HRH, Menko Kesra Office, Head of SecretariatCtr for Health Admin & Policy Studies(CHAMPS-UI), DirectorTeaching and advising PhD students, Medical, Dentistry,

Public Health, Nursing schools of several universities

Adang Bachtiar

INTER-PROFESSIONAL EDUCATION

A Public Health Education’s Point Of View

Adang Bachtiar MD.MPH.ScDadang@post.harvard.edu

Bali – Desember 2011

THE GLOBAL PUBLIC HEALTH CHALLENGES

49%

27%

9%

15%

22% 43%

14%

21%

Communicable diseases, maternal and perinatalconditions andnutritional deficiencies

NCD

Neuropsychiatric Disorders

Injuries

1990 2020

Source: WHO, Evidence, Information and Policy, 2000

YR 2000 PREDICTION

YR 2008 (NEW) PREDICTION

2005: 60% deaths, related to NCD

(from 27%: 1990) 47% global burden

2020 (prediction): 73% deaths, related to NCD (Yr

2000 prediction: 43%) 60% global burden

80% NCD problems at LMIC (related to poverty)

WHO (2008)

POVERTY

Decrease in:•Quality of life•Productivity•Learning ability•Savings

Increase in:.Debts.Dependency

NCDIncrease in: •Personal & env risks•Unbalanced diet

Decrease in:•Education & information access•Ability to access services

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting, (Doha, Qatar, May 2009)

Global Risk Assessment 2009World Economic Forum

Asset price collapseRetrenchment from globalization

Oil and gas price spike

NCDs

Flu pandemicFiscal crisis

Food crisis

Infectious disease

LIKELIHOOD

SEVE

RIT

Y IN

US$

NOT ONLY Commonality factors…

Tobacco

Diet

Physical Activity

Alcohol

Cardiovascular

Cancers

Diabetes

Chronic Respiratory

Osteoporosis

Oral Health

Mental Health

Source: WHO, Global Status Report on NCD, 2010

BUT..FAST GROWING FUNDAMENTAL ROOT CAUSES

UNBALANCED DIET SEDENTARY LIFE STYLE

% Lipids

¯ SERATvegetablescereal

Phytoestrogensbioactivate molecules

¯ Folate, B6 ®

Homocysteinaemia ® Thrombosis

OBESITY ® DIABETES ® CHDSex hormone

changes

CANCERS: breast, endometrium

Trans fatty acids

Saturated fats

+ + +

+ +

+

-

-

Antioxidants

+

-

+

+

+

+

Total Fat

n-3 fatty acids -Atherosclerosis

BEYOND HEALTH DETERMINANTS (!)

Modified from: WHO, Global Status Report on NCD, 2010

SOLUTION?

3-“Health in All Policy”

2-Health System Level

3 LEVEL STRATEGIES

5 MDG Targets

MDG-NCDTargets

1-Family & Community

Level

Primary care

Referral care

Social Capital

for health

6.Health leadership

5.Financing h-care

4.Drugs & supplies

3.Surveillence

2.Manpower mgmt

1.Quality of care

Public Health services Food securityHealth sector Policies

Community Based

Poverty reduction

acceleration

Gender

TNP2K

Family welfare

Education

4 NCD Risks

Food Safety

Taxes

Trades

PUBLIC HEALTH CARE

SYSTEM

• Central & sub-national regulations• Sectoral synergism

• Resource mobilisation

• PROMOTIVE• PREVENTIVE• CURATIVE• REHABILITATIVE• DEVELOPMENT• Infrastructure• Human resource• Budget• Quality Assurance• Participative

•Effective monitoring system

•Empowerment

•Self reliance

Professionalism Multidisciplinary Life Long Learning

PARTICIPATIVE & EMPOWERED

EFFECTIVITY

PUBLIC HEALTH POLITICS & POLICY

DemandSupply

Advocacy

GOAL:Accessibility-Availability-Quality-Equity

What is Inter-Professional

Education?

Grouped students in multidisciplinary teams Assigned teams a problem from “practices” Guided students through the steps of the

problem-solving process Recognize relevant knowledge Identify what needs to be learned Acquire knowledge and work towards

solution

CORE ELEMENTSFACILITATOR

TASKSISSUES

PROBLEMS(CONTAINING SOME

UNKNOWN ELEMENTS)

STUDENT GROUPTHE LEARNING ‘”FIELD”

KICK-STARTS LEARNING PROCESS

GROUP DYNAMICS

GROUP RESPONSE

5 PROPOSED DOMAINS

.

.

.1.GOAL:

Participatory, collaborative and

coordinated partnership between multi-providers

and clients

3.DEALING WITH INTER-PROFESSION

AL DIFFERENCES & FOCUS

4.COLLABORATIVE LEADERSH

IP

5. COMMUNIC

ATION & TEAM

FUNCTIONING

2.ROLE CLARIFICA

TION & DEVELOPM

ENT

SIMPLE

COMPLEX

Q-

AU

DI

T

TQ

M-

RIS

K

MG

MT

CLA

SS

– L

AB

-

CLIN

ICA

L/R

EFER

RA

L -

P

HC

Modified from: Canadian Interprofessional Health Collaborative, 2010

CLIENT CENTERED Competency Statement:

Learners/practitioners seek out, integrate, and value, as a partner, the input, and the empowerment of patient/client/family/ community in designing and implementing public health care

SIPOC paradigm:

I P O CS

I P O CS

Internal:

External:

Domain -1:

ROLE CLARIFICATION

Competency Statement: Learners/practitioners understand their own

role and the roles of those in other professions, and use this knowledge appropriately to establish and meet patient/ client/family and community public health goals.

Domain -2:

DEALING WITH INTER-PROFESSIONAL DIFFERENCES AND FOCUSES

Competency Statement: Learners/practitioners actively engage self

and others, including the client/patient/ family and community, in positively and constructively addressing interprofessional conflict as it arises.

Domain -3:

COLLABORATIVE LEADERSHIP

Competency Statement: Learners/practitioners understand and can

apply leadership principles that support a collaborative practice model.

Domain -4:

COMMUNICATION &TEAM FUNCTIONING

Competency Statement: Learners/practitioners understand the

principles of team dynamics and group processes to enable effective interprofessional responsive communication and team collaboration.

Domain -5:

CONTEXTUALITIES

3 concepts underpinning the 5 domains:

THE CONTEXT OF PRACTICES

ENCOUNTERED COMPLEXITY

QUALITY AND SAFETY PARADIGM

PRACTICES CONTEXT

According to the nature of Public Health, practice options can be at: Class:

E.g., simulation of cases from different angles and profession

Laboratory: E.g., genome aspect of public health

Clinical settings: E.g., case management and risk

identification-mgmt Community and social settings:

E.g., full public health intervention

ENCOUNTERED COMPLEXITY_1

Community-based health effort Interprofessional education related to:

Community mobilisation & health promoteur

Family health care, including Family physician, Community nurses & Midwives

Env health assesor and epidemiologist Health administrator at PHC level Public health disaster team

ENCOUNTERED COMPLEXITY_2

Primary care IPE related to:

Health planner & administrator at PHC level Health promotion specialist Family health care, including Family

physician, Community nurses & Midwives Epidemiologist & Env health manager Primary medical & public health disaster

team

ENCOUNTERED COMPLEXITY_3

Referral care IPE related to:

Hospital manager Health promoteur and counsellor Hospital epidemiologist Health and safety specialist Medical doctors Nurses and midwives Other health profession at hospital

QUALITY & SAFETY ASPECT

The spectrum can be, respectively: Quality inspection Quality audit and review Quality assurance Total Quality Improvement including patient

safety Risk management at public health settings

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1

Descriptors

Criteria 3 2 1

Realism Based on an actual or fictionalized real-world situation linking topic to learner.

Contrived or contains unrealistic elements that decrease credibility.

Unrealistic, lacking relevant context.

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1Realism Based on an actual or

fictionalized real-world situation linking topic to learner.

Contrived or contains unrealistic elements that decrease credibility.

Unrealistic, lacking relevant context.

Content Addresses significant conceptual issues; directly related to major content goals.

Encourages superficial rather than in-depth understanding concepts.

Relevance of topic peripheral or not apparent.

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1Realism Based on an actual or fictionalized

real-world situation linking topic to learner.

Contrived or contains unrealistic elements that decrease credibility.

Unrealistic, lacking relevant context.

Content Addresses significant conceptual issues; directly related to major content goals.

Encourages superficial rather than in-depth understanding concepts.

Relevance of topic peripheral or not apparent.

Engage-ment

Stimulates discussion and inquiry through its relevance and presentation.

Generates limited or superficial discussion; provokes little curiosity.

Lacks a “hook”; obscure or pedantic presentation.

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1Complexity Appropriately

challenging; group effort and cooperation required; some ambiguity appropriate; integrates multiple concepts.

Difficult but may encourage a “divide and conquer” approach. Concepts not well integrated.

Solution accessible to most students working alone; focused on single concept.

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1Complexity Appropriately challenging; group effort

and cooperation required; some ambiguity appropriate; integrates multiple concepts.

Difficult but may encourage a “divide and conquer” approach. Concepts not well integrated.

Solution accessible to most students working alone; focused on single concept.

Resolution Open to multi-disciplinary resolutions or multiple pathways to solution, depending on students assumptions and reasoned arguments.

Resolution is more obvious but allows reasonable opportunity for judgment and discussion.

One right answer is expected; limited opportunity for analysis and decision making.

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1Structure Progressive

disclosure via multiple stages, multi angle builds on existing students knowledge.

Staging does not flow well; transition could be improved.

Too much or too little information provided at once; short cuts thinking/research.

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1Structure Progressive disclosure via

multiple stages, builds on existing student knowledge.

Staging does not flow well; transition could be improved.

Too much or too little information provided at once; short cuts thinking/research.

Questions Analytic in number, short, and open-ended; encourage deeper understanding.

Most are directive & descriptive; preempt student-generated learning issues.

Lead to “yes-no” answers rather than thoughtful discussion.

Rubric to Evaluate IPE

Descriptors

Criteria 3 2 1Structure Progressive disclosure via multiple

stages, builds on existing student knowledge.

Staging does not flow well; transition could be improved.

Too much or too little information provided at once; short cuts thinking/research.

Questions Limited in number, short, and open-ended; encourage deeper understanding.

Most are directive; preempt student-generated learning issues.

Lead to “yes-no” answers rather than thoughtful discussion.

Research Promotes substantive research using multiple approaches.

Research limited to secondary data and textbook material.

Limited necessity for research.

Rubric to Evaluate IPE

WAY FORWARD

1. Organisation of physical resources

2. Organisation of IPE teaching team

3. Syllabus content

4. Managing student groups

5. Evidence of benefits required

6. The risks involved

7. Where next?