Candidacy defense v13 semifinal

DESCRIPTION, EVALUATION AND MODELING OF LEARNING IN INTERDISCIPLINARY TEAMS

Jesús Ibarra, MD, MMEd, MS Dissertation Research Proposal

Advisory Committee: Hongbin Wang, PhD (Chair)

Dean Sittig, PhD Craig W. Johnson, PhD

Joan Engebretson DrPH, AHN-BC, RN James P. Turley, RN, PhD

February 1, 2013

School of Biomedical Informatics

2 Education

MEDICAL DOCTOR • 1979 - 1986

PEDIATRICS • 1986 - 1990

MASTER OF MEDICAL EDUCATION • 2001 - 2005

MS HEALTH INFORMATICS • 2009 - 2011

DOCTORAL STUDENT HEALTH INFORMATICS • 2009 – current

Practice in the field of transdisciplinary

knowledge acquisition and pediatric care

Leader

Researcher

Physician

University teacher

Physician

B. S. Biomedical Engineering

(2003)

B.S. Nutrition and well being

(2004)

B.S. Nursing (2006)

B. A. Management. Health Syst.

(2007)

Dentistry (2008)

MdPhD (2008)

M.D. (1976)

Patient, family &

community

Design of new programs: Development of an interdisciplinary health care team

5 Why is this important to Biomedical Informatics?

“Biomedical informatics (BMI) is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, driven by efforts to improve human health.”

“Faculty should design BMI graduate programs so that every student works collaboratively:

Team effectively with partners within and across disciplines”

(Kulikowski et al, 2012)

Goals 6

To understand changes in fields as they integrate

To establish differences in multi, inter and trans disciplinary fields

To understand how integrated teams function and means to improve them

To present my proposed research project

Outline

1.  The case for interdisciplinary team work

2.  Identified problems

3.  My research   Goals   Theories   Aims   Methods   Time schedule

4.  Questions

8 Real life situations are complex and require teams educated across disciplines

9 The case for transdisciplinary team work • Growing emphasis in health research,

services, education and policy (Choi, 2007)

•  Funding agencies call for research involving multiple disciplines (NIH)

• Hospitals establish multiple disciplinary teams to provide care (Kessler, 2006)

Education occurs in silos

MDs Nurses Respiratory Therapists Managers

Problem

•  There is a mismatch between education and practice.

• Students learn their professional domains in a mode of silos, but are expected to approach complex problems in real world in a collaborative transdisciplinary fashion.

• Education is being pursued with disciplines apart from each other.

Problem of terminology

• Common terms: multidisciplinary, interdisciplinary, transdisciplinary (Grossman, 2005)

• Ambiguous definition, interchangeable use (Whitfield, 2004)

13 Poor communications (Pietroni, 1992) • Each profession

•  develops own language, only insiders know

•  uses different words with same meaning

▫  cognitive risks

•  uses a range of languages

14 So, to improve interdisciplinary team learning we must… • Understand the context in which interdisciplinary

team learning takes place

•  Find better ways to analyze interdisciplinary team learning

And I think that (My hypothesis)

There may be certain combinations of elements that can result in more effective interdisciplinary

team learning

16 So, in other words, to improve inter-disciplinary team learning we must…

Understand the learning of interdisciplinary teams G

Model the integration of disciplines

Assess the experience of learning in I.D. teams

17 1. Constructivism (Vygotsky, Piaget, Dewey, Vico, Rorty, Bruner)

(Hall, 2012)

Absolute knowledge

situated learning

Knowledge “constructed”

apply across

situations

Constructivism

Information Processing View

multiple perspectives

“authentic” assessment

“real world” learning

pre-existing knowledge

“Metacognition”

social context

group learning

“student centered”

“guide on the side” “negotiation”

2. Experiential Learning (Kolbe)

Concrete experience (1)

Forming abstract

concepts (3)

Observation and

Reflection (2)

Testing in new

situations (4)

(Wheeler, 2012)

19 To improve interdisciplinary team learning we must…

Student centered (C)

Pre-existing knowledg(C) Concrete experience (EL) Testing new situation (EL)

Constructivism

Experiential learning

3. Knowledge representation

1.  Surrogate, substitute for the thing itself

2.  Set of ontological commitments – in what terms should I think about the world?

3.  Fragmentary theory of intelligent reasoning

4.  Medium for pragmatically efficient computation

5.  Medium of human expression – a language in which we say things about the world

(Davis et al, 2000)

21 Flowchart representation of a spectrum of low to high integration of disciplines using a flowchart method.

22 4. Integration of disciplines: The Integration Ladder(Harden, 2000)

1.  Isolation

2.  Awareness

3.  Harmonisation

4.  Nesting

5.  Temporal coordination

6.  Sharing

7.  Correlation

8.  Complementary programme

9.  Multi-disciplinary

10.  Inter-disciplinary

11.  Trans-disciplinary

A comparison (Choi, 2006)

Multidisciplinary Interdisciplinary Transdisciplinary Keyword Additive Interactive Holistic Mathematical example

2+2 = 4 2+2=5 2+2=yellow

Food example a salad bowl a melting pot a cake

Pre-existiing knowlge (C) Concrete experience (EL) Testing new situation (EL)

Surrogate (KR) Intelligent reasoning (KR)

Pragmatical Comput. (KR)

Integration ladder (ID)

1. Constructivism 3. Know Representation

4. Integrat. of disciplines 2. Experiential learning

Identification 1.  Self Assessment 2.  Information Seeking 3.  Personal Goal Setting 4.  Strategic Planning 5.  Self-Monitoring

Formation 1.  Team Goal Setting 2.  Leadership 3.  Role Identification 4.  Trust 5.  Interdependence 6.  Social Support 7.  Peer Feedback 8.  Client Feedback 9.  Expert Feedback 10. Communication &

Collaboration Tools 11. Information Tools 12. Cognitive &

Knowledge Creation Tools

13. Awareness 14. Appreciation

Adaptation 1.  Goal Alignment 2.  Shared Mental Model 3.  Understanding 4.  Creativity

Collective-Efficacy Team-Outcome

Teacher

Self-Efficacy Individual-Process

5. Model of Interdisciplinary team learning (Lei)

Adapted from Lei, 2007

26 Promoters to enhance teamwork

(Choi, 2007)

Strategy Promoting the promoters (P)

Team P1. good selection of team members P2. good team leaders P3. maturity and flexibility of team members

Enthusiasm P4. personal commitment of team members

Accessibility P5. physical proximity of team members P6. the Internet and email as a supporting platform

Motivation P7. incentives

Workplace P8. institutional support and changes in the workplace

Objectives P9. a common goal and shared vision

Role P10. clarity and rotation of roles

Kinship P11. communication among team members P12. constructive comment among team members

Dealing with barriers Strategy Barring the barriers (B)

Team B1. avoid poor selection of disciplines and team members B2. avoid poor process of team functioning

Enthusiasm B3. avoid lack of proper measures to evaluate success of interdisciplinary work B4. avoid lack of guidelines for multiple authorship in research publications

Accessibility B5. avoid language problems Motivation B6. avoid insufficient time for the project

B7. avoid insufficient funding for the project Workplace B8. avoid institutional constraint

Objectives B9. avoid discipline conflicts

Role B10. avoid team conflicts

Kinship B11. avoid lack of communication between disciplines B12. avoid unequal power among disciplines

(Choi, 2007)

Identification (CDTL)

Formation (CDTL)

Progress (CDTL)

Goal alignment (CDTL)

1. Constructivism 3. Knwl Representation 5. Model Cross-Discip. team learning Th

4.Integrat. of disciplines 2. Experiential learning

Innovation

•  This research challenges and seeks to understand the proposal of shift of current educational practice, which is predominantly oriented towards one discipline.

• My contribution is a better understanding of how the members of transdisciplinary teams form and function,

• Also, to develop a model of learning in transdisciplinary teams

Evaluation

• Using an existing survey, it will be applied to a new population of students trained in health disciplines.

• My application fills a gap in interdisciplinary learning in the biomedical and health disciplines field.

•  I am comparing the success of the weighted model versus the previous unweighted CDTL by using statistical measures.

Specific Aims •  AIM 1. To establish an understanding of what are

interdisciplinary teams, and how they differ from multidisciplinary and transdisciplinary teams.

▫  Review the literature to sustain the work of interdisciplinary teams, describe promotors and detractors of team activity.

Specific Aims •  AIM 2. To model the concept of interdisciplinary teams

through the application of computational knowledge representation techniques.

▫  Employ knowledge modeling methods, including task analysis, collection and analysis of domain knowledge, use of computational software, and knowledge representation free-ware.

Specific Aims •  AIM 3. To assess the learning of interdisciplinary teams,

to address their cross disciplinary team learning.

▫  Assess the levels of identification, formation, and identification achieved by a type of interdisciplinary team of students

▫  Assess the degree to which teams of interdisciplinary teams Integrate, adapt and are identified to these population

Aim 1 Understand

Interdisciplinary team learning

Aim 2 Model the concept of

Interdisciplinary teams

Aim 3 Assess how the

members of inter-D teams learn

Formation (CDTL)

Progress (CDTL)

35 Aim 1. Understand Interdisciplinary team learning •  Inclusion criteria: relevant publications,

meaning that the publication should examine teaching and learning in interdisciplinary higher education. Peer reviewed. English literature

• Purpose: Establish understanding of how interdisciplinary teams are defined in the literature; how collaboration is conceived; how a team is defined, and which are its stages; what is the evidence of value of teamwork; and what is team based learning.

36 Aim 1. Understand Interdisciplinary team learning •  Time: 1992 to 2012

• Search terms multidisciplinary learning, transdisciplinary learning, interdisciplinary learning.

• Search strategy focused on title, abstract, and key words in order to obtain publications with a clear focus on teaching and learning within the context of interdisciplinary higher education.

• Database searched: the Educational Resources Information Centre (ERIC).

Aim 1 Understand

Formation (CDTL)

Progress (CDTL)

Review of the literature

Definitions multi-, inter-, trans D (IV) Definition Collaboration (DV) Promotors and detractors (DV) Evidence value teamwork (DV)

38 Aim 2. Model the concept of Interdisciplinary teams • Application of computational knowledge

representation techniques

• A piece of knowledge explored, in relation to the concept of interdisciplinary health care teams, employing the principles espoused by Harden, Choi, Russell & Norvig, and Brachman & Levesque.

39 Aim 2. Model the concept of Interdisciplinary teams • Computer application exploration ▫  Microsoft® Office Visio® 2007, PRO forma, Tallis,

CLIPS, and Protégé.

• Archetype ▫  PROforma

• Expert system representation ▫  CLIPS

• Ontology ▫  Protégé,

40 Example of Knowledge Representation Expert system representation using CLIPS. Sample of definition of levels and variables that characterize each level.

Aim 1 Understand

Formation (CDTL)

Progress (CDTL)

Comp. Knowledge Rep. techniques

Definitions multi-, inter-, trans D (IV) Definition Collaboration (DV) Promotors and detractors (DV) Evidence value teamwork (DV)

Multidisciplinary health care team (IV) Integration (DV)

42 Aim 3. Assess how the members of inter-D teams learn

3.1 Analyze the experience and activities of identification.

3.2 Describe how the members of the interdisciplinary team formed and functioned.

3.3 Characterize how the members of an interdisciplinary team made progress

Setting

•  Tecnologico de Monterrey School of Medicine and Health Sciences in Mexico is SACS accredited

•  Provides special interdisciplinary learning environment in health sciences undergraduate programs

•  Educational programs include Medicine, Nutrition, Nursing, Management of Health Systems, Dentistry, Biomedical Engineering, and Clinical Psychology.

44 Aim 3. Assess how the members of inter-D teams learn •  Population. Students enrolled in the Programs of the School

of Medicine and Health Sciences in Monterrey, Mexico •  Sample. Available sample of 194 potential students

representative of an interdisciplinary population, which might include students of ▫  Medicine,

▫  Nursing,

▫  Biomedical engineering,

▫  Nutrition and wellness,

▫  Management of Health Systems,

▫  Dentistry,

▫  Clinical Psychology

Research Questions •  Are higher levels of identification (IV), formation (IV),

and adaptation (IV) associated with higher levels of inter disciplinary team learning (DV)?

•  Are there demographic differences in interdisciplinary team learning (DV), by demographic category (IV)?

DV = Dependent variable IV = Independent variable

46 Aim 3. Asses how the members of inter-D teams learn Data collection

Questionnaire • Existing measurement instrument: Cross-

Disciplinary Team Learning Questionnaire (Lei

• Validated for a theoretical model via statistical analysis,

• High Cronbach alpha reliability coefficient (0.97)

47 Aim 3. Characterize how the members of inter-D teams learn Questionnaire

24 items in four sections (variables)

•  Inter-disciplinary learning (DV)

• Self Assessment (IV)

•  Team Formation (IV)

•  Team Progress and Accomplishments (IV)

(Lei, 2007)

48 Aim 3. Assess how the members of inter-D teams learn Demographic variables •  Team name • Project name •  Initial major in • Gender • Class level • Work with team member from different majors • Semester in projects • Age

49 Aim 3. Assess how the members of inter-D teams learn

Choose one Description

1.Island of knowledge

I have mastered my discipline, but do not have experience in other disciplines

2. Awareness I am aware of the discipline’s goals and constraints.

3. Appreciation I have begun to build a conceptual framework of the other disciplines, am interested to understand and support the other disciplines’ goals and concepts, and know what questions to ask.

4. Understanding I have developed a conceptual understanding of the other disciplines, can negotiate, am proactive in discussions with participants from other disciplines, provide input before the input is requested, and use the language of other disciplines.

(Adapted from Lei, 2007)

Item: Inter-disciplinary learning (DV)

50 Aim 3. Assess how the members of inter-D teams learn Items: Self-Assessment (IV)

1.  I assessed how my abilities fit with project requirement

2.  I was able to find information about project requirements

3.  I set personal goals for the project. 4.  I defined steps to achieve my personal goals.

5.  I applied my discipline-specific knowledge.

51 Aim 3. Assess how the members of inter-D teams learn Items: Team formation (1) (IV) 1.  The team defined project goals. 2.  Project leader(s) contributed to the success

of the project. 3.  Team roles were based upon team members’ discipline-specific

abilities.

4.  Team members trusted one another to perform tasks

5.  Team members depended upon one another’s contribution.

6.  Team members helped one another out.

7.  Team members provided peer feedback on a weekly basis.

8.  The team asked for feedback from the project partner. (Adapted from Lei, 2007)

52 Aim 3. Assess how the members of inter-D teams learn Items: Team formation (2) 9.  The team asked for feedback

10. The team used various communication and collaboration technologies

11.  The team used various information technologies to search, organize, retrieve, and store data and information.

12.  The team used hardware and software tools

13.  Team members were aware of goals and constraints of one another’s disciplines

14.  Team members asked questions to understand one another’s disciplines.

53 Aim 3. Assess how the members of inter-D teams learn Items: Team Progress and Completion (IV) 1.  Team members aligned personal goals with

project goals.

2.  Team members combined the knowledge, techniques, methods, or theories of one another’s disciplines as the project progressed.

3.  Team members used language and concepts of one another’s disciplines as the project progressed.

4.  The team generated new ideas to solve problems in the project.

5.  The team converted new ideas into useful and viable products.

54 Aim 3. Characterize how the members of inter-D teams learn Data collection

• Questionnaire available in a web page

• SurveyMonkey online survey tool(www.SurveyMonkey.com)

• Consent form for online survey

•  Translated version in Spanish with back to English translation

55 Aim 3. Characterize how the members of inter-D teams learn Scale

Participants will be asked to rate each of the 24 items in the questionnaire using a five-point Likert scale

1=Strongly disagree

2=Disagree

3=Neither agree nor disagree

4=Agree, and

5=Strongly agree

Models • Regression equation • Sample size. Need 25 subjects in each of the 4

group levels of dependent variables. About 107 subjects

•  Test with SPSS procedures ▫  Regression ▫  Multinominal Logistic Regression ▫  Standard Regression ▫  MANOVA (demographic variables)

▫  Correlation procedures (dependent variables)

57 Aim 3. Characterize how the members of inter-D teams learn Focus groups •  Qualitative research: group of 6 to 8 people asked

about their perceptions, opinions, beliefs, and attitudes towards idea of interdisciplinary team learning

•  One or two Focus Groups •  Researcher will serve as objective moderator •  Will encourage participants to freely discuss their

feelings and concerns about interdisciplinary team knowledge acquisition.

•  12 to 16 individuals invited to guarantee 6 to 8 participants

58 Aim 3. Characterize how the members of inter-D teams learn Focus groups

• Will move from general toward more specific, in-depth questions and, finally, closure.

▫  Example: after question, “What do you like about transdisciplinary teams?”,

▫  ask, “if you could build new transdisciplinary teams from scratch, what would you do to make them the best possible?

Aim 1 Understand

Formation (CDTL)

Progress (CDTL)

Survey Focus groups

Comp. Knowledge Rep. techniques

Definitions multi-, inter-, trans D Definition Collaboration (DV) Promotors and detractors (DV) Evidence value teamwork (DV)

Multidisciplinary health care team (IV) Integration (DV)

8 Contextual: Initial major (IV) 5 Self assessment (IV) 14Team formation (IV) 2 Inter-disciplinary learning (DV) 5 Team progress/accomplishments (IV)

Time Schedule 60

Summary

• Understanding multiple discipline teams is relevant for biomedical informaticians

• Some issues of learning in transdisciplinary teams have been identified

• A baseline understanding of how transdisciplinary teams function has been established

• Research project has been presented

Acknowledgements

•  Faculty ▫  Hongbin Wang, PhD

▫  Dean Sittig, RN, PhD

▫  Craig W. Johnson, PhD

▫  Joan Engebretson DrPH, AHN-BC, RN

▫  James P. Turley, RN, PhD

▫  Adol Esquivel, MD, PhD

•  Fellow Students

Questions?

““You are never too old to set another goal or to dream a new dream.”

-C.S. Lewis

Candidacy defense v13 semifinal

health research

interdisciplinary field

interdisciplinary teamlearning

interdisciplinary team

education practice

human health

health care teampatient

transdisciplinary fieldsto

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