June Harris, an employee within our clinic, approached me with a
scenario that I feel is worth examining for current and future employees
in our facility. As you may know, June is a member of our
multidisciplinary team that has received training in phlebotomy, EEG and
office procedures. She performs these duties in addition to her primary
focus of radiography in which she received her degree.
Recently, June had an interesting situation arise with a patient. The
patient questioned Juneís abilities and expertise as a phlebotomist since
her nametag denoted her as a radiographer. The patient became speculative
and leery of the employee, prompting a barrage of questions. The employee
answered the questions adequately and in a friendly manner and the office
visit proceeded amicably.
I am assembling a team of health care professionals from our facility,
including a nurse, a patient care advocate, a legal staff representative,
an instructor, a physician and an allied health student to examine our
responsibilities and roles as patient educators in a multidisciplinary
staffing environment. My hope is that the team can develop some level of
understanding of situations of this nature and determine various
The team will meet July 29, 1999 at 8:00am. I would like for the team
to present its recommendations and opinions at this meeting. Please devote
20% of your work time to this issue, both for meeting preparation and to
review various solutions that may be immediately implemented in our
How can we as allied health professionals and educators
prepare recommendations for educating students and staff who are cross
training or already cross-trained to function in and handle a variety of
patient education situations in the workplace, in such a way that:
- it meets the July 29th deadline
- it does not exceed 20% of the teamís work load and time
- educates students and staff on how to address and work through
situations like this
- the public is aware of changes in healthcare, including
multi-disciplinary teams and cross-trained students and staff
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Cervero, R. (1992). "Professional practice, learning and continuing
education: An integrated perspective." International Journal of Lifelong
Education, 11(2), 91-101.
"Executive Leadership and Management Consulting Group," http://www.competere.com/
Felch, William Campbell. (1996). The secret(s) of good patient care:
thoughts on medicine in the 21st century. Westport, CN: Praeger.
Gelmon, Sherrill. (1997). "Accreditation, core curriculum and allied
health education: barriers and opportunities." Journal of Allied Health,
"Human Anatomy Online," http://www.innerbody.com/htm/body.html
Makely, Sherry. (1998). Multi-skilled health care workers : issues
and approaches to cross-training ; how to combine skills, design
training programs, utilize staff, overcome obstacles, and make
multiskilling work for you. Bloomington, ID: Pine Ridge
Nurse patient interaction [videorecording]. (1990). (Available from
Concept Media, Inc., PO Box 19542, Irvine, CA 92623-9542)
Rosenberg, Steven. (1989). The changing rural health care delivery
system: development of alternative models. Kansas City, Mo.: National
Rural Health Association.
Sullivan, Toni. (1998). Collaboration: a health care imperative. New
York: McGraw-Hill, Health Professions Division.
"Virtual Health Care Teams,"
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Based on the meet the problem document, students are to
perform impromptu skits of the meeting scheduled for July 29th. The
skits will be based on the following information:
1- Each group will
perform a skit. Groups may not exceed six members, since there are six
individuals being asked to participate in the meeting.
2- The skit
is to depict the meeting activities and discussions. It should cover the
information presented in the meet the problem document, research
opportunities, opinions of the participants based on prior knowledge and
expertise and possible solutions to the situation.
3- Students will
have thirty minutes to prepare. Materials are available in the classroom
for reference as well as the Internet connection in the back of the
4- Skits should last 10-15 minutes.
The intent of this exercise is to address the topic of patient
education in this scenario in an adequate fashion for the materials and
timetable provided. Students should propose various solutions to the
problem and provide support for those options. Other intents of the
exercise are to teach students to prepare for a variety of presentation
situations, team approaches to work, effective communication skills and
The audience for the presentations will include classmates and other
faculty or staff members from the disciplines involved in the scenario.
The invitation is open to all allied health faculty and staff, but all
radiography instructors will be in attendance.
During each presentation, the audience members will critique the
presenting group based on ability to address the topic, to offer
solutions, communication skills, team effort and meeting time
constraints stipulated (10-15 minute limit). Audience members are to
record scores on the capstone assessment instrument.
After all skits are complete, students and audience members will
discuss the proposed solutions. Each student and additional audience
members will be asked to reiterate the solutions discussed in the skits
(these will be recorded in space provided on the rubrics). A list of all
possible solutions will be developed and posted for further discussion
in upcoming class meetings.
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INSTRUMENT FOR CAPSTONE PERFORMANCE
1- Problem is clearly stated and
2- Solutions are proposed and explained 20
3- Problem is vaguely stated, but solutions are still
proposed and explained 15 pts______
4- Problem is not stated and
solution quality is low 12 pts______
1- Each member actively participates in the skit
Each member contributes valuable information or support 15 pts______
3- Members participate moderately and offer semi-relevant information
4- Members participate slightly and offer little
information 10 pts______
1- Team members speak clearly
maintain good eye contact with others during skit 20 pts______
3- Team members mumble slightly, decreased eye contact 16
4- Team members mumble and focus on script too much 13
1- Group used creativity in presentation
2- The appropriate meeting members were portrayed 10 pts______
3- Group shows attempts to be creative and plays parts well 8
4- Group shows little creativity and redefines characters
in meeting for skit 6 pts______
Possible Solutions addressed in the skits:
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Possible Solutions to Problem
1- Worker is able to address situation appropriately and allay the
concerns and fears of the patient.
a. Worker is able to communicate effectively with
b. Worker allays fears, promoting more personal
relationship with patient.
c. Worker performs task correctly and
painlessly, building trust with patient.
d. Worker is able to
multitask, i.e. communicate, perform tasks with an amicable ending.
a. Worker did not incorporate other team members in
b. Worker may be distracted with the onslaught of
questions from the patient.
c. Worker may not have the authority to
answer all questions (medical ethics).
d. Worker may not have been as
time efficient with patient due to multitude of questions.
1- Worker involves other health care team members in handling the
situation with the patient.
a. Worker is able to function as a team player.
Worker completes task with help of other team members.
health care team members can provide communication assistance.
Other health care team members can perform the task if necessary.
a. Involving others in this situation may incite doubt
in the patient about the worker.
b. Involving others in this
situation may cause delays in the patient's medical visit.
Involving others may cause overall delays in other duties (other
patients do not receive their care as promptly)
d. Involving others
may incite hard feelings for added work.
1- Showing confidence and ability to
perform a task will give the patient a sense of confidence (if not
gratitude) in the worker.
2- If the worker attempts to answer all
questions from the patient, even those that might be out of the worker's
scope of practice, the issue of professional boundaries and ethics might
have to be addressed
1- Handling a situation efficiently
and effectively may show other team members certain skills the worker
has and may be able to use in various situations.
2- Inability to handle certain situations that necessity the
help of other workers may cause animosity within the team because of
lack of time to complete individual tasks.
My preferable solution to the situation is to handle the situation
independently of other team members. When working with patients, the
worker should have an appropriate level of communication skills that
allows he/she to convey their skills and confidence to the patient. When
patients ask questions, the worker should be candid and attempt to allay
the fears of the patient. Workers who have to relay heavily on their
coworkers to handle situations might cause unnecessary animosity within
the unit. So, I would promote independence unless the situation is
outside the worker's scope of practice or ability.
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After the impromptu skits are completed, the class will
review the scenario and all possible solutions presented. Students will
state the solutions that were presented in each skit while the
instructor records the statements on a black board or poster board.
Space will be provided on the Capstone Rubric for students to record the
solutions presented in the skits. If any solutions are not stated, the
instructor will offer coaching questions to elicit the desired responses
from the students.
Once all possible solutions are announced and recorded,
the students will rank the solutions from highest to lowest in terms of
importance and viability. The statements will be numbered on the left
side of the board.
The next step is to determine the best possible solution
for the situation. Students will be limited to selecting one solution
and will be asked to discuss their decision and the reasoning for
selecting it. Then, with coaching questions and statements from the
instructor, students will examine other solutions and alternatives to
their best possible solution selection. All discussions will occur as a
After examining all solutions, their rankings and the
class' selection of a solution, the instructor will coach the class
through questions and statements to ensure all topics and areas of
concern have been addressed in the discussion and activities. If other
information is uncovered, it will be addressed and analyzed. Once the
information is discussed, changes may be made to the solution list
prepared earlier in the session.
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Meeting the Problem
1- What information do you
have to begin with in this patient education situation? ( C )
resources or insights into clinic staffing and staff education would be
helpful to prepare with? ( M )
3- What is the best approach to
addressing this worker's dilemma immediately and long-term? ( EC )
Know/Need to Know Board
1- What is the first step in
preparing for the upcoming staff meeting? (C)
2- What are the
strategies for addressing patient education issues based on the
information presented on these two boards? (M)
3- How can you verify
the staffing and education information presented on these two boards?
Writing Problem Statements
1- What information about this
patient education dilemma do you have from the problem statement?
2- How do you apply the information from the problem statement to
determine the best way to train the public on changes in health care
(multi-disciplinary teams)? (M)
3- What constraints might inhibit
reaching the four solutions depicted in the statement, including the
deadline, time budget, educate the staff on communication skills and
educate the public on new trends in health care? (EC)
Information Gathering and Sharing
1- What is most important
to students and professionals in multi-disciplinary environments in this
scenario, i.e. the goals? (C)
2- Have you considered interviewing the
former student for more information? (M)
3- From what you have, what
medical or staffing information do you want more on?
Generating Possible Solutions
1- Is patient education a
viable solution, based on the amount of time that they interact with
health care providers? (C)
2- What 'holes' exist in this possible
solution presented? (M)
3- What scenarios would offer in the meeting
for patient and staff interactions and what you implement as an
immediate remedy? Why?(EC)
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