Transcript Document

The AMUsE Model:
A Strategy to Assess Attitudes, Motivation, Utility
and self-Efficacy in Interprofessional Team Training
Collaborators
• Doug Brock, PhD
• Chia-Ju Chiu, RN
• Linda Vorvick, MD
• Erin Abu-Rish, BA/BSN, MA, RN
• Dana Hammer, PhD
• Brenda Zierler, PhD, RN
Funded in part through grants from the Macy Foundation and the Agency for
Healthcare Research and Quality (AHRQ).
Interprofessional Education
World Health Organization
• Interprofessional education occurs when two or more professions
learn about, from and with each other to enable effective
collaboration and improve health outcomes.
• Collaborative practice can improve access to healthcare,
appropriate use of clinical resources and patient care and safety.
• Collaborative practice can reduce error, mortality, staff turnover
and conflict among caregivers.
Assessment in Interprofessional
Education is Difficult
• Time between training and practice….
• Establishing the link between training and practice…
• Team and individual performance factors interact…
• Observational measures are difficult to develop and validate…
•
Observational measures are generally more time consuming to learn
and require significant resources to administer and to score…
Back to Basics
• Measure the foundations of learning and later
performance…
• Develop simple theory-based constructs…
• Ensure low cost, ease of administration ….
• Ask students…..
AMUsE
Utility
Motivation
self-Efficacy
Attitudes
Performance
Theoretical Models
• Built on:
– Attitudes (Ajzen—Theory of Planned Behavior)
– Motivation (Deci and Ryan—Self-Determination Theory)
– Utility (Bernoulli—Expected Utility Theory)
– Self-Efficacy (Bandura—Self-Efficacy Theory)
The AMUsE: A Self-Assessment Instrument
• Attitudes (4 Likert items)
• Motivation (6 Likert items)
– Extrinsic (3 Likert items)
– Intrinsic (3 Likert items)
• Utility (3 Likert items)
• self-Efficacy (8 Likert items)
An Interprofessional Training Opportunity
Interprofessional Training
AMUsE – Psychometrics
Items
Cronbach’s
Alpha
Pre
Cronbach’s
Alpha
Post
4
6
3
8
0.90
0.84
0.88
0.82
0.87
0.83
0.79
0.81
AMUsE
Attitudes
Motivation
Utility
self-Efficacy
AMUsE Pre-Post
Pre
Post
Mean (95% CI) Mean (95% CI)
Paired
t-Test
Effect
Size d
0.000
0.000
0.000
0.010
0.65
0.40
0.70
0.23
AMUsE
Attitudes
Motivation
Utility
self-Efficacy
4.3
3.6
4.1
3.7
(4.2,4.4)
(3.5,3.7)
(4.0,4.2)
(3.6,3.8)
4.6
4.0
4.5
3.8
(4.5,4.7)
(3.9,4.1)
(4.4,4.6)
(3.7,3.9)
Correlations
Post AMUsE Scales
Attitudes
Motivation
Utility
self-Efficacy
0.66
0.65
0.65
ns
0.57
0.56
0.48
0.51
ns
0.41
0.67
0.64
0.65
ns
0.52
0.36
0.30
0.31
ns
0.27
Leaders:
shared information.
created opportunities.
assigned tasks.
0.34
0.30
0.31
0.31
0.31
0.30
0.32
0.33
0.33
ns
ns
ns
Team Members:
offered help.
were consulted for experience.
asserted patient safety concerns.
asked for assistance.
exchanged information with patients.
asked questions.
0.27
0.36
0.30
0.28
0.26
0.27
0.28
0.26
0.36
0.33
0.26
0.30
0.24
0.29
0.33
0.29
0.25
0.20
ns
ns
0.25
ns
0.26
0.25
TeamSTEPPS (TAQ)
Team Structure
Leadership
Situation Monitoring
Mutual Support
Communication
Observed Behaviors (Reported by Student)
Factor Analysis of the AMUsE
• Complex Structure
– Attitude and Utility items highly inter-correlated
– Self-Efficacy breaks into two clear factors
– Motivation strongly a function of performance
expectations
A revised instrument?
Short AMUSE Items (14 items)
Learning with others helps me become a more effective member.
Patients benefit if students learn together.
Shared learning increases ability to understand clinical problems.
Team training exercises help me appreciate other professionals.
I perform well in team based healthcare activities.
I perform well in simulated environments.
I perform well in settings that bring together students from other professions.
I can work effectively in teams.
I can contribute valuable insight to teams.
I can easily facilitate communication between team members.
I am able to resolve conflicts between individuals effectively.
I feel I can take on a leadership role in a team and be effective.
I am good at integrating information and suggestions into a plan.
I am effective at delegating responsibility for tasks.
Attitudes
Efficacy
"Team"
Efficacy
"Leading"
Performance
Expectations
0.84
0.80
0.78
0.86
0.64
0.67
0.75
0.66
0.74
0.77
0.59
0.81
0.78
0.63
Factor loadings (>.40) with named factors
Conclusions
• The AMUsE seeks to capture 4 dimensions underlying success within
interprofessional training.
• Early efforts to examine this structure suggest 4 principal dimensions.
• Relationship between attitudes and intrinsic motivation warrant further
attention.
• Modern theories of motivation and decision making may supplant
“utility”.
• Self-efficacy in interprofessional training and activities may reflect two
constructs, one suggesting efficacy in effective team work and the
second suggesting efficacy in taking a leadership role.