Dave Plough
Hello everyone, welcome to Collaborative Conversations. I'm your co -host, Dave Plough and I am joined today by, well, as always, by Dr. Barbara Maxwell.

Barbara Maxwell
Hi everyone.

Dave Plough
So today's episode is not a part two, I want to stress that. But it is a second interview between Dr. Maxwell and our Deputy Director, Jennifer Burba. Barbara, what would you like to say about this second conversation that the two of you had?

Barbara Maxwell
Probably first and foremost, and this is exciting conversation for us, you'll probably hear it as Jennifer and I talk, our level of excitement about what we've been doing with the curriculum here at Indiana University. Really as a result of a listening tour to our constituents and our stakeholders, looking and taking a deep dive into the data. We have lots of data here at the center and taking a deep dive into that data to tell what's happening with the curriculum, what's working well, what's not working well, where we might want to make adjustments. And we'll walk you through the process of doing what a lot of uni professional programs are doing at the moment in transforming a traditional curriculum into a competency based curriculum.

So Jennifer and I's conversation is about how we as a team at IU have really reshaped our curriculum to truly focus on the collaborative competencies as the end marker of what we're doing with our learners and all of the processes and the ways of thinking and doing and the use of evidence and theory and really sound educational principles and cognitive science that we've used to get there.

So lots of stuff that we're really passionate about and we hope you're as passionate about it as us once you finish this episode.

Dave Plough
I would call it a jam -packed episode. It is. So yeah, with that, you've given us a good teaser, as we call it in the business. You've given us a nice little teaser, so we're going to go ahead and I guess toss to you. You can take it away now, Barbara.

Barbara Maxwell
Thanks, Dave.

Jennifer Burba
When we spoke the last time, we talked about the IPE Center and that we were charged with developing this culture of collaboration across the state and build stronger and better healthcare teams for the future.

So the first step was to develop a care professional curriculum. A curriculum design team was assembled for representatives of those eight healthcare, social care, public health schools. Plus we added a pharmacy faculty from the Purdue College of Pharmacy to that program to make sure that it was complete. Everyone had a voice in and the pharmacy also had a need for it, a professional curriculum. So this design team built a series of well -defined curricular components addressing the IPEC or the Interprofessional Education Collaborative's core competencies.

So at the time we were in the 2016 version of those core competencies. And so the team built around that. The intention was work towards those competencies. The curriculum was built in what we reference anchors or these learning events that covered content designed to address the competencies. The original design team was really thoughtful in addressing the competencies and they created events where the students could come together and learn from, about, and with each other, which is the foundation of interprofessional collaborative learning.

So in 2016, fall that year, we released the first anchor event for the Teach curriculum. Over time, it has had changes made to the curriculum. And from your perspective, because you came in and really looked at the curriculum and talked with others, can you tell us about those changes? What happened that has brought us to today and what we are doing now?

Barbara Maxwell
Yeah, happy to. So when I stepped in right at the end of 21, 2021 to lead the center. We're at the tail end of the pandemic. I don't think any of us will ever forget that time, but we were at the tail end of it. And classes were still being delivered online, including the interprofessional learning for students here at Indiana University. And as a new leader, I started travelling the state on a listening tour, meeting as many of our key stakeholders as I possibly could and really trying my best to carefully listen.

And to get their impressions of the curriculum, of the centre, about how the curriculum had changed over time, how it had adapted, get the history of it, learn kind of how it had been made, kind of what you shared, Jennifer. You how was it built? Who built it? What's happened to it over time? How's it changed? But specifically, how closely does it meet their needs or not?

So at the same time that I was doing this listening tour, the centre team... as a team, we started to look at the teach evaluation data. So we started to look at what the data actually said. So the good thing is we've got absolute gallons of data and really robust data using reliable and valid tools. So lots and lots and lots of data, there's no shortage on the process and on the outcomes of the curriculum. And the curriculum is delivered to more than 4 ,000 students from more than 20 different professions across Indiana University and at partnering universities.

So that makes a heck of a lot of data. So we started taking a dive into what the story was that that data told. And what we noticed was that the data was telling a story, a very particular story and a very helpful story of what was working. what wasn't and also why. So we were able to find some clues about why some elements of the curriculum weren't working as well as we thought. And it revealed that over time, what the story told us that over time, the absolutely beautiful work that the faculty team that originally built the curriculum had put into tying the outcomes that they intended to see with the activities that they had built and the metrics that they were using to measurement that over time that had been nibbled away at. And the activities, the flow and the process of the curriculum that had been so nicely designed had changed over time. The activities didn't look the same as they did at the beginning. Pieces of the curriculum had been left behind. The nibbling away, and I call it nibbling away very specifically because it was these small changes over time, little alterations, little shifts in things, a little bit of lost content here, a change in the way that the team learning happened over here, meant that the curriculum was out of sync. And that's the really good story that the data told. The activities the intended outcomes and the assessment tools were now mismatched.

So Jennifer knows this, that I'm a big lover of John Bigg's work in higher education, teaching and learning. If you haven't read any of John's Bigg's work, I would really recommend you go and look at it. He's retired now. He's from New Zealand, Kiwi. And he has a marvelous book that is about teaching and learning principles in higher education and just wonderful foundational, educational, pedagogical concepts that can help you design really effective learning. And under his prints, this really good design principle from John Biggs of constructive alignment, it starts all good design starts with the end in mind.

So we start with what we always think is the last piece. Sometimes we rush to build, we build a something and because we want to bring the students together and we want to give them an opportunity, we build, but we don't really very willfully decide what it is is the outcome we're looking for. So really identifying what those intended learning outcomes are for the learners. Then we build very specific learning activities that get have a good sense will actually lead them down that path to achieve those learning objectives. And then we select tools to assess if these outcomes are actually achieved.

So that alignment, that being in sync between what the end goal is, backtracking to what the activity should look like, and then selecting the measures, that's the part that had been nibbled away at and they didn't fit in alignment anymore. They were offset with each other. Maybe there was a measure being used somewhere that didn't really relate anymore to the activity that was being done. So the data that was coming from it wasn't telling us whether that intervention worked because it had kind of offset the measure from the activity.

So the other thing that happened that was really timely for us as we're at the listing tour, we're looking at the curriculum, we're seeing the data that had been nibbled away at and was out of alignment. The other thing that happened was the collaborative competencies from IPEC, the Interprofessional Education Collaborative, that we use in the U .S. as the intended outcomes of interprofessional learning were being revised. And so the new competency document was actually released in November 2023.

We were in the process of redesigning or rethinking our curriculum when the draft came out and we picked up that draft right away and started to use it because we knew that the competencies were going to change. So since the purpose of our curriculum is to create people who are competent in these collaborative competencies, we really needed to take another look at the curriculum because the competencies had shifted.

Jennifer Burba
So I think this is probably a time where we could step in and take a look at that curriculum. Let's talk about how our new interprofessional core curriculum evolved and why it evolved the way that it did. Can you speak to the changes and why it changed?

Barbara Maxwell
Think back again to John Beggs and his principle of constructive alignment, a pedagogical principle. We started with the end of mind. By identifying what our learners are expected to achieve through participation in our curriculum.

So if we deliver this curriculum, what are we expecting to happen to the learners? And that answer was really simple. The collaborative competencies. That's what we're aiming for. So our end goal is for our learners, especially when you're talking about the future healthcare providers, not people who have been seasoned in healthcare, in social care, and in public health for a long time, newbies, that gaining the competency in these collaborative competencies was our end goal.

Jennifer Burba
It was so important for us on how we built the new curriculum to start with those competencies.

Barbara Maxwell
Yeah. And if the IPAC collaborative competencies were our end point,

That led us to a realisation that we needed to move away from what we had, was a traditional content -focused curriculum in TEACH and towards a competency -based curriculum. So if our end goal is competencies, surely our curriculum should be competency -based. And so to do that, we used the WHO Global Competency Framework for Universal Healthcare Coverage from 2022 as a guide. And I would really advocate anyone who's watching this podcast and wants to know more about competency -based education, go and get that document. It is one of the easiest, most easily transferable versions of telling you this is what competency -based education looks like and here's some strategies to get you started that I've ever seen. So really good resource and we use that.

So it led us to was building these competency trajectories, thinking about where our learners step in and how over the course of their learning, at what stages are they really ready to engage in learning about the different collective competencies. So the four competency domains of values and ethics, teams and team working, communication, interprofessional communication specifically, and roles and responsibilities.

And this led us to actually identify that we actually had two distinct types of learners that entered at different levels of competency. We had the traditional entry level students who are preparing to really just begin stepping their foot into the profession that they've selected for the first time. And then we had these post -professional learners who are working individuals already in their profession.

who were taking advanced degrees to elevate their degree status. And they had two very different competency trajectories, two very different competency pathways. And therefore we needed two forms of the curriculum. Because if you're looking at competency and you're measuring trajectories, where the step -in point is with experience and workplace learning and everything else, is very different for different kinds of learners.

The other thing that we did was we conducted a content analysis of the key concepts that were in these new competencies. And this led us to identify the key concepts then that we would need to deliver in our hybrid longitudinal curriculum. And they would form the focus of the curriculum moving forward. Starting with the end in mind, the competencies, the competencies themselves held the notion of the content. So we knew content to pre -din because the content areas were described in the competencies. So that start with the end in mind, backtrack to what the actual contents and concepts would be.

Jennifer Burba
You know, when you started talking, you talked about when you came, we were in the pandemic and how it necessitated this adaptation to an online platform. That gave us the experience of working online and also led to this hybrid curriculum that we have.

And what we know from evidence, educational research evidence, that the hybrid education is incredibly effective. But in our old teach curriculum, any online materials that we delivered in our learning management system, Canvas, were more focused on design, more focused on preparing a student for in a professional event. They weren't concept or competency focused at all.

So we really started thinking about that hybrid model and the modules built in Canvas that address the key concepts that came from that content analysis you mentioned of the core competencies. And bringing students together for these learning activities so they work on this Canvas information and then we bring them together in a synchronous learning activity, whether that be online or in -person, ideally in -person.

We can engage them with the concepts and give them time to practice and engage with the knowledge and skills of the collaborative competencies that they have been learning about.

Barbara Maxwell
Yeah, and that's so important to the new curriculum and the way that it's been built. So we built it on evidence, science pedagogy, on what we know about really effective learning science and on what we know about cognitive learning and cognitive processing and memory formation. And for example, from the evidence on memory formation, we know that we need to ensure that individual learners have repetition with variability. They don't hear a concept once and that's it. You repeat the concepts, but you have it with variability. So in different formats, in different ways, maybe introduce the notion of psychological safety, which we do early on, but as the students progress through the competencies, now they're learning about how effective it is within highly effective teams. And then they move on again and now they see how psychological safety affects them within conflict management. So you're revisiting that concept, but with variability.

And so we use those types of concepts to kind of help build. going back to that hybrid model.

Jennifer Burba
What we wanted to do is provide the learners with that content and that competency information upfront. We moved from this online content that was really prep work for an event, again, I'm going to use that word very deliberately, for an event to this conceptual, didactic curriculum. We've introduced and reinforced key professional concepts that are contained in that collaborative competency.

And as students progress through the curriculum, they are, as you said, building on that. So we're constantly repeating with variability the information that they're getting so that they can apply it in different aspects. Before we weren't really giving them a hybrid curriculum, as we talked about, but instead just preparing them to meet in person. We might give them a little bit of content just to be prepared.

But it was mostly a process driven rather than content driven application by using our money management system.

Barbara Maxwell
And that's a really good part about when you really think about building competency based education, you don't start with the content, you start with the competencies. And then the online curriculum now is full of these concepts that came from the collaborative competencies that the students are going to engage with. So it kind of brings those competencies to life. It's not let's prep for what happens when you meet in person. It's now let's prep on the concepts that then you're going to use when you meet together.

Jennifer Burba
Right. And we're teaching them along the way. So in Canvas, they have these learning modules and they're compact so they can start and stop as they need to. It looks very wet website based rather than these modules that are set up. So it becomes a little more engaging for them. They can contain a variety of learning opportunities in their activities and it challenges them and it makes them reflect on the concepts and the content along the way.

So it's not read this and then later on we're going to talk about it. It's read this. How do you feel about this? So, Do you agree? Do you disagree? Giving them opportunities to record what it is that they have learned, what they're getting out of that to bring to a team learning activity. Now they've done all the work. They're ready. They know the content and now they have an opportunity in these team learning activities to practice, to talk about what they were of online.

Barbara Maxwell
And I think that's kind of a great way to describe kind of that the elements that have caused that move away from an event focused learning for the students to that more robust competency -based curriculum. So moving from events, moving to curriculum.

Jennifer Burba
Yeah, that's a and important point that we have done internally is our language has changed. We don't talk about events anymore. We no longer run events. We actually built a curriculum out as a team. have these activities that it's the whole curriculum. It's not seen as these one -offs any longer.

Barbara Maxwell
And one really key thing, and we did talk about it in our, last time we talked together about changing the focus and bringing a real lens onto attitudes. So one of the other things that changed was how we think about attitudes and the critical role that attitudes play in leading to the behaviors that we're expecting the learners to engage in. And so if we're expecting people to engage in behaviors, then we know that their attitude towards those behaviors is crucial. If I don't value it, and if I don't think this is actually very important at all, if I have no notion why it matters, then why would I do it? So they need to have an attitude that this really matters, this work matters, this interprofessional learning really matters.

Jennifer Burba
The knowledge and skills being layered on top of that attitude leads to those change behaviors. So I feel more motivated to learn something if my attitude is that it's important than something that I don't value. Without that attitude that interprofessional collaboration matters, it's unlikely they're going to engage in even taking in the knowledge, learning the skills and their intention for collaborative behaviors to change in the workplace.

This realization to us actually led us to explore the theory of planned behavior, which has this built in. So, you know, we're working on their attitude, it's all a part of the content. Attitude is one part of a three -part portion of the of planned behavior, helping them understand why these are important. Why does it matter? Talking with them about social norms, that's the second part. How do social norms impact their behavior and the behavior of others? Helping or giving them skills that lead to the next part, which is building self -efficacy. So feeling that they can do it. Can they really enact these behaviors in order to bring about change and then benefit the people that they work for, or they work with, and frankly themselves?

Barbara Maxwell
I'm bringing those concepts back time and time again. So throughout the curriculum, re -enforcing that why it matters, having them hear from different voices as they step into a new part of the curriculum, that it's not just abstract work. It's not just these theoretical concepts. It's not just things that they think don't happen, but hearing from people who work in the roles that they're stepping into, the professions that they want to become and that they're training to become hearing them say, let me tell you about when this really matters. Let me give you an example. Hearing people who have had good or bad experiences of health or social care or community engagement because there was really effective collaboration and hearing from those who haven't and hearing from teams in the community who are doing amazing collaborative and inter -agency work sometimes with really unique partners that you wouldn't even imagine, and they can show the evidence that it makes a difference on the people and populations because that's what we're about, collaboration to improve the lives of people and populations. When you can actually showcase that to the students, that is all attitudinal work to give them a sense that this actually really matters.

And it's a really good example of repetition with variability that we keep coming back to different voices. They keep hearing different individuals and different teams say why this matters. And so that really helps the curriculum truly to move from that event based curriculum to building a really sound pedagogy that's built on that cognitive science, built on sound pedagogy, constructive alignment from John Beakes kicks off with this really great focus on why it matters because we're aiming for behaviors. So if we just give knowledge and skills and we don't address attitudes, if we really focus on the end in mind, the behaviors, we have to work really hard on setting the attitude. So it's based on the components of the theory of planned behavior and that's been really instrumental in grounding our curriculum on really good theory. So it's a competency based curriculum. It's not a traditional curriculum. It's based on really sound evidence and we share a heck of a lot of evidence from all different places. That's part of that why it matters as well. Do you want to see the outcomes of this? We'll show you the outcomes of it. You so we're really focused on using evidence, including evidence from the pedagogy of effective education, cognitive science, how people learn, the theory of planned behavior how you can actually facilitate people to engage in specific behaviors and if they have the intent to do it. as you said Jennifer, if they develop an attitude that matters, if they develop, if they see social norms, they hear from people who engage in this work saying this is really important, hear from the people they would care or provide services to saying this is really important. So you're building social norms.

And then you layer on the knowledge and skills. They develop an intent to engage in behavior and the theory of planned behavior is a predictive model. So it says that if you have an intent, if you can build intent, the likelihood of them actually engaging those in those behaviors is higher. So that's how you get to behavior. So that's just a beautiful way of how, you know, we can lead to specific behaviors that we want them to engage with.

Jennifer Burba
Right. And we give them an opportunity to practice those behaviors in a psychologically safe environment through these learning activities. And I think that also builds on their self -efficacy, thus leading to their attitudes towards a behavior change being possible and that theory of planned behavior.

Barbara Maxwell
Yeah. So that's been really instrumental, that kind of thought about attitudes and put in not saying you know, knowledge skills, attitudes, behaviors, but saying attitudes, knowledge skills layer on top. And then the outcome we're looking for is behaviors. sure.

Jennifer Burba
And like you said before, we have built in the entire curriculum that thought of attitudes with attitudes. We have this message that this matters. tell people are telling them this matters and it extends from the beginning, from orientation to when they are ready to go into their practical or real world settings.

Barbara Maxwell
so we rolled out the first part of our new curriculum. We've shared a lot about it and a lot of our thoughts. Boy, we could do many, many podcasts sharing our thoughts and the models that we've used and things like that as we've been building it and thinking about it. We've learned a lot, but we actually rolled it out in the first part of the new curriculum in the fall of 2023.

And officially sunset the Teach curriculum in April of this year, so April 24, we sunset the Teach curriculum. We ran our last pieces of that for the students who had started in that. So we as a team, I know we're really excited to implement the rest of the curricular stages in this fall coming up and to see now what story will the data tell us this time around.

Dave Plough
And that is for our second conversation between my co -host Dr. Maxwell and Jennifer Burba here at the IU IPE Center. If you would like to learn more about what we're doing here at the center, about the different experiences we offer, about the curriculum we work on, you can do so by visiting our website at ipe .iu .edu.

You can also do so by following us on social medias. We're active on LinkedIn. That's the place that I usher you two to find out the most about what we are, what we're doing and where we're going to be.

Barbara Maxwell
I'm really hopeful Dave that after listening to Jennifer and I today that you carried over some of the excitement that we have when we talk about the curriculum and the changes that we've made and why we made them and why it matters. And if you're thinking to yourself, I'd love to know more about X that they mentioned. So for example, how we've used the theory of planned behavior or you have other ideas for a podcast and information that you'd really like to hear people discuss, then please email us your ideas and suggestions to ipectr at iu .edu. We'd love to hear from you.

Dave Plough
Yeah. And I want to add one more thing. That's usually where we wrap up. But as we're recording this right now, this is our fifth episode and this is a five episode first season run.

So there aren't going to be any more for a little while, but we are planning on coming back in just a few months with a whole new batch of episodes covering a whole new batch of topics, titles, and a whole new set of guests. So be on the lookout for that. It'll be coming up again on the website that I mentioned earlier, our website, but also on all of our social medias and wherever good podcasts are found.

With that, want to thank you, Barbara, for being the guest host for this first season, and I look forward to doing more of these with you. And thank you, listeners, for sticking with us, checking us out, and we will catch you next time when we come back with collaborative conversations. Cool.