IAPM PRELIMS

DISCIPLINE (Historical Perspective)

• derived from the Latin word “disciplina" → instruction given to the student (also by way of a disciple by an older individual, teacher, or mentor

DISCIPLINE (Historical Perspective)

• describes the difference in the levels of knowledge between the involved people who either have basic and/or specialized knowledge

DISCIPLINE (Historical Perspective)

• it was used in the early Christian church to differentiate the "celestial) and "non-initiated" individuals → shows that the term "discipline" is closely associated with power & knowledge

• Theoretical subjects/fields

• Practical subjects/fields

• Productive subjects/fields

In ancient Greece → disciplines were hierarchically arranged (based on the division on knowledge) which are as follows:

THEORETICAL SUBJECTS/FIELDS

• highest level of priority

• this covered theology, mathematics, and physics according to Aristotle & arranged in descending order of importance)

PRACTICAL SUBJECTS/FIELDS

• moderate level of priority

• this encompassed ethics and politics

PRODUCTIVE SUBJECTS/FIELDS

• lowest level of priority

• this included art, poetry, and technology

• A transformation occurred at universities in the late Middle Ages; so medicine, theology, & law were established in European universities → principles of basic study where divided into: and these two form the seven liberal arts

1. TRIVIUM

2. QUADRIVIUM

TRIVIUM

Comprised logic, grammar, and rhetoric

QUADRIVIUM

Encompassed arithmetic, geometry, astronomy, and music

Sir Isaac Newton's Principia (mathematical principles of natural philosophy) and Nicolaus Copericus’ heliocentric theory (planets orbit around the sun) paved the way for the birth of modern science → which is marked by the following:

1. Identification of a Problem

2. Conduction of Suitable Experiments

IDENTIFICATION OF A PROBLEM

• included the formulation of a question (i.e., hypothesis)

CONDUCTION OF SUITABLE EXPERIMENTS

• through the use of a microscope or telescope

DISCIPLINE (historical perspective)

• evolution of disciplines may be viewed as the outcome of the increasing number of scientists and academic staff members at university institutions

Education

Is the transfer of extensive & broad based knowledge

Training

Aims to prepare an individual for specific tasks

DISCIPLINE (contemporary perspective)

may be applied in two fields:

1. as a measure to maintain order and control → as seen with scholars, students, & soldiers

2. to divide and classify knowledge

PATHWAYS BY WHICH THE INTERDISCIPLINARY APPROACH WAS DEVELOPED

• explained by discipline-oriented division of knowledge:

  • historical development

    • originated in ancient Greece

    • initiated the academic dispute about the division & hierarchical classification of knowledge

    • this process advanced up to present day & appears to still be in progress

  • increasing specialization of the disciplines drives one to adopt modes of thinking

* The purpose of individual disciplines is to classify knowledge

DISCIPLINARITIES

the following terms are often mistakenly utilized interchangeably, but these are not synonyms:

1. Intradisciplinary

2. Multidisciplinary

3. Crossdisciplinary

4. Transdisciplinary

5. Interdisciplinary

INTRADISCIPLINARY

• monodisciplinary or unidisciplinary approach that pertains to working within a single discipline, field, or specialization

• part of this approach is vertical integration

MULTIDISCIPLINARY

• pluridisciplinary approach wherein individuals from different disciplines are working together (with each drawing on their own disciplinary knowledge) → but the subject matter itself is independent of one another

• There is no attempt to synthesize or draw together various perspectives

CROSSDISCIPLINARY

• views one discipline from the perspective of another

• may span across disciplines → but remains connected by a single shared subject matter

TRANSDISCIPLINARY

• creates a unity of intellectual frameworks beyond the disciplinary perspectives

• approach that transcends the traditional borders of each discipline to upskill every team member to a higher quality

INTERDISCIPLINARY

• involves integrating knowledge, skills, and methods from several disciplines using a real synthesis of approaches that focus on a central subject matter

• concentrates on the core subject matter from numerous perspectives

• a holistic approach that stresses linkages

• also referred to as horizontal integration

INTERDISCIPLINARY

≥ 2 disciplines align resources in educational endeavors including engaging in combined courses and establishing cooperative projects Presence of a broader scope of knowledge

DISCIPLINE

body of scientific knowledge that is everchanging with the integration of creative conceptualization & formal research findings

PROFESSION

Organization body consisting of persons who are committed to a vision & are educated with particular disciplinary knowledge to promote that vision

INTERPROFESSIONAL

• professionals in healthcare settings offer their unique disciplinary knowledge for service to individuals with particular health challenges

• More specific to the job title

*Specialty

As a noun pertains to a chosen expertise, skill, and/or talent.

*Discipline

as a verb is to train an individual bydnstruction and exercise.

HEALTH CARE TEAMS

• advocated to deliver primary care services

HEALTH CARE TEAMS

• team-based approach ensures focus is always on the patient's needs & expectations

HEALTH CARE TEAMS

• may be large or small, centralized or dispersed, face-to-tace or virtual → with tasks that can be focused & brief or broad & lengthy

HEALTH CARE TEAMS

• defined by the degree of interaction among members and the sharing of the responsibility of care

*TEAM MEMBERS

• comprised of a variety of health care professionals, as well as the patients loved ones or family members

*TEAM MEMBERS

• can be hospital-based or outpatient-based

*TEAM MEMBERS

• may be limited to two, or consist of as many as twelve or more

*TEAM MEMBERS

• members may choose to meet formally or in person around a table, by phone, or through internet access (but there are some health care teams do not meet at all)

*TEAM MEMBERS

• may restrict their responsibility to conducting patient assessment, or expand their role to be involved in the entire process of care

*Not every scientist or academic has the aptitude for interdisciplinary team work→ best for those who tend to think divergently

INTRADISCIPLINARY TEAM

• tasks are carried out by different members who work in the same discipline, field, or specialization

MULTIDISCIPLINARY TEAM

• several members of diverse disciplines perform their roles separately to generate a specific plan within their disciplinary boundaries

MULTIDISCIPLINARY TEAM

• hierarchically organized wherein the highest-ranking team member takes the role of the leader

MULTIDISCIPLINARY TEAM

• there is generally very little direct communication among team members

MULTIDISCIPLINARY TEAM

• members work parallel to each other, but stay within their boundaries with the medical record often serving as the vehicle to share information

MULTIDISCIPLINARY TEAM

• each member focuses on their own work → without explicit regard to interaction

CROSSDISCIPLINARY TEAM

• subject matter is studied by multiple members through the application of methodologies of other unrelated (or overlapping) disciplines, fields, or specializations

TRANSDISCIPLINARY TEAM

• numerous members from various disciplines work together to blend their skills and share roles outside the boundaries of their discipline, field, or specialization

TRANSDISCIPLINARY TEAM

• members are very familiar with the roles and responsibilities of other members that functions (to some extent) can become interchangeable

TRANSDISCIPLINARY TEAM

• one collective group with no boundaries

TRANSDISCIPLINARY TEAM

• elements are difficult to implement or operationalize → but some aspects are possible

INTERDISCIPLINARY TEAM

• multiple members from various specialties or disciplines work collaboratively to develop goals & treatment plans - while maintaining distinct professional responsibilities and individual assignments (often blurring the boundaries)

INTERDISCIPLINARY TEAM

• non-hierarchical since leadership function is shared

INTERDISCIPLINARY TEAM

• members are expected to engage and learn from one another by attending meetings

INTERDISCIPLINARY TEAM

• assumes the problem being addressed is so complex that no one discipline alone possesses the skills and knowledge to address it

INTERDISCIPLINARY TEAM

• members complement one another's expertise they believe the combined contribution of the team is greater than any one discipline, field or specialization can provide

IMPORTANCE OF INTERDISCIPLINARY TEAMWORK

• refers to factors that contribute to the rising need for interdisciplinary team work

  • INCREASING AGING POPULATION

  • INCREASING COMPLEXITY OF NECESSARY SKILLS & KNOWLEDGE

  • INCREASING SPECIALIZATIONS WITHIN HEALTH PROFESSIONS & A CORRESPONDING FRAGMENTATION OF DISCIPLINARY KNOWLEDGE

  • CURRENT EMPHASIS IN MANY COUNTRIES' POLICY DOCUMENTS ON MULTI-PROFESSIONAL TEAMWORK

  • PURSUIT OF CONTINUITY OF CARE

INCREASING AGING POPULATION

• pertains to the fraity of older individuals → who require the care of multiple specialists

INCREASING AGING POPULATION

• new advancements have given people the chance to live longer → resulting in a large number of patients with multiple needs associated with complex and/or chronic conditions

INCREASING COMPLEXITY OF NECESSARY SKILLS & KNOWLEDGE

• successful patient care of complex or comprehensive cases requires a larger capacity of skills & knowledge → which makes specializations even more necessary

INCREASING SPECIALIZATIONS WITHIN HEALTH PROFESSIONS & A CORRESPONDING FRAGMENTATION OF DISCIPLINARY KNOWLEDGE

• stresses that one health care professional will not be capable of meeting all the complex needs of the patients → choosing to stand alone may also lead to burnout (which can compromise the patient's care)

INCREASING SPECIALIZATIONS WITHIN HEALTH PROFESSIONS & A CORRESPONDING FRAGMENTATION OF DISCIPLINARY KNOWLEDGE

• interdisciplinary teams with multiple specialists (each focusing on a narrow aspect of their field) can aid in resolving the fragmentation

CURRENT EMPHASIS IN MANY COUNTRIES' POLICY DOCUMENTS ON MULTI-PROFESSIONAL TEAMWORK

• includes the development of shared learning or peer learning

CURRENT EMPHASIS IN MANY COUNTRIES' POLICY DOCUMENTS ON MULTI-PROFESSIONAL TEAMWORK

• patients would receive collaborative care from experts in specific disciplines

PURSUIT OF CONTINUITY OF CARE

• emphasizes the move towards continuous quality improvement → for both the clinical and operational aspects of a health care professional's practice

PURSUIT OF CONTINUITY OF CARE

• quality improvement is process done as a team → ensures each team member continuously finds better ways to provide better patient care and service

PURSUIT OF CONTINUITY OF CARE

• model for improvement (i.e., four stages of the PDSA cycle) are as follows:

  • Plan: analyze the process, determine what changes would most improve the process, & establish a plan for making the necessary improvements

  • Do: carry out the change/s into motion → but on a small scale or trial basis

  • Study: check if the changels are actually working

  • Act

    • D1) if the change/s are working → implementation is done on a larger scale

    • D2) if the change/s are not working → refine or reject it, and then begin the cycle again

PRINCIPLES OF GOOD INTERDISCIPLINARY TEAMWORK

1. Positive Leadership and Management Attributes

2. Communication Strategies and Structures

3. Personal Rewards, Training, and Development

4. Appropriate Resources and Procedures

5. Appropriate Skill Mix

6. Supportive Team Climate

7. Individual Characteristics that Support Interdisciplinary Teamwork

8. Clarity of Vision

9. Quality and Outcomes of Care

10. Respecting and Understanding Roles

PRINCIPLES OF GOOD INTERDISCIPLINARY TEAMWORK

Refers to characteristics that can be reframed as competency statements than an effective high-functioning interdisciplinary team may be expected to demonstrate

POSITIVE LEADERSHIP AND MANAGEMENT ATTRIBUTES

a leader must be clearly identified to take on the chairperson role

POSITIVE LEADERSHIP AND MANAGEMENT ATTRIBUTES

• chosen individual should be able to perform the following roles and responsibilities to be a good leader for the team:

  • establish a clear direction, management, and vision for the team

  • maintain a fairly democratic approach

  • uphold shared power based on knowledge and expertise

  • ensure personal development is aligned with line management

  • provide support and supervision to the team members

  • become a conscientious listener for the team and act accordingly

COMMUNICATION STRATEGIES AND STRUCTURES

• appropriate systems must be in place to promote communication within the team

COMMUNICATION STRATEGIES AND STRUCTURES

• refers to intra-team communication that include (but are not limited to) the following:

  • members are able to discuss and resolve difficulties within the team

  • everyone feels they can listen and speak out freely within a team context

  • members can maintain a "two-way" communication (even within a large team)

  • integrate collaborative decision-making and effective team processes

PERSONAL REWARDS, TRAINING, AND DEVELOPMENT

• aims to improve morale and motivation

PERSONAL REWARDS, TRAINING, AND DEVELOPMENT

• facilitates individual perks for promotion and progression that include (but are not limited to) the following:

  • exploiting opportunities to gain new knowledge

  • enriching growth by sharing knowledge

  • boosting career development

  • promoting financial rewards

  • augmenting suitable training for skill enhancement

  • achieving continuous professional development and education

APPROPRIATE RESOURCES AND PROCEDURES

• these structures are in place to uphold the vision of the service

APPROPRIATE RESOURCES AND PROCEDURES

• physical resources & facilities include (but are not limited to) the following:

  • team meetings or case conferences

  • organizational factors

APPROPRIATE RESOURCES AND PROCEDURES

• working procedures & practices include (but are not limited to) the following:

  • communication systems

  • referral criteria

APPROPRIATE SKILL MIX

• teams value diversity and need input from a wide range of members who can bring complementary experience or attributes to the team

APPROPRIATE SKILL MIX

• stresses to the proficiency, expertise, and overall know-how of the members of the team that include (but are not limited to) the following:

  • competencies

  • mix of health care professional or practitioners

  • balance of personalities

  • ability to make the most of other team members' backgrounds

  • timely replacement or cover (for empty or absent posts)

SUPPORTIVE TEAM CLIMATE

• refers to the environment or atmosphere where team members feel comfortable in interacting and collaborating with one another

SUPPORTIVE TEAM CLIMATE

• it emphasizes team culture of trust that include (but are not limited to) the following:

  • creating an interdisciplinary atmosphere

  • valuing and respecting the contributions of other members

  • fostering consensus

  • nurturing camaraderie, fun, & friendship between colleagues

Four main dimensions of team climate are as follows:

1. Participative safety

2. Common objectives

3. Task orientation

4. Support for innovation

PARTICIPATIVE SAFETY

abilities of team members to engage in the decision-making process

COMMON OBJECTIVES

• clarity of shared team objectives can predict the effectiveness of the team

TASK ORIENTATION

responsibility and commitment to perform agreed tasks to a high

SUPPORT FOR INNOVATION

expectation that each member and team (as a whole) will strive

INDIVIDUAL CHARACTERISTICS THAT SUPPORT INTERDISCIPLINARY TEAMWORK

• promotes role interdependence while respecting individual roles and autonomy

INDIVIDUAL CHARACTERISTICS THAT SUPPORT INTERDISCIPLINARY TEAMWORK

• highlights personal qualities that include (but are not limited to) the following:

  • approachability

  • appropriate delegation

  • being able to compromise

  • confidentiality

  • decisiveness

  • empathy

  • willingness to take initiative

  • patience

  • tolerance

  • personal responsibility

  • exploring how roles may overlap

  • knowing one's strength and weaknesses

  • acquiring, demonstrating, and sharing new skills & knowledge

  • reflexive practice (introspection, self-awareness, or examination of one's own behavior and actions)

CLARITY OF VISION

• incorporates a set of values that clearly drives the direction of team's service provision and the care provided

CLARITY OF VISION

• these values must include (but are not limited to) the following:

  • portraying a uniform and consistent external image of the service

  • demonstrating professional commitment

  • displaying the ability to cover each other's roles (i.e., flexibility)

  • addressing uncertainty at a strategic level

  • managing change/s

QUALITY AND OUTCOMES OF CARE

• centers on the quality of patient-focused services

QUALITY AND OUTCOMES OF CARE

• entails demonstrating a high standard of care for patients that include (but are not limited to) the following:

  • ensuring patient satisfaction

  • encouraging patient feedback to improve the quality of care

  • capturing and documenting of the outcomes of evidence of care (and using that as part

  • establishing timely interventions

RESPECTING AND UNDERSTANDING ROLES

• comprehending the limitations or boundaries of each team member's role may have a potential impact on patients

RESPECTING AND UNDERSTANDING ROLES

• adequate awareness of the roles & responsibilities include (but are not limited to) the following:

  • sharing of power (based on knowledge and expertise)

  • joint-working (i.e., shadowing opportunities and joint visits or assessments)

  • autonomy in decision-making (competent professionals to make their own decisions)

STEPS IN CREATING AN INTERDISCIPLINARY TEAM

1. Confirm Shared Esthetic Goals

2. Uphold shared functional/occlusal goals

3. Substantiate shared biologic goals

4. Develop common approaches in record gathering

5. Establish a systematic approach to treatment planning

6. Determine the treatment approach of each member

7. Meet regularly

8. make the process an enjoyable collaborative experience

9. Celebrate success

10. Learn objectively from the cases that fall short

STEPS IN CREATING AN INTERDISCIPLINARY TEAM

Build a team of dedicated dental professionals who share a common goal of providing optimum healthcare to the patient

CONFIRM SHARED ESTHETIC GOALS

• improving the esthetic eye of each team member is best accomplished by sharing and evaluating various essential photographs of given cases

• objectives:

  • for the team to arrive at a similar view about the case at hand

  • each team member is aware of the treatment options for the patient

UPHOLD SHARED FUNCTIONAL / OCCLUSAL GOALS

• discuss similarities and differences pertaining to one's occlusal philosophy arriving at a common occlusal philosophy among all team members can be challenging at times

• high level of importance is often placed on temporomandibular joint health → developing a the team approach

SUBSTANTIATE SHARED BIOLOGIC GOALS

• requires all team members to be focused on ensuring that the patient has excellent oral self-care and any biologic issue/s must be quickly addressed

• to maximize the self-cleansing nature of the natural tooth structure, special emphasis centers on the following:

  • creating ideal tooth positions

  • producing appropriate tooth contours

• dental professionals agree that the dentition and/or oral cavity should not exhibit the following:

  • gingival inflammation / infection

  • periodontal diseases

  • dental caries

DEVELOP COMMON APPROACHES IN RECORD GATHERING

• team members must share as many records as possible and includes (but are not limited to) the following: radiographs, mounted study models, photographs, and scans (i.e., computed tomography scans, magnetic resonance imaging scans, etc.) → patients may be frustrated or discouraged if diagnostic procedures would need to be repeated