Mohammed T. Abou-Saleh

AN INTERDISCIPLINARY TEAM TRAINING PROGRAM 797treatment of patient problems, rather than superimposing acostly didactic approach which, at best, can expect to yield onlyshort-term effects because of frequent staff turnover andadministrative changes.More concretely, the geriatric psychiatrist is trained in themethods of team leadership, using geriatric assessment as a centraltheme, and the methods of facilitating interdisciplinary teamcollaboration among the kinds of people associated with the chainof patient care, the treatment team. The geriatric psychiatrist alsoreceives, as part of his/her core training, instruction in a method ofdeveloping with the team the universe of management decisionsavailable to them in that particular setting (i.e. the TreatmentDecision Guide). By using case examples, review of patientrecords, videotapes of case conferences, admission interviews,etc., the geriatric psychiatrist (as facilitator) and the team arrive atan understanding of good and bad management decisions, whatproblems exist in making treatment decisions, how these problemsdevelop, what treatment options are (or might be) available, whatmethods team members use in arriving at appropriate treatmentdecisions, and what possible alternatives exist in arriving at adiagnosis. By establishing with the team the criteria that must bemet in order to arrive at a particular treatment decision, thegeriatric psychiatrist and other team members establish goals andobjectives for any specific treatment decision available to them anddiscuss how assessment can be used to better link patient problemsto the appropriate treatment decision. Through this process, theTreatment Decision Guide 14,15 is developed. This TreatmentDecision Guide identifies the dynamic pathway for use ofinformation regarding the patient in planning, implementing andmonitoring treatment. The Treatment Decision Guide providesteam members with a guide for using assessment and is also auseful, cost-effective and durable recipe for planning treatment.Clinical ApplicationsPOISE sensitizes the geriatric psychiatrist to the psychosocialproblems that have a high frequency in the elderly long-term carepatient population. It provides the geriatric psychiatrist with aprogram for upgrading the interaction process between interdisciplinaryteam members through group process exercises andlectures, which emphasize the role of the geriatric psychiatristand other team members in assessing the well-being of patientsand linking that assessment to treatment. The program thengoes on to train the geriatric psychiatrist to lead teams andtrain other team members in team leadership.POISE also improves the quality of staff interaction and teamfunctioning by: (a) setting up systematic approaches andprocedures for making appropriate treatment decisions; and (b)once this system has been set up, providing a device by whichprofessionals and paraprofessionals relate to one another inoperating the ongoing system themselves. This is done primarilythrough the use of the Treatment Decision Guide and SystematicProblem Solving. In addition, POISE enhances patient care byimproving staff knowledge and skills in regard to assessment. Thisis accomplished through group exercises designed to build thegeriatric psychiatrist’s and other team members’ skills in observingpatients and formulating decision plans based on thoseobservations. In this way, the geriatric psychiatrist is trained to bea facilitator, who provides the team with a mechanism by whichthe group does its own learning on an ongoing basis.SUMMARYThe Program for Organizing Interdisciplinary Self-education,POISE 16 , is one program that has demonstrated that theprinciples of interdisciplinary collaboration and team trainingcan be applied successfully in a geriatric psychiatry residency/fellowship program 13 . The learning process involved in POISEcovers the skills, knowledge and attitudes of team membersregarding the following program components: team development,management, and maintenance; and program needsassessment.POISE focuses on the training of geriatric psychiatrist fellows inthe following areas 13 :1. The role each member of the team plays in assessing thepatient.2. Linking each member’s assessment to a treatment plan.3. Systematic approaches and procedures for making appropriatetreatment decisions. This includes methods of defining andnegotiating team members’ roles; case study approaches toprioritizing treatment goals; and systematic approaches toproblem solving.4. The Treatment Decision Guide (TDG): a guide designed bythe interdisciplinary team members specifically for patientmanagement in their particular institution, the TDG providesa key to arriving at available treatment alternatives in thatinstitution.After the geriatric psychiatrist is trained in POISE, he/she istrained in the method of teaching other interdisciplinary treatmentteam members the POISE method and thus provides theteam members with the crucial techniques for maintaining theongoing team themselves. Once the geriatric psychiatrist isassigned to the interdisciplinary team, the emphasis of thetraining is on shared leadership functions of all team members,with designated leaders, experiential learning to facilitate teamfunctioning and problem solving, and ongoing orientation of newteam members (to team objectives and norms).REFERENCES1. Kennedy G, Goldstein M, Northcott C et al. Evolution of thegeriatric curriculum in general residency training: recommendationsfor the coming decade. Acad Psychiat 1999; 23: 187–97.2. Shulman K. The future of geriatric psychiatry. Can J Psychiat 1994;39(suppl 1): S4–8.3. Colenda CC. Essential curriculum in geriatric psychiatry for generalinternal medicine residency and geriatric medicine fellowship. Am JMed 1994; 97(suppl): 4A, 15–18S.4. Schmitt M, Watson N, Feiger S, Williams T. Conceptualizing andmeasuring outcomes of interdisciplinary team care for a group oflong-term, chronically ill institutionalized patients. In Bachman J, ed.,Interdisciplinary Health Care: Proceedings of the Third AnnualInterdisciplinary Team Care Conference. Center for Human Services,MI: Western Michigan University, 1982.5. Schmitt MH, Farrell MP, Heinemann GD. Conceptual andmethodological problems in studying the effects of interdisciplinarygeriatric teams. Gerontologist 1988; 26: 753–64.6. Toner J, Gurland B, Gasquoine P. Measuring depressive symptomatologyin an inpatient psychogeriatric population. Gerontologist1984; (abstr)24: 196.7. Toner J, Gurland B. Interdisciplinary team training for geriatrichealth care providers. Gerontologist 1983; (abstr)23: 191.8. Toner J, Meyer E. Multidisciplinary team training in the managementof dementia: a stress management program for geriatric staff andfamily caregivers. In Mayeux R, Gurland B, Barrett V et al., eds,Alzheimer’s Disease and Related Disorders: Psychosocial Issues for thePatient, Family, Staff and Community. Springfield, IL: Charles C.Thomas, 1988: 81–102.9. Toner J, Gurland B, Leung M. Chronic mental illness and functionalcommunication disorders in the elderly. Am Speech–Language–Hearing Assoc Rep 1990; 19: 54–64.10. Toner J. Interdisciplinary treatment team training: A trainingprogram in geriatric assessment for health care providers. In