34 Chapter 2 DISCUSSION We developed a six-step process to create geriatric cases that can be used for classroom IPE. The six steps are based on the characteristics of three consensus methods (DT, NGP and CDP), so the content of the cases could be validated. We chose a geriatric focus and an interprofessional setting, but the six steps can also be used in a variety of other settings. When conducting this research study, we experienced some difficulties. First, the process was time-consuming, especially for the coordinator, i.e. the researcher. However, we see this as a one-time investment. A constructed case can be re-used in an educational setting for many years. Furthermore, this approach involved minimum effort from the experts, so they were willing to participate. In the last round, both the medical resident and the nurse reported that they found that reviewing the cases was ‘a nice thing to do, because they did it together’. During the validation process, an online questionnaire for experts can result in further distributing the workload, but that will need to be developed. Secondly, the consensus process for the case content was also difficult. The results indicate that experts may easily agree upon the content of frequently seen cases. In Step 1, several of the characteristics were similar. In Step 3 and Step 5, there were a few items that needed to be discussed. There was a lot more diversity in the experts’ opinions of the treatment plans. Almost every expert in Step 3 had a unique opinion about the items that should be included in the treatment plans, e.g. whether or not to consult an occupational therapist or to order a chest X-ray. The number of ‘secondary items’ in Step 4 demonstrates this diversity: 45 about the treatment plan versus three about the content. It was possible to score the case complexity using INTERMED for the elderly. All the experts in clinical practice scored the cases similarly. Differences were seen by the experts that scored the complexity using their own judgment, not INTERMED. Case 1 was estimated to be more difficult and Case 4 was estimated to be less difficult when INTERMED was not used in comparison to when it was used. It is possible that the experts focused on the diagnosing dilemma more heavily than when using INTERMED. For example, in Case 1, the symptoms were vague, which can make diagnosing more difficult; therefore, difficulty of Case 1 was rated higher when experts used their own judgement instead of INTERMED. In contrast, in Case 4, there was a clear description and no diagnosing dilemma, but the background, comorbidity and severity of the symptoms made it complex. This case was rated less difficult by experts’ own judgements. The literature confirms the biopsychosocial strength of the INTERMED: it focuses on social and psychological problems as much as on diagnosing dilemmas (Wild et al., 2011). Scoring based on the experts’ own judgment has not
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