Using Collaboration Essentials
Implementing CE

Collaboration Office Rounds Format
The centerpiece of the Collaboration Essentials program is the use of collaborative office rounds, which are designed to foster joint pediatrics/child psychiatry continuing education and problem-based learning in the psychosocial developmental aspects of child health.

The essence of these case-based discussions is “a small group experience that promotes free exchange of ideas and provides for a continuing relationship with resource faculty and other group members” (Fishman et al., 1997). In 1989, these rounds originated out of an increasing emphasis on the mental-health aspects of primary care for children and adolescents. Postgraduate collaborative office rounds with community pediatricians continue with support from the U.S. Maternal and Child Health Bureau in a dozen sites across the country. Jointly led by a pediatrician and child and adolescent psychiatrist, these study groups, which emphasize the practical challenges confronted in the community, have been well received (Schwam and Maloney, 1997; Thomasgard and Collins, 1998).

Fishman et al. (1997) noted that that the potential of collaborative office rounds “may be more fully realized by applying this approach more widely…A natural extension would be to explore the applicability of this approach to new situations and withdifferent group compositions.” The Collaboration Essentials program is the extension of the collaborative office rounds concept to a residency training program level. While there is a long history of joint teaching endeavors, this program is unique in bringing together trainees from both disciplines in a format that enhances communication, models collaboration in case management, and establishes new linkages. Presently, there are no training programs in the country that bring pediatric and child/adolescent psychiatry residents together in a similar format.

Case-based Teaching Vignettes
Case-based teaching was selected for the content of the rounds used in the Collaboration Essentials program because case discussions are more effective in promoting critical thinking and analysis (Barnes et al. 1994a; Barnes et al., 1994b).With support from The Maternal and Child Health Bureau and The Genentech Foundation for Growth and Development, Knight et al. (2001) developed for pediatric residents a standardized case-based curriculum on child growth, development, behavior, and adolescent medicine that incorporated the Bright Futures (Green and Palfrey 2000) health supervision guidelines. They developed a series of illustrative clinical cases with accompanying written educational information, which appeared promising for teaching pediatric residents (Knight et al., 2001).

For the Collaboration Essentials program, it was critical to have specific cases that met the following collaborative office rounds objectives: 1) to enhance understanding of psychosocial aspects of child development, disorders, and disability and increase practitioners’ ability to help children and families deal with these issues; 2) to expand power to discriminate between transient disturbances and more serious psychiatric disorders which require referral; 3) to promote collaboration between pediatricians and child psychiatrists; and 4) to facilitate a more comprehensive approach to health. For this manual, pediatricians and child and adolescent psychiatrists jointly wrote three new clinical cases. (See individual cases in following sections.) These cases have been selected to illustrate a range of problems, including depression, substance abuse, and somatoform illness, that residents from both disciplines are likely to confront.

Group Participants
A Collaboration Essentials group should have 6-15 participants, including both pediatric and psychiatry residents. Pediatric trainees can range from interns through senior residents and specialty fellows. Child and adolescent psychiatry residents are  recommended, although general psychiatry residents and other mental health trainees or staff can participate. Triple board residents (i.e., pediatrics, psychiatry, and child psychiatry) as well as some child neurology residents are also suitable participants.

A child psychiatrist and a pediatrician facilitate each group. The facilitators should maximize student interaction as well as encourage residents to learn from one another by: 1) maximizing student-to-student interaction and participating as equal members of the group; 2) meeting the group members at their level and encouraging advanced students to teach others; 3) asking questions to keep the discussion going; and 4) trusting the group to find the answers, as there is no single best answer to questions posed (Blaschke et al., 2002). Facilitators are told that the program is designed for the residents to learn to collaborate at the clinical crossroads, rather than to learn one subject in expert depth. (See Appendix 1 for more specific guidelines for facilitators).

Group Format
There are two recommended formats for running a Collaboration Essentials rounds. The rounds comprise three cases, each of which requires 60 minutes for adequate discussion. The first format requires a minimum of one 4-5 hour block, in which the  trainees are exempt from their usual duties, so that all three cases can be discussed. It generally includes at least one 10-15 minute break midway through the block. The rounds can be paired with either a lunch or a snack to allow social connection among the participants. There might also be a short didactic talk on a topic common to both participating disciplines.

The second format requires separate 1-hour sessions over the course of a 3-6 month period. These hours must be protected time, so that the trainees may focus on the case discussion without distraction. In this format, the program is embedded within the ongoing teaching schedule in the training programs. Continuity of group membership and leadership across these sessions is important.

In each format above, all case handouts should be provided to the group facilitators at the beginning of each case discussion. The cases are designed to facilitate discussion through the following format: 1) distribute first part of case and have participants read aloud; 2) discuss participants’ thoughts about the case based upon this information; 3) hand out second part of case and indicated handouts; 4) discussion and thoughts continue with this additional information, 5) give out final part of case and indicated handouts, and 6) finish case discussion. The participants can be given notebooks to organize the written material provided to them. The Facilitators Guide that accompanies each case is intended to provide facilitators with ideas and thoughts on each case and is not given to the participants.