AAMC Reporter: July 2005

Betsy VanLeit, Ph.D. Assistant professor and director, New Mexico Rural Health Interdisciplinary Program

Building Bridges Between Health Professions

By Whitney L.J. Howell

SUNY Downstate students worked with local residents to create murals that demonstrate how all health professionals are integral to providing quality healthcare.

Improper transfusions, surgical injuries, and mistaken identities cost the American healthcare system up to $29 billion each year, according to the Institute of Medicine, and have been attributed in part by medical educators to communication breakdowns between health professionals.

Officials in academic medicine believe a sharper focus on building relationships among the multiple professions is one way to avoid medical errors.

This year, the AAMC, along with partners in nursing and pharmacy, investigated how healthcare programs are currently teaching their students to work with members of different medical professions. Representatives from the Association, nursing, and pharmacy visited four programs. According to Linda Lesky, AAMC assistant vice president for the division of medical education, they provided a guide for implementing interdisciplinary training nationwide.

"We did an in-depth study of what works and what doesn't," Lesky said. "After reviewing all four programs, we came up with what elements are likely to guarantee success in improving communication and collaboration between students of different healthcare professions."

SUNY Downstate students created murals with local residents

Of the four schools with interprofessional education programs, State University of New York (SUNY) Downstate Medical Center is the only one administered by students. The University of Colorado School of Medicine, the University of Florida College of Medicine, and the University of New Mexico School of Medicine also have programs that bring healthcare students together.

SUNY Downstate's program, called the Team-Building Initiative, began five years ago under the leadership of a medical student who worked in multicultural education and conflict resolution. It is a yearlong, extracurricular endeavor that joins students from the schools of medicine, nursing, and other health-related professions, including physical therapists, midwives, and physician assistants. The goal is to bring together 10 students from each discipline, according to Joanie Hope, M.D., the initiative's founder.

SUNY's initiative has two parts, team-building and team action. During team building, the students learn how the roles of all medical workers are related and about any stereotypes associated with certain healthcare professions in 11 three-hour sessions. Students are encouraged to share any life experiences they have had that could illustrate the need for interdisciplinary cooperation.

Team action requires the students to implement what they learned in the team-building sessions and design a project that will enhance the health status of the community they choose to target, Hope said. Recently, the students produced a video promoting interdisciplinary work that debunked the stereotypes of professions. They also organized a conference exposing high school students to healthcare careers and their rights as patients.

Although students do not receive credit for voluntarily participating in the team-building initiative, Hope said their response has been overwhelmingly positive. She wants students to complete the program with a clear understanding that one person cannot provide comprehensive medical care.

"I want them to walk away with a tool bag of skills, ready to work within a group," Hope said. "I want them to be self-aware and to know how to interact in group settings, working through differences of profession, rank, and culture."

New Mexico's Rural Health Interdisciplinary Program may not be student-administered, but students are enthusiastic about the program. According to Betsy VanLeit, Ph.D., assistant professor and director of the Rural Health Interdisciplinary Program, students look for more interprofessional training, and she hopes the interest continues because the program must be refunded every three years.

"Our students love the program," she said. "They love the active learning and the fact that it's student-centered and is relevant to what they'll be doing in the future."

Rural Collaborative

New Mexico's program brings together more than 100 students from 12 programs, including medicine, nursing, dental hygiene, and social work, for interdisciplinary teamwork experiences in rural, underserved areas. During the spring semester, groups of eight to 12 students from five or six disciplines meet every Friday afternoon to create and discuss patient cases where cooperation could be beneficial.

Students take their training into rural communities during the summer months, work in specific clinical areas during the week, and set aside time for a community health-related project on select days with their original group of mixed professions. Each team must use problem-solving skills to fashion a project that fulfills a healthcare need unique to their community, such as a youth medical mentoring program, VanLeit said.

The program benefits both New Mexico students and the surrounding community, VanLeit said, and the school wants to expand the program in the future to include psychiatry students.

"The Interdisciplinary Program is a great way to bring new information into the academic setting, energize students of all professions to work together, and enhance the medical care the community receives. It's a win-win situation," VanLeit said.

Judgment Calls

Rather than teach interprofessionalism with seminars on teamwork and community projects, the University of Colorado School of Medicine approaches professional collaboration through an ethics course. The main goal, according to Jackie Glover, Ph.D., associate professor in the Center for Bioethics and Humanities, is to give students the proper tools to make reliable ethical judgments in medical situations and to use those skills to work effectively with other health professions.

"We want to create and demonstrate respect for all healthcare students," Glover said. "That way, they can work together to have a positive impact on patient care and will know much more about other professions."

The ethics course is required for all first-year students in six programs, including child health associates/physician assistants, dentistry, nursing doctorate, medicine, pharmacy, and physical therapy. Small groups of 10 students and two faculty members spend 10 weeks together involved in case-based learning where they discuss respect for patients, the patients' well-being, and children and adolescents as patients. Some sessions also tackle "hot topics," such as whistle-blowing, emergency contraception, and organ donation.

Student response has been so supportive that next year Colorado will extend the program into the second year. First-year students will complete a five-week program and fulfill the remaining five weeks during their second year. The cases students encounter will be more challenging to reflect their increased experience.

The Interprofessional Health Education Project at the University of Florida College of Medicine, started in 1996, has also had a profound effect on how students perceive their future careers, said Richard Davidson, M.D., M.P.H., director of the Program for Interdisciplinary Education.

"More than 90 percent of our students feel that they have learned things that would dramatically improve their future practice," Davidson said. "And many of the students continue to correspond with the families they work with in this program for many years after their time in the program is complete."

More than 400 students participate in the education project each year. Davidson said the two-semester timetable, which includes discussions and home visits, can prepare students to work more effectively with other health professionals in the future.

Each year, the students divide into small groups and are assigned to a family with health problems. Florida is careful not to choose families that are too healthy or those that have too many medical difficulties, Davidson said, because the program is meant to reflect what students will more typically encounter during their future practices. Currently all first-year students in dentistry, pharmacy, medicine, public health, psychology, and physical therapy are involved.

Throughout the first semester, students conduct several home visits to create a health profile of their family, including social, physical, and dental status. After compiling a thorough history, the group incorporates suggestions from all health professions into a project to enhance the family's health. For example, previous students developed a diabetic cookbook, redesigned a baby monitor system so a paraplegic could communicate requests, coordinated hospice services, and arranged for a woman without emergency service to be integrated into the 911 system.

Despite the popularity of these programs and the benefits they provide to both students and future patients, the schools do encounter some roadblocks. With so many students from multiple programs involved, finding time for everyone to meet can be frustrating. Also, according to Colorado's Glover, the programs work well only when the various deans support them. And, as in New Mexico's case, appropriate funding is an ongoing concern.

Regardless of potential hurdles, the program directors agree the hardships cannot overshadow the benefits of creating a more collaborative healthcare environment.

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