AAMC Reporter: May 2008

A Word from the President: "Interprofessional Collaboration: We Are Willing — Can We Find the Way?"

In recent years, there has been growing recognition of the need to think and work interprofessionally on the front lines of patient care. Some of this momentum began in 2003 when the Institute of Medicine (IOM) published its report—Health Professions Education: A Bridge to Quality—and identified work in interdisciplinary teams as one of five core competencies for all health professionals. More recently, in meetings with nursing, pharmacy, and other groups, I repeatedly hear a readiness to improve the way we work together and find myself inspired by leaders such as Lucinda L. Maine and Kenneth W. Miller of the American Association of Colleges of Pharmacy, whose thoughtful Viewpoint appears in this issue. Within the AAMC, we have designated interprofessional health education and practice a key strategic area through our strategic thinking and planning (STP) process, and continue to view it as vital to changing our health care culture.

Yet despite the good intentions of all—physicians, dentists, nurses, pharmacists, and other health professionals—our interaction with one another remains minimal. If we all agree interprofessional collaboration is in the best interests of our patients, and if we are indeed willing, what stands in the way? I believe there are three sets of inter-related hurdles: the way each profession educates students, the lack of a common foundation when we try to work in team settings, and health care delivery models that run counter to providing high-quality patient care.

First, in large measure, each health profession still tends to educate students within its respective ivory tower. Even in academic medical centers with the full range of health professions schools, the amount of cross-disciplinary training is minimal and hampered by several factors. These factors range from the difficulty of scheduling common lectures (due to conflicting academic calendars) to differences in the way each profession ensures and maintains competence (what the IOM report called "a patchwork of institutions, all working independently").

Another factor that works against joint learning opportunities is the disparate stages in which our students find themselves as they form their professional identities. A second-year medical student seated on one side of a lecture hall, for example, is only beginning to internalize what it means to be a doctor, whereas a second year nursing student seated on the other side is halfway through the process of "becoming" a nurse. If one is not yet comfortable in one's own professional shoes, it is often difficult to fully appreciate the critical role played by other professionals.

Absent this common educational foundation and shared perspective, it should come as no surprise that we are unprepared to work together in a teamenvironment. At best, we have a poor understanding of each other's roles. At worst, we find ourselves in unfortunate competition with one another, particularly when it comes to scope of practice. Is it any wonder we see so many bitter battles fought in state legislatures over the authority to admit patients or prescribe drugs? At the health system level, these attitudes are reinforced by prevailing models of health care delivery which bring us together as loose collections of individuals providing specialized services, instead of highly integrated teams of professionals coordinating care.

Can we overcome these hurdles? I believe our mutual desire to improve patient care is much stronger than the sum of differences that have precluded greater collaboration. Working to address these differences—many of them embedded in our respective professional cultures—will not be easy and progress likely will be achieved in small—but significant—steps.

As a starting point, we must push harder to better integrate interprofessional learning opportunities into our education and training. Even if we cannot synchronize academic calendars to schedule common lectures,we can make those lectures and other teaching materials more commonly available. Last month, for example, the AAMC and the American Dental Education Association (ADEA) announced a partnership to make dentistry teaching materials available on MedEdPORTAL®, the AAMC online repository of teaching materials. (For information on other joint educational activities between the AAMC and ADEA, I encourage you to read this month's front page news story about the Medical School Objectives Project on oral health education.) Additionally, we have begun discussions with the American Association of Colleges of Nursing to make our institutions' simulation centers more widely available by developing an inventory of the technology these centers use.

Turning to our students, while we cannot hasten formation of their professional identities, we can foster better appreciation of each other's profession. Our joint work with representatives from dentistry, pharmacy, nursing, and other allied professions to develop common measurements of professionalism is a critical step in this process. We also must work to tone down the rhetoric of interprofessional scope of practice battles, and redirect our efforts toward larger issues that have implications for all of us, such as predicted workforce shortages and federal support for health professions through Title VII and Title VIII programs. An excellent model here is our participation in the Health Professions and Nursing Education Coalition (HPNEC), which now includes more than 60 organizations from a wide variety of professions and specialties.

Finally, we must work together in exploring new delivery models, such as the medical home concept approved last February by the AAMC Executive Council. Through a medical home system of care, patients receive continuous and comprehensive care coordination by an interdisciplinary team of providers. By working together to further research and develop this model,we will have the opportunity to jointly consider key issues such as financing and implementation.

If we all agree that greater interprofessional collaboration makes sense for our patients, and collectively are truly willing, we can overcome each of the hurdles I have described.Our focus must be patient-centered, not profession- centered. Providing high-quality health care is not the sole domain of a single profession, but the shared responsibility and privilege of all.

Darrell G. Kirch, M.D., AAMC President and CEO

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