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Interprofessional Learning Prepares Students for Team-Based Practice

Kim Krisberg , special to AAMCNews
September 27, 2016

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Students practice skills on a mannequin at the New York Simulation Center
Students practice skills on a mannequin at the New York Simulation Center (NYSIM), a partnership between NYU School of Medicine and City University of New York.

Editor’s Note: Throughout 2016, AAMCNews will explore how medical schools and teaching hospitals are educating the next generation of physicians in an environment of discovery and innovation.

Health care has never been a one-person show. Patients may think of doctors first, but keeping people healthy has always involved a variety of professionals, from nurses and pharmacists to social workers and public health practitioners. Today, this reality is driving an emerging educational movement that gives students the skills to make interprofessional collaboration a cornerstone of everyday practice.

“I think it’s a huge part of the innovations we need to see in health care,” said Alan Dow, MD, MSHA, assistant vice president of health sciences for interprofessional education and collaborative care at Virginia Commonwealth University (VCU) School of Medicine. “One of the challenges we have is providing good examples of interprofessional collaboration in practice. It’s not the way health care has traditionally functioned.”

Interprofessional education (IPE) curricula are popping up at medical and health professions schools nationwide, to prepare students for team-based practice.

In 2009, the AAMC, along with five other associations representing health professions schools, created the Interprofessional Education Collaborative (IPEC) to advance IPE. In 2011, IPEC published a report outlining IPE’s core competencies that concentrate on four main domains: values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork. Those competencies are now informing innovative IPE experiences nationwide.

In February, nine additional associations—representing podiatry, physical therapy, veterinary medicine, psychology, and optometry, among others—joined the collaborative. The expansion of IPEC membership “marks a significant and growing commitment across the health professions in the United States to make collaborative, patient-centered care a reality,” said Richard W. Valachovic, DMD, MPH, IPEC president and president and CEO of the American Dental Education Association, in a news release.

At VCU School of Medicine, Dow used the competencies to map IPE activities and assess students’ baseline understanding of interprofessional care. Dow, who also serves as director of the university’s Center for Interprofessional Education and Collaborative Care, said students believe interprofessional care is important, but they lack the skills to make it an effective reality.

“Our goal is to broaden their contextual view of a patient’s world. As they go out to practice, our hope is that they’ll be more likely to have a desire to be collaborative and feel more comfortable doing so.”

David Farmer, PhD, University of North Texas Health Science Center

VCU health sciences educators are closing that gap by formalizing and integrating IPE into VCU health sciences curricula. Today, VCU medical students begin IPE in their second semesters, learning about quality and safety alongside nursing and pharmacy students. All fourth-year medical students work on a virtual team with students in pharmacy, nursing, and social work on a semester-long project to manage a geriatric patient moving through four phases of care. Students confront issues that could produce adverse results without effective collaboration. For instance, Dow said, a patient has separate medication lists in her electronic medical record and her pharmacy record, and she brings a different list to a nurse during an appointment. She gives her social worker yet another list. The scenario challenges students to work together to figure out an optimal medication regimen.

At the University of North Texas (UNT) Health Science Center, the Department of Interprofessional Education and Practice bridges collaborative education gaps across the schools of medicine, pharmacy, public health, health professions, and biomedical sciences. According to David Farmer, PhD, the department’s inaugural director, the initial charge was to create an institutional IPE committee. Although each school already had its own IPE curriculum committee, the committees were not coming together, Farmer said.

UNT’s medical students receive IPE during all four years and into residency. The ultimate goal, Farmer said, is to create a common curriculum for all health science students, in addition to the longitudinal IPE program that is part of each instructional year.

Farmer said many IPE experiences are developed through a social learning philosophy, or the idea that students learn from and with one another. In one exercise, known as “Elena’s Case,” students care for a Hispanic girl from birth to adolescence, with a specific focus on the determinants that put her at risk for obesity and diabetes. This example purposefully forces students to coordinate their skills to prevent the onset of serious medical problems, Farmer said.

“Our goal is to broaden their contextual view of a patient’s world,” said Farmer, also an assistant professor of medical education at UNT. “As they go out to practice, our hope is that they’ll be more likely to have a desire to be collaborative and feel more comfortable doing so.”

Virtual collaboration

Of course, integrating IPE curricula presents the practical hurdles of bringing together hundreds of students who are on different schedules and learn through different modalities. At New York University (NYU), those pragmatic challenges led educators to bring students together virtually.

Led by Maja Djukic, PhD, RN, an assistant professor in the NYU College of Nursing, and Marc Triola, MD, an associate professor in the NYU School of Medicine, researchers designed an online IPE curriculum that pairs nursing and medical students with virtual teammates. The curriculum includes modules on communication and conflict resolution, interdisciplinary care planning, and informatics. In one virtual scenario, a patient gives different answers about medication adherence to providers, demonstrating the importance of sharing notes to create the most effective care plan.

“We had very easy buy-in from students … they’re really very interested in learning about one another’s educational structures.” said Triola, who also directs the university’s Institute for Innovations in Medical Education. “Many have already had experiences in team-based learning; they’re just less hierarchical.

Triola and Djukic compared a group of virtual IPE learners to a group that participated in both virtual and in-person learning to determine whether one method was more effective. According to their research, published last year in the Journal of Interprofessional Care, virtual IPE was just as effective as in-person learning. The findings may be especially pertinent for nursing and medical schools that do not have a partner school or that have a shortage of faculty trained in IPE, Djukic said.

In fact, their virtual IPE curriculum is available for other schools to use free of cost. As of late February, Triola said the curriculum’s five core educational modules and two virtual patient modules had been completed about 3,500 times. He added that the virtual curriculum may be a good fit for busy clinicians as well, many of whom went to school before IPE was on the radar.

“This is a moving target as health care evolves,” Triola said. “But [IPE] is absolutely critical. If we have high-functioning health care teams, we can do so much more to provide value.”

This article originally appeared in print in the April 2016 issue of the AAMC Reporter.

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