Embraced in clinical care, interprofessional collaborations are gaining traction in health science colleges
By Dawn Goodlove
Wendy Fiordellisi (’12 MD) realizes the overwhelming amount of information medical students must absorb about diagnosis and treatment of disease leaves little room in the brain or time in a day to consider issues like medication adherence, insurance, or support systems.
“Then you make the transition to first-year resident, and all of a sudden you have to figure out the logistics of, say, getting things set up for a discharged patient at home, as in physical therapy or IV antibiotics. It’s a big reality check because you’ve never thought about this before,” she says.
“But to do what’s best for the patient and get all the loose ends tied up, you’ve got to understand the roles of members of the health care team—including the nurse, the physical therapist, the pharmacist, and the social worker—and have good relationships with them,” says Fiordellisi, a resident in a general medicine inpatient unit at University of Iowa Hospitals and Clinics.
She sees interdisciplinary teams handling patient cases daily. And her unit is piloting TeamSTEPPS—Strategies and Tools to Enhance Performance and Patient Safety—a national training system that advocates using workshops and simulations to foster communication and teamwork among health care professionals.
While interprofessional practice occurs in many care environments, interprofessional education (IPE) has been slower to catch on. At the majority of U.S. institutions with health science colleges, future doctors, nurses, pharmacists, dentists, and allied health professionals only occasionally share the same curriculum or learn from faculty outside their own disciplines. However, an abundance of evidence has shown that interprofessional teams deliver a higher quality of care at a lower cost and decrease hospitalized patients’ length of stay as well as reduce medical errors. Knowing that, more colleges and universities are forging collaborations among the health sciences to better prepare students for the real world of team-based, patient-centered care.
At the UI, IPE has been an important, though uncoordinated, teaching approach in the health science colleges
for more than 15 years. For example, Clinical Beginnings, a weeklong skills training course for third-year medical students transitioning from classroom to clinical learning, has for several years included students and faculty facilitators from other UI health science colleges during a case-based team learning exercise. And the UI Mobile Clinic, now in its 12th year, serves uninsured or medically underserved populations thanks to student and faculty volunteers from across the health sciences, who partner to run the program that provides free health screenings, physical exams, and health education.
In successful collaborations, students aren’t expected to master the skills of all professions, but rather understand and develop respect for the specialized roles each professional brings to the team.
“There’s a grassroots effort going on now, where we’re slowly seeing more IPE activities. We’re really trying to ground what we do in the competencies of interprofessional learning, trying to be more mindful of that,” says Tanya Uden-Holman, PhD, associate dean for education and student affairs and clinical associate professor of health management and policy in the UI College of Public Health.
“We want our health professions students doing more than sitting in an auditorium taking up physical space together,” Uden-Holman says.
The Interprofessional Education Collaborative (IPEC), a collective of organizations that represent higher education in allopathic and osteopathic medicine, dentistry, nursing, pharmacy, and public health, has identified four competency domains and their associated behaviors that are foundational to IPE:
- Values and ethics for interprofessional practice
- Roles and responsibilities
- Interprofessional communication
- Teams and teamwork
Interest in IPE is growing for a number of reasons: research that validates team-based care, the Affordable Care Act’s emphasis on preventive care and population health, and an insistence by health professions accrediting bodies that IPE be included in the curriculum.
Uden-Holman chairs a steering committee of faculty and students from the UI health science colleges that formed in 2012 to develop and implement a comprehensive and coordinated IPE plan for the university. Over the past two years, the steering committee has helped with the formation of a UI student organization; hosted faculty development workshops and presentations by IPE experts from other institutions; and facilitated the launch of a pilot course for 500 first-year health science students, Interprofessional Skills and Team Based Health Care. Grouped into dozens of interdisciplinary teams, the students work together—through electronic communication or face-to-face—on simulated patient cases, with faculty from the health science colleges directing and assessing their progress.
For IPE to be most effective, experts say, activities should be introduced early in students’ training.
Last year, first-semester medical students in a human anatomy course were taught by senior-level physical therapy (PT) students to perform an examination of the shoulder region after completing a related dissection. The collaboration allowed the medical students to apply their new knowledge of anatomy to a clinical exam skill, while also learning about another profession. The PT students learned to deliver instruction appropriate to their audience—“a critical professional skill as they engage with patients, clinical trainees, and members of other professions,” says Richard Shields, PT (’85 MA, ’92 PhD), chair and department executive officer of physical therapy and rehabilitation science in the UI Carver College of Medicine, as well as a member of the IPE steering committee.
“Future IPE exposures like this will teach our students important situational benchmarks to better understand roles among the health care team,” Shields says.
Another new IPE activity involved six health science students—in dentistry, medicine, nursing, pharmacy, physical therapy, and public health—who studied an actual UI Hospitals and Clinics patient case and developed a comprehensive care plan that could be used to treat the patient, who needs a liver transplant. In monthly meetings, the team clarified individual responsibilities and team goals, identified elements of the case they needed to understand from their various professional perspectives, and exchanged ideas for long-term management of the patient’s condition.
“In the life of many patients with chronic liver problems, their care requires the collaborative effort of the physician, social worker, and pharmacist, as well as nursing, nutrition, and physical therapy. A team clearly improves outcomes, and that is what we want to highlight,” says Antonio Sanchez, MD, clinical associate professor in gastroenterology and hepatology in the UI Carver College of Medicine.
As the students moved through the project, Sanchez surveyed their attitudes toward interprofessional practice. He hopes the results from this pilot exercise will drive future IPE activities specific to the needs of UI health science trainees.
“The art of medicine requires mastering communication skills, defining the needs of each patient, and understanding the required professionals that will foster a patient’s recovery. These skills can be learned and—especially during small-group sessions—can be emulated. They are essential to good patient care,” Sanchez says.
Further examples of IPE include medicine and pharmacy students collaborating on a grand rounds presentation, and nursing and PT students training each other on tending to patients with significant mobility issues, an activity that begins in the fall. The nursing students will guide the PT students on using hospital equipment that assists in lifting patients; PT students will take the lead during training sessions with simulated patients in the home.
“In IPE experiences, our students feel they have an opportunity to tell their story and to reshape the stereotype that nurses are just following orders. That feels wonderful to them,” says Ellen Cram, PhD, RN, assistant dean of undergraduate programs and clinical associate professor in the College of Nursing, and a member of the IPE steering committee.
Future of IPE at UI
As these grassroots examples of IPE develop on campus, the UI Health Sciences Policy Council—which includes the health science deans, UI provost, and vice president for medical affairs—is considering recommendations for moving forward.
The IPE steering committee has suggested:
- Establishing an IPE center to implement curriculum and other education-related activities across the health science colleges, with dedicated resources to ensure sustainability
- Creating a cadre of faculty with expertise in teaching IPE competencies
- Gaining institution-wide support for competency-based IPE as the standard for educating health professions students
- Encouraging student-led leadership and learning in IPE
Despite the challenges of implementing IPE, the University of Iowa has many factors in its favor, Uden-Holman says, including five health science colleges and a strong history of collaboration across the university.
“Health care reform is telling us what we’ve done in the past isn’t going to be what we need in the future, so we have to look at new models,” Uden-Holman says. “To provide high-quality care that is cost-effective, we need to be able to work in teams. Systems and payers expect to see that.”
Ideas for training tomorrow’s health care professionals come from all corners.
“It would be wonderful if students could take specific electives to work toward an interprofessional certificate or letter, which would give tangible proof to future employers of interest and engagement in IPE,” suggests Mallory Breuker, who served as treasurer of the new Students for Interprofessional Education group before graduating this year with a dual degree in pharmacy and public health.
Resident Wendy Fiordellisi believes her unit’s TeamSTEPPS training sessions could also benefit groups
of interprofessional students.
“Now I go out of my way to communicate with everyone. It’s not a bother to call a nurse and say, ‘What about this?’ They want that,” Fiordellisi says.
“It’s reassuring that patients see we’re all on the same team, sending the same message to them, and working together for them. We’re not reinforcing a hierarchy here. We’re trying to take care of patients.”
Load: Will faculty have time for collaboration and course development, and will they receive training and incentives to teach in an IPE system?
Learning: With full course loads and rigid schedules to ensure students are thoroughly trained in an individual discipline, how can coursework be synchronized so health science students physically learn together?
Leadership: Is there a mechanism for centralized coordination of IPE, since each health science college has its own dean and administration?
Logistics: Will dedicated, shared resources be allocated to support a centralized, coordinated IPE program, including physical space, communications, scheduling, and staff?
Health Sciences at the UI
Carver College of Medicine
605 medical students
48 students in physician assistant program
120 students in physical therapy program
373 graduate students
College of Nursing
535 students in undergraduate programs
260 students in graduate programs
College of Dentistry
320 dental students
90 students in graduate specialty programs
College of Pharmacy
432 PharmD students
73 PhD students
College of Public Health
356 master’s and doctoral students