Med schools shift focus to team-based care

In their first year of medical school, students at the Medical University of South Carolina join with students from all of the university's degree programs, including nursing, pharmacy and health administration.

During a semester, the students work in teams to solve a hypothetical patient sentinel event. They must determine what went wrong and come up with multiple recommendations for the patient's care.

The exercise is part of a required course implemented in 2009 to give students their first exposure to interprofessional care.

"The idea is that they learn, for all health care providers, what the scope of practice is and what the responsibilities are, so that they can really reach out and use other professionals to the best of their ability," said Amy Blue, PhD, family medicine professor and director of the university's Creating Collaborative Care program.

As the nation shifts toward more team-based care and the medical home model, medical schools are working to provide their graduates with the skills needed to use these approaches in a changing health care system. Interprofessional training is offered or being developed at several schools, including East Tennessee State University, the University of California San Diego, Loyola University Chicago, Thomas Jefferson University in Philadelphia and the University of Kentucky.

In addition, six national associations of health professionals have formed the Interprofessional Education Collaborative. The group's goal is to better integrate and coordinate the education of nurses, physicians, dentists, pharmacists and other health professionals to provide more collaborative care.

"We believe this is the future of quality patient care," said Lucinda Maine, PhD, RPh, executive vice president and chief executive officer of the American Assn. of Colleges of Pharmacy, which is part of the initiative.

Interprofessional training has become a necessity, said Stephen Shannon, DO, MPH, president of the American Assn. of Colleges of Osteopathic Medicine. Gone are the days when most doctors would finish their training and go into solo private practice. Now, many employers expect doctors to have experience and skills needed to work in a team-based environment.

"This is being as much driven by what is happening in the health care system as by the students," Dr. Shannon said. "Students today are engaged in a different sort of social environment. Through social media and technology, they are collaborating with one another all the time."

Groups in the IPEC are the AACP, the AACOM, the Assn. of American Medical Colleges, the Assn. of Schools of Public Health, the American Dental Education Assn. and the American Assn. of Colleges of Nursing.

Sharing resources

The IPEC aims to help schools develop interprofessional training programs to better prepare the health care work force for team-based care, said Carol A. Aschenbrener, MD, AAMC chief medical education officer. "Every health professional needs to be prepared for collaborative practice. The needs of the population are more complex and can't be met by any one profession," she said.

The collaborative has developed core competencies for interprofessional practice that all training programs should address. It will host a faculty development institute in May to discuss best practices and give faculty in different health professions experience working together. IPEC also is developing a website for sharing information about interprofessional training, Dr. Aschenbrener said.

"The goal would be to assemble a whole library of material on those core competencies so that faculty don't have to reinvent the wheel," she said.

Several schools already offer interprofessional training for students. The Quillen College of Medicine at East Tennessee State University, for example, has offered such training for 20 years through its rural practice program in Rogersville and Mountain City, Tenn. About 815 students have graduated from the program.

"Our idea was to have it be not only a community-based program but also interprofessional," said David Linville, MD, ETSU acting associate vice president of Rural & Community Health & Community Partnerships.

Students spend one day a week in the rural community. They do clinical rotations, have classes with students in other health professions and work in teams on a community health project, such as trying to find ways to reduce childhood obesity.

With interprofessional training, students learn values and ethics for team-based practice, Dr. Linville said. They get firsthand education on the roles and responsibilities of different health professionals, how to interact with one another and whom they can go to for different needs. "We're all working toward improved quality care and outcomes," he said.

At Loyola University Chicago, major changes are under way to integrate interprofessional training into the curriculum for both nursing and medical students. The nursing school is being moved to the same campus as the medical school and will be housed in an adjoining building.

Starting in the fall, medical and nursing students will train together in a new, virtual six-bed hospital, learning to work as a team on simulated patients. "With interprofessional training, they learn a true respect for what everybody brings to the table," said Fran Vlasses, PhD, RN, associate professor and chair of the Health Systems Leadership and Policy Dept. at Loyola University Marcella Niehoff School of Nursing.

Overcoming "natural barriers"

It's especially important for students to be exposed to interprofessional training early, Dr. Shannon said. It allows them to see patients' needs and realize they can't solve them all on their own. "It's good for students early in their training to get a sense of their limitations," he added.

But developing interprofessional training programs isn't easy, said AACN President Kathleen Potempa, PhD, RN. The health professions have been educated separately for so long that finding ways to integrate them can be a challenge. Different schools have different schedules, academic calendars and curricula.

"Coming together with a content area that meets all the needs of the different programs is not easy," Potempa said. "When you drill down and actually try to do it, there are some natural barriers that have to be overcome."

It also can be difficult for faculty to adjust if they don't have interprofessional training themselves, said Aaron Michelfelder, MD, vice chair and professor of family medicine at Loyola. It's easier for students to adapt. "The students don't have the same biases as faculty do," he said. "The students are much more open and less caught up in their specific profession, so they are much more open to collaboration."

Finding the resources needed to integrate programs is another major challenge, Maine said.

"Everybody is strained for resources right now and trying to figure out what is the resource model for team-based delivery," she said. "Until team-based care and interprofessional practice become the standard, our educational opportunities are going to be limited."