by
Kathy Tang, PharmD, PGY1 Pharmacy Practice Resident, University of Maryland
Medical Center
For health care professionals, collaborative
practice is the basis for providing patient-centered, comprehensive care.
However, health care professional students often only experience
interprofessional collaboration on their first advanced practice experience in the
hospital.
What medications was the patient actually taking at home? Which medications are appropriate now, can the patient afford them, and does the patient understand how to take them? What is the discharge plan? Does the patient have access to primary care services? How can we safely transport the patient home? These are the kinds of questions that students (pharmacy, nursing, social workers, and medical students alike) must ask when they first encounter patients. But are they sufficiently prepared to work together to address and answer them?
I first become interested in interprofessional education
in the classroom setting when I attended the University of Maryland
Interprofessional Education Day (IPE Day) activities as a first year pharmacy
student. One day on the University’s academic calendar was blocked off and
students from all professional programs were encouraged to attend a series of
seminars. In the afternoon, they worked
together on a patient case. That was the day that I learned that nurses often
ask patients about the medications taken at home. That was the day that I
learned that social workers assist in arranging patient transportation and finding
the necessary equipment to continue treatments at home. That was the day I
realized that interprofessional education was needed in the classroom and that
it was sorely lacking in our curriculum.
Why hasn’t interprofessional education been
assimilated into every healthcare professionals’ curriculum? The answer is
multifactorial. In a survey of academic deans of U.S. and Canadian dental
schools, several challenges were cited.1 Cost and coordinating a
common curriculum between different professional schools has been difficult to
overcome. It requires years of planning
and collaboration between the academic dean of each school. Classes must be
synchronously scheduled, professors/instructors must be available to teach classes,
staff must be trained, and so on. While these barriers are daunting enough for large
universities with multiple health professional programs on a single campus, it’s
nearly impossible for stand alone schools to pair up, let alone coordinate
between 3 or 4 different programs on separate campuses.
Another barrier – and perhaps the most difficult
one to surmount — is profession-centrism. This occurs when a professional group
“nourishes its own pride and vanity, boasts itself superior, exalts its own
divinities and looks with contempt on outsiders.”2
Profession-centrism promotes competition and prevents health care professionals
from acknowledging each other’s skills and roles. I have experienced this many times,
in the hospital and community settings alike. As a fourth year pharmacy student
at an independent community pharmacy, I identified an opportunity to optimize a
patient’s medication regimen. When I contacted the physician to express my
concerns, he stated that he had been practicing for more than 20 years and that
pharmacists had no role in helping make therapeutic decisions for patients. Physicians
aren’t the only one’s who harbor profession-centric beliefs. Frankly every
health professional is prone to thinking that they are intrinsically better than others.
Its OK to have pride in one’s profession, but we must overcome this kind
of mentality if we truly want to teach students about and model interprofessional
collaboration.
Exposing health professional students to the respective
roles and responsibilities of team members is certainly one way to counter
profession-centrism. For example, during the annual Interprofessional Education
(IPE) Day, the realistic cases highlighted the complex social, nursing, diagnostic,
and medication needs of patients. The overall response was extremely
positive. One medical student noted that
she did not know how much pharmacists knew about therapeutic decision-making or
could do follow-up monitoring. The social work student addressed many of the
social barriers that the medical and pharmacy students simply overlooked. While
the IPE day activities at the University of Maryland were very helpful, others
have take it one step further. For example, the University of Pittsburgh uses standardized
colleague encounters to improve pharmacy students’ ability to communicate evidence-based
recommendations. Not only did this help build communication skills but it also
improved student confidence.3
Other studies have examined the effect of interprofessional
course work on students’ understanding and respect for the professional roles
on a team. Faculty at the University of Toronto developed a 5-week
interprofessional program where student initially (week 1) discussed areas of common
professional knowledge and experience and then worked together through patient
cases as a team (weeks 2-5).4 A survey of the student participants
found that there was a significant increase in students’ appreciation of each
profession’s scopes, roles, and values.
Moreover, participants had a stronger belief that collaboration was important
to achieve the best patient care outcomes. Another study involved a yearlong
structured program with nursing and PhD psychology students. Qualitative data revealed
that participants had increased clarity of each others’ roles, approaches, and
resources as well as how to collaborate in practice.5
So how can we make interprofessional education
throughout the curriculum a reality? The
first step is to create a common vision
of interprofessional development. On campuses where there are multiple
health care professional schools, representatives from each school must meet
and create a shared vision as part of their respective schools’ goals. Then, formation of an interprofessional education
committee is necessary to turn ideas into action. Committee members should
consist of members of each of the health professional schools and led by a
dedicated full-time champion (most often a professor who cares deeply about
interprofessional collaboration). The committee should meet at regular
intervals for continuous program improvement. The next step, and perhaps the
most time intensive, is curriculum
development, requiring the interprofessional education committee to work
with the individual schools to align the curriculums. Last, but certainly not
least, is teaching professors how to
deliver instruction in a interprofessional manner. To achieve this, an active
learning approach should be used. For example, East Carolina University’s Rural
Health Training Program has an interprofessional preceptor development course
that consists of several meetings and cases taught over multiple, highly
interactive sessions.6
Interprofessional education in the classroom will
never be a reality unless we make an effort to address professional-centrism,
create a shared vision, and develop a plan.
There’s lots of work that needs to be done. Let’s get started … now.
References
- Formicola AJ, Andrieu SC, Buchanan JA, et al. Interprofessional education in U.S. and Canadian dental schools: an ADEA Team Study Group report. J Dent Educ. 2012 Sep;76(9):1250-68.
- Pecukonis E. Interprofessional education: a theoretical orientation incorporating profession-centrism and social identity theory. J Law Med Ethics. 2014 Dec;42 Suppl 2:60-4.
- Davies ML, Schonder KS, Meyer SM, et al. Changes in Student Performance and Confidence with a Standardized Patient and Standardized Colleague Interprofessional Activity. Am J Pharm Educ. 2015 Jun 25;79(5):69.
- Pinto A, Lee S, Lombardo S, et al. The Impact of Structured Inter-professional Education on Health Care Professional Students' Perceptions of Collaboration in a Clinical Setting. Physiother Can. 2012 Spring; 64(2): 145–156.
- Priest HM, Roberts P, Dent H, et al. Interprofessional education and working in mental health: in search of the evidence base. J Nurs Manag. 2008 May;16(4):474-85.
- World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice. Health Professions Network Nursing and Midwifery Office. 2010: 9-41.
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