Attitudes toward Healthcare Teamwork between Osteopathic Medical Students in an Interprofessional or Intraprofessional Clinical Education Program

The past decade witnessed momentum toward redesigning the U.S. health care system with the intent to improve quality of care. To achieve and sustain this change, health professions education must likewise reform to prepare future practitioners to optimize their ability to participate in the new paradigm of health care delivery. Recognizing that interprofessional education (IPE) is gaining momentum as a crucial aspect of health care professions training, this article provides an introduction to IPE programs from three different academic health centers, which were developed and implemented to train health care practitioners who provide patient-centered, collaborative care. The three participating programs are briefly described, as well as the processes and some lessons learned that were critical in the process of adopting IPE programs in their respective institutions. Critical aspects of each program are described to allow comparison of the critical building blocks for developing an IPE program. Among those building blocks, the authors present information on the planning processes of the different institutions, the competencies that each program aims to instill in the graduates, the snapshot of the three curricular models, and the assessment strategies used by each institution. The authors conclude by providing details that may provide insight for academic institutions considering implementation of IPE programs.

Erratum

Negotiating challenges in community-based interprofessional education programs

Celebrating the Culture of Interprofessional Collaboration in Athletic Training

The effectiveness of interprofessional education in university based health professional programs: A systematic review

The effectiveness of interprofessional education in university based health professional programs: A systematic review.

Interprofessional Education: Fad or Imperative

Pursuing Excellence: Innovations in Designing an Interprofessional Clinical Learning Environment.

Framing the Future: Exploring Inter-Professional Education and Practice in an Undergraduate Course

Evidence-based practice collectively involves research evidence, clinician expertise, and patient preference while making health care decisions. Due to health care reform legislation, there is grea...

East Tennessee State University James H. Quillen College of Medicine.

In recent years, a number of historians of nursing and have asked whether our field might more appropriately and inclusively be renamed the history of health care.1 To outsiders, history of medicine appears to reinforce conceptual and professional silos that have historically privileged the role of physicians, Western medicine, and disease over more integrative accounts of caregiving, diverse epistemologies of healing, and health. Today, the mantra that interprofessional education and practice are the future of health care offers an explicit invitation to move beyond the disciplinary and professional silos often replicated in our approach to health-care history. While nurse-physician relationships have received considerable attention from historians, this section expands on that base to explore the history of the development of interprofessional education and practice more broadly.Five of the seven papers in this special section were presented at a lunch session on the history of interprofessional education and practice at the annual meeting of the American Association for the History of Medicine (AAHM) in 2014. As the authors document, the concepts of teamwork and interprofessionalism are not new, although, as Julie Fairman points out, the term interprofessional is of more recent coinage. The case studies here help establish the range of precedents and the varied contexts across the twentieth century for both informal learning and working together and more formal interprofessional teams that arose in response to the efficient organization of care, workforce issues, and demands for health-care delivery. This timeline departs from the tendency of practitioners to locate interprofessionalism primarily as a post-World War II movement best characterized by the development of advanced practice nursing, physician assistant programs, and specialized units and teams in hospitals.2 Taken together, and supplemented by the lively discussion at the AAHM session, these articles elucidate key themes emerging from the historical examples of interprofessional education and practice and suggest an agenda for further exploration.Inherent in the appeals for interprofessional education and practice, as Fairman notes, is the assumption that changes in education and practice will be a magic bullet producing new epistemologies and increasing quality of care. This must be disaggregated into more specific questions about what interdisciplinarity and interprofessionalism mean in practice. Are there problems that require a particular combination of knowledge and skill that cannot be solved any other way, such as the physiology and diet research questions posed by Ancel Key's Laboratory of Physiological Hygiene or the treatment decisions that benefit from bringing together pharmacists and clinicians at the bedside? To what extent must members of health-care teams master the knowledge base of the other professions represented, as exemplified by the clinical pharmacist curriculum and training for nurses in a range of medical skill sets as preparation for team practice? Can interprofessional teams function purely with the combination of individual professional expertise, on the model of rehabilitation? Where and why are new hybrid professions like nurse practitioners and physician assistants required? Is there a secondary implication that interprofessional practice will also be more holistic or ecological in its approach? Daniel Brauner's article on the cardiac arrest protocol suggests that interprofessional teamwork in the hospital can also produce greater biomedical reductionism, running against the trend toward holism fostered by interprofessional teams for family and community-based patient care.The articles also engage the reciprocal, shaping relationship between interprofessional practice and sites of care-the containers for health-care delivery. Beth Linker discusses the spread of rehabilitation units in hospitals, and Jennifer Gunn looks at the rise of community health centers, as an alternative to rural hospitals, designed to accommodate the need for a different interprofessional mix in the face of scarce physician labor. …

Interprofessional Collaboration: How Audiologists Contribute to Population Health

Interprofessional Education (IPE) is a goal many of us in academic medicine strive for, but the true outcome of training in a way that transcends disciplinary boundaries, both in the classroom and in in clinical environments, remains a challenge. ADFM held a webinar in September to address critical challenges of executing IPE, including: stakeholder buy-in; curriculum development; venues for teaching; financing; relationship management; defining roles and responsibilities of learners and teachers; and interface with regulatory bodies. The roughly 30 webinar participants were equally split among family medicine department chairs, family medicine department administrators, family medicine faculty, and individuals in other academic roles. The majority (62%) were from allopathic medical schools, with another 15% each from Large Regional Medical Centers or “other” settings, and the final 8% from academic health center residency programs. The vast majority (91%) had IPE as part of the curriculum with the majority of these experiences noted as a combination of elective and required. Over three-quarters of participants reported that they were directly involved in IPE at their home institutions. The webinar was moderated by Denise Rodgers, MD, Vice Chancellor for Interprofessional Programs at Rutgers Biomedical and Health Science, and featured innovative IPE case studies from 4 institutions, presented by professionals representing family medicine, pharmacy, and nursing: Christine Arenson, MD and Christine Jerpbak, MD, Sidney Kimmel Medical College, Thomas Jefferson University; Brian Prestwich, MD, Keck School of Medicine of University of Southern California; Dan Mickool, MS, RPh, University of New England; Carolyn Rutledge, PhD, FNP-BC, Old Dominion University. In addition to addressing the common list of challenges, each presenter described the numbers and types of students and residents participating in the IPE, as well as the number and types of educational offerings, and whether they are required or elective. The individual presentations were prepared according to a standard template and a list of resources was developed. These resources and presentations, as well as a video of the webinar, can be found on the ADFM website at: http://www.adfammed.org/Members/Webinarsresources. On the website, the webinar reached far more than just the real-time participants, with over 150 “unique” visitors during the 2 weeks following the webinar, many of whom visited the site multiple times. Participants’ questions during the course of the presentations pertained to the following issues: (1) financial stability and sustainability; (2) students/learners as “change agents” and the notion that they “eat this up”; (3) using real clinical sites for learning as opposed to simulation; (4) taking advantage of opportunities in IPE for scholarship and telehealth/distance learning; (5) leadership development and teaching learners what it means to work as a team, not just to form teams; (6) addressing professional biases about hierarchy on teams; (7) logistical challenges of scheduling with physical distances between learners’ professional schools (one area where distance learning can be very helpful); and (8) tools for assessing teamwork. Dr. Rodgers summarized several important points for everyone moving towards IPE within their own institutions. First, the biggest issue confronting IPE is financial support and sustainability, as creating a stable and effective program is resource intensive. Grants are an important source of funding, but we need to consider whether programs can be sustainable when grant funds are gone—and need to figure out ways to bring in IPE innovations that are cost- and time-effective. Second, ensure that IPE is seen as critical in a number of clinical settings, not just ambulatory care. Including IPE in the inpatient setting is extremely important, although it may be the most difficult to carry out. Third, there are research questions we should be addressing in our work around IPE. How much IPE is enough? At what point do we introduce IPE so that students’ appreciation for working as members of a team is maintained throughout their clinical careers? How will we measure whether or not our interventions on the educational side mattered? How do we overcome the logistical challenges? Which IPE experiences are best? Finally, Dr. Rodgers noted that moving students into hospital settings where they see less-than-ideal examples of interprofessional communication and collaboration undermines the education received on the importance of working in interprofessional teams and how to be collaborative across professions. Although we are beginning to see some evidence that the introduction of IPE into an institution may actually cause the faculty and the clinicians to look at how well they are collaborating interprofessionally in their own clinical practices, a larger question remains about how raising student expectations about team performance may influence those who are teaching them to perform better as members of teams. More broadly, this also raises the issue of the integration of interprofessional practice, both its importance and the “how.” ADFM plans to hold a follow-up webinar in the spring focusing on the issues around interprofessional practice.

So Long, Silos