Education For Interprofessional Teamwork: Times Have Changed

Nursing school dean and PCP advisory board member is encouraged to see a movement towards interprofessional education for health professionals students. At PCP, we love to see students of all the health care professions learning together, and we want to see it at every training institution. It's that kind of change that The Primary Care Project supports. Read Dr. Tilden's story, then take the pledge!

By Virginia Tilden, Ph.D., R.N.

It’s been a long time since I was a baccalaureate nursing student at Georgetown University in Washington, D.C., but my memory is sharp about this fact: nothing in our curriculum taught us to work as an interprofessional team.  In 1967, the year I graduated, nursing was a rigid, rule-based discipline driven as much by hospital policy and faculty dogma as by scientific evidence. And, just like medicine, it was siloed by its own knowledge, traditions, and truths.  Even back then it struck me as odd that we nursing students and fellow medical students cared for the same patients when barely a word passed between us. Further, our faculty seemed unaware of each other, as though the two professions operated in parallel universes with almost private and separate languages about the very same patients for whom we jointly cared.

A lot has changed in 45 years, and I’m so glad to have been a witness and a driver of this change, both in my career in academic nursing and as dean of a nursing school.  At academic health sciences universities and colleges across the country, the clamor for interprofessional education (IPE) for team-based care has grown loud – borne of the wave of quality and safety improvement that followed the IOM’s reports of the quality chasm in American health care. Study after study on the root cause of medical errors has implicated the same core demon: poor communication and failures in teamwork within and across the health professions that care for the patient and family.

A recent major accomplishment has been the consensus from six major US education organizations, representing the professions of dentistry (ADEA), allopathic medicine (AAMC), osteopathic medicine (AACOM), nursing (AACN), pharmacy (AACP), and public health (ASPH), on core competencies for interprofessional collaborative practice. These competencies are being translated into learning activities at universities across the country, aimed at reducing the persistent stereotypes students carry about each other and enhancing appreciation for the knowledge, skills, and perspectives each profession contributes to the care of patients in a seamless and coordinated plan of care.  The University of Minnesota has become the national coordinating center charged with accelerating the pace of interprofessional education nationwide. Other milestones include the AAMC’s creation of an IPE section of its MedEdPORTAL as a national clearinghouse to share interprofessional competency-based learning resources for health professions educators; and the AACN’s on-going sponsorship of IPE faculty development institutes.

Of course, in practice, IPE is difficult. Despite a strong trend nationally in the direction of integrated curricula for team training, fueled by program funding from foundations and federal agencies, the sticking points are well known to academic leaders. Entrenched curricula, inflexible accreditation standards, different academic calendars, threats to professional identity, and criteria for promotion and tenure that don’t reward faculty for collaboration – all slow the work of IPE. Nonetheless, most students today gain some experience in interprofessional teamwork, whether in simulation labs with computerized mannequins or in team huddles in community clinics.  But more must happen, and soon, if we are to supply the next generation of graduates with the communication, interpersonal, and professional skills they need to work together. The price of failure to change is the continued production of graduates seriously misaligned with the needs of the public they serve.

Fortunately, incentives for overcoming barriers are everywhere, not the least of which is the Affordable Care Act. Noting that nearly half of U.S. adults report that their health care providers fail to coordinate care, many tenets of the ACA put pressure on health system provider teams to improve care coordination.  And reducing unnecessary rehospitalizations, which is clearly dependent on interprofessional teams, is now an urgent financial concern for hospitals.

Primary care is an ideal learning environment to bring together students from multiple professions. Complex patients with multiple acute and chronic conditions, overlaid by social and behavioral challenges, lend the opportunity for trainees to see the contributions each profession makes to coordinated and effective care and to be part of a high-performing team. 

I was reminded what it’s like to be part of such a team at the 2011 invitational SGIM Patient-Centered Medical Home Education Summit. As always, experiential learning – in this case, my own – is more powerful than theoretical learning. At the summit, I found myself embedded in a small group of amazing thought-leaders in medicine and nursing, who struggled to define the characteristics of primary care practice that are most desirable for role-modeling effective teamwork to students.  We settled on a set of key behaviors of team members borrowed from Salas and Burke’s “Is there a ‘big five’ in teamwork?”: team leadership, collective orientation, mutual performance monitoring, backup behavior, and adaptability. Our team’s continued e-communication on this topic resulted in our presentation of a workshop at the 2011 Academic Internal Medicine Week, “Lessons from Geese: Teaching Teamwork in a Patient Centered Medical Home,” and publication of a scholarly paper, “There is no ‘I’ in a patient centered medical home: Defining teamwork competencies for academic practice,” forthcoming in Academic Medicine.

My point here is less about these products and more about my experience of the process of this team work. Nothing is quite as satisfying as being a respected and valued contributor to the worthy work of an interprofessional team aimed ultimately at improving the care of the patients we serve. This sense of collaboration on common goals and the exhilaration of achieving those goals is the payoff of IPE for students. The larger payoff, of course, is better care for patients.  As I said, times have changed.

Virginia P. Tilden, Ph.D., R.N., F.A.A.N., is dean and professor emerita at the University of Nebraska Medical Center College of Nursing and professor emerita at Oregon Health & Science University School of Nursing. She serves on PCP's National Advisory Board.

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Posted by Sonya Collins on Nov 19, 2013 9:16 AM US/Eastern
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