Interprofessional Education At
DGSOM
Margaret L. Stuber, MD
MEC October 10, 2012
Not a new topic
• Two World Health Organization reports in
1988, “Continuing education for Physicians”
and “Learning Together to Work Together for
Health”.
• “Health Professionals learning from, with and
about one another”
• Thistlethwaite J. Med Educ 2012 46 (1) 58-70
Institute of Medicine report
• 2001 Crossing the Quality Chasm: A New
Health System for the 21st Century
• “All health care professionals should be
educated to deliver patient-centered care as
members of an interdisciplinary team,
emphasizing evidence-based practice, quality
improvement approaches, and information.”
Follow-up IOM report
• Health Professions Education: A Bridge to
Quality proposed core competencies for all
clinicians, regardless of discipline, including
“Work in interdisciplinary teams: cooperate,
collaborate, communicate, and integrate care
in teams to ensure that care is continuous and
reliable.”
Changing healthcare
• Shortages and high cost of doctoral level
providers
• Training of new “mid-level” providers ( dental
therapists, physician assistants)
• Concept of a medical home
• Move to HMO structure
Changing accreditation standards
• Medicine
• Nursing
• Dentistry
Current impetus for the topic
• 2011 publication of a pamphlet jointly by the
national professional educational organizations of
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Dentistry
Medicine (allopathic)
Medicine (osteopathic)
Nursing
Pharmacy
Public Health
“Core competencies for Interprofessional Collaborative Practice” sponsored by the
Interprofessional Education Collaborative.
Proposed Competency Domains
• Competency Domain 1: Values/Ethics for
Interprofessional Practice
• Competency Domain 2: Roles/
Responsibilities
• Competency Domain 3: Interprofessional
Communication
• Competency Domain 4: Teams and Teamwork
Values/Ethics for
Interprofessional Practice
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Place the interests of patients and populations at the center of interprofessional health
care delivery.
Respect the dignity and privacy of patients while maintaining confidentiality in the delivery
of team-based care.
Embrace the cultural diversity and individual differences that characterize patients,
populations, and the health care team.
Respect the unique cultures, values, roles/responsibilities, and expertise of other health
professions.
Work in cooperation with those who receive care, those who provide care, and others who
contribute to or support the delivery of prevention and health services.
Develop a trusting relationship with patients, families, and other team members (CIHC,
2010).
Demonstrate high standards of ethical conduct and quality of care in one’s contributions to
team-based care.
Manage ethical dilemmas specific to interprofessional patient/ population centered care
situations.
Act with honesty and integrity in relationships with patients, families, and other team
members.
Maintain competence in one’s own profession appropriate to scope of practice
Roles/Responsibilities
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Communicate one’s roles and responsibilities clearly to patients, families, and other
professionals.
Recognize one’s limitations in skills, knowledge, and abilities.
Engage diverse healthcare professionals who complement one’s own professional
expertise, as well as associated resources, to develop strategies to meet specific patient
care needs.
Explain the roles and responsibilities of other care providers and how the team works
together to provide care.
Use the full scope of knowledge, skills, and abilities of available health professionals and
healthcare workers to provide care that is safe, timely, efficient, effective, and equitable.
Communicate with team members to clarify each member’s responsibility in executing
components of a treatment plan or public health intervention.
Forge interdependent relationships with other professions to improve care and advance
learning.
Engage in continuous professional and interprofessional development to enhance team
performance.
Use unique and complementary abilities of all members of the team to optimize patient
care.
Interprofessional communication
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Choose effective communication tools and techniques, including information systems and
communication technologies, to facilitate discussions and interactions that enhance team
function.
Organize and communicate information with patients, families, and healthcare team
members in a form that is understandable, avoiding discipline-specific terminology when
possible.
Express one’s knowledge and opinions to team members involved in patient care with
confidence, clarity, and respect, working to ensure common understanding of information
and treatment and care decisions.
Listen actively, and encourage ideas and opinions of other team members.
Give timely, sensitive, instructive feedback to others about their performance on the team,
responding respectfully as a team member to feedback from others.
Use respectful language appropriate for a given difficult situation, crucial conversation, or
interprofessional conflict.
Recognize how one’s own uniqueness, including experience level, expertise, culture, power,
and hierarchy within the healthcare team, contributes to effective communication, conflict
resolution, and positive interprofessional working relationships (University of Toronto,
2008).
Communicate consistently the importance of teamwork in patient-centered
Teams and teamwork
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Describe the process of team development and the roles and practices of effective teams.
Develop consensus on the ethical principles to guide all aspects of patient care and team
work.
Engage other health professionals—appropriate to the specific care situation—in shared
patient-centered problem-solving.
Integrate the knowledge and experience of other professions— appropriate to the specific
care situation—to inform care decisions, while respecting patient and community values
and priorities/ preferences for care.
Apply leadership practices that support collaborative practice and team effectiveness.
Engage self and others to constructively manage disagreements about values, roles, goals,
and actions that arise among healthcare professionals and with patients and families.
Share accountability with other professions, patients, and communities for outcomes
relevant to prevention and health care.
Reflect on individual and team performance for individual, as well as team, performance
improvement.
Use process improvement strategies to increase the effectiveness of interprofessional
teamwork and team-based care.
Use available evidence to inform effective teamwork and team-based practices.
Perform effectively on teams and in different team roles in a variety
Modalities used
• Service learning, such as in free clinics
(University of Connecticut)
• Practice learning, using simulation
• (University of Washington)
• Case studies and team-based learning
(Jefferson Health Mentors program)
• Ongoing small group seminar
• (DGSOM at UCLA)
What have we done at UCLA?
• 2007-2008: Leadership meetings of the
schools of nursing and medicine
• 2009: Pilot with two nursing faculty and a few
advanced practice nursing students as elective
• 2010: Required participation of one class (20)
of advanced practice nursing students
• 2011: Elective participation of 9 advanced
practice nursing students
This year
• All (28) second year acute care nursing
students are required to participate in three
quarters of small-group Systems Based
Healthcare class
• Six School of Nursing faculty serve as small
group tutors for the course
Structure of the course
• Meets for 3 hours on Tuesday or Thursday
morning
• Sessions are once or twice a month,
September through June
• Small groups are made of 7 to 9 students and
two tutors
• Tutors are from different disciplines, including
medicine, nursing, psychology and social work
Content of the course
• Focus is on topics which are encountered in a
clinical setting but often not discussed
• Fulfill numerous graduation requirements
• Examples
– Medical error
– Conflict of interest
– Bias and assumptions
– Death and dying
Process of course
• Students each are assigned an article to read
and report on for the group
• Students each write a reflection on the topic
of the week and share this with the group
• One of the students facilitates the group
• Discussion, including polite disagreement, is
encouraged
• Students also use group for a home base
Obstacles
• SON and SOM are on different calendars,
including start dates, vacations, and end dates
• Evaluation systems are on different platforms
• This is part-time school for nursing students,
full-time for medical students
• Nursing students often live very far away
Discoveries
• Medical students and faculty did not know
what advanced practice nurses did, how they
were trained, or their scope of practice
• Medical students felt uneasy about roles and
boundaries, such as between nurse
anesthetist and anesthesiologist
• Nursing students were surprised that medical
students could be nice and not arrogant
Modifications
• Need to be clear that this is learning for both
groups, not just for medical students to learn
from nursing students
• Emphasize the commonalities, such as being
under constant scrutiny and feeling
incompetent after having been competent
• Address age and experience differences
• Emphasize the developmental stage of taking
on a new role and responsibility
Plans
• Try to see if this types of year-long interaction
changes behavior on the wards using
observation and 360 degree evaluation
• Use a simulation to test out how they respond
to work within a team
• Develop new instruments, e.g. Intrinsic
Association Test
What might be done in dentistry?
• Could coordinate with schools of public health, nursing,
medicine ( no pharmacy or PA school s at UCLA)
• Could do service learning together
• Could do simulations together
• Could participate in seminars
• Could coordinate a day on integrated care
• Connecting Dental Education to Other Health Professions
Michael C. Alfano, D.M.D., Ph.D., J of Dental Education, 2012
Questions?