Education for the Emergency Room
When health-professions graduates get into hospitals or other clinical settings as doctors, nurses, pharmacists or other medical workers, they are thrust into situations where they must work as teams. Yet despite widespread agreement that students in all medical fields should be trained in a set of common, basic skills to help them work together, they are still often educated in silos.
On Tuesday, experts from the different fields insisted that period is coming to a close with what they say is “landmark” new progress on the issue.
What’s different this time, they said, is that the effort has gotten buy-in from key parties in academe, medical professionals, the federal government and philanthropists. “We’re really all on the same page,” Carol A. Aschenbrener, executive vice president of the Association of American Medical Colleges, said during a news conference Tuesday. While calls for better interprofessional education have been on the radar of the AAMC since at least 1965, according to a new report, it has caught on among more of the professions in the last decade or so. “This time our call to meaningful interprofessional education has much more fertile soil.”
The press conference coincided with the release Tuesday of two reports that aim to get the ball rolling. The first identifies the core competencies that a handful of major groups of medical educators agree students should have in order to work effectively across the medical professions. The skills were selected by officials of the six groups that make up the Interprofessional Education Collaborative (IPEC): the AAMC; the American Dental Education Association; the Association of Schools of Public Health; and the American Associations of Colleges of Nursing, Pharmacy, and Osteopathic Medicine.
The second report, on team-based competencies, came out of a February conference at which 80 or so leaders from the various health professions considered the core competencies and explored strategies to implement them in health professional education and medical care. (That conference was sponsored by three private groups, the Josiah Macy Jr. Foundation, the American Board of Internal Medicine Foundation, and the Robert Wood Johnson Foundation.)
The development of this common language was the first step to interprofessional education for "all health-profession students,” Aschenbrener said. The next step begins this morning, when the groups reconvene to discuss ways to encourage the dissemination and adoption of this agenda.
Teams of providers not only bring more collective knowledge to the table, they also are better equipped to handle the realities of everyday practice, the report on team-based skills says. “Nursing, medical and other health professions schools typically still educate students separately in courses and classrooms, often on campuses that aren’t even close to each other. Few students have an opportunity to work together in either the classroom or clinical settings. After graduation, however, most are thrown into complex clinical situations and expected to function as part of the team,” the report says. “Nor are most students being taught how to manage patients with multiple complex chronic conditions, ensure patient safety or engage patients in shared decision making. Educational curriculums have not been updated to reflect these and other changes in everyday practice.” George E. Thibault, president of the Macy Foundation, also said in that report, “The health care system will not be able to keep pace with these explosive changes unless it moves to a team-based care model. But the delivery system cannot make that shift effectively until the education system begins to train new health professionals in collaborative practice.”
The IPEC panel identified four “competency domains” in which all health professionals should be fluent: values and ethics for interprofessional practice, roles and responsibilities, interprofessional communication, and teams and teamwork. Within those domains are 38 behavioral “sub-competencies,” which include placing the interests of patients and populations at the center of interprofessional health care delivery; communicating one’s roles and responsibilities clearly to patients, families and other professionals; choosing effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function; and describing the process of team development and the roles and practices of effective teams.
To advance interprofessional collaboration in education and practice, and promote the core competencies identified in the IPEC report, the conference attendees created five “action strategies": communicate and disseminate the core competencies; develop interprofessional faculty and resources; strengthen metrics and research; develop new collaborative academic practices and new collaborations with community learning sites; and advance policy changes.
Medical education is undoubtedly in flux, and potential solutions to an evolving profession have ranged from personalized degrees to outcome-based competence measurement. But one component that’s always part of the conversation is training students across professions to work together.
A number of factors are making collaborations between professions more important than ever, the conference report says; among them are health care work force shortages, shifting technology, the 32 million additional people who bear a potentially high disease burden and will soon be insured under the Affordable Care Act, and an aging population with multiple chronic illnesses.
“In its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine called on academic institutions to begin educating health professionals to work collaboratively. A decade later, this has yet to happen on a significant scale,” the report says. “Most experts, including the conference sponsors and the IPEC panel, believe that in order to deliver high-quality, safe and efficient care, and meet the public’s increasingly complex health care needs, the educational experience must shift from one in which health profession students are educated in silos to one that fosters collaboration, communication and a team approach to providing care. The goal of the conference was to energize leaders to pave the way for a future in which interprofessional health teams will provide care that leads to better health outcomes, improved patient experiences of care, improved efficiency and increased job satisfaction for health professionals.”
The panelists said there is “an explosion of interprofessional activities occurring across the nation,” but cautioned against putting too much confidence in that. What’s still needed is more institutional commitment, they said. “There is a lack of top administrative leadership support for adequate resources to create an interprofessional component to health professions students’ education,” according to the core competency report. “In institutions that implement systematic programs of interprofessional education top leadership support has been critical.”
Nonetheless, there are pockets of progress all over. That report also highlighted the work that some universities are doing to address this issue. Institution-level programs are being implemented with top administrative support at the University of Minnesota, Western University of Health Sciences, and the Medical University of South Carolina, which chose interprofessional education as a topic for a 10-year quality enhancement plan required for re-accreditation.
Another challenge institutions face is cohesive scheduling allowing them to bring students together across the professions; as a solution, the University of California at San Francisco and Rosalind Franklin University in Illinois have shifted to a common calendar across their various medical education programs. Faculty development is also an issue because the content and process differs from the usual work, but South Carolina, Western University of Health Sciences and the University of Toronto have addressed that problem, the report says, with programs and guidelines for tenure and teaching that develop, support and encourage interprofessional education.
Evidence shows that health care is better when it’s delivered in teams, and educators and practitioners need to move in that direction, Thibault said at the press conference. “We know that can happen and we’re beginning to see it happening,” he said. “The movement has started and this is a way to accelerate the movement…. We believe that it’s only in this way that we’ll fulfill our promise to the public.”
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