Aug. 1, 2013
A collaborative approach: VCU leads the way in teaching a team-based practice of medicine
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While recovering from recent surgery, the man lying in the hospital bed took a sudden turn for the worse. His vitals were crashing and he began coding. His health care team sprang into action. A team leader assessed the situation, flipped open the patient’s chart and read aloud background information. She began to advise her team – a physician, two nurses, a care partner and a resident – what needed to happen next.
They mobilized and swiftly followed her lead, calling out medication doses and what they were doing as they were doing it. The efforts paid off, as the man – actually, a fully wireless, portable patient simulator that closely mimics the anatomical workings of the human body – started to stabilize.
The teammates – fourth-year students from the VCU schools of medicine and nursing – had just wrapped the fourth scenario in a series of eight simulator-driven situations that were part of an interprofessional education course, a new addition now being included in the curriculum of the health care schools at VCU.
After each scenario, the team had an opportunity to discuss their actions with each other and a faculty member who observed their interaction. With each subsequent scenario, there was marked improvement in communication and greater structure to how they performed their tasks and care for the patient.
VCU is among the leaders in interprofessional education – a growing trend used in the training of future generations of health care professionals. With little or limited opportunities to work together while still in school, many of these students would only have their first interaction with other health care disciplines on the first day on the job – with real patients.
Interprofessional education is designed to get multiple health care professions working as a team and communicating effectively. Many people may not realize that it takes the expertise of many different disciplines – physicians, nurses, pharmacists, care providers, technicians and more – to come together and care for a single patient. Each one of these experts needs to be on the same page and in agreement.
“Traditionally, with health care education, we’ve trained individual disciplines separately and expected them to come together as a team once they are taking care of patients,” said Alan Dow, M.D., assistant vice president of VCU Health Sciences’ Center for Interprofessional Education and Collaborative Care, and associate professor in the Department of Internal Medicine in the VCU School of Medicine.
“What we are trying to do is take the idea of working together as a team and bring it back into the classroom – into the safe areas like simulation where we can teach people how to work together as a team,” he said.
Dow, a 2011 Macy Faculty Scholar, is leading a research project through support from the Josiah Macy Jr. Foundation to examine how increased collaboration among health professionals can improve patient care and how to teach team-based competencies that foster effective interprofessional practice. Dow is in the process of creating an interprofessional curriculum that other institutions can use, providing them with a toolkit for instruction and assessment to ensure successful adoption.
“At VCU, we’ve done small forms of interprofessional education projects for many years, but this is the first time we’ve really committed as a campus to doing large-scale interprofessional education where we’re bringing together whole classes of learners to do various activities such as patient simulation or managing virtual patients,” Dow said.
In 2013, the School of Medicine will be unveiling a newly designed curriculum that will launch a new standard in medical education.
“A key element in the new curriculum will be from day one, students working together in teams,” said Isaac K. Wood, M.D., senior associate dean for medical education and student affairs in the VCU School of Medicine.
“They will learn in teams, teach each other in teams and evaluate team performance as this will be the cornerstone of how they function the remainder of their professional lives. Essential to this is functioning in interdisciplinary teams. Training students early on to cross-cultivate backgrounds, knowledge and skills is essential to assuring the highest and safest quality of patient care.”
According to Dow, some of the communication tools they are training students to employ in the health care setting are derived from military and aviation training. This includes the SBAR – Situation, Background, Assessment, Recommendation; and Repeat-Backs/Call-outs, which are ideas of how people transfer information so that they understand as a group what’s happening with a patient and how they need to move forward to take care of that patient.
Lauren Cranfill, a student in the VCU School of Nursing, participated in the once-a-week, two-week interprofessional education course and feels she has benefited from the interaction with fellow health care students considerably.
“It was a lot of effective communication and calling-back,” said Cranfill, who graduates in December.
“You make sure that everyone around you is aware of what is going on so that the patient as a whole is taken care of, and everyone is clear (with what is going on),” she said. “I feel that now, in a code situation, I will not feel afraid or shy of interacting with anyone – med students, doctors etc.”
Dow said that another advantage to improving communications is that it helps students learn to look at the patient more actively. Many times, doctors, nurses and techs are more focused at all the data – the monitors, the patient’s test results – and less on the patient. So this way of learning also forces these students to look at the patient and assess their needs.
Additionally, the debriefing session provides further feedback and can help students learn by going back through how they handled the situation. It allows them to identify areas to improve on and provides reinforcement for positively managed situations.
Jean Ellen Zavertnik, clinical assistant professor in the VCU School of Nursing and one of the faculty members leading the interprofessional education program efforts, said interprofessional education provides an element of cross-training where students can get an idea of what other disciplines do before they experience it in the field.
“For example, while medical students and nursing students may focus differently on patient care processes – each is integral to taking care of a patient,” said Zavertnik.
“If we put our heads together, it can really impact the outcome for our patients – and that really is the bottom line – what can we do to improve quality patient outcomes.”
According to Zavertnik, another benefit of communication and interaction between the disciplines in a simulated “safe” environment is to lessen communication barriers and perceptions of how students see each other. Initially, she said, students of one discipline may be intimidated by students of another discipline. But if they have exposure to each other early in the learning process, they can learn how to work together and have an understanding of what needs to take place to care for a patient.
Cranfill and her classmates believe interprofessional education will go a long way.
“I think the more experience we can have with this the better, because the reality of it is that we are going to be working in teams and we’ll be working with other disciplines,” Cranfill said. “The more practice we have the better for the patient.”
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