Twenty-first century physicians must successfully function in a health care environment that capitalizes on the resources of teams to deliver patient care. Improvements in quality, reduction in cost, optimization of efficiency and ultimately achieving the best possible patient outcomes and safety all depend on highly effective and smoothly functioning teams. Physicians-in-training are at an ideal teachable moment in their professional development to understand and master these team communication skills.
At UPSOM, the approach to interprofessional and team education is to incorporate this as a longitudinal curriculum theme where there is a progressive build and reinforcement throughout the four years. Students develop these skills through a spectrum of clinical and non-clinical experiences, each contributing to their personal development. Within this domain is also the development of leadership skills which includes both the ability to lead and the ability to function well with a leader.
Help all students develop the skills and behaviors necessary to function well within and to lead professional and interprofessional teams.
The following are a sample of the curricular experiences in interprofessional and team education.
Since it was initiated in 2008, this annual half-day experience provides students from all University of Pittsburgh Health Sciences Schools, including all first year medical students, the opportunity to learn together about the essential and fundamental importance of interprofessional healthcare delivery. After observing a patient interview, students heard from a diverse panel of health sciences deans about the opportunities for improved patient care and interprofessional communication that were revealed. Students were then charged to develop their own proposals for improving interprofessional education at the University of Pittsburgh as part of an annual prize competition for curricular development in this domain.
Medical students necessarily are assimilated into interprofessional teams in a variety of care settings as part of the clinical experience. For example, the anesthesia and surgical faculty serve as superb and continuous models of how physicians may interact with a multi-disciplinary team as nurses, technicians, perfusionists and a broad range of support staff come together in the complex environments of the peri-operative and surgical suite.
All students also have at least two week's experience in emergency department care as part of the Specialty Care Clerkship. Students are immersed in an environment that depends on synchrony among all members in the chain of health care delivery, beginning in the pre-hospital setting and extending all the way to the inpatient ward, as for example the trauma team. Here, students come to learn how the contributions of all of the trauma team members from various medical, surgical, nursing, imaging and laboratory departments converge to deliver the best possible care with the greatest rapidity and clear communication. They also have an opportunity to observe the dynamic nature of these highly functioning teams as leadership roles are often quite fluid with the arrival and departure of various clinical specialists to the trauma resuscitation suite.
Students are exposed to a range of interprofessional teams during the Clinical Experiences Course, a required course for first- and -second year students. Students often rotate in clinical settings that are primarily staffed by physician extenders and other health professionals. Medical students, as physicians-in-training, are well served to recognize that the majority of patient benefit in these settings is delivered by someone other than the physician. This provides an irreplaceable opportunity for modeling how they may function well as part of interprofessional teams, and a glimpse of how a large portion of health care will necessarily be delivered looking to the future.
All third-year medical students join with nursing and pharmacy students for this week-long course that consists of didactic, small group, and nursing home experiences that highlight the interdisciplinary nature of patient care and the special contributions each profession provides to high-quality patient care.
As a component of the Pre-Clerkship Course that marks the transition from the pre-clinical to clerkship years, all rising third-year students participate in a curriculum on disaster preparedness, including preparation for a possible pandemic. Part of that disaster curriculum is a pandemic avian influenza hospital simulation exercise. This unique simulation exercise provides teams of medical students with an opportunity to treat overwhelming numbers of influenza patients in a mock hospital setting. When students assume the working roles of nurse, nursing assistant, and physician, they immediately gain insight into two subjects that are difficult to teach: 1) the potentially overwhelming nature of an infectious pandemic; and 2) the vital importance of teamwork, cooperation, interdisciplinary respect, and leadership in healthcare endeavors. Students readily gain appreciation for the essential roles of every member of the healthcare team in a manner that cannot easily be replicated in everyday experiences.
This fourth-year elective brings together advanced-level students in medicine, nursing, pharmacy and social work to learn about and practice team-based care, in clinical settings. A combination of small group discussions, problem-solving sessions and clinical care provides a rich experience where students come to appreciate the complexities of how interprofessional teams function and how to make this functioning ever more successful.
The University of Pittsburgh has recently developed a student chapter of the Institute for Healthcare Improvement’s Open School and already has a very active membership that includes students from all of the healthcare professions. In 2010, for the first time, a team of four students entered the CLARION competition, a national contest analyzing the root cause of a poor patient outcome and presenting their findings. The dedicated team members won the competition and garnered an automatic invitation for the University to the 2011 competition. First-year students are encouraged to apply for the summer interprofessional Patient Safety/Quality Improvement Fellowship sponsored by the Jewish Healthcare Foundation.