RESIDENT PORTFOLIO
Interprofessional Education and Collaboration: A Call to Action for Emergency Medicine
n the resident portfolio piece “Go Team!,” Drs. Bucher and Veysman shine a spotlight on the need for training in interprofessional education and collaborative practice. My fellow colleagues, we are being called to act. The time is now. Our institutions, our communities, our trainees, our nation, and most of all, our patients need us. “Why,” you ask? First, a challenge to the reader. Imagine a health professional separate from your own discipline. If you are a physician, imagine a nurse as an example. Now, describe to that person your understanding of his or her training and scope of practice, the values and ethics of his or her profession, and his or her education, to effectively communicate with your profession in the context of patient care. How well did you do? If only we could ask your hypothetical colleague! For the purposes of this commentary, I assume you were less than perfect. Now I ask you to reflect on a recent conflict between health professionals representing separate disciplines that you witnessed, caused, or resolved in your clinical setting. What was the root cause of that conflict? The answer . . . communication, lack of understanding of separate perspectives, lack of respect of the other’s opinion . . . or all of the above? Did this conflict have the potential to affect patient safety, patient satisfaction, and/or provider morale? These brief examples highlight our own lack of understanding of the other members of the health care team. Dr. Butcher, almost as if he knows many of our own experiences, emphasizes this beautifully when he writes: “When I started my residency, I did not realize just how vital, experienced, and capable our nurses are.” Colleagues, this phenomenon is prevalent, it is a function of our training, and it must change. Interprofessional education (IPE) occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.1 The core content of IPE and its methods for education lead to necessary knowledge, skills, and attitudes to produce a collaborative practice-ready workforce to address the health needs of the patients we serve. The health needs facing our nation are vast and include an aging population with increased disease complexity, widening health disparities, suboptimal health literacy, high prevalence of medical error despite a renewed focus on patient safety, and the yet-to-be-determined effects of the Affordable Care
I
© 2014 by the Society for Academic Emergency Medicine doi: 10.1111/acem.12404
Act. With the exception of a few examples, our education and health care systems operate within separate profession-specific silos. We are educated separately, for the most part, yet are paradoxically expected to function efficiently as a team when we assemble together to diagnose, treat, and educate our patients. This fragmentation stifles our ability to truly reach the triple aim goal articulated by the Institute for Health care Improvement (IHI).2 They charge that the method to optimize our health care education and delivery system is to: 1) improve the care of the patient, 2) improve the health of the population, and 3) decrease the cost of care. How well do you think we can meet that goal and address the needs of our patients using our current fragmented system of education and health care delivery? I assert that emergency medicine is the specialty best prepared to lead this reform. Why? Our keen perspective represents an asset to the health and education reform in our country. We appreciate the direct effects of collaborative practice on patient outcomes when it succeeds and when it fails. We create solutions when resources are limited. We innovate when others are tradition-dependent. We appreciate the continuum of education from undergraduate medical education to practice. And we understand, use, and teach evidence-based methodologies. A recent systematic review on the effect of IPE on professional practice and health care outcomes found that IPE produced positive outcomes in the following areas: diabetes care, collaborative team behavior in operating rooms, management of care delivered in cases of domestic violence, emergency department culture and patient satisfaction, collaborative team behavior, and reduction of clinical error rates for emergency department teams.3 Based on the growing body of evidence to support IPE across all health disciplines, it is now a required accreditation standard for multiple health disciplines as well as our own emergency medicine milestones.4 Now that we know “why” this is critical for our specialty to engage in IPE, let us discuss “how.” In May 2011, the Interprofessional Education Collaborative (IPEC) released the “Core Competencies for Interprofessional Collaborative Practice.”5 This joint effort, sponsored by the national organizations for allopathic medicine, osteopathic medicine, nursing, dentistry, public health, and pharmacy, used best-practices methodology to establish four IPE competency domains: 1) roles
ISSN 1069-6563 PII ISSN 1069-6563583
833 833
834
and responsibilities, 2) values and ethics, 3) effective communication, and 4) teamwork. These domains, and included subcompetencies, provide you as a clinical scientist a framework to guide curricular innovation and evaluation, scholarship dissemination, and faculty development. While the domains represent the foundational core content necessary to set the stage for IPE innovation, I assert that IPE is more of a teaching methodology compared to a specific content area. This perspective works to our advantage as a specialty. After you finish this article, I challenge you to list the content that is essential to our practice of emergency medicine that is also essential to another health profession. You will quickly realize that this list is very long. To mention just a few: resuscitation management, chronic pain management, death and dying, cultural competence, quality improvement and patient safety, professionalism, patient- and family-centered care, effective team-based communication, and transitions of care. Why are we all teaching the same content separately? We are the experts at efficiency, are we not? This represents a tremendous opportunity for leadership and development on the local, regional, and national levels. We are a creative and innovative specialty. Examine your own educational efforts, those of your department, and those within your health system. When content is applicable across professions, can you invite a representative to coteach with you and include learners from that other profession? When you are faced with the barrier of limited resources to create new initiatives, can you adapt your proposal for IPE to advocate for shared resources while satisfying accrediting standards across multiple professions? If you wish to improve the health outcomes for vulnerable populations and complex chronic conditions to decrease your department’s recidivism, can you involve other professions that share these goals while designing educational learning experiences for an IPE cohort of students? The answer is yes. How much more beneficial could this be for a promotion and tenure dossier, for your departmental bibliography, for future protected time negotiations, or for future extramural funding opportunities? But more importantly, how beneficial can this be to your day-to-day morale? How beneficial can this be to our future learners? But most importantly, we need to do this for our patients. Dr. Bucher learned to appreciate the importance and impact of when two disparate but very similar professions come to respect each other’s roles and responsibilities, values and ethics, effective communication, and principles of teamwork when he wrote: “Today, those
RESIDENT PORTFOLIO
nurses, who have watched me grow up on the job, are comfortable asking me, not the attending, to address problems with critical patients. They know that they can trust me to responsibly lead the team.” Colleagues, you do not have be an IPE expert to teach and model IPE. Read the IPE Core Competencies document to begin your own personal journey to better understand how you can adapt your expertise using IPE.5 You are being called to act. Use the innovative, creative, and scientific skills our specialty imparted on you to use IPE in a way to make the experience better for our patients, to improve the health of our population, and to decrease the cost of care. Dr. Bucher says it best when he states: “Sometimes, it is the small things that matter.” I could not agree more. Lee Wilbur, MD ([email protected]) Professor and Vice Chair Department of Emergency Medicine Director – Interprofessional Education; Division of Academic Affairs University of Arkansas for Medical Sciences Little Rock, AR Supervising Editor: Carey C. Chisholm, MD.
References 1. World Health Organization. Framework for Action on Interprofessional Education and Collaborative Practice. Available at: http://www.who.int/hrh/resources/ framework_action/en/. Accessed Jun26, 2014. 2. Institute for Healthcare Improvement. The IHI Triple Aim. Available at: http://www.ihi.org/engage/initi atives/TripleAim/Pages/default.aspx. Accessed Feb 28, 2014. 3. Reeves S, Perrier L, Goldman J, et al. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013;3:CD002213. 4. Beeson MS, Carter WA, Christopher TA, et al. Emergency medicine milestones. J Grad Med Educ 2013;1 (Suppl 1):5–13. 5. Interprofessional Education Collaborative. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Available at: http://nnlm.gov/bhic/2011/05/26/core-competenciesinterprofessional/. Accessed Feb 28, 2014.
Interprofessional Education and Collaboration: A Call to Action for Emergency Medicine
n the resident portfolio piece “Go Team!,” Drs. Bucher and Veysman shine a spotlight on the need for training in interprofessional education and collaborative practice. My fellow colleagues, we are being called to act. The time is now. Our institutions, our communities, our trainees, our nation, and most of all, our patients need us. “Why,” you ask? First, a challenge to the reader. Imagine a health professional separate from your own discipline. If you are a physician, imagine a nurse as an example. Now, describe to that person your understanding of his or her training and scope of practice, the values and ethics of his or her profession, and his or her education, to effectively communicate with your profession in the context of patient care. How well did you do? If only we could ask your hypothetical colleague! For the purposes of this commentary, I assume you were less than perfect. Now I ask you to reflect on a recent conflict between health professionals representing separate disciplines that you witnessed, caused, or resolved in your clinical setting. What was the root cause of that conflict? The answer . . . communication, lack of understanding of separate perspectives, lack of respect of the other’s opinion . . . or all of the above? Did this conflict have the potential to affect patient safety, patient satisfaction, and/or provider morale? These brief examples highlight our own lack of understanding of the other members of the health care team. Dr. Butcher, almost as if he knows many of our own experiences, emphasizes this beautifully when he writes: “When I started my residency, I did not realize just how vital, experienced, and capable our nurses are.” Colleagues, this phenomenon is prevalent, it is a function of our training, and it must change. Interprofessional education (IPE) occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.1 The core content of IPE and its methods for education lead to necessary knowledge, skills, and attitudes to produce a collaborative practice-ready workforce to address the health needs of the patients we serve. The health needs facing our nation are vast and include an aging population with increased disease complexity, widening health disparities, suboptimal health literacy, high prevalence of medical error despite a renewed focus on patient safety, and the yet-to-be-determined effects of the Affordable Care
I
© 2014 by the Society for Academic Emergency Medicine doi: 10.1111/acem.12404
Act. With the exception of a few examples, our education and health care systems operate within separate profession-specific silos. We are educated separately, for the most part, yet are paradoxically expected to function efficiently as a team when we assemble together to diagnose, treat, and educate our patients. This fragmentation stifles our ability to truly reach the triple aim goal articulated by the Institute for Health care Improvement (IHI).2 They charge that the method to optimize our health care education and delivery system is to: 1) improve the care of the patient, 2) improve the health of the population, and 3) decrease the cost of care. How well do you think we can meet that goal and address the needs of our patients using our current fragmented system of education and health care delivery? I assert that emergency medicine is the specialty best prepared to lead this reform. Why? Our keen perspective represents an asset to the health and education reform in our country. We appreciate the direct effects of collaborative practice on patient outcomes when it succeeds and when it fails. We create solutions when resources are limited. We innovate when others are tradition-dependent. We appreciate the continuum of education from undergraduate medical education to practice. And we understand, use, and teach evidence-based methodologies. A recent systematic review on the effect of IPE on professional practice and health care outcomes found that IPE produced positive outcomes in the following areas: diabetes care, collaborative team behavior in operating rooms, management of care delivered in cases of domestic violence, emergency department culture and patient satisfaction, collaborative team behavior, and reduction of clinical error rates for emergency department teams.3 Based on the growing body of evidence to support IPE across all health disciplines, it is now a required accreditation standard for multiple health disciplines as well as our own emergency medicine milestones.4 Now that we know “why” this is critical for our specialty to engage in IPE, let us discuss “how.” In May 2011, the Interprofessional Education Collaborative (IPEC) released the “Core Competencies for Interprofessional Collaborative Practice.”5 This joint effort, sponsored by the national organizations for allopathic medicine, osteopathic medicine, nursing, dentistry, public health, and pharmacy, used best-practices methodology to establish four IPE competency domains: 1) roles
ISSN 1069-6563 PII ISSN 1069-6563583
833 833
834
and responsibilities, 2) values and ethics, 3) effective communication, and 4) teamwork. These domains, and included subcompetencies, provide you as a clinical scientist a framework to guide curricular innovation and evaluation, scholarship dissemination, and faculty development. While the domains represent the foundational core content necessary to set the stage for IPE innovation, I assert that IPE is more of a teaching methodology compared to a specific content area. This perspective works to our advantage as a specialty. After you finish this article, I challenge you to list the content that is essential to our practice of emergency medicine that is also essential to another health profession. You will quickly realize that this list is very long. To mention just a few: resuscitation management, chronic pain management, death and dying, cultural competence, quality improvement and patient safety, professionalism, patient- and family-centered care, effective team-based communication, and transitions of care. Why are we all teaching the same content separately? We are the experts at efficiency, are we not? This represents a tremendous opportunity for leadership and development on the local, regional, and national levels. We are a creative and innovative specialty. Examine your own educational efforts, those of your department, and those within your health system. When content is applicable across professions, can you invite a representative to coteach with you and include learners from that other profession? When you are faced with the barrier of limited resources to create new initiatives, can you adapt your proposal for IPE to advocate for shared resources while satisfying accrediting standards across multiple professions? If you wish to improve the health outcomes for vulnerable populations and complex chronic conditions to decrease your department’s recidivism, can you involve other professions that share these goals while designing educational learning experiences for an IPE cohort of students? The answer is yes. How much more beneficial could this be for a promotion and tenure dossier, for your departmental bibliography, for future protected time negotiations, or for future extramural funding opportunities? But more importantly, how beneficial can this be to your day-to-day morale? How beneficial can this be to our future learners? But most importantly, we need to do this for our patients. Dr. Bucher learned to appreciate the importance and impact of when two disparate but very similar professions come to respect each other’s roles and responsibilities, values and ethics, effective communication, and principles of teamwork when he wrote: “Today, those
RESIDENT PORTFOLIO
nurses, who have watched me grow up on the job, are comfortable asking me, not the attending, to address problems with critical patients. They know that they can trust me to responsibly lead the team.” Colleagues, you do not have be an IPE expert to teach and model IPE. Read the IPE Core Competencies document to begin your own personal journey to better understand how you can adapt your expertise using IPE.5 You are being called to act. Use the innovative, creative, and scientific skills our specialty imparted on you to use IPE in a way to make the experience better for our patients, to improve the health of our population, and to decrease the cost of care. Dr. Bucher says it best when he states: “Sometimes, it is the small things that matter.” I could not agree more. Lee Wilbur, MD ([email protected]) Professor and Vice Chair Department of Emergency Medicine Director – Interprofessional Education; Division of Academic Affairs University of Arkansas for Medical Sciences Little Rock, AR Supervising Editor: Carey C. Chisholm, MD.
References 1. World Health Organization. Framework for Action on Interprofessional Education and Collaborative Practice. Available at: http://www.who.int/hrh/resources/ framework_action/en/. Accessed Jun26, 2014. 2. Institute for Healthcare Improvement. The IHI Triple Aim. Available at: http://www.ihi.org/engage/initi atives/TripleAim/Pages/default.aspx. Accessed Feb 28, 2014. 3. Reeves S, Perrier L, Goldman J, et al. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013;3:CD002213. 4. Beeson MS, Carter WA, Christopher TA, et al. Emergency medicine milestones. J Grad Med Educ 2013;1 (Suppl 1):5–13. 5. Interprofessional Education Collaborative. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Available at: http://nnlm.gov/bhic/2011/05/26/core-competenciesinterprofessional/. Accessed Feb 28, 2014.
