Using Local Resources to Enhance Students’ Clerkship Experience L.M.Mellor, MD Rutgers-RWJMS-Centrastate Family Medicine Residency

What is Interprofessional Collaboration in Healthcare? “IPC is the practice of healthcare professionals with diverse educational and professional backgrounds communicating with the common goal of providing quality comprehensive healthcare services to patients, their families and communities”(1) According to the Institute of Medicine, IPC will facilitate better care and decrease costs.(2)

Institute Of Medicine on IPC In 2011 the IOM reported that increasing IPC would reduce costs and increase quality of care as healthcare professionals working together would duplicate tests less and increase communication, thus streamlining medical care for patients (2).

Interprofessional Education The practice of including instruction on IPC in the education of health professional students

Interprofessional Education 3 schools at forefront (3): Rosalind Franklin Univ of Medicine-didactic course required for all studs Univ of Florida-Home visits with IP teams of students Univ Washington-50 course offerings with studs from different professional schools

Current Research in IPC Mostly seen in the Nursing literature The Teamwork that is the basis of IPC is linked to better healthcare outcomes (theoretically) Enhanced communication and respect for other team members is a major benefit of IPC that can be demonstrated to students

Recommendations for Developing an IPC Curriculum Get REAL Administrative support Set up a program structure Get committed faculty Acknowledge the students for their efforts (3)

Barriers to IPC Professional Culture (4) Preconceived Notions (5) It is mostly directed toward inpatient situations and experiences

It is Important to get students when they are in the early phase of education!(6,7) Early students are more likely to be open-minded! It is best to begin IPC/IPE before preconceived notions and stereotyping become ingrained.

What is our IPC Goal for students in the Family Medicine clerkship? Begin at the ground level to learn to work with and in teams composed of professionals with different educational backgrounds(2) in an OUTPATIENT setting Forming a “Team” in the traditional sense is difficult because it is an OUTPATIENT rotation- we may not have everyone together in the office We need to use different educational methods to demonstrate IPC

How do we do it? MODELING IS BIG!!!!!!!! This includes: How faculty/residents present information to patients when referring to other practitioners How we communicate with paraprofessionals ( on the phone, in the office with staff, while talking with other doctors, etc) How we describe the work the other team members do to the students

What else can we do to increase IPC in the clerkship? Introduce the student to various “team” members. Remember that our “team” as an outpatient doc is a little different than that seen in hospital– ours is spread out in different locations, usually. Have the student spent ½ day per week at the site of a different team member to see what they do.

Community Resources and Team Members Alcoholics Anonymous Al-Anon Narcotics Anonymous Food Bank Jail Juvenile detention facilities/Job-corp Schools (elementary, middle and high schools) Drug Rehab centers

AA, Al-Anon, NA Important to have a host Students go to an open meeting with the host Important community resource that every student should see- we refer to it a lot, it is very valuable

Food Bank Spend a session seeing how it operates and what is available to patients

Jail/Juvenile detention facilities/Jobcorp Do a presentation at the local jail or juvenile detention center—Let’s face it, most of us have never seen inside a jail! Trouble with lockdowns and security

Schools Combine working with school nurse to see what that is like along with presentations to the students on health topics. Talk about Family Medicine to the kids.

Drug Rehab Centers Work with the clinicians to see what their work is like; attend a group session

Hospital/Clinic Resources Social Worker Library Dieticians Physical/occupational therapists Nursing homes Audiology Sleep center Psychologists

Social Worker While the hospital social worker faces different challenges than the out patient social worker, many offices do not have a social worker on premises, so this is a good alternative.

Library Tour with librarian and demonstration of research capabilities in medical cases

Nutritionist/Dietician Work with clinician as she makes assessments and reccommendations

Physical therapist/ Occupational therapist Often clinicians refer without any idea of what these paraprofessionals do- spending a session with them can be illuminating

Nursing homes Great for the student who has not worked in one yet, this can be a real eye-opening experience

Audiology Hospital Audiology services are often called on in Family Medicine

Sleep Center If available, this can be an interesting collaborative experience

Psychologists Working with hospital based psychologists can be a useful learning opportunity

Family Medicine Preceptor as a Bridge between these resources Modeling by ordering these services and explaining the value of these services to patients Using these resources while with pts seen in the office Getting patients and students to see the value of the services By respecting these professionals, increase teamwork and collaboration

In conclusion… Value of IPC seems logical and intuitively makes sense. As yet, studies have not shown any statistically significant differences (8) Increasing teamwork and respect among health professionals can only lead to better outcomes and beginning to foster this early in medical education will hopefully pay many dividends in the future!

By exposing medical students to Interprofessional Collaboration early in their medical careers we can foster teamwork that should lead to better medical care!

THANKS!

References 1- Four Steps to Interprofessional Collaboration; Accessible Healthcare Institute; yourahi.org; july 1, What can be done to encourage more interprofessional collaboration in health care; Health Policy Snapshot, Robert Wood Johnson Foundation, Sept Interprofessional collaboration: three best practice models of interprofessional education, Med Educ Online; 2011;16.

continued 4-Interprofessional teamwork: Professional cultures as barriers; Journal of interprofessional Care, 06 jul 2009 p Student attitudes to undergraduate interprofessional education; Journal of Interprofessional Care; 6 Jul 2009, p Facilitating undergraduate interprofessional learning in healthcare: comparing classroom and clinical learning for nursing and medical students; Learning in Health and Social Care; vol2, Iss2; p Jun 2003.

More references 7-Interprofessional perceptions of healthcare students; Journal of Interprofessional Care; 06 july 2009; p Interprofessional Collaboration: effects of practice based interventions on professional practice and healthcare outcomes; The Cochrane Library; 08 Jul 2009.