At our Thanksgiving table, my husband raised his glass in a toast. Present were all four of the children in our blended family and their partners, our five grandchildren, plus miscellaneous in-laws. The table was loaded with dishes contributed by each family. The little ones were already consuming turkey and the adults smiled and clinked glasses. In some years, the youngsters might have been squabbling or the adults sighing with worry. But this year everyone brought their best and the feast was magic. All complimented the multiple chefs and the children took pride in being turned out in lovely clothes and in their good manners.
There was food in abundance and enough leftovers for everyone to take home. It occurred to me that this magical time came about because each did his part and took pride in it.
Everyone doing their part, and doing it well, is the fundamental premise of interprofessional practice, and when done right, it, too, is magic. The patient has a panoply of professionals who can address problems and answer questions. There’s strong follow-up. Good metrics follow. In the end it is less expensive to manage patients with a team. For example, in the intensive care unit, patients cared for by a team spend a whole day less in the unit, reducing cost considerably.
To develop the magic of teams, we have to train in the interprofessional spirit. Using the first big grant we received from the Josiah Macy Jr. Foundation in 2010, we developed a pre-clinical course to introduce our students in all the health professions to the principles of interprofessional teams. Now, more than 600 students participate in this course, which has expanded to several sessions each year. But classroom time can only do so much.
Health profession students must practice in clinical settings in order to truly learn how to work together. But creating, deploying, engaging with, and reviewing interprofessional teams is not easy. In fact, at one meeting of the education interest group at the National Academy of Medicine, I heard a professor at an Ivy League school say flatly that it could not be done!
The Macy Foundation and CWRU think otherwise. The foundation supported the planning and execution of pilot studies of team education in clinical settings. Macy I-LEAP program tests took place in federally qualified health centers, medical intensive care units, emergency rooms, and the pediatric clinic. They consisted of five-member teams of medical, dental, nursing, PA, and social work students. We learned a lot in the first year, and now version 2.0 is in progress. A critical feature has been the development of essential competencies for interprofessional achievements. If you don’t know the end you are aiming for, you won’t be an effective educator – and students won’t learn successfully.
Macy I-LEAP is not our only patient-focused interprofessional program. In Aging in Place, teams of three students from different disciplines visit elders every other week for several months and observe the impact of social and environmental factors on our ability to deliver care. The Abington Foundation has provided support for that program.
CHOMP (the Collaborative Home for Oral Health, Medical Review and Health Promotion) pairs nursing and dental students in the clinical setting. The longest-running interprofessional program of them all, the Student Run Health Clinic, combines medical, nursing, and social work students in care of patients at Circle Health on Saturdays. This outstanding program is now supported by the Key Bank Foundation.
We are always working to develop the kind of leading-edge initiatives that are the envy of the field. We will expand the pilot programs that have been successful, but it takes money. We have garnered both philanthropic support and peer-reviewed grants, but we need more. We’ll keep at it.
The new health education campus, designed to foster the underlying cultural changes so essential to complete the interprofessional program, cannot help but enhance our creativity and opportunities for collaborative success. Our development in this area is only beginning.
We want to create magic.