In this month’s letter, ADEA President and CEO Dr. Rick Valachovic checks in with leaders on three campuses where interprofessional education took root early on and continues to flourish.
I hope that this month’s Charting Progress will set the record straight for those who still think that interprofessional education (IPE) is just a passing fad. As you may have heard me say before, addressing the introduction of IPE has been a focus of much of my attention in the past couple years. When you hear about what is happening at some of our schools, you’ll see that this investment is paying off handsomely.
IPE is maturing, and a number of our campuses have recently made dramatic strides. This month, I will tell you about some of the progress occurring at institutions that were early adopters. Next month, I’ll cover what has been happening with the Interprofessional Education Collaborative (IPEC)—of which ADEA is a founding member—and highlight developments on two campuses that participated in the first Interprofessional Faculty Development Institute, held just over a year ago. If you are looking for a way to jump-start IPE on your campus, you’ll find next month’s letter of special interest.
Right now, let me share the latest developments on three campuses that have been leaders in this area.
In 2009, I spoke with Dr. Charles N. Bertolami, Dean of the New York University (NYU) College of Dentistry, about the bold experiment then taking place on that campus. His predecessor, Dr. Michael C. (Mike) Alfano, had set events in motion several years earlier with a vision of bringing primary health care into the dental office. He approached the dean of the NYU College of Nursing and proposed that nursing move out of the School of Education and into the College of Dentistry. The move came to pass in 2005, and soon the College of Nursing had established a nurse faculty practice within the College of Dentistry, where nurse practitioners deliver primary health care. (You can read more about this historic merger in my earlier Charting Progress.)
When I spoke with Charles in connection with that article, he summarized the relationship at that time this way: “We have a functional connection between dentistry and nursing, but it hasn’t been fully exploited.”
Today the relationship is more like a marriage, at least that’s the word that Dr. Andrew I. Spielman, Professor of Basic Science and Craniofacial Biology at NYU, used when we recently spoke. The description seems apt because, together, the schools have produced several dozen offspring, including nine joint educational programs, three joint global outreach programs, and 25 joint service-learning programs, such as one that has dental students instructing nursing students about how to perform pediatric oral exams, and another that has nursing students instructing dental students about how to handle medically complex and difficult children.
At the faculty level, members of both schools are teaching in each other’s programs. They have given 12 interprofessional presentations and received seven grants for joint projects, and they have 26 joint papers published or in press. Additionally, 300 dental faculty and 100 nursing faculty have received training through the NYU Evidence-Based Practice Academy, implemented by the colleges of dentistry and nursing. The training led to the integration of this past year’s nursing students into the College of Dentistry’s elaborate evidence-based dentistry case presentation exercise. Andrew describes this last as a remarkable team effort. When the students present, “Everyone is in concert like an orchestra,” he says.
Meanwhile the role of the nurse faculty practice in educating dental students has expanded. One of the nurse practitioners is frequently available on the clinic floor, providing consultation on demand. Twice a week, nurse faculty spend time in the dental intake clinic helping students chart patients’ medical backgrounds and educating students on various diseases that can impact the management of patients’ oral health care. Most recently, the College of Dentistry set up an elective summer rotation for senior students, who can now spend one day a week observing in the nurse faculty practice.
With the increase in traffic between the two clinics, NYU has begun to evaluate the interprofessional oral-systemic health practice model that the jointly situated clinics represent. They are asking questions such as, “Is having a faculty practice on a dental school’s premises viable and cost-effective? How many patients are referred?”
In 2015, the College of Nursing will move from its current location 23 blocks south to a new, interdisciplinary health sciences education and research building across the street from the College of Dentistry. The move will, in Andrew’s words, “cement this marriage,” which he praises for its transformative effect.
“If anything, I would characterize this as a broadening of the dental faculty’s horizon in that they are not alone, and that they cannot be away from the health care table,” he concludes. “Dentists have to be part of the team.”
Amen to that.
“As a faculty member, I had an evaluation form one time that said interprofessional activity, and I had no idea how to incorporate that into my course.” This confession comes from Dr. Elizabeth S. (Betsy) Pilcher, Associate Dean for Institutional Effectiveness and Professor in the Division of Restorative Dentistry at Medical University of South Carolina (MUSC). At the James B. Edwards College of Dental Medicine, Betsy is also the point person on IPE. The fact that she can remember her initial unease with the concept conveys just how far—and how quickly—MUSC has come since its pivotal decision to prioritize IPE in 2005. That is the year the university launched its Creating Collaborative Care (C3) initiative and established an office to oversee its interprofessional activities.
Today, every university school has interprofessional activity as part of its strategic plan, and IPE is thoroughly enmeshed in each school’s culture. For proof, one needs to look no further than the last Collaborating Across Borders, a North American conference that focuses on interprofessional education and collaborative practice in health care. MUSC had 16 presentations, more than any other school.
“Faculty are now aware, and they are reaching out and getting involved,” Betsy tells me. That involvement might mean taking part in the Interprofessional Day programming that introduces all first and second year MUSC students to the concept. It might mean teaching the mandatory semester-long course in IPE, developing case scenarios, or offering an elective.
IPE is now included in faculty evaluations and in promotion and tenure criteria, although faculty participation in these activities is voluntary. Dr. John J. (Jack) Sanders, Dean of the James B. Edwards College of Dental Medicine, tells me that faculty is enthusiastic about IPE. In fact, he has been surprised by how many people have become involved in C3’s six-month-long Faculty Development Institute. Now in its fourth year, the program has grown so popular that MUSC has had to offer it twice in the past 12 months. Nevertheless, Jack and Betsy expressed concern that a mechanism be found to compensate faculty for the time they devote to IPE activities.
“We still have faculty volunteers,” Betsy explains. “We haven’t had a decline, but we hear some grumbling because it is volunteering.”
These sound like normal growing pains in what is otherwise a very successful initiative, one that Jack believes has transformed the culture on campus. Both Jack and Betsy are especially pleased to see an oral health awareness taking root in the other colleges and receiving increased emphasis in their curricula.
“Even though everybody was on the same campus before,” Jack tells me, “they went to different buildings, and honestly, had very little knowledge of one another. Now they appreciate what the other health professions are doing, and their patients will be better off for it.”
In the near future, MUSC will take another big step in furthering IPE by expanding its opportunities for students to interact interprofessionally to more outreach sites, including a school-based clinic that serves the medical and dental needs of area children.
In 2009, I also wrote an article about new dental schools opening. If you read it, you may remember that it featured Western University of Health Sciences (WesternU) and that one of the university’s central goals is graduating clinicians who are able to work in collaboration with other health care professionals.
Since the first dental students arrived on the Pomona, California, campus, they have been exposed to a curriculum that openly prioritizes IPE. This exposure is most visible in WesternU’s decision to set aside a block of time on Wednesday afternoons when students from all nine colleges come together to work in small interprofessional teams. They study communication, scope of practice, patient safety, team building, and other topics that are broadly applicable to all the health professions. Given the difficulties of releasing faculty from their other duties, WesternU draws on volunteers from the ranks of faculty, staff, and the community, and trains them to facilitate these small groups.
I called Dr. Steven W. (Steve) Friedrichsen, Professor and Dean of the College of Dental Medicine, to ask how the college’s approach to IPE is evolving. We spoke 38 days before the first class of dental students was scheduled to graduate, and, among other things, Steve praised their strengthened communication skills.
“The inaugural class has a strong sense of how to communicate with other professionals,” Steve told me, “and they have an improved understanding of when it’s important to communicate.”
With the didactic piece of the IPE curriculum well established, Steve and his colleagues are now focused on developing WesternU’s clinical opportunities for interprofessional collaboration. They are developing rotations between the colleges of optometry and dentistry, and they just piloted a four-credit medical student rotation in oral health at community- and school-based sites.
Steve is also excited about a new opportunity that leverages the interprofessional nature of the campus to influence health care policy. Faculty, professional staff, and students from the different colleges have been invited to work with the 29-year-old Center for Oral Health on developing legislative issue briefs. Each profession will bring its unique perspective to this endeavor to help create richer, more informed legislation and policy. Developing the briefs is a noncredit activity, but participants will receive a stipend thanks to funding provided by Colgate Oral Pharmaceuticals.
“The College of Dental Medicine took the lead in bringing the Center for Oral Health to WesternU’s campus, developed the Colgate Interprofessional Scholars program to contribute to the center’s work, and has initiated a research collaboration between the basic science faculty at the dental school and faculty at the College of Optometry. They are studying the vascular pattern of the retina to see if it correlates with changes in the jaw that lead to drug-induced osteonecrosis.
In my 2009 article I concluded that, “Western’s experience seems to validate the notion that starting with a clean slate makes the wholesale embrace of innovation a lot easier for new schools than for established ones.” When I spoke with Steve, his comments supported this notion.
“Whether you’re dealing with curriculum or research or extracurricular activities or designing innovations, the university likes to see an interprofessional approach as part of the plan,” Steve observes. “They are very encouraging and supportive, and that’s obviously a critical component of making it successful.”
Indeed, support from senior administrators at both the school and university levels has been identified as one of the key components of thriving IPE programs.
Next month, I’ll visit with folks on two campuses where IPE initiatives are just getting under way and share links to resources that we all can use. Meanwhile, teams from all over the country will be gathering in Northern Virginia next week to explore quality improvement and patient safety at the 2013 Interprofessional Faculty Development Institute. I look forward to seeing some of you there.