The Changing Face of IPE and Collaborative Care

Dr. Richard ValachovicIn this month’s Charting Progress, Dr. Rick Valachovic explores how dental schools can enrich their IPE programs and improve the care they provide by establishing collaborations outside the health professions.

Last fall, I ventured north of our offices in Washington, DC, to spend a day at the University of Maryland, Baltimore (UMB). From the office of UMB President Jay Perman, M.D., I looked out over the streets of West Baltimore. Many Americans associate this community with poverty, rioting and police violence, but Jay views this corner of the city quite differently. He sees it as a laboratory, one where students can learn about the social determinants of health—safe neighborhoods, walkable streets, access to nutritious foods and health services—and one where interprofessional education (IPE) can thrive.

Jay is a pediatric gastroenterologist with a passion for IPE and a strong belief that public universities must serve their communities. To that end, he chairs the board of the Downtown Partnership of Baltimore and serves on the boards of a local foundation, a regional business association and a public-private partnership dedicated to advancing the health, safety and success of Baltimore’s youth. In 2013, he established the Center for Community-Based Engagement and Learning to enhance UMB’s involvement with local children and families. And he wants all of the university’s students to develop a similar appreciation for the potential of West Baltimore.

That’s where IPE and its changing face come in. UMB may not be unique, but it certainly is unusual. Its schools of the health professions—dentistry, nursing, medicine and pharmacy—and its graduate programs in the health sciences are situated on a health and human services campus that includes schools of social work and law. As a result, these professions, not usually thought of as “health” professions, are easily integrated into UMB’s interprofessional activities.

“It’s great,” says Jacquelyn Fried, RDH, M.S., Associate Professor, Director of Interprofessional Initiatives and Acting Graduate Program Director at the University of Maryland School of Dentistry. “It really takes the patients from soup to nuts. When you’re looking at a geriatric case, you’re looking at legal issues such as advanced directives and disability rights; and with social work, you’re looking at quality-of-life issues, the family dynamics. It adds a really nice element to the whole experience.”

These diverse schools have always shared a campus, and some previously offered courses in geriatrics, human sexuality and other topics that cross professional lines. But collaborations that span the entire campus are relatively new. IPE figures prominently in UMB’s 2011–2016 strategic plan, and the establishment of the Center for Interprofessional Education in 2013 cemented IPE’s importance within the university. Today, UMB strives to educate all its students to take a team-based approach to providing high-quality, affordable health care and human services.

Students take part in a variety of classroom and community initiatives, from an annual IPE day, during which interprofessional teams of students collaborate to solve a complex case using standardized patients, to participation in the JACQUES Initiative,1 a 12-year-old effort both to serve Baltimore residents living with HIV and to combat the spread of the virus. Rounding out the program are a University of Maryland School of Pharmacy case competition, opportunities for community-based team exercises in long-term care and in emergency-department settings, and courses such as Health Care Law, which encourage interprofessional enrollment.

Ten years ago, UMB brought its various schools together to create a Master of Public Health Program by capitalizing on existing offerings within the university’s profession-specific schools. At that time, Susan Wozenski, J.D., M.P.H., was offering a course in program planning and evaluation within the University of Maryland School of Nursing. She is now director of the dual M.S./M.P.H. program at the nursing school, and the program planning and evaluation class has become a core component of that degree.

“It was a great class,” she told me, but with the introduction of M.P.H. students from other professions, “it became an even better class.”

Susan is an attorney who says she sees health challenges through the lens of policy change, legislative issues and regulation. For example, when it comes to helping people with addictions, she thinks of using drug courts, which combine supervision, testing, sanctions and incentives to promote adherence to clinical treatments. This diversity of perspectives is also evident in her classroom, where the students tackle real-world problems that range from reducing Type 2 diabetes in Baltimore’s school children to combatting cholera in Haiti.

“No one profession has all the tools and resources to solve these large problems,” she observed. “Knowing what other disciplines can contribute gives you a tremendous advantage when problem solving.”

Because Jay Perman couldn’t agree more, he created UMB’s President’s Clinic. Every Tuesday, he invites a team of students from UMB’s seven professional schools to work with him and colleague Elsie Stines, RN, M.S., CPNP, a nurse practitioner, on an actual case with interprofessional dimensions. Students conduct thorough medical histories and physical exams, engage in dialog with patients and their families, and consult with one another to develop a plan of care. The presence of social work and law students makes the health professions students aware of social issues that may underlie a health complaint and of barriers to care that may impede effective treatment. Above all, students come to appreciate the value of treating the whole patient rather than simply focusing on the disease. Jay hopes that this exposure to team-based care delivery will prime students for practicing collaborative care once they are out in the field.

Of course, UMB is not alone in venturing beyond the health professions to enhance IPE and improve care delivery. The award-winning CARES2 program at the University at Buffalo School of Dental Medicine is one of several initiatives that incorporate social work students or professionals in dental school clinics to better resolve patient needs that can interfere with care. On other campuses, the more distantly related fields of architecture and engineering are also part of the IPE mix.

Larry Schnuck, AIA, is Vice President and Team Leader for medical education at design firm Kahler Slater, an ADEA corporate member known for its expertise in designing health professions schools. Larry tells me that IPE and collaborative care have been drivers in all the firm’s recent projects. (You can read about two of these in the March 2014 issue of Charting Progress.)

The firm recently designed new facilities for the University of Wisconsin-Madison School of Nursing. Among other features, the new space will support collaboration among experts from the schools of nursing, computer science, public health and engineering who are seeking environmentally based ways to improve human health. The building will contain the Center for Aging Research and Education (CARE), which will feature a full-scale and fully instrumented mock apartment to introduce students to the latest technologies that can improve the safety and efficiency of care delivery in the home.

Such exciting new learning environments not only promote collaboration, they also result from collaboration, a process that Kahler Slater routinely employs.

“Not unlike what we’re trying to do through our designs,” Larry told me, “we encourage collaboration here at the firm. It’s not one person, it’s a team that works together, along with the client and even some of their stakeholders in the community, to design these facilities.”

This summer, UMB announced that it had received funding for a new Interprofessional Education Center Facility that will likely be housed in a vacant building in its West Baltimore neighborhood. The facility will include simulated clinical space and become the new home of the President’s Clinic.

It’s clearly time for schools that want to grow their IPE programs to look beyond the health professions for partners that can help prepare students to address the social, cultural and environmental dimensions of health. Even though care occurs at the individual level, it’s critical to remember that other forces also influence our patients’ health and well-being. Getting the perspective of nonhealth professionals can remind us that addressing family dynamics, living environments and even public policy may be just as important for improving patients’ health as the clinical care we provide.

As IPE evolves to include a broader range of professions, it is also worth noting that this approach to professional development can benefit other professions. Faculty from the College of Social Sciences, Health, and Education at Xavier University, a Jesuit institution in Cincinnati, have been among the most active participants in the faculty development institutes run by the Interprofessional Education Collaborative. Health fields account for a minority of the college’s 11 undergraduate programs, but Doug Olberding, Ed.D., sees IPE as a “unifying bridge” that can help the disparate programs within his college develop a stronger identity within the university and a collective sense of purpose. Doug, who is Chair of the Department of Sports Studies, was charged with facilitating a year-long reimagining of the college in 2014.

“In academia, we’re so siloed. That’s the basic problem in health, but it’s an issue for any profession,” Doug believes. “When you can communicate outside your own discipline, you learn so much more.”

His colleagues agree. They have proposed a new name—the College of Professional Sciences—and a new college-wide focus: IPE.

1 Joint AIDS Community Quest for Unique and Effective Treatment Strategies
2 Counseling, Advocacy, Referral, Education and Service

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