Louisiana: Home to IPE’s Secret Ingredient

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic talks with two educators at Louisiana State University Health New Orleans School of Dentistry about their recipe for interprofessional education.

At the Louisiana State University Health New Orleans School of Dentistry (LSUSD), interprofessional education (IPE) has become an integral part of the culture, growing from the personal experiences and commitment of its faculty members.

LSUSD’s focus on IPE came about in large part thanks to an individual many of you know: ADEA Past President (2010–11) Sandra Andrieu, Ph.D., Associate Dean for Academic Affairs and Director, Program in Advanced Dental Education at LSUSD. Sandra awoke to the urgency of preparing health professionals to provide collaborative care through her husband’s experiences with Parkinsonism and Lewy body dementia. Along with ADEA Senior Scholar in Residence Leo Rouse, D.D.S., FACD, she represented ADEA on the Interprofessional Education Collaborative (IPEC) expert panel that drafted Core Competencies for Interprofessional Collaborative Practice. And thanks in large part to Sandra’s zeal, ADEA members received a thorough introduction to IPE at the 2011 ADEA Annual Session & Exhibition in San Diego.

Following her success in San Diego, Sandra established a grassroots working group at LSU, and in 2012, university administrators supported the effort by appointing a formal IPE Committee. The group set an initial goal: to give each student at least one IPE experience while enrolled at LSU. This decision prompted the creation of an elective course that drew strong attendance from students across all LSU Health Sciences Center (LSUHSC) schools. From there, individual programs began developing IPE experiences with each other, an effort that continues to grow.

Then in 2013, LSU seized on the opportunity provided by its upcoming health sciences center accreditation to develop an IPE infrastructure able to catapult their efforts to the next level. Faculty endorsed a Quality Enhancement Plan that involved creating a Center for Interprofessional Education and Collaborative Practice, hiring a director, Tina Gunaldo, Ph.D., D.P.T., M.H.S., and naming Center liaisons from each of the six LSUHSC schools—steps that have dramatically increased IPE activity at other universities.

“We realized that we were siloing IPE, which is exactly what we didn’t want to do,” Sandra reflected. “IPE can’t be something separate; it needs to be integrated into the culture and the curriculum. We wanted it to become part of the fabric of education at the Health Sciences Center.”

Sandra and her colleagues could not have achieved what they did without the full backing of LSUSD’s Dean, Henry Gremillion, D.D.S., MAGD, who started his deanship in 2008 and currently serves as ADEA’s Board Director for Deans. Henry has recognized the importance of interprofessional collaboration since graduating from LSUSD in 1977. At the start of his career, he was that rare solo practitioner who was not isolated. Far from it.

In his small community, Henry set up shop next door to the town physician and across the street from the town pharmacist. He remembers the three of them being in and out of each other’s workplaces on an almost daily basis, providing de facto coordinated care for the town’s 2,000 residents. As a result, Henry was already acculturated to collaborative practice when he started a residency in orofacial pain at the University of Florida. The program brought dentists together with neurologists, neurosurgeons, psychologists, physical therapists, and anesthesiologists, as well as ear, nose and throat specialists, deepening his understanding of interprofessional practice.

“My entire practice life has pretty much been spent in an interprofessional collaborative care environment,” Henry told me, “so when I arrived at LSU School of Dentistry as Dean, I was ecstatic about coming back to my alma mater and being a part of IPE’s growth and expansion.”

By 2016, LSU’s IPE initiatives had far exceeded the university’s initial IPE goals, but Dr. Gunaldo, Sandra and the other liaisons weren’t satisfied. In their view, each of the school’s achievements was isolated, and therefore vulnerable to shifts in priorities that might arise in the future.

That insight was the inspiration for Team Up, a new two-year longitudinal course now required of all first- and second-year LSUHSC students. On the first Monday of every month, they come together in 65 teams of 11 students each to learn “from, by and with each other” with the help of a faculty facilitator. The teams also develop their observational skills through a Health Partner program that has teams connect with a member of the community to learn about that person’s health care goals, access to resources and experience of receiving care. In the second year, Team Up sessions will analyze a wide range of clinical cases.

“I think all of us were a bit naïve and thought what we were doing before Team Up was great,” Sandra told me, “but experience offers wisdom, and we now know that to make IPE sustainable and meaningful, students have to see it reflected across all programs every day. Now IPE is no longer an appendage to the curriculum. It’s embedded in established courses and threaded throughout the curriculum.”

IPE has touched a chord with the more than 185 LSUHSC faculty who volunteer to facilitate Team Up on Monday nights. They also meet as a group to prepare ahead of time, a process the faculty has found extremely rewarding.

“What we learn from each other is amazing,” Sandra says. “We see things from different perspectives, so our knowledge has grown by leaps and bounds.”

Students have also been swept up in LSU’s IPE spirit. The InterProfessional Student Alliance (IPSA) is thriving. In addition to hosting workshops, members of the volunteer organization engage in interprofessional projects ranging from research on “hotspotting” and patient engagement to teaching cooking and nutrition to hungry families.

Three years ago, IPE at LSU took on a clinical dimension as well with the construction of an urgent-care-type clinic staffed by nurse practitioners on the school of dentistry grounds. It’s a place where dental, dental hygiene and nursing students, along with dental practice residents, gain clinical exposure to an interprofessional environment and learn about patients’ general health conditions, as well as their immediate dental needs.

“The feedback I’m getting from students is that they really love it,” Henry told me. “The day we had our ribbon-cutting,” Henry recalls, “a patient came in from 40 miles away because he required extractions. Well, the team found out during that visit that he also had hypertension and diabetes—which he did not know he had. I was visiting with him that day, and he was actually in tears because he felt like it was the first time he had someone care about him as a whole person and not just look at the individual parts.”

Despite living far away, the patient returned to the clinic for follow-up care and education about his chronic conditions, a pattern Henry would like to see repeated in other interprofessional clinics throughout the state.

Indeed, LSUSD is developing another ambitious program—this one focused on enhancing care for the state’s rural population. The school just accepted its first applicant to the Rural Dental Scholars Track, which will allow the student to work at a Federally Qualified Health Center in northern Louisiana to experience on a daily basis the value of practicing with other health professionals.

I asked Henry and Sandra to give me LSU’s recipe for IPE success. They listed several familiar ingredients:

  • A core group of committed faculty.
  • Support from senior administrators.
  • Investment in an IPE center.
  • Hiring a center director dedicated to advancing IPE.

They also highlighted the momentum generated by the accreditation process and the pivotal decision to embed IPE in the curriculum through Team Up. Then, reflecting on the history of IPE’s development at LSU, Sandra revealed what struck me as its “secret ingredient.”

“The discussions that brought IPE to light were personal,” she told me. “When we first got together, we talked about our own struggles and our family members’ struggles with health care. Those experiences provided the passion and it’s never waned,” she emphasized. “If someone came and told us, you have to teach IPE, it would never have gained the traction that it has. You have to believe in your gut that this is a need.”

Clearly, she and Henry have a fire in the belly when it comes to preparing students to communicate interprofessionally and provide collaborative care. They and their colleagues are not engaged in IPE just because they see it as an abstract good. They’ve seen people they care about—whether family or strangers—suffering needlessly because of poor communication and uncoordinated care. They don’t want that to happen to anyone else.

Of Note 

The ADEA Commission on Change and Innovation in Dental Education 2.0 (ADEA CCI 2.0) is addressing some of the same concerns Sandra and Henry raise by exploring person-centered care. If you haven’t read ADEA Chief Learning Officer Anthony Palatta’s recent Journal of Dental Education Guest Editorial or the latest ADEA CCI 2.0 white paper, I encourage you to do so. You will also find related commentary from an interprofessional group of educators in the latest ADEA CCI Liaison Ledger.

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