Interprofessional Education: It's Here to Stay

Laura A. Stokowski, RN, MS

Disclosures

March 24, 2014

In This Article

Education Meets Practice

JoAnne M. Saxe, DNP, MS, ANP, FAAN, Clinical Professor and Codirector, Adult Gerontology Nurse Practitioner Master's Specialty, UCSF School of Nursing

The University of California, San Francisco (UCSF), is another place where the synthesis of IPE with traditional nursing curricula has not always been smooth. The effort has paid off, however, and not only students, but patients, are now reaping the benefits.

JoAnne M. Saxe, DNP, MS, ANP, FAAN, has seen firsthand the value of IPE in the education of prelicensure healthcare professional students. As a health sciences clinical professor, and Codirector of the Adult Gerontology Nurse Practitioner Master's Specialty at the UCSF School of Nursing, Dr. Saxe is involved in curriculum development and in teaching several courses that integrate IPE principles and content. In fact, according to Dr. Saxe, one of the greatest things about IPE is the number of different ways that it can be accomplished.

Here at UCSF, our IPE efforts have been somewhat organic. We started out small, but now it has spawned a fever. You could say an IPE epidemic is now spreading throughout UCSF. All of our students have to be involved in IPE in some capacity at some point in time during their education, yet it's often occasional and sporadic for most learners. Most students do not interact together for an extended period of time (eg, an entire quarter). The interface happens for 1 day, for example, and then they may not have another experience for weeks. We have had to be creative. We need to look at other ways of bringing the professions together.

For example, at UCSF, students from multiple disciplines (NP, medicine, pharmacy, dentistry, physical therapy, social work, nutrition) participate in a 1-day simulation exercise in which professional actors are hired to portray patients in realistic scenarios, with a well-thought-out script and an evaluation tool.[11] The students work in teams to assess the "patient's" concerns and develop a plan of care. The "patient" has complex healthcare needs (for example, a man with atrial fibrillation with anticoagulation therapy, hypertension, hyperlipidemia, advanced periodontal disease, low back pain with limiting activity, a recent transient ischemic attack, and medication noncompliance). A team of faculty observers is in another room watching the students on real-time video, and scoring their performance. Students participate in a postexercise debriefing session with the faculty team, when they have an opportunity to discuss and reflect on their teamwork, efficiency, and the quality of care they provided to the patient.

"Students universally love these experiences," says Dr. Saxe, who has participated in these exercises as a faculty observer. "And there are lots of 'aha' moments, such as, 'Oh, so that's what a pharmacist can do,' or 'That's what a social worker does.'" A study assessing this simulation-based interprofessional learning published by UCSF faculty member Maria Wamsley and her team[11] showed significant differences in attitudes toward team-based care by learner profession, and high levels of faculty and student satisfaction before and after interprofessional standardized patient exercises conducted with teams of medical, NP, dental, pharmacy, and physical therapy students.

Another program at UCSF that really defines the future of IPE and interprofessional collaborative practice is taking place at the San Francisco Veterans Affairs Medical Center. Teams of NP students and medical residents are learning team-based primary care by providing primary care to veterans in patient-aligned care teams (PACTs). Each PACT consists of an NP student, 2 medical residents, a registered nurse, licensed vocational nurse, and medical clerk. For a full year, the NP student and each resident have their own primary care patients, and share the entire panel of patients to ensure well-coordinated care for the patients on their team.

Traditionally, a problem with clinical education is that students rotate frequently, and the patient's care suffers from a lack of continuity of care. With PACTs, the NP student provides continuity for the patients on the team's panel while the medical residents are on rotations at the hospital. "The goal is to make sure that no one drops the ball, delays are minimized, and the patient has ready access to care." explains Dr. Saxe. "The program emphasizes core competencies for collaborative practice, including shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement.[12] There is no going back -- we are going forward with this model, making it even richer, and disseminating the clinical training model to other sites."

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