Interprofessional Health Care

AHEC students work and learn in interprofessional teams to provide care for the urban underserved.

Advanced practice registered nurse Lisa-Marie Griffiths with the UConn School of Nursing talking with Urban Health Scholars during a learning retreat. (Photo provided by Petra Clark-Dufner)

Interprofessional. It’s become a buzzword in the health care field. But at Connecticut Area Health Education Center (AHEC), it’s much more than the latest trend. It’s a guiding principle, a mission. It’s the way of the future.

“UST was interprofessional before interprofessional was center stage in the health care system,” says Dr. Bruce Gould, associate dean for primary care at the University of Connecticut School of Medicine and director of CT AHEC.

The Urban Service Track (UST) is a two-to-four year program depending on the length of course of study for UConn medical, dental, pharmacy, nursing and social work students, as well as students from Quinnipiac University’s Physician Assistant (PA) Program.

The students work and learn in interprofessional teams to provide care for the urban underserved. UST serves as a national model for interprofessional health care training and has the unique feature of being a collaborative effort between two academic institutions, six schools at four campuses. To date, UST has enrolled 338 students over its seven year history and is poised to engage 50 additional students in fall 2014. Student participants are called Urban Health Scholars because of the enhanced learning and community based experiences received through the Urban Service Track program.

What is IP?

An interprofessional approach to health care, or IP for short, is the coordinated care of patients by a collaborative team of health care providers. It means consulting with dentists, pharmacists, nurses, or whoever has the necessary expertise to contribute to the patient’s treatment plan.

First-year medical student David Moise (standing) with Dr. Bruce Gould and advanced practice registered nurse Kelly Newlin-Lew. (Photo provided by Petra Clark-Dufner)

The traditional model of health care is a rigid pyramid with the physician at the top, explains Cynthia Booth Lord, director of Quinnipiac’s PA Program. The IP model is more like a rubber band, she describes. At various points in the patient’s treatment, different health professionals take the lead, stretching the rubber band in different directions. The patient, always at the center of the treatment plan, benefits from more comprehensive, less compartmentalized care.

“It’s not about the initials after your name. It’s about what you have to bring to the table at a particular moment,” Lord says of the IP method. “This doesn’t happen naturally,” she points out. “People are very territorial—especially high-achieving medical professionals.”

Everyone plays a role

William Whalen, third-year UConn medical student and UST scholar, concurs, “The best thing about working in an interprofessional setting is that everyone has a role to fulfill. Everyone contributes, regardless of years practicing or the initials after their names.”

In UST, students from different programs and different universities work together in teams to organize and run events like free clinics for migrant farm workers, community health fairs and health career education programs for children and youth. They travel to Hartford and Washington, D.C., to learn about legislative advocacy, and participate in learning retreats where they focus on particular underserved populations.

“Our learning retreats are specifically designed for us to solve patient cases by working in interprofessional teams,” explains Jennifer Crowley, a fourth-year pharmacy student. “It just feels natural to look to the dentist or social worker when solving cases on clinical rotations or in class.”

Third-year medical student Rose Barham, adds, “At learning retreats, everyone talks through the case. Everyone picks up on different facets of the plan. It’s really helpful to go through that process.”

The IP approach is instilled in students early on so that it becomes ingrained.

Urban Health Scholars discussing a case at a learning retreat. (Photo provided by Petra Clark-Dufner)

“Since most of the schools involved in UST recruit scholars in the first one to two years of their respective programs, interprofessional teamwork is a part of our curriculum from the very beginning,” Crowley says. “It becomes a habit to think interprofessionally.”

UST faculty and community practitioners from a variety of health professions and settings model IP teamwork. They work together to teach and provide experiential learning opportunities for Urban Health Scholars.

“Every time I do an Urban Service Track retreat or go out with students, I learn more. It makes me a better practitioner,” says Dr. Ruth Goldblatt, UST faculty member from the UConn School of Dental Medicine. “The faculty members teach and learn from each other. Many of us have been working together since the inception of UST eight years ago. We help each other and serve as a resource for each other. We are role modeling for the students.”

Superior training for students

UST’s IP approach benefits Urban Health Scholars in important ways, according to participants.

“It gives me a much better understanding of the skill sets of other health professionals,” says Barham, “It helps me to build relationships faster.”

AHEC Faculty meeting. (Photo provided by Petra Clark-Dufner)
UST faculty meeting. (Photo provided by Petra Clark-Dufner)

According to Whalen, “I have learned what my limitations are and when I need to call in another health professional,” something many doctors never learn. He adds: “You learn how to communicate professionally. That’s a great tool to have in your toolbox.”

Their preceptors also notice the difference in these students, and have told many of them so. Urban Health Scholars start their rotations ready from day one to interact with patients, families and other practitioners, according to those who supervise them.

“The students who have had the benefit of UST training not only have much greater comfort and willingness in collaborating with the entire health care team,” says Devra Dang, UST co-director and clinical faculty member from the UConn School of Pharmacy. “They also come with a good foundation of how to best take care of underserved patient populations.”

Why we need IP

The students aren’t the only ones who benefit from an IP approach. The current state of health care is beginning to demand it.

“I do not think interprofessional teamwork is important, I think it is imperative,” insists Crowley. Our health care system is at a critical point. The current shortage of primary care providers, coupled with the expected influx of patients who will receive health coverage under the Affordable Care Act, “is a volcano about to erupt,” she fears.

Interprofessionalism can help alleviate this crisis, Crowley claims. Team management of patient care frees up the primary care providers’ time. “Trying to care for a patient from a uniprofessional standpoint is not only time-inefficient, but it also typically results in poorer health outcomes for our patients,” she says.

Lord agrees. Health care has changed tremendously just in the last decade, she maintains. Children today are surviving congenital conditions that not long ago were fatal. We’re living longer with more complex health issues. “We need everyone’s expertise,” Lord asserts.

And the Urban Health Scholars are leading the charge.

“They work in an environment and in a manner that aligns with the way medical care is supposed to be practiced rather than the way it actually is practiced,” says Dr. David Henderson, associate dean of medical student affairs at UConn Health. “They are modeling the future of health care.”

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