Author: Dr. Caryn LaBuda, Assistant Professor, Midwestern University
The buzzword throughout health care and especially throughout optometry is interprofessional communication and care.
While sounding simple on paper, interprofessional education (IPE) presents a series of challenges, but that does not mean that we should not endeavor to reach this destination, especially as the health care model continues to shift in this general direction.
Two professors that are well respected in the field of IPE, Dr. Frank Ascione and Dr. Alan Dow, presented a webinar entitled, “Innovative IPE Instructional Methods: Strategies & Lessons Learned.” IPE sounds to the average listener that it should be one of the easiest things to implement in our educational system. After all, we all do it. We communicate with primary care physicians about our diabetic and hypertensive patients. Is that enough? Is that truly what IPE is and should be for Doctors of Optometry? Do we teach our students on a daily basis that the hierarchy of medicine is no more and that we need to work with all professions to take the best care of our patients? Do we challenge ourselves to follow that rule?
Dr. Dow from Virginia Commonwealth University challenges all of us as educators and healthcare providers to evaluate education as a tree, especially that of an interprofessional nature. The roots of this tree are the pre-curricular experiences that our students have had. We know as educators that this can be extremely varied, some students have worked in health care practices, other students have never set foot in a medical office. How do we ensure that both types of students and everyone in between reaches their true potential of being the best health care provider that they can be? The answer is simple. According to Dr. Dow, it is based on the foundational experiences that we as providers and institutions provide them, and this forms the trunk of their interprofessional knowledge. These experiences are often formed through online coursework where teams of multiple professions are working together to solve a problem and devise the best solution for the patient.
At Virginia Commonwealth University, they accomplish building a solid trunk for all of their students through a series of three courses with a variety of programs involved in each course, whether that is social work, law, medicine, psychology, or dentistry. Some of these courses are simulation based and online where the students work independently, yet collaboratively on solving a patient issue. Other aspects of the course involve going to the simulation center and working on different patients and realizing that each member of the team plays a critical role in the management of the patient. And yet, we need each other in order to ensure the patient is receiving the best care. As the students move on through the curriculum and reach the branches and the leaves of their tree of learning, the experiences that they are exposed to become more rooted in their fields. For example, a practitioner who is working in an advanced ocular health clinic who gives bad news a good percentage of their day, may be paired with someone who is concentrated in social work or psychology, an occupational therapist, and a pharmacist to deliver the news and to allow a transition into other fields so the patient can maintain their quality of life.
The challenge that Dr. Dow faces is a balance between the student wanting real experiences and their actual ability to engage and learn something from these real experiences. Dow suggested that student wants, while important, should always come secondary to what they need to learn. For example, discussing a case on scleral depression before the student has learned about the sclera, may result in low engagement by the student. However, if we use the same case after a student has learned about the sclera, the retina, and the technique of BIO, then all of a sudden that case has meaning to the student and the knowledge yielded will be high. Dow suggests that faculty focus on identifying the roles of the health care team initially and build into those experiential cases.
Dr. Ascione from the University of Michigan provided a complementary perspective to this IPE seminar. He proposed that at the University of Michigan IPE should be co-curricular rather than a separate, subjective curriculum. In this sense, it is a required activity for the student to complete, and this can be affiliated with a course, but there is no grade or credit hour assigned to this specific activity. At first when this program was implemented, there seemed to be a lot of doubt as to how much effort students and faculty would put into this type of venture, but the results have far exceeded expectations and the program only continues to grow.
Dr. Ascione presented that classroom base learning is not the fundamental for their IPE, but rather it is based on case studies where discussions can continually grow and change. In these series, it is not only about treating the patient medically, but it also evaluates social justice in medicine or how the changing health care system is affecting our patients in all walks of life. He reports that the faculty have had creative license in terms of designing these co-curricular objectives and not only are multiple fields of medicine represented, but also the fields of law, insurance workers, business, and social workers.
One could easily ask after this seminar how can it be that there are two different, but yet very successful ways to implement IPE in the optometry world. The answer is these techniques are not that different, yes there is a credit hour difference and perhaps even an implementation difference, but the quality of what these programs are trying to do is the same. We as optometric educators are called to provide this type of care to our patients on a daily basis. Shouldn’t we be teaching our students to do the same?
Whether we decide to implement IPE as a course or as a required activity, the important take home message is that we are teaching students that they are part of a team, that their input matters and that the input of the other team members also matters. It is no longer a question of “I am the doctor so what I say goes.” Rather it is a question of “though I am the doctor, what does everyone else involved in the case think, so the patient receives the best care?” Of critical importance, however, as stated by both of these respected educators is that the team is not only made up of the health care workers or the lawyers or the other professions, but the patient is a key member at this table of discussion and all of us involved need to remember that.