Educate to Collaborate

I think we all agree that patient care has been, and continues to be, a complex activity—one that commands all health care professionals to work together effectively for the sake of the patient. Yet I hear that this is far from the case.

Over the past year, I have been dismayed to read more and more editorials (predominantly by physicians) lambasting PAs and NPs for their attempts to more fully integrate themselves into the health care system. There has been a great deal of stereotyping of our professions. Words and phrases such as inadequate education, incompetence, trying to be a physician, lack of adequate supervision, as well as other criticisms, have been used. It made me wonder how many of these critics have actually worked with or around a PA or an NP for a significant period of time.

Of course, I am biased. It has been my experience over the past 30+ years that physicians who work with PAs and NPs on a regular basis actually develop an understanding of their value to the health care team. There are times, of course, when this is not true—but for me, this is more often than not the case.

Medical students, PA students, and NP students, in my estimation, identify early on with their future professions, learning from their professions’ leaders and reinforced by professional associations. While this is important, Majoor¹ noted, this “all too easily results in rigid and protective demarcations between professions who need to work closely together to respond effectively to the needs of the same patients, families, and communities.”

Should we be making a conscious effort to foster understanding and collaboration at an earlier stage, rather than waiting for it to occur (or not) once health care providers are established in practice? Maybe this is a crazy idea, and maybe there are more barriers than bridges. But according to Barr,² “Partnership has become so fashionable that it is tempting to assume that all reasonable men and women will unite in common cause. Experience teaches otherwise: best laid plans too often founder for lack of attention to differences which can bedevil relationships between professions and organizations.”

In recent years, interprofessional education (IPE) has become the new buzzword. According to the Centre for the Advancement of Interprofessional Education, IPE “occurs when two or more professions learn with, from, and about each other to improve collaboration and the quality of care.”³ (The emphasis is mine.)

Two reports issued by the Institute of Medicine in the past decade have sparked renewed interest in IPE. To Err is Human identified the magnitude of preventable medical errors, and Health Professions Education: A Bridge to Quality recommended redesigning health professionals’ training, including more interdisciplinary training. Have we, as medical educators, just given lip service to these suggestions? A search of the literature finds very little discussion of physicians, PAs, and NPs learning together, either during their entry-level education or in their practice settings.

Despite this dearth of research, in the past few years, many educational programs have attempted the development of IPE as a way to improve how professionals work together to take care of patients. The emphasis is on interdisciplinary teams, patient-centered care, and quality improvement. IPE has frequently been used with content related to prevention (primary, secondary, and tertiary), geriatric medicine, chronic disease management, and ethics.

Institutions that have utilized this model have reported significant challenges in implementing such programs, which Cashman, Meyer, and Page⁴ identified as:

• Integrating schedules across disciplinary units

• Scheduling time for all faculty members to meet and plan

• Integrating schedules between schools and community collaborators

• Coordinating activities in different geographic locations

• Obtaining course approval from participating disciplinary units

• Offering courses under multiple academic calendars

• Coordinating complex community factors in order to provide clinical experiences needed by large numbers of students

• Coordinating service activities with community-based partners

They also reported institutional-level challenges in areas such as recruitment of students, identification and engagement of faculty who have the time and interest to participate, and coordination of courses across academic programs (including which program[s] will receive credit and payment for courses). Additional issues include the need to sustain and build momentum in these programs over time, from seeking funding to expanding the concept into other fields.⁴

This is not to suggest these challenges are insurmountable. Cashman, Meyer and Page also identified factors that can improve an IPE program’s chances for success. These focus, overall, on a “team” approach: seeking student input during early planning, partnering with local Area Health Education Centers, and seeking community support for off-campus projects, among others.⁴

Growing evidence seems to support the expectation that educational programs will prepare health professions students, and current practitioners, for collaborative work. How best to support this is the question. Does the concept of “one size fits all” work? Are the professions (MD, DO, PA, NP) so different that the barriers outweigh the opportunities?

I’d love to hear your thoughts on this. E-mail me at [email protected].

I think we all agree that patient care has been, and continues to be, a complex activity—one that commands all health care professionals to work together effectively for the sake of the patient. Yet I hear that this is far from the case.

Over the past year, I have been dismayed to read more and more editorials (predominantly by physicians) lambasting PAs and NPs for their attempts to more fully integrate themselves into the health care system. There has been a great deal of stereotyping of our professions. Words and phrases such as inadequate education, incompetence, trying to be a physician, lack of adequate supervision, as well as other criticisms, have been used. It made me wonder how many of these critics have actually worked with or around a PA or an NP for a significant period of time.

Of course, I am biased. It has been my experience over the past 30+ years that physicians who work with PAs and NPs on a regular basis actually develop an understanding of their value to the health care team. There are times, of course, when this is not true—but for me, this is more often than not the case.

Medical students, PA students, and NP students, in my estimation, identify early on with their future professions, learning from their professions’ leaders and reinforced by professional associations. While this is important, Majoor¹ noted, this “all too easily results in rigid and protective demarcations between professions who need to work closely together to respond effectively to the needs of the same patients, families, and communities.”

Should we be making a conscious effort to foster understanding and collaboration at an earlier stage, rather than waiting for it to occur (or not) once health care providers are established in practice? Maybe this is a crazy idea, and maybe there are more barriers than bridges. But according to Barr,² “Partnership has become so fashionable that it is tempting to assume that all reasonable men and women will unite in common cause. Experience teaches otherwise: best laid plans too often founder for lack of attention to differences which can bedevil relationships between professions and organizations.”

In recent years, interprofessional education (IPE) has become the new buzzword. According to the Centre for the Advancement of Interprofessional Education, IPE “occurs when two or more professions learn with, from, and about each other to improve collaboration and the quality of care.”³ (The emphasis is mine.)

Two reports issued by the Institute of Medicine in the past decade have sparked renewed interest in IPE. To Err is Human identified the magnitude of preventable medical errors, and Health Professions Education: A Bridge to Quality recommended redesigning health professionals’ training, including more interdisciplinary training. Have we, as medical educators, just given lip service to these suggestions? A search of the literature finds very little discussion of physicians, PAs, and NPs learning together, either during their entry-level education or in their practice settings.

Despite this dearth of research, in the past few years, many educational programs have attempted the development of IPE as a way to improve how professionals work together to take care of patients. The emphasis is on interdisciplinary teams, patient-centered care, and quality improvement. IPE has frequently been used with content related to prevention (primary, secondary, and tertiary), geriatric medicine, chronic disease management, and ethics.

Institutions that have utilized this model have reported significant challenges in implementing such programs, which Cashman, Meyer, and Page⁴ identified as:

• Integrating schedules across disciplinary units

• Scheduling time for all faculty members to meet and plan

• Integrating schedules between schools and community collaborators

• Coordinating activities in different geographic locations

• Obtaining course approval from participating disciplinary units

• Offering courses under multiple academic calendars

• Coordinating complex community factors in order to provide clinical experiences needed by large numbers of students

• Coordinating service activities with community-based partners

They also reported institutional-level challenges in areas such as recruitment of students, identification and engagement of faculty who have the time and interest to participate, and coordination of courses across academic programs (including which program[s] will receive credit and payment for courses). Additional issues include the need to sustain and build momentum in these programs over time, from seeking funding to expanding the concept into other fields.⁴

This is not to suggest these challenges are insurmountable. Cashman, Meyer and Page also identified factors that can improve an IPE program’s chances for success. These focus, overall, on a “team” approach: seeking student input during early planning, partnering with local Area Health Education Centers, and seeking community support for off-campus projects, among others.⁴

Growing evidence seems to support the expectation that educational programs will prepare health professions students, and current practitioners, for collaborative work. How best to support this is the question. Does the concept of “one size fits all” work? Are the professions (MD, DO, PA, NP) so different that the barriers outweigh the opportunities?

I’d love to hear your thoughts on this. E-mail me at [email protected].

I think we all agree that patient care has been, and continues to be, a complex activity—one that commands all health care professionals to work together effectively for the sake of the patient. Yet I hear that this is far from the case.

Over the past year, I have been dismayed to read more and more editorials (predominantly by physicians) lambasting PAs and NPs for their attempts to more fully integrate themselves into the health care system. There has been a great deal of stereotyping of our professions. Words and phrases such as inadequate education, incompetence, trying to be a physician, lack of adequate supervision, as well as other criticisms, have been used. It made me wonder how many of these critics have actually worked with or around a PA or an NP for a significant period of time.

Of course, I am biased. It has been my experience over the past 30+ years that physicians who work with PAs and NPs on a regular basis actually develop an understanding of their value to the health care team. There are times, of course, when this is not true—but for me, this is more often than not the case.

Medical students, PA students, and NP students, in my estimation, identify early on with their future professions, learning from their professions’ leaders and reinforced by professional associations. While this is important, Majoor¹ noted, this “all too easily results in rigid and protective demarcations between professions who need to work closely together to respond effectively to the needs of the same patients, families, and communities.”

Should we be making a conscious effort to foster understanding and collaboration at an earlier stage, rather than waiting for it to occur (or not) once health care providers are established in practice? Maybe this is a crazy idea, and maybe there are more barriers than bridges. But according to Barr,² “Partnership has become so fashionable that it is tempting to assume that all reasonable men and women will unite in common cause. Experience teaches otherwise: best laid plans too often founder for lack of attention to differences which can bedevil relationships between professions and organizations.”

In recent years, interprofessional education (IPE) has become the new buzzword. According to the Centre for the Advancement of Interprofessional Education, IPE “occurs when two or more professions learn with, from, and about each other to improve collaboration and the quality of care.”³ (The emphasis is mine.)

Two reports issued by the Institute of Medicine in the past decade have sparked renewed interest in IPE. To Err is Human identified the magnitude of preventable medical errors, and Health Professions Education: A Bridge to Quality recommended redesigning health professionals’ training, including more interdisciplinary training. Have we, as medical educators, just given lip service to these suggestions? A search of the literature finds very little discussion of physicians, PAs, and NPs learning together, either during their entry-level education or in their practice settings.

Despite this dearth of research, in the past few years, many educational programs have attempted the development of IPE as a way to improve how professionals work together to take care of patients. The emphasis is on interdisciplinary teams, patient-centered care, and quality improvement. IPE has frequently been used with content related to prevention (primary, secondary, and tertiary), geriatric medicine, chronic disease management, and ethics.

Institutions that have utilized this model have reported significant challenges in implementing such programs, which Cashman, Meyer, and Page⁴ identified as:

• Integrating schedules across disciplinary units

• Scheduling time for all faculty members to meet and plan

• Integrating schedules between schools and community collaborators

• Coordinating activities in different geographic locations

• Obtaining course approval from participating disciplinary units

• Offering courses under multiple academic calendars

• Coordinating complex community factors in order to provide clinical experiences needed by large numbers of students

• Coordinating service activities with community-based partners

They also reported institutional-level challenges in areas such as recruitment of students, identification and engagement of faculty who have the time and interest to participate, and coordination of courses across academic programs (including which program[s] will receive credit and payment for courses). Additional issues include the need to sustain and build momentum in these programs over time, from seeking funding to expanding the concept into other fields.⁴

This is not to suggest these challenges are insurmountable. Cashman, Meyer and Page also identified factors that can improve an IPE program’s chances for success. These focus, overall, on a “team” approach: seeking student input during early planning, partnering with local Area Health Education Centers, and seeking community support for off-campus projects, among others.⁴

Growing evidence seems to support the expectation that educational programs will prepare health professions students, and current practitioners, for collaborative work. How best to support this is the question. Does the concept of “one size fits all” work? Are the professions (MD, DO, PA, NP) so different that the barriers outweigh the opportunities?

I’d love to hear your thoughts on this. E-mail me at [email protected].