Bridges to Better Care

Learning together, health professional students place patients in the center of the health-care team.

By Brenda Hudson

“Health care administrators only care about money.” “Pharmacists have it easy—there’s no stress in counting pills.” “Doctors think they know everything.” These are some of the stereotypes about health care professionals— stereotypes that may exist in the public mind but also, perhaps more surprisingly, arise within the ranks of the health care profession.

“We don’t always have a firm understanding of our colleagues in other health care professions,” says Karyn Baum, professor of medicine in the Medical School. Physicians may not realize how much nurses know about a patient’s condition, she says, or pharmacists may not be fully aware of how public health professionals prevent disease. Although health care increasingly is being provided by interprofessional teams, contact between professions is sometimes limited. As a result, misconceptions can be perpetuated in the work place and the classroom.

Baum and colleagues from nursing, public health, pharmacy, and health care administration are addressing the need for better interprofessional understanding through a new course, Interprofessional Teamwork for Patient- Centered Care. “We want students to realize what each profession brings to the table,” says Baum. In addition to examining how different professions are educated and how their expertise fits into health care overall, the course will also teach health care professionals how to use communication skills to resolve conflicts with each other and to improve the quality of a patient’s care.

The course is one of many ways in which the University encourages collaboration in learning across fields. Within the Academic Health Center, there are programs that hook up dentists with researchers in fields as diverse as microbiology and informatics, provide a joint emphasis in animal and human health, and offer a dual medical and public health degree, to name a few.

Interprofessional collaboration, says Barbara Brandt, assistant vice president for education for the Academic Health Center, “is not a new concept, but it is getting new life.” In 2003, the Institute of Medicine identified interprofessional education as a national imperative in its report Health Professions Education: A Bridge to Quality. In response, Medical School Dean Deborah Powell is currently leading a national initiative with the Institute of Healthcare Improvement on developing interprofessional curriculum. In addition, the Academic Health Center promotes interprofessional education so that its graduates will better serve Minnesota. “We believe providing opportunities for students to learn together early and throughout their education will ultimately improve health care,” Brandt says.

Coordinating the nursing segment for the interprofessional teamwork course are Ruth Lindquist, associate dean in the School of Nursing, and her colleague Karen Dunlap. They’re enthusiastic about my students, ‘Let’s picture the patient right in the middle’” of the health care team, says Dunlap. “As health care professionals, we need to look at what each profession can bring to benefit the patient,” Lindquist adds.

Dunlap sees nurses as having the “greatest impact on the relationship with the patient. We serve as a conduit of information about our patients,” she says. The communication between nurses and physicians is crucial, adds Lindquist. “There is a real link between safety and communication. For instance, when a nurse says, ‘I’m worried’ to a doctor, that nurse means ‘you should come’”—nuances the course is designed to address.

Bill Riley coordinates the public health segment of the course, which he hopes will provide a wider understanding of the role of public health policy and the importance of prevention in health care. “Different professions are trained very well” in their own areas, he says, “but have not been trained well enough to work as a team.”

A broad range of knowledge also is crucial for administrators. Health care administration students need strong business skills, says Sandra Potthoff, director of the master’s in health care administration program. “But in order to really work in the best interest of the patients, they also need to understand the clinical process.” Exposing other professionals to health care administrators’ function and background, Potthoff believes, will dispel some of the stereotypes surrounding fiscal and organization management in health care.

Students aren’t the only ones learning. Faculty members became “a microcosm of the course,” says Baum. Working together and learning that the professions use terminology differently, for example, “helped us understand what our students will experience.”

Don Uden, professor in the College of Pharmacy, sees the benefits of interprofessionalism in practice. As well as coordinating the pharmacy segment of the interprofessional course, Uden codirects an immunization program for nursing and pharmacy students, the first of its kind in the nation. Once certified to give flu shots, the students administer shots in clinics across campus. “If an infectious disease crisis occurs on campus,” says Uden, “these students can be part of a response team.” The immunization program is just one way in which pharmacists are doing more than dispensing pills. “More and more pharmacists now are in clinics, managing patients’ medications,” he says, “and medical outcomes are better because of this.”

Clinical pharmacist Ila Harris agrees. She teaches medical residents and pharmacy students side-by-side at her practice in the Twin Cities. “By working together, family medicine residents learn about cost-effective drug therapy and the process of reviewing patient medications, while pharmacy students gain a better understanding of how physicians approach medically complicated patients,” she says. For instance, patients who are on anticoagulants may need close assessment of their medications. Harris ensures involvement of both professions in monitoring the patient’s medical condition and adjusting medication.

Interprofessionalism also bridges human and animal health. Diseases such as anthrax, West Nile virus, and avian influenza have health implications for both people and animals, says Will Hueston, director of the University’s Center for Animal and Food Health Safety in the College of Veterinary Medicine. The need is clear for more veterinarians who also are credentialed in public health. Since 2002, the University has offered a dual degree (Doctor of Veterinary Medicine / Master’s of Public Health) and expanded recruitment of mid-career veterinarians for the executive public health practice M.P.H. program.

Working across these two disciplines prepares professionals who can “work at the interface of animal and human health where people, domestic animals, and wildlife share close contact,” says Hueston. “The public health veterinarians are especially qualified to work in areas of emerging infectious diseases, food safety, prevention and control of disease transmission between species, and emergency preparedness and response,” he adds.

Interprofessional education also involves interdisciplinary research training, such as the School of Dentistry’s Minnesota Craniofacial Research Training Program, known as MinnCResT. The program offers research fellowships “designed to develop a cadre of scientists who explore the interdisciplinary frontiers of craniofacial, dental, and oral health research,” says director Mark Herzberg. MinnCResT is supported by the National Institute of Dental and Craniofacial Research to develop diverse teams of trainees and mentors who work across fields ranging from biology, neuroscience, microbiology, and genetics, to immunology, dentistry, and engineering. He adds: “The program helps to bridge basic science research with questions of clinical importance”— research which may lead to innovative treatments.

These same treatments may one day be used by students now attending the interprofessional teamwork class or participating in one of many collaborative efforts at the University— providing better understanding, and ultimately better care for patients.