New Vision For Education

Leaders around the Academic Health Center envision how to best educate the next generation of health professionals.

By Rich Broderick

This spring, Matt Thompson got to do something out-of-the-ordinary for a fourth-year medical student. He worked collaboratively with students from other disciplines in the Academic Health Center in assessing patients and developing comprehensive treatment plans.

Thompson was part of an innovative three-year pilot project called the Geriatric Rural Interdisciplinary Team, or GRIT. For two weeks, University students in nursing, medicine, dentistry, pharmacy, and social work, along with Augsburg College physician assistant students, gathered in Moose Lake to participate in a for-credit course that placed them in a variety of interprofessional learning settings.

Together the students attended seminars on issues in geriatrics, rural medicine, and interprofessional teamwork, made site visits to clinics on the Fond du Lac reservation and elsewhere, and interviewed geriatric patients at Mercy Hospital and Health Care Center in Moose Lake, which hosted the program. In the second week, students evaluated a patient with Type-2 diabetes and some symptoms of congestive heart failure.

“We interviewed [the patient] as a team and broke down her history into different aspects—social history, medical history, medication history, dental history,” explains Thompson. “Then we gathered and talked about a care plan. I’ve done plenty of care plans but not with members of other professions.”

“Students [in GRIT] realized, ‘Oh, I never thought about the dental issues or the social aspects of a geriatric patient’s situation in rural Minnesota,’” says Dan Mareck, physician and assistant professor in the Department of Family Medicine, Medical School Duluth, who received a federal grant to develop and underwrite the innovative program. “What students said was most valuable about the experience was developing an appreciation of other health care disciplines and of how important it is to be able to work in an interprofessional team context.”

Breaking down education silos

GRIT is just one example of a transformation underway in education across the Academic Health Center, a transformation that seeks, among other things, to change the traditional “silo” mode of health care training both in the classroom and in service-learning settings.

The impetus behind the change comes from numerous sources. Patients increasingly see themselves as partners in their own health care. There is a growing demand for accountability—from the public, from insurance carriers, and from the health care professions themselves. For example, two recent, highly publicized reports from the Institute of Medicine zeroed in on the need to develop a safer, more patient-focused health care system, one that is also efficient, timely, equitable, and effective.

These IOM reports complement in many ways a project sponsored by the Accreditation Council for Graduate Medical Education that identifies six core competencies that today’s doctors need to acquire, including interprofessional and interpersonal communication skills, and practice-based learning and improvement which, among other things, means knowing how to access the vast amounts of information now available through electronic media. Similar calls for interprofessional development and continuous education have been sounded in other health care professions.

Systems-based practice

“We haven’t educated students enough about the health care system in which they will find themselves practicing,” says Deborah Powell, dean of the Medical School. “We give them some courses about this in their first or second year, but that’s simply not sufficient. More and more health care is provided in outpatient settings by interprofessional teams, but our education has been very segmented and we haven’t chosen students who have backgrounds in systems development or team building and we don’t train them to develop those skills.”

The best way to ensure that development, Powell believes, is to inject an interprofessional emphasis throughout the curriculum, from the first semester of undergraduate studies, all the way though graduate work and residency programs.

“We need to make this a real experience, not something artificial,” says Louis Ling, the newly appointed head of Graduate Medical Education for the Medical School. “That means having interprofessional exposure throughout training.”

Ling is part of a new medical education team assembled by Powell, who herself was appointed dean only in 2002. The other members of the new team include Kathleen Watson, interim senior associate dean for education, and Linda Perkowski, the new associate dean for educational and curricular development. Like Ling, both Watson and Perkowski are committed to developing curriculum that is truly interprofessional, reflective of new ideas of expanded core competencies, and rooted in a vision of medical education as a continuum that stretches from undergraduate work all the way through a professional career.

“One of our big themes is the vertical integration of graduate and undergraduate medical education,” observes Watson, a recent recipient of the prestigious Parker J. Palmer Courage to Teach Award. “The old divide between medical school where you learn stuff and graduate medical education, which is predominately clinical, needs to be bridged.”

Interprofessional initiatives

In addition to GRIT, there are several other key interprofessional initiatives taking place throughout the AHC, several under the auspices of the Academic Health Center Office of Education:

• This fall, AHEC, the Minnesota Area Health Education Center, the AHC’s educational platform for connecting with Greater Minnesota, will be identifying effective interprofessional health care teams and placing students in those sites. “Right now, there are few opportunities for our students to actually apply what they are learning in interprofessional settings,” observes Jeny Stumpf Kertz, AHEC’s deputy director in the AHC Office of Education. “We are in the process of developing those opportunities.”
  

• Opened in 2003, the Interprofessional Education and Resource Center (IERC), houses 18 exam rooms monitored by closed circuit cameras for viewing and video recording used to assess and evaluate students’ clinical skills. An AHC Office of Education center, IERC is open for use by faculty and students from medicine, nursing, pharmacy, public health, dentistry, veterinary medicine, and all other AHC programs. This fall, nursing and medical students will, as part of their education, use the new facilities to do practice physical assessment skills as interprofessional teams.
  

• CHIP, the Center for Health Interdisciplinary Programs, has long been a “meeting place for students from across AHC” according to Jenny Meslow, the organization’s director. CHIP is part of the AHC Office of Education. Now CHIP also has become the home of CLARION, a student-founded group designed to foster interprofessional understanding.
  

• The Learning Commons, a joint venture between the AHC Office of Education and the Bio-Medical Library, offers a high-tech “commons” room where students and faculty from every college and department in AHC can come and learn about the latest information technology. For faculty, it’s a place to learn about new ways of teaching using technology. For students and residents, it’s a place in which to practice new ways of learning, like evidence-based practice using the latest technology.
  

• In addition, this past year, 54 second-year Duluth campus medical students enrolled in the Clinical Rounds and Clerkships class worked with 100 fourth-year nursing students from College of St. Scholastica in Duluth in performing assessments on a standardized patient, then jointly preparing short- and long-term treatment plans. The program, an initiativecreated by Jeff Adams, director of Clinical Coursework Overview on the Medical School’s Duluth campus, will expand this coming year to include four standardized patients and participation by College of Pharmacy students on the Duluth campus. “The students reported that they really liked working with each other,” says Adams. He adds: “Early exposure to other health care professionals is important in terms of avoiding interdisciplinary stereotyping.”
  

• On the Twin Cities campus, students from nursing and pharmacy are using the knowledge they learn in courses about immunization to put on an interprofessional clinical skills lab administering flu shots to faculty, staff, and students.
  

• For the past three years, first semester nursing students enrolled in a course in ethics and first year medical students in a course titled Physician and Society have worked together to examine ethical and other complex issues facing health care professionals. “This involves 160 medical and 130 nursing students, so the logistics are pretty challenging,” says Mary Rowan, director of the post-baccalaureate certification program in the School of Nursing. “But the students love the classes and wish they could do more things like it.”

More opportunities ahead

Amidst all these initiatives and a growing enthusiasm for change, no one at AHC is underestimating the scope of the task lying ahead.

“These changes face a lot of challenges not just from the traditions of medical education, but from the very way the system is financed,” observes Barbara Brandt, the AHC’s assistant vice president for education. “One of the biggest challenges we face is accreditation. In the Academic Health Center, we have 194 profession-specific and specialty accreditations. Each has its own requirements for the curriculum.”

Having said that, however, it’s important to note that the University is uniquely situated to lead the way in health care education. From its inception, the AHC has emphasized an interdisciplinary approach to teaching, research, and clinical care. It was that founding philosophy—and the fact that the Medical School is located in the midst of a great research university—that convinced Linda Perkowski to come to Minnesota from her previous position as director of the Office of Educational Programs at the University of Texas-Houston’s Medical School.

“I’ve been working in medical education for 30 years now,” she says. “In Minnesota, for the first time I am working in a medical school where the entire undergraduate university is connected to the Academic Health Center. That opens the way for ample opportunities for collaboration in interprofessional teaching and research.”