Stronger Together

“We offer a course on global health run by the business school. There is another one on trauma through the schools of education, nursing and social work. It explores various trauma among health educators, children and other groups. It looks at broader aspects of society. We’re also doing some technological innovations with simulations and clinical experiences.” Student pharmacists must look beyond simply focusing on medications to be part of a team, he noted.

“When you are looking at a skill set, it isn’t just the technical aspects of drug products,” Ascione continued. “It is learning to transmit that information to a team and giving appropriate advice. Unless pharmacists are sensitive to the perspectives of other professions, they may be too narrow in their approach and less effective team members.”

At Texas Southern University College of Pharmacy and Health Sciences, IPE is interwoven through the curriculum in a didactic setting in the first, third and fourth years, with an experiential focus in the second year. All first-year students take a communications lab, according to Dr. Portia Davis, interim executive director, Division of Interprofessional Practice and Simulation, and associate professor of pharmacy practice, and participate in interprofessional work sessions with students in disciplines such as respiratory therapy nursing and health administration. “Students work to disclose a medication error to a patient’s family as a result of a communications failure,” Davis explained.

“In the spring of the first year, students are enrolled in an ethics course, which they take at the same time with clinical lab sciences students, respiratory therapy students and others,” she continued. “That course features ethical problem solving with clinical vignettes. It includes panel discussions and active learning. In the second and third years, we try to pair students in our community settings on their rotations with students from one of our local teaching hospital systems. Sometimes it works well but sometimes scheduling logistics with medical students doesn’t work for all students. They work together under the supervision of both clinical pharmacists and physicians in chronic disease state clinics to create care plans.”

As part of their cocurricular activities, third-year students attend a large-scale interprofessional event at the University of Texas Medical Branch. Davis said that the event, which involves at least 14 disciplines, explores a patient case surrounding a high school athlete who becomes septic and has complications requiring amputations. Social and administrative sciences as well as underrepresented disciplines such as medical humanities are included. “Our students are always well received and come back thankful to hear how much it opens others’ eyes to what pharmacists can do,” she said. “That event seems to be their most memorable experience.”

The college of pharmacy’s largest event—a simulation case for fourth-year students that uses high-fidelity mannequins—aims to incorporate all disciplines. Students work together to document and work through a plan for patient care; a student-led debriefing includes guest facilitators. Davis said she is committed to adding more layers to the current IPE experience.

Faculty underwent facilitator training for a poverty simulation just before the pandemic. The plan is to offer a virtual session later this year but Davis hopes it will become an annual event. “While what we’ve done has been impactful, I don’t think it’s been enough,” she noted. “With everyone being forced to work remotely due to COVID-19, some of the barriers have been eliminated so we want to expand upon what we currently offer.”

Examining the IPE Landscape

The American Interprofessional Health Collaborative (AIHC), the professional community of the National Center for Interprofessional Practice and Education, conducted a survey in late 2019 to increase understanding of IPE organizational models. Dr. Elena Umland, associate dean of academic affairs at the Jefferson College of Pharmacy and associate provost for interprofessional practice and education at Thomas Jefferson University, who served on the survey task force, said the goal was to answer questions such as what does the IPE organizational structure look like at different schools; how much support is coming from the administration; does it live within a particular college; is it centralized; and what contributes to the success of a program?

“We were hoping this report would lay the foundation so people can see where we’re starting from,” Umland said. “You need the resources to deliver a high-quality IPE program. From a pharmacy perspective, institutions and colleges can use this report to say, we could be further ahead with this if we had some resources. One of the findings had to do with the value placed on IPE relative to promotion and tenure—it’s not always explicit in our guidelines. The institutions that do [tie those together] tend to have faculty who seem more vested in participating in IPE.”

Dr. Sarah Shrader, professor, University of Kansas School of Pharmacy, who led the task force and was outgoing national chair of AIHC when survey preparations began in March 2019, said the survey accomplished the goal of reporting on how IPE is organized nationally and what is happening on the ground. “Now that we have our arms around what is happening, we continue tracking it and we are starting to think about best practices,” she said. “What is happening that is working well that we could suggest for others to follow? We’ve done some further analysis and in the manuscript that we’re trying to finish and submit, it will go a step further than the report. We will make some suggestions about best practices and how to best organize IPE based on our findings.” That document will be published later in 2021.

Shrader noted that survey results underscored the need for senior administration to have a better understanding of IPE and the resources it takes to maintain a robust program. For example, at the University of Kansas School of Pharmacy, there are at least a dozen faculty, along with pharmacy residents and students, that facilitate several IPE activities. “It is a huge undertaking. We are fortunate to have the support of our talented faculty and pharmacy administrators. Unfortunately, this is not the case at all institutions,” she said.

“We as an Academy are proud that pharmacy is one of the drivers of IPE thanks to our aggressive accreditation standards,” she continued. “Hopefully faculty champions can use this report to continue to drive change, which will better position IPE within their organization. In terms of areas for improvement of IPE, the majority of respondents said universities and organizations should think through including this more intentionally in promotion and tenure guidelines. So many pharmacy faculty are highly involved leaders in IPE, we want to see them getting credit for that. The other thing we saw from the data was the need to think about ways to get more faculty involved in IPE and honor the amount of time it takes. We want to make sure that the work and service on IPE committees is accounted for just like any other types of teaching commitments are within schools of pharmacy. Often what we see is people get involved because they believe so passionately in IPE, but they are not allocated the time that’s needed to develop and facilitate IPE events.”

The National Center’s Brandt said the curriculum needs to prepare student pharmacists for the clinical environment, and she is focused on the idea of flipping IPE to include collaborative practice. Shrader developed a free online course with the National Center (Nexusipe.org) that teaches how to teach in practice. “My vision for pharmacy would be to take stock of how to teach in practice,” Brandt noted. “We can do all the curriculum in the world and mapping of competencies in the classroom but if our students go into practice and they are not seeing the role models, we are really wasting our time. Pharmacy schools with other health professions need to focus on how we are going to teach collaboration in our experiential programs.”

Shrader agreed that there needs to be a push for IPE in practice settings. “It’s the being intentional aspect of it that people are wrestling with,” she noted. “One challenge is scaling the IPE in practice settings so that all students have an opportunity to get appropriate amounts of exposure and get evaluations from non-pharmacy preceptors and students from other professions.” As Michigan’s Ascione pointed out, the pandemic revealed the holes in our healthcare system and the need for health professions to work together. “From the intensive care unit to community care and health disparities—you can’t solve those issues in segments,” he said. “We need to take a broader approach. I am hoping for a more integrative approach to dealing with healthcare. Pharmacy is going to be important because pharmacy is in the community.”

Collaboration Leads to Better Patient Care

At Jefferson’s College of Pharmacy, the provost’s office provides centralized support for the Jefferson Center for Interprofessional Practice and Education (JCIPE). Every class participates in the two-year longitudinal Jefferson Health Mentors Program (JHMP) in conjunction with the colleges of health professions, medicine, nursing and rehabilitation sciences; in total, 13 disciplines currently participate. Programs such as this have positively impacted faculty in that they routinely interface with faculty from other professions.

“Through this flagship program, interprofessional student teams are paired with a community volunteer who has at least one chronic condition. We refer to these volunteers as mentors,” Umland explained. “The main purpose of the two-year program is to learn what it’s like to be a person with a chronic health condition, to learn what it’s like to traverse the healthcare system.” Those meetings always took place in person, so Umland said they had to get creative when the pandemic began last March.

“Some [student teams] used FaceTime and some used the telephone as we became sensitized to the cost to the mentor of using their cell phone data plans to communicate,” she continued. “The mentors may not have unlimited data on their phones, or some of our older mentors may not feel comfortable with the technology. As we got ready for fall, we needed to recruit new mentors. Part of that involved assessing their comfort with and training them on the technology if needed. It went pretty seamlessly. We still had facilitated discussions where faculty met with small student group teams to talk about the module and debrief—we used Zoom for that. Other JCIPE programs depending on simulation for delivery found simulation by Zoom to be a challenge. But we have phenomenal full-time staff who were able to assist facilitators in getting through the steps for team modules in small groups.”

Brandt said the pandemic illustrated technology’s vital role in delivering patient care. “Last spring we had people contacting the National Center asking for help,” she noted. “They had to flip the curriculum in the middle of a semester. We offered webinars and we really were focused on the technology aspects. What we’re learning is that the students are positively rating their experiences with this flip in IPE. People are adapting and learning how to foster collaboration. People are starting to see the value of that experience related to telehealth. We’ve been talking about telehealth and training for decades. Many didn’t take it seriously. Now, having to be on Zoom, they see that it has the potential to develop skills in telehealth. I think this experience is going to teach us a number of lessons about effective methodology for using telehealth.”

At Texas Southern, an interdisciplinary simulation center allows students to work collaboratively on patient cases and gain experience with clinical decision making. Davis said that since the pandemic, they have made an effort to incorporate telehealth into interprofessional activities. “I am hoping we really stay true to our mission to produce practice-ready graduates,” she said. “You need a strong interprofessional base for this. They need to be comfortable and know their role in team-based care and be able to provide virtual patient care. They must be able to contribute to teams remotely and go above and beyond when situations require such actions. Our students are building a good foundation but I want them to be confident interacting with other disciplines, regardless of their area of practice or practice setting. We’re building strong leadership skills and strong team skills. I’m hopeful that what we have learned with this pandemic will strengthen the knowledge that we have to be flexible, we must see and place our efforts toward the big picture for optimal patient care.”

Umland agreed that the goal is to prepare students to practice collaboratively. “When I meet with first- and second-year students, regardless of discipline, I tell them that before IPE you would spend years trying to figure out everyone’s place in the healthcare system is and who does what,” she said. “Now, by introducing them to each other and having them get to know each other as people at the beginning of their training, they have a much better appreciation for each other. They enter practice being able to communicate well, understand their peers well and the skills of collaboration are foundationally there. The purpose being that patient care is improved, and when you participate in patient care as part of a highly functioning team, your love for your profession improves. Burnout is less. It is so much more rewarding.”

Ultimately, IPE furthers the goal of enhanced patient care, Shrader pointed out. “New practice models are emerging where people will have to have interprofessional teamwork and communication skills in order for them to be successful,” she said. “IPE is one of the things that will help us achieve the quadruple aim in healthcare: providing better patient outcomes, a better patient experience in our healthcare system, doing it as efficiently as possible in terms of costs and resources and making sure we are providing a good experience for the healthcare providers themselves through teamwork and collaboration in a way that increases the joy and value of their work.”

Jane E. Rooney is managing editor of Academic Pharmacy Now.