August 8, 2013

Students promote interprofessional training programs

Two groups of Vanderbilt students from different disciplines of health care recently completed projects with a common goal: promoting interprofessional training for the next generation of health care professionals.

From left, Sarah Quirk, R.N., and Kathleen Danhausen, R.N., both second-year nurse midwifery students, and Deepa Subbi Joshi, third-year medical student, gather at the Shade Tree Clinic, where they shared leadership of the early pregnancy program.

Two groups of Vanderbilt students from different disciplines of health care recently completed projects with a common goal: promoting interprofessional training for the next generation of health care professionals.

The students say the opportunities they have had to train through Vanderbilt’s interprofessional programs are making them better prepared to work together in the future.

Third-year School of Medicine students Clint Morgan, Richard Latuska, Gretchen Edwards and Cristina Farkas produced a project as participants in the Vanderbilt Program in Interprofessional Learning (VPIL). They participated in clinics as part of teams that include nurse practitioner, pharmacy and social work students. The four were recognized with the 2013 Outstanding Poster Award for a Trainee at the Southern Group on Educational Affairs/Southern Group on Student Affairs annual conference in Savannah, Ga.

In their project, they compared the performance of VPIL medical classmates with classmates trained in clinics only alongside other medical students. Trained, standardized patients scored VPIL medical students significantly higher overall, especially on relationship building and communication activities like eliciting the patient’s view or discussing lifestyle issues and prevention strategies.

“The faculty also scored VPIL students higher, but we thought that it was especially relevant from a health care systems perspective that people trained to represent the average patient walking in to a clinical setting, with no presumed training in health care/expectations, scored interprofessional medical students higher,” Morgan said.

The students said within VPIL they also are gaining an expanded personal view of how care may be provided in the future.

“It has really opened up my awareness. I didn’t know that in some states pharmacists can prescribe directly to patients, autonomously. It has us thinking about the patient perspective and access to care,” said Farkas.

Edwards agreed, saying in her clinic she learned nurse practitioners are very capable of managing chronic health conditions.

“And honestly, that had me doing a bit of soul searching about my role. It was humbling, but as we enter what is still a hierarchical system for work, we have a new perspective, and are open to changes for the betterment of the patient,” Edwards said

Latuska said he feels interdisciplinary training may actually help develop medical students into leaders who can take an open-minded approach on finding ways to provide care to a growing pool of patients, in a system with fewer health care dollars.

“I know many established providers may be set in their ways, or feel unable to change things, even though they are frustrated by the way they are now. By doing this we can see there may be more effective ways of providing care. We will take that forward,” Latuska said.

In a second project, Nurse Midwifery students Kathleen Danhausen and Sarah Quirk worked with medical student Deepa Joshi to produce a position paper encouraging medical-student-run clinics around the nation to consider interdisciplinary collaboration. The students co-directed the Shade Tree Early Pregnancy Program (STEPP) within the Vanderbilt medical student-run Shade Tree Clinic for the uninsured. The students said interdisciplinary sharing of leadership early in training may speed a culture change.

“For me, it’s learning a language with which to communicate,” Danhausen said. “We learn it is not threatening or calling into question your skills or knowledge. It’s trusting and knowing when to call on other team members and feeling comfortable calling in other people from other professions in order to give better care to patients.”

Joshi said she is learning from both the STEPP experience and her experiences as a VPIL student that interdisciplinary care may sometimes be more patient-centered.

“Sarah and I also happen to be in the same VPIL clinic and we had a powerful experience where 11 or 12 people were surrounding one father who was getting custody of a child with cystic fibrosis. It was a difficult time, but for him to know there was this army of talented people caring for him, all trying to provide the best care from different viewpoints; we could see that was powerful to him. That helped us believe,” Joshi said.

Faculty instructors in the interprofessional programs say they are proud of Vanderbilt students who have taken what they have learned to national meetings and student organizations.
Robert Miller, M.D., associate professor of Allergy, Pulmonary and Critical Care Medicine, and co-medical director at the Shade Tree Clinic, said there are current conversations with the School of Nursing to bring more nursing students into Shade Tree. He and Mavis Schorn, Ph.D., CNM, senior associate dean for Academics at Vanderbilt University School of Nursing and principal provider in the STEPP clinic, say they enjoy modeling collaborative work for the students.

“They want to see us modeling the team approach, sharing respect and interprofessional competencies. It appears to me to be growing. The students themselves are making that happen with leadership selection and volunteer recruiting,” Schorn said.