Interprofessional Education and its Role in the Emergency Department

Katelynn Baska, MSIV, Philadelphia College of Osteopathic Medicine
EMRA MSC Northeast Coordinator 

Alexa Van Besien, MSIII, University of Maryland School of Medicine
EMRA MSC Mid-Atlantic Representative

Healthcare as a “team sport” is not a new concept.  Successful patient management hinges on a collaborative effort between all areas of care, including: physicians, physician assistants, nurses, pharmacists, technologists and technicians, physical therapists, rehabilitation specialists, emotional and social support services, etc.  However, training in each of these fields often involves learning and practicing only with colleagues in your own profession.  This is where interprofessional education becomes important.  Interprofessional education (IPE) is an interactive teaching tool where health professions students from multiple disciplines are brought together for the purpose of learning together to improve interprofessional communication and teamwork.  It allows for students to use the skills and knowledge they’ve each acquired during their training and apply them in an environment that more closely reflects a healthcare setting. Additionally, it is a unique opportunity as a student to practice your role in the healthcare team and to better understand the expertise and challenges of other professions.

Interest and investigation into interprofessional education stemmed from concerns over patient safety where, “failures of teamwork and interprofessional communication were, and continue to be, frequent causes of harmful medical errors.”1 Because of this, implementing collaborative, multidisciplinary educational opportunities into traditional teaching curriculum is a proposed method of improving patient outcomes. In 2010, the WHO released the Framework for Action on Interprofessional Education and Collaborative Practice in acknowledgement that “there is sufficient evidence to indicate that effective interprofessional education enables effective collaborative practice.”2 The AAMC also became involved in promoting interprofessional education by joining with five other health professions associations to create the Interprofessional Education Collaborative (IPEC).  In 2011, IPEC published a Core Competencies for Interprofessional Collaborative Practice report that outlined the core competencies central to IPE curricula; the IPEC has since expanded to include 14 additional association members and released an updated report in 2016.3  With all of these efforts dedicated to the incorporation of interprofessional education, what does the data show? 

A 2019, 34-item, single-stage survey found that medical students had overwhelmingly positive perceptions and attitudes toward interprofessional education.4 In addition, a systematic review of IPE studies conducted by Reeves et al, found that seven out of fifteen studies reported positive outcomes in: diabetes care, emergency department culture and patient satisfaction, collaborative team behavior and reduction of clinical error rates for emergency department teams, collaborative team behavior in operating rooms, management of care delivered in cases of domestic violence, and mental health practitioner competencies related to the delivery of patient care.  Four of the studies had mixed positive and neutral outcomes and four reported no impact on patient outcomes.5  Due to the variety between the studies compared and the small number of studies that fit the review criteria, it’s difficult to draw generalizable conclusions; however, the data suggests that inclusion of interprofessional education in medical curricula has positive implications.

Many medical institutions have heeded these recommendations, implementing various methods of interprofessional education into their curricula.  Philadelphia College of Osteopathic Medicine (PCOM), for example, has continued to develop the available opportunities for health professions students to collaborate.  PCOM HEARTS, the institution’s Student-Run Clinic, allows for DO and PsyD Clinical Psychology students to work together in providing healthcare to Philadelphia’s most vulnerable at three different homeless shelters in the city. Clinical PsyD students also lead balint groups and work in research teams with DO students. In addition, PCOM has partnered with Villanova University’s M. Louise Fitzpatrick College of Nursing to provide DO, PsyD, and nursing students the opportunity to participate in collaborative medical crisis simulations and case conferences/grand rounds.  Outside of these examples, PCOM offers longitudinal case reviews, seminars, research reviews, and full-day symposiums and discussion groups on a variety of topics (ie. sexual orientation and gender nonconformity, self-care, disaster planning/COVID, leadership, etc) between DO, PA, clinical psychology, mental health counseling and clinical health psychology students. 

At the University of Maryland, students participate in lectures on IPE as part of a longitudinal course spanning the entirety of medical school. A unique opportunity includes the ability for students to participate in the “President’s Interprofessional Education Clinic”, where students from the University of Maryland Baltimore’s School of Medicine, Nursing, Pharmacy, Dentistry, Law, and Social Work collectively see patients under guidance of Dr. Jay A Perman MD, the former President of the University of Maryland Baltimore, and current Chancellor of the University System of Maryland.  Additionally, the University of Maryland School of Medicine offers elective courses for MSIV students that focus on IPE such as Interprofessional Culinary Health and Medicine, Geriatric Medicine, Medical Genetics, Patient Safety, and Quality Improvement, 

While interprofessional education is beneficial for all medical fields, honing skills such as effective communication and efficient teamwork is particularly salient for emergency medicine. Successfully navigating emergent situations requires that all participants understand their role and the roles of others, demonstrate value and respect for their teammates, and feel as though they are a part of the team. A focus group study conducted in 2018 that included fourteen Emergency Medicine residents found that although residents perceived interprofessional communication skills to be “essential for their daily practice,” they did not feel as though their formal education reflected this importance.6 This highlights the need for incorporation of interprofessional education not only in medical school, but also in residency curricula.  Inclusion of interprofessional simulations, case discussions, and reading clubs, as per the suggestions of the residents in the study, could greatly improve the relationships among the healthcare staff in the emergency department. The first step toward proficiently working together as members of the same team is the ability to put yourself in the shoes of others; interprofessional education is an excellent tool for providing that perspective. 

References:

1. Dow, A., &  Thibault, G. (2017). Interprofessional Education - A Foundation for a New Approach to Health Care: NEJM. Retrieved from https://www.nejm.org/doi/10.1056/NEJMp1705665
2. World Health Organization. (‎2010)‎. Framework for action on interprofessional education and collaborative practice. World Health Organization. https://apps.who.int/iris/handle/10665/70185
3. Interprofessional Education Collaborative. (2016). Core Competencies for Interprofessional collaborative practice: 2016 update.  Washington, DC: Interprofessional Education Collaborative.
4. Zechariah, S., Ansa, B.E., Johnson, S.W., Gates, A.M., De Leo, G. (2019). Interprofessional Education and Collaboration in Healthcare: An Exploratory Study of the Perspectives of Medical Students in the United States. Healthcare(Basel) v 7(4) doi: 10.3390/healthcare7040117.
5. Reeves, S., Perrier, L., Goldman, J., Freeth, D., Zwarenstein, M. (2013). Interprofessional education: effects on professional practice and healthcare outcomes. Cochrane Systematic Review- Intervention. https://doi.org/10.1002/14651858.CD002213.pub3
6. Bekkink, M. O., Farrell, S. E., Takayesu, J. K. (2018).  Interprofessional communication in the emergency department: residents’ perceptions and implications for medical education. International Journal of Medical Education v. 9 262-270. doi: 10.5116/ijme.5bb5.c111