by Raymond F. Lamore III, Pharm.D., PGY1 Pharmacy Resident, the Johns Hopkins Hospital
The strategy of treating patients as a part of a “multidisciplinary team” has become common in many progressive medical centers. Utilizing the various skills of different members of the medical team can lead to significant improvements in patient care. Recently, literature has been published demonstrating the impact that pharmacists can have on patient outcomes as a part of the multidisciplinary team.1-3 Based on this body of literature, there has been a surge of opportunities for pharmacists to participate in point-of-care treatment as a part of an inter-professional team.
As a part of the medical team it is a necessity for the pharmacist to be able to appropriately interact with the other members and understand their point of view. This expansion in our “job description”, begs the question: Are we trained to do this!? I am not questioning a newly trained pharmacist’s ability to answer pharmacological questions and make clinical decisions, rather asking if we have been properly trained to be an effective member of the medical team. Unless you have had a job within a hospital as an intern, your interaction with various members of the medical team was probably minimal; with most occurring during your final year in school during advanced pharmacy practice experiences (APPEs). Many have concluded that the difficulties encountered in working with multiple professions stem from a lack of knowledge regarding the different roles and a relative absence of teamwork skills.4 In 2007, the American Association of Colleges of Pharmacy (AACP) Professional Affairs Committee advocated that “all colleges and schools of pharmacy provide faculty and students meaningful opportunities to engage in education, practice, and research in interprofessional environments to better meet the health needs of society.”4
This leads to a second question. Should students be introduced to the different members of the medical team during classroom-based instruction. Interprofessional education can add many benefits to a college of pharmacy’s curriculum.5 The World Health Organization defines interprofessional teaching as “…students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”5 An expert panel from the Interprofessional Learning Collaborative suggested the following key objectives for interprofessional teaching:6
· Relationship focused
· Process oriented
· Linked to learning activities, educational strategies, and behavioral assessments
· Able to be integrated across the learning continuum
· Sensitive to the systems context/applicable across practice settings
· Applicable across professions
· Stated in language common and meaningful across the professions
· Outcome driven
Interprofessional teaching would also add depth to the students’ ability to perform analysis, as different members of the medical team utilize a variety of thought processes in clinical decisions. These perspectives and processes differ from a pharmacist’s. Educational researchers have found benefits to this teaching modality, as it helps students to recognize bias, think critically, tolerate ambiguity, and acknowledge and appreciate ethical concerns.5 Introducing students to different members of the medical team may also increase their confidence when communicating recommendations. This interprofessional model of teaching and learning could seamlessly progress from the classroom into experiences partnered with students from many health professional programs.
In 1995, a nursing and pharmacy school completed an interesting clinical collaborative project, in which students from each school were paired so that they could utilize their “profession specific” skills in patient care situations.7 During the project, students met weekly in the hospital to jointly present at case conferences to their peers. The students worked in pairs, one from each discipline, in selecting a patient case, plan a case study, and present the results to the group. This experience required the students to collaborate, utilizing negotiation skills and critical thinking processes. Common issues that were addressed by the nursing students, included: physical signs and symptoms, medication administration, laboratory values, discharge needs, and self care abilities. Whereas, student pharmacists would address pharmacological therapy, allergies, polypharmacy, pharmacokinetics, contraindications, route of administration, and adherence.
After the completion of the project student comments were positive. They expressed appreciation for a collaborative approach to patient care. This project demonstrated great success as both groups of students expressed an appreciation for the complementary nature of the two health care professions. This early experience lead to expanded implementation of these experiences in the respective curriculum.8 This form of interprofessional education is a great way to collaborate with other members of the team and gain an early appreciation for their roles in patient care. The only foreseeable complication in this approach would be possible scheduling complications between academic institutions and having resources (hospital, staff, etc.) to allow for team meetings and collaboration.
Taking a interprofessional approach to teaching and learning is a tool to enrich the curriculum of any college of pharmacy. Utilizing this approach to educate pharmacists will open the doors for early interaction and collaboration with the various members of the health care team and broaden learning experiences for students.
References:
1. Marshall J, Finn C, Theodore A. Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay. Crit Care Med. 2008;36:427-433
2. Cohen V, Jellinek S, Hatch A, et al. Effect of clinical pharmacists on care in the emergency department: A systematic review. Am J Health-Sys Pharm 2009;66:1353-61.
3. Gattis W, Hasselblad V, Whellan D, et al. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team. Arch Intern Med. 1999;159:1939-1945
4. Page R, Hume A, Trujillo J, et al. Interprofessional Education: Principles and Application. A Frame Work for Clinical Pharmacy. Pharmacotherapy 2009;29(3):145e–164e.
5. Romanelli F, Bird E, Ryan M. Learning Styles: A review of theory, application, and best practices. Am J Pharm Educ 2009;73:1-5.
6. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
7. Science Education Resource Center at Carlton College. Starting Point: Teaching and Learning Economics. Why Teach with an Interdisciplinary Approach? Accessed: November 6, 2011.
8. Robertson K. Interdisciplinary professional education: A collaborative clinical teaching project. Am J Pharm Educ 1995;59:131-136.