Teamwork: Educating Future Health Care Professionals in Collaborative Care
As health care awareness grows, and patients address increasingly more complex navigation channels necessary for treating chronic illness and long-term health conditions, Kathy Dontje is working to deliver the highest quality care at the most efficient and effective levels for both patients and health care professionals.
Dr. Dontje described the situation: Patients with both mental health and chronic health conditions are likely to receive better care from a team of health care professionals than from a physician or nurse practitioner that works alone. The number of these patients is on the rise—the U.S. population is aging, and there are higher rates of obesity and related disease, to cite two reasons for the increase—and schools need an established curriculum to prepare students to work within a model of interprofessional collaborative care. Dontje was awarded more than $700,000 for a three-year grant from the federal Health Resources and Services Administration (HRSA) to develop an effective curriculum that provides students with that education and experience.
The program she has developed, with the involvement of faculty from MSU and Ferris State University, is called EPICC (Education to Promote Interprofessional Collaborative Care). EPICC puts nurse practitioner students, osteopathic students residents, and pharmacology students in three-person teams. Together they work through the curriculum, practice on simulated cases, and treat patients at clinics in Detroit. According to Dontje, the goal of this model is to provide learning experiences that will substantially benefit underserved populations in a safe environment while also instilling an interdisciplinary work approach to care.
Last spring, the first cohort of students completed the program. One of the challenges Dontje faced was coordination. The pharmacy students come from the College of Pharmacy at Ferris State University. Both the residents (College of Osteopathic Medicine) and nurse practitioners (College of Nursing) are enrolled at MSU, though the residents are in Detroit, and the nurses come from all over the state.
Because of these geographic challenges, the first phase of the program is online coursework. The students later gather on the MSU campus for a day of simulated cases with live actors. Finally, they are placed in a clinic where they put what they've learned into practice.
"One of the struggles in all clinics is that there are lots of students," Dontje said, "and so the teams didn't quite pair up the way I would have liked them to. So we did more online discussion of cases to pull them back together for that time period."
The program begins with basic team building, with an emphasis on communication and managing conflict.
"The educational modules provided information for how you build teams," Dontje said. "Students have to first value the team and feel that teams are an important component to good health care. Then you have to know how to communicate. One of the things that we don't do well is communication—you're not always saying the same thing even when you think you are—we're all health care professionals but we still have our own jargon."
The other area, managing conflict, creates an interesting challenge. In the health care environment, many people feel uncomfortable challenging decisions made by colleagues, especially colleagues in roles above them in the institutional hierarchy. So, as Dontje explained, students need to know: "How do you confront people when you know something isn't right? It's that process of understanding why it is important to do and how can you do it in an appropriate way."
Since residents and nurse practitioners have their own patients and are accustomed to being the final word on their patients' treatment, it is important that they learn how to both challenge decisions and be open to colleagues when their decisions are questioned. With the first cohort, Dontje said, it was often the student pharmacists who bridged gaps. Since doctors and nurse practitioners have a lot of overlapping knowledge, it's the pharmacy students who challenge team members to think hard about what their colleagues have to offer.
For many of the participants, the experience was significant. "I don't think people realize at times what one person's role is versus another person's role," Dontje said. "They also don't always understand what the educational background is or how much they have to offer and share. We don't always sit down in a clinic and talk about our different expertise: 'Well, you have an interest in this, and I have an interest in that, pull me in with this patient.' That kind of conversation doesn't often happen."
Dr. John Sealey, a graduate of Michigan State's College of Osteopathic Medicine, is the director of Medical Education for Authority Health GME in Detroit, where he sees firsthand how the team model leads to better care for the patients.
"Patients get service they have never been able to get," Sealey said. He also noted that the regular clinic staff have been impressed by the student teams and have mentioned they'd like to see more of that model at work.
When asked how she would assess the program after that first cohort, Dontje said, "There are some examples now in clinics that it's working, and that's the wave of the future, hopefully. Working as teams, in addition to a primary care provider, we would have a pharmacy person right in your primary care clinic who could come talk to you about your medicine."
Dontje was recently named to the 2016 Fellows of the American Association of Nurse Practitioners, an honor that recognizes nurse practitioner leaders who make outstanding contributions to health care through clinical practice, research, education, or policy.