The benefits of health professionals working together to improve individual patients' care are numerous. However, there are often unexpected barriers that make discussion difficult. The University of Kansas Medical Center aims to make interprofessional communication easier, and the Department of Family Medicine is leading the charge.
When Dr. Jana Zaudke took over the Interprofessional Teaching Clinic, it was in the very early stages of development, but she knew the potential of such a program, as did many other members of the Department of Family Medicine.
"We've only been successful because Family Medicine is so supportive of teamwork between health professionals," says Dr. Zaudke.
The department has certainly seized on the idea of working interprofessionally. Dr. Shelley Bhattacharya's 'Geriatrics Champions Program' focuses on teaching nursing students, as well as physical and occupational therapy students how to work with older adults. Although medical students do not take part, many Family Medicine faculty members and residents serve as group leaders in the classroom setting.
Although there was already plenty of enthusiasm for collaborating across professions, there wasn't a blueprint when it came to starting the IPTC. As far as Dr. Zaudke is aware, there were no other teaching clinics in the country with such a heavy emphasis on working interprofessionally. Many safety net clinics such as the JayDoc Clinic are run and manned by students of different health fields, but they do not have the focus and goal of each student discovering and taking advantage of each other's talents and strengths.
"We were just figuring things out so there was some trial and error," says Dr. Zaudke. "But I think one of the keys to the [IPTC's] success has been our willingness to change."
Initially the IPTC model was more prescriptive. Each profession was given a particular role to play during the encounter. For example, students were given a flowchart and expected to stay within well-defined parameters for their particular profession.
"The students disliked the prescriptive model," Dr. Zaudke says. "They wanted more freedom to ask different questions, so that was one of the first changes we made."
As the students discover each other's strengths, they begin to play off of each other. Lines of questions often take unexpected turns and the interprofessional teams discover information that may not have surfaced in a normal doctor-patient discussion.
In addition to adjusting the educational model, the IPTC now sees patients six half-days a week and even more health professions have become involved. Nursing, medicine, and pharmacy students have been involved since the beginning. NowIPTC has welcomed students from the School of Health Professions, School of Law and PhD candidates in Clinical Psychology from KU College of Arts and Sciences.
As an example of an evolving collaboration, Dr. Zaudke invited undergraduate students in the the Health Information Management program to situate their quality improvement project in IPTC. "These HIM students watched every step of a patient's journey through the clinic. From registration to checkout, they analyzed what worked well and what could be improved and then reported their recommendations. It was really exciting to see the HIM and IPTC students learning from each other. ."
In addition to ambulatory care, hospitalized patients on the Family Medicine inpatient service are also getting the benefit of this type of partnership in the form of the 'Transition Huddle'. During the huddle, nurses, physicians, social workers, case managers, pharmacists, physical therapists, and lawyers from KU's Medical-Legal Partnership meet daily to discuss patients' progress toward discharge. This has the added benefit of allowing everyone involved in an individual's care to have the same information. During Dr. Zaudke's tenure as the Director of the Family Medicine inpatient service, "Our Transition Huddles have set the standard for exceptional communication, collegiality and collaboration."
Family medicine's role in interprofessional health care is likely to increase says Dr. Zaudke.
"It's a natural fit for Family Medicine," she says. "This is where care is going."
Recently, Dr. Zaudke learned that she and her interprofessional partner, Dr. Sarah Shrader PharmD, have received a Macy Foundation grant for their project, "The Faculty Preceptor as Nexus: Developing Preceptors Who Blend Interprofessional Practice and Education at the Point of Primary Care." Drs. Zaudke and Shrader will develop a faculty development package to assist faculty preceptors in blending live interprofessional practice within an interprofessional education curriculum. Not only will the home-grown IPTC benefit from this work, but Drs. Zaudke and Shrader will disseminate the package to primary care sites across the state of Kansas.