The dream team

Why HSC students are learning to work together … and how patients will benefit

By April Frawley Birdwell

First-year Health Science Center students Johnny Williams, May Wang and Amanda Malo visit with Georgia Vickers, 85, as part of the Interdisciplinary Family Health Course, one example of how UF is training health science students to work together.

The brown paper sack dropped to the table with a crinkling thud. Reaching gingerly into the bag, Georgia Vickers pulled out a thick pile of worn letters, her wrinkled hands hesitating over the aged blue envelopes as she spread them on the table.

“Let me advise you,” Vickers says, looking toward the three students sitting around her kitchen table on an overcast Sunday afternoon in January. “Save your correspondence because it will be like a journal of your life.”

Like her carefully brewed green tea and Pepperidge Farm cookies, these pearls of wisdom are just something Vickers likes to share with the trio she affectionately refers to as “my students.”

Goergia Vickers, 85, talks to IFH students during the home visit./Photo by Maria Belen Farias

Medical student May Wang, nursing student Amanda Malo and dental student Johnny Williams have been visiting Vickers in her home almost every month since the start of the fall semester as part of the Health Science Center’s Interdisciplinary Family Health course.

IFH, as it is known, brings 600 first-year students from five of the six HSC colleges together in groups of three to visit with families across the Gainesville area. Together, students work on a project to help their family and they learn what it is like to experience health issues and concerns from the patient’s point of view. For Wang, Malo and Williams that has meant learning what it is like to live with macular degeneration — Vickers is legally blind — and helping her with projects she can’t do sans sight, such as organizing old love letters and snipping stretches of antique crochet from worn pillowcases. But perhaps most importantly, the experience gives the rookie students opportunities to learn to communicate, with their patients … and each other.

“We all have different perspectives and different things we have learned,” Malo says. “I never would have thought to ask the questions they have asked. It has definitely helped us collaborate better.”

The course has been teaching health students to work together in teams for 15 years now. But with a heightened focus on the importance of collaboration and teamwork across the field of health care, there has been a renewed push in the HSC to embed more programs like this in the colleges’ curricula.

Why? Studies have shown that many errors in health care ultimately result from lapses in communication. This means teaching students more about each other and giving them the chance to work together now could save patients’ lives later.

“Health care is not a solo sport anymore,” says Eric Rosenberg, M.D., physician director for quality and patient safety in the department of medicine and interim chief of internal medicine. “It is a team sport.”

The roadmap

Richard Davidson, M.D., M.P.H., sees the future of health science education sort of like a roadmap.

Every student in every HSC college is on a specific road. Sometimes these paths intersect. Sometimes they veer off into their own direction. But in the same way many roads converge on a city on the map, eventually, many of those paths will take students to the same place — around a bed, taking care of a sick patient.

“In the past, academic institutions were composed of learning silos. Colleges each taught their own students and there was little interaction between students or faculty,” says Davidson, a professor of medicine, epidemiology and health policy research who was recently appointed associate vice president for health affairs for interprofessional education. “The Institute of Medicine has shown that many problems with patient safety are related to communication problems among health-care providers. They have recommended that health professions students be taught in teams to best prepare them for collaborative patient-centered practice. It is impossible for any one provider to care for a patient by themselves; we all need to work with other health professionals. The patient stands to benefit when all of this comes together.”

The goal is finding these intersections, and implementing interprofessional education in a way that makes sense, which, given the logistics of bringing together students from multiple professional colleges, is easier said than done. Each college already has its own packed curriculum so it is hard to simply find time when students can meet, let along align a new course so it dovetails with what students in different fields are learning at any given time.

In order to offer more opportunities for students to learn together, Davidson is developing a roadmap that starts when a student begins training and ends in graduation. Along that path, students will learn how to be professionals in their own fields and will also take part in joint programs to master skills students in other fields need to know, too. These interprofessional competencies include content such as communication skills, professionalism, learning about other health professions, and the best ways to work successfully as teams, Davidson says.

Davidson and other education leaders across the HSC have been working to increase interprofessional education for years now. Progress has been made at a steady, albeit slow, pace. Aside from IFH, which has expanded over the years, a group of faculty was formed a few years ago to focus on interprofessional education. This interprofessional group, called the Faculty Learning Community, has worked to develop pilot projects focused specifically on patient safety and end-of-life care.

“The reason it has not happened is it is hard to implement,” said Diane Beck, Pharm.D., associate dean for curricular affairs and accreditation in the College of Pharmacy and a member of the Faculty Learning Community. “Overcoming logistics is hard. (But) we are making progress.

“The bottom line is, what is important is the patient,” Beck says. “If something is going to bring you closer to providing better patient care, then we need to do it.”

The bedside

The case involved a woman who needed to undergo knee arthroscopy so she would be able to perform better on the ski slopes. The surgery, scheduled at the end of the day on a Friday, followed several complex procedures. Running behind, the surgeon moved the surgery to a different, more convenient operating room, where staff members and nurses were not used to doing this type of procedure. The nurses express some concern but are not adamant.

Later in surgery, one of the nurses, unfamiliar with the protocol and medicines administered during the surgery, is asked to give the patient a dose of epinephrine. Misunderstanding the doctor, she gives the patient a dose that is 1,000 times too much, causing the patient to enter cardiac arrest …

IFH students also meet in small groups, led by an interprofessional group of faculty, to discuss issues such as patient safety./Photo by Maria Belen Farias

Huddled around a table in the Center for Simulation Safety and Training on the ground floor of the Communicore Building, 11 IFH students listened carefully to scenarios like this, each an example of a lapse in patient safety, highlighting what they thought went wrong.

“The nurse should have clarified what he wanted,” one student says.

Another student nods and adds, “They should have clarified all the meds that would be needed during the surgery.”

The hypothetical case highlights what experts say is one of the biggest contributors to medical errors: the failure of health-care workers to voice their concerns. This often occurs because of hierarchical issues, such as not wanting to speak up to an attending physician, or not listening to another member of the team.

“The reality of clinical practice is we have to work in teams,” says Rosenberg, also a member of the Faculty Learning Community. “If you round in a hospital, you will see a physician, nurses, a pharmacist, a physical therapist, a social worker, sometimes a dietitian …”

From the patient’s perspective, it doesn’t matter, ultimately, who makes a mistake, be it doctor or nurse, physical therapist or pharmacist, Rosenberg adds. If a mistake is made or a patient has a bad experience, he or she will think negatively of the entire institution.

“Health care is highly collaborative and patients see us as one entity, too,” he says. “I really think this is the new frontier in teaching safety and quality. We can do a lot within a discipline, but the real untapped frontier in improving the quality of care hinges upon how effective we are in getting students from various disciplines to collaborate because that is what their entire future careers are going to be spent doing.”

The classroom

Two major changes last year finally got the ball seriously rolling, Beck says. Interprofessional education was added as a key initiative to the UF&Shands strategic plan, and Davidson was appointed to the new role of associate vice president overseeing interprofessional education.

“I am excited about the emphasis of the strategic plan, and the support provided by Dr. Guzick, the deans of the Health Science Center and Shands for interprofessional education,” Davidson says. “While UF is nationally known for our IFH course, we intend to expand that effort into a state-of-the-art, nationally recognized program in interprofessional education.”

As part of his appointment, Davidson leads a committee composed of the education deans from the six HSC colleges and educational technology expert Erik Black, Ph.D. Together, they are planning ways to incorporate more student interaction and collaboration into the colleges’ curricula.

Amanda Malo, a first-year nursing student, serves tea to Georgia Vickers, Johnny Williams and May Wang./Photo by Maria Belen Farias

Initially, Davidson’s team is developing a common set of learning objectives that must be met by students in all the HSC colleges, such as learning about other health professions and teamwork. But how these requirements will be met will likely differ from college to college. Each college will inventory what they are already doing and evaluate which learning experiences meet the objectives and which ones do not. The role of Davidson’s office is to help develop additional curriculum content that will meet those objectives that are not covered currently, and to help the colleges evaluate and assess student performance.

The overall goal, says Gail Childs, director of curriculum and instruction for the College of Dentistry, is to find the best ways to prepare students to work together in the future.

“That is the balance we are looking at, what would enhance our students professional lives and prepare them for practice,” Childs says.

It’s the same balance that is already happening in IFH.

“It’s definitely interesting to see other people’s perspectives and hear about what classes they are taking,” says Dafne Darre, a first-year student in the College of Nursing accelerated program who is taking IFH now. “I have learned a lot about different career paths and opportunities. Everyone has something different. We all learn how to work together with people from different professions.

“I really like the idea. You don’t really get this opportunity at any other point.”

•••

At Georgia Vickers’ house, the conversation has turned from World War II love letters to movies, specifically the movie “Inception.” Vickers is a big Leonardo DiCaprio fan.

Johnny Williams, a first-year dental student in the IFH course, watches Georgia VIckers read through a magnifier./Photo by Maria Belen Farias

But as the tea is poured and the cookies placed on the table, Vickers turns to her students, a serious look on her face. It’s time to give the students her “little spiel,” the one she has given to each of the groups of IFH students who she has met during the past three years she has been in the program.

“By the time you get into your professions, you’ll be dealing with more older people than younger,” she says. “What you are doing is important. It is important they hear you and understand you. So talk in a measured pace so they can hear you and talk straight to them. Whoever you are talking to, turn and face them and you will be blessed forever by your patients.

“And boy, did you all pick the right professions to go in.”