When University of Wisconsin-Madison leaders asked Jeanette Roberts, PhD, MPH, in 2013, to devote another year to her role as dean of the School of Pharmacy, her affirmative response brought with it a deeply held condition: creation of a center that would foster coordination among health care-related programs throughout UW-Madison.
At that time, after a decade leading the school, Roberts was preparing to pursue a one-year Robert Wood Johnson Foundation health policy fellowship in Washington, DC, but the School of Pharmacy needed extra time to find a qualified candidate to succeed her as dean. Also, the school’s recent reaccreditation brought to the forefront new pharmacy standards that emphasize collaboration among various health care professions. Roberts viewed those accreditation standards as a bellwether for other professions.
Fast forward to September 2016, and UW-Madison is celebrating the debut of the Center for Interprofessional Practice and Education (CIPE). The UW Schools of Medicine and Public Health (SMPH), Nursing, Pharmacy and Veterinary Medicine are founding members, and Roberts—who recently completed her health policy fellowship—is the center’s first director.
National and local health professions leaders and learners have long discussed the importance of teaching these fields in an interprofessional way. As early as 1972, an Institute of Medicine report, “Educating for the Health Team,” described organizational, political, ethical and legal barriers to effective, safe team-based patient care.
The report urged that academic health centers “must recognize an obligation to engage in interdisciplinary education and patient care, and establish regional consortia of health professional schools not otherwise associated with academic health centers … to foster educational teamwork.”
Yet, more than 40 years later, teamwork remains a major challenge in hospitals, with communication posing one of the biggest threats to patient safety, according to the National Center for Patient Safety (NCPS). For instance, an NCPS review of more than 7,000 adverse events and close calls in Veterans Administration hospitals found that communication failure was the root cause or a contributing factor in 75 percent of cases, according to a 2015 Report to Congress by the U.S. Government Accountability Office.
In line with its overarching goals to help improve core competencies in interprofessional health education, the CIPE aims to enhance interprofessional communication and overcome causes of communication failure. To do so, it will analyze and work to improve communication throughout the training of health care professionals in classroom, clinical and extracurricular settings.
“We’re beyond the point of arguing that interprofessional health education is valuable,” Roberts says. “UW Health risk managers told me that if they hire graduates who don’t have interprofessional language, or who don’t have this type of knowledge across disciplines, the health care system is at high risk of negative patient outcomes and malpractice suits.”
Roberts and the CIPE Advisory Council— which consists of faculty and staff from the various member schools — are building the infrastructure to achieve CIPE’s aims; they soon will recruit an associate director. Everyone involved hopes to see CIPE grow into an organization that will reform health education to encourage better communication and collaboration, and ultimately improve patient care and safety.
“The whole point is to graduate collaboration-ready practitioners who are very comfortable and adept at walking into a setting and talking with social workers, physicians, physical therapists and other health care professionals,” Roberts explains.
Changing Education to Reflect Health Care Delivery Shortcomings
Although he took an unusual path into health care, it wasn’t by chance that Joseph Zorek, PharmD, ended up at UW-Madison.
Zorek, who’s been an assistant professor in the UW School of Pharmacy since 2013, spent three years teaching in secondary education before attending pharmacy school at the University of Illinois at Chicago. He then completed a two-year pharmacotherapy residency at Texas Tech University Health Sciences Center in Amarillo, where he developed a research focus in interprofessional practice and education.
Believing that pharmacists’ expertise was vastly underutilized, and searching for a framework to address this problem, Zorek became interested in the work of the National Center for Interprofessional Practice and Education at the University of Minnesota. That center’s efforts are oriented around the “Nexus,” which they describe as the interface between health professions education and health care delivery. The Nexus affords an opportunity to create deeply connected, integrated learning systems to transform education and care together
“The ultimate goal is to create better health for patients and populations, but the idea they started rallying around is that we can’t do that unless we change the educational system,” Zorek notes. “That really struck me, partly because I had been a high school social studies teacher.”
He continues, “I had all this educational background, and I gravitated to this idea of the Nexus and how important educational policy changes or curricular changes could be in impacting health care outcomes.”
For Zorek, the appeal of moving his career to UW-Madison was two-pronged: It offered him the chance to make interprofessional practice and education the foundations of a research program, and he would have the opportunity, through CIPE, to help mold the university’s efforts in this area from the ground up.
He spends a large portion of his time promoting a better understanding of various health care professionals’ roles and responsibilities so students are prepared to work collaboratively on teams. For example, at the UW School of Pharmacy, he has developed a course for first-year students that explores numerous ways pharmacy can be practiced and how pharmacists interact with other health professionals to strengthen team-based care.
Zorek notes, “One purpose of the course is to make sure pharmacy students understand all of their profession’s roles and responsibilities so they can adequately teach other professionals about pharmacy’s roles.”
A CIPE team is developing a related course, “Foundations of Interprofessional Education.” It will be offered as a pilot for medical, nursing and pharmacy students in fall 2017 and as an elective/selective for students in those programs in spring 2018. Ideally, the course eventually will be available for all health professions students. Some programs have expressed interest in making the course a requirement in the future.
At the SMPH, the MD Program’s new ForWard Curriculum emphasizes interprofessional health education and team-based care as one of 10 “threads” deemed so vital that it’s woven into teaching throughout all four years of medical school
Robert Holland, MD, thread director for quality, safety and interprofessional health education, shares that the ForWard Curriculum emphasizes interprofessional education to help graduates maximize the diverse backgrounds of health professionals to provide better, safer team-based care.
“In the past, we’ve always had experiential learning within health care teams, so a lot of what students learned about interprofessional concepts was through an implicit or informal curriculum,” Holland says. “Now, starting with their first block of learning, medical students are explicitly exposed to these concepts.”
Another of CIPE’s major goals is to help various professional programs coordinate shared student experiences. Holland and SMPH Clerkship Curriculum Manager Roberta Rusch, MPH, note that the varying degree levels of the programs have posed challenges in the past, but they expressed optimism that the new center will find ways for students to learn together.
“It’s not just about teaching students what a pharmacist does or what a physician assistant does,” Rusch shares. “It’s about how we can help change the culture so all health care professionals work together, collaboratively, to improve patient outcomes. We hope the emphasis of interprofessional health education in the ForWard curriculum will help move us in that direction.”
She adds, “Our challenge is to identify or create quality assessments to measure student competencies in interprofessional health and team-based care. Dr. Holland and I are considering looking at businesses—not just thinking of health care professions, but how people work together in other industries and how they measure good teamwork.”
The Center’s Future
While CIPE is debuting with involvement from core health professions schools that deal with patient and animal care, Roberts and the CIPE Advisory Council envision expanding throughout UW-Madison to include 20 or more undergraduate and graduate programs. From engineering to law, there’s a wealth of knowledge and interest that can enrich the interprofessional experience, according to Roberts.
“The center has the potential to facilitate the transformation of education,” Zorek notes. “We can play an instrumental role by getting students out of the ‘silos’ of individual programs and into the same spaces to learn about, from and with each other.”
Holland says there are no boundaries for what programs could be included because many would add value to the center.
“I would never look at another profession and say, ‘I don’t think we can benefit from collaboration,’” Holland comments. “I think everyone has something to add, and we can celebrate the diversity of backgrounds as we work to improve patient care.”