Transforming clinical education and preparing health professionals
to work in and lead patient-centered interprofessional teams
The revised deadline for the Semi-Annual Evaluation Template upload to the CoEPCE Portal is March 15th. Please contact Jennifer Hayes with questions about the submission.
The Office of Academic Affiliations (OAA) Coordinating Center Learning Visit in Seattle this week was hosted by Co-Directors Joyce Wipf, MD, Laurie Angelo, MS, ANP-BC and program manager Gail Eck. VA Office of Academic Affiliations (OAA) visitors included OAA Chief, Dr. Bill Marks, Health Professions Education; Dr. Judith Bowen, CoEPCE Physician Consultant; Dr. Kathryn Rugen, CoEPCE Nurse Consultant and Laural Traylor, National Program Manager from the Coordinating Center and Jennifer Hayes, program evaluator attended on behalf of OAA’s Evaluation and Analytics unit.
The visit started with a delightful lunch and discussion with a group of the Seattle CoEPCE learners. The learners shared thoughts about the program and provided program feedback and recommendations. One trainee reported the experience as “phenomenal” and the group overall was pleased with their development noting that it was “far superior to the experiences of their non-CoE cohort.” Trainees reported having good exposure to the right level of patient complexity and good opportunity to learn about chronic disease management. They felt the huddle experience was helpful and improving as the interdisciplinary group of learners become more connected and comfortable. The learners further reported they had opportunity to work with seasoned professionals of other disciplines and found particular value in exposure to pharmacy and mental health staff. The Learning Visit team had time to observe clinic patient sessions and trainee team building and had stimulating discussion with VA Leadership, CoEPCE faculty and evaluation team members. The visit came together with learners, CoEPCE champions and VA and University leaders and partners in an intimate think tank and CoEPCE Advancement Forum.
The Advance Forum was a grand opportunity for stakeholders to come together and think about the program value and areas in which to grow. Bill Marks led the forum discussion with questions focused on the contributions of the project. VA was praised by Affiliate partners, noting that the "vision (for this program) in VA was incredible." These stakeholders encouraged continued diffusion of program innovations such that this important work can be translated into practice external to VA. Another partner remarked that the program is "absolutely a win-win" and went on to state that trainees are better prepared to function in new interdisciplinary team systems.
Along this train of thought, the OAA visit team was advised to continue to define team based care and remarked that “the contributions towards helping the nation understand the value of this care was of great importance.” It was also noted that this program is a "prototype for the future" in respect to dwindling resources and cost containment (quality and safety included) and is a model that the nation can build on as we learn to understand our outcomes. There was further encouragement for programs to look at the impact on the Patient Aligned Care Team (PACT/ non CoE) and how the CoEPCE is impacting PACT. The notion was strong that to build on this prototype, learners absolutely need leadership development. It was felt that the trainees are being well prepared but that they don’t get this important leadership training in school. Having the ability to lead, to take part in policy development (both local and national) to move the policy from concept to implementation and bringing together varying disciplines to practice change skills will be central roles for these leaders in the future.
As with any system change, there are cultural challenges and challenges around infrastructure redesign and the administrative burdens that may slow progress. Scheduling was noted as one such challenge. Bill Marks noted that scheduling should not be a hindrance to optimal training experience and that we absolutely should not let schedules determine how these revolutionary programs are established. For scheduling (or any barrier to success), Dr. Marks insisted, "We (VA) and our partners (University) can put our heads together and will figure it out!"
In further support for the program Seattle’s Designated Education Officer (DEO), Catherine Kaminetzky stated that "trainees and learners (due to their relationships) feel huge responsibility to these patients." They know where they want the patient to go, and they are learning about the tools and how to use the tools (data driven) that will improve patient care. She stated "we expect that these individuals will be leaders" and that we are setting up the expectation that it is NOT acceptable to not have data on their patients. Cathy said "THIS is the new baseline."
What did we learn in Seattle? We learned a lot, though we can’t possibly share it all here. We do know that we are working towards creating systems in which teams are developing camaraderie, they are learning to talk, to share their independent knowledge and teach each other their different languages and styles. We have learned that proximity is key to this process and space IS an important issue and one that we need to continue to pay close attention to when we are building our programs . We are learning how to build a place of pride and mutual respect and a medical home in which Veterans are bound to receive better, safer and more cost effective care. What isn’t to like?