Transforming clinical education and preparing health professionals
to work in and lead patient-centered interprofessional teams
VA's Centers of Excellence, Primary Care Education (CoEPCE) Transforming clinical education and preparing health professionals to work in and lead patient-centered interprofessional teams
About CAB IV
Collaborating Across Borders IV (CAB IV) is an interprofessional meeting that originated as a conference between the United States and Canada with the support of the American Interprofessional Health Collaborative (AIHC) and the Canadian Interprofessional Health Collaborative.
The Centers of Excellence Primary Care Education (CoEPCE) presentations include a workshop and posters. The workshop, entitled “VA Centers of Excellence in Primary Care Education: Health Care Delivery and Educational Redesign at the Point of Interprofessional Care and Learning”. The workshop was led by Kathryn Rugen, PhD, FNP-BC, CoEPCE Coordinating Center, Nurse Practitioner Consultant. Amber Fisher, PharmD, presented perspectives from the Boise CoEPCE; and Joyce Wipf, MD, Co-Director, VA Puget Sound CoEPCE and Professor of Medicine, University of Washington and Anne Poppe, PhDc, MN, RN, Evaluations Coordinator, VA Puget Sound CoEPCE shared experiences from the Seattle CoEPCE. Their presentation provided an over overview of the national Coordinating Center and the five Centers of Excellence in Primary Care Education. Highlights from the program included discussions around national initiatives, implementation and core domains, continuity, trainee growth, curriculum development, promising practices, select/early qualitative experiences and important lessons learned.
During the small group part of the workshop participants had an opportunity to describe their own facility’s stage of interprofessional program implementation and experiences. Several described IPE curricula at their academic institutions, and not surprisingly, mostly in classroom level experience. Many are exploring the much needed translation from education to the clinical practice setting.
Other attendees noted common difficulties in matching academic schedules to clinical workplace requirements. Those attendees working in private ambulatory clinics lamented practice regulations and reimbursement as one of the primary challenges they face in testing new models of interprofessional care delivery. At least two groups specifically identified challenges of workload and patient care assignments between nurse practitioners and family physicians.
Joyce Wipf wrapped up the workshop session with an intriguing summary observation. She focused on the success of interprofessional education and collaboration in primary care in VHA and put forth the idea that "the key to effective transformation may lie in embracing the complementary differences between the professions, asserting that the multiple roles and perspectives of the team outweigh the production of the ultimate primary care provider practicing in silo." The session was well-received and several attendees remained to discuss specific issues of interest. One physician from South Carolina (who heard a 2012 CoEPCE presentation) noted, "It's exciting to see the CoE progress in just one year - we’re watching to see what you are doing!"
In talking with Amber Fisher after the meeting, she further explained some of the themes that arose during the CoEPCE workshop (and on several occasions during the meeting). A recurring theme addressed by Joyce Wipf, earlier in this report included those barriers around clinical scheduling and academic calendar conflicts. When asked about that topic, Amber said she believes that removing this barrier would expedite success but indicated that it will take some work from the university side to rethink their schedules. Another interesting question, Amber said, revolved around the definition of an authentic team.
To put this in context , in considering teams in healthcare, Baker, Day and Salas (2006) assert that calling healthcare professionals "teams" and structuring work in team based design is not enough to support team effectiveness and safety. The authors believe that an authentic team can only be characterized as such by actual/stated characteristics. In support of this idea, Amber explained that many universities are doing a good job with IP education but participants report that there is a notable lack of practice sites that offer the level of teamwork learned in the academic setting. So it is truly difficult to integrate healthcare trainees into the team environment in the clinical setting. Amber went on to say that there are a very few clinical practice sites that really embody the spirit of interprofessional education and practice (such as those modeled by the VHA CoEPCE), and there simply aren’t enough to support the need for transition from education to actual practice opportunities. She indicated that trainees are coming out of education with high level of expectations for clinical practice and are often disappointed in their clinical practice activities and said. "The trainees realize and we as IP professionals know that the level of team practice in the community is just not where it could be." Further, she said that it is "really hard to match a well-prepared student to an ideally prepared practice site" and that even if clinical sites are offering teamwork activity it isn't at the level that matches the intent of interprofessional teamwork and practice…or the 'authentic team." This fueled the idea for the development of an indicator that would gauge a set of stated criteria, conditions (or even a checklist) for clinical program development and trainee engagement.Conference Posters:
The meeting additionally hosted two VHA CoEPCE posters.
Boise's Amber Fisher, Co-Directors Scott Smith, MD and Melanie Nash, MSN, DNP-C as well as Melissa Green, PharmD shared "Teaching Patient Centered Interprofessional Collaboration in a Veterans Affairs Primary Care Clinic". The poster reflected upon successful innovations and teaching models and the relationship between formal instruction and the practice environment. Implications: Presentations to this international audience educated others on VA opportunities, initiatives, and emphasis on interprofessional education and collaboration.
Seattle's Anne Poppe and Joyce Wipf (additional co-author Catherine Kaminetzky, MD) presented "Building an interprofessional primary care graduate clinical training program for medical residents, doctor of nursing practice students and associated health professions: Early lesson learned". This poster highlighted the Seattle CoEPCE key informant interview evaluation effort and shared some of the themes that describe early experiences from those involved with the Seattle program (see preliminary results in text box below). In addition, the poster reviewed the OAA mission and vision for the Centers of Excellence, and the Seattle CoE program design.
Some Seattle CoEPCE Early Experiences (Key Informants Interviews)
The VA CAB IV presentations and submissions may be found on the Coordinating Center Sharepoint Intranet
Other Conference presentations may be found on the CABIV Conference Website.