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A new “united we learn” model for doctors and nurses

Shutterstock | S_L
Shutterstock | S_L

The image isn’t at all shocking or unfamiliar: doctors and nurses working side-by-side in the hospital—treating, fixing, preventing, educating…you name it, they’re doing it. And the tighter the teamwork, the better the care.

So why is it that doctors and nurses don’t really cross paths in any meaningful (sometimes messy) way until it’s “go” time and all the mannequins have been swapped out for very real patients with very urgent needs? Are we setting doctors and nurses up to fail at playing nice in the hospital by placing a hold on important, collaborative experiences?

In a recent blog post from The New York Times, Dhruv Khullar, M.D., M.P.P., and resident physician at Massachusetts General Hospital and Harvard Medical School offers his own two cents on the great doctors and nurses divide:

There are few group projects in medical school — which is strange when you consider that there are few solo practitioners in the real world.

Of course, doctors in-training still do a heck of a lot. And yet…

What I did not do, ever, was take a class with anyone studying to be a nurse, physician assistant, pharmacist or social worker.

Okay, so when exactly do all these experts take their place on the same playing field?

It wasn’t until residency that I first began to understand just how many professions come together to take care of a single patient — what exactly they do, how they do it, and how what I do makes their jobs easier or harder.

Ah—so that’s when. But the fusion isn’t exactly seamless. Here’s why:

There is surprisingly little education on what it means to be a leader of a medical team, with its nurses, physician assistants, pharmacists, respiratory therapists, physical therapists, dieticians and case managers. There is even less discussion of how to understand one another’s roles, perspectives, frustrations and limitations.

Instead, traditional education emphasizes separate training for each health professional, which inadequately prepares students and residents for new models of health care delivery that emphasize team-based care and shared responsibility for patients.

Only now, people are noticing.

In 2001, the Institute of Medicine issued a report recommending that all health professionals receive training in interdisciplinary teams. Since then, the Accreditation Council for Graduate Medical Education has integrated interprofessional learning into its competency milestones.

And the timing couldn’t be better, since a more fragmented system of health care is officially on it’s way out:

Recently, the Department of Health and Human Services announced that by 2018 it aims to have half of all Medicare payments under alternative payment models, including bundled payments, primary care medical homes, and accountable care organizations.

Translation? A need for increased levels of integration and cooperation among health care providers is comin’ in hot. But while the general consensus is “good, let’s do it,” the prep pace isn’t exactly record-breaking. Which is why lots of folks are excited about a new initiative that emphasizes inter-professional training now underway at six universities.

Here’s a little taste of what that looks like:

Participating schools designed a variety of creative learning models to bring students together, such as inter-professional Grand Rounds conferences and web-based learning modules; small-group exercises to develop care plans or break bad news; quality improvement projects to improve hand hygiene or prevent falls; and clinical simulations with debriefing sessions during which all team members had the opportunity to describe what went well and what could have been improved.

Of course, research is still in the early stages, but not surprisingly, all signs have been pointing to “useful, definitely useful” thus far. And then there are a few more minor details:

Research suggests that it is important to start this process early, as student willingness to engage in inter-professional training seems to decline over time, except, interestingly, for nursing students. Research also suggests that doctors — expected to lead health teams — might stand to benefit most from such training. One study found that while three-quarters of physicians rated their collaboration and communication with nurses as high or very high, only about a third of nurses felt the same way.

The author’s conclusion?

Our recognition that today’s patients need teams has outstripped our recognition that today’s teams need training. It’s time to fix that — together.

Want to check out the full article? Fantastic—you can find it here.

And while we’re on the topic…

You can also find, just below, a comments section, which we encourage you to use freely and frequently. So go ahead—have at it. We’ll be taking stock of all the brilliant responses that find their way in there.

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