Advancing Interprofessional Education and Collaborative Practice (IPECP) in Undergraduate and Graduate Medical Education in the U.S. DeWitt C. Baldwin Jr., M.D. Scholar in Residence, ACGME JCIPE 2014 Conference October 11, 2014 Philadelphia, Pa.
Physicians, Non-physician Clinicians, and Other Health Workers,1850-2010 4,000 Health Employment per 100,000 of Population. 3,500 3,000 2,500 2,000 1,500 1,000 500 0 1850 1880 1910 1940 1970 2000 2010 Managers Technicians Therapists Aides LPNs RNs Pharmacists Dentists NPCs Physicians Adapted from Kendix and Getzen and the Bureau of Labor Statistics
The Continuum of Education Secondary School Undergraduate/ Pre-professional Graduate/ Professional School Post-Graduate/ Clinical Practice Transitions
Advancing Interprofessional Education and Collaborative Practice (IPECP) in Medical Education Background Recent reports on health care reform in the U.S. from the Institute of Medicine, as well as many others have strongly recommended enhancing interprofessional teamwork and collaboration as a way of improving patient care and patient safety (preventing medical error).
IPECP in Undergraduate Medical Education July 1, 2013. The Liaison Committee on Medical Education (LCME) implemented this standard: The core curriculum of a medical education program must prepare medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients.
Interprofessional Education and Collaborative Practice (IPECP) in Undergraduate Medical Education Association of American Medical Colleges (AAMC) Graduation Questionnaire(2013)
Have you participated in any required curricular activities where you had the opportunity to learn with students from different health professions? Response Percent Yes 73.4 No 18.5 Not Sure 8.1 Total 100.0 AAMC All School Report Graduation Questionnaire 2013 https://www.aamc.org/download/350998/data/2013gqallschoolssummaryreport.pdf (All medical schools in 2013) Number of responses 13,517
If yes, which other profession(s) have you had the opportunity to participate or interact in educational activities? (2013, AAMC GQ) Profession Nursing 81.9 Pharmacy 79.1 Physician Assistants 65.4 Social Work 51.6 Physical Therapists 48.8 Occupational Therapy 36.3 Osteopathic Medicine 29.2 Dentistry 27.2 Psychology 25.2 Public Health 21.7 Other 4.8 Veterinary Medicine 1.7 Percent
What was the nature of the learning experience(s) with other health professions students? (2013, AAMC GQ) Response Percent Lecture only, basic science 23.7 Lecture only, clinical subject 31.8 Patient-centered case problems 43.7 Clinical simulations 32.7 Active engagement with patients 76.8 Community projects or service learning activities 24.3 Team Skills Training 25.5 Other 2.9
The learning experience with other health professions students helped me gain a better understanding of the roles of other professions in care of patients (2013, AAMC GQ) Strongly Disagree (1) Disagree (2) Neutral (3) Agree (4) Strongly Agree (5) 4.3% 3.7% 15.6% 49.1% 27.3% Mean Count (N) 3.9 9,864
Interprofessional Education and Collaborative Practice (IPECP) in Graduate Medical Education
Developing Expectations and Requirements about Residency Training in Interprofessional Teamwork and Team-based Care ACGME- 1999 Adopted Six Core Competencies Specific Program Requirements, including Team-based care ACGME- 2002 Required Residency Programs To develop specific learning, training activities, and evaluation methods for the Six Competencies, including IPECP. Assisted with learning resources. Work as a member/leader of a health care team or other professional group. Work in inter-professional teams to enhance safety and quality of care ACGME- 2013-14 Next Accreditation System Mandated assessment of IPECP competencies 2X/year
IPECP in Graduate Medical Education: Data Sources AMA-Freida Online Database 2008-2013 Electronic information for medical students from Program Directors concerning their residency programs, including special training opportunities. ACGME-Special Resident Survey 2009 Specific Question re IPECP training experience ACGME Resident Wellness Survey 2013 Multi-specialty survey of over 22,000 U.S. residents currently in training concerning their personal experience with such IPECP training experiences.
U.S. Residency Programs Offering Formal Program to Foster Interdisciplinary Teamwork (AMA-FREIDA ONLINE) 2007-2008 2012-2013 All Programs 25.9% (n = 8,716) 46.2% (n = 8,868)
Formal Program To Foster Interdisciplinary Teamwork by Specialty (High Specialties in 2008: AMA-FREIDA) Specialty 2008 Geriatric Medicine (Int. Med). Geriatric Medicine (Fam. Med.) 69.4% 61.9% Sleep Medicine 56.3% Internal Medicine 48.8% Family Medicine 43.2% Child and Adolescent Psych 41.9% Neonatal 41%
Formal Program To Foster Interdisciplinary Teamwork by Specialty (High Specialties in 2013: AMA-FREIDA) Specialty 2008 2013 Change Geriatric Medicine (Int. Med). Geriatric Medicine (Fam. Med.) 69.4% 76.9% + 7.50% 61.9% 75.6% + 13.70% Sleep Medicine 56.3% 60.8% + 4.50% Internal Medicine 48.8% 67.1% + 18.30% Family Medicine 43.2% 66.7% + 23.50% Child and Adolescent Psych 41.9% 61.8% + 19.90% Neonatal 41% 58.8% + 17.80%
Formal Program To Foster Interdisciplinary Teamwork by Specialty (Low Specialties in 2008: AMA-FREIDA) Specialty 2008 Vascular Surgery 9.4% Urology 10.6% Plastic Surgery 10.6% Radiology (Dx) 13.2% Ophthalmology 13.6% Pathology 14.2% Orthopedic Surgery 16.5%
Formal Program To Foster Interdisciplinary Teamwork by Specialty (Low Specialties in 2013: AMA-FREIDA) Specialty 2008 2013 Change Vascular Surgery 9.4% 31.7% + 22.30% Urology 10.6% 36.3% + 25.70% Plastic Surgery 10.6% 31.9% + 21.30% Radiology (Dx) 13.2% 25.8% + 12.60% Ophthalmology 13.6% 27.4% + 13.80% Pathology 14.2% 19.4% + 5.20% Orthopedic Surgery 16.5% 22.1% + 5.60%
WHAT DO THE RESIDENTS SAY ABOUT THEIR IPECP EXPERIENCE?
ACGME RESIDENT WELLNESS SURVEY 2013 January May of 2013, upon completion of the ACGME annual accreditation/compliance (duty hours) survey, residents were given a link to our optional Wellness Survey Over 22,000 responded, nearly 1 in 5 residents ~18-22% of every core specialty represented
35.0% 30.0% 25.0% 20.0% 15.0% 32.7% ACGME Resident Wellness Survey, 2013 Over the last 2 weeks, on how many days did you participate in clinical training activities with persons from other health professions? N = 21,215 39.0% 28.3% 10.0% 5.0% 0.0% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Days
Average number of days in past two weeks in clinical training activities with non-physicians Neurological Surgery Transitional year Emergency Medicine Plastic Surgery Vascular Surgery Family Medicine Surgery-General Physical medicine/rehabilitation Orthopedic Surgery Cardiothoracic Surgery Internal medicine/pediatrics Anesthesiology Pediatrics Radiation oncology Urology Otolaryngology Neurology Psychiatry Cardiology Internal medicine Obstetrics/Gynecology Preventive medicine Radiology Pathology Ophthalmology Dermatology 3.62 3.96 4.22 4.63 6.92 6.65 6.65 6.54 6.49 6.25 6.21 6.18 6.16 6.02 5.98 5.84 5.81 5.80 5.75 5.73 5.71 5.57 5.43 5.32 5.12 5.07.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 *Data from 2013 Resident Experience Survey
Interprofessional Education and Collaborative Practice (IPECP) in GME by Specialty Some exposure in the past two weeks High Low Family medicine 77.3% Dermatology 54.72% Physical medicine 76.6% Ophthalmology 55.7% Radiation oncology 76.52% Radiology Diagnostic 57.41% Preventive medicine 75.86% Internal medicine 62.6% Emergency medicine 75.3% Pathology 63.01% Neurosurgery 72.67% OB/GYN 63.24% Anesthesiology 63.62%
Average number of days in past two weeks in clinical training activities with non-physicians Neurological Surgery 6.92 Transitional year 6.65 Emergency Medicine 6.65 Plastic Surgery 6.54 Vascular Surgery 6.49 Family Medicine 6.25 Surgery-General 6.21 Physical medicine/rehabilitation 6.18 Orthopedic Surgery 6.16 Cardiothoracic Surgery 6.02 Internal medicine/pediatrics 5.98 Anesthesiology 5.84 Pediatrics 5.81 Radiation oncology 5.80 Urology 5.75 Otolaryngology 5.73 Neurology 5.71 Psychiatry 5.57 Cardiology 5.43 Internal medicine 5.32 Obstetrics/Gynecology 5.12 Preventive medicine Radiology Pathology 4.22 4.63 5.07 Red: Surgical Green: Primary Care Ophthalmology 3.96 Dermatology 3.62.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 *Data from 2013 Resident Experience Survey
Closing Reflections: Critical Events 1948 WHO Definition of Health Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity 1970 Sidney Garfield and the Health Model Taking care of the Sick, the Early Sick, the Worried Well, and the Well. Sci. Amer.Vol 222 Rosalie Kane from interdisciplinary to interprofessional and team to teamwork Value Added to bottom line of evidence. Population health outcomes, Patient safety, Community-building, good will, trust, cooperation, collaboration.
Acknowledgements I would like to acknowledge the assistance of the following collaborators: Sarah Brotherton PhD Joanne Schwartzberg MD Nick Yaghmour MPP And The support of the Josiah Macy Jr. Foundation