“I wish that they had taught us about collaboration in medical school.”
– comment from a senior Canadian general practitioner at the Informatics Technology for Community Health conference (ITCH 2017)
At Oregon Health & Science University (OHSU) we incorporate collaboration skills as part of the education of tomorrow’s healthcare providers. Since 2012 the university has had a goal of preparing “all OHSU students for deliberatively and intelligently working together with a common goal of building a safer and more effective patient-centered and community-oriented health care system within Oregon and across the United States.” This university wide effort encompasses initial training, practice in community settings, and re-evaluating the educational environment.
The interdisciplinary collaboration training begins with a one credit mandatory course for all of OHSU’s diverse programs – students in medicine, nursing, dentistry, pharmacy, nutrition, and other health programs. All students complete this course in their first year at OHSU. Taught over three quarters, the small seminar (ten to twelve students) course has two instructors from different professions for each seminar. Each seminar group is composed of students from multiple programs (typically 4 to 5 programs represented in each seminar group). In 2016-17 604 students took this introductory course with 94 faculty members. The students completed the Institute for Health Improvement’s basic course modules in patient safety, and then worked together in small interdisciplinary teams to complete projects. In one project they analyzed a patient safety issue they observed and developed multi-disciplinary action programs to improve care delivery. By participation in this class, they learned about the commonalities in professional training and ethics across the professions represented at OHSU. Students reported that they learn more from each other in this program than for the formal instruction, and that at the end of the sequence they had a better understanding of and respect for the other professions.
During their formal coursework students are also allowed to take courses offered on an interdisciplinary basis, ranging from anatomy (now includes physician assistant, dentistry, and pharmacology students) to community health and narrative medicine. The different programs are designing interprofessional simulations to give students the experience of working with other professions in a safe situation (for example ICU situations using a high fidelity manikin that dies if care is not provided properly), before needing to do this with real patients.
Then, as part of their clerkships and practicums, many students spend a four week rotation in a rural health setting. In this session, the students share housing with students from the other OHSU programs. In addition to their clinical experiences within their profession, students work together on community-based programs to improve the overall health of the communities in which they are living. These programs focus on needs identified by the members of the community, and often are continuing projects passed from one cohort to another. Examples have included the creation of a food pantry and increasing access to dental care in a rural area. One important learning from this program is the importance of listening to the community and creating sustainable programs by meeting the community’s felt needs.
Additionally, as part of the Interprofessional Care Access Network program (I-CAN) students can volunteer to work together to improve care delivery for communities where they are completing their regular clinical rotations. One example in this program was a program to better coordinate first responder initial care with the other medical resources in the neighborhood.
OHSU also recognizes that students learn collaborative behaviors from role models faculty and preceptors. Not only are faculty evaluated on their collaborative behaviors, but we work to recruit clinical placement sites that exemplify good teamwork.
We are not perfect; we need to do much more. We have revised our initial training programs significantly to increase the amount of peer learning, many of our community partnerships are just beginning, and we still have some financial barriers that limit the collaboration between schools. The number of collaborative simulations needs to be increased significantly. But, as part of our strategic vision, we also realize that we need to continue to build collaboration between programs to better prepare our students for the future.
This may be easier in Oregon than in other environments. Oregon has been at the forefront of implementing patient-centered medical homes and providing incentives for coordinated care (Accountable Care Organizations). With a scarcity of providers and significant disparities in health outcomes for rural and economically disadvantaged communities, there is support for moving to team-based care. And, as Oregon’s only health care university, OHSU is cognizant of its duty to provide this care. As expressed in our vision
“Collaboration starts here.”