President Jay A. Perman, MD, and Elsie Stines, MS, CPNP, who together conduct the weekly President's Clinic as a model of interprofessional education, delivered a lecture Dec. 8 at the School of Nursing (SON) in which they challenged the University of Maryland campus in Baltimore to widely adopt the concept.
Perman said there is an urgent need for "interprofessional education and teamwork" to prepare health care professionals and to improve safety and quality in delivering health care. To carry out that mandate, he said he has appointed a task force of faculty members from each school. He called on interested parties to contribute ideas to task force members to help them move forward on implementation.
Perman and Stines, who appeared as co-presenters, delivered their lecture in the SON auditorium to an audience that included deans, administrators, faculty members, and students from several schools and many nurses and others from the University of Maryland Medical Center. The presentation, at the invitation of SON Dean Janet D. Allan, PhD, RN, FAAN, was the Dean's Distinguished Virginia Lee Franklin Lecture, an annual endowed event that pays tribute to a 1954 SON alumna. In the photo, Stines, left, and Perman are shown with Allan.
In her introductory remarks, Allan said the teamwork of Perman and Stines exemplifies the concept of interprofessional education and practice that is at "the core of the nation's new vision for health care delivery." She said the collaboration between a physician and an advanced practice nurse demonstrates by example "the way out of our professional silos into a more team-based, patient-focused way to provide care."
A pediatric gastroenterologist, Perman pioneered the interdisciplinary teaching model at the University of Kentucky (UK), where he was dean of the College of Medicine and vice president for clinical affairs. He established the Dean's Clinic, providing pediatric care in tandem with Stines, a 2000 graduate of the SON who specializes in caring for children with gastrointestinal and nutritional disorders.
They first began working together in Baltimore where Perman had chaired the Department of Pediatrics at the University of Maryland School of Medicine (SOM) from 1999 to 2004. Stines was a pediatric nurse practitioner at the University of Maryland Hospital for Children. Stines became director of collaborative programs at UK, and she recently accepted a position as project director in the president's office at the University of Maryland.
At the campus in Baltimore, Perman and Stines began conducting a pediatric clinic every Tuesday starting in October that expands their previous model of interprofessional education. Rotations include faculty and students not only from the SON and SOM but also from the Dental School and the schools of law, pharmacy, and social work.
When Stines encounters medical students who have been assigned to the clinic, 60 to 70 percent have given positive feedback, she said. Some students have sent written reflections, and she shared several excerpts: "Very inspirational." "You both helped lay out a vision for the future here."
Stines said effective collaboration as in the President's Clinic model requires practitioners to share commonality of goals, show trust and respect, and engage in reciprocal consultation. Too often that is not the case. Barriers to a successful pairing of an advanced practice nurse and a physician include factors such as a perception of competition and incongruent practice styles.
Perman explained that interprofessional education (IPE) occurs when two or more professionals learn from and about each other or students from one profession are taught by faculty from more than one profession. But generally in higher education, "we do not teach team," he said. "The teachers need to be taught as well, a major issue about faculty development."
In health care delivery, the team concept is gaining support on multiple fronts. For example, Perman cited a 2010 report by the Carnegie Foundation that found teamwork among disciplines improves quality but also leads to better patient outcomes, greater patient satisfaction, and professional job satisfaction.
Yet rigorous studies of efficacy are scarce. Speaking of such research, he said, "It's work that needs to be done, perhaps with us contributing."
Perman announced the creation of an IPE task force that is charged with devising strategies and creating venues for interdisciplinary education. He has appointed as co-chairs Patricia Morton, PhD, RN, ACNP, FAAN, associate dean for academic affairs, SON; and Edward Pecukonis, MSW, PhD, associate professor, School of Social Work (SSW). Members are Richard Dalby, PhD, associate dean for academic affairs, School of Pharmacy; Frank Calia, MD, MACP, vice dean of clinical affairs, SOM; Grishondra Branch-Mays, DDS, MS, associate professor, the Dental School; Diane Hoffmann, JD, MS, associate dean for academic programs, School of Law; and Stines of the Office of the President.
Perman noted that the University has an interdisciplinary precedent in its minimester course offered each January by the SSW Maternal and Child Health (MCH) program. Students from any school may take the one-credit elective. Pecukonis, the co-chair of the new task force, directs MCH and has been a regular at the President's Clinic on Tuesdays. Faculty and students are urged to contribute input to the task force representatives of their respective schools.
The presentation "'We':Interprofessionalism in Healthcare Education and Delivery" may be viewed here. Perman and Stines define interprofessional education and practice, outline barriers and benefits, and present a simple teaching and practice model to show how to use the concept effectively.