Lessons of Team-Based Care Come to Life

April 16, 2018    |  

On a wall in the office of University of Maryland, Baltimore (UMB) President Jay A. Perman, MD, hangs one of his favorite quotes: “Teach thy tongue to say ‘I do not know’ and thou shalt progress.”

The quote, from the philosopher Maimonides, is emblematic of the importance of working on teams that span disciplines in providing health care to a patient, Perman told an audience of about 300 students who gathered April 4 in the University of Maryland School of Nursing (UMSON) auditorium for the 6th Annual IPE (Interprofessional Education) Day. (View video below and a photo gallery here.)

Heather Congdon, Pharm D, BCPS, CDE, assistant dean of the School of Pharmacy program at the Universities at Shady Grove and a co-director of the Center for Interprofessional Education(center), listens in as students from multiple disciplines collaborate on a care plan for a standardized patient during the 6th Annual IPE Day.

Heather Congdon, Pharm D, BCPS, CDE, assistant dean of the School of Pharmacy program at the Universities at Shady Grove and a co-director of the Center for Interprofessional Education(center), listens in as students from multiple disciplines collaborate on a care plan for a standardized patient during the 6th Annual IPE Day.

“Believe me, the things that I don’t know, that she knows, I can’t begin to count,” Perman said, gesturing toward Elsie M. Stines, DNP, MS, CRNP. Stines oversees the President’s Clinic, an interprofessional clinic in which students across disciplines join Perman in caring for patients. She is a pediatric nurse practitioner at the University of Maryland Medical Center and serves as Perman’s assistant vice president of special projects and initiatives.

“You want to do it right? You want to get the job done? You need a team,” said Perman, who has made IPE a priority at UMB.

Through firsthand accounts from patients and their families who have benefited from a team-based approach to health care, to interactions with standardized patients, IPE Day is designed to help students learn how to effectively communicate with professionals outside of their area of study, what skills they can share with other disciplines, and how interprofessional communication affects the quality of care.

UMSON Dean Jane M. Kirschling, PhD, RN, FAAN, director of the Center for Interprofessional Education, also welcomed IPE participants.

“A deep commitment to interprofessional education and practice can both inform and truly transform the care that we give to our patients and their families,” she said.

The lessons of an interdisciplinary care approach came to life as students heard from Riseli Perez, who received help from a multidisciplinary team at the President’s Clinic when her son, Oscar, suffered a traumatic brain injury last year. The family shared their experience on a panel kicking off IPE Day. Joining them were other members of the President’s Clinic team: Victoria “Tori” G. Marchese, PhD, PT, associate professor, University of Maryland School of Medicine (UMSOM); Jill A. Morgan, PharmD, BCPS, BCPPS, associate professor, University of Maryland School of Pharmacy (UMSOP); Everett Smith, clinical field instructor from Social Work Outreach Community Services with the University of Maryland School of Social Work (SSW), and Ryann Mayer, RDN, LDN, pediatric dietitian.

“I just want to say thank you to this wonderful team,” Perez said. “I remember that day when I walked into that office. I was like in a dark tunnel. I didn’t know what to do. I didn’t know where to go. I didn’t have any resources at all for how to help my son.”

Team members were not only concerned about Oscar but also about his mother, struggling to keep things afloat with a critically ill son and four other children.

“It was hard for me, but when I walked into the room, I saw the nursing student, I saw the doctors, the social worker, the nutritionist, the physical therapy, the dental school student, and I was like, 'Oh my God, thank you God for this,' because I was lost,” Perez said. “As a mother, seeing your son lying in the bed, telling me he’s not going to make it, it was hard. And when I met all these wonderful people that day, I went home and I just started crying with Oscar. And I told him, 'I think we’re going to have hope.'”

Students had an opportunity to put team-based health care into practice later in the afternoon as they broke into multidisciplinary groups to meet in breakout sessions at the School of Nursing, the Health Sciences and Human Services Library, and the Southern Management Corporation Campus Center. Their task: develop a care plan for trained actors, also known as standardized patients, posing as “Dolores/Doug Darling” who had been diagnosed with high blood pressure and Type 2 diabetes.

At the end of the afternoon, Heather Congdon, Pharm D, BCPS, CDE, assistant dean of the School of Pharmacy program at the Universities at Shady Grove and a co-director of the Center for Interprofessional Education, led the students in an afternoon forum in which they shared their thoughts about IPE Day and their learning experiences.

Nicole McKenzie, a UMSOM student, said she found the interdisciplinary approach to patient care freeing.

“I knew that the rest of the team was going to be working on the other parts of the problem that I don’t know how to address,” she said. “Sometimes we don’t have such a great interprofessional team at the ready. You feel kind of blocked. I felt freed up to work on my portion.”

While McKenzie found the experience liberating, fellow UMSOM student Ian Wellington said he felt the opposite, that having so many people provide input into a patient’s care left him feeling hindered when it came to communicating with the patient directly.

“I think a big problem with this (interprofessional) approach is the communication aspect,” he said. “When you have 10 people and one patient, that can kind of get lost. Doing it all at once might kind of crowd the patient and kind of hurt the interaction with them and the provider.”

Kristen Millender, a student from University of Maryland School of Dentistry, countered that these days, many patients have a team in place, just not one that the provider interacts with on a regular basis.

“I really value sharing information because there’s some overlap, but we all have different scopes. Reality is, there are a lot of patients that have a team. We just may not be in communication with each other,” she said. “But they come to see us and we may have that one-on-one time. It is important to have that cohesiveness and also to have a general understanding of how other disciplines can help.”

Congdon, who works in an interprofessional clinic in Montgomery County with pharmacy, nursing, and social work students treating patients with uncontrolled diabetes and anxiety or depression, echoed that sentiment when she explained how students are learning beyond their particular disciplines by practicing in the clinic. Social work students had to learn about A1C tests, which diabetes patients need regularly to see whether their blood sugar levels have been staying within a target range. Over time, social work students learned which A1C levels were dangerous and which were acceptable, Congdon said.

“It was really exciting to get to that level where the different disciplines are learning something about the other disciplines that they might not know otherwise if they weren’t working together in a team,” Congdon said.

UMSOP student Andrew Bilodeau said he was impressed by the amount of respect his fellow team members showed each other.

“Sometimes you don’t know how it’s going to be when you’re working with a group of other disciplines,” he said. “At least in my group, and what I could see, everyone had a lot of respect for one another. No one was spoken over and we took our time and I think it really added to our experience.”

For June Struder, a UMSON nurse practitioner (NP) student, the day provided an opportunity for her to educate other students about the role of a nurse practitioner. Like a physician, a nurse practitioner can prescribe medications, make referrals, and conduct clinical exams.

“I think a big misconception is that because I am from the School of Nursing, I fulfill a nurse’s role, and although that is correct, I am an RN, NPs have the same train of thought as a physician,” she said. “I think educating other specialties about roles and specific things within those roles is really important. Because each role, like we’ve all said, brings something special to the table, but it’s important to know not to step on each other’s toes or to discount each other.”

SSW student Syeira Anthony also was happy to clear up any misconceptions people might have about social workers.

“There’s always this perception that social work fixes everything,” she said. “Yes, we do a lot. We help in a lot of ways, but we can’t just do everything. There’s some things that are just out of our power. So it’s important to find who is the right person to go to and not just dump everything on the social worker.”