Laurie Neely, PT, DPT, assistant professor, University of Maryland School of Medicine (UMSOM), knows firsthand the benefits of a team-based approach to health care. While performing diabetes screenings at the Weinberg Housing and Resource Center, an emergency homeless shelter in West Baltimore, a student pulled her aside. The student was part of a collaborative interprofessional team of physical therapy and pharmacy students using their combined skills to screen homeless people for diabetes.
“One of the students grabbed me and said, 'I’m not really sure what’s going on,' ” said Neely. The woman was very quiet, did not want to talk to the case workers, and refused to take off her shoes. When Neely observed the woman, she quickly realized she needed urgent care.
“When I looked at her shoes, she had blood and pus oozing out, so I told the student, 'We don’t want to be the ones to take her shoes off, but we need to refer her,’ ” Neely said. The woman was immediately taken to the emergency room but died in the hospital about a month later, Neely said.
Despite the woman’s death, case workers were grateful Neely and her students were able to refer her to a hospital where she died under a physician’s care, rather than out on the street, alone.
Neely and her team were recipients of a 2016-2017 Interprofessional Seed Grant designed to prepare health, law, and human services professionals to work collaboratively on interprofessional teams focused on improving the lives of people locally, nationally, and globally. Their project, “Improving the Health of Homeless Individuals Diagnosed with Diabetes Mellitus Through Interprofessional Student Activities,” provided service learning experience for physical therapy and pharmacy students.
Neely and three other teams presented the results of their 13-month projects at the 2017 Seed Grant Symposium on Nov. 15.
The University of Maryland, Baltimore (UMB) has placed a high priority on interprofessional education (IPE), and its importance is recognized in the University's 2017-2021 Strategic Plan. During opening remarks, UMB President Jay A. Perman, MD, said team-based care is better care for patients and providers alike. “It results in better outcomes with greater satisfaction on the part of patients and greater satisfaction on the part of those of us who provide care” he said.
Barbara Resnick, PhD, CRNP, FAAN, associate professor, University of Maryland School of Nursing (UMSON), and Nicole Brandt, PharmD, MBC, BCPP, CGP, FASCP, professor, University of Maryland School of Pharmacy (UMSOP), are in Year 2 of a three-year project, “Interprofessional Care in Geriatrics Program: Applying Evidence to Clinical Practice,” which added the skills of medical and physical therapy students to the established team pulled from the University of Maryland School of Social Work (UMSSW) and UMSON.
The project developed from a long history of interdisciplinary work in geriatrics and focused on meeting the needs of elderly residents in the Mount Clare senior housing facility in West Baltimore to help them successfully age in place. The team of students and faculty worked with residents during open enrollment, assisted with fall prevention workshops, and provided blood pressure screenings. The residents benefited from the level of care, but students also reaped numerous benefits by learning how they can work together in their future practices.
Second-year medical student Ryan Cherng said he was grateful for the opportunity to work with students from other disciplines to help prepare for real-life experience outside of the classroom. “Suddenly, after we graduate, we’re thrown into this new scenario where we’re working with colleagues and we don’t really know where our roles diverge,” he said.
Cherng described a situation in which a patient he had been following for two years was having trouble managing his medication. “You think that a doctor writes down the prescription and the patient is going to follow up and get the prescription, but there’s other things we have to worry about,” he said. “This is just one example of a case where pharmacy, medicine, nursing, and social work all work together to hopefully allow this patient to age in place and really understand and take ownership of his own health care."
Isabel Rambob, DDS, clinical assistant professor, University of Maryland School of Dentistry (UMSOD), collaborated with the Graduate School and UMSON to provide interprofessional training to physician assistant and nursing students on how to perform HIV oral screenings.
HIV has oral manifestations, including dry mouth and periodontal disease, which can easily be missed by primary care providers, according to Rambob. “As a dental professional, you can be one of the first ones to identify the signs and symptoms of HIV during oral screening exams,” she said. The pilot project used online training, simulation, and community outreach to increase interprofessional knowledge of the oral manifestations of HIV.
A nursing student who worked with two dental students and a physical therapy student during a day of simulated oral exams said learning oral assessment skills will be a great benefit for a nursing career. The student noted in a journal that was part of the project, “We consistently worked as a team and learned a great value of information from each other in our respective fields.” The student said all UMB students should have an interprofessional experience. “As a campus with varying different fields, I would be very pleased to see a simulation such as this implemented in every program. I truly believe it would better shape us as health care professionals,” the student said.
Caring for patients with an advanced illness can be challenging and requires excellent clinical and communications skills, according to UMSOP Professor Mary Lynn McPherson, PharmD, MA, BCPS, CPE. That’s why she and her collaborative team developed an interprofessional online course on palliative care using scripted videos with scenarios including pain assessment of a nonverbal patient; a family meeting for a patient with an advanced illness; and a demonstration of an effective transdisciplinary hospice team meeting.
“It’s tough to teach clinical content and skills-based activities such as breaking bad news online, so I had to really put on my thinking cap,” said McPherson. For example, in the pain assessment portion of the course, McPherson and her team filmed vignettes of a patient with varying levels of pain and communication ability. Students were asked to watch the videos and determine the patient’s level of pain by examining facial expressions and picking up on nonverbal cues such as breathing and bracing.
Many of the video clips have been used in an online course this semester. McPherson also has used several of the clips in face-to-face teaching at the School of Pharmacy this semester. The majority of the clips will be used in the PALC 605 course that starts in January.
Mangla S. Gulati, MBBS, assistant professor, UMSOM, collaborated with UMSON and UMSOP on “Building a High Reliability Organization-Interprofessional Development for Safer Care.” The goal of Gulati’s project was to build a core skill set for professionals to use to improve patient safety.
The selection of the grant recipients was based on evaluation of proposals that met criteria in one of two categories for collaborative work:
Interprofessional education: “When students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” (World Health Organization, 2010).
Interprofessional team-based care: Care delivered by intentionally created and usually relatively small work groups in health care that are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients.
The Center for Interprofessional Education is a national leader in providing interprofessional education for health, law, and human services professionals that is grounded in best practices for educational innovation and assessment. A hallmark of the center is education that improves health care and human service delivery resulting in enhanced well-being.