Pulse
Taking One (Course) for the Team
The University of Minnesota is teaching future health professionals how to work together so they can better keep patients out of harm’s way.
Karyn Baum, M.D., M.S.Ed., was barely out of medical school and facing a rotation in a local hospital’s intensive care unit when she overheard other interns talking about how the nurses in the unit were “difficult” and made things “tough” for the physicians. Baum was struck by their “us versus them” remarks. “Because I never learned about the scope of other health professionals’ practice, I was not prepared to deal with it,” she recalls. After starting the rotation, Baum, who is now an associate professor of medicine at the University of Minnesota, realized that the nurses were not trying to be difficult. “They were just detail-oriented and conscientious,” she says. “And they were there for the same reason as I was: to take care of very sick patients.”
Baum’s experience as a new physician in the mid-1990s was not unique. Thinking and working in silos has been pervasive in health care, and it has negatively affected patient safety. In its landmark 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) documented how patient safety was being compromised in this country in part because health care “relies on outmoded systems of work.” What’s more, the IOM found that clinical education was not keeping pace with the ever-changing complexities of the health care system and was in need of a “major overhaul.” In a subsequent report on health professions education, the IOM emphasized that all health professionals should be taught to deliver care as members of an interdisciplinary team.
A Curriculum Whose Time Has Come
Baum, who also serves as a special assistant to the medical school’s dean, was so affected by her experience that she became a faculty advisor for the university’s Clarion competition, in which teams of health professions students produce root-cause analyses of so-called “sentinel errors” such as a written order not getting entered into an electronic medical record. Through her work with Clarion, she got to know faculty from other health fields. Together, they created a teamwork course for students in pharmacy, dentistry, public health, health care administration, nursing, and medicine. The course, Interprofessional Teamwork for Health Professionals, was first offered in 2005 and is a requirement for medical and health care administration students.
“A big part of the course is getting the students to understand the roles of all the different professions,” says Baum, who teaches it. “They learn what the scope of practice is for a pharmacist, a nurse, a doctor, a public health professional, and in the process of gaining that knowledge and awareness, they learn to trust each other.”
Students hear from faculty in the various schools about their roles within the health care system; learn the difference between stable teams (consisting of professionals who work together for years) and rapid-response teams (made up of individuals who may not know each other but come together in an emergency such as a code event or large-scale disaster) and the way they interact; face a simulated emergency, during which they must work with students and practitioners from other disciplines; and conduct a root-cause analysis of an actual medical error.
Throughout, Baum emphasizes the importance of communication. She suggests using a universal language such as SBAR (reporting the patient’s Situation and the Background of that situation, then giving an Assessment and Recommendation for what to do). “By using the same method of communication, everyone will know how the information will flow, regardless of their profession or training, and no important detail will be left out.” Adopting such an approach can require some team members to alter their thinking about their role. Nurses, for instance, are not traditionally trained to make recommendations. And doctors might not know when to ask a nurse or pharmacist for their counsel.
Each year, Baum tweaks the syllabus of the teamwork course based on student feedback, incorporating more small-group activities and online components. “The lecture hall is obviously not the best place to learn teamwork because you are not processing the information where you are immediately able to apply it,” she explains.
Baum is currently working on incorporating the teamwork curriculum into a series of modules called the Essentials of Modern Medicine. The self-directed modules delve into topics such as biomedical ethics, health care financing, and teamwork and will feature simulated scenarios and opportunities to shadow health professionals in a clinical setting. The curriculum will be rolled out in 2009.
Education for All
Awareness of the necessity of teaching teamwork appears to have trickled up. In December 2006, the deans of the schools of dentistry, pharmacy, public health, nursing, medicine, and veterinary medicine established the Center for Interprofessional Education. The purpose of the center is to make teamwork courses and other interprofessional educational experiences a requirement for all students in the university’s Academic Health Center.
“I think the expectation is that health care has high-functioning teams, and the reality is that it doesn’t,” says Gwen Halaas, M.D., director of the center. Halaas says the center also plans to offer continuing education and is developing an online teamwork course.
Ultimately, the goal of these efforts is to improve patient outcomes. Whether that happens remains to be seen. Thus far, Baum is encouraged by comments from former students. “I’ve had students come up to me when they were on the wards and say how glad they were that they had this course, and that’s wonderful,” she says. “But at the end of the day, I want to know that it helped patients do better, which is why we are all there working together in the first place.”—Jeanne Mettner