Interdisciplinary medical education and care

Interdisciplinary Training
I. Overview
Collaboration among health professionals is the key to future positive patient outcomes. Each
health-care professional is trained with specific a knowledge base and unique skills, which enable
them to perform a patient service they are most have most experienced. Health care providers
working as a team will bring specific strengths of each discipline to focus on the care of the patient
and will supplement weaknesses of other team disciplines. The goal of the interdisciplinary team
approach is to decrease costs, improve patient care, reduce morbidity and mortality through patient
safety and error reduction, while improving healthcare worker satisfaction and professional working
relationships (Allen, 2006). The World Health Organization (WHO) has supported the
interdisciplinary health care model for over 10 years has promoted interprofessional models of care
demonstration programs (Oandasan, 2005)
The medical management of a patient’s illness includes the care contributions made by nurses,
pharmacists, social workers, hospital management and physicians. Each of these professional
areas work independently to fulfill their obligations of their positions, but improved patient disease
management outcomes depends on the interdisciplinary cooperation between all involved areas.
Lack of professionally trained interdisciplinary staff has a potentially negative impact on the future of
medical care.
Research suggests that healthcare workers lacking professional training and skills may neglect
essential aspects of assessment and medical case management. These factors include; patient and
family understanding of the disease, the medical management of the condition, the importance of
home care, the financial, social and psychological impact the disease process has on the patient
and family.
The result of inadequate comprehensive care plans results in the patients needs not fully being
realized or meet. Staff with less professional interdisciplinary training may not be adequately
prepared to handle the current difficult medical, ethical and social issues that help patients and their
families navigate the complex service of todays healthcare delivery systems.
Each professional area involved in the healthcare setting is interdependent on the other providers.
For example, professionally trained social workers are more likely than paraprofessionals to provide
effective case management services for clients with complex problems. Pharmacists with a better
understanding of a patients limitations, unique medication needs and understanding the disease
process are more likely to utilize the full potential of the available pharmaceutical options available.
The nurse typically knows the patient on a personal level and can provide insight into the potential
success or failure of carrying out a healthcare plan. The nurse ultimately executes the medical and
pharmaceutical plans and provides the social worker with direct feedback on the patient’s care plan
and current status. Hospital management is playing an increasingly larger role in medical care, as
the healthcare dollar is becoming more limited and scrutinized. Patient clearance for a medical
procedure or hospital admission is often dependent on authorization from third party payers and
hospital management is playing a more integral role in this process. The more management
understands about the disease process and its social impact, the better prepared those

professionals will to aid in the interdisciplinary care of the patients.
As medical science progresses and the complexity of our health care environment becomes more
complicated, the need for a more integrated provider system becomes more essential.

II Interdisciplinary
a. Defined
To achieve better outcomes and to reduce costs, a health care system focusing on integrative health
care throughout the continuum of care and to more strategically use the full complement of health
professionals within the workforce is required. Primary care includes health promotion, disease
prevention, and the management of acute and chronic illness.
The goal of an integrated model is to enable the current medical system to move from a sporadic,
reactive, disease-oriented and physician-centric to an environment that provides an emphasis on
health, wellness, early intervention for disease, patient empowerment, and a focus on the full range of
physical, mental, and social support needed to improve health and minimize the burden of disease
(IOM, 2009).
The health care interdisciplinary group approach is designed to enhance educational and, ultimately,
patient outcomes. In the current health care environment, clinicians face increasing complexities of
patient care. There has been an increase in specialization and segregation of health professionals.
This has created a challenge to collaborate among those professions that contribute to the health care
of patients. The interdisciplinary approach to complex patient care is to educate, train and group
various professionals together to form a more unified health care team. Nurses, social workers,
pharmacists, hospital management, physicians, and other health care professionals work together in
the health care setting and, therefore, would benefit from learning together through allocated
interdisciplinary educational programs. This interdisciplinary approach is proposed to be a
nonhierarchical, professional blend of health care services that provides a cooperative continuum of
decision-making, patient-centered care and support.

The core principle of interdisciplinary education is that each participating profession provides input and
guidance to the area of care most relevant to its role with information being shared continuously and
freely. The goal is to culture an environment of mutual professional contribution and education with
maximizing team communications, aiming to ultimately to optimize the care of the patient (IOM, 2003).

i.

Current use in medical training and in allied Health training

American health care is moving from being a multidisciplinary fragmented system to a more integrated
interdisciplinary approach. The goal of an integrated health care team is to understand the related medica

health concepts, implement a shared language and form a patient based plan based on the best of each
separate disciplines.

The Future of Nursing Education reports made several recommendations for improving the standard nurs
curriculum (CRMJFIFN, 2011). One of these suggestions included a more widespread introduction of
interprofessional education. After graduation from a nursing program, the report states that there needs t
lifelong continuing nursing and interdisciplinary education (CRWJFIFN, 2010).

The medical social work education programs have been in existence since the mid-1900’s. The medical s
worker focuses on the relationship between the disease process and social adjustments. Today the medi
social work educational aim is to more specifically prepare students to work in the current health care
environment. Here the social workers interact more closely with health professions than ever before.

Medical education has also been active in addressing the complicated needs of today’s patient. Many
academic centers have made a commitment to education that fosters the interdisciplinary team approach
health care professionals. It has been realized by physicians that the interdisciplinary approach to patient
can clearly benefit the patient and improves physician care parameters. The unrealized contributions of th
other disciplines act to relieve some of the patient welfare burden to more effective health care partners o
team.

Pharmacy education has traditionally incorporated many medical health related topics. There
has been a recent effort to increase collaborative educational settings with the other health care
fields. Northeastern Ohio Universities College of Pharmacy began an integrated pharmacy and
medical curriculum in 2007. The curriculum was developed for interdisciplinary education
involving both colleges. The combined student body is taught together in lecture classes as
well as in small group active learning and interaction sessions. Patient care scenario
challenges are used to facilitate discussion and problem solving in the group settings.
Teaching involves professors and teams of students from both disciplines (Allen, 2006)

The currently available business health care and medical management educational programs include the
medical group management association (MGMA) and American college of medical practice executives
(AMPCE) graduate school placements. Internship-residency programs are available for graduate student
these internship-residency programs the students gain hands-on, experience in medical practice manage
Typically the experience follows the university program’s didactic course work and offers students exposu
organizational operations, decision-making and the opportunity to participate in health care projects. Earn
certification as a Certified Medical Practice Executive (CMPE) benefits healthcare administration and pro
physicians, medical practices, hospital systems the leadership that provides financial and organizational
success to an integrative health care setting (ACMPE, 2012).

The goal of interdisciplinary training is to improve patient outcomes. The benefit of the wisdom and resou
of the different disciplines on the health care team can result in improved patient treatment.

III. Unique Benefits and Limitations of Interdisciplinary training

Each discipline is exposed to the structure and knowledge base of the others. This results in increased a
to or knowledge of resources for each of the disciplines. The exposures we have in our training influence
attitudes and professional management after training. Exposure to and understanding the services of an
discipline will facilitate utilization of other disciplines through out their career. Becoming familiar with the o
disciplines with frequent professional interactions, results in a better understanding of how each discipline
inter-relates to one own. This exposure in training leads to an increased ease of access to expertise outs
individual’s area one the training is complete.

Mensah (1999) described in a publication, an approach to hypertension in which interdisciplinary teams w
more effective in reducing rates of hypertension than were physicians alone.
In large University hospital a prospective study was instituted to evaluate the possible benefits of an
interdisciplinary approach to patient management (Mudge, 2006). There was an intervention group, with
enhanced allied health services, and a traditional care group as a control. The interdisciplinary interventio
resulted in reduced index length of stay while the hospital mortality and patient functional decline were bo
significantly reduced in the intervention group over a 6-month period. Patients reported a more positive ra
about their health improvement 1 month after discharge. Both physicians and the other allied health
professionals reported a higher satisfaction rate than the control group.

A diabetes education program for healthcare professionals utilized an interdisciplinary approach to prepa
healthcare professional to participate in community based diabetes care and certification (Valdez, 2007).
This group developed a curriculum for themselves, their clients, and their clients' families. The target aud
for this program were physicians, nurses, pharmacists, and dietitians. The multidisciplinary faculty provid
expertise in the delivery of a comprehensive program for healthcare professionals. Registered nurses,
registered dietitians, pharmacists, the business component was implemented by an individual with a mas
degree in business administration, and physicians with credentialing in endocrinology were included as
educators.

There are a few concerns regarding the interdisciplinary approach to patient care. It will take a greater am
of time to gain consensus across disciplines that historically aim to preserve and protect domains of prac
Most professional domains have been taught and encouraged to emphasize differences of their services
distinctions rather than shared values and goals. It may also be that not all involved educators or “opinion
leaders” in the local educational community will endorse this type of integrated training.

The time required to participate in a special interdisciplinary section of training would have to either take a
from another learning experience or extend the length of the primary training program to participant is en
in.

Additional concerns have been raised regarding future educational, institutional or political mandates that
arise out of enthusiasm for a too rapid implementation of interdisciplinary healthcare ideation (Clark, 2004
The potential is that there is a danger the improvement efforts reported by some interdisciplinary projects
result in premature mandates placed upon clinicians by administrators and regulatory authorities. These
groups may require clinical implementation of interdisciplinary programs without recognition of the time a
recourses required for interdisciplinary teamwork training. Therefore some programs will be less likely to
meaningful and effective. A similar effect may involve federal government and foundational grant awards
well.

IV.

Framework for Training – Health Care Reform

The US health care reform momentum was initiated by a developing concern about the limited correlation
between the amount of resources expended and the outcomes in terms of health status. Health care refo
the pursuit of better outcomes in quantity and quality of health services using the same or fewer resource

In the health sector, these objectives are commonly expressed in terms of improving equal access to serv
effectiveness of medical care, efficient utilization of medical resources, satisfaction of users and sustaina

The current timeframe is appropriate for the development of a more firmly established interdisciplinary tra
program for medical health professionals. The progression of health care reform places an emphasis on
effective patient management while reducing cost.
a. Degree Path focus on collaborative problem solving

The degree path for each discipline would require completion of a core curriculum within their professiona
domain with an added certification of Interdisciplinary Health Care Provider (IHCP). This added credentia
might serve as an incentive for specific and more complicated health care settings, such as intensive car
burn units.

The IHCP certified social worker would complete the medical social worker track in the accredited master
social work programs. Since there exist didactic course work and hospital fieldwork placements for this m
social work masters students, an additional “rotation” designated for a higher-level involvement in an
interdisciplinary team would be required.

Pharm.D. students after completing their course work , enter a course of clinical experience where the
pharmacy student develops essential skills, such as consulting patients, delivering immunizations and
performing screenings . During the final two years, students are placed in patient care settings under the
supervision of licensed pharmacists. These rotations allow students to experience different areas of phar

including inpatient, ambulatory operations and electives. The IHCP certified pharmacist would have comp
the required Phar.D. requirements and a completed a 6-month term on the team.

Nursing participates would most optimally participate as part of an advanced nursing degree. Participants
masters in nursing program (MSN), administrative nursing or a nurse practitioner program would be eligib
The IHCP certified nurse would complete a 6-month rotation on the team.

Healthcare administrating management participants would be at the master’s level. There are currently m
group management (MGMA) and American college of medical practice executives (AMPCE) InternshipResidency Programs available for graduate students. In these internship-residency programs the studen
gain hands-on, experience in medical practice management. Typically the experience follows the univers
program’s didactic course work and offers students exposure to organizational operations, decision-maki
and the opportunity to participate in health care projects. The IHCP certified healthcare management
administrator would complete a 3-month rotation of the team. A major benefit of this certification would be
greater acceptance of the healthcare administrator in the physician community. In addition, this traditiona
“business” person would have a greater understanding of the mechanics of providing health care service

This interdisciplinary program would be based primarily in hands-on training like most internships, howev
classroom component could be used to complement the program. The classroom time would be best utili
small group problem solving tasks. These tasks may include the students that are scheduled to join the
interdisciplinary team on the next rotation. This would provide a pre-clinical introduction to both the mater
well as the other students and mentors they will be working with.

Within each discipline, the rotations on the teams should be staggered to provide an ongoing level of qua
care. There should be a one-week overlap of one student to teach the incoming student “the ropes” of the
on the team. In addition, the completion of a “rotation” by a discipline should be staggered, so there is no
than one new team member per month. This will also maintain the professional quality of the team.

Each student representing a disciple on the team would be required to give an analysis of patient care in
area. In addition, the team in a weekly conference would comprehensively review one patient to allow
maximum cross-disciplinary learning. The healthcare management would provide the hospital logistic, leg
and financial aspects of the care. The nurse would provide the daily demands of the patient care, includin
timing and implementation of the nursing care, the effectiveness of the physician’s orders for specific nur
care and the continuity of care through out the 24-hour nursing cycle.

Attainment of certification would require a satisfactory rating by the program training staff of each of discip
Allen, D. D., Penn, M. A., & Nora, L. (2006). Interdisciplinary Healthcare Education: Fact or Fiction?.
American Journal of Pharmaceutical Education, 70(2), 1-2.
http://www.ajpe.org.ezproxy.med.nyu.edu/doi/pdf/10.5688/aj700239

Oandasan I. & Reeves S. (2005) Key elements for interprofessional education Part 1: the learner, the edu
and the learning context. Journal of Interprofessional Care 1(21), 21–38.

IOM. 2009. Health professions education and integrative healthcare. Washington, DC: The National Academ
Press.

www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Health%20Professions%20Educatio
and%20Integrative%20HealthCare.pdf
IOM. 2003. Health professions education: A bridge to quality. Washington, DC: The National Academies Press.

ACMPE. 2012. www.mgma.com/acmpe/
(CRMJFIFN, 2011) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursin
the Institute of Medicine; Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health
Washington DC: National Academies Press; 2011.

(CRWJFIFN, 2010) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursin
the Institute of Medicine. A Summary of the February 2010 Forum on the Future of Nursing: Education.
Washington DC, National Academies Press, 2010. http://www.nap.edu/catalog.php?record_id=12894
Mensah, G.A. (1999). Refining strategies for the prevention and control of hypertension and related
complications. Ethnicity and Disease, 9, 327 – 332.

Mudge*, S. Laracy, K. Richter, C. Denaro (2006). Controlled trial of multidisciplinary care teams for acute
medical inpatients: enhanced multidisciplinary care. Internal Medicine Journal. Volume 36, Issue 9, page
558–563
Clark, P. G. (2004). Institutionalizing interdisciplinary health professions programs in higher
education: the implications of one story and two laws. Journal of Interprofessional Care, 18(3), 251261.

Valdez, G., Dadich, K., Boswell, C., Cannon, S., Irons, B., Vickers, P., & Esperat, C. (2007).
Planning and implementing an interdisciplinary diabetes workshop for healthcare professionals.
Journal of Continuing Education in Nursing, 38(5), 232-237.

Interdisciplinary medical education and care

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