Learning as a team to work as a team for improved patient care

Instructor Karnjit Johl with medical students
School of Medicine Associate Professor Karnjit Johl, who teaches clinical-technique classes to medical students, is working with Betty Irene Moore School of Nursing leaders to develop similar joint classes for nursing and medical students, enabling them to develop team-oriented skills early in their education.

In today's health-care environment, individuals are acquiring increasingly complex lifestyle diseases – cancer, heart diseases and diabetes – that require treatment from teams made up of physicians of different disciplines, nurses with specialized expertise and other health-care professionals.

These teams must work well together for the sake of effectiveness and patient safety, individual and family engagement with the plan of care and, of course, individuals' satisfaction with the care they receive. While teamwork can be learned on the job, many experts believe teaching nursing, medical, social-work, pharmacy, dietary students and others in teams will give them the perspective and skills they will need to work well in teams in the future.

With the establishment of the new Betty Irene Moore School of Nursing, UC Davis will offer an educational curriculum that prepares students for this new multidisciplinary approach to health care.

Building a new program

"We are in the unique position of being able to build a program that, from the start, will include opportunities for students to work and learn side-by-side," says Heather M. Young, a registered nurse with a doctorate in nursing science who is UC Davis' new associate vice chancellor for Nursing.

Young, who will serve as the new school's dean when the UC Board of Regents approves the school, says she is excited to work with others on campus to build a model in interdisciplinary education for health-care professionals.

Young's enthusiasm is equally matched by her colleagues in the School of Medicine who are eager to enhance the learning experiences of their medical students.

"We have a chance to do something that has never been done before," says Ann Bonham, UC Davis School of Medicine executive associate dean for Academic Affairs. "And that is to afford nursing students, medical students and other health-care professionals an opportunity to train shoulder-to-shoulder in small-group settings with patient-centered cases."

Ann Bonham"Team-based health care by nurses, physicians and other health-care providers means better, safer and more efficient care for patients, and that will transform health care in country for the better."
— Ann Bonham, School of Medicine executive associate dean for Academic Affairs

Students from both schools will participate side-by-side on healthcare teams from the very beginning. The interprofessional education will extend beyond the medical and nursing schools to the Graduate School of Management and eventually the proposed school of public health.

"What had been lacking," Bonham says, "are the opportunities to interact together as a health-care team on cases involving patients, but we plan to fill that gap."

Maximizing student interactions

Building the UC Davis nursing school from scratch means its academic schedule can be structured in a way that maximizes potential interaction with medical, business, and public-health students. It also means being able to attract both students and faculty to a campus that has a demonstrated commitment to interprofessional education.

"The learning experiences of students and the professional lives of faculty will both be enhanced by interprofessional education," Bonham says.

Young arrived at UC Davis in August from Ashland, Ore., where she was the Grace Phelps Distinguished Professor, director of Rural Health Research Development and director of the John A. Hartford Center of Geriatric Nursing Excellence at the Oregon Health and Science University School of Nursing. She is a nationally recognized expert in gerontological nursing and rural health, as well as a fellow in the American Academy of Nursing.

Young finds the welcoming environment at UC Davis for both the School of Nursing and the concept of teaching and training students in interprofessional teams ideal for achieving the bold goals of the new initiative.

Top-level support

She points to the newly created position of assistant dean of Interprofessional Education as evidence of the support and commitment by UC Davis Health System.

Nurse Debra Abernethy
UC Davis Medical Center nurse Debra Abernethy is among hundreds of health-care professionals who take advantage of continuing education classes at the Center for Nursing Education. The center provides more than 35,000 continuing education hours annually.

Jana Katz-Bell, a medical school administrator who helped write the grant to fund the new nursing school, now holds 50-percent appointments in both the School of Nursing and School of Medicine as assistant dean for Interprofessional Education.

"My role is to oversee programs that bridge the two schools and seek new opportunities for interprofessional programs on our Sacramento campus," she says.

Katz-Bell also oversees the integration of telehealth and simulation technologies, two great opportunities for interprofessional education.

Using technology to learn

A statewide telehealth implementation, facilitated by the California Telehealth Network and funded by the Federal Communications Commission and Proposition 1D, will expand broadband-equipped telehealth sites in California to 500 over the next three years. Led by UC Davis and the University of California Office of the President, the FCC initiative's goal is to improve rural health-care access throughout California.

Simulation training already occurs in an interprofessional environment, Katz-Bell says. Medical students, practicing nurses, physicians and first-responders train as teams using the latest simulation technology.

"With the opening of the nursing school, we have a chance to really expand the simulation-training opportunities for students," she says.

In addition to including nurses in these established programs, faculty members need to be on the lookout for additional interprofessional programs and research opportunities, says Katz-Bell. She says it will be part of her job to help faculty explore collaborative opportunities that will advance health in innovative ways.

"That requires a shift away from the traditional medical and nursing educational curricula," Katz-Bell explains.

A new curriculum

The good news, says physician Suzanne Eidson-Ton, is that the shift is well under way. Eidson-Ton is among those from the medical school who have been asked to help create the new nursing curriculum.

"As educators, we recognize that to produce better doctors and better nurses, we need to add a component to their education that focuses on building the skills necessary for interprofessional team-work," says the assistant clinical professor in the Department of Family and Community Medicine. She is also director of predoctoral education for the family medicine department.

Along with several other medical school faculty, Eidson-Ton teaches a course in doctoring that utilizes small-group discussion and interviews with actors who pose as patients to address issues a traditional medical school curriculum doesn't cover, including health disparities, breaking bad news to patients and working on interprofessional teams.

"There will always be a need for medical students to have their own doctoring course, but we have a tremendous opportunity for nursing students to have a similar nursing course and to offer several joint sessions that focus on the team aspect of patient care," she says.

Teaching students in small interprofessional groups will provide opportunities to learn the skills required to collaborate on future teams throughout their careers, says physician Karnjit Johl. A medical school associate professor, Johl is an expert in small-group learning.

UC Davis Medicine

UC Davis MedicineThe Winter Issue of UC Davis Medicine explores interprofessional education at UC Davis where nursing students at the new Betty Irene Moore School of Nursing will learn shoulder-to-shoulder with School of Medicine students to enhance the effectiveness of health-care teams of the future.

Click here to read more of UC Davis Medicine.

Small-group learning

At the medical school, students are placed in small groups starting in their first year. These students are exposed to a wide variety of healthcare professionals. Johl says students from all health-profession programs should have significant exposure to the education, expertise and priorities other professionals bring to a healthcare team.

"It can only benefit students for them to work together and learn about what each other does before they need to work together with patients in a high-stress environment," Johl says.

Johl also says she sees very few challenges to incorporating nursing students into the small-group clinical environment.

"We already work with nurse practitioners on a regular basis and look forward to including the nursing students in our groups."

Still, Young is aware that nursing and medical faculty members will need both formal and informal support when they begin to work on interprofessional teams as educators.

"We will have to support the faculty in meeting multiple goals with a shared curriculum and within a shared experience."

A moral imperative

Bonham says it is nothing less than a moral imperative for educators across the country to make the individual and institutional changes necessary to offer interprofessional education to their students in the health professions.

"Team-based health care by nurses, physicians and other health-care providers means better, safer and more efficient care for patients," she says. "And that will transform health care in our country for the better."