Resource - Indiana Rural Health Association

Interprofessional Education
at a Federally Qualified
Health Center
Who Are We?
Dr. Eric Beachy, MD
Medical Director
Dr. Jim Buechler, MD
Director Emeritus
Richard G. Lugar Center for
Rural Health
Dana Edwardson
Clinical Mental Health
Counseling Graduate
Indiana State University
Learning in Silos
Today’s Health Care Training
What is Interprofessional
“When students from two or more
professions learn about, from and with each
other to enable effective collaboration and
improve health outcomes.”
(WHO – 2010)
The Goal of IPE
“The Goal of this interprofessional learning is to
prepare all health professions students for
deliberately working together with the common
goal of building a safer and better patient-centered
and community/population oriented U.S. health
care system.”
Interprofessional Education Collaborative Expert
Panel – 2011
Other Definitions
Interprofessional Teamwork - “The levels of cooperation, coordination,
collaboration characterizing the relationships between professions in delivering
patient-centered care.” (IECEP – 2011)
Interprofessional Team Based Care - “Care delivered by intentionally
created, usually relatively small work groups in health care, who are recognized
by others as well as by themselves as having a collective identity and shared
responsibility for a patient or group of patients, e.g., rapid response team,
palliative care team, primary care team, operating room team.” (IECEP – 2011)
Interprofessional Collaborative Practice - “When multiple health
workers from different professional backgrounds work together with patients,
families, caregivers and communities to deliver the highest quality of care.
(WHO – 2010)
History of Interprofessional
• First started to be looked at approximately 50
years ago
• First scholarly articles regarding IPE appeared in
the Journal of Medical Education in 1965
• Institute of Medicine Conference
“Interrelationships of Educational Programs for
Health Professionals” was held in 1972
Early Drivers of Interest in IPE
IOM Committee Expressed the following reasons for IPE:
– Desire to use existing health care workforce optimally
and cost-effectively
– Desire to ensure that health care workers are trained
and enabled to practice to the full scope of their
– Recognition of need for effective multi-disciplinary
teams and that the educational system at the time
was not preparing health professionals for team work
Interesting Early Articles
“A Student-Run Course in Interprofessional
Relations” – Journal of Medical Education
March 1977
– A student-driven collaborative course for
students in the disciplines of medicine,
nursing, physical therapy and occupational
“The Mini-God Syndrome” Journal of Medical Education –
February 1978
“Arrogance is a rather common failing among physicians….
outwardly, it is expressed in various behavioral patterns, such as
belittlement of the patient or the nursing staff or in self-exaltation
over colleagues.”
“This phenomenon can be uprooted quite easily on condition that
every one of us is conscious of it, is persistent in his self restraint,
and remembers to treat every fellow human being with due
Recent Explosion of Interest in IPE
Average annual articles published by decade in Academic
Medicine (formerly Journal of Medical Education)
Annual average IPE articles
Annual average IPE
1965-1974 1975-1984 1985-1994 1995-2004 2005-2014
Why is IPE Important Today?
The same issues as were present in the 1960s
and 70s persist today
We need to prepare tomorrow’s healthcare
workers to collaborate effectively with all members
of the healthcare team to improve patient care,
outcomes, provider satisfaction (and thus
retention), and cost-effective care delivery
A Small, Experimental IPE Effort
Initiated by the Lugar Center for Rural Health – participating organizations included
the IUSOM, Indiana State University (Physician Assistant and Clinical Mental Health
Counseling students), VPCHC
The Project
To provide clinical students from varying
disciplines the opportunity to work in
collaborative partnerships to more effectively
treat patients of a rural Federally Qualified
Health Center.
Valley Professionals Community
Health Center
• Federally Qualified Health Center (FQHC)
• Offers primary and behavioral health care services to citizens
of Parke and Vermillion counties in west central Indiana
• Serves residents below 200% of the Federal Poverty Level
(FPL), uninsured, underinsured, Medicaid, Medicare, privately
insured patients
• VPCHC has three service delivery sites
– Clinton, IN (Vermillion Co.)
– Cayuga, IN (Vermillion Co.)
– Bloomingdale (Parke Co.)
Bloomingdale Clinic
Valley Professionals Community Health Center
• Opened in 2013
• See over 700 patients annually
• Located in Parke County:
– Health Professional Shortage Area (HPSA)
– Partial-county Medically Underserved Area (MUA)
– Population of 17,152
– 36.9% of residents living below 200% of the FPL
Who was Involved?
• Medical Preceptor
• Behavioral Health Preceptor
• Medicine
IU School of Medicine
• Clinical Mental Health Counseling Graduate Student
Indiana State University
• Physician Assistant
Indiana State University
*By chance, a practicing NP was also present for several sessions
Perceived Possible Barriers
(Prior to Start of Project)
• Patient Receptiveness
• Patient Volume
– Too much or too little would not work
• How would students interact with each
• Preceptor Time
How was it Structured?
• 4 afternoons in fall 2013
– October 22, October 29, November 5, November 12
• Students, preceptors all present in exam room (if patient
willing – most were)
• Medical HPI initiated by Medical Preceptor with follow-up
questions asked by learners
• Behavioral Health history taken by counseling student
and/or Behavioral Health preceptor
• At the end of each afternoon, team sat down together
and discussed patients, interactions, learning points
Evaluation - Course
Course Survey
• Assessed whether course objectives were met:
– Have an enhanced understanding of Federally Qualified Health
– Enhance skill sets such as history taking and physical
– Become more comfortable communicating with students in other
healthcare disciplines
– Better understand the level of education, training, and skill sets
required of other healthcare disciplines
– Better understand the benefits of IPE and the collaboration of
multiple disciplines toward the enhancement of patient care
Evaluation - IPE
Interdisciplinary Education Perception Scale (IEPS)
Luecht et al, (1990, Journal of Allied Health, 181-191)
• Valid, evidence-based tool
• Measures attitudes deemed important in the
interprofessional setting
• Completed pre/post course
Results - What was Learned?
• Every student responded that each objective was
met fully
• Attitudes toward IPE improved
• Knowledge of other health professions increased
• Collaborative learning was enjoyable!
• Multiple patients had Behavioral Health needs that
would not have been uncovered without this
collaborative exercise
• Patients felt like the “center of attention” – most
were very receptive
Why Did it Work?
Patient volume appropriate
Preceptor buy-in
Student receptiveness
Patient engagement
How Could it Be Improved?
• Expanded scope of disciplines involved
• Expanded number of sessions
• Involving Students at various levels of
– e.g. including upper level medical and PA
students, possibly residents
• Framework for Action on Interprofessional
Education and Collaborative Practice
World Health Organization (2010)
• Core Competencies for Interprofessional
Collaborative Practice – Report of an Expert
Panel (May 2011)
- Sponsored by Interprofessional Education

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