News and Commentary Building Care Teams in Pediatrics

Pediatrics is an interprofessional endeavor, involving not only physicians but also nurses; social workers; respiratory, physical and occupational therapists; pharmacists; dieticians; child life specialists; medical assistants; and many others.

All these health professionals desire the best outcomes for their patients. Realizing that goal requires them to collaborate, even when time is short and opportunities for face-to-face discourse may be limited. Members of the interprofessional team need to understand each other’s roles and unique strengths. They need to feel comfortable sharing important observations and information with their colleagues in a timely manner—even if they are trainees.

It sounds simple, but it’s not how most health professionals are trained.

At Harvard Medical School, where I’m a pediatric hematologist-oncologist and an Assistant Professor of Pediatrics, opportunities for interprofessional education have been developed within the early portions of our curriculum. But when students make the leap into the clinical arena, formal opportunities for interprofessional training have proven elusive.

As a Macy Faculty Scholar, that’s what I’m working to change, by bringing interprofessional education opportunities into the core clinical clerkship for Pediatrics at Harvard. So many trends in medicine reinforce the need for interprofessional training. The patient safety movement, for example, has taught us that you can’t rely on a lone “expert” to ensure safe care. Good team function set in a larger system of care is essential to keeping care safe, and when it’s not there, patients get hurt. And if we’re serious about providing patient-centered care, then we must excel as a team, because no single health professional can cover all the bases to meet patients and their families where they are.

Historically, the doctor has been viewed as the expert everyone turns to for direction. But given the information explosion in modern medicine—the National Library of Medicine counted nearly 1.2 million MEDLINE/PubMed citations in 2016 alone—that’s not realistic. No doctor has expertise in everything, and it’s not appropriate to expect doctors to be the sole keepers of knowledge anymore. Doctors need to be able to rely on other people—and those people must feel comfortable asserting themselves, even when it means respectfully disagreeing with someone more senior (when you’re a trainee, that’s everyone).

The intervention that I’ve designed for Harvard Medical School’s six-week Pediatrics clerkship aims to help students understand what it means to be part of an effective interprofessional team.

The clerkship begins with a case-based, faculty-facilitated discussion of how interprofessional collaboration can influence patient outcomes. In this three-part scenario, a 13-month-old boy is about to be discharged from the hospital after an admission for pneumonia. What should be a happy and triumphant occasion turns into a stressful ordeal for the patient’s mother because the interprofessional team is not collaborating effectively. The group, which includes medical students as well as trainees from nursing, social work, pharmacy, and nutrition, discuss how the case could have been handled better and how an “ideal” team works.

We then ask students to participate as members of an interprofessional team at the hospital, going on rounds and participating in huddles and case conferences. We invite students to record their observations and reflections in an online journal. Students also interview two other health professionals on their team with whom they share patients to learn about roles and how they work on the team.

The last part of the intervention is a simulation experience about interprofessional conflict resolution. In this scenario, the student encounters a more senior nursing colleague and a disagreement in the care plan develops between the two. It’s a challenging yet realistic situation in which the medical student must recognize the conflict and navigate it so as to align with the nurse and ensure good care for the patient. Meanwhile, medical student peers and educators from both medicine and nursing observe the simulation and give structured feedback during a debrief.

The training rolled out last October, and we’ve received positive feedback from students. They appreciate the opportunity to learn from other professionals, including how to recognize and leverage the strengths of all their colleagues so that the whole team works better.

It’s important to understand that everyone on the team shares the same goal: the best possible outcome for the patient and the patient’s family. Each team member has a role to play in producing that outcome.

Interprofessional teamwork is not just the future of health care—it’s what health care should be right now. As a Macy Faculty Scholar, I hope this project will help increase medical students’ understanding of what it means to be part of an effective interprofessional team.

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