Last month, I had the privilege of joining Maine Medical Center’s Interprofessional Partnership to Advance Care and Education (iPACE) retreat as their keynote speaker. The iPACE model was initially conceived by Maine Medical Center as an innovative educational intervention for residents and fellows, but over the years, as its value and impact became clear, it has evolved to become something more. With the support of the ACGME Pursuing Excellence grants and the AMA Reimaging Residency grants, iPACE has helped advance our understanding of how to redesign the clinical learning environment to enhance the education of resident learners as well as to improve patient outcomes and the interprofessional health care team experience. With this wealth of data in hand, the leaders of MaineHealth have built upon the success of iPACE and are using this model as the catalyst to redesign inpatient health care delivery across their health system.
What are the key principles of the iPACE model for inpatient care? They include:
- Patient-centered care that involves an interprofessional team that includes the patient and their family
- Intentional, structured, and collaborative team practice
- Full involvement of the care team in formulating and communicating patient care plans
- Purposeful learning by the interprofessional team
- Geographic proximity of the patient and care team
- Promoting team members’ full scope of practice and well-being
- Commitment to and participation of the full team in rapid cycle quality improvement
The iPACE model has already been shown to provide more efficient and cost-effective care, improve patient and healthcare team experience, and better prepare current and future healthcare team members to meet the challenges of working in a rapidly evolving clinical environment.
The idea that an educational intervention can actually be the basis for better patient outcomes, a better patient experience, and a valuable and rewarding team experience is not a new one— in fact, this was something I experienced time and again during my own medical education. However, in more recent years, I have been saddened to witness that many academic medical centers have lost sight of the transformative potential of education in deference to a business model which either does not or cannot appropriately prioritize the kinds of principles that iPACE espouses.
As an intern at the University of Chicago many years ago, I participated in teaching rounds every morning with the team at the bedside. My attending physician, Dr. Harvey Golomb, a renowned hematologist-oncologist, gave me the roadmap for how to present my patients to the interprofessional clinical team: five minutes at the bedside—engaging the patient; presenting the history, physical examination, and clinical data from memory; and providing at least two references from the primary medical literature pertaining to the patient’s clinical condition. This format required students and residents to communicate the medical issues with clarity and precision, while simultaneously reaffirming the humanity of the patient and problem-solving with the other members of the interprofessional team. My residency program, with the encouragement of the ACGME, was organized around the same key principles articulated in the iPACE model, imprinting on me the essential value of an interprofessional team-based approach to patient care. This value was reaffirmed by the Institute of Medicine over a decade ago: “Team-based care is one of the guiding principles of a learning health system. It stresses interdependence, efficient care coordination, and a culture that encourages parity among all team members.”
But where are all these high-performing interprofessional care teams expected to come from if our learners are not actually being educated in a clinical learning environment that models this for them? The Josiah Macy Jr. Foundation has invested in interprofessional education as a key priority for funding since 2010, beginning with my predecessor, Dr. George Thibault. After I began my tenure as President in 2018, we decided to deepen and expand our ideas of what we might accomplish in the priority area of interprofessional education. We reconfigured this priority area to focus on learning in and from high-performing interprofessional care teams and looked for projects that would increase these collaborations among future health professionals in clinical learning environments.
Clinical learning environments have historically trained students, residents, and graduate students in various health professional schools and programs to be highly skilled, but largely autonomous, professionals. This “siloed” approach has long been understood to be ineffective and should be replaced by environments where health professionals and their learners operate with those from other professions as a highly collaborative team. The Macy Foundation is focused on high-performing interprofessional team care as the optimal model for patient care and for training future health professionals.
Maine Medical Center’s iPACE model is truly an exemplar. Further, they are doing what we, as a foundation, and the only foundation dedicated to improving the education of health professionals, most hope to see: using innovation in health professions education to meet an important mission by serving the patient’s needs and improving the health of the public. I congratulate them on their outstanding work and will be paying close attention to the transformation of health care delivery based on this model.