We recently piloted a small group experience in interprofessional education (IPE) at Emory. This was the dry-run of a multi-institutional grant on IPE using the same techniques. The idea is that leaders of education in the various disciplines are expected to work together to bring about IPE, but the individuals really don’t know each other very well. They come from different cultures with different hierarchies, leadership, even dress codes. So the first step ought to be getting to know each other. We planned an eight month experience working with 11 faculty leaders from disciplines of Medicine, Nursing, Physical Therapy and Physician Assistants. We would engage in exercises requiring that we work closely together. One example was to role play forming a team for error disclosure to a patient and family. The agenda behind the exercises was to lay the groundwork for IPE by building trust and collaboration. Another example also involved forming a team to plan and deliver bad news to a patient with cancer.
At the end we agreed that the program had been a great success. It was surprising how quickly we had dropped the professional posturing and begun relating to each other as one person to another. We used an approach that has worked previously in forming physician groups that are highly engaged and supportive. Early on we used narratives. This exercise knitted us together so that role plays could be done in a spirit of trust and cooperation. Trust allows honest, really helpful feedback, which is wonderful for learning and creates a highly satisfying group-process.
Why are narratives so effective? I think telling stories is really fundamental to being human. Writing a story about yourself – in this case we prescribe that it be a story about success or overcoming a challenge – seems to reach a depth of honesty and insight that comes out less easily when the assignment is just to speak. So as we listen to someone read their story, with our deepest respect and understanding, and then help them to make sense of the story, help them to reach the bottom of it; we then begin to feel we know the person, and they learn more about themselves. These narrative exercises in a group of 11 faculty members may go on for two to three weeks.
A nurse in our group explained the importance of the group-process: she wrote “about two incidents in my professional life which have haunted me with shame. The point was not really the content of the stories, which were failures of communication with physicians. The point was that I felt safe enough within the group to discuss them. I was able to be vulnerable. This is the basis for successful IPE work.” A physician described the safety in the group, and how quickly this developed. He said, “Because we understood that this was going to be confidential, some things I haven’t shared with anyone else. Being able to understand other professionals and their unique skills and perspectives is important in order to create a coherent IPE program. I feel that bringing this group together has already brought about interesting synergies that I am using in other IPE groups.”
The Road Ahead
Thanks to a new grant from the Macy Foundation, we plan to do this at seven other universities. We will follow the format of first knitting the groups together by sharing stories; then, having them work collaboratively to practice skills and teamwork. I expect this simple formula to succeed again. Sometimes reviewers have commented on my manuscripts that talking about group-process and writing stories sounds like jargon. Maybe you’d have to be there to fully understand. This isn’t jargon, it’s basic humanity: We understand our lives by telling stories. If an authentic, compassionate understanding of each other results, then that’s what makes us human.
William Branch, MD, MACP, is Carter Smith, Sr., Professor of Medicine and Past Director of the Division of General Internal Medicine at Emory University School of Medicine. He was founding director of the Primary Care Residency at the Brigham and Women’s Hospital in 1974, among the first primary care residency programs. He was a key leader of the New Pathway project at Harvard Medical School, serving as Coordinator of the required first year Patient Doctor Course in 1988 and Director of the required third year Patient Doctor Course from 1989 to 1995.