The following interview with Vanderbilt University School of Medicine and School of Nursing, a Macy grantee, originally appeared on the Health Affairs blog.
Well before the Affordable Care Act was passed in 2010, efforts to expand interprofessional education (IPE) were beginning to change the mindset that permeated much of health professional education in the US. One such example is the Vanderbilt Program in Interprofessional Learning (VPIL) that was established in 2010 with initial support from the Josiah Macy Jr. Foundation, and later from the Baptist Health Trust.
To learn about the challenges, successes, and surprises experienced by those who developed and lead IPE at Vanderbilt, I interviewed Linda Norman, dean of Vanderbilt University School of Nursing, Bonnie Miller, associate vice chancellor for Health Affairs and senior associate dean for Health Sciences Education at Vanderbilt University Medical Center, and Heather Davidson, director of Program Development for VPIL.
Peter Buerhaus: What were the key challenges faced when you started IPE at Vanderbilt?
Linda Norman: Although the School of Medicine and the School of Nursing had a history of trying to work together to develop IPE, we had never come up with a common and sustainable place to put IPE in our respective curriculums. Everything we had tried previously ended up as an add-on to the curriculum. We had numerous discussions about how to create IPE that would be meaningful to students and also contribute to clinical operations. Initially, we thought only of nursing and medicine but the more we examined the clinical situation, the more we realized that other health care providers were integral. So we looked at adding pharmacy and then social work. The challenge was to identify the place in the curriculum where our health professions students and interprofessional education would best fit.
Bonnie Miller: We did not want IPE to be a new requirement for all students, but rather, we hoped to figure out ways that IPE could help fill established requirements. For example, within the School of Nursing IPE would fulfill credits in community health, and in the School of Medicine IPE substituted for certain elective courses and now provides credit for a required course, Foundations of Healthcare Delivery (FHD). Not all of our students are required to participate in VPIL. The notion of having one program that would meet requirements for four very different professions was quite challenging.
Heather Davidson: The challenge of integrating IPE into the curriculum also involved developing new roles for the initial VPIL faculty. Faculty representing each of the four health professions had to become liaisons between VPIL and their home professional school. Their work included negotiating the alignment of the home school’s goals, objectives, competencies, credit requirements, etc. with the innovative vision of an IPE curriculum in order to eliminate the “add on” effect for the program. They had to be creative when identifying where a VPIL experience could be substitutive and simultaneously nurture their own role as part of the interprofessional faculty team charged with creating a meaningful educational program that met IPE goals. The initial work at operationalizing the program had to be perceived as a “win-win” by everyone involved. Therefore, faculty from different institutions had to tackle a unique challenge of supporting a curriculum that would hit their own needs as well as the needs of the IPE vision. Although their liaison role was vital in the early stages of design and implementation, it has continued to be extremely important as we have worked to make the program sustainable. Schools have gone through curriculum reform, shifting schedules and our own continual improvement.
Norman: In the beginning we decided we were not going to let schedules stand in our way for getting IPE accomplished. We agreed that we would do whatever was necessary to have the students from four disciplines be together at the same clinic with the same team on the same day for a two-year period. We knew that IPE could be derailed by scheduling issues and failing to have common expectations, common competencies for the students, and faculty who were champions. We sought to overcome these challenges by engaging the academic administrators of each of the programs and obtain their buy-in before we started planning the curricula. We intentionally partnered with people who had the same level of commitment that we did, and were conscious not to let extraneous things get in the way.
Miller: Logistics are formidable and can become a seemingly overwhelming obstacle when programs do not have the energy or will to overcome them. Without dedicated commitment at the ground level among the faculty members who are creating the program and key administrators supporting them, IPE won’t happen.
Davidson: We have used words like creativity, tenacity and flexibility to describe the characteristics of the people who are committed to IPE and have decision-making power at the different institutions. This was not a one time, “let’s design the program,” and figure out all the logistics. Logistics is an enduring challenge as each school is continuing to improve itself, make curricula changes, and prepare for the implications of health reform.
Miller: Even though these were start-up challenges, many of them have not completely gone away. We overcame them, but they continue to show up in a variety of different forms. It is not just the initial commitment but rather it is an ongoing commitment. To be sure, the fact that the Macy Foundation was interested in the program and provided a large grant has helped sustained our commitment and enthusiasm.
Norman: Our commitment was also strengthened by the accrediting bodies for each of our disciplines who were looking closely at how we integrated IPE into the curriculum. Also, each of our academic professional organizations was urging the development of IPE. Another challenge we faced involved determining the level of the nursing, medical, pharmacy, and social work student that should be included in our IPE model. Should it be a new learner or a more experienced learner? As a group, we decided that the new learner was the best place to start. We had not seen anything in the IPE literature about using new learners; most IPE at the time involved more experienced learners. We wanted to provide IPE when students had not yet developed notions about their own discipline.
Davidson: Choosing the clinic placement sites was also a challenge because so few clinics are actually thinking about IPE. Consequently, IPE was not going to be a “normal role modeling experience” where students are precepted in clinic settings. We had to find clinics that were willing to take on a group of four students and clinical faculty willing to teach those students who were not from their own profession. This challenge has continued as we have expanded the number of students over the years.
Miller: The things that should not be challenges actually become challenges, such as space. Even when you have staff and preceptors who buy into the idea, it turns out that having room for four extra learners in your clinic, with the required number of exam rooms, and the ability to manage and direct traffic, becomes a limiting factor.
Continue reading Peter Buerhaus’ interview with the Vanderbilt team at the Health Affairs blog.