Ted James, M.D., Associate Professor at the University of Vermont College of Medicine, discusses his work to develop an interprofessional quality improvement and safety curriculum.
Macy: Why are you interested in interprofessional education?
James: If there was a drug that prevented medical complications and dramatically improved outcomes, people would jump on it. It would become a billion dollar industry. Well, we have the answer—teamwork and communication. It is so simple, so effective, and so inexpensive. It’s very low-hanging fruit, and we really should capitalize on it.
But for the most part, these things are not typically taught in medical school. Instead, once medical students graduate and begin practicing, they have to learn quickly and on their own how to work with other health professionals. It seems like common sense that, if we can teach doctors, nurses, pharmacists, and other health professionals to talk to each other and work together early on in their education, from their first years in the classroom, they will become proficient in working together and won’t have to learn it on the job, when patient safety and quality of care are at stake.
What specifically are you planning for the University of Vermont?
We’re at the start of a two-year effort to identify, develop, and implement opportunities to integrate teamwork and collaboration across our health professions schools.
UVM has experience with this type of effort, and has been a pioneer in the area of interdisciplinary training and teamwork, but our efforts haven’t been uniform. Instead, lots of good projects and programs have been happening independent of each other across the various schools. It’s time to bring all that effort and energy together and, hopefully, develop a larger and more integrated curriculum that eventually spans every year of training and involves all the health professions schools.
How will quality and safety be integrated into your project?
We’re still in the planning stages, but one of the IPE opportunities we’re exploring is a curriculum focused on patient safety and quality improvement. Higher quality care requires health professionals to function well together as a team, and a high-functioning care team certainly produces better outcomes than a team of autonomous individuals, so it makes sense to partner the two.
Just look at the research on reducing surgical errors via a simple checklist. There’s been a lot written on this, most notably by Dr. Atul Gawande at Brigham and Women’s Hospital in Boston. He found that having the surgical team walk through a simple checklist—introduce everyone on the team by first name, confirm the patient’s name, confirm that everything needed for the surgery is prepped and ready—having them actually talk to each other before the surgery, is just good communication and coordination. It’s usually not lack of knowledge that results in dramatic surgical errors, like patients receiving the wrong surgery or surgery on the wrong side of their bodies. Errors tend to be the result of miscommunication and wrong assumptions that could have been avoided by simply talking to each other.
Is interprofessional practice something you’ve encountered as a surgical oncologist?
Patient-centered, team-managed care is a model that seems to work incredibly well in the cancer world. Breast cancer care in particular has been a leader in standardizing the performance of high-functioning teams and improving patient outcomes as a result. As a matter of practice, I meet regularly with my patients’ other providers and we talk about all aspects of a patient’s care. I’d like to see more of this team-based approach become part of health care practice in general. It should be the norm.
In medicine, at least, the focus traditionally has been on physician autonomy—the doctor as the decision maker at the top of the hierarchy. I’m not sure that was ever the ideal model, and it’s certainly not right for today’s world. Today, the doctor is one of a team of leaders. It’s less about the doctor’s unilateral decision-making skills and more about the contributions he or she brings to the team. When I’m in the operating room, for example, I might be thought of as the team captain in that particular setting, but it’s not about me directing everyone how to do their jobs, it’s about me leading the team in a way that fosters collaboration and communication, and ensures the highest quality of care.
What do you envision as the future for health professions education and how will it change health care?
I see a future where the walls between different health professions schools at universities are broken down. Students from all the health professions will be talking together, learning together in classrooms, working on group projects together from their first moment on campus, before they ever step foot into the clinical environment. They will learn from each other in a way that they don’t currently have opportunity to do. They’ll know firsthand what training, skills, and knowledge their teammates bring to the practice of health care.
If we start fostering those team-based relationships in the classroom, we will breakdown a lot of the misconceptions, misunderstandings, biases, and stereotypes that currently get in the way of collaboration in practice.