Most patients think about healthcare in the United States as a single, interconnected system. They don’t necessarily distinguish between primary care providers, specialists, public health experts, emergency providers, and others. While the COVID-19 pandemic has certainly opened many eyes to the intricacies of our healthcare system and the various roles that contribute to keeping people healthy, we know that the collaboration often assumed by the public does not always happen. We also know that the way we educate health professionals plays a crucial role in helping the providers and experts of the future to operate more in unison for the good of patients’ health.
As with many elements of our health professions education system, the pandemic has highlighted the importance of interprofessional education (IPE) and created new challenges in creating IPE programs and delivering IPE-focused care to patients. At the McGovern Medical School at UT Health, Jennifer Swails, MD, FACP, and her team saw these challenges firsthand and began looking for creative ways to bring IPE curriculum to a community and patients’ bedsides.
“Typically, IPE curriculum has been limited to simulation exercises,” said Dr. Swails. “There are a lot of different barriers to bringing interprofessional students to the patient bedside, which also means that patients and communities often are not seeing the benefits that true interprofessional collaboration can bring.”
Dr. Swails and her team at UT health saw an opportunity to align clinical teams of medical, dental, and nursing students working in the Houston area with non-clinical public health and biomedical informatics students working on public health projects.
With support from leadership at the McGovern School and funding from the Josiah Macy Jr. Foundation, Dr. Swails and her team organized and developed an eight-week curriculum that created interprofessional student teams linking direct patient care with community-based public health projects.
Delivering Interprofessional Education to Patients and Communities
Working in teams under the supervision of an interprofessional group of faculty, students in the Improving Care Access and Realizing Equity (ICARE) program are partnered with community organizations. These partnerships are crucial to the program’s success. The teams work with the leaders in the community to understand the challenges they face, identify their needs, and develop workable solutions to a variety of health care issues like access to medication, lack of services between visits, sub-specialty availabilities (e.g., cancer screening, mental health support) or lack of communication between clinic and patients.
The teams start by building skills in interprofessional collaboration and meeting with the organizations and leaders to understand the community they’ll be working in and their needs. The teams will then work together to address these problems on the individual and community levels. Delivering equitable care is also a crucial element of these partnerships as many community programs provide healthcare services to patients without health insurance and to historically marginalized groups in the Rio Grande Valley. Students work with their partner organizations to deeply understand the challenges that those in the community face.
Following the initial orientation, relationship- and skill-building period, the students work in teams that are both clinical and project-based (non-clinical). They meet with patients to assess individual needs and perform research and analysis on a population level. The clinical students will meet with an assigned family or patient and help design a care plan while the project-based students conduct needs assessments and look at the broader context of a particular health challenge.
For an example of how this will work, Dr. Swails described a recent example from the school’s telemedicine practice. There, a clinical team worked with an individual with issues related to their rheumatoid arthritis. After meeting with the patient, the clinical team discovered the patient was having trouble accessing their rheumatoid arthritis medication at the beginning of the pandemic. The patient had to drive from Texas to Mexico to get their medication and when there was a lockdown, getting across the border was difficult. After identifying the issue, the clinical team focused on immediately rectifying the problem and worked to identify a better way for the patient to get their medication. Through the ICARE program, the clinical team would then flag the issue for the non-clinical team, who would look at the overall population of patients and identify barriers contributing to decreased access and availability. Once these were established, the teams would then work together to find solutions and present them to the community. This would help the community create a process to surpass these types of issues in the future.
“I think this is the way we as providers and health professionals want it to work, but it can sometimes feel like the systems are designed without respect for our patients,” said Dr. Swails. “We want to help teach our students how to form these connections to take patient health needs to the public and population health levels and then back to the patient while trying to keep the lens on both of those things at the same time so we can really serve both.”
Delivering Community Impact
After the four-week period of working with patients and the community, the clinical and non-clinical teams spend the final two weeks preparing a final presentation. The students present their experience, findings and recommendations to the community and receive feedback. This element is crucial to the success of the program. The final presentation helps bring lasting impact to the community partners who continue to handle health issues within their communities. They are getting support from both the clinical and non-clinical teams’ perspectives to identify and implement tangible solutions to health challenges. At the same time, the students better understand the feasibility of their proposed public health interventions and develop a stronger ability to apply what they’ve learned in the future.
“At its core, we’re delivering care to real patients while working to help real communities,” said Dr. Swails. “The longstanding relationships we have with our community partners are built on trust and respect and are crucial to the program’s success. Our partners appreciate the tailored help they can receive through the program, and our students gain respect for the time and effort it takes to engage community partners adequately.”
McGovern Medical Schools is finishing up the ICARE pilot program, and they hope to expand to work with 700 students per year starting in the fall of 2022. Meanwhile, Dr. Swails and her team are beginning to assess the program’s impact and are interested in continuing to expand it across Texas. They hope to eventually create a general model that can be implemented in other regions.
“I think the pandemic has just further shown how important something like this is,” said Dr. Swails. “If we can create a model that is workable for others, we would love to disseminate it and make it a lot easier for people to implement this in their own communities.”