Transforming clinical education and preparing health professionals
to work in and lead patient-centered interprofessional teams
The ALL SITE CALL will be held on March 20th at Noon ET. Please be prepared to reflect and share the state of your overall program and what you have learned.
The visit started off with an opportunity to observe the VA EdPACT huddle including staff and learners. This early daily gathering helps ensure that all team members are talking throughout the day, anticipating patient needs and assessing and adjusting resources to match those needs to improve patient access and clinic flow. San Francisco clinic flow is also improved by evening and Saturday hours.
When discussion revolved around the benefits of diverse interprofessional interactions one physician learner remarked that he found that many "stereotypes around nursing and medicine to be untrue"…he went on to state "everyone is generous in sharing knowledge and that makes for a better patient experience and outcome." Learners in the EdPACT often experience the value of a "warm handoff" in which they provide care and directly refer and introduce the patient to one of the other interprofessional team members. When asked by site visitors about their experiences learners reflected on rotations outside of the VA system and reported that the experience in EdPACT was more intensive and valuable as they have an opportunity to practice in a very different way than (“envious”) peers outside of the program.
The learners reported that having the opportunity to have their own patient panel elevates the training experiences to a different level. These health professionals expressed sharing a satisfying sense of accountability for their patients. One learner remarked that though they (the learners) have a preceptor to guide and support them, that it was obvious that the learning team members felt a deep sense of responsibility very much like they might experience upon completing their training programs and working independently. Several trainees in the room agreed and one of the EdPACT faculty commented on her sense of feeling unprepared in her early career, going on to share that she would have appreciated and benefitted from similar learning opportunities. Several of the learners agreed that the EdPACT was an important opportunity to learn about each other and build the relationships necessary to come to trust one another with their patients. It was also relayed that during their time together in the EdPACT that they learned about the unique value and knowledge base of other disciplines and the potential impact on patient care.
One trainee reported that the EdPACT’s regularly scheduled Collaborative Case Conference was a great way to understand how other professions care for their patients. The Learning Visit team observed this interactive live videoconference in San Francisco VAMC as the San Bruno CBOC team members led the discussion. This learning opportunity not only keeps the more remote outpatient clinic engaged with their San Francisco center, it eliminates some of the geographical challenges around training and patient care and helps the participants gain interprofessional practice experience in primary care through a broad base of expertise using role modeling and cross discipline discussion.
The end of the visit included the EdPACT Advancement Forum. This well-attended forum included an impressive number of VA executive leadership and other champions from the San Francisco VAMC and Academic leaders from the University of California at San Francisco. Malcolm Cox welcomed attendees and kicked of the forum with a reflection, proposing to the group that the deficiency in healthcare in the United States is not medical knowledge, but is more based around the challenges in working with other people. He went on to say that interprofessional education must be institutionalized and to realize the benefits of culture change and the associated transformation would require joining the academic and practice community. Cox believes that this is not an unachievable concept. He admitted that we (VA) don't know how to do this yet, and though we have a good start with the Centers of Excellence in Primary Care Education, we will gain incredible experience through partnerships, hard work and insight…and we will be able to do it better. Harry Hollander of UCSF commented that UCSF is already seeing the benefits of the partnership with EdPACT in that residents are coming back to the program and are involved in educational conferences and advancement discussions at the university and that by virtue of working in these interprofessional teams that the residents are way ahead of their colleagues, “raising the bar for the entire program.”
Cox then went on to praise the efforts of the EdPACT and their leadership and affiliates and said that "the future of healthcare delivery is team based and they only way to achieve an efficient healthcare system is by working together – so you are doing something very, very important."