Opportunities for Interprofessional Education Among 3rd and 4th Year Medical

and Pharmacy Students in a Clinical Community-based Practice Learning

Environment

Iqbal Khan, Ph.D.*Kathryn R. Martin, Ph.D.*

Ray R. Maddox, Pharm.D.***Medical College of Georgia at Georgia

Regents University**University of Georgia College of

Pharmacy

SESSION OBJECTIVES

• Describe the regional clinical campuses of the Medical College of Georgia at GRU and College of Pharmacy at the University of Georgia.

• List core competencies for inter-professional collaborative practice.

• List and describe activities and techniques useful in providing IPE for 3rd and 4th year medical and pharmacy students at clinical regional campuses.

• Identify IPE activities for allied health students, particularly nurses, that can be included in those designed for medical and pharmacy students.

Learners will be able to:

Resources for Regional Clinical Campuses

Iqbal Kahn, Ph.D.Assistant Dean, Medical College of Georgia

Georgia Regents University

A. Establishing a Clinical Campus

> Workforce predictions have influenced the expansion of Medical Schools throughout the history of US Medical Education.

> In the 60’s and 70’s federal policies and subsidies were available for the expansion of medical school growth.

> No such subsidies are available under current economic conditions.

INTERPROFESSIONAL EDUCATION

A. Establishing Clinical Campus

> Academic Institutions have provided the funds needed OR found creative ideas to increase class size.

> In 2003, American Association of Medical Colleges ( AAMC) , predicted a nationwide shortage of physicians by 2020.

> A similar shortage was predicted by American Association of Colleges of Pharmacy (AACP).

> The nursing profession has always seen shortage of RNs. RN prediction is in line with Physicians and Pharmacists.

INTERPROFESSIONAL EDUCATION

A. Establishing Clinical Campuses

> Medical College of Georgia, established in 1823, the 13 th oldest medical school in the country, increased its class size from 190 to 230 in 2010, totaling 920 students . Main campus is in Augusta, a partnership campus in Athens. 3 clinical campuses: Albany, Savannah and Rome

> UGA College of Pharmacy, established, in 1903 has a class of 145 students. Main campus is in Athens; clinical campuses are in Augusta. Albany and Savannah.

> College of Nursing in Augusta is 80 years old has 909 students with a campus in Athens.

1903 Flag ship

1828 Flag ship

INTERPROFESSIONAL EDUCATION

B. What is a Clinical Campus:

A clinical campus is a partnership established between an Academic Institution and a Community based

Hospital where third and fourth year Medical and Pharm. D students receive their clinical training.

Southeast Georgia Clinical CampusSt. Joseph’s/Candler Health

System, Savannah

Northwest Georgia Clinical Campus

INTERPROFESSIONAL EDUCATION

C. Challenges and Opportunities:

Partnering with a community hospital is like finding a spouse.

> Mutual Respect ( goes a long way)

> Mutual benefits ( win-win situation)

> Mutual investment (my money is mine, your money is mine, too)

> Academic Institution benefits from EXCELLENT clinical training.

> Community Hospitals benefits by being affiliated with an academic institution

> Students benefit by having intensive, hands on training

> Community benefits by generating new blood to come set up their practices in the community.

INTER-PROFESSIONAL EDUCATION

C. Challenges and Opportunities:

> Having 3rd and 4th year MD students, Pharm. D. students

and Nursing students under one roof, without doubt, will create an environment of mutual respect.

> Better understanding of each others knowledge and skills.

> Creating an environment of learning together

> Great opportunities to LEARN, TEACH and LIVE together.

IN MY OPINION IT CREATES AN AWARD WINNING OPPORTUNITY FOR EVERY ONE INVOLVED.

INTER-PROFESSIONAL EDUCATION

Core Competencies For Interprofessional Collaborative Practice

Kathryn R. Martin, Ph.D.Associate Dean, Medical College of Georgia

Georgia Regents University

ACCREDITATION STANDARDS

• The Liaison Committee on Medical Education (LCME) standard:

• “The faculty of a medical school ensure that the core curriculum of the medical education program prepares medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients.”

• The American College of Pharmacy Education (ACPE) standard:

• “The curriculum must prepare all students to provide entry level patient-centered care in a variety of practice settings as a contributing member of an inter-professional team. In the aggregate, team exposure must include prescribers, as well as other health professionals.”

JUSTIFICATION OF STANDARDS

• ~ 10,000 prescription medications

• ~ 1/3 of adults in US take 5 or more prescription drugs

• Harm experienced by patients as a result of exposure to a medication constitutes adverse drug effects (ADEs):

• ~700,000 ED visits per year

• ~100,000 hospitalizations per year

• ~Affects 5% of hospitalized patients

• One of the most common causes of patient errors

• -- Agency for Healthcare Research and Quality (psnet.ahrq.gov)

ACADEMIC IPE COLLABORATIVE EXERCISE BETWEEN MEDICAL AND PHARMACY STUDENTS

• Teams of M3 and P3 students

• ~6-8 students per group

• Teams randomly assigned, based on geographical campus location

• Teams can meet:

• In person (preferred)

• Google Hangout/Facetime

• By phone

IPE EXERCISE, FROM THE M3 STUDENTS

• M3 students select one current patient record – patient must be taking at least 3 prescription drugs

• M3 students succinctly present patient to P3 students.

• Presentation must include:

• Pertinent history

• Physical examination upon admission

• Test results

• Diagnosis

• Routine and PRN prescriptions

IPE EXERCISE -- PHARMACY STUDENTS

• Discuss drug mechanism of action, metabolism and excretion of each prescription

• Assess the appropriateness of current prescriptions on the basis of health condition, individuals and therapeutic goals of each prescription

• Determine if there are better Rx options

• Evaluate the effectiveness, safety and affordability of each Rx

• Provide evidence that the prescriptions reduce morbidity and/or mortality

• Provide costs of each prescription and determine if a less expensive option is available

IPE EXERCISE: M3 AND P3 STUDENTS TOGETHER…

• List the most common and life threatening side effects of each Rx

• Assess prescription-taking behaviors and compliance with each prescription

• Identify medication-related problems and evaluation the need for intervention

• Evaluate prescriptions for interactions with each other or other commons prescriptions

• Identify any pharmacogenetic considerations

• Identify two additional knowledge gaps relevant to the patient

• Identify, analyze, and synthesize information relative to knowledge gaps

• Evaluate credibility of information

• Describe approach to gathering the information

• Provide feedback to each other on the process of gathering information

IPE EXERCISE TIMELINE…

• January-February: Submit 1 exercise

• March-April: Submit 1 exercise

• August-October 15: Submit 1 exercise

• October 16-December: Submit 1 exercise

Activities and Techniques Useful for IPE

Ray R. Maddox, Pharm.D.Assistant Dean, College of Pharmacy

University of Georgia

INTERPROFESSIONAL EDUCATION

“Occasions when students from two or more professions learn with, from and about each other to improve collaboration and the quality of care.”

Learning with, from and about each other in any context is a professional socialization process

Freeth et al. Effective inter-professional education: development, delivery, and evaluation. Blackwell Publishing. Oxford, UK, 2005.

Regional clinical campuses present a unique opportunity for the

development of inter-professional education. These campuses

are the best example of “real world” practice settings for all

students.

• Research

• Social

• Didactic

• Clinical

• Service activities

IPE LEARNING ACTIVITIES FOR GRU & UGA STUDENTS

DIDACTIC ACTIVITIES

• Didactic/small group education on timely drug therapy topics

• M-3/P-3 drug therapy exercise

• Joint quarterly medical grand rounds

• Joint quarterly journal club

CLINICAL ACTIVITIES

• Co-precepting at the bedside and in the ambulatory care/community settings

• Patient care training where students work alongside one another to provide timely state of the art care in both inpatient and outpatient settings

SERVICE ACTIVITIES

• Community outreach – programs where students address specific needs within the community:

• MedBank

• St. Mary’s Community Center

• Good Samaritan Clinic

• Brown Bag Clinics

RESEARCH-RELATED ACTIVITIES

• Some students have interest in participating in clinical research

• Significant opportunity with clinical faculty for involvement

• Pharmacy encourages student participation

• Professional meetings with forums for presentation of student research

• Pharmacy/medical student research collaboration is valuable

SOCIAL ACTIVITIES

• Socialization of disciplines through use of shared leisure and classroom space

• Integration of disciplines to foster a team approach to delivery of healthcare

• Early curricular integration of teaching activities

FOSTERING IPE AMONG ALL HEALTHCARE DISCIPLINES

• Colleges of Medicine, Pharmacy, Dentistry and Nursing have initiated development of various IPE programs at the State level.

• Initiatives in SE Georgia can be done with programs at Armstrong State and Georgia Southern Universities.

• Other regional campuses can follow suit.

SUMMARY

• IPE in Georgia’s state-funded health discipline schools can enhance the care of its citizens.

• Young practitioners can collaborate and use their professional expertise and knowledge to the benefit of each other.

• Regional campuses provide a unique environment for this type of clinical education.