Adopting a New Model for Interprofessional Student Education in an Ambulatory Primary Care Site – a MSEDI project Presented by: Emily Herndon MD, FAAFP Assistant Professor, Director of Undergraduate Medical Education Dept. of Family & Preventive Medicine Osler Society Advisor Emory School of Medicine, Atlanta, GA Catherine W. Dragon, PA-C MMSc Director, Clinical Education Department of Family and Preventive Medicine Emory Physician Assistant Program

Disclosures Emily Herndon MD, FAAFP Catherine W. Dragon, PA-C MMSC Susanna Alfonso MD, MHCM, FAAFP Jonie Fawley PA-C, MPAS Julie Johnson MD, FAAFP Erin Lepp PA-C, MMSC Lissette Valdes PA-C, MMSC

Objectives

2012 The Society of Teachers in Family Medicine and The Physician Assistant Education Association presented a joint position statement supporting interprofessional collaboration. “We recommend that medical schools, PA programs, and family medicine residencies expand the use of interprofessional clinical sites for students and residents, where they will learn how to efficiently and effectively provide patient-centered, team-based care as members of future patient-centered medical homes.”

Response to Recommendation Since both STFM and PAEA have recognized the importance of interprofessional education, the FM and PA faculty at EUSOM have designed a new model of interprofessional clinical training during the required ambulatory primary care clerkship.

Why is This Important? Patient safety movement Governmental policies New healthcare model for primary care Interdisciplinary training to prepare students to be part of interdisciplinary healthcare teams

Why is This Important in Family Medicine? Drivers for Family Medicine include: Declining number of medical and PA students entering primary care Increasing demand for primary care providers Shortage of primary care clinical training sites

Current State at Emory EUSOM houses the MD, DPT, PA, AA & Medical Imaging programs EUSOM and the School of Nursing have collaborated to present interprofessional (IP) training twice/year. Case-based, simulated exercises MD & PA students will occasionally rotate together on inpatient teams

Current State at Emory In the past the IP training days were required by some programs and only encouraged (but not mandatory) for others No paid dedicated faculty for IP education (faculty volunteers only) No intentional collaboration between programs to have students from different health fields work together in a clinical setting

Emory Family Medicine at Dunwoody Primary Longitudinal Clinic for the Emory Family Medicine Residency

Preceptor: ‘What do you think is going on?’ Student: ‘It could be pneumonia.’ Preceptor: ‘Is there anything else to consider?’ Student: ‘I guess it could be bronchitis or heart failure.’ Preceptor: ‘Why did you rule those things out?’ Student: ‘The focal findings as well as the fever make those less likely to me, but we should probably do a chest X-ray to confirm the diagnosis.’ Preceptor: ‘Sounds like a good idea. What do you want to treat her with?’ Student: ‘I’m not sure. Maybe amoxicillin?’ Teach a general principle Reinforce what was done well Correct learner’s errors and make recommendations for improvement 1 Physician and 1 Student Cognitive Apprenticeship Model

Physician PA Resident Team of Multiple Learners Medical students and PA students Nursing Behavioral Health Lab Techs Team of Multiple Teachers

Study Methods Comparison of composite data of all medical students (Quantitative and Qualitative Data) pre-intervention Pre and post rotation survey of all student learners

Preliminary Results-Qualitative Data “The staff I was able to work with at the Dunwoody clinic were incredible” “It seemed like the entire clinic was dedicated to education” “The Dunwoody clinic has a FANTASTIC staff, full of people that obviously enjoy what the do and teaching students”

Preliminary Results of RIPLS - Quantitative Data The pre and post questionnaire demonstrated that the students maintained or increased their agreement with statements about the benefits with working on a interdisciplinary team (Q 1 – 9, ).

Preliminary Results of RIPLS - Quantitative Data Con’t Questions inquired about any negative attitudes towards training together. One student was positively changed by the training. 3 students maintained their selection that they disagreed with the negative aspects of interprofessional training.

Challenges Faculty and Staff Buy In Knowing the student learners and their level of knowledge Training staff to focus on patient care as well as active teaching Support from clinical administrators Abandon perceived hierarchies

Future Directions Structured didactic lectures by interdisciplinary faculty Measure changes in perception of faculty and residents Measure perceived or actual patient health outcomes Demonstrating this model to other clinical sites

Lasting Impressions

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