Implementing Clinical Interprofessional Education: A Planning Guide for Clinical Practices and Preceptors

IPE is not an end in itself but is one strategy to achieve the goals of (1) patient-centered care, (2) optimal care experiences for patients and their families, (3) patient safety, (4) improved quality of care, (5) enhanced health throughout the population, and (6) reduced costs of care. The value and success of interprofessional care is measured by how well it achieves these aims.

- US DHHS Advisory Committee on Training in Primary Care Medicine and Dentistry, 2013


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Interprofessional education at UNE: From classroom to point of care

UNE’s commitment to interprofessional education (IPE) began in 2000 with its interdisciplinary health and healing initiative (I2H2), developed in response to the growing understanding among health care leaders that high-quality health care is the result of effective teamwork across health professions. The UNE Interprofessional Education Collaborative (IPEC) was established in 2010 to provide all UNE health professions students with a foundational knowledge of IPE, and soon began to realize its vision of becoming a nationally recognized leader in campus-to-community interprofessional education, practice, and research.

By 2015, UNE’s IPE leaders and colleges of Osteopathic Medicine and Pharmacy had collaborated to establish two primary care-based IPE clinical partnerships. The UNE Center for Excellence in Health Innovation (CEHI) was created to expand UNE health professions student teams’ IPE in patient care settings, with particular emphasis on serving rural, vulnerable, and clinically complex populations.

CEHI’s evolving clinical IPE initiatives are expected to result not only in positive attitudes regarding collaborative patient care within student teams, but ultimately to impact health care’s Quadruple Aim of improving patient outcomes, reducing costs, improving patient experience of care, and improving the experience of providing care.

Clinical interprofessional partnerships

UNE currently trains student interprofessional teams within two Maine-based clinical IPE partnerships: the MaineGeneral Health Family Medicine Institute IPE Program and the Eastern Maine Medical Center Family Medicine IPE Program. Both partnerships feature shared medical/pharmacy care management activities, including team home visits for clinical complex patients that often include a staff social worker and/or registered nurse (RN). 

UNE has partnered with Penobscot Community Health Care to develop an osteopathic medicine/physician assistant/pharmacy IPE program with a dual focus on care management and population health competencies. UNE’s Clinical Interprofessional Curriculum (CIPC) has provided the foundation for this model, and will continue to serve as a resource and framework for IPE programs going forward. This ensures that student training is aligned with practices’ priorities in addressing Patient Centered Medical Home standards of comprehensive team-based care, as well as with HRSA Primary Care Training and Enhancement competencies in Interprofessional Education, Social Determinants of Health, Oral Health, Health Literacy, and Shared Decision Making.

Planning questions for your practice

As each clinical practice prepares to implement interprofessional student training activities, it should consider the following questions:

1. Which health professions should be included in our IPE care model?

  • Practices wishing to start by pairing medical and pharmacy students can benefit from several years’ lessons learned at the two established Maine IPE sites. However, your practice’s unique patient profile, staffing pattern, student capacity, and unique strengths and needs should shape your own IPE program.

2. How will implementing onsite IPE enhance the quality of care at our practice? 

 

  • This question can serve as the foundation for selection of your IPE care model. Relevant quality areas may include: Achieving/maintaining PCMH recognition related to team-based care, care management and population health; improving adult HEDIS, CAHPS and/or ACO metrics related to preventive care, control of chronic conditions, medication review and management and patient experience; and reducing high service utilization and related costs of care.

3. What current interprofessional processes and strengths does our practice have to build on? 

 

  • Examples may include local Community Care Teams (CCTs); multiple professions and/or interprofessional processes already on-site; existing and/or potential preceptorships with students of two or more health professions; and clinicians trained in IPE or IPE champions.

4. How can pre-visit team briefings and post-visit debriefings be built into our student teams’ IPE experience? Who will facilitate these discussions?

 

  • While visit briefings help student teams to align their role-based perspectives and objectives regarding an upcoming patient visit, debriefings help teams to “examine…the role of various providers in delivering services, gaps in available services, the involvement of clients, the level of collaboration between providers, systems issues, etc. Asking thought-provoking and critical questions about client care and team functioning becomes integral to the students’ learning.” (Deutschlander and Suter, 2011). These team discussions may be led either by clinical preceptors or medical educators.

5. What types of training might our preceptors need to serve as IPE facilitators? 

 

  • The Interprofessional Facilitation Scale can be used to gauge your practice’s level of expertise with facilitating interprofessional teams’ learning activities. (This tool and additional IPE facilitation resources are listed below under Key Elements of Successful Clinical IPE Models.)

6. How will our practice assess the impact of interprofessional care on students, the practice, and/or patients?

 

  • While UNE evaluates the impact of each of its clinical partners’ IPE activities on student knowledge of and attitudes toward team-based care, you may wish to measure the impact of IPE on practice-specific measures. 
  • For more information about IPE evaluation, please contact UNE Research Associate/IPE Evaluator Ruth Dufresne, SM at rdufresne@une.edu.

Key elements of successful clinical IPE models

Begin with personal/social interprofessional team building time. Facilitators and preceptors of IPE teams have found that teams benefit greatly from “get to know you” time prior to working together with patients. This time is important for developing psychological safety for all members of the IPE team and results in improved communication in clinical settings. Please see Orientation for Interprofessional Student Teams: Tips for IP Student Team Members for a list of suggested activities.

Provide TeamSTEPPS training for all team members. Ideally, all student team members, preceptors and facilitators should receive TeamSTEPPS training. This may be accomplished by completing the Orientation for Interprofessional Student Teams: TeamSTEPPS Group Activity. If in-person TeamSTEPPS training is preferred, this may be available via UNE — contact Ian Imbert, M.P.H. at iimbert@une.edu for information.

Clarify team roles, responsibilities and “ground rules." Utilize the Orientation for Interprofessional Student Teams: Tips for IP Student Team Members, and the resources listed below to guide this process critical for a high-functioning and effective team

Those interested in and/or assuming the role of facilitator or preceptor will find helpful knowledge and tools via the following resources:

Select and define an interprofessional care model and workflow. Selection of an IPE model and workflow should be based on the professions that will make up your student team, and your practice’s clinical priorities.
UNE’s clinical partners have most experience to date with pairing medical and pharmacy students for care management activities. This student pair, joined by a social worker, social work student and/or registered nurse, has been effective at three sites in addressing complex patient needs in both office and in-home settings. A medical/pharmacy/social work team can have an impact on key quality measures such as high or inappropriate ER utilization; admissions and readmissions; medication management; and chronic condition management measures such as BP, LDL and HbA1c. 
IPE workflow development should include well-defined processes for:

  • Patient identification
  • Chart review by all team members prior to visits
  • Pre-visit team briefing to set visit agenda and goals, and to establish roles (e.g., team leader)
  • Structuring visits, including any assessment or care planning tools used
  • Team debriefing and self-reflection, including reflection tools used
  • Patient follow-up, such as call back, home visit, or referral

​IPE models have also been developed outside UNE in areas such as geriatrics/functional status, chronic pain/substance use, oral-systemic health, and wound care. Such care teams might include physical therapy, occupational therapy, nursing, dental, dental hygiene and/or nutrition students in addition to medical, pharmacy and social work students. Additional IPE care models, workflows and resources are listed below:

Assess your clinical IPE activities. As your practice gains experience with IPE, a “Plan Do Study Act” approach can be used to improve your program based on evaluation data (qualitative and/or quantitative) as well as participant perceptions of IPE challenges and successes. Questions about assessing your IPE program can be directed to Ruth Dufresne, S.M. at rdufresne@une.edu. Several validated assessment tools are also available from the National Center for Interprofessional Practice and Education.