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No 'I' in Health Care

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Dr. Sanjay Mehra, a Vidant cardiology physician, prepares to insert a catheter in a central vein of a mannequin in the Simulation Center. Mehra is assisted by Dr. Laura Gantt, executive director of the ECU College of Nursing’s Concepts Integration Labs. (Photography by Cliff Hollis)


NO 'I' IN HEALTH CARE

ECU adopts team approach to health sciences education


By Crystal Baity
ECU News Services


As a public health nurse in Beaufort County, Carol Rose ’12 is one of several providers caring for women with breast and cervical cancer.

“You realize that you have to be teammates with these other professions,” she said.

Dr. Elizabeth Baxley hears many stories like that. “In essence we’ve been training them in silos and expecting the day that they walked across the stage to get their diploma they would magically know how to work together and understand each other’s role and provide safe and satisfying care to all patients,” says Baxley, senior associate dean for academic affairs and professor of family medicine in the Brody School of Medicine.

A number of recent studies have shown that effective communication among various health care providers help reduce preventable medical errors. Across the nation, accrediting bodies for health sciences disciplines are encouraging interprofessional education in the curriculum. Effective teamwork helps reduce mistakes caused by miscommunication and clears up misunderstandings of roles or responsibilities in caring for patients.

“The quality and safety of patient care really depends on strong teams of providers who value each other and who look out for each other,” says Dr. Phyllis Horns, vice chancellor of health sciences. “It creates an environment that is very patient-centered and addresses it in a cultural and sensitive way.”

At ECU’s new chapter of the Institute for Healthcare Improvement Open School, students examine how their role in the health care team could make a difference to a patient, develop leadership skills and take a broad look at health care systems, says Baxley.

"It's important to know your team and what they're capable of as fast-paced as our world is in the emergency room," says Michael Morris, an emergency department nurse at Vidant Medical Center who recently practiced in the lab with a resident physician to insert a central venous line in a mannequin torso.

Ian Bryan, a second-year medical student from Greenville, says learning together while still in school creates balance and a smooth transition to the workplace.
"The more we work together, the easier it gets and the better it is for patients," Bryan says. "It streamlines things."
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Vidant Medical Center Emergency Department Nurse Michael Morris and Dr. Cache Reed, a resident medical psychiatry physician, check the placement of a central venous linein the Brody School of Medicine's Clinical Simulation Center.

Changing the system

Historically, universities have compartmentalized health profession students: nurses in nursing schools, physicians in medical schools, pharmacists in pharmacy schools, and social workers in schools of social work.

Liz Bates, who earned a master’s degree in communication sciences and disorders in May, saw collaborative care in her clinical placements.

“When health care providers are communicating with each other, it makes assessments and treatment plans much easier to implement, and providers are able to deliver treatment more quickly,” Bates says.

Dr. Joan Wynn, chief quality officer for Vidant Health in Greenville, says the future of primary care isn’t a lone practitioner but team-based providers. “Studies show that training in teams is an effective strategy to prevent poor outcomes,” Wynn says. “We know interprofessional education improves patient safety and the quality of care.”

Several studies from the Institute of Medicine, Institute for Healthcare Improvement and other health care agencies have shown that effective communication and teamwork help reduce preventable medical errors.

“Interdisciplinary means they (the patients) are receiving the benefit of each discipline and the special element that discipline brings,” said Wynn, an ECU alumna and adjunct faculty member in the ECU College of Nursing.

At Vidant, one example of this team-based approach occurs in “multidisciplinary rounding,” where patients are cared for by a multi-specialty team that includes a case manager, nutritionist, nurse, physician and physical therapist among others. Rehabilitation and physical medicine adopted a multidisciplinary care approach many years ago.

Teamwork also promotes a more rewarding work environment, Wynn says. “Each discipline sees they are making a difference, which is why most people go into health care,” she said.

‘A top goal of the division’

One place that students, residents, physician faculty and staff regularly practice team-based care is in the Brody School of Medicine’s Clinical Simulation Center, a safe zone where mannequin ‘patients’ are diagnosed and treated and clinical skills are sharpened.

“The idea is to pre-train people before they get to the bedside,” says Dr. Walter “Skip” Robey, director of the clinical simulation program and assistant dean for simulation and safety education. “It’s not fair to place them in an environment that’s high risk so we do it here and assess their performance before they move to the next step.”

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When health sciences professionals collaborate to treat patients, both the health sciences students and the patients they treat benefit from the interdisciplinary approach.

“Maintaining the lines of communication is half the battle,” Robey said. “Knowing what your colleagues’ duties and expertise are—it’s not always evident.”

The Joint Commission on Accreditation for Healthcare Organizations, the Institute of Medicine and others have embraced it.

“That gives us an extra kick to do this,” Horns says. “It’s a top goal of the division.”

ECU’s School of Dental Medicine is already recognized for creating new ways of educating students through the development of community service learning centers, where fourth-year dental students will live and practice in rural North Carolina communities. “We are excited about exploring possibilities to participate in an integrated care practice model, creating a unique opportunity for other learners to be at the same site,” says Dr. Geralyn Crain, assistant dean for educational support and faculty development in dental medicine.

“We are one point of entry into the health-care delivery system,” Crain says. “We do not treat diabetes or other systemic disease, but we do have to recognize it and treat our patients who have these conditions. When our patients come in, they’re not just a mouth, they’re a whole person.”


Changes are coming. ECU will implement a new comprehensive core curriculum in patient safety and clinical quality improvement for all medical students as part of a $1 million grant from the American Medical Association.

The Brody School of Medicine was one of 11 schools in the nation selected in June to change the way it educates students while keeping its focus on rural and underserved populations. The school will work with Vidant and ECU’s health-related disciplines to foster interprofessional skills and prepare students to lead health care teams as part of the transformation, Baxley says.

A natural fit for rural care

Interprofessional practice isn’t a new concept at ECU, with its focus on providing health care to rural and underserved populations.

More than 20 years ago, the Brody School of Medicine’s Dr. Doyle “Skip” Cummings and Dr. Maria Clay received a rural-health training program grant that took students from a variety of health-related majors to work with faculty in eastern North Carolina communities. Students lived in Eastern Area Health Education Center (AHEC) housing and worked within their own discipline. One day a week, the students would work together, visiting patients in homes, touring the community or providing care.

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A student preps a needle to use in a procedure. Mastering complex skills through repetition in a nonthreatening environment is a key benefit to simulation education.
The program continued for 14 years until faculty, anticipating federal funding cuts, converted it to distance-education courses to preserve the program. It was a natural fit with telemedicine already proving to be a valuable resource for health care providers. “We felt strongly that interdisciplinary education marries with rural health,” says Clay, chair of the bioethics and interdisciplinary studies department and director of clinical skills assessment and education.

Today, an “Introduction to Rural Health Care Teams” course enrolls about 100 students per semester, mainly freshmen and sophomores from across campus who plan to major in a health career. An upper-level course “Designing Rural Health Care” challenges students to design a fictional health system for a rural eastern North Carolina county based on demographic data.

Another graduate-level course, “Clinical Consulting Teams” focuses on preventative health and potential interventions based on community needs.

Integration of medicine, psychology, nursing and allied health professions are essential in treating patients, and why ECU is an exceptional place for the future, says Dr. Sam Sears. A professor of psychology and cardiovascular sciences, he recently won the O. Max Gardner Award—the highest UNC-system honor given annually to a faculty member who makes the greatest contribution to the welfare of the human race.

“This is a place that can respond to modern challenges,” says Sears. “This is not a stodgy medical school or stodgy campus. This is a place that says what are the new challenges and how can we address them. How can we come up with novel solutions to address novel problems? That’s academia. Industry can’t do it the way academia can.”



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