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Medical Schools Push Teamwork

Would-be doctors, nurses, and other health professionals increasingly study together.

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An EMT crew wheels an elderly patient with a fractured hip into the ER, where she's greeted by a nurse and a doctor who say she'll need surgery. Then it's off to meet the X-ray technician, the surgeon, surgical residents, and the floor nurses, who will change when a new shift starts at 8 p.m. Next up: the operating room team, the cardiologist, the radiologist, the anesthesiologist, and the phlebotomist. Then it's on to recovery—and more doctors, nurses, and occupational therapists.

All told, a patient like this woman could easily encounter more than 80 healthcare professionals, says Peter Boling, director of geriatric medicine and a professor at Virginia Commonwealth University in Richmond. They might be working as a well-oiled team, or they might be barely cooperating.

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At VCU and a growing number of medical schools, the push is on to ensure true collaboration. Interprofessional education, which integrates medical students' training with that of nurses and other health professionals, has been tried here and there since the 1960s. But acceptance has come slowly, given the need to redesign curricula and coordinate several schools' students and faculty, and a lack of proof that the strategy improves care.

The pace may pick up, however, as the health system lasers in on ways to contain costs. The promise of teamwork, experts say, is more comprehensive care, shorter hospital stays, and fewer errors and unnecessary procedures.

"Change will be forced on our profession," predicts George Thibault, president of the Josiah Macy Jr. Foundation, which devotes nearly 40 percent of its $4 million to $5 million in yearly grants to interprofessional education.

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In 2011, VCU's assistant dean for medical education received a two-year award of $200,000 from the foundation to meld studies across all five health schools: medicine, nursing, pharmacy, dentistry, and the allied health professions such as nurse anesthesia and physical therapy. New coursework will include lessons about what each professional is (and is not) trained to do, and classes in which hundreds of students from the different disciplines will meet at the beginning and end of the course and do the majority of the work online or outside of class in small teams.

In a one-day simulation workshop already up and running, a high-tech mannequin patient suddenly goes into cardiac arrest and stops breathing. Six medical, nursing, and pharmacy students must work together to diagnose and treat the patient.

"Not only was I teaching my knowledge on medication, I was also learning a lot about diagnosis and tests," says pharmacy resident Lindsey Wasco, who needed a teammate's help to decode the EKG monitor but, when standard medications didn't work, was the one everybody turned to for a next step.

Elsewhere, institutions from Weill Cornell Medical College and Vanderbilt University's School of Medicine to the University of Minnesota Medical School offer or now are working toward interprofessional education. The University of Colorado's Anschultz Medical Campus in Aurora brings students from five health professional schools together in one place. The University of South Florida's College of Medicine has just opened a three-story advanced medical learning center aimed at "simulating the team model that occurs in clinical practice."

At the Yale University School of Medicine, where the medical curriculum is being redesigned, interprofessional teams already have begun to make rounds together in the nursery. The goal, says Yale Associate Professor of Pediatrics Eve Colson, is medicine's version of a well-trained flight crew.

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