July 2019 | Richard Malone, PharmD & MHA | Contributing Editor: Denise Klinker, PharmD & MBA
While recently perusing the pharmacy literature, I ran across an interesting commentary on the interprofessional education (IPE) movement in pharmacy training. Before I could finish reading the first introductory paragraph, my mind quickly wandered back to my days as a pharmacy student and resident. I landed in early 1994 in Eastern Tennessee, where one of my most memorable clinical rotations in the fourth year of my Pharm.D. curriculum occurred. I was assigned an Infectious Diseases APPE with an adjunct College of Pharmacy faculty member at my school’s primary teaching hospital. It was a very desirable opportunity with only a few openings for students each year, and I was excited to start the rotation.
Per the usual drill, I met my preceptor on the first day of the rotation and went over the plan for the month. I was surprised to see, included in the plan, daily interactions with an infectious diseases (ID) physician in addition to the typical regular meetings and topic discussions with my clinical pharmacist preceptor. My preceptor told me there was no better way to learn about ID than seeing patients first hand, hearing their histories, and working together as a team to develop the patient’s care plan. I understood that logic, but I’ll admit I was a tad anxious about rounding one-on-one with a well-known and extremely busy infectious diseases (ID) physician whom I’ll call Dr. I.
Dr. I was intense and extremely knowledgeable, but very friendly. She outlined specific expectations of me on Day 1 of the experience. I was intimidated enough to arrive early, stay late, and attempt to make myself of some value to her over the coming days. In short order, Dr. I had managed to convert my feelings of inferiority and fear into a new understanding of how my skillsets of pharmacotherapy and pharmacokinetics complemented hers. Together, she was more efficient than she would have been alone despite taking time to teach me ID pearls along the way. I learned invaluable lessons, as well as a new mindset toward working with physicians and others on the team, understanding their perspectives related to approaching treatment regimens to appreciate the sacrifices that physicians make before and beyond getting that “MD” after their names. Dr. I might have even learned a few things from me.
Fast forward 25 years and imagine my surprise that IPE in pharmacy education is still considered a movement. The movement started for me in 1994, and I’ve sought opportunities to collaborate with as well as learn from professionals from other disciplines ever since. In my opinion, IPE is a necessity to grow effective healthcare practitioners. Despite making measurable progress, IPE is not consistently incorporated into the pharmacy curriculum across the country.
What is IPE?
There are many descriptions of IPE floating about, but I prefer the definition put out by the World Health Organization (WHO) in 2010 with a slight modification… I would replace “students” with “students and/or practitioners.”
“When students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”
Regardless of definition, the focus of IPE is clear and logical. IPE is a collaborative effort to educate healthcare providers in an interdisciplinary and collaborative manner that produces improved patient outcomes. There is no better place than clinical learning environments to provide opportunities for pharmacy students to learn with and from other health science students and practitioners.
The IPE Accreditation Mandate
The “Guidance for Standards 2016” document released by the Accreditation Council for Pharmacy Education (ACPE) in 2015 accelerated the integration of IPE into both introductory pharmacy practice experiences (IPPE’S) and advanced pharmacy practice experiences (APPE’s). In addition to an entire standard (Standard 11) dedicated to IPE, the concept is mentioned multiple other times throughout the document. Key elements within the standard include interprofessional team dynamics, education, and practice. ACPE also provides methods for achieving effective IPE in its guidance document including partnering with external institutions and healthcare facilities, the use of non-pharmacist preceptors, new technology to facilitate IPE, and simulation exercises in the absence of “real world” scenarios.
Given that background, let’s take a quick look at how IPE is carried out in practice. A 2017 report from an AACP taskforce described the various types of IPE activities seen on pharmacy student experiential rotations. As shown in the graphic below, the long-standing tradition of rounding with patient care teams unsurprisingly ranks near the top of the chart. Although a potential source of IPE, the educational value of rounding can be extremely variable depending on roles and format. Most interestingly, activities that did not meet the criteria for IPE led the pack in this particular survey, indicating respondents may not have a clear understanding of the components of an effective IPE activity.
More immersive and robust opportunities can be created when intentional efforts are put towards creating an optimal interprofessional clinical learning environment at experiential sites. The National Collaborative for Improving the Clinical Learning Environment (NCICLE) recently published proceedings from an NCICLE symposium where this very topic was discussed and described the value of optimizing and the characteristics of Interprofessional Clinical Learning Environments (IP-CLEs) as well as the roles of leadership and other stakeholders.
The National Center for Interprofessional Practice and Education also provides tools for educators and providers to create “a deeply connected, integrated, learning system to transform education and care together.” One of those tools is the Interprofessional Collaborative Organizational Map and Preparedness Assessment (IP- COMPASS). The tool is “a framework to help clinical settings become better prepared to provide intentional interprofessional learning experiences.” The tool focuses on institutional settings and provides step-by-step instructions on how to develop optimal interprofessional clinical learning experiences.
Ensuring and Documenting IPE Activities and Competencies
While creating effective IPE experiences hinges on the aforementioned efforts, equally important is a set of well-defined learning objectives and competencies specifically defining purpose and measures of success. The Interprofessional Education Collaborative published an update on the Core Competencies for Interprofessional Collaborative Practice in 2016. The IPEC document describes four core competencies and more detailed sub-competencies often used in student formative and summative assessments:
- Work with individuals of other professions to maintain a climate of mutual respect and shared values. (Values/Ethics for Interprofessional Practice)
- Use the knowledge of one’s role and those of other professions to assess and address the health care needs of patients appropriately and to promote and advance the health of populations. (Roles/Responsibilities)
- Communicate with patients, families, communities, and professionals in health and other fields responsively and responsibly that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease. (Interprofessional Communication)
- Apply relationship-building values and the principles of team dynamics to perform in different team roles effectively. Planning, delivering and evaluating patient/population-centered care, population health programs, and policies that are safe, timely, efficient, effective, and equitable. (Teams and Teamwork)
The IPEC competencies are supported by several national organizations, including those in the Health Accreditors Collaborative (HPAC).
Ongoing assessment is key to both an individual student’s success and continuously growing and improving an IPE program. Individual students need feedback regularly. Just as I tell my employees, an annual performance appraisal should contain no surprises if I’ve done my job as a manager, a student’s midpoint evaluation and final grade should not be a shocking revelation when received. Preceptors must make it a priority to provide continuous feedback to students. Utilizing tools that direct both the key points evaluated and the interval at which feedback occurs can be extremely helpful as time slips away quickly.
Best practice includes the use of an integrated software solution for documenting and reporting IPE activities. PharmAcademic™ developed and marketed by the McCreadie Group, Inc. is one such solution. PharmAcademic™ automates college of pharmacy and residency program management and enables students, preceptors, and administrators to review elements of performance with ease. The software captures assessments from preceptors and students, documents performance, and provides robust reporting capabilities for administrators. In short, PharmAcademic™ puts the data needed to evaluate the performance of an IPE program from individual students to the curriculum overall at your fingertips.
Creating an effective IPE program involves much more than placing students and professionals from multiple disciplines in close proximity and hoping fruitful interactions spontaneously erupt. In addition to creating a culture for learning across disciplines, an effective IPE program must include intentional interactions with predefined goals and objectives, measurable competencies, a solid method for tracking progress, and a reporting mechanism capable of supporting continuous monitoring for areas of improvement.