A Model for Catalyzing Educational and Clinical Transformation in Primary Care: Outcomes From a Partnership Among Family Medicine, Internal Medicine, and Pediatrics

Enhancing team development in an internal medicine resident continuity clinic

Interprofessional teamwork is important for the provision of safe, high value patient care and is recognized as essential by the ACGME. We aimed to assess the impact of an interprofessional continuity clinic teamwork curriculum on perceptions of team development and patient safety. This project was conducted in an IM Resident Continuity Clinic where 96 residents, supported by 28 faculty and 48 interprofessional team members, attended continuity clinic two afternoons per week during alternating months of a 50/50 outpatient-inpatient training model. Teams were configured into two groups of residents, faculty and interprofessional team members. The randomly selected intervention group participated in strategically-timed TeamSTEPPS training. The control group received usual clinic education. Teamwork and safety climate were measured using the Team Development Measure (TDM) and Safety Attitudes Questionnaire (SAQ) collected before and after the intervention. Following the teamwork curriculum, team development improved in the intervention group as compared to control [mean change (95% CI) +13.9 (+9.3, +18.6) versus + 4.8 (+0.4, +9.1), p = 0.007]. Though 30% of the individual items on the SAQ improved significantly in the faculty intervention group as compared to control, the overall improvement in SAQ [intervention mean change + 0.4 (+0.2, +0.5), control mean change + 0.2 (-0.1, +0.5)] was not statistically significant (p = 0.36). It is feasible to implement a TeamSTEPPs-based interprofessional teamwork curriculum among IM residents in a block clinic model and achieve enhanced teamwork and safety attitudes. Additional assessment of clinical and educational outcomes is ongoing.

Interprofessional teamwork is the foundation of effective psychosocial work in organ transplantation

Interprofessional teamwork (IPT) is a well-established idea spanning multiple professional fields and supported by decades of literature. IPT is underemphasized in the medical literature despite its known impact on patient safety and care delivery. While many transplant teams adeptly work together, little has been written about team dynamics in organ transplantation and less on how IPT principles apply to transplant psychosocial clinicians. This editorial summarizes IPT principles, extrapolates key elements to psychosocial work in organ transplantation, flags potential barriers, collates practical strategies for teamwork enhancement, and identifies areas for future study.

Essentials of Ambulatory Care: An Interprofessional Workshop to Promote Core Skills and Values in Team-based Outpatient Care

Introduction

Team-based, interprofessional approaches to outpatient care are critical to high-quality patient care. However, few specific educational interventions promoting these skills in graduate level health care trainees have been described to date.

Methods

University of Minnesota faculty from the Schools of Medicine, Pharmacy, and Nursing created an interprofessional workshop experience exploring core concepts in outpatient care for graduate level trainees in pediatrics, family medicine, medicine-pediatrics, internal medicine, graduate-level nursing, and pharmacy. We focused on four key content areas: teamwork, systems thinking, the patient-centered health care home, and patient-centered communication. The workshop included brief didactics, role-plays, team-based experiences, and interactive skill practice. Participants completed an end-of-day survey reflecting on knowledge and attitude.

Results

From 2014-2017, nine workshops reached 305 trainees. Survey results from the 2015-2016 academic year are representative of our overall results and revealed that learners found the content high yield, and that they valued the opportunity to learn with their interprofessional colleagues. Improvements in perceived knowledge were noted in all domains. Trainees also reported increased skills, with 81% reporting both increased confidence in working within the interprofessional team, and change in attitude, and 90% reporting increased interest in working with their interprofessional colleagues after the workshop.

Discussion

Creating an opportunity for postgraduate level trainees from a variety of disciplines and professions to convene and focus on interprofessional team-based skills can fill a gap in interprofessional learning as they enter practice. Trainees were able to draw on their everyday experiences and find common ground with their interprofessional colleagues.