June 07, 2017
By Brian Whepley
Put a medical student, a social worker, a nurse and a speech pathologist to work on a problem and what do you get?
A well-rounded solution that applies a range of skills to a medical issue complicated by a mixture of social and systemic factors.
That's the intent of CLARION, an annual case-based team competition hosted by the University of Minnesota's Center for Health Interprofessional Programs. This year, taking part for the first time in several years, one of those teams came from KU School of Medicine-Wichita and Wichita State University.
The team consisted of Cliff Kissling, a soon-to-be fourth-year medical student from Wichita; Destinee Baucum, a nursing student; Karissa Marble-Flint, who recently earned her doctorate in speech-language pathology and is joining the WSU faculty; and Kelly Guzman, who received her master's in social work in May.
Their challenge - identical to one given to teams nationwide - was to tackle the problem of obesity in a rural area, concentrating on a Hispanic family with immigration issues and poor access to health care.
"We addressed the case by involving the local church, the schools and local government, and by adopting some changes in the local health care clinic," Kissling said.
CLARION's goals are to teach participants about leadership, interprofessional teamwork, communication, patient safety and quality, and patient-centered care.
At the competition April 8 in Minneapolis, the team did well with their 20-minute presentation and follow-up questions from three judges, Kissling said. They didn't place in the top three, but achieved the larger goal.
"Learning how to communicate with these other professions is huge," he said. "Just knowing how to share your concerns and appreciate their concerns is a skill that I developed, to ask, 'How is this team going to provide the best care for the patient?' We all have to understand that the other's role is important. It wasn't the real-world hospital, but it was close."
The four-member team came out of a group of about 20 students from across the medical school, KU School of Pharmacy and Wichita State. Before getting the actual case in late January, the group attended weekly sessions on teamwork and other skills that would help in the competition. Then the larger group was whittled down because of time commitments and the reality that just four could compete nationally.
Their focus was a family of four from fictional Hamilton. The father worked part time in the fields and part time at a canning company. The mother, because of immigration status, didn't work outside the home. The main characters were a 16-year-old girl and her younger brother, both born in the U.S. The team identified areas of focus for each member, based on training and experience.
"My part of our presentation was to create a patient-centered medical home, so that all aspects of their care went through one physician, enabling us to keep better track of obesity and diabetes and so on," Kissling said. "I called several organizations to talk about the intricacies. I also called farmworker organizations to help the patient understand how they can access services."
Baucum, the nursing student, performed a cost analysis and created an implementation plan. Guzman used her social work training to plan outreach through parish nurses and how to work with the local community college, which had English-as-a-second-language students.
Marble-Flint, the speech pathologist, brought her training and real-world experience as well, having taught summer school to migrant children with Head Start in Nebraska. "When we got the case and found out it was about a migrant family, I knew I had to be involved," she said.
"It was a really good experience in that I was kind of teaching other health professionals about this other side of speech pathology, which is the education side and working with kids in schools -being advocates for their language and literacy development," she said. "We also discussed what the school board could do to make policy changes related to childhood obesity."
"I am really fortunate that I had this opportunity because I can use these skills in the classroom in the near future," Marble-Flint said.
Debbi Lehner, a senior health services educator in WSU's College of Health Professions, oversaw the project but, by contest design, took a hands-off approach. "They could ask us questions and we could point them to information, but we couldn't coach." Or, as Kissling put it, "All of the professors really let us run with it. We learned more that way."
"Our team was the only one to come up with a patient-centered medical home," said Lehner, who watched presentations by four of the 14 teams from across the country. "Our team also proposed involvement with the church in the community, which was a positive that the judges commented on."
"I think it was an eye opener for them all. They have all been involved in other activities, but this was more intense and detailed and longer term than they've had before," Lehner said. "They will have this common experience and potentially the perspective that we are a health care team, that they can rely on each other. I really felt they got that."
"Working with Cliff, working with a medical student, it really kind of broke down barriers or a stereotype that I had about physicians," Marble-Flint said. "Cliff was so relatable and willing to answer my questions.
"All of the group members were open and willing to learn," Lehner said. "They were very well matched in their skill sets and talents."
"In medicine we try to get them to think about social impacts on health, but usually when a patient comes into the office, they think about the biomedical stuff," said K. James Kallail, associate dean of research at KU School of Medicine-Wichita. "Exposure to other professions during training enhances their thinking, so they will know enough to say, 'I need social work, I need PT, I need pharmacy,' and to go out and get their help."
"I don't expect a physician to be a social worker, a speech pathologist or a pharmacist. But they will recognize that they don't have the tools and will go to the people that do," said Kallail, who was the medical school's CLARION point person.
"I hope that the medical school and WSU keep participating in this, and hopefully we can get more people participating and have a local competition," Kissling said. "It was a great experience. I hope to help the CLARION team next year."KU School of Medicine-Wichita