Interprofessional training provides medical education for the real world
October 03, 2016
By Brian Whepley
A little after 9 a.m., the dry-erase board is empty, but will soon be filled with the names of patients, their symptoms and the students assigned to see and treat them at JayDoc Community Clinic.
Max Jolly, a third-year student at KU School of Medicine-Wichita, is director for the day at the student-run clinic supplying needed care to people, often working but poor, who otherwise might not get it. Each Saturday, medical students and other volunteers at JayDoc, operating at Guadalupe Clinic, 940 S. St. Francis, will see about eight to 10 patients.
Jolly kicks off introductions of the day's volunteers. Dr. Michael Kalkhoff, a family medicine resident from Via Christi is the attending physician. First-year medical student Michael Oakes will work with more experienced medical students Wade Billings, Kelly Zachariasen, and Alex Johnson.
Next up are the most recent additions to the JayDoc team - pharmacy faculty and students. Ashley Crowl, a clinical assistant professor with KU School of Pharmacy-Wichita, is preceptor for the day. Third-year pharmacy students Carli Christian, Mary Stevens, and Binh Vo will consult with Crowl and visit patients alongside the medical students.
The pharmacy school's involvement at JayDoc began last fall and is just one of several ways the 80-student pharmacy campus and KU School of Medicine-Wichita are working together to prepare students for a health care system increasingly focused on teamwork and interprofessional education.
"Medicine is now using a team-based approach," said Rick Kellerman, chair of the Department of Family and Community Medicine at KU School of Medicine-Wichita. "It's the doctor, the pharmacist, the physical therapist working together, communicating for improved outcomes. If we get students together early in this training, that's going to help in the long run."
"For medical students and pharmacy students, it creates a longer and more lasting collaboration so when they start residencies or professional careers, they will reach out to members of other professions," Crowl said. "We need to work together to optimize patient care."
Cost and suitability of drugs are issues that make pharmacy students particularly helpful at JayDoc, said Missy Norton, a third-year pharmacy student.
"To step in and say, 'This medication has this side effect and might not be right for this patient.' And especially at Guadalupe, where cost is a big concern, helping find a good medication for the patient's problem at a low cost. That's where we can use a lot of our drug resources and references, along with everything we've learned in pharmacy school," Norton said.
Pharmacy students and faculty are there to answer questions about medications and to educate patients about new medications, Crowl explained. "If they have a new medication device like a glucose meter or inhaler, we can educate them on how to use it."
"JayDoc is the real world. It's just run by student physicians and student pharmacists," Norton said. "It's easier to remember certain contraindications or adverse reactions when you experience it firsthand with the patient."
Down at the family medicine clinics
"If you go into a major hospital, you often have clinical pharmacists on the rounding team. They are part of the team and are there to counsel," said Robert Emerson, associate dean for the KU School of Pharmacy-Wichita. "By having our faculty working in the family medicine clinics, we achieve a similar approach and expertise."
Residents from the KU School of Medicine-Wichita family medicine program staff the clinics - which are run in partnership with Wesley and Via Christi hospitals. Pharmacy faculty members have been stationed there - as have fourth-year pharmacy students - since 2014.
"Some of the training benefit is getting exposure and comfort with each other, understanding what they do and what we do," says Matt Kostoff, clinical assistant professor. "The big thing is having a greater respect for each other's roles. When they are out practicing on their own, they will have that understanding. They won't be afraid to initiate those conversations. The more they can see early on it's really going to help. It can be eye-opening."
Kostoff and fellow faculty members Crowl and Tiffany Shin, who serve at the Via Christi clinics, share their expertise with more than pharmacy students.
"I give a monthly lecture to residents on various topics," said Kostoff. "I have students lead the case-based discussions. As a faculty member, I'm always looking for opportunities to teach the students and residents."
"The attending physicians also utilize pharmacy faculty as a source of expert drug knowledge," Emerson said. "The physicians have patients on numerous medications, and the pharmacist on site can do medication reviews and make recommendations. It's a huge benefit not only to the physicians and residents but also to the patients."
The relationships and familiarity developed at the family medicine clinics pay off at JayDoc.
"When the residents are there, they know how pharmacy can fit in," Shin said.
Learning together in a number of ways
Clinical encounters are a valuable part of the collaboration, but they are just one.
For several years, pharmacy students have given flu shots during Operation Immunization each October at Guadalupe Clinic and other locations, while medical students have performed health screenings, including measuring blood pressure and glucose levels.
Another example is TeamSTEPPS, a developing program that seeks to reduce errors by instilling teamwork and communication skills in health professions. Medical students, pharmacy students and ones from nursing, social work, physical therapy and other fields participate in events that range from learning basic teamwork skills to more advanced training involving simulation equipment and standardized patients.
"When we opened the pharmacy campus here, we wanted to ensure that we were integrating our faculty with the medical community, that we were developing interprofessional relationships," Emerson said. "It's the right thing to do. It's the way that health care and pharmacy practice needs to go. We cannot work in silos."
Emerson found a receptive audience at KU School of Medicine-Wichita, as well as at Wichita State University's College of Health Professions. With many different programs, campuses and accrediting bodies involved, it's challenging to align curricula and events. But Emerson said having many partners dedicated to interprofessional education has made it work, whether in a clinic or a classroom.
Pharmacy students are taking part in the medical school's problem-based learning sessions, where first- and second-year medical students are presented a case that's intended to develop and challenge their diagnosis skills.
"Our students by that time have a lot of drug knowledge and can really contribute," Emerson said of the sessions. "They benefit from being able to work collaboratively to see the process, to see what the physician goes through to diagnose a particular disease or condition and then to determine the best course."
"When pharmacy students are present, it changes the dynamic," Kellerman said. "Pharmacy students develop a better understanding of how we come to a conclusion to use a certain medication. And the medical students learn more about potential side effects of medications. So it works both ways in terms of both the medical students and the pharmacy students learning from each other."
And education, to provide better care, is the goal - whether it's occurring in the classroom or in a clinic.KU School of Medicine-Wichita