Connecting the Dots

Abstract

Health systems around the United States are embracing new models of primary care using interprofessional team-based approaches in pursuit of better patient outcomes, higher levels of satisfaction among patients and providers, and improved overall value. Less often discussed are the implications of new models of care for health professions education, including education for physicians, nurse practitioners, physician assistants, and other professions engaged in primary care. Described here is the interaction between care transformation and redesign of health professions education at the largest integrated delivery system in the United States: the Veterans Health Administration (VA). Challenges and lessons learned are discussed in the context of a demonstration initiative, the VA Centers of Excellence in Primary Care Education. Five sites, involving VA medical centers and their academic affiliates in Boise, Cleveland, San Francisco, Seattle, and West Haven, introduced interprofessional primary care curricula for resident physicians and nurse practitioner students beginning in 2011. Implementation struggles largely revolved around the operational logistics and cultural disruption of integrating educational redesign for medicine and nursing and facilitating the interface between educational and clinical activities. To realize new models for interprofessional teaching, faculty, staff, and trainees must understand the histories, traditions, and program requirements across professions and experiment with new approaches to achieving a common goal. Key recommendations for redesign of health professions education revolve around strengthening the union between interprofessional learning, team-based practice, and high-value care.

An Interprofessional Education Project to Address Veterans’ Healthcare Needs

“…Coordination of various health professional students' schedules so they can simultaneously attend class and clinical experiences is challenging (Gilman, Chokshi, Bowen, Rugen, & Cox, 2014;Swenty, Schaar, & Butler, 2016 course to nearing graduation (Gilman, Chokshi, Bowen, Rugen, & Cox, 2014). This variety of experiences seemed to enrich students' learning as all students contributed information and insights to facilitate team problem-solving during case scenarios or standardized patient experiences.…”

Ready to collaborate?: medical learner experiences in interprofessional collaborative practice settings

“…Numerous IPCP models have been established across healthcare; however, IPCP implementation can vary widely in terms of overall structure and degree of interprofessional integration, leveling of hierarchy, and patient and family integration [6][7][8]. Additionally, implementation can be challenging [9][10][11][12].…”

Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education

“…The VA's nationwide implementation of Patient Aligned Care Teams (PACT) in 2010 introduced fundamental changes in VA primary care based on the patient-centered medical home model (Nelson et al, 2014;Rosland et al, 2013). Soon afterwards, OAA recognized the need to redesign primary care education to maintain alignment with primary care delivery (Bowen & Schectman, 2013;Cox, 2013;Gilman, Chokshi, Bowen, Rugen, & Cox, 2014). In 2010, OAA released the first of three national requests for proposals (RFP) for VA facilities to seek funding to develop and implement interprofessional team-based curricula to achieve clinical practice-education integration (Department of Veterans Affairs, 2010).…”