A Medical Student’s Perspective on Interprofessional Collaboration

 

By Alhasan N. Elghouche

The reality of effective patient care calls for more than learning medical knowledge and clinical facts; it requires successful collaboration within the healthcare team. This is especially true in the context of an increasingly complex and multifaceted healthcare system that requires the ability to skillfully navigate and utilize resources for optimal patient outcomes. I have been fortunate to attend an institution that facilitates meaningful collaboration among various healthcare professions. My last two clinical rotations took place in the intensive care unit (ICU) and emergency department (ED), and I recall numerous interactions with nurses and nursing students, physical therapists, pharmacists and pharmacy students, social workers, paramedic students, and physician consultants. These interactions are valuable educational experiences. Recognition of the roles and responsibilities of various healthcare professionals and active engagement with those individuals leads to knowledge on how to interact, communicate, and facilitate their work.

Many of my interprofessional experiences were facilitated by placing students from different disciplines within the same physical setting. During the ICU rotation, I worked alongside pharmacy and nursing students. Just as the attending intensivists would communicate with the clinical pharmacist and nursing staff, the student counterparts would conduct similar interactions, which were mutually educational. One such instance occurred when a patient experienced a myocardial infarction; following the event, I had a fruitful conversation with the pharmacy students regarding timing, titration, and routes of nitroglycerin administration in such situations. This direct collaboration led to mutual respect and an appreciation of what the various members of the healthcare team contribute to patient care. The pharmacy students also welcomed the interaction because it gave them an opportunity to act on their fund of knowledge within the framework of a real patient scenario.

Students from various disciplines may also be placed in the same setting within the context of simulated patient scenarios. Simulation-based training has been shown to positively influence knowledge of effective communication and teamwork behavior (Patterson et al., 2013). I was part of one such scenario during my ED rotation, which placed medical and nursing students together and allowed them to react to patients simulating an asthma exacerbation, trauma, and acute coronary syndrome. Among other insights, these scenarios highlighted the importance of clear communication between physicians and nurses.

In addition to being in the same physical setting, students must be afforded a certain level of autonomy in order to effectively practice worthwhile multidisciplinary cooperation. It has been my experience that appropriate levels of medical student autonomy provide a framework for immersive clinical experience and lasting knowledge (Williams & Deci, 1998). This validated model of instruction, known as active learning, allows students to take responsibility for their education and actively participate in the process as opposed to merely observing (Bonwell & Eison, 1991).

My ED rotation provided that very autonomy within a safety net of physician and nursing supervision. That autonomy allowed and required students to communicate directly with physician consultants and associated healthcare personnel. I learned more by, for example, actually being part of the conversation with the pharmacist regarding the peak plasma time of a medication my patient had ingested (and relaying that information to the rest of the team) instead of standing on the sideline listening to that conversation take place. I learned more by actually speaking to the orthopedic consultant myself and describing the mechanism of injury and subsequent radiographic findings that characterized a fracture. And though one can learn the indications for immediate reduction of fracture versus splinting and outpatient follow-up from observation, being an active part of the conversation fostered effective communication and participatory, lasting understanding.

My ED rotation also led to a greater appreciation of the departmental role of nursing. As I was seeing the triaged patients before my attending physician, I communicated directly with the nurses and integrated their clinical impression and concerns regarding a patient’s condition before conducting my own history and physical examination.

There were also paramedic students rotating through the ED who would ask to see patients with me. I would relay to them important warning signs to watch for that would indicate an acutely life-threatening process. As I provided them with relevant information, I concurrently crystallized that knowledge within my own mind, thereby enacting the words of Joseph Joubert: “to teach is to learn twice.” I also had the benefit of coordinating the care of my patients with social workers. Finding solutions for a patient with transportation issues or an uninsured patient who needed surgical intervention led me to further appreciate the role of social work and the psychosocial issues that might exacerbate a patient’s clinical plight.

Medical students at the end of a shift in the ED were also required to “change over” their patients to other medical students. This transition of care has been cited as a potential source of medical errors (Thomas et al., 2013). Actively engaging in the process at the student level fosters an understanding of the importance of this event for patient safety and how to effectively communicate to ensure a smooth transition of care. These are skills best introduced at the student level to ingrain good practices and encourage their continued development during internship and residency.

Allowing students to make their initial impressions and clinical decisions free from a superior’s scrutiny grants them ownership of the educational process and an engaged manner of learning that includes interprofessional collaboration. Permitting students to manage patients with more graduated autonomy and in a well-supervised setting alongside other healthcare workers will improve patient safety. Further, trainees will gain lasting knowledge in a safe setting that will enable future success when they have no choice but to operate autonomously.

There are also ways to actively include students in critical safety initiatives. In another example from my ICU rotation, the medical students were charged with making sure the daily safety checklist had been completed for each patient (e.g. “Foley catheter still needed? Appropriate prophylaxis in place?”). Another instance was the inclusion of students in “timeouts” within the operating room; once again, active student involvement within the process facilitated a higher level of awareness regarding the importance and utility of that process.

In summary, numerous benefits arise from interprofessional collaboration at the student level, and active engagement of students within patient care lays the groundwork for that collaboration. This type of engagement is highlighted above in high-impact settings such as the ICU and ED; if these types of experiences are possible in such acute environments, they are likely to be successful across all spheres of healthcare education. Recognition of and participation in these concepts at the student level augments the educational experience and enhances subsequent patient care.

References:

Bonwell, C., & Eison, J. (1991). Active learning: Creating excitement in the classroom. AEHE-ERIC Higher Education Report No. 1.

Patterson, M. D., Geis, G. L., LeMaster, T., & Wears, R. L. (2013). Impact of multidisciplinary simulation-based training on patient safety in a paediatric emergency department. BMJ Quality & Safety, 22(5), 383-393.

Thomas, M. J. W., Schultz, T. J., Hannaford, N., & Runciman, W. B. (2013). Failures in transition: Learning from incidents relating to clinical handover in acute care. Journal for Healthcare Quality, 35(3), 49-56.

Williams, G. C., & Deci, E. L. (1998). The importance of supporting autonomy in medical education. Annals of Internal Medicine, 129(4), 303-309.