Interprofessional education contributes to better patient outcomes

“Interprofessional education is an important pedagogical shift in advancing health professional education in the 21st century with the appealing premise that once health care professionals work as a collaborative team, patients receive better care,” Len V. Koh, PhD, OD, MBA, FAAO, and Joshua Baker, MS, OD, told Primary Care Optometry News in an interview.

According to the Centre for the Advancement of Interprofessional Education, the values of interprofessional education (IPE) include:

• Focusing on the needs of individuals, families and communities to improve their quality of care, health outcomes and well-being;

• Applying equal opportunities within and between the professions and all with whom they learn and work;

• Respecting individuality, difference and diversity within and between the professions and all with whom they learn and work;

• Sustaining the identity and expertise of each profession;

• Promoting parity between professions in the learning environment; and

• Instilling interprofessional values throughout uniprofessional and multiprofessional learning.

“One of the drivers of health care reform has been the desire to improve delivery models that ultimately improve patient outcomes,” Jennifer L. Coyle, OD, MS, FAAO, dean, College of Optometry, Pacific University, and past president of the Association of Schools and Colleges of Optometry (ASCO) explained in an interview. “The future of health care is more team-based, with providers from all disciplines collaborating with each other to make decisions about treatment and management plans.”

Image: Casser L

According to a 2013 survey report from ASCO, 19 schools and colleges of optometry out of 21 total U.S. programs reported participation in IPE activities, and nine indicated IPE as a program requirement. A total of 12 programs reported case-based discussion as an IPE activity. Fourteen institutions indicated they provide interprofessional patient care. Finally, eight institutions reported partnerships with schools and programs outside of their own institution.

Through IPE, optometry students gain a better understanding of the roles and skills of other professionals such as physicians, dentists, nurses, podiatrists, physician assistants, physical therapists, occupational therapists and pharmacists, according to Koh, assistant dean of clinical Affairs, Midwestern University, and Joshua Baker, associate dean of academic affairs, Arizona College of Optometry.

The collaboration helps students strengthen their own professional identity while also helping them recognize the overlap of different functions, according to John Baker, OD, MSEd, assistant dean for patient care education, Illinois College of Optometry, and Melissa Vitek, OD, FAAO, director of international and continuing education, Salus University.

“The IPE model provides real-life socialization opportunities that may help avoid conflict and/or competition in their professional roles,” they said.

Kevin Alexander, OD, PhD, president of Marshall B. Ketchum University, recently gave a keynote address at the ASCO IPE summit held at Ketchum, which hosted 21 of the 23 North American ASCO member institutions, one of the two associate member schools in Canada and representatives from 10 different health professions.

“I graduated optometry school in the 70s,” he said. “When we graduated, we found ourselves in a 20-foot lane for most of our careers and rarely spoke to other practitioners unless we suspected diabetes. I want to see our profession completely transform from where we were to where we can be if we recognize that we have a stake in the overall health of the patient – beyond glasses and glaucoma.”

Students become better equipped to solve real-life interprofessional challenges and build an interprofessional network during their training, according to Koh and Joshua Baker. The comanagement of patients with ocular and vision needs is an essential component of an optometrist’s duties; IPE helps better prepare students to work with other professionals.

“Overall, IPE can enhance students’ motivation to collaborate, change their attitude and perceptions, and cultivate interpersonal group and organizational relations for better health care outcomes,” Koh and Joshua Baker explained.

Linda Casser, OD, FAAO, FNAP, professor and coordinator of interprofessional education initiatives, Salus University, believes that the timing of optometry actively embracing IPE is exciting, as IPE is expanding from hospital-based teams and academic health center teams to community-based teams. She added that successful IPE efforts have brought a new energy and enthusiasm for students and faculty who are involved.

In the end, all of the experts agree that the ultimate goal of IPE is improved patient and population outcomes.

Challenges of IPE implementation

In 2014, ASCO formed an IPE task force, which became the Interprofessional Education and Collaborative Practice (IPECP) Committee. Based on surveys from 2013 and 2015, the 21 schools and colleges of optometry reported lack of time as the most common barrier to IPE.

Casser, a PCON Editorial Board member, said that a commitment on the part of the institution is essential and sustaining it over time requires a strong commitment as well. For example, as people come and go at an institution and organizational structures change, maintaining IPE through those types of transitions can be a challenge.

“Another challenge is the need to change faculty and administrator perceptions and attitudes about embracing these experiences in their already full programs,” Coyle, also a PCON Editorial Board member and chair of the ASCO IPECP Committee, said. This is currently happening across optometry institutions in the U.S. and Canada, she said.

Koh and Joshua Baker agreed: “Attitudinal differences in health professionals and amongst faculty members can pose challenges to successful implementation of IPE. They may be resistant to changes due to increased workloads and lack of time, or they do not share the perceived value of IPE. Different professional programs have different curricula, which can be very rigid; thus, accommodating IPE can be difficult.”

John Baker and Vitek spoke about the lack of knowledge of first steps necessary to commence IPE, although they noted a positive trend building. According to the IPECP Committee survey, eight institutions reported a lack of knowledge of the first steps in 2013, while only five institutions reported this as a barrier in 2015.

Lack of interest by faculty, limits on physical resources, scheduling challenges, geographical barriers, funding and cultural barriers were other cited hindrances.

Furthermore, assessing the benefits of IPE has come under scrutiny in the literature, according to John Baker and Vitek.

“Trends in the U.S. health care system indicate there will be an increasing need for collaborative patient care; therefore, institutions training health care professions have an obligation to provide their students with effective IPE training,” they noted.

“Moving to an IPE culture is difficult. Not everyone is going to be on board,” Alexander professed.

He suggested involving faculty at all levels of the organization to spread enthusiasm and support.

“You have to cultivate champions. Cultivate people on the inside who are on board and excited at all levels of the organization,” he said.

Current IPE in practice

Casser believes the perfect IPE model would be “purposefully inclusive,” including all health care professions.

“The perfect model has all disciplines at the table, each having an acknowledged role and contribution to the interprofessional team. Interprofessional education and practice should be a continuum throughout a health care provider’s education and career, including continuing education,” she said.

While Salus University has incorporated an IPE approach for many years, an IPE committee was formed in the fall of 2012, which Casser has chaired since its inception. She is also coordinator of IPE efforts for the campus.

“Overall, no matter what IPE project we’ve launched, it’s the collaborative process of the project and the enhanced mutual familiarization that have been so important,” she explained.

An interprofessional evidence-based practice core curriculum course is required for all students enrolled in Salus’ optometry, audiology, physician assistant, occupational therapy and speech-language pathology degree programs. Other active IPE projects at Salus University include:

• collaborations between vision rehabilitation, occupational therapy and speech-language pathology students;

• a voluntary interprofessional clinical problem-solving course and educational research project;

• interprofessional integrated multisensory screenings and follow-up care for post-9/11 veterans enrolled at two local community colleges;

• patient care collaboration involving optometry students and nurse practitioner students from a local school of nursing; and

• patient care collaboration between optometry students and family medicine residents from a local hospital.

The Illinois College of Optometry is developing collaborative practice opportunities that include:

• strengthening the IPE for students rotating through a required fourth-year Veteran’s Administration externship;

• providing diabetic eye care at student-run clinics;

• developing collaboration between occupational therapists and students providing vision rehabilitation;

• clinical rotations in specialty medical clinics for residents and direct ophthalmoscopy training for medical residents; and

• opening a pharmacy within the clinical facility, the Illinois Eye Institute, with a long-term goal of providing interactions between optometry students and pharmacy students.

At Midwestern University, first-year students take the interprofessional health care course, which includes students from every medical profession, to learn about each other’s specialty, team-based health care and the One Health initiative.

“One Health is a worldwide strategy for expanding interdisciplinary collaborations and communication in all aspects of health care for humans, animals and the environment,” Joshua Baker explained.

Midwestern’s second-, third- and fourth-year optometry students conduct an interprofessional laboratory, direct ophthalmoscopy for doctors of osteopathy, where they teach first-year osteopathic students clinical skills. Low vision and vision rehabilitation partner with the occupational therapy program to provide team-based care for patients with significant vision loss, according to Koh.

They explained that optometry and other health professional students interact with one another regularly to discuss interdisciplinary management of chronic diseases.

“Experience that will be invaluable after graduation,” they added.

Coyle believes the perfect model begins in the first year of professional school, “with students from multiple programs communicating and problem-solving from the start of their curriculum.”

Pacific University’s College of Health Professions introduces first-year students to interprofessional collaboration through a required course in which the college of optometry has been redesigned into a blended face-to-face, online module and clinical practicum elective for its students, Coyle explained.

The Interprofessional Diabetes Clinic is Pacific’s ultimate clinical experience, where optometry students work as a team with others from dental hygiene, physical therapy, occupational therapy, audiology, professional psychology and pharmacy to provide care for patients with diabetes.

Optometry, physician assistant and pharmacy (coming this fall) students at Ketchum University can expect public health courses, medical Spanish, evidence-based medicine, medical ethics and clinical case conferences, all of which lend themselves to group interaction, Alexander explained.

“These courses are all very powerful avenues for students to begin working and learning together in the first year or very early on,” he said.

Ketchum courses are tailored to provide social interaction, clinical simulation and interprofessional training in a guided learning environment.

“The ideal comprehensive IPE curriculum also includes opportunities for students to teach each other skills, such as optometry students working with physician assistant students on direct ophthalmoscopy,” Coyle continued. “The best models start with classroom experience and move into lab settings and, ultimately, students from multiple professions are working together in a clinical setting.”

“We want our students to be able to communicate clearly with other health care professionals,” Alexander said, “coordinate care with other professions, comanage conditions with other practitioners and understand that they have a role in the complete care of a patient. If we have given our students a real understanding of those things, then we have given them a truly interprofessional education.”

The future shaping IPE

“Trends in the U.S. health care system indicate there will be an increasing need for collaborative patient care,” John Baker and Vitek said. “Therefore institutions training health care professions have an obligation to provide their students with effective IPE training.”

A number of health care professional schools are being required by their accrediting bodies to include IPE in their curriculum, they explained.

Many of the experts agree that there will be more publications on best practices in addition to current recommendations and resources from the IPEC and the National Center for Interprofessional Practice and Education.

“Integrated care systems provided by an interprofessional health care team will become more widespread as health care organizations adapt to meet the ultimate goal of the Affordable Care Act in optimizing outcome and value while containing health care cost,” Koh and Joshua Baker remarked.

Research from the National Academies Press suggests that only recently have researchers begun to look beyond the classroom and learning outcomes for the impact of IPE on issues like patient safety, patient and provider satisfaction, quality of care, health promotion, population health and the cost of care.

“A comprehensive conceptual model would greatly enhance the description and purpose of IPE interventions and their potential impact,” the researchers wrote. “Such a model would provide a consistent taxonomy and framework for strengthening the evidence base linking IPE with health and system outcomes.”

Studies should be focused on developing a broad consensus on how to measure interprofessional collaboration effectively across a range of learning environments, patient populations and practice settings, according to the study.

“Such studies should include an economic analysis and be carried out by teams of experts that include educational evaluators, health services researchers and economists, along with educators and others engaged in IPE,” the researchers wrote.

“Although there is a need for more data to support it, improved patient outcomes are the ultimate goal of quality IPE,” John Baker and Vitek said. “I believe we will see increased efforts in collecting and disseminating that data. The results of the data will drive further trends in IPE and patient-centered, team-based care.”

Alexander stressed that there is no IPE how-to book or roadmap to follow.

“There’s no single answer. You can buy into the concept and you have to find your way, depending on what resources you have available,” he said. “The beauty of the ASCO summit was collaborating with other institutions and talking about that we’ve all tried and what works and doesn’t.”

“Certainly, IPE will be a growing and integral part of optometric education in the future,” Koh and Joshua Baker concluded. “It is anticipated that IPE will be a part of accreditation standards required by the Accreditation Council on Optometric Education in the near future, as various forms of interprofessional-ability are being adopted by other accreditation agencies, including the Accreditation Council for Pharmacy Education, the Commission on Dental Accreditation and the Commission on Collegiate Nursing Education.” – by Abigail Sutton

• References:
• Baker JL, et al. Optometric Education. 2015;40(2)72-76.
• Barr H, et al. Principles of interprofessional education. Centre for the Advancement of Interprofessional Education website. https://www.caipe.org/. Posted January 2011. Accessed March 9, 2016.
• Casser L, et al. Family medicine residents, optometry students and faculty members engaged in health professions education and collaborative patient care: An example of a community-based interprofessional initiative by a member institution of the Association of Schools and Colleges of Optometry. Presented at: Global Forum on Innovation in Health Professional Education, Board on Global Health, Institute of Medicine. Washington, DC, May 1-2, 2014.
• DiStefano A, et al. Interprofessional education initiatives at Salus University: A unique perspective in both didactic and clinical education. Presented at: JCIPE Conference, October 12, 2014.
• Institute of Medicine. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. T.he National Academies Press OpenBook website. https://www.nationalacademies.org/home. Posted April 22, 2015. Accessed March 9, 2016.

• For more information:
• Kevin Alexander, OD, PhD, can be reached at: kalexander@ketchum.edu.
• John Baker, OD, MSEd, can be reached at: jbaker@ico.edu.
• Joshua Baker, MS, OD, can be reached at: jbaker@midwestern.edu.
• Linda Casser, OD, FAAO, FNAP, can be reached at: lcasser@salus.edu.
• Jennifer L. Coyle, OD, MS, FAAO, can be reached at: coylej@pacificu.edu.
• Len V. Koh, PhD, OD, MBA, FAAO, can be reached at: lkoh@midwestern.edu.
• Melissa Vitek, OD, FAAO, can be reached at: mvitek@salus.edu.

Disclosures: No product or services were mentioned in the article that would require financial disclosure.