First, we must remain focused on our goal and articulate the purpose of IPE more clearly than ever: that it is a means to improve the quality of care given to patients. Teams that work well together provide better care, but that is a message that too few have heard. We are not pursuing IPE as an end in itself.

Second, it is time to choose a path. As I said on the final day of the conference, letting a thousand flowers bloom works for a while, but we have to select what’s working in IPE. We cannot do it all. We need to ask what ideas we have developed that can be brought to scale and truly become indispensable features of health professions education.

Third, we need to unite education reform with practice reform. Neither can work in isolation.

Over the coming months the Foundation will prepare the conference’s proceedings and include recommendations on the future direction of IPE. It will be up to all of us—attendees, grantees, and others—to choose a path for IPE that advances us to the point where all health professionals at all schools see and experience interprofessional education as integral to their preparation for practice.

I must thank each participant, panelist, and faculty member for bringing the thinking and discussion to the point where we now find it and for their roles in making our recent conference a resounding success. We look ahead to higher hurdles for IPE, but it will be thanks to you when we summit them.

When I took the helm in 2008, the goal of better aligning health professions education with the health care system was a core objective. This year, the theme of “alignment” began to take hold, particularly around interprofessional education (IPE) and graduate medical education (GME).

IPE is the single largest component of our grant portfolio, and we are increasingly viewed as a beacon in what is an ever-expanding field. It was inspiring to see our grantees’ work so prominently visible at many key meetings I attended in 2011, and in the conference we recently convened on the topic. (I recommend that you revisit our blog posts in the News & Commentary section to read more.) There is still much work to be done on IPE in 2012 and beyond—so stay tuned.

GME reform is another example of a needed realignment in academic medicine. Although the GME system in the United States has served us well, it must evolve rapidly to adapt to a changing health care system and changing patient populations and needs. To that end, we recently announced funding for one of our recommendations for reform: an Institute of Medicine study of GME finance and governance that will commence in June of this year.  (You can read our recommendations for reform in our two reports on GME reform here and here).

I look forward to more signs of impact in 2012 and, as always, welcome your thoughtful feedback and ideas about issues related to our fundamental mission: improving the education of our nation’s health professionals.

Interprofessional education (IPE) is extremely important to support the development of effective and efficiently functioning health care teams to deliver the increasingly complex care that is being required by patients in the 21st century.  Simulation is a tool that can be used to support interprofessional education and the development of effective teams.

The simultaneous meetings had partially overlapping sessions.  One was designed to educate its attendees about the principles of interprofessional education and the roles that simulation could play as a tool to support it.  It drew over 450 persons, a significant percentage of the 2500 registrants who attended SSH’s annual meeting.  The second meeting was invitational.  It drew representatives of 22 organizations who after attending the opening session of the educational meeting, worked separately to design a set of next steps for fostering better interprofessional education including the use of simulation as a tool.  The initial results of the invitational discussions were presented at the end of the educational meeting.

The educational meeting covered a lot of territory including the Core Competencies for Interprofessional Education that were promulgated in May, 2010 by the Interprofessional Education Collaborative (IPEC) .  It emphasized the roles that simulation, including the use of standardized patients as well as a variety of mechanical and computerized educational settings and programs, could play in helping learners in a variety of health professions (e.g., medicine, nursing, pharmacy, dentistry, allied health professions) to acquire the core competencies. 

The organizations that participated in the invitational meeting included representation for patients, the Joint Commission, and a variety of professional organizations involved in education and health care delivery (e.g., organizations such as the Association of American Medical Colleges, Association of Allied Health Professions, American Association of Colleges of Pharmacy, American Nurses Association, American Society of Anesthesiologists, etc).  The 22 participating organizations agreed to promote IPE and simulation as a tool for achieving better interprofessional practice; develop a common core message and use existing sources such as IPEC’s core competencies in disseminating their message to their spheres of influence.  The discussions were wide-ranging and in addition to use of simulation as a tool covered faculty development issues, common and accessible resources (e.g., the IPE central repository/portal that the Association of American Medical Colleges is developing under a new grant from the Macy Foundation) , development and sharing of evaluation tools, and identifying research needs.  As a result of the Macy Foundation grant in support of the meeting, the findings of the discussion and conclusions of the 22 participating organizations are now being developed into a White Paper that can be disseminated by each participant including the Macy Foundation.

Here are some of their reflections:

Molly Cooke, UCSF and president-elect of the American College of Physicians
Cooke reflected on her career and experience with providing care interprofessionally to suggest that interprofessional experiences may be most effective when the patient is set to benefit the most—and that IPE simply for its own sake might not be sufficient.  “Why are we doing this?” she asked. “I think that is the core question. In my mind it’s about making patient care better and that’s the test we need to put our innovations to.”

Patricia Benner, UCSF School of Nursing (Emerita)
Benner suggested that the notion of professionalism in health professions needs to change, with greater emphasis on patient-centeredness: “One of the lessons…is that students like it if it’s about the patient. We need IPE to be a new paradigm of focus on the patient and a shared identity with a lot more mutual trust.”

Linda Headrick, University of Missouri-Columbia
Headrick noted that she has witnessed interprofessional tensions melt away when professionals come together around a patient and find that they need each other to achieve their shared goal of excellent care.  She concluded that designing IPE in a way that puts patients at the center is therefore key. She emphasized that best practices need to be conceived as a way to integrate learning and learners at all levels, so that they are actively involved in both the delivery and improvement of care.  “If we design best practices without the learners and try to add them in later,” she asked, “how is that going to work?”

Madeline Schmitt, University of Rochester (Emerita)
“We are in a time of majestic change,” Schmitt noted in her reflection. Continuing the theme of patient centeredness as the lynch-pin of IPE, Schmitt recalled a powerful memory from her training as a nurse, when a physician had taken note of her close communication with a patient and, valuing it as an enhancement to the care he could provide, invited her to see the patient with him. “I thought about care differently from that point on,” she said.

The Josiah Macy Jr. Foundation has awarded the Institute of Medicine (IOM) $750,000 to study the governance and financing of graduate medical education (GME). An independent review of the goals, governance and financing of the system for training physician residents in the United States was one of several recommendations issued by experts at an October 2010 conference about GME reform sponsored by the Macy Foundation.

GME is largely responsible for the size and composition of the physician workforce in the U.S. But the education of doctors hasn’t kept pace with changes in health care delivery and practice. Over the past two years, the Macy Foundation has convened more than 50 national leaders in academic medicine, health policy, and medical education to help transform the GME system.

Medicare contributes $9.5 billion to GME; Medicaid about $3 billion. Because GME is a public good that receives a large share of public dollars, leaders convened by Macy over a series of two conferences agreed that the system “must be accountable to the needs of the public.” The first conference, co-sponsored with the Association of Academic Health Centers in October 2010, focused on the regulation, financing, and size of GME. In May 2011, the Macy Foundation hosted a follow-up conference focusing on the content and format of GME. Two reports capturing the conclusions and recommendations from these meetings were issued by the Foundation in 2011.

“Though the GME system in the United States has served us well and is a model for the rest of the world, it must evolve swiftly to adapt to a changing health care system and health care needs.” says George Thibault, president of the Macy Foundation. “We hope the IOM study will provide a roadmap that helps move us closer toward a graduate medical education system that ensures an effective physician workforce for the future.”

Calls for GME reform have echoed across the country for decades. The Foundation has itself examined this issue twice, in the 1980s and the 1990s. In December 2011, a bipartisan group of U.S. Senators called for an IOM review of GME funding and governance, mirroring recommendations in the Macy report, Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education System.

To conduct this study, IOM will appoint an 18-member committee with expertise in health care systems, health economics, health professions education, and GME financing and accreditation at all levels. The committee is anticipated to examine current regulation, financing, content, governance, and organization of GME and recommend how to modify the system to produce a physician workforce that meets current and future societal needs.

The Macy Foundation grant constitutes approximately half of the support that the IOM needs to carry out the study, and the other half will be provided by public and private entities. The study is expected to begin June 1, 2012 and be completed in Spring 2014.

Read more about the study: http://www.iom.edu/Activities/Workforce/GMEGovFinance.aspx

Macy President George Thibault with former CMS administrator Donald Berwick

“What are we trying to get done?”

That was the question Don Berwick, former CMS Administrator, posed to participants gathered yesterday at the Macy Conference on Interprofessional Education (IPE).

By teaching health professions how to work collaboratively and in teams, we believe we can improve patient care and ultimately improve the health of the public. This is the end game of our collective efforts to advance IPE. Yet we can lose sight of this goal when deep in the weeds of curriculum development or as we strive to navigate scheduling challenges, find classrooms large enough to teach nursing and medical students together, and overcome other obstacles to implement IPE.

Berwick urged the audience to revisit the aim of IPE and use it as a touchstone to guide action. And he encouraged participants to think about how IPE is linked to health care’s “triple aim” of better care, better health and lower costs.

With spending on health care consuming more and more of our GDP, there is an imperative to reduce the cost of health care and direct savings into other areas of need, such as education, wages and job training, or roads and infrastructure. But health professionals education rarely addresses this issue. Berwick shared the story of his daughter, a second year resident who is learning new and exciting ways to practice medicine, such as how to use the internet for patient care and how to work in teams, but has never been taught anything about health care costs.

IPE has the potential to help lower costs. Through teamwork and improved communication we can reduce duplication of effort and decrease errors, cutting out waste from the system. The next step, as Gerri Lamb of Arizona State University pointed out from the audience, is to make that link “more conscious and explicit.”

Perhaps one outcome of this conference will be the need for more thoughtful consideration of how IPE can help make health care more affordable, whether IPE should pursue the triple aim and how we incorporate health care costs into our methodology and evaluation. Stay tuned!

Across the U.S. and the world, students from medical, nursing and other health professions schools are participating in interprofessional education (IPE)—learning with, from and about each other. By participating jointly in seminars, working together to solve problems in a classroom setting using role play or simulation exercises, or undertaking clinical placements that require a team-based approach, these students are being exposed to the skills, knowledge, attitudes and behaviors required to improve collaborative practice and quality of care.

While this type of interactive learning across the health professions is still very much on the sidelines—health professions education remains largely designed to produce individual providers—Scott Reeves, Director of the Center for Innovation in Interprofessional Healthcare Education, believes IPE is at a tipping point.

In this morning’s plenary session, Reeves outlined strategies to expand IPE and move it into the mainstream of health professions education. He challenged participants to move away from a focus on their own institutions and work together collectively to address the challenges and opportunities that lie ahead. Priorities included:

Synthesizing best practices
We have a rich array of IPE programs being tested and implemented across different settings and with a variety of health professional students, what Reeves characterized as “a smorgasbord of interprofessional activity.” We must tease out trends from these diverse activities and synthesize best practices so we can develop a common battery of models that can be scaled up.

Conducting rigorous assessment
To date, we’ve done a good job at assessing individual behavior and showing how IPE has changed student’s attitudes and perceptions. Now, we need to collect evidence about the long term impact of IPE on behavior and practice. We must also move away from assessing individual students on their competencies, to thinking about how we assess teams of students on collective activities.

Developing faculty
IPE largely relies on a small group of highly dedicated faculty. If we are to expand IPE, we must expand the number of faculty providing this type of education. We must give faculty the right training and evaluate their performance. Institutions must set aside time for faculty to engage in IPE and recognize faculty members who undertake IPE.

“You’ve given us a lot of meat to chew on as we move through the next couple of days,” noted Macy President George Thibault.

Conference participants will dig deeper into these issues and others over the course of the two-day conference.

We have strong evidence that health care delivered by well-functioning teams leads to better outcomes, yet the norm is still to educate our health professionals in silos. By bringing together these IPE innovators, we hope to gather collective wisdom and identify best practices that can help catalyze more planned and rigorous IPE.

Together with leaders from philanthropy, government, health care and education, these interprofessional educators will share successes, challenges and lessons learned from their programs and come together for focused discussion around key aspects of IPE, such as teaching quality and patient safety interprofessionally, faculty development for IPE, and use of simulation and online learning in IPE.

Donald Berwick, MD, former CMS Administrator and Scott Reeves, PhD, MSc, PGCE from the Center for Innovation in Interprofessional Healthcare Education at the University of California, San Francisco, will kick-off the two-day meeting.

You can see highlights from the conference by following us on Twitter (@macyfoundation) and reading this blog.

Video from the event will be archived on the website, and a summary of the proceedings will be published later this year.

Read more about IPE:

Educating Nurses and Physicians: Toward New Horizons

Team Based Competencies: Building a Shared Foundation For Education and Clinical Practice

Who Will Provide Primary Care And How Will They Be Trained?