A recent NYT blog highlights how medical education trains its varied professionals, doctors, nurses, physicians assistants, in totally isolated silos, even though today they almost always actually practice in integrated teams.
But, there are now some changes described in the article extract pasted below:
The push toward more collaborative care has been underway for years. In 2001, the Institute of Medicine issued a report recommending that all health professionals receive training in interdisciplinary teams. . .
. . . [t]he Robert Wood Johnson Foundation and three other leading foundations recently helped start the National Center for Interprofessional Practice and Education to improve teamwork and break down siloed training approaches. Another initiative, Retooling for Quality and Safety, led by the Josiah Macy Jr. Foundation and Institute for Healthcare Improvement, awarded grants to six universities to support interprofessional activities aimed at integrating patient safety into medical and nursing school curricula. Participating schools designed a variety of creative learning models to bring students together, such as interprofessional Grand Rounds conferences and web-based learning modules; small-group exercises to develop care plans or break bad news; quality improvement projects to improve hand hygiene or prevent falls; and clinical simulations with debriefing sessions during which all team members had the opportunity to describe what went well and what could have been improved.
Data evaluating whether interprofessional training improves teamwork, communication and leadership is still preliminary, but promising. A study of over 600 medical, nursing, physiotherapy and occupational therapy students enrolled in an interprofessional training course found that all student groups gained knowledge of other professions’ work, but also developed a deeper understanding of their own professional role. Other research suggests that joint clinical simulation and facilitated debriefing sessions can improve confidence by providing collaborative care for a rapidly deteriorating patient and enhance communication by increasing providers’ ability to identify various professional roles, “close the loop on patient care,” and correct others in a constructive manner. Similar results have been found for medical and nurse anesthetist students in operating room simulations. At the resident level, the use of multidisciplinary rounds — in which doctors-in-training discuss diagnoses and patient care issues with case managers, nursing coordinators and others — has been shown to improve hospital performance on quality metrics for heart failure and pneumonia and decrease how long patients stay in the hospital.
While it is certainly true that the range of other professionals who are thought to work regularly with lawyers is smaller than those who work with physicians, surely that is a restatement of the problem, rather than an excuse for our failure to consider equivalent approaches.
More and more lawyers are working regularly and closely with social workers, yet how many law school clinical programs are teaching this skill? In the defense world, investigators are critically important, but how many have the experience of learning with lawyers? Similarly, I doubt that many incubators are yet including the integration of other professionals into the curriculum.
Indeed, what about the idea of co-training for lawyers and doctors? Given the spread of medical legal partnerships, how many law schools include a class on working with doctors and other medical professionals, and how many medical schools expose their students to partnering with (rather than fearing) lawyers.
Similarly, I would hope that the trend to exploring expansion of “beyond lawyers” roles will speed and be sped by approaches such as these. Indeed, one of the strengths of the Washington State Limited License Legal Technician model is the participation of the state’s law schools in the educational component.