Innovative Education Techniques Used to Improve Health Care Teams - January 19th, 2010

A team approach in which physician and non-physician health care professionals work closely to treat patients has been shown to positively influence patient outcomes, but it can be a challenge because of communication barriers and the different perspectives and backgrounds of the key players.

Two years ago The University of Texas at Austin joined with the University of Texas Medical Branch, Austin Community College and Seton Medical Center Austin to give medical, nursing, social work and pharmacy students inter-professional team training at the Clinical Education Center (CEC) at Brackenridge (former Children's Hospital of Austin).

Dr. Marilla Svinicki, a professor in The University of Texas at Austin College of Education’s Department of Educational Psychology, is director of the curriculum committee that develops learning activities for the students at the CEC.

“We want to get the students from each different health profession to sit down, talk and ultimately gain new insights into the strengths, challenges and resources endemic to each area,” said Svinicki. “To do this, we present six ‘case events’ each year for the students. At the case events, about 60 nursing, medical, social work and pharmacy students gather at the CEC and are given a patient scenario that represents a particularly difficult situation for a health care team. The topic for each case is chosen by the curriculum committee”

An expert panel of community health care professionals, medical students who are residents and University of Texas at Austin faculty work together to create what’s called the “case nugget,” or fully fleshed-out patient story, that will be presented to student teams.

In one recent “case nugget,” the story is that a young woman goes to a hospital emergency room with flu-like symptoms. It’s soon discovered that her situation is much more dire than originally thought - she’s HIV positive and is admitted to the hospital to stabilize her condition. The woman is a single mom, and, as it turns out, lives with her grandmother. The grandmother is raising the woman’s young child, and the woman is a substance abuser who has never held a job.

While the patient is in the hospital she has a manic event, and the doctors and nurses find out that she’s bipolar. The health care team has to figure out if she’s stable enough to release from the hospital and if she’ll be able to handle the physical complications of taking HIV drugs as well as her bipolar medicine, which don’t mix well. They consider her home situation and the level of irresponsibility her past reveals. Can her grandmother take on the responsibility of caring for her as well, and will she be able to avoid high risk behaviors in the future?

To answers these questions, representatives from each different profession collaborate.

At the case event the students are broken up into teams of around two medical students, two nursing students, one social worker and one pharmacy student, and they are given the patient scenario in phases. They have one hour to work on the case, choosing a diagnosis and devising a discharge plan.

The expert panel that created the case nugget attends the case event in the last hour and goes over the student teams’ responses, asking them to discuss how they came up with a diagnosis and making sure their recommendations for follow-up care are thorough.

“People in these different health care areas don’t often have an opportunity to get together and hear from one another,” said Svinicki. “The medical students tend to make diagnoses and come up with treatment plans, and the pharmacy students typically end up dealing with medications, for example. There’s been a long tradition of personality differences and biases among the professions, and those sometimes form barriers to the team approach. In some instances, one group may not trust or understand the other.

“After the case event, participants are asked to rate the inter-professional team experience and also asked from which health care profession they learned the most. Everyone almost always says they gained the most unexpected and useful information from the social worker. Each team member has specific expertise and is seeing something that the others don’t see, and what we hope they learn as a team is that each person doesn’t have to know everything. Other professionals are right there and available – use them.”

Svinicki said that she sees her directorship of the education committee as an opportunity to showcase innovative instructional processes and techniques developed in the College of Education and plans to add an ethics component and simulated patient care to the case nugget in the near future.

The next case event is scheduled for Feb. 12 and deals with a geriatric patient’s health concern.

—Kay Randall, University Communications, 512-232-3910