Teaching interdisciplinary geriatrics team care

Abstract

Objectives: Addressing the current fragmentation and lack of coordination of health care requires that health professionals be skilled and motivated towards interdisciplinary team care. The objectives of our program are to (1) enhance attitudes towards team health care and (2) improve group interaction skills among interdisciplinary health care learners.

Description: We nested an educational intervention focusing on skills and attitudes in interdisciplinary team care within a one-month rotation in an interdisciplinary geriatrics clinic. One day each week, a morning is devoted to small-group seminars, and learners participate as members of an interdisciplinary geriatrics clinical team in the afternoon. Learners are from four disciplines and include an internal medicine resident, a nurse practitioner, a social worker, and pharmacy students. During the small-group seminars, eight hours are spent focusing on team care through facilitated discussions with assigned readings that include (1) motivational information and personal stories regarding the fragmented nature of current health care and personal attitudes and experiences with team care (2 hours), (2) a review of selected effective group communication skills (e.g., querying another learner about reasoning behind a statement before responding with a counter-opinion) (one hour), (3) case studies with team care planning and debriefing on group process behaviors (four hours), and (4) exploration of the potential relevance of team care to learners' own career paths (1 hour). The remaining seminars are devoted to topics in clinical geriatrics and managed care, and to reviewing patient files for the afternoon clinic. In the interdisciplinary clinic, learners spend an additional 18 hours seeing patients with a team that includes faculty from each of the four disciplines. Patients are seen jointly, and care plans are developed and implemented collaboratively. The primary outcome measures are pre- and post-rotation attitudes regarding interdisciplinary team care. Concurrent controls who do not participate in the program are also assessed. Additional measures include faculty observation of communication behaviors, review of written interdisciplinary care plans, and learner perceptions of the value of the rotation. After a one-year planning and pilot period, the educational program is now in its third month of operation.

Discussion: Previous team-care training programs for health professionals have demonstrated difficulty in fostering effective attitudes and skills. During the planning and pilot year, we identified barriers to success that included (1) negative baseline attitudes toward interdisciplinary team care, especially among medical residents, (2) unrecognized assumptions and behaviors by learners regarding authority and power relationships within the team, and (3) specific concerns by learners regarding the effectiveness and efficiency of health care teams. We hope to demonstrate success through a program that includes direct examination of learners' attitudes and their origins in a safe environment, immediate feedback regarding group behaviors, case-based learning, and direct role exposure to a well-functioning interdisciplinary team.