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Dentistry integral in University of Michigan’s first interprofessional education course

June 15, 2015

By Kimber Solana

Editor’s note: This is the first in a series of ADA News articles on interprofessional education, a teaching model that emphasizes a need for students from different health care professions to learn and work together to improve the quality of patient care.

Interprofessional Education logo
Ann Arbor, Mich. — A patient recently diagnosed with tongue cancer is about to start radiation therapy. He has urgent dental problems, difficulty swallowing that’s becoming worse and other health problems. He lives far away from a medical center and runs a small business that depends on him to be there.

What is the optimum way to develop the best treatment plan for the patient and make sure he receives the best possible care for all his needs? The answer: Various health professionals — a dentist, physician, nurse, pharmacist and a social worker — have to work together.

This scenario is part of the University of Michigan’s first interprofessional education course that launched in January, involving about 300 students from the schools of dentistry, medicine, nursing, pharmacy and social work. Of those students, about 115 were third-year dental students.

 “There’s not one right answer, but there are elements of a good answer. And they can only achieve those by working together,” said Dr. Carol Anne Murdoch-Kinch, associate dean for academic affairs at the UM School of Dentistry. “The main thing is that all the problems of the patient are addressed, and the team members use a cohesive approach to providing care to the patient.”
Although there’s literature about interprofessional team-based care going back 40 years, a number of things are occurring today that’s prompting the need for IPE. It’s a teaching model, though it varies by institution, that educators around the country say is becoming more necessary as health care reform continues to reshape the future of health care delivery and focus.

The IPE model is a foundation for team-based practice, which is recognized as one of the most promising solutions in increasing the quality of health care patients receive while addressing the increasing cost of health care in the country, said Dr. Richard W. Valachovic, president and CEO of the American Dental Education Association.

“The focus of the future clearly is in team-based care,” he said. “But if it is the wave of the future, the question for us becomes, where does dentistry fit in?”

At UM’s semester-long IPE course, which is the culmination of over three years of planning, dentistry is an integral part of providing collaborative patient care.

Three years ago, the university sent an interprofessional team to the first Interprofessional Education Collaborative Institute, a collaboration of six national education associations of schools of the health professions formed in 2009, to study and learn what was going on at the national level, about different IPE programs in the country and receive guidance on developing a pilot program for their institutions.

Afterwards, the UM team and faculty created several pilot programs including one that put nursing and dental students and pediatric dental residents in a clinic to provide preventative care for children and to better understand barriers involved in interprofessional settings. Last year, the school took a step further with a pilot program through the school’s community-based dental education program.

At one of the school’s 30 CBDE sites, the Hamilton Health Center in Flint, Michigan, fourth-year dental students work directly with students in other health care professions as part of an two-week rotation at the site. The dental students are involved in the initial physical assessments of the patients working with the nurse practitioner students. Not only are they providing dental care, they play an integral role in physical assessment.

In addition, the UM’s IPE effort received a $3 million “transformation” grant through the provost’s Third Century Initiative — developed to fund innovative teaching and scholarship approaches — and a $3 million matching grant from the school’s health sciences dean to transform the learning experience and learning environment for all of UM’s health profession students.

“The overall vision is that all health sciences students on campus will engage in multiple interprofessional education and practice experiences appropriate to their future practice, chosen from a menu of diverse activities, courses or clinical rotations,” Dr. Murdoch-Kinch said. “And every program will determine what the appropriate amount of mandatory or elective experiences will be for their profession.”

Dr. Mark Fitzgerald and Dr. Gundy Sweet

Instructors: Dr. Mark Fitzgerald, of the University of Michigan School of Dentistry, and Dr. Gundy Sweet, of the College of Pharmacy, discuss how the first day for one of the university’s first interprofessional education course went. The two professors taught a group — one of five groups — of 52 students in dentistry, medicine, nursing, pharmacy and social work.
The first of those experiences the school created was the IPE program that launched in January. About 300 enrolled students were divided in teams of about seven each, with about two students from the School of Dentistry. The class was also mandatory for 75 third-year students from the School of Pharmacy, and required for Integrated Health Scholars and Detroit Clinical Scholars from the School of Social Work. The class was an elective for other social work students — totaling 36 students. Another 20 medical students and 16 graduate nursing students chose the course as an elective.

The teams were grouped into five sections — each participating school led a specific course or module. Every two weeks, the teams move to another building on campus to take on a different case.

At the School of Dentistry, the case of the patient diagnosed with tongue cancer was led by a dental faculty member, along with a pharmacy faculty member — an interprofessional collaboration among faculty.

The patient case involved an older male who had a history of tobacco use and alcohol consumption. The dental implications in the problem were clear. There were teeth that needed to be extracted, and radiation therapy is known to significantly affect oral health. But the students also had to take into account the patient’s overall health, unique family situation, insurance coverage and access to care. All of the health professions had a very important and specific role to play in developing the overall care plan for that patient.

“The dentist needed to work with the radiation doctor or physician; the social worker helped the others understand how the patient was going to access the health care he needed,” said Dr. Murdoch-Kinch. “The pharmacy students helped the other understand the drugs the patient will be taking, what he’s taking now and how chemotherapy would interact with his medications.”

The patient’s desires and needs were paramount to the final care plan. For dental students, there may be a time in the treatment process when the teeth become less important than, for example, surviving.

The first semester ended in April. While there will be changes and tweaks to be made, overall, it was well-received, said Dr. Murdoch-Kinch. An executive committee is currently evaluating the first semester to discuss what worked well, what could be improved, and how to move forward.

“As you would expect from any classroom setting, especially using team-based learning, some teams will be really effective, some less,” said Dr. Murdoch-Kinch. “Some issues are related to personalities and preferences, some related to skill level and prior experience to working in teams. But that’s the real world.”

To study how the concepts of the IPE course are applied in the real-world practice settings, the third-year dental students — who became fourth-year dental students in May — will begin their rotation at UM’s clinics, including the Hamilton Health Center. The students will be part of the first group going in these clinics with a preparatory course.

students of dentistry, medicine, nursing, pharmacy and social work in the Kellogg Auditorium at the University of Michigan School of Dentistry
Introductions: About 50 students of dentistry, medicine, nursing, pharmacy and social work gathered in the Kellogg Auditorium at the University of Michigan School of Dentistry to participate in the school’s first course in interprofessional education.
“Any course or clinical experience we design has to be relevant to the real world that the student will enter upon graduation. Students can recognize right away when something is not authentic or it’s something they’ll never apply,” Dr. Murdoch-Kinch said, adding that the committee has already collected data from previous fourth-year students for comparison to the group with the preparatory course.

In addition, UM is currently working on developing an integral interprofessional special needs clinic — a location has already been identified — that will provide interprofessional care for patients with special needs. The focus for the clinic will be on dental care, but together, nursing, social, pharmacy and medical students and faculty will be providing a “one-stop” place for an integrated care model for the patients.

“We have pretty lofty goals and we are deliberately taking a scholarly on our approach to doing this. We’re not just doing it because it sounds like a good idea,” she said. “We need to assess if changing the way we teach health profession students and provide team-based care to patients actually makes a difference in outcomes. We want to have the evidence to support the best approaches to educating health professionals and improving health. And if it doesn’t lead to improvements, we have to keep looking and searching for the best ways to achieve that. That is the end goal.”