Working Better, Together: Interprofessional Education, Training, and Practice

Welcome to Primary Care Considered, the blog of the Student Leadership Committee at the Center for Primary Care. Featured monthly in the Center’s newsletter, this section highlights the projects, activities, and past successes of the SLC. Please join us at our events and share your thoughts!

In this post, SLC member and BSN/MSN student of MGH Institute of Health Professions, Victoria Hill, shares her personal experience working as a community health worker on an interdisciplinary primary care team, and how this experience informed her pursuit of nursing and her interest in the Interprofessional (IP) Subcommittee on the SLC. Victoria shares successes from the IP subcommittee’s first year on the SLC and her hopes for integrating multidisciplinary collaboration into all of the SLC’s work in the coming years.

I cautiously walked up the concrete path of the public housing building, unsure if I had arrived at the right unit. I rang the doorbell and waited for Roberto to answer the door. He slowly cracked open the front door, peered outside, and greeted me with a warm smile. He led me down the dark hallway to the one-bedroom apartment he shared with his adult son and grandchild. We sat down at his plastic dining room table. As he reached for a glass for water, I couldn’t help but notice the several missing cabinet doors and the barren pantry.

Roberto had missed several appointments with his primary care provider.  As a community health worker who was assigned to his case, I spoke with Roberto several times a week to check in and see how he was doing. Our interactions fell into a routine– we would often confirm an appointment for later in the week, but when the day arrived, Roberto wouldn’t arrive for his appointment and his phone would be disconnected.

Roberto’s primary care provider (PCP), mental health clinician and I often communicated about his case and strategized on what we could do to ensure he received the best possible care for his depression and uncontrolled diabetes. While Roberto and I had spent several appointments together in the clinic, it was on that crisp fall day when I visited him at home that I began to understand his life on a deeper level.

I spent the following two years working as a community health worker at a local community health center. As I worked with Roberto and other Latino patients with chronic diseases to find housing, address food insecurity, and coordinate their health care appointments, I saw many of the challenges patients face in finding the resources essential to taking care of themselves. Without the basic necessities of life–like food, financial security or housing–how can we expect patients to care for their complex medical issues?

After visiting Roberto that day in his home, I came to understand why he often didn’t make his appointments. His public housing apartment was off the side of a highway, making it very difficult for him to walk twenty minutes to catch a bus, which then took over an hour to arrive at the health center. His isolated housing situation and expensive cell phone made maintaining relationships with loved ones almost impossible. His barren pantry made managing a medical condition like diabetes very difficult.

The time I spent building relationships with patients and colleagues was what initially drew me to pursue a career in nursing and primary care. Roberto’s clinical care team, for example, included a PCP, medical assistant, practice assistant and registered nurse. His health depended just as much on his mental health clinician, with whom he visited monthly, as on the finance and access department that ensured he had health insurance and was being billed appropriately, as on the phlebotomist who drew his labs. I was struck by the fact that each of these individuals played a key role in guiding Roberto in his journey to be holistically healthy and that each person prioritized supporting his well-being.

In the summer of 2014, I left my job as a community health worker and began nursing school. As a nursing student, I have been generously mentored by experienced nurses. However, as the first few semesters of nursing school came and went, I longed to interact with other members of the care team beyond reading their notes in the electronic medical record. I have vivid memories of sitting in on rounds, during which time I was drawn into the rich interactions between the nurses, the doctors, the respiratory therapist, the pharmacist and the students. Each person held an essential piece of the puzzle in providing high quality patient care and meeting the needs of the patient.

Joining the Interprofessional (IP) Subcommittee on the Student Leadership Committee (SLC) at the Center for Primary Care offered an opportunity to fulfill that desire. Every year, the SLC selects four to five topics to focus on, and several subcommittees are formed to develop projects and events related to each theme. This was the first year that the SLC formed an IP Subcommittee. Moreover, it was the first year the committee recruited and engaged multidisciplinary students from other health professions schools throughout the city. In many ways it was a unique opportunity to be part of the first IP Subcommittee, but also the chance to work with interdisciplinary students within this organization.

Through the SLC, I’ve had the opportunity to interact with students from dental, medical, business and public health training backgrounds. Sitting at a table with my four teammates, and hashing out the plans and details for the term, brought me back to working at the community health center. I was excited to be collaborating once again with a diverse team towards a common set of goals. But this time, our objective was different. We weren’t aiming to improve clinical outcomes or identify patient needs. Rather, we aimed to find new ways to promote interprofessional education and training for others. It was thrilling, inspiring and fulfilling. It was a unique chance to be surrounded by others from different backgrounds who cared about the same things.

To meet these objectives, the IP Subcommittee planned three successful events over the course of the spring term. These events drew over 100 participants from nursing, occupational therapy, speech language pathology, medical, dental, business and public health educational tracks. The most memorable event was the IP case workshop. Diverse teams discussed a particularly difficult case in which an older adult with complex medical issues faced various safety risks while living at home alone. The interventions proposed and the rich discussions that accompanied them during the case workshop demonstrated the power of interdisciplinary collaboration, learning,  and communication.

Collaboration for complex patient care is not always a smooth process. There are often times when individuals do not agree on what the priorities or interventions should be. It’s difficult to find time within busy schedules to sit down and discuss individual cases and to build interdisciplinary plans. It can be hard to understand what one another’s roles and responsibilities are. Despite these challenges, I strongly believe that interdisciplinary practice is the best path forward, for professionals and patients alike. Moreover, if this type of collaboration can be integrated into health care clinician education and training, individuals may value this collaboration early in their careers, and be more inclined to incorporate it in their future practice.

As we move into the next SLC term, I eagerly await the powerful work that will occur. My hope for the SLC is that interprofessionalism becomes a value that is integrated into every subcommittee across the organization, rather than the focus of one subcommittee. By doing so, we can strive for not only a richer educational and professional experience, but ultimately improved patient care, satisfaction, and outcomes.

This is something I learned when working with Roberto. No individual professional can walk with a patient through their journey alone; rather, it takes a collaborative, multidisciplinary team with a common purpose to travel alongside the patient and support them in reaching their ultimate destination.

Patient details have been changed to protect patient privacy. Victoria Hill can be contacted at vhill@mghihp.edu.