Building Mutual Respect and Teamwork Among the Healthcare Professions

Hospitals and health sciences schools across the country are recognizing the need for interprofessional teamwork. They realize that health care providers, as well as those who train them, need to move beyond the stereotypes of the different professions and the culture of hierarchy. The goal is twofold: better patient care and more satisfied healthcare workers.

Programs currently underway in schools include small discussion groups, role-playing, and pairing medical and nursing students in simulation exercises. At CUMC, the Narrative Medicine Program plays an important part.

Rita Charon, MD, PhD, professor of clinical medicine and director of the Narrative Medicine Program at the College of Physicians and Surgeons, is well known for her work using narrative skills to help healthcare professionals to understand patients’ experiences, as well as what they themselves undergo as clinicians. “When narrative medicine training began,” she says, “we knew that developing reading and writing skills made clinicians more attentive and perceptive. It was a revelation to me that another result was team building.”

The Josiah Macy, Jr. Foundation has supported a number of projects in interprofessional teamwork. In 2009, the foundation funded a planning year for faculty from the four CUMC schools to investigate healthcare team development. Throughout 2010, eight participants, two from each school, met for bimonthly seminars. Using methods from the Narrative Medicine Program, they worked on breaking down the walls that divide the professions.

“One of the most satisfying aspects of the program,” says Janice Smolowitz, DNP, EdD, professor of clinical nursing and associate dean, practice, at the School of Nursing, “was that we formed new relationships that extended beyond the seminar. There are people I now feel I can approach if I have a problem or question, whereas before I wouldn’t have.”

Smolowitz points out that all the professions work under the stresses of structure. “But a program like this,” she says, “can help us to break down the structural barriers that interfere with our delivering the best health care possible and that diminish the professional and personal satisfaction we derive from our work.”

The real cultural change, says Martin Davis, DDS, senior associate dean for student and alumni affairs at the College of Dental Medicine, will come from students.  “A great example,” he says, “is CoSMO (Columbia Student Medical Outreach), a program that provides medical services to uninsured residents of Upper Manhattan. Although CoSMO was started by a group of first-year medical students, it quickly expanded to include students of dentistry. The hope is that they will soon be joined by nursing, public health, and social work, all working together on a common goal: the patient's health.”

Debra Kalmuss, PhD, professor of clinical population and family health at the Mailman School of Public Health, said that the participants in the planning year seminars had no idea what they were getting into. “I loved the narrative work,” she said. ”I think we all shared parts of ourselves that we wouldn’t have otherwise; that process has the potential to make better listeners and communicator of all of us.”  She added, however, that learning to be better communicators is only one part of what is needed to foster interprofessional teamwork. ”Change also has to take place at the structural level, which enforces the existing hierarchies and professional barriers. I also think that economic factors are going to change how health care is delivered in this country, and those changes will affect how the professions interact with and relate to one another.”

As medicine becomes more high-tech, the need for interprofessional teamwork becomes only more critical. “The age of the independent solo practitioner is over,” says Ronald Drusin, MD, professor of clinical medicine and vice dean for education. “The Norman Rockwell image of the kindly family doctor was meaningful when medicine had far fewer technical tools in its armament.  But patient care now involves many more practitioners, with many kinds of expertise.  Medicine is practiced in teams―teams of physicians from different disciplines and teams of healthcare professionals, including physicians, nurses, dentists, public health workers, and social workers.”

As the 2010 seminars drew to a close, the question became, how are we going to teach this? The answer was interprofessional education seminars across the four schools. The pilot programs will be funded by a new $1 million, 4-year Macy grant. One seminar will launch in spring 2012, with the hope of adding two or three per semester.

The seminars will be for credit and will meet a requirement in each of the schools. Each seminar will have 16 students, 4 from each school.  Each seminar will be hosted by one faculty member, to provide continuity throughout the semester, with faculty from all four schools teaching segments of the seminar. The topic for the first seminar will be “The Cultures of Health, Illness, and Health Care.” In future semesters, seminars will be offered in “The Patient’s Lived Experience of Chronic Illness,” “The Self-Telling Body,” “ Professional Teams in End-of-Life Care,” “Caring for Underserved Populations,” and “Communities of Practice in Healthcare Settings.” The expectation is that eventually all CUMC students will participate in the seminars as part of their professional training.

The Macy grant is also funding two related projects. One, at Mailman, is the development of a certificate program in healthcare team effectiveness. The other is a demonstration project at the College of Dental Medicine for enlarging the scope of dental practice to include screening for prevalent conditions such as diabetes and hepatitis C, as well as arranging medical treatment for identified cases of disease..