Inter-professional Educationin the

Clinical Setting

Miguel Olmedo DNP, FNP-cNP Residency Director

Family Health Center of Worcester

Objectives

Participants will be able to:

• Describe the FHCW NP Residency Program

• Demonstrate understanding of the IPE currently taking place at Family Health Center of Worcester

Family Health Center of Worcester

• FQHC

• Over 33,000 patients seen yearly

• Over 37 Languages

• Onsite Services

• Teaching site for family medical residents, medical students, NP’s, pharmacy students and PA students.

Nurse Practitioner Residency

• Post graduate NP residency which began in 2009

Focus on primary care in community health

• Twelve month residency with subsequent year commitment

• Only NP Residency in Massachusetts

CHC – Connecticut

PCHC – Maine

13 others Nationwide

Why A Residency

Impetus of the residency - fifty percent NP turn over between 2003-2008

Exit interviews: factors included complexity and size of patient panel, increased stress, long hours and limited clinical support

Residency Overview

• Focuses on increasing clinician autonomy, improving competence and enhancing clinical confidence in community health setting

• Clinician retention

• Designed in such a way that residents train along side other disciplines (team) in order provide optimal care and improve clinical outcomes

Benefits

Better equip Nurse Practitioner to take on full responsibility of comprehensive primary care for complex underserved populations across all life cycles

Build upon the education and clinical knowledge acquired in academia through an intensive clinical and inter-professional mentorship experience

Residency Goals

• Improve clinical confidence

• Enhance provider autonomy

• Refine and foster clinical skills that will enhance patient care outcomes

• Improve overall comfort in managing complex patients

• Foster and strengthen inter-professional collaboration

Clinic Schedule

• Residents have 7 primary care clinic sessions per week

• One subspecialty clinic per week

• One session for clinical didactic per week with Umass Family Medicine Residents

• All clinic sessions are precepted by FHCW faculty providers (MD and NP) that are blocked specifically to mentor

• Over 1400 visits per year

Fostering Inter-professional Education/Care

at FHCW

Inter-professional Education

“the process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population… involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to optimize the patient’s participation… Inter-professionality requires a paradigm shift, since inter-professional practice has unique characteristics in terms of values, codes of conduct, and ways of working. These characteristics must be elucidated”

(WHO, 2010)

What is IPE?

Inter-professional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes

(WHO,2010)

Why IPE

• “When multiple health workers from different professional backgrounds work together with patients, families, caregivers and communities, they are likely to deliver the highest quality of care”

(WHO, 2010)

Inter-professional Education at FHCW

• FHCW embraces inter-professional care/education model

• Current healthcare disciplines: Medical, Nursing, Pharmacy and Behavior Health

Ongoing Inter-professional Education

• Weekly Didactics

• Variety of primary care clinical topics that MD faculty present to residents (NP and MD)

• Classroom setting

Ongoing Inter-professional Education

• Team Precepting

• Behavioral Health Faculty• MD/NP faculty• Pharmacy

• Observe clinical care by NP or MD residents and provide “real time” feedback for an entire clinical session

Commentary/feedback may include – communication, physical exam, Dx and Management, fund of knowledge, education, overall patient interaction…..

Ongoing Inter-professional Education

• Chart Rounds

• Daily clinical discussions post session

• MD/NP/Pharm.D./Behavioral Health disciplines (students and faculty)

NP Residents are mentored by:

• MD & NP faculty

• Behavioral Health faculty

• Pharm.D. faculty

MD Residents are mentored by:

• MD & NP faculty

• Behavioral Health Faculty

• Pharm.D. faculty

IPE is dynamic, hands on learning that is taking place at FHCW daily

Residents feel part of a team that is patient centered and comprehensive

Preliminary Results

• NP Residents perceive themselves as more competent and autonomous in providing care

• Feel part of IP holistic care team

• Likely to remain working in FQHC

How do Residents feel?

• “I thought is was a wonderful experience, we learned a lot from one another”• Shelby Freed FNP – NP Resident 2011

• “It’s great that we have the opportunity to work with and learn from other health professionals during clinic sessions”• Toy Lim FNP - NP Resident 2012

• “This program is transformative in terms of residents (MD and NP) ability to solve clinical problems and develop comprehensive treatment plans”

• “There is no substitution for group education in this model”

Mathew Silva Pharm.D.

Associate Professor

Massachusetts College of Pharmacy and Health Services

Worcester, Ma 01610

Future of IPE

• Transforming how learners are learning and patient care is provided

• Promising

• “Equipping a workforce with new skills and new ways of relating to patients and each other demands both retraining of the current health professions workforce and inter-professional learning approaches for preparing future health care practitioners” (IOM, 2001, p. 19)

“

“If you’re expected to work together why not learn together?”

Ivy F. Oandasan MD Associate Professor and Research Scholar Department of Family and Community Medicine

Faculty of Medicine, University of Toronto

Acknowledgments

• Umass Medical Family Residency Department

• Family Health Center of Worcester

• Funders• Jessie B. Cox Charitable Foundation• Fairlawn Organization• Massachusetts Area Health Education Center

Thank You

Contact information:

Miguel.olmedofhcw@umassmed.edu

Office phone: 508-792-7581

645 Park Ave

Worcester, MA 01610