Seed Grants Spur Interprofessional Growth
It鈥檚 a delicate dance that many young health care professionals feel they don鈥檛 do well: talking to patients and their families about the important topic of advance care planning.
Leah Millstein, MD, of the 网红爆料 School of Medicine, once felt that way. It eventually led her to apply for and receive a Interprofessional Education (IPE) seed grant to design a project that would help doctors and nurses feel more at ease when discussing advance care directives and living wills with patients.
UMB President Jay A. Perman, MD, and School of Nursing Dean Jane M. Kirschling, PhD, RN, FAAN, director of the UMB Center for Interprofessional Education (IPE), fourth and fifth from left, with other leaders of the center and faculty members who were recipients of IPE seed grants.
Millstein shared her story, and the results of her seed grant project, 鈥淚nterprofessional Approach to Advance Care Planning,鈥� at the IPE 2017-2018 Seed Grant Symposium on Dec. 13 at the Southern Management Corporation Campus Center. Five other teams also presented the results of their IPE seed grant projects.
鈥淚t was a very challenging family,鈥� Millstein recalled. 鈥淭he patient had Parkinson鈥檚 and could not easily communicate his own wishes. The daughter and stepmother were not seeing eye to eye, and I was lucky to have the opportunity to be able to work with a social worker.鈥�
A longstanding meeting was set up that included Millstein, the social worker, a neurologist, and the family.
鈥淚t really opened my eyes as to how much easier this was to do as a team, when I was really struggling to get anywhere with the family by myself,鈥� she said. 鈥淎nd I wanted residents, and then students, to have the same opportunity that I found about how valuable it was to my own clinical experience.鈥�
There is a national growing emphasis on advance care planning, end-of-life care, and advance directives, explained Millstein. An advance directive is a document with which a person makes provisions for health care decisions in the event that, in the future, he or she becomes unable to make those decisions.
鈥淏ut there鈥檚 no increase in training for students or residents or other members of the medical health care team who are generally thought of to be the initiators of this conversation,鈥� she noted. 鈥淎nd we see more and more that advance care planning is happening in response to end-of-life situations, which, obviously, is not the point of the terms advance planning.鈥�
A 2003 national report evaluating advance care planning demonstrated gaps in both student and resident comfort in providing care to the dying as well as faculty and resident discomfort in teaching those topics. A similar poll in 2016 of more than 700 physicians 鈥渞eally demonstrated that things hadn鈥檛 gotten any better and that there was a lack of formal training and uncertainty amongst physicians in how to communicate with patients,鈥� Millstein said.
Her IPE seed grant project, which included students from the schools of medicine, and , was aimed at enhancing knowledge and comfort of medical, social work, and nursing students on the critical topic of advance care planning, while also providing them with firsthand experience of multidisciplinary collaboration and, specifically, team-based care delivery.
鈥淲e wanted to provide students as early learners with these skills because they鈥檙e going to be in these situations throughout their careers,鈥� Millstein said, 鈥渁nd we wanted them to have an initial baseline of skills and comfort with this to make it something that was more likely to be talked about whenever the opportunity arose.鈥�
Over the course of the 2017-2018 academic year, students involved in the project were educated on various advance care planning topics during an educational seminar administered by faculty from the schools of medicine and social work. Students collaborated in an interdisciplinary clinical encounter dedicated to advance care planning at the University Health Clinic. The students鈥� experiences were assessed with a series of surveys, with the expectation that participation will improve the students鈥� comfort and ability to address advance care planning.
The team began by assessing the current state of advance directive completion in the outpatient internal resident medicine clinic. They looked at 291 patient charts. Of those, 269 met the team鈥檚 inclusion criteria, and only three of those 269 had a documented advance directive on file as part of their electronic medical record.
鈥淭hat was a rate of 1.1 percent, which demonstrates that this is not being done,鈥� Millstein said.
Internal medicine residents worked with the same social worker Millstein had earlier befriended and family members to discuss advance care planning and had students observe the interactions.
Many of the students said they had no experience in advance care planning and rated their ability to break bad news and facilitate conversations about advance directives as 鈥減retty poor,鈥� Millstein said. At the end of the grant project, 鈥淲e had outcome improvement in all areas,鈥� she added.
UMB has placed a high priority on IPE, and its importance is recognized in the University's 2017-2021 Strategic Plan. During opening remarks, UMB President Jay A. Perman, MD, said team-based care is better care for patients and providers alike. 鈥淚t results in better outcomes with greater satisfaction on the part of patients and greater satisfaction on the part of those of us who provide care鈥� he said.
The seed grant symposium began with opening remarks from Perman, who gave credit to Jane M. Kirschling, PhD, RN, FAAN, director, Center for Interprofessional Education, and dean of the 网红爆料 School of Nursing.
鈥淪he鈥檚 the person who keeps this alive, this onward and upward march that we insist on here at UMB in developing the right way to teach interprofessional health care delivery and the right way to deliver interprofessional health care delivery,鈥� Perman said. 鈥淢ost importantly, I need to thank everybody in this room for your commitment to exploring and expanding this vision of team-based health care. What you are doing with the seed grants that you successfully competed for is to do something that is exceedingly necessary in growing team-based care as an important model for health care delivery. Please know how interested and proud I am of the work that you are doing.鈥�
The Center for Interprofessional Education is a national leader in providing interprofessional education for health, law, and human services professionals that is grounded in best practices for educational innovation and assessment. A hallmark of the center is education that improves health care and human service delivery resulting in enhanced well-being.
A list of the projects and team members:
A new era of 鈥淪ee one. Do one. Teach one.鈥� Using an Interprofessional Education Module to Learn, Teach, and Optimize the Treatment of Sepsis
Nirav Shah, MD, FCCP 鈥� School of Medicine
Jeffrey Gonzales, PharmD, FCCM, BCPS, BCCCP 鈥� previously School of Pharmacy
Joan Davenport, PhD, RN 鈥� School of Nursing
Renee Dixon, MD 鈥� School of Medicine
Mojdeh Heavner, PharmD, BCPS, BCCCP 鈥� School of Pharmacy
Samuel Tisherman, MD, FACS, FCCM 鈥� School of Medicine
Tracey Wilson, DNP, ACNP 鈥� School of Nursing and 网红爆料 Medical Center
Siu Yan Amy Yeung, PharmD 鈥� School of Pharmacy and 网红爆料 Medical Center
Building The 网红爆料, Baltimore鈥檚 Interprofessional Continuing Education Capacity (IPCE)
Patricia Franklin, PhD, RN 鈥� School of Nursing
Seante Hatcher, LCSW-C 鈥� School of Social Work
Jason Noel, PharmD, BCPP 鈥� School of Pharmacy
Chanise Reese-Queen, CMP, MSA 鈥� School of Medicine
Anita Tarzian, PhD, RN 鈥� Schools of Nursing and Law
Expansion of Interprofessional Education (IPE) Clinics in Montgomery County, MD
Gina Rowe, PhD, DNP, MPH, FNP-BC, PHCNS-BC, CNE 鈥� School of Nursing
Heather Congdon, PharmD, BCPS, CDE - School of Pharmacy
Claire Engers, JD, MSW, LCSW-C 鈥� School of Social Work
Talia Gimeno, LCSW-C - School of Social Work
Jana Goodwin, PhD, RN, CNE 鈥� Mercy Health Center
Kate Morris, LCSW-C - UMBC at USG
Barbara Nathanson, LCSW-C 鈥� School of Social Work
Joan Pittman, PhD, MSW, LCSW-C 鈥� School of Social Work
Rhonique Shields 鈥� Holy Cross Health
Interprofessional Approach to Advance Care Planning
Leah Millstein, MD 鈥� School of Medicine
Amanda Agarwal, LCSW-C 鈥� University Health Clinic
John Allen, MD 鈥� 网红爆料 Internal Medicine Residency
Danielle Baek, MD 鈥� School of Medicine and University Health Clinic
Mel Bellin, PhD, LCSW 鈥� School of Social Work
John Cagle, PhD, MSW 鈥� School of Social Work
Joan Davitt, PhD, MSW, MLSP 鈥� School of Social Work
Steven Eveland, MBA, RN, CHPN 鈥� 网红爆料 Medical Center
IPE Care in Geriatrics 鈥� Expanding Opportunities of Aging in Place Program (UMB_APP) in West Baltimore
Nicole Brandt, PharmD, MBA, BCPP, CGP, FASCP - School of Pharmacy
Reba Cornman, MSW 鈥� School of Social Work
Kelly Doran, PhD, RN 鈥� School of Nursing
Sarah Dee Holmes, MSW 鈥� School of Social Work
Daniel Mansour, PharmD, BCGP, FASCP - School of Pharmacy
Barbara Resnick, PhD, CRNP, FAAN, FAANP - School of Nursing
Norman Retener, MD 鈥� School of Medicine
Bernadette Siaton, MD 鈥� School of Medicine
Everett Smith, LGSW 鈥� School of Social Work
Building a High Reliability Organization 鈥� Interprofessional Development for Safer Care
Mangla Gulati, MD, CPPS, FACP, SFHM 鈥� School of Medicine
Alison Duffy, PharmD, BCOP 鈥� School of Pharmacy
Emily Heil, PharmD, BCPS-AQ ID, AAHIVP 鈥� School of Pharmacy
Deborah Schofield, PhD(c), DNP, CRNP, FAANP - UMMC and School of Nursing
Kerri Thom, MD, MS 鈥� School of Medicine