Making the Rounds in South Jersey
WORDS BY BARBARA HURLEY / PHOTOGRAPHS BY JOHN EMERSON
aul Boulos understands interprofessionalism better than most. "I have lots of professionals in my family," the second year student at the School of Osteopathic Medicine says, an understatement to be sure. "My father's a dentist and my mom manages his office; my brother and his wife are both podiatrists. My fiancée is finishing her first year at the Pennsylvania College of Optometry. My aunt is a psychiatrist, my uncle a nephrologist, and several cousins are pharmacists. And did I mention that my sister is a first year student here at SOM?" He stops to take a breath. "Our dinner table conversation almost always revolved around their amazing experiences."
Home for Boulos is Holmdel, and growing up and listening to these stories certainly impacted his ultimate career decision. He admits that his "first true love" was paleontology, but losing a 27-year-old cousin to complications of a congenital heart defect drew him to cardiac research at the University's Graduate School of Biomedical Sciences in Newark. He earned a Master of Biomedical Sciences degree there before deciding on SOM. Now a student senator representing the medical school, he was a natural fit to become part of the planning committee for a series of events on UMDNJ's Stratford campus that explore the future of healthcare delivery and the role of interprofessionalism.
Effective teamwork among healthcare professionals has been consistently identified as a key requirement for improved patient care and ultimately better clinical out- comes. This new emphasis on a team approach means that many professionals — not just physicians — perform a variety of specialized functions designed to meet the physical, emotional and psychological needs of the patient. But what makes healthcare professionals effective team members? How are these skills developed? How will healthcare professionals learn to understand and respect the credentials, scope of practice and function of each member of the healthcare team?
If collaborative work among the professions — interprofessionalism — is the future of excellent health professions education and healthcare delivery, UMDNJ's Stratford campus is setting the pace.
These are some of the questions at the core of the InterSchool Collaboration Group formed by the six schools of the University with programs on the Stratford campus. In 2009, the Group introduced an Interprofessional Grand Rounds (IPGR) series, a response to a call to action from the Institute of Medicine and other leaders in health professions education to embrace and advance the concept of "team."
Grand rounds have traditionally been an important teaching tool and ritual of medical education and inpatient care. Usually a specific medical problem and a particular patient were presented to an audience of doctors, residents and medical students. Over time, Grand Rounds have evolved into sessions rarely having a patient present and more closely resembling a lecture. Adding a new dimension to the concept, the IPGR presents the broader picture, welcomes all healthcare professionals, and stresses the value of working together to better serve the patient.
Planning the IPGR in Stratford has itself been an exercise in collaboration among the schools and the Student Senate. Students from all the schools are invited, and nearly 200 on average attend the hour-long, late afternoon sessions. These events have covered a variety of topics from an interprofessional perspective: Diabetes and Weight Loss, Alzheimer's disease, Fragile X and Autism, for example.
The latest session, on April 26, focused on smoking and health and an interprofessional approach to a patient with chronic obstructive pulmonary disease and emphysema. Faculty included professors and instructors from six UMDNJ schools in Stratford, and Student Senator Boulos served as moderator. "The campus goes smoke free on July 1," he notes, "and the Grand Rounds
was planned with this in mind. We looked at smoking and disease. But on the positive side, we also got to see how many resources there were to help smokers."
Boulos sees the IPGR as windows into his future, which at this point he thinks may be research. Whether he ultimately finds himself in a laboratory or a physician's office, he already understands how important it will be to patient outcomes for the lines of communications between professions to be open. "I think health care is becoming less about the disease and more about the individual patient," he says, "and this will require a better understanding of how the different professions interact. Everyone needs to be on the same page."
The IPGR project is coordinated by the School of Osteopathic Medicine, the largest school in Stratford, and not coincidentally the one led by Thomas Cavalieri, DO, a recognized national expert on interprofessional education. He was an invited participant in a public-private collaboration of the Health Resources and Service Administration (HRSA) and various foundations that explored team-based competencies as a foundation for education and clinical practice. And previously he had been appointed by the Secretary of Health and Human Services to the advisory committee on HRSA's interdisciplinary and community- based linkages.
"Professional education has been very discipline specific," Dean Cavalieri notes. "Our Interprofessional Grand Rounds ask faculty to go beyond sharing content in their own field of expertise to talk instead about the potential of collaboration." And he is quick to add that the ultimate goal is to demonstrate how patients benefit when healthcare professionals work together. He is convinced they will.
A New Spin on Rotations
illian Longobardo admits that she completed her rotation in OB/GYN at Our Lady of Lourdes in Camden with "chills and tears in her eyes." You see, she had delivered three babies during this "incredible experience." But Longobardo, starting her third year in UMDNJ's Physician Assistant (PA) program, was also one of the first on the University's southern New Jersey campus to experience a new way of looking at clerkships, or rotations, where future healthcare professionals are trained to function as team members.
|NIÑA TAMAYO, SOM '13, AND PA STUDENT JILLIAN LONGOBARDO|
Longobardo's appreciation for teamwork came when a good friend who was a physician assistant encouraged this pre-med student to shadow her before choosing a career direction. "I'm an outgoing, friendly person and saw that PAs got to spend a lot of time with patients," Longobardo recalls. "But I also saw how closely the PAs work with doctors."
This year for the first time students at the School of Osteopathic Medicine (SOM) shared rotations with four PA students and also saw firsthand just how closely the two work together. Medical school students have traditionally spent the first half of their training in the classroom and the second half in clerkships in teaching hospitals. There they rotate through different medical specialties and treat patients under the supervi- sion of physicians. They learn by viewing and doing.
Now a third year medical student at SOM, Niña Tamayo has been doing just that. She met Longobardo on the OB/GYN rotation. "I felt camaraderie with Jillian from the moment we met," she remembers. "We would see patients together and discuss interesting cases. I never really had the mindset that she was the PA student and I the med student."
Tamayo came to medical school from Chicago with a background in public health and nutrition where she had already experienced working as part of a team. "Bringing professionals together not only facilitates the communication process and gets everyone on the same page," she says, "but it also helps us tackle a problem from different angles and improve our approach to patients. I think it encourages thoroughness and creativity."
|PA STUDENT KELLY WEBB|
Matthew McQuillan, MS, PA-C, is the assistant director for clinical education in the PA program, located in the School of Health Related Professions. "Now all the University's medical schools have inter- professional clerkships," he says. Besides the educational importance of clinical training, he believes that this shared experience will lead to the mutual understanding and respect that will advance collaboration among the health professions.
How are the interprofessional clerkships working? "Well," according to PA student Kelly Webb, who is completing an eight-week rotation in internal medicine at Kennedy Hospital in Washington Township. "We are all just students with the same expectations," Webb reports. "I think the med students now have a greater respect for PAs and what we do. They asked lots of questions."
Webb herself answered some weighty questions about her own future before embarking on PA training. An art school graduate working as a graphic designer, she decided that life sitting all day in front of a computer screen was not for her. She enrolled in a post-baccalaureate pre-med program at Rider University to prepare for shifting gears into a new career. She is enthusiastic about her decision and has enjoyed the interaction with medical students. "In the long run," she notes, "it's about knowledge and each team member understanding and respecting what the other one knows."
Dentistry & Medicine, Better Together
he Journal of the American Osteopathic Association recently published a letter submitted by faculty members at UMDNJ-New Jersey Dental School and UMDNJ-School of Osteopathic Medicine describing a successful collaborative venture that integrated modules dealing with oral health issues into the osteopathic medical curriculum. The faculty signing the letter were all key to the success of this educational innovation. Their thoughts are summarized below.
The Oral Cavity and Total Body Health
Hundreds of diseases affect and manifest themselves in the oral cavity, and a developing area of knowledge and research connects oral and systemic health. Conditions such as periodontal disease, for example, may impact such systemic conditions as cardiovascular disease and diabetes mellitus. Conversely, systemic disease can adversely impact the oral cavity.
Head and neck cancers are an area of particular concern. In many patients, diagnosis of these cancers is not made until the disease has metastasized; consequently the five-year survival rate has remained at only about 50 percent. By expanding awareness among physicians of the clinical appearance of oral and head and neck cancers, more precancerous lesions and early cancerous lesions could be detected, vastly improving the cure rate.
Comprehensive oral, head and neck examinations will allow physicians to observe adverse oral health conditions, leading to appropriate diagnoses and referrals for treatment. In addition, multiple diseases that have oral manifestations will be diagnosed in a more accurate and timely manner, improving treatment for the patient.
An Innovative Collaboration
These concepts were the driving force of a groundbreaking collaboration between the University's New Jersey Dental School (NJDS) and the School of Osteopathic Medicine(SOM). The result was a unique curriculum on oral health for osteopathic medical students and the creation of a Department of Dental Medicine at the medical school.
Faculty from the dental and medical schools developed a dental medicine curriculum taught within existing medical disciplines as modules to coordinate with and enhance the education of osteopathic medical students. These modules are currently integrated into the second, third and fourth years of the medical curriculum. They build upon each other and require students to call upon knowledge gained in other medical classes.
The modules range from Comprehensive Oral/Head and Neck Examination to Prevention and Early Detection of Oral Cancer to Clinical Pathways Protocol. The latter protocol was developed at the dental school and is now shared with the osteopathic medical students. The focus is an algorithm for patients who have specific medical diagnoses that may require dental or oral consultation or additional treatment before, during or after primary medical treatment. The goal is to teach students to deal with oral conditions and improve medical treatment outcomes.
Education Beyond the Lecture Hall
In addition to classroom-based lectures and laboratories, second- year medical students have the opportunity to rotate through the UMDNJ Dental Center to observe patients being treated for various oral conditions, allowing them to observe the clinical application of the knowledge they have gained.
In their third year, students participate in an Enrichment Program as part of their family medicine clerkship. Students are presented with a series of case-based scenarios covering the oral-systemic connection and dental medicine in various medical specialties. Each student has an opportunity to discuss and present a differential diagnosis, drawing upon previous experience in both the medical and dental medical curricula.
The faculty of the Department of Dental Medicine is also involved in the fourth-year geriatric program at SOM. There are plans for further enrichment of the curriculum in such areas as head and neck pain and treatment of dental pediatric patients.
Both medical and dental professionals need to be aware of the importance of assessing, managing and referring patients with oral health problems in order to maintain the optimal general health of patients. The oral health curriculum for osteopathic medical students at UMDNJ has proven to be a successful approach to enhancing skills and raising awareness.
Arnold H. Rosenheck, DMD,
Assistant Dean, Acting Chair, Community Health, NJDS
George J. Scott, DO, DPM, Assistant Professor,
Family Medicine, SOM
H. Timothy Dombrowski, DO, MPH,
Associate Professor, Chair, Internal Medicine, SOM
Harold V. Cohen, DDS,
Professor, Diagnostic Sciences, NJDS
Jill A.York, DDS, MAS,
Associate Professor, Community Health,
Alan Kleiman, DMD,
Clinical Instructor, Oral and Maxillofacial Surgery,
Community Health, NJDS
Joshua S. Coren, DO, MBA,
Acting Chair, Associate Professor, Family Medicine, SOM