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Interdisciplinary education on the HSC

campus

Report to the Kaiser Permanente Foundation December 16, 2009

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IPE Relationships

MD, PA, SODM,

SOPH, SON

HSC

AHEC

Rural Colorado

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Campus visionThe Anschutz Medical Campus of the

University of Colorado Denver was intentionally designed to facilitate collaborative, interprofessional education. Shared instructional facilities Shared faculty locations Interdisciplinary Student Academic

Communities (SACs)

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What is IPE ?

I. Students working in another discipline

II. Students working together

III. Education and training programs are conducted together.

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I. Students learning about or working in another

discipline Provides opportunities for:

Awareness Appreciation Knowledge transfer

Example: Shadowing (Learning by observation) Started in November ‘09 with

SOM, PA, Pharm and Dent. Oral health introduced into SOM Systemic topics taught in SODM

However, one student is at home, the other is not.

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IIa. Students working together as peers

Problem solving in an instructional setting Example: Interdisciplinary rural track sessions

• Healthy communities session 11/5/08• Suicide prevention session 4/22/09• Brown bag medication reconciliation 12/16/09

Dental students teaching medical students about the oral examination

New topics: Disaster training and triage Pandemic flu preparation

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IIb. Students working together as peers

Clinical service and problem solving Direct patient care that is collaborative and

benefits the patient. Ongoing examples:• Disease management clinics

– Diabetes– Anticoagulation

• NWSS health screening clinics • Health Action Day• Cinco de Mayo• Merino school health fair

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III. Education and training programs conducted

together This level of IPE activity requires campus-

wide collaboration and is a work-in-progress of the IPE steering committee Schedules Curriculum overlap Matching various levels of students Faculty roles Budgets Etc. Etc.

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III. Education and training programs conducted

together This is a goal not only of the Kaiser IRTS

program, but also of the HSC. IRTS partners from SOM, PA, SOPH, Pharm, Dent

and Nursing have been contributing, and leading the way on this goal by actively participating in the HSC IPE Steering Committee:

Albino, Judith; Armstrong, Gail; Barley, Gwyn; Barton, Amy; Bowler, Fara; Brown, Kristen; Brunson, Diane; Burtness, John; Carrothers, Terri; Childs, Marguerite; Deutchman, Mark; Earnest, Mark; Elashvili, Ana; Erickson, Vicki; Ericsson, Barbara; Franson, Kari; Gascoigne, Jan; Glicken, Anita; Glover, Jackie; Hemstreet, Brian; Huff, Jim; Kluender, Randy; Krugman, Richard; Levine, Mark; Madigosky, Wendy; Magee, Deidre; Magilvy, Kathy; Melillo, Allegra; Mellis, Karen; Montgomery, Linda; Mouton, Melissa Jo; Nair, Kavita; Potter, Brad J; Rapport Mary Jane; Silsby, Bradford; Turner, Christopher; Valdez, Connie; Yancey, Lynne

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III. Education and training programs conducted

together The Kaiser IRTS program piloted a model

IPE program in June, 2009 in the form of the Rural Immersion Week in Sterling Colorado.

Other existing models: Campus-wide ethics curriculum – ongoing IRTS oral health workshop 10/21/09

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IPE initiative overview

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IPE structure and programs

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Health Mentors Program

Interprofessional teams of 4‐6 students Paired with health mentor from the community with a

chronic physical or mental illness or disability Teams remain together for two years. Teams meet every six weeks with their mentors to complete

specific tasks Health history, experiences with access to care and care integration Experiences with illness and care, an individualized wellness plan Behavioral and mental health Prescription and over the counter drugs and safety

Embedded in this curriculum and within each task will be an exploration of roles and orientations of the different professions involved and skills building in teamwork and communication.

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IPE Rotations

Interprofessional collaborative practice experiences at clinical training sites with school-specific requirements

Model IP practices at underserved sites

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IPE Clinical Transformation

Interprofessional simulations, video monitoring and feedback Center for Advancing Professional

Excellence (CAPE)

TeamSTEPPS training (developed by AHRQ) Shared model and language for clinical

communication

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Student Interprofessional Academic Communities16 student-lead gathering places in

Education II including: Rural Health Global Health Wellness and Fitness Urban Underserved, and

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Current IPE programs and how KIRTS leads the

way IP Service Learning Oral-Systemic Health curriculum

SOM Phases I - IV Medical presentations to dental students

CF-3 program (state-wide) Rural Immersion week Rural clerkship integration Support for the Rural Health Student

academic community (SAC) Support for SODM Rural Track and others

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This work has involved formation of an extensive, complementary network of

partners Kaiser Foundation Colorado Area Health Education Center Department of Family Medicine Delta Dental of Colorado Foundation and Frontier

Center School of Dental Medicine The Children’s Hospital Colorado Trust Caring for Colorado Cavity-Free-at-Three program NWSS

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IP Service LearningNWSSCourage ClassicStrides for EpilepsyHealth action dayCinco-de-Mayo

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Need data on number of participants in various IP Service Learning

programs

NWSSCourage ClassicStrides for EpilepsyHealth action dayCinco-de-Mayo

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Oral Health

Dental Home

Systemic Health

Medical Home

Interdisciplinary Oral-Systemic Health

Curriculum

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A unique public/private partnership…

A unique public/private partnership…

University of Colorado DenverSchool of Dental Medicine

and theDelta Dental of Colorado Foundation

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Forging a New Link Between Dentistry

and Medicine for Better Patient Care

Forging a New Link Between Dentistry

and Medicine for Better Patient Care

THE FRONTIER CENTERTHE FRONTIER CENTER

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Create an educational

paradigm that focuses

on the oral-systemic

connection and builds

inter-professional

understandingOral disease is a disease like any other, and should be treated.

Everything in the body is connected - having a chronic infection is

a serious problem...that can have systemic impact.

Prevention and shared preventive practices among various health

providers can improve systemic health.

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Inter-professionalpartnerships enhance

patient care by building bridges

Inter-professionalpartnerships enhance

patient care by building bridges

Through educational programs targeted at medical and dental students, medical residents and practicing dentists and physicians, we are working to improve understanding about the oral-systemic connection and its impact on our patients’ general health.

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Impact on the MD CurriculumImpact on the MD CurriculumFirst Year: PBL case on oral lesions and oral cancer

Second Year: oral/systemic connection lecture

Third Year: oral exam workshop with dental students

Fourth-year: two-week electives:Acute Dental/Oral Problems in Adults & ChildrenChild Oral Health

Resident Education: Faculty development workshops on implementing Smiles for Life oral health modules

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Impact on Practicing Medical Providers

Impact on Practicing Medical Providers

CME events: Child oral health

Oral emergencies

Fluoride varnish application

Motivational interviewing

Cavity-Free-at-Three program15 public health sites trained

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Medicaid Payment Change

- initiated July 2009

Medicaid Payment Change

- initiated July 2009 Medical providers are eligible for payment for

child oral exams, oral health counseling and FL varnish application

Children age 0 through 5th birthday Can be billed four times per year CF-3 or Smiles for Life training needed

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First Year:Interaction between dental and medical homesChild oral health in general dentistry Blood pressure reading techniques

Second Year:Periodontal disease impact on health.New Health History FormOral Pathology: oral cancer and systemic diseases.Simulation lab

Third year:Medical interviewing and SP’sMedical topics: CV disease, pregnancy, dermatology

Fourth Year:Work directly with ACTS preceptors.Medical topics: hepatitis B and C Adult Preventive Care Guidelines

Impact on the DDS Curriculum

Impact on the DDS Curriculum

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Frontier Center Future Directions

Frontier Center Future Directions

PREVENTION! - Maximizing the impact of Cavity-Free-at-Three

Involving all health team members

Catalyze a shift from treatment-based philosophy of oral care to a more prevention-focused approach

PREVENTION! - Maximizing the impact of Cavity-Free-at-Three

Involving all health team members

Catalyze a shift from treatment-based philosophy of oral care to a more prevention-focused approach

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Cavity Free at Three Program

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Cavity Free at Three Program

Need some data from Su and KarenStart dateFunders# trained

Sites

Taken over by AHEC 9 months agoActivity since takeover

9 months 10sites 150 individual providers 2000 kids

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CF-3 TrainingCF-3 Training

Didactic and on-site hands-on through AHEC

Didactic and TCH-based hands-on through TCH CF-3 clinic

CF-3 will be a standard element of KIRTS for students from all disciplines.

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Interdisciplinary Rural Immersion

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Interdisciplinary Rural Immersion

Sterling, CO June 5-9, 2009 “Experience what a rural community has

to offer, with an eye toward assessing health – in the broadest sense of the word.”

Interdisciplinary participants:√ 6 MD students √ 1 Public Health student√ 3 PA students √ 1 Psychology student√ 6 Pharmacy students √ 3 Spouses, 2 children√ 2 Nursing student √ 3 Faculty

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Interdisciplinary Activities

Interdisciplinary investigation groups:

Acute health care Community & economy Criminal justice/law

enforcement Education system Long-term care Mental health Public health and safety

Group visits Hospital Prison

Social Activities Dormitory housing Group meals Ranch visits Drive-In movie

Publicity Newspaper Radio Television

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What we learned…

Close interrelationships between community groups and agencies

Community members play multiple roles Local problem-solvingRich opportunities for individual growth

and leadership Interest in rural life positively reinforced

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Sponsors and Costs Sponsors:

Colorado Trust Kaiser Foundation

Costs: Planning and making community connections Travel, housing, food Student stipends Faculty time

Future plans Repeat annually in new sites Caring for Colorado grant application

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Upcoming Rural Immersion

June 14-18, 2010 in Delta CO area

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Rural clerkship integration

Planning started in July 2009, first cohort implemented in Nov, 2009

Students from Medicine, PA, Pharmacy and Nursing shadow each other.

Started with six cohorts Initial evaluation completed

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Clerkship

integration

schedule for Q1 -

2010

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Clerkship integration January 2010

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Januay 2010 IPE links

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Clerkship integration evaluation (Nov-Dec

‘09)Need data from Diedre

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Clerkship integration activities in developmentShadowingDisease management clinics

Diabetes Anticoagulation

Community health Health fairs School screenings

• Oral health• Immunizations

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Clerkship integration activities in development

(continued)Hospice visitsNursing home visitsCommunity mental health visitsService learning:

School Health Professions counseling

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Interdisciplinary Rural Tracks

CHA/PA Program

Pharmacy ??

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CHA/PA program Rural Track

Started in 1993 3-5 month clinical rotation block in a

rural community of less than 15,000 in the 3rd year

65% of RT graduates are practicing in rural communities

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SOM Rural Track Started in 2005 with a grant from the

Colorado Trust Goal: increase the number of

students who eventually enter, and remain, in practice in rural areas.

About 10% of the SOM classes Emphasizes but does not require

primary care

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SOM RT Curriculum Longitudinal over 4 years Twice weekly in first 2 years

Seminars Workshops

4-week summer rural preceptorship Intersession meetings in years 3 & 4 Residency/community links

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SOM RT Class of 2009

Match results:

7 Family Medicine(5 in Colorado)

2 Pediatrics (1 in Colorado)

2 Emergency Medicine(1 in Colorado)

1 General Surgery (in Colorado)

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RT 2010

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RT 2011

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RT 2012

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RT 2013

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School of Dental Medicine RT

Newly starting 100-hour program Seminars on dental topics Rural Grand Rounds  Rural Track activities with SOM Interdisciplinary Rural Immersion week Rural ACTS rotation Rural Health SAC activities

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Interdisciplinary RT sessions

Follow Rural Grand Rounds once monthly Rural Tracks form the base of student

participants for RT sessions and immersion weeks: SOM PA program Dental Medicine Pharmacy Public Health

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RGR and IRT seminarsRural Grand Rounds

1/09 Rural healthcare policy 2/09 Rural diabetes care 3/09 Public Health 4/09 HPRN – Asthma/Colon CA

5/09 Air medical transport 9/09 What’s wrong with Rural CO

10/09 Oral Health 11/09 Rural HIV 12/09 CORHIO 1/10 Child abuse 2/10 Healthcare policy (CRHC) 3/10 Health professions (CHI)

IRT seminars Healthy communities

11/5/08 Suicide prevention 4/22/09 Summer preceptorship

reports 9/11/09 Oral health workshop

10/21/09 Summer immersion reports

11/18/09 Medication reconciliation

12/16/09

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IRTS Publicity: Ritter

As part of its community benefit program, Kaiser Permanente made a $2.4 million dollar grant to establish the University of Colorado Denver’s Interdisciplinary Rural Training and Service Program (IRTS).

“I applaud the University of Colorado Denver and Kaiser Permanente, two local health care leaders, for pushing the envelope and thinking innovatively about the type of public-private partnership that can address critical health needs in our state.”

http://www.cufund.org/2009/06/11/students-may-be-solution-to-shortage-of-medical-professionals-in-rural-colorado/

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IRTS Publicity: Calonge

The numbers demonstrate the need. According to the Colorado Rural Health Center, seven counties have no dentists, six have no full time primary care physicians, and one has no primary care physician.

“Colorado is largely a rural state and many of our rural counties are facing significant shortages in health care professionals living and working in their communities,” said Ned Calonge, chief medical officer of the Colorado Department of Public Health and Environment. “This innovative partnership will help address these shortages by supporting the recruitment and retention of new health profession graduates in currently underserved communities.”

http://www.cufund.org/2009/06/11/students-may-be-solution-to-shortage-of-medical-professionals-in-rural-colorado/

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IRTS Publicity: 9 News… the Colorado Area Health Education Center system is working with the

University of Colorado-Denver Medical School on the Anschutz Campus in

Aurora to get more students interested in working along the Eastern Plains.

More than 20 students from the school of medicine, school of nursing, and

school of pharmacy are taking part in the Interdisciplinary Rural Training and

Service Program, led by Dr. Mark Deutchman.

"The goal is to immerse students in rural life," said Deutchman, director of the rural track at the University of Colorado Denver Anschutz Medical Campus. "It's really a lifestyle choice. It's a different kind of life. It's also a family choice and so that's why we've invited spouses along with these students."

Most of the students in the immersion program are no strangers to rural life. Deutchman says they target people from rural backgrounds to foster their feelings of giving back to communities they can relate to. "They know rural life, but they don't necessarily know rural health care,"

Deutchman said. "Targeting students all the way from the elementary level to get them thinking about health care careers,“ Deutchman said.

The program is funded by The Colorado Trust, a grant-making foundation. It's also paid for by a $2.4 million grant from Kaiser Permanente

http://www.9news.com/news/education/article.aspx?storyid=117472&catid=129

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IRTS Publicity: Aurora Sentinel

According to the Colorado Rural Health Center, seven counties in Colorado have no dentists. Along with a grant from the Colorado Trust that funds the track, the Interdisciplinary Rural Training and Service Program at CU Denver started with a $2.4 million grant from Kaiser Permanente Colorado in the spring 2009. The program will mingle students from other disciplines to prepare them to work together in rural areas. Dr. Jandel Allen-Davis, MD, the vice president of government and external relations for Kaiser Permanente Colorado said the health care provider invests money where it’s needed and will help make a difference. “The goal of the (IRTS) program is to help duplicate what we’ve done in the School of Medicine rural track program in the other areas – pharmacy, dentistry, nursing, etc,” Deutchman said. “It’s to get the students to learn together because they’re going to have to work together once they get out in the real world.”

http://aurorasentinel.com/articles/2009/06/25/news/metro_aurora/doc4a43d05c847002171... 6/26/2009

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Professional School Admissions Issues

Many urban applicants have impressive portfolios International travel Extensive extracurricular activities Experiences made possible by having grown up in large

metropolitan areas Professional parents who have above average

resources.

This may put rural applicants at a competitive disadvantage unless their unique experiences are recognized

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Rural applicant experiences to be recognized in the

application process Consistent history of working on the family farm

or ranch Significant amounts of time devoted to helping

care for siblings or other relatives Consistent history of working away from home to

add to family income Being first in the family to attend college or apply

to professional school Extracurricular activities and leadership in

organizations such as FFA or 4-H

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IPE Relationships

MD, PA, SODM,

SOPH, SON

HSC

AHEC

Rural Colorado