'We all have blind spots'

This story was published in the winter 2024-25 issue of 12th & Marshall. You can find the current and past issues online.

On a Thursday night in April, groups of five to six medical, nursing and pharmacy students walked into a simulated hospital room in the McGlothlin Medical Education Center and met a standardized patient.

The patient had recently transferred to an inpatient unit from the medical respiratory ICU, where they were diagnosed with bacterial meningitis. The transfer process and hospital room were riddled with communication, documentation and physical environment issues, each deliberately planned and placed by the course instructors.

For 20 minutes, the students practiced conducting rounds on the patient. But as they listened and asked questions, they were also scanning the room for safety errors, noting each one on their worksheets: The exam room door was left open. The patient’s name was misspelled on their wristband, and they didn’t have a fall risk bracelet. The ICU discharge notes listed incorrect medications. The room lacked PPE, and used needles were handled unsafely.

As the students worked, faculty facilitators from the same three disciplines looked on through one-way mirrors.

“I see a lot of people holding onto the needle,” one said.

“Do they see there’s no PPE?” wondered another.

Another added excitedly, “This is the most fun I’ve had in a long time.”

The exercise helped the students practice looking for medical mistakes under the pressures of a live simulated clinical setting. Equally important, it allowed them to experience working with an interprofessional team — and potentially reshape health care interactions in the future.

Breaking down barriers

The error simulation was a component of IPEC 502: Interprofessional Quality Improvement and Patient Safety, topics that have long been components of VCU’s medical, nursing and pharmacy programs. In recent years, however, the siloed approach has been replaced with a cross-disciplinary model taught through the Center for Interprofessional Education and Collaborative Care, or IPE Center.

The IPE Center aims to promote interprofessional teamwork between students in VCU’s schools of Medicine, Nursing, Pharmacy and Dentistry, as well as adjacent disciplines like psychology, occupational and physical therapy, social work, and others. Students learn from and with their peers in other disciplines through intentionally designed interprofessional courses, simulations, wellness clinics and other activities.

VCU’s focus on interprofessional education began in 2011, when Alan W. Dow, M.D., H'04, now the division chief for hospital medicine, received a two-year fellowship from the Josiah Macy Jr. Foundation. The grant funding allowed Dow to design, implement and assess three interprofessional education programs: a virtual geriatric case, a critical care simulation and a case series previously offered by the College of Health Professions. The following year, VCU established the IPE Center with Dow as its director, and the three original programs gradually transitioned into required credit-bearing courses.

The IPE Center also has expanded its offerings with a focus on natural overlaps in the core competencies for each field and trending topics in health care. “The opioid crisis; diversity, equity and inclusion; anything that you see in health-related news can be delivered as interprofessional education,” says Kelly Lockeman, Ph.D., associate professor in the School of Medicine and interim assistant vice president for interprofessional education and collaborative care. “We look at what each profession is focusing on and see if there are opportunities to bring learners together to collaborate around a particular area of interest.”

IPEC 502, which launched in spring 2016, is an amalgamation of three preexisting patient safety courses required in medicine, nursing and pharmacy. Faculty from each program reviewed the curricula to identify commonalities, forming the basis of the integrated course. This past spring, 425 students from all three schools participated.

The simulation is a critical component of the course. Not only have students expressed a desire to practice their skills in a clinical setting, but by working together on a shared project, they can see firsthand the varied expertise their peers bring to an integrated team.

Early on, the simulation was an interactive written activity. Working in small interprofessional groups, students assumed the roles of various stakeholders, such as the patient, hospital administration, doctors, nurses and the patient’s family. They worked through a series of modules looking at the case from each stakeholder’s perspective. Taking a cue from popular escape room activities, each participant worked to reveal a portion of a keycode that, together, would allow the team to unlock and escape the exercise.

The exercise was designed by James M. Dittman, M'22, now a vascular surgery resident at the University of Washington. Prior to his medical school graduation, Dittman was working with a faculty member on a medical education research project and saw an opportunity to apply the escape room model to the interprofessional course he had previously taken.

“Gamification is helpful in the interprofessional space because you’re asking groups of people who are not familiar with each other to interact in a meaningful way,” he says. “These exercises make it more fun and low stakes and invite them to be creative together.”

Robert DeGrazia, M.D., the former course director for IPEC 502, developed the live simulation model for the escape room. He remembers how, as a new resident, he faced several challenges transitioning from a siloed medical education to suddenly working alongside other professions on the floor, and wanted to help students think differently about collaboration.

“The first module was just breaking down stereotypes of the other professions,” he says. “I wanted students to see that these people aren’t a barrier preventing you from getting your job done. They’re also working within their respective fields, and we all have the same goal. The hope is that it helps foster interprofessional collaboration quicker when they get into the field.”

'Each discipline has its own role'

After the safety simulation in April, students gathered in a lecture room to debrief on the experience. Responding to a series of prompts, the teams noted the simulated hospital room’s deficiencies, their comments appearing on screens throughout the room.

“This would not be a good hospital to be in,” one read.

“There were more errors than we had had space for,” said another.

As the conversation shifted to the teamwork involved, students pointed out how it took the experience of all three professions to escape the simulation room. The nursing students were most aware of the supplies and setup of the room. Pharmacy students quickly identified medication mistakes and drug interactions. And the medical students typically asked the most questions of the patient.

“We all have blind spots,” one commenter posted.

Lockeman says it’s essential for students to learn early on to value their colleagues’ perspectives and the importance of a collaborative approach to health care. By the time they move into clinical practice, the hope is that interprofessional care is second nature.

That’s why the IPE Center decided from the start that every student in VCU’s largest health care programs would be required to participate in interprofessional education — and that these offerings wouldn’t be one-off activities but integrated throughout the curricula. It’s a decision that sets VCU apart from many of its peers.

“At most institutions, they might bring everyone together for one big interprofessional day where they do a disaster simulation or some other activity, and then have speakers and panels. It’s more like a conference,” Lockeman says. “Ours is embedded throughout the curriculum, and the experiences build on each other.”

In addition to required courses, the IPE Center offers a variety of electives and cocurricular activities, some of which bring in students from a broader range of disciplines to examine complex care across the community.

In February, the center hosted a competition in which teams of four VCU students representing at least two different health professions analyzed a public health case and created a potential solution. Proposals were reviewed by a panel of faculty judges from a variety of health-related fields, and the winning team proceeded to the national CLARION competition hosted by the University of Minnesota in April.

Medical student Yumna Rahman, from the Class of 2027, worked with teammates from pharmacy and dentistry and an undergraduate premed student. Together, they developed an action plan to respond to an emerging virus, including outreach to rural communities, budgeting for PPE and other supplies, and strategies for educating the public about vaccines.

Rahman says the case competition and other in terprofessional education experiences at VCU are helping her make the most of interprofessional relationships.

“We need to be specifically taught what information we should seek from each team member,” she says. “We have to know what to ask them for in order to collaborate.”

The IPE Center continues to expand its offerings, such as integrating smaller-scale lessons and activities into existing courses. For instance, if both the medicine and occupational therapy programs have a unit on population health, the IPE Center might bring everyone together for a case that looks at population health from both perspectives.

Lockeman says they’re also considering how to bring interprofessional education into the clinics, which are still largely siloed. Nursing students train with nursing preceptors, and medical students are matched with attending physicians, even when they’re all working in the same clinical setting.

“How can we capitalize on the fact that these learners are all in the same spaces?” Lockeman says. “How can we get them to learn about these clinical cases together? That’s our next big area of opportunity.”

By embedding an interprofessional mindset early and often, the IPE Center hopes to train providers who eschew stereotypes and hierarchies that have historically impeded health care. Instead, they want providers to shift health care systems from a siloed model to a more patient-centered, community-oriented and collaborative one.

“They need to understand that it’s OK to say, ‘I don’t know. Let’s talk to the person trained to do this,’ or to advocate for the role their profession can play in caring for a patient,” Lockeman says. “They need to understand shared leadership, that in some situations, the physician does not have the most knowledge. They need to be able to collaborate with a physical therapist, a speech therapist or a respiratory therapist to make sure the patient is getting the best care possible.

“We should recognize that each discipline has its own role, and who is best suited to provide care in that context.”

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The School of Medicine communications team is always looking to highlight student success, faculty achievement, cutting-edge research and innovative initiatives around the MCV Campus. If you have an idea for a story, please submit your pitch to laura.ingles@vcuhealth.org.