Education: Interdisciplinary Education – More than Just Buzzwords?
By Josh Adams
Three years ago, I traveled across the nation on a whirlwind tour that is the medical school interview process. Among all the facility walk-throughs, lunches with students, and the all-important interviews, one topic continued to show up like medical students at a free lunch: interdisciplinary education. Each school had a unique way of attempting to integrate interdisciplinary medical education into its curriculum, but everybody agreed that this is an important part of medical education that needs attention.
Fast-forward three years; after completing two years of medical school I’m wondering, “Where is the interdisciplinary, multi-specialty, integrated approach? Was all that talk during interviews just a bunch of hype?” Some schools have more effectively incorporated interdisciplinary education into their busy didactic and clinical coursework, but there are no set requirements from governing/accreditation bodies for interdisciplinary education as a mandatory part of education across the board. Unfortunately, students—including me—are often left to integrate interdisciplinary education and patient safety into their education on their own accord.
As a first-year student, I navigated my way through the many anatomy, physiology, histology, and other tests that became my life. This new life required me to sit in class for most of the day and study for upcoming tests at night. I was busy to say the least. Nowhere in the 50 credit hours of classes that governed my life was there any formal interdisciplinary education.
As a podiatric medical student, the American Association of Colleges of Podiatric Medicine (AACPM) sets curriculum guidelines for what material needs to be taught in my classes. Each of the nine podiatry colleges in the United States must periodically meet rigorous requirements to gain and renew accreditation. According to the AACPM website, the curriculum taught at each of the podiatric colleges consists of the following standards in order to become a Doctor of Podiatric Medicine (DPM).
The course of instruction leading to the DPM degree is four years in length. The first two years are devoted to classroom instruction and laboratory work in the basic medical sciences, such as anatomy, physiology, microbiology, biochemistry, pharmacology, and pathology. There is some clinical exposure in the first and second year. During the third and fourth years, students concentrate on courses in the clinical sciences, gaining experience in the college clinics, community clinics, and accredited hospitals. Clinical courses include general diagnosis (history taking, physical examination, clinical laboratory procedures, and diagnostic radiology), therapeutics (pharmacology, physical medicine, orthotics, and prosthetics), anesthesia and surgery (Frequently asked questions, n.d.).
It’s easy to see that the AACPM curriculum guide fails to mention interdisciplinary education or efforts to encourage team-based medicine that are becoming the new normal. Podiatry is not alone in failing to recognize the need for interdisciplinary education. Similar curriculum requirements from the American Association of Colleges of Osteopathic Medicine (AACOM) neglect to address interdisciplinary education:
The first two years of lectures, laboratories, and other learning experiences are designed to prepare the student for the last two years of medical school, which are the clinical clerkship years.
Early clinical exposure is an important part of many curricula. Specific learning methods and curricula vary from college to college. (Overview of the four-year curriculum, n.d.)
Since, “specific learning methods and curricula vary from college to college,” schools may or may not choose to include interdisciplinary education as part of their required class work. Students who want a well-rounded, interdisciplinary education but are not given the opportunity through required course work are left on their own to find some way to add this important aspect of healthcare to their knowledge base. Sadly, for many students, that never happens. The first actual implementation of interdisciplinary, team-based medicine is then forced upon the recent graduates as residents or even on the job for some health professionals. This “crash-course” experience that many medical students face as they move out of the classroom and into the clinic could be avoided if these concepts were more effectively included in the classroom. Although my educational experience has not involved formal interdisciplinary methods to promote teamwork, I have been fortunate to find alternative means to supplement what is not covered in class on my own.
While attending a free lunch-time learning event during my second semester (medical students love free food) I was introduced to an important concept that motivated me to learn more about how medicine might improve and what is currently being done to improve patient safety. The lecturer shared startling statistics about the condition of our current medical system; one of every seven hospital patients experience some sort of medical error, and 100,000 patient deaths each year are directly linked to medical errors. I was shocked; how is the medical system killing more people than many terrible diseases? Initially, I resolved to become the best medical provider possible and not be part of the problem.
As I continued to learn more about why medical errors occur, I began to see that although I may try to do my very best to provide safe care, humans are not perfect, and I will make mistakes. My determination changed as I realized that healthcare providers are not the problem; the healthcare system and education system that trains healthcare providers are the real problems that need to be fixed.
Armed with this new knowledge, I became more involved in voluntary programs offered at my university to supplement what my courses left out. I became involved in starting an Institute for Healthcare Improvement (IHI) Open School Chapter at my school and began to use the IHI online modules to solidify ideas about patient safety and healthcare improvement. Not to pat myself on the back, but most medical students won’t become involved in such programs unless they are required. Leaving this vital part of medical education up to each individual student is a huge risk; too often, students graduate without these important skills.
The benefits of interdisciplinary education and early exposure to team-based medical practices while a medical student are made clear by several IHI modules. Modules entitled, “Understanding Medical Error and Patient Safety, Human Factors and Safety, Teamwork and Communication,” and “Leadership, ” have all helped me understand why medical errors happen; more importantly, I have learned what I can do as an individual to change parts of the broken system. A famous quote from Albert Einstein says, “Intellectuals solve problems; geniuses prevent them.” Improving the medical system requires changing the mind-set of medical providers and creating a workforce that seeks to prevent medical errors by improving faulty systems. There is no better setting than medical school to instill within future medical providers the importance of team-based medicine and how it relates to patient safety.
Across the nation, schools are implementing interdisciplinary classes into required curriculum, helping to set the stage for real-life healthcare scenarios. A great example of one school’s implementation of interdisciplinary classes comes from Western University of Health Sciences in Pomona, California. During the first two years of their schooling, all students take four classes under the title of Inter-professional Education (IPE):
IPE 5000 is offered as part of the college curriculum for all first year, entry level health professional students and is a university requirement for all participating colleges. The course is designed to prepare the healthcare student to practice patient-centered collaborative care through a team approach. Working in small inter-professional teams, students will explore cases representing conditions across the human lifespan.
IPE 6000: The majority of the course is independent study with students engaging in a large scale tabletop activity where they apply team tools necessary to solve a healthcare dilemma (Doctor of podiatric medicine, n.d.).
Western’s example shows what is possible. They have found a way to integrate interdisciplinary education into demanding schedules as required courses. So, why haven’t all medical schools across the nation done the same? The answer is simple; it isn’t required. If governing bodies like the AACPM, AACOM, and others do not require it for accreditation, interdisciplinary education will continue to exist only as a spattering of select programs across the medical education community. It’s time for those with the power to change curriculum requirements to step up so that interdisciplinary education will be more than just a buzzword to medical students everywhere.
Josh Adams is a podiatric medical student (class of 2017) at California School of Podiatric Medicine, Samuel Merritt University, in Oakland, California. He may be contacted at joshua.adams@samuelmerritt.edu. Adams is also a member of the IHI Open School, which offers professionals and students online training in quality improvement and patient safety. Learn more at ihi.org/openschool.
References
Doctor of podiatric medicine. (n.d.). Retrieved from http://prospective.westernu.edu/podiatry/curriculum-15/
Frequently asked questions. (n.d.). Retrieved from http://www.aacpm.org/html/careerzone/cz3_faqs.asp
Overview of the four-year curriculum. (n.d.). Retrieved from http://www.aacom.org/become-a-doctor/med-students/curriculum-overview