Yale Nursing’s Involvement in Launching Interprofessional Program

YSN faculty members Linda Pellico, PhD, MSN, CNS-BC, RN, Phil Martinez, MSN, APRN-BC, and Deborah Fahs, DNP, MSN, FNP-C, RN, have been working with Yale School of Medicine Professor Eve Colson, MD, MHPE, FAAP, on an interprofessional clinical program for medical, nursing and physician assistant students. Now in its pilot phases, the program promises to be an exciting change in the coming years! Pellico has been advocating for and leading the development of an interprofessional program for 10 years, and Martinez and Fahs have been actively working on the interprofessional program for two years now.

Originally, the program was started after its founders witnessed multiple instances of medical error caused by lack of communication between medical professionals. Ultimately, the mission of the interprofessional program is to improve communication between medical providers and actively overcome hierarchical structures. Tracy Chidsey, one of YSN’s clinical site coordinators, has also been highly involved in the coordination of clinical sites and preceptors. Additionally, David Burke from Yale School of Management has joined the project studying organizational barriers and methods to help overcome existing hierarchy.

This collaboration between the medical, nursing and physician assistant programs is funded through a Macy Foundation grant for interprofessional education. Initially, the program looked to make curriculum changes that would bring together the schools for common classes. However, the vision has since expanded to utilize the clinical arena as a venue to facilitate interprofessional interactions, learning, and development. Beyond their individual learning, students will also actively contribute to research and change in the health care field by examining in broader strokes the power systems embedded in our healthcare system. Martinez explains the significance of student involvement by revealing that he and his colleagues are blind to the power disparities of the hospital because they are accustomed to it. “We use the student’s eyes because they are fresh, and they can see the whole system and the inherent problems that experienced providers and faculty can no longer see," he said.

The project, which is now in its second pilot phase, originally started with nine students from all of the involved schools performing clinicals in the inpatient setting. This semester, the second pilot has expanded to 35 students, 10 of whom are from YSN. Currently, the students involved in the interprofessional program work in groups of three in a variety of outpatient clinical sites throughout Connecticut, including a pediatric irritable bowel disease clinic, a stroke clinic, the VA, a cystic fibrosis clinic, and a hospice service. Next year, the pilot will double in size and is expected to reach full force the following year, involving over 250 students. The implementation of the interprofessional program will correspond to and complement the anticipated curriculum redesign at YSN. 

At this point, the majority of the interprofessional clinical sites are outpatient, which has allowed students the opportunity to develop long-standing relationships with their patients, while working together as a team and dividing the plan of care. Additionally, the students have been able to assist the clinical sites and provide more holistic care by providing home visits, as well as following patients through their referrals to physical and occupational therapy, as part of their clinical experience. 

Moving forward, finding sufficient clinical sites around Connecticut has been one of the greatest logistical challenges of the interprofessional program, as clinical sites must have the willingness and capacity to accept three students coming in together, as well as have both physician and nurse practitioner preceptors to meet the requirements of each program. However, Fahs confirms that all of the logistical challenges are vastly outweighed by the benefits and potential this program holds. "For every stumbling block we face, the students bring back really great stories that confirm the value of this program,” she said. “One of the unique aspects of this program is that all the programs learn topics and skills on different timelines, so it allows the students from each program to share and teach their strengths, while learning from their peers subjects they have not yet covered."

In addition to developing teamwork and collaboration skills, the interprofessional program also provides a template for the students to work through professional conflicts and develop the communication skills necessary to overcome them that will be relevant throughout their healthcare careers.

The program has enhanced the relationships between the faculty of the programs. Fahs reflects on a recent faculty meeting where she observed faculty from each school socializing beforehand with one another and ultimately sitting intermingled during the meeting; a development to which she attributes to the new teamwork and camaraderie that has grown from the interprofessional program. Martinez adds, “Many physicians did not fully see and understand what nurses can do until they started working with us." As it continues to grow, the interprofessional program is an exciting development for the education of nursing students, as well as an important foundation upon which to initiate changes and reform in the future of healthcare and the hierarchies within the system.

Jenny Bagg ’17 shares her experience as a student in the pilot phases of the program: The interprofessional program brings its participants, and the Yale Schools of nursing, medicine and physicians associates to the forefront of medical training. Once we graduate as nurse practitioners, we will be working alongside physicians and physician associates day in and day out. We will need them and they will need us. For the benefit of our patients, it is critical that we are able to communicate effectively and seamlessly coordinate care across the three disciplines. The importance of the interprofessional program is that it cultivates in the participants an understanding of and respect for the roles of other types of providers.

 By learning together as novices, we are able to see the others’ professions through eyes that have not been tarnished by working under hierarchical structures. We are all new and starting on the ground floor in our fields. I’m fortunate and honored to be a part of this longitudinal clinical experience. I know my future patients and those of the two medical students in my cohort will benefit from our participation in this program. I look forward to its expansion. It should be a model for all healthcare education moving forward. We work together in the real world, why not in school?

Written by Joanna Harran '16

Yale University