A Structured Model to Optimize Longitudinal Team-based Care in an Outpatient Interprofessional Clinical Learning Environment
To optimize the interprofessional clinical learning environment (IP-CLE) in ambulatory care and provide quality interprofessional education based on the Interprofessional Education Collaborative (IPEC) competencies, effective systems and processes should ideally include:
1) an intentional working agreement established by the learners before delivery of care in the IP-CLE,
2) a patient-centered approach to establish and prioritize mutual goals during interprofessional practice (IPP),
3) deliberate reflection on the working agreement to promote constructive revisions between sessions of care and
4) a final reflection on the continuum of care delivery at conclusion of the IPP experience.
Given students will be exposed to a variety of interprofessional team members episodically through their education and as practitioners, the value of these four tenets can be emphasized by faculty, scaled/adapted according to available disciplines, and implemented by learners in multiple care environments. Involving six colleges and the school of social work at a comprehensive academic medical center, faculty guide eight teams of eight to ten learners through this process, providing care for up to three medically/socially complex patients at a charitable clinic once monthly for four visits. Student teams implement their working agreements under faculty supervision, engage patients to establish mutual goals/treatment plans and expand their understanding of team member scopes of practice. Faculty-facilitated reflections after each clinic prompt insights gained and refinements to the working agreement/care process, while the final reflection from the IPP experience captures holistic perspectives.
Student outcomes from this IP-CLE include a significant increase in the teamwork, roles and responsibilities subdomain of the validated Interprofessional Attitudes Scale from baseline and compared to a cohort of teams without an IPP component. End of program student evaluations indicate quantitative agreement that four pre-specified IPEC competencies were met and qualitative student comments provide meaningful examples supporting the value of this model in the IP-CLE.