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Teamwork in the time of COVID

Posted by Emma Mattson and Emily Stembridge on Friday, March 19, 2021 in Features, Spring 2021 .

Illustration by Sally Elford / Ikon Images

Amid many adjustments to learning and teaching during the early days of COVID-19, Vanderbilt University School of Medicine’s interprofessional approach has endured.The Vanderbilt Program in Interprofessional Learning (VPIL), for example, continues in its effort to bring students in nursing, medicine, pharmacy and social work together in an authentic learning environment that prepares them for collaboration once they enter the workforce.

Established in 2008, VPIL comprises students from the five different disciplines to form interprofessional teams. Over the course of two years, the team spends one afternoon a week in a clinic together seeing patients, creating personalized care plans, and working under a mentoring medical preceptor.

“There was a need to train our students in an interprofessional way and a need for future health care professionals to learn to work as a team,” said Melissa Hilmes, MD, associate professor of Radiology and Radiological Sciences and co-director of VPIL. “Health care teams can improve health outcomes and deliver high value to patients. We wanted to find a way to accomplish this at Vanderbilt.”

The first cohort of students, admitted in 2010, kicked off the program by attending VPIL’s first summer immersion week. Immersion week brings forward expert speakers to lead sessions about group dynamics, social determinants of health and the patient experience. In 2020, immersion week included discussions on the impact of both the March 2020 tornadoes and the pandemic in the Nashville community.

Since 2010, around 40 students every year have joined this unique learning community. Last year, however, presented new challenges for the program. Incoming first-year students were entering clinic for the first time under unusual circumstances, while second-year students returned to the program with altered expectations and new safety guidelines.

Though logistics and safety measures have changed, the radical interprofessional focus — and all the benefits that go along with that — have remained the same.


Adapting to New Circumstances

When medical students returned in person to VUSM’s campus in fall 2020, they were met by a variety of new safety precautions and regulations. VPIL students, in particular, only interacted with COVID-negative patients at their respective clinics and wore appropriate PPE at all times.

For Marshall Wallace, now in his second year of VPIL, COVID has meant seeing a slightly different group of patients. The walk-in clinic where his team works sees a lot of what he calls “bread-and-butter problems,” everything from arm rashes to abdominal pain. Normally, that list would also include influenza and mild respiratory problems, but since those patients have a higher likelihood of having COVID, his VPIL team no longer interacts with them on a regular basis.

VPIL teams also stay socially distanced as much as possible, which means that team members interact with the patient in pairs or one-on-one, rather than as a whole team at once. That doesn’t mean their collaboration has diminished, however. If anything, the new challenges have only strengthened their communal resolve.

First-year medical student Alex Miller’s recent experience on a home visit exemplified this strength. Her team, which includes a nurse practitioner, a counseling student and a pharmacy student, conducted a socially-distanced front porch visit to one of their patients at his place of residence. Their visit focused on brainstorming ways to improve his health through methods outside of prescription or referral.

On this visit, the diverse strengths of the team members really shone through, Miller said. They brainstormed with the patient on everything from better organizing his medications to reconnecting with his faith community.

“It’s awesome to be able to see how you can improve a patient’s life through all these different avenues and improve a patient’s overall health in a more holistic way,” Miller said. “I’ve really enjoyed that.”

Although home visits may have looked different in 2020, they are a powerful tool in the VPIL program, says Shannon Cole, DNP, APRN-BC. Established by the School of Nursing, they can help students paint a bigger picture of what is impacting a patient’s overall health, and students often have enlightening findings to share with their preceptor.

“The students get to know their teammates, faculty and staff, but most importantly, we want them to get to know the patient population,” Cole said. “Home visits provide an opportunity for the students to advocate in a unique way for these patients and their families.”


An Interprofessional Perspective on Medicine

Malini Anand, another first-year VPIL student, has known for years that interdisciplinary connections would be crucial for her medical perspective. In fact, when she was an undergraduate student, she collaborated closely on an interdisciplinary team at a free women’s health clinic in her area. She even wrote about her interdisciplinary values in her medical school personal statement, and when she heard about VPIL on her Vanderbilt interview day, she immediately knew she wanted to join the program.

“I knew that was something I definitely wanted more exposure to in medical school,” Anand said. “[VPIL] has only solidified how important interdisciplinary work is to me, because it just completely changes your perspective on how you even approach patient care.”

Now, Anand says, she thinks through more than the differential diagnoses: she also considers the patient’s emotional state, socioeconomic status and potential barriers to making recommended changes in nutrition or medication.

Miller, too, highlighted the lessons that she learns from listening to her team members from varying professions.

“Each team member focuses on different aspects. For me, I get to practice the medical interviewing, and the counseling student can focus on social determinants of health,” Miller said. “It’s really nice being able to hear and be part of other students’ conversations with the patient, because they’re so different from what I’ve been learning from the medical standpoint.”

Hilmes agrees that it is vital to know the abilities, expertise and responsibilities of other health care professions. “It creates a level of respect and understanding between them,” she said. “In turn, they contribute to a higher level of patient care, which is important now more than ever.”

Miller said the interprofessional experience has changed her approach to medicine.

“It’s really highlighted the importance of not only being knowledgeable about the patient’s medical condition and how to fix that through medication or other medical intervention, but also the social determinants. How do we change behavior to increase medication compliance? What are the biggest barriers to this patient’s health?”

In fact, Miller said, understanding the patients’ needs from an interdisciplinary perspective builds an even stronger provider-patient relationship.

“When the patient sees that you’re aware of these other things that are going on, it instills more trust,” Miller said.


Taking on New Responsibilities

Acclimating to the interdisciplinary setting forms a crucial part of the first year in VPIL. After all, each student has to become acquainted with the clinic, their preceptor, the other team members and the patient population they’ll be serving. For some students, VPIL is their first formal clinical experience.

VPIL brings to light many issues like food insecurity, access to care and lack of transportation, says Danielle Stefko, VPIL program manager. “We’ve heard many first-year students say they had no idea people were so isolated or could live on so little. Our goal is that students will remember these experiences when they provide care in their future careers,” she said.

There is a lot to learn, but after completing activities like home visits and summer immersion, second-year VPIL students feel well-equipped to take on more clinical responsibilities and more difficult cases.

“As an M2, we shift more into the clinical side of patient care rather than shadowing,” reports second-year student Leigh Campbell. “In our clinic, we are also working on our VPIL quality improvement project.”

Wallace, also a second-year medical student, notes that about this time last year his team was still figuring out how the clinic worked, what questions to ask, and how best to collaborate as a team.

Now, his preceptor has more confidence in the team’s ability, Wallace said. She often pairs the team members up to see the patients by themselves first, before regrouping to talk about patient care. This gives Wallace first-hand experience diagnosing many issues he’ll need to be proficient in as a future physician.

As for Campbell, taking on increased responsibility with her team has convinced her never to lose appreciation for the non-physician members of a health care team.

“Learning from my team and about their various curriculums in nursing, pharmacy and social work showed me how integral each of them is in patient care. They all bring an individual skill set from their training,” Campbell said. “I have enjoyed getting to know them and building friendships that will last outside our time in VPIL together.”

Moving forward, VPIL will continue to create opportunities for students to learn interprofessionally and deliver high-value health care in an increasingly complex world. It will involve an even wider variety of students in the program, which in the past has included students from the Divinity School.

Cole and Hilmes hope VPIL will continue to have a positive impact in the Nashville community. “A large part of our curriculum is centered around educating students on the social situations that can affect health and access to care,” said Cole. “We truly hope the community benefits from the work of our students, faculty and staff for years to come.”