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Vital Signs

Fostering cross-disciplinary communication

By Laura Stephenson Carter

In 1999, the Institute of Medicine released an alarming report blaming 98,000 deaths a year nationwide on medical errors. Ever since, there's been stepped-up attention to healthcare quality and patient-safety issues. One cause of errors can be poor communication among providers, especially those in different disciplines.

Reduce: "Increasingly, we are seeing the call for more interprofessional communication in health care . . . to improve quality, enhance patient safety, and reduce waste and redundancy in the system," says Susan Reeves, a vice president at DHMC as well as chair of nursing at Colby-Sawyer College in New London, N.H. "The problem is we do very little in healthprofession education—medicine, nursing, pharmacy . . . to actually teach students how to best communicate among the various disciplines."

A number of academic medical centers, including DHMC, have started tackling the communications problem head-on. They are encouraging students to work together in interdisciplinary teams so they can learn to communicate effectively with one another.

Case: For the past three years, Dartmouth has sent a team to a national contest at the University of Minnesota called the Clarion Interprofessional Team Case Competition: A Systems-Based Practice. The organization has hosted local competitions since 2002 and national ones since 2005. The Dartmouth teams include one student each from DMS's M.D. program, DMS's health-policy program, Colby- Sawyer's nursing program, and the University of Connecticut's pharmacy school.

The members of the Dartmouth team used to be chosen by DMS faculty. But this year, Dr. Greg Ogrinc, director of the Office of Research and Innovation in Medical Education, ran a local contest to give more students a chance to work together. In February, five interdisciplinary teams presented, to a panel of judges, an analysis of the causes of a typical medical error—and their recommendations for systems changes to prevent future such errors. The test case, a composite of several real cases, involved a suspected overdose at an Arizona hospital.

The winning group—M.D. student Sharon Silveira, master's of public health student KumkumSarkar, nursing student Taylor Forsberg, and pharmacy student Jonathan Reynolds—was one of 12 teams at the Minnesota competition, held in April.

The case for the national event involved a young woman of limited financial means who had been diagnosed with lupus. She died in a hospital after several "hand-offs." That's the term for what happens when a patient is moved to another unit or turned over to other caregivers at a shift change; in the case of the woman with lupus, her providers failed to adequately communicate to each other the severity of her illness.

While the Dartmouth team didn't win the national competition, the participants were nonetheless pleased by what they gained from the process. "I learned so much about interdisciplinary teamwork, both inside and outside the hospital," says Sarkar, who did the financial analysis for the team's presentation. "I also learned about the importance of the role of different types of health professionals for patient care."

Core: "We recognize that this competition is not a substitute for true interprofessional teaching for our health-professional students," says Ogrinc. "We're working to make interprofessional teamwork a core part of our students' learning."

Even so, Reeves feels the competition is beneficial in its own right. "One could see that the students had gained an appreciation for each others' contributions to the team," she says, "as well as gained comfort in talking with—and disagreeing with—each other."

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