BETHESDA, MD 12 June 2009—An experiment in interprofessional education at the Johns Hopkins Hospital in Baltimore has taught pharmacists that medical students may not realize that they can turn to nonphysician staff members for their professional expertise.
The experiment consisted of a two-week elective educational program for medical students that included hands-on sessions with staff pharmacists, respiratory therapists, nurses, and other members of the patient care team.
Pharmacy preceptor Cathy Walker, coordinator of education and training for the department, described the experience for the pharmacists and the students as "walking in somebody else`s shoes."
Walker said five medical students who took the elective course spent a day this spring working alongside hospital pharmacists. She said the group started the day by attending a 90-minute session with a pharmacy administrator who provided an overview of pharmacy practice and how the medication-use process works at the hospital.
"Then the medical students spent half a day with one of our point-of-care pharmacists," she said. "Those are the pharmacists that are out on the nursing units and are responsible for everything from medication order entry to providing drug information, even looking for missing doses. So the medical student was basically shadowing that pharmacist for half a day."
For the remainder of the day, Walker said, each student was paired with a clinical pharmacist from the same area as the point-of-care pharmacist. The students went on rounds with these clinical specialists, whose main work was to provide drug information for the patient care team.
Walker said the nursing staff had decided to give the students a full experience that included the less-glamorous aspects of the profession, and she encouraged her pharmacists to follow the nurses` lead.
"Do every aspect of your job," she advised them.
She said there was plenty of communication between the students and the pharmacists, who soon realized that the students had little understanding of the order-entry process.
"This was surprising to all of the pharmacists—that the medical students thought that they punched the order into the computer, and then the drug comes up. They hadn`t even thought about the fact that the order was being reviewed by a pharmacist, and all the different things that the pharmacist looks at when they`re reviewing that order," Walker said.
For example, she said, the students hadn`t realized that when they order gentamicin for i.v. administration, the pharmacist must specify the infusion fluid and inform nursing of the number of minutes to administer the infusion to deliver the full dose of drug.
"A couple of the pharmacists even took the medical students down to see how the robot works and how the [i.v. admixture] machines work," Walker said. The intent, she said, was to show the students the behind-the-scenes work that goes into medication preparation and the professional training pharmacists need to prepare each dose before it is sent to the nursing unit for a patient.
Walker said pharmacists at Johns Hopkins often work with pharmacy students and residents and that "shadowing" is a common practice at the hospital.
But she said the medical student program was less formal than the experiences provided to pharmacy students, who spend much more time at the practice sites and have their progress formally assessed.
The idea for the interprofessional project came from second-year medical student Sujay Pathak, working in collaboration with Peter Pronovost, a critical care physician and nationally recognized patient-safety expert at Johns Hopkins. Walker said Pathak had observed, during the hospitalization of a family member, how important teamwork is to patient care, and he believed medical students would benefit from learning about the work of nonphysician hospital professionals.
The American Medical Association, in response to a request from its medical student section, last year adopted a resolution to recognize "that interprofessional education and partnerships are a priority of the American medical education system." The resolution also stated that the association will investigate whether mandatory interprofessional training should be incorporated into medical education.
Two ASHP policy statements have been approved that contain language supporting the need for interprofessional collaboration during the education of pharmacy students.
Walker said "physician buy-in" for the project was critical to getting it approved and launching the first session. With the support of the pharmacy department, Walker said she carefully chose which pharmacists to approach about the project.
"I knew that those pharmacists were very interested in doing this type of thing," Walker said. "And I actually picked different [patient care] areas on purpose just to not overwhelm any one area."
Walker said the pharmacists came away with the impression that the medical students had been taught to be self-reliant, so they tended to consult their handbooks and other paper resources, but not their professional colleagues.
"It came out during the day that they hadn`t thought about using the respiratory therapists, they hadn`t thought about using the palliative care resources," Walker said. "They were just strictly thinking about what they have in their hands, and not that they should be using other people as well."
She said the pharmacists believed that their sessions with the medical students were time well spent.
"Overwhelmingly, they all said they would do it again," Walker said of the pharmacists. She said it was "eye opening" for the pharmacists and the students to realize they had inaccurate preconceived ideas about what each profession does and knows about the other`s role in patient care.
Walker said that if the rotation is repeated, she would like all of the medical students to tour the medication-preparation area. She said feedback from the students indicated their preference to start the day with this tour and then follow it with the hospital administrator`s session on pharmacy practice.
She said the project included formal surveys of participants before and after their experience. The study findings will be submitted for publication after the survey data are analyzed.