Life, in general, is interdisciplinary. Airplanes cannot fly without engineers who build, mechanics who fix and pilots who fly. Taking care of patients requires teams of providers—physicians, nurses, pharmacists, medical assistants and others—or patient care suffers. Yet, too often, distinct schools within universities may function as siloes, with each teaching a discrete subject matter.
For our medical school at Brown University, we realized long ago that our students benefit from learning from other health professionals, like pharmacists and nurses. In the past, physicians were the sole repository of medical knowledge and often worked alone in taking care of patients, perhaps with a single nurse or medical assistant. To practice effective medicine now though, requires teams, with physicians providing the diagnosis and treatment; nurses helping to manage patients and coordinate care management; pharmacists recommending medications and then titrating them and social workers managing the non-biological factors that affect health. Students often do not realize the role these other health professionals play, especially early in their training. Working with schools of nursing, pharmacy, social work and others enables our students to understand that collaborating and coordinating with other health professionals is key to taking the best possible care of individuals.
It is not just with other health professionals that we try to build relationships. At Brown, we developed a program called the Primary Care-Population Medicine (PC-PM) Program. In this program, students earn a medical degree along with a Master of Science Degree in Population Medicine. The master’s degree is designed to teach students about important factors related to healthcare such as health disparities, social determinants of health, leadership and health economics. These are subject areas where physicians might not be as knowledgeable, and so it is important to involve other faculties, such as social work, public policy and sociology faculty members. Ultimately, these faculties provide the knowledge and skills that our students need to succeed as leaders in health care.
There are other areas where collaboration is important. We instituted a medical humanities curriculum at Brown. As part of this, our students study art at the Rhode Island School of Design and apply the lessons learned there to the care of patients. Some of our students are working with engineers to design innovative strategies for patient flow in clinics or how to make the best use of clinical space. These educational endeavors, which we feel are important to developing well rounded physicians, are not possible without building relationships with faculties from across our institution, but also other universities as well.
What It Takes to Build Relationships that Formalize into Partnerships
Building these relationships requires a number of things. The first is a general understanding of how everyone contributes. For example, our medical students, prior to working with other health professionals, often have no idea what other professions do. They do not realize that pharmacists can be incredibly helpful in recommending medications; or how helpful social workers can be in navigating an individual through often complex social situations; or that nurses are on the frontlines of patient care (more so than physicians)— managing acute situations at the hospital bedside but also helping with complex care coordination. Educating students (and our faculty) about the vital roles other health professionals play is incredibly important.
The same can be said about other faculty. Health policy experts understand decisions behind the Affordable Care Act in much more detail than physicians. Lawyers understand how to navigate legal situations, such as unfit housing, that may be affecting a patient’s health. Engineers understand how to improve the flow of a clinic or make the waiting room a more effective use of space. Knowing how each partner can contribute makes collaboration more effective (and in our case, the care of patients much more seamless).
The second factor is constructing partnerships. There may be initial skepticism around how effective a partnership may be, especially with disparate professions. At our medical school, we believe in reaching out to prospective partners, meeting with them, brainstorming ideas for collaboration and then piloting our ideas on a small scale. This allows us to get a sense of how successful the partnership may be and to problem solve any challenges that may arise. We then evaluate the collaboration with our stakeholders (typically students) to get a sense of their perception of the collaboration. If it something that looks to be effective and sustainable, we then try to build on our collaboration, rolling it out on a larger scale.
The third factor is ensuring equanimity amongst the partners. One partner should not be responsible for planning all of the curriculum or assuming all the costs. There should be equal effort put into the partnership among all parties. There also should not be a hierarchy. In the past in medicine, physicians were often viewed at the top of hierarchy. For a partnership to really be effective, all partners must be viewed on level footing, by the partners themselves and by the stakeholders.
Finally, the same efforts put into building the partnership, should be continued in maintaining the partnership. For example, in the medical school at Brown, we meet regularly with our partners in nursing, pharmacy and social work to ensure that we continue to meet the goals and objectives of our curriculum, to discuss curricular innovations that we would like to implement and to problem solve around barriers.
The Benefits of Collaboration
In the last two years at Brown, we have developed two innovative, integrated dual-degree programs. The first, as previously mentioned, is the PC-PM program. In this program, students learn from lawyers, health policy experts, health economists, nurses, life coaches, social workers, community organizers and physicians. This type of collaboration, for example, allows students to understand that health and healthcare are not the sole domains of a physician. Instead, students learn that professionals from a multitude of health professions contribute to the care of patients and populations. This concept also role models the idea that physicians cannot do it all, and that there are others—from both within and outside the health professions—that contribute to the care of individuals.
The second program we developed is a program in which students receive a medical degree and a master’s degree in Public Affairs. This program, in conjunction with the Watson Institute at Brown, allows students to think about the care of patients and populations through different but equally important frames. Students learn the medicine from physicians and the policies affecting medicine from health policy experts. For example, students may see a patient in clinic who was uninsured until the Affordable Care Act became law; they will then learn about the intricacies of the Affordable Care Act in their MPA studies.
When we develop dual-degree programs, we take the approach that says the programs should be integrated and not separate (as MD/master’s degree courses typically are). We believe it is important for students to learn in an integrated fashion and be able to apply what they have learned in their practice setting.
The benefits for us in doing so is great. These programs are innovative, with few other universities offering the level of integration we do. This means that our institution can be a leader in education and provide a framework for these dual-degree programs at other institutions. It also allows for partnerships that may not have existed otherwise to be created, nurtured and explored. These partnerships allow for collaboration not just in education, but in research as well and hopefully serve as a framework for other partnerships in the university setting (not just between the medical school and other schools, but between distinct university departments like chemistry and art). Finally, these partnerships hopefully allow for a trickle-down effect to practice. If we are educating students in a multi-disciplinary fashion, when they are in practice, collaboration will be second nature to them.
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