The Importance of Interprofessional Education

(upbeat music) - This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals and students. I'm your host, Justin Kreuter, the bow tie bandit of blood. A transfusion medicine pathologists at Mayo Clinic. Today, we're rounding with Dr. Kamran Mirza, associate professor of pathology, medical education and applied sciences and vice chair of education for the department of pathology and laboratory medicine at Loyola University Chicago Stritch School of Medicine.

And we're really excited to have him on the podcast today to talk about interprofessional education. So thank you for joining us today, Dr. Mirza. - Thank you so much for having me. - I think that there's many different ideas that come to mind when people talk about interprofessional education. And I know that some of us that are really in the literature on this, this has really been a challenge. And so I'm curious maybe to start us off

from your perspective, why is interprofessional education an important topic for us clinicians, lab medicine colleagues, the students as well? - Sure, absolutely.

I think my own introduction to interprofessional education was when I as a pathologist started working on developing a master's degree in medical laboratory science and in our day-to-day practice as you know, we work with medical laboratory scientists all the time and I value what they do, but it wasn't until I started creating educational programs that actually dealt with what they were doing on a day to day basis, that I really started understanding the value of what they represent.

And if I think about the future of medicine, even actually the present times in medicine, I find that no one can really practice in a silo. There are gray zones around all of us, right? Whether we be physicians, whether laboratory professionals, et cetera. And I think from my own experience, the value of interprofessional education perhaps can be discussed in three different settings. One would be patient care, which is obviously first and foremost.

And I would say that for good patient care, we need to be able to really understand what the roles of the different professionals within medicine, right? Or within healthcare are achieving. So I think that, if we think about it from a patient centered lens, we'll realize that understanding the value or the education or collaborative education with our colleagues around us is probably better for healthcare overall. The other is for education itself.

I think that, our residents in pathology, for example, or my graduate students in medical laboratory science or my medical students, they will perhaps understand their job, the knowledge that they need to know and the functioning of diagnostics better when they are involved in interprofessional sorts of activities, whether they be simulation-based or just didactic. And finally, I think that it's really great for advocacy.

I think that it's very important to have people on your side who understand what you do. And if all of our healthcare workers are trained in interprofessional education in a way that they understand what their counterpart is doing, I think that's really great for advocacy on like a broader level, federal level, right? Where everyone can support the other profession within healthcare, within the discipline of medicine. I think that, it's basically a win-win as far as I'm concerned.

- Yeah, thanks for kind of breaking us off in this and highlighting, I think we're all agreeing about we can't practice in a silo. It really is. And that's one of the things I love about medicine is that we're in a team sport environment. I think about, sometimes there's some very transparent areas where I think about interprofessional practice, you kind of started us off, when we have interdisciplinary rounds that may occur. - [Kamran] Right.

- And also, there's also challenges that come with that, right? You highlighted different professions, we have different roles. And so there's also just a different schedule all together.

- Right. - What do you think are a few of those key lessons that you've learned about, how to really do this interprofessional education? - I think that what I've learned, I guess in a nutshell, is that you need a champion for it. It needs to be pushed from the highest levels of administration, in order for it to be valued, I think. That's one lesson.

The other lesson that I've learned is that there are more opportunities for it that exists than we typically think about, I think if this takes a little bit of out of the box thinking. If we look at basically the structure around us, as you know right now in the throws of God knows which number, increase the numbers of cases we're getting with COVID-19, we know that the lab staff is strapped. Like we know we have openings everywhere. It's really a difficult situation.

So in this particular situation, carrying the banner of interprofessional education and having activities may not be the appropriate time for it. But I think that, if planned correctly there overlaps, and I love how you discussed it as an integrated, like lab rounds, right? Like where people have pharmacists and they have nurse practitioners and they have, many different disciplines or professions within healthcare coming in to round on patients directly.

Why can't we do that when it comes to pathology and lab medicine, and perhaps it will look different, right? The way we see patients looks different. We don't see them in-person, at least most of us, right? Unless you're doing blood bank or cyto, we see them at the microscope, or we see them as a fluid. And I think that surrounding that structure there are mechanisms in which I think we can do an interprofessional type of a teaching activity.

In my experience, it's been mostly didactic or simulation-based. And so I am dealing with a lot of trainees in my roles in education. And so the work is easier to put together, right? Because it's already, like it's basically putting it into their didactic schedule.

I think it also becomes very unique when you're familiar with the different people who are champions in interprofessional education, and you can pick and choose kind of, I can pick a resident, a pathology resident, let's say I have a star who knows medical about science really well, and he or she could go and teach in the medical laboratory science program.

Similarly, one of our program managers in the medical laboratory science program could be a great asset in some of the laboratories we do for medical students. And so of course it will take a little bit of planning because there are challenges with time. But I think that a lot of opportunities exist if we put the lens of interprofessional education on when we're looking at curricular development. - I really liked the idea you're kind of expanding to, there's more opportunities out there.

And I think you're saying that, we all come across key people that seem like they're very open and sharing, what is it that they do in their practice?

How do you think we make it a meaningful experience for the students, right? Because just having a simulation and having people co-localized for a period of time, how does that made a significant event? - I totally agree. I think that there needs to be a certain amount of intentionality towards this, right? To be successful, like any other kind of educational activity, there needs to be a goal in mind, right? We need to have goals and objectives. We need to have the right audience.

We need to have the right speaker. We need to know, that the speaker is going to cover what we would like them to cover and then we need feedback. We need evaluation and feedback of the session. I think that by and large, when we think about laboratory medicine as pathologists, I think we will do a good job as to understanding what types of things our trainees need. But perhaps there are things outside our realm that we haven't thought about, right?

And I think that the setting also really matters. I think that we're very fortunate here at Loyola University, the health sciences campus, that we have a couple of different schools, right? You mentioned, we have a buckets of school of health sciences and public health. We have a medical school, we have a nursing school, we have an institute for bioethics.

And I think that there are opportunities that organically arise because of the fact that you have numerous people doing similar, but different things. And then there are opportunities that you need to create. And I think that the ones that you're trying to need to create need to be created very intentionally so that you kind of are doing a service to the students and not wasting their time. And I think that it has to be an iterative process.

It has to be a process that's guided by feedback so that you can do it better in the future. But I think that, all in all, I would say that there isn't any type of interprofessional activity that I would deem useless, to start off with. I would definitely say that there's use utility in kind of putting something together. However, I do agree that there could be some activities that perhaps aren't as useful as others.

And I think that maximizing on those which are useful or engaging to the students is best because I think that for the longevity, you do need students to keep promoting and showing interest in it, otherwise interest will just fizzle out. - It kind of brings up that idea of feedback and, it makes my heart go pitter-patter when you say the idea of being iterative, right? And really there's something special about just getting started.

With the feedback, a lot of times, and I've been guilty of this asking did you like this, the simulation or something? And I think as we're learning, or at least I'm learning, that's a very low level of feedback that may not, really probably should not be as informative to what do I do? How do I iterate this? And so I'm kind of curious,

what sort of approach do you take to feedback to get that feedback that's really going to help you meaningfully iterate in a positive way? - That's a great question. I think that the generic question of whether you like something or not, that's actually not a bad question, right? To start off with, I think that if for example, even in that simplistic question, the answer is no, we didn't like it. Well then, we definitely need to decide to be more granular with why they didn't like it.

But I do think that that isn't necessarily an unhelpful question. That said, though, I do agree that, I think that part of the feedback should be developed or the questionnaire for the evaluation should be developed as you're creating the structure for the session, I would say. And then that way it's easier to be more granular about specific aspects of it, especially the aspects that you are a little hesitant or not so sure about putting together.

And then after that, naturally making it easy for them to answer, like at scale, kind of easy, like shorter numbers, like not too long. You can leave certain things open-ended so that they can put their thoughts there, but otherwise having quantifiable objective data is probably important. One thing that has helped me a lot, I think is just, in-person feedback, from a group of individuals who've participated in the course or the sessions, for example.

And I think that there's a lot of value in this sitting together and asking them before they come to the session. And we do this for medical school. We do this for graduate school. We do it in our house staff meetings as well, this idea that call it the feedback that you have as a group, right? And anonymously put it together on a piece of paper, and then we can go over it, right? What worked? What didn't work? What you would improve and why, right?

And what I realized is that over time students as they change years, they will come up with similar examples or similar questions that we've thought about in the past, implemented them and they haven't worked. And so we can tell them that, oh, we tried this two years ago and it didn't work for this, whatever reason. And then sometimes it's amazing students have a brilliant way of viewing things. And sometimes these fantastic ideas come about which you haven't even considered before.

So I think that in general, it does take a lot of love and effort to putting it together. But over time it can become a great product. - I'm gonna enter the confessional with you for a second Dr. Mirza, I would say, I am better about things that are happening quickly. For example, in transfusion medicine here, I get new anesthesia trainees every two weeks. And so there's some things that are happening very frequently and I'm really quite good at being iterative and making changes.

Some of the other things that we do, like when I teach the medical students, when it comes like once a year, if I can confess to you that I'm not necessarily the best at those less frequent yet very critical things. I'd like to be better.

Do you have any kind of advice for maybe people, if there's other people like me out there that have difficulty, some of the less frequent things yet still important things, how can we still keep forward movement on those. - Since we're at a confessional, I'll confess to you as well. There are times when that one yearly lecture that I gave, as soon as I'm finishing it.

And based on the questions that are asked live, I think, oh, wow I should probably change these slides, or change this thing on the side. And then the whole year goes by and I haven't done it. So that's a problem I think that as educators, we need to continue to see beyond our doors, right? There are some natural tendencies for us not to do that until we're forced to. That said, though, I will tell you, Dr. Kreuter there is someone in that course who is keeping an eye on that evaluation.

So what you're talking about is self improvement, and that's a very lofty, elevated goal, which I applaud you for. But I can assure you that if there was something, administrative or an issue in the lecture that you gave, you would be told by some other authority that you need to make some changes. So I think there are two levels of feedback or change that we need to consider. One is, are you effective, right?

And that is happening because if you're not effective in any LCME or any kind of accredited program, there is a mechanism in place to let you know as a teacher that you're not being effective. What you're talking about is elevating the game, right? And elevating the game is something that naturally is a beautiful thing that we need to keep aspiring towards. And that's more of a stuff driven thing.

I think that, as long as we can keep a balance of trying to elevate for things that are less frequent, I think you're okay. Basically. - I appreciate your framework and also swaging some of my guilt there. Now I imagine that some of our listeners may very well know you from social media and your social media expertise. I'm always curious about these junctions that we have in our practices. And I'm curious about,

do you have any broad thoughts about how social media may or may not have a role in this interprofessional education? - Okay, let me roll up my sleeves. Yeah. So absolutely. I remember I talked about, a few minutes ago I talked about the setting is important, right? And I think that, and the reason why I think I value the setting is because we recently developed a school of health sciences and public health. And we didn't have that in a couple of years ago when I started here at Loyola.

And I think that what I realized by its presence is that it's really great to have things happen on campus, but what COVID-19 has taught us, if there is a silver lining to that gray cloud, it is that you don't necessarily need everything to happen in one campus for it to be successful.

And social media is that missing piece really where you and I both know, I'm going to speak like a social media nut, I'm sure people will be laughing about it 'cause they know how nuts I can be, but it's all backed up by successes, right? The fact that, what if you don't have a pharmacy program where you're teaching, right? And you would like a pharmacist's input.

Or what if you don't have a nursing program at the same place or a medical worker science program or a pathology training program, or what if you're AP only. You can put that energy towards social media and find the missing piece, the missing element that you need for that IPE, for that interprofessional education through social media.

Many of the talks, let's say I've given in the last couple of years have been supplemented by people that I found on social media, who are experts in the things that I don't know anything about. And we have been able to speak at national gathering, international kind of conferences, and we've invited them over locally into our own residency program. And now with Zoom, look at our conversation, right? I'm not even sitting with you in your office, I'm like hundreds of miles away.

And I think that what we've realized is that the future of education really is hybrid in that sense, right? iConference is a hybrid, iDidactics is a hybrid. And so I think that if you think about interprofessional education, I think the rules are the same. You can really go and find whatever you're looking for and you are not restricted anymore by the kind of boundaries of your own institution.

And I think that that's very important for interprofessional education when it comes to trying to find people who are like-minded champions, who will put together something good. If you don't have one on campus. I think that it's a win-win. So that's another check. Social media has a lot of issues. I'm not saying that it's all perfect, but I think that when it comes to education, specifically interprofessional education, I think it's a win-win. - That's wonderful.

I love the idea of this combination of the rules are the same, but you're in this new environment, right? That's something that I think as humans that's sort of something new but in a new context, it's so exciting and interesting to dive into. I hope that some of our listeners start thinking along those lines.

I'm curious though, we've kind of dabbled in a couple of things and talked about a lot of great topics that hopefully some people are thinking about, identifying champions, thinking about opportunities, looking at the setting and being very deliberate at that, thinking about how are we really gonna capture that feedback if we just take it to maybe that practical kind of

what would be a good call to action next first step for our listeners that maybe, aren't as developed yet in this area, but are stimulated by this conversation. What do you think would be a good step one or two for them to look at the next couple of weeks? - Sure, absolutely. All right. I think that everybody has to figure out where they're at, what types of training programs that they are dealing with and then start there.

So I'll speak as a pathologist naturally with a residency training program here. I think that if I didn't have a medical laboratory science program, which I do, if I didn't have one, I would say that, perhaps that you need to find synergies. I think you need to find synergies where, and I'm going to keep giving you an example of a pathology training program.

I think that there are synergies in, let's say where a history technology program talks to bachelor students in histotech about how historic technology happens and what histotech's role is. When are PGY one residents come in and they kind of start learning the art of frozen sections and doing that histotech part, right? Find synergy there, do a session where you can have both types of students trainees in one room.

Similarly for clinical pathology, I think that the field is wide open, where you can have your graduate students in medical laboratory science or, and I've talked sometimes over Zoom to institutions that aren't Loyola at all, like they're far away and I've given sessions on flow cytometry for example. These are equally relevant to floor techs, to medical laboratory scientists as they are to our medical students and also of pathology residents.

I think that if you break up what your trainees need to learn, and you put them in the context of how they will implement that in real life, who are the individuals or the types of groups or professions that are going to be touching our trainees lives in their professional careers, right? And I think that getting those individuals together early on, it doesn't have to be every single session is interprofessional, right?

It can just be like, let's say one session a year or two sessions a year, depending on where you are. But I would say that as call to action, try and recognize what types of interprofessional activities would be beneficial for your students, what they are currently doing. And maybe develop a plan to create one more session, let's say in calendar year 2022, right? One more session and build towards that.

And if you need any assistance in championing this, you can find me on social media and I'm happy to assist. - Brilliant. I love these next steps of looking for synergies and then reflecting on what's gonna be that meaningful activity. I think that's something that all of our listeners out there can be thinking about clinicians, laboratory professionals.

And students this is something that you can put attack in and think about as well for, as you're looking at your education, because sometimes I think that interprofessional activities can be occurring that we're not really even quite aware of or deliberate about. And I think that for student listeners, that's something maybe that they can take forward is to when they are exposed to an interprofessional activity, to be thoughtful and reflect on that. - Absolutely.

- We've been rounding with Dr. Mirza on interprofessional education. Thank you so much again for being here. - It was my pleasure. Thank you. - To our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email. Please direct any suggestions to [email protected]. If you've enjoyed Lab Medicine Rounds podcasts, please follow or subscribe until our next rounds together.

We encourage you to continue to connect lab medicine and the clinical practice through insightful conversations. (upbeat music)