High-yield interprofessional learning is transforming health professions education at the San Francisco VA Medical Center
Rebecca Shunk, MD, Professor of Clinical Medicine, Department of Medicine, UCSF; Associate Chief of Staff for Education, Co-Director of the Center of Excellence in Primary Care Education at San Francisco VA Health Care Center
Our hospitals and clinics across UCSF are our biggest classrooms—full of teachers passionately committed to continual learning, compassionate care, and teamwork.
Ask Rebecca Shunk, MD, to define ‘high-yield interprofessional learning’ and you’ll quickly see how her commitment and ongoing efforts in this area are enhancing the work and learning environment of trainees, faculty, and staff at the San Francisco VA Health Care Center and across the UCSF medical education community.
She and colleagues, including Bridget O’Brien, PhD, Associate Professor in UCSF’s Department of Medicine and Researcher in the Center for Faculty Educators, Anna Strewler, NP, Assistant Clinical Professor in the School of Nursing, and Maya Dulay, MD, Associate Professor in UCSF’s Department of Medicine, pioneered a model of primary care education at the VA—the Center of Excellence in Primary Care Education (COEPCE)—based on an interprofessional, team-based, patient-aligned approach to care.
Trainees in the COEPCE include internal medicine residents, nurse practitioner (NP) students and residents, pharmacy residents, psychology fellows, social work interns, and dietetic interns.
“With no models or templates, and few best practices to guide us, we dreamed big and worked to translate key principles from the general literature on workplace learning into the components of an educational program,” says Dr. Shunk, who develops and leads curriculum delivery for the COEPCE. “At our Center of Excellence, we teach the concepts of care coordination, shared decision making, performance improvement, and communication.”
Dr. Shunk cites ‘high-yield’ elements such as coached team ‘huddles’ that support learners and staff to collaborate as high-functioning teams; staff engagement in quality improvement projects that benefit the clinic; and faculty community building activities like weekly educational leadership meetings, monthly faculty development workshops, and biannual curriculum planning retreats.
“Interprofessional learners really value learning about each other personally and professionally. These insights create a synergy that improves their care of patients and augments their learning.”
Since its inception, the COEPCE has improved team-building and team culture in clinic, and created a climate that proactively improves systems and processes of care.
Examples of recent interprofessional, trainee-driven improvements include increasing hepatitis C screening in primary care, coaching primary care providers to de-escalate diabetes medications for patients at risk for hypoglycemia, and creating a patient intake form for new patients to more efficiently provide details of their medical history.
“Quality improvement work is an excellent way for trainees to practice effective teamwork and learn skills for improving healthcare systems that can be readily applied in their future careers,” says Dr. Dulay, Associate Director of Clinical Education for the COEPCE. “Our staff highly value trainees’ innovation and collaborative efforts to positively impact patient care and our clinic environment.”
Now in its seventh year, COEPCE’s impact extends beyond primary care. The San Francisco VA Health Care Center trains upwards of 1,000 UCSF learners annually from each of its professional schools. As the Associate Chief of Staff for Education at the VA, Dr. Shunk supports diverse, forward-thinking learning opportunities for learners across a range of health professions and training levels. Recent additions at the VA include a joint UCSF geriatrics palliative care fellowship program, NP residency program in primary care and mental health, and medical student clinical microsystems clerkships.
“The VA offers a rich, dynamic clinical learning environment in which learning is purposeful, relevant, relationship-focused, and reflective,” says Dr. Shunk. “Our center’s clinician-educators believe we can transform healthcare by preparing graduates of health professional programs to work in and lead patient-centered, interprofessional teams that provide coordinated care.”
Dr. Shunk’s influence in interprofessional education extends beyond the VA. She is a member of UCSF’s Interprofessional Professional Education (IPE) curriculum development working group, which is charged with identifying interprofessional opportunities across the professional schools and future IPE curriculum delivery opportunities. Nationally she is a leader in the VA’s interprofessional academic initiative (iaPACT) and in the Society of General Internal Medicine.