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Students talking at pharmacy IPE event.

IPE: Collaborative Learning Delivers Collaborative Healthcare

  • Massachusetts College of Pharmacy and Health Sciences (MCPHS) is one of the few schools in the world to offer Interprofessional Education (IPE) programs that not only span the health sciences, but also engage first year students.

    Our IPE programs bring together students and faculty from different disciplines, schools, and campuses to teach and learn from one another. And in the process, they broaden their perspective and discover new ways to address the diverse challenges in their respective fields.

    We recently sat down with Stacie Spencer, Professor of Psychology in the School of Arts and Sciences, and Paul Kiritsy, Associate Professor of Pharmacy Practice in the School of Pharmacy, to talk about a global challenge facing the medical industry—medication adherence.

    Together, you coordinate a university-wide IPE training exercise for students. Could you tell us about your goal?

    Prof. Spencer: We’re in an era of collaborative care, so we need to help students start building that knowledge early on. In IPE, students and faculty from different professions join forces to solve a real-world problem. The goal is to help students and professionals gain a better understanding of the roles and responsibilities of their own profession and those of other professions. We’re one of the few programs that’s doing something like this.

    Prof. Kiritsy: IPE is about students teaching students. From an MCPHS standpoint, we have all these professions that deal with a patient. The theme of this is patient-centered care, and they all fit into that. It’s also a great opportunity for upperclass students to teach first years, and for all students to learn about different medical professions from one another.

    How did you get the idea for the IPE training exercise?

    Prof. Spencer: Paul and I talked a lot about IPE. He had a section of pharmacy students, and I had health psychology students. Then we asked another instructor who had pre-med and pre-physician assistants (PA) students. We had students and faculty go through the simulation, and come together twice in the semester to talk about the experiences. When Susan Jenkins came in from Dental Hygiene, we added an oral health component.

    The feedback from students was great: “We think everyone should have to do this. It’s really eye-opening.” So we added someone from PA Studies. Finally, we had every first year seminar section taking it, and that was huge.

    Prof. Kiritsy: We had the “wrinkle” by then—halfway into it, they found out that they needed to change or add meds. so we got closer to the challenges of adherence.

    How does the protocol at MCPHS differ from that at other schools?

    Prof. Spencer: IPE is often when people are in their clinical years, but we’re starting as early as possible. A few years ago, we had the groups come together and create videos where they’re talking about how four different professions can help improve patient adherence and all work together. When the patient leaves with the medication, for example, it’s not just the prescriber’s or the pharmacist’s responsibility to make sure that they’re ready to go. How do other professions, along with those two, work together?

    And the breadth of participation is university wide. We had Introduction to the Major (ITM) sections, as well as Nursing, Pharmacy, Pre-Med, Pre-PA, Healthcare Management, and Pharm-Psychology sections.

    Prof. Kiritsy: An important point that Stacie made was that a lot of the IPE programs at other schools are offered at the end of the curriculum, but we are doing this in the first year when students are true 18-year-olds.

    Could you highlight some of the key pieces of the program?

    Prof. Spencer: One of the major pieces is allowing the instructors to build the curriculum in any way they want. We gave them a simulation, they choose the assignments and reflections, and there are no minimum standards. What are the behaviors? How is engaging in this behavior and adhering to the best advice for being healthy similar to being a student and all the advice you’re getting from professors, advisors, and success coaches about how to be a healthy student? What is it that moves someone in the right direction behaviorally?

    In pharmacy, we can talk about the actual medications, the issue of adherence within pharmacy, or what has become their standards of practice, and just setting the stage for later. We have some really cool space here that students at other schools don’t usually get to go into until they hit their professional years. Everybody sees our amazing pharmacy lab on tours. But up until this point, only the pharmacy students went inside. Now, all these first year students are seeing what it’s like.

    Prof. Kiritsy: We’re demystifying it.

    Prof. Spencer: Here’s another great thing that Paul added. Every student got an insurance card and money. We had three levels of insurance, which added an interesting twist. One of the insurance cards requires them to decide. Basically, they’re told, you don’t have the money for all these medications. Which ones are you going to get now? And the pharmacists who are fifth- and sixth-year students are interacting with them at that counter as though they were at a real-life pharmacy.

    We videotaped one PA student with a simulation patient. They got to hear a PA discuss the medications and conditions being treated. Our wrinkle that time was an oral health issue that connects back to the medical conditions of that patient. The patient has diabetes and esophageal reflux, and those set you up for having a dental problem. Students really connected with these kinds of dental issues. So it was as true to healthcare as we could possibly make it.

    Prof. Kiritsy: There’s such a multitude of learning that comes out of it. Some of these students have never had a prescription filled in their life because they’ve been healthy, and the one time they had an earache Mom filled it. Some of them have no idea about insurance. So we always have that one medication that requires an identification.

    The core of the adherence exercise was still happening for our freshmen with new wrinkles being added on to continually improve this. An additional benefit was that as it grew through the years, we were able to bring in upperclass PAs to explore some of the psychosocial components of making a decision. It’s a behavior.

    Do subjects such as abuse of medication ever come in to play?

    Prof. Kiritsy: Yes, the opioid epidemic. We built the Percocet simulation so that we’re going to give you 30 tablets, but you only need 3 days’ worth. We purposefully loaded them, and I had a faculty member say, “That’s not real. No one would ever really give you 30 tablets.” I said, “Great talking point. Keep it, because some will do that.” So, we had faculty members questioning what we were doing, and then saying, “Ah, good point. Okay.”

    Prof. Spencer: For the Nexium simulation candies, we had Good & Plenty because it has lots of licorice. So if you don’t like licorice, you’re really not going to like it first thing in the morning. That’s a talking point. What happens when a patient has to chew the medication?

    You mentioned that you wanted the vessel for these pills to be noticeable. Why?

    Prof. Spencer: Yes, because if someone needs to take a medication in the middle of the day, how will they behave? Do they care if people notice? Do they want to answer those questions, or are they going to have to think twice about? If I’m at my real place of employment and don’t want people to ask me what I’m doing, how will I deal with taking a medication?

    We know from upperclass students who’ve gone through this simulation, that it has an impact. We’ve had first years say, “I can’t wait to be an older student to play that role.” So we don’t solve their problems for them. We ask students, “How would you solve that problem in the real world?”

    Talking about the real world, how does the experience of first years contribute to their subsequent years?

    Prof. Spencer: For Introduction to the Major, instructors are supposed to talk about the curriculum for that major—here’s where you are, and here’s where you’re going. We suggest that they point out where they’re going to revisit the curriculum to help students better understand not just adherence, but other healthcare issues as well.

    This is just one piece of what healthcare professionals think about, but this exercise really does connect. And when you get to your clinical programs, they’ll be talking about adherence. In pharmacy, it’s in the professional years, and I’m sure they see it when they start. If they haven’t already been working at a retail pharmacy, they’re going to think differently when those patients come up and get frustrated.

    And we have that conversation about what does this mean for the manufacturers of medications? If you have someone take meds four times a day, why not look at other ways it could be dispensed or dosed less frequently? What do we need to understand better, and where’s the biology in this? Then there’s the marketing side of all that. Having a conversation about just one of these things will be so important for students as health professionals.

    It’s also important for them to understand that every patient is different in what their insurance covers, in what they like to do with their time, in what medication does and doesn’t taste good, and in their understanding of how they’re supposed to be taking their medications.

    Prof. Kiritsy: Some of our students’ reflections will be: “It’s tough being a patient.”

    Massachusetts College of Pharmacy and Health Sciences (MCPHS) offers 100-plus degree programs that empower the next generation of healthcare professionals and provides interprofessional educational experiences designed to give students the hands-on experience they need to thrive in their future careers.