Taking an Interprofessional Education, Transdisciplinary Action Approach To

1. Marlene M. von Friederichs-Fitzwater, Ph.D., MPH, Assistant Professor, Hematology/Oncology; Director, Outreach Research & Education, UC Davis Cancer Center Taking an Interprofessional Education, Transdisciplinary Action Approach To Reduce Cancer & Health Disparities

2. Historical Notes on Interdisciplinary and Interprofessional Education Concept of using health care teams usually ascribed to Martin Cherkasky (Montefiore Hospital, New York City, 1948) Started as way to provide home care services to patients in local community with a hospital outreach program of physicians, social workers and nurses. Other countries had similar “team approaches” to health care (India, England, etc.) Expanded to other US hospitals and into mental health care. Interdisciplinary teams further developed in 1970s with the work of Kurt Lewin who proposed “a group is more than the sum of the individuals within it.” Social and behavioral scientists began making substantial contributions about structure, function and process of small groups or teams.

3. Interdisciplinary Education Ideal – if we educated students together, they would practice more efficiently and effectively together. Reality – medical, nursing, public health, social/behavioral sciences, social work, etc. have very little contact with each other through education experience. A 1972 Institute of Medicine report supported the concept of interdisciplinary education for health science students. Results – several elective interdisciplinary educational courses; then Nevada’s Health Sciences Program created entire interdisciplinary curriculum from college entry to graduation for all pre-professional and professional students in 11 health-related disciplines. More programs cropped up across the US; federal funding became available; most programs ceased by 1980 and federal funding decreased. Collaborative education and practice was not easy and often was regarded as an expensive luxury. (Baldwin Jr, DC. 2007. Some historical notes on interdisciplinary and interprofessional education and practice in health care in the USA. Jrnl of Interprofessional Care, 21(SI): 23-37

4. Current Changes During past decade, resurgence of interest in interdisciplinary education and practice. Increased awareness of inadequacies of current health care system in meeting basic primary care needs of larger segments of population. Rising health care costs, growth of health maintenance organizations (HMOs) with new workplace rules and roles. Result – New call for teamwork and collaboration among health professionals and programs to train such persons. Increased private and federal funding and companion thrust to increase community input and participation. Developing interest in total quality management (TQM) or continuous quality improvement (CQI) and improvements in the quality, efficiency and effectiveness of health care. Now, principles and practices of CQI are applicable and needed in education of health care professionals.

5. Lessons Learned Task of teaching cooperation and collaboration in health care is not easy. Attempts to promote such efforts meet overwhelming barriers of disciplinary territoriality and systems inertia. Each new generation seems to have to repeat the experiences and frustration of the past. Difficulty of publishing reports of interdisciplinary efforts in established disciplinary journals. Limitations in amount of time and effort in developing curriculum; scheduling of classes; appropriate advising and mentoring; professional and disciplinary “turf-guarding”; insular certification and accreditation requirements; administrative resistance; initial expense of new programs.

6. Today Aging population, rising incidence and prevalence of cancer and other chronic diseases. Increasing awareness of cancer health disparities and need for improved cancer screenings and lifestyle changes. Move from “cure” to controlling symptoms, maximizing patients’ level of functioning and quality of life. Increasing complexity of knowledge and skills needed to provide comprehensive care. Increasing specialization and less opportunity for interdisciplinary care even as need for it increases. Reinforced through the socialization processes of educational experiences. Each discipline has its theories, methods, “cognitive maps.”

7. A Preliminary Effort to Offer First Interprofessional Educational Special Study Module at UC Davis – Winter Quarter 2011 Commitment to community-based participatory research (CBRP) and new transdisciplinary (TD) action research to reduce cancer health disparities; to improved holistic patient cancer care; and to become a better transdisciplinary researcher. Began with literature review; interviews; professional meetings; etc. for curriculum development. Implemented first Interprofessional Education Special Study Module in Winter 2011 (four week, intensive format with 3 hour classes, outside readings, student-run class discussions, and final research project/paper/presentation) Results and lessons learned.

8. Vision of Interprofessional Education Teaching & learning process that fosters collaboration between two or more professions. Students learn with, from and about one another. Socialize multidisciplinary students to work together, to help them develop mutual understanding, and respect for each other, impact collaborative practice competencies.

9. Transdisciplinary Action Research Interdisciplinary and transdisciplinary research vary greatly -- methodologies and conceptual frameworks TD means learning each others’ language, theories, methods TD - resources are distributed over time and space; rankings of staff and discipline are constructively fluid; no discipline or perspective has permanent authorization over any others; belief that complex problems require processes and solutions that transcend disciplines and go beyond pure disciplines

10. Understanding Cancer Disparities Socioeconomic status (low, poverty) Culture Social injustice Discovery Delivery

11. Community Engagement & Community-Based Participatory Research Necessary for effective solutions/interventions Key to successful translation of science into improved population health Recognizes community as unit of identity, not a subject of research Integrates knowledge and intervention for mutual benefits of all partners Promotes a co-learning and empowering process that attends to social inequalities

12. American Indians Historic trauma, genocide, forced migration Epidemiology Molecular biology Bioethics Nutrition Behavioral science Sociology Music Film-making Education Medicine California Tribal Epidemiology Center California Rural Indian Health Board, Inc. Tribal Elders Cancer Disparities

13. Learning and Teaching Lessons Interprofessional education (IPE) courses need to grounded in a range of learning and teaching theories with flexibility for new approaches. Create a non-threatening learning environment where students feel psychologically safe to be open and honest about perceptions of other professions. Guide discussions about differences and similarities among the professions (medicine, nursing, social work, public health, etc.). Reflection is a key component of IPE learning and teaching strategies, need to allow time for that to happen. Students should be presented with a number of complex issues related to hierarchy, role blurring, leadership, decision-making, communication and respect, to name a few.

14. Relevant Learning Experiences • Type of setting influences student motivation to engage in IPE activities. • Need support from professional leaders to achieve status of IPE. • Elective courses perceived as not essential for health professionals. • Need group balance for effective IPE learning.

15. How does Interprofessional Education Lead to Transdisciplinary Action Research and Why Should We Care? In order to address cancer health disparities in innovative ways and solve the complex cancer health issues, “synergy science” is needed. To create cancer health equity, we need an analytical framework that can address the following questions: How adequate is a model in relating the micro (individual) level to the macro (social) level? How adequate is a model in relating conscious agency of social actors to the social structure in which they operate? Can a model provide an explanation for the discontinuous and foundational changes in the system as a whole?

16. A TD Action Approach • Transdisciplinary (TD) team established to develop a process for understanding: • Social determinants of cancer in the AI/AN population: • forced migration • genocide • historical trauma • Culturally effective interventions to prevent, control and treat cancer among Native Americans and other underserved populations. • Community- and tribal-based participatory research methods, evaluations and dissemination.

17. Acknowledgements • Frederick J. Meyers, M.D., M.A.C.P. • Executive Associate Dean, UC Davis • School of Medicine • UC Davis American Indian Advisory Council • 2011 medical and nursing students: • Eileen Andrae Ashely Treece • Ren Bee Radhika Sreeraman • Priscilla Duarte Brian Kruose • Deborah Greenwood • Laura Jones • Lisa Martinez • Frances Patmon • Arlette Rogers • Gretchen Spickler • Oleg Teleten • Terri Wolfe