Pressure Points This is the fifth in a series of special issues taking a closer look at the factors shaping modern medicine.

Keeping Pace: Educators Respond to Vast Changes in Health Professions

Everywhere you look, the health care landscape is changing. Reform ushers in fresh approaches to care delivery (take population health management, for starters), new business models, cutbacks in medical research—plus rapid-fire innovations that are redefining what clinicians, nurses, and scientists actually do every day.

This constant change creates a pressing need for health professionals to learn new skills sets; it demands out-of-the-box approaches to patient care and scientific discovery. Medical schools, nursing schools, and other health-related training programs are rethinking how they prepare students for the real world. They're also finding ways to help established professionals stay current.

Here, to keep ahead of the curve, URMC administrators have created the Institute for Innovative Education (IIE), a program charged with overseeing a system-wide transformation of the medical center's educational priorities and programs. With IIE, URMC is building on its national reputation for being innovative in education, initiating interprofessional training, and embracing new technologies.

Interprofessional Education: If You Want to Fly, Get Off the Boat

It's a typical day in the operating room, and the gang's all here: One patient—and more than half a dozen surgeons, anesthesiologists, technicians, and nurses. Each team member brings his or her unique expertise to the table, but the synergy between teammates is what makes the procedure succeed.

No matter what setting they are in, health professionals rarely work alone. Health care is a team sport. However, that's not how these professionals have traditionally learned to do their jobs. Different disciplines—nurses, physicians, social workers, nutritionists, pharmacists, bioengineers, and others—have learned independently. This makes it practically impossible for students to develop an understanding of the interactions between team players, or how to share accountability.

"You wouldn't teach someone how to fly an airplane by showing him how to drive a boat," said David R. Lambert, M.D., senior associate dean for Medical Student Education and a member of the IIE board of directors.

Studies show patients get better care and recover more quickly when treated by a successfully integrated team of providers. That makes interprofessional education more critical than ever, since health systems are increasingly being held accountable for their results. What's more, rather than paying providers separately, new federal and private payment models increasingly are paying groups of providers a lump sum to manage an entire episode of care (e.g. a hip replacement surgery, from surgery to rehabilitation). And that means those networked providers have to work well together to figure out the most effective way to allocate resources. If they're prudent, there's the potential to share savings.

The IIE is making interprofessional education a top priority at URMC. Board members are scrutinizing curriculums from different disciplines, hoping to find areas that intersect. They're developing new courses, like the Patient Quality and Safety module being jointly taught to medical students and students in the accelerated baccalaureate nursing program. Students from different disciplines are being assessed together, too, to see how they perform on a team.

"The very best path to having teams of providers work well together is to have them educated together," said Kathy Rideout, Ed.D., P.N.P-B.C, F.N.A.P., dean of the School of Nursing and an IIE board member.

Technology: A Long Way from Levi's

Its name might evoke thoughts of denim, but Blue Gene/Q is actually a speed machine. The IBM supercomputer can make trillions of complex calculations, spitting them out in less time than it takes you to add two-plus-two. This head-spinning ability to make sense of "big data," fast, is even surpassing scientists' capacity to apply it to real world situations.

URMC's Blue Gene/Q is the mother lode of data-manipulation, but countless other technological advances are also putting unprecedented amounts of information at our fingertips—both in laboratory and clinical settings. These innovations, big and small, will greatly expand our capacity to be effective—and efficient—in patient care and research.

First, however, we have to know how to use new technology. IIE is working to develop nimble mechanisms for teaching technology—and not just to students. For example, if the institution were to replace stethoscopes with handheld, portable ultrasounds, then physicians, residents, fellows, nurses, and others at URMC all would have to learn how to use the device. No small feat. Other good examples are the implementation of electronic medical records (consider our eRecord launch just a couple years back) and telemedicine.

Second, health professionals have to know how to sift through and interpret the vast amounts of information generated by these new technologies. As innovation advances relentlessly, we are garnering far too much knowledge to teach in school. Instead, URMC is putting a new emphasis on teaching clinical reasoning skills that can be adapted to different situations. That means teaching students how to ask the right questions to find a solution—instead of simply asking for the solution.

Technological change is also prompting URMC educators to update their teaching toolbox. Today's students are much more tech-savvy, so faculty members must become increasingly savvy themselves. They're incorporating iBooks, digital micrographs, virtual patient simulation, videos, and more into their lessons. Accrediting agencies are also stepping up the demand for these offerings.

Giving Facilities a Second Glance

Traditional lecture halls and labs don't meet the needs of today's learners. To accommodate interprofessional learning and new technology, the IIE is working hand-in-hand with URMC's Center for Experiential Learning to adapt URMC's current facilities. The CEL is modernizing the institution's educational space, with the $3 million Phase I due for completion this fall.

"All rooms will be flexible," said Sarah E. Peyre, Ph.D., director of CEL and a member of the IIE board. "We need space that meets the needs of educational programs, rather than the other way around."

Structurally, the 5,800 square feet being modernized will accommodate small classes for individual disciplines—or big classes for interprofessional learning. Walls that surround four, 40-student classrooms will collapse to make way for two, 80-student rooms. Tables on wheels and folding chairs will make it easy to switch between the variations.

The CEL also is making sure there will be plenty of places for students to plug in their laptops and iPads. The rooms will be high-tech, allowing for webcasting and videoconferencing. Cameras will allow students to record team exercises or virtual simulations, providing an excellent feedback mechanism. Future modernization phases include clinical exam rooms and a mock operating room.

"Students will be able to demonstrate their skills and show us they know what they are doing before they ever touch patients," said Peyre.

For more on the IIE, visit www.urmc.rochester.edu/institute-innovative-education.aspx, or check out this article that appeared in this summer's Rochester Medicine.

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