Inside Duke Medicine

New course brings M.D., PA, PT students together for training, promotes team-based approach to care

Duke has long been a proponent of a team-based approach to health care.

Examples include creation of the physician assistant profession in the 1960s by Eugene A. Stead, Jr., M.D., then chairman of the Department of Medicine, and with the Division of Family Medicine’s recognition in 2009 as an early innovator in the development of the “medical home” concept.

Passage of the new health care reform bill focuses the future on team-based approaches, and Duke again has aligned itself with that forward thinking.

This time, the model is rooted in the very beginning of training for tomorrow’s health care providers. The result is an interprofessional course on prevention that brings together medical students, physician assistant students and physical therapy students during the first week of the first year of their training.

The idea is to bring the students together as early as possible in their curriculums and introduce them to the concept of caring for patients as a team. They meet each other, learn about their respective programs, develop a trust for each other’s roles, and learn how they can work together.

“From day one, it makes them comfortable with the idea of sharing the responsibility of patient care with other providers,” says Brian Caveney, M.D., MPH, one of the course directors.

The class is divided into teams of six to seven students from each of the disciplines – M.D., PA and PT. Each team is assigned a project that involves a public health concern in the Durham community. Members are tasked with working together to develop a prevention strategy for the problem. Some topics have included asthma in teens, gun violence and diabetes.

The course lasts four weeks. The first three weeks consist of lectures on prevention and group assignments for their projects. During the fourth week, the students present their projects to the other groups.

“We got into our small groups and learned how to work together as a team, which is something that we are going to need to do in our careers,” says Jon Kochav, a first-year medical student.

The results surpassed the instructors’ expectations, according to Caveney. “Their ability on such short notice, with such limited, prior knowledge, to be able to put together really detailed, intricate intervention plans that were very realistic and very doable, was impressive,” he says.

Allison Lozon, a first-year PT student, found it beneficial that everyone could relate and sympathize with each other and “start off on an equal playing ground.” She says she’s now comfortable interacting with all professions.

“When we are in a hospital setting, we need to be comfortable talking to the doctors, who are signing off on everything; the PAs, who come in and work with them on a more regular basis; and the PTs, who see them everyday and work on their rehab,” she says.

“It was definitely an atmosphere of collaboration and understanding,” says Jamie Arton, a first-year PA student. “We all brought different perspectives to our presentations and the class as a whole based on our experiences and our different programs.”

“Duke is really at the forefront of trying to integrate our schools and our educations and to get us working together before we even start our careers,” Kochav says.

“This could easily springboard into a lot of other models of team-based care,” Caveney adds.