Using interprofessional education strategies to improve collaborative attitudes among infectious diseases and cardiology physician trainees

Dear Sir

In its recent report to Congress, the Medicare Payment Advisory Commission cited the “lack of formal instruction and experience in multidisciplinary teamwork” as a deficit in US physician education (MedPAC Report 2009). Interprofessional education (IPE) has been proposed as a means to improve collaboration amongst healthcare providers. Generally IPE programs address providers from different professions, such as nurses and physicians, however the divide in skills and attitudes between different specialist physicians can also be wide. Some evidence suggests that physicians are less inclined toward medical interdisciplinary teamwork than other health professionals (Leipzig et al. 2002).

We undertook a pilot study examining the impact of an interdisciplinary education program, designed using IPE strategies, on the collaborative attitudes and preconceived interspecialty stereotypes of cardiology and infectious disease (ID) physician trainees. A two-part educational series examining topics that require interspecialty collaboration was administered to fellow trainees. Each session was co-facilitated by one ID and one cardiology faculty and included a 20 minute didactic literature review, followed by a 40 minute interactive small group exercise in which fellows broke up into mixed groups and reviewed sample clinical cases highlighting differing specialty opinions that arise in these situations.

A two-part research questionnaire, measuring professional stereotypes and attitudes about collaboration and IPE, was administered to trainees in a one group pre-test-post-test design. 35 fellows completed pre-intervention surveys while 21 attended both sessions and completed matched post-tests.

Although 100% of fellows agreed (by dichotomized Likert scale) it is important for different specialists to work collaboratively and that IPE would improve their collaboration, trainees identified deficits in modeling of collaborative skills by supervisors. Only 75% of cardiology fellows and 90.9% of ID fellows felt their attendings always modeled good communication with other specialists. 45.8% of cardiology fellows and 81.8% of ID fellows reported witnessing supervisors making disparaging comments about other specialty recommendations.

Baseline positive and negative professional stereotypes were demonstrated. There was a significant increase in agreement among ID fellows post-intervention that cardiologists are “collaborative” (on a 6-point Likert scale, mean 3.20 increased to 3.90).

Absent formal instruction in multidisciplinary teamwork in US physician training programs, modeling is an important mechanism for teaching these skills, yet trainees report deficiencies in modeling of collaborative behaviors by supervisors. An IPE program can increase the perception that another specialty group is collaborative. IPE, among other curricular innovations, may serve a need for teaching collaborative competency among US physician trainees.