Medicine and pharmacy cross the divide in collaborative care initiative

In mid-March, an innovative teaching scenario took place in Monash University's new Learning and Teaching building in Clayton. Nearly 500 students from two separate schools gathered to learn about each other, and how to communicate.

But this wasn't just about talking. The 168 pharmacy and 309 medical students – all second-years – met under the guise of a thunderstorm asthma emergency in Melbourne in an exercise to develop hands-on skills in interprofessional practice called 'Collaborative Care – Action on Asthma'. The idea aligns perfectly with both faculties' collaborative care curriculum framework.

Dr Fiona Kent, a physiotherapist and senior lecturer, is the collaborative care curriculum lead for Monash Medicine, Nursing and Health Sciences.

"A lack of shared vision can lead to errors in patient care,” she said. “This is an opportunity to get to know the roles of different professions and learn how we can work together.”

It's the first combined activity between pharmacy and medicine at Monash and will lead to many others; a cardiovascular mock-up is being planned for next year. Both Dr Kent and Professor Tina Brock, Director of Pharmacy Education, said the model should be "core practice" for all health faculties. It's  the beginnings of a significant move towards training students for collaborative working.”

Already there are many overlaps in the things medicine and pharmacy students are taught. Medical students learn a level of pharmacology, for example, and pharmacy students learn some physiology. "Big overlaps," said Professor Brock, "but students don’t necessarily know that.

"Like any tribe, if I know you're like me I speak to you in an informal shorthand. So even though the curriculum overlaps, in most cases the students and, later, practitioners wouldn’t know they have a shared experience."

Complementary knowledge

There are differences between the two groups, of course. Pharmacy is about therapeutics, or how patients use medicines to improve health. Medicine is more about diagnostics and treatment – figuring out what's wrong in the body and how to address the problem. "But if we can tap into our complementary knowledge and skills," Professor Brock said, "the patients will be safer and have better care."

She cites a real-life 2015 case in Melbourne in which a 77-year-old with a skin condition died as a result of a strong medicine prescribed by a doctor and dispensed by a pharmacist. The Age recently reported the doctor and pharmacist missed an opportunity to address a potential overdose situation, which resulted in tragedy.

Professor Brock said a lack of “role understanding and polished interprofessional communication skills” can mean health professionals from many fields struggle to connect the dots for optimal care.

Professor Brock also pointed to major issues in the UK, where, according to the BBC, GPs, pharmacists, hospitals and care homes may be making 237 million drug errors a year, some with potential for great harm. The errors included the wrong drugs being prescribed, incorrect doses dispensed, and delays in medicines being administered.

British university researchers, the BBC reported, with limited data, estimated the drug errors caused 700 deaths a year.

“Lapses in care are mostly due to transitions in patients between sectors and communication issues,” Professor Brock said. “Monash has identified that health professionals working together is important, so the University has created a collaborative care framework that we're in the infancy of implementing.”

“We may fiercely hold our domains of practice as our own, but healthcare is a team business."

“We can nip away at this,” she said, “or we can go full-scale. So why not give all second-years the opportunity to work together on something that really matters?”

The idea initially came from the Deputy Dean of Medicine, Professor Michelle Leech. Professor Brock had overseen similar interprofessional collaborations at the University of California, San Francisco, where she was Associate Dean for Global Health and Educational Innovations.

According to Dr Kent, the collaboration care in curriculum is about “scaffolding” the development of teamwork skills of both professions and advancing the modern healthcare mantra of ‘patient-centred care'.

“We may fiercely hold our domains of practice as our own,” she said, “but healthcare is a team business. Our curriculum needs to prepare students for that.”

Tina Brock was Professor, Centre for Medicine Use and Safety, Director of Pharmacy Education, Faculty of Pharmacy and Pharmaceutical Sciences at Monash University at the time of writing this article.