Challenges to Coordinating Clinical Outreach to Improve Both Interprofessional Practice Initiatives and Global Health

Introduction: Patient centered global health care requires diverse professionals to address the clinical, biological, social, an political factors that contribute to the health of communities, regions and nations. Interprofessional education is an intervention where the members of more than one health or social care profession, or both, learn interactively together, for the explicit purpose of improving interprofessional collaboration or the health/wellbeing of patients/clients or both (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2018). The immediate goal is to engage students in both cognitive and social/relational learning. The goal is to produce a collaborative practice-ready workforce of individuals who have received training in interprofessional education. Global outreach missions are an opportunity for disciplines within Academic Health Centers to advance interprofessional practice initiatives. Collaborative practice experiences provide faculty and students an opportunity to deliver care as part of an interprofessional clinical team. Although highly impactful, challenges exist in coordinating meaningful global outreach experiences with predictable outcomes.

Methods: In 2015, the University at Buffalo Schools of Nursing and Dental Medicine recruited faculty and students to participate in their first interprofessional global outreach mission serving the underserved population in the city of Knoxville, Tennessee that lies in the Appalachia region. Since then, they have collaborated on multiple global outreach missions to include the island of Lesvos, Greece working with the refugee population, the city of Dakar in West Africa working with the locals that lack health and or dental care. These trips involve nursing students working directly with dental student on each patient’s healthcare plan. As the planning process evolves for each trip, the faculty experience a variety of barriers and challenges before finalizing the project plan. Coordination of faculty, students, clinical support team members, clinic site logistics, government regulations, translation services and active engagement with Non-Government Organizations (NGO) on location are major factors that can potentially affect the team’s ability to provide quality care.

Our global outreach used the Institute for Healthcare Improvement’s Plan, Do, Study, Act (PDSA) cycles during the planning and implementation of these experiences (“How to Improve,” 2018). The team, which includes faculty planning and attending the mission, starts each global outreach by asking, “What are we trying to accomplish?” The team then sets specific aims that are time-specific and measureable for each experience.

It is important for all members of the interprofessional practice initiatives to recognize the impact of culture on delivering patient centered care and understand how to engage vulnerable populations, build trust, and communicate effectively with team members. The University at Buffalo School of Nursing and Dental Medicine have collaborated with the University at Buffalo Community of Excellence in Global Health Equity office to provide a training curriculum for international outreach missions. The training guarantees that students and faculty have the knowledge and cultural competency needed to navigate differences in social norms and behaviors, language, communication styles, politics, and religion. Using both PDSA cycles and the training curriculum have proved to enhance the impact and partnership development of the interprofessional team experience.

Case Study: In April 2018, the UB School of Nursing traveled to a rural town of Galette, Haiti with a team of 18 individuals from the disciplines of nursing, pharmacy, and medicine. This trip involved the setup of a mobile med clinic that provided screenings, health assessments, diagnosis, and treatments. The success of this interprofessional collaboration allowed faculty from both the Schools of Nursing and Dental Medicine to establish a partnership with a local hospital in a town called Borgne. The interdisciplinary global outreach team will return to this hospital in 2019 and will include students from the Schools of Nursing, Pharmacy and Dental Medicine. Working side-by-side for each patient, the students receive an opportunity to learn more about each other’s discipline as well as how to work as part of an interdisciplinary team.

Results: Each global outreach mission benefits the patients, team members, and the local health workers at the outreach sites with whom we have collaborated. The global outreach collaboration between Nursing and Dental Medicine in Dakar, Senegal performed 1,585 procedures to help treat 414 adult and pediatric patients. Procedures included extractions, fillings, restorations, sealants and fluoride varnish. Each patient received a triage screening to include vital signs, medication reconciliation, allergy assessment, a medical history and exam.

Conclusion: Each mission establishes relationships with the local organizations with whom we connect. These partnerships have helped to sustain the global outreach program. Each year there is opportunity to return to the outreach location to provide follow up care and evaluation of the previous years’ work. Interprofessional education and team resiliency, resulting from implementing PDSA cycles and training curricula, will assist educators in expanding global health curriculums and reducing the impact of challenges in planning future collaborative practice experiences.