by Preston Seaberg

Anne sat in the exam room feeling anxious and unsure. One month prior, the unassuming 53-year-old had been diagnosed with type 2 diabetes during an office visit she scheduled after feeling more fatigued than usual. Her treatment wasn’t going well. She chose not to continue metformin when it upset her stomach, but the substitute medicine sometimes dropped her blood sugar too much. Over the previous month she had two hypoglycemic collapses while buying groceries, and despite these dangerous episodes of low blood glucose, her blood sugar log showed that her average reading was actually increasing. The doctor’s recommendations for healthy foods were expensive and bland, and besides, she had persistent mouth pain that made eating a chore. Plus her prescription eyeglasses no longer helped her see clearly.

Living in a state known for its Southern hospitality, Anne nonetheless had a difficult life and was often overlooked, underestimated or disempowered. Still, she found medical providers she could trust at the Good Shepherd Ministries Medical Clinic in Oklahoma City. They were caring and patient, and—perhaps most importantly—they didn’t make her feel dispirited about her dire financial situation. In fact, the only people able to qualify for medical or dental care at Good Shepherd were those unable to afford it. Sometimes, though, even free care can be too expensive for those with unreliable transportation and unstable employment, and Anne worried that missing work to go to the doctor would be grounds for termination.

Since Anne had scheduled her return visit on a day she was not scheduled to work, she was not preoccupied with thoughts of being fired. Instead, she was nervous about the new way her visit was to be structured. She had agreed to participate in a pilot project named Empowering Patients through Interprofessional Collaboration (EPIC) created by the nearby University of Oklahoma Health Sciences Center (OUHSC). Rather than seeing a nurse followed by a physician, Anne would visit with an interprofessional team comprising students from each of the OUHSC’s seven health colleges. More specifically, her team of twelve student providers represented as many disciplines: nursing, physician assistant, public health, healthcare administration, social work, dentistry, dental hygiene, physical therapy, audiology, nutrition sciences, pharmacy and medical doctor. There would be a startling number of new faces, but Anne was intrigued by the breadth of problems the team would be equipped to address. She heard a knock on the door, took a deep breath and put on a smile.

Meanwhile, we students were restless. Some of us fidgeted in our seats; others paced. Each wondered the same thing: could such a hodgepodge of different minds really work as a cohesive unit? We had spent so little time together before Anne’s visit, but suddenly we found ourselves confronted with a real patient’s real needs. There were no dry runs. There were no do-overs. Ours, it seemed, would be a baptism by fire.

Up to that point, we had spent just twelve hours together in guided learning and team-building experiences. In a mix of didactic and flipped-classroom-style education, our supervising faculty led us through an innovative and interactive curriculum based on the core competencies of the Interprofessional Education Collaborative, helping us discover our roles through interprofessional speed dating and challenging us to practice teamwork by building a tower out of spaghetti and marshmallows. Most importantly, we team members created a working agreement to define our care delivery model and our approach to teamwork well before we saw a patient. Foundational to our agreement was the idea of continuous improvement. We established a written procedure for evaluating our process both internally and—through solicited, direct patient feedback—externally at each visit, and we developed a protocol for changing our process when there was opportunity for improvement. Providers are expected to know these and other advanced leadership skills on day one of their employment, yet traditional curricula neglect to equip students with knowledge and practice. EPIC filled that gap.

Even though our first visit with Anne was chaotic, it was a thing of beauty. We held high-level discussions on evidence-based care and practice guidelines. We listened to, appreciated and evaluated dissenting voices based solely on merit. The quiet members of the group spoke up. The team viewed mistakes as integral to perpetual, incremental improvement. Tellingly, we felt free to share those missteps—a key aspect of a culture of safety. Best of all, our patients made real gains. Anne, for example, lowered her average blood sugar while simplifying her medication regimen and eliminating hypoglycemia. She also received an in-office denture reline, customized nutritional education and sample menus incorporating foods she liked to eat, and new prescription eyeglasses. All was free of charge, and all was in the same place at the same time, thus sparing her expenses from travel and missed opportunity from the ballooning number of initial and follow-up visits necessary in a traditional multi-office, referral-based system.

EPIC has forever changed the way I view health care and what is possible when patients are simply given the tools they need to meet their health goals. On completing residency, I plan to seek an appointment as a primary care clinician and educator in general internal medicine. I hope to use my experience in EPIC to advance interprofessional education at the undergraduate and graduate levels, and through interprofessional practice I will seek to increase the scope of care available to my future patients. I can’t wait to get started.

Preston Seaberg is a newly minted graduate of the University of Oklahoma College Of Medicine where he was an active leader in areas of quality improvement, patient safety and interprofessional education. He began his internal medicine residency at the Mayo Clinic in July.