Pharmacy Student Participation in an Interdisciplinary Case Conference

American Journal of Pharmaceutical Education, 2003 by Joyner, Pamela U, Tresolini, Carol P, Harward, Donna H, Davis, W Ashley

The standardized patient training protocol, in use by the School of Medicine Standardized Patient Program at UNC-Chapel Hill since the early 1990s, includes multiple training sessions that total 4 to 5 hours of instruction, role play, and rehearsal, directed by the standardized patient trainer, for each case. Standardized patients for each case are taught the appropriate physical presentation a particular patient would have (eg, posture relative to physical condition, stuttering technique, and the issues that prompt the stutter), as well as appropriate responses to questions about psychosocial issues. Since these case conferences do not include conducting a physical examination, these patients are not required to learn the physical responses to specific examination procedures. By standardizing the clinical presentation, medical history, social issues, and patient affect and appearance through multiple training sessions, the patients provided each interdisciplinary group with identical opening comments and equivalent opportunities to elicit information pertinent to developing a patient-centered management plan. Through eliciting information from their respective patients during a 30-minute interview, students could model their professions' unique contributions to a patient's care, interact with other health professionals in an authentic encounter, and engage in developing a specific interdisciplinary patient management plan.

By assigning students to small groups according to their professional discipline, the committee ensured that each small group included representatives from at least 4 different health professions. Pharmacy students, along with nursing, medical, and social work students, were assigned across all 3 cases. Speech pathology, audiology, and physical and occupational therapy students were assigned to patients with pertinent medical and social histories (eg, stuttering, hearing loss, impaired mobility). Each interdisciplinary small group was assigned to 1 of the 3 cases based on the group's composition. As indicated in Table 1, the number of participating students varied across disciplines. Since there were fewer students in the social work, speech, and audiology courses, these professions were not represented in each small group. To ensure a high level of interaction within the groups, each group comprised only 8 or 9 students.

The World Health Organization's International Classification of Function and Disability, which merges medical and social models for a more holistic understanding of the patient and their environment, was selected to give structure to the collaboration and discussion. This model provides a framework for thinking about multiple influences on health and illness and provides a unified, standard language for describing human functioning and disability as a component of health. One of its purposes is to provide a scientific basis for understanding, studying, and describing functional states associated with health conditions. The model focuses on human functioning and disturbance in functioning across 3 interdependent dimensions: (1) body structure and function and impairments, (2) individual activities and limitations on activities, and (3) participation in society and restrictions on participation. The model focuses attention on improving contextual factors (personal and environmental), health promotion, and social participation by removing societal hindrances and encouraging the use of social supports. In addition, the model addresses the complex relationships and interactions between an individual's health condition and the unique circumstances present within their life that facilitates or restricts their participation, satisfaction, enjoyment, and fulfillment. The World Health Organization updated the model in 2000; further information can be found at http://www.who.ch/icidh.12 Since faculty from social work and allied health were the only facilitators with previous experience in using the WHO model, all facilitators received training about the model.