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Pediatrics, Integrated care, and the Family-Centered Medical Home

Posted By Karen Schetzina, Friday, June 7, 2013
Developing a Professional Identity

Karen's post is the final installment in this series.
Click here to read the first, second, third, and fourth posts.

I appreciate the opportunity to comment as the final post in this series from my perspective as a pediatrician and medical educator. Reading the comments of Drs. Reitz and Bishop and Mr. Ellison has provided me as a medical provider with greater insight into the challenges that psychology and family therapy colleagues may experience as part of an integrated primary care health team. This type of dialogue is important. In addition to developing one’s own professional identity, understanding each others’ roles and perspectives are keys to functioning effectively in interprofessional teams.

Acquiring effective written and oral communication skills and developing a common language among disciplines (and familiarity with our different dialects) is also essential. Even in the inpatient environment, where everyone is providing care under one roof and mostly within the same room, care can be uncoordinated if communication among providers, patients, and family members is poor.

I share the opinions that educators should do more to ensure that trainees develop broader skills, experience a range of clinical models, and be afforded early educational opportunities that are interprofessional and collaborative. Spreading innovations and improvements within groups, including educational reform within institutions, can be challenging however, due to the characteristics of the innovation itself, the willingness or ability of those involved to adopt the changes, and the organizational culture and infrastructure to support change.

This series has provided a stimulating discussion of the evolution of professional identity, influence of provider personality on practice style, balancing tradition with innovation, and the value of inter-professional collaborative training experiences.

An international commission of professional and academic leaders in medicine, nursing, and public health recently published a framework in the journal Lancet for transforming health science education that is relevant to this discussion. The commission called for educational reform to improve health systems, including "interprofessional and transprofessional education that breaks down professional silos while enhancing collaborative and non-hierarchical relationships in effective teams” (Frenk et al 2010).
The current prevalence of behavioral risks and chronic conditions and associated demands on our health system calls for training professionals and fostering systems for integrated care. Providing team-based, integrated care with nurses, physician, psychologists and other health professionals within the primary care setting can help in achieving the goal of a family-centered medical home and improve patient outcomes. Institutions, including ours, are beginning to develop and expand interprofessional academic health science curricula to address cross-cutting relevant core competencies including roles & responsibilities, interprofessional communication, teams & teamwork, and values & ethics.

Leadership from institutional officials and educators as well as influence from health system employers under pressure to demonstrate improvements in care delivery by their health care teams may continue to drive this educational reform.

I would like to thank my fellow bloggers and readers for their comments. This series has provided a stimulating discussion of the evolution of professional identity, influence of provider personality on practice style, balancing tradition with innovation, and the value of interprofessional collaborative training experiences. I look forward to similar discussions with colleagues around integrated care in the future.

Karen Schitzina

Karen E. Schetzina, MD, MPH, FAAP is Associate Professor and Director of Community Pediatrics Research in the Department of Pediatrics at East Tennessee State University Quillen College of Medicine.

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Megan Miranda says...
Posted Monday, June 17, 2013
I appreciate your enthusiasm, Dr. Schetzina, regarding the reform of family-centered health care practices to work collaboratively to address the biopsychosocial aspects of the patient's care and well-being. It is important to have the appreciation for and understanding of the quality of care that could be available to patients and their families, especially those with the patient-member being a chronically-ill child. I feel that progressive medical reform and education has an ethical obligation to research the positive outcomes associated with following a collaborative process and address the BPSS aspects of patient care and include medical family therapists as a necessity, not just an elective add-on for trainees, in the near-future.
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