Despite the advances occurring in medicine, being told that you have cancer would be devastating to anyone. One of the most important things that must be done is to ensure that cancer patients are well supported and that they receive high quality patient-centered care. In a community teaching hospital like St. Joseph’s Health Centre, Toronto, creating a culture that learns, innovates, educates and uses new knowledge to improve care is critical to delivering on our commitment to providing the best care.
One example where this has been achieved is seen at St. Joseph’s Dr. H. James Watt Oncology Clinic where patient care and education are brought together through the new development of an interprofessional education and orientation program.
“Our (clinic) orientation program shows medical learners our approach to interprofessional education and collaboration – and gives them a “real life” sense of how we do things in the clinic to provide quality, patient-centered care,” says Dr. Jerry Maniate, Oncologist at St. Joseph’s and Assistant Professor, University of Toronto.
Dr. Maniate explains that when he first came to St. Joe’s two years ago, there was no clear curriculum for medical learners in the clinic. “Because of my interest in education, I wanted to explore how to make this learning experience better, more appropriate, interprofessional and realistic – especially to show how medical care can be provided in a community teaching hospital setting.”
The orientation program, which launched last year, has seen five medical learners run through the new approach and has been successful thanks to the support from all members of the oncology team.
“Historically most training rotations within the health professions have followed an apprenticeship model, which means that you only work with your supervising staff working in your profession – so social work students would work with the social worker on the floor, nursing students would work with the nursing staff. And the same thing was true for physicians – you would stick with them and that’s all you would do,” explains Maniate.
Medical learners have the chance to learn with, from and about all of the health professions and roles that contribute to caring for oncology clinic patients during their four-week rotations. “This approach reflects the reality of how the staff in our clinic work as an interprofessional team,” says Dr. Maniate. “And the heart of this really comes down to becoming more patient-centered in our approach to care and understanding the experience of our patients, throughout their journey though the clinic. When our patients come to the clinic they don’t see one person, they will see everyone throughout their care journey. And their experience is shaped by each of those people,” he adds.
Dr. Maniate worked with his team to develop an orientation package for medical students and residents, outlining the different roles that contribute to patient care, such as nursing, social work, dietitian, unit clerks and pharmacy, and is provided to learners before their rotation starts. Once the clinical placement begins, the first step is to have the students meet one-on-one with the team members to hear, discuss and better understand their unique role within the team and with the care of the patient.
While the majority of trainees are not specifically oncology trainees – they are medical students, family medicine residents or internal medicine residents – there is a need to focus on the generalist aspects of medical training rather than the unique specific details of oncology such as cell signaling pathways and apoptosis mechanisms.
While the program has been successful so far with medical students and residents, the aim is to integrate the approach for all student placements with the Hematology / Oncology service. “Ideally we want to have medical trainees, social work, dietitian, nursing and pharmacy students run through the orientation together. We are going to be working with our Interprofessional Education colleagues to increase the number of trainees that come through the clinic. Students would still be working with their preceptors but also have the opportunity to have joint sessions to discuss patient cases and explore how teams can work together to provide patient-centered care,” says Dr. Maniate.
Dr. Maniate’s hope is that this program is a way to showcase St. Joseph’s aspirations to make interprofessional education, interprofessional and patient-centered care very important. “It’s not your typical rotation in which students simply follow the senior staff around or see a patient and review a case – our goal is to try and look at the roles of health professionals as communicator, collaborator, manager, health advocate, scholar and professional, and really ensure that students get an exposure to that and gain a better understanding of their role and as a physician within a team.”