By Nicole Fauteux
“I have eight sophomore dental students and nowhere to put them on Fridays. Do you have any ideas?”
That question, posed in 2009 by her academic dean, got Dr. Lillian M. Mitchell thinking. The former Director of Fixed Prosthodontics at the University of Alabama at Birmingham (UAB) School of Dentistry had just completed interdisciplinary training through the first Faculty Scholar’s Program offered by the university's Geriatric Education Center (GEC). One of Dr. Mitchell’s fellow trainees was the medical director of Fair Haven Retirement Community, the largest such community in the state. The facility, which is overseen by physicians on the UAB medical faculty, offers six levels of care from independent living through the end of life. During the training program, the medical director informed Dr. Mitchell that not all the oral health needs of the residents were being met.
“I called her and said, ‘I have eight students who know how to clean teeth. Would you want us to come start doing oral hygiene at the nursing home?’” Dr. Mitchell recalls. “Her response was, ‘Yes. When can you start?’”
Fair Haven had only a small medical clinic with two exam rooms and no dental equipment, but on Friday, January 15, 2010, dental students arrived and went to work using their own instruments and mechanical tooth brushes that Dr. Mitchell purchased on her own. A short time later, another physician asked Dr. Mitchell if a medical intern could join the group to learn how to do oral exams. Dr. Mitchell seized the opportunity to integrate medical trainees, who, in turn, helped her dental students do a better job of medically evaluating patients.
“This was the first true interprofessional experience for our dental students at UAB,” says Dr. Mitchell, “and it continues to this day.”
Thanks to the work of Dr. Mitchell and others affiliated with the GEC, which is supported by a grant from the Health Resources and Services Administration (HRSA), the study of caring for geriatric patients has become a leading vehicle for teaching interprofessional collaboration at the university. Fair Haven proved to be a natural venue for IPE since so many of UAB's health professions programs already had rotations there. These functioned independently, however. Today, junior and senior dental students interact with students and residents of medicine, occupational therapy and nutritional science, social work, optometry and pharmacy through a structured program designed by GEC Faculty Scholars, including Dr. Mitchell.
The Interprofessional Clinical Experience (ICE) for Healthcare Professions Trainees in a Nursing Home Setting gives students the opportunity to gain a better understanding of their roles within the health care team while working together to develop a comprehensive care plan for an individual patient. According to Dr. Mitchell, students are given basic information about the patient they will meet and then work as a team to structure a patient interview, “so there's collaboration before they ever see the patient.” During the preparatory period, students might discover that occupational therapy is about helping people with their daily activities (not about employment), or that dentists and optometrists can play a role in primary care by screening for hypertension, diabetes and other medical issues. Armed with this new understanding, students work as a team to develop questions for the patient, jointly conduct the interview and collaborate on a plan of care.
The GEC has also developed a large-scale interprofessional team-training exercise for its health professions students during which faculty members interview patients before a student audience. Students then break into facilitated small groups to develop care plans. While the two programs share common goals and similar elements, Dr. Mitchell points out that the strength of ICE is its intimacy.
“Having students from so many disciplines working together one-on-one with patients makes it far more instructive,” she believes.
Since the advent of ICE, a number of developments have occurred at UAB. The dental school has reorganized, and Dr. Mitchell has put aside her duties in the former Department of Prosthodontics to become Director of Geriatric Dentistry in the newly created Division of Behavioral and Population Sciences. Fair Haven, the university and the community partnered to build a dental clinic at the retirement community to make fuller use of the student talent rotating through its doors, expand training opportunities in geriatric dentistry and increase access to care for a vulnerable population. And the university recognized Dr. Mitchell with a Faculty Teaching Award for her roles in founding the geriatric dental clinic and creating opportunities for interprofessional collaboration.
Dr. Mitchell is clearly as passionate about providing geriatric care as she is about IPE, yet she readily acknowledges that not all students (or practicing professionals for that matter) have the compassion to work with older adults. Her message to her students is that demographics will soon make geriatric care a part of most dental practices whether or not dentists choose to specialize in this area. By 2030, one in five Americans are expected to be age 65 or older . In her current role, Dr. Mitchell takes special pleasure in observing the bonds that develop among students from various disciplines as they care for this population.
“Our dental students and the optometry students take gross anatomy and basic science courses together in the first two years,” she says. “They actually know each other, so a lot of the barriers get broken down automatically. When they come to ICE, it's amazing to watch these light bulbs go off in the seminar room when they’re all there planning patient care together.”