a dentist could call a physician and say, ‘I currently have our patient in the chair, and this is
what’s going on,” Diane Brunson, RDH, M.P.H., says, “that would
take us so much further down the road in terms of [improved] health outcomes.”
former Colorado State Dental Director and Past President
of both the American Association of Public Health Dentistry and the Association
of State and Territorial Dental Directors, Prof. Brunson is in an excellent position to evaluate
the potential of interprofessional education (IPE) and collaborative care.
background has made me a believer,” she says, adding, “In many ways IPE is a
public health approach to improving overall health.”
this perspective, is it any wonder that Prof. Brunson was tapped by The
University of Colorado (CU) School of Dental Medicine (SDM) to serve as Director
of Public Health and Interprofessional Education?
state-of-the-art Anschutz Medical Campus has many advantages when it comes to
teaching interprofessional collaboration. The campus was designed to facilitate
IPE, with students from all the health professions programs sharing facilities.
But despite this strong foundation, CU has experienced many of the challenges
other schools face in implementing IPE.
her vantage point as a representative to CU’s IPE Council, Prof. Brunson has
seen most of them. The first was getting all of the schools on—“or at least close to”—the same academic calendar so
that every student would be available for IPE on the same afternoon each week
over the course of two semesters. To achieve this synchronization, schools
needed to adjust their didactic lecture and experiential rotation schedules.
didn’t happen overnight,” Prof. Brunson says. “We accomplished this because the
offices of the Chancellor and Vice Chancellor for Health Affairs stated this
was a priority.” Even so, the calendars are still not perfectly aligned,
although the introduction of an online component to the IPE curriculum has
solved the problem for the present.
major challenge has been finding faculty who can afford the time needed to
train for and then facilitate IPE classes, which use team-based learning. “Most
of our faculty have significant clinical responsibilities with upperclassmen,” Prof.
Brunson says, explaining that it takes at least five hours a week to serve as a
facilitator for the first- and second-year IPE program—time most clinical
faculty simply don’t have. She says CU has had some success recruiting from the
community, including outside the health professions. “Some of our best
facilitators are lawyers and hospital chaplains,” she reports.
dentistry, there’s also the need for a greater emphasis on intraprofessional training. Inspired by the keynote address given
by Judith Buchanan, D.M.D., Ph.D., M.S., at the 2013 ADEA CCI Summer Liaisons
Meeting, Prof. Brunson arranged for senior dental hygiene students from the Community
College of Denver to work in teams with second-year dental students last
semester. They were assigned a periodontology case that emphasized roles and
responsibilities within the dental team. Prof. Brunson plans to repeat the
exercise in the fall and hopes to involve a dental assistant program as well.
“As a dental
hygienist, Prof. Brunson brings great passion to the intra- as well as
interprofessional team interactions that strengthen education, research and
patient care,” says Denise Kassebaum, D.D.S., M.S., Dean of CU SDM. “Throughout
her career, she has promoted the value of teamwork and interprofessional
collaboration in the practicing dental community, in community partnerships,
and in state government, as well as in our classrooms and clinics.”
her successes in these venues, Prof. Brunson sometimes finds it hard to
communicate the value of collaboration to dental students. “We’re asking
students to envision a new type of dental practice that frankly doesn’t exist
in many places yet,” she says. The first orientation to CU’s nascent IPE
program exemplified the problem. The case of “Bill,” a man with diabetes who is
hospitalized for a kidney infection, was well received by her colleagues, but
Diane saw a serious deficit.
was mentioned about dental,” she recalls, “and I had 52 dental students in the
audience.” She immediately approached the director, who invited her to edit his
slides to give the case an oral health dimension. “That’s how I got my nose
into this,” she says.
experience as a dental hygienist working in a very intraprofessional private
practice many years ago has helped her to visualize what collaborative practice
should look like and how dentistry fits into the bigger picture.
safety net clinics, particularly community health centers, come closest to the
model we’re trying to instill,” she observes, “but even they are not really
sure how to practice interprofessionally. Many clinics have services collocated,
but not really integrated.”
she tries to convey to her students that the health care system is changing. “Dentistry
has been pretty siloed in the past,” she tells them, “but there’s going to be
more and more demand for patient-centered care. Our students are going to have
to know how to collaborate with other health professionals. We want to be sure
they’re ready for the coming changes, so they can succeed.” Finding faculty
members who see what dentistry could look
like as part of interprofessional practice is one key to moving IPE forward.
ensure that CU’s IPE program is meeting its goals, the IPE Council has
introduced evaluation tools and processes that go beyond those used by the
university to assess other programs. In addition to typical course evaluations,
students use a tool created by CATME SMARTER Teamwork, which allows them to
evaluate themselves and the other members of their team. Prof. Brunson hopes to
eventually find a way to use the data collected to see whether large
discrepancies between peer- and self-evaluations might predict difficulties
students may encounter during the clinical years.
IPE Council has also brought in outside evaluators from the CU School of
Education and Human Development to help evaluate the IPE program. “That’s been
really helpful in figuring out where the potential problems are, so we can address
them now, not find out years down the road that we’re not meeting the needs of
our students,” she says.
of the ideas that have arisen through the evaluation process include:
schools spend more time preparing students for their first IPE experience.
general practice residents who are CU graduates to explain the merits of IPE to
dental faculty to develop more cases (perhaps related to drug addiction or oral
cancers) that allow dentists to make medical diagnoses.
Brunson believes such cases would help dental students become more invested in
IPE by demonstrating its relevance.