When the Affordable Care Act (ACA) was implemented in 2014, an estimated 10 million more people in the U.S. gained access to healthcare. But the influx of new patients tends to be less affluent and more diverse than previous patient populations.
Research shows that low-income, minority patients tend to have more risk factors for chronic illnesses; therefore, healthcare providers must be able to identify correlating concerns across health disciplines, such as the increased likelihood for gum disease in people with diabetes.
According to Rick Valachovic, president of the American Dental Education Association (ADEA), other evolutions in healthcare — such as the rise in ambulatory care centers — are adding to the need for healthcare providers and health professions educators to reinvent traditional methods for treating patients.
Interprofessional Education Provides Team Solutions
Interprofessional education (IPE), for which the ADEA advocates, is one way professional schools are preparing future healthcare providers to deliver culturally competent, patient-centered care.
The World Health Organization’s report “Framework for Action on Interprofessional Education & Collaborative Practice” defines IPE as follows: “Students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.” The report continues, “Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”
Increasingly, healthcare providers are required to provide care in teams. IPE emphasizes collaborative care by eliminating silos and educating students from different health fields together in the classroom.
“It’s true, dental schools developed independently of pharmacy, nursing, and medical schools because our care is mostly inpatient,” Valachovic says. “But dentistry has always had a focus on IPE, so we feel we have something to bring to the table.”
When considering other reasons for IPE’s importance, beyond a changing healthcare system, Valachovic points out that “the mouth is a mirror to the rest of the body.” For instance, diseases such as leukemia can present symptoms in the mouth, and dentists need to be aware of what those signs can indicate.
From the medical perspective, Dr. Maryellen Gusic, chief medical education officer of the Association of American Medical Colleges (AAMC) and a pediatric physician, says poor oral hygiene or prolonged bottle use can cause health issues in children. Therefore, she stresses the importance of oral care to parents.
Gusic is a member of the Interprofessional Education Collaborative (IPEC), which formed in 2009, and Valachovic is its president. Along with the AAMC and ADEA, IPEC comprises the American Association of Colleges of Nursing (AACN), the American Association of Colleges of Pharmacy (AACP), the American Association of Colleges of Osteopathic Medicine (AACOM), and the Association of Schools and Programs of Public Health (ASPPH).
“IPEC’s primary goals are to help provide member institutions with a common language and ways to assess competencies,” Gusic says. “IPEC provides for faculty development, serves as a voice to promote the importance of IPE to policymakers, and evaluates the results — there has to be science to back up its importance.”
Since 2009, IPEC has grown into a collaborative supported by organizations of optometry, physical therapy, and speech pathology and audiology, among others. The expansion in the types of health professions supporting IPEC reveals a growing recognition of the importance of IPE.
Another indicator of its significance is seen in the Liaison Committee on Medical Education’s decision to update its accreditation standards for 2015, which now require medical schools to include IPE in their curriculum to receive accreditation.
Diversifying Healthcare Delivery Using Holistic Admissions
To ensure that health professions schools are able to produce ample numbers of racially and socioeconomically diverse physicians to better serve a diverse patient population, a growing number of schools are moving to holistic, race-neutral admissions policies to diversify their student bodies.
As the name suggests, this type of review process takes into account the whole person, not just college transcripts and entrance exam results. Essays and letters of recommendation — along with demographic data, such as first-generation status and employment history — help review committees select candidates to move on to the interview portion. Exemplary applicants have proven leadership experience, strong moral and ethical values, and a history of working with underserved populations.
Additionally, the ideal candidate will have “an aptitude to be humanistic,” says Marc Nivet, chief diversity officer for the AAMC.
“Holistic applications are meant to be customizable after schools address two things,” Nivet says. “First, understanding what is the mission of the institution. Are they preparing students for graduate research, or do they want to address shortage areas? Schools have to articulate their mission, then look for those students. Second, schools have to be willing to dive deeply into applicants’ backgrounds and be comfortable with not having all of the focus on tests and GPA.”
Nivet acknowledges the challenges associated with holistic admissions — evaluating essays for ethical traits requires more time and staff — but he believes there will soon be a way to make things more efficient, by using technology — such as Skype, for example — to do a remote pre-interview session in place of essays.
Despite these challenges, the impact holistic admissions has had on diversity in schools using this method is profound. A report published in September by the collaborative Urban Universities for HEALTH, of which the AAMC is a part, affirms its value.
Of the 228 health professions schools surveyed, those that reported using “some” or “many” holistic review elements saw a combined 89 percent increase in student body diversity. Ninety-three and 91 percent of dental and medical schools, respectively, use holistic review in their admissions processes, more than the other types of health professions schools surveyed.
Further, while increasing diversity, schools did not sacrifice academic quality. Thirty-eight percent of the schools in the report saw an increase in the average GPA of their incoming class and 52 percent saw no change. A combined 96 percent reported that graduation rates at their schools remained unchanged or had increased.
Summer Program Helps Fill the Pipeline
Encouraging underrepresented students to apply to dental or medical school has its own challenges. But Valachovic credits the Summer Medical and Dental Education Program (SMDEP) for serving as a pipeline. “The SMDEP is a very robust program, and the numbers are phenomenal,” he says.
Freshmen or sophomore undergraduate students interested in dental or medical school spend six weeks taking courses aimed at developing their study and science skills. Valachovic says the rate of acceptance to dental school for SMDEP participants is 66 percent, twice the rate for all other dental school applicants. Furthermore, 100 percent of accepted SMDEP applicants matriculate.
More health professions schools are moving toward holistic review and IPE as effective ways to create a culturally competent healthcare workforce by allowing more students who have overcome significant barriers to matriculate. When they become physicians and dentists, these students are more sensitive to the needs of their patients, especially low-income and minority patients, with whom they may share similar experiences.
Visit MedEdPortal.org for resources on developing interprofessional education skills.●
Rebecca Prinster is a senior staff writer for INSIGHT Into Diversity.