Learning Together to Treat Patients with Complex Needs

Interprofessional student-led grand rounds is helping to create a future in which teams of diverse health professionals work together to improve and support the health of their patients.

An interprofessional team of RFU students selected a challenging clinical case to study, discuss and present: a 13-year-old girl, who had been brought to the ER when school officials noticed cuts on her arms, with a history of poorly managed Type 1 diabetes, depression and anorexia, and a complicated family situation involving physical, emotional and sexual abuse. The future health professionals, who include three graduates of RFU's Biomedical Sciences program, worked together to develop a hypothetical treatment plan that called for close attention to and careful coordination with their patient, her family and each other.

We learned that the IP team has to communicate very carefully with the patient and with each other.

“She needed a lot of follow-up and all the appointments might be overwhelming and that’s why our team collaboration is so important,” said Chantal Creighton, MS '17, CMS ’21, who during the university’s Interprofessional Student-Led Grand Rounds helped present the case as part of a primary care dream team of disciplines including pediatric endocrinology, psychiatry, pharmacy, podiatry and psychology.

“We learned that the IP team has to communicate very carefully with the patient and with each other,” Chantal said. “You can’t assume anything. We all emphasized careful follow-up with her and her family and making sure she’s compliant with everything she has to do.”

Lori Thuente, PhD, RN, education specialist in the DeWitt C. Baldwin Institute for Interprofessional Education and assistant professor of interprofessional healthcare studies, coordinates the student-led grand rounds.

“You see students teaching each other and you see the light bulbs go on,” Dr. Thuente said. “For example, a medical student realizes why it is so important for pharmacy to be involved in every step of the treatment process — because they may not know all the medications as well as a pharmacist. A pharmacy student asks, ‘What does a pathologists’ assistant do?’ IP Student-Led Grand Rounds is a real-life opportunity to work interprofessionally in a safe and controlled environment.”

The young patient’s treatment plan, in addition to prescriptions for rapid- acting insulin administered through a wearable pump and 30 mg of Prozac, also included: cognitive behavioral therapy, nutrition counseling, family intervention, education on hypoglycemia and how hyperglycemia can affect foot health, in addition to regular foot exams.

“One way to make sure patients with complex medical problems don’t get overwhelmed is to offer medication therapy management,” said Camisha Ruffins, COP ’21, who provided a crash course on insulin to the grand rounds audience. “We can help promote medication adherence and keep our patient’s confidence level up.”

Joana Abed Elahad, MS '17, CMS ’21, said she learned a lot about other healthcare disciplines while working together to prep for the presentation.

“I gained tremendous respect for pharmacy,” she said. “It felt like Camisha fit the piece to my puzzle and helped me see how important it is for physicians to work not just with physician assistants and nurses, but pharmacists. She explained how insulin like lispro can help to maintain near normal blood glucose levels when administered via a pump. It’s interesting to hear the different perspectives of the healthcare professions.”

During the grand rounds, Erin Chatten, CHP ’18, who is pursuing a master’s in clinical counseling and hopes to earn a PhD in clinical psychology, discussed psychological care that might benefit the troubled young patient. While preparing the presentation, she connected with Chantal over their shared interest in working with patients on lifestyle change.

“Psychologists can advocate for assessing the patient as a whole person by asking, ‘How is your condition affecting your life?’” Erin said. “‘How is your overall mood and day-to-day functioning?’ We can model and teach students of other healthcare disciplines how to speak with patients about health behavior change in a motivating and inspiring way, rather than a shaming or stigmatizing way.”

Erin, who implemented an integrated health behavior change counseling program at the university’s Interprofessional Community Clinic, is an advocate for integrated mental health.

“Evidence-based research shows that the model is effective,” she said. “It’s more convenient for patients and it can increase adherence to care.” Shajira Mohammed, MS '17, SCPM ’21, noted during the grand rounds that the mismanagement of the young patient’s diabetes and her history of substance abuse and self- destructive behavior called for special attention to the lower extremity to prevent diabetic neuropathy, compromised blood flow and foot ulcers. The patient’s history of self-cutting also made her more prone to infection and problems in wound healing.

“She’s only 13!” Shajira exclaimed as she talked about risk stratification, lifestyle changes, proper footwear and long- term management and support that involved the patient, her family and teachers. “It is imperative that her healthcare providers and her social support system work together to ensure her health and minimize long-term repercussions.”