An Interprofessional Team Performance Training Program for the Care of Vulnerable Patients in the Ambulatory Setting

Health professions trainees often want to care for vulnerable populations, but their good intentions can be tested by patients’ complex medical, psychological, and social needs. Well-functioning care teams can respond to these challenges through communication, coordination and supportive relationships, but this requires teams to train together. In this paper, we describe a year-long ambulatory curriculum that trains post-graduate primary care and mental health trainees in key aspects of teamwork and relationship-centered care as they care for patients with complex biopsychosocial problems. The curriculum was developed and implemented with two cohorts of trainees from primary care, mental health and pharmacy disciplines (n =31) that were immersed in an interprofessional team caring for homeless Veterans in a patient-centered medical home (PCMH). Our curriculum is relevant for any clinical site seeking to improve team-based care for patients with complex conditions. It is grounded in an evidence-derived team performance framework that addresses three key aspects of well-performing teams: meeting practices (standardizing time and processes for collaborative care using checklists), taskwork (understanding team members' roles and responsibilities, and how to improve care), and teamwork (building humanistic relationships with patients and team members, and communicating respectfully). The curriculum is experiential and requires trainees to work on an existing patient care team and participate in team-based care processes (e.g. huddles, team meetings, panel management). We address stakeholder engagement, faculty and team development, culture building and logistics. Using two previously validated instruments to assess trainee perceptions of team performance and personal burnout at 6 and 12 months, we found that the program led to improvements in trainees’ perspectives of team performance, their relationship skills, and the effectiveness of their meeting practices, while also avoiding burnout. Key factors contributing to the success of the program are co-locating the professions, faculty role-modeling of team practice and communication behaviors, promotion of a relationship-centered culture, regularly scheduled workplace learning activities and planned IP learning sessions that support team-based practice.