Learn together, practice together

Debra Bakerjian, center, a clinical professor at the School of Nursing, leads an education research project where physician assistant, nurse practitioner and medical students spend time together in the classroom and also practice as teams at a local clinic.

Teamwork plays an important role in many aspects of life — not only in sports, but also in business, in government — and in health care. Studies show that care in a team-based environment enhances disease prevention, diagnosis and treatment.

SPLICE itself the product of a team
SPLICE is an outgrowth of the residency interprofessional education program Professionals Accelerating Clinical and Educational Redesign, or PACER, that Bakerjian and UC Davis School of Medicine physician Tonya Fancher lead as principal investigators. They collaborate with other faculty physicians, nurse practitioners and pharmacists as part of the projects that bridge both the medical and nursing schools.

However, health care interactions frequently are one-on-one, between a patient and a nurse, or between the individual and a provider, such as a nurse practitioner, physician or physician assistant. Historically, health care education was similarly compartmentalized. Nurse practitioner, physician assistant and medical students traditionally trained in disparate programs.

Recognizing the value of teamwork in contemporary health care, faculty at the Betty Irene Moore School of Nursing at UC Davis and the UC Davis School of Medicine together initiated the integrated, primary care education model: System-transforming, Patient-centered Longitudinal Interprofessional Community-based Education, or SPLICE. The project is funded by a $2.49 million, five-year grant that the federal Health Resources and Services Administration awarded in 2016.

Improving care processes and outcomes through coordination among team members is a fundamental goal of SPLICE, explains its principal investigator, Debra Bakerjian, a clinical professor in the School of Nursing.

“SPLICE embraces the concept of ‘warm handoffs’ for patients — coordinated planning and smooth transitions among different team members in the practice,” Bakerjian says. “Imagine a team consisting of a physician, a nurse practitioner or physician assistant, a pharmacist and social worker, working together to help individuals manage their chronic disease. All team members, functioning at the top of their professional practice, collaborating to provide efficient and effective care incorporating consumer goals, preferences and self-management.”

The SPLICE curriculum is intended to prepare health professional students to work in teams. SPLICE commingles physician assistant, nurse practitioner and medical students along with medical and pharmacy residents. The curriculum encompasses classroom sessions as well as clinical experiences that teach culturally appropriate approaches to care.

SPLICE immerses participants in interprofessional, team-based clinical practice at the Sacramento County Health Center, which is a Federally Qualified Health Center that performs preventive and primary care for people regardless of insurance status or ability to pay.

“Once we finish evaluating and refining our team-based models, we plan to scale them to help transform care in a wide variety of practice settings,” Bakerjian says. In that way, SPLICE team members will demonstrate how their team-based health consumer care improvement concept can be replicated elsewhere.”