Interprofessional Teams in Primary Care: Improving Provider Relationships and Patient Care

Neha Sandeep, PA-C
2022 William H. Marquardt Community Health Access Fellow

December 13, 2022

I first learned the value of interprofessional experiences in medical education as a PA student at Boston University School of Medicine’s Physician Assistant Program. During my clinical year I joined Harvard Medical School’s Cambridge Integrated Clerkship (CIC). With the CIC, I participated in a six-month longitudinal clerkship at Cambridge Health Alliance, a community-based healthcare system in the greater Boston area. A unique feature of the CIC program was participating in multiple clinical rotations (family medicine, obstetrics and gynecology, orthopedics, internal medicine, and pediatrics) weekly for six months rather than following the traditional block model of clinical rotations. This integrated model of rotations allowed me to follow patients over several months. I had a longer time to develop relationships with patients, preceptors and peers than in my previous clinical rotations. Another innovative element of this program was the opportunity to learn alongside other students of healthcare professions. In addition to our shared weekly didactic lessons, we worked together in clinical settings.

In my OBGYN rotation, my preceptor, Dr. Tara Singh, paired me with a second-year MD student. As a team, we interviewed patients, came up with differential diagnoses, presented patients to our preceptor, and proposed treatment plans. This close collaboration was a novel and rich learning experience for me. I learned that despite our separate medical training paths, we had a lot in common. We shared a strong desire to learn. We both had gaps in our clinical knowledge we were eager to fill, and we both had areas where we were confident. Our collaborative relationship allowed us to help one another grow. We had an open dialogue in which we shared our knowledge and experiences with each other to address insecurities and build understanding. This dynamic was humbling and helped break down barriers I had felt in my previous interactions with medical students.

This learning experience with CIC was my first chance to experience the benefits of working on an interprofessional team. In my current practice as a family medicine PA at Cambridge Health Alliance, I work on a diverse team of physicians, PAs, clinical pharmacists, nurses, social workers, sexual and reproductive health counselors, and a variety of other team members. My interprofessional learning experiences while training have prepared me to work in this setting and rely on all team members equally. I deeply value each one for the unique skills and training they bring, not their degree or title. I feel comfortable reaching out to my team physicians with clinical questions, discussing cases with my nurses and pharmacists, and reaching out to social workers for their unique insights on patients’ needs. The ability to consult and rely on my team members allows me to provide comprehensive care for my patients. This was especially critical while working through a global pandemic that brought increased pressures for all healthcare workers. I found that my relationships with team members strengthened my resilience as a provider.

I now train students of my own and dedicate an evening every week to precepting at a clinic designed to foster interprofessional learning. This clinic brings together PA, NP, and MD students from medical programs in the Boston area. We ask students to pair up – ideally with a student from a different training program – to see patients together, support each other through patient interviews and physical exams, and collaborate to present patients to preceptors. It brings me joy to see students sharing clinical knowledge, exchanging information about their respective training paths and future professions, and just getting to know each other as people. Whether it is conversations about the differences between PA and MD training, the struggles of preparing for upcoming exams, or conversations about favorite songs on a recently released pop album, I get to witness relationships blossoming between these previously siloed medical trainees.

With this interprofessional clinic, I hope to share what I learned about relying on my medical team members of all disciplines, approaching each other with humility and understanding, and creating genuine connections with each other. I want my students to experience how fostering relationships with team members of all backgrounds allows for better patient care. These relationships may also be an important tool to combat provider burnout. I can personally attest that these connections and the feeling of support I receive from all members of my team allow me to envision being a primary care PA for many years to come.