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Teaching Medical Teamwork Right From The Start

A project now under construction in Cleveland will eventually house the Case Western Reserve University's medical, dental and nursing schools, as well as the Cleveland Clinic's in-house medical school. (Courtesy of Cleveland Clinic)


CLEVELAND 鈥斅燭here鈥檚 a new building going up on the campus of the Cleveland Clinic. A very big building.

The structure will house the new Case Western Reserve University Health Education campus, eventually including Case Western鈥檚 medical, dental and nursing schools, as well as Cleveland Clinic鈥檚 in-house medical school.

鈥淭he idea is to create a 鈥榤ini campus鈥 that gives each school its own identity but fosters collaboration,鈥 said Chris Connell, one of the architects.

The building, which will cost almost half a billion dollars, will provide an estimated 8.5 football-fields鈥 worth of space and enough concrete to build a 75-mile-long sidewalk. It is expected to be open to the first classes of students in 2019.

But this part of the project is less the beginning and more the culmination of a long-running effort at Case to train different types of health professionals how to work together. Health care in the 21st century is increasingly being provided by teams, say the projects鈥 advocates, yet most health care professionals don鈥檛 encounter their 鈥渢eammates鈥 until they are well along in their training.

鈥淗ealth care is no longer a gladiatorial sport, where you had the one health care provider; you know mano a mano, one on one, battling a disease,鈥 said James Young, a cardiologist who heads the . 鈥淚鈥檓 involved with heart transplantation and mechanical devices for the heart,鈥 he said. 鈥淏oy, you can鈥檛 do it by yourself.鈥

On this particular day, about a mile away from the construction site, a small group of students from the medical, dental, nursing, and social work schools were gathered on Case鈥檚 main campus around a conference table. Every student in every health professions school is required to attend a seminar like this twice a year 鈥 one of the ways in which the training programs are already encouraging collaboration.

At this particular session, the students are tasked with figuring out how to best treat a (hypothetical) patient 鈥斅燼 35-year-old woman with hypertension, obesity and diabetes. She has come to the (fictitious) clinic with a series of injuries she said she got falling down a flight of stairs. Meanwhile, her boyfriend is in the lobby acting disruptively.

The students discuss and argue about which of the patient鈥檚 problems to address first, and what to do about the boyfriend. They don鈥檛 end up reaching a consensus, but faculty overseeing the group say that鈥檚 OK.

Jim Young, Dean of Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University School of Medicine. (Courtesy of Cleveland Clinic)

James Young, Dean of Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University School of Medicine. (Courtesy of Cleveland Clinic)

鈥淚 think that’s fabulous,鈥 said Kristin Victoroff, an associate dean at the dental school. 鈥淚t is actually an indicator of a functioning group, where’s there enough trust in the group where you can say what you really are thinking.鈥

But that鈥檚 not the only way the university is trying to foster 鈥渋nterprofessional鈥 education. For example, at a free oral health clinic elsewhere in Cleveland, dental students and nurses collaborate to treat real patients. Other activities bring students together to discuss problems that cross professional lines, like obesity or pain.

鈥淲e all have to deal with pain whether it鈥檚 dentists or social workers or nurses,鈥 said Carol Savrin, an administrator at the Case nursing school.

Efforts such as these to train doctors, nurses and other health professionals together have been tried for years. And they haven鈥檛 always been successful.

鈥淚 think they come in with some preconceived or stereotyped notions of what a doctor [or] a social worker is,鈥 said Scott Wilkes, an assistant dean at the Case social work school.

Yet getting everyone on the same page is critical to preventing medical mistakes, said Patricia Thomas, a vice dean at the Case medical school.

In studying the problem, she added, 鈥渢he root of many of our errors had to do with the fact that our professions were not working effectively together for patient care.鈥

Administrators say that is why the new building is so important.

It鈥檚 not just the formal training together, said Victoroff of the dental school, 鈥淚鈥檓 excited about the informal interactions that are going to happen.鈥

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