Teaching Medical Teamwork Right From The Start

There's a new building going up on the campus of the Cleveland Clinic. A very big building.

"The skylight that we're standing under will eventually cover the area of an entire football field," says Russ Saghy, who oversees construction projects for the Cleveland Clinic.

The skylight is part of the new Case Western Reserve University Heath Education campus. The joint project with the Cleveland Clinic 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.

When it opens to the first classes of students in 2019 it will provide an estimated 8.5 football fields worth of space and enough concrete to build a sidewalk that's 75 miles long. The cost: almost $500 million.

"The idea is to create a 'mini campus' that gives each school its own identity, but fosters collaboration," says Chris Connell, one of the architects, who is with Foster & Partners.

Collaboration is the ultimate goal, those involved in the project say. Health care in the 21^st century is increasingly being provided by teams, yet most health care professionals don't encounter their "teammates" until they are well along in their training.

"Health 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," says Dr. James Young, a cardiologist who heads the Cleveland Clinic Lerner College of Medicine.

"I'm involved with heart transplantation and mechanical devices for the heart," he says. "Boy, you can't do it by yourself!"

The new building, however, is less the beginning and more the culmination of a long-running effort at Case to train different types of health professionals together.

As construction workers pour concrete and erected scaffolding, about a mile down the road at the Case main campus, a small group of students from the schools of medicine, dentistry, nursing and social work gather around a table in a conference room.

Their mission: to figure out how to best treat their pretend patient — a 35 year-old woman with hypertension, obesity, and diabetes. In the hypothetical scenario the students have been asked to work through in this training exercise, the patient has come to their clinic with a series of injuries she says she got falling down a flight of stairs. Meanwhile, according to the scenario, her boyfriend is in the lobby acting disruptively.

The students discuss and argue about which of the patient's problems to address first, and what to do about the boyfriend.

They don't end up reaching much of a consensus, but faculty members overseeing the group say that's OK.

"I think that's fabulous," says Kristin Victoroff, an associate dean at the dental school. "It 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."

The twice-a-year seminars aren't the only collaborations that bring students from different health professions together. At a free oral health clinic in Cleveland, for example, nurses and dental students work together to treat real patients. Other activities bring students together to discuss interdisciplinary problems — like obesity or pain.

"We all have to deal with pain whether [we're] dentists or social workers or nurses," says Carol Savrin, a nurse practitioner and senior administrator at the Case nursing school. "So they're taking a common thread and coming at it from a variety of different angles."

This approach isn't new. Efforts to train doctors, nurses, and other health professionals together have been tried for years. And they haven't always been successful.

"I think they come in with some preconceived or stereotyped notions of what a doctor [or] a social worker is," says Scott Wilkes, an assistant dean at Case Western's school of social work. Breaking down those stereotypes by giving students from various disciplines a place to hear other perspectives and different types of knowledge, in their earliest training days, could make a difference, proponents of the new joint-campus say.

Getting everyone on the same page when that happens is critical to preventing medical mistakes, says Dr. Patricia Thomas, an internist and vice dean overseeing medical education at the Case Western Reserve medical school.

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

Update at noon ET: This post should have noted that the Cleveland Clinic is among NPR's financial supporters. Kaiser Health News was not aware of that.