Health professions students from the University of Arizona, Arizona State University and Northern Arizona University learned to collaborate across professional lines and tackle logistical and ethical problems of a disease outbreak in Arizona; sites in Tucson and Phoenix representing Bisbee, Flagstaff, Phoenix, Prescott, Tuba City, Tucson and Yuma were linked through real-time telemedicine video conferencing.
For the first time in the nation, an interprofessional education activity has gone statewide to include health professions students and faculty from all three state universities.
For nearly three hours on Tuesday morning, Nov. 27, a simulated pandemic flu emergency involving nearly 550 students and more than 40 faculty facilitators from the University of Arizona, Arizona State University and Northern Arizona University helped prepare future health professionals to understand and tackle the complex logistical and ethical problems of a disease outbreak in Arizona while underscoring the importance of collaborations across professional lines.
“Pandemic Flu: An Exercise in Disaster Preparedness,” presented by the University of Arizona’s Interprofessional Education & Practice (IPEP) program, involved participants at eight sites – seven in Tucson and one in Phoenix. Sites represented Bisbee, Flagstaff, Phoenix, Prescott, Tuba City, Tucson and Yuma and were linked through real-time telemedicine video conferencing.
The Tucson sites, which included the emergency operations center (EOC), were at the Arizona Health Sciences Center, 1501 N. Campbell Ave.; the Phoenix site was at the Phoenix Biomedical Campus, 435 N. Fifth St.
Participants included students and faculty from the UA College of Medicine – Tucson, UA College of Medicine – Phoenix, UA College of Pharmacy, UA College of Nursing, UA Mel and Enid Zuckerman College of Public Health, UA James E. Rogers College of Law, Arizona State University School of Social Work in Phoenix and Tucson, and Northern Arizona University College of Health and Human Services’ Physician Assistant program in Phoenix.
The simulated pandemic is part of a four-week mini-course designed to teach and reinforce quality, safety and effectiveness through interprofessional teamwork. Students are asked to respond as a team to a variety of ethical dilemmas and scenarios and then analyze their actions.
“There’s no ‘right’ answer to some of these questions; we want students to see the complexity of these issues and the role and perspectives of other professionals,” says Hal Strich, associate director of the MD-MPH Dual Degree Program offered jointly by the UA College of Medicine – Tucson and UA Mel and Enid Zuckerman College of Public Health, and a member of the IPEP pandemic flu planning committee.
The mini-course includes online learning, which students complete in the two weeks prior to the live interprofessional teamwork experience. The online learning includes an ice-breaker so students have a chance to meet their interprofessional team in advance of the simulated pandemic.
The simulated pandemic began at 9 a.m. with a pandemic flu mock newscast, followed by remarks delivered in real-time streaming video to teams of students in Tucson and Phoenix by Andreas Theodorou, MD, chief medical officer, The University of Arizona Medical Center – University Campus; UA professor of pediatrics; chief of pediatric critical care medicine and associate head, UA Department of Pediatrics. Dr. Theodorou addressed the role of the emergency operations center (EOC), resource allocation and workforce needs in a public health emergency and the uses of new communication technologies. “It [an emergency] can happen to anyone. Being prepared and learning are critically important,” says Dr. Theodorou.
“All-Hazards Emergency Preparedness, Mitigation and Response,” the concept of disaster preparedness and the local, state and national infrastructure in place to respond to a public health emergency, was discussed by Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the United States; distinguished professor with the UA Mel and Enid Zuckerman College of Public Health; and president of Canyon Ranch Institute. During the “hotwash” (debriefing) that concluded the exercise, Dr. Carmona advised, “There should always be a cautious paranoia…test yourself and never be complacent. We must be interdependent on one another.”
Interprofessional teams of six students were assigned to rooms representing eight Arizona communities: Tucson, Flagstaff, Prescott, Bisbee, Tuba City, Yuma and Phoenix. The students discussed various disaster scenarios relating to a worldwide flu epidemic striking Arizona; for example, how to distribute limited supplies of vaccines and the health-care worker’s duty to treat when their own health is at risk.
Student teams also were paired with experts who staffed a live EOC in the UA College of Medicine – Tucson. The EOC officials included UA, hospital, state and national health-care leaders with expertise in public health and infectious disease:
- Andreas Theodorou, MD, chief medical officer, The University of Arizona Medical Center – University Campus; UA professor of pediatrics; chief of pediatric critical care medicine and associate head, UA Department of Pediatrics.
- Richard Carmona, MD, MPH, FACS, 17th Surgeon General of the United States; distinguished professor, UA Mel and Enid Zuckerman College of Public Health; president, Canyon Ranch Institute.
- Christopher Robertson, JD, PhD, associate professor, UA James E. Rogers College of Law; officer of emergency preparedness, The University of Arizona Health Network.
- Theodore Tong, PharmD, director, Pharmacy Task force, Metropolitan Medical Response System; advisor, pharmacy preparedness for biological and chemical terrorism, The University of Arizona Health Network.
- Amy Waer, MD, assistant professor of surgery and interim assistant dean for medical student education, UA College of Medicine – Tucson.
- Nafees Ahmad, PhD, professor and director, Immunity and Infection Block and Microbiology and Immunology Discipline, UA College of Medicine – Tucson.
- Charles A. Schable, MS, chair, UA Institutional Biosafety Committee; former director, Coordinating Office of Terrorism Preparedness and Emergency Response at the U.S. Centers for Disease Control and Prevention.
The simulated pandemic concluded with a “hotwash” debriefing session moderated by Dr. Carmona and featuring EOC officials who addressed many of the issues that come up in a pandemic emergency and responded to student questions.
“Pandemic Flu: An Exercise in Disaster Preparedness” Background
The University of Arizona’s Interprofessional Education & Practice (IPEP) pandemic flu exercise has been held six times since 2008.
It was developed in response to a 2003 Institute of Medicine (IOM) report, “Health Professions Education: A Bridge to Quality,” that delineated core areas in which students should develop and maintain proficiency around the organizing principle that “all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.”
Since the 2003 IOM report, interprofessional education has been implemented for health professions students in a number of academic programs, both nationally and internationally.
In 2012, the UA IPEP program’s single-day pandemic flu exercise was transformed into a four-week mini-course to include online learning and team interaction. The IPEP mini-course is designed to help students explore and understand the complex social, psychological, legal and public health issues they will face as health-care professionals during an infectious disease pandemic.
Student learning objectives are three-fold: to identify and explore these complex issues in addition to the ethical issues that arise during an infectious disease pandemic; to articulate the roles and functions of different health and human services professionals; and to explain how cooperation among federal, state and local jurisdictions and public-private agencies and organizations can improve effective disease control measures.
Among the issues addressed during the exercise are:
- Mass care, limited resources and patient triage. Resources are limited and vaccines may not be available for everyone; a decision must be made to prioritize who will receive vaccines and in what order. Students must decide how to make allocation decisions, prioritize and justify their decisions.
- Health and safety of health-care workers. Students explore issues related to their duty as health-care workers and how to provide care when their own health and safety are at risk. Students must decide if they would care for patients when they themselves are at risk of exposure to a potentially lethal pathogen.
The 2011 pandemic flu exercise was documented by AHSC BioCommunications for use in the largest-ever international conference on interprofessional health education, “Collaborating Across Borders III, An American- Canadian Dialogue on Interprofessional Health Education & Practice.” The CAB III conference was held Nov. 19-21, 2011, in Tucson and attended by more than 750 national and international government leaders, policy makers, health-care professionals, educators and students.
For more information about the pandemic flu interprofessional mini-course, please contact Yvonne Price, Interprofessional Education & Practice (IPEP), 520-834-8983, email: firstname.lastname@example.org
Photo by: Sun Czar Belous, UA College of Medicine – Phoenix