Recently, our lab conducted, with support from the Canadian Thoracic Society, an extensive survey of pulmonary rehabilitation (PR) programs in Canada. One question we asked was: Do you provide training to students in your clinic? We will be publishing the results related to training and continuing professional development in PR this year, but quickly I can tell you that only about half of the respondents answered ‘Yes’ to that question.
Thinking back to your own training, it is likely that your specific education in pulmonary rehabilitation depended largely on what health care discipline you were in. As a physiotherapist, I received three years of training in exercise testing and prescription, but did not work in a pulmonary rehabilitation program in any of my clinical rotations. Considering how few programs there were in BC, this is no surprise. But the fact that only half of our existing programs in Canada have students working with them ensures that the vast majority of clinicians of the future will have no practical experience in a PR program.
This hurts our programs in many ways. First, it often means that any time a new program is started, not only are the health care professionals working in the new PR program going on little experience, it also means that they have few people in their discipline to support them as they begin. Second, programs can become stagnant without the injection of fresh ideas and new enthusiasm. Third, and maybe most importantly, PR is missing out on maintaining a flow of engaged and dedicated health care professionals who are choosing PR as their health care practice area of choice. I know of programs that have shut down due to the inability to attract staff.
So how can interprofessional clinical education support PR, and how can PR provide an fantastic training experience? First, let me define interprofessional clinical education. Simply put, interprofessional education is the process of learning health care in collaboration with students from other health disciplines. Initially, this took the form of case-based learning, where a case was introduced to a group of students with representation from a variety of health disciplines, all of whom would bring their discipline expertise to solving a health care scenario. However, it is recognized that students do not adopt an interprofessional approach to health care in clinical practice if they do not see this emulated in their health care environment, with active engagement from their clinical educators. So interprofessional clinical education was introduced. An interesting feature of this type of clinical education is that supervision of students can be from any health care professional. So a nurse can supervise a student physician, physical therapist, pharmacist, etc. This kind of education is challenging but rewarding for the students. Hence, there is a need to develop interprofessional clinical education opportunities.
I believe that PR is a great environment for interprofessional clinical education. Our patients come to us with a diagnosis of chronic lung disease, but as we all know, they arrive with many other physical, mental and psychosocial health issues as well. However, many of these health issues are relatively stable and long-standing. Most programs are not well-equipped to handle all of these problems as they don’t have the full complement of health care professionals. Some programs only have 1-2 staff. But a well-selected interprofessional student team, with a mix of junior and senior students, could provide much-needed care for our patients and a rich learning opportunity for our students.
In a current environment where most programs are taking no students, jumping right into an interprofessional clinical education experience may be too much to ask. But I think it might be the way of the future, and will go a long way to ensuring the sustainability of our programs while improving the health of our patients.
All the best,
Pat.
