Volume 52, Issue 6 p. 1000-1006

Disciplinary Split: A Threat to Geriatrics Interdisciplinary Team Training

David B. Reuben MD

David B. Reuben MD

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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Lené Levy-Storms PhD, MPH

Lené Levy-Storms PhD, MPH

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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Misty N. Yee MS

Misty N. Yee MS

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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Ming Lee PhD

Ming Lee PhD

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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Kenneth Cole PhD

Kenneth Cole PhD

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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Martha Waite MSW

Martha Waite MSW

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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Linda Nichols PhD

Linda Nichols PhD

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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Janet C. Frank DrPH

Janet C. Frank DrPH

From the * UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii VA Long Beach Healthcare System, Long Beach, California § VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, Sepulveda Ambulatory Care Center and Nursing Home, Sepulveda, California Departments of Preventive and Internal Medicine, VA Medical Center, University of Tennessee Health Science Center, Memphis, Tennessee.

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First published: 24 May 2004
Citations: 37
Address correspondence to David B. Reuben, MD, Multicampus Program in Geriatric Medicine and Gerontology, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095. E-mail: [email protected]

Funding by the John A. Hartford Foundation.

Abstract

In 1995, the John A. Hartford Foundation launched an initiative to strengthen geriatric interdisciplinary team training (GITT) for advanced practice nursing and masters-level social work students and residents in internal medicine and family practice. As part of the national evaluation of the initiative, case-study and cross-case designs were employed using quantitative and qualitative data to examine the influence of cultures, regulations, and attitudes of individual disciplines on interdisciplinary training efforts at the first eight GITT programs.

This evaluation found that attitudinal and cultural traditions of the different health professions faculty and students (disciplinary split) remain as important obstacles to creating an optimal interdisciplinary team–training experience. In general, physician trainees participated least enthusiastically in GITT. In part, this lower level of enthusiasm may have been the result of inconsistent medicine faculty support of the program. At all but one program, physician trainees also had shorter GITT training experiences than other disciplines. In addition, the disparity in level of training by discipline of GITT participants may have contributed to attitudinal barriers to interdisciplinary training. Discipline-specific regulatory and accreditation barriers also impede interdisciplinary training. Nevertheless, GITT experiences at some clinical sites, especially home visits, appeared to promote interdisciplinary training.

Some barriers to creating and implementing GITT programs may be best approached at the level of accrediting agencies and certifying organizations. Others will require local and national efforts of leaders in the different disciplines to model and support good team care.