Why I Teach: With Dr. Brian Cross
In the latest episode of the Why I Teach podcast, Dr. Brian Cross discusses ETSU’s nationally recognized interprofessional education (IPE) program. The IPE program brings together faculty and students from the health sciences to learn and practice team-based care in health care settings.
Dr. Cross, Assistant Vice Provost and Director of the ETSU Center for Interprofessional Collaboration, takes a look back at how the IPE program has evolved over the past decade, and he highlights developments in the curriculum that will continue to equip our students with invaluable communication, teamwork, and problem-solving skills for careers in health care.
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Dr. Brian Cross
This thing that has been discussed within the university so much with "Go Beyond,” and we think it's really important to move our students now out into the community and to take these skills as teams and find environments where they can engage patients, communities, families to improve the health.
Dr. Kimberly D. McCorkle
Hi, I'm Kimberley McCorkle, Provost and Senior Vice President for Academic Affairs at East Tennessee State University. From the moment I arrived on this campus, I have been inspired by our faculty, their passion for what they do, their belief in the power of higher education, and the way they are transforming the lives of their students. This podcast is dedicated to them: Our incredible faculty at ETSU. Hear their stories as they tell us "why I teach.”
In this episode, we will talk with Dr. Brian Cross, Assistant Vice Provost and Director of the Center for Interprofessional Collaboration at the East Tennessee State University Academic Health Sciences Center.
Dr. Cross has 30-plus years of clinical experience in many ambulatory areas, including the Indian Health Service, the VA health system, endocrinology and cardiology, academic practices, and multispecialty private practice medical groups. For most of the last 23 years, Dr. Cross has created advanced collaborative practice environments, mostly in primary care, integrating clinical pharmacy services within both large private practices, as well as academic practice models. Such collaboration will not only greatly assist our students, but it will help those they serve for generations to come. He has been awarded multiple teaching award from colleges of pharmacy, nursing and medicine at multiple universities, and he has spoken on the connection between collaborative practice and learning and training at national and international meetings. In 2018, he was a Fulbright Scholar at the Royal College of Surgeons of Ireland, focusing on the bridge between interprofessional learning and collaborative practice. This year, he will be awarded fellowship status at the National Academies of Practice, the only interprofessional group of health care practitioners and scholars dedicated to supporting affordable, accessible, coordinated, quality health care for all. Dr. Cross has been an ardent supporter of the interprofessional education at ETSU, and I look forward to learning more about its progress and its future in our conversation today. Enjoy the show.
Dr. Cross, welcome to the show. I start my podcast with the same question for every guest. Take me back to your first day of teaching at ETSU as a faculty member, and looking back on that day, what is one piece of advice that you would have given yourself?
Dr. Brian Cross
I've thought about this question for a while because first I listen to the podcast, and so I know that I was supposed to prepare this way. But second, I think this is the kind of question that causes you to pause and ask, like, so what do I really think to the answer to this question? So I actually wrote down the answer because I want to make sure that what I was thinking is clear. Yes. And so what I would say to myself back then is that teaching is not simply giving students facts that they give back to you on an exam. It is the connection between inspiration, challenge, wonderment, and giving enough time and space for them to be able to answer the “why" questions more than the "what" questions. And that learning is a journey, not a destination, that should be filled with joy and fun.
Dr. Kimberly D. McCorkle
Well, Dr. Cross, as we get started, why don't we start with you sort of telling us what is IPE and how does it function?
Dr. Brian Cross
Yeah, I think that's an important foundational kind of… So what is this and why are we doing this? I think one of the things to appreciate is this: This word has probably been in existence for 40 years, started in Europe, Canada. The United States, was actually slow to kind of take this this word up. For the people who do work that is called interdisciplinary, I would tell them this is a similar kind of thing. Interprofessional specifically came out of the health professions. And so that word is typically aligned with health professions, either practice or education. But at its core, it comes from a report that came from the from the U.S. government called "Crossing the Quality Chasm.” And specifically, it took them 250 pages, but basically what they said after they were done is that we should train together as health professions and we should practice together as health professions.
Fast forward 15 years, a second thing is published from The Lancet that says medical error is the number three reason for mortality in the United States. That kind of ups the game on… It's clear that the system that we currently send our graduates into is not one that is open, let's say, for team-based processes of care consistently. Right. And so at its foundation, what we are trying to do in interprofessional education, and then preparing them for interpersonal practice, is is breaking down these walls of hierarchy in practice and explaining to them the value, the reason, and the data that supports team-based care to improve outcomes of their patients, their families and the communities that they live in.
Dr. Kimberly D. McCorkle
Tell us about the colleges that are involved in IPE at ETSU.
Dr. Brian Cross
As we said, the word interprofessional kind of is aligned with health professions. And so the educational process here at ETSU is specifically focused on the five colleges in the Academic Health Sciences Center— so the College of Pharmacy, Medicine, Nursing, Public Health and Clinical and Rehabilitative Health Sciences. Within that is approximately 18 different programs that are touched in some form or fashion by the IPE program here at ETSU. It's great. And all of this takes place in Bishop Hall, right on the VA campus. All of the face-to-face gatherings.
And Bishop Hall, we jokingly say, that 2018 was sort of the “big bang" of IPE at ETSU. 2018 was when the building officially opened. This is a state-of-the-art simulation building, about 36,000 square feet, two full floors of simulated space that is both ambulatory in nature. So there are clinic rooms that look like a primary care office, an apartment living space, and then high-fidelity spaces like an emergency room and ICU, those kinds of things, as well as soon-to-be nine debrief spaces, where after this simulated experience, there is a safe space for the team of students to come and kind of debrief what just happened to them from an educational process. It's great. And you have community volunteers who participate in this process. We do. So within those days when there are, when the teams are going through this training simulation, we will Zoom active, engaged teams across the Tri-Cities, both in academic practices as well as private practices, around particular themes. So this coming spring, we will be bringing folks in from the community specifically to talk about communication and conflict resolution within their practices. And so while the students are going through that training, we then bring in a group of practitioners to talk about the very same stuff that they were just going through that day. That's great.
Dr. Kimberly D. McCorkle
Your bio focused on your work in collaborative practice environments and interprofessional education, or IPE, as we call it. But your career began in pharmacy. Tell us about your background and how it has led you to your current role at ETSU.
Dr. Brian Cross
Yeah, it sort of reminds me of the Grateful Dead, song, "What a Long, Strange Trip
it's Been.” Right. So I grew up in West Virginia. I have a B.S. in pharmacy, which
is a degree that's not even offered any longer. I did a residency in Boston. I went
to the Indian Health Service in Arizona. That's where I met my wife on a very small
San Carlos Apache reservation in Central Eastern Arizona. And then did a stint in
the VA in Florida, then went back for my PharmD at UT in Memphis, did a second residency
at the Med in in Memphis, and then joined faculty at the University of Tennessee in
family medicine and primary care. Mm hmm. After that, moved up here to Northeast Tennessee,
took a collaborative position with a large medical group here in the Tri-Cities, in
collaboration with the University of Tennessee. And then in 2010, came to ETSU and
joined the College of Pharmacy. I will say that I think those early years, being in
environments where we had to collaborate because of the nature that we found ourselves
in, say, in the Indian Health Service, we were in a single-wide trailer and the team
total was five people. Everybody had to be good at a lot of different things. I think
it made me appreciate the importance and value of team. But I will say I think I was
more selfish in figuring out how I would be a more important member of the team then.
And only as I went through more environments and realized that nobody was supposed
to be more important than any other person on the team. And I guess I say all that
to say I'm only now at a place where my head and heart are in the right place that
I could be leading something like what we're trying to accomplish with IPE now. It's
great.
So it's clear that there's been a shift toward a greater appreciation for interprofessional practice and education among health care professionals. In what ways have you seen that manifested in health care and also education settings?
Dr. Brian Cross
I'd say in the early days, so and I'm not even sure what that means anymore. But, you know, 20- or 30-plus years ago, where collaboration was happening more commonly was in the clinical spaces and so on rounds or in the clinic or things like that, learners of different backgrounds may be accidentally in the same space and maybe accidentally learn from one another. Fast forward a while. There's some government reports that say we need to do better both in practice and education. And then, like with most things, regulations come down and accreditation standards begin to change. And you then have standards that say you must do X, Y and Z. And then you begin to see the training moving into the curricular spaces instead of just in the clinical spaces. And so now I think our challenge is creating the bridge between the foundational curriculum like we are trying to establish here, with a bridge from that to the clinical space and being intentional in taking the team training we do in a simulated environment, making sure that that stays with them and moves into the clinical spaces consistently. Does that help? It does.
Dr. Kimberly D. McCorkle
So related to that, tell us how IPE has developed here at ETSU.
Dr. Brian Cross
Yeah. IPE is a strange thing to talk about in our country. It developed over time. For ETSU, the journey, we're now in our 10th year or so. So in 2013, a former vice president and the deans in the Health Sciences Center kind of came together and said, "we need to do something.” That led to a small cohort of students going through a volunteer process, and we began to refine experiences and curriculum and things like that. And then over that journey of now ten years, moving from something that was a volunteer, small group of students to now a group of students of more than 700, and faculty of more than 90 or so from all five colleges. and the Academic Health Sciences Center.
Dr. Kimberly D. McCorkle
So will you tell us a bit more about the current IPE processes and models that are in place here at ETSU and how those help prepare students who are going to work in health care?
Dr. Brian Cross
Sure. Right now we have two foundational models. The first one is the synchronous model. That is an on-ground, in person two-year, four semester experience. The four core domains of interprofessional education are the thematic processes by which we do all of our teaching. So on each day there is a theme. Those domains are communication, roles and responsibilities, teams and teamwork, and values and ethics. The second year is sort of the application, if you will. These same teams of students with faculty facilitators follow a patient longitudinally over the year, and then we end the entire experience with a formal reflection period where each of the teams give a pseudo-TED Talk to the other teams about the patient and the team process that they’ve learned. The second model that we used beginning in 2019 is the asynchronous online. So this is for learners who may never be physically in Johnson City, but they still receive training through our online process. We incredibly lucky that we opened this model in 2019 and learned in a year what we needed in 2020 when our synchronous model went to online. It was still synchronous and people gathered real time. But we used Zoom for all of the gatherings. And unlike many IPE programs in the country, we actually expanded our program during those two years that we were online and not face to face and actually grew by about 150 students at that time. In another six months or so, we hope to open a third model, and I think we'll talk about that maybe a little bit in the future.
Dr. Kimberly D. McCorkle
Well, so tell us a bit about what the challenges and opportunities have been for faculty and students as you've developed the IPE curriculum and the models.
Dr. Brian Cross
I think the challenges would be not a surprise. So when you are trying to teach students from five different colleges, schedules are an amazing task. So to gather students from five different programs, from five different colleges, 18 different programs into a common space for a two-hour period of time to do something requires an inordinate amount of gathering around tables and taking people to lunch and convincing people of value. I think the next thing is the convincing of value of it within and inside of a curriculum. And I think the third thing is how is it valued at the faculty workload standpoint? So that when we are asking faculty to be faculty facilitators in these small groups, so these are groups of 8 to 10 students and they are with the same group for an entire year. It's not a huge ask, but for all faculty I think workload is always a major issue. And so we have spent the last several years integrating the ask into the workload model for all of the colleges. And so now these are, they are given credit for teaching just like they would for anything else. I would say those are the major obstacles that most people describe. I think the benefits are the ability for both faculty and students to come together in a common space and learn from, with, and about students and faculty from other places. And therefore realize, just like all the conversations that are like this, we have way more in common than we don’t. But we don't realize that if we don't come and have these conversations.
Dr. Kimberly D. McCorkle
Do you have a favorite story about a student who seemed to really benefit from this model — that being able to observe that sort of aha moment?
Dr. Brian Cross
I don’t have one, but I would say I would I have a collection or collective. I continue to get, as we have graduates now heading out into the world, these emails and texts that will come in and say, it’s not that I didn't realize the value and importance of this when I was in it. but we were in simulated environments, and so I just want you to hear that all of this stuff that we were doing, I'm now in residency, I am now in practice, and all of these things that you were planting, I keep seeing them returning. And the things that many people will describe as soft skills, I’m clearly realizing these are actually the foundational skills that make me a better clinician. I say to all of the students, "Our job isn't to make you a pharmacist or a physician or a nurse, etc.. It's to make you the best version of whatever that thing is that your home college is making.” So I guess that's my favorite story. We do have several marriages that have come out of the IPE. So we have … I wouldn't claim to be an interprofessional matchmaker, but we do have some interesting stories over the years of people coming together and still having a marriage and family gathering. And I think that's kind of humorous as well. Sort of teamwork taken to … Expanding that concept of teamwork.
Dr. Kimberly D. McCorkle
Tell us what's on the horizon for IPE at ETSU.
Dr. Brian Cross
So one of the things I mentioned when we were talking about models is starting in the fall of 2024, we will open the third model, which is a self-directed, online one semester focused specifically at the undergrad learner level. And we are excited to announce that over the next two years of that being open, we will have now engaged all of our BSN students in the College of Nursing, the largest college in nursing in the state of Tennessee. And it has been a major task to get all of those students accounted for in this training. So that's one of the things that's happening curricular-wise. It's fantastic. We're also really excited about being involved in more programing and things on Main Campus. So things like the Basler Chair that has just been announced here in the last week or so on main campus. The chair this year brings a very interesting and unique background of the bridge between the performing arts and healing. And so we are engaging her in a couple of different events where we will bring students from arts and sciences and the health sciences into a common space to have conversation about that. And then a similar event that we will host with faculty and practitioners in the community around the same kind of discussion of does the arts have a role to play in the healing? Yes. A couple of other things on the horizon. This is our 10th anniversary, so we're going to have a graduation ceremony the first week of March. This is going to be the largest graduation we've ever had. Probably upwards of 300 students will come through that event. Congratulations. And we're also really excited that our featured speaker this year is one of our initial faculty from ten years ago who is now at the University of Michigan and returning to give kind of a just from where I've come to where I am, and kind of coming back to the roots of where he started and the initial faculty group. We hope to have all of them at that event and sort of have some wonderful pictures and just some time to reminisce about all of the stuff that's happened in IPE in the last ten years. Yes. I think the last thing that I would mention is just that bridge we were talking about and this, this thing that has been discussed within the university so much with go beyond. And we think it's really important to move our students now out into the community and to take these skills as teams and find environments where they can engage patients, communities, families to improve the health. And so we are with small projects looking for opportunities to take. In the same way we started IPE. So in a small way, there's a couple of things that we’ve done so far engaging in RAM. So having some of our interprofessional student teams involved in service to the underserved. And then there is a model that has been in practice now for about four years called ETSU Health Bridge, and this is engagement we use a interprofessional group of students to provide service to the unhoused in Johnson City.
Dr. Kimberly D. McCorkle
What has been the response from our community partners in the program that we've offered here for our students in the ways that we're preparing them in this space?
Dr. Brian Cross
I'm glad you asked that. So one of the things that I forgot to mention that is really important is when we gather in Bishop Hall several times a year, we will Zoom in community teams that are in practice. Yes. And we think it's really important for the students to meet real teams and we don't pick them on purpose so they'll say this. But we hear them say a lot is we wish we had received training like this when we were going through a process. We have learned this kind of on the street, but our lives would have been so much easier if there was an intentional curriculum to create this foundational skill set before we were in practice. And so I think every time, so we've had leaders from the Chamber come to our building and do team training. I think it's reassuring that every time we engage with folks in the community, there is a clear realization there's a need for this. And the question is, why are we not more intentional in it from a community standpoint, from a nation standpoint? I think this is just another example of these feel like soft skills and things that people assume we just do naturally. Right. I think we continue to see that they don’t necessarily come naturally to everybody. Right. Thank you. Finally, what impact do you hope that you have made on your students? So when we begin every IPE event, I ask the students to make sure that their heads and their hearts are aligned before we go into our training. I think it's really important that both of those organs are used and aligned in care. We talk about those numbers that we recite all the time. 34727, 250,000. That's the mantra of ETSU, IPE, which just simply is them being understanding, being able to understand why we’re doing this. And that is for the people who are harmed in our current health care system from medical errors as a direct result of lack of communication in the team. I hope that they understand that care from a team is always better outcomes for patients. And then I, I hope the last thing is that, that every member of the team appreciates and realizes the importance that every other member of the team is equally valuable to the team. The picture that I would draw for them, is this a round table, not a rectangular table. There is no head. Everyone has an appropriate voice. We say many times in our training, if you see something, then I hope you have the confidence within and the trust within the team, that you feel like your voice can speak up and say something about harm that you're afraid is about to happen. Yeah. Hope. I think our challenge to them is being the change agents of a system that still needs a significant amount of work. And so what I, what I hope what we've made on them is giving them confidence that they can speak up in a system that still needs some work.
Dr. Kimberly D. McCorkle
Yes, that’s wonderful. Thank you, Brian. I really enjoyed our conversation and I appreciate your commitment to interprofessional education at ETSU and the way that you inspire students and faculty with the clear passion you have for this work.
Thank you for listening to Why I Teach. For more information about Dr. Cross, the ETSU Center for Interprofessional Collaboration, or this podcast series, visit the ETSU Provost website at ETSU dot Edu slash provost. You can follow me on social media at ETSU Provost and if you enjoyed this episode, please take a moment to like and subscribe to Why I Teach wherever you listen to your podcasts.