With PIVOT App, Trainees Build Knowledge Together Over Time

Jennifer Mandal, MD

By Shelley Wong

Technological advances in health care are expanding and changing how care is delivered to patients and how interprofessional team members engage with each other. Instead of meeting in person, many interactions between health care colleagues are conducted through email, e-consults, and telemedicine consults. To deliver care efficiently and effectively in the 21st-century, students need opportunities to practice collaborating with colleagues in an online, asynchronous manner.

In spring 2018, Jennifer Mandal, MD, a clinical fellow in rheumatology, Leslie Floren, PharmD, a faculty member in the School of Pharmacy, and colleagues launched the first interprofessional pilot of the PIVOT (Practice Improvement Using Virtual Online Training) app, pairing 16 third-year medical students with third- and fourth-year pharmacy students. PIVOT is a natural fit in interprofessional education due to its flexibility and cost savings; students don’t have to be in a classroom or at the same place at the same time, which significantly reduces logistical barriers along with the expense of creating standardized patient experiences.

“In interprofessional education, we have to think creatively and sometimes outside the box in how we deliver logistically feasible curriculum to trainees,” said Mandal. “PIVOT is an exciting, innovative new platform for us to explore because it offers clinically relevant cases to students, but allows them to practice modern skills.”

Interprofessional dialogue through technology is especially important in managing complex chronic diseases. Over two weeks, trainees worked together on an interactive case of a 44-year old woman presenting with fatigue, joint pain, and low-grade fever, who is ultimately diagnosed with lupus.

The app features direct messaging with interprofessional colleagues and faculty facilitators in addition to embedded videos, imaging studies, simulated consult forms and laboratory order forms. PIVOT was developed in 2015 by UCSF rheumatologist Maria Dall’Era, MD, in collaboration with web developer Sebastian Andreatta and piloted for School of Medicine students in 2015-2016 focusing on rheumatology cases.

The feedback has been overwhelmingly positive. “Students crave experiences that feel clinically relevant,” said Mandal. “I was pleasantly surprised to see how the pharmacy and medical students really engaged as they created knowledge together. The vast majority did multiple rounds of back and forth sharing clinical information, and also spent a lot of time to express appreciation for their colleagues.”

Mandal and colleagues are exploring opportunities to expand the repertoire of cases and use the app as one more tool in UCSF’s IPE curriculum that enables students to collaborate in meaningful ways.