2009 Rho Chi Lecture: Interdisciplinary Health Professions Education: A Systems Approach to Bridging the Gaps

Article excerpt

None of us is as smart as all of us.

--Japanese proverb

It is an absolute privilege and honor to stand before you as the 2009 Rho Chi Award recipient. Paying homage to those intellectual leaders and the community of scholars who have come before me, I am truly humbled to have been asked to give this lecture. In keeping with the spirit and fundamental objective of the Rho Chi Society, which is to "promote the advancement of the pharmaceutical sciences through the encouragement and recognition of sound scholarship," I would like to share my thoughts with you on the criticality of interdisciplinary health professions education and would like to suggest a systems approach to bridging the gaps that exist today. In setting the stage for this lecture, allow me to start by sharing with you the story of the crash of United Airlines flight 232 in 1989.

The crash of a DC-10 in Sioux City, Iowa, in 1989 was a major, uncommon tragedy in American aviation. Many lives were lost. But this great tragedy also served as an important lesson and opened new thinking in the training of cockpit crews. On July 19,1989, when United Airlines flight 232 took off from Stapleton International Airport in Denver, Colorado, and headed to Philadelphia, Pennsylvania, via Chicago's O'Hare International Airport, no one could have imagined what lay ahead.

About an hour and 7 minutes into the flight, at an altitude of 37,000 feet, the fan disk on the Douglas DC10 aircraft tail engine broke in two and suffered an uncontained failure. (1) All controls on the aircraft failed except for the power levers in the remaining 2 engines. Using all possible means and resources, Captain Alfred Haynes, First Officer William Records, Second Officer Dudley Dvorak, and DC-10 flight instructor and pilot Dennis Fitch, made an emergency landing on the runway at the Sioux City, Iowa, airport. Unfortunately, during the landing, the aircraft split in two. That day, 111 people lost their lives, including 110 passengers and 1 crew member. (2)

High-Performance Organizations

Behind the scenes of this tragedy lie truth and triumph. With the skill, collaboration, and concentrated efforts of the flight crew and an instructor pilot, the lives of 175 passengers and 10 crew members were saved. Today, the efforts of these crew members are often referenced as a classic example of effective crew resource management (CRM). According to the Civil Aviation Authority, CRM is defined as "a management system which makes optimum use of all available resources--equipment, procedures and people--to promote safety and enhance the efficiency of flight operations." (3) Originally developed by the National Aeronautics and Space Administration at a 1979 workshop titled "Resource Management on the Flightdeck," CRM was initiated in response to the increasing number of human errors at the root of aviation accidents. Over the years, its success has been measured using 2 criteria: (a) crew attitudes showing acceptance or rejection of CRM concepts and (b) flight deck behavior. (4) Studies suggest that positive attitudes among aircraft crews in flight deck management are highly correlated with positive outcomes, (5) and the observation of crews under non-jeopardy conditions provide the most useful data of crew practices and coordination. (6)

CRM uses the core principles of effective teamwork, standardized communication, situational awareness techniques, effective decision-making, and leadership strategies to improve cockpit safety and quality within the aviation industry. (7) These collaborative and interdisciplinary skills were used by the crew of Flight 232 on July 19, 1989, and are still used in every US aircraft, on every flight. Just this January you may recall the emergency landing of US Air flight 1549 into the Hudson River. With 148 passengers, including a baby, and a flight crew of 7 (2 pilots and 5 crew members), all passengers safely escaped. …