Wendy Mouradian, MD, MS, FAAP
Professor of Pediatric Dentistry, UW School of Dentistry
Associate Dean of Regional Affairs and Curriculum, UW School of Dentistry
Why (and how) did you get involved with IPE?
Dr. Mouradian: “I feel like most of my career has involved some kind of IPE, although we didn’t call it that back then.” After working as a general pediatrician in a rural community, Mouradian returned to the UW to train as a developmental pediatrician at the Maternal and Child Health Leadership Education in Neurodevelopmental Disabilities Program at the Center for Human Growth and Development, a rich IPE environment focused on the care of children with special health care needs.
“As developmental pediatricians we were often consulting with school teachers, psychologists, nutritionists, social workers and others involved in the care of our patients.” But later as a team member and then Director of the Craniofacial Program at Seattle Children’s Hospital (1994-98), Mouradian entered a truly unique team environment – one which included Pediatric dentistry, Orthodontics and Oral and Maxillofacial Surgery among the 14 disciplines providing family-centered care for children with cleft lip and palate and other craniofacial conditions.
“That is where I really got it”, Mouradian says. “Here were entire worlds that the medical system was ignoring. We worked closely with Communication Disorders, Audiology, Nursing, Social Work and Surgical specialties, but the mouth had been largely ignored in my previous interdisciplinary experiences. Even though my father was a dentist, I had somehow managed to go through medical training without a basic understanding of oral diseases and conditions and the importance of the orofacial complex to the overall health and quality of life. The mouth and face are such a part of our identity and presentation to the world. Yet in the age of fluoride and modern dental care, these problems were invisible to most of my medical colleagues. But for children with craniofacial conditions- as well as those from disadvantaged populations – it’s different. They experience these problems disproportionately and they can be devastating. In fact it was the psychologists, social workers and nurses who helped us understand the impact of these conditions on children and their families. We were only to ready to offer surgical solutions, but often the answers lay in supporting family resilience and positive social adaptations. This changed the direction of my career profoundly.”
During these years Mouradian undertook a Certificate in Health Care Ethics, focusing her scholarly work on ethical dilemmas in oral and craniofacial care. She initiated a collaboration with the UW School of Dentistry, which generated, among other things, a conference on ethics and health policy related to dental care for children. This meeting attracted national attention and Mouradian found herself working at the NIDCR at the National Institutes of Health for the next three years organizing and chairing a Surgeon General’s Conference on Children and Oral Health, The Face of the Child, and related activities.
“When I returned from NIH I was fortunate enough to become a part of the HSPICE program under the leadership of Dr Pam Mitchell,” Mouradian notes. This became a fertile ground for meeting and collaborating with other faculty interested in IPE. Armed with these interests and meeting similarly-minded faculty, Mouradian was able to generate oral health training programs for medical students and primary care residents, and public health training for pediatric dental residents, and soon became embedded in the Dept. Pediatric Dentistry. Most notably this led in to the development of the Regional Initiatives in Dental Education (RIDE) program, a WWAMI-like program which prepares dental students to care for rural and underserved populations through extensive community-based training and IPE experiences.
What do you believe are the benefits of IPE?
Dr. Mouradian: “For me it was always about IPE to address health disparities and the multiple determinants of health outcomes, whether at the population or individual level. Oral health disparities are due, in part, to the isolation of dentistry from the rest of the health care system. For this a very particular kind of IPE is needed,” Mouradian maintains, and she has championed this effort nationally and at the UW.
“We have benefitted so much from advances in IPE since those early days,” Mouradian says. “Given momentum by the patient safety movement, IPE at the UW, and around the world, has been driven by Nursing. Just look at what has resulted – all the IPE work at the UW (including CHISE), IPEC competencies and a national IPE movement. IPE is now part of the Accreditation Standards for all the health professions. Sometimes I think we physicians were the last to get it. I believe the IPEC work has created the language and conceptual grounding for this movement. Often we noticed power gradients, interdisciplinary conflict and ethical dilemmas in the craniofacial context, but we didn’t have a language to adequately understand these issues to help us achieve optimal team care for patients and families.”
“The IPEC competencies also support leadership development at the deepest level. Affirming shared values, listening to and respecting others around you and learning how to work collaboratively across power gradients are part of effective leadership for any health professional at any level.”
What has been the most memorable experience/highlight of teaching IPE so far?
Dr. Mouradian: “I don’t think I can identify a memorable experience or highlight. What is most notable to me is our gradual move from considering IPE issues none of the time, to some of the time. I am grateful to be a part of the IPE movement on this campus to take us to all of the time. It should be just how we do business as health care providers and teams. But the education world has huge inertia: we are all going to have to pull together to get there.”