Letter

Two inter-professional initiatives, the Interdisciplinary Professional Education Collaborative in the United States and the Interprofessional Education Programme in the UK, are working to discover how health professionals can gain knowledge and skill in the continuous improvement of health care. They are seeking closer links between health care delivery and health professional education, between the needs of patients and communities, and those of learners. The ultimate goal is to create health care that: (1) seeks to understand and meet patients' needs; (2) organises care as a system focused around that need; (3) takes advantage of what teams of professionals can do when they work well together; and (4) improves constantly through the active efforts and innovative ideas of the health care team. This paper describes the initiatives and identifies common lessons for health care delivery and interprofessional education.     

Educating interprofessional learners for quality, safety and systems improvement

Most health professionals in training, as well as those in practice, lack the knowledge and skills they need to play an effective role in systems improvement. Until very recently, these competencies were not included in formal (or informal) educational curricula. Interprofessional collaboration - another core competency needed for successful systems improvement - is also inadequately taught and learned. Achieving Competence Today (ACT) was designed as a new model for interprofessional education for quality, safety and health systems improvement. The core of ACT is a four-module active learning course during which learners from different disciplines work together to develop a Quality Improvement Project to address a quality or safety problem in their own practice system. In this paper we describe the ACT program and curriculum model, discuss our strategies for maximizing ACT's interprofessional potential, and make recommendations for the future.     

Reflections from an interprofessional education experience: Evidence for the core competencies for interprofessional collaborative practice

The Core Competencies for Collaborative Practice identify the skills needed by every health care provider to be successful in implementing interprofessional practice. Health professions students need to build skills for interprofessional practice as emerging professionals. Reflection is a core skill needed for successful interprofessional practices. This study identifies themes from an interprofessional education research project and discusses their congruency with the Competencies.     

Facilitating interprofessional education and practice

Collaborative patient-centred care has the potential to address serious issues in the Canadian health-care system such as those related to increasing complexity of care; patient safety and access; and recruitment and retention of health human resources. This approach involves teams of health professionals working together to provide more coordinated and comprehensive care to clients. It places priority on the preferences of the patient and fosters respect for the skills and perspectives of all health-care providers. Interprofessional education at the undergraduate, graduate and practice levels is essential for facilitating the transition to team-based care. The author presents the rationale for collaborative care and describes an interprofessional education project at Memorial University of Newfoundland that is preparing students and health professionals for this groundbreaking change in practice.     

Up a river! Interprofessional education and the Canadian healthcare professional of the future

The benefits of an interprofessional approach to patient care are becoming well known and the adoption of these ideas for collaboration by future healthcare professionals will be influenced by positive exposures during pre-licensure education. Although much work has been done, the establishment of interprofessional education in health care programs is still in the developmental phase in many centers. But the need for such education is obvious and urgent. Once these new professionals enter into practice, they will be expected to function as members of interprofessional teams. Therefore, they should be equipped with the skills they will need to function effectively on a team. The future of the healthcare system relies on the education of tomorrow's professionals. When we finally train healthcare professionals to perform as part of a team, "paddling in harmony", we will be able to steer toward our goal of an efficient, sustainable and safe health care system. If we do not learn to work together, we will continue to go in circles.     

Knowing your allies: Medical education and interprofessional exposure

Collaborative, team-based, interprofessional approaches to patient management are becoming increasingly recognized as beneficial to health outcomes. This project aimed to develop interprofessional skills among 134 third year medical students that were of clinical educational value to the students, and through activities that directly benefited the rural health professionals in their daily work. Placements were undertaken during a six week rural clinical attachment, mainly throughout South-West Queensland. Pre- and post-placement self-report questionnaires completed by both students and health professionals were used to evaluate the project. Results showed that over 80% of the health professional group reported the medical student placements were useful. Similarly, almost 80% of medical students reported positive changes in their attitude to other health professionals from the placement, and 91% indicated they had derived clinical educational benefit from their interprofessional activity. Despite difficulties due to poor communication between the various parties involved, the project proved successful in improving medical students' skills, knowledge and perceptions concerning interprofessional practice, through a placement and educational project which delivered practical benefits to rural health professionals and rural communities.     

Students’ perceptions of interprofessional collaboration on the care of diabetes: A qualitative study

Interprofessional education can promote healthcare professionals' competence to work in interprofessional collaboration, which is essential for the quality and safety of care. An interprofessional approach is particularly important in complex, chronic diseases like diabetes. This qualitative study evaluated changes in medical and nursing students' perceptions of interprofessional collaboration, induced by a novel interprofessional education course on diabetes care with practical elements. Data from focus-group interviews of 30 students before and after the course were analyzed by using inductive and deductive content analysis. The students’ perceptions were illustrated as Elements of Collaborative Care (e.g. Quality of professional care relationship) and Elements of Interprofessional Collaboration (e.g. Importance of communication and Valuation of collaboration). The post-course interviews added one subcategory (Need of resources) to the pre-course perceptions, and there was improvement in ten areas of self-perceived competence in performing or understanding interprofessional collaboration on diabetes care. The course improved the students' self-perceived competence and confidence in interprofessional collaboration on the care of patients with diabetes, and their understanding of interprofessional collaboration changed towards a more patient-centred and holistic perspective. The findings support further implementation of IPE with practical elements in future health professionals’ education.     

Knowing your allies: medical education and interprofessional exposure

Collaborative, team-based, interprofessional approaches to patient management are becoming increasingly recognized as beneficial to health outcomes. This project aimed to develop interprofessional skills among 134 third year medical students that were of clinical educational value to the students, and through activities that directly benefited the rural health professionals in their daily work. Placements were undertaken during a six week rural clinical attachment, mainly throughout South-West Queensland. Pre- and post-placement self-report questionnaires completed by both students and health professionals were used to evaluate the project. Results showed that over 80% of the health professional group reported the medical student placements were useful. Similarly, almost 80% of medical students reported positive changes in their attitude to other health professionals from the placement, and 91% indicated they had derived clinical educational benefit from their interprofessional activity. Despite difficulties due to poor communication between the various parties involved, the project proved successful in improving medical students' skills, knowledge and perceptions concerning interprofessional practice, through a placement and educational project which delivered practical benefits to rural health professionals and rural communities.     

Up a river! Interprofessional education and the Canadian healthcare professional of the future

The benefits of an interprofessional approach to patient care are becoming well known and the adoption of these ideas for collaboration by future healthcare professionals will be influenced by positive exposures during pre-licensure education. Although much work has been done, the establishment of interprofessional education in health care programs is still in the developmental phase in many centers. But the need for such education is obvious and urgent. Once these new professionals enter into practice, they will be expected to function as members of interprofessional teams. Therefore, they should be equipped with the skills they will need to function effectively on a team. The future of the healthcare system relies on the education of tomorrow's professionals. When we finally train healthcare professionals to perform as part of a team, “paddling in harmony”, we will be able to steer toward our goal of an efficient, sustainable and safe health care system. If we do not learn to work together, we will continue to go in circles.     

Reducing barriers to interprofessional training: promoting interprofessional cultural competence

The need to train health professionals who can work across disciplines is essential for effective, competent, and culturally sensitive health care delivery. By its very nature, the provision of health service requires communication and coordination between practitioners. However, preparation for interdisciplinary practice within the health care setting is rare. The authors argue that the primary reason students are not trained across disciplines is related to the diverse cultural structures that guide and moderate health education environments. It is further argued that this profession specific "cultural frame" must be addressed if there is any hope of having interprofessional education accepted as a valued and fully integrated dimension of our curriculum. Each health discipline possess its own professional culture that shapes the educational experience; determines curriculum content, core values, customs, dress, salience of symbols, the meaning, attribution, and etiology of symptoms; as well as defines what constitutes health, wellness and treatment success. Most importantly, professional culture defines the means for distributing power; determines how training should proceed within the clinical setting; and the level and nature of inter-profession communication, resolution of conflicts and management of relationships between team members and constituents. It might be said that one factor limiting interdisciplinary training is profession-centrism. If we are to achieve effective and fully integrated interdisciplinary education, we must decrease profession-centrism by crafting curriculum that promotes interprofessional cultural competence. The article explores how to promote interprofessional cultural competence within the health education setting.     

“They have no idea of what we do or what we know”: Australian graduates' perceptions of working in a health care team

Globally it has been suggested that interprofessional education can lead to improvements in patient safety as well as increased job satisfaction and understanding of professional roles and responsibilities. In many health care facilities staff report being committed to working collaboratively, however their practice does not always reflect their voiced ideologies. The inability to work effectively together can, in some measure, be attributed to a lack of knowledge and respect for others' professional roles, status and boundaries. In this paper, we will report on the findings of an interpretative study undertaken in Australia, focussing specifically on the experiences of new graduate nurses, doctors and pharmacists in relation to ‘knowing about’ and ‘working with’ other health care professionals. Findings indicated there was little understanding of the roles of other health professionals and this impacted negatively on communication and collaboration between and within disciplines. Furthermore, most new graduates recall interprofessional education as intermittent, largely optional, non-assessable, and of little value in relation to their roles, responsibilities and practice as graduate health professionals. Interprofessional education needs to be integrated into undergraduate health programs with an underlying philosophy of reciprocity, respect and role valuing, in order to achieve the proposed benefits for staff and patients.     

Interprofessional exemplars for health professional programmes at a South African university

Abstract

There are promising shifts towards transforming health professions education in South Africa, which include the development of interprofessional education undergraduate curricula. Interprofessional education was conceived as a means to improve quality of care by bringing together professions to learn and work in teams, thereby overcoming negative stereotypes and understanding and valuing the roles of the different health care professions. This paper aims to advance the agenda of transforming health professions education by showcasing the development of exemplars of interprofessional education offered in the Faculty of Community and Health Sciences at the University of the Western Cape in order to assist other higher education institutions in the process of developing interprofessional curricula. Each exemplar encompasses a range of interactive learning methods. Lessons learnt include the need for a common framework for interprofessional education; “buy in” and a mind-set change of academics and institutional structures to support and operationalize interprofessional education.     

Continuing professional development for interprofessional teams supporting patients in healthcare decision making

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients’ needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients’ and professionals’ values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives.     

Mastering improvement science skills in the new era of quality and safety: the Veterans Affairs National Quality Scholars Program

Rationale, aims and objectives Healthcare professionals need a new skill set to ensure the success of quality improvement in healthcare. The Department of Veterans Affairs (VA) initiated the VA National Quality Scholars fellowship in 1998; its mission is to improve the quality of care, ensure safety, accelerate healthcare re‐design, and advance the improvement science by educating the next generation of leaders in quality and safety. We describe the critical need for leadership in quality and safety and interprofessional education, illustrate the curriculum, provide lessons learned by fellows, summarize key lessons learned from the implementation of an interprofessional education approach, and present most recent accomplishments. Methods Narrative review. Results As of 2011, 106 program alumni are embedded in the health care delivery system across the United States. Since 2009, when nurse fellows joined the program, of the first nine graduating interdisciplinary fellows, the tailored curriculum has resulted in five advanced academic degrees, 42 projects, 29 teaching activities, 44 presentations, 36 publications, six grants funded or submitted, and two awards. Conclusions The VA National Quality Scholars program continues to nurture and develop leaders for the new millennium focusing on interprofessional education. The nations' health care systems need strong interdisciplinary leaders in advanced quality improvement science who are dedicated to improving the overall quality of health and health care.     

Reducing barriers to interprofessional training: Promoting interprofessional cultural competence

The need to train health professionals who can work across disciplines is essential for effective, competent, and culturally sensitive health care delivery. By its very nature, the provision of health service requires communication and coordination between practitioners. However, preparation for interdisciplinary practice within the health care setting is rare. The authors argue that the primary reason students are not trained across disciplines is related to the diverse cultural structures that guide and moderate health education environments. It is further argued that this profession specific “cultural frame” must be addressed if there is any hope of having interprofessional education accepted as a valued and fully integrated dimension of our curriculum. Each health discipline possess its own professional culture that shapes the educational experience; determines curriculum content, core values, customs, dress, salience of symbols, the meaning, attribution, and etiology of symptoms; as well as defines what constitutes health, wellness and treatment success. Most importantly, professional culture defines the means for distributing power; determines how training should proceed within the clinical setting; and the level and nature of inter-profession communication, resolution of conflicts and management of relationships between team members and constituents. It might be said that one factor limiting interdisciplinary training is profession-centrism. If we are to achieve effective and fully integrated interdisciplinary education, we must decrease profession-centrism by crafting curriculum that promotes interprofessional cultural competence. The article explores how to promote interprofessional cultural competence within the health education setting.     

Continuing professional development for interprofessional teams supporting patients in healthcare decision making

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients' needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients' and professionals' values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives.     

Interprofessional education and service learning: a model for the future of health professions education

Abstract

The implementation of interprofessional education for healthcare professionals has been lackluster, at best, since it was recommended by the Institute of Medicine. There have been various attempts in institutions of higher learning to meet this goal with mixed results. Herbert Wertheim College of Medicine, Florida International University has developed the Green Family NeighborhoodHELP? (GFNHelp) program to meet this challenge. GFNHelp is an interprofessional, longitudinal, service-learning program for healthcare students. Through participation in this program medical students team up with students from other professions, such as nursing, social work, and law, and collaborate to improve health outcomes for medically underserved families in the community. This educational program emphasizes the Core Competencies of the Interprofessional Education Collaborative through community-based service-learning, allowing student teams to engage firsthand and address the impact of social determinants on health.     

Advancing interprofessional patient safety education for medical,nursing, and pharmacy learners during clinical rotations

Clinical errors are common and can lead to adverse events and patient death. Health professionals must work within interprofessional teams to provide safe and effective care to patients, yet current curricula is lacking with regards to interprofessional education and patient safety. We describe the development and implementation of an interprofessional course aimed at medical, nursing, and pharmacy learners during their clinical training at a large academic medical centre. The course objectives were based on core competencies for interprofessional education and patient safety. The course was offered as recurring three 1-hour sessions, including case-based discussions and a mock root cause analysis. Forty-three students attended at least one session over a 7-month period. We performed a cross-sectional survey of participants to assess readiness for interprofessional learning and a before and after comparison of patient safety knowledge. All students reported a high level of readiness for interprofessional learning, indicating an interest in interprofessional opportunities. In general, understanding and knowledge of the four competency domains in patient safety was low before the course and 100% of students reported an increase in knowledge in these domains after participating in the course.     

Interprofessional education and working in mental health: in search of the evidence base

Aim To explore interprofessional attitudes arising from shared learning in mental health. Background Inter‐professional education in healthcare is a priority area for improving team‐working and communication. Many studies have attempted to evaluate its benefits and challenges, although few emanate from the mental health arena. However, producing evidence to link educational input with clinical outcomes is notoriously difficult. This project attempted to produce evidence for changes in interprofessional attitudes and stereotypes. Method(s) Mental health nursing students and clinical psychology trainees participated in inter‐professional education. An evaluation tool was designed to evaluate the experience and outcomes, and to consider implications for interprofessional working. Results There was an increase in clarity regarding roles, approaches and resources, and how to collaborate in practice. There was no significant change in professional identity. Many challenges were identified, including differences in academic level, previous experience, expectations, assessment, motivation and effort. Conclusion Despite the challenges, it remains important to offer collaboration with future mental health colleagues as a foundation for effective team‐working. Recommendations are made for creating inter‐professional education opportunities for diverse student groups. Implications for Nursing Management Mental health professionals need to work effectively in multidisciplinary teams. Drawing on available guidance, managers should encourage and support team members to undertake shared learning where possible, both within clinical settings and through more formal educational provision. In this way, managers can facilitate collaborative relationships which will pay dividends for the provision of effective mental health care. This project adds to the limited knowledge currently available on interprofessional learning and attitudes within a mental health context.     

HIV and rehabilitation: development of a conceptual framework for curriculum planning

The overall purpose of this paper is to present the development of a conceptual framework of existing HIV curricula and educational resources on to inform future curriculum planning for the education of rehabilitation professionals on rehabilitation in the context of HIV/AIDS. We conducted a scoping review of the literature from 1980 onwards to identify existing HIV curricula and resources used with current or future health professionals. Preliminary findings were reviewed with a national Advisory Committee and a framework was developed to inform future curriculum planning. The Conceptual Framework of Existing HIV Curricula for Health Professionals classified curricula based on whether it was interprofessional or uniprofessional, and targeted to rehabilitation professionals or more broadly included other health professionals. This framework consisted of four intersecting components that represented different types of curricula: (a) interprofessional HIV curricula specific to rehabilitation professionals, (b) uniprofessional HIV curricula specific to rehabilitation professionals, (c) interprofessional HIV curricula for health professionals, and (d) uniprofessional HIV curricula for health professionals. Evidence from the framework suggested that an interprofessional HIV curriculum designed for rehabilitation professionals may be an ideal model from which to build future HIV rehabilitation curricula. In summary, a range of HIV curricula exist that vary in the type of educational approach and the range of health professionals targeted. Future development, implementation, and evaluation of an interprofessional education curriculum will help to increase knowledge and capacity among current and future rehabilitation professionals so that they may better meet the needs of people living with HIV/AIDS in Canada.