Interdisciplinary education and teamwork: a long and winding road

PURPOSE: This article examines literature on interdisciplinary education and teamwork in health care, to discover the major issues and best practices. METHODS: A literature review of mainly North American articles using search terms such as interdisciplinary, interprofessional, multidisciplinary with medical education. MAIN FINDINGS: Two issues are emerging in health care as clinicians face the complexities of current patient care: the need for specialized health professionals, and the need for these professionals to collaborate. Interdisciplinary health care teams with members from many professions answer the call by working together, collaborating and communicating closely to optimize patient care. Education on how to function within a team is essential if the endeavour is to succeed. Two main categories of issues emerged: those related to the medical education system and those related to the content of the education. CONCLUSIONS: Much of the literature pertained to programme evaluations of academic activities, and did not compare interdisciplinary education with traditional methods. Many questions about when to educate, who to educate and how to educate remain unanswered and open to future research.     

Interdisciplinary didactic instruction at academic health centers in the United States: attitudes and barriers

Interdisciplinary care is a method of providing patient care through a team approach that incorporates the efforts of various health care providers. Studies show that this approach can improve patient care and decrease overall costs to the healthcare system. Despite the evidence for the benefits of interdisciplinary care, there are no well-defined models for training students during their didactic years to become members of an interdisciplinary team. This study utilized an investigator-developed questionnaire to determine the attitudes of administrators of professional schools in the USA toward interdisciplinary education, identified the perceived barriers to interdisciplinary education, examined the extent to which interdisciplinary education is occurring at academic health center campuses, and identified the courses that might best be taught in an interdisciplinary format. Administrators from medicine, nursing, and pharmacy hold positive attitudes toward interdisciplinary instruction. Respondents from nursing and pharmacy hold more favorable attitudes than their counterparts from medicine. Positive attitudes are seen more frequently among females than males, and among respondents from public single and multi-campuses than from private campuses. This study demonstrated that administrators espouse very positive attitudes toward interdisciplinary education, although they perceive the barriers to interdisciplinary education and the courses most suited for anointer disciplinary approach differently. More discussions among administrators of various disciplines may allow barriers to be overcome and allow development of interdisciplinary didactic courses that could test the hypothesis that these courses are more cost effective and more likely to foster interdisciplinary teamwork in the clinical setting. This revised version was published online in June 2006 with corrections to the Cover Date.     

Health policy implications of health promotion and disease prevention for allied health

Regardless of the direction health policies in this country may take, allied health professionals seem uniquely positioned to meet the health promotion needs of a variety of clients, such as patients, families, other providers, employees, and members of communities. If allied health professionals choose to respond to health promotion as an area of clinical expertise, they will have to accept the challenge presented by the numerous complex issues associated with implementing a new discipline. However, the successful application of energy and resources to resolving these problems would allow allied health professionals to provide significant interventions in meeting national health goals. This article reviews the history of health promotion in the United States, discusses current practices in health promotion, and suggests some future trends.     

The Rural Elderly Assessment Project: A Model for Interdisciplinary Team Training

SUMMARY

The Rural Elderly Assessment Project (REAP) was designed to train occupational therapy, physical therapy, physician assistant, and public health faculty and students to conduct interdisciplinary team health assessments with rural, community-dwelling older adults. This article highlights key features of the project's design and implementation and presents preliminary evaluation data from the 25 students who participated in the project. Students completed several pre- and post-test measures. Statistically significant improvements were observed in all but one of the knowledge, skill, and attitude domains that were specifically targeted by the project. Students identified a variety of benefits they received from participating in the project, and all students indicated that they would recommend the project to another student. Implications for project replication and interdisciplinary team training of allied health students are discussed.     

The potential for using cognitive styles as selection predictors for allied health education administration programs

Institutions of higher education appear to be using inappropriate measures to select students who aspire to become allied health education administrators. Therefore, new selection predictors need to be developed and validated. This article reports the results of a survey investigation conducted to determine the feasibility of using two cognitive styles, dogmatism and integrative complexity, as selection predictors for allied health graduate leadership programs. The findings indicate that current allied health education administrators are similar in cognitive style, low in dogmatism and high in integrative complexity. The findings support the premise that cognitive styles are related to both occupational choice and performance and, thus, provide a potentially powerful basis for selecting appropriate individuals for allied health graduate leadership programs.     

Developing interdisciplinary courses for allied health students: a retrospective view

Innovative interdisciplinary education in allied health has been developed in order to give students insight into role competencies of other professionals, improve the quality of health care while reducing costs, and facilitate the interdependent functioning of allied health care providers in meeting patient or client needs. The process of interdisciplinary course development requires the same communication and needs identification by faculty as is necessary for the provision of team care by practitioners. A retrospective account of interdisciplinary course development in a major health sciences center, together with materials developed for class presentation, may serve to encourage this type of activity elsewhere.     

Challenges of preparing allied health professionals for interdisciplinary practice in rural areas

Meeting the health needs of individuals in rural communities involves addressing the challenges of complex multifaceted health problems, limited local health resources and services, isolation, and distance. Interdisciplinary collaboration can create solutions to health care problems that transcend conventional, discipline-specific methods, procedures, and techniques. This paper reports on the four-pronged approach of the Western Maryland Area Health Education Center used to prepare allied health students to be interdisciplinary team members in rural areas. It describes the development of four interdisciplinary instructional team member training venues (in-class instruction, Web-based modules, service-learning programs, and faculty development workshops) that integrate opportunities to develop and practice interdisciplinary health promotion skills in rural communities. Challenges to implementing the model are described, including developing faculty and student training participation, integrating training venues into existing programs at participating institutions, and designing a unified program evaluation.     

AIDS education for health care professionals in an organizational or systems context.

Traditionally, health education for practicing health professionals, as well as members of the public, focuses on the individual and relies on changing personal behavior. However, health care for persons with acquired immunodeficiency syndrome (AIDS), and members of their families, mainly is delivered within health and human services organizations. Providing AIDS education for health care professionals in an organizational or systems context shifts the focus from the individual to the group and from changing a person's behavior to offering health care professionals opportunities for interaction. In an organizational or systems approach, they can address patient care issues collectively, share interdisciplinary knowledge, identify problems of common concern, plan coordinated and integrated responses, and provide mutual support. A strategy for planning AIDS education is proposed for key administrators, supervisors, and care providers, who are the gatekeepers, opinion makers, and role models of organizations. Addressing organizational, community, and health care delivery system issues as part of an education program provides a forum for defining problems and a basis for uniting professionals and developing solutions.     

Diagnosing and improving functioning in interdisciplinary health care teams

Interdisciplinary teams play a key role in the delivery of health care. Team functioning can positively or negatively impact the effective and efficient delivery of health care services as well as the personal well-being of group members. Additionally, teams must be able and willing to work together to achieve team goals within a climate that reflects commitment to team goals, accountability, respect, and trust. Not surprisingly, dysfunctional team functioning can limit the success of interdisciplinary health care teams. The first step in improving dysfunctional team function is to conduct an analysis based on criteria necessary for team success, and this article provides meaningful criteria for doing such an analysis. These are the following: a common team goal, the ability and willingness to work together to achieve team goals, decision making, communication, and team member relationships. High-functioning interdisciplinary teams must exhibit features of good team function in all key domains. If a team functions well in some domains and needs to improve in others, targeted strategies are described that can be used to improve team functioning.     

Interdisciplinary case management: a model for intervention

Interdisciplinary case management is required when clients present problems that do not fall within the purview of any one discipline. The interdisciplinary approach entails the participation of professional and support staff, along with the client and his/her family, in diagnosis, individual program planning, implementation, and evaluation. For example, interdisciplinary case management for a patient with Prader-Willi syndrome (PWS) results in cost-effective, efficacious treatment. Because of the diversity of symptoms, the treatment of Prader-Willi syndrome must incorporate knowledge and skills from a variety of areas. A model for the interdisciplinary case management of PWS is presented. The model is problem focused and emphasizes goals formulated and acted upon by the disciplines represented on the client's treatment team. Communication and coordination of efforts are central to the utility of the model. Additional benefits of interdisciplinary case management include the opportunity for ongoing education and role expansion of team members.     

A clinical education and practice placements in the allied health professions: an international perspective

This report describes the outcomes of extensive discussions surrounding clinical education and practice placement issues undertaken by an international group of allied health educators (in audiology, occupational therapy, physiotherapy, and speech pathology) who have met since 2001 as part of Universitas 21 Health Sciences annual meetings. The report outlines key issues associated with clinical education and practice placements from an international perspective and across these four allied health professions. The allied health practice context is described in terms of the range of allied health educational programs in Universitas 21 and recent changes in health and tertiary education sectors in represented countries. Some issues and benefits related to supervision during allied health students' practice placements are addressed. A new approach is proposed through partnership such that frameworks for the provision of practice placements can be created to facilitate student learning and educate and support clinical educators. A set of guidelines that can enhance partnerships and collaborative practice for the benefit of clinical education within complex and changing health/human service and educational environments is proposed.     

Boom or Bust: Future of Health Profession Education

The future of allied health education depends greatly on the nature of economic, social, political and health trends. It behooves educators and administrators to consider such trends as dramatic cutbacks in educational funding, revision of Medicare and Medicaid hospital reimbursement policies, establishment of diagnosis related groups (DRG), increasing technology, the wave of conservatism and the aging population. The effect on the health professions is speculative, however, knowing these trends and properly preparing, revising and reorganizing for them will keep allied health educational programs viable. This paper addresses the trends and their impact on education.     

Allied health representation: a call for action

The Coalition of Allied Health Leadership (CAHL) 2000 Representation Team sought 1) to secure Federal advisory appointments for allied health professionals and 2) to connect allied health representatives with Federal advisory committees, councils, boards, and other deliberative bodies. Among the deliberative bodies providing recommendations on a broad range of issues to the President of the United States and the Executive Branch, there are over 1,000 advisory committees, councils, and boards, with more than 20,000 members. Recommendations made by the deliberative bodies include those related to health care. The literature and Web sites reveal allied health professionals have little or no representation on the bodies that represent allied health professionals and their constituents. These findings provide insights into Federal-level deliberative bodies to which allied health professionals have access or on which they warrant representation. This article reports background information, including the CAHL 2000 Representation Team objectives; an overview of federal advisory committees; recommendations for gaining access to deliberative bodies and active participation in fulfillment of Healthy People 2010 goals; and continued commitment to such representation by the CAHL and allied health professionals.     

Information sharing in interdisciplinary team meetings: an evaluation of hospice goals

The author observed interdisciplinary team (IDT) meetings of "Town Hospice" to examine how the company goal of providing for the "psychosocial needs of the patient and their loved ones" is addressed. More specifically, she used an ethnographic approach to explore how case managers negotiate the addition of psychosocial information about patients during IDT meetings. She found that psychosocial information on patients was primarily limited to three types of information sharing: (a) information related to care goals, (b) family issues related to bereavement and caretaking, and (c) the request of additional help from team members. Furthermore, she understood that the addition of psychosocial information creates a dialectical tension for the team.     

The optimum utilization and appropriate responsibilities of allied health professionals

A number of issues related to the optimum utilization and appropriate responsibilities of allied health professionals are raised based upon the perspective of the experience of the U.S. in recent years. Various definitions and concepts related to these issues are presented in order to assess the state of both training and use of allied health professionals in diverse settings. It is suggested that idiosyncratic needs and solutions in specific cultural contexts do not allow a generalizable conclusion to be drawn, although several principles can be put forward. The experience in the development and training of allied health professionals in the U.S. is analyzed using a variety of frameworks, including structural-organizational models as well as an historical approach. An empirical example of the extent and level of responsibilities of a variety of types of allied health professionals is offered, and the role of associated practice characteristics is observed to impinge upon role performance, giving an insight into the problems and potentials of these manpower resources. Finally, a discussion of the western model as a paradigm for allied health professional training and utilization in the global context is considered, and various strategies and suggestions for the future are offered.     

An Interdisciplinary Health Team Training Program for School Staff in Minnesota

ABSTRACT: This paper describes an interdisciplinary health team training program for school-based clinic staff in Minnesota. The project sought to improve team functioning, level of practice, and health care services at the school sites. Participants were interdisciplinary staff members from clinics in senior high, middle, and elementary schools. The program consisted of further development in team training knowledge and skills and educational sessions on issues identified by participants. Evaluations indicated participants reported greater knowledge and improved team functioning experiences from the team training. Gains also were shown in knowledge and skills in specific school topic areas such as violence, resiliency, working with resistant families, and self-care. The program could serve as a model for other interdisciplinary school health team training.     

St Joseph's Community Health Centre model of community-based interdisciplinary health care team education

As our reliance on interdisciplinary health care teams for meeting the multidimensional needs of the community becomes greater, new interdisciplinary education programmes and learning experiences are needed to educate students and health care professionals to become better team players. The St Joseph's Community Health Centre (SJCHC) model of community-based interdisciplinary health care team education was developed with support from McMaster University and the Educational Centre for Aging and Health's Clinical Teaching Unit Without Walls. The SJCHC model is structured as one 3-h session each week for eight consecutive weeks and is an elective learning experience for students. Six to eight senior health, social science and other health-related students work with two group facilitators as a team on discussion theme topics: team dynamics; role issues and professional values; collaboration and conflict; communication, leadership and power; client-centred goal-oriented care; and consumerism issues. The success and impact of the SJCHC model has been measured by several primary and secondary outcomes outlined in the Charting the Outcomes of Educational and Clinical Approaches (COECA) model.     

Hospice social workers’ perception of being valued by the interdisciplinary team and the association with job satisfaction

ABSTRACT

Being valued and respected by colleagues is an important contributor to job satisfaction in hospice and other health care settings. The purpose of this study was to examine how the perception of feeling valued by different members of the interdisciplinary team and interdependence of team members are related to hospice social workers’ job satisfaction. The study aims were to examine: (1) the degree to which hospice social workers feel valued by other members of the interdisciplinary team; and 2) whether this is associated with job satisfaction. A nonprobability sample of 203 hospice social workers completed an online survey assessing job satisfaction, perception of feeling valued by each of the professionals on the interdisciplinary hospice team, interdependence of team members, and professional and personal characteristics. The final regression model for intrinsic job satisfaction included feeling valued by doctors and by other social workers, and interdisciplinary interdependence. The final model for extrinsic job satisfaction did not include any of the perception of feeling valued by others on the interdisciplinary team, although interdependence and the number of social workers at the hospice were significant in this model. Reasons for the difference in these models and the practice and policy implications are discussed.     

A follow-up study of allied health educational and career interests of graduates of a high school for health professions.

In response to reports and trends suggesting a national shortage of health professionals, a survey was administered to graduates from Houston's High School for Health Professions, in part to measure their interests in pursuing higher education and careers in the allied health fields. Project administrators were concerned that only 82 of 1,028 survey respondents indicating a career choice (8.0%) expressed interests in allied health. The career choices, educational pursuits, perceptions regarding likelihood of career attainment, and factors influencing career attainment of these 82 respondents were examined. Ultimately, it is believed that many students are unaware of allied health professions, and that others simply do not perceive allied health disciplines as attractive career options. Results of this study are consistent with other reports suggesting that new strategies must be employed nationally to promote greater participation in allied health, especially by groups previously underrepresented in these professions.