Professor Jill Thistlethwaite reflects on her experience of interprofessional education, her recent work with the Center for Interprofessional Practice and Education at the University of Minnesota, and highlights a range of valuable new resources available.
It is always heartening to read new papers on interprofessional education (IPE) in the mainstream health and education journals. I have been involved in IPE since the mid 1990s but was working in what I later realised was an interprofessional general practice in the UK for several years before that. IPE, of course, predates my experiences by several decades. The World Health Organization (WHO) has published several documents with an interprofessional focus: for example Learning together to work together for health (WHO, 1988) and Framework for Action on IPE (WHO, 2010). More recently it has given us: Transforming and scaling up health professionals’ education and training (WHO, 2013). In relation to IPE these guidelines state that ‘Health professionals’ education and training institutions should consider implementing IPE in both undergraduate and postgraduate programmes’ while recognizing that ‘the quality of the evidence supporting this recommendation is low, and the strength of the recommendation is conditional’ (p.14).
Last year I co-edited a book with my colleagues Dawn Forman (UK) and Marion Jones (New Zealand) entitled Leadership Development for Interprofessional Education and Practice (published by Palgrave) and there will be a second volume later this year. Chapters include historical perspectives from the UK, Canada and the USA, while educators in such places as Kenya, Indonesia, Japan and the Philippines shares their stories about the rationale for and the implementation of IPE at their institutions.
My years as a full-time general practitioner (family physician) in the north of England involved working with a co-located team of health professionals including practice nurses, community nurses, midwives, physiotherapists and psychologists. For a time we even had a social worker with us for one afternoon a month. For a number of reasons, including a change in the funding model within the National Health Service (NHS), this full and fruitful collaboration did not last. I moved into academia with an ideal for practice (though of course we had our problems) and found that health professional education was still carried out in much the same way as it had been when I was at medical school. Yes, the medical curriculum was now integrated and we were introducing early patient contact, but there was still virtually no interaction between students of the different professions all based at the same university.
Nearly twenty years later there have been changes. But us interprofessional champions are still asked about ‘evidence’ and still confronted with the logistical barriers that are often used as an excuse to avoid trying to put people together. Moreover, there are many places where students undertake their clinical rotations that do not role model the interprofessional collaboration ethos: the organisational culture can be a powerful example of the hidden curriculum. There are however fine examples of multidisciplinary and interprofessional teams in action, and the wider collaborations that enhance patient care.
Last year I was very fortunate to receive an Australian-American Fulbright senior scholarship and spent four months at the National Center for Interprofessional Practice and Education at the University of Minnesota in Minneapolis. The Center, whose director is Professor Barbara Brandt, is funded for five years to evaluate IPE and interprofessional collaborative practice projects in several US states. Specifically, in the States, the focus is on examining health care delivery according to the ‘triple aim’, whether an intervention/innovation: improves the patient experience of care (including quality and satisfaction); improves the health of populations; and reduces the per capita cost of health care. The Center has a very useful website which includes a resource exchange and discussion boards; there are many examples of papers relating to IPE and collaborative practice and users are encouraged to post comments on these: www.nexusipe.org
Many institutions providing IPE are grappling with the problem of assessment: how do we know that students have met our defined interprofessional learning outcomes or competencies? There are several published tools that focus on different aspects of evidence of learning including some that measure attitudes and some that assess behaviour. Frequently none of these are just quite right for a specific institution. The Center resource exchange features many of the tools and the original papers in which they are described. People are encouraged to share their experiences with the tools and how useful they have found them and in what contexts. In Australia we are just finishing a project funded by the Office of Learning and Teaching (OLT) during which we have developed a tool for the observation of an individual learner’s behaviour during an interprofessional teamwork based activity. The project team includes several universities in Australia and overseas: University Technology Sydney; the University of Queensland; the University of Central Queensland; Curtin University (Western Australia); the University of Derby (UK); and the University of British Columbia (Canada); with Professor David Boud as a consultant. The output is the iTOFT (the individual teamwork observation and feedback tool), which has an emphasis on feedback to enhance learning. It is assessment for learning rather than assessment of learning. The report and papers should be published later this year.
Returning to evidence, I was honoured during my time in the USA to be invited to speak at the Institute of Medicine in Washington DC. The meeting was entitled: ‘Measuring the Impact of Interprofessional Education (IPE) on Collaborative Practice and Patient Outcomes’ details of which are available at: www.iom.edu and the resulting report will be published there in due course.
During 2014 I spoke about and ran workshops on IPE in Germany, Malaysia, Indonesia and Switzerland. The triggers for IPE are similar in these countries but there are differences globally in the resources available to change an existing system of education. Wide-ranging discussions at all levels are required to discuss and implement models of interprofessional working in health systems and services. We cannot expect future generations of junior health professionals to advocate for change by themselves.
It is an exciting time within the field of interprofessional education and collaborative practice. I hope that some of the excitement translates into action and we improve patient and client outcomes and care in the next decades.