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Introduction
Professional programs in higher education, such as healthcare, aim to prepare students for practice through the acquisition of appropriate and relevant knowledge, skills, attitudes, and values. They should also focus on students’ integration into the profession: their becoming professionals and subsequently being professionals.1 However, as professional identity formation has been conceptualized as “an on-going process of interpretation and re-interpretation of experiences,”2 one could argue that an individual can never be but is always becoming a professional. There is, however, a frequently held assumption of one profession, one identity, although a professional is acknowledged as having multiple roles. In this chapter, we question what happens to professional identity in the context of modern healthcare and contemporary education of the health professions, which is increasingly characterized by teamwork and collaborative practice, and accordingly, whether healthcare professionals also need to nurture and sustain an interprofessional identity. The question then follows as to whether their interprofessional identity subsumes the uniprofessional or whether an individual may move between the two identities depending on context and inclination. Are health professionals plural actors as the French sociologist Lahire suggests? “And so we are plural, different in the different situations of ordinary life, foreign to other parts of ourselves when we are engaged in this or that domain of social existence.”3 Daily living involves circulation through different roles: employee, researcher, parent, partner, teacher, and practitioner. But in these roles, are people mainly demonstrating differences in behavior depending on context rather than identity? Are healthcare professionals and students doing rather than being or becoming? As Hafferty has suggested in relation to medical students, the act of developing a “professional presence” is “best grounded in what one is rather than what one does.”4
“Being interprofessional” has been described as consisting of three aspects: knowing what to do (thinking about what action is needed and why); having the skills to do what needs to be done (being competent and practicing correctly); and conducting oneself in the right way during performance (including appropriate attitudes and values).5 However, these three aspects can just as easily be applied to “being professional” or being “uniprofessional.” By debating and defining interprofessional competencies and their translation into behavior in the workplace, health professional educators may gain a greater sense of the additional attributes that constitute being interprofessional. Lists of such competencies frequently include the following: values and ethics, understanding roles and responsibilities of other healthcare professionals, interprofessional communication, and teamwork and collaborative practice (see, for example, the Interprofessional Education Collaborative [IPEC] of the United States core competencies document).6 Very broad competencies are not particularly helpful as many of these are abstract, socially constructed, and difficult to translate into observable and assessable behaviors.7 Moreover, being competent is not evidence of professional identity, just as behavior is not necessarily evidence of how people think, what they believe, and what their values are.
D’Amour and Oandasan have defined interprofessionality as “the development of a cohesive practice between professionals from different disciplines.”8 In addition, Brooks and Thistlethwaite have proposed that interprofessionality is characterized by “the transformation in practice which may result from combining and blending specialist knowledge and expertise.”9 They have also posed some critical questions about the transformation in identity that is associated with working and learning across professional boundaries, such as in the context of interprofessionality, and the synergy and possible disjunctions between multiple identities.9 We note that the term “interprofessionalism” is also found in the literature and has all the nuances and controversies associated with professionalism. IPEC defines “interprofessional professionalism” as a “consistent demonstration of core values evidenced by professionals working together, aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, [and] accountability to achieve optimal health and wellness in individuals and communities.”6
Helping students to achieve interprofessional competencies to ultimately improve patient care is one of the functions of interprofessional education (IPE). Another, although not always as explicitly stated, is the development of an interprofessional or “collective” identity.6 There is ongoing debate in relation to IPE as to the best time to facilitate health professional students to “learn from, with and about each other.”10 The question is informed by work on professional identity formation and professional stereotyping. Proponents of the early introduction of interprofessional learning activities feel that such interaction reduces the likelihood of one profession forming negative opinions of the others, while other educators believe that students should be confident with their own profession’s identity before learning more about their future colleagues. However, no one so far has convincingly shown that the timing of IPE helps or hinders either uniprofessional identity formation or the development of an interprofessional persona. The majority of the evaluations of IPE initiatives at the pre-qualification (pre-licensure) level are short-term explorations of whether learning outcomes have been met and competencies mastered, and frequently they focus solely on learner satisfaction.11 While change in attitudes to interprofessional learning and working may be measured before and after the learning activities (commonly through the use of RIPLS – the Readiness for Interprofessional Learning Scale,12 and the IEPS – the Interdisciplinary Education Perception Scale)13, such measurement says little about the process of professional identity formation. Outcomes-based evaluations focus on product rather than process and ignore the “personal transformation” process that underlies professional socialization.4
In this chapter, we reengage with these important questions. In particular, we ask if “being interprofessional” is an identity in its own right in a changing and complex healthcare context characterized by teamwork and collaborative practice and, if so, whether this interprofessional identity coexists with or subsumes the uniprofessional identity. We discuss the implications for health professions education arising from our critical reflection on these questions at the end of each main section and at the end of the chapter.
Learning to be a (uni)professional
In becoming and subsequently being a healthcare professional, students and trainees develop a range of beliefs, attitudes, values, and expectations about the profession they have entered. Thus, a professional identity is forged and encompasses the norms, beliefs, values, and world views of that particular group or community.14
Shulman suggests that novice professionals are taught about three fundamental dimensions of professional work: “to think, to perform and to act with integrity.”15 (Note the similarity here to Hammick et al.’s three aspects of being interprofessional discussed above.5) Each profession tries to achieve this learning through “signature pedagogies,” which acknowledge that education and training are not simply about knowledge transmission but also about preparation for a professional role.15 While there are some similarities across the health professions in that experiential learning in clinical settings is common to most, the type of tutor or supervisor, the style of group work, and the use of simulation and skills laboratories vary. The rituals of learning in medical school, for example, include ward rounds, bedside teaching, students being asked to “clerk” patients and report back (mostly without being observed), simulated patients, and the practice of clinical skills on mannequins and plastic limbs. The predominantly siloed education of the health professions ensures that one type of student is unaware of the curriculum and signature pedagogies of another. This results in a lack of understanding of roles and responsibilities when the professions come together to attempt to work together. As Shulman writes, “Signature pedagogies are important precisely because they are pervasive…. [T]hey define the functions of expertise in a field, the locus of authority, and the privileges of rank and standing.”15
During their prequalification programs, students are socialized into their profession and professional role and undergo a critical period of professional identity formation.16 Role acquisition occurs through learning and teaching: didactic and interactive, social and clinical. Role models and formal, informal, and hidden curricula influence how a novice professional develops a sense of (uni)professional self.17 Health professions education is still delivered predominantly by members of the same profession, either by faculty academics, who might no longer practice clinically, or by clinical tutors or supervisors in clinical settings. While basic scientists and specialist educators may also be involved, it is the professionals who reinforce their professional culture, values, beliefs, and practices5 as both teachers and role models. The literature is extensive on this topic, and examples are found in individual professional and interprofessional journals. Socialization into one profession is frequently thought to preclude the ability to collaborate across professional lines, as students assimilate the culture, values, jargon, and working practices of their developing new identity.16 IPE is seen as a way of helping individuals understand the attributes of other professions to facilitate future collaborative practice. However, other studies have shown that developing a professional identity serves an important preparatory function for interprofessional familiarization,18 with IPE then aimed at introducing students to other professions so they may develop an understanding of their roles and responsibilities within healthcare teams and the wider health system.
Implications
Health professions education requires an appropriate mix of uniprofessional and interprofessional activities chosen to help students meet appropriate learning outcomes as defined by their professional accreditation bodies and their institutions. Learning outcomes should be assessable and cover “knowing what to do,” “having the skills to do what needs to be done,” and “conducting oneself in the right way during performance.”5 Learning focuses on an understanding of the nature of professionalism, professional identity, one’s own professional role, and the roles of other professionals involved in healthcare delivery. Competency frameworks, such as that of IPEC,6 are helpful in developing outcomes.
Theories of identity formation from an interprofessional perspective
While the literature is abundant with examples of identity development within (uni)professional contexts (as demonstrated in this book), there has been less discussion about professional identity formation from an interprofessional perspective. In this regard, Whittington’s chapter on “Interprofessional education and identity,”19 published by the Higher Education Academy (UK) in 2005, neatly summarized some of the most commonly applied theories of identity formation at that time. Whittington noted that identity theories are many and remain controversial, while there is no consensus on the meaning of “identity” itself. The chapter outlined three perspectives, with both similarities and differences among the three. The first of these, the social identity approach, is cited frequently in the interprofessional literature and has been the subject of empirical studies; it is grounded in social psychology. The second theory takes a constructionist viewpoint, with a focus on discourse and narrative. The last combines many elements, including social structuralism and constructionism, with psychological insights, to probe the concept of self-identity in the twenty-first century. Such theories try to make sense of what some have called the “tribes of the health professions,”20 with their attendant tribal boundaries and conflicts that focus mainly on difference and competition.
In the sections below, we delve deeper into these three theoretical fields from an interprofessional perspective, updating Whittington’s exposition with more recent work. We begin with the social identity approach by revisiting the work of Allport, the American psychologist who introduced the term “in-group” and the contact hypothesis.
Social identity theory: Allport’s contribution
Allport’s seminal work on prejudice was published in 1954. Its language is of its time, with his work being influenced by the prevalent social conditions and attitudes to ethnicity and race in that decade.21 He coined the term “in-group” in relation to a person’s place in society, proposing that the in-group to which one belonged depended on one’s “race, stock, family tradition, religion, caste and occupational status.”21 His contact hypothesis provided a framework for considering intergroup attitudes and postulated that positive outcomes are only possible if different groups pursue common goals and, at the same time, if the environment is supportive of their working together. There are four stages of contact, which Allport described as a peaceful progression. In the first, sheer contact, different groups come into proximal contact. This may lead to competition, but also, over time, to accommodation: people from specific in-groups relax and become at ease with one another while still respecting and valuing their differences. The fourth stage is assimilation. Not all groups go through all four stages; groups may resist assimilation and want to hold onto what makes them distinct. In some cases, this resistance may revert to further competition or even to overt conflict.21 Relating this to health professions education, IPE is an opportunity for health professional students to meet through contact and to accommodate over time, but it is not generally considered to be aimed at facilitating assimilation, because the professions, while frequently overlapping in scopes of practice, remain distinct.
We believe that “third culture personality,”22 derived from intercultural work, is a better term than assimilation: ideally, professionals such as nurses with their own professional identities (first culture), come into contact with other professionals, such as physical therapists, physician assistants, and doctors (second culture), and learn together to work together within a collaborative culture of healthcare (third culture).23
Social identity theory: beyond Allport
Social identity theory is an amalgamation of two related theories: social identity and self-categorization. It derives in part from the work of Allport and focuses on intergroup relations.24 While acknowledging the existence of personal identities, the hypothesis is that some of us define ourselves based on our membership in groups and the derived shared social identity. Social identity theory encompasses how individuals from one profession or community compare and differentiate themselves from other professional groups and deal with issues of rivalry, stereotyping, discrimination, and status. Tajfel and Turner appropriated the term in-group and contrasted this with “out-group,” stating that there is pressure “to evaluate one’s own group positively through in-group/out-group comparisons,” which “lead social groups to attempt to differentiate themselves from each other.”25 Through identification with our own social group (or profession), we may form biases and become prejudiced against other groups. Furthermore, we may stereotype out-group members and make unfavorable comparisons of their attributes with our own in-group’s, thus establishing our sense of self and boosting our self-esteem: the process of intergroup differentiation.25 As Whittington succinctly states, “Social identity theory deals with the implications of distinctions between ‘us’ and ‘them’.”19
Self-categorization theory suggests that there are three levels that can define the self: personal identity (the individual); social identity (one’s in-group); and interspecies (the self as a human being – human identity).26 When an individual privileges group identity over self, depersonalization occurs and one’s perception of group homogeneity is enhanced. Group membership is seen as prescriptive and defines what attitudes, values, and behaviors are appropriate for each situation and setting (in our context, such definition is at the core of professionalism). This process facilitates collective behavior and a move from thinking about “I and me” to “we and us.”19
Of course, groups have status differences within any society. A group’s position in the hierarchy confers varying amounts of power and influence. If one is unhappy with one’s in-group’s prestige, there are a number of options: leaving the group; taking the necessary steps to become part of another group (through, for example, additional qualifications or marriage); making unflattering comments about relevant out-groups; and engaging in activities to promote equity among groups. The in-group hypothesis has similarities to the thinking of Bourdieu and his conceptualization of habitus, field, and capital.27 Habitus refers to the socialized norms or tendencies that guide behavior and thinking through one’s upbringing and place in society (i.e., one’s in-group), and through the influence of what have been referred to as norm circles.28 It is not necessarily static and can be changed, as can one’s membership in a group or profession through the accrual of capital – economic, social, symbolic, and cultural. Cultural capital, for example, is what you know, including professional qualifications. It has a major role in defining how much power one has in a given “field.” One’s field is the environment or arenas in which an individual lives and works. Position in a given field depends on the amount and quality of capital accrued and may be the result of competition with others in the same field but in a different in-group.
Taken together, the social identity approach has challenged traditional assumptions about stereotyping. Allport defined a stereotype as “an exaggerated belief associated with a category. Its function is to justify (rationalize) our conduct in relation to that category”21 (category meaning generalization). Previously, stereotypes had been thought of as fixed mental representations, resistant to change. Now they are thought to be amenable to alteration depending on context and familiarity with alternative viewpoints.29 This is of importance to IPE, which aims to reduce and challenge the formation of stereotyping across the health and social care professions.30 (We discuss stereotypes in more detail below.) These theories, though nearly forty years old, are still applied in the interprofessional literature, possibly because “the social identity approach is a rare beast; a meta-theory that is ambitious in scope but ultimately rests on simple, elegant, testable and usable principles.”31
Discourse and narrative
Whittington’s second perspective focuses on discourse and narrative.19 Many social theorists argue that discourse shapes our social world, drawing on the work of Foucault32 and of other social constructionists. Social constructionism holds that social phenomena are understood as “the outcome of discursive interaction rather than as extra-discursive phenomena in their own right.”33 While “discourse” has many meanings, the underlying premise is that how we collectively think and communicate about the world affects the way the world is;28 in other words, we construct meaning in interaction with others, using language as the primary medium.19 What is important is the content of this communication, rather than the linguistic norms and the language that are used.28
Thus, from this perspective, identities are not given, but are continually being constructed and reconstructed through dialogue and interaction with others. Identities are affected by the age, gender, culture, values, ethnicity, sexuality, status, profession, and even health33 of the people interacting. In relation to identity, a “narrative” approach offers a promising avenue for exploring the stories that people tell about how they make sense of their identity. A “narrative” approach to identity elaborates the account of how identity is constructed. Individuals use narrative to reconstruct their “autobiographical past” and ponder on the future so that their lives gain a degree of purpose, meaning, and usefulness.34 Narratives can be highly interactional and conversational.35 The result is a coherent story of their identity over time.35
Self-identity in the twenty-first century
Under this third heading, Whittington19 references the work of Giddens36 and discusses contemporary life, with its global reach, profound changes, and technological advances that are leading people to challenge tradition and ways of behaving. Of course, Whittington was writing after the development of the Internet, but before the explosion of social media, smart phones, and interconnectivity, with their opposing features of collectivity and isolation. People no longer need to meet in the same geographical location but can still be “face-to-face.” People (or at least those with access to the right technology) expect to be able to access anything at any time: instant gratification. Health professionals are able to become members of diverse virtual communities, frequently hiding their real identities behind avatars and pseudonyms, expressing opinions and feelings in postings that others may describe as “unprofessional.”
Giddens36 suggested that the self has become a reflexive project. The notion is articulated through the leading question of “Is everything alright?” as a central motif.36 Here, self-identity refers to the “self as reflexively understood by the person”36 and reflexivity means the human capacity to turn the attention of consciousness back upon itself: we are aware of being aware, of thinking about thinking, and are able to provide accounts about ourselves.37 However, the explosion of knowledge and doubt about its veracity have led to uncertainty and a sense of risk, which can erode trust in authority and tradition, and anxiety about one’s identity and place in the “system.”19
Implications
Simply combining healthcare students for shared learning (i.e., learning the same content side by side) is not sufficient to reduce intergroup prejudice or improve intergroup attitudes and, indeed, may have deleterious effects. To reduce intergroup tensions, it is important to develop strategies that will create a positive and interactive learning environment where two or more professions learn together.38 The experience of “us” and “them” in poorly constructed IPE can be elicited simply as an in-group consisting of students of the same discipline as the teacher and an out-group of students from another discipline, giving a sense of discrimination by the in-group against the out-group.38
IPE in the early stages of health professional education should frequently involve small-group work during which the students talk about their profession and its roles and responsibilities (as they understand them at the time) and tell stories about how they came to be students and the influences on that choice. Patients’ stories are often interwoven into these sessions with narratives of how different members of the team collaborate to ensure the optimal outcome. Experienced clinicians may tell stories of their work. Thus, IPE, as evidenced by a UK-based audit, is being delivered through “expository, student-centered, interactive and conversational practice-based methods where the learners actively constructed knowledge for themselves from an array of experiences, rather than concentrated on knowledge-based subject matter communicated from the teacher to the taught.”39 Students learn to become reflective practitioners.
As students gain more clinical experience, interprofessional small-group work should consider the discourses of the different professions and how these might affect collaboration and power relationships; for example, what are the issues arising from identifying those who receive healthcare as patients, clients, or service users?
Threats to professional identity
We now consider the following threats to professional identity: conflict, fault lines, and stereotyping.
Conflict
In the field of healthcare delivery, conflict has been described as occurring when “behavior is intended to obstruct the achievement of some other person’s goals.”40 That interprofessional practice and collaboration may engender conflict among the healthcare professions is highlighted by the inclusion of competencies related to negotiation and conflict resolution in a number of educational frameworks. For example, the Interprofessional Education Collaborative (USA) includes the following under “communication”: “Use respectful language appropriate for a given difficult situation, crucial conversation, or interprofessional conflict; contributes to conflict resolution,”6 while the National Interprofessional Competency Framework of the Canadian Interprofessional Health Collaborative (CIHC) has interprofessional conflict resolution as the last of its six competencies: “Learners/practitioners actively engage self and others, including the patient/client/ family, in dealing effectively with interprofessional conflict.”41 Despite the inclusion of conflict in these competency frameworks, it is rarely covered well or even at all in health professional curricula.42
Conflict has been linked to the hierarchy and subsequent differential treatment across professional groups that threaten professional identity.43 While medicine may claim to be one of the oldest professions, other areas of healthcare have professionalized over the decades, with the attendant specialized body of knowledge and skills, code of conduct, and self-regulatory bodies that constitute a “profession.”44 The “newer” professions have members who develop a specific professional identity commensurate with their role. Professions, as they mature, challenge the older examples and begin to encroach on the traditional boundaries of the competition.45 Professional boundaries and identities are interlinked; they are constructed and maintained by professionals themselves while varying over time, as the professions themselves are not static. The healthcare professions are viewed as different, with diverse approaches to patient care and varying professional jargon in spite of being united in the provision of optimal patient care. Practice is constructed from different perspectives.46 Alongside this differentiation, each profession may hold stereotypical views of others and define their identities in contrast rather than in common.
Fault lines
McNeil et al.43 extended the typology of Chobrot-Mason et al.47 to explore the triggers that cause “fault lines” to appear within interprofessional teams and how these relate to conflicts of professional identity. Such fault lines, similar to geological faults in the Earth’s surface, are explicit or hidden fractures that cause friction, displacement, and collisions, and have the potential to lead to dysfunctionality within teams. Chobrot-Mason et al.47 based their typology on field data from two studies involving 11 different countries and more than 150 people, across a range of organizations, such as financial services, education, and manufacturing. Analysis was framed by social identity theory and the notion of intergroup anxiety, which has a historical basis depending on prior conflicts between groups, such as different professions, as well as current conditions. They found that conflict was escalated by anxiety related to what was happening in society in general, as well as differential treatment, conflicting values, expectation of or reluctance for assimilation (at odds with Allport’s “peaceful progression”),21 and insulting or humiliating action. When intergroup anxiety was particularly high, even simple contact could lead to polarization and adverse outcomes: “Dominant and non-dominant group members interpret differential treatment very differently.… [I]n addition to promotions, pay, disciplinary actions and allocation of developmental opportunities served as the foci of the differential treatment. All of these distribution decisions have the potential to activate employee feelings of being undervalued and underappreciated.”47
Extrapolating the triggers to health professional identity conflicts, McNeil et al.43 highlight the dominance of the medical profession, even in interprofessional teams when medical supervision is often deemed necessary during “collaborative care.” Medicine is powerful compared to the other professions, and seeks to retain its power in many countries, restricting the autonomy of other health professionals and their scope of practice. In relation to the specific triggers of fault lines, McNeil et al.43 provide examples from the literature such as higher pay for doctors (differential treatment), divergent views about the quality of life (different values), the medical profession arguing against independent nurse practitioners (assimilation), and offensive language being used about other professions (insult or humiliating behavior). However, they could not find examples of conflict arising from simple contact.43
Stereotyping
Stereotypes serve as justifying devices, which fall into three types.48 Ego-justification occurs when individuals feel better about themselves through the denigration of others. Group-justification rationalizes discrimination against other groups and helps members feel positive about their own group and its membership. System-justification legitimates institutional forms of prejudice and discrimination while promoting hierarchical structures. Low-status groups tend to be referred to in more communal, socio-emotional terms, while high-status groups are described in action and achievement-orientated terms.48 For example, in relation to their relative positions in the hierarchy of the health professions, nurses are caring; doctors are diagnosticians.23
Implications
Learners need to be introduced to the possibility and nature of conflict arising in and between healthcare teams, both inter- and intraprofessionally. However, this should be after they have had experience of working collaboratively with peers and have an understanding of how teams function. Formal and informal professionalism discussions should be facilitated to help identify and acknowledge conflict and its etiology and effects, while providing activities for senior students to develop skills in negotiation, shared decision-making, and values-based practice.49,50 The fact that we form stereotypes through early experience48 provides a strong rationale for IPE to begin early before stereotypes form, though frequently students arrive at university with preconceived ideas about the health professions through their own experiences of healthcare and media portrayal.
Boundary crossing and interprofessional identity
A professional boundary is found at the point where one health profession’s role and scope of practice ends and another’s begins. How boundaries are perceived as either fixed or permeable may help or hinder interprofessional practice. Boundaries may be viewed as sociocultural differences, which cause discontinuities in practice or interaction.51 As professions mature, such boundaries may become contested spheres of practice, while collaborative practice allows for some overlapping of roles, which requires negotiation and reconstruction.52 Boundary crossing leads to learning at a horizontal level, a form of expansive learning that is transformational and co-configured.53 If the professions attempt to stay within their traditionally defined boundaries, the potential for interprofessional learning is lost as the professions defend their territory and reduce dialogue.
If we consider the goal of interprofessional practice is to deliver patient-centered collaborative healthcare, then barriers to achieving this goal include the factors discussed above: organizational structuralism, power relationships between the professions (and between professionals and their clients), role socialization, and differences in professional values.50 Values “operate as standards by which our actions are selected.”55 A profession that appears homogeneous may consist of individuals with very different values.50 There is frequently an assumption that coworkers, team members, and members of our own profession have similar values to our own50 and therefore, we may not think of exploring these before or while working together.
A further approach to conceptualizing traversing professional boundaries has emerged from preliminary work exploring health professional education in longitudinal integrated clinical placements. Daly et al.56 explored a setting, in which up to thirty students from different professions were placed at any one time in a rural community, from the perspective of the medical students.56 It was the informal curriculum,57 with multiple encounters between students, patients and their families, and clinical teachers and other health staff, that played an important role in supporting and extending student learning. Learning in a longitudinal placement and the development of professional identity as a rural practitioner took place through a process of socialization, alluding to the socially constructed and situated nature of learning. Learning can be conceptualized as a social phenomenon that reflects “our own deeply social nature as human beings capable of knowing.”58 Wenger proposed a social learning system as a way of framing learning as a social process underpinned by a dynamic interplay between “social competence and personal experience.”59 It involves communities of practice, boundary processes, and identity formation. A community of practice58 is the basic unit of analysis within a social learning system and is defined as a “group of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.” Communities of practice (CoP) can be understood as the “containers” or learning spaces, in which competence is developed within a social learning system. Individual learners participate in multiple CoPs, negotiate the boundaries between them in different ways, and so develop their personal and social identities.60 This raises the question of whether the notion of a social learning system can be usefully applied to understand the elements and processes affecting interprofessional learning within a longitudinal integrated placement program.
Implications
We acknowledge that many of the clinical environments through which students rotate might not, or appear not to, have a strong ethos of team-based care delivery or interprofessional collaborative practice. If students only learn “with, from and about”10 other health professionals during their formal IPE sessions, they may consider that “all this learning-about–the-other must not be so important… a null curriculum operating at full steam.”61 However, the emerging evidence of the utility of longitudinal integrated clinical placements in facilitating the acquisition of teamwork competencies62 suggests that such placements are one way of promoting the development of interprofessionalism, providing that students from two or more professions are co-located.
The transformation of the barriers discussed earlier into facilitators may be carried out in four phases of activity: sensitization, exploration, implementation, and evaluation.
The specific actions within each phase are the following:
• Sensitization: awareness of power imbalance and professional socialization;
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