J.E. Thistlethwaite

Introduction

The adjective interprofessional describes a strategy in which practitioners learn and work together for a common goal. It implies dialogue and negotiation, consensus and compromise, as well as mutual understanding and respect. The most widely used definition for interprofessional education (IPE) is that of the UK-based Centre for the Advancement of Interprofessional Education (CAIPE), which was updated in 2002: ‘occasions when two or more professions learn from, with and about each other to improve collaboration and the quality of care’ (CAIPE 2002). Here ‘professions’ refers to health and social care and to both prequalification students and qualified practitioners. The prepositions ‘from’, ‘with’ and ‘about’ are important as they imply that learning is interactive and equitable. Collaboration, and therefore collaborative practice, as a goal of IPE is now becoming a commonly used term, along with teamwork.

A number of educational, psychological and sociological theories underpin the development and delivery of IPE. These include, but are not limited to, professional socialization, communities of practice, adult learning theory and transformative learning.

The rationale for IPE

For many programme planners the impetus for introducing interprofessional outcomes into a course is that they are now mandated or recommended by increasing numbers of professional accreditation bodies, for example, the General Medical Council (GMC) in the UK and the Interprofessional Education Collaborative of the United States. The underlying rationale is the changing international health and illness profile, with an increase in chronic and complex disease as the population ages, as well as the patient safety agenda and the importance of health promotion. Health and social care is now predominantly a team-based enterprise as practitioners specialize and patients move between primary, secondary and, potentially, tertiary care sectors. Beyond the core team, collaboration also occurs on a wider scale and may include interactions with schools, the police and the judiciary as well as diverse health and social care providers.

Planning for IPE

Successful delivery of IPE is not easy, but too often the difficulties are highlighted and used as an excuse for stifling development and innovation. The first requirement in any institution or postgraduate programme is an interprofessional champion: a highly committed health or social care professional with experience in the area who is able to lead by example, motivate others, challenge stereotypes and role model ‘being interprofessional’. Such a person needs to be able to engage with all the professional education leads whose students or practitioners will be joining the programme(s) and have options for solutions to the common difficulties that will arise while enabling people to suggest their own strategies for successful implementation. The interprofessional educator often straddles departments in universities and clinical settings and will need a colleague within each profession or faculty with whom to liaise and plan. The profession of the IP lead should not be important, but the planning team should be inclusive of all the professions who will be learning together.

Once the planning team is in position, consideration needs to be given to the following: the number of students/learners and what professions will be involved; whether all activities are mandatory or if there will be a choice; the timing of the activities (early, late or throughout the course); the number of hours and over what time frame; where learning will take place (classroom, clinic, ward, etc.); the type and timing of assessments; and how many rooms and facilitators will be required. In addition, the people responsible for coordinating the timetables and for overseeing the budget need to be identified.

Learning outcomes for IPE

The logistical and capacity barriers to effective prequalification IPE are of course immense: large numbers of students, with profession-specific timetables, often learning in academic and clinical environments with limited space. The work required to negotiate these hurdles is only rewarded if there is an added value to students’ learning through bringing them together (face-to-face and/or online). Therefore, it is extremely important that careful consideration is given to explicit learning outcomes for interprofessional activities. These will derive in part from any professional accreditation standards set for prequalification or postqualification continuing professional development (CPD) programmes. The published learning outcomes should be such that they would be unlikely to be achieved without interprofessional interaction. The aim is, thus, shared learning rather than common learning, i.e. ‘from’, ‘with’ and ‘about’.

For example, for students learning how to measure blood pressure (a common skill for many healthcare professions), there should be outcomes over and above profession-specific and generic skills such as patient communication and clinical skills. Moreover, students and facilitators should know what the outcomes are, how they can be met and how they will be assessed.

The most frequently defined outcomes fall into six main areas: teamwork, communication, understanding of roles and responsibilities, ethical issues, the patient and learning/reflection (Thistlethwaite & Moran 2010). There are a number of frameworks for IPE in which outcomes are also referred to as competencies, capabilities and objectives. As demonstrated by the GMC quote above, the terminology in these documents varies, and often multiprofessional, multidisciplinary and interdisciplinary are used interchangeably.

Learning activities

As IPE has been undertaken in various formats, locations and learning environments since the 1960s, there is a rich menu of learning activities that can be scrutinized when planning new initiatives. The decision about activities should be based on the need to align the defined learning outcomes with learning opportunities, but programmes are also constructed pragmatically, taking into account student numbers and available resources such as space and trained facilitators.

Prequalification

In higher education, not everyone will have the luxury of starting new programmes with completely blank curricula through which interprofessional activities can be woven. More commonly, interprofessional learning is added into already crowded curricula, or it may take the form of student-selected options or electives.

The common curriculum model involves students from different health and social care professional training spending 1 or more weeks learning together full-time. This may be a full first year of study. For example, at the Auckland University of Technology (AUT) in New Zealand, students undergo a common first year before differentiating into professional groups and undertaking profession-specific modules. The New Generation project of Southampton University in the UK has students undertaking interprofessional units over 2 weeks for a number of times during their first year (O’Halloran et al 2006). Implementing this sort of activity requires curriculum renewal across health and social care professional programmes in order to integrate fully the interprofessional learning into each profession’s timetable.

Interprofessional modules may involve classroom activities based on teamwork and professionalism. There may be early patient/client contact in community or clinic settings with mixed groups of students interviewing patients/clients.

In Canada, the model proposed by Curran and Sharpe (2007) adopts a curricular approach, which exposes students to interprofessional education at an early stage in their training with subsequent regular reinforcement. Early evaluation has shown satisfaction amongst students and faculty as well as significant effects on attitudes toward interprofessional teamwork and education. At Leicester University (UK), interprofessional student groups visit patients in their homes, adopting a biopsychosocial approach to eliciting their stories and planning management.

 All health professional students undergo clinical attachments at various points in their training; by mapping such attachments, it should be possible to bring the professions together at some point to provide team-based experiences that are as authentic as possible.

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