In 2010, the World Health Organization provided the following definition of Interprofessional Education:
“Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”
Sounds pretty straightforward, doesn’t it? Just need a large enough room, right? In reality, developing meaningful interprofessional educational events is, to say the very least, highly challenging.
There are a number of reasons for this, some logistical and others attitudinal.
The logistic challenges are formidable. Professional schools have separate and independently developed curricular content and scheduling. Finding common ground and common space within those busy and packed programs is akin trying to get a group of busy commuters to stop and pause as they rush for the train. Moreover, any changes have to be approved by three independent Curriculum Committees, all (very understandably) aware of any impact new programming may have on their overall program. They are also very cognizant of their accreditation responsibilities which require them to ensure “centralized and independent” control of their curricula.
As difficult as these logistic challenges may be, the attitudinal barriers are even more daunting. Many students fail to see the value, being understandably focused on their individual program objectives. Many faculty members, while conceding the value, feel it is something better learned passively within the clinical environment through role modeling, and that valuable dedicated classroom time is best spent delivering what they consider more essential “core content”. These attitudes undermine the commitment that is required to overcome the logistics. In the words of Nilofer Merchant, “Culture trumps strategy, every time”. (Harvard Business Review: https://hbr.org/2011/03/culture-trumps-strategy-every)
Certainly, history is littered with partial successes or abject failures. During my tenure, I have personally been involved or witnessed numerous enthusiastic, well-intentioned and carefully thought-out approaches that have not achieved sustained success. This has been the case whether the efforts were local, or at the provincial or national levels.
Most recently, Dr. Leslie Flynn has been chairing a group that has again taken up the formidable challenge of developing a program of interprofessional education for the three schools within the Faculty of Health Sciences (Medicine, Nursing, Rehabilitation Therapy). They have developed an innovative and attractive program of learning events intended to provide both educational relevance to students of all three schools, and an opportunity for them to engage interactively. Their initial program offering begins this week.
Given the rather checkered history and recognized challenges, many might be tempted to ask, “why bother?”
A cogent rationale is provided in the preamble to the description of objectives that constitute the Collaborator competency in the CanMEDS framework:
Collaboration is essential for safe, high-quality, patient-centred care, and involves patients and their families, physicians and other colleagues in the health care professions, community partners, and health system stakeholders.
Collaboration requires relationships based in trust, respect, and shared decision-making among a variety of individuals with complementary skills in multiple settings across the continuum of care. It involves sharing knowledge, perspectives, and responsibilities, and a willingness to learn together. This requires understanding the roles of others, pursuing common goals and outcomes, and managing differences.
The College of Family Physicians takes a very similar position in its “Undergraduate Competencies from a Family Medicine Perspective” document:
As Collaborators, family physicians work with patients, families, healthcare teams, other health professionals, and communities to achieve optimal patient care.
The College of Nurses of Ontario describes the following in Entrance to Practice Competencies for Registered Nurses:
Collaborates with other health care team members to develop health care plans that promote continuity for clients as they receive conventional, social, complementary and alternative health care.
Physiotherapy Education Accreditation Canada (PEAC) is the organization responsible for accreditation of Rehabilitation Therapy programs in this country. In Essential Competency Profile for Physiotherapists in Canada, an essential Collaborator role is described as follows:
Physiotherapists work collaboratively and effectively to promote interprofessional practice and achieve optimal patient care.interprofessional practice and achieve optimal client care.
It seems then, that we all agree on the concept of Collaboration. But even more significant is the alignment about the “why bother” issue. It’s apparent from these statements that our mutual commitment is based on a shared acceptance of a fundamental truism – that collaboration provides for better patient care. Agreeing to Collaboration conceptually is not enough and, to borrow from Hamlet, “There’s the rub”. Those noble objectives ring hollow unless followed by deliberate action. That action should consist largely of what we have come to recognize as Interprofessional Education, or “IP”. IP is basically the walk that makes the talk. It actualizes our commitment to promote patient care through collaborative effort of all professionals whose training allows them to positively impact our mutual patients. It requires that we understand what others have to contribute, respect those contributions, and find ways to communicate and work together effectively.
We don’t commit to these efforts simply because they’re “the right thing to do” (although they are), or because fairness demands it (which it does), or because we wish to achieve accreditation standards (which we do). We commit to IP because, first and foremost, it’s in the interests of our patients to do so.
And that should be reason enough.