Promoting Interprofessional Education

The standard of care deemed appropriate for the management of many common medical and health conditions requires integration of multiple disciplines as well as the ability to access care at different sites. The lack of a coordinated approach to multidisciplinary assessment can result in delays in diagnosis, delayed development of appropriate treatment plans, and barriers to the receipt of care.¹ There is a need for health care delivery and family and community health services that are well coordinated, free of errors, sensitive to patient needs, and responsive to the patient’s subjective experience. To fulfill these requirements, frequent and full collaboration between health care professionals is imperative.^1–3 Globalization, migration, and widespread health disparities call for interdisciplinary and interprofessional approaches to improve the health status of individuals, families, and communities in the United States and abroad.^4–6 Evidence from some educational programs strongly suggests that future health care providers and public health workers would be better prepared to effectively meet the challenges of today’s health care systems through interdisciplinary curricula and interprofessional education.

In 2000, the National Academies of Practice brought together an expert panel representing 10 health care disciplines to define the issues of interdisciplinary health care and to formulate clear objectives to move toward an interprofessional education plan. It was hoped that such a plan would lead to interprofessional practice and better heath care for all Americans. The objectives developed included funding requests for both interprofessional education and interprofessional research along with a call for consensus on the curriculum components required for interprofessional education.⁷ In 2001 and in 2002, additional reports were issued because the many existing barriers resulted in only small movements toward interprofessional practice. These reports amplified the call to action for new modes of health care delivery using interprofessional care. Multiple researchers have conducted studies with differing models of interprofessional education. Although the results have been published, there has been little, if any, global movement to integrate health professions and public health educational programs.^8,9

The concept of multiple disciplines’ addressing the needs of patients, families, and communities together requires that each of the disciplines understands the skills and knowledge of other health care professionals in an effort to bridge communication between disciplines. The terms multidisciplinary, transdisciplinary, and interdisciplinary refer to the characteristics of a health care delivery team. In a multidisciplinary team, each discipline independently contributes its experience to an individual patient’s care. Team members work parallel to one another, and direct communication among team members is rare, except through the provider in charge (usually the patient’s primary care physician). In transdisciplinary practice, the roles of individual team members are blurred, and their functions frequently overlap. Here, each team member must become sufficiently familiar with their colleagues’ disciplines to assume a significant portion of the others’ roles. In an interdisciplinary team, members work closely together and communicate frequently to optimize care for the patient. In clinical practice, this type of model is also referred to as “interprofessional” care. The interprofessional team is organized around a common set of problems, as opposed to being organized around a single physician, and meets frequently to consult. Each team member’s assessment is taken into account to allow for global patient management.¹⁰

The focus of this resolution is interprofessional education of health care and public health professionals. This is simply shared learning by students from multiple health disciplines.

Interprofessional education has been defined as an educational intervention during which members of more than one health or social care profession learn interactively together for the purpose of improving collaborative practice or the health and well-being of patients.⁴

The American Academy of Pediatrics has been vocal about the need for the health and related systems to focus on coordinating the health and related care of children with special health care needs. In 1999, the American Academy of Pediatrics recommended that primary care providers and tertiary care centers work cooperatively in an effort to link patients and their families to a full spectrum of services. The purpose of this resolution was to ensure that the care was appropriate (not fragmented or duplicated), that it was streamlined to ensure appropriate services were delivered, and that services were patient centered.¹¹ These services include health, education, and social services. A study published in 2008 concluded that a poor medical home leads to barriers in accessing needed therapeutic and supportive services.¹² It is incumbent on the team to “cooperate, collaborate, communicate, and integrate” as one of the core competency recommended for health profession education.¹³ A team approach to health care has gained support from many organizations⁹, and has shown promise in many health care^15–18 and health professions education^4,19–31 programs. The Institute of Medicine strongly suggests that we must include the interdisciplinary approach into the education of our health care providers in an effort to improve patient-centered health outcomes.⁹

The use of interprofessional teams in health professions programs has enhanced student learning, created opportunities for service to the community,³² and has supported the attainment of important elements of community capacity such as participation, training in groups, information sharing, networking, critical reflection,³⁴ and cultural competency.³⁴ Interprofessional student health teams have been used to address the maldistribution of health care professionals and to improve access to care for underserved rural populations^35,36

APHA has previously adopted policy resolutions supporting interprofessional cooperation in the management of hypertension³⁷ and diabetes³⁸ and within community health centers.³⁹ Despite a growing body of evidence, the ultimate impact of interprofessional education and multidisciplinary approaches to patient care remains uncertain,⁴⁰ and a lack of knowledge about key nonphysician professional roles persists.⁴¹ More rigorous studies are required to provide reliable evidence.^3,42

Despite the potential benefits, many barriers to interprofessional education persist, including already overcrowded curricula in health professions schools and schools of public health, lack of support from faculty and administration, financial constraints, and perceived isolation of some health professions.⁴³ The development and successful implementation of an interprofessional education approach is dependent on a variety of factors, including the attitudes of students, faculty, administrators, and practitioners.^24,44,45 Strong individual disciplinary cultures often persist, which may lead to territorialization, not integration. Stereotyping of other disciplines continues, and providers need to be taught how to properly function within a team approach to care.

Three interrelated barriers to interprofessional collaboration were recently identified: the way in which each profession educates its students, the lack of a common foundation when health professions try to work in team settings, and health care delivery models that make it difficult to provide high quality patient care.⁴⁶ It is quite natural for providers to be resistant to change and fearful about the potential loss of autonomy in an interprofessional model. In addition, some organizations that use health care teams may be more resistant to innovation and change.

To create a culture for interprofessional collaboration in clinical practice, these barriers must be overcome. A shared learning environment and collaborative practice setting may help to alleviate these tendencies. Interprofessional continuing education may also help to facilitate a positive and collegial team environment. Evaluation of a program’s effectiveness is a key element to overcoming the relative lack of evidence for an interprofessional approach to education and ultimately to interprofessional patient care environments. Such evaluations would provide the opportunity to assess health outcomes and patient satisfaction. In this way, programs can learn from previous success and failures.

Carroll-Johnson summarized what interprofessional collaboration could achieve for all, “Imagine a world where each group’s expertise is held in regard, offered, and shared as the need arises. Imagine a time when the patient can determine which kinds of practitioners he or she needs or wants, and then imagine a system that makes those professionals available.”⁴⁷, p 619 APHA—

1. Calls on health professions education programs and schools of public health to incorporate coursework and clinical training emphasizing cross-disciplinary and interprofessional interactions including the development of an interdisciplinary curriculum.
2. Calls on health professions education programs and schools of public health to evaluate the outcomes of curricular changes to assess differences in students’ and graduates’ communication skills, knowledge, attitudes, and understanding of the roles of different members of the interprofessional health care team. 
3. Urges health professions education programs and schools of public health to rigorously evaluate the impact of interprofessional education on professional practice and health care outcomes.
4. Encourages providers of continuing professional education to offer training and courses in interprofessional care featuring a multidisciplinary faculty of recognized experts from different disciplines and different health care fields.
5. Urges health care researchers to form interprofessional collaborations for the study of health care education and health policy.
6. Urges the Agency for Healthcare Research and Quality (AHRQ) and other funding agencies to fund research on the effectiveness of interprofessional health care education.
7. Urges AHRQ to fund the use of new technologies and the development of an Internet clearinghouse for interprofessional health care education.

References

1. Annandale E, Clark J, Allen E. Interprofessional working: an ethnographic case study of emergency health care. J Interprof Care. 1999;13:139–150.
2. Soothill K, Mackay L, Webb C. Interprofessional Relations in Health Care. London: Edward Arnold; 1995.
3. Zwarenstein M, Reeves S, Barr H, Hammick M, Koppel I, Atkins J. Interprofessional education: effects on professional practice and health care outcomes (Review). The Cochrane Library. 2007, Issue 3.
4. Haq C, Baumann L, Olsen CW, et al. Creating a center for global health at the University of Wisconsin-Madison. Acad Med. 2008;83:148–153.
5. Carey TS, Howard DL, Goldmon M, et al. Developing effective interuniversity partnerships and community-based research to address health disparities. Acad Med. 2005;80:1039–1045.
6. Goldmon MV, Roberson JT Jr. Churches, academic institutions, and public health: partnerships to eliminate health disparities. N C Med J. 2004; 65:368–372.
7. Brashers VL, Curry CE, Harper DC, et al. Interprofessional health care education: recommendations of the National Academies of Practice expert panel on health care in the 21st century. Issues in Interdisciplinary Care: National Academies of Practice Forum 2001;3(1):21–31.
8. Greiner A. Educating Health Professionals in Teams: Current Reality, Barriers, and Related Actions. Washington, DC: Institute of Medicine; 2002.
9. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
10. Hall P, Weaver L. Interdisciplinary education and teamwork: a long and winding road. Review. Med Educ. 2001;35:867–875.
11. Ziring PR, Brazdziunas D, Cooley WC, et al. American Academy of Pediatrics; Committee on Children With Disabilities. Care coordination: integrating health and related systems of care for children with special health care needs. Pediatrics. 1999;104(4 Pt 1):978–981.
12. Benedict RE. Quality medical homes: meeting children’s needs for therapeutic and supportive services. Pediatrics. 2008;121(1):e127–e134.
13. Greiner AC, Knebel E, eds., Committee on the Health Professions Education Summit. Health professions education: a bridge to quality. Washington, DC: National Academy Press, 2003. Available at: www.nap.edu/catalog/10681.html. Accessed February 5, 2008.
14. World Health Organization. Learning to work together for health. Report of a WHO Study Group on Multiprofessional Education of Health Personnel: the team approach. World Health Organ Tech Rep Ser. 1988;769:1–72.
15. Sidorov J, Shull R, Tomcavage J, et al. Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria. Diabetes Care. 2002;25:684–689.
16. Cutler TW, Palmieri J, Khalsa M, Stebbins M. Evaluation of the relationship between a chronic disease care management program and California pay-for-performance diabetes care cholesterol measures in one medical group. J Manag Care Pharm. 2007;13:578–588.
17. Van Gils CC, Wheeler LA, Mellstrom M, et al. Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients. The Operation Desert Foot experience. Diabetes Care. 1999;22:678–683. 
18. Mollica RL, Gillespie J. Care Coordination for People With Chronic Conditions. Portland, Me: National Academy for State Health Policy; 2003.
19. Horsburgh M, Merry A, Seddon M, et al. Educating for health care quality improvement in an interprofessional learning environment: a New Zealand Initiative. J Interprof Care. 2006;20:555–557.
20. Larson EL. New rules for the game: Interdisciplinary education for health professionals. Nurs Outlook. 1995;43:180–185.
21. Johnson AW, Potthoff SJ, Carranza L, et al. CLARION: a novel interprofessional approach to health care education. Acad Med. 2006;81:252–256.
22. Horsburgh M, Lamdin R, Williamson E. Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning. Med Educ. 2001;35:876–883.
23. Pollard KC, Miers ME, Gilchrist M, Sayers A. A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention. Health Soc Care Community. 2006;14:541–552.
24. Hind M, Norman I, Cooper S, et al. Interprofessional perceptions of health care students. J Interprof Care. 2003;17:21–34.
25. Gavin J, Lempp H, Elliman A, Grogan C. Teaching partnership: linking a medical school and a community trust. Br J Community Nurs. 2002;7:32–36.
26. Lowry LW, Burns CM, Smith AA, Jacobson H. Compete or complement? An interdisciplinary approach to training health professionals. Nurs Health Care Perspect. 2000;21:76–80.
27. Kahn N, Davis A, Wilson M, et al. The interdisciplinary generalist curriculum (IGC) project: an overview of its experience and outcomes. Acad Med. 2001;76:S9–S12.
28. Kutner JS, Westfall JM, Morrison EH, et al. Facilitating collaboration among academic generalist disciplines: a call to action. Ann Fam Med. 2006;4:172–176.
29. Vermund SH, Sahasrabuddhe VV, Khedkar S, et al. Building global health through a center-without-walls: the Vanderbilt Institute for Global Health. Acad Med. 2008;83:154–164.
30. Koplan JP, Baggett RL. The Emory Global Health Institute: developing partnerships to improve health through research, training, and service. Acad Med. 2008;83:128–133.
31. Andrus NC, Bennett NM. Developing an interdisciplinary, community-based education program for health professions students: the Rochester experience. Acad Med. 2006; 81:326–331.
32. McWilliams A, Rosemond C, Roberts E, Calleson D, Busby-Whitehead J. An innovative home-based interdisciplinary service-learning experience. Gerontol Geriatr Educ. 2008;28:89–104.
33. Gilkey MB, Earp JA. Effective interdisciplinary training: lessons from the University of North Carolina’s student health action coalition. Acad Med. 2006;81: 749–758.
34. Matsunaga DS, Rediger G, Mamaclay B, et al. Building cultural competence in an interdisciplinary community service-learning project. Pac Health Dialog. 2003;10(2):34–40.
35. Hamilton CB, Smith CA, Butters JM. Interdisciplinary student health teams: combining medical education and service in a rural community-based experience. J Rural Health. 1997;13: 320–328.
36. McNair R, Brown R, Stone N, Sims J. Rural interprofessional education: promoting teamwork in primary health care education and practice. Aust J Rural Health. 2001; 9(suppl 1):S19–S26.
37. American Public Health Association. APHA policy statement 81-18. Inter-professional cooperation in high blood pressure control. Washington, DC: American Public Health Association; 1981. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=990. Accessed November 19, 2008.
38. American Public Health Association. APHA policy statement 2000-2. Reducing the incidence of blindness, Lower extremity amputation, and oral health complications in minority populations due to diabetes mellitus. Washington, DC: American Public Health Association; 2000. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=207. Accessed November 19, 2008.
39. American Public Health Association. APHA policy statement 63-19. The development of community health service centers–present and future. Washington, DC: American Public Health Association; 1963. Available at: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=510. Accessed November 19, 2008.
40. Hammick M, Freeth D, Koppel I, Reeves S, Barr H. A best evidence systematic review of interprofessional education: BEME guide no. 9. Med Teach. 2007;29:735–751.
41. Keough ME, Field TS, Gurwitz JH. A model of community-based interdisciplinary team training in the care of the frail elderly. Acad Med. 2002;77:936.
42. Cooper H, Carlisle C, Gibbs T, Watkins C. Developing an evidence base for interdisciplinary learning: a systematic review. J Adv Nurs. 2001;35:228–237.
43. Rafter ME, Pesun IJ, Herren M, et al. A preliminary survey of interprofessional education. J Dent Educ. 2006;70:417–427.
44. Curran VR, Deacon DR, Fleet L. Academic administrators’ attitudes towards interprofessional education in Canadian schools of health professional education. J Interprof Care. 2005;19 (Suppl 1):76–86.
45. Curran VR, Sharpe D, Forristall J. Attitudes of health sciences faculty members towards interprofessional teamwork and education. Med Educ. 2007;41:892–896.
46. Kirch DG. Interprofessional collaboration: we are willing–can we find the way? AAMC Reporter. 2008;17(8):2.
47. Carroll-Johnson RM. Redefining interdisciplinary practice. Oncol Nurs Forum. 2001;28:619. 

Back to Top