Interprofessional education where are we now and where should we be heading

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Interprofessional education where are we now
and where should we be heading?

• Kiran Veerapen FRCP (Edin), MMed (Dundee)
• Adjunct Clinical Instructor, Island Medical
  Program.
• Interdisciplinary PhD Candidate- University of
  Victoria

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Yes..
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Yes..BUT
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Yes..BUT

• What.. When.. Why.. How..
• Does it work..
• Well, what do we really mean ??

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Definition has been lacking, semantics
bewildering, evaluations few and the evidence
base elusive (Barr 2008)
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Interprofessional Education

• Occasions when two or more professions learn
  with, from and about each other to improve
  collaboration and the quality of care (CAIPE 2002)

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Where are we now ?How did we get here ?
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1960s-1990s
Szasz 1969
IPE 2008
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It appears that, among other problems, the
health professionals employ their talents
inappropriately, and as a consequence, scarce
human resources are wasted. Evidence also
indicates that fragmentation and
compartmentalization, both of scientific
investigation and the approach to human problems,
and of poor communication between those who
provide different components of the health
services. (Szasz 1969)
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1960s-1990s
Discrete, small, independent initiatives. No
sustained planning or funding To improve working
relations between health care professions
Szasz 1969
IPE 2008
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1960s-1990s
Discrete, small, independent initiatives. No
sustained planning or funding. To improve working
relations between health care professions
Szasz 1969
IPE 2008
Vocational education integrated into higher
education
Shift to primary and community care 1990s
2000 and on The era of errors
To Err is Human 2000 The Bristol Inquiry 2001 The
Canadian Adverse Events Study 2004
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1960s-1990s
Discrete, small, independent initiatives. No
sustained planning or funding To improve working
relations between health care professions
Szasz 1969
UBC College of Health Disciplines 2001
IPE 2008
Vocational education integrated into higher
education
Shift to primary and community care 1990s
Health human resource crisis
2000 and on The era of errors
To Err is Human 2000 (USA) The Bristol Inquiry
2001(UK) The Canadian Adverse Events Study 2004
Canada Romanov Report 2002 First Ministers
Accord on Health Care Renewal 2003 UK NHS Plan,
DoH 2000
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• The direction of our health care system
  must be shaped around health needs of individual
  patients, their families and communities.. If
  health care providers are expected to work
  together and share expertise in a team
  environment, it makes sense that their education
  and training should prepare them for this type of
  working arrangement Romanov report 2002
• National human health resources - 80 million
  HHR planning, recruitment and retention and
  interdisciplinary education for collaborative
  patient centred practice 2003 Federal budget
• Health care delivery models of the future
  clearly envision teams of health care providers
  working together to meet patient needs. Health
  Council of Canada 2003
• Premise IPE will contribute to improved patient
  and provider satisfaction and patient outcome and
  retention of health care workers (and ? Cost
  effective)

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1960s-1990s
UBC College of Health Disciplines 2001
IPE 2008
Vocational education integrated into higher
education
Shift to primary and community care 1990s
2000 and on - Health human resource crisis
2000 and on The era of errors
Canada 2003 Health Canada Interprofessional
Education for collaborative patient centred
practice (IECPCP) initiative Funded
projects 2005 National Health Sciences Students
Association (NaHSSA) 2006 Canadian
Interprofessional Health Collaborative
(CIHC) Centre for Advancement of
Interprofessional Education (CAIPE)
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1960s-1990s
UBC College of Health Disciplines 2001
IPE 2008
Vocational education integrated into higher
education
Shift to primary and community care 1990s
2000 and on - Health human resource crisis
2000 and on The era of errors
IPE in Academia- From occasional courses towards
more sustainable programs Journal of
Interprofessional Care Regulatory reforms and
funding in BC Ontario Accreditation
process Mandatory course in IPE Univ. of
Alberta, Univ. of Toronto (2009) and McMaster
Univ (soon) Multiple elective small group courses
available
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? Objectives of IPE
? To know about roles of other professions ? To
be able to work together ? To be able to
substitute for others ? To find flexible career
pathways (Finch 2000)
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Collaboration

• An interprofessional process of communication
  and decision making that enables the separate and
  shared knowledge and skills of health care
  providers to synergistically influence the
  patient care provided (Way Jones 2000)

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Collaboration ?
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Shades of Collaboration

• Gregson (1991) isolation, encounter,
  communication, partial collaboration and full
  collaboration
• Loxley (1997) Extent of systems thinking

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Collaboration- what makes it so difficult?

• Professional Identity and the other
• My values versus yours
• Taught to lead an irony of medical education
• Scope of practice where are the boundaries?
• So who is carrying the can?
• Groups that have divergent objectives will have
  hostile and discriminatory intergroup relations.
  Realist conflict theory (Brown et al 1986)

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Whither regulation ?

• Scope of practice
• Licensure
• Certification
• somewhere in between
• Medicolegal liability

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Does collaborative practice change outcome ?

• Patient outcomes
• Staff retention
• Staff satisfaction

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Collaborative Practice IPE

• A two way street
• No matter how good the IPE, assumptions,
  attitudes and practices in the workplace can
  frustrate interprofessional practice Barr 2008
• Under stress people revert to modeled behavior as
  apposed to learned behavior

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IPE The evidence

• Prelicensure early or late ?
• - Attitudes
• - Ability to work in a team
• - Improved Patient Outcome
• Post Licensure - contextual
• Attitudes
• Ability to work in a team
• Improved Patient Outcome

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IPE Principles CIHC

• One size does not fit all- univ/college, acute
  care/community, rural vs urban, from province to
  province
• Resources are required
• Curricula changes are essential
• IPE must be introduced at the right time
• Collaborative learning environments must be
  created
• Structures must be modified to support
  collaboration
• IPE should be embedded in the system
• Evidence makes the best case for IPE
• Interprofessional players must engage the
  community

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IPE promptings from theory

• Adult learning active, experiential,
  reflective, contextual, modeling good practice,
  relating the personal to the professional
• Social contact hypothesis (Tajfel 1981) people
  respond positively to those who are rewarding to
  them
• Realist conflict theory (Brown et al 1986) Groups
  that have divergent objectives will have hostile
  and discriminatory intergroup relations whereas
  groups with common objective will display
  conciliatory behavior
• Social identity theory (Turner 1999) Part of a
  persons self concept is based upon identity as a
  member of groups to which he or she belongs.

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IPE The process

• Outcome and competency based curricula
• Common Competencies those held in common between
  all professions ? Ethics
• Complementary competencies those that
  distinguish one profession from another
• Collaborative Competencies those necessary to
  work effectively with others

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IPE The processWith, from and about

• Interactive learning (small groups, equal
  distribution)
• Exchange based learning
• Action based learning
• Observation based learning
• Simulation based learning
• Practice based learning

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Interprofessional learning involves co-reflection
like a double mirror held up to see aspects of
oneself that one cannot see directly in a single
mirror (Wee 1997)
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Where should we be heading ?
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• While IPE remains elective or at best a single
  mandatory course, what does uniprofessional
  education promote ?

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Interprofessional dialogue
Senior Faculty
Trainees
Students
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Interprofessional dialogue
Senior Faculty
Trainees
Students
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Interprofessional dialogue
Senior Faculty
Trainees
Students
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The future

• Reconciling professional interests
• Establishing the common ethical values
• Clarifying scopes of practice and roles
• Regulatory support
• Faculty buy in and development

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Collaborative Patient Centred Practice for
Interprofessional EducationUniprofessional
preparation IPE