Evolving Theory in Interprofessional Education: Perspectives from Sociology

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Evolving Theory in Interprofessional Education
Perspectives from Sociology

• Alan Borthwick,
• Eloise Carr,
• Marilyn Hammick
• Margaret Miers

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Characteristics of Sociology

• Social constructionist view of knowledge
• Scepticism
• Interest in professional power

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Policy objectives of interprofessional education
Finch (2000)

• To know about the roles of other professions
• To be able to work with other professionals, in
  the context of a team
• To be able to substitute for roles played by
  other professionals
• To provide flexibility in careers moving
  across

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Three transitions

• Professional transition becoming a member of a
  profession professional socialisation
• Workforce transition
• Knowledge in transition

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Professional socialisation

• Illustrated by early studies of medical students
  learning their role as leader of the team, making
  decisions and dealing with uncertainty
• Whitehead (2007) argues that for
  interprofessional education to succeed, the
  rationale for medical students hidden
  curriculum have to be considered

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Studies of nursing socialisation

• Stages of doctrinal conversion (Davis 1975)
• Learning to fit in (Melia 1987)
• Historic importance of significance of gender

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Changing models of professionalism (Davies 1995)

• Old professionalism
• mastery of knowledge
• unilateral decision making (dependent patient,
  deferential colleagues)
• autonomy and self management
• Detachment

• New professionalism
• reflective practice
• interdependent decision making (patients
  empowered, colleagues involved)
• collective responsibility
• engagement

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Social ecology

• Interprofessional working develops through
  face-to-face interactions that take place in
  space and time (Abbott 1998)
• Ethnographies of organisation of spaces, use of
  tools and technology and choreography of bodies
  related to learning and cognition

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Social diversity amongst professional recruits

• Diversity complicates notions of gaining a
  professional identity
• Movement away from fixed notions of identity
• What sort of identities support flexible career
  routes moving across

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Workforce transition key issues

• Healthcare policy agenda
• emphasises the need for innovative redesign of
  the workforce
• workforce flexibility
• inter-professional role boundary transitions
• (Cameron Masterson 2003 Larkin 2002)

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Drivers for workforce redesign

• Drivers for change
• workforce shortages
• unmet demand for services
• ageing populations
• technological innovation specialisation
• neo-liberalism, NPM economic rationalism
• (Allsop 2006 Nancarrow Borthwick 2005
  Willis 2006)

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Workforce transition the impact on the
professions

• Challenges exclusivity of knowledge and skill
  base (social closure)
• Larsons professional project (1977) as ongoing
  defence of boundaries
• jurisdictional disputes over contested
  boundaries create obstacles (Abbott 1988)

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Enabling workforce transition strategies in
practice

• Negotiated order roles agreed at micro-level
  (Allen 1997, 2001)
• reprofessionalisation redefine parameters to
  maintain control over jurisdictions (Lupton 1997,
  Fournier 2000 Zetka 2003)
• incorporation - organisational rather than
  occupational boundaries valued (Carmel 2006)
• discretion in boundary overlap (Goodwin et al
  2005)

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Professional knowledge in transition context

• Possession of a particular knowledge the social
  value of a given profession
• This value means that society permits self
  regulation, right to independent thought, minimal
  state control of professional practice ...
• Modern society demand for variety of services
  need for more than one profession

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Transitions in ways of professional knowing

• 21C public services require a different approach
  to how meaning is realised
• A change from collecting knowledge to integrating
  knowledge (Beattie 1995)
• For example, integrating topics around a client
  group in order to deliver collaborative care

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Categories of knowledge

• Singulars, e.g. anatomy, chemistry
• Regions, for a field of practice, e.g.
  physiotherapy
• (Bernstein 1996)
• and for interprofessional knowledge
• Terrains that bring aspects of several regions
  together
• (Hammick 1998)

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Knowledge in transition

• challenges the moral orthodoxy
• threatens the social cohesion of each profession
• demands some mediation of professional
  socialisation

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Your thoughts

• About the importance of these transitions
• About the implicit or explicit theories you use
  to explain/understand such transitions
• About difficulties you have encountered around
  transitions when involved in ipl and your
  strategies for overcoming difficulties