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Issues for debate Interprofessional education: Partnerships in the educational proc

Toby Bressler a, *, Lori Persico b


a
Maimonides Medical Center, USA b
Patient Safety Institute, North Shore-LIJ Health System, USA
a r t i c l e i n f o
Article history: Accepted 16 July 2015
Keywords: Nursing education Interprofessional education Teamwork Professional development Patient safety
a b s t r a c t
The curriculum for healthcare professionals is primarily dictated by the demands of the specific disci- pline. Detailed curricula
are essential to develop professional healthcare providers such as nurses, physicians and pharmacists. Traditional educational
methods created a system or process where pro- fessionals operate in isolation from each other. A siloed structure inhibits
effective communication, patient-centered care and safety. Today the focus in healthcare has shifted towards a more patient-
centeredness approach using interprofessional collaboration to achieve optimal patient outcomes. Nurses are at the forefront of
patient care and play a key role in quality patient care and improved patient outcomes. Interprofessional education is one type of
academic strategy that nursing educators can incorporate into educational curricula.
2015 Elsevier Ltd. All rights reserved.
Introduction
Today's fast paced healthcare is placing many demands on healthcare professionals. Patients are living longer with multiple
co-morbidities, requiring complex clinical management. Currently the life expectancy in the United States is 78.7 years, and
more than fifty percent of all deaths each year are from chronic heart disease, cancer and stroke (Center for Disease Control and
Prevention, 2010). The multifaceted medical regimens and increased patient acuity levels requires collaboration and
communication between all of levels of healthcare providers.
The acute care and community settings rely on an interdisci- plinary team of providers. Patient-centered models are essential
because of its focus on the whole-person and integration of all aspects of healthcare, which offer the potential to improve
physical health, behavioral health, access to community-based social ser- vices, and management of chronic conditions (National
Conference of State Legislature, 2012). The coordination of care is required between disciplines for best patient outcomes.
Healthcare reform mandates the implementation of initiatives aimed at improving the quality and efficiency of patient care, and
the application of clinical interventions according to the Center of Medicaid Services' guide- lines (American Public Health
Association, 2012).
The prevalence of chronic illnesses and co-morbidities in the United States requires an interdisciplinary approach and collabo-
ration to manage health. Nursing plays a key role in the coordina- tion and integration of care and services from multiple
providers (Robson, 2012, p. 2). Working in teams is an essential skill to pro- vide the best patient outcome. Effective
communication is an important aspect of patient safety and interprofessional education may help to remove possible silos
between professions and facili- tate increased coordinated care.
Interprofessional education (IPE) is defined as a shared learning experiences among health profession students across
disciplines, with the goals of professional identification, the edification of strong clinical teams and the improvement health
outcomes (Thistlewaite, 2012). The goal of interprofessional learning is to prepare all health professions students for
deliberatively working together with the common goal of building a safer and better patient-centered care (Interprofessional
Education Collaborative, 2013). The aim of this article is to consider interprofessional edu- cation as a possible next step towards
enhancing nursing educa- tional curricula.
Background
The interprofessional education (IPE) and interprofessional teamwork movement are not new concepts in health care; these
* Corresponding author. Tel.: +1 718 283 8641.
E-mail addresses: Tbressler@maimonidesmed.org (T. Bressler), LPersico@nshs.
concepts began over half a century ago. A needed change to medical education was identified by Silver (1968) with the advocacy
of a edu, lpersico@lions.molloy.edu (L. Persico).
team approach for preventative family care, the IPE movement
http://dx.doi.org/10.1016/j.nepr.2015.07.004 1471-5953/ 2015 Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect

Nurse Education in Practice


journal homepage: www.elsevier.com/nepr
Nurse Education in Practice 16 (2016) 144e147
continued with Szasz (1969) developing a plan to better integrate members of the health care team and finally with the Institute
of Medicine (IOM, 1972) first report, titled Educating for the Health Team. This IOM report (1972) discussed the imperative to
develop significant relationships between educational programs for the health professions. Over two decades later, the Pew
Commission (1998) identified the need for interprofessional teamwork as one of 21 essential competencies. In the 21-century the
IOM reported on health education (2003) and the future of nursing (2010) each of these reports call for health professionals to
develop interprofes- sional competency and the necessity for interdisciplinary practice to be incorporated into educational
models. The call for reform continued in 2011 by the Interprofessional Education Collaborative (IPEC) with its release of the
Core Competencies for Interprofessional Collaborative Practice. The emphasis of IPEC endeavors was to detail the critical
elements for circular development for teamwork and collaborations across various healthcare professionals. The main goal is to
educate health professionals to become teams and pro- vide team-based quality care to improve the safety of patient care. Patient
safety became a central concern in health care with the Institute for Medicine's (IOM) landmark report, To Err Is Human (1999),
noting an estimated 98,000 deaths due to medical errors that could have been prevented. The quality of healthcare was addressed
in the IOM report (2001), Crossing the Quality Chasm: a new health system for the 21st century. This report called for a redesign
of healthcare in order to reduce risk, assure safety and to institute systems or processes that help prevent and mitigate er- rors.
Members of the healthcare team are to actively work together and communicate to ensure an appropriate exchange of informa-
tion and coordination of care. Therefore, the importance of adequately preparing the workforce to make a smooth transition into a
thoroughly revamped healthcare system cannot be under- estimated (IOM, 2001, p.6). Interprofessional education can become
the standard in teaching collaborative practice and develop effi- cient team dynamics that are vital to patient safety.
The traditional curriculum for physicians, nurses, and other members of the health care team directly focus on specific disci-
pline content with clinical experiences for theory application. Discipline specific clinical practicums currently promote parallel
practice and do not ensure the development of team building skills or collaborative practice. The scarcity of interprofessional
education results in underlying confusion of each profession's roles in patient care and can promotes tribalism (Carlisle et al.,
2004). The coor- dination of patient care does not solely involve the independent actions of one healthcare discipline.
Academic programs have begun to incorporate interprofessional education into academic curricula but the outcomes in
relationship to the level of engagement remains to be formally evaluated. Although individual and organizations are becoming
increasingly involved in promoting or implementing IPE, it is important to recognize that there is a continuum of engagement in
IPE which can range from asking students to read about roles of other pro- fessional, to a fully integrated, co-created curriculum
that embeds and models the philosophy of IPE in everything it does (Barnsteiner et al., 2007, p. 148). The National League of
Nursing Accreditation Commission and the Commission on Collegiate Nursing Education have recently required the inclusion of
IPE into all levels of nursing programs, unfortunately consensus for a model has yet to emerge and current modalities remain
insufficient (Na- tional League for Nursing (NLN), 2012).
Nursing education
The nursing profession has a central position in patient care. A reform of nursing educational model is not new to the
profession.
T. Bressler, L. Persico / Nurse Education in Practice 16 (2016) 144e147 145
The Flexner Report (1910) first identified the imperative to reform the medical education system and similarly the Goldmark
report helped to revolutionize nursing education (Garling, 1985). The call for education reform continues to reverberate today.
The Carnegie Foundation report, Educating Nurses a Call for Radical Transformation connotes the urgency for educational
rede- sign as a social imperative to meet the profound changes in nursing practice and healthcare (Benner et al., 2010).
Traditionally, academia concentrates on the socialization of nursing to role distinctiveness, rather than professional development.
Nursing education must make more intentional use of these trans- formational experiences, focusing on the formation of
professional identity rather than on socialization (Benner et al., 2010). According to The Future of Nursing Leading Change and
Advancing Health, nurses are to become full partners with physicians and other healthcare professionals, in redesigning
healthcare (IOM, 2010). The coordination of care requires nurses to have a skill set to help coordinate and lead the team in
patient care management. Inter- professional learning is essential in order to enhance team collab- oration and communication
and acknowledged as a high priority for patient safety (Liaw et al., 2013). As previously mentioned teamwork and collaboration
among healthcare professions is vital for safe and effective healthcare.
The current climate of patient safety demands that nurses make prudent clinical decisions and understand overall team
dynamic for best patient outcomes. Patients across the health care continuum are vulnerable and rely on the nurse's knowledge
and ability to make prudent clinical decisions while interacting with multiple professions. Nurses are at the center of patient care,
promoting continuity of care and increased patient safety among many different health professionals.
Recently, the American Association Colleges for Nursing became an active partner in IPEC to promote communal,
patient-centered care. An interdisciplinary expert panel was comprised of the following professional organizations: the American
Association of Colleges of Nursing, the American Association of Colleges of Oste- opathic Medicine, the American Association
of Colleges of Phar- macy, the American Dental Education Association, the Association of American Medical Colleges, and the
Association of Schools of Public Health. The panel established IPE competencies in alignment with the IOM's competencies for
healthcare professionals. These four core competencies are: 1) values and ethics for interprofes- sional practice, 2) roles and
responsibilities, 3) communication and 4) team and teamwork (Interprofessional Education Collaborative, 2011). With the goal
being to accelerate the movement toward truly interprofessional education and practice, IPEC is working to heighten
collaboration among all providers to advance high quality, integrated healthcare delivery, (American Association of Colleges of
Nursing, 2012, para. 2). The report documented academic ex- emplars of interprofessional education and detailed theoretical
frameworks among interdisciplinary health care professionals.
IPE fosters interdisciplinary learning in a corresponding manner. The Cochrane Collaboration (2013) defined interdisciplinary
in- struction as:
An IPE intervention occurs when members of more than one health and/or social care profession learn interactively together, for
the explicit purpose of improving interprofessional collab- oration and/or the health/well-being of patients/clients. Inter- active
learning requires active exchange between learners of different professions,
(Zwarenstein, Reeves, Barr, Hammick, Koppel, Atkins, p.6). Role comprehension, effective communication and building team
dynamics are central components of interprofessional
education curricula. A study focused on teamwork found that nurses describe collaboration as having input into decision-making,
while physicians express it as having their needs anticipated and directions followed (Markay et al., 2006). Overlapping
curriculum encourages interprofessional collaboration thus providing an in- tegrated experience where various disciplines
actively engage with each other in patient care settings.
Supporting evidence
Research has shown collaboration of health professionals can lead to improved patient outcomes, especially between
physicians and nurses (Hammick, 2002; Barnsteiner et al., 2007). An interna- tional meta-analysis of IPE studies have shown
favorable results in teamwork, decreased clinical errors, improved patient education and increased overall team competency. The
Cochrane Collabora- tion Review, Interprofessional education: Effects on professional practice and healthcare outcomes (2013),
revealed only seven out 15 studies to show improvement in the following areas: diabetes management, mental health practices,
team communication and collaboration, reduction in medical errors in emergency depart- ment and operating room settings.
There is a need to explore the relationship between interprofessional education and patient outcomes.
Challenges to IPE
Even though individual and population health are dependent on well-integrated teams of doctors, nurses, social workers and
others, obstacles remain for IPE. Some of the identified barriers are: lack of institutional leadership, academic calendar
variability, faculty at- titudes, lack of geographic proximity of the different disciplinary institutions, changing team learner skills,
lock-step curricular pat- terns, inconsistency in professional program entry, unaligned pedagogical approaches, the policy of
sharing of course credit and limited financial funding (Greer et al., 2014). The hurdles IPE are to be overcome in order to
improve the collaboration of care for pa- tients with chronic diseases. The leading cause death and disability in the United States
is chronic illness (Healthy People.gov, 2011); patients rely on healthcare providers for the coordination of care to improve health
outcomes.
IPE is a global phenomenon. Most recently there has been a global initiative by the World Health Organization (WHO) and
the United Kingdom's, Centre for the Advancement of Interprofessional Education (CAIPE). These entities sought to define IPE
and outline the critical elements of interprofessional education. WHO points out that, IPE occurs when two or more professions
learn about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010, p. 13).
CAIPE aims to pro- mote and develop interprofessional education with and through its individual, corporate and student
members, in collaboration with like minded organizations in the UK and overseas, for the benefit of patients and clients (Centre
for the Advancement of Interprofessional Education, 2014, para. 3).
Educational models
Current academic settings have established interprofessional educational programs to develop collaborative practice in orga-
nized clinical experiences. This educational strategy promotes in- teractions between professions. Allowing multiple healthcare
professionals to learn together while interacting with patient may helps to establish roles, teams and communication, thereby
increasing the potential to improve patient outcomes in both the community and the acute care setting.
T. Bressler, L. Persico / Nurse Education in Practice 16 (2016) 144e147 146
The management of patient care can possibly be refined when nurses, physicians and allied health professionals are jointly
educated. A model curriculum for IPE was established by faculty at Curtin University, the Interprofessional Capability
Framework as shown in Fig. 1 (IOM, 2013, p. 19).
The assumptions underpinning this framework are: 1) collabo- rative practice is critical to client safety and quality care, 2)
inter- professional education occurs on a continuum from early exposure to other professions through to collaborative practice in
teams in the practice setting, 3) the learner will move through the levels at different rates according to their personal and
professional expe- riences, 4) a student's capacity to demonstrate interprofessional capabilities in different settings will be
impacted by their comfort level, familiarity and skill set within that context (Curtin University, 2010, p.5). Client or patient
centered service, client safety and quality and collaborative practice are the three core elements for the framework. The core
elements are underpinned by five collaborative practice capabilities-communication, team function, role clarification, conflict
resolution and reflection. Each of these interacts with each other to achieve the three core elements (Curtin University, 2010).
The aim of interprofessional education is not solely instruction, but an effort to impose interprofessional prac- tices among future
teams.
Developing collaborative practice is essential outside the acute care settings. Community based experiences are important in
order to learn team management for chronic illnesses. As previously mentioned, the incidence of chronic illness and the changes
in health policy dictates the need for coordinated care in the com- munity setting. In concurrence, community environments and
lo- cations, health literacy, culture and education levels affect optimal health. Nursing schools can model the programs instituted
at the University of Southern California (USC). The community experience incorporates four health professions. The Students
Helping and Receiving Education (SHARE) is a safety net program offering crit- ical services to vulnerable populations, such as
medication recon- ciliation, medical and pharmacy volunteers and smoking cessation classes (IOM, 2013). Another program at
USC is The Patient- Centered Interdisciplinary Collaborative. This student-run clinic was created by students and contains 200
student volunteers, 25 preceptors, 2 clinical sites (urgent care centers), and a team of medicine, occupational therapy, pharmacy
and physician assistants students (IOM, 2013). The team-based approach fosters healthcare professionals to communicate and an
opportunity to work within their scope of practice while utilizing the methods of interprofes- sional education.
Fig. 1. Interprofessional Capability Framework (IOM, 2013, p. 19).
Another modality of interprofessional education is through simulation based education. Simulation-based education is a growing
teaching strategy because it allows the learner an optimal opportunity to learn in safe yet structured environment.
Simulation-based education (SBE) is a teaching approach for interprofessional education. Simulation is a teaching strategy and
not a technology, its aim is to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke
or replicate substantial aspects of the real world in a fully interactive fashion (Gaba, 2004). SBE produces a positive learning
experience in which students can refine their patient skills, and collaborate with interprofessional team members in a risk-free
environment (Robertson and Bandali, 2008). Post simulation the educator pro- vides guided questioning to allow the learner to
reflect on clinical performance. Reflection is the process of looking back on an experience, evaluating its congruence with current
meaning, generating new meaning, and mapping new experiences onto existing memory structures (Murphy, 2004, p. 227).
Participating in a replicated patient scenario yields a tangible experience in which students connect theory to practice. A
simulated interprofessional experience encourages instructors and students from a wide vari- ety of educational programs to
communicate, understand, function, and study together as a team. The NLN (2012) has identified several universities as
exemplars of IPE simulation based education.
Conclusion
Interprofessional education may be helpful in improving patient outcomes and optimizing the patient's health and wellness.
Nurses are the frontline of individual and population health as leaders' patient care. An individualized plan of care requires the
use of multidisciplinary teams to be effectively and efficiently communi- cating with all the members of the health care team
including the patient. The coordination of care relies on the expertise of physi- cians, nurses, pharmacists and social workers
however; these professionals do not function independently. The traditional approach of working in silos creates communication
failures and impairs patient safety (Robson, 2012). Interprofessional education models may lead to role comprehension, enhanced
communication and better teamwork, thereby decreasing medical errors and improving patient safety. When working collectively
as a team with the patient at the center of that team, the winner will be the pa- tient. As all interprofessional health care
professionals will attest, our primary role is to do no harm.
Acknowledgments
Veronica D. Feeg, PhD, RN, FAAN. Associate Dean & Director of the PhD Program. Molloy College.
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