Joanne Disch, PhD, RN, FAAN

“As the complexity of knowledge and skills required for good patient care continues to grow and the number of individuals
involved in the management of a single patient accordingly increases, effective team functioning becomes progressively more
important. Physicians and nurses are the most active participants in this team. In the hospital setting, however, it is apparent that
their efforts in patient care are not always efficient or harmonious; and recognition of this fact has led to growing national
concern.” Thus wrote Dr. Barbara Bates, a physician, in 1966, almost 50 years ago, in an article titled “Nurse-Physician
Teamwork” (Bates, 1966, p. 69.).
In subsequent years, the need for interprofessional education (IPE) has been identified as a necessary precursor to effective
team functioning and quality care. It has become readily apparent that nurses and physicians cannot continue to learn in
professional silos and then be expected to learn collaborative behaviors and attitudes between graduation and their first days in
clinical practice. Organizations such as the Institute of Medicine (IOM) published Educating for the Health Team (1972) and
Health Professions Education: A Bridge to Quality (2003); the World Health Organization advanced A Framework for Action on
Interprofessional Education and Collaborative Practice (2010). New orga- nizations have been established, such as the American
Interprofessional Health Collaborative (Blue et al, 2010) and the Interprofessional Education Collaborative (American
Association of Colleges of Nursing, 2011) with its set of interprofessional core competencies. Students are being actively
involved through initiatives such as the Institute for Healthcare Improvement’s Open School program and student-run
interprofes- sional case competitions such as Clarion. Most recently the Health Resources and Services Administration
established the Coordinating Center for Interprofes- sional Education and Collaborative Practice at the

President’s Message Interprofessional Education and Collaborative

Practice
University of Minnesota Academic Health Center (Health Resources Administration, 2007).
Publications and initiatives to improve IPE and collaborative practice (CP) are tremendously important as they create
momentum and direction for needed change. However, we need to remember that CP occurs in more than acute care settings, and
IPE includes more than nursing and medical students. Although the major focus on interprofessional practice and educa- tion has
centered on academic health centers (AHCs), and those are good places to start, the transformation that is required requires a
broad cross-section of options and ideas e and a challenge to some traditional assumptions.
For example, there are 137 medical schools in the country, 129 pharmacy schools, and 1711 nursing schools (for pre-
licensure) e and approximately 100 AHCs e obviously not enough to improve interprofes- sional competencies if only the
traditional professions are involved. In settings where the traditional profes- sions are not represented, faculty should be encour-
aged to partner with colleagues in other schools, colleges, or departments in their colleges or universi- ties, or in their
communities. Fields such as nutrition, social work, industrial engineering, design, law and occupational therapy tremendously
influence health and can provide students excellent opportunities to develop interprofessional skills and to think more broadly
about health and its determinants.
A second challenge to a traditional assumption is whether a significant amount of time and effort has to be spent on careful
matching so that students are “at the same level.” This is not always feasible, given the levels of students and schedules.
Furthermore, the reality of the work environment is that people will usually not be “at the same level” e and realistic learning can
promote learning about teamwork under conditions such as power differentials, hierarchy, conflict, and differing values and goals
of care.
Another assumption to challenge is that the solution to achieving interprofessional work is through recon- ciling the different
schedules of the various health professions’ schools. It is well known that sitting together in a classroom does not result in
interprofes- sional learning (Cronenwett et al, 2007). What promotes learning are discussions around case studies, debriefing
after shared experiences, team learning through case competitions, interactive and guided learning. These can occur within the
classroom setting, or outside it, in person or via Web chats. One approach could be to assign students from different professions
to an ongoing group that follows a family with its intergen- erational health issues across the students’ programs of
study, taking the learning and experiences out of the traditional classroom and schedule constraints.
Barnsteiner et al (2007) identified six characteristics that would be in place when IPE is integrated: (1) an explicit philosophy
of IPE that permeates the organi- zation and is well-known, observable, measurable; (2) faculty from the different professions co-
creating the learning experiences; (3) students having inte- grated and experiential opportunities to learn collab- oration,
teamwork, and how they relate to the delivery of safe, quality care; (4) IPE learning experiences embedded in curricula and part
of the required case- load for students; (5) demonstrated competence by students according to a single set of interprofessional
competencies; and (6) an organizational infrastructure that fosters IPE. One additional characteristic that we would hope to see as
organizations commit to IPE and CP is a revised mission statement for the school, college, university and/or AHC. At the
University of Minnesota, the AHC mission statement includes the goal: “Educate the next generation of doctors, nurses,
pharmacists, dentists, public health professionals, and veterinarians.” How exciting it would be to see some- thing eventually like
“Create expert teams of health- care providers who will transform health and health care.together.”
references
American Association of Colleges of Nursing. (2011). Core
competencies for interprofessional collaborative practice. Retrieved from http://www.aacn.nche.edu/education-
resources/ipecreport.pdf. Barnsteiner, J., Disch, J. M., Hall, L., Mayer, D., & Moore, S. M.
(2007). Promoting interprofessional education. Nursing Outlook, 55(3), 144e150. Bates, B. (1966). Nurse-physician teamwork.
Medical Care, 4(2),
69e80.
4
Nurs Outlook 61 (2013) 3 e 4
Blue, A., Brandt, B., & Schmitt, M. H. (2010). American
Interprofessional Health Collaborative: Historical roots and organizational beginnings. Journal of Allied Health, 39(3) SI,
204e209. Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J.,
Mitchell, P., Warren, J., et al. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122e131. Health
Resources and Services Administration. (2012). New
coordinating center will promote interprofessional education and collaborative practice in health care. Retrieved from
http://www.hrsa.gov/about/news/pressreleases/ 120914interprofessional.html. Institute of Medicine. (1972). Educating for the
health team.
Washington: National Academies Press. Institute of Medicine. (2003). Health professions education: a bridge to
quality. Washington: National Academies Press. World Health Organization. (2010). A framework for action on
interprofessional education and collaborative practice. Geneva: World Health Organization. Retrieved from. http://www.who.
int/hrh/resources/framework_action/en/index.html.
Author Description
Joanne Disch, Clinical Professor, University of Minne- sota School of Nursing, Minneapolis, MN.
Joanne Disch, PhD, RN, FAAN University of Minnesota, School of Nursing Minneapolis, MN Corresponding author: Dr. Joanne
Disch University of Minnesota School of Nursing 6-101 Weaver-Densford Hall 308 Harvard St., SE, Minneapolis, MN 55455 E-
mail address: disch003@umn.edu
0029-6554/$ - see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2012.11.002