Interprofessional education and collaboration: A path to sustainability
Posted: July 22, 2020
The World Health Organization defines interprofessional education as “when students from two or more professions learn about, from, and with each other to enable effective collaboration, and improve health outcomes” 1. The intent of such education is for students and healthcare providers to develop the knowledge, skills, attitudes, and behaviors to effectively engage in interprofessional collaboration in practice. This is defined as “when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care” 1.
In the U.S., the Interprofessional Education Collaborative (IPEC) developed a set of collaborative competencies that identified targeted competency domains for interprofessional collaborative practice 2. These include roles and responsibilities, teams and teamwork, values and ethics for collaborative practice, and interprofessional communication. These competencies have significant utility in the design and evaluation of interprofessional endeavors.
There is a wide array of validated evaluation tools available for assessing these competencies. The National Center for Interprofessional Practice and Education, housed at the University of Minnesota, has developed a repository of tools and is working to collate national-level data using a recommended data set. At A.T. Still University (ATSU), we have been making great efforts to use standardized measures that can add to the national data repository, including the standard use of the Interprofessional Collaborative Competencies Assessment Scale (ICCAS) 3,4 in our interprofessional activities. This is a retrospective pre-post assessment that addresses all four collaborative competency domains. Results from our interprofessional activities have consistently shown statistically significant positive changes for our students in all four collaborative competencies.
There are several ongoing challenges to engaging in and growing interprofessional education and collaborative practice.
- COMPLEXITY – Interprofessional education and collaborative practice are complex social interactions, set within complex and adaptive systems, involving diverse delivery methods, participants, settings, and intended outcomes. One thing does not fit all programs, all settings, all teams, or all intended outcomes. Care must be taken to ensure the design and delivery of interprofessional activities are specifically targeted to identified outcomes. In the case of IPE, these would be learner outcomes related to the collaborative competencies, and for interprofessional collaborative practice, these would be patient- and system-level outcomes. The quadruple aim has been identified as the target for interprofessional collaborative practice in the U.S. The quadruple aims are improving the individual experience of care, improving the health of populations, reducing the per capita cost of healthcare (the triple aim proposed by Berwick, Nolan, and Whittington 5), and improving the experience of those providing care (added by Sikka, Morath, and Leape 6).
- IT INVOLVES HUMANS – Interprofessional endeavors are socially based and necessitate changes in attitude and behaviors. It involves practitioners and educators changing their norms, their way of being, and their ways of doing their work. This is not an easy task, especially when it challenges long-established hierarchies and ways of working that impact the power dynamics between professions.
- THE SYSTEM – Our health and education systems in the U.S. are not necessarily aligned for effective collaboration. New policies are needed at the systems level to address financing, funding and remuneration, workforce planning, structures, policies, and processes needed to support interprofessional team-based collaborative practice. A positive example is an observable shift to increased collaboration and team-based care in response to the move towards value-based payments.
- SUSTAINABILITY – The time has come to address sustainability efforts. We are beginning to see this shift in the U.S. with accreditation standards now containing language related to IPE. Last year, we saw the release of the Health Professions Accreditors Collaborative’s Guidelines on Developing Quality Interprofessional Education (HPAC)7. This was formally endorsed by 24 professional accrediting agencies including those representing all of ATSU’s professional entry-level programs. Significant efforts are also being made to anchor current IPE efforts by moving them from volunteer and elective activities to be components of the core curriculum.
- IN THE END, IT IS ALL ABOUT VALUE! – How do we get to the point where interprofessional collaboration is embedded into our culture? The WHO Framework for Action on Interprofessional Education and Collaborative Practice challenged us to make interprofessional collaborative practice our new normative practice. We have been making great progress at ATSU, with a wide array of interprofessional collaborative activities occurring across the University every year. We have robust programs supported by internal and external funds.
Across ATSU’s schools, colleges, centers, and offices, we have received over $6 million in external grant funding to address interprofessional education, collaborative practice, and integrated care.
For the last five years, we have been working on an interprofessional education initiative that focuses on oral-systemic health. This work was funded by a $1.9 million HRSA grant awarded to ATSU’s Arizona School of Dentistry & Oral Health. This work has involved faculty, clinicians, and students from dental, osteopathic medicine, and physician assistant (PA) programs. In the classroom, students have undergone a series of active learning interprofessional education modules addressing the four IPEC collaborative competencies2. In the dental clinic, students have had opportunities to engage in interprofessional patient assessments and to observe in the emergency dental clinic. Medical and PA students have been trained by dentists to give intraoral injections and we have feedback from students in the practice of the value of this skill in easing oral pain for patients attending the emergency room. We are beginning to see these educational efforts impact patient outcomes.
In the practice setting, we have been building the stage for interprofessional practice by building interprofessional clinical opportunities for students in community health centers. For example, work using warm hand-offs between medicine and dentistry was shown to decrease dental “no show” rates. This work was presented as a student poster at the Nexus Summit in Minneapolis (Shukla, C., Howell, S., Michaelis, R., & Cottam, W. Decreasing No Show Rates in a Dental Clinic at a Federally Qualified Health Center Following Referral from a Medical Clinic).
In Kirksville, Missouri, ATSU’s Area Health Education Center (AHEC) office was awarded a $5,574,592, grant: A Statewide Network for Interprofessional Health Care Workforce Development and Practice Transformation in Rural and Underserved Missouri (Principal investigators: Janet Head, EdD, MS, RN, and Hong Chartrand, DPH, MPA). This grant includes a requirement to develop a two-year interprofessional scholars program. The AHEC scholars program was designed for health professions students wishing to supplement their education by gaining additional knowledge and experience in rural and/or underserved urban settings. It is a two-year commitment by the students who are exposed to an interprofessional curriculum that involves clinical, didactic, and community-based activities, with all experiential or clinical training conducted in rural and/or underserved urban settings. In the 2018-19 academic year, the first pilot cohort of 31 health professional students from across Missouri entered into the scholar’s program.
Across ATSU, we have developed and implemented both required and elective interprofessional courses and continue to host a wide array of extracurricular interprofessional opportunities, many of which involve service to our local communities. Many of these activities have been ignited by our students, passionate collaboration champions, dedicated to ensuring the best outcomes for patients and for the populations we serve through implementing effective team-based care.
The interprofessional cross-campus collaborative case is a six-to-eight-week collaborative experience that offers students the opportunity to work together in interprofessional teams to meet the holistic needs of a patient and their family. The case is presented in a website format with information on the person, their family, and home community, including audio and written narratives from the person and their family, along with documentation from the healthcare providers involved in their care. This case collaborative is unique in that it does not ask students to develop a plan of care as is the traditional case structure, rather it asks students to address interprofessional competencies. They are tasked with demonstrating how they place the person and their family’s at the center of care, building an interprofessional team to meet their unique needs, developing strategies that ensure both effective communication and teamwork. The students are drawn from all ATSU residential programs and have been complemented by a wide range of students from partnering with other universities and colleges (e.g. Truman State University, Arizona State University, Brookline College, and Grand Canyon University). The participating professions have included athletic training, audiology, clinical psychology, communication disorders, dentistry, health education, law, nursing, occupational therapy, osteopathic medicine, physician assistant, physiotherapy, and social work. Data from this event has consistently demonstrated statistically significant changes in all four collaborative competencies. This ATSU model for interprofessional case collaboration, along with the cases developed, is now being used by other universities and organizations across the U.S. and internationally.
ATSU’s Office of Interprofessional Education and Collaboration partnered with universities and healthcare organizations across the state in establishing the Arizona Nexus, a statewide collaboration to support the growth and development of interprofessional education and collaborative practice across Arizona. The Office of Interprofessional Education and Collaboration also hosted the first statewide Arizona Nexus Interprofessional Conference.
Service-learning can provide rich opportunities to bring students from different professions together to learn with, from, and about one another. However, this requires an intentional design, with a focus on building activities with the potential to support the development of interprofessional collaborative competencies. In Arizona, we have seen this intentional design used by the Center for Resilience in Aging’s Still Standing Falls Prevention Outreach. This is the largest falls prevention program in the state of Arizona. In the 2018-19 year, 206 students from ATSU’s Arizona School of Health Sciences’ athletic training, audiology, occupational therapy, physician assistant studies, and physical therapy programs committed an estimated 8,600 community service hours preparing for, traveling to, and conducting fall prevention classes for 630 community elders at 54 community sites. The program has been intentionally designed to support data collection on ATSU’s core professional attributes, which includes interprofessional collaboration.
ATSU is also participating in interprofessional initiatives at the national and global levels. Faculty and students have presented their interprofessional work at both national and international conferences and Barbara Maxwell, PT. PhD, DPT, FNAP, director of the Office of Interprofessional Education and Collaboration at ATSU, serves on the Board of the American Interprofessional Health Collaborative and is the U.S. representation to the Global Confederation for Interprofessional Education and Collaborative Practice.
It is clear that there is much to be celebrated, and ATSU’s Office of Interprofessional Education & Collaboration is focused on continuing to grow and sustain our interprofessional collaborative efforts and is working to ensure we embed interprofessional education and collaborative practice into ATSU’s institutional culture.
by Barbara Maxwell, PT, PhD, DPT, FNAP, professor and university director of interprofessional education & collaboration
Reference List
1. World Health Organization. Framework for action on interprofessional education and collaborative practice. 2010. Geneva: WHO.
2. Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative.
3. MacDonald C, Archibald D, Trumpower D, Casimiro L, Cragg B, Jelly W. (2010). Designing and operationalizing a toolkit of bilingual interprofessional education assessment instruments. Journal of Research in Interprofessional Practice and Education. 2010; 1;3.
4. Schmitz CC, Radosevich DM, Jardine P, MacDonald CJ, Trumpower D, Archibald D. The Interprofessional Collaborative Competency Attainment Survey (ICCAS): A replication validation study. Journal of Interprofessional Care. 2017. 31:1: 28-34.
5. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health and cost. Health Affairs. 2008. 27; 759–69.
6. Sikka R, Morath JM, Leape L. The Quadruple Aim: care, health, cost and meaning in work. BMJ Quality & Safety 2015. 24, 608-610.
7. Health Professions Accreditors Collaborative. Guidance on developing quality interprofessional education for the health professions. 2019. Chicago, IL: Health Professions Accreditors Collaborative.