Health CommitteeWritten evidence from the Centre for the Advancement of Interprofessional Education (ETWP 13)

In Support of Interprofessional Education in Pre-registration Courses for Health and Social Care

CAIPE is a charity and company limited by guarantee which promotes and develops Interprofessional Education (IPE) with and through its individual and corporate members. It works with like minded organisations in the UK and overseas, to promote the health and wellbeing of individuals, families and communities (www.caipe.org.uk).

Summary

The case for interprofessional collaborative working is recognised and accepted as essential for effective health and social care delivery by governments across the world. A flexible, collaborative ready workforce is dependent on the way in which professionals are educated.

CAIPE holds that well planned, interprofessional, interactive learning promotes flexible, mutually supportive, patient centred and cost effective collaboration, not only in interprofessional teams, but also more widely within a policy-aware understanding of organisational relationships.

CAIPE makes the case for outcome-led competency-based interprofessional curricula grounded in a coherent, theoretical rationale, while safeguarding the identity of each profession and respecting profession-specific requirements and benchmarking statements.

1. Interprofessional Education (IPE)

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

1.2 Explanations for the growing interest in providing IPE during pre-registration courses include the need:

To respond collaboratively to the complexity of problems presented by individuals, families and communities which outrun the capacity of any one profession, putting specialist care and treatment in a holistic context;

To improve patient safety by improving communication and collaboration between professions variously responsible for the same case;

To manage relationships between the growing number of professions and their specialties resulting from medical and technological advance;

To match consumer and media pressure to improve care and services with finite resources in the face of escalating costs; and

To deploy human resources optimally.

1.3 A well planned pre-registration professional education proposal will identify how the IPE envisaged will engage with these and other challenges in its objectives, content and learning methods within a coherent rationale.

2. Cultivating Collaboration

2.1 Collaboration is planned and purposeful endeavour within a defined legal and policy context, to ensure comprehensive provision of quality care which transcends demarcations between professions, practice settings and organisations. Teamwork is at its heart.

2.2 Integrating services is not enough to ensure collaborative practice unless and until the professions are actively, positively and collectively engaged in mediating the application of policies to practice.

CAIPE recommends that: all pre-registration IPE proposals take collaborative practice as their starting point; interprofessional teamwork is central in students’ learning.

3. Encouraging Flexible Working Across Professional Boundaries

3.1 Effective interprofessional teamwork facilitates flexible working grounded in mutual understanding, respect and trust between members. Members empower each other within the constraints of law, policy and patient safety to respond expeditiously, economically and effectively to needs beyond predetermined professional demarcations. Duplication is reduced.

CAIPE recommends that: interprofessional learning is designed to encourage flexible working across organisational and professional boundaries.

4. Improving Care and Services

4.1 Critical appraisal of policy and practice from interprofessional perspectives heightens students’ awareness of the need for collaborative practice to improve care and services, as each professional group extends its competence to complement those of the others.

CAIPE recommends: that the interprofessional learning be designed to generate commitment to work individually and collaboratively to improve care and services.

5. Involving all the Parties

5.1 IPE is best planned collaboratively between the participant professions and other stakeholders, including universities, service agencies, students and service users, acknowledging and resolving differences to ensure that proposals are internally consistent and externally credible.

CAIPE recommends: that all the stakeholders are involved in the planning.

6. Dealing with Difference

6.1 Where and how to introduce IPE between two or more professional courses is complex. Courses differ in rationale, length and structure including patterns and timing of practice placements. Teachers differ in their practice backgrounds, their theoretical orientation and their preferred learning methods.

CAIPE recommends: that time and opportunity is provided during the planning process to address and resolve differences between the professional courses and between the teachers.

7. Underpinning with Theory

7.1 IPE built on a theoretical foundation is more coherently planned, consistently delivered, rigorously evaluated and effectively reported (Barr et al, 2005; Colyer et al, 2005; Hean et al, 2009).

CAIPE recommends: that each proposal is underpinned by a theoretical rationale.

8. Building Collaborative Competence

8.1 Regulatory bodies promote outcomes which inform collaborative practice (General Medical Council, 2009; Nursing and Midwifery Council, 2010; Health Professions Council, 2009) complemented by formulations of interprofessional competencies (Canadian Interprofessional Health Collaborative, 2010; Interprofessional Education Collaborative Expert Panel, 2011; CUILU, 2006).

CAIPE recommends: that outcomes from students’ interprofessional learning are defined as competencies or capabilities and curricula planned accordingly.

9. Preparing the Teachers

9.1 Many teachers and practice supervisors are underprepared and feel undervalued in their interprofessional teaching role. Preparation is essential.

9.2 Teachers as “facilitators” enable students from different professions to enrich and enhance each other’s learning; sensitive to the perspectives, perceptions and particular needs of each individual and profession; able to turn conflict into constructive learning (Anderson et al, 2009 & 2011; Freeman et al, 2010; and Howkins & Bray, 2008).

CAIPE recommends: that all teachers and practitioners involved in facilitating IPE receive orientation, preparation and ongoing support.

10. Mixing and Matching the Learning Methods

10.1 IPE is interactive, calling on a repertoire of methods (Barr, 2002; Freeth et al, 2005). E-learning is widely introduced for self-directed and group-led learning blended with face-to-face learning (Bromage et al, 2010). Interprofessional practice learning permeates professional learning in the classroom and the workplace. Every student needs at least one interprofessional group placement during their course, for example, on an interprofessional training ward (Jakobsen et al, 2009) or in an interprofessional community setting (Lennox & Anderson, 2007).

CAIPE recommends: that a repertoire of learning methods be included.

11. Cultivating Mutual Understanding

11.1 Students create their own opportunities to learn with, from and about each other. Teachers and practice supervisors provide more structured opportunities in the classroom and on placement, where students compare and contrast their professions’ roles and responsibilities, explore relationships within and between groups, building on positive examples, but also taking into account ways in which allegiance to one group can be at the price of invidious, prejudiced or stereotypical perceptions of others. They enable their students to relinquish negative stereotypes as they compare reciprocal perceptions in a positive and supportive climate.

CAIPE recommends: that teachers and practice supervisors optimise interactive opportunities for students’ to learn from and about each other’s professions.

12. Involving the Students

12.1 Students differ in their approaches to learning, including interprofessional learning, depending on their prior experience of teaching from schooldays through to their professional education. Some engage more easily with interprofessional learning than do others. All need orienting to its purpose and process to be not only responsible for their own learning, but also their obligations to each other as part of the student group.

CAIPE recommends: that every effort is made to include student groups for professions likely to work in the same settings in their subsequent careers; that students are actively involved individually and collaboratively in steering their interprofessional learning.

13. Involving Service Users and Carers

13.1 Contributions from service users and carers are widely valued in professional and interprofessional education for their unique and firsthand experience (McKeown et al, 2010). They contribute to IPE in curriculum planning and review, teaching, mentoring and student assessment. They need induction, preparation and support, taking care not to compromise their integrity and spontaneity.

CAIPE recommends: that service users and carers are involved as teachers and mentors in IPE after preparation and followed by ongoing support.

14. Assessing the Learning

14.1 Assessment should be based on demonstrated competence for collaborative practice. It may be formative, but students and teachers are more likely to value summative assessment counting towards professional qualifications.

CAIPE recommends: that students’ achievement of outcomes from their interprofessional learning are subject to summative assessment.

15. Observing Requirements

15.1 Pre-registration IPE is planned within the context of requirements for the validation of the professional courses in which it is implanted. Progress has been made towards harmonising regulations regarding IPE and collaborative practice for allied health, medical, nursing and midwifery and social work courses (Health Professions Council, 2009; General Medical Council, 2009; Nursing & Midwifery Council, 2010; Department of Health, 2002 respectively), complemented by broad-based benchmarking statements from the Quality Assurance Agency (QAA, 2006) summarised by Barr and Norrie (2010).

CAIPE recommends: that each proposal harmonises requirements and benchmarking statements for the professional courses in which it is implanted.

16. Laying Foundations for Continuing Interprofessional Development

16.1 Realistically, pre-registration IPE is the first step in a career-long continuum of interprofessional development, as students savour the taste and develop the habit for sustained, systematic and reflective learning during and following their professional courses.

16.2 Continuing interprofessional development complements continuing professional development education in which it is often embedded. It enables practitioners to respond effectively to changing roles and responsibility. It holds in check runaway expectations of outcomes from pre-registration IPE, acknowledging constraints of time in crowded professional curricula and students’ capacity at the outset of their professional journeys.

CAIPE recommends: that objectives, content and learning methods during pre-registration IPE are designed to lay the foundations for continuing interprofessional development.

17. Evaluating the Investment

17.1 The above information will help when formulating criteria with which to evaluate pre-registration proposals which include IPE. The same proposals may also be subject to evaluation as part of internal and external reviews for the professional courses in which it is implanted. Proposals which break new ground, for example, in the problems addressed or the methods employed, may merit systematic and independent research to contribute to the growing evidence base.

In January 2012, CAIPE is publishing a Guide to Commissioning Interprofessional Education within Preregistration Courses for the Health and Social Care Professions. The Guide is addressed to commissioners and regulators as the two groups which, by working in tandem, have the power and authority to ensure that IPE is not only included across professional courses but also accords with best practice grounded in evidence and experience. The case made is pregnant with implications for future policies for education and training for the medicine, health and social care professions. CAIPE is ready and willing to assist.

18. References

Anderson, E, Cox, D & Thorpe, L (2009). Preparation of educators involved in interprofessional education. Journal of Interprofessional Care 23 (1) 81–94

Anderson, E S, Thorpe, L N & Hammick, M (2011). Interprofessional staff development:
Changing attitudes and winning hearts and minds. Journal Interprofessional Care 25 (1) 11–17

Barr, H (2002). Interprofessional education: Today, Yesterday and Tomorrow. London: the Learning and Teaching Support Network www.health.heacademy.ac.uk

Barr, H, Koppel, I, Reeves, S, Hammick, M & Freeth, D (2005). Effective Interprofessional education: argument, assumption & evidence. Oxford: Blackwell Publishing

Barr, H & Norrie, C (2010). Requirements regarding interprofessional education and practice. A comparative review for health and social care. www.caipe.org.uk

Bromage, A, Clouder, L, Thistlethwaite, J & Gordon, F (2010). Interprofessional e-learning and collaborative work: Practices and technologies. IGI Global

CAIPE (2002). Interprofessional education—a definition. www.caipe.org.uk

Canadian Interprofessional Health Collaborative. A national competency framework for interprofessional collaboration. www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf

Colyer, H, Helme, M & Jones, I (2005). The theory-practice relationship in interprofessional education. London: Higher Education Academy: Health Sciences and Practice. www.health.heacademy.ac.uk

CUILU (2006). Interprofessional capability framework. Sheffield: The Combined Universities Interprofessional Learning Unit.

Department of Health (2002). Requirements for social work training. London: Department of Health.

Freeman, S, Wright, A & Lindqvist, S (2010). Facilitator training for educators involved in interprofessional learning. Journal of Interprofessional Care 24 (4) 375–385

Freeth, D, Hammick, M, Reeves, S, Koppel, I & Barr, H (2005). Effective interprofessional education: Development, delivery & evaluation. Oxford: Blackwell

General Medical Council (2009). Tomorrow’s doctors. London: General Medical Council

Health Professions Council (2009). Standards of education and training guidance. London: Health Professions Council

Hean, S, Craddock, D & O’Halloran, C (2009). Learning theories and interprofessional education. Learning in Health and Social Care 8 (4) 250–262

Howkins, E & Bray, J (2008). Preparing for interprofessional teaching: Theory and practice. Oxford: Radcliffe Publishing

Interprofessional Education Collaborative Expert Panel (2011). Core competencies for interprofessional collaborative practice: report of an expert panel. Washington D.C.: Interprofessional collaborative

Jakobsen, I, Fink, A M, Marcussen, V, Larsen, K & Hansen T B (2009). Interprofessional undergraduate clinical learning; Results from a three year project in a Danish interprofessional training unit. Journal of Interprofessional Care 23 (1) 30–40

Lennox, A & Anderson, E (2007). The Leicester model of interprofessional education: A practical guide for implementation in health and social care. Newcastle: Higher Education: Medicine, Dentistry and Veterinary Medicine.

McKeown, M, Malihi-Shoja, L & Downe, S (2010). Service user and carer involvement in education for health and social care. Oxford: Wiley-Blackwell

Nursing & Midwifery Council (2010). Standards for pre-registration nursing education. London: NMC

QAA (2006). Statement of common purpose for subject benchmarks for health and social care. Bristol: the Quality Assurance Agency for Higher Education in England.

December 2011

Prepared 22nd May 2012