by Olga Heath, Ph.D. and Vernon R. Curran, PhD
This project has been funded through the Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP) initiative, Health Human Resources Strategies Division, Health Canada.
The training of healthcare professionals in Newfoundland and Labrador, as in the rest of Canada, has traditionally been largely based on silos in which health professionals are educated in relative isolation. Recent national commissions, committees and policy documents in Canada have identified the importance of reshaping the academic curriculum to produce graduates who have the interprofessional knowledge and skills needed to function effectively as part of a team in the clinical world of collaborative practice (Commission on the Future of Health Care in Canada, 2002; Health Council of Canada, 2005).
Interprofessional Education (IPE) is defined as members of two or more healthcare professions engaged in learning with, from and about each other (Barr et al., 2005). There is evidence that IPE can help to break down stereotypical views professionals hold about one another and can result in an increased understanding of the roles, responsibilities, strengths, and limitations of other professions (Parsell & Bligh, 1999; Barr et al., 2005). A number of principles are believed to be important in the design of IPE curricula:
- relevance to learners’ current or future practice (Oandasan & Reeves, 2005)
- use of typical, priority health problems that require collaborative approaches for their solution (WHO, 1988)
- interprofessional learning based in clinical practice (Reeves & Freeth, 2002)
- learning methods which facilitate interaction between learners from different professions, including small-group learning formats such as case-based and problem-based learning (Oandasan & Reeves, 2005)
The Centre for Collaborative Health Professional Education of Memorial University of Newfoundland initiated a comprehensive IPE curriculum development project in 2005. Funded by Health Canada as one of 20 IPE projects supported across the country, the goal of this project is to expand and promote IPE activities in both education and practice settings, and thereby enhance the collaborative competencies of an increased number of learners and practitioners in the province of Newfoundland and Labrador. Memorial is the only university in the Province offering professional degrees in medicine, nursing, pharmacy, and social work; these schools have chosen to participate in the interprofessional education curriculum.
Figure 1 depicts the Interprofessional Education Curriculum Framework model introduced at Memorial University. The model reflects the various components of IPE; maps each of the components onto a framework of professional development; and acknowledges the value of the profession-specific competencies and the education and practice contexts in which the project is grounded. As is the case for any significant change to an academic curriculum, the success of implementation of IPE in health and social service settings ultimately depends upon the support and buy-in of the learners and practitioners in those settings.
While the components of Memorial University’s IPE program can be used independently, there is sequential knowledge and skill development that is built into the developmental stages of the professional academic curriculum. There are elements of the IPE program associated with each of the four stages of health professional development as defined by Miller, Freeman & Ross (2001): preclinical stage, clinical novice stage, probationer stage, and practitioner stage - as illustrated in Figure 1.
The pre-clinical learner is one who has little clinical exposure and is therefore limited by their lack of knowledge of professional roles and experiences in real clinical situations (Miller, Freeman & Ross, 2001). The focus of IPE in the pre-clinical stage is to prepare the learner to conceptualize practice from a collaborative perspective. It emphasizes the likelihood and value of working as part of either a formal or informal interprofessional team and the importance of understanding what contributes to successful team functioning. In an effort to introduce students to the practical experience of working collaboratively before practice placements begin, an Interprofessional Service Learning Project was established to encourage students from different professional schools to work together toward achieving a common goal, thereby simulating a team-like environment.
The pre-clinical stage also introduces two Interprofessional Education Learning Blocks. The Health Promotion Block is designed to create an awareness of common aspects of practice (e.g. illness prevention and ethics) which can serve as a focus for collaboration. Likewise, the Professionalism Block is designed to increase knowledge about professional roles in healthcare, as well as, the rewards and challenges of Interprofessional Practice (IPP).
Clinical Novice Stage:
The clinical novice stage is defined as that point in a professional’s training at which gradual exposure to clinical experience begins (Miller et al. 2001). From an IPE perspective this is a critical point in the development of attitudes towards collaborative practice because it is the first time many students will see how health and social service teams function (Morison & Jenkins, 2007). There are two components of the clinical novice stage: modules and practice placements.
Similar to the IPE Learning Blocks structure, modules are affiliated with existing courses and scheduled in a common timeslot. There are six modules in areas in which collaborative care has been demonstrated to be valuable, including: Health and Well-Being of Children, Rehabilitative Care, Geriatric Care, HIV/AIDS Care, Mental Health Practice and Newborn Care. The objective of the modules is to be able to consolidate the information covered in the IPE Learning Blocks and to successfully apply that knowledge to a variety of patient populations.
The practice placements, where often for the first time learners see professionals working together, are a unique opportunity to develop knowledge and skills for interprofessional teamwork. The practice placements involve three distinct components: a two hour face to face workshop supplemented by an online summary of the material covered; student and preceptor handbooks in which the information in the workshop is summarized and coupled with specific suggestions for IPP enhancement; and a Competency Reflection Journal which prompts review, discussion and documentation of required IPP competencies within the context of the team environment in which the student and preceptor are working. One of the most important concepts covered in the workshop and handbooks is the various styles of IPP. Many students and preceptors assume that collaboration only occurs when there is a formal team in place with supporting structures such as interprofessional rounds and team charting. However, IPP occurs more commonly when there is a psychologist, a family physician and a pharmacist working together with a patient/client who has a major depression and is being treated both with psychotherapy and medication. In both situations there is more than one professional contributing meaningfully to the patient/client care, creating a wealth of learning opportunities for health professional students. A key concept covered in the workshop and handbooks is the behaviors which characterize highly functional and dysfunctional teams.
The objective of the practice placements is to successfully apply what has been learned in the IPE Learning Blocks and modules to the practice setting. This involves familiarizing students with the IPP competencies their schools or faculties expect them to attain and the skills needed to work towards those competencies.
As learners develop a degree of comfort in their own professional role, they make the transition from clinical novice to probationer. The probationer is a senior learner who is familiar with the practice environment, but is not yet a full fledged practitioner in a clinical or practice environment (Miller et al. 2001). To address IPE needs in this stage of professional development, an Interprofessional Collaboration training workshop has been introduced in partnership with the Regional Integrated Health Authorities in the Province. These full day workshops focus on the development of collaborative competencies amongst post-graduate medical trainees (residents) and other regulated health professionals with whom the residents interact in team settings. These workshops, which are offered in a variety of clinical practice areas, form an important part of the continuum of training for medical residents. They provide the opportunity for both residents and clinical staff to identify barriers to IPP in their clinical area and to brainstorm solutions to those challenges.
A graduate level course on Interprofessional Education in the Health Professions has also been introduced via distance learning for graduate students in the health, education and community service professions, allowing for a higher level of study for those who may be interested in developing IPE opportunities for health professionals both within and outside of the university system.
The practitioner stage includes those professionals who are qualified (e.g. licensed, certified, and registered) to practice in a particular profession. Practicing clinicians are role models not only for their own profession, but for any learners with whom they may come in contact. To reach this key population of practicing health professionals, a ten-session blended learning program comprising face-to-face and video-conference instruction was developed in which eight specific mental health interventions were taught with a focus on the value of interprofessional collaboration. Collaborative Practice in Rural Mental Health is a post-licensure continuing interprofessional education (CiPE) program offered to primary healthcare sites in the Province. The main purpose of this CiPE program is to enhance the collaborative mental health practice competencies of primary healthcare providers and other community-based professionals.
Faculty development is an essential component of the proposed Interprofessional Education Curriculum Framework model. With the expansion of IPE programming across the curricula of participating academic units and with the promotion of interprofessional learning opportunities in practice settings, the need to enhance clinical and academic educators’ knowledge, skills and attitudes toward IPE has proven paramount. Already faculty development activities have included a focus on attitudinal change, increased understanding of the roles and responsibilities of other healthcare professionals, and skill acquisition in the areas being taught to students.
Psychology in IPE:
Although there are clinical and counseling psychology training programs associated with most of the universities at which Health Canada’s Interprofessional Education for Collaborative Patient Centred Practice (IECPCP) projects were funded, psychology training programs were participants in only 20% of the projects. It is unknown if psychology training programs were not invited to participate or decided not to be involved, but the absence of psychology in discussions of interprofessional role definition and sharing is a significant concern. It is worrisome that health professional students in many universities across Canada, including Memorial University, are learning about the interprofessional treatment of mental health issues without realizing that in many cases psychologists would and should be integrally involved in the treatments. These students will exit their exposure to IPP having no clear idea of what a psychologist does and how they can be of value to other professionals as they care for their patients/clients. Because physicians are so often an essential source of referral for psychologists, it is especially important for these professions to take advantage of the opportunity to educate and be educated about the rewards and challenges of collaborating in practice.
Although at present there is no professional training program in psychology at Memorial University, there are plans to offer a PsyD program that will open its doors in the fall of 2009. In the planning stages of the training program, the committee recognized that most clinical psychologists will work as part of either a formal or informal team and will need to acquire the requisite skills to do so effectively. In response to this need, the Centre for Collaborative Health Professional Education was approached and has agreed to have the clinical psychology training program added as a participant along with medicine, nursing, social work, and pharmacy in the IPE curriculum. In a classroom with other health professional students, psychologists in training will be involved in the learning blocks and modules where appropriate and will form working relationships and have the ability to advocate for their profession. In addition, trainees will participate in the Practice Learning component of the curriculum.
The participation of students in the IPE curriculum means that more psychology faculty will have an opportunity for involvement, giving psychology a voice in the planning of new initiatives and the revising of existing curricular components. The recognition of the value of IPP for patient/client care, staff morale and cost containment make it likely that it will continue to influence health professional training and practice in the future. Psychology needs to become a participant in the interprofessional training process, thus ensuring the psychology perspective is recognized in curriculum design and students are equipped to function in the clinical world of interprofessional collaboration.
Olga Heath, PhD, Counselling Centre/Faculty of Medicine, Memorial University, Canada
Vernon R. Curran, PhD, Faculty of Medicine, Memorial University, Canada
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