Negotiating challenges in community-based interprofessional education programs

Several expert panels have recommended interprofessional collaborative practice (IPCP) as an integral part of improving the quality and safety of care delivery to meet the complex health needs of patients. IPCP is attained by collaborative communications between two or more health professionals from various disciplines who share in clinical decisionmaking. IPCP increases patient satisfaction and improves health outcomes, yet few health professional students learn how to work within collaborative interprofessional teams. The health professional programs at one Midwestern University implemented Interprofessional Education (IPE) programs with the goal of facilitating IPCP team work and to foster effective communications among the health professional students. The successes that resulted were positive comments from students, faculty, and clinical staff and increased student confidence in interactions with other disciplines. The challenges that were encountered include scheduling difficulties, apathy of faculty and students, and incompatible clinical practice experiences. Understanding challenges and negotiating ambiguity of implementing IPE/ IPCP community-based programs is important in developing a well-trained interprofessional workforce and closing the gap between health professionals’ education and clinical practice experiences. Received: 06/01/2015 Accepted: 10/13/2015 Published: 11/09/2015 © 2015 Brommelsiek & Peterson. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Community-Based Interprofessional Education Programs EDUCATIONAL STRATEGY 2(3):eP1084 | 2 Introduction Over the past two decades, numerous reports have recommended the inclusion of interprofessional practice as an integral part of improving the nation’s health care system and for meeting the increasingly complex health needs of patients (World Health Organization [WHO], 2010; Lancet Commission, 2010; Interprofessional Education Collaborative [IPEC], 2011; Institute of Medicine [IOM], 2000, 2003, 2013). The Institute of Medicine in their report, To Err is Human, (IOM 2000) focused on quality and safety in healthcare, recommending improved interprofessional communication to reduce morbidity and mortality rates. Crossing the Quality Chasm: A New Health System for the 21st Century suggested interprofessional collaborative practice as a strategy for health professionals to effectively work together in care teams (IOM, 2001). In a more recent report, the World Health Organization (2010) analyzed the global workforce shortage, identifying increased IPE as one solution for improving the delivery of safe, competent care, and for addressing health professional workforce needs. Interprofessional education (IPE) and interprofessional collaborative practice (IPCP) first emerged in the United Kingdom in the mid 1960’s with early initiatives focusing on primary care and community-based care (Barr & Waterton, 1996). Interprofessional education is an approach to better prepare healthcare students for future careers as members of interprofessional care teams (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011). The Center for the Advancement of Interprofessional Education (CAIPE) (Finch, 2000) defined IPE as an educational opportunity when two or more health professions learn with and from one another. CAIPE also viewed IPE as a way to improve collaboration, improving both quality and delivery of health care services. As a standard for healthcare delivery, interprofessional teams are becoming more common. Yet, there remain gaps between the demand for interprofessional health providers and the incorporation of interprofessional learning into core curricula (Gilbert, 2005). Students in healthcare professions, including advanced practice students in nursing, pharmacy, social work, dentistry, and clinical psychology, are entering the workforce without the necessary skills to function effectively as members of interprofessional clinical teams (McNair, Stone, Sims, & Curtis, 2005). Efforts to improve this inadequacy are ongoing through the implementation of evidence-based practice and incorporating interprofessional skills training into the classroom and clinical education of health professional students. IPE and IPCP have been identified as strategies to improve quality and safety in healthcare by providing students opportunities to work as collaborative teams (IOM, 2003). According to Barnsteiner, Disch, Hall, Mayer, and Moore (2007), teamwork among health professionals is seldom intuitive, but a skill that must be acquired through education and clinical training. The vast majority of health professional students continue to receive their training within the confines of their own discipline. Teamwork with other disciplines has frequently been omitted from curricula with the assumption that health professionals will learn interprofessional collaboration in the workplace following graduation (Newhouse & Spring, 2010). IPE and IPCP, as part of the core curricula of health professional education, help to facilitate interpersonal communication (Brock et al., 2013), foster flexibility among the health professions (Koppel, Barr, Reeves, Freeth, & Hammick, 2001), and promote adaptability within ever-changing healthcare delivery systems (Freeth, Meyer, Reeves, & Spilsbury, 1998); all important attributes for improving health outcomes. IPCP has also been credited for helping to reduce hospital stays, admissions, and readmissions (Dietrich et al., 2004; Tieman et al., 2006), as well as a way for improving the management of complex health issues such as multiple chronic conditions (WHO, 2002). Additionally, IPE and IPCP can lead to greater confidence and job satisfaction among the health professions (Keller, Eggenberger, Belkowitz, Sarsekeyeva, & Zito, 2013). As the U.S. population increasingly grows older and more culturally diverse, an integrative approach to care will require increased numbers of health professionals trained in IPE and IPCP. IPE may be implemented in freestanding programs or through integration of two or more established professional programs (Barr & Wateron, 2000). Casto (1987) advocated the development of IPE curricula early in students’ professional clinical education and clinical practice in order to encourage the benefits of working H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu. edu/hip 2(3):eP1084 | 3 collaboratively as members of interprofessional care teams. According to Clark (2006), IPE is conceptually derived from social learning theory and includes components of leadership, communication, and conflict management among interprofessional team members. Closely aligned with experiential learning, a process-based method (Kolb, 1984), IPE draws on an individual’s reactions and actions informed by group experiences, such as flexibility and cooperation as a member of a team. Similar to the experiential processes, IPE often includes conflict resolution, helping students learn to negotiate differing opinions and values while gaining insight, understanding, and trust among team members (Orchard, Curran, & Kabene, 2005). Although IPE and IPCP have numerous benefits in the delivery of care and for improving quality and safety, implementation of these programs is not a seamless, natural process for most health professional programs. Integrating interprofessional teamwork and learning into pre-existing health education frameworks comes with its own set of barriers and challenges. Lash, Barnett, Parekh, Shieh, Louie, and Tang (2014) described potential barriers to IPE as a lack of institutional support for cross-discipline curriculum, shared learning spaces, and incongruity of perceived benefits of IPE programs among health professionals. Other major challenges for implementing IPE programs identified in the 2013 report, Learning to Improve Health from Interprofessional Models Across the Continuum of Education to Practice: Workshop Summary, are the lack of preparation of health professional faculty to deliver IPE training and classroom and clinical scheduling conflicts among the various professional programs (IOM, 2013). A significant challenge facing implementation of IPE and IPCP programs is that the provision of these concepts is relatively new in many U.S. institutions ,coupled with a lack of familiarity of IPE and IPCP by practicing health professionals. This lack of awareness may interfere with the didactic and clinical integration of IPE/IPCP into the educational experiences of health professional students. The purpose of this paper is to discuss one Midwestern university’s strategies for implementing IPE and IPCP programs for health professional students and to discuss the challenges associated with implementing these initiatives within various health professions schools and communitybased healthcare facilities. In response to the growing need to educate and develop a collaborative and interprofessionallyoriented healthcare workforce, the Health Resources and Services Administration’s (HRSA) Advanced Nursing Education Program (ANEP) awarded funds to assist in the development of IPE curricula that included several community-based IPCP experiences. These projects required creating an interprofessional practice framework that was flexible enough to negotiate unforeseen challenges as well as adaptable for working with multiple health professions schools and community partners.