The challenge of interdisciplinary teams.

An ongoing challenge in the practice environment is how to facilitate members of different health professions working together in ways that result in the best care possible for clients and families (Greiner & Knebel, 2003). We use the terms multidisciplinary, interdisciplinary, and interprofessional to describe these teams and care environments that are increasingly essential to manage today's complexities of health care delivery. This challenge has been a long-standing issue that has not been resolved easily. Thus it stands, probably more critical than ever in today's practice environments. One aspect of the issue may be semantic. There are differences in the meaning and the implication of the terms, although often they are used interchangeably. Multidisciplinary implies members of two or more disciplines working together to address a common problem. The member of each discipline contributes from his or her disciplinary perspective, and the essence of each discipline is largely maintained. This likely characterizes the typical environment in many health care settings today. Interdisciplinary means two or more disciplinary perspectives collaborating in a manner so that the sum of the effort is greater than how each discipline might interpret a situation or what each discipline might produce individually. Increasingly, research teams are comprised of members from different disciplines who bring their unique perspectives and methods to bear on a complex question or phenomenon. Sometimes this results in the development of new disciplines such as bioinformatics, proteomics, and neuroscience. Interprofessional, on the other hand, conveys members of different professional groups, working together to accomplish mutual goals. It does not convey the "sum is greater than its parts" notion of interdisciplinary, although it could. Also, whenever the term "professions" is used, it conveys the notion of boundaries and control rather than collaboration or interaction with other groups. Typically the goal for interprofessional health care teams is the creation of collaborative care plans focused on a patient's complex needs (Cooper, Carlisle, Gibbs, & Watkins, 2001). Although lack of clarity surrounds the use of the terms, there are more substantive issues to be addressed. Over the last 50 years there have been calls for reform of health professions education by various private foundations and governmental agencies. Frequently the educational experiences of students in the health professions are disjointed from the expectations for teamwork in the practice environment after graduation. One antidote for this is to educate health professions students together, in interdisciplinary or interprofessional programs, for at least part of their learning experiences. Although this makes good sense, progress toward this goal has not been satisfactory. In 2000, a survey found that fewer than 15% of U.S. nursing and medical schools offered any interdisciplinary programs (Greiner & Knebel, 2003). When health professionals are part of a team comprised of members of various health professions, they need to have a new set of knowledge and skills to be effective team members. This new set of knowledge and skills includes: * Learning about and understanding the expertise, knowledge, and values of each health profession * Knowing how to work cooperatively and collaboratively with other disciplines and professions * Skills to function in a group, including the ability to assess group dynamics and communication, negotiation, and conflict resolution skills. …