About two months ago, I had the rare privilege of taking off my "dean's hat" to experience clinical simulation as a faculty member with my colleagues in medicine, nursing, pharmacy, athletic training and physical therapy. Together we learned about the importance of patient care simulations and case debriefing in learning together on interprofessional teams. The yield was extraordinary. In a school disaster simulation, I saw a team come to terms with identifying a leader based on ability to communicate the critical messages among patients and providers, rather than on the traditional hierarchy of placing a physician in charge. I saw a team experience the revelation that health professionals increase a patient's distress by firing questions simultaneously. I saw another team defuse a potentially volatile situation so that patient safety and care could be maintained. And I saw a nurse recognize the need to pursue a swallow consultation from a speech-language pathologist before transferring a patient from intensive care to a medical floor.
So, what is all the interprofessional education fuss about? The idea is to bring pre-professionals together to break down potential professional barriers. Historically, our health professions educate future professionals in disciplinary silos, yet the curricula of several health-related professions (such as speech-language pathology, audiology, nursing, physical therapy, social work and nutrition) emphasize skill development in similar areas. These include advocacy, teamwork, ethics, effective communication, family, client- or patient-centered care, and evidence-based practice.
Further, each profession contributes to the health and wellness of clients/patients in educational and medical settings—often sharing roles and responsibilities for care and support. Interprofessional education may be just what we need to be responsive to current health care and educational reforms. But what real value is added by integrating IPE into our communication sciences and disorders curricula? Are there possibilities for educational innovations using clinical simulations and interprofessional case-based scenarios? Can we afford to make the needed changes if we aspire to integrate the IPE competencies? How do we ensure that competencies in our own disciplines are not compromised?
Recently, I collaborated with the Council of Academic Programs in Communication Sciences and Disorders to ask training programs across the country to share their experiences with IPE. Responses revealed many programs are just beginning to explore the potential of IPE, while others have already established it in their programming.
The overwhelming response and excitement about what is happening across the country tempers the usual questions, such as:
- Are we in competition with our colleagues?
- Are we worried about encroachment?
- New questions are emerging:
- Are we coming to a new understanding of what it means to be a health professional?
- Do we understand the role of IPE in educational settings?
- Are we educating our students to function in more flexible and very different practice environments than when we were trained?
It seems important to examine what we see as our role. My colleague Sarah Abrams, a public health nurse, suggests we consider role theory as it deals with how we interrelate under stable and changing conditions. Abrams suggests that, particularly in times of increasing role demands and complexity, professionals value their independence, control over their practice and variety in what they do.
Competition among professionals, however, seems an inappropriate focus if we are committed to high-quality care for people with a range of health and educational needs. Does it matter whose territory it is? Does it add value to our practice innovations? When role confusion and stress occur in complex practice environments, have we prepared ourselves for interprofessional give-and-take? These are difficult but important questions to ask of ourselves, and one another.
To accomplish our desired collaboration, we need to adjust our training and practice. If we use our collective skills flexibly and based on clients' needs, we are sure to increase our success as measured by our clients' positive outcomes, as well as to reduce our role-related stress. We can learn much from our colleagues in nursing, pharmacy and medicine, who already are modeling what can and should be happening.
Our curricula can incorporate the IPE competencies [PDF] established in 2011 by the Interprofessional Education Collaborative (e-mail firstname.lastname@example.org). This group included organizational leadership in nursing, medicine, osteopathic medicine, pharmacy, dentistry and public health. Some CSD programs have already begun incorporating such competences, as found in a call for information from ASHA and CAPCSD (see chart online [PDF]).
IPE logistics—among them institutional silos and divisive academic structures—are clearly not easy. Can institutions of higher education retool themselves to become more flexible and nimble in addressing the fast-paced changes in technology, systems of care and student learning needs? My very wise nursing colleague Sarah Abrams noted in a 2012 editorial she wrote for Public Health Nursing (p. 387) that, "In academe we have become accustomed to doing more with less. Perhaps this is an opportunity disguised as an onerous challenge." IPE may be just the magic we need to advocate for change and create teamwork to ensure innovation in education!