Challenges to Preprofessional Programs in CSD
Kathy L. Coufal, PhD, Professor and Chair and Doctoral Coordinator and
Julie Scherz, PhD, Associate Professor and Graduate Coordinator
Communications Sciences and Disorders
Wichita State University
A variety of terms have been used to draw attention to the cooperation needed among stakeholders involved in providing interprofessional practice (IPP), and therefore to the need for interprofessional education (IPE) to prepare the future workforce (Odegard, 2006). The term interprofessional education has been defined as "a learning process in which different professionals learn from, with, and about each other in order to develop collaborative practice" (Freeth, Hammick, Koppel, Reeves, & Barr, 2002, p. 2). If the goal is to produce professionals who advocate for and engage in coordinated patient care, preprofessional education programs must provide their students with a forum that allows them to learn together.
Best Practice: Interprofessional Team Processes
Why does personnel preparation continue to be discipline-centered when substantial evidence exists that demonstrates the efficacy of interprofessional team processes as best practice to achieve optimal performance outcomes (i.e., Coufal, 1993a; Mackenzie et al., 2007)? In communication sciences and disorders (CSD), the call to action is not new. The theoretical framework, critical components, and professional competencies essential to an interprofessional, holistic approach to service delivery were summarized by Coufal (1993b) and followed by implementation examples. The contemporary lexicon has changed slightly, but, moreover, the conversation has been expanded to include more partners. The primary impetus for this change is the pressures put upon all health care providers; earlier conversations occurred largely in the context of special education (Ensher, 1989; Gutkin, 1993; Hillier, Civetta, & Pridham, 2010).
Demonstrating Discipline-Specific Knowledge in Interprofessional Contexts
To prepare future CSD professionals to be successful in any work setting requires the creation of diverse learning environments that engage students in developing their understanding of how their discipline-specific knowledge can be integral to team-based decision making. To attain such outcomes demands that those of us in higher education engage in conversations with our colleagues across disciplines and immerse students in learning opportunities that involve critical thinking and effective communication about roles, responsibilities, team processes, leadership, and systems theory. We cannot presume that students will infer such knowledge or develop effective interpersonal, team-based skills unless they have overt instruction, models, and meaningful experiences, followed by feedback from experienced professionals. Bhutta et al. (2010) made clear that the paradigm shifts in educational programs and institutional functions require dialogue and debate that lead to partnership, collaboration, and the formation of teams. Such shifts depend on a well-organized and comprehensive evidence-based foundation, coupled with tools for implementation that result in collaborative team functioning.
The evolution from discipline-specific care and hierarchical processes toward an inclusionary team process requires that every member of the team develop and employ strong relational skills and effectively coordinate his or her work with the work of other team members. "Relational coordination in the form of high-quality communication, mutual positive regard, trust, and active engagement are associated with a stronger collective identity, reduction in status differential, increased ability to respond to pressures with resilience, job satisfaction, and retention of staff" (Weiss, Tilin, & Morgan, 2014, p. xxiii). To develop students' knowledge and skills, to prepare them to become valuable members of the team, they must develop these abilities and perspectives in tandem with the discipline-specific competencies they bring to the team. Further, they must understand the stages of team development and their roles and responsibilities in that evolution. Some characteristics of a team are preexisting, such as each member's discipline-specific responsibility to the client and the shared concern among other professionals, the client, and the client's contextual partner(s). Other qualities of the team evolve as the members engage in the complex process of determining mutually defined goals, developing trust, sharing ownership and responsibility for both process and outcomes, and effectively communicating with one another. The collective wisdom of the team emerges through the process and results in new understandings and perspectives, as well as creative solutions to complex problems—solutions different from what any individual team member would derive if working alone (Coufal, 1993b).
To accomplish the mandate of IPE, an expert panel identified four core competencies for interprofessional collaborative practice (Interprofessional Education Collaborative Expert Panel, 2011). These are:
- Values/ethics for IPP
- Interprofessional communication
- Teams and teamwork
At Wichita State University, we have experimented with several IPE activities to promote development of these competencies. The following are a few examples.
- Case-based learning situations where students from physical therapy, physician assistant, nursing, and other health care professions work together to plan appropriately for a client with complex care needs (Competency: roles/responsibilities)
- Simulated patient experiences where students from six of the seven disciplines in our College of Health Professions interact with a standardized patient in a real-time situation to focus on care for various stages of recovery from stroke (Competency: values/ethics; communication)
- "Baby day" where students from speech-language pathology, audiology, and physical therapy work together to examine typically developing infants and toddlers to assess their motor and communication skills (Competency: teamwork)
- Consultation between CSD students and students in bioengineering on their senior design projects involving the development of a tool to measure various parameters of an augmentative and alternative communication device (including touch sensitivity and visual glare factors; Competency: communication)
- An interdisciplinary autism spectrum disorder diagnostic team serving young children and their families—team members include professionals and students from health care, medicine, education, and psychology—in an intensive arena-style assessment process (all four of the IPE competencies)
In each of these experiences, our students started with an initial sense of frustration when their counterparts appeared to know nothing about our discipline-specific roles and responsibilities. By the same token, however, our students had little understanding of the roles and responsibilities of their team members' disciplines. A sense of appreciation emerged over time through teamwork and communication, as students learned a common patient-centered approach to solving complex problems.
This work will not be without difficulty! Faculty need to learn to leave their discipline-specific silos just as much as do their students. The need to concede bits of knowledge or practice approaches to another professional has caused consternation for some faculty. In that light, faculty development is as necessary a part of the interprofessional picture as student development. Faculty from different disciplines in the College of Health Professions at Wichita State have worked together to develop simulation scenarios to engage students. Brown-bag lunch sessions have been devoted to topics related to the provision of IPE.
Given the enthusiastic responses we have seen from our students, the work required in the development of interprofessional education activities should be well worth the effort.
Bhutta, Z. A., Chen, L., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Zurayk, H. (2010). Education of health professionals for the 21st century: A global independent commission. The Lancet, 375(9721), 1137–1138.
Coufal, K. L. (1993a). Collaborative consultation: A problem-solving process. Topics in Language Disorders, 14(1).
Coufal, K. L. (1993b). Collaborative consultation for speech-language pathologists. Topics in Language Disorders, 14(1), 1–14.
Ensher, G. L. (1989). The first three years: Special education perspectives on assessment and intervention. Topics in Language Disorders, 10(1), 80–90.
Freeth, D., Hammick, M., Koppel, I., Reeves, S., & Barr, H. (2002). A critical review of evaluations of interprofessional education. London, UK: UK Centre for the Advancement of Interprofessional Education.
Gutkin, T. B. (1993). Demonstrating the efficacy of collaborative consultation services: Theoretical and practical perspectives. Topics in Language Disorders, 14(1), 81–90.
Hillier, S. L., Civetta, L., & Pridham, L. (2010). A systematic review of collaborative models for health and education professionals working in school settings and implications for training. Education for Health, 23, 1–12.
Interprofessional Education Collaborative Expert Panel. (2011, May). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.
Mackenzie, A., Craik, C., Tempest, S., Cordingley, K., Buckingham, I., & Hale, S. (2007). Interprofessional learning in practice: The student experience. British Journal of Occupational Therapy, 70, 358–361.
Odegard, A. (2006). Exploring perceptions of interprofessional collaboration in child mental health care. International Journal of Integrated Care, 6, 347–357.
Weiss, D., Tilin, F., & Morgan, M. (2014). The interprofessional health care team: Leadership and development. Burlington, MA: Jones & Bartlett Learning.