Theoretical insights into interprofessional education: AMEE Guide No. 62

Figures & data

Table

Practice points

Make full use of the range of theories available as tools to articulate and defend the best interprofessional educational practice: do not limit your reading to frameworks that are linked to interprofessional education as the only key word. Team working, collaboration, continuous care, etc. provide a pool of literature to draw on. Building social relationships between learners (and teaching staff) from different professional groups should be an explicit aim of an interprofessional education curriculum. The theories of social constructivism and social capital support the tenet that learning that takes place in interprofessional education cannot be achieved in professional or social isolation. Use theories to justify and guide learning and teaching methods from the outset of interprofessional education curriculum development and redevelopment, and for both practice-based and campus-based initiatives. Post-modern society increasingly demands that staff make the transition from independent work underpinned by their own professional knowledge to collaborative working based not only on their knowledge but also on the terrains of knowledge that emerge from interprofessional thinking. Knowing how professional knowledge is created and its traditional links with power and control can help staff and students to manage their reactions to interprofessional education and collaborative practice.

Table 1.  Some exemplars of tools in the theory tool box that have been applied in interprofessional education

Name of theory	Authors who have applied the theory to interprofessional education	Brief description	Practical questions?
Contact hypothesis	Carpenter et al. (2003, 2006) and Carpenter and Dickinson (2008)	Interprofessional education brings students of different professional groups in contact with each other, under a range of predetermined conditions that promote positive attitudes to grow between professional groups	What conditions do I need to introduce into my curriculum that will generate positive attitudinal change/growth in my students? How do I know if attitudes have changed?
Activity theory	Engeström (2001)	Engestrom (2001) uses the concept of activity systems to frame the learning that takes place when parents and practitioners from different professions and organisations work collaboratively to plan and monitor the care of sick children admitted to their care	How do organisations learn from each other in an interagency context and how can this be improved?
Complexity theory	Cooper et al. (2004)	Through reference to concepts of connectivity, diversity, self-organisation and emergence we are able to make sense of complex linear and non-linear processes involved in designing, coordinating and delivering curricula. Interprofessional education is recognised as multidimensional with both predictable and unpredictable outcomes	To what degree can we plan the specific learning outcomes of an interprofessional education curriculum? When do we need to accept that some learning is emergent and cannot be planned for?

Figure 1. Summary of the dimensions/categories into which theories may fall.

Table 2.  A range of dimensions to consider when deciding which, when, why and how to use a theory

Agency dimension	For whom would the theory be useful and how could the theory be applied differently by each individual-whether they be the policy maker, the curriculum developer, the facilitator, the student or the researcher and evaluator? A theory may be deemed useful by one group but not others. Equally, a theory may be used in one way by one group but in another way by another
Temporal dimension	When in the interprofessional education experience might the theory be usefully applied? That is, is theory being used to develop hypotheses around when interprofessional education should be delivered, e.g. pre- or post-registration? At the beginning or end of pre-registration training?
Location dimension	In which learning environment might the theory be useful? This differentiates between theories that may be useful to explore campus-based interprofessional education versus practice-based education. The location dimension and temporal dimension are to some degree linked as where education happens may depend on when it happens
Micro- vs. macro-dimensions	The micro-level refers to learning at the level of the individual student; macro-level learning has a wider remit and encompasses learning that may occur within communities, systems or organisations as a whole. For example, if the curriculum developer is focused on enhancing student learning within the interprofessional education context s/he may draw on social constructivist learning theories to articulate how this micro-level learning takes place and how interprofessional education group sessions can be better facilitated to achieve this. Alternatively, if an interprofessional education lead wishes to articulate to students the complexity of interagency working and help them manage crossing institutional boundaries between the University and different practice settings, then the use of the macro-level theories of activity theory describing the interaction of these two systems may be appropriate (see the seventh section for more detail)
Utility dimension	What task might the theory help us achieve? Might the theory have an explanatory value, e.g. in explaining the role and process of interprofessional education and why learning to be interprofessional is important for pre-registration students and how it is enacted; alternatively, the theory could assist in planning ways of delivering effective interprofessional education or in fact be used to substantiate the development of interprofessional education that responds to stakeholder evaluations

Case Study Box 1. Being an interprofessional education lead: working with others

20 October 2008

I have just been appointed the interprofessional education lead in the newly established Faculty of Medicine and Health Sciences, at the University of Hope. When the Dean of Faculty invited me to take on this role I felt flattered, particularly as I had only recently been appointed as a lecturer on the five year medicine programme. She gave me some policy documents and a list of interprofessional education learning outcomes to digest, with a directive to develop an interprofessional education programme within the Faculty. The Dean also said there is a small staff development budget for this initiative.

In response, I’ve set up an Interprofessional Education Curriculum Planning Committee to develop interprofessional education modules, incorporating these learning outcomes in a consistent way across each level of study, in all programmes within the Faculty. The members include all of the Faculty's Award Leaders to ensure professional representation from the medicine, nursing, radiography and physiotherapy programmes. To support the validation of this interprofessional education programme, the Dean has encouraged me to ensure that service users and students are also invited to be members to ensure their views on interprofessional education course development are heard.

Some of the committee members have already expressed doubts about the value of interprofessional education. One comment was that it pushed more important topics out of the curriculum and another complained that he would have a job convincing his colleagues that they should become interprofessional facilitators. It would be helpful for them to hear why it should be part of the undergraduate learning experience from an external speaker.

I am keen that the doubts of some in the team are considered and that I create a forum in which we can inject new ideas and enthusiasm into the delivery of this interprofessional programme. I’ve also decided that we will need to get to know about each other if we are to work together effectively. Perhaps I could use the staff development budget to plan a workshop and invite the keynote speaker I heard at last year's Interprofessional Education Tomorrow conference to introduce it. He spoke about the application of social capital theory in interprofessional education. A similar presentation to the Education Curriculum Planning Committee, followed by group activity, could act as a catalyst to stimulate discussion and debate that could set the foundations for a new and exciting interprofessional curriculum in the Faculty, one underpinned by sound theory and research evidence.

Later …

The guest speaker led a workshop with members of the Education Curriculum Planning Committee, with an introduction to social capital and its potential application to interprofessional education.

After this introduction, committee members participating in workshop were asked to generate a range of hypotheses that related to the development of the interprofessional curriculum (Boxes 2–5).

Case Study Box 2. Being an interprofessional education lead: designing interprofessional learning

5 January 2009

It's the second meeting of the Interprofessional Education Curriculum Planning Committee. The good news is that four service users and two pre-qualifying students attended the meeting. However, not all Award Leaders prioritised attendance! This meant that I had to chase some colleagues for their responses to suggestions for interprofessional education curriculum development. At times I wondered if we would ever reach agreement about the length and duration of the modules given the varying durations of programmes, different academic abilities of students and the need to work with some nightmare timetabling clashes. The social capital workshop was very helpful for us to organise our thinking and reach a consensus. However, for some committee members, the use of social capital was out of their current educational experience.

Further the time pressures on delivering an interprofessional education curriculum meant that they did not have the luxury of exploring and generating evidence that would support the social capital propositions raised. Falling back on tried and tested education/learning theories allowed them to remain within their theoretical comfort zones and rely on more established theoretical underpinnings. At our next meeting we have agreed to discuss the design of the learning experience and we have to decide on content and assessment. From today's meeting it's clear that I need to do my homework on this before the meeting and present some options: otherwise we will have a learning experience driven by those with the strongest opinions!

Case Study Box 3. Being an interprofessional education lead: responding and rethinking

23 June 2010

Well, thank goodness, the first module of the interprofessional education programme is over. There were a few teething problems with room booking clashes and facilitators either turning up unprepared or indeed, not turning up at all! However, nothing prepared me for our students’ evaluations of their interprofessional education experiences. Quite a few made it very clear that they did not enjoy the experiences at all. They didn’t see the relevance of it to their particular practice; didn’t like the timing of the modules in relation to their clinical placements or it being timetabled on a Thursday afternoon. This list goes on: some felt that some students in their group didn’t put any effort in to the formatively assessed activity, resulting in unbalanced workloads, and some felt overpowered by others in the group.

More positively, most students thought their group was the right size and they liked the combination of students from different professions. There were also positive responses to the way we organised the learning around an authentic practice related issue and gave them freedom within their groups to take whatever direction they wanted to in terms of a solution.

So now I’m working with the Interprofessional Education Curriculum Planning Committee to address the major issues that need revising in preparation for the next academic year. It's a real struggle to secure enough interprofessional education facilitators. Many of those who participated this year are telling me that, owing to other commitments, they are unable to be an interprofessional education facilitator next year. There seems to be a feeling amongst some of them that interprofessional education may lead to students from other professions knowing too much about how to do the work traditionally done by practitioners from their profession. One or two have told me that they feel very insecure during the interprofessional learning groups, mainly it seems because questions arise that they don’t know the answer to. Thank goodness enough of them are willing to continue and want to better understand the student's comments.

And I need a way to help us all understand why it felt such a challenge and how to mitigate that next year, especially for the students but I just don’t know where to start. We need to think clearly about the way forward and that's not something that can be done in a two hour meeting. Maybe an away day as I still have money in the staff development funds? I shall have to do some sound preparation if we are to get useful outcomes that everyone agrees with and are practical enough to develop the modules in a way that satisfies students and staff.

Case Study Box 4. Being an interprofessional education lead: a theory informed curriculum

30 September 2011

The first module of the revised interprofessional education curricula starts tomorrow. I’m nervous but more confident than this time last year that the module will run smoothly and be more acceptable to students and staff. There is much more support now from the facilitators and they say they are feeling more relaxed now they understand that it will never be possible for them to answer all the student's questions. We even have some spare staff to take over if anyone reports sick … so different from last year. A few of them are pairing up to do some interprofessional team teaching; this way interprofessional socialisation will be role modelled by staff. We’ve made some changes to the delivery and content of the interprofessional modules including providing sufficient time for students from the different professions to get to know each other in informal ways with shared travel and longer coffee break times. The curriculum now includes some time for the facilitators to talk to their students about professional knowledge and the idea that their discussions about patient care or service delivery should aim to bring together their different knowledges.

The Dean has asked me to write a briefing paper on these changes She's interested in why we’ve changed certain aspects and left others alone and, in particular, in what sort of progress we’ve made towards having a relevant, effective and efficient interprofessional curriculum that is integrated with the other parts of all of our professional programmes (Barr & Ross 2006) Apparently, one or two of the Faculty Awards staff who are on the Interprofessional Education Curriculum Planning Committee want to take that approach with some of their uniprofessional modules. Looks like we’ve set a trend! I’ll start it now but won’t be able to finish it until the feedback from students and staff is analysed. At least this year our evaluation is theory-led –we’re now using realistic evaluation which involves collecting more qualitative data and doing this in a more systematic way so we can analyse the links between the education process, mechanisms and outcomes. We’ve asked the students and service users on the Interprofessional Education Curriculum Planning Committee to participate in the collection of this data. It all feels very different to last year … I’m really enjoying being the interprofessional lead.

Table 3.  Assumptions underlying ALT or ‘Andragogy’

Number	Assumption underlying ALT
1	Adult learners need to know the relevance of what they need to learn before undertaking to learn it
2	Adults prefer responsibility for their decisions and desire to be viewed as capable of self-direction
3	Adults accumulate a greater volume of experience, which represents a rich resource for learning and necessitates individualisation of learning strategies
4	Adults become ready to learn things when they need to know them in order to cope effectively with real life situations
5	Adults have a task-centred orientation to learning and like to feel free to focus on the task or problem
6	Students can work collaboratively and in dialogue with others with mutual trust and respect, between both peers and lecturers, to shape and deepen understanding
7	While adults are responsive to some external motivators, their most potent motivators are internal

Source: Knowles (1990) and Kaufman (2003).

Comment Box 1. Some propositions from the curriculum development committee on the composition of interprofessional learning groups based on social capital theory

After the talk by the invited speaker, the curriculum development committee discussed how their new understanding of social capital could be applied to the development and delivery of interprofessional education. They first considered some of the ideas on the network dimensions of social capital and explored what the optimum affective and physical characteristics of an interprofessional education leaning group should be. In other words, they considered the ideal composition of the student interprofessional learning group. They raised the following questions and addressed these with hypothetical solutions as below:

• What size of interprofessional education group will maximise positive learning with, from and about each other?

The Committee reflected on the talk on affective network characteristics and discussion of how larger groups may have lower levels of cohesion and strong working relationships are less easily formed. However, the speaker also suggested that groups must be sufficiently large, to contain members with a wide enough range of knowledge and skills to effectively achieve the task as a team. The Committee proposed that interprofessional learning groups between 6 and 8 be created, as these are likely to contain students with a range of skills but are not so large that cohesion is compromised.

• How many professions should be represented within the group and which professions specifically should be combined in one group for maximum effect?

One committee member insists that teaching collaborative skills can be done uniprofessionally and wants to pull out from the interprofessional education programme. A uniprofessional approach brings together a group of neophyte professionals that share common skills and knowledge. The speaker, participating in the committee's discussion, reminds them that whilst this homogeneity may promote strong group cohesion, it mitigates against any exchange of skills or knowledge of each other's professional group. A uniprofessional group is less likely to address the group task in an innovative fashion (Borrill & West 2000). A professionally heterogeneous group is important in the development of bridging capital (relations between different professional groups). However, bonding capital (relations within the same professional network) is important also (Looman & Lindeke 2005, DiCicco-Bloom et al. 2007). The Committee agreed that therefore the group should have at least two of each profession; so, both forms of capital can grow within the interprofessional student group.

They also concluded that when planning the heterogeneous make-up of the group, some thought should be given to the type of knowledge and skills that each professional group brings to the task. This is facilitated if the task itself is centred on a clinical context or authentic learning context. For example, the mental ill health of the prison population is unacceptably high. The Committee discuss the context of Offender Health, a particular interest of one of the committee members. Improved mental health assessment and reporting when defendants pass through court prior to prison is essential (Hean et al. 2011). The committee member suggested a student task could centre on the enhancement of psychiatric reports requested of the mental health services by the criminal justice system. An interprofessional learning group could then bring together two mental health students, two medical students, two social work students (and ideally two law students) to explore and exchange their professional perspectives on this challenge.

• How frequently should students interact with the interprofessional education group during their interprofessional education task?

The committee decided that this will vary by task and suggest that in the early stages of an interprofessional learning activity, frequent interaction and participation is required to build the social relationships required for the team's success. The Committee believe frequent participation is best achieved if interprofessional education modules are delivered as a block over a 2-week period.

• What role does each member play in the interprofessional education group and what should be their level of their involvement in the group task?

The committee reflected on the influence of levels of participation in a network on social capital generation. They concluded that students should be encouraged to take an increasingly active role in the interprofessional learning group. Where the facilitator may initially lead the group, students should be encouraged to take over this leadership as the team develops. They should be encouraged to discuss and rotate roles within the team, alternating between chair and scribe, for example. Active participation in the group should be encouraged through promoting a commitment to shared goals and the setting ground rules.

In all of the above suggestions/discussion, the committee recognised that much of their discussion, although with a strong theoretical underpinning, now required a strong evaluation.

Comment Box 2. Some propositions by the Curriculum Development Committee on building Trust, Resources and Norms of engagement within the interprofessional learning group

After discussion of the desired characteristics of the interprofessional learning group, the Curriculum Development Committee turned their discussion to the processes that take place within the groups and applied the new understanding of social capital to underpin their recommendations. They asked:

• How do we build trust in the interprofessional learning group?

The committee believed that the role of trust and trust building should be made explicit to students and that a role of the facilitator is to explain the importance of developing interprofessional trust. They should engage students in trust building activity. Trust grows within an environment of interdependence and as such has an element of risk associated with it. Activities may be designed in which each team member holds unique skill or knowledge sets that they must communicate clearly, transparently and perform competently. Team members should be encouraged to behave in consistent and predictable ways, be ready to delegate and share control of the task as well as show a concern for each team member. It should be made clear that behaving in this way during a joint task builds their professional reputation and shows them to be trustworthy to other members of the team, particularly members of other professions upon whom they will rely during the task (Tomlinson & Lewicki 2003, Pullon 2008, McMurtry 2010).

• What are the external resources of the interprofessional education student group?

The committee discussed the skills, knowledge and experiences that different professionals bring to their interprofessional education group. Again, they believed that an authentic clinically related task facilitates the identification of these external resources. They referred back to their earlier discussion (Box 2) about a student task developing a template for a psychiatric report required to transfer information on the mental health of a defendant between the Mental Health Services and Criminal Justice System: Student lawyers bring an understanding of the legal system and the decisions facing a magistrate/judge when dealing with defendants. If magistrates are dealing with defendants with mental health issues they need to decide whether diversion from the criminal justice system to a secure unit, a community order or a custodial sentence is required. However, to make this decision they must rely on the knowledge/resource of the mental health professional to understand the public risk the defendant poses and the relationship between their mental illness and the crime committed. The Mental Health professional holds this knowledge/resource but needs to understand in turn the legal dilemmas facing the magistrate to be able to provide information in their reports that will be useful for the magistrate. Law students and mental health student nurses, for example, in a common task to enhance the template for the psychiatric report satisfy the requirements of both agencies. They should be encouraged to share information resources each informing the other of the knowledge requirements of each agency and how communication could be facilitated between them (Hean et al. 2011).

• Are norms and rules of team working, resource/information sharing in place?

The Committee recognised that norms are important to the working of the interprofessional learning group but that the students groups have only limited time together and there is insufficient time available for norms of team working to develop naturally. They agreed for students to be encouraged to set clear ground rules, especially with regard to roles and issues of freeloading, on the way they intend to work and interact over the task. If these are not set explicitly and early on, the group is unlikely to be successful.

Table

Social capital has been used as a tool to explore the student learning group. It could equally be used to explore the benefits, challenges and processes of the education planning committee itself as a formal network and hence a source of social capital. The size, heterogeneity and frequency of participation, roles, cohesion, trust, resources and norms of the committee are the keys. Through this lens, the composition, processes and outcomes of this committee might be framed to form testable propositions, through which the management and delivery of interprofessional education could be enhanced.

Table

Bourdieu P. 1997. The forms of capital. In: Halsey AH, Lauder H, Brown P, Stuart Wells A, editors. Education-culture, economy, and society. Oxford: Oxford University Press. pp 46–58.

Coleman JS. 1988. Social capital in the creation of human capital. Am J Sociol 94:S95–S120.

Hean S, Cowley S, Forbes A, Grifiths P, Maben J. 2003. The M-C-M’ cycle and social capital. Soc Sci Med 56:1061–1072.

Table

Many theories overlap and complement each other. In the discussion of ALT, a deep approach to learning allows for the transfer of learning from one learning context to another. Similarly, in a discussion of the generation of social capital in the interprofessional student learning group, it is proposed that social capital is reinvested in interprofessional teams in practice. In both approaches, the transfer of learning is fundamental from one context to another.

Table

Some interprofessional education e-learning resources to explore:

Interprofessional and Inter-agency Collaboration (IPIAC), Social Care Institute for Excellence: http://www.scie.org.uk/publications/elearning/ipiac/index.asp

E-Learning Support for Inter-Professional Education in Health and Social Care (ELSIE):

http://www.health.heacademy.ac.uk/projects/jiscdel/del1_rlo

Centre for Inter-Professional e-Learning (CIPEL): http://www.cipel.ac.uk/

Table

Clark P. 2006. What would a theory of interprofessional education look like? Some suggestions for developing a theoretical framework for teamwork training 1. J Interprof Care 20(6):577–589.

Craddock D, O’Halloran C, Borthwick A, Mcpherson K. 2006. Interprofessional education in health and social care: Fashion or informed practice. Learn Health Soc Care 5(4):220–242.

Hean S, Craddock D, O’Halloran C. 2009b. Learning theories and interprofessional education: A user's guide. Learn Teach Health Soc Care Pract 8(4):250–262.

Hughes M, Ventura S, Dando M. 2004. On-line interprofessional learning: Introducing constructivism through enquiry-based learning and peer review. J Interprof Care 18:263–268.

Table

Compare the above discussion on the monopoly each profession has over a particular knowledge set, with the discussion earlier on social capital and the external resources held within the network that can only be accessed by other members of the interprofessional team through social interaction. Both these approaches are essentially talking about the same thing, although articulating this in two different ways. You may find one or other of these approaches assist your understanding of interprofessional education in your context.

Figure 2. An example of the creation of a terrain of care formed through the overlap of five regions of knowledge.

Comment Box 3. Using ALT models to develop an interprofessional education curriculum

Our interprofessional education lead at the University of Hope has done her homework by reading up and digesting the basics behind ALT. In doing so, she has identified two recent models of interprofessional education to illustrate how theory can be effectively used to inform curriculum development. The models chosen were the Seamless Care Model (Mann et al. 2009) and the University of British Columbia Model (Charles et al. 2010). For each interprofessional education model, she summarised the benefits of the theoretical frameworks used; associated factors that curriculum developers needed to consider; the instructional approaches used; and how they were implemented in each institution. The results of this exercise are presented as Tables 4 and 5. These examples illuminate the utility of theory in guiding curriculum development processes, aiming to provide students with a positive interprofessional learning experience that responds to stakeholders’ evaluations.

Our interprofessional education lead believes that by using learning and teaching methods based on educational theories and derived principles, University of Hope educators will become better interprofessional education facilitators. She believes that this will improve students’ knowledge, skills and attitudes towards interprofessional Education, resulting in better skilled practitioners who are capable of working collaboratively to provide patient-centred care and improved outcomes.

Comment Box 4. For discussion at the interprofessional education curriculum development committee's away day

Our interprofessional education academic lead plans her away day and prepares some points for discussion, exploring some of her experiences of resistance to interprofessional education and through a sociological lens.

If professional education plays a role in socialising students, socialisation into the values and characteristics of a particular profession, how can we best organise and enable our students to develop interprofessional values and characteristics; so, students learn both how to be a practitioner in their chosen profession and how to work interprofessionally?

We need to create the right circumstances for students in interprofessional learning groups to willingly share their own professional knowledge with students from other professions. How do factors such as control and power come into this and how can facilitators enable the necessary knowledge sharing?

Staff can feel very vulnerable when asked a question they do not know the answer to and this is likely to happen when facilitating interprofessional learning groups. What would resolve these issues?

Thinking back to our discussions about social capital and how not knowing about what other's know may inhibit knowledge transfer, what is the optimal way to organise interprofessional education so students can translate each other's knowledge where necessary and from there create new and shared knowledge?

Table

Bernstein B. 1971. Class, codes and control. Vol. 1. London: Routledge.

Clark P. 2006. What would a theory of interprofessional education look like? Some suggestions for developing a theoretical framework for teamwork training 1. J Interprof Care 20(6):577–589.

Freidson E. 1970a. Profession of medicine – a study of the sociology of applied knowledge. Chicago: University of Chicago Press.

Freidson E. 1970b. Professional dominance – the social structure of medical care. New York: Atherton Press.

Freidson E. 1994. Professionalism reborn: Theory, prophecy, and policy. Cambridge, MA: Polity Press.

Fournier V. 2000. Boundary work and the (un)making of the professions. In: Malin N, editor. Professionalism, boundaries and the workplace. London: Routledge.

Larson MS. 1977. The rise of professionalism – a sociological analysis. Berkeley: University of California Press.

Larkin GV. (2002). The regulation of the professions allied to medicine. In: Allsop J and Saks M, editors. Regulating the health professions. London: Sage. pp 120–133.

Table 4.  Seamless care model (Mann et al. 2009)

Component of theoretical framework (Mann et al. 2009)	List of benefits in components of the theoretical framework	Factors that need to be considered in each component of the theoretical framework	Instructional approaches used in this overall theoretical framework	Implementation of each instructional approach used in this overall theoretical framework
Social cognitive theory	– Provides learning opportunities through on-going dynamic reciprocal interactions of individuals, their behaviour and the environment. – Guides the development of interprofessional educational interventions to include consideration of factors affecting the learning context, teaching and factors contributing to the learners’ perceptions and experience. – Enables observation to inform curriculum development decisions via the use of role modelling and demonstrations. – Enables students, facilitators and service users to build self-efficacy through practice.	– The need to incorporate role models to demonstrate collaborative practices by the facilitators and in the locations selected for the students’ experiences. – The need to develop interprofessional educational tasks that allow students, facilitators and patients to build self-efficacy through practice.	(1) Active learning and experience in solving authentic problems	(1) Inclusion of service user groups with healthcare needs that require a collaborative interprofessional approach to their management and active service user participation to achieve desired outcomes.
				(2) Active involvement of learners in the framing of problems experienced by these service users and in working with them to develop and implement approaches to their solution.
			(2) Small-group collaborative practice experience and problem-solving	(3) Formation of small interprofessional student practice groups to facilitate collaborate learning experiences, involving all group members. Solving real problems experienced by service users affords experiential learning opportunities, developing students’ knowledge, skills and perceptions of self-efficacy.
			(3) Problem-based learning	(4) Presentation of a problem in the clinical setting by a real service user, generating a process of self-directed learning and its application to the problem.
Situated learning	– Facilitates learning through apprenticeship and active participation in the practices of a community of professionals. – Enables learners to be regarded as legitimate participants of the community, working from the periphery of the community towards the centre with increasing responsibility and involvement. – Facilitates learning via guided participation in the practices of the community, through which identity and meaning are developed.	– The need to provide learning opportunities that enable students to participate legitimately in existing communities of practice where collaborative models of practice had been established. – The need to provide support to enable students to establish their own community of practice conducive to developing knowledge and skills to provide interprofessional collaborative patient care.	(4) Opportunities for reflection and integration of learning	(5) Inclusion of opportunities for students to reflect on personal experiences, the content and process of their team's work and the outcomes achieved via seminars and discussions.
			(5) Cooperative learning	(6) Embodying key skills such as interdependence, face-to-face interaction, collective decision-making, individual accountability, interpersonal and small group skills, in the individual and group processes involved in the assessment and development of a collaborative patient management plan.
Constructivist learning theory	– Enables learners to construct their own personal knowledge and representation of the world, via building on past knowledge and experience to incorporate new knowledge. – Encourages learners to actively participate in learning. – Enables students to be provided with an authentic experience in a rich environment. – Offers students the opportunity to reflect and integrate learning.	The need to arrange the placement of student groups in collaborative settings, to promote an interprofessional understanding of service users’ care and their respective roles.

Table 5.  University of British Colombia Model of Interprofessional Education (Charles et al. 2010)

Component of theoretical framework (Charles et al. 2010)	List of benefits in components of the theoretical framework	Factors that need to be considered in each component of the theoretical framework	Instructional approaches used in each stage of this overall theoretical framework	Implementation
Transformational learning	– Takes into account the development of self, involving interaction with others. – Offers an opportunity to free people from the biases acquired during earlier learning experiences by engaging in learning opportunities that challenge their world view. – Encourages students to critically reflect, through discussions with others, to comprehend their own and others’ world views.	– The need to recognise that students’ learning experiences need to incorporate time and opportunity to comprehend current ways of collaborative working with others; and change behaviours. – The need to develop learning opportunities that encourage students to be critically reflective and participate in dialogue, in order to challenge existing attitudes and beliefs about their own profession and that of others. – The need to link the timing of the interprofessional education experience to students’ readiness to learn, taking into account the belief that change is incremental coupled with an apparent connection between a deep level of understanding and level of education.	Exposure stage. Junior level students participate in parallel learning experiences with peers from other professions via: (1) interprofessional conference; (2) social activities.	(1) Organising an interprofessional conference exposing students to peers from other disciplines and introducing them to the concept of interprofessional practice. (2) Encouraging the student body to organise interprofessional social activities promoting collaboration and interaction.
			(3) Health Care Team Challenge (HCTC) event, held before a large audience of peers, faculty and community practitioners, where two Teams of students are challenged to produce a collaborative case management plan within a specified time.	(3) Inviting students, staff and community practitioners to attend a HCTC event. Create two interprofessional student teams challenged to work on a case that has been provided by Faculty, and develop a collaborative management plan within an agreed time in response to a number of pre-determined questions put forward to them by a moderator. At the end of the event, arrange for both teams to be given feedback by community practitioners, and encourage all students observing the HCTC to reflect on their observations to inform their appreciation of interprofessional practice.
			(4) Student participation in a health outreach clinic, working in partnership with people with challenging healthcare needs and learning about other professions.	(4) Arranging for students to attend a health outreach clinic to work primarily under the supervision of clinical educators from their own profession. During this time, students are also exposed to the view of other professions via training sessions, team meetings and joint activities with the patient group.
Developmental theory	– Provides opportunities to keep our sense of self or to change, appreciating that interactions occur within our own personal history and sense of self, interpersonal interactions, and the cultural and social context in which we operate. – Recognises that the environment in which students are trained and the people with whom they interact can significantly influence their professional development. – Offers students through the systematic exposure to other professions, an opportunity to learn that there are other ways of seeing the world. – Broadens students’ perspectives, minimising communication issues and misunderstandings that may occur between health professions.	– The need to provide learning experiences that enable students to be challenged on an intrapersonal, interpersonal and interprofessional community basis within the broader learning environment. – The need to incorporate opportunities for students to interact with members from other professions during the course of their programme.	Immersion stage. Senior level students with more in-depth knowledge of their professions via: (1) Campus and practice placement experiences, enabling students to learn collaboratively with peers from other professions. (2) Students are offered opportunities for ‘self-reflection’ needed to transform their current perspectives on themselves, their professions and others.	Developing interprofessional learning opportunities, learning from (1) UBC's Interprofessional Rural Programme of British Columbia; and (2) the accredited Interprofessional Health and Human Service Courses.
				(1) Establishing a partnership programme between Universities, health authorities and other external stakeholders to facilitate the development of learning opportunities where students can practice interprofessional collaboration in rural interprofessional education community placements. Allocate interprofessional groups of between four and seven students to these placements where students can practice interprofessionally and meet profession-specific objectives. Supervised by an educator from their own profession students receive feedback on their collaborative and team-working skills from a range of professions.
				(2) Develop accredited modules, taught by a team representing different professions, that enable students to participate in campus- and practice-based learning opportunities. Provide students with opportunities to communicate with their peers, reflecting on interprofessional practice with people from a specified group.
			Mastery. Advanced level learning opportunities appropriate for graduate students with considerable experience. (1–3) The instructional approach used encourages advanced critical thinking skills, a high degree of self-reflection and an in-depth appreciation of the contribution of one's own and other professions in health and social care.	(1) Developing a certificate in Practice Education. The programme at UBC aims to develop practice educators capable of supervising students from their own and other professions. It utilises on-line learning experiences, requiring experiences in the practice setting and building on existing interprofessional skills in the focused role of an educator.
				(2) Providing graduate students with an opportunity to build on existing skills in interprofessional practice by enrolling on an interprofessional project. Such a programme at UBC is entitled the Interprofessional Psychosocial Oncology Distance Education Project (IPODE), involving students from a range of professions. These students, working in small web-based learning teams, are given education opportunities to improve their ability to provide interprofessional, collaborative patient-centred care in psychosocial oncology practice.
				(3) Awarding an annual prize to a practice team, demonstrating excellence in interprofessional teamwork and service delivery leading to improved patient care. The team has to be composed of at least three health disciplines and at UBC the prize is awarded at the HCTC, celebrating interprofessional practitioners.

Table A. 1. Pedagogical approaches and application in interprofessional education

Pedagogical approach	Further reading	Application in interprofessional education
Problem-based learning	An educational approach that aims to develop analytical and critical thought, cooperative and self-directed learning and the integration of knowledge and skills within the context of practice and self-motivation (Biley & Smith 1999, Newble 2002)	(Goosey & Barr 2002, Reynolds 2003, Hoffman & Harnish 2007)
Practice-based learning	The clinical integration of teaching to improve students’ knowledge, skills, attitudes and behaviour (Coomarasamy and Khan 2004); and in interprofessional education, promote future team-working by focusing on the quality of care for patients (Reeves & Freeth 2002, Guest et al. 2002)	(Guest et al. 2002, Reeves & Freeth 2002, Wakefield et al. 2006, Morison & Jenkins 2007, Young et al. 2007)
Guided discovery learning (GDL)	GDL refers to a context and framework for student learning through the provision of learning outcomes (Spencer & Jordan 1999). Here, the principle of what is to be learnt is not given, but rather the learners have responsibility for exploration of content and achieve understanding through self-directed study (Boydell 1976, Spencer & Jordon 1999).	(O’Halloran et al. 2006)
Experiential learning	Experiential learning, via for example the use of simulated ward environments, is a conflict-filled process, out of which comes the development of insight, understanding and skill (Kolb 1984).	(Ker et al. 2003, Issenberg & Scalese 2007, Swan et al. 2008, Dillon et al. 2009)
Reflective practice	The theory of reflective practice, attributed to Schon (1987), is a post-modern educational theory, emphasising relationships between knowledge and experience. It has been identified as a fundamental student centred and pedagogical approach used in all interprofessional education initiatives (Miller et al. 2006), and is considered to be an essential skill as a means of continuous change and learning (Schon 1987, Holme 1998).	(Campion-Smith & Wilcock 2000, Miller et al. 2006)

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