Steering the development of interprofessional education

Introduction

The UK Centre for the Advancement of Interprofessional Education (CAIPE) grounds its latest Interprofessional Education Guidelines (CAIPE, 2016) in its Statement of Principles (CAIPE, 2011), building on the experience of its members and the interprofessional movement nationally and internationally, findings from recent UK research (e.g. Barr, Helme, & D’Avray, 2011, 2014), and evidence from systematic and scoping reviews (e.g. Reeves et al., 2016). In this editorial we summarise, with CAIPE’s permission, selected sections of the Guidelines, specifically: understanding interprofessional education, implementing interprofessional learning, formulating outcomes, adapting teaching and learning methods, learning for practice, assessing learning, involving students, involving service users and their carers, minding resources, being cost-effective, aligning learning, aligning regulation, evaluating interprofessional education, and transforming professional education from within.

The guidelines are addressed, in the first instance, to UK organisations responsible for commissioning, developing, delivering, evaluating, regulating, and overseeing interprofessional education (IPE) during prequalifying and continuing professional education to inform consistent policies, practices, and procedures to ensure efficient, effective, economic, and expeditious planning and implementation of IPE interventions and strategies. Messages may resonate more widely.

CAIPE interprofessional education guidelines

Understanding interprofessional education

IPE enables two or more professionals to learn with, from, and about each other to improve collaborative practice and quality of care (CAIPE, 2002). Well planned and conducted, it can promote flexible, coordinated, complementary, patient–centred, and cost-effective collaboration in interprofessional teams.

The statement of principles enshrines and extends those for adult learning. Responsibility for managing the learning rests not only on the individual but also on the group whose members as a community of practice explore how each can contribute to a process of socially constructed learning as they reflect on new experiences from different perspectives, align their values, and integrate their observations into logical theories in decision-making and problem-solving (Barr & Gray, 2013; Kolb, 1984; Lave & Wenger, 1991; Wenger, 1998).

Prequalifying IPE can create opportunities to explore ways in which professionals can work more closely together to respond more fully, more effectively, and more economically to multiple and complex needs while heightening students’ appreciation of safe and good practice. Learning together can cultivate mutual awareness, trust, and respect, countering ignorance, prejudice, and rivalry. Interdependence in learning may pave the way for interdependence in practice.

Ideally, prequalifying IPE is the first step from induction and orientation into advanced, specialist and changing roles along a continuum of interprofessional development (CIPD) woven into the continuum of professional development (CPD). Realistically, much remains to be done to achieve that goal.

The collaboration for which IPE prepares is more than cooperation. It is planned, purposeful, concerted, and sustained endeavour within a defined legal and policy context to ensure comprehensive provision of quality care which transcends demarcations between professions, between practice settings, and between organisations. Students can learn to empower each other in a nurturing and mutually supportive environment to collaborate flexibly, economically, expeditiously, and effectively across predetermined professional boundaries.

Appraising policy and practice critically from interprofessional perspectives can alert students to the need for closer collaboration to improve care and services. They may discover that integrating services is not enough to deliver better care unless and until the professionals are actively, positively, and collectively engaged, mediating the application of policies to practice, countering unintended consequences, resolving rivalries and conflicts, pulling together for the good of those whom together they serve.

Implementing interprofessional learning

IPE is best planned jointly at every level closely involving educators from all the relevant professions with practitioners, managers, students, service users, and carers. Much can be learnt by comparing and contrasting IPE interventions and strategies, but one size does not fit all. Each planning group has to find its own solutions allowing time and opportunity to reconcile differing expectations.

Formulating outcomes

Composite benchmarks (QAA, 2006) set overall standards before programme planners formulate competency or capability-based outcomes (Canadian Interprofessional Health Collaborative, 2010; Combined Universities Interprofessional Learning Unit, 2010; Interprofessional Education Collaborative Expert Panel, 2011). The use of outcome-led curricula leaves educators and students an opportunity to develop teaching and learning content and methods in response to their particular needs and interests (Barr, 1998; Reeves, 2012).

Adapting teaching and learning methods

A range of learning methods have been adopted and adapted from professional for interprofessional education from which educators choose (Barr, Koppel, Reeves, Hammick, & Freeth, 2005). Experienced educators may well change them as students’ needs evolve and to hold their interest. No one method suffices. Whichever are selected they should be active, interactive, reflective, and patient centred.

Learning for practice

Interprofessional practice learning is more robust when universities and practice agencies enter into mutually beneficial agreements ensuring, on the one hand, that IPE placement experiences are available in the necessary numbers to the required standard and, on the other hand, that practice educators are prepared, supported, and valued.

Relying on students to identify the interprofessional learning opportunities for themselves falls short. Practice-based educators may assemble those opportunities with university-based educators. Together, they can generate collaborative and team-based opportunities for co-located students (Barr & Brewer, 2012). A well-planned sequence of placements progresses from observation to hands-on, team-based practice.

Technologically enhanced learning has been widely adopted in IPE, e.g. reusable “learning objects” accessible online (Gordon, Booth, & Bywater, 2010), “virtual communities” (e.g. Quinney, Hutchings, & Scammell, 2008), and simulation where students comprising an interprofessional team practice their respective interventions together around a manikin (Boet, Bould, Burns & Reeves, 2014; Thomas & Reeves, 2015). But technologically enhanced learning must not replace practice-based learning, however hard it may be to find enough suitable placements.

Assessing learning

Assessment of students’ IPE should be based on demonstrated competencies for collaborative practice. It may be formative, but students and educators are more likely to value assessment that is summative towards professional qualifications. Some students may be required to demonstrate interprofessional outcomes when completing profession-specific assessments. Procedures, criteria, and credits should be consistent across professions and across courses (Wagner & Reeves, 2015).

Involving students

There is growing evidence for providing IPE for all health and social care students during their prequalifying courses (Reeves et al., 2016). Pressure can build to include an open-ended list of professions as IPE gains popularity. Depending upon the configuration of professions engaged in collaborative practice, some universities are extending IPE beyond health and social care to include, for example, students from sports and leisure, school teaching, law, probation, and police. Choices may, however, be constrained by the range of professionals studying in the same location, eased sometimes by assembling the preferred mix across sites, schools, or universities.

Students often respond more positively, and more readily see relevance, when they are learning with professionals with whom they anticipate working after qualifying. That can be difficult to arrange where those professionals are taught in different universities or at different levels, i.e. prequalifying and post-qualifying. The absence of one or more professionals whose role is pivotal in collaborative practice may make the IPE seem less relevant, however carefully educators may try to compensate.

Limits must, however, be set. A narrowly elitist definition, restricted to the established professions, excludes many whose engagement in collaborative practice is essential, with much to give and gain during IPE. Conversely, an egalitarian definition which blurs the boundary between professionals and other occupational groups may optimise student mix for collaborative practice, but detract from the search for shared professional values, dissuade more established professions from participating, and limit learning opportunities.

Educators engage students as adult learners. That may run counter to students’ prior experience at school or university. They may need help in letting go of deferential and hierarchical styles of learning where the teacher was the unchallenged authority, before being ready to embrace egalitarian, democratic, and socially constructed learning. They may need help also in relinquishing assumptions about professional relationships and hierarchies colouring reciprocal perceptions in the student group. Preparation is essential for students to understand the IPE process and their educators’ expectations.

Involving service users and their carers

Service users and carers should be at the centre of IPE. At the lowest level of involvement, they may simply be the person with whom a group of students work. At higher levels, they may work alongside educators to design learning, teach, select, mentor and assess students, and review the IPE (Anderson & Lennox, 2009; Cooper & Spencer-Dawe, 2006; Furness, Armitage, & Pitt, 2011; McKeown, Malihi-Shoja, & Downe, 2010).

Considerations that need to be borne in mind include: the relevance of service users’ and carers’ experience to students’ learning needs; their readiness to share personal matters; and their vulnerability. Service users are more effective in their teaching roles, more confident, and more at ease when they have preparation and ongoing support from the educators.

Minding resources

Small group teaching, on which effective IPE relies, needs an ample supply of comfortably appointed syndicate rooms ensuring privacy to discuss confidences. A large lecture theatre may also be needed for interprofessional groups to come together for shared didactic teaching. Access to clinical skills laboratories is critical to enable all the students to engage in simulated IPE. Libraries need to stock interprofessional texts, journals, and learning materials for the benefit of students and teachers (Nordquist, Kitto, & Reeves, 2013).

Being cost-effective

Investment needed to plan an IPE strategy is repaid when cost-effective educational systems result and returned with interest when it drives collaborative practice leading to more efficient and more economic delivery of care (Berwick, Nolan, & Whittington, 2008). Small group learning carries a price tag offset where agreement is reached and logistics resolved to combine lectures for core subjects across professional programmes. Technologically enhanced learning can also result in savings once the initial outlay has been met. IPE strategies that reinforce community-based care result in savings where they reduce or delay hospital admissions and expedite discharge planning.

Aligning learning

Misalignment between the professional courses can frustrate best made plans to weave the interprofessional teaching and learning sequentially, logically, and progressively into each. Coordination and commitment are needed within and sometimes between universities to synchronise systems and structures to accommodate not only timetabling and placement patterns but also assessment procedures and criteria. Misalignment between classroom, placement, and virtual environments can result in disjointed learning leaving the students to make connections with difficulty; compounded when more than one university sends students to more than one practice agency. Universities and agencies need to agree plans that reconcile requirements and structures for placements (Anderson, Cox, & Thorpe, 2009; Long, Dann, Wolff, & Brienzabc, 2014).

Aligning regulation

Misalignment between regulatory systems can result in costly duplication of effort in the preparation of review material in response to different requirements at different times resulting in conflicting advice and decisions, and missed opportunities for comparative critique. Requirements and procedures differ between universities internally and between regulatory bodies externally rendering it difficult to ensure that procedures and criteria are consistent, coherent, and comparable. Efforts have been made between regulatory bodies to conduct reviews concurrently for those professional courses including the same IPE strategy thereby facilitating comparative critique of process and outcomes. The dividends outweigh the difficulties.

Evaluating interprofessional education

Universities expect educators to monitor and report IPE interventions. Some educators go further, engaging in systematic investigation sometimes included in research leading to higher degrees. A recently published Journal of Interprofessional Care Practice Guide formulates the evaluation questions (Reeves, Boet, Zierler, & Kitto, 2015). Relatively few IPE interventions are subject to independent and external research. Available funds may best be protected to evaluate innovative pilot approaches that may merit wider adoption (Freeth, Reeves, Koppel, Hammick, & Barr, 2005).

Transforming professional education from within

From the outset, the World Health Organization (WHO, 1973) invoked IPE as the means to reform professional education. Returning to that theme (WHO, 2013), it envisaged that a transformative professional educational system for health professionals could be achieved through IPE by activating the case championed by the Lancet Commission (Frenk et al., 2010).

Concluding comments

We took care throughout the preparation of the guidelines to ensure that they reflected the perceptions of IPE enjoying broad-based support amongst its UK stakeholders, to be tested against scholarly critique and evidence. We were at pains not to stray across the fuzzy line between guidelines and requirements. Our task was to inform, steer, and advise, leaving commissioning and regulatory bodies to decide when and how to translate within their respective statutory duties, and universities and their service partners to apply in education and practice.

Initial responses confirm that the guidelines are being welcomed in that spirit. They are being discussed by CAIPE Board members with IPE-active universities and relevant central bodies in the four UK countries. Regulatory bodies for the health professions have assured CAIPE that the guidelines will be taken into account when they next revise related professional and interprofessional education requirements. Health Education England has invited CAIPE to work with it during a rolling programme of developmental work, while the Professions’ Standards Authority has indicated that it will be taking IPE and the guidelines into account during its forthcoming UK review of health professions’ regulation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.