Interprofessional science: an international field of study reaching maturity

Introduction

For the past twelve months I have managed to resist my Editor-in-Chief privilege for Editorials, in order to allow space for the many high-quality and innovative pieces our community has chosen to publish in this Journal. However, the dawn of a new decade presents too great a temptation. In this Editorial I examine recent developments in interprofessional practice and education, alongside some persisting challenges, to conclude that over the past three decades interprofessional scholarship has been moving steadily toward a state of maturity that is now nearing our grasp. I submit that our knowledge is being gradually consolidated into a unified field, which I refer to here as Interprofessional Science, a term I chose to denote continuous progress toward: a scientific field of study devoted to advancing pedagogies, applied processes and research methods to promote uptake and evaluation of interprofessional collaborative approaches in health and social care education, practice and research; contributing to patient-centered, quality, safe, sustainable and resilient health systems.

Interprofessional developments

A decade ago, our former Editor-in-Chief, the late Professor Scott Reeves, identified five ideas for the development of the interprofessional education and practice field:

1. Employ more observational work to generate data related to the interactive processes which actually occur during interprofessional activities – learning, facilitating and collaborating – rather than relying on individuals’ perceptions;

2. Gather longer-term outcomes to provide a better understanding of the translation of interprofessional activities into collaborative behavior, enhanced practice and the delivery of care;

3. Undertake economic analyses of interprofessional education and practice activities to begin to generate data and insights into their respective costs and benefits;

4. Move beyond single-site studies, to engage with colleagues in other organizations and undertake multi-institution studies that will provide broader empirical inferences that can build a more comprehensive and compelling evidence base;

5. Ensure that theoretical perspectives become a core part of the work which is undertaken to develop and study interprofessional education and practice activities. Also, that such work begins to problematize our everyday assumptions in order to generate a more critical approach to understanding the field (Reeves, 2010).

Reflecting a few years later (Reeves, 2016) he noted positive movement in all five directions, although cautioned our field is still young and the need to grow our evidence base remains a priority. The above five ideas remain as relevant today as they did then; even though the last few years have seen significant movement, development and international growth of our field. Below I summarize some highlights.

Interprofessional scholarship

The scholarship of the interprofessional field has grown significantly to represent diverse research methodologies and approaches focusing on students, practitioners and organizations. This led to substantial advances in the pedagogy of interprofessional education as well as innovations in collaborative practice (for the most popular papers of 2019 see, Cohen, Fletcher, Hood, & Patel, 2019; Forbat, Mnatzaganian, & Barclay, 2019; Lee, DeBest, Koeniger-Donohue, Strowman, & Mitchell, 2019). One indicator for this proliferation in interprofessional research activity can be gleaned from the increasing submissions to this Journal, now hailing from over 50 countries. More importantly, this work is used to inform everyday academic and clinical practice with over a quarter of a million downloads per year.

The portfolio of publications in the Journal has diversified, with each issue now including: Interprofessional Education and Practice Guides, that share lessons and practical advice for those wishing to develop new or grow existing initiatives; Original empirical articles, that report on rigorously conducted studies of experimental, observational, qualitative and mixed-method designs that advance the scholarship of the interprofessional field internationally; Systematic, realist, qualitative and scoping reviews that consolidate knowledge, generate collective insights and set directions for future research; Short reports, which disseminate education and practice innovations, report on work in progress, or recently completed compelling research; and Guest editorials to encourage debate among the interprofessional community on important matters for interprofessional health and social care. Exciting developments for 2020 and beyond are afoot, including some long-awaited special issues, to be introduced in forthcoming editorials.

Consistency and diversity

Success and growth are not without challenges, specifically with regard to striking a balance between consistency and diversity of outputs. While creativity and innovation must be encouraged, an element of consistency is inevitable if the field is to move forward systematically. One way to improve consistency and quality of reporting is through consulting standard reporting guidelines, conveniently collated by the EQUATOR network (Simera et al., 2010, www.equator-network.org). This includes guidelines for reporting systematic reviews, scoping reviews, qualitative and quantitative designs, simulation studies, and more. Moreover, the reporting of interprofessional interventions, educational interventions in particular, continues to present a challenge. One way to improve the reporting of such interventions could be through using the Replicability of Interprofessional Education (RIPE) tool (Abu-Rish et al., 2012, https://collaborate.uw.edu/calendar/demo-event-1/abu-rish-2012-appendix-g-ripe-tool-12-11-11/), uptake of which has been limited so far.

Confusion over terminology remains a concern, although consistency has improved. Interprofessional education definitions by the Center for the Advancement of Interprofessional Education (Centre for the Advancement of Interprofessional Education, 2019) and (World Health Organization, 2010) are increasing in uptake, as are definitions of different kinds of interprofessional activity, namely teamwork, collaboration, coordination and networking (Xyrichis, Reeves, & Zwarenstein, 2018). Later this year a Guest editorial in this Journal will focus on the development of a common terminological framework for the interprofessional field, which will go a long way toward enhancing our ability to communicate, synthesize and accumulate knowledge moving forward.

Internationalization

The interprofessional education principles reinforced on health professions students – learning with, from and about each other – permeate the field and are also present in health professional practice, continuous education and research. Commitment to these principles also guide international developments, where emerging regions not only learn from more established ones but also contribute new knowledge and perspectives. Two themed issues in 2019 exemplify this approach, with one showcasing interprofessional initiatives from Sub-Saharan Africa (Botma & Snyman, 2019) and the other collating international experiences concerning the interprofessional workforce (Tomblin Murphy, Gilbert, & Rigby, 2019). This body of work from across the world is very impressive indeed, both for its conceptual contributions and the diversity of experiences it introduces to the interprofessional field. Reading and reflecting on the papers in these themed issues, and the many more papers published in regular issues over the years, one conclusion is inevitable: as an international field, our work shows more similarities than differences; and at the face of common challenges, we have more issues bringing us together than pushing us apart. As we concluded in an earlier editorial:

[…] Different parts of the world are vulnerable to different socioeconomic pressures, opportunities and challenges, but at a fundamental level we are more similar than different. Changes in health and illness patterns, the ageing of the population, rise in chronic conditions, multimorbidity and non-communicable diseases demand new models of health and social care centred around patient and community need. Combined with a global shortage of health and social care workers, the way we currently deliver care may be unsustainable in the long run. This realisation opens up spaces for a dynamic reconfiguration of professional responsibilities, with the creation of new roles and potentially the decommissioning of others. It is partly through this current state of flux, stemming from the need to innovate and evolve care delivery, that the interprofessional field gets its impetus (Xyrichis & Ross, 2019, p. 273).

Networking

In the years following the Lancet Commission on health professions education (Frenk et al., 2010) and the World Health Organization framework for action on interprofessional education and collaborative practice (World Health Organization, 2010), scholars across the globe have embraced the potential of this movement initiating developments at scale. National networks for the promotion of interprofessional education and practice have grown and flourished in different regions, generously supported with advice and experience sharing by the more established organizations such as the Center for the Advancement of Interprofessional Education (CAIPE) in the United Kingdom, and the Canadian Interprofessional Health Collaborative (CIHC). Examples of significant emerging networks include REIP in South and Central America, IndIPen in India and AfrIPEN in Sub-Saharan Africa. In 2012, we also witnessed the birth of the National Center for Interprofessional Practice and Education in the USA, which has spearheaded practical developments while nurturing interprofessional scholarship across the fifty states. In showing genuine collaborative spirit, these diverse organizations came together, joined by many more, under their common vision to form the Global Confederation for Interprofessional Education & Collaborative Practice (Interprofessional.Global). Attention from policy makers has followed suit, with interprofessional education and collaborative practices in health and social care now appreciated as paramount in most national and international developments for achieving quality and safety, strengthening health service delivery systems and achieving universal health coverage (see for example, World Health Organization, 2016; Pan American Health Organization, 2017, National Academies of Sciences, Engineering, and Medicine, 2018).

Conclusion

Interprofessional scholars internationally are making strides in advancing the field, and developments are too many to list in a short editorial, but collectively these all point to a young field rapidly reaching maturity. Here, I suggested this maturing field as Interprofessional Science: the scientific field of study devoted to advancing pedagogies, applied processes and research methods to promote uptake and evaluation of interprofessional collaborative approaches in health and social care professions education, practice and research; contributing to patient-centered, quality, safe, sustainable and resilient health systems.

The potential of the interprofessional field is limitless and its international growth inevitable. Interprofessional, international collaborative efforts are more important than ever to ensure coordinated and focussed conceptual and practical advancements that consolidate and extend our knowledge base. Current trends suggest we are steadily moving toward a new era of health and social care, where interprofessionality is the new normal and old uniprofessional ways something to look back on with puzzlement. The future of interprofessional care is exciting albeit unpredictable, but if the last three decades are anything to go by then great innovations are expected that, ultimately, can contribute to better health and social care, for all.

Acknowledgments

Sincere thanks are due to the Journal Editorial Board for their unwavering support of our interprofessional community of authors. Special thanks to our peer-reviewers, without whom the quality of our Journal could not be sustained.

Disclosure statement

AX is the Editor-in-Chief of the Journal of Interprofessional Care, a Board Member of the Centre for the Advancement of Interprofessional Education, and steering committee member of the King’s Centre for Team-based Practice & Learning in Health Care. He is recipient of research funds from the National Institute of Health Research, the Guy’s & St Thomas’ Charity and King’s College London. Views expressed here are those of the author and not necessarily those of the affiliated organisations.