Forecasting interprofessional education and collaborative practice: towards a dystopian or utopian future?

Introduction

There are professionals, some known as futurists, who are paid to predict the future even though it is a notoriously difficult and unreliable thing to do. Wittgenstein is quoted as saying: “I won’t say ‘See you tomorrow’ because that would be like predicting the future, and I’m pretty sure I can’t do that” (Drury, 1984). Yet here we are in this article considering the future of interprofessional education (IPE), which both of us have attempted in this journal before (Langlois et al., 2020; Thistlethwaite, 2008). There is a tendency when considering the future to state what we would like to happen (aspirational and typically utopian) rather than what is more likely to happen taking into account current trends and the lessons of history (speculative and more often than not dystopian). Predictions vary depending on their provenance. For example, higher-income and Western-facing jurisdictions’ future-gazing frequently assumes that personalized or precision medicine, based on genomic screening and targeted treatments, is the future of healthcare and will be widely available (see for example, Garvan Institute of Medical Research, 2017). The impact of the social determinants of health that affect lower- and middle-income jurisdictions, and the economically disadvantaged in their own higher-income countries, tends to be neglected.

Discussion

IPE is now accepted globally as an integral part of health professions education. There have been major gains in the last two decades to this effect, including development of an increasing number of interprofessional networks globally and dedicated interprofessional academic positions in universities (Xyrichis, 2020). However, recent history tells us that IPE’s penetrance into mainstream education is fragile, and its popularity waxes and wanes depending on funding and national commitment (Lawlis et al., 2014). Thus, an aspiration for the future needs to have a strategy for attainment and sustainability, or, to use the popular term, a roadmap. We stress here that the future of IPE cannot and should not be considered separately from the future of healthcare practice and delivery. In addition, we would also argue that health and social care should be integrated for the optimal well-being of a community.

Our future curricula should align with evolving health service models while also enabling a dialogue between universities as education providers and health-care settings as experience enablers. The health professions literature continues to highlight the difficulties in transition from knowledge building to practice: the translation of learning into clinical performance (Naumann et al., 2021). For many health profession students there remains a major gap between clinical experience pre-qualification and the first weeks or months as an accredited health professional (Graf et al., 2020). From our experience, and the work of colleagues, we know that difficulties in transition and unpreparedness may include: the varying nature of teams and teamwork depending on the particular clinical environment and the staff therein (Monrouxe et al., 2017); understanding how the local health system works and where novice health professionals fit into existing hierarchies; recognizing the cost of care for patients and communities and how this affects health outcomes and adherence; coping with uncertainty; and the wider collaborations and networking that function with varying degrees of success across health and social services (Reeves et al., 2018). There is a risk that IPE focuses on a narrow definition of teams and teamwork that does not enable students to observe, discuss and participate in the complexity of practice as enacted in their context.

The National Center for Interprofessional Practice and Education in the United States refers to the nexus as a means of bridging the gap between education and health-care delivery through the creation of a deeply connected, integrated learning system to transform education and care together (https://nexusipe.org/defining-your-nexus). Part of this work involves the promotion of high-value care as health-care costs continue to rise globally. High-value care, also known as value-based health care, is the provision of the best care possible, efficiently using resources, and achieving optimal results for each patient (Merriman et al., 2020; Razmaria, 2015). Resources here include health and social care professionals and a consideration of redefining roles, responsibilities and professional boundaries to rationalize management. High-value care, and indeed high-value education, informed by evidence and experience is likely to be a topic for every health professions curriculum along with an emphasis on the need to reduce environmental waste such as clinical supplies predominantly manufactured from plastic (Kleber & Cohen, 2020).

The call is growing for ensuring that health professionals learn about planetary health and the impact of climate change and pollution on health and disease (McDermott-Levy et al., 2019; El Omrani et al., 2020). This is a subject well suited to interprofessional discussion and collaboration (Global Consortium on Climate and Health Education, 2021). Future health professionals will have to grapple with the growing environmental and societal effects of global warming, and they need to be prepared.

It is difficult to speculate on how future technological advances will impact on IPE and health care, sorting science fact from science fiction. At the All Together Better Health Conference in Kobe, Japan in 2012, a robotics expert described the research into development of robot carers as one solution to Japan’s aging population coupled with a low birth rate. Collaborative robots with augmented intelligence, known as cobots, are now employed in various sectors to work with humans in shared workspaces (Walch, 2019). It is possible that a cobot as carer will become a member of an interprofessional team in the future, with increasing autonomy and communication capabilities – though only in high-income households. Students in high-income countries may learn with and through platforms that allow them to directly interact with knowledge and each other without the need for hand-held devices. There could be even less need to memorize “facts” and regurgitate them in written assessments of knowledge. Collaboration can be at the neural level: two or more minds learning together to work together to diagnose and manage ill-health. In relation to such advances, we need to be mindful of the health inequities among the global community (World Health Organization, 2018), such as we have seen with COVID-19 vaccines (Hunter et al., 2022), that may worsen in the next decades.

Much of IPE remains focused on enriching experiences for health profession students and in so doing building their collaborative competence. Interprofessional collaborative practice competencies are of course essential, though teaching these often relies on more traditional notions of professions and healthcare teams (Mink et al., 2021). The future composition of the healthcare team is uncertain, but it will likely look very different (Xyrichis & Ross, 2019). Across the world, new professional roles are emerging, tasks are shifting, and professions are being asked to expand their scope of practice (Fraher & Brandt, 2019). While discussions and initiatives on the future health workforce take place at policy level (European Commission, 2020; WHO, 2016), implications for collaboration at the level of everyday practice are rarely considered. To be sure, changes in the healthcare system of professions in the form of shifting jurisdictions are nothing new and have been ongoing for some time (Xyrichis et al., 2017). However, the global shortage of health workers, rising population health needs, and ever-present risk of new epidemics and pandemics have accelerated workforce changes at a pace rarely seen before (Goldman & Xyrichis, 2020). Health professional students of the future may find themselves working in new kinds of teams where previously established ways of working no longer apply. Indeed, they may find themselves needing to engage in a process of re-professionalization: re-think, reestablish, and re-assert their professional identities and roles within new kinds of teams.

Where there is a lack of certain professionals, a plasticity approach that allows for health professions to have overlapping roles and functions depending on the context may become the norm (Fraher & Brandt, 2019). IPE at pre- and post-licensure levels may then prove essential to avoid a return to fragmented and disjointed healthcare practices, and to prepare new and established professions for new kinds of collaborative entanglements. Skills, strategies and competencies of such re-professionalization are currently missing from many health professions curricula but may prove indispensable in future.

Conclusion

Dystopian or utopian, the future of interprofessional collaborative practice and consequently of IPE will likely be different than what any of us can envisage. In the new space created by technological advancements, resource constraints, greater integration of education and practice, planetary health concerns, and workforce changes the role of IPE will remain pivotal to helping health profession students navigate a rapidly changing world. While neither of us identify as a futurist, we do caution against complacency. Whatever the future holds there will be pressures on and expectations of interprofessional scholars. We trust the issues raised in this editorial help spark debates at all levels about the future of IPE and collaborative practice so we can start to prepare collectively for what lies ahead.