The organic and strategic growth of interprofessionalism in athletic training

Introduction

Interprofessional education (IPE) has been recommended to help promote collaborative patient-centred care (e.g. World Health Organization (WHO), 2008). The athletic training (AT) profession has long embraced the tenets of interprofessional practice (IPP) but many times was not included in discussion of IPE at the institutional, governmental, and international levels. As a result, the concept of IPE, which has been an emphasis in medicine, nursing, and other healthcare professions since the 1980’s has not been a part of AT programmes. While many health professions accreditors have integrated IPE competencies into their standards, little is known about how AT – a profession with historically less direct institutional alignment to the health sciences – can incorporated IPE into their programmes. In 2012, the Executive Committee for Education (ECE) of the National Athletic Trainers’ Association (NATA) authored the “Future Directions in Athletic Training” document which made recommendations regarding the evolution of AT (Executive Committee for Education, 2012). A strategy for the formal inclusion of IPE into AT was developed and implemented in order to inform the AT profession, peer professions, and other stakeholders about the importance of including IPE within AT programmes (Rizzo, Breitbach, & Richardson, 2014). This editorial summarizes the organic growth of interprofessionalism in AT and the strategic implementation of the recommendations, including additional opportunities as professional preparation in AT grows and evolves in the future.

The process

The NATA ECE began a process of developing the “Future Directions” document to give direction to AT education as the profession moved forward. The decision was made to include IPE in these recommendations (Executive Committee for Education, 2012). However, formal and informal data showed that AT educators did not have a high level of knowledge regarding IPE and so it was not widely implemented within many AT programmes (Breitbach & Cuppett, 2012).

A strategic process was developed to engage a wide variety of AT educators and clinicians in the development of a white paper to inform the profession on the foundation, terminology, and best practice regarding IPE and IPP. Additionally, it was seen that this process not only inform the AT profession, but also inform other groups about the importance of AT in interprofGessionalism, such as faculty/leaders from peer health professions, leaders at academic institutions, scholars in the interprofessional field, and stakeholders that influence public policy.

A call was made in September 2013 for interested individuals and 23 were selected for the project. Four work groups were subsequently formed to develop the following topical areas: background of IPE and IPP; the effect of IPE on AT programmes, students, and faculty; the effect of IPP on AT’s and their patients/clients; and best practice regarding pedagogy. In addition to the work group members, two individuals served as the coordinators and primary authors and two others served as reviewers for the final drafts of the paper. An effort was made by these individuals to focus on the paper as a whole and honour the integrity of the work done by the individual work groups.

The “Interprofessional Education and Practice in Athletic Training” white paper was finished in spring 2014. The paper was accepted by the NATA Board of Directors at their March meeting. The decision was then made to submit the white paper for peer review for publication in the Athletic Training Education Journal, where it underwent peer review, revision and was published in later in the summer (Breitbach & Richardson, 2015).

The product

The white paper serves as a comprehensive reference document to the AT profession regarding IPE and IPP. It also serves as an outstanding resource for other stakeholders on the importance of including AT in interprofessional initiatives. It begins by providing background information and insight into the history of IPE and IPP in healthcare. Also included is a comprehensive table of key interprofessional terminology.

In the paper, IPE is presented as a key method to promote understanding of “health professions’ scopes of practice, effective collaboration methods and potential patient benefits” (Breitbach & Richardson, 2015, p. 172). The paper also addresses the societal needs for IPE and IPP including recommendations by the WHO and the Interprofessional Education Collaborative (IPEC) Core competencies (IPEC, 2011; WHO, 2010). IPE is also seen as a continuum with three progressive steps, (1) interprofessional preparation which in turn drives (2) effective teamwork, which hopes to produce an outcome of (3) improved service and patient care. (Barr, Freeth, Hammick, Koppel, & Reeves, 2006).

The paper acknowledges that healthcare practice is transitioning to IPP and outcome based models, in which IPE can provide a vehicle to introduce the concepts of interprofessionalism and team-based care as outlined in IPEC (2011) core competencies. IPE can provide positive opportunities for professional socialization, strengthening the students own professional identity and their need to advocate for their role as a health professional (Lie, Walsh, Segal-Gidan, Banzali, & Lohenry, 2013). Early exposure to the roles of peer health professions can also promote a positive view of other health professionals (Hertweck et al., 2012). This can help create an understanding of how the knowledge, skills, and abilities they gain through their professional preparation can contribute to healthcare teams who share the objective of improved patient outcomes (Mueller, Klingler, Paterson, & Chapman, 2008). Indeed, future projections show an approximate 20% increase in demand for US health professionals (US Bureau of Labor Statistics, 2013). This increase in demand occurs at the same time that practice models are transitioning from uniprofessional, siloed practice to collaborative practice. A major benefit of IPE is that it is designed prepare entry-level professionals to be collaboration-ready by teaching and practising the skills required for IPP (Institute of Medicine, 2013).

Barriers to the implementation of IPE and IPP are also noted in the white paper. IPE barriers can include curricular capacity, strong uni-professional identities, lack of institutional support, and the challenges of pedagogy for large diverse classes (Breitbach & Richardson, 2015). It is important that the pedagogy be grounded in learning theory with well-coordinated interprofessional teaching teams (Reeves, Goldman, Burton, & Sawatzky-Girling, 2010). Curricular issues can be addressed through varied learning experiences, whether they are intra-curricular or extra-curricular. Institutional support is essential, but resource availability may not necessarily be a barrier (Breitbach et al., 2013). The white paper provides a pedagogy matrix of strategies listed on a continuum from low to high resource demands (Breitbach & Richardson, 2015).

The paper stresses that alignment of programmes in like academic units also provides for greater likelihood of success for IPE initiatives (Jones et al., 2012). Inclusion of AT programmes in these initiatives can provide students in the IPE programme exposure to AT as a health profession with a unique practice setting. IPE can therefore promote a greater understanding and respect between students in the health professions involved in the programme. It also can provide additional faculty resources for the IPE programme. A summary of key benefits and barriers of AT in IPE to students, faculty, and their institutions is also presented in the paper (Breitbach & Richardson, 2015).

The progress

The AT profession has made considerable progress regarding IPE and IPP since the inception of this process. It has become a consistent theme in major conferences since 2013 including keynote or featured presentations at two Athletic Training Educators Conferences, the Canadian Athletic Therapists Annual Meeting and the World Federation of Athletic Training and Therapy Meeting. In 2014, the NATA ECE began developing Member Interest Groups and the NATA IPEP Interest Group was the first. It is based as a LinkedIn group, with a Twitter feed. The IPEP Interest Group provides a structure for many different groups to have a voice on IPEP, dissemination and exchange of information on IPEP, and advocacy of AT involvement in IPEP initiatives. Research and scholarly dissemination is also growing in this with regard to IPE and AT programmes (Kraemer & Kahanov, 2014; Pole, Breitbach, & Howell, 2015).

In 2014, IPE was included in the Commission on Accreditation of Athletic Training Education (CAATE) Post-Professional Accreditation Standards (Commission on Accreditation of Athletic Training Education, 2014). The CAATE is in the process of revising its professional programme standards and it is hoped that IPE will be included in the next iteration of the standards. This is especially important considering that the Athletic Training Strategic Alliance which includes the NATA, the CAATE, the Board of Certification, and the NATA Educational Foundation announced in 2015 that within 7 years all professional programmes in AT must move to the master’s level (Athletic Training Strategic Alliance, 2015). This timing is important for inclusion of IPE in AT programme because over 300 bachelor’s level programmes will be revising curricula as they move to the master’s level. New CAATE standards would provide direction to these programmes and their institutions as they look to be involved in IPE initiatives.

Concluding comments

The AT profession is experiencing an evolution, finding its place among its peers in the health professions. In turn, its accreditation standards are changing to meet the needs of the changing profession. IPE provides many benefits to the profession, which has long engaged in IPP but has not historically been involved in IPE initiatives. There are many barriers to this involvement including psychological, sociological, and structural factors. Athletic Training needs to strive to make its implicit culture of dedication to collaborative practice more explicit through formalized incorporation of IPE in its professional preparation.

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of this article.