Breaking down professional barriersBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7465.s99 (Published 04 September 2004) Cite this as: BMJ 2004;329:s99
In health care, interprofessional education isn't just about having nursing and medical students being taught side by side in the lecture hall; it's more about allowing different professions to come together so that they can learn from and about each other, with the aim of improving collaboration and ultimately the quality of patient care. For example, participants from different health and social care professions might work as a team through a complex ethical dilemma or “near-miss” incident to generate possible solutions that incorporate a variety of professional perspectives.
Interprofessional education is said to be most effective when it occurs in small groups or interactive settings where participants can draw upon their different experiences and knowledge, and where they value the contributions of other professionals or students. In a sense, this takes place informally on a daily basis in most hospitals and primary care settings, but there are moves to incorporate this type of education more formally in undergraduate and postgraduate programmes.
Although interprofessional education in health care is not particularly new—in 1988 the World Health Organization saw it as a key area for development1—in the United Kingdom it seems to be gathering momentum. The new NHS “university” is keen to promote interprofessional working and learning, and the government is funding four “leading edge” pilot sites in England offering interprofessional education for undergraduate health and social care students.
When should interprofessional education start?
Should interprofessional education begin when students have developed a sense of professional identity, so that they can interact with future colleagues from a stable foundation? Or should we employ it as early as possible, before stereotypes are learnt and become embedded? The jury is still out on when best to introduce students to this mode of education, but perhaps the more worrying news is that stereotypes of medical professionals seem to exist even before the start of training.2 In other words, it's an uphill battle from the start.
But does it work?
Patients see many different professionals during their “patient journey.” It therefore makes sense that we should all be working together collaboratively and not pulling in different directions. But what's the evidence that interprofessional education actually makes a difference and achieves the ultimate goal of improving patient care? Is the evidence robust? And if not, should we be so willing to embrace it? Evidence for the effectiveness of interprofessional education is weak and is particularly lacking at the undergraduate level.2 One study from St George's Hospital Medical School and Kingston University actually found that medical, radiography, physiotherapy, and nursing students ended up with even more stereotyped views of each other after taking a course in interprofessional education—hardly the desired outcome. It seems that interprofessional education has been accepted as a good thing by the powers that be and we are now scrabbling around trying to find the evidence to back this up. But is this a sensible way forward?
Necessary conditions for interprofessional education to be effective4
Syllabus relevant to all those involved
Taught at level that is understandable, but interesting to all
Use of small groups and interactive forums
Participants must be secure in their respective professional identities
Participants must feel themselves to be on an equal footing
If the evidence is weak, then why is interprofessional education such a favourite with the UK government? Sheffield's project states in one of its newsletters, “Although long term impact on service delivery is as yet speculative, interprofessional learning is considered a key component of the government's modernisation agenda.”3 The answer may be more to do with political imperatives than a measured, evidence based approach.
It might be that interprofessional education is so attractive to the government because it encourages colleagues to explore and understand each other's roles and responsibilities and therefore may counter resistance further down the line when professionals are asked to renegotiate their traditional working patterns and duties.
But perhaps this is to read too much into the drivers for interprofessional education of tomorrow's caring professionals. The idea of putting patients first, and building services and professional roles around their needs (rather than meeting the approval of health workers), seems a laudable aim.
And if learning from and about our colleagues can help achieve a truly patient-centred health service, then that's surely something we would all want to support. It would just be nice if we had a little more evidence first.
Go to web extra at bmjcareers.com/careerfocus for references and more information about pilot sites for interprofessional learning