Push for Interprofessional Education Picks Up Steam

    • November 20, 2013

At Thomas Jefferson University in Philadelphia, interprofessional education isn’t just an academic buzzword. It’s built into the university’s strategic plan.

The university, which offers degrees in health sciences, founded the Jefferson InterProfessional Education Center in 2007 to set new educational standards for interprofessional education. The goal is to train health professionals to move out of their proverbial silos and work more collaboratively to deliver better, safer, and more patient-centered health care.

To do that, the center created curricula to ensure that students master core competencies of interprofessional collaborative practice. It also offers a “health mentors program,” in which students from various disciplines work together with a member of the community who has at least one chronic illness; educational collaborative practice opportunities in interprofessional “clinical rounding,” in which students from various professions discuss a joint plan for a patient; and team-based simulation training, in which students treat and assess patients together as members of health care teams.

“Our wish is to create so many interprofessional opportunities that our students will be able to select from a variety throughout their academic careers,” said Elizabeth Speakman, EdD, RN, CDE, co-director of the center and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2012-2015). “The long-term goal is that students, when they enter practice, will naturally assume those types of relationships and avoid the kind of ‘silo care’ that we often see today.”

The university is on the vanguard of a growing movement calling for interprofessional education at health professions schools. Proponents say this kind of education will prepare students to practice in coordinated, well-functioning health care teams, which will help meet increasing, and increasingly complex, patient needs. Ultimately, it will improve patient outcomes, streamline health care services, and help improve satisfaction among providers, they say.

Like the patients they serve, the nursing profession also stands to benefit. More collaborative practice will empower nurses, which will likely improve morale and job satisfaction, Speakman said. That may improve recruitment and retention, which could help curb a looming nurse shortage. “I can’t imagine it wouldn’t have a positive impact,” she said.

Gaining Traction

Health care experts have called for more team-based care for decades, but the movement has gained traction in recent years. “I’ve been in nursing for more than 30 years, and I’ve never seen this level of engagement occurring around this very important issue,” said Judith Halstead, PhD, RN, ANEF, FAAN, professor of nursing at the Indiana University School of Nursing and immediate past president of the National League for Nursing.

Barbara Brandt, PhD, the associate vice president for education at the University of Minnesota Academic Health Center and head of its federally funded National Center for Interprofessional Practice and Education, agreed. “It’s amazing how people are coming together,” she said. Health professions education programs “are making big changes” to incorporate interprofessional education into their coursework, she said. “We’re seeing institutions collaborate in new ways.”

The movement got a boost in 2010, when the Institute of Medicine (IOM) released a report on the future of nursing that called for interprofessional education and collaborative practice.

In 2011, the Interprofessional Education Collaborative released a report that articulated an urgent need for team-based care and provided a blueprint for action for educators and administrators. It identified four core competencies: an understanding of the values and ethics involved in interprofessional collaborative practice; knowledge of the roles and responsibilities of various health professionals; the ability to communicate effectively across disciplines; and experience working as members of teams delivering health care services.

In 2012, the Health Resources and Services Administration announced a $4 million grant to support the creation of the center on interprofessional practice and education at the University of Minnesota. Also supported by RWJF and other foundations, it is gathering evidence about effective practice and education strategies.

And in 2013, the IOM released a report summarizing two workshops that explored the link between interprofessional education and collaborative practice. The workshops were conducted under the auspices of an IOM-supported forum on innovations in health professions education.

Expanded Collaboration Among Accreditors

Also in recent years, health professions accreditors have been putting more emphasis on interprofessional education requirements and working together in unprecedented ways.

In 2009, the Accreditation Council for Continuing Medical Education, the Accreditation Council for Pharmacy Education, and the American Nurses Credentialing Center created a new joint accreditation program for continuing education for health care professionals. Designed to advance interprofessional education and collaborative practice among working professionals, it offers a unified, streamlined accreditation process. Since its launch, jointly accredited organizations have substantially increased the number of interprofessional educational activities they offer to professionals.

Continuing education accreditors in medicine, pharmacy, and nursing have been collaborating for 15 years. In February, they hosted “Interprofessional Accreditation in Support of Interprofessional Education: An Exploratory Meeting of Accreditors” in Chicago. The inaugural meeting brought together continuing education accreditors from a variety of health professions to identify areas of alignment among the accreditation systems and opportunities to support interprofessional collaborative practice.

Organizations that accredit nursing and pharmacy schools incorporated interprofessional education requirements into accreditation standards years ago, according to Polly Bednash, PhD, RN, FAAN, chief executive officer of the American Association of Colleges of Nursing.

But this year, the Liaison Committee on Medical Education, which accredits programs that grant MD degrees in the United States and Canada, wrote new language into its standards stating that the core curriculum of a medical education program “must prepare medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients.”

Bednash is “thrilled to see that medicine has come along here ... It’s one more piece of the growing focus on this.”

Also this year, the Commission on Collegiate Nursing Education (CCNE), an organization that accredits baccalaureate and graduate degree nursing education programs, put a greater emphasis on interprofessional education in its revised standards by incorporating the updated curricular essentials for master’s-level nursing programs. For years, CCNE has required programs at the baccalaureate, master’s, and doctoral levels to incorporate nationally accepted curricular essentials that address interprofessional competencies.

Accreditors from agencies representing three health professions—nursing, medicine, and pharmacy—have been meeting for several years to discuss the role they can play in putting a renewed emphasis on interprofessional education among health professions programs. But this year, the group expanded to include accreditors representing public health, osteopathic medicine, and dentistry. Accreditors representing all six professions met for the first time last month in Chicago to exchange information and share perspectives related to interprofessional education.

“It is important for our educational programs to embrace interprofessional education, but we can role model by embracing it ourselves and not working in silos as accreditors,” said CCNE Executive Director Jennifer Butlin, EdD. “We consider it a significant step forward to expand our group ... and we want to continue to meet to have this dialogue.”

RWJF Senior Program Officer Maryjoan Ladden, PhD, RN, FAAN, also called the meetings an “important first step” but said there is a long way to go before interprofessional education standards are fully embedded into health professions curricula. “We strongly encourage them to really look at what it would take on their part to move things forward in terms of making interprofessional education a standard, rather than an add-on or an afterthought.”

Fully integrated interprofessional education might look a lot like it does at Thomas Jefferson University, which has put standards in place to ensure that all graduates are able to “work together and collaborate in working teams,” Ladden said. That, she said, will improve patient outcomes and provider satisfaction, and reduce medical errors. “That’s the end game.”

Getting to meaningful collaborative practice won’t be easy, Bednash added, but “the challenge is being met by educators. Now the practice world needs to change the way people practice together.” And that involves sticky issues such as changing payment structures to emphasize bundled payments and value-based care. “It’s going to be very complex.”