Elsevier

Nurse Education Today

Volume 29, Issue 3, April 2009, Pages 276-283
Nurse Education Today

Developing inter-professional learning: Tactics, teamwork and talk

https://doi.org/10.1016/j.nedt.2008.09.006Get rights and content

Summary

Teamwork and collaboration between all health professionals results in high quality clinical care, and increased job satisfaction for staff. Encouraging inter-professional learning (IPL) may be advantageous in developing more effective teams. There is little rigorous research in this area, but many small uncontrolled studies do demonstrate positive results. IPL involves structured learning opportunities that enhance problem-solving abilities and conflict resolution. It should be clearly differentiated from shared teaching (or multidisciplinary/multiprofessional learning), where common content is taught to many professions without any intention to develop interaction. To counteract the sometimes negative attitudes in both students and staff, educators need to commence IPL early in the programme, base it in both theoretical and clinical placements and ensure that it is valued and assessed. Difficulties with timetabling and accommodation need to be solved prior to commencement. A facilitator should be employed, and a team of committed lecturers developed, with an emphasis on teamwork and the discouragement of individualism. Opportunities for student interaction and ways of improving group dynamics within non-threatening learning environments should to be sought, and instances of conflict embraced and resolved. Future IPL programmes should be rigorously evaluated and may demonstrate enhanced inter-professional relationships and improved quality of patient/client care.

Introduction

To ensure high quality outcomes of clinical care, teamwork and collaboration between all health professionals is essential (Payne and King, 1998, Chaboyer and Patterson, 2001, McPherson et al., 2001), as patient or client care given by any one professional on their own can never be as good as care given by a full team. Health care professionals, who understand each others’ roles and can work effectively together, have been shown to provide higher quality care (Barnsteiner et al., 2007). In addition, members of efficient and collaborative teams experience higher levels of job satisfaction (Chaboyer and Patterson, 2001, Dechario-Marino et al., 2001).

Given these findings, we need to examine how best to prepare health care professional students for effective teamwork. Intuitively, one would surmise that encouraging all health professionals to learn together would be advantageous in developing more effective teams, with proven benefits for patients, clients and staff alike. However, there is little hard evidence to show that the immense effort that goes into developing inter-professional programmes actually has any effect. The plea for an increase in inter-professional education, practice and research is an international issue, with one review (Lavin et al., 2001) identifying 51 articles from across the globe that contribute to this debate. The first Cochrane systematic review on the topic (Zwarenstein et al., 2001), found 89 studies that examined this area, but none were sufficiently rigorous to demonstrate any significant impact of inter-professional learning (IPL) on either health care outcomes or practice. One year later the review was updated (Reeves, 2001), and six more studies were found that could be included; however, the results were variable. In 2008, the review was updated again (Reeves et al., 2008), with no further studies of a suitable quality added, which is an interesting finding given the number of published papers in the last decade describing initiatives world-wide in IPL. As there is still insufficient evidence to support or refute the recommendation to use IPL, we must fall back upon our intuition and the results of many small, uncontrolled studies.

Certainly, there are a number of committed academics and organisations that believe firmly in the benefits of IPL. The National League for Nursing (NLN) in the United States of America (USA) is one such organisation, that states that if people are going to practise together when qualified, they should be educated together also, so that they realise their common goals (National League for Nursing, 1998). They have delineated a package of core content for shared learning among all health care professionals that includes: behavioural sciences, community health, death and dying, health informatics, nutrition, ethics, interpersonal communication skills, teamwork skills and professionalism (National League for Nursing, 1998). This is helpful, not only as a guide to topics that may be taught, but also because it provides a list of issues that will give beneficial discussion opportunities for students, which is useful for exposing them to the attitudes and opinions of a wide variety of other people, from different professional backgrounds.

It is important to differentiate between shared teaching and shared learning, as the two stem from a very different ethos. Shared teaching, (or multidisciplinary/multiprofessional learning), is the teaching of common content to a number of professions, usually in a large group, without any intention to develop teamwork or interaction (Barr, 2001). It is an arrangement usually entered into for economic rather than sound educational reasons (Horsburgh et al., 2001) and may not provide any appreciable benefits (Singleton and Green-Hernandez, 1998). At worst, if there is no class discussion and the students arrive and leave together in their own discipline-specific groups, they will not even meet or become familiar with the other student groups.

Shared learning is true inter-professional learning, which involves a structured learning process with planned learning opportunities that enhance team working skills, including problem-solving abilities and conflict resolution (Cooper et al., 2001). The aim has been described as “to develop adaptable, flexible, collaborative team workers with high level interpersonal skills, who understand the contribution each health profession makes to patient and health outcomes” (Horsburgh et al., 2001, p. 877). Because of this, the emphasis is not so much on learning topics such as biological sciences or health promotion, but on developing teamwork and problem-solving skills, and the focus should be on this objective from the commencement of the programme (Horsburgh et al., 2001).

Section snippets

Development and evaluation of inter-professional learning programmes

Despite the fact that there is little or no robust evidence to show that inter-professional education is effective (Cooper et al., 2001, Reeves et al., 2008) the consensus view of academics world-wide appears to be that it should be encouraged (Atkins and Walsh, 1997, Barr et al., 1999, Jiffry, 2002, Clinton et al., 2006). Pilot programmes have been introduced in the USA (Buck et al., 1999, Rodehorst et al., 2005, Selle et al., 2008), Canada (Banks and Janke, 1998, Kearney, 2008), Australia (

Commence inter-professional learning early in the programme

It has been suggested that IPL is not successful until the later stages of the programme, when each health care student fully understands their role (Mariano, 1999). That is an understandable view, and certainly most role-play situations, team problem-solving or discussion of intricate inter-professional clinical scenarios are best left until the more senior years. It is important, though, to introduce collaborative working early in first year (Parsell et al., 1998), while teaching more

Meet the challenges

There are many technical and administrative challenges to overcome in organising IPL, especially when a number of disciplines are included (Parsell et al., 1998). Usually large cohorts are involved, with differing accreditation requirements, so that discussion is often necessary to reach a consensus or compromise view of suitable shared course content. Timetabling can be difficult, and there is usually a lack of suitable facilities to teach large groups together and the numerous small groups

Improve the learning environment

A non-threatening learning environment should be created, to encourage inter-professional communication and to build confidence (Godson et al., 2007), as students who feel embarrassed or nervous will not contribute to discussions. Using an interactive style, giving high quality feedback and preserving a positive culture in the learning environment all enhance learning (Victoroff and Hogan, 2006).

Increase student interaction

Collaborative working implies that team members are interdependent, and have mutual respect and

Conclusion: moving towards successful inter-professional learning

The literature demonstrates insufficient research to provide a convincing argument either for or against inter-professional learning. However, given the world-wide involvement in this technique, it would appear to be an educational development that should be encouraged. To facilitate this, the motivational tactics, ideas for development and maintenance of teamwork and good communication skills within the teams described above will, coupled with enthusiasm from you, the readers of this paper,

References (81)

  • S.N. Mhaolrúnaigh et al.

    The preparation of teachers for shared learning environments

    Nurse Education Today

    (1998)
  • S. Miller et al.

    Certified nurse-midwife and physician collaborative practice. piloting a survey on the Internet

    Journal of Nurse-Midwifery

    (1997)
  • P.A. Payne et al.

    A model of nurse-midwife and family physician collaborative care in a combined academic and community setting

    Nurse Midwifery

    (1998)
  • S. Reeves et al.

    Emerging themes: an exploratory research project of an interprofessional education module for medical, dental and nursing students

    Nurse Education Today

    (1998)
  • T.K. Rodehorst et al.

    Use of interdisciplinary simulation to understand perceptions of team members’ roles

    Journal of Professional Nursing

    (2005)
  • D. Salmon et al.

    Shaping the interprofessional agenda: a study examining qualified nurses’ perceptions of learning with others

    Nurse Education Today

    (2001)
  • S. Seren et al.

    Conflict resolution skills of nursing students in problem-based compared to conventional curricula

    Nurse Education Today

    (2008)
  • J.K. Singleton et al.

    Interdisciplinary education and practice. Has its time come?

    Journal of Nurse-Midwifery

    (1998)
  • S.R. Stapleton

    Team-building: making collaborative practice work

    Journal of Nurse-Midwifery

    (1998)
  • S. Ahluwalia et al.

    Transforming learning: the challenge of interprofessional education

    British Journal of Hospital Medicine

    (2005)
  • E. Anderson et al.

    Evaluation of a model for maximizing interprofessional education in an acute hospital

    Journal of Interprofessional Care

    (2006)
  • S. Banks et al.

    Developing and implementing interprofessional learning in a faculty of health professions

    Journal of Allied Health

    (1998)
  • H. Barr

    Interprofessional Education: Today, Yesterday and Tomorrow Learning and Teaching Support Network Centre for Health Sciences and Practice

    (2001)
  • H. Barr et al.

    Systematic review of the effectiveness of interprofessional education: towards transatlantic collaboration

    Journal of Allied Health

    (1999)
  • D. Barrington et al.

    Student evaluation of an interactive multi-disciplinary clinical learning model

    Medical Teacher

    (1998)
  • C.M. Begley

    Collaborative care – a challenge for us all. Guest editorial

    Australian Journal of Advanced Nursing

    (2003)
  • J. Braithwaite et al.

    An action research protocol to strengthen system-wide interprofessional learning and practice

    Health Services Research

    (2007)
  • J.G. Bruhn

    Problem-based learning: an approach toward reforming allied health education

    Journal of Allied Health

    (1992)
  • M.M. Buck et al.

    Implementation and evaluation of an interdisciplinary health professions core curriculum

    Journal of Allied Health

    (1999)
  • J. Carpenter

    Interprofessional education for medical and nursing students: evaluation of a programme

    Medical Education

    (1995)
  • W.P. Chaboyer et al.

    Australian hospital generalist and critical care nurses’ perceptions of doctor–nurse collaboration

    Nursing and Health Sciences

    (2001)
  • M. Clinton et al.

    The Impact and Effectiveness of Interprofessional Education in Primary Care: A RCN Literature Review

    (2006)
  • H. Cooper et al.

    Developing an evidence base for interdisciplinary learning: a systematic review

    Journal of Advanced Nursing

    (2001)
  • H. Cooper et al.

    Beginning the process of teamwork: design, implementation and evaluation of an inter-professional education intervention for first year undergraduate students

    Journal of Interprofessional Care

    (2005)
  • J.A. Copley et al.

    Making interprofessional education real: a university clinic model

    Australian Health Review

    (2007)
  • S. Coster et al.

    Interprofessional attitudes amongst undergraduate students in the health professions: a longitudinal questionnaire survey

    International Journal of Nursing Studies

    (2008)
  • V.R. Curran et al.

    Attitudes of health sciences faculty members towards interprofessional teamwork and education

    Medical Education

    (2007)
  • A.E. Dechario-Marino et al.

    Nurse/physician collaboration: action research and the lessons learned

    Journal of Nursing Administration

    (2001)
  • M. Farrell

    Enabling interprofessional education: the potential of elearning

  • D. Freeth

    Sustaining interprofessional collaboration

    Journal of Interprofessional Care

    (2001)
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