Monday, September 14, 2009
Although interprofessional education (IPE) has been in the literature since 1978 (WHO, 1978) and identified as an important component of health care, only recently does it seem to have reached the ‘tipping point’ in Canada (“the levels at which the momentum for change becomes unstoppable”) (Gladwell, 2002). Many will be familiar with the statement from the Romanow report that suggests the necessity of IPE to ensure collaborative practice:
“…in view of… changing trends, corresponding changes must be made in the way health care providers are educated and trained. If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.”
Over the past year, I have had the opportunity to work as the Interprofessional Education leader at SickKids Hospital. Reflecting on my experiences has made me think about where dietetic education ‘fits’ in the realm of IPE. With the movement towards explicit IPE initiatives the dietetic community must discuss integration of the concept into dietetic education.
IPE is when “two or more professions learn with, from and about each other to improve collaboration and the quality of care” (CAIPE, 2002), and often involves IPE student placements. IPE is felt to be important to foster effective teamwork, and comprehensive, collaborative practice CIHC, 2009). Outcomes include increased knowledge of others’ roles, the ability to communicate effectively, reflection on practice, trust, mutual respect, willingness to collaborate, and increased patient/family centred care (Cooper et al., 2001; D’Amour & Oandassan, 2004; Oandassan & Reeves, 2005; Robson & Kitchen, 2007). When activities are relevant and realistic interprofessional learners have a positive attitude toward IPE and demonstrate positive changes in behaviour, service and patient care (Hammick et al, 2007).
Dietitians work in collaborative health care models that support our abilities to perform. Although dietitians are not strangers to the benefits of collaboration, the benefits of engaging students explicitly in IPE activities, or empowering them to collaborate, may not be clear. While many of us have cultivated our working relationships to benefit each other and our clients, governments are now dictating that we make this learning explicit for students. In the absence of formal IPE placements, dietetic educators are challenged to think about how to make this explicit for dietetic interns.
It has been argued that in a clinical setting interprofessional rounds and meetings are educational opportunities where interns can learn with, from and about each other. Interestingly, in one of our IPE placements a student suggested that Occupational Therapists (OT) cared for the infants and Physiotherapists (OT) cared for the older children. She learned this by observing who spoke during rounds when patients were discussed. Only by consulting the therapists for our IPE placement did she learn the extensive decision-making process that determines the primary therapist and division of responsibility between OTs and PTs. If students of other disciplines are making incorrect assumptions about the roles of healthcare professionals, dietetic interns may be doing the same. If that is so, when might they have the opportunity to correct these mistakes?
Dietitian-preceptors have unique opportunities to have a lasting impact on the development of budding professionals. We help shape their attitudes and beliefs about dietetics, discuss elements of collaboration amongst professions, and the impact on client care and services. Preceptors have the responsibility to facilitate interprofessional learning and influence the development of IPE competence among their students (Oandassan & Reeves, 2005; Hammick et al, 2007). While influencing learning, we must consider the spectrum of learning (Oandassan & Reeves, 2005). At one end, uniprofessional education (learning with members of one’s profession) is important for competency attainment while at the other end, interprofessional education teaches students to work collaboratively.
Timing is essential as early introduction of IPE may lack relevance, and hinder or delay professional training (Cooper et al, 2001).
With the movement to integrate IPE into undergraduate health care professional curricula we have an obligation to engage dietetic interns in discussions to:
• clarify the roles of other colleagues involved in delivery of patient care and services
• distinguish characteristics and discuss commonalities amongst professions
• make interprofessional communication and collaboration explicit to prevent misunderstandings and misconceptions
• encourage shadowing opportunities with colleagues in other disciplines to increase the relevance of care/ services
These opportunities should be timed well so that we graduate highly skilled dietitians who have trust in others and have the knowledge, skills and attitudes to perform as competent and collaborative healthcare professionals.
Even without explicit IPE placements, we can employ strategies that contribute to the interprofessional learning of dietetic interns.
Jennifer Buccino, MEd RD CDE
The Hospital for Sick Children