THE FORMS OF MULTIPROFESSIONAL EDUCATION

3.2.1 Multiprofessional and Interprofessional Education Objectives

Many authors have set out a range of aims of their multiprofessional education programmes. A common aim is that it sets out to promote collaborative practice (Carpenter 1995a & b, Carpenter and Hewstone 1996, Barr 1996, Wahlstrom et al 1997). [By the previously discussed CAIPE classification these are interprofessional education programmes.] The skills of collaboration are promoted by many courses (Miller et al 1999, Perkins and Tryssenar 1994, Pomeroy and Philp 1994). Some authors go further and define the collaborative skills that participants will acquire. Morrow and Hargie (1996) describe the influencing and persuading skills that students should develop during their education in order to be able to collaborate effectively at the practitioner-practitioner interface although this was a uniprofessional programme for pharmacy students. They specify that students should gain theory, an ability to reflect on personal influencing style and the application of tactics and strategies that enhance the influencing situation. Miller et al (1999) also found collaborative skills to be a valuable aim for multiprofessional education in particular an ability to communicate using assertive and facilitative communication styles across status differences and to be able to deal with interprofessional conflict.

Barr (1996) focuses the objectives of IPE into three key areas. Firstly programmes should attempt to modify attitudes and perceptions. This refers to reducing the negative and enhancing the positive attitudes of one profession towards another and valuing others perspectives. Secondly to enhance motivation to collaborate so that professions are positively disposed towards working with others and finally help students to acquire what he calls ‘collaborative competencies’ such as networking, communicating, negotiating and handling conflict. Pirrie et al (1998) found in their 2-year qualitative study of the views of students and course providers that they suggest some courses enhance personal and professional confidence which helps to underpin participants ability to undertake effective collaborative practice.

3.2.2 Programme Content

All courses developed participants knowledge but in different areas. The following are some of the types of content included in programmes and concludes with Barr’s (1996) typology which sheds light on the range of content available.

Some courses offered professional knowledge in for example the area of profound and multiple learning disability (Lacey 1998) or ambulatory care of patients with diabetes (Lorenz and Pichert 1986). Other courses aim to promote an awareness of the roles of their own and other professionals’ roles. Knowledge of stereotyping was seen as important on some courses with Miller et al (1999) suggesting that participants should be aware of stereotypes and their value. Carpenter (1995b) designed a whole course for medical and nursing students with the aim of reducing the typical doctor/nurse stereotype. The incorporation of reflection into programmes is seen as important with several initiatives aiming to promote reflective practice (Holland et al 1994, Pirrie et al 1998, Miller et al 1999) in interprofessional learning and working so that participants are able to be flexible and open to different perspectives.

Barr (1996), who is at the forefront of developments in interprofessional education, sets out some of the curriculum features, which he believes will help to engender the philosophy of collaborative practice. He divides these into the course objectives, curriculum content and learning methods. The curriculum content he argues should contain common, comparative and specialist content. Common being subjects that are shared by professions such as themes from the health and social sciences e.g. early multiprofessional work at University College Salford included a common communication skills element (Hughes and Lucas 1997). Specialist content he describes as being particular to one profession. An example here might be the knowledge and skill required to correctly position patients on a ward for a mobile x-ray examination. This would be specialist radiography knowledge but valuable for nurses who collaborate with radiographers at the bedside. Comparative content that bridges the gap between common and specialist content. Barr describes this as opportunities for students to learn about one another. This might be in respect of roles and functions or the opportunities and constraints of a profession.

This typology neatly categorises the different content of interprofessional education programmes. Having considered the content of programmes it would seem logical to discuss how the content is delivered as this will have consequences on the effectiveness of the education and will determine, by the definition above, whether the educational programme is inter- or just multiprofessional.

3.2.3 Learning method

Two types of learning method are distinguished by Barr (1996). These are ‘received learning’ and ‘interactive learning’. He goes on to subdivide the latter and describes, among others, problem-based learning. Interestingly he quotes University College Salford as taking the UK lead in this (Davidson and Lucas 1995).

Received learning was operating on several courses although this was often in conjunction with some other interactive learning method. Lorenz and Pichert (1986) provided team training for medical students in ambulatory care of the diabetic patient. The programme was 32 hours long spread over 8 mornings in 1 month. Each morning consisted of a 1-hour seminar where doctors and other professionals in roughly equal proportions presented core content. This would suggest that this programme would be classed as ‘Nesting’ in the Harden (1998) classification (appendix 2). The students then see patients under teacher supervision. Although portrayed as an interprofessional training course it is designed essentially for medical students. The authors stating that:

“Opportunities for medical students to participate in encounters between patients and nurses or dieticians are

routinely provided so the [medical] students can observe first

hand the functions of the non-doctors.” p 196

Therefore although dealing with real patients it could not be classified as truly ‘Transprofessional’ (Harden 1998 – appendix 2) as the situation is not as it would be in the ‘real world’, there being a lack of interprofessional activity. The nature of the learning appears to be more observational hence it could be classed more as received than interactive learning.

Lacey et al’s (1998) 1-year part time programme for those involved with learning disability was set up to provide an interactive multidisciplinary learning experience. Participants formed multiprofessional groups from different educational backgrounds and can be assessed at different levels. The teaching was interactive including for example role-plays and of 30 taught sessions 7 were devoted to collaboration. However over the four years experience they reported that only 1 of 18 groups taking the course together were ‘multidisciplinary across agencies’. This the authors felt lessened the value of the multiprofessional learning as much of the learning disability work required was across agency boundaries. Although there were some role plays within this teaching and learning strategy the paper did not specify any other interactive method. This would imply that there was a proportion of traditional didactic teaching occurring. This programme was also offered as a distance learning package that might also have reduced the interactive nature of the learning experience.

3.2.4 Transprofessional education

Greene et al (1996) designed a course for medical and pharmacy students that was truly interactive and transprofessional. A problem-based learning approach was taken and real elderly patients were selected as it was felt that they have a variety of medical problems and polypharmacy needs. Students spent one 2½ hour session working in pairs with a patient. They were required to obtain a medial history and compile a medication profile for the first 30 minutes whilst with the patient. They had tutor support when and if required. They then organised their information and presented it back to the whole group with justification of their findings. The major disadvantage of this programme was that the session was only 2½ hours long. It is unlikely that this would be sufficient to change attitudes and develop sufficient skills and knowledge for the session to have a major impact on the future collaborative working for the participants. However it was positively evaluated by the students and staff.

Probably the most innovative of approaches to interprofessional education has been undertaken in Sweden at the University Hospital in Linkoping. This could be described as being at the ultimate end of transprofessional in Harden’s classification. Wahlstrom et al (1997) describes the Linkoping Training Ward which has been set up using real patients and health professional students along with some qualified staff. At Linkoping

University all the faculty of health students study a 10-week module together in a problem-based learning format. Called ‘Man and Society’ it is integrated between the health programmes, including medical students, and enables students to acquire knowledge in tutorial groups related to for example, ‘ethics’, ‘health’ and ‘conditions of life’. There are other joint elements later in the programmes. At the end of the programmes, in the last or second to last term, students spend a compulsory 2 weeks on the training ward. The ward is based in an orthopaedic clinic and contains patients with hip fractures. It was felt that this category of patient needed the care of a complete medical and rehabilitation team. Students are divided up into multidisciplinary care teams and are given primary responsibility for the care and rehabilitation of the patient. Permanent and part-time qualified staff provides supervision but it is stressed that they are there as resource people. The authors report positive learning experiences and are undertaking a fuller evaluation.

One of the criticisms of this clinical teamworking experience by the students is that the time is too short. They don’t begin to work effectively until the second week and feel they would benefit from 2 further weeks. It would be interesting to look at the views of patients who might be cared for in such an establishment. As the students are usually given responsibility for the care of patients what happens when something goes wrong? Is it ethical to provide such care for patients by unqualified staff? Also are patients given the choice of being cared for here or in a more traditional setting? This form of learning experience fits in with Barr’s (1996) typology for a successful interprofessional learning environment. It is interactive and transprofessional but as with other papers on interprofessional education has yet to be rigorously evaluated.

The need for interactivity within the interprofessional learning experience was met through modern technology on a programme designed to educate health and social care service teams involved with the care of the elderly (Holland et al 1994). The ‘LIFE SPAN’ interdisciplinary curriculum for the elderly was composed of four modules. The curriculum aimed to provide learning experiences which involved the formation of a team, patient assessment and planning activities and a care planning conference. Six- month long training seminars were offered in a year. Each seminar was divided into four sessions each meeting once a week for 4 hours. Teams of between 6 and 11 people were formed and they gained their learning experiences at a retirement campus in Louisville, Kentucky. This provided experience of providing services to the elderly who

had no, little or total care needs. The authors recognised the difficulty of getting all team members together in one place at one time for face-to-face contact. They overcome this problem by using a range of communication aids. These include email, telephone conferencing, two-way videoconferencing and facsimile. Unfortunately no evaluation of these facilities was undertaken although the authors state that a grant has been awarded and they will be evaluating videoconferencing in the future. If this form of communication was found to be successful it might open the way for greater collaborative opportunities in the future as participants are not bound by geographical constraints. This has the potential to open up a whole new area of interactive multiprofessional learning.