Educational System
The educational system obviously has a huge impact on IPE and IPC (IPE and IPC are inextricably linked). D’Amour and Oandasan’s, 2004 model of IPE and IPC can serve as a companion to the model used in this paper to show the interface between the educational system and the care setting. The former basically being a deliverer of IP competencies to the latter. Although the context is different (educational institute versus care setting) the same themes or determinants that apply to a health professional team also apply to a team of educators designing a learner centred IP curriculum (for example, willingness to collaborate is central). Proponents of IPC see the need to make IPE and IPC even more inextricably linked (i.e. practice settings need to be more integrated into education settings and vice versa). Moreover care providers (with patients themselves being part of the care team) should simultaneously be taking an explicit teaching and learning role, so there is a culture of teaching, learning and researching in care settings. One can’t escape an implicit teaching and learning role as, for better or worse, modeling is perhaps the most powerful mode of teaching.
One participant explained:
One of the major gaps of the education system relates to this lack of integration between the university and the worksite:
Topics raised around the education system could be linked to who should be taking IPE, who should be delivering IPE, what they should be learning (competencies), and how they should be learning it:
At the risk of oversimplifying much of the information above, some general statements could be:
- Everyone learning, practicing or managing in the health sector needs ongoing IPE.
- Responsibility for IPE is shared across post secondary institutions in partnership with health care institutions, the LHINs and community agencies.
- IPE/IPC competencies should encompass cross cultural training, leadership competencies, communication and interdisciplinary decision making skills.
- All partners should use the tools at their disposal to enhance IPE, with experiential learning being key.
I was part of a teaching and ethics curriculum for a number of years … and over and over again it was just really clear that we can talk about some of these ethical principles, how you reflect on ethical issues and how you can integrate it with your practice as health providers, but as learners if you are not working with people that are modeling that, that are at least modeling their aspirations to be an integrated practitioner, it is very hard and so similarly if we are not in an organization where there are clearly people that are part of the organization that are modeling an interprofessional way of doing things, it is very tough. Because people will see people saying do as I say not as I do. I think those are challenges.
And that [IPE at the University] is where it starts and so what I am immediately worried about is those poor souls [the students]. They are expecting an interprofessional environment and so how do we do the bridging as they may find the direct care providers are not all caught up with this. The education of our direct care providers was not at all based on any of these principles So [two IPE instructors], you can do all these things with the students in an academic setting, but wham we will knock it out of them, I tell you, when they get here, because they are not going to see that [IP] environment necessarily so.
Comments about Interprofessional Education
Who should be taking IPE
- Recruit right students into health professions (want to be there for health and not other reasons)
- Medical training for interpreters would enhance their contributions
- Train personal support workers since small communities lack health professionals, but PSWs could continue treatment plans
- Managers in health care need IPE training (or else it won’t happen)
- Nursing is key (largest workforce and curriculum needs adjustments)
- Faculty teaching IPE first need to learn with, from and about each other
- When you work in IPC you learn from each other and you learn by collaborating
- Medical students need to be included more (medicine often viewed as leader of health care)
- For sustainability need to enhance IP skills of providers in community
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Who should be delivering IPE
- Definite University role at the undergrad, grad and post grad levels in all health sciences
- Every single [health science] course at undergrad level should have IPE component
- Role for LHINs to share IPE/IPC success stories, identify gaps
- Trust/confide in other professions allows learners to get their training from others
- In-service learning key
- [our health centre] is always open to taking on students
- Use student teams to inform clinical teams
- Champions needed (in both academic and care settings)
- Need a coordinator of placements
- Clients are educating the community (as to benefits of IPC)
What should they be learning
- Continuing to increase knowledge and trust
- Skills in interdisciplinary or outside the box decision making; tolerance for diversity
- Learning together will drive IP culture
- First hand cross cultural training is needed (especially in Northern Ont). NOSM students will have better appreciation due to placements
- Leadership competencies specific to IPC setting
- Don’t realize what you don’t know about another discipline until you sit down and they tell you what, how and why they do it that way
- Courses where students recognize difference between multiprofessional and IP, communication skills
- That IPE is an approach, rather than actual content
- Need to understand what other professions do
- Need to give high priority to IP knowledge and skills
How should they be learning it
- Continuing education (e.g. case conferencing)
- Students should take a rotation up north
- Move people around to cross pollinate knowledge, skills and attitudes
- Web based learning environment (helps logistics and distance, but challenge to make it a rich learning environment)
- Have diverse faculty in one program
- Apply lessons from one context (e.g. ER) to another
- Facilitating Leadership in Interprofessional Care (FLIC) project helpful
- IP placements
- Need to experience and reflect on IPC to understand it*
- Need for loud and consistent IPE
- Celebrate success stories in IPE and IPC
- Patients (or target population) need to be consulted
Note: *indicates number of times comment repeated