Stephen C. Shannon, DO, MPH
The Growing Case for Interprofessional Education
Several weeks ago, I had the opportunity to participate in a meeting that mayspell an important milestone in health professions education. The meeting, “Team based Competencies: Building a Shared Foundation for Education and Clinical Practice,” was sponsored by the U.S. Health Resources Services Administration, the Josiah Macy Jr. Foundation, Robert Wood Johnson Foundation and the American Board of Internal Medicine Foundation, in collaboration with the Interprofessional Education Collaborative (IPEC). IPEC is a partnership of The American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Nursing, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges and the Association of Schools of Public Health. The attendees included invited leaders from practice, academia, foundations, accreditation, regulation and health delivery systems. We engaged in a conversation about the core competencies that are needed in Interprofessional Education (IPE) to train a health professions workforce for team-based practice. The recommended competencies were developed to serve as an adjunct to the general professional competencies of the individual health professions, and were grouped into four core competency domains:
- Values/Ethics for Interprofessional Practice
- Roles/Responsibilities for Collaborative Practice
- Interprofessional Communication
- Interprofessional Teamwork and Team-based Care
A full report of the conference and resulting recommendations will be released in the near future.
Interprofessional education has resurfaced as a prominent part of the dialogue in health professions education because of the congruence of a number of factors. These include:
- A number of reports (most prominently the Institute of Medicine’s 2001 report, Crossing the Quality Chasm (highlighting patient safety and quality problems in the U.S. health care system), and the follow-up 2003 report, Health Professions Education: A Bridge to Quality).
- Growing evidence that team-based practice improves quality of care, with the nation’s largest health care delivery system—the Veteran’s Administration—most prominent in this regard.
- Increased economic and organizational integration of the U.S. health care system.
- The importance of team-based care to both Medical Home primary care initiatives and health system initiatives to establish Accountable Care Organizations.
- The traditional acceptance of and reliance on team-based care in geriatrics, and planning for the large increases in the geriatric population in coming decades (a near 80 percent increase in those over age 65 in the next 20 year—25 million more seniors), nearly all of whom will have at least one chronic disease, and nearly half of whom will have three or more chronic diseases.
- The implication of physician workforce shortages for health care in coming decades.
- The expectation of a new generation of health professionals-in-training for a system-based collaborative practice environment.
- The incorporation of systems-based practice and professionalism competencies into pre-doctoral and graduate medical education.
- The introduction of IPE into accreditation standards by some health professions (pharmacy, nursing, and under consideration by the LCME).
- Increased levels of training and specialization throughout the health professions, and the demands of case management and complexity in health care delivery.
The Affordable Care Act provides a major impetus to IPE as well, establishing mechanisms to fund innovations in health care delivery and focusing some health professions education grant opportunities in this direction.
To some extent, we have been down this road before. The call for interprofessional practice has been one aspect of attempts to deal with issues of health care access, workforce shortages and organizational changes in health delivery for decades (e.g., the 1972 IOM report, Educating for the Health Team; HRSA’s establishment of Geriatric Education Centers in 1985; the Pew Health Commission’s 1995 report, Critical Challenges: Revitalizing the Health Professions for the Twenty-First Century). The interdisciplinary efforts of those times were seen as a way to provide access and efficiency to a health care system that was perceived as under stress from rising costs and access inequities.
There is some evidence that it may be different this time. The same issues of access, costs and growing workforce shortages have been joined by increasing recognition of team-based care’s potential to enhance quality—in health care, health promotion and disease prevention. The growing evidence of how health teams enhance quality of care, coupled with the patient safety movement, has helped generate a significant amount of support for IPE by leadership in the health professions and practice communities. This is also joined by the hope that the medical home model of primary care will improve the practice environment and enhance the experience of health care delivery for both patients and practitioners.
However, there is a lot we don’t know about IPE. We don’t really know yet how to implement IPE. Research remains to be done on how best to provide interprofessional training, when in the professional training cycle it should be incorporated, how to implement it in the variety of educational settings, and what changes can be made in the clinical training environment to avoid disruptions and untenable costs. We are set up for a period of innovation in these areas, and hopefully research will give us guidance as to what works in the education of physicians and other members of the health care team.
All these issues hold special meaning for osteopathic medical education. Many of our colleges are moving into IPE with major initiatives, taking advantage of the environments offered by their colleagues in the other health professions within their universities or affiliates, and attempting to do so in the community—as opposed to academic medical center—setting. Next month, we will be focusing on interprofessional education at the Joint AACOM & AODME 2001 Annual Meeting (see related article below). I hope you will join us as we explore how interprofessional, team-based medical education can help future physicians meet the nation’s needs, particularly in the post-health care reform era. For more information about the Annual Meeting, visit the AACOM web site.