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Figure 7-1 Interprofessional collaboration competency domain.
(Source: Interprofessional Education Collaborative. Core
competencies for interprofessional collaborative practice: 2016
update. Interprofessional Education Collaborative. 2016. Accessed
April 5, 2022. https://ipec.memberclicks.net/assets/2016-Update.pdf.
Reprinted with permission from Association of American Medical
Colleges.)
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INTERPROFESSIONAL EDUCATION
TERMINOLOGY
The terminology related to IPE can be confusing because meanings
of “multidisciplinary,” “interdisciplinary,” and “interprofessional” may
differ in the literature.4 The former terms describe a simple and
additive approach to patient care, with several health care providers
providing independent services and each responsible for their own
specialty. As described earlier, IPE is a more coordinated approach
in which there is an integration and collaboration to include the
viewpoints of many different professions to optimize patient care.
4
To help clarify and standardize interprofessional terminology,
HPAC has compiled a consensus table (Table 7-1).
14
Table 7-1
Consensus Terminology in the Published Literature
Term Definition Organization
Interprofessional
education
“When students from two or more professions
learn about, from and with each other to
enable effective collaboration and improve
health outcomes.”
WHO
a
Interprofessional
collaborative
practice
“When multiple health workers from different
professional backgrounds work together
with patients, families, carersb, and
communities to deliver the highest quality of
care.”
WHO
a
Interprofessional
teamwork
“The levels of cooperation, coordination and
collaboration characterizing the
relationships between professions in
delivering patient-centered care.”
IPEC
c
Interprofessional
team-based
care
“Care delivered by intentionally created,
usually relatively small work groups in
health care who are recognized by others
as well as by themselves as having a
collective identity and shared responsibility
for a patient or group of patients (e.g., rapid
response team, palliative care team,
IPEC
c
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primary care team, and operating room
team).”
a
World Health Organization. Framework for Action on Interprofessional Education
& Collaborative Practice. 2010.
http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf.
b
The term caregivers is more commonly used in the United States.
c
Interprofessional Education Collaborative. Core Competencies for
Interprofessional Collaborative Practice: 2016 Update. 2016.
https://ipec.memberclicks.net/assets/2016-Update.pdf
Source: Health Professions Accreditors Collaborative. Guidance on Developing
Quality Interprofessional Education for the Health Professions. Health Professions
Accreditors Collaborative. 2019. https://healthprofessionsaccreditors.org/wpcontent/uploads/2019/02/HPACGuidance02-01-19.pdf.
CASE 7-4
QUESTION 1: You are on an internal medicine APPE rotation and on rounds with
a patient care team that includes a medical student, nursing student, and
dietetics student. The medical resident presents a case of an elderly patient
recently admitted with worsening heart failure and determines what the
treatment plan would be without involving anyone else on the team.
Is your experience considered an example of IPE?
Although one should understand what IPE is, it is also important to
clarify what does not constitute IPE. For example, students from
different health professions learning the same topic in a classroom
setting (eg, pharmacology) without interacting and discussing the
material as it pertains to their respective discipline are not
considered IPE.4 Nor is it IPE when a faculty member from another
profession lectures pharmacy students unless that person
incorporates some component on how the professions would interact
in providing patient care.4 Also, experiences on APPE rotations that
are directed by someone from another profession that do not include
sharing of responsibility for patient care are not considered IPE.
3
Consequently, the experience described in Case 7-4, Question 1, is
not considered IPE. Clearly, the underlying theme of any IPE activity
is that it should be a collaborative effort of students representing
different professions.
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INTERPROFESSIONAL EDUCATION MODELS
The creation of an effective model for IPE should start with the
understanding that this is just the initial step in providing patientdirected care.3 An interprofessional environment helps students from
one profession learning from individuals representing another
discipline to better develop skills that will help improve their own
profession-specific skills and to more effectively work in a teambased setting.3 There also needs to be a commitment that IPE be
incorporated within the curricula of all programs within an institution
to help sustain its future viability.3 In addition to other health
profession students, pharmacy students should be considered
essential to any IPE model. As the practice of pharmacy has evolved
into more of a patient-focused, clinically oriented dynamic, pharmacy
students must be able to step into frontline roles with other health
professional students who have had a tradition of “hands-on” patient
care.
Outreach to other institutions that educate important health care
students critical to the IPE team, such as medicine, dentistry, and
social work, will become necessary. This requires communication,
shared planning and training, and, ultimately, formal agreements
among institutions to participate in IPE.
The stage of socialization within the specific profession must be
considered when creating interprofessional teams as well.
3
Socialization of health care students has been defined as “the
acquisition of knowledge, skills, values, roles and attitudes
associated with the practice of that particular profession,” and can be
exhibited by the language, behavior, and demeanor that are
representative of that specific discipline.3 It is important that students
maintain their professional identity when participating in an IPE
model. When creating student teams, one should try to balance them
regarding where they are in their professional education and
socialization.3 Medical students who are in the fourth year of their
program paired with less experienced health care students may
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negatively impact the learning of other students if the medical
student assumes a more dominant role.
3
CASE 7-5
QUESTION 1: M.M. is a 65-year-old retired male who presented to his provider 3
days ago with reporting increased shortness of breath (dyspnea) upon exertion.
He reports noting swelling in his ankles for months that has started to get worse
over the past 2 weeks. This is making it difficult to go up the stairs to his
apartment and to wear his shoes toward the end of the day. In the past week,
he has had a decreased appetite, nausea and vomiting, and tenderness in the
right upper quadrant of the abdomen. He reports that he has not taken his
medications in the past month because he did not think they were helping him.
The patient lives alone with his dog in a small two-bedroom apartment on the
second floor of a multifamily home. He has a daughter who lives in another
state and who visits him during the holidays. The patient was hospitalized and
treated for a diagnosis of exacerbation of congestive heart failure (CHF) and is
now being discharged home. A physician, PA, nurse, social worker, and
pharmacist are part of a discharge planning team working with M.M.
How does the approach of the pharmacist to M.M.’s care differ from that of
the other team members?
One element of an IPE model is understanding that different
professions may vary in how they approach patient care. Medicine
and pharmacy tend to focus on eliminating or “ruling out” causes of a
patient’s patient’s reported symptoms, whether it is medical or drug
related.3 Although the physician or PA may focus primarily on the
medical evaluation of M.M., the pharmacist would determine whether
any of his medications were causing effects that may have
contributed to his belief that they were not helping him. The
pharmacist would also work with M.M. to develop a plan that would
enhance adherence to his discharge medications. Some other
members of the team, such as the nurse and social worker, may take
a more holistic approach and address the patient from a broader
perspective.3 This would include considering any family or
environment issues that may affect M.M.’s progress such as ability
for self-care when living alone and not having a relative living close
by. They could plan to make sure that M.M. has the proper support
at home. The nurse can also educate the patient about the
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importance of adherence to proper diet and to recognize early signs
and symptoms of exacerbation. Some professions such as social
work or psychology tend to be more involved with the patient or
family for a more prolonged period of time, particularly if a change in
behavior is warranted.3 Another consideration with how different
professions approach patient care is that medical students are
typically trained to be decision-makers regarding clinical problemsolving, which has been a long-standing part of the culture of
medicine.19 As noted previously, team-based care means a shared
responsibility for patient care on the part of all team members and
should not be dominated by any one profession.
INCORPORATING INTERPROFESSIONAL
EDUCATION INTO THE CURRICULUM
CASE 7-6
QUESTION 1: In your first professional year in pharmacy school, you are in an
introductory health care seminar course with other health profession students. A
fellow classmate shares that she would prefer to be with only other pharmacy
students until later in the curriculum.
What are the possible benefits of having other health care students in an
introductory-level course?
The goal of IPE is to develop knowledge, skills, and attitudes that
result in interprofessional team competence.10 This includes not only
clinical skills but also communication, conflict resolution, and team
building skills, in addition to respecting the roles and responsibilities
of other health professions.3 IPE is best when it is incorporated
throughout the entire curriculum in a vertically and horizontally
integrated manner, in which collaboration, teamwork, and patientcentered care are introduced to students before their entering the
professional phase of the curriculum.10 It has been reported that
early exposure to the IPE approach enhances students’ confidence
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in their professional value, supports their respecting the contributions
of other professions, and better prepares them for providing patient
care.20 It has additionally been noted that early educational
experiences within an IPE program increase the appeal of
collaborating with other professions, reduce any potential negative
stereotypical attitudes one may have toward these other professions,
and enhance communication skills regardless of any specialized
knowledge one may have.
21
The American Council for Pharmacy Education (ACPE), the
pharmacy education accrediting body, included IPE in Standard 11 of
their 2016 Standards and Guidelines for Accreditation.22 To meet this
standard, the PharmD curriculum “should prepare all students to
provide entry level, patient-centered care in a variety of practice
settings as a contributing member of an interprofessional team. In
the aggregate, team exposure includes prescribers as well as other
healthcare professionals.”22 Pharmacy schools must develop an
interprofessional education plan throughout the didactic and
experiential portions of the curriculum applying to all students in a
variety of practice settings.
The key elements of this standard include interprofessional team
dynamics, interprofessional team education, and interprofessional
team practice that incorporate all the IPEC core competencies. The
interprofessional dynamics section of the standard addresses values
and ethics, interprofessional communication, conflict resolution, and
honoring interprofessional roles and responsibilities. The standard
indicates that “these skills should be introduced, reinforced, and
practiced in the didactic and Introductory Pharmacy Practice
Experience (IPPE) components of the curriculum, and competency is
demonstrated in the Advanced Pharmacy Practice Experience
(APPE) settings.”
22
The interprofessional team education component includes
“opportunities for students to learn about, from, and with other
members of the interprofessional health care team. Through
interprofessional education activities, students gain an
understanding of the abilities, competencies, and scope of practice
of team members.”
22
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The team practice section mandates that “all students competently
participate as a healthcare team member in providing direct patient
care and engaging in shared therapeutic decision-making.” They all
should “participate in experiential educational activities with
prescribers/student prescribers and other student/professional
healthcare team members, including face-to-face interactions that
are designed to advance interprofessional team effectiveness.”
22
In January 2018, the ACPE Board added the additional guidance
that the expectation for IPE experiences in both the didactic and
experiential components of the curriculum would include
prescribers/student prescribers with the “mix of prescribers to include
(but is not limited to) physicians and their students in both the
didactic and experiential components of the curriculum.”
23
INTERPROFESSIONAL EDUCATION
GUIDANCE DOCUMENT
As more health professions accrediting bodies have mandated IPE
activities in their respective training programs, there has been a
movement to provide more guidance to ensure the quality and
viability of these programs. Quality IPE training also helps develop
collaborative practice teams that will proliferate and become a model
of patient care to help promote better population health. The National
Center for Interprofessional Practice and Education (National
Center) is a public/private partnership housed at the University of
Minnesota that was founded in 2012 to “provide the leadership,
evidence and resources needed to guide the nation on the use of
interprofessional education and collaborative practice to enhance the
experience of health care, improve population health and reduce the
overall cost of care.”
7
The National Center collaborated with the HPAC to release its
Guidance on Developing Quality Interprofessional Education for the
Health Professions in 2019.14 The goals were to “facilitate the
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preparation of health professional students for interprofessional
collaborative practice through accreditor collaboration and to provide
consensus guidance to enable institutions to develop, implement,
and evaluate systematic IPE approaches and IPE plans.”
13
The document recommends that quality IPE plans include the
following characteristics: (a) a rationale; (b) outcome-based goals;
(c) a deliberate design; and (d) assessment and evaluation. The
rationale should articulate a vision, framework, and justification for
the IPE plan. Outcome-based goals should be achievable by
students to demonstrate interprofessional competencies for
collaborative practice. A deliberate design of the IPE plan should
incorporate a variety of intentional interprofessional activities that are
integrated longitudinally into the entire length of the curriculum and
demonstrate achievement of the outcome-based goals appropriate
for the level of the learner. The assessment and evaluation process
should quantify the students’ proficiency in interprofessional
competencies throughout the curriculum and serve as an evaluation
of the institutional IPE plan for quality improvement.
14
CASE 7-7
QUESTION 1: Your school of pharmacy would like to incorporate a foundational
IPE activity into the didactic curriculum.
How should planning be initiated for an activity involving students from
multiple health care professions?
As mentioned previously, IPE must be incorporated into the
pharmacy curriculum for all students throughout the length of the
curriculum to meet ACPE accreditation standards.
22
The HPAC/National Center guidance document14 will function as a
blueprint in the development of the rationale, outcome-based goals,
deliberate design, and the assessment/evaluation of the proposed
activity.
The overall IPE curricular plan must be considered when
designing the first activity because subsequent programming will
continue to build upon this foundation. An interprofessional team is
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vital for successful development of any IPE activity in academia.
Faculty and staff are most often the activity developers. Each
student profession targeted to participate in the activity should be
represented on the faculty/staff development team and this team
must agree on an activity that will benefit all participants. As
mentioned earlier, participating students should be at similar levels
within their professional education. Faculty and staff who value IPE
and interprofessional collaboration are best suited for the
development team as opposed to assigned participation by a
department chair/supervisor. Having student members on the
development team is extremely beneficial. Students can provide a
reality check for what is being expected of the participants during the
activity and the level of knowledge/skills of the activity participants.
The focus of the activity must be linked to one or more of the IPEC
core competencies,11 and specific, measurable objectives must be
developed. Each objective should then correspond with an
assessment method that will allow evaluation of students’
achievement. An interactive component is essential for any IPE
activity because students should be learning about, with, and from
each other. The quality of an IPE activity is dependent on the quality
of the student interaction. Careful consideration needs to be given to
the type of interaction that can reasonably fit within the timeframe of
the activity. Examples of interactions include patient case
discussions, group assignments, role-play, and simulation.
CASE 7-7, QUESTION 2: The interprofessional development team will develop
an IPE activity that will involve pharmacy students and several other health care
profession students that are local to the School of Pharmacy. What are
additional considerations for the team?
Scheduling is often the rate-limiting step for any IPE activity. The
challenge of making sure that the activity is part of the curriculum
requires that there is synchronization within all professional curricula
to allow for interprofessional education. There should be buy-in from
upper administration as well as close cooperation between the
administrative faculty and curriculum committees of each
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