Have investments in interprofessional education led to changes in practice?

Categories: Policy.

This included contributing $28 million dollars to build training centres across Canadian colleges and universities.

Investing in interprofessional education was motivated by the belief that changing the way health care professionals work together would be a key part of health system renewal. More interprofessional practice was envisioned as a way to achieve the goals of  health system renewal set out by the Romanow Commission on the Future of Health Care in Canada of improving patient centredness, safety and quality of care.

The first step to lead this change was teaching the next generation of health care professionals how to more effectively work together.

A decade after this federal investment was made alongside some provincial governments contributions, Healthy Debate asks whether this investment in education has translated into better interprofessional practice.

A ‘world class’ interprofessional education system

While it might seem straightforward that health care professionals will have the skills to work together on patient care, research has demonstrated that these skills need to be taught.

Just because people work near or with each other, does not mean that they are working interprofessionally.

Interprofessional education focuses on developing the skills needed for health care providers to work together in teams. It focuses on improving understanding of what various health professionals do, and how to effectively communicate and collaborate in patient care.

Louise Nasmith, principle of the University of British Columbia College of Health Disciplines and member of the Canadian Interprofessional Health Collaborative steering committee says that the federal investment made Canada a world leader in interprofessional education, with “every university in Canada with a medical school having an office of interprofessional education”.

Part of this investment took the form of 20 demonstration projects, funded through the Interprofessional Education for Collaborative Patient-Centred Practice (IECPCP). This totaled approximately $28 million dollars, according to Sandra MacDonald-Rencz, Executive Director of Health Canada’s Office of Nursing Policy.

These projects included developing curricula and practicum’s for interprofessional education across faculties of medicine, nursing and allied health. For example, a University of Manitoba demonstration project focused on interprofessional placements and learning in geriatric care. Another project led by Cancer Care Nova Scotia was a partnership with St. Francis Xavier University to develop 10 modules of interprofessional cancer care for their nursing students.

There were also unprecedented levels of research on interprofessional education. Canadian researchers dominated and advanced the study of interprofessional education during this time, in part due to evaluations of the demonstration projects and other federally-funded research in this area.

The demonstration projects through IECPCP have all wrapped up. With no further federal dollars for interprofessional education, universities and in some cases provincial governments, have stepped in to keep the interprofessional education curriculum and programs built with these dollars going.

Interprofessional education seems to be here stay. Accreditation bodies are now including standards of interprofessional education as part of the curriculum across schools of medicine, nursing and other allied health professions (such as physiotherapy and pharmacy).

Questions remain though on how Canada’s interprofessional education structure will change behavior of health care professionals in practice.

While there have been many studies which evaluate the short-term outcomes of education programs, such as student attitudes towards other professionals, there is a lack of strong evidence on the relationship between interprofessional education and practice.

Scott Reeves, a professor at the University of California San Francisco and editor of the Journal of Interprofessional Care notes “there is a dissonance between what is taught and practice, with cultural and organizational issues impacting collaborative practice.”

A lot of rhetoric” and “lip service” for interprofessional practice

In spite of Canada leading on interprofessional education, interprofessional practice is far from a reality in most health care settings.

Nasmith says that students going into practice find “lip service” paid to interprofessional practice. She says it is not yet “embedded into the organizational fabric of how business is done through professional development and continuing education.”

MacDonald-Rencz acknowledges that federal funding for interprofessional education spanned about 10 years, and that “to really get practice changes, you need an investment of 20 to 25 years… unfortunately priorities do change.”

Learning to work together is cultural. Reeves suggests that while “there is a lot of rhetoric about team work, a lot of practitioners do not know what a good interprofessional team is.” He stresses the need for health care workplaces to include interprofessional education as part of ongoing professional development.

Nasmith says “there hasn’t been an investment in the system in allowing people to work collaboratively.” In order to really bring concepts of interprofessional education into practice, health authorities, hospitals and other provider organizations need to partner with universities and use their resources to help translate the ideals taught to students into practice.

Some provinces, such as Alberta and Ontario have moved ahead with province-wide strategies for interprofessional education and practice.

Ontario’s Blueprint for Action

Ontario has been identified as a leader in interprofessional practice. The provinces’ 2007 Blueprint for Action saw the development of core competencies for interprofessional care and resources to help translate the ideals of collaboration and teamwork into clinical practice.

An example of bridging education and practice has been the University of Toronto Centre for Interprofessional Education SCRIPT (Structuring Communication Relationships for Interprofessional Teamwork) program. This program developed clinical teaching units and curriculum for interprofessional education in general internal medicine, rehabilitation and primary care.

Maria Tassone, director of the Centre for Interprofessional Education, noted that the curriculum was based on “an intentional partnership between education and practice environment.” Tassone says “government set the tone for collaborating” by  offering financial incentives for interprofessional education programs that were partnerships between academic and practice settings.

Alberta Collaborative Practice and Education Framework for Change

Alberta has more recently embraced a provincial strategy for interprofessional care. The Collaborative Practice and Education Framework for Change, was launched in fall 2012 and brought together various stakeholders, including professional groups, universities, employment associations and government to develop a framework for interprofessional practice. Doing this across Alberta was motivated by the belief that “large scale system change toward a norm of collaborative practice in health care delivery requires that future efforts be co-ordinated in an integrated, strategic approach.”

However, funding tied to specific interprofessional practice programs has yet to emerge from the Framework.

Doug Myhre, Associate Dean of Distributed Learning and Rural Initiatives at University of Calgary’s Faculty of Medicine notes that “there is no money attached to this, it’s just a statement.” Myhre says while “everyone believes this is the right thing to do, no one is putting money into it.”

While there may not be specific projects linked to the framework, some practice models in Alberta, such as the Primary Care Networks, which are led by family doctors, working with other health professionals like nurses and pharmacists, do promote interprofessional practice.

Nevertheless, Myhre argues that “the PCN’s didn’t entrench education into their mandate.” There are concerns that in the absence of formalized ongoing professional education, it is difficult to change professional culture and improve collaboration in practice.

Maintaining momentum for interprofessional practice

While Canada has been identified as a leader in interprofessional education and research, translating this into practice remains a challenge.

Ivy Oandasan, a family doctor and researcher who led the evaluation of the 20 federal demonstration projects, describes the material developed from federal demonstration projects as “good work, lost in a drawer.”

She suggested that while universities continued to support interprofessional education after federal funding for interprofessional education dried up, many health care provider organizations and governments have moved on to other priorities and haven’t provided the supports necessary to change practice – ongoing education and partnerships.

There has been a great deal of high quality curriculum development, trainees and research in interprofessional education generated in the past decade. Now, it seems up to provinces, health authorities and provider organizations to support interprofessional learning as part of professional development, to help bring these ideals into practice. As Louise Nasmith says “its not going to happen because you throw people together.”

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