|Year : 2007 | Volume
| Issue : 3 | Page : 93
A Framework for Integrating Interprofessional Education Curriculum in the Health Sciences
VR Curran, D Sharpe
Memorial University of Newfoundland, St. John's, Nl, Canada
|Date of Submission||31-Jul-2007|
|Date of Acceptance||28-Sep-2007|
|Date of Web Publication||24-Nov-2007|
V R Curran
Centre for Collaborative Health Professional Education, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Nl, Canada, AIB 3V6
Source of Support: None, Conflict of Interest: None
Context: Traditionally, the structures of health professional education in Canada and elsewhere have been largely based on "silos" in which health professionals are educated in relative isolation to one another. The curriculum content and structure has followed strict disciplinary lines. Recent commissions, committees and policy documents in Canada have identified the importance of reshaping educational preparation and the professional training of health care professionals (Commission on the Future of Health Care in Canada, 2002; Health Council of Canada, 2005).
Objectives: This brief communication describes an interprofessional curricular approach that combines characteristics of Barr et al.'s (2005) extracurricular and crossbar models of interprofessional education curriculum.
Methods: An interprofessional education curriculum that combines principles of an integrative, continuous, early-to-late and blended learning approach.
Discussion: The curricular approach supports exposing students to interprofessional education at an early stage in their training and then to continue with regular reinforcement. Another guiding principle is that interprofessional education is integrative rather than supplementary to the existing core curriculum. Early evaluation results suggest favourable satisfaction amongst students and faculty as well as significant effect on attitudes toward interprofessional teamwork and education. An ongoing evaluation is continuing based upon the various levels of Freeth et al.'s (2002) interprofessional education evaluation framework.
Keywords: Interprofessional relations, professional education, curriculum
|How to cite this article:|
Curran V R, Sharpe D. A Framework for Integrating Interprofessional Education Curriculum in the Health Sciences. Educ Health 2007;20:93
Interprofessional education (IPE) involves members (or students) of two or more professions associated with health or social care engaged in learning with, from and about each other (Barr et al., 2005). There is evidence that IPE can help to break down stereotypical views that professionals hold about one another and can result in an increased understanding of the roles, responsibilities, strengths and limitations of other professions (Parsell & Bligh, 1999; Barr et al., 2005). A number of principles are believed to be important in the design of IPE curricula:
- relevance to learners’ current or future practice (Oandasan & Reeves, 2005);
- use of typical, priority health problems that require interprofessional approaches for their solution (WHO, 1988);
- interprofessional learning based in clinical practice (Reeves & Freeth, 2002); and
- learning methods which facilitate interaction between learners from different professions, including small-group learning formats such as case-based and problem-based learning (Oandasan & Reeves, 2005).
Barr et al. (2005) describe two different models for implementing university led interprofessional education curricula. The “extracurricular” model is characterized by the assignment of interprofessional education to time outside regular class contact hours. The use of an extracurricular model is believed to be useful in paving the way for integrated models later (Barr et al., 2005). A more integrated and intensive model, the “crossbar model”, introduces shared learning sequences across professional education curricula. In some cases, crossbar curriculum models may include blocks of joint study in which students from different professions learn together for an initial period before embarking upon profession-specific studies. Another application of the crossbar model may be through the introduction of common practice placement learning.
The Center for Collaborative Health Professional Education of Memorial University of Newfoundland initiated a comprehensive IPE curriculum development project in 2005. The goal of this project is to expand and promote IPE activities in both education and practice settings and thereby enhance the collaborative competencies of an increased number of learners and practitioners in the province of Newfoundland and Labrador. Memorial University of Newfoundland is the only university in the province and it offers programs leading to professional degrees in medicine, nursing, pharmacy and social work.
Figure 1 depicts the various components of the Interprofessional Education Curriculum Framework being introduced. The key curricular areas are illustrated by the various rectangular and oval geometric shapes, while the large vertical arrows represent the core professional curriculum or competencies of the partnering academic units and professions. The vertical arrows to the left of the figure represent the broad developmental stages of a health and/or community service professional.
Figure 1: Interprofessional education curriculum framework
The pre-clinical/practice learner is one who has limited clinical exposure and is therefore limited by the lack of knowledge of the realities of professional roles and experiences of real clinical situations (Miller et al., 2001). A series of Interprofessional Education Learning Blocks have been integrated across each academic unit’s curriculum. These Blocks are affiliated with existing courses within the curricular structure of each academic unit and scheduled in a common timeslot. The learning strategy is based upon common learning about health promotion and illness/disease prevention concepts and principles, and blended learning which combines case-based asynchronous e-learning, face-to-face case-based learning and a panel discussion with interprofessional team members. An interprofessional service-learning project has also been introduced.
Clinical Novice Stage
The clinical novice developmental stage typically involves gradual exposure to clinical learning (Miller et al., 2001). A number of Interprofessional Education Learning Modules have been developed to introduce students to interprofessional collaborative approaches with a variety of patient populations. Similar to the Block structure, IPE Modules are affiliated with existing courses and scheduled in a common timeslot. The learning strategy is based upon common learning about interprofessional collaboration and blended learning which combines case-based asynchronous e-learning, face-to-face case-based learning and a panel discussion with interprofessional team members. A further programming component targeting the clinical novice is the promotion and development of Interprofessional Practice Placement Learning Experiences. These experiences are intended to expose learners to varying models of collaborative care through demonstrative practice settings.
As learners develop a degree of comfort in their own professional role, they make the transition from clinical/practice novice to probationer. The probationer is a senior learner who is familiar with the clinical environment in general, but is not yet resident in a particular clinical/practice environment (Miller et al., 2001). An Interprofessional Collaboration training workshop has been introduced in partnership with the Regional Integrated Health Authorities in the province. These workshops focus on the development of interprofessional collaborative competencies amongst post-graduate medical trainees and other regulated health professionals. A graduate level course on Interprofessional Education in the Health Professions has also been introduced via distance learning for part-time graduate students in the health, education and community service professions.
The practitioner stage includes those professionals who are qualified (e.g. licensed, certified, and registered) to practice in a particular clinical/practice environment. Collaborative Practice in Rural Mental Health is a post-licensure continuing interprofessional education (CiPE) program offered via the videoconferencing technology network in the province. The main purpose of this CiPE program is to enhance the collaborative mental health practice competencies of primary health care providers and other community-based professionals.
Faculty development is a key component of the proposed curriculum framework. With the expansion of interprofessional education programming across the curricula of participating academic units, and with the promotion of interprofessional learning opportunities in practice settings, the need to enhance clinical and non-clinical educators’ knowledge, skills and attitudes to foster interprofessional education has proven paramount. Faculty development activities have included a focus on attitudinal change, increased understanding of the roles and responsibilities of other health care professionals and skill acquisition in the areas being taught to students.
An interprofessional education Steering Committee is responsible for advising on all aspects of the project and sharing project information with their respective groups within the health and education system. Membership includes representatives of the academic and service setting partnership, as well as patients, practitioners, educators and learners. A Joint Interprofessional Education Planning Committee is responsible for advising on interprofessional education curriculum development initiatives at the pre-licensure education level. Interprofessional Education Curriculum Teams have been established with faculty representatives from each academic unit.
Figure 2: Overall Mean Student Satisfaction Scores for Pre-Licensure Interprofessional Education Modules and Blocks
The curriculum evaluation framework is based on a modified version of Kirkpatrick’s program evaluation model (1967) which was proposed by Freeth et al. (2002). Their model of outcomes of interprofessional education includes the six levels listed in Table 1. Evaluative information is being collected at both formative and summative stages during the curriculum development and implementation phases. Figure 2 summarizes preliminary overall mean student satisfaction scores across IPE modules and blocks offered at the pre-licensure level (e.g. undergraduate). The student satisfaction scale is comprised of ten 5-point Likert scale items (1 = ‘strongly disagree’ to 5 = ‘strongly agree’) that measure satisfaction with content, organization and design. Internal consistency of the scale was found to be very high (Cronbach’s alpha of 0.91). Mean satisfaction scores ranged from 3.10 for the Medicine students in the Health and Well Being of Children Module to 3.95 for the Nursing and Allied Health students in the Mental Health Care Module.
Table 1: Components of Evaluative Framework Model
The approach supported by this curriculum framework is one that exposes students to elements of interprofessional education at an early stage in their training and then continues throughout the curriculum with regular reinforcement. Our belief is that a continuous, early-to-late approach is necessary (Parsell & Bligh, 1999). Another guiding principle is that the interprofessional education curriculum is integrative rather than supplementary to the existing core curriculum of each academic unit. The curricular approach combines characteristics of both of Barr et al.’s (2005) extra-curricular and crossbar models of interprofessional education curriculum. The ongoing evaluation of the curriculum project will be useful in measuring the effect of a systematic curricular approach to fostering and promoting interprofessional education and its subsequent impact on the various levels of Freeth et al.’s (2002) evaluation framework.
BARR, H., KOPPEL, I., REEVES, S., HAMMICK, M. & FREETH. D. (2005). Effective interprofessional education – Argument, assumption and evidence. CAIPE London, United Kingdom: Blackwell Publishing.
COMMISSION ON THE FUTURE OF HEALTH CARE IN CANADA (2002). Building on values: The future of health care in Canada: Final report. Commissioner: Roy J. Romanow, Ottawa: Queen's Printer.
FREETH, D., HAMMICK, M., KOPPEL, I., REEVES, S. & BARR, H. (2002). A critical review of evaluations of interprofessional education. London: CAIPE.
HEALTH COUNCIL OF CANADA (2005). Modernizing the Management of Health Human Resources in Canada: Identifying Areas for Accelerated Change. Retrieved January 25, 2006 from: http://healthcouncilcanada.ca/en/index.php
KIRKPATRICK, D.L. (1967). In Craig, R. & Bittel, L. (Eds). Training and development handbook. New York: McGraw-Hill.
MILLER, C., FREEMAN, M. & ROSS, N. (2001). Interprofessional practice in health and social care: Challenging the shared learning agenda. London: Arnold.
OANDASAN, I. & REEVES, S. (2005). Key elements for interprofessional education. Part I: The learner, the educator and the learning context. Journal of Interprofessional Care, 19: 21-38.
PARSELL, G. & BLIGH, J. (1999). Interprofessional learning. Postgraduate Medical Journal, 74:89-95.
REEVES, S. & FREETH, D. (2002). The London training ward: An innovative interprofessional learning initiative. Journal of Interprofessional Care, 16: 41-52.
WORLD HEALTH ORGANIZATION (WHO). (1988). Learning together to work together for health. (Technical Report Series 769). Geneva: WHO.