A cascade of federal reports have advocated during the past few decades for more interprofessional education and practice.¹^–⁷ The 2011 report on Core Competencies for Interprofessional Collaborative Practice⁷ is based on a core assumption that “…disciplinary competencies are taught within professions. The development of interprofessional collaborative competencies (interprofessional education), however, requires moving beyond these profession-specific educational efforts to engage students of different professions in interactive learning with each other. Being able to work effectively as members of clinical teams while students is a fundamental part of the learning.”^{7(p 1)}

All health professions share the responsibility for promoting good for their individual patients, but we also have a professional responsibility for promoting health as a public “good.” Promoting the common good in health care requires health professionals to work together as stewards of scarce resources to deliver quality care and to take responsibility for shaping health policy that ensures access to care and promotes health. We need to remember that professional education is a powerful portal to professional life where students begin their formation of professional identity and “habits of mind.”⁸ We have an opportunity to build a strong foundation for interprofessional collaborative competencies through interprofessional education opportunities.

A good starting place for beginning to engage in interprofessional education is sorting out the operational definitions (Table 7-1).^7,⁹ Interprofessional education is defined quite simply as, “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.”⁷ A key phrase in this definition is learning about, from, and with each other.⁹ Interprofessional education is not sitting in the same classroom or sharing classes, nor is it engaging in a health screening for elders where the physical therapy student performs balance screening at a station and the occupational therapy students complete cognitive assessments at another station. What does it take to engage students in learning about, from, and with each other? Here is where we have the opportunity to help students grasp the critical importance of the underlying values and core components of professions’ social contract. Here are key teaching and learning points to keep in mind:

1. Respect for human dignity as a moral compass. Although students may readily grasp the meaning, behaviors, and actions that are consistent with demonstrating respect with their patients, they must begin to explore and experience how one builds mutual respect and trust when working with colleagues across professions.

2. Understanding our collective interprofessional social contract. Professions have an obligation to serve society and support the common good in health care. Real health improvement relies not only on direct care but also on addressing the environmental and social determinants of health, prevention, and health promotion.⁷ Health care is a scarce resource that will continue to require health professionals working together with public health professionals in delivering care that is safe, efficient, and effective.

3. Moving beyond behavioral objectives to development of habits or dispositions. Although we continue to place much emphasis on professional core values and on abiding by codes of ethics, it is the professional formation and ways of “being” that are long-lasting. These elements of “who one becomes” are best facilitated through development of, not simple behaviors, but consistent patterns of behaviors that are habitual and predictable. Students’ ability to engage in critical self-reflection in relation to professional identity and interprofessional professionalism is paramount.⁹

Table 7-1 Definitions Used in Interprofessional Education and Practice

Concept	Operational Definition
Uni (disciplinary)	A health professional working independently to care for a patient
Interprofessional education	Students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.
Interprofessional collaborative practice	Multiple health workers from different professional backgrounds working together with patients, families, caregivers, and communities
Interprofessional teamwork	Levels of cooperation, coordination, and collaboration that are central to relationships between professions in patient-centered care
Interprofessional competencies in health care	Integrated enactment of knowledge, skills, and values/attitudes that define working together across professions, with other health care workers, with patients, families, and communities to improve health outcomes
Multiprofessional education	Various disciplines are brought together to understand a particular problem or experience and offer different perspectives on the problem. This is an additive approach, not an integrative approach.
Transdisciplinary	Health professional team members become familiar enough with the concepts and approaches of colleagues that they can “blur the lines” and the team can focus on collaborative analysis and decision making.

Data from Core Competencies for Interprofessional Collaborative Practice. Report of an Expert Panel. Interprofessional Education Collaborative, 2011; and Royeen CB, Jensen GM, Harvan R (eds): Leadership in Interprofessional Health Education and Practice. Sudbury, MA: Jones and Bartlett, 2009.

Interprofessional education has, as its centerpiece, teams working together in using the “distributed intelligence” of the team. The challenges in designing learning experiences that effectively build students’ ability to be “collaboration ready” are important opportunities for educational innovation. This chapter provides a beginning blueprint for this work.

Key strategies for addressing common barriers in interprofessional education

Importance of organizational capacity and support

As with any sustained organizational change, initiatives such as interprofessional education will require a mindset for producing change in the institutional culture, and a comprehensive, integrative approach is required to achieve successful outcomes.^10,¹¹ It is critical to begin by knowing the culture in which your work will be situated. The extent to which programs are housed in public, private, or faith-based institutions and the institution’s mission and available resources will drive the extent to which interprofessional initiatives will be developed. Regardless of institutional mission, one may argue that interprofessional care skills are consistent with the values of the health professions.^{12(p 317)} As academic programs attempt to develop interprofessional education (IPE) and interprofessional practice (IPP) strategies for health care, few have effectively outlined the necessary components underlying a program’s organizational context and culture that create the capacity for IPE. Greenfield has proposed the “interprofessional praxis audit framework” (IPAF) as a tool to identify the components of institutional capacity for IPE.¹³

The term praxis refers to the translation of theoretical knowledge into practice, and audit outlines the systematic process used to assess the concept of organizational culture for IPE. The IPAF is composed of five dimensions: context, culture, conduct, attitudes, and information. The model is helpful in considering the impact of the organization’s shared values, beliefs, and behaviors, including its constraints, available resources, and the external policy and political milieu that will determine success for interprofessional initiatives.¹³ Context is the key external environmental variable related to how interprofessional interactions are influenced by policies, guidelines, protocols, initiatives, and funding. Culture is designated as an internal variable that represents shared values and norms held by organizational staff.¹³ Constructs, conduct, and information are the final audit variables described in the model that determine how individuals behave and communicate to enhance patient outcomes. The IPAF is a tool to help “map” the level of collaboration by facilitating a multidimensional and multi-level examination of the organization’s level of capacity for and engagement with IPE.¹³ When justification for interprofessional initiatives are clearly linked to mission, the mission becomes grounded in a manner that is difficult to deny. A clearly articulated mission statement should link societal needs and the social contract that health professionals should espouse to produce congruence and solid justification for IPE. This congruence should also be codified in the institution’s strategic plan for the essential link to resource allocation as the activities are formalized.

Since interprofessional initiatives were introduced in the health professions nearly 45 years ago, a myriad of challenges beyond organizational culture have been identified. Many strategies are available to meet these challenges, but many problems may be resolved through the use of a few key strategies:

• Foster organic (or “grassroots”) development of interprofessional interaction

• Foster connections between faculty and administration levels

• Build educational expectations for students

• Encourage wider faculty adoption of interprofessional interaction

Encourage Wider Faculty Adoption

Flexible curricular strategies to address barriers in interprofessional education

One of the most important concepts in designing interprofessional curricular activities is to realize that “one size does not fit all”—this is the reason why understanding the institution’s culture is a prerequisite for curriculum development. Various approaches have been described, ranging from didactic mandatory and elective coursework, to practice-based simulations, to community-based health promotion activities. In a systematic review of formal IPE programs from 1966 to 2005 by the Best Evidence Medical Education (BEME) Collaboration of the United Kingdom, Hammick and colleagues ¹⁸ reviewed 399 studies, of which 107 met review criteria, and the 21 strongest evaluations of IPE were included in the analysis. Of the 21 programs, most of the studies were from the United States (54%) and United Kingdom (35%), with the majority of IP curricular learning experiences lasting longer than 2 days (54% lasting ≥ 7 days; 24% lasting 2 to 7 days), although curricular interventions ranged in duration from 1 to 2 hours to several months. IPE was equally distributed between hospital- and community-based environments (45% each).¹⁸ The systematic review found that customization of curricular offerings and exposure of students to authentic environments were important mechanisms for positive outcomes of IPE. The authentic settings allowed participants to recognize their unique perspectives about themselves and others as they were forced to interact in a complex way within the IPE event. In addition, the strongest programs indicated that principles of adult learning for IPE are key factors for students to appreciate the outcomes of IPE. Hammick asserts that effective learning about being interprofessional occurs best in a context that reflects the students’ current or future practice.¹⁸ Some of the most effective IPE programs offer students a “menu” of learning opportunities, and examples of model programs are outlined in the concluding section of this chapter.

Faculty development in interprofessional education

How to develop faculty: core competencies and training models

Before interprofessional education initiation, “a systematic planning, development, and implementation process should be outlined including a plan for faculty and curricular development.”^{19(p 60)} Before faculty members move too quickly to adopt interprofessional educational experiences, they need to step back and think about developing the faculty! We cannot assume every faculty member has had positive interprofessional experiences in his or her clinical or academic work. Faculty development is an important step in shaping a collective vision among the faculty about interprofessional education. Purposes for faculty development will need to be identified, and the faculty development model will need to be matched to the institutional context in order to align these elements for institutional success.

Purpose of faculty development in interprofessional education

IPE faculty development initiatives are necessary for educators and administrators ¹⁹; Steinert proposed seven development approaches to promote IPE²⁰:

Table 7-2 Topical Areas Often Presented in Interprofessional Education Sessions for Educators

Area	Components
Interprofessional roles and responsibilities	Individual professional roles and responsibilities Limitations of respective professional role Group dynamics Professional role hierarchies
Professionalism	Educational requirements for each profession Consensus building within a team Conflict resolution and negotiation skills Interdependent relationships among professional members Valuing diversity
Communication	Effective verbal skills Active listening skills Communication barriers within teams Group facilitation techniques Ways to overcome miscommunication that frequently emerges from people holding differing perspectives
Pedagogy	Active learning techniques Ways to connect theory to practice Giving specific and sensitive feedback to students and partners Facilitation of critical reflection to recognize and implement change Passive role modeling Competency in using any technology used in interprofessional education activities Team teaching
Assessment	Selecting and administering targeted assessments related to learning objectives Identifying process improvements based on evidence

Data from references 19-22 and 24.

Development models

Faculty development models range from train-the-trainer sessions to self-study. Table 7-3 lists the various types of models that can be considered to develop faculty for interprofessional education. Regardless of the faculty development model that is selected, there are a number of issues that must be addressed for such sessions:

• What are the goals for the faculty development sessions?

• What type of pedagogy is used for faculty development sessions?

• Who is the target audience and how will they be invited to development sessions?

• What are the indicators of success for accomplishing the faculty development sessions?

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