Interprofessional Education: Just Another Catch Phrase?

by Allison Butts, Pharm.D., PGY1 Pharmacy Practice Resident, The Johns Hopkins Hospital

Only nine months into my pharmacy career and I’m tested every day to effectively use my clinical knowledge, rational decision-making skills, adaptability, and confidence to deliver optimal patient care working alongside health professional colleagues.  I found the transition from student pharmacist to licensed pharmacist to be fairly smooth, which I attribute to the interprofessional education I received in pharmacy school.  If healthcare practitioners are expected to work together, communicate, and use their skills in an integrated manner, it seems clear that it is best to train students in an interprofessional environment.  In writing this essay I reflected on my educational experiences and how best to prepare students for practice in healthcare today.

In 2003, the Institute of Medicine (IOM) issued a report entitled, “Health Professions Education:  A Bridge to Quality.”  This report highlighted a number of necessary changes to professional health care education to improve the quality of care provided in the United States.  The report emphasized five core competencies that should be addressed through professional education:  patient-centered care, evidence-based practice, quality improvement, informatics, and interprofessional teams.¹   The Accreditation Council for Pharmacy Education (ACPE) addressed the 2003 IOM reports and adopted the core competencies into their 2007 Guidelines for ACPE Accreditation Standards, with a special focus on interprofessional education.²  In 2011, a joint effort between the American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and the Association of Schools of Public Health further refined the core competencies.³  A 2012 survey found that only 34% of the participating colleges of pharmacy provided instruction regarding interprofessional teaming.  Most of these colleges / schools of pharmacy has some interprofessional teaching in their curriculum (53%), while others offered it as topic within a course (24%) or as a standalone course (17%) format.  While only a third were actively teaching interprofessional teaming, an impressive 83% of respondents indicated a desire to include this core competency into their curriculum.⁴

Colleges of pharmacy from across the country continue to look for new ways to teach the principles of interprofessional teaming in their curriculum.  Faculty from the South Carolina College of Pharmacy, MUSC Campus, recently published data on pharmacy students’ perceptions regarding interprofessional collaboration after completing a required longitudinal clinical assessment course.  The course addressed several domains of interprofessional education in nine separate learning activities.  The activities involved students from pharmacy, physician assistant studies, medicine, and nursing.  The Interprofessional Education Perception Scale (IEPS) was used to assess the perceptions of pharmacy students prior to and at the completion of the course.  In 16 of the 18 questions surveyed, perceptions of interprofessional collaboration improved after completing the course.  The items that had the most improvement were:  “individuals in other professions respect pharmacists” and “individuals in my profession are positive about their goals and objectives.”⁵

Other published examples of interprofessional teaching models include a required introductory pharmacy practice experience (IPPE) course in which pharmacy students visit practice sites of local physicians and nurse practitioners who serve as primary preceptors, participation in a service-learning advanced pharmacy practice experience (APPE), medical missions trips, patient simulation activities, and interprofessional didactic coursework.^6-12

Looking back on my pharmacy education, I recognize how fortunate I was to have trained at an institution located within a large academic medical center, especially one in which clinical pharmacy services are full integrated in the delivery of care.  When considering my personal experiences and reconciling them with examples from the literature, there is a combination of approaches that I believe will create the optimal environment for students to learn about the principles of interprofessional teaming and become skillful team members:

• Provide interprofessional experiences early and often.  It is never too early in the curriculum to introduce students to their health care colleagues.  Students across disciplines take many of the same basic science classes early in their respective programs, so should be feasible to have students from different professional programs in the classroom together.  Activities should evolve as students move through their curricula, allowing for the development of solid relationships prior to clinical rotations.
• Engage students in the development of interprofessional initiatives.  Students themselves can be the best gauges of a program’s success.  By understanding their needs, goals, and perceptions, educators can tweak the curriculum to best prepare students for clinical practice.
• Develop unique methods of student assessment.  Students are often graded at the completion of a interprofessional patient care activity (real or simulated) based on a SOAP note or patient presentation.  Educators should also measure the success of the team by how well they utilize their colleagues.  Students should be asked what each team member contributed as well as how they utilized their teammates to accomplish their tasks.
• Provide variety.  Ideally, health care students should interact with students from several different professional programs.  There are admittedly resource limitations and logistical barriers, but colleges/schools of pharmacy should strive to work with at least two other professional degree programs.  Create a variety of learning activities and consider nontraditional experiences to achieve the competency standards. 

The concept of interprofessional education is more than a catch phrase in today’s professional education landscape.  It is a true necessity in preparing pharmacy and other health professional students to become successful practitioners.  Primary professional education organizations have formed a united voice in favor of this practice model and interprofessional training should be a priority at schools/colleges across the country.

References

1. Greiner AC, Knebel E, eds.  Institute of Medicine.  Health Professions Education:  A Bridge to Quality.  Washington, DC:  National Academies Press; 2003. Accessed 10 March 2014. 
2. Accreditation Council for Pharmacy Education.  Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree.  Guidelines Version 2.0 for Standards 2007.  Effective February 14, 2011.  Accessed 10 March 2014. 
3. Interprofessional Education Collaborative Expert Panel.  Core Competencies for Interprofessional Collaborative Practice:  Report of an Expert Panel.  Washington, DC: Interprofessional Education Collaborative; 2011.
4. Zeind CS, Blagg JD, Amato MG, and Jacobson S.  Incorporation of Institute of Medicine Competency Recommendations within Doctor of Pharmacy Curricula.  Am J Pharm Educ.  2012; 76: Article 83.
5. Shrader S, Griggs C.  Multiple Interprofessional Education Activities Delivered Longitudinally Within a Required Clinical Assessment Course.  Am J Pharm Educ.  2014; 78: Article 14.
6. Turner CJ, Altiere R, Clark L, Dwinnell B, and Barton A.  An Interprofessional Introductory Pharmacy Practice Experience Course.  Am J Pharm Educ. 2004; 68: Article 10.
7. Jones KM, Blumenthal DK, Burke JM, et al.  Interprofessional Education in Introductory Pharmacy Practice Experiences at US Colleges and Schools of Pharmacy.  Am J Pharm Educ.  2012; 76: Article 80.
8. Johnson JF.  A Diabetes Camp as the Service-Learning Capstone Experience in a Diabetes Concentration.  Am J Pharm Educ.  2007; 71: Article 119.
9. Werremeyer AB, Skoy ET.  A Medical Mission to Guatemala as an Advanced Pharmacy Practice Experience.  Am J Pharm Educ.  2012; 76:  Article 156.
10. Fernandez R, Parker D, Kalus JS, Miller D, Compton S.  Using a Human Patient Simulation Mannequin to Teach Interprofessional Team Skills to Pharmacy Students.  Am J Pharm Educ.  2007; 71: Article 51.
11. Van Winkle LJ, Cornell S, Fjortoft N, et al.  Critical Thinking and Reflection Exercises in a Biochemistry Course to Improve Prospective Health Professions Students’ Attitudes toward Physician-Pharmacist Collaboration.  Am J Pharm Educ.  2013; 77: Article 169.
12. Westberg SM, Adams J, Thiede K, Stratton TP, Bumgardner MA.  An Interprofessional Activity Using Standardized Patients.  Am J Pharm Educ.  2006; 70: Article 34.