Effectiveness of interprofessional education and new prospects

Although no solid evidence supports the effectiveness of Interprofessional Collaboration's (IPC) in improving professional practice and healthcare outcomes (Reeves, Pelone, Harrison, Goldman, & Zwarenstein, 2017), the investment of resources to develop interprofessional education (IPE) programs that generate the conditions for its realization is significant (IPEC 2016). The international literature identifies IPE as important in preparing nursing students and other healthcare professionals for their roles as healthcare providers (Darlow et al., 2015; Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013; Reeves et al., 2016). At the same time, interdisciplinary cooperation and good teamwork are important components of clinical settings, and when they are lacking, the consequences may include negative patient outcomes, a low level of professional work satisfaction, and wasted resources (Robben et al., 2012). Although there is limited and weak evidence supporting the effectiveness of IPE (Reeves et al., 2013), these problems likely reflect the heterogeneity of the studies conducted on IPE programs, which differ greatly and are not always solid from the perspective of pedagogical construction. Thinking of the IPE approach as a new paradigm in nursing education (O'Connor, 2018) leads to the risk of persisting in training different professionals in rigid, single-professional silos (Bennett et al., 2011) that obstructs comparison and collaboration between them when they find themselves working together in clinical practice at the end of their training. This contradicts what the Australian Commission on Safety and Quality in Health Care (O'Rourke, 2007) and others have expressed about the importance of incorporating the eight learning domains of IPC in the undergraduate education of healthcare professionals. Consequently, there is a lack of purposeful alignment between education and healthcare delivery systems around the world (Cox, Cuff, Brandt, Reeves, & Zierler, 2016). For many years in the USA and Canada, important support has been guaranteed at the government level and by private organizations for projects relating to both IPC and IPE (Department of Health, 1997; Health Canada, 2003; Institute of Medicine, 2000, 2013; WHO 1976, 2010), including the creation of documents to support the dissemination of IPE at an academic level (IPEC, 2011, 2016). Moreover, if the WHO (2010) prediction is accurate, there will be a shortage of approximately four million healthcare professionals worldwide in the coming years, and a potential response to this could be a rapid expansion of the healthcare workforce, including new educational approaches that involve IPC (Kanji, Lin, & Krekoski, 2017). In fact, IPC and IPE represent strategic opportunities to prepare a more flexible healthcare workforce able to maximize limited resources and provide a wide range of different services together in a variety of healthcare settings (Kanji et al., 2017). In Europe, sensitivity to, and support for, these essential themes occurred several years later, but it was supported equally by some countries that considered them important as a response to healthcare needs in continuous evolution. Examples of IPE programs established well are represented by the experience of the Linköping University (Sweden), Karolinska Institutet of Stockholm, and The Royal London School of Medicine and Dentistry (Cecchi & Marucci, 2010). We are confronted continuously with older people, and chronic illness and multimorbidity, all factors that increase demands for healthcare services (Barnett et al., 2012). These countries understood what WHO highlighted in 2010: beginning with local healthcare needs, only by including IPE in the training of the present and future workforce will professionals be created who are ready to respond to these needs, as well as building a stable healthcare system able to improve health outcomes. Furthermore, in other countries, such as Italy, medical education curricula and healthcare degrees have included IPE programs in some universities only in recent years, although these experiences are still local, and are not formalized nationwide (Zanotti, Sartor, & Canova, 2015). In contrast, in Switzerland, the Académie Suisse des Sciences Médicales (2014) provided significant support at the national level. Applying its “Charte of Collaboration Entre Les Professionnels De La Santé”, it wants to help optimize patients’ treatment to ensure healthcare in the context in which there is an increasing shortage of healthcare professionals, and to support the work of those who practice in this sector. It has been argued that the interprofessional approach should characterize both practice and graduate and postgraduate training. This position has helped strengthen the commitment of those academic institutions that for years have been experimenting with IPE models for different healthcare professions by providing common modules that integrate specific knowledge (Bianchi et al., 2017). The research financed by the Swiss National Research Fund also is dedicated to understanding the factors that facilitate and hinder IPC in these institutions (Staffoni et al., 2017) and in 2017, the Federal Office of Public Health (FOPH) also launched a programme to promote research projects on IPE and IPC to focus attention on these important themes. A point—sometimes forgotten when referring to IPC and, consequently, IPE—are the roles of patients and families (WHO, 2010), roles that the Australian Nursing and Midwifery Federation (2014) emphasizes underline the importance for nurses to focus on patients and their families, and to develop good communication with, and work collaboratively with other members of the healthcare team. What role can the nursing profession, its associations, and the providers of information (journals, media, social media, etc.) play to advance from a paradigm of monoprofessional education to one of IPE that must include patients and families as important actors in the process? The first thing is to understand clearly the important effects that this paradigm shift will have in improving the healthcare system, both with respect to patient outcomes and professional satisfaction. Thereafter, it is essential to promote IPE as a unique approach to train healthcare professionals and consider the different mechanisms that shape the way IPE is developed. These can be divided into two categories: “educator mechanisms (for academic staff, training, champions, institutional support, managerial commitment, and learning outcomes) and curricular mechanisms (logistics and scheduling, programme content, compulsory attendance, shared objectives, adult learning principles, and contextual learning: WHO 2010, p. 12). With awareness of both these points, it will be possible to act effectively and efficiently and seek the active collaboration of the other professions involved in this cultural change. It will only be possible to overcome those factors that present obstacles to the introduction and implementation of IPE, including cost, lack of administrative support, resources, and funding, with the collaboration of all the professionals involved (Foronda, MacWilliams, & McArthur, 2016; Titzer, Swenty, & Hoehn, 2012).

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