Clinical interprofessional education for integrated care: Articulating competencies

Integrated care (IC) is designed to help keep older persons and those living with chronic illness out of hospital and in their homes for as long as possible. Definitions of IC are wide and varied, but the most comprehensive understanding is that IC requires coordination across the social worlds of public health, the patient/client, social and health care (mental and physical) services and professionals, between primary, secondary and tertiary care systems. Therefore, the task of articulating interprofessional (IP) competencies with emerging IC competencies has the added complexity of integrating systems-based with IP competencies. The task of articulating IP competencies with emerging IC competencies has [the] added complexity. Jill Thislethwaite, in this journal,1 has already provided an insight into the complexity of ‘integrated care and interprofessional education’. Clinical educators will need to educate and develop the health and social care professions of the future for IPIC. Here, we reflect on two recent articulations of IPIC competencies in the literature. We then provide examples from our own IP learning (IPL) practice, as IPL coordinators for health care students, exploring how and where we integrated IP competencies with domain-based competencies for a practice that transcends all types of IC: medication safety at transitions of care for patients. Clinical educators will need to … develop the health and social care professions of the future for IPIC. For IP clinical educators, the articulation of IP practice competencies with emerging IC competencies is gaining traction. Using a qualitative participatory co-design process, O'Donnell et al.2 published a ‘starter kit’ for the development of IP collaboration competencies for IC teams working with older people in Ireland. This resulted in the generation of an IP collaboration competency framework for IC, comprising three domains (knowledge of the team; communication; shared decision making) and six competencies (understanding roles and making referrals; sharing information and communicating effectively; supporting decision-making with older people and collective clinical decision-making) (Table 1). A recent scoping review by Michielsen et al. articulated the IP primary care competencies for IC of people living with chronic illness.3 These IPIC competencies can be seen in the third column of Table 1. The articulation of IP practice competencies with emerging IC competencies is gaining traction. For our student IPL activity, a clinical site experiential learning session, we address medication safety across transitions of care. The World Health Organization (WHO) ‘Medication Without Harm’ framework4 provides us with a means for articulating to students the activity aim: for health care students to work interprofessionally on reducing medication-related harm. The IPL activity based in the hospital setting involves medication reconciliation and optimisation for patients upon admission, addressing medication safety at transition of care from primary care setting (community-based care, home or nursing home) to hospital. The IP teams collaborate and communicate with each other as a team, and they take leadership of the task and engage with the patient in the hospital setting. Within the WHO framework, there are four domains (patients and the public, systems and practices of medication, health care professionals and medications), 16 subdomains (four for each domain) and three key action areas: (i) polypharmacy; (ii) high risk situations and (iii) transitions of care. By mapping the subdomains of this WHO framework to IPL competencies in the Canadian Interprofessional Health Collaborative (CIHC) framework,5 we generated an articulation of IPL competencies for this type of IC practice (see Table 1, first column). To answer the question ‘are interprofessional competencies for integrated care universal?’, we mapped our generated IPL competencies for medication safety across transitions of care to the developed IP competencies for IC of older persons2 (see Table 1). Upon comparison, all IPIC competencies match in terms of concept, and the terminology applied to articulate the construct are the same across (i) patient engagement, (ii) communication and (iv) collaboration, but less so for (iii) teamwork and (v) leadership (‘knowledge of team’ or ‘understanding roles’ instead of ‘teamwork’; ‘collective decision-making’ instead of ‘leadership’ or ‘shared leadership’). However, when comparing IPIC competencies for chronic illness generated by the scoping review by Michielsen et al.,3 we found that all IPL competencies for our type of IC area (column 1) matched exactly, articulating with the IPIC competencies from the review (column 3). We can conclude that overlap exists between IP competencies generated for our IP medication safety education across transitions of care and different IC programme competency frameworks, but that not all of them are articulated exactly in the same way. This reflection might prompt debate in the field about whether we, as IP educators, or members of the IPIC community, should be articulating IP competencies using the same lexicon across all IC programmes, rather than separate ones. Further work to connect IP and IC, especially to embed these frameworks efficiently and constructively to guide health care education, is necessary to support the development of IPIC guided programmes and articulation of IPIC competencies. Debate about whether we …. should be articulating IP competencies using the same lexicon across all IC programmes. Aislinn Joy: Conceptualization; writing—original draft; writing—review and editing. Aoife Fleming: Writing—review and editing. The authors have no acknowledgement to disclose. Open access publishing has been facilitated by University College Cork, as part of the Wiley - University College Cork agreement via the IreL Consortium of Irish research libraries. The authors have no conflict of interest to disclose. The authors have no ethical statement to declare. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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