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Position Statement: All
health care disciplines share a common and primary commitment
to serving the patient and working toward the ideal of health
for all. While each discipline has its own focus, the scope
of health care mandates that health professionals work collaboratively
and with other related disciplines. Collaboration emanates from
an understanding and appreciation of the roles and contributions
that each discipline brings to the care delivery experience.
Such professional socialization and ability to work together
is the result of shared educational and practice experiences.
Multidisciplinary education and
practice occur when several disciplines work in parallel,
often with independent goals. In contrast, interdisciplinary
education may include a variety of disciplines from health
and other fields of study that collaborate through joint planning,
decision-making, and goal-setting. Nursing students should
be educated in an environment that provides such interdisciplinary
educational experiences based on mutual understanding and
respect and designed to enhance the practice of each discipline.
One vital component of any educational endeavor is evaluation
of its success. Thus, educators are responsible for assessing
the results of an interdisciplinary approach to assure that
collaboration is enhanced, the delivery of care is facilitated,
and patient outcomes are improved.
Definition
Interdisciplinary Education
- An educational approach in which two or more disciplines
collaborate in the learning process with the goal of fostering
interprofessional interactions that enhance the practice of
each discipline. Such interdisciplinary education is based
on mutual understanding and respect for the actual and potential
contributions of the disciplines.
Background
Complex Patient Care Demands An
Interdisciplinary Approach
More than a decade ago, the increasing
complexity of patient care and the resultant increasing need
for collaboration between health professionals was articulated1.
The ability to co-labor (collaborate) is clearly vital when
the plethora of health professionals and their increasing
specialization and role differentiation combine with the complexity
of patient care demands to make interdependency among professionals
essential.
More recently, deTornyay has suggested that
a philosophical shift must occur in order for the current
and future generations of faculty to prepare professionals
who can effectively meet the basic health care needs of the
American public. She described a "culture of collaboration"
in the year 2005 in which faculty from schools of medicine,
nursing, social work, public health and other disciplines
jointly assume responsibility for the creation of the learning
environment. She noted that there was a dearth of recent medical
and nursing literature providing substantive discussion of
interdisciplinary development in education and practice2.
Yet, the complex health needs of society exceed the capability
of any single discipline.
Professional Socialization Begins
Early
While interdisciplinary education has
been recommended as part of a holistic, cooperative agenda
for health care1-7, there has been little work
to examine how and when such education should occur. Nevertheless,
several things seem clear. First, professional socialization
begins early, often before career choices are even made .
Second, professional socialization occurs in the context of
other professions8. Lastly, the skills needed for
collaboration--negotiation, team building, joint decision
making, and problem solving--are learnable, but the content
and methods to best teach these skills are rare in current
curricula. In fact, very few schools for health professionals
include any interdisciplinary experiences, either classroom
or clinical, as part of their course work9.
The Pew Health Professions Commission recommends
that curricula be revised to promote teamwork and interprofessional
contact6. The foundations for interdisciplinary
collaboration can be laid from the inception of advanced education.
In a survey of 114 programs in nursing, occupational therapy,
physical therapy, audiology, and medical technology, faculty
identified the most important contributions of general education
to professional development. These included written and verbal
communication skills, problem solving, understanding behavior,
and developing values10, skills clearly vital to
collaboration. Thus, interdisciplinary education is enhanced
when introduced early in the liberal arts core of professional
studies.
Interdisciplinary education of health professionals
is part of a larger movement in health care to scrutinize
costs and maximize efficiency of care delivery by moving from
an environment of competition to one of collaboration. Major
foundations such as Robert Wood Johnson, Pew, and Kellogg
are focusing attention in their funding initiatives on partnerships
among professions and among institutions and communities.
But barriers have been daunting, and many efforts at developing
interdisciplinary educational programs have failed or simply
fallen by the wayside9.
There are a number of challenges to be addressed
in order to assure the success of interdisciplinary educational
endeavors. These challenges may be philosophical and sociological
(gender and class differences between professions, differences
in professional respect and commitment to an interdisciplinary
approach, differences in disciplinary focus and mission),
organizational and structural (scheduling and timing differences
among programs, appropriate student mix and level of student,
geographic separation, lack of adequate clinical sites for
interdisciplinary experience, financial reimbursement), or
academic and professional (overlapping and converging roles
with potential loss of disciplinary identity, need for faculty
development, identifying core content and shared experiences,
selecting disciplines to be involved, finding and training
appropriate mentors). Despite the barriers, programs are being
initiated and are creating some models of collaboration.
Outcomes of Interdisciplinary Education
Must Be Assessed
While studies are beginning to validate that
patient outcomes, quality of care, and patient and provider
satisfaction are improved in a collaborative practice setting5,
11-13, the role of the educational process in enhancing
or interfering with collaboration has not been well documented.
Studies of interdisciplinary educational programs have included
evaluations of such factors as awareness/knowledge of roles,
shared decision making, attitudes toward collaboration and
toward other disciplines, provider and patient satisfaction
with collaborative clinical programs, and quality of written
care plans. Such studies, however, have been few in number,
usually single-site case studies with no comparison group,
and have included short follow-up periods and/or small numbers
of participants. They generally have focussed on a single
condition or patient group such as diabetes or gerontology.
None has assessed patient health-related outcomes or costs
of care.
Throughout the history of health care, practices
and procedures have been introduced with minimal critical
assessment. Interdisciplinary education seems to be a vital
step in the movement toward coordinated systems of efficiently
delivered, cost-effective, high-quality health care. It is
also fraught with philosophical and practical challenges.
Hence, an evaluation of the effects of interdisciplinary education
on patient care and studies to determine how to maximize educational
benefit are essential.
Recommendations
For schools of nursing:
Develop programs and curricula that incorporate
opportunities for undergraduate and graduate nursing students
to interact in a collaborative manner with a range of disciplines
in the provision of health care.
Seek to establish mechanisms with other disciplines
for joint planning and decision making in order to identify
shared content and clinical experiences.
Collaborate with other health care disciplines
to develop, implement, and evaluate models of interdisciplinary
education.
Seek opportunities to provide clinical experiences
that foster an interdisciplinary approach.
Conduct research to evaluate outcomes (particularly
patient outcomes) of interdisciplinary models of education
and practice.
For AACN:
Develop a database of examples and models
of interdisciplinary education.
Conduct regional workshops or seminars to
explore issues related to interdisciplinary education.
Prepare a monograph for health professionals
on interdisciplinary education.
Establish liaisons with other professional
organizations for the purpose of considering joint statements
and activities designed to foster interdisciplinary education.
Task Force on Interdisciplinary
Education Members:
Elaine L. Larson, PhD, Task Force Chair
Dean, School of Nursing
Georgetown University (DC)
Nancy O. DeBasio, PhD
President/Dean, Rockhurst College
Research College of Nursing (MO)
Mary O. Mundinger, DrPH
Dean, School of Nursing
Columbia University (NY)
Joyce K. Shoemaker, EdD
Dean, School of Nursing
Medical College of Ohio
(Approved by Membership -- March
20, 1995)
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