Leading Initiatives

Interdisciplinary Education and Practice

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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)

References

  1. Mechanic, D., & Aiken, L.H. (1982). A cooperative agenda for medicine and nursing. New England Journal of Medicine, 307, 747-750.
  2. de Tornyay, R. (1994). Creating the teachers of tomorrow's professionals. Inquiry, 3l, 283-288.
  3. Forbes, E.J., & Fitzsimons, V. (1993). Education: The key to holistic interdisciplinary collaboration. Holistic Nursing Practice, 7, 1-10.
  4. Fagin, C.M. (1992). Collaboration between nurses and physicians: No longer a choice. Academic Medicine, 67, 295-303.
  5. Pew Health Professions Commission (February 1993). Health professions education for the future: Schools in service to the Nation. San Francisco: Pew Commission.
  6. Sharp, N. (1992). Community partnerships in health professions education. Nursing Management, 23, 14-15.
  7. Association of Academic Health Centers. Allied health programs in academic health centers: Special opportunities for education, research and service. Washington DC: Association of Academic Health Centers.
  8. Waugaman, W.A. (1994). Professionalization and socialization in interprofessional collaboration. In Commission on Interprofessional Education and Practice, Intraprofessional care and collaborative practice. Pacific Grove, CA: Brooks/Cole Publishing Company, 23-31.
  9. Larson, E.L. (1995). The need for interdisciplinary education for health professionals. Nursing Outlook, in press.
  10. Arlton, D., Ernst, M., & Sunderwirth, S. (1990). General education in the professional curriculum: Faculty perceptions of contribution. Journal of Allied Health, 19, 49-56.
  11. Baggs, J.G. (1989). Intensive care unit use and collaboration between nurses and physicians. Heart and Lung, 18, 332-338.
  12. Knaus, W.A., Draper, E.A., Wagner, D.P., & Zimmerman, J.E. (1986). An evaluation of outcome from intensive care in major medical centers. Annals of Internal Medicine, 104, 410-418.
  13. Editor. (1984). Nurse-physician communication affects patient care. Health Affairs, 16, 29-31.

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