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The Status of Interprofessional Education and Interprofessional Prevention Education in Academic Health Centers

A National Baseline Study

Greer, Annette G., PhD, RN; Clay, Maria, PhD; Blue, Amy, PhD; Evans, Clyde H., PhD; Garr, David, MD

Author Information
doi: 10.1097/ACM.0000000000000232
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Abstract

Mirroring the emphasis of the U.S. health care delivery system, health professions education in the United States has traditionally focused more on teaching students to identify and treat disease than on educating them to meet the aim of reducing the incidence and prevalence of disease.1 However, in light of recent health care reforms, the value of prevention has never been greater. If prevention is to have more prominence in the health care delivery system, then training in prevention must begin in the education programs that prepare professionals for clinical practice.1

At the same time, recognition of the value of interprofessional education (IPE)—in which health professions students learn with, from, and about one another to prepare for collaborative practice—is at a greater level than at any time in the past 60 years.2 The simultaneous heightened appreciation for prevention and IPE is significant because prevention is an area that can benefit from an interprofessional (IP) team approach: A single clinician providing direct patient care rarely has time to address all recommended preventive services, but an IP team can provide those services.3

If the goal is to increase health professionals’ ability to deliver preventive services, especially by means of IPE, a first step would be to establish a baseline measure of the status of IPE and IP prevention education in U.S. health professions schools, thereby providing an indication of where additional efforts are needed. Studies documenting the status of IPE in the United States have been primarily discipline-specific, however. For example, Blue et al4 surveyed medical schools and found that IPE was an evolving process that generated interest but faced barriers such as funding limitations, lack of institutional leadership, academic calendar variability, and faculty attitudes. Evidence of an increase in some medical schools’ interest in IPE was revealed by the formation of the medical school deans’ Health Professions Education Collaborative, whose organizational goals included advancement of IP learning and whose membership grew from 10 deans in 2004 to 48 in 2007.5 Griner5 found that barriers to successful implementation of IPE in health sciences education included a lack of geographic proximity of the different disciplinary schools/colleges and the variability of the team learner skills.

To determine the status of IPE in pharmacy, Smith et al6 conducted focus groups at six pharmacy schools and their IPE partners. They identified six benefits of IPE, three of which were directly linked to common academic missions: effective practice models, improved communication, and enhanced teamwork. The other three benefits were economies of scale, research/scholarship, and improved quality of care. Smith et al also sought to identify implementation issues surrounding IPE in colleges of pharmacy and the higher education institutions in which they were located. They found that barriers to IPE implementation included space, lock-step program curricular patterns, inconsistency in professional program entry, pedagogical approaches, and limited financial resources.

Therefore, although specific disciplines have examined their role in IPE, to the best of our knowledge the literature lacks a comprehensive view of the health professions colleges, schools, and programs engaging in IPE and IP prevention education in the United States. Thus, in this study, we sought to determine the status of IPE and IP prevention education in academic health centers across the nation.

Background

IPE is not a new concept. Baldwin7 documented evidence of “interdisciplinary” health care team training with a focus on preventive health being offered as early as 1953. Baldwin attributed the Lyndon B. Johnson administration’s focus on social justice as the impetus for the participation of more than 5,000 medical and other health professions students in interdisciplinary primary care projects through community health efforts from the early 1960s until the mid-1970s.7 Interdisciplinary team training, now known as IP team training, has been occurring since then within academic health centers in the United States. Sporadic funding for IPE has been garnered through government sources, including the federal Health Resources and Services Administration’s Quentin N. Burdick Programs, and private sources such as the Pew Charitable Trust, and the John A. Hartford, Robert Wood Johnson, Josiah Macy Jr., and W.K. Kellogg foundations. A few of the programs funded by these organizations emerged from initiatives designed to train faculty in developing, delivering, and evaluating IP prevention education learning activities.3,8–13 Further, since 1972, the Institute of Medicine has published a series of reports advocating IPE.14–16

In 2010, the Josiah Macy Jr. Foundation convened a group of disciplinary leaders in health sciences to explore future primary care education.17 This resulted in an urgent call for changes in the primary care education infrastructure to help improve access, quality, and continuity of health care, and to lower costs as increasing demands for health care delivery services loom. It was noted that economic strains require innovative reengineering of the existing models of primary health care delivery and health sciences education. Further, regulatory and reimbursement issues limited the ability of many primary care professionals (such as nurse practitioners and physician assistants) to function at the higher end of their scopes of practice in an efficient and cost-effective manner. Solutions proposed included IPE for future primary care practitioners to prepare them to work as members of teams. The language used was emphatic: “Interprofessional education should be a required and supported part of all health professional education … [and] barriers that limit members of the health care team from learning or working together should be eliminated.”17

Hence, in the consensus of the authors, the following research questions arose: (1) What is the status of IPE in the United States? and (2) What is the status of IP prevention education in the United States?

The study reported here grew out of a 2007–2008 funded initiative sponsored by the Association for Prevention Teaching and Research (APTR) for U.S. faculty teams creating IP curricula that included community-based prevention activities.1 The APTR Institute for Interprofessional Prevention Education offered IP faculty teams from health sciences schools the opportunity to attend a workshop where experts in IPE curriculum development and evaluation could assist them in the creation of academic environments that would advance IPE at their institutions. This workshop included multiple team-based sessions during which the faculty refined their curricular plans for institutional implementation.1

Clay and Greer18,19 conducted evaluations during 2007 and 2008 to measure outcomes of the APTR Institutes and found variations in both the IPE experience of and the outcomes produced by the faculty teams. Teams with more IPE experience were able to implement IP curricula at much faster rates. The lessons learned and barriers faced by the faculty teams echoed those reported in the literature: lack of institutional leadership, academic calendar variability, faculty attitudes, lack of geographic proximity of the different disciplinary schools/colleges, variability of team learner skills, space, lock-step program curricular patterns, inconsistency in professional program entry, unaligned pedagogical approaches, and limited financial resources. It became clear to these authors and the APTR that it would be useful to measure an institution’s stage of development and its level of experience as applicable to implementing IPE.20,21 Therefore, these authors undertook the development of an instrument to help identify impediments to a desired level of IPE and to assist in planning IPE. That instrument was adapted to create the survey instrument used in this study, as described below.

Method

Study instrument

The APTR sought to develop an instrument that could help academic programs (1) assess their levels of IPE and IP prevention education and (2) guide their planning efforts for advancing IPE and IP prevention education. The APTR Institutes in 2007 and 2008, and the literature, provided ample guidance about the key topics to include in the instrument (i.e., course work, clinical rotations, infrastructure, policies, and other aspects of health professions education supporting IPE). With support from the Josiah Macy Jr. Foundation, Greer and Clay21 developed the IPE Assessment and Planning Instrument (API), published in 2010, which was designed for use by academic institutions as a self-assessment tool to plan and/or evaluate their progress toward IPE goals. (The IPE API is available online at http://www.aptrweb.org/store/ViewProduct.aspx?ID=1344597.)

We felt that the IPE API was rigorous enough in its reliability, having internal consistency and demonstrating content and face validity, that we could use it as the basis for designing an instrument to measure the status of IPE and IP prevention education in the United States. However, we felt that it was too long (> 20 items) to obtain a robust response rate. Whereas the IPE API includes a number of questions to measure aspects of mature IPE efforts, we decided that this study’s survey instrument should focus on basic IPE elements.21

Thus, we extracted the 10-item survey used for this study. Eight items asked whether the respondent’s college/school had courses or clinical rotations/internships with opportunities for IP collaborative learning experiences or IP prevention education, personnel with designated responsibility for IPE or IP prevention education, infrastructure to support IP efforts, and IP or similar language in official institutional documents. Response options were “yes,” “no,” and “don’t know.” Two items requested information about the unit represented (institution and state, the college/school within that institution, the respondent’s professional discipline) and the respondent’s title. (For wording of items, see Appendix 1.)

We believed that IPE requires infrastructure at the college/school level of health professions education programs. We expected that the initial survey results would serve as a baseline for tracking the progress of U.S. health professions education programs over time.

We took a qualitative approach to testing the dependability of the survey instrument, using triangulation of feedback from various groups who reviewed the items selected for inclusion. We asked colleagues engaged in IPE initiatives (e.g., APTR Institute attendees, members of the Canadian and American Interprofessional Health Collaboratives) to review and critique it. We also obtained critical feedback from attendees at the March 2010 Interprofessional Care for the 21st Century: Redefining Education and Practice conference in Philadelphia, Pennsylvania. We modified the survey instrument in light of feedback received. Finally, we asked several individuals familiar with IPE constructs to pilot-test the instrument.

This research was reviewed and approved as exempt by the East Carolina University internal review board.

Study sample

Initially, we targeted health professions education programs within academic health centers to receive the survey. We created a database of colleges and schools, using the Association of Academic Health Centers (AAHC) public membership listing, along with institutional leaders. We faced two challenges in determining whom to send the survey to at each institution: First, the unit of analysis was the college/school/program; second, no person could be identified as having information related IPE solely on the basis of his or her title. Thus, we decided that we would send the survey to the highest-ranking individual (i.e., the dean of a college/school or the director of a program), who could delegate completion of the survey to the appropriate person within his or her college/school/program.

To enhance the likelihood of reliable data collection, we conducted extensive research to determine the appropriate academic leader at each college/school within the academic health centers included in the list of AAHC member institutions. In our final selection process, we determined that each health sciences unit leader within the larger academic health center/university should be invited. We placed contact information for the dean or leader in a sample database. Finally, we obtained permission and support from the AAHC’s president and board of directors to distribute the survey to the listed member institutions.

Data collection, management, and analysis

We distributed the online survey (which was hosted by SurveyMonkey, a secure commercial surveillance product, at www.surveymonkey.com) via a link that we e-mailed to 346 contacts at 100 AAHC member institutions with an accompanying letter of support from the AAHC president. We collected data from September through December 2010. We developed a reminder tracking system and sent follow-up e-mails to nonresponders on two occasions during the surveillance period. When e-mails were returned with invalid addresses, we made secondary attempts to secure appropriate addresses. We then outlined a proprietary process for systematic review of the data prior to data analysis.

This proprietary process included the establishment of a dataset that could be manipulated for analysis. We downloaded the response data into Microsoft Excel and established a complete database. Data were sorted by university and by state to determine demographic indicators of the dataset. We established criteria for cleaning the database prior to analysis. We conducted descriptive statistical analysis along with cross-tabulations.

Results

The survey was accessed by 168 contacts, of whom 129 completed the survey. One completed survey was marked invalid and one was withdrawn at the request of the respondent’s university, leaving a total of 127 respondents who completed surveys. Response rates were difficult to calculate because the survey invitation encouraged recipients to share the survey with units throughout the institution. Of the 100 universities at which contacts received invitations, 68 (68.0%) in 31 states and the District of Columbia were represented in the responses.

Respondents identified their academic titles, and all but one of these char acterized some level of leadership within the institution represented. Medicine was somewhat overrepresented in the responses (see Table 1). IP collaborative learning experiences were well represented, with 108 (85.0%) of the 127 respondents affirming existence of such opportunities in courses and 102 (80.3%) reporting them in clinical rotations/internships. Fewer respondents reported having courses (n = 74; 58.3%) or clinical rotations/internships (n = 62; 48.8%) in which students from one profession/discipline worked with students from another to learn prevention.

Table 1
Table 1:
Survey Results, National Interprofessional Education and Interprofessional Prevention Education Baseline Study, 2010

Regarding infrastructure, 87 (68.5%) of the 127 respondents indicated that personnel with responsibilities for IPE were in place at their institutional unit, and 76 (59.8%) indicated that there were personnel responsible for prevention education. More than three-quarters of public health respondents (7/9; 77.8%) reported personnel at their school with designated responsibility for prevention education. More than half of the 127 total respondents (n = 76; 59.8%) reported the presence of an IPE office or center. Finally, 95 (74.8%) of the total respondents reported IP or similar language in formal communications and official institutional documents.

Discussion

The results of our national baseline study show that health professions courses and clinical rotations/internships that offer opportunities for IPE experiences are more prevalent than IP infrastructure (e.g., personnel with responsibility for IPE, IP office/center) at U.S. universities. This study provides evidence that the culture of health professions education includes IPE activities and suggests that faculty have developed IP course work and clinical experiences at the majority of the 68 universities represented by respondents. However, the results also suggest that there is a need for more attention to be paid to infrastructure, resources, and policies to support IPE models. This study highlights the need for the integration of prevention education.

Our findings serve as a positive indication that there is a basis for creating synergy for a paradigm shift to IP health sciences education. That many respondents reported IPE in health sciences courses and clinical experiences is important news for those eager to initiate IPE at their institutions as it signals the availability of resources. For example, syllabi exist from which to design course work.1,19 Further, IPE clinical training activities that have been tried and tested are available for application to specific clinical programs.22,23

A good number of respondents indicated that their institutions have personnel with designated IPE responsibilities; it may be possible to obtain sample roles and responsibilities/job descriptions or compensation information. The fact that some institutions have designated IPE faculty suggests that we should concentrate on how institutional barriers to faculty involvement in IPE (e.g., lack of incentives for team teaching, outdated promotion guidelines) can be overcome everywhere.24 Lastly, the lack of pervasiveness of IPE infrastructure affords opportunities for the development of new models and, possibly, new funding opportunities to support the creation of sustainable infrastructure.

Whereas the status of IP prevention education is similar to that of IPE (i.e., course work and clinical experiences are more pervasive than are designated personnel or infrastructure), our survey results clearly indicate a lower prevalence of IP prevention education than of IPE in general. IP prevention courses and clinical experiences may provide key opportunities for students from different professional disciplines to learn together.

This research is significant in that it indicates that we do not need to create IPE models de novo. The presence of IPE course work and activities predicts an accelerated rate of IPE activities in health professions instructional programs, thereby hastening implementation of newly adopted IPE core competencies and accreditation standards.24–26 IPE-specific accreditation standards are in place for the following disciplines: dental medicine, nursing, occupational therapy, pharmacy, physical therapy, physician assistant studies, and public health.24–26 The new Coordinating Center for Interprofessional Education and Collaborative Practice should also advance IPE efforts.27

This study had limitations. One is that respondents may have been more likely than nonresponders to have IPE activities already under way. Another is the fact that some institutions were represented by multiple respondents (different disciplines, unreplicated) within a single college/school/program.

Our survey results lead us to conclude that a national assessment of the status of IPE and IP prevention education is possible. Although this study has shown that useful data can be obtained from leaders who are willing to provide information about their institutions and themselves, one study at one point in time is not sufficient. As IPE and prevention assume greater roles in health sciences education and in health care delivery, ongoing surveillance will be needed to track new and better IPE models and outcomes attributable to IPE and IP prevention education.

Acknowledgments: The authors acknowledge the Association for Prevention Teaching and Research (APTR) in the substantive groundwork in the development of the Interprofessional Education Assessment and Planning Instrument, upon which this study’s survey instrument was based, and the identification of the constructs of measures.

References

1. Evans CH, Cashman SB, Page DA, Garr DR. Model approaches for advancing interprofessional prevention education. Am J Prev Med. 2011;40:245–260
2. Josiah Macy Jr. Foundation. 2012 Annual Report: Accelerating Interprofessional Education. 2012 New York, NY Josiah Macy Jr. Foundation http://www.macyfoundation.org/docs/annual_reports/macy_AnnualReport_2012.pdf. Accessed January 20, 2014
3. World Health Organization Framework for Action on Interprofessional Education and Collaborative Practice. 2010 Geneva, Switzerland World Health Organization http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf. Accessed January 10, 2014
4. Blue AV, Mitcham M, Smith T, Raymond J, Greenberg R. Changing the future of health professions: Embedding interprofessional education within an academic health center. Acad Med. 2010;85:1290–1295
5. Griner PF. Leadership strategies of medical school deans to promote quality and safety. Jt Comm J Qual Patient Saf. 2007;33:63–72
6. Smith KM, Scott DR, Barner JC, Dehart RM, Scott JD, Martin SJ. Interprofessional education in six US colleges of pharmacy. Am J Pharm Educ. 2009;73:61
7. Baldwin DC Jr. Collected works on interdisciplinary and interprofessional education and practice (listed chronologically by category). J Interprof Care. 2007;21(suppl 1):108–112
8. Walsh CL, Gordon MF, Marshall M, Wilson F, Hunt T. Interprofessional capability: A developing framework for interprofessional education. Nurse Educ Pract. 2005;5:230–237
9. Howell DM. Interprofessional education programs today: Surveying model programs in the U.S. Introduction. J Allied Health. 2010;39(suppl 1):e119
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11. Mareck DG, Uden DL, Larson TA, Shepard MF, Reinert RJ. Rural interprofessional service–learning: The Minnesota experience. Acad Med. 2004;79:672–676
12. Thistlethwaite J, Moran MWorld Health Organization Study Group on Interprofessional Education and Collaborative Practice. . Learning outcomes for interprofessional education (IPE): Literature review and synthesis. J Interprof Care. 2010;24:503–513
13. Charles G, Bainbridge L, Gilbert J. The University of British Columbia model of interprofessional education. J Interprof Care. 2010;24:9–18
14. Institute of Medicine. Committee on Quality of Health Care in America I. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001 Washington, DC National Academies Press http://www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx. Accessed January 13, 2014
15. Institute of Medicine. Committee on the Future of Rural Health Care. Quality Through Collaboration: The Future of Rural Health. 2005 Washington, DC National Academies Press http://www.iom.edu/Reports/2004/Quality-Through-Collaboration-The-Future-of-Rural-Health.aspx. Accessed January 13, 2014
16. Institute of Medicine. Committee on the Health Professions Education Summit. Health Professions Education: A Bridge to Quality. 2003 Washington, DC National Academies Press http://www.iom.edu/Reports/2003/health-professions-education-a-bridge-to-quality.aspx. Accessed February 4, 2014
17. Cronewett L, Dzau V Co-Chairs’ Summary of the Conference: Who Will Provide Primary Care and How Will They Be Trained?. 2010 New York, NY Josiah Macy Jr. Foundation http://macyfoundation.org/docs/macy_pubs/jmf_ChairSumConf_Jan2010.pdf. Accessed January 13, 2014
18. Clay MC, Greer AG. APTR Evaluation 2007 Institute for Interprofessional Prevention Education. 2007 http://www.aptrweb.org/prof_dev/institute.html. Accessed June 14, 2010
19. Clay MC, Greer AG. APTR Evaluation 2008 Institute for Interprofessional Prevention Education. 2008 http://www.aptrweb.org/prof_dev/institute.html. Accessed June 14, 2010
20. Greer AG, Clay MC. Office of Interdisciplinary Health Studies Education, East Carolina University. J Allied Health. 2010;39(suppl 1):e129–e130
21. Greer AG, Clay MC. Interprofessional education assessment and planning instrument for academic institutions. J Allied Health. 2010;39(suppl 1):224–231
22. Association for Prevention Teaching and Research. Health Professions Education Programs Resources. . APTR Promoting Health Through Prevention Education and Research. 2007;1 http://www.aptrweb.org/educationforhealth/healthprofessions.html. Accessed June 22, 2012
23. Association for Prevention Teaching and Research. Education for Health: A Vision for 2020 Successful Practices Project. 2011 . Published http://c.ymcdn.com/sites/www.aptrweb.org/resource/resmgr/successful_practices/successful_practices_publica.pdf?hhSearchTerms=Education+and+for+and+Health%20. Accessed June 22, 2013
24. Knettel A Making the Business Case for Interprofessional Education and Training. 2011 Washington, DC Association of Academic Health Centers http://www.aahcdc.org/Resources/ReportsAndPublications/IssueBriefs/View/ArticleId/99/Making-the-Business-Case-for-Interprofessional-Education-and-Training.aspx. Accessed January 1, 2014
25. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. 2011 Washington, DC Interprofessional Education Collaborative:1–56 http://nnlm.gov/bhic/2011/05/26/core-competencies-interprofessional/. Accessed January 1, 2014
26. Zorek J, Raehl C. Interprofessional education accreditation standards in the USA: A comparative analysis. J Interprof Care. 2013;27:123–130
27. U.S. Department of Health and Human Services, Health Resources and Services Administration. . Coordination Center for Interprofessional Education and Collaborative Practice. http://www.hrsa.gov/grants/apply/assistance/interprofessional/. Accessed February 4, 2014

Survey Items and Prompts, National Interprofessional Education and Interprofessional Prevention Education Baseline Study, 2010 Demographic items

  1. Please provide the following information:
    • University/institution
    • Your college/school
    • Your professional discipline
    • State
  2. Please provide us with the title you hold at the school or college at your institution.

Multiple-choice items (response options: yes, no, do not know)

  • 3. This school or college offers courses that include opportunities for interprofessional collaborative learning experiences.
  • 4. This school or college offers courses in which students from one profession/discipline work with students from another profession/discipline to learn prevention.
  • 5. This school or college offers clinical rotations or internships that include opportunities for interprofessional collaborative learning experiences.
  • 6. This school or college offers clinical rotations or internships in which students from one profession/discipline work with students from another profession/discipline to learn prevention.
  • 7. This school or college has personnel with designated responsibilities (e.g., administrative, teaching, or research) for interprofessional education.
  • 8. This school or college has personnel with designated responsibilities (e.g., administrative, teaching, or research) for prevention education.
  • 9. This school or college has interprofessional or similar language which appears in official institutional documentation (e.g., mission or vision statement, strategic plans, governance documentation).
  • 10. This institution has an office, center, or other infrastructure that supports interprofessional efforts.
© 2014 by the Association of American Medical Colleges