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Interprofessional Continuing Education in Healthcare

healthcareI confess I’m usually not a big fan of sports metaphors in medicine. But I must admit, in the years since I graduated from medical school in 1984—into a healthcare system in which professional roles were sharply defined, turf lines were clearly drawn, and there were obvious inviolable hierarchies among the caregivers within the hospital setting—healthcare has since become much more of a “team sport.” The delivery of care, especially in the hospital setting, which is so much more complicated and sophisticated than it was even a decade ago, mandates that we all work together. This applies not only to multidisciplinary collaboration among physicians of different specialties; and by the way, the rise of the hospitalist specialty has done more to spur this than perhaps any other educational, clinical, or demographic development. It also applies to interprofessional collaboration—that is, physicians, nurses, pharmacists, nurse practitioners, physician assistants, physical and occupational therapists, dieticians and nutritionists, wound care techs, imaging techs, social workers and case managers . . . I could keep going without any risk of overstating my case. Healthcare today in the inpatient environment really is that complex. Achieving optimal outcomes—whether measured clinically, financially, or by patient satisfaction—demands collaboration and good communication among all providers to supply “wrap-around” and safe care to the patient. The delivery of interprofessional care requires professional continuing education that takes this into account.

In the past, individual healthcare professions have been educated in silos, teaching to the ultimate responsibility and accountability of each role. Unfortunately, many of the errors made in patient care occur in the spaces between these silos, where clinicians have not been trained to share expertise from different perspectives and be willing to share responsibility, data collection, and decision-making. While in contemporary undergraduate and graduate healthcare education, interprofessional conferences, rounding, and even social activities are becoming more common, the vast majority of clinicians in practice today have not been taught during their training the importance of this new reality of shared provision of care. That is where continuing medical education, aimed at interprofessional audiences, can fill the gaps.

Joint-accredited (see https://www.jointaccreditation.org/) continuing education (CE) providers design, develop, implement, distribute, assess, and evaluate programs for multiple health professionals. The current standards enable educational programs to be simultaneously accredited to provide dentistry, medicine, nursing, optometry, PA, pharmacy, psychology, and social work continuing education credit. Such programs, when widely distributed, advance patient care-driven, team-developed, and learner-focused education among a broad range of healthcare professionals. This may seem intuitive, but breaking down siloes and turf barriers has never been straightforward. But what is the “guiding light” target? It is collaboration to improve patient outcomes.

The Institute of Medicine (IOM) has issued a series of reports demonstrating the relationship between poor team performance and negative patient outcome.1 In 1999, the IOM’s landmark report To Err is Human: Building a Safer Health System, described to howls of concern not only from organized medicine but also from the lay public and even within our national political debate, the impact of medical errors on clinical outcomes in terms of human lives.2 Importantly, recommendations from the report included establishing interdisciplinary team training and implementing an interdisciplinary, collaborative approach to re-designing complex systems of healthcare delivery. Innovative and inclusive education and training were seen as critical for success because most care is indeed delivered by multidisciplinary, interprofessional teams of people, yet health care training is focused too often on individual responsibilities.

The IOM’s 2003 report Health Professions Education: A Bridge to Quality stated that healthcare professionals must “cooperate, communicate, and integrate care in teams to ensure that care is continuous and reliable.”3 Finally, the World Health Organization (WHO) issued a framework for action, describing the need for professional education in healthcare to address what they called “interprofessional collaborative practice” (IPCP) globally. The WHO defined IPCP, again intuitively, as “healthcare professionals working together with patients and caregivers to deliver the highest quality of care.” When members of the healthcare team understand each other’s professional roles and buy into the need of those roles to complement and depend on each other, their collaboration becomes more effective, thus improving safety and patient outcomes.4

Following these leads, interprofessional continuing education (IPCE) is evolving. There is evidence correlating engagement in IPCE with improvements in healthcare professionals’ knowledge, attitudes, competency, and performance.1,5,6 There is also evidence that patient and system outcomes are improved.1,5 Going forward into a clinical world of advanced technological and therapeutic options that no one discipline or profession can hope to grasp in its entirety, it is vital that healthcare professionals have access to continuing team education in the didactic, simulation, and practice settings.

Dr. Pollack is privileged to serve as the Medical Director for AcademicCME, https://academiccme.com/, a joint accredited education provider, where he is able to help develop innovative and engaging multidisciplinary, interprofessional programs aimed at improving patient care.

REFERENCES

  1. Regnier K, Chappell K, Travlos DV. The Role and Rise of Interprofessional Continuing Education. J Med Regul. 2019;105(3):6-13. doi:10.30770/2572-1852-105.3.6
  2. Institute of Medicine (US) Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. (Kohn LT, Corrigan JM, Donaldson MS, eds.). Washington (DC): National Academies Press (US); 2000. http://www.ncbi.nlm.nih.gov/books/NBK225182/. Accessed February 23, 2020.
  3. Institute of Medicine (US) Committee on the Health Professions Education Summit. Health Professions Education: A Bridge to Quality. (Greiner AC, Knebel E, eds.). Washington (DC): National Academies Press (US); 2003. http://www.ncbi.nlm.nih.gov/books/NBK221528/. Accessed February 23, 2020.
  4. World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice.; 2010. http://apps.who.int/iris/bitstream/10665/70185/1/WHO_HRH_HPN_10.3_eng.pdf. Accessed February 26, 2018.
  5. Hammick M, Freeth D, Koppel I, Reeves S, Barr H. A best evidence systematic review of interprofessional education: BEME Guide no. 9. Med Teach. 2007;29(8):735-751. doi:10.1080/01421590701682576
  6. Reeves S, Fletcher S, Barr H, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39. Med Teach. 2016;38(7):656-668. doi:10.3109/0142159X.2016.1173663

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