The Importance of Interprofessional Education for Students in Communication Sciences and Disorders

Interprofessional Education (IPE)

IPE occurs when students from two or more professions work together to learn with, from, and about each other to facilitate effective collaboration, integrated service provision, and improved outcomes for people who need care (Centre for the Advancement of Interprofessional Education, 2002; World Health Organization [WHO], 2010). The key terms in this universally accepted definition are learning “with, from, and about each other.” This differentiates IPE from other forms of shared learning, such as when students from two or more professions attend the same class but do not actively work in interprofessional teams as part of their learning experience.

Although the concept of IPE is not new and its implementation has waxed and waned over time (Allan, Campbell, Guptill, Stephenson, & Campbell, 2006; Clark, 2011; Frenk et al., 2010), the ongoing endorsement of the Institute of Medicine (2001, 2003, 2010), the WHO (2010), and published guidelines from organizations such as the Interprofessional Education Collaborative (IPEC; IPEC Expert Panel, 2011a, 2011b) have resulted in its resurgence in the United States, Canada, the United Kingdom, Europe, and Asian-Pacific countries. This resurgence is further supported by findings from a recent systematic review of 15 studies investigating the effect of IPE on professional practice and health care outcomes (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013). Learning through IPE, students gain insight into the teamwork that effective, person-centered service provision entails and confidence to be an effective team player when they enter the workforce (Sargeant, MacLeod, & Murray, 2011; WHO, 2010). Increasing data document that students who have participated in IPE during their programs of study are more comfortable with collaborative work and shared decision-making in systematic approaches to care. This collaborative professional practice results in improved health care outcomes and increased patient satisfaction with care (Reeves et al., 2013), issues that are central to effective professional practice (The Joint Commission, 2010).

Audiologists and speech-language pathologists are expected to be active and contributing members of interprofessional teams when they begin work, whether their work is in an educational, corporate, or medical setting. Thus, it makes sense for IPE to be integrated into the curriculum of programs in Communication Sciences and Disorders (CSD), and the American Speech-Language-Hearing Association (ASHA) has joined a lengthy list of organizations, institutions, and philanthropists to endorse such learning (Goldberg, Koontz, Rogers, & Brickell, 2012; Johnson, 2013).

The need for the integration of IPE into CSD programs was highlighted at ASHA’s 2012 Health Care summit (McNeilly, 2013) and by ASHA’s 2013 President, Dr. Patty Prelock, in her comments to the membership in the ASHA Leader (Prelock, 2013). In 2013, ASHA formally established an Ad Hoc Committee on IPE and charged it to identify strategies to (a) assist academic programs and professionals to develop IPE and practice, (b) facilitate connections with other organizations to support IPE and practice, (c) measure the value of IPE and practice in health care, and (d) address IPE in accreditation, certification, and licensure requirements. As a complement to the work of the Ad Hoc Committee, the main focus of the Researcher-Academic Town Meeting at the 2013 ASHA convention was the workshop “Interprofessional Education: Leading Audiologists and Speech-Language Pathologists Into a Collaborative Era.” IPE-specific continuing education opportunities also were initiated throughout the daily convention program and continued at the 2014 convention. ASHA’s Special Interest Group on Higher Education has focused on educating members about IPE (Friberg, Ginsberg, Visconti, & Schober-Peterson, 2013) and students have been involved in the Group’s initiatives (Sirl & Bosze, 2014). More detailed information about these activities is available on the ASHA website (www.asha.org).

Collaborative Competencies and Interprofessional Learning Models

As the ASHA membership awaits the findings and recommendations of the Ad Hoc Committee on IPE, valuable information on strategies to facilitate interprofessional learning and its inherent collaborative competencies can be found in the two IPEC publications on core and team-based competencies (IPEC Expert Panel, 2011a, 2011b). Collaborative competencies are designed to complement profession-specific competencies and are categorized in four general domains: (a) Values and Ethics: ensuring that services provided are client-/patient-centered, respectful, ethical, and culturally appropriate; (b) Roles and Responsibilities: understanding the roles and responsibilities of diverse team members in the health and social care professions, including the client/patient, along with any limitations in skills, knowledge, and abilities; (c) Interprofessional Communication: listening actively and with ongoing reflection to establish and maintain effective communication and problem-solving, using appropriate communication tools and techniques; and (d) Teams and Teamwork: engaging in ethical, evidence-based, and effective teamwork for person-centered care (IPEC Expert Panel, 2011a, 2011b). These competencies align with those advocated by the WHO (2010).

To facilitate the acquisition of collaborative competencies, IPEC advocates implementing a three-stage learning model during students’ programs of study: (a) exposure to IPE (introduction), (b) immersion (development), and (c) competence (readiness for entry-into-practice), with summative and formative assessments within each stage. The IPEC guidelines provide learning objectives for each of the competency domains, and include examples of IPE initiatives conducted by programs across the United States that can be replicated or adapted by other academic and clinical programs. The guidelines are intended to be flexible rather than prescriptive. The principles underlying interprofessional competencies, the competency domains, and the three-stage learning model through which students’ collaborative competencies are developed are summarized in Figure 1.

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Figure 1.

The IPEC framework for the acquisition of interprofessional knowledge and competency.

Two additional comprehensive reviews of IPE have been published since the IPEC reports. These reviews by the Interprofessional Curriculum Renewal Consortium, Australia (2013) and Barr, Helme, and D’Avray (2014) in the United Kingdom confirm ongoing local, national, and international support of IPE as central to the preparation of students in the health professions to promote safe, effective, efficient, and sustainable health care. The reports summarize foundational theories for IPE, classify the range of evidence-based IPE methods (summarized in Table 1), identify resources, compare international interprofessional curriculum frameworks, and clarify delivery options for determining how IPE will fit in the curriculum. For example, will the IPE activities be (a) discrete or integrated, (b) mandatory or optional, (c) implicit or explicit, (d) individual or group, (e) common or comparative, (f) interactive or didactic, and where, how, when, and for how long will the IPE activities be held? The reports include case studies as exemplars for interprofessional learning and provide recommendations for the future management, organization, teaching, and evaluation of IPE in universities. Data presented in the reports show that with the integration of IPE into any curriculum, isolated interprofessional events developed by entrepreneurial faculty can be segued into sequenced, cumulative, progressive, and assessed learning across courses and clinical experiences for all students. Online learning is possible in an interprofessional framework but needs to be complemented by face-to-face learning. Furthermore, in addition to positive student learning outcomes, participating academic and clinical faculty can develop collegial interprofessional relationships and learn new teaching and research methods that assist in career advancement (Barr et al., 2014; Interprofessional Curriculum Renewal Consortium, Australia, 2013).

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Table 1.

Classification of Evidence-Based Interprofessional Education Learning Methods.

Classification of learning	Learning methods used
Exchange based	Debate, games, problem-solving, case discussion, seminar, or workshop
Observation based	Joint visits, shadowing of other professionals, participation in team meetings
Action based	Collaborative inquiry (patient interview, service provider interview, analysis of the problems raised, feedback, and recommendations for change), problem-based learning, case-based learning, joint research and projects with clinical outcome measures
Simulation based	Experiential groups, role-plays, skill acquisition
Practice based	Work-related assignments, clinical placements

Source. The Interprofessional Curriculum Renewal Consortium, Australia (2013, pp. 56–57). Details of the learning methods and supporting references are provided in the report.

To date, the focus of IPE has been on health care, targeting person-centered and evidence-based care, patient safety, and improved health outcomes. Thus, published models integrating interprofessional learning into health care curricula are found most easily in medically oriented journals such as the Journal of Interprofessional Care, the Journal of Allied Health, Academic Medicine, and Medical Education Online (e.g., Bandali, Parker, Mummery, & Preece, 2008; Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Christianson, McBride, Vari, Olson, & Wilson, 2007; King et al., 2012; Klocko, Krumweide, Olivares-Urueta, & Williamson, 2012; Scott, Altenburger, & Kean, 2011; Thannhauser, Russell-Mayhew, & Scott, 2010). Complementary interprofessional strategies to facilitate organizational change, team-based education, peer coaching, and student–faculty–community partnerships can be found in journals such as Work, Higher Education Research & Development, the Journal of Continuing Education in the Health Professions, Science, the Journal of Public Health Management Practice, and Professional Development in Education (e.g., Cavanaugh & Konrad, 2012; Gaughan, Gillman, Boumbulian, Davis, & Galen, 2011; Goldberg et al., 2010; Ravet, 2012; Silver & Leslie, 2009; Vale et al., 2012).

Measuring the Effectiveness of IPE

Parallel to the importance of measuring the outcomes of any clinical intervention, it is critical to measure student learning associated with participation in interprofessional activities to document the ongoing value of IPE and identify strategies that are and are not effective (Reeves et al., 2013; WHO, 2010). Valid and reliable scales are available to facilitate such measurement. As an example, the 19-item Readiness for Interprofessional Learning Scale (RIPLS; McFayden, Webster, & Maclaren, 2006) documents students’ readiness for interprofessional learning using four sub-scales: Teamwork and Collaboration (Items 1–9), Negative Professional Identity (Items 10–12), Positive Professional Identity (Items 13–16), and Roles and Responsibilities (Items 17–19). A 5-point rating scale is used for each item: 1 = strongly disagree to 5 = strongly agree. Another scale, the 37-item Assessment of Interprofessional Team Collaboration Scale (AITCS; Orchard, King, Khalili, & Bezzina, 2012) also uses a 5-point rating scale (always to never) to assess how well students are collaborating with regard to partnership/shared decision-making (19 items), cooperation (11 items), and coordination (7 items). A valuable compendium of additional articles that describe instruments used to evaluate the impact of IPE has been collated by the University of Southern California and is available at http://norris.usc.libguides.com/ipe.

Data from non-validated questionnaires and self-reflection commentary can be valuable (Goldberg, Brown, Mosack, & Fletcher, in press). However, there is agreement that such data must be strengthened by pre- and post-data analysis, ideally from multiple sources, in carefully designed case studies. Furthermore, rigorous studies with objective cognitive-behavioral measures of learning, randomized participants, control groups, comparison of interprofessional and program-specific learning, and cost-effectiveness outcomes are needed to document the perceived positive effects of IPE (Reeves et al., 2013; Simmons & Wagner, 2009).

Ongoing Challenges in the Implementation of IPE

Establishing and maintaining consistent institutional support, a working culture that values interprofessional priorities over profession-specific priorities, and linked curricula to promote competency-based, patient-centered interprofessionalism have been documented as ongoing challenges in the implementation of IPE (Frenk et al., 2010; WHO, 2010). These issues continue to surface in the report by Barr et al. (2014), along with the need for professional and regulatory body support. Including students from medicine, dentistry, and pharmacy in interprofessional learning with students in allied health professions and nursing remains difficult in the United States and United Kingdom, but less so in Australia and Canada. Having a skilled, knowledgeable, and respected IPE coordinator in place in any program is seen as critical to (a) ensure academic and clinical educators are prepared for interprofessional teaching, (b) realign professional courses and identify interprofessional learning pathways in course descriptions, (c) synchronize competency-based assessment and learning, (d) develop partnerships to enhance clinical placement-based IPE, and (e) facilitate IPE research initiatives (Barr et al., 2014; Interprofessional Curriculum Renewal Consortium, Australia, 2013).

Conclusion

Students in CSD need to be given opportunities to develop the knowledge and competencies required to work collaboratively and effectively with members of diverse professions. This interprofessional knowledge and competency is integral to providing quality person-centered care for children and adults with communication and related difficulties across a range of work settings. IPE, through carefully planned, coordinated, and sequenced learning activities, is advocated as a necessary step in which interprofessional knowledge and competency can be achieved. A variety of learning models and evaluation strategies are available through published literature. As academic and clinical educators plan IPE activities, it is important to include team members who are knowledgeable about research design to ensure meaningful data are obtained before and after each activity and to compare the impact of interprofessional and program-specific learning. Such documented outcomes are vital to promote IPE and facilitate institutional support and culture change.