The potential advantages and disadvantages of introducing interprofessional education into the healthcare curricula in Spain

Summary

The complexity of contemporary clinical practice demands that increasingly skilled high quality health and social care is provided to individuals. However, the failure of health and social care professionals to work collaboratively has been widely reported in the international literature. Hence, interprofessional education has been suggested as a means of improving both interprofessional understanding and respect across a diverse range of practice disciplines. In this way, functional barriers can be challenged or broken down; teamwork enhanced and healthcare outcomes improved.

Lack of conclusive evidence to substantiate the above healthcare benefits has been attributed to weak methodological approaches when evaluating such educational initiatives. In Spain barriers to implementing interprofessional education are potentially less challenging. Recent legislative demands following the Bologna Agreement on European Higher Education is compelling Spanish higher education institutes to engage in radical educational reforms. Consequently, this paper examines some of the advantages and disadvantages of introducing interprofessional education into health and social care curricula in Spain to see when and how interprofessional initiatives might be assimilated into the health care curricula. In this way lessons learned from a thorough review of the relevant literature might help to inform such educational reforms across mainland Europe and beyond.

Introduction

An ageing population, the escalation of chronic illness and modern endemic diseases such as HIV now characterise contemporary healthcare (Goble, 2003, Hall and Weaver, 2001). For this reason, it is no longer possible for one health discipline to provide a complete package of care for such conditions (Heinemann, 2002, McCallin, 2003). However, merely assembling multiple professionals together does not guarantee the attainment of high quality care. Instead, the co-ordination and integration of comprehensive care packages are now thought to be essential if healthcare is to be successful (Heinemann, 2002).

Nevertheless, there is considerable evidence to suggest that contemporary healthcare professionals find it difficult to work together (Davoli and Fine, 2004, Elston and Holloway, 2001, Johnson et al., 2003). Examples of the later are evidenced by teamwork failures highlighted during inquiries following tragic incidents in the UK (The Bristol Inquiry, 2001, The Shipman Inquiry, 2002). For this reason, the literature has repeatedly attempted to explore why practitioners are unwilling to engage in interprofessional working. Newbury et al. (1997, p. 84) summarise these reasons suggesting reluctance to participate in collaborative working emanates from role confusion; tribalism and professional rivalry.

The origins of such dynamics have been laid at the door of educational establishments where students are first initiated into a profession. Hence, in those faculties where unidisciplinary education abounds, there is little opportunity for teaching interprofessional skills; increasing communication difficulties and perpetuating isolationist practices (Drinka and Clark, 2000, Tunstall-Pedoe et al., 2003). To compound this situation, Brooks and Brown’s (2002) phenomenological qualitative study looking at the significance of organizational routines involving nurses, doctors and allied health professionals, revealed that rigid organisational structures and professional hierarchies reinforced solitary attitudes from the outset of an individual’s career. Interprofessional education is one way of facing up to such dilemmas and occupational hindrances by encouraging two or more professions to learn with, from and about each other to facilitate collaboration and improve the quality of care (Barr, 2000a, Barr, 2001, CAIPE, 2004, Goble, 2003).

Healthcare benefits following the implementation of interprofessional education are seen as the long-term payback derived from achieving greater collaboration amongst professionals (Barr, 1994, Barr, 2000b, WHO, 1988). Contemporary patient care needs to be seen as part of an integrated whole. Thus, by encouraging professionals to share knowledge and work collaboratively, interprofessional education lays down solid foundations on which to integrate professional expertise in order to provide holistic care, which can then result in improved health outcomes (Barr, 2001, Gill and Ling, 1995).

Apart from enhanced healthcare outcomes, other valuable effects expected from improving communication and collaboration between professionals are reductions in task duplication, the speeding up of care delivery and more congruent provision of information for patients (Barr, 1994, Bultema et al., 1996). More importantly, given that interprofessional education provides practitioners with a broader knowledge base, professionals are better able to cope with a wider number of tasks (Barr, 2001). This, in turn, leads to a more flexible workforce, maximisation of human resources and alleviation of workforce shortages (Barr, 2001, Miller et al., 1999, Spratley and Pietroni, 1996).

Diverse professions covering the same or similar aspects of care leads to a sharing of professional workload pressures and a diminution of functional barriers (Barr, 1994, Barr, 2000b, Barr et al., 1998, McMichael and Gilloran, 1984). Thus, by enhancing interprofessional relationships and sharing workload pressures, practitioners are able to achieve increased job satisfaction, thereby reducing the incidence of burnout (Barr et al., 1998, Barr, 2000b, McGrath, 1991).

Recognizing the potential of interprofessional education, international organisations such as the World Health Organisation (WHO), the World Federation of Medical Education (WFME) and the Organisation for Economic Co-operation and Development (OECD) have rigorously campaigned for its worldwide expansion since the early 1970s (Oandasan and Reeves, 2005a, Tope, 1996). These movements have had a strong impact in countries such as Finland, Sweden, Norway, The Sudan, South Africa and Thailand all of which have engaged in national endeavours to introduce interprofessional education into their healthcare curricula (Areskog, 1988, Barr, 2000b, Goble, 1994). Additionally the United Kingdom, United States, Australia and more recently Canada have also undertaken a number of research projects to introduce interprofessional education into healthcare curricula (Baldwin, 1996, Barr, 2000b, Goble, 2003, McNair et al., 2005, Oandasan and Reeves, 2005a). Although many projects were initiated in the early 1970s, innovations leading to the integration of interprofessional education within healthcare curricula are still in their infancy and evidence to support the indiscriminate implementation of interprofessional education across the full spectrum of healthcare curricula remains scant (Barr, 2001, Freeth et al., 2002, Goosey and Barr, 2002, Hall and Weaver, 2001, Mattick and Bligh, 2003, Zwarenstein et al., 2001, Zwarenstein et al., 2005).

Evidence supporting the putative association between implementing interprofessional education and subsequent improvements in interprofessional collaboration and patient outcomes tends not to have been generated from university based programmes but workplace base initiatives (Cooper et al., 2001, Freeth et al., 2002, Zwarenstein et al., 2005). Despite evaluations of interprofessional education programmes revealing positive outcomes in terms of participants’ satisfaction with the learning experience, modified perceptions towards other disciplines and self reported attitudinal and/or behavioural change towards greater interprofessional working, little is known about its effectiveness and/or impact on patient care (Cooper et al., 2001, Freeth et al., 2002).

Zwarenstein et al., 2001, Freeth et al., 2002, argue that lack of evidence is not the same as evidence of ineffectiveness. The lack of conclusive evidence regarding the efficacy of interprofessional education is partly explained by the lack of methodological rigour and lack of appropriate evaluation methods employed in existing research projects. Therefore, far from suggesting the abandonment of such educational strategies, further research using more rigorous evaluation methods undertaken on a global basis is recommended to strengthen the evidence available to underpin the implementation of such strategies (Barr, 2000b, Freeth et al., 2002, Zwarenstein et al., 2001).

In Spain, where little interprofessional healthcare education currently occurs, both the University Education System and healthcare curricula are undergoing profound change in response to the European Higher Education requirements for reform (Ley 44, 2003, Ministerio de Educación, Cultura y Deporte, 2003). The ensuing modernization programme includes the expansion of undergraduate nursing, physiotherapy and social work curricula impacting on the length and content of such courses while also opening the gates for postgraduate study opportunities. Following such reforms all health care disciplines will have an equal opportunity for postgraduate study (Ley 44, 2003, Ministerio de Educación, Cultura y Deporte, 2003, Ministerio de Sanidad y Consumo, 2006a). Moreover, the above programmes now have to include interprofessional communication skills teaching (Consejo General de Enfermería, 2003, Ley 44, 2003, Maciá Soler et al., 2006). Such radical reform provides a singular opportunity within Spain to introduce interprofessional education within healthcare curricula to further attest to its effectiveness as an educational strategy. Hence, it is an opportunity for Spanish higher educational establishments to contribute to the body of knowledge regarding interprofessional education if implemented and evaluated using rigorous methodological approaches.

Hence, this paper attempts to examine the relevant literature on interprofessional education in order to analyse the feasibility of introducing this educational approach within healthcare curricula in Spain. To fulfil this objective the ensuing debate will explore the advantages and disadvantages of introducing interprofessional education within healthcare curricula, as well as exploring a number of unresolved debates regarding when and how best to introduce this educational approach.