1. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Assessing the Evidence for Interprofessional Education 6 th APA-PHS Conference 2008, Kuala Lumpur John H.V.Gilbert Ph.D., FCAHS Principal & Professor Emeritus, College of Health Disciplines, UBC Project Lead, CIHC

2. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca IPE At A Glance World Health Organization 1978 Alma Ata Declaration 1988Learning Together to Work Together in Health 2008Framework for Action on Interprofessional Education and Collaborative Practice Significant Signposts 1995The Quality in Australia Healthcare Study (Australia) 2000 To Err is Human (IOM, USA) 2001The Bristol Inquiry (UK) 2003Health Professions Education – A Bridge to Quality (IoM, USA) 2004The Adverse Events Study (Canada)

3. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca The Definition Interprofessional Education (IPE) occurs when two or more professions learn with, from and about each other in order to improve collaboration and the quality of care. (CAIPE, 2002) (see the Canadian Interprofessional Health Collaborative’s (CIHC) Statement on the Definition and Principles of IPE: http://www.cihc.ca/resources-files/CIHCStatement_IPE_Final.pdf )

4. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca IPE is TO and FOR, a diverse cast of characters 4

5. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca 2008 The Health Care Workforce Challenge “Anything that is labour intensive in a labour saving world becomes prohibitively expensive” (The late US Senator, Daniel Patrick Moynihan)

6. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Problems Facing Healthcare Policymakers Increasing shortages of health providers specialties Disparities in access to healthcare services Unequal incentives and pay structures for health providers Expanding scopes of practice (forcing curricula and competency changes) New and emerging health professions Consumer expectations & demands Cost

7. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca What have policymakers learned? Increasing the number of students in health professional schools does not solve the problem Training should be on the basis of population need not population ratio Innovative new ways are needed to change the way health services are delivered and the ways in which providers interact with each other IPE is one solution = one process to teach students and practitioners how to effectively work across professional boundaries

8. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Benefits of IPE Reduces wait times Addresses challenges in chronic disease management Improves workplace safety & job satisfaction Improves organization of care, (ie, referrals between professions) Builds efficient work patterns Maximizes existing processes Improves documentation (ie, guidelines, protocols, etc.) Evidence makes the best case for IPE

9. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca The Evidence IPE enables students and practitioners to learn the knowledge and skills necessary to work collaboratively. IPE enhances practice, improves the delivery of services and may also have a positive impact on patient care.

10. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Benefits for Students Many universities and colleges now offer IPE courses and practica to health and human service students. Most studies report that students enjoy their interprofessional experiences. Curricula changes enhance the ability of universities and college to offer these experiences. For more information on student engagement in IPE, the National Health Sciences Students’ Association at www.nahssa.ca is a national student-run organization with active chapters across Canada.

11. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Antecedents to Patient-Centred Collaboration Inherent Factors Interpersonal differences e.g. age, gender, culture Fear of change e.g. place, time, persons Stereotypic rivalry e.g. me, him/her, them Power, income and status e.g. salary vs. fee-for-service Language e.g. gender, profession, social class, jargon External Factors Models of practice e.g. medicine, nursing, social work Management structures e.g. acute care, community Management priorities e.g. money, space, people

12. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca IPE Curricula: Learning Together Use the definition intelligently: A/W/F Use the entire practice curricula Ensure: –the sum > the parts u –NOT another silo –NOT 3:30 – 4:30 on Friday. –Nota Bene: IPE is NOT about the personal pronoun

13. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca The Collaborative Model IPE is a means to an end IPE provides a microcosm of collaborative practice IPE is a demonstration of the art of the possible IPE recognizes that competition is never wholly absent from professional and interprofessional education IPE recognizes a reality: Rivalry introduced from relationships in the world of work are examined as part of the learning experience.

14. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca

15. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Moving Collaboration to the Practice Setting All settings in which health care teams already function –Primary health care –Chronic disease management –Rehabilitation

16. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Big Challenges No internationally agreed on definition of IPE, ergo –Different audiences have differing interpretations –No precise & measurable curricula, ergo –No agreed set of competencies Lack of methodologies to test a definition of IPE Limited quantitative data on effectiveness

17. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Meeting the Challenges Adopt a global definition of IPE that encompasses every health and human service discipline. Leave no room for multiple interpretations Adopt a common set of goals that every discipline can adhere to Adopt one set of core competencies, regardless of discipline and geographic location Foster & build a strong research program

18. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Today’s Lessons, Tomorrow’s Solutions Governments must recognize the importance of implementing meaningful interprofessional policies Courses and projects specific to IPE should be offered in the workplace Quality improvement approaches should be implemented to support IPE in enhancing practice, delivery of services and patient care Practicing professionals should mentor students on IPE, and students should share their IPE knowledge with mentors

19. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Future Directions Reports of IPE should: Clearly articulate precise details of the program under evaluation and a clear discussion of methodological limitations (e.g. sampling, detection bias) Provide specific information about the educational processes employed within an IPE program, and provide both quantitative and qualitative data to describe the outcomes of those processes

20. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Future Directions The IPE research community should: Develop methodologies to improve the generalisability of their studies (ie, examining opportunities to combine existing data sets from single sites) Build mechanisms to foster multi-site and multi- institutional longitudinal studies Construct knowledge dissemination strategies to ensure (and assure) the translation of results into effective teaching and learning experiences

21. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca IPE Is generally well received by participants Can enable students and practitioners to learn the knowledge and skills necessary for collaborative working Can enhance practice, improve the delivery of services and make a positive impact on care Can be effectively delivered in a variety of clinical settings. AND The use of quality improvement approaches such as Continuous Quality Improvement or Total Quality Management can support IPE in enhancing practice, delivery of services and patient care

22. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca Key Ingredients for Success One size does not fit all Assign resources Change curricula Create collaborative learning environments Modify structures to support collaboration Embed in educational and health care systems Engage the wider community in IPE

23. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca A Major Lesson Learned Commit to sustain: The only cash flow is an institution’s cash flow Build on what exists: –Create collaborative platforms for IPE across post-secondary institutions that facilitate curricular change and interaction –Identify and champion existing IP teams inside health care to develop innovative Collaborative Learning Environments –Promote & support student-led Collaborative IPE Initiatives

24. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca COMING SOON!

25. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca A special thanks to my colleagues for their great work on the synthesis report … Scott Reeves, St Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto Joanne Goldman, St Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto Brenda Sawatzky-Girling, Canadian Interprofessional Health Collaborative Andrea Burton, Canadian Interprofessional Health Collaborative

26. CIHC is a 5-year initiative funded by Health Canada www.cihc.ca