So we had a session the other day on interdisciplinary teamwork—where some couple hundred students in their first year of medicine, dentistry, pharmacy, nursing, occupational therapy, physiotherapy and a few more I can’t remember, crammed into the Rebecca Cohen Auditorium for a 2 hour session on inter-disciplinary teamwork.
For those who aren’t familiar with the term, or for the nursing student sitting in front of me who spent the entire session texting (in plain view) her bum-chums on how trashed she got last night, interdisciplinary teamwork is just what it sounds like–its about integrating the expertise and knowledge of various professionals in working towards a common goal. It means bringing physicians and nurses and pharmacists and the many other professionals involved in health-care delivery, together to work in a cohesive manner to support a patient back to health. Interdisciplinary teamwork (in its various incarnations as multidisciplinary teams or collaborative teams and the like) is neither a new concept nor a particularly groundbreaking one—in fact the simplicity of the concept (i.e. two brains are better than one) is rather deceiving with respect to how its actually implemented.
I could probably talk for a bit about what interdisciplinary teamwork really is, how it should work and why we need it. But I’m going to save that for another post.
My rant this time-a-round, is going to be about something that struck me as we walked out of the auditorium that day. You see, I think interdisciplinary teamwork is an absolutely essential component of appropriate and timely health-care today. What health-care delivery was 20 years ago, is not what it is today. The entire environment has changed—we’re moving towards community-based healthcare provision (or at least that’s the plan), patients are taking a greater responsibility in the healthcare decision making process, younger physicians are looking for a greater work-life balance, and our population is not only growing, but aging incredibly quickly. All these things have created a health-care environment that no longer supports (nor should it) the work of professionals in vacuums or the mentality of silos (ooh, this is definitely going to be another post!). And there is increasing evidence to say that clinical care as measured through patient outcomes, is clearly better when delievered via interdisciplinary teams. The reality, and as cringe-inducing as this might be to some of the older school professionals, is that teamwork is really going to be the way of the future. There’s no denying that. And thankfully, the healthcare system and academia is starting to wake up to this new reality.
My beef however, is with the incessant ranting and raving about interdisciplinary teamwork and interprofessional education (IPE). The concept of IPE is that if we expect health professionals to work together collaboratively in teams when they graduate—well then, maybe we should teach them how to work in teams. Brilliant. We actually do need that; we need mentors/teachers to model teamwork, we need to understand what other professionals have to offer, we need to know how efficient teams work. This understanding is not all of a sudden going to appear to us the day we graduate. Again, there is plenty of evidence out there that says that IPE should absolutely be mandated into health professional training programs. Some very credible organizations such as the World Health Organization and the Institute of Medicine have been calling for greater IPE for years—something they have been doing because they recognize the value of integrating learning between various professionals that seems to enhance their ability to function better in a collaborative healthcare environment.
The problem, and the true focus of my rant, is that we keep talking about implementing IPE, but never actually get around to doing it. Much like the calls for greater interdisciplinary teamwork in healthcare, the call for interprofessional education have been loud and clear—and hollow.
Academics from coast to coast have tangoed with the idea of interprofessional education for years. They’ve held conferences, they’ve brought in guest speakers, they’ve consulted the experts, they’ve had more conferences. And the outcome? Well good-golly-me, we’re going to wait to see what those guys do first before we commit ourselves to anything as radical as this. Give us a few more years and we’ll commission a Royal Report and get back to you. Are those butter scones over there?
Okay, so I know I sound a bit tongue-in-cheek, but you get the point right? We KNOW that IPE is needed, we KNOW that it results in better outcomes, we KNOW how to do it because there are jurisdictions that have accomplished this fairly well. We have the resources, we have the capabilities and frankly, we really need to start pumping out health professionals that are capable of working in a team environments because our health system is going to suffer if we can’t.
So why do we insist on bringing in more experts to talk about it, and rant and rave about how interdisciplinary teamwork (and by extension, interprofessional education) is the next best thing since sliced bread—and then leave it at that?
This recent IPE session entitled “Less me and more we” was a perfect case in point. Not one classmate of mine that I spoke to, thought this session any more interesting than standing in the backyard watching a tree grow. And I completely agreed. The saving grace in it, was that many of my classmates truly do see the value of interdisciplinary teamwork and interprofessional education—they’re just not sure about the execution. In fact, most of the research that I’ve come across on this topic suggests that one of the biggest turn-off for students (especially medical students) is poorly executed interprofesional education. They want to learn how to engage in it, they want to know how to best go about tackling interprofessional work, they want to understand better what their roles and the contributions of other professionals are. They do not want to be sitting in 2 hour sessions only to listen to why IPE is so important. Do it. Don’t just talk about it.
As far as I know, we have one more session planned in the next few weeks. And I believe our pharmacology unit next has some co-learning with the first year pharmacy students, which is good. But I hope that’s not the end of it. Because if 2 sessions on interdisciplinary teamwork and a few weeks of sitting in the same class as pharmacy students is all we get of interprofessional education in our 4 years of medical school—its not looking very promising. And really, it would be a real travesty to have brought in experts to talk to us about how important it is to have IPE—only to have that be the first and last we ever hear of it.
8 Comments on “Ramblings on interprofessionalism”
You’ve made some excellent points Amit! As an addition to your observations, I’d like to make one of my own. I agree with you, and many more of my colleagues, that interprofessional education, development, and eventually practice, are essential. And so, my hopes for our recent session were high.
However, as the presentations wore on this past Tuesday, I began to get the impression that the session became less about educating on interdisciplinary care and more about labeling certain professions in the system (physicians were pointed out) as people who held a notion that they were power brokers and bosses in the system. I had to ask myself “Who are these physicians?” I haven’t met them yet. The physicians who have been involved in my early training have demonstrated a collaborative attitude to a fault. And as for my classmates? We are the other professions - a vast spectrum of our class have actually served in a variety of health professions.
I’m an advocate for interprofessional as much as anyone else. However, I have to agree with Amit. The time is past to bemoan the paternalistic, lone ranger attitudes of the past. It’s time to do interprofessional practice - and a good start would be good faith and a positive attitude in its presentation. I don’t want to be told I’m something I’ve never been simply because I’ve chosen a profession that used to have a particular approach.
Thanks Amit for a great post!
Amit and Brad, I couldn’t agree more! You said exactly what we all were thinking. Of course we all know working together is important. I just don’t see how two hours of being told that working together is important will accomplish anything. I would rather have been given some tools to work in a collaborative environment by being educated about different strategies on how to work with other health care professions. Or maybe been told about a few generalized examples of health care professionals working together, I think the session would be more pertinent that way. I would also have liked to learn about the specific roles, responsibilities and knowledge bases of different health care professionals so that when I go out into the workforce I will know who to turn to for specific advice and will be able to best integrate the various strengths that are brought to the table.
Lastly, I could not agree with Brad more about singling out certain professions. Of course certain people will be jerks, but I think their comments were a little unwarranted. In all of my experience thus far in the hospitals and in clinics I have witnessed physicians working in a cooperative team environment with other health professionals in quite an amicable manner. In all fairness, insulting one faculty won’t make them want to work with other people, it will just make them defensive (I thought that would be common sense, but nothing about that presentation really was to begin with….) I believe it was rather unfair to point the finger at one profession and plant preconceived ideas in everyone’s heads; that accomplishes nothing - we want to change models of health care delivery to provide optimal patient care, not perpetuate stereotypes.
I thought this was going to be a short little comment, but it turns out I have a lot to say…. definitley not a fan of last Tuesday evening! Empower us with ideas so that we can make the change rather than ambiguously harp on us to make it.
Awesome…
And maybe people trying to push for IDP should avoid having talks that bash physicians in front of their future collegues. I’m pretty sure that only works against IDP.
reference: the final speaker at the IDP session in question
As a random reader (and current health-care worker), I must say I am very impressed with the quality discussion going on here. I’d like to point out that contrary to Bradley’s post, those ‘bossy’ physicians DO exist. The fact that a first year medical student has yet run into them is not surprising, as they are typically the ones who do not actively (or willingly) participate in education and training. I can tell you from first hand experience that the older generation of physicians holds a much greater percentage of these one-minded professionals. Re-educating them into the relatively new idea of multi-discplinary medicine is a daunting task, but one that is undoubtedly a major obstacle it’s actual implementation.
Rob, I am inclined to agree with you regarding older physicians. My thoughts on the matter were summed up nicely by Max Planck (a physicists):
“A new scientific truth does not, generally speaking, succeed because the opponents are convinced or declare themselves educated, but because they die and the new generations from the beginning learn about it as the truth”.
In this case it’s not a scientific truth but rather a new way of delivering health care, but the fact remains that we pretty much have to wait for the old guard to die (or retire) before our new way of thinking will take over.
On an unrelated note, I am fairly cynical.
Just wanted to pipe in here. I absolutely agree with Brad/Jayani/Tim about not wanting to perpetuate stereotypes…….BUT, there is ample evidence/research to suggest that physicians ARE the least likely to play nice in the sandbox.
I completely agree with you guys that its not appropriate to make comments (as were made) in a crowd of 400 soon-to-be-health-professionals, particularly in light of the younger students in direct-entry programs (without an undergrad) who may not have had any prior interprofessional, or real experience in the health-care context. Painting all physicians with the same brush as brash, arrogant, solo-flyers, only flames the fire by putting those ideas into impressionable heads.
But the reality of health-care, is that physicians have always been ‘captains-of-the-ship’ and as Rob and Alex point out, the older guard seems to have very strong desires to keep it that way. Younger physicians are much more likely to engage in interdisciplinary work and collaboration and so as the new generation of physicians comes up through the ranks, we have the potential to change that culture of physicians at the top of the food chain–but thats not an easy task.
I’ve done a little bit of digging around on this subject for a paper i wrote on interdisciplinary teamwork–and as i said before, the evidence suggests that the reality is that physicians are indeed the least likely of any health professional to actively engage in TRUE interdisciplinary teamwork (that doesn’t mean they’re all uncooperative jerks, it just means things like changing status quo of physicians at the top of the hierarchy, turf-guarding etc make physicians incredibly uncomfortable).
This topic, the concept of socialization of physicians (how we take people and make them doctors) and the culture around the profession, is of serious interest to me. There are a lot of topics within this area that would make for some very interesting discussions……i’ll start to brainstorm a few for a some posts. But great to see discussion on these boards. AND WE ACTUALLY HAVE SOME OUTSIDE READERS!!! WOO-HOO!!!!
cheers.
Hello everyone,
Well this is an interesting website and you should be proud of putting ths together. I would just like to say that in theory working in a team is great. There is, however, a need to have some leaders in this team and rightly, or wrongly, it is the physician in the medical system.
Everyone seems to have great ideas to help patients but when things go wrong or it is past 4 in the afternoon, this team seems to evaporate. The physician is left holding the bag for the care of the patient. I am fine with that but if other professions do the above, they should not get upset when decisions are made without them.
good luck to you (you will need it)
So proud of my 93 other Co-monkeys….
Some very interesting points indeed. I too have some comments about the plenary session and the ‘physician bashing’ from yes..you guessed it, a fellow physician. While I agree the older generation have a culture of power brokers within the system, this implies a strict hierarchy of care for a patient. While this nature of patient management is undoubtedly not favorable today, I do think that physicians are uniquely equipped to be facilitators in patient care. As the saying goes our training is is an inch deep and 10 miles wide, with constant exposure to wide range of health care. Moreover, if one digs into the past of many physicians, they have had held multiple leaderships positions and careers, many of which were also in health care. This is not to say that physicans shall rule with the iron fist when making the final decisions of care, but rather… what is so bad about having a physician central in facilitating all of the other health care professionals?
As for the group sessions of IPL…I enjoyed meeting other health profession students….but ruined it was the facilitator who seemed to be using the session of an inappropriate platform for her own views on diversity (including gender issues). Furthermore, how about that ’survey’!…if i recall correctly it was Likert scale which is inherently biased in its design for this purpose in the first place. My colleagues at my table were in full agreement that a session to get to know other health professional students and there career roles would be far more beneficial.
Stay well everyone