Interprofessional education (IPE) aims to improve patient outcomes and the quality of
care. Interprofessional learning outcomes and interprofessional competencies are now
included in many countries health and social care professions accreditation standards.
While IPE may take place at any time in health professions curricula it tends to focus on
professionalism and clinical topics rather than basic science activities. However generic
interprofessional competencies could be included in basic science courses that are offered
to at least two different professional groups. In developing interprofessional activities at
the preclinical level, it is important to define explicit interprofessional learning outcomes
plus the content and process of the learning. Interprofessional education must involve
interactive learning processes and integration of theory and practice. This paper provides
examples of IPE in anatomy and makes recommendations for course development and
evaluation. Anat Sci Educ 8: 299304. V
C 2015 American Association of Anatomists.
Anatomical Sciences Education JULY/AUGUST 2015 Anat Sci Educ 8:299304 (2015)
Dr. Darrel Kirch, the president of the Association of of knowledge and skills outcomes, thought must be given to
American Medical Colleges (AAMC), has advocated for IPE the added value of the interprofessional interactive process.
as a critical component in health care, while recognizing its Content is learned with others (i.e., common learning) while
importance in basic science education particularly anatomy the added value of interprofessional learning is the learning
(Kirch and Ast, 2015). However, in the United Kingdom from and about (i.e., shared learning). This added value
audit one of the case study sites (Canterbury Christ Church relates to generic learning outcomes that should be met by all
University), which has a major commitment to IPE, reported professions but which require an interprofessional process to
that shared learning has been successful across many pro- do so (Thistlethwaite and Moran, 2010).
grams except those classroom-based focusing on anatomy There are a number of interprofessional competency
and physiology (Barr et al., 2014). The course conveners sug- frameworks which can be used to set learning outcomes for
gest this may be due to the different requirements of the nonclinical activities by careful selection of appropriate com-
pathways in these basic sciences (Barr et al., 2014). Indeed, petencies (Thistlethwaite et al., 2015). For example the Inter-
interprofessional champions may wonder whether, when IPE professional Education Collaborative of the United States
has such logistical barriers to overcome as large student (IPEC Expert Panel, 2011) has defined interprofessional com-
numbers at multiple sites and with different professional petencies within four domains: (1) Values and ethics for inter-
accreditation standards, trying to interprofessionalize the professional practice (VE); (2) Roles and responsibilities
curriculum in anatomy, physiology etc. is worth the addi- (RR); (3) Interprofessional communication (CC); and (4)
tional organization for such little educational gains. Teams and teamwork (TT).
This article explores the nature of early preclinical inter- In the first domain the IPEC Expert Panel (2011) states
professional education including what it may achieve and that: these values and ethics are patient centered with a
why. The term preclinical is in itself problematic. It derives community/population orientation, grounded in a sense of
from the time when the medical curriculum was obviously shared purpose to support the common good in health care,
divided into learning without, and learning in the presence of and reflect a shared commitment to creating safer, more effi-
and through interaction with, real patients. Preclinical cient, and more effective systems of care and mutual
included the basic sciences (anatomy, physiology, biochemis- respect and trust are foundational to effective interprofes-
try, etc.) and those clinical sciences that could be class-room sional working relationships for collaborative care delivery
taught. Students then donned their white coats and were initi- across the health professions (IPEC Expert Panel, 2011). All
ated into clinical environments, predominantly hospital health professional education from the first day of a program
wards. is working towards these aims, though they may not seem
specifically relevant during an anatomy tutorial or an inte-
grated session on the functions of the heart. However, if the
INTERPROFESSIONAL EDUCATION: outcomes are included in the course materials this highlights
CONTENT AND PROCESS the importance of respect and trust for good working rela-
tionships during learning as well as in clinical practice.
Interprofessional education can potentially take place at any
For each domain there are associated competencies. While
time in a health professionals career. It should not be limited
the majority of these relate to practice and patient care, those
by location or seniority. However, the main requirements are
in Table 1 can be adapted to fit with preclinical and nonpa-
that there are defined learning outcomes for any stage of the
tient exposure learning activities. These competencies focus
interprofessional process, whether this is in a dissection room
on respect, communication between team members, active lis-
or an operating theatre. Educators need to consider what is
tening and discussion, feedback, teamwork processes and
the added value of bringing two or more health professional
reflection. Such outcomes can be achieved through problem-
students together to learn with, from and about each other.
based, case-based or group-based learning in which students
It is useful to think of the desired content and process of an
are working in small groups that require teamwork, coopera-
interprofessional learning activity. The content is the subject
tion, and collaboration. Such teamwork is a feature of
matter or topics to be learnt. The professions need to have
whole-body dissection and surface anatomy sessions. The
such content in common, for common learning to be appro-
facilitator helps not only with the acquisition of science
priate. Preclinically the topics recommended for students
knowledge but also with the development of team process
have tended to be those relating to soft skills such as com-
and reflection on learning and working together.
munication, ethics and professionalism. These three areas are
Students from different health professions even at an early
complex and challenging for learner and educator alike. The
stage of their programs will have some sense of professional
process is how learning is facilitated through the chosen
identity and their professional role (Carpenter and Dickinson,
teaching methods. The definition of IPE indicates that learn-
2011). Facilitators can compare and contrast the knowledge
ing is through an interactive and shared process rather than a
and skills base of the various professions to highlight how no
didactic transmission of knowledge through lectures or indi-
one professional group knows, or will know, everything, at
vidual e-learning.
the same breadth or depth. Just as a division of responsibility
helps with group learning, so the diverse roles of health pro-
COMPETENCIES FOR fessionals complement each other in patient care delivery. In
INTERPROFESSIONAL EDUCATION group learning it is important to draw students attention to
the process of the learning and well as the content. For stu-
When considering any form of educational intervention it is dents the process includes defining and discussing the inter-
important to define the learning outcomes and consider how professional learning outcomes and the means of achieving
these will align with the proposed learning activities (Biggs them by agreeing on goals, division of responsibilities and
and Tang, 2007). Learning outcomes are derived from both group tasks, timing of meetings, and discussion of group
content and process. In addition to the basic sciences content dynamics.
300 Thistlethwaite
Table 1.
Examples of the Interprofessional Education Collaborative of the United States Competencies for Basic Science Education (IPEC
Expert Panel, 2011)
Specific competencies
CC4. Listen actively, and encourage ideas and opinions of other team
members.
TT1. Describe the process of team development and the roles and prac-
tices of effective teams.
302 Thistlethwaite
communicate effectively. They could also be asked to reflect over 10 weeks and 30 hours facilitated group formation and
on team performance. thus group working. As the authors state this type of learn-
In Roy J. and Lucille A. Carver College of Medicine at ing approach is resource intensive and there is no discussion
the University of Iowa in Iowa City, IA the combination of of how it may be possible to run it for all students.
medical and physical therapy (PT) students has a slightly dif- However it provides evidence IPE is possible within the
ferent focus in that senior PT students act as near-peer teach- basic sciences.
ers for the more junior medical students specifically for These four studies have in common, as with many evalua-
musculoskeletal content. Learning outcomes for both sets of tions of IPE (Thistlethwaite et al., 2015), only short-term
students included the development of professional behaviors evaluation, i.e., evaluation directly after the intervention.
with the opportunity to practice these through engagement While this is important we need more longer term feedback
with another profession (Shields et al., 2015). The objectives on effects and impact in terms of what is retained from the
of the sessions (rather than the learning outcomes for stu- experiences and how further learning and interaction are
dents) were evaluated and included satisfaction with the near- affected by the interactions. Does learning at the basic scien-
peer activity, whether the PT students were prepared to teach, ces stage translate into a greater facility for interprofessional
and whether the content could be developed to involve areas collaboration during clinical rotations?
other than the shoulder. Both sets of students found this to
be a worthwhile experience as based on evaluation findings
(Shields et al., 2015). However there is no discussion about CONCLUSION AND
any achieving of specific interprofessional learning outcomes. RECOMMENDATIONS
This is not to detract from the success of the interaction but
to highlight probable difficulties in defining interprofessional Interprofessional learning outcomes and interprofessional
outcomes and assessing whether students have learned inter- competencies are now included in many countries health
professional competencies from such interventions. The medi- and social care professions accreditation standards. While
cal students did see the activity as an opportunity to learn IPE may take place at any time in health professions curric-
about another profession but it is not clear what they learned ula it tends to focus on professionalism and clinical topics
and how useful this was. The medical students did ask for rather than basic science activities. The generic interprofes-
further opportunities to learn more about the profession of sional competencies could be included in basic science
physical therapy and how PTs approach clinical problems, courses that are offered to at least two different professional
suggesting that the added value of bringing the two sets of groups. To be truly interprofessional I offer the following
students together could be enhanced by more in-depth defini- recommendations for course development, and for subse-
tion of the interprofessional learning outcomes. quent evaluation:
A pilot study from the University of Bern, Faculty of Med- The planning and development committee should be
icine in Switzerland differed in involving medical and nursing interprofessional
students learning anatomy during two modules: one in first- The added value of overcoming any logistical barriers such
year and one in second-year (Herrmann et al., 2015). The as student numbers and adequate space for activities
authors present the learning in terms of the about, with and should be rationalized
from of the definition of IPE. First year students learned Interprofessional learning outcomes for interprofessional
about each other in terms of exchanging details about their competencies need to be defined as well as discipline-
curricula; they learned with and from first by practicing nurs- specific content
ing skills together in the skills laboratory and then by learn- The outcomes, learning activities and assessment need to
ing anatomy together. Moreover the medical students taught be aligned
the nursing students how to use a microscope. In the second Each profession needs to be engaged and the relevance of
year the focus was on ultrasound and the gastrointestinal sys- the learning outcomes obvious for each profession
tem. The specific interprofessional learning outcomes are not Careful thought needs to be given to the development of
discussed. Again RIPLS was used as an evaluation tool. Over- appropriate assessment tasks for the interprofessional as
all the intervention was well received and was seen as con- well as the knowledge outcomes
tributing to a mutual understanding between the two The interprofessional outcomes should be seen as part of a
professions (Herrmann et al., 2015). spiral curriculum to be revisited in subsequent courses
At McMaster University, Faculty of Health Sciences in As there is a lack of literature in this area, plan the evalua-
Hamilton, Canada the mix of students is more ambitious and tion at the same time as the educational intervention and
involves 28 volunteer medical, nursing, midwifery, occupa- build in longer term follow-up
tional therapy, physical therapy, and physicians assistant stu- Do not rely solely on attitudinal tools such as RIPLS to
dents undertaking an interprofessional, problem-based gross evaluate change as it is important to consider how and
anatomy dissection course in groups of seven (Fernandes why change occurs as well as the outcomes
et al., 2015). One learning outcome is for students to under-
stand each others scope of practice by each profession
educating the other members of their group about their roles NOTES ON CONTRIBUTOR
through discussion of clinical scenarios. The evaluation of
this project indicates that the process does enhance knowl- JILL E. THISTLETHWAITE, M.B.B.S., Ph.D., F.R.C.G.P.,
edge of anatomy and physiology, while also having a posi- F.R.A.C.G.P., is an adjunct professor, health professions edu-
tive effect on students attitudes to and perceptions of cation consultant, and family physician, affiliated with the
interprofessional collaboration. While RIPLS was one tool University of Technology Sydney (UTS) and the University of
used to look at attitudinal change, richer data were collected Queensland, Sydney, Australia. She provides support for the
through focus group interviews. That the course took place development of interprofessional education globally and is
304 Thistlethwaite