SERVICES
These frameworks are admirable, but have often resulted “in more confusion, with the introduction of varying definitions about similar constructs (such as competency and its relation to terms such as learning objective, learning outcome, and capability), particularly in relation to what IPE actually means” (Thistlethwaite et al., 2014).
6.2.3 Value of the international IPE competency frameworks
Thistlethwaite et al. (2014: 873) further emphasise that for inter-professional compe- tency frameworks to be of benefit to students, educators and HCPs, “they need to add value to existing curricula outcomes, rather than duplicate them, and to emphasise those outcomes that may be attained only through inter-professional activities”.
For students to achieve inter-professional competencies, they need to become active team members. Students on longitudinal placements are therefore more likely to attain inter-professional competencies.
good role-modelling by staff is an essential component of IPE. IPE reforms should be aligned with changes in healthcare delivery and practice reform. Students who do not see HCPs working together in practice are unlikely to consider that collaborative inter-professional practice is important.
The university of British Columbia (uBC) has developed a model of IPE which consists of three overlapping learning stages, namely “exposure, immersion and mastery”.
In an article describing the model the authors provide examples of learning opportunities for each stage (Charles et al. 2010). The model leans heavily on Mezirow’s (1998) theory which emphasises that a properly structured IPE curriculum can provide an excellent platform for transformative learning.
To graduate, students in the health professions are assessed primarily as individuals.
Assessment of inter-professional competencies, however, should not only look at individuals but also at team performance as whole (Thistlethwaite et al., 2014).
Lingard (2009) states: “our way of seeing competence reflects the individualist orientation of the education system” and “that we cannot guarantee that, by bringing together individuals assessed as competent, a competent, functioning team will result”. Talbot (2004) argues that competency is not synonymous with competence and that criterion-referenced approaches do not encourage deep and reflective engagement required during professional practice-based learning.
He argues “that attainment of competencies does not guarantee satisfactory performance, which requires technical ability aligned with reflective practice”. The inclusion of reflection as a competency might counter this concern.
6.2.4 Assessment of IPE competencies
Thistlethwaite et al. (2014) point out that the assessment of competencies is not well defined in any of the frameworks. They point out that the broad competencies can sometimes be difficult to translate into observable behaviours. Lurie (2012) argues that the situations in which competencies are relevant have to be specified and,
according to Thistlethwaite et al. (2014), this “has implications for the development of work-based assessments (WBAs)”.
In a recent study, Blue et al. (2015) reviewed the current state of assessment in IPE.
This was done by interviewing 20 IPE programme leaders in the uSA and Canada, a literature review and an expert research meeting. They found that a diverse collection of methods and tools exist for the assessment of IPE competencies. These include tools to assess individual students’ attitudes (e.g. the Readiness for Inter- professional Learning Scale (RIPLS) (Parsell and Bligh, 1999) and the Interdisciplinary Education Perception Scale (IEPS) (Luecht et al., 1990), as well as number of instruments for the assessment of institution-specific goals and objectives. Only a few programmes used systematic processes to assess students’ skills and behaviours in IPC. One exception being the use in Canada of the behaviour-based Inter- professional Collaborator Assessment rubric (ICAr) (Curran et al., 2011). A limited number of programmes report the use of modified objective-structured clinical exam (OSCE)-type or behaviourally based teamwork instruments for student assessment in a team context.
The authors conclude that the following are needed:
a Multiple methods of learner assessment that measure knowledge, skills and behaviour over time in various contexts (i.e. exam scores, reflective essays, projects, self-assessments, team-based assessments, multi-source feedback, preceptor assessments, etc.).
b Sound, behaviourally based assessments including objective-structured clinical exams that are team-based or require engagement with other professionals; alternately, an assessment rubric-grounded in observed behaviours.
c Frameworks that link a learner’s performance with team and patient outcomes.
6.2.5 Summary
In summary, a number of national competency frameworks for IPE have been developed in, inter alia, the uSA, Canada, Australia and the united kingdom (uk).
A framework is still needed for the South African context. For students to optimally master IPE competencies, they need to be integrated as members of healthcare teams, preferably during longitudinal clerkships, and be exposed to good role- modelling of IPC practice. Inter-professional learning (IPL) is dynamic and IPE should follow a staged approach progressing from ‘exposure’ (or ‘novice level’) in the early years through ‘immersion’ (or ‘intermediate level’) and finally ‘mastery’
(entry to ‘practice level’) before graduation. In the South African context attention should be given to the potential of the internship and community service to build on the competencies acquired during undergraduate study.
An IPE framework should also provide guidance on the educational activities and processes that facilitate the acquisition of competencies. One of the challenges is that there is little guidance on the best methods and tools to assess IPE competencies. What is clear is that not only attitudes to inter-professional practice
should be assessed, but also knowledge, skills and behaviours. Students should not only be assessed individually, but also in teams and assessment should also be aligned with their developmental stage.
6.3 Adopting an inter-professional approach to individualised healthcare
To facilitate effective inter-professional communication and collaboration health workers need a common bio-psycho-social-spiritual approach to patients (Fig. 6.3), allowing each profession to add its pieces to form a patient’s ‘health mosaic’, using the same terms with the same understanding, and utilising the same framework for clinical reasoning and decision-making.
Figure 6.3: The ICF as inter-professional care and collaboration framework
(adapted from WHO (2001) and used with permission of Talaat and Ladhani (2014) In a recently published article, Snyman et al. (2015) discussed such a framework:
“In 2001 the wHO launched the International Classification of Functioning, Disability and Health (ICF) as a comprehensive coding system for functioning and disability, a conceptual framework and “common language between all professions” (wHO, 2001). In HPE, ICF has not been widely taught as a
Bio-psycho-social-spiritual approach
in the context of ethics, human rights and legal framework