CHAPTEr 6
6.1 Introduction
IPE is defined by wHO as “the process by which a group of more than two professions, specifically students from health-related occupations with different educational backgrounds, learn together during certain periods of their education with interaction as an important goal”. ICP in healthcare occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings (wHO, 2010).
The importance of IPECP lies in its potential as a transformative approach to healthcare. The WHO (2010) stresses the following: “governments around the world are looking for innovative, system-transforming solutions that will ensure the appropriate supply, mix and distribution of the health workforce. One of the most promising solutions can be found in inter-professional collaboration”.
6.1.1 Aims
This chapter aims to:
a discuss the key components of an IPECP strategy, namely:
• inculcating and assessing core competencies;
• adopting an inter-professional approach to healthcare;
• providing innovative ideas to empower role models through faculty development and capacity building in the service-delivery sector;
b identify enablers and barriers and suggest steps to address these;
c stimulate discourse to study the impact of IPECP on HPE, patient outcomes and health systems;
d explore ways to ensure the sustainability of IPECP in South Africa;
e formulate recommendations.
These different components of implementing an IPECP strategy will be discussed in more detail.
6.2 Inculcating and assessing core competencies for ICP (See Chapter 7)
6.2.1 Uni-professional competency frameworks
globally, there is a shift towards competency-based training in the health professions and in IPE. This has led to the development of a number of general (uni- professional) competency frameworks. These include:
a CanMEDS 2015 Competency Framework of the College of Physicians and Surgeons of Canada (Frank et al., 2015) (an adapted version of the 2005 version was accepted by the Medical and Dental Board of South Africa) (HPCSA, 2014).
b Learning Objectives for Medical Student Education (AAMC, 1998).
c Tomorrow’s Doctors (gMC, 2009).
d Standards for Assessment and Accreditation of Primary Medical Programmes (AMC, 2012).
e reference List of general Physician Competencies (Englander et al., 2013).
6.2.2 IPE-specific competency frameworks
IPE-specific competency frameworks have also been developed. The following are used internationally:
a Canada: A National Inter-professional Competency Framework (CIHC, 2010).
b uSA: Core Competencies for Inter-professional Collaborative Practice (AACN et al., 2011).
c Australia: Inter-professional Capability Framework (Curtin university, 2011).
6.2.2.1 why do we need IPECP-specific competency frameworks?
The need for competencies for IPECP is listed in the American framework (IECE Panel, 2011) and is said to be required to:
a “create a coordinated effort across the health professions to embed essential content in all health professions education curricula;
b guide professional and institutional curricular development of learning approaches and assessment strategies to achieve productive outcomes;
c provide the foundation for a learning continuum in inter-professional competency development across the professions and the lifelong learning trajectory;
d acknowledge that evaluation and research work will strengthen the scholarship in this area;
e prompt dialogue to evaluate the ‘fit’ between educationally identified core competencies for inter-professional collaborative practice and practice needs/demands;
f find opportunities to integrate essential inter-professional education
content consistent with current accreditation expectations for each health professions education programme;
g offer information to accreditors of educational programmes across the health professions that they can use to set common accreditation standards for inter-professional education, and to know where to look in institutional settings for examples of implementation of those standards;
h inform professional licensing and credentialing bodies in defining potential testing content for inter-professional collaborative practice”.
6.2.2.2 Canadian framework
In the preamble to the Canadian framework (CIHC, 2010), gilbert provides a lens through which this and other IPE competency frameworks should be viewed:
“well-researched, clearly defined and measurable competencies are now the norm across the professions, where uni-professional standards are relatively easily articulated. Describing and defining inter-professional competencies has proven to be a much more difficult task because at the present time, the field of inter- professional education and care is still not well understood.”
In the Canadian framework (Fig. 6.1), inter-professional communication and patient/client/family/community-centred care are seen as ’supporting domains’
that influence the other four domains. underpinning this are three considerations that influence the way the framework is applied namely the complexity of the situation or encounter, the context of practice, and quality improvement.
6.2.2.3 American framework
In the development of the American Core Competencies for Inter-professional Collaborative Practice (IECE Panel 2011), the following ’desired principles’ for inter- professional competencies were identified:
a Patient/family-centred.
b Community/population-orientated.
c Relationship-focused.
d Process-oriented.
e Linked to learning activities, educational strategies, and behavioural assessments appropriate for the learner.
f Able to be integrated across the learning continuum.
g Sensitive to the systems context.
h Applicable across professions.
i Stated in language common and meaningful across the professions.
j Outcome-driven.
The brief of the IPEC to its expert panel was to recommend a core set of competencies relevant across the professions for ICP as well as learning experiences and educational strategies for achieving the competencies. Such an approach highlights “essential behavioural combinations of knowledge, skills, attitudes, and values that make up a ‘collaborative practice-ready’ graduate” (AACN et al., 2011).
6.2.2.4 Australian framework
The Australian framework (Curtin university, 2011), is underpinned by the following assumptions:
Quality ImprovementContextual Issues Contextual IssuesQuality Improvement
A partnership between a team of health providers and a client in a participatory, collaborative and
coordinated approach to shared decision-making around health and social issues