Complex Patient Care Demands An Interdisciplinary Approach
More than a decade ago, the increasing complexity of patient care and the resultant increasing need for collaboration between health professionals was articulated1. The ability to co-labor (collaborate) is clearly vital when the plethora of health professionals and their increasing specialization and role differentiation combine with the complexity of patient care demands to make interdependency among professionals essential.
More recently, deTornyay has suggested that a philosophical shift must occur in order for the current and future generations of faculty to prepare professionals who can effectively meet the basic health care needs of the American public. She described a "culture of collaboration" in the year 2005 in which faculty from schools of medicine, nursing, social work, public health and other disciplines jointly assume responsibility for the creation of the learning environment. She noted that there was a dearth of recent medical and nursing literature providing substantive discussion of interdisciplinary development in education and practice2. Yet, the complex health needs of society exceed the capability of any single discipline.
Professional Socialization Begins Early
While interdisciplinary education has been recommended as part of a holistic, cooperative agenda for health care1-7, there has been little work to examine how and when such education should occur. Nevertheless, several things seem clear. First, professional socialization begins early, often before career choices are even made . Second, professional socialization occurs in the context of other professions8. Lastly, the skills needed for collaboration--negotiation, team building, joint decision making, and problem solving--are learnable, but the content and methods to best teach these skills are rare in current curricula. In fact, very few schools for health professionals include any interdisciplinary experiences, either classroom or clinical, as part of their course work9.
The Pew Health Professions Commission recommends that curricula be revised to promote teamwork and interprofessional contact6. The foundations for interdisciplinary collaboration can be laid from the inception of advanced education. In a survey of 114 programs in nursing, occupational therapy, physical therapy, audiology, and medical technology, faculty identified the most important contributions of general education to professional development. These included written and verbal communication skills, problem solving, understanding behavior, and developing values10, skills clearly vital to collaboration. Thus, interdisciplinary education is enhanced when introduced early in the liberal arts core of professional studies.
Interdisciplinary education of health professionals is part of a larger movement in health care to scrutinize costs and maximize efficiency of care delivery by moving from an environment of competition to one of collaboration. Major foundations such as Robert Wood Johnson, Pew, and Kellogg are focusing attention in their funding initiatives on partnerships among professions and among institutions and communities. But barriers have been daunting, and many efforts at developing interdisciplinary educational programs have failed or simply fallen by the wayside9.
There are a number of challenges to be addressed in order to assure the success of interdisciplinary educational endeavors. These challenges may be philosophical and sociological (gender and class differences between professions, differences in professional respect and commitment to an interdisciplinary approach, differences in disciplinary focus and mission), organizational and structural (scheduling and timing differences among programs, appropriate student mix and level of student, geographic separation, lack of adequate clinical sites for interdisciplinary experience, financial reimbursement), or academic and professional (overlapping and converging roles with potential loss of disciplinary identity, need for faculty development, identifying core content and shared experiences, selecting disciplines to be involved, finding and training appropriate mentors). Despite the barriers, programs are being initiated and are creating some models of collaboration.
Outcomes of Interdisciplinary Education Must Be Assessed
While studies are beginning to validate that patient outcomes, quality of care, and patient and provider satisfaction are improved in a collaborative practice setting5, 11-13, the role of the educational process in enhancing or interfering with collaboration has not been well documented. Studies of interdisciplinary educational programs have included evaluations of such factors as awareness/knowledge of roles, shared decision making, attitudes toward collaboration and toward other disciplines, provider and patient satisfaction with collaborative clinical programs, and quality of written care plans. Such studies, however, have been few in number, usually single-site case studies with no comparison group, and have included short follow-up periods and/or small numbers of participants. They generally have focussed on a single condition or patient group such as diabetes or gerontology. None has assessed patient health-related outcomes or costs of care.
Throughout the history of health care, practices and procedures have been introduced with minimal critical assessment. Interdisciplinary education seems to be a vital step in the movement toward coordinated systems of efficiently delivered, cost-effective, high-quality health care. It is also fraught with philosophical and practical challenges. Hence, an evaluation of the effects of interdisciplinary education on patient care and studies to determine how to maximize educational benefit are essential.
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