Interprofessional Education in Medical Education

Abstract

This paper reviews the literature to clarify the meaning and implementation of interprofessional education. The author identifies practice, authenticity of the field, and socialization as key components, explaining that the ultimate goal of the education is the health of patients and communities. Reviewing the conceptual confusion and limited outcome measurements in previous research, the study proposes community-based education and longitudinal research examining context and process.

Introduction

Interprofessional education (IPE) is an educational approach in which multiple professions collaborate to improve the health of patients and communities. Following the publication of guidelines by the World Health Organization (WHO) in 1973, various countries implemented IPE across the public and private sectors. Chronic diseases, aging populations, rising healthcare costs, a shortage of general practitioners, and inequalities in medical services created a need for collaboration.

Despite extensive discussion, the meaning of IPE and methods for implementing it remain unclear. Challenges included limited attention to theoretical foundations and the specific characteristics of medical settings, as well as inconsistent use of related concepts. This literature review clarifies the concept of IPE and proposes directions for its application in Korean medical education.

Literature search

Web of Science was searched using ‘interprofessional’ as the search term. The search covered the period from the earliest records to December 9, 2016. Of the 5,621 documents initially retrieved, 3,973 were English-language journal articles. Restricting the search to the Journal of Interprofessional Care and designated journals in medical and nursing education narrowed the selection to 1,058.

The selection criteria included conceptual and theoretical papers exploring the meaning of IPE, literature reviews, and case studies describing curricula. Opinion pieces and experimental and survey studies without specific case descriptions were excluded. Of the 50 articles selected for full-text review based on their abstracts, 23 were chosen using the same criteria. A search of the Research Information Sharing Service using the same term identified 9 domestic articles, of which one was included after reviewing the titles, abstracts, and full texts. Books and reports identified during the review were also used.

Background of interprofessional education

The historical origins of IPE lie in the establishment of professional boundaries. Professionalization originated in the guilds of medieval Europe and developed into distinct professional domains in the early and mid-19th century. In the mid-to-late 20th century, recognition grew that fragmented professions had limited capacity to respond to public demands.

In the UK, projects emphasizing community health were conducted from the 1970s to the 1990s. The Center for the Advancement of Interprofessional Education (CAIPE), established in 1987, supported exchanges among educators. In the US, networks for collaboration and resource sharing were formed in response to local healthcare needs. Canada has promoted IPE under government leadership since the 1990s, adopting resolutions, allocating budgets, and establishing expert advisory committees from 2003 onward.

Theoretical review

General Systems Theory, organizational learning, Activity Theory, and Complexity Theory were examined as frameworks for explaining medical services and learning environments. Medical services function as open systems shaped by social relationships and environments. Within these systems, individuals and teams create knowledge and adapt to change.

Social Identity Theory explains prejudice arising from some professions’ sense of superiority and the process of integrative socialization. Transformative learning, situated learning, communities of practice, and informal learning address learning through joint problem-solving, reflection, and daily tasks.

The review introduces earlier discussions that treat failure as an opportunity for continuous improvement. The account offered by Nisbet and colleagues emphasized triple-loop learning, which applies lessons from experience to other contexts, and learning aimed at system change. Given the limits of existing theories’ explanatory scope, the review proposes an ongoing dialogue between empirical research and theory.

Definition of interprofessional education

‘Interdisciplinary’ focuses on communicating and integrating knowledge across academic disciplines. ‘Interprofessional’ refers to practical activities, interactions, reflection, and the conditions influencing these processes. The scope of analysis includes interactions among individuals, medical institutions, and systems.

In multidisciplinary approaches, experts apply knowledge from their own fields with little interaction across fields. In interprofessional approaches, professionals exercise their expertise while considering other experts’ perspectives and the context of practice. In transprofessional approaches, understanding that transcends professional domains and the team’s shared goals are central. The review associates IPE with the latter two approaches. The framework presented by Harden described 11 methods ranging from isolated teaching to integration.

The WHO’s 1988 definition emphasized shared goals and joint learning among healthcare workers. CAIPE proposed a definition in 1997 and revised it in 2006, and the WHO adopted it in 2010. IPE is a process in which two or more professions learn together, from each other, and about each other to improve collaboration and healthcare outcomes.

IPE places the needs of patients, families, and communities at the center. Its meaning evolves in response to the complexity of medical services and changes in their delivery.

Key components of interprofessional education

The successes and mistakes of daily work become opportunities for learning. The review views patients, families, and communities as partners in practice, emphasizing working together and learning new methods. Given practical constraints, education based on observation, action, and simulation has been used as an alternative way to provide practical experience.

Practice settings bring formal and tacit knowledge together as people adapt to changing situations. Patients’ housing, educational environments, and employment opportunities also affect health. Proposed educational approaches included opportunities for students to participate in patient care as members of a medical team and service-learning that combines community engagement with learning.

Socialization is the process of becoming a member of an occupational community by learning its values, attitudes, and behaviors. Socialization within isolated professions can hinder IPE. The review discusses incorporating interprofessional socialization and identity formation into programs addressing attitudes, knowledge, and skills.

Timing and methods of interprofessional education

One position held that participation before acquiring basic knowledge and skills could create negative preconceptions about other professions. Another held that learning together from the outset could reduce the development of prejudice. The literature offered no definitive recommendation on timing.

The dual identity model by Khalili and colleagues consists of three stages: breaking down barriers between professions, interprofessional learning and collaboration, and forming a dual professional identity. Because the stages are cyclical, environments that support repeated learning are considered suitable. A literature review by Abu-Rish and colleagues covering the five years from 2005 to 2010 identified small group discussions, problem-based learning, interactions with patients, community projects, and simulations as the main methods.

Outcomes of interprofessional education

Since the 1980s, research on outcomes has sought to establish a policy rationale for IPE. Some randomized controlled trials provided limited evidence of its effectiveness. The author explains that a lack of confirmed positive outcomes does not, in itself, establish that IPE is ineffective. Many studies measured satisfaction and changes in perceptions within limited settings and with limited theoretical grounding.

Agreement on learning outcomes also varied. The main outcomes reviewed were teamwork, roles and responsibilities, patient safety, effective services, communication, continuous learning and reflection, and ethics and attitudes. Competencies were categorized as common to all professions, complementary across professions, or collaborative, enabling professionals to work together. The review proposes focusing evaluation on situated competencies exercised in changing practice settings and on improvements in patient care services.

Research directions

The review proposes system-level research addressing community health and welfare, service effectiveness, cost reduction, and the relationship between education and medical services. This approach tracks implementation processes, relationships within specific contexts, and participants’ learning experiences longitudinally alongside outcomes. Evaluations of IPE using randomized controlled trials should account for the specific characteristics and complexity of practice settings.

Advice for implementing interprofessional education

Difficulties identified in the literature included participants’ limited understanding, the complexity of medical services, short-term pressure to reduce costs, and limited research on processes and outcomes. Other obstacles examined included short lectures or team activities, curricula unrelated to collaborative tasks, and students’ limited experience and limited reflection on their roles.

Further challenges included interprofessional hierarchies, a lack of team leadership, inadequate information technology and environments, financial constraints, and difficulties sustaining programs through institutional change. The review proposes reaching agreement on shared goals, developing staff and educational provision, cooperation among programs, and long-term support from governments and institutions. The domestic study by Yoon and Lee identified the fee-for-service system as a barrier to collaborative care and proposed a new payment system and systematic educational programs.

Conclusions

The review views individual, organizational, and inter-organizational learning as centered on practice, authentic settings, and socialization, with patient-centered health and welfare as the goal of IPE. Previous research provided limited conceptual clarity and theoretical grounding and few inductive longitudinal examinations of context and learning processes. Effects observed in one setting also have limited direct applicability to another.

Community-based education and collaborative learning communities are proposed as future directions. This approach envisions re-examining doctors’ roles and socialization in patient-centered medical villages where hospitals, schools, medical institutions, and welfare organizations cooperate. Given the focus of these discussions on North America and Europe, the review proposes curriculum research tailored to Korea’s social context.

Reading notes

Selecting 23 of the 1,058 papers retrieved from the designated journals on the basis of concrete descriptions of concepts, theories, and educational curricula aligns with the review’s aim to clarify the meaning of IPE. Experimental and survey studies without specific case descriptions were excluded. The review’s contribution lies in clarifying the meaning of IPE and organizing the contexts and conditions in which it is implemented. Learning transfer also offers a perspective on how understanding other professions during training leads to adjustments in roles and changes in communication in actual patient care. Among the outcome studies examined, findings on satisfaction and changes in perceptions are interpreted primarily in relation to participants’ educational experiences.

References

Han, H. (2017). Interprofessional education in medical education: Can we break the silos? Korean Medical Education Review, 19(1), 1–9. https://doi.org/10.17496/kmer.2017.19.1.1