Importance of Interprofessional Education for Occupational Therapy

Background

In the 21st century, health care has seen a local, national, and global shift from provider-driven to client-centered care, sparking the international movement toward care delivered by interprofessional teams. Today, ICP is widely recognized as the basis for effective care delivery (Haddad et al., 2019). Interprofessional care delivery improves health outcomes and has been shown to increase quality of care, improve the coordination of care delivery for clients with complex conditions, decrease health care errors, reduce hospitalization time and costs, enhance accessibility for clients, and contribute to improvements in client satisfaction and workforce well-being (Doherty, 2019; Frenk et al., 2010; Committee on Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes, Board on Global Health, Institute of Medicine [hereafter Institute of Medicine], 2015; National Academies of Practice, 2019; National Academies of Sciences, Engineering, and Medicine, 2019; Weiss et al., 2014). Despite the focus of the discussions on ICP in traditional health care settings, teamwork skills are critical in all areas in which occupational therapy practitioners work, especially as their roles in population health and social determinants of health expand (Mastel-Smith et al., 2020 ; Molitor & Feldhacker, 2019).

Moreover, today’s health professions students must develop the knowledge, skills, and behaviors that result in interprofessional team competence (Health Professions Accreditors Collaborative [HPAC], 2019). This knowledge development begins both in the classroom and in fieldwork or capstone experiences. Multiple national and international health organizations and accreditation bodies have invoked IPE as a means to reform health professions education and make it more responsive to contemporary health care needs. The joint creation of a reflective, collaborative, and interprofessional learning environment enables the development of effective team values, skills, and competencies. IPE and collaborative practice also promote team-based structural solutions. This attention to professional cultures and status hierarchies can serve to advance contemporary pedagogies. For example, it can serve to move antiracist pedagogy from cultural competency to structural competency, allowing learners to critically reflect on their own positions on racism and the societal cycles of oppression responsible for health disparities (Cahn, 2020). These concepts apply not only to interactions with clients but also to interactions among team members, where issues of power and privilege have been demonstrated to have a direct impact on team function (Engel et al., 2017; Meleis, 2016; Pecukonis et al., 2008). This is a consideration not just across teams but also intraprofessionally to ensure that both occupational therapists and occupational therapy assistants are valued team members (Penner et al., 2020).

Interprofessional competencies have been integrated into accreditation standards across the health professions to ensure that students are effectively prepared to function as members of the interprofessional care team. Current Accreditation Council for Occupational Therapy Education (ACOTE®, 2018) standards include requirements that ensure that occupational therapy practitioners are effectively prepared at the entry level to communicate and collaborate interprofessionally, demonstrate a team approach to care delivery, and have an understanding of the principles of team dynamics. In addition, occupational therapy curricula must prepare entry-level practitioners to “identify occupational needs through effective communication with clients, families, communities, and members of the interprofessional team in a responsive and responsible manner that supports a team approach to the promotion of health and wellness” (ACOTE, 2018, p. 32).

Why Interprofessional Education? The Ethical Imperative

Best practice and ethical practice are inextricably linked (Doherty & Peterson, 2016). ICP is built on a foundation of mutual respect and shared values. The Occupational Therapy Code of Ethics (AOTA, 2020) states that occupational therapy practitioners will “respect the practices, competencies, roles, and responsibilities of one’s own and other professions to promote a collaborative environment reflective of interprofessional teams” (p. 5) and “engage in collaborative actions and communication as a member of interprofessional teams to facilitate quality care and safety for clients” (p. 9). When functioning as effective interprofessional team members, occupational therapy practitioners uphold their ethical obligation to be respectful of the practices, competencies, roles, and responsibilities of other health professions and the evidence-based outcomes of this collaborative care delivery model (Slater & Cusick, 2019). Interprofessional care teams rely on trust, collaboration, and shared accountability. They embrace diversity and individual differences and respect the unique cultures, values, and expertise of other health care team members (Interprofessional Education Collaborative [IPEC], 2016). When occupational therapy learners are exposed early and often to interprofessional collaborative education and practice, they have the opportunity to develop shared moral agency, ethical decision-making, and ethical reflection that honors the tenets of ICP (Doherty & Purtilo, 2016). In this way, the moral obligation to best practice and client-centered care that balances the rights, duties, and responsibilities of the client, family, and care providers is aptly supported.

Key Terms, Definitions, and Core Competencies

In its Guidance on Developing Quality Interprofessional Education for the Health Professions, HPAC (2019) supports the recognition of a consensus on the language used in IPE and practice. The World Health Organization (WHO, 2010) defines IPE as occurring “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (p. 7). The 2018 ACOTE standards also endorse this definition. We recommend aligning IPE curricula within occupational therapy programs with this definition.

The HPAC (2019) guidance document elaborates on the WHO’s (2010) definition of IPE by breaking down the elements of learning. The guidance document describes the knowledge and skills attained through examples of learning activities that occur about, from, and with other professions. In occupational therapy education, IPE should ensure that occupational therapy and occupational therapy assistant students learn about other professions they will encounter in clinical and community settings. Learning “about” other professions includes understanding practitioners’ roles, responsibilities, and scope of practice and addressing potential biases and stereotypes that might act as barriers to collaboration. In addition, occupational therapy learners should have IPE opportunities and experiences through which they learn from other professions and teach those in other professions about occupational therapy’s role in health care. IPE can truly be the starting place to expose others on a health care team to occupational therapy; as health care teams form, this exposure can ensure that, when appropriate, occupational therapy is included to ensure the delivery of optimal client care. IPE should include experiential learning activities with other professions. Learners need to practice team skills with those in other professions to be ready for collaboration. As mentioned, opportunities to practice the development of team skills should occur often across occupational therapy education.

IPE curricula are intended to build skills toward the Core Competencies for Interprofessional Collaborative Practice (IPEC, 2011, 2016). The IPEC (2016) Core Competencies are as follows:

Values and Ethics for Interprofessional Practice. Work with individuals of other professions to maintain a climate of mutual respect and shared values.

It is important to understand that each IPEC core competency has several subcompetency areas that provide detailed components to guide ICP (see IPEC, 2016). An IPE curriculum should align with the definitions of IPE and the core competencies, as well as with the standards set forth by ACOTE, which correspond with the WHO’s (2010) definition of IPE.

Recommended Pedagogy for Interprofessional Education

IPE has evolved, and its delivery now is dictated by context and resource allocation. However, specific best practices in pedagogy should be considered in the design and delivery of IPE. The HPAC guidance document recommends that IPE curricula develop a strong rationale and endorses the use of the Institute of Medicine’s (2015, p. 29) interprofessional learning continuum as guidance. The learning continuum acknowledges that implementation of IPE can be supported or challenged by the organization’s cultural context and that interprofessional teamwork requires lifelong learning. It supports assessment as a core component of the IPE curricula, which is discussed in detail later in this position statement. IPE curricula are diverse; however, all should include these core elements: a clear rationale, outcome-based goals, a deliberate design, and assessment and evaluation (HPAC, 2019). Occupational therapy IPE should be no exception.

Higher education theory can provide a foundation for both the rationale for and the deliberate design of IPE curricula, laying the groundwork for much of the context of IPE. In essence, IPE is often infused with multiple educational theories. IPE educators should consider theory as a grounding framework for the IPE curriculum and instructional design. The literature has identified Kolb’s (1984) theory of experiential learning as an applicable theoretical framework for IPE. Although the literature does not offer specificity regarding the number of IPE activities to include in the curriculum, it is well established that providing multiple experiences is critical for learners to evolve in their IPE skill development. Kolb’s cycle of active experimentation, concrete experience, reflective observation, and abstract conceptualization provides a structure for consideration of the design of both curriculum and individual IPE activities (Fewster-Thuente & Batteson, 2018).

Eduardo Salas’s work in team science provides a structure for the skills that learners need to develop to engage in effective interprofessional teamwork and to ensure learners are collaboration ready (Salas, Reyes, & McDaniel, 2018; Salas, Zajac, & Marlow, 2018). IPE curricula and learning should focus on developing the seven Cs: capability (knowledge, skills, and attitudes for teamwork), coaching (shared leadership), cognition (shared understanding), communication, conditions (a culture that supports collaboration), cooperation (committed to working together), and coordination (effectively address conflict). Educators designing IPE curricula and learning activities should provide opportunities to grow in their skills related to the seven Cs. The seven Cs give structure to the deliberate design identified in the HPAC (2019) guidance document.

Outcomes-based goals are important to any IPE curriculum. When developing a curriculum design, educators should consider who their learners will be. After they envision their learners, the next step is to develop learning objectives and outcomes. These should be mapped to IPE activities to ensure that a clear strategy for designing specific learning activities exists. The IPEC (2016) core competencies provide clear guidance and can provide a structure for the identification of learning objectives and outcomes.

It would be disingenuous to recommend one type of curriculum or one type of learning modality for IPE. Learners benefit from a diverse set of experiences and from exposure to a variety of learning experiences and students from other professions, both within and outside health care. Learning experiences can be effective when delivered in person or online as long as they meet the IPE criteria of students from two or more professions learning about, from, and with each other to enable effective collaboration and improve health outcomes. IPE education experiences are also influenced by the type and composition of learners outside occupational therapy and the resources available to implement certain learning activities, such as simulation. Educators are best served if they identify interprofessional learning outcomes and align them with educational experiences. The IPE literature has demonstrated support for a variety of pedagogical approaches, including, but not limited to, case discussions, high- and low-fidelity simulations, service learning, community-based experiences, clinical learning experiences, and telepractice and telehealth experiences (see Table 1 for exemplars and citations of supporting evidence). In addition, intraprofessional and interprofessional experiences that include occupational therapy assistants are of critical importance to consider in any IPE curriculum involving occupational therapy (Wagenfield et al., 2017). Although some methods may offer more robust learning outcomes, no specific dose or type of IPE has been shown to be ideal. Instead, IPE should occur within a pedagogy supported by the academic institution. IPE activities should offer experiences across the curriculum, from the start of a program through the clinical practice environment. In addition, IPE activities will best prepare learners for interprofessional collaboration if they are offered across the curriculum and not simply to comply with accreditation guidelines.

Designing an Assessment Plan for Interprofessional Education

As part of IPE implementation, a carefully considered assessment plan is critical to (1) understand the impact of an IPE learning experience, (2) determine what students have learned from their engagement in the experience, and (3) evaluate student learning to improve the experience. The body of research in the area of IPE evaluation and assessment has grown exponentially in the past few decades, so there is no shortage of measures and models of evaluation in the area of IPE assessment. Rather than recommending specific assessment models, tools, and approaches, this section provides occupational therapy educators and practitioners with multiple considerations to ponder when developing IPE student assessment plans and when sharing assessment resources.

Consider the Purpose and Use of the Interprofessional Education Assessment Plan

The initial step in designing an IPE assessment plan is to determine the purpose of the plan and reflect on how the assessment results will be used (Reeves et al., 2015; Russell et al., 2017). A formative assessment may provide feedback to students or instructors to refine thinking, behavior, or curricula. Alternatively, a summative assessment might focus on providing evidence that individuals or a team of learners have achieved specific learning outcomes, performed a skill, or perceived an experience. A balanced IPE assessment strategy includes both formative and summative assessments and has implications for methods of data collection. Table 2 contains examples of assessment methods that address the purpose of IPE assessment plans.

Align Assessment Choices to Student Learning Outcomes

Sound IPE assessment plans demonstrate alignment between methods of assessment data collection and IPE student learning outcomes (SLOs). To create this alignment, constructs identified within SLOs are matched with assessments that measure specific interprofessional constructs. These constructs may also be termed content domains and are the various characteristics or behaviors one is interested in understanding through measurement, such as depression, independence, or performance. Common constructs in the IPE literature include areas of knowledge (of roles and responsibilities of one’s own or another profession, client safety, client-centered care), skills (in communication, conflict negotiation, leadership, client safety), behaviors (of professionalism, decision-making), and attributes (attitudes, beliefs, confidence; Schmitz & Cullen, 2015).

It is important to determine the relationship among the SLOs specific to the IPE construct. For example, in addressing a potential IPE SLO that “students will demonstrate effective communication when interacting with members of other health professions,” the construct of interest might be interprofessional professionalism. In this example, the assessment plan may include a standardized assessment designed to assess interprofessional professionalism, such as the Interprofessional Professionalism Assessment (Frost et al., 2019). Likewise, the Interprofessional Socialization and Valuing Scale (King et al., 2010) could be selected to evaluate the construct of interprofessional socialization in an IPE simulation learning experience for which an SLO is that “students will differentiate between the roles and responsibilities of different professions.” For an assessment plan intended to determine whether students can understand participants’ experiences, a qualitative approach may be needed, such as that designed by Holmes et al. (2020), using reflection journals as the assessment method.

Consider the Range of Outcomes When Assessing Student Learning

When aligning assessment choices with SLOs, it is also important to consider the range of outcomes inherent in IPE learning experiences. One way to identify outcomes is to examine a learning continuum (e.g., preprofessional education, foundational education, advanced professional education, continuing professional development). Alternatively, outcomes may also be chosen on the basis of a hierarchy arranged by impact of educational experience. One useful model that examines a range of outcomes was initially developed by Donald Kilpatrick (1959, 1994) as a training evaluation model and modified by IPE scholars to offer a six-point typology covering levels of IPE outcomes (Reeves et al., 2017). The levels of IPE outcomes are described in Table 3.

The alignment among assessment choices, constructs, SLOs, and outcome levels is important when the validity of an assessment plan is being evaluated. Validity refers to how well the assessments measure what they are intended to measure. By aligning these components, assessment results will better inform the aims of the assessment plan and, in turn, the effectiveness of the pedagogy.

Integrate Standardized Assessment Tools

The body of research describing standardized assessments is growing in the area of IPE, and many existing assessment tools are available for inclusion in assessment plans. These standardized tools and published findings allow users to make informed decisions when they are developing an IPE assessment plan. Reviewing this literature can inform the selection of an assessment tool, aligning purpose, SLOs, and methods, as well as other assessment features, such as psychometric properties (i.e., validity, reliability, responsiveness to change), tool construction (i.e., accessible, unbiased, and with inclusive language), and administration procedures (i.e., length of time needed to administer, cost, training, equipment).

To select standardized assessment tools, one can examine databases commonly available through institutional libraries, such as the Mental Measurement Yearbook, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Education Resources Information Center), and PsycINFO. In addition, the National Center for Interprofessional Practice and Education (Nexus, 2021) is widely recognized for its curated collection of high-quality measurement instruments. This collection contains an overview and descriptive and psychometric elements of each assessment included. Nexus (2015) has also developed a companion guide to this collection titled Evaluating Interprofessional Education and Collaborative Practice: What Should I Consider When Selecting a Measurement Tool?

Designing a sound assessment plan for IPE requires intentional consideration of purpose, learning objectives, and desired outcomes and a review of the current literature. When the plan is carefully designed, the results offer invaluable insights into student learning and guide enhancement of future IPE learning experiences.

Faculty Development to Engage in Interprofessional Education

IPEC (2016) identified the need for faculty development as a key aspect of successful delivery of IPE experiences. It is vital that faculty be prepared to facilitate the interprofessional focus of such learning initiatives and to use their intended outcomes, and this requires a pedagogical shift away from disciplinary education (Doll et al., 2018). Moreover, the facilitation of IPE experiences requires specific knowledge, skills, and attitudes that can be cultivated through faculty development, but faculty development is recognized as a complex process (Watkins, 2016). One benefit of IPE-focused faculty development is the opportunity to build a network of faculty to support IPE endeavors (Blakeney et al., 2016) and enhance its sustainability (Anderson et al., 2009).

The focus on preparing faculty to teach IPE can range from developing teaching capacity while enhancing an understanding of IPE competencies and frameworks, selecting and implementing assessment approaches, or implementing strategies for reflection after IPE experiences. Effective IPE training should encourage faculty members’ positive attitudes toward IPE education, develop their understanding of the theoretical perspective of IPE, and increase their competence to develop and deliver successful IPE experiences (Davis et al., 2015). Above all, it is key that faculty model the essential skills and core values of interprofessional collaboration for learners.

Entities such as IPEC provide useful resources related to faculty development. In addition, institutional teaching and learning centers may be prepared to provide faculty development in this approach. However, some research has indicated that faculty may be resistant to participating in IPE faculty development and think they would not benefit from training in this area. Therefore, any faculty development related to IPE needs to be carefully planned, strategic, and proactive and identify faculty ambassadors or champions for IPE (Doll et al., 2018; Grymonpre, 2016).

For faculty who are embarking on IPE at the activity, course, or curriculum level, it is essential that they investigate IPE resources and initiatives at their institution. IPE initiatives may reside at various college or university levels, depending on the size and type of institution, and they may have informal leaders or formal directors. Therefore, it is important to explore the IPE academic landscape before embarking on a new IPE initiative. Identifying key personnel engaged in IPE at the institution can garner support, lead to collaboration, and facilitate the enhancement of IPE initiatives at the campus.

In addition to identifying available institutional resources, faculty may need to enhance their individual learning in this area to support development of effective learning experiences. Professional development needs related to IPE will depend on faculty members’ role or IPE responsibilities. Because IPE initiatives can range from developing an activity for a course to leading IPE strategic planning and development, faculty need to identify appropriate professional development opportunities to support their learning goals and career trajectory. National professional associations such as AOTA have web-based resources related to IPE and can be an excellent resource. Moreover, national IPE associations such as Nexus (https://nexusipe.org/), HPAC (https://healthprofessionsaccreditors.org/), and IPEC (https://www.ipecollaborative.org) provide many resources, guidance documents, and professional development activities.

Conclusion

Occupational therapy practitioners value collaboration with clients, families, and health care team members. To build team skills, learners need IPE that is robust and designed with the best practices identified in this document. Occupational therapy educators are critical members to include in the design and implementation of IPE for both occupational therapy learners and learners in other professions. Exemplars of a variety of types of IPE are included in Table 1 to provide a resource for occupational therapy educators. Health care is a team sport; it is critical that occupational therapy practitioners be prepared team members, and IPE offers that preparation.