Beyond the Lamppost: A Proposal for a Fourth Wave of Education for Collaboration

Abstract

Interprofessional education (IPE) is an increasingly popular educational model that aims to educate health care students to be better collaborators by enabling them to learn with, from, and about each other. IPE’s rising popularity is evident in the increase in scholarship on this topic over the last few decades. In this Perspective, the authors briefly describe three historical “waves” of IPE: managing the health workforce through shared curriculum, maximizing population health through health workforce planning, and fixing individuals to fix health care. Using insights from the social sciences and past practice, they then discuss six reasons why the current third wave of IPE is likely to fall short of meeting its goals, including that (1) IPE is logistically complex and costly, (2) IPE is developmentally inappropriate, (3) the link between IPE and key outcomes is still missing, (4) IPE insufficiently engages with theory, (5) IPE rarely addresses power and conflict, and (6) health care is an inertial system that IPE is unlikely to change. The authors conclude by sharing their vision for a fourth wave of education for collaboration, addressing workplace systems and structures, which would combine undergraduate, uniprofessional education for collaboration with practice-based interventions.

Measuring the performance of interprofessional primary health care teams: understanding the teams perspective

“…Internationally there is also a strong move to team-based primary health care, often referred to as medical homes, to enhance integration of services and emphasize health promotion and chronic disease management (Hutchison et al , 2011; Naccarella et al , 2013). The evidence to date suggests that interprofessional collaboration contributes to the structures and processes of primary health care, including patient satisfaction and access to care (Donabedian, 2005; Hogg et al , 2008), however, limited knowledge exists about the impact that interprofessional collaborative teams have on patient health outcomes (Paradis and Whitehead, 2018). …”

Making it real: the institutionalization of collaboration through formal structure

“…Collaborative ideas and values have in recent years been incorporated within a wide variety of formal structures attached to the education, training and certification of clinicians (Paradis & Whitehead, 2018). Chief among these have been competency frameworks, such as the Royal College of Physicians and Surgeons of Canada (RCPSC) CanMEDS Physician Competency Framework (Frank, 2005;Frank et al, 2015), and the Accreditation Council for Graduate Medical Education (ACGME) Core Competencies, developed in the USA (see Holmboe, Edgar, & Hamstra, 2016).…”

“…This "collaborative ideal" acknowledges and pays tribute to the multiplicity of perspectives and contributions that constitute contemporary healthcare and endorses collaborative practice to improve the quality of care delivery. Indeed, collaboration has been proposed as a solution to a wide array of problems, from ineffective care to treatment errors, a fragmented system, patient and provider dissatisfaction and resource waste (Paradis & Whitehead, 2018). This is despite the fact that efforts to make care processes more collaborative have resulted in rather modest impacts on care quality and health outcomes (Reeves, Pelone, Harrison, Goldman, & Zwarenstein, 2017;Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013).…”

“…A neo-institutional perspective on collaboration can shed light on how the ideal of collaborative care is transformed into the taken-for-granted structures of practice. It may also help to explain why, despite seemingly ubiquitous enthusiasm (see Paradis & Whitehead, 2018), evidence of impact on desired outcomes is, to date, so modest. By focusing on the normative aspects of collaborationrather than how it works or on how power defines itand the creation of structures that reflect widely-shared cultural norms, this perspective highlights the powerful role of ideas and values in influencing individual and organizational behavior.…”

Social Network Theory in Interprofessional Education: Revealing Hidden Power

“…In a 2015 review of 2191 IPE-related articles, Paradis and Whitehead found that only 6 articles discussed issues and solutions related to sociological power. 22 Paradis and Whitehead 23 have argued that the predominant theory informing IPE initiatives has been contact theory. 24,25 When applied to IPE, contact theory is premised on the notion that simply bringing different groups together will reduce prejudice and galvanize positive group relations.…”