Inter-professional education – need of the hour

In India despite the large infrastructure and attention to need to provide healthcare needs, the public sector actually provides only about 20 per cent of actual care services. The balance of care is provided by private hospitals and practitioners according to a report published in Insight by ISB. Considering the huge population of India and with increasing prevalence of chronic diseases, advancement in health care technology, and growing complexity of health care delivery has made it virtually impossible for a clinician practicing alone to maintain the knowledge and the skills required for providing optimal care. In this context there is a need for coordination of multiple healthcare professionals in clinical setting and hence Inter-Professional Education (IPE). Inter-professional educational experiences address team building and collaborative inter-professional care and involves students, faculty, and other members of different health professions in a variety of settings, including shared teaching and learning environments. However the concept of inter-professional education in India is in nascent stage or I can say nil. Hence, there is a need for redesigning health professions education process which requires a substantive and sustained commitment to the implementation of inter-professional education across the full spectrum of major health care disciplines.

A model for development of IPE
To implement inter-professional education there is a need to bring the concerned organizations from medical, dental, nursing, pharmacy, public health and policy makers under one umbrella to form  a working group with committed members for developing a common vision for how the respective professions could combine their unique abilities to deliver patient-centered team-based care, promote efforts to reform health care delivery and financing in line with that vision, and foster meaningful inter-professional learning experiences to support team-based care of the future.

Core competencies for IPE and practice
Core competencies for inter-professional education collaborative practice, contains recommendations on inter-professional core competencies for health professions students, delineated by four content domains, to provide integrated, high-quality care to patients within the nation’s evolving health care system.

Ethics
Inter-professional practice requires working with individuals of other professions to maintain a climate of mutual respect and shared values. These values has to place the interests of patients and populations at the centre of IP health care delivery and respect the unique cultures, values, roles/responsibilities and expertise of other health professions.

Roles/responsibilities
Learning to be inter-professional requires an understanding of how professional roles and responsibilities complement each other in patient-centered and community/population oriented care.  People during inter-professional practice need to recognize one’s limitations in skills, knowledge, and abilities and communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention.

Inter-professional communication
Developing basic communication skills is a common area for health professions education, but health professions students often have little knowledge about or experience with inter-professional communication. Learning to work together to communicate and manage emotionally difficult information with patients and families, such as end-of-life information, or error disclosures requires openness, understanding, and an ability to convey messages in a sensitive and respectful manner.

Teams and teamwork
Working in teams involves sharing one’s expertise and relinquishing some professional autonomy to work closely with others, including patients and communities, to achieve better outcomes. Shared accountability, shared problem-solving, and shared decision are characteristics of collaborative teamwork and working effectively in teams. Valuing working with others to deliver patient-centered care that is community/ population-oriented, being clear about one’s own and others’ roles and responsibilities, and practicing inter-professional communication contribute importantly to teamwork behaviors and effective team functioning.

Accreditation of IPE
Accreditation has been shown to be an effective lever for change in achieving better care environments for providers and patients and better education environments for students. Accrediting bodies representing different health professions should collaborate to create a common IPE standard. This would offer the best opportunity to en masse, for graduates to see the world through the eyes of other professions. A bold move like this would not only ensure baseline preparation across the professions, but would also send a powerful signal to all Indian health professions colleges to explicitly acknowledge IPE in their vision, mission statement, goals and include inter-professional care curriculum. Regulators must develop, establish and maintain standards and quality improvement programs that will enable professions to practice inter-professional care. Initiatives should be taken in developing accreditation criteria on how to practice inter-professional care within institutions. Evaluation and public reporting processes must be part of the implementation process in order to identify which activities are working well and help determine which need further attention. In this regard an evaluation framework should also need to be designed by the experts from different professions.

We believe that establishing these core competencies for health professionals and the accrediting standards will provide the valuable transformative direction needed to improve the nation’s health care system. However politics and policy can play a huge role in advocating for change. Identifying and supporting inter-professional education and ensuring appropriate collaborative practice-friendly policies is a challenge and sharing the positive outcomes of successful collaborative programmes may be limited but significant steps towards broadening the use of inter-professional collaboration is the need.