There are many ways in which students can become proac tive interprofessional learners, be it in the clinical or in the university setting. Contemporary methods of communica tion mean that it has never been easier to form a network of fellow learners. Online networks can offer a stimulating and safe environment for the development of a range of professional skills. In order for students to lead in a learn ing context it is important to understand that:
•
there is always more than one way to deal with a situation;•
no two people will react in exactly the same way to a given situation;•
the way that you react to an incident really matters;•
by reflecting on interprofessional learning incidents you will be better able to cope with similar episodes in the future;•
a positive attitude and selfesteem will enable you to strive for excellence;•
whatever other factors are present, the service user must always be the most important entity.In studentled interprofessional learning the mentor does not need to be a tutor or health professional – another student may take on this role. A study by Clouder et al. (2010) suggested that student learning is optimised by peer mentoring. They found that where students across a range of disciplines engaged in web based interprofessional online discussion forums the role of mentor was valued by other students who, at times, found the student added value compared with a profes sional mentor. A student mentor can offer empathy and
Tidy’s physiotherapy
Calls to discuss the need for ‘reprofessionalisation’ are based on the recognised need for individuals to shift their identity and commitments from being profession focussed to the organisation in which they work (Hafferty and Light 1995). The previous discussion suggests that professional identity might be the foundation on which individuals can go forward to optimise teamwork, al though research by Baxter and Brumfitt (2008) suggests that, again, contextual factors, such as team size and regular contact, were important in developing team iden tity, rather than professional identity. Professional identity and its interaction with interprofessional relations and interprofessional learning is clearly complex. In agreement with Kreber (2010), we suggest that it might be helpful to think of (professional) identity formation as essentially intersubjective, dialogical and relational in nature. Team work is an important element, but, perhaps more impor tantly, Wackerhausen (2009: 471) reminds us that ‘our professional means come and go but our professional raison d’etre stays. That is, relentless searching for and using the most excellent means available to do the best we pos sibly can for the patient’. Accepting this raison d’etre is part of our professional identity that takes us closer to effective interprofessional practice.
CONCLUSION
The importance of IPE in preparing undergraduates for a world of work where coordinated collaborative practice is the norm should not be underestimated. By engaging in IPE students are able to experience, in a safe environment, the complexity of joint working and the ways in which individual professional sensitivities can, and do, get in the way of decisionmaking, as well as culminating in a less linked and more fragmented experience for patients. IPE is a useful precursor to improved collaborative working; today’s practitioners need to be capable of working across boundaries and providing seamless holistic patient care with colleagues. In 1988, the WHO called for IPE on the basis that learning together translates into improved working together (WHO 1998).
This chapter has sought to provide the reader with an overview of the current thinking around IPE within the context of contemporary health and social care practice, as well as instil in the reader a sense of its importance in the preparation of graduate health and social care practitioners.
As the historical perspective shows, IPE is not a new concept and yet there is still much work to be done on securing a robust evidence base to support the investment both educators and practitioners put into its ongoing inclusion in education programmes, which both prepares new graduates and supports the ongoing professional development of the health and social care workforce. associated with that profession, becoming a nurse, a medic
or a physiotherapist. Socialisation is ‘the process by which people selectively acquire the values and attitudes, the interests, skills and knowledge – in short – the culture current in groups in which they are, or seek to become, a member’ (Merton et al. 1957: 278). The process has been described as ‘indoctrination’ (Sparkes, 2002) and certainly involves elements of ‘internalization’ (Hayden 1995) of professional norms.
Inevitably, different training and philosophical ap proaches have resulted in the professions evolving separately (Fitzsimmons and White 1997) and in the pro fessions being described as ‘warring tribes’ (Becher and Trowler 2001). The sense of shared identity that develops in groups promotes what William Sumner identified in 1906 as ‘ingroup’ and ‘outgroup’ dynamics (Brewer 1979). Social identity theory explains how such dynamics effect intergroup relations; people seek for their ingroup a positive distinctiveness from outgroups; in other words, they distinguish between ‘us’ and ‘them’ (Tajfel et al. 1971). However, research suggests that rather than indi viduals who identify strongly with their ingroup – ranking outgroups more negatively, as might be expected – those who are positive about their ingroup are also positive about other groups (Hind et al. 2003). This finding is attributed to wider contextual factors, such as membership of diverse student groups of healthcare professionals. These students were also more positive about IPE, suggest ing that a strong professional identity does not mitigate against students’ willingness to engage positively in it. This finding supports Clouder’s (2003) conception of ‘sociali sation as interaction’ based on social constructionist theo ries that suggest that society creates individuals, who, in turn, create society (Berger and Luckman 1966). Socialisa tion as interaction allows socialisation to be seen in a less deterministic way, especially if, as is advocated by the IPE movement, students are exposed to one another in a way that allows them to develop awareness of their profession in the context of others.
Clouder’s research findings suggest that repressive and deterministic socialisation processes are mitigated by the potential for individual agency. Rather than being envel oped by the influence of professional discourses, ‘scarcely aware of changes to their own identity’ (Clouder 2003: 220), she has suggested that they are capable of individual agency able to make choices; options include conformity and deviance, commitment or noncommitment, attrac tion or aversion (Vanderstraeten 2000). Clouder suggests that such choices result in individuals’ differential posi tioning within their professional culture, either identifying wholly with it or sitting on its fringes. Fringe positions may be conducive to making connections with others in different professions as they are inhabited by individuals who have decided where they sit within their profession, who then have the confidence to explore wider interpro fessional practice.
physiotherapist means being equipped with the knowl edge, skills and values distinctive to physiotherapy, and recognising, understanding and valuing the knowledge skills and values distinctive to other professional groups. Physiotherapists who are confident in their own profes sional knowledge, skills and values will be able to recog nise when they are the best professional for the job and when it is more appropriate for another professional to do the job. IPE as a mechanism for promoting more effective collaboration and teamworking can help to prepare graduates for the daily negotiation of professional boundaries as an integral part of work in order to provide patientcentred care.
The benefits of IPE are well documented and this chapter has introduced readers to the history, drivers, key concepts and practices of IPE alongside an exploration of some of the complexities inherent in any collaborative endeavour (including IPE). The authors acknowledge the need for more evidence to substantiate the benefits of IPE as a precursor to effective collaborative work practices; however, the growing evidential base (Horder 2004; Bokhour 2006; Stone 2006; Lennox and Anderson 2007; The authors of this chapter have highlighted the impor
tance of IPE in the undergraduate curriculum to help prepare graduates for a world of work where collaborative practice is becoming increasingly the norm. The publica tion of the most recent NHS white paper: ‘Liberating the NHS’ (DH 2010a) reinforces the requirement for collabo rative practice in health and social care. For all practition ers this means that every opportunity to develop those skills required for effective collaborative practice should be seized.
For undergraduates concerned with learning to be a particular type of professional with all the inherent uni professional requirements this demands, the inclusion of IPE can sometimes be viewed as less valuable than those uniprofessional aspects. The authors of this chapter hope to convince readers that IPE is an important aspect of their undergraduate education. It is possible to learn to be a particular type of professional within an interprofessional learning context.
Learning to be an effective physiotherapist in the twenty first century necessitates active engagement in IPE. IPE provides opportunities to practise and experience collabo rative working in a safe environment. Learning is a process not performed in isolation from others. As Wenger (1998) asserts, learning involves collaboration and engagement between learners, each influencing and, in turn, being influenced by each other; learning outcomes become shared by communities of practice. IPE is a natural place for this to occur.
Social learning theories (Wenger 1998) suggest that learning with, and through, interaction with others builds communities of practice. This chapter has tried to high light the importance of interprofessional education as a way of developing the knowledge skills required for col laborative working. It can be argued that building com munities of learning through engagement in IPE is the best way to develop such knowledge and skills. IPE com munities of learning provide a safe environment where undergraduates can test out their own professional role and identity alongside peers from other professional groups doing the same. Collaborative learning, practice and work are never easy, and are difficult to negotiate on a daily basis. However, it is imperative that today’s practitioners are able to practise such professional nego tiation on a daily basis if they are to practise person centred health and social care. IPE offers a vehicle to support this and through collaboration between profes sionals lead to:
•
improved services;•
improved health outcomes;•
effecting change.The importance of working closely with other profes sionals to provide care that is truly focussed upon people and their families cannot, and should not, be underesti mated (DH 2000b; Wilcock et al. 2009). Being an effective
Weblinks
Australasian Interprofessional Practice and Education Network (AIPPEN): http://aippen.net/index.html Canadian Interprofessional Health Collaborative (CIHC):
www.cihc.ca
Centre for the Advancement of Interprofessional Education (CAIPE): www.caipe.org.uk
European Interprofessional Education Network (EIPEN): www.eipen.eu
Global Health Workforce Alliance: www.who.int/workforcealliance/en
Health Professions Global Network: http://hpgn.org/ International Association for Interprofessional
Education and Collaborative Practice (InterEd): www.interedhealth.org
Japan Interprofessional Working and Education Network (JIPWEN): http://jipwen.dept.showa.gunma-u.ac.jp/
Journal of Interprofessional Care:
http://informahealthcare.com/jic
National Health Sciences Students’ Association (NaHSSA): http://nahssa.ca/en/gateway
Nordic Interprofessional Network (NIPNet): http://nipnet.org/
The Network: Towards Unity for Health: www.the-networktufh.org
World Health Organization (WHO): www.who.int/en London Deanery: Interprofessional Education
http://www.faculty.londondeanery.ac.uk/e-learning/ interprofessional-education/Interprofessional%20 education.pdf
Tidy’s physiotherapy
more effective collaboration between professionals. IPE that puts patients at the centre promotes collaboration between professionals, reinforces professionals’ collabora tive competence and relates collaborative learning to col laborative practice (Horder 2004; Hendrick and Khaleel 2008; Wilcock, 2009).
Clarke 2006; Cooper and SpencerDawe 2006) is testa ment to the enduring interest in IPE. Current political and societal drivers (DH 2010a, 2010b) continue to ensure that IPE and interprofessional working remain a high priority in health and social care. As West et al. (2006) assert, more positive patient outcomes are realised through greater and
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