Chapter 3
Interprofessional Education – Evidence It Works

In today's environment with the need to demonstrate value for money, irrespective of the sector, but particularly in the hard pressed health arena, a key question is … Does Interprofessional Education () work? Is it still the case that nurses prefer learning with their peers and doctors with doctors? Therefore, there needs to be a certain level of evidence that IPE works, and works for patients, not just for the staff.

This chapter will review some of the published work in this field. The level of evidence for the effectiveness of IPE interventions varies from randomised controlled trials to descriptive and exploratory studies. The levels of evaluation also have a wide range and include improvement to patient care, perception and understanding of other professionals.

Harden's Ladder

In considering any studies that attempt to investigate the effectiveness of IPE it is useful to use re‐visit Harden's ladder (Harden 2000) in order to map or at least to attempt to map across. As will become apparent, the educational interventions reported in a wide range of studies utilise a diverse array of teaching methods, not all of which easily sit with the IPE arena.

To recap, the particular approaches that can be used lie along a continuum with Isolation at one end to Trans‐disciplinary at the other. Harden described these as 11 steps in multiprofessional education. These can be used to benchmark any teaching/learning experience.

Harden’s 11 steps:

1. Isolation
2. Awareness
3. Harmonisation
4. Nesting
5. Temporal co‐ordination
6. Sharing
7. Correlation
8. Complementary
9. Multi‐disciplinary
10. Inter‐disciplinary
11. Trans‐disciplinary

Harden devised the ladder as a means to facilitate integration in curricula. He describes that as one moves up the ladder there is less focus on the separate disciplines or professions but an increasing need for integration. The previous SPICES model (Harden et al. 1984) for curricula integration is represented as a continuum with single discipline teaching at one end and full integration at the other. Harden's view was that as one moves up the ladder that there was a greater need for staff participation in the design and delivery of the curriculum, hence the ladder could be useful for any organisation to help in planning. Each of these levels is a description essentially based on the level of collaboration. It must be remembered, that each is an appropriate teaching strategy depending on the specific aims and objectives of the course or programme.

Isolation

This is the scenario where each profession organises it's own learning and is completely unaware of what is learnt by any other professions and does not take any steps to learn of others. This is the extreme end of the uniprofessional education () spectrum. An example would be a short two‐hour course with the learning objective of each first year trainee in surgery being able to suture a scalp laceration. That is a specific procedural task that does not and is not likely to require any other clinician to be involved. Hence, an UPE approach could be argued to be appropriate.

Awareness

At this level, each profession has a level of awareness of each other's roles and this may be referred to in the teaching or training but there is no formal collaboration between the different professions.

Harmonisation

At this level there is some discussion and consultation between the professions in regard to the design of the learning. This may be reflected in more explicit reference to each other's roles. In this scenario the programme remains UPE but with a greater level of acknowledgement of other professionals roles and contributions.

Nesting

At this level, we are moving closer to more involvement in a planned fashion of other professions in the design and delivery of the learning. However, the main focus is still UPE with the second (other) professions contributing to just one aspect on the learning, for example within a medical school module on clinical skills in psychiatry a community pharmacist provides a two day placement for students.

Temporal Co‐ordination

With this level, the two or more professional groups share in the learning programme but there is no planned collaboration between them. An element of joint planning of the learning is required but this is at a superficial level only. Any collaboration is by chance and not by design. An example is learners from two or more professions attending the same lecture. In this scenario the unplanned IPE may occur as a result of the informal networking, but is not planned. This form of unplanned IPE is extremely valuable as an unintended consequence.

Sharing

Moving along the continuum, we have the next step, shared teaching. This is where there is planned interaction between the different professionals as a part of the programme. This shared learning/collaboration at this level, refers to only one well‐demarcated aspect of the programme. So the programme as a whole is UPE with one aspect where collaboration exists.

Correlation

This stage refers to a further step into a more planned multi‐professional () perspective with regular, well defined MP sessions embedded in a UP programme.

Complimentary

This stage is where there is almost equal emphasis on UP and MP with each aspect or approach complementing the other.

Multi‐disciplinary

At this level, the emphasis on UPE all but disappears with the focus on a multi‐disciplinary approach. However each profession discusses the ‘problem’, in the scenario of Problem Based Learning, from it's own perspective. So the learners learn by addressing a jointly owned problem together, but from the perspective of their own profession.

Inter‐disciplinary

With this stage, all learners look at the problem with the other profession’s perspective as well as their own. So in a role play scenario, for example, the nurse may ‘play’ the physiotherapist. Learning is focused on the objective of enhancing collaborative practice. So, there is common content but with the similarities and differences in approach between the professions explored and discussed in a planned fashion.

Trans‐disciplinary

In this stage, the MPE takes place in the context of clinical practice. The environment is not a classroom but in real practice settings. An example is the University of Limburg (Wahlstrom and Sanden 1998) where all professions learn together in clinical IPE wards as active working participants.

Using Harden's ladder can be a useful reference point when considering or analysing any learning. It can also be used as one element to gather a clear picture of where your programme lies or where it could lie. As such, this can then be used as a baseline for design and for considering what steps you might want to take to move the learning from say nesting, to the next level or decide that for your learners nesting is an appropriate strategy at this point.

Although useful to some extent, Harden's ladder has limited usefulness in practice as an assessment tool.

Barr (1996) described a number of different dimensions of IPE that can also be used. These are explored in detail in Chapter 6.

A framework described by Xyrichis et al. (2017) offers a more or potentially more useful approach. Please see Chapter 5 for more detail.

The Evidence for Effectiveness of IPE Interventions

In this section two Cochrane reviews will be examined in some detail; (i) Reeves et al. (2013) and (ii) Reeves et al. (2017).

It is important to understand the methodology and in particular the aims and subsequent search strategy used by Reeves et al. (2013) in their Cochrane review of the effectiveness of IPE.

There were two stated objectives:

… to assess the effectiveness of IPE compared to;

1. separate, profession specific education interventions; and
2. control groups which received no education intervention.

The types of study included were randomised controlled trials (), controlled before and after () and time interrupted studies ().

The eligibility criteria for participants was broadly defined as all health and social care professionals. The types of interventions included all types of education, training and learning which involved more than one profession in joint interactive learning. The authors defined an IPE intervention as follows:

An IPE intervention occurs when members of more than one health or social care (or both) profession learn interactively together, for the explicit purpose of improving interprofessional collaboration or the health/well being (or both) of patients/clients. Interactive learning requires active learner participation, and active exchange between learners from different professions.

(Reeves et al. 2013, p. 5)

Randomised Controlled Trials

The randomised controlled...