INTERPROFESSIONAL EDUCATION FOR COLLABORATION

Learning How to Improve Health from
Interprofessional Models Across the
Continuum of Education to Practice

WORKSHOP SUMMARY

Patricia A. Cuff, Rapporteur

Global Forum on Innovation in Health Professional Education

Board on Global Health

NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



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INTERPROFESSIONAL EDUCATION for COLLABORATION Learning How to Improve Health from Interprofessional Models Across the Continuum of Education to Practice WORKSHOP SUMMARY Patricia A. Cuff, Rapporteur Global Forum on Innovation in Health Professional Education Board on Global Health

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The workshop that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and the Academic Consortium for Complementary and Alternative Health Care, the Academic Council of the Academy of Nutrition and Dietetics, Academic Council of the American Physical Therapy Association, the Accreditation Council for Graduate Medical Education, the Aetna Foundation, the Alliance for Continuing Education in the Health Professions, the American Academy of Family Physicians, the American Academy of Nursing, the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Associa- tion of Colleges of Pharmacy, the American Association of Nurse Anesthetists, the American Association of Nurse Practitioners, the American Board of Family Medicine, the American Board of Internal Medicine, the American Board of Obstetrics and Gynecology, the American Board of Pediatrics, the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists, the American Dental Education Association, the American Medical Associa- tion, the American Occupational Therapy Association, the American Psychological Association, the American Society for Nutrition, the American Speech-Language-Hearing Association, the Association of American Medical Colleges, the Association of American Veterinary Medical Col- leges, the Association of Schools of the Allied Health Professions, the Association of Schools and Programs of Public Health, Atlantic Philanthropies, the Bill & Melinda Gates Foundation, China Medical Board, Council of Academic Programs in Communication Sciences and Disorders, the European Forum for Primary Care, Ghent University, the John A. Hartford Foundation, the John E. Fogarty International Center, the Josiah Macy Jr. Foundation, Kaiser Permanente, the National Academies of Practice, the National Association of Social Workers, the National Board for Certified Counselors and Affiliates, Inc., the National League for Nursing, the National Organization of Associate Degree Nursing, the Physician Assistant Education Association, the Robert Wood Johnson Foundation, the Society for Simulation in Healthcare, the Uniformed Services University of the Health Sciences, and the Veterans Health Administration. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13:  978-0-309-26349-8 International Standard Book Number-10:  0-309-26349-2 Additional copies of this workshop summary are available for sale from the National Acad- emies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www. iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Interprofessional education for collabo- ration: Learning how to improve health from interprofessional models across the continuum of education to practice: Workshop summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR EDUCATING FOR PRACTICE WORKSHOP SERIES1 Lucinda Maine (Co-Chair), American Association of Colleges of Pharmacy Scott Reeves (Co-Chair), University of California, San Francisco Malcolm Cox, Veterans Health Administration Jan de Maeseneer, Ghent University Madeline Schmitt, American Academy of Nursing Harrison Spencer, Association of Schools and Programs of Public Health George Thibault, Josiah Macy Jr. Foundation Brenda Zierler, University of Washington Sanjay Zodpey, Public Health Foundation of India 1  Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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GLOBAL FORUM ON INNOVATION IN HEALTH PROFESSIONAL EDUCATION1 Jordan Cohen (Co-Chair), George Washington University Afaf Meleis (Co-Chair), University of Pennsylvania Kenn Apel, Council of Academic Programs in Communication Sciences and Disorders Carol Aschenbrener, Association of American Medical Colleges Gillian Barclay, Aetna Foundation Mary Barger, American College of Nurse-Midwives Timi Agar Barwick, Physician Assistant Education Association Geraldine Bednash, American Association of Colleges of Nursing Cynthia Belar, American Psychological Association Joanna Cain, University of Massachusetts School of Medicine Carol Carraccio, American Board of Pediatrics (until February 2013) Linda Casser, Association of Schools and Colleges of Optometry Lincoln Chen, China Medical Board Yuanfang Chen, Peking Union Medical College Marilyn Chow, Kaiser Permanente Elizabeth Clark, National Association of Social Workers Thomas Clawson, National Board for Certified Counselors and Affiliates, Inc. Darla Coffey, Council on Social Work Education Malcolm Cox, Veterans Health Administration Jan De Maeseneer, Ghent University Marietjie de Villiers, Stellenbosch University James G. Fox, Association of American Veterinary Medical Colleges Roger Glass, John E. Fogarty International Center Elizabeth Goldblatt, Academic Consortium for Complementary and Alternative Health Care Mary Jo Goolsby, American Academy of Nurse Practitioners (until May 2013) Yuanzhi Guan, Peking Union Medical College Neil Harvison, American Occupational Therapy Association Douglas Heimburger, American Society for Nutrition John Herbold, National Academies of Practice Eric Holmboe, American Board of Internal Medicine Pamela Jeffries, Johns Hopkins University School of Nursing Rick Kellerman, American Academy of Family Physicians Kathryn Kolasa, Academy of Nutrition and Dietetics 1  Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. vii

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John Kues, Alliance for Continuing Education in the Health Professions Maryjoan Ladden, Robert Wood Johnson Foundation Lucinda Maine, American Association of Colleges of Pharmacy Beverly Malone, National League for Nursing Beth Mancini, Society for Simulation in Healthcare Damon Marquis, Alliance for Continuing Education in the Health Professions (until July 2013) Lemmietta G. McNeilly, American Speech-Language-Hearing Association Donna Meyer, National Organization of Associate Degree Nursing Fitzhugh Mullan, George Washington University Thomas NascA, Accreditation Council for Graduate Medical Education Andre-Jacques Neusy, THENet Warren Newton, American Board of Family Medicine Kelly Wiltse Nicely, American Association of Nurse Anesthetists Liana Orsolini, Robert Wood Johnson Foundation Health Policy Fellows Rajata Rajatanavin, Mahidol University Scott Reeves, University of California, San Francisco Edward Salsberg, Health Resources and Services Administration, U.S. Department of Health and Human Services (until September 2013) Madeline Schmitt, American Academy of Nursing Nelson Sewankambo, Makerere University College of Health Sciences Stephen Shannon, American Association of Colleges of Osteopathic Medicine Susan Skochelak, American Medical Association Harrison Spencer, Association of Schools and Programs of Public Health Rick Talbott, Association of Schools of the Allied Health Professions George Thibault, Josiah Macy Jr. Foundation Jan Towers, American Academy of Nurse Practitioners Richard Valachovic, American Dental Education Association Sarita Verma, University of Toronto Patricia Hinton Walker, Uniformed Services University of the Health Sciences Shanita Williams, Health Resources and Services Administration, U.S. Department of Health and Human Services Holly Wise, Academic Council of the American Physical Therapy Association Brenda Zierler, University of Washington Sanjay Zodpey, Public Health Foundation of India IOM Staff Patricia A. Cuff, Senior Program Officer viii

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Rachel M. Taylor, Associate Program Officer Megan M. Perez, Research Assistant Audrey Avila, Intern Nikita Srinivasan, Intern Christen Woods, Intern Patrick W. Kelley, Senior Board Director Julie Wiltshire, Financial Officer ix

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Reviewers This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and respon- siveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Hugh Barr, University of Westminster, UK John R. Finnegan, Jr., University of Minnesota School of Public Health Jill Thistlethwaite, Mayne Medical School, Australia Brenda Zierler, University of Washington Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the work- shop summary before its release. The review of this workshop summary was overseen by Terry T. Fulmer, Northeastern University. Appointed by the Insti­ute of Medicine, she was responsible for making certain that an t independent examination of this workshop summary was carried out in a ­ccordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this work- shop summary rests entirely with the author and the institution. xi

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Preface A century after Flexner, Goldmark, and Welsh-Rose revolutionized postsecondary education for health professionals, two significant reports from the Lancet and the Institute of Medicine (IOM) sought to similarly redesign the education of health professionals for the 21st century. The independent Lancet Commission led by Julio Frenk and Lincoln Chen released Health Professionals for a New Century: Transforming Educa- tion to Strengthen Health Systems in an Interdependent World. The IOM produced The Future of Nursing: Leading Change, Advancing Health. Both of these reports provide high-level visions for the health professions, but rely on educators to identify, through a process of continuous learning and innovation, the relevant best practices and mechanisms for scaling up proven, improved approaches to integrated health professional education. To facilitate the implementation of the recommendations from the IOM and Lancet Commission reports, the IOM created an ongoing, evidence- based forum for multidisciplinary exchanges on innovative health profes- sional education initiatives. Known as the Global Forum on Innovation in Health Professional Education, this forum not only convenes stakeholders to illuminate contemporary issues in health professional education, but it also supports an ongoing, innovative mechanism to incubate and evaluate new ideas—a mechanism that is multifocal, multidisciplinary, and global. Members of the Forum represent multiple government agencies, indus- try, academia, foundations, and professional associations. They are drawn from developed and developing countries and come together twice yearly for Forum-sponsored workshops. These workshops provide a platform for relationship building across disciplines and sectors. Such diversity within xiii

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xiv PREFACE the Forum is an essential ingredient for innovation and creativity. With 59 members from 16 disciplines and 8 countries, the Global Forum is well positioned to be a catalyst for positive change. Members are committed to breaking down professional silos that impede communication and coopera- tion among health educators and health professionals and to addressing issues of social justice and health equity around the globe. In our first two workshops, members of our Forum sought to address “interprofessional education.” The specific interest was in better understanding the relation- ships between education and practice in hopes of ultimately improving patient care, advancing population health, and increasing the value of the entire health system. We would like to thank all those who made the workshops and this F ­ orum possible. Without our sponsors, none of this could have happened. We would also like to thank the planning committee and, in particular, the co-chairs Lucinda Maine and Scott Reeves, who adeptly assisted IOM staff in pulling together two fantastic workshop agendas. We express our deepest ­ appreciation to IOM interns Audrey Avila, Nikita Srinivasan, and Christen ­ Woods for their support; to IOM staff members Patricia Cuff, Megan Perez, and Rachel Taylor for their expert guidance; and to Patrick Kelley for his superb leadership as the director of the Board on Global Health. This report is a summary of what took place at our 2012 Forum- sponsored events and is a testament to the hard work and dedication of all who make up the Global Forum on Innovation in Health Professional Education. Jordan Cohen, Forum Co-Chair Afaf Meleis, Forum Co-Chair

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Contents 1 Introduction 1 2 Interprofessional Education 7 3 Implementing Interprofessional Education for Improving Collaboration 25 4 Metrics 43 5 Interprofessional Education Within the Health System 55 6 Learning from Students, Patients, and Communities 75 7 Moving Forward by Looking Back 85 APPENDIXES A Workshop Agendas 97 B Speaker Biographies 109 C Summary of Updates from the Innovation Collaboratives 129 D Faculty Development Programs at Various Universities 147 E Disruptive Innovations 157 xv

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