All together for health?

In the wake of the first world meeting of healthcare students, Emily Spry explains the importance of aiming for more interprofessional education and practice

In November 2005, 230 pharmacy, nursing, and medical students from 42 countries attended the first world meeting of healthcare students. The event in Malta was held by four organisations that represent pharmacy and medical students at the European and international level, and which for the first time have worked together on this scale. Known as the World Medical and Pharmacy Students' Joint Symposium (WorldMaPS), the meeting gave students a unique opportunity to break down barriers between the professions. They discussed, worked, and celebrated, as lectures and interactive sessions explored the idea of interprofessional education and practice and what this might mean for the future of health care around the world.

Strong professional identities are a long standing feature of the healthcare environment and those identities are laid down from the first days as students. Nurses, pharmacists, and doctors, to name just a few of those involved in patient care in a modern healthcare system, each have their own unique knowledge, skills, and perspective (box 1). Healthcare students go through a process of “professionalisation,” which consists of an adoption of the attitudes and working culture associated with a particular profession as well as acquiring the knowledge and skills essential to its practice. Later on, in the workplace, professionals may have little understanding of the roles of the other healthcare professions and may undervalue the other professions' contribution to care for the patient, making interprofessional teamwork difficult.

The bodies that accredit UK medical and pharmacy schools insist that the skills and attitudes necessary to work well with other professionals are prioritised in undergraduate education.^w1

Throughout the UK NHS, there is an increasing awareness that health care is not always adequately centred on the needs and safety of the patient. As medical care becomes more interventional, the risk of adverse events for patients is higher. The lessons from other high risk industries, such as aviation, are that the working environment must be redesigned not only to avoid critical incidents but to facilitate people, to acknowledge and learn from them. Patient safety is thus a powerful motivation for governments and regulatory bodies to insist on improved interprofessional team working. More generally, if we want health care to be responsive to the needs of patients, there needs to be an effective team approach in which information and responsibility are shared appropriately to allow the best decisions to be made. For example, the Medicines Partnership, an initiative supported by the UK Department of Health, reports that problems with drugs are implicated in up to 17% of hospital admissions. This is an area where a partnership between patient, doctor, pharmacist, and other healthcare professionals is essential and needs to be improved.^w2

Like any cultural change, it is easier to talk about interprofessional teamwork than it is to implement. Traditionally, the doctor has led the healthcare team, often for good clinical and legal reasons. In some fields, high quality interprofessional teamwork is well established, for example, in some areas of mental health. More controversial have been attempts to redefine the boundaries around the different professions, such as prescribing powers for nurses and involving pharmacists in the management of chronic diseases. These changes are also motivated by cost. For example, a nurse primary care practitioner can free up a great deal of a primary care doctor's time.

If interprofessional working is the way forwards then how do we achieve it? Education is the obvious starting point. If future healthcare professionals are to work together, they must be educated appropriately. Arguably, this needs to be tackled at all levels of training. One model is of joint teaching at undergraduate level, such as teaching basic anatomy to medical and nursing students.^w3 This is known in the United Kingdom as a common foundation programme. Similarly, students from different professions might have joint problem based learning sessions.

Medical education expert Professor Peter McCrorie argues that interprofessional education is more effective when focused on common skills such as communication, rather than basic knowledge. Moreover, a successful model must provide genuine interaction between the students; sitting in a lecture theatre together cannot in itself improve interprofessional understanding.

At St George's Medical School, University of London, McCrorie and colleagues have developed an innovative programme in which students from medicine, nursing, occupational therapy, and physiotherapy work together. The students are put into interprofessional teams that work in shifts to run a rehabilitation ward in a local hospital for five weeks. As well as doing the work appropriate to their own profession, the students meet as a team to handover patients at the changeover of shifts. As a group, they also have reflective time with a facilitator and finish the placement with a group presentation on what they have experienced and learnt. Major challenges have included timetabling, fitting with different course requirements, and the appropriate level of supervision. Overall, the students learnt a lot and acquired new respect for each other's professions.

Better interprofessional working has been seen as a critical factor in reducing adverse events for patients in the United States, where up to 98 000 people die as a result of medical error each year.^w4 Students at the University of Minnesota run case competitions for interprofessional student teams “enabling them to achieve a 360 degree perspective on patient safety in today's healthcare system and how it might be improved.”^w5 Internationally, there are very few other examples of interprofessional education.

After an informative, interactive, and sunny week in Malta, WorldMaPS participants adopted a statement detailing their desire for changes in health care and their education (see box 2 on studentbmj.com). In issuing this statement, participants signed up to be advocates for a shift towards a cooperative interprofessional approach to patient centred care to optimise health outcomes. In many countries, considerable pressure from students, professionals, governments, and patients will be required to make their ideas a reality.

1. General Medical Council. The new doctor: recommendations on general clinical training. London: GMC, 2005. www.gmc-uk.org/education/foundation/new_doctor.asp (accessed 9 Dec 2005).
2. Cheung S, Cheung C, Persuad J. A survey of junior doctors’ attitudes towards pharmacists and how their interaction may be improved. Pharm J 2003;270:163-4.
3. Finch J. Interprofessional education and teamworking: a view from the education providers. BMJ 2000;321:1138-40.
4. Institute of Medicine. To err is human: building a safety health system. Washington, DC: National Academy, 1999.
5. University of Minnesota CHIP Student Center. Clarion: students building a better healthcare system together. www.chip.umn.edu/CHIP/committees/clarion.html (accessed 26 Nov 2005).