Silos and the Timing of IPE
A frequently described barrier to the implementation of interprofessional education leading to interprofessional collaboration is the silo phenomenon. Historically, students in the health and health care professions are trained in isolation from other professions, and are thus limited in the opportunities to learn about each other prior to engaging in the care or management environment where they are destined to work together. Open questions regarding silos are whether silos serve a purpose and, if so, can the function of silos be achieved while promoting greater integration of training and development of collaborative skill.
Whether intentional or not, silos are a reflection of the necessary identity of the professions. We do not train generalists. Given the complex environment and advanced skill sets needed to deliver managed care, by necessity we compartmentalize training and health care delivery into professions. As the health and health care environments become more complex, due in part to the rapid inclusion of technology and advancement of medical and social sciences, the number of professions has increased. Notably, the American Medical Association list over 80 recognized professions, even without the inclusion of many of the related fields that comprise the health and health care environment. Identified professions are not simply a label, but comprise the necessary definitions of skills that require training and scope of practice defined in delivery of services.
The barrier to effective collaborative practice produced by the culture of silos occurs when students experience an insular training environment with little or no contact with students from the professions they will collaborate with in practice. A debate emerges immediately as to when to introduce students to the concepts of team-based health and health care. On one side is the notion that, until students have a true identity to share, namely that of their chosen profession, there is little ground to be gained in IPE. This can be argued from the strategy of learning promoted by the IPE culture of students learning “from, with, and about” each other: if they know little of their profession, what can students impart as early stage learners to the IPE environment? A counter-argument is that early introduction to collaboration is essential to build the sought after bridges between silos, maintaining the identity of the professions but integrating the core competencies of team work and collaboration into the fabric of uniprofessional training. I propose a simpler argument in favor of early introduction of IPE.
The separation of trainees in the health and health care professions is often exactly that, a separation. If we reflect on where our students are coming from before entering a professional program we soon realize that many are already training together. Whether it is in the public school system before entry into single-degree-level training or in prerequisite undergraduate programs required for entry into graduate or predoctoral programs, many of these students are already learning together. They take many of the same qualifying courses, master the same basic sciences that underpin the fields of health and health care, and undergo rigorous admissions processes to gain entry into the profession. In this regard early IPE is not the challenge to bring students together, but rather the challenge to keep them from moving apart through the specialized training required by their profession.
In the coming weeks I will discuss the attitudes of early stage learning to IPE and discuss the course material that can promote the development of an interprofessional identity that augments, but does not replace, the identity they will develop as members of a profession.
This guest blog was written by Paul Jardine, Research Associate Professor, Department of Diagnostic and Biological Sciences - School of Dentistry, Center for Interprofessional Education - Academic Health Center, Course Director - Foundations of Interprofessional Communication and Collaboration, University of Minnesota.