An Interprofessional Learning Module in Education, Social and Health BA Programmes at VIA University College By Esben Hulgaard, senior lecturer and programme coordinator, VIA UC, February 2010 Interprofessional learning is becoming a still more important issue in the education programmes within the social, educational and health related fields. It reflects the demands to the professionals for being able to participate in interprofessional collaboration. This paper will focus on an interprofessional learning module that was developed and carried through for the first time in October 2009 at four different campuses at VIA University College, Denmark involving 1400 students and 50 lecturers from Teacher education, Social education, Social work and Nursing programmes. The sociological view on professionals In trying to identify the ground for interprofessional collaboration the first step can be to look at the professions and their characteristics. There is a long tradition in sociological theory for looking at professions and their rise and function in modern society. Here I propose to narrow the theoretical view on professions down to two angles. The traditional sociological view on professionals understanding of professionals stresses the autonomy of the professionals and the monopolization of certain occupations obtained through education 1. The result is that professionals can be seen as driven by a sort of collective egoism (Brante 1988) and therefore have difficulties when they are expected to collaborate. If we see this way of looking at professionals as one pole the opposite view on professionals is proposed by Ellen Kuhlmann who identifies new types of professionals: As yet their voices are soft, but the post-modern professionals seem to be more open to teamwork and interdisciplinary problem-solving, taking less pride in autonomy (Kuhlmann 2004:84) When we look at interprofessional collaboration in practice we might very well see these two positions represented, it is therefore important that we take the different positions into consideration when we design interprofessional learning programmes. The demand for interprofessional collaboration It is widely acknowledged that interprofessional collaboration is essential in care and education: For the first time, there is a declared belief at virtually all points of the social care spectrum, from government, through the organizations that review services and their performance, to training and the front line, that: - Partnerships between agencies are essential.. - Skilled collaboration.is making partnerships work (Whittington 2003:13) In Denmark the government wants a more coherent service; consequently the Government will strengthen collaboration, coordination and knowledge across the public sector (DK Government Quality reform 2007) The municipalities in Denmark share the same expectations to the professionals about interdisciplinary and interprofessional problem solving, and are putting forward these recommendations to the municipalities 1 These characteristics are shared by functionalists and neo-weberian theories on professions 1
- Facilitate the possibilities for the professionals for getting to know each others competences and methods - Create common development of competences and qualifications across professions and sectors - Promote the development of common pedagogy and common tools (The National Association of Local Authorities, October 12. 2007) In Denmark the public demand for interprofessional collaboration has led to a ministerial order of integrating Interprofessional Elements in the curriculum of various educational programmes. I will return to the requirements in these modules later. Interprofessional learning Especially within health care and social work education programmes there has been discussions on, and development of interprofessional education. In UK there have been interprofessional movements within different fields since the 19sixties. (Barr 2002) CAIPE, Centre for the Advancement of Interprofessional Education in founded in 1987 and offers the following definitions: Multiprofessional education: Occasions when two or more professions learn side by side for whatever reason Interprofessional Education: Occasions when two or more professions learn from and about each other to improve collaboration and the quality of care. (CAIPE 1997) There are in the academic world a lot of supplementary and alternative concepts combining a prefix (inter-, multi-, cross-, trans-) with adjectives (professional and disciplinary) and nouns (education, training, learning and studies) (Barr 2002). In this context I will primarily refer to the concepts of Interprofessional Learning and Interprofessional Education. It seems that there is an increasing recognition within the professions of the necessity of interprofessional collaboration for the good of the care takers or clients. Whittington points out that: Effective interprofessional collaboration appears to require practitioners to learn, negotiate and apply the following: What is common to the professions involved The distinctive contribution of each profession What may be complementary between them What may be in tension or conflict between them And How to work together (Whittington 2003:49) Barr proposes a provisional typology of interprofessional education. Three dimensions are pointed out: The relation between the objectives, the content and the learning methods and the stage of their professional education that the participants have reached. Secondly the length and location of the learning module in the programme, and thirdly the number of professions included. (Barr 2002) The evaluations of interprofessional education in undergraduate programmes that have so far been conducted suggest that the outcome primarily relates to changes in knowledge, skills, attitudes and beliefs among the students. Yet there is emerging evidence that interprofessional education can, contribute to collaboration in practice. (Barr 2002:30) 2
The Involved Professions As mentioned earlier interprofessional education in UK has seemingly primarily been taking place within Health professions, in Social care and Social work. However it is stressed by Barr that the professions involved in interprofessional collaboration depends upon the field in which the work is taking place. Child protection, for example, includes police officers and schoolteachers as much as health visitors, GP s paediatricians and social workers, mental health psychologists as much as nurses, psychiatrists and social workers, and juvenile justice probation officers and youth workers. Clergy, community workers, housing officers and lawyers are just some of the other professions involved as occasion demands. (Barr 2002:24) In the report of an Interprofessional Workshop at Brunel University for students in Health and Social Care it is remarked that challenged the teaching team why professionals such as lawyers and teachers had not been invited to participate (Shea 2008) It seems that there is openness among academics and students to widen the field of professions represented in the interprofessional learning modules. The importance of bringing teachers together is pointed out by Barr: There are few occasions when teachers engaged in different fields of interprofessional education meet to compare experience. Yet different traditions, for example, in child protection, primary care and learning difficulties, might gain much from such encounters. (Barr 2002:34) Interprofessional modules in Danish BA programmes In the last couple of years an interprofessional element has been integrated in the Danish BA programmes in Education, Social Work and Health by ministerial order. The University Colleges are in the process of implementing the new legislation. There are some differences in the way the interprofessional element is described in the various programmes as it can be seen below. Ministerial order on study programme for Bachelor in Teacher Education 2 : 20 The Interprofessional element must be organized so that the student on the basis of her professional teacher identity gains knowledge in other relevant professional programmes and understands the common grounds and the limits for her own and other professions in problem solving especially in the work with children and young people with special needs. 21 The interprofessional element must be conducted in collaboration with at least one of the professions relevant to the teacher profession in order to ensure better problem solving in the collaboration between the professions. The Interprofessional Element is 8 ECTS credits 3 Ministerial order on study programme for Bachelor in Social Education 4 2 The teacher education Programme in Denmark is aimed at both primary and secondary school 3 A semester is 30 ECTS, 1 ECTS is equivalent to approx. 1½ weeks of study 4 The Social Educator Programme in Denmark is aimed at a very broad working field, including nursery school, day care, leisure time, youth and community work, children s home and other institutions for children and young people, working with people with physical and or mental disabilities and people with social problems. 3
5. Through theoretical and practical courses in other relevant professional areas, the student will learn how to work with persons in other professions and solve defined tasks. The Interprofessional Module contributes to the purpose of the study programme in that the student - on the basis of personal knowledge of own and other professions becomes qualified to cooperate with persons from other professions and take innovative approaches in interprofessional work. The Interprofessional Element is 8 ECTS credits Ministerial order on study programme for Bachelor in Social Work 5. The study programme includes interprofessional elements in the theoretical education as well as in the practice placement. Each element must be conducted in collaboration with at least one other profession relevant to the Social Worker. The Interprofessional Element is 8 ECTS credits Ministerial order on study programme for Bachelor in Nursing The interprofessional module is aimed at the various contributions by the different health professions to promote quality, continuity and interprofessional collaboration in relation to the patient There is focus on the importance of social, cultural and institutional factors in relation to health promoting, health-keeping and preventive actions The learning outcome for the student is the ability to participate in interprofessional collaboration with respect for and recognition of the responsibilities and competences of her own profession as well as the responsibilities and competences of other health professions in relation to multiprofessional problem solving The most significant difference in the descriptions of the Interprofessional Elements in the various programmes is that the Teacher Education, The Social Education and Social Work programmes all refers to the collaboration with other relevant professions, whereas the Nursing Programme points out the interprofessional collaboration with other health professions. Across Professions an Interprofessional Module in 4 BA programmes in Education, Social Work and Nursing in October 2009 VIA University College is a recent merger between 5 centres for higher education, it has more than 15.000 students on 7 campuses. Geographically VIA UC covers Mid Jutland, it was therefore decided that the Interprofessional Project week in October 2009 should take place at 4 campuses. 1400 students and about 50 lecturers from four BA programmes were involved. The programmes were, Teacher Education, Social Education, Social Work and Nursing. The students were in their 3rd., 4th. or their 5th. semester and the module was compulsory for the students to attend. The professions involved on two of the campuses were Teacher Education, Social Education and Social Work and on two campuses: Teacher Education, Social Education and Nursing. There were a common set of learning objectives for the four campuses, which are cited below; apart from the common aims each campus had formulated supplementary aims. Learning Objectives: 4
The student will achieve knowledge about specific areas of the tasks, the expertise and responsibilities of other professions, and competence to identify specific dilemmas and possible actions in interprofessional collaboration. The society to which the social educator, the teacher the social worker (and the nurse) are educated is constantly changing. Professionalization, specialization and outsourcing require that the professionals work together in network, teamorganisations and cross-sector collaboration. In the public sector there is a need for interprofessional coordination and collaboration in innovative ways in order to meet the needs of the target groups in the best possible way. ( Professioner på Tværs 2009) The organisation of the week differed somewhat at the four campuses, but there was a general element of peer to peer learning in interprofessional groups, where the students worked with cases containing problems of a nature that demanded interprofessional problem solving. It was also a general element that lecturers from different BA-programmes were working together in small groups facilitating the learning processes in the interprofessional groups of students. Averagely there were 3 lecturers facilitating a large group of 70 90 students, the large group was then again split up in working groups with about 8 10 students. Evaluation The interprofessional module was evaluated by an electronic questionnaire where students were asked to rate different aspects of the module on a scale from 1 to 10 where 10 was the top. 33% of the participating students responded to the electronic evaluation. In the following short resume, 1 5 points are rated as not OK, and 6 10 points is rated as OK The main points in the student s evaluation were a general dissatisfaction with the information about the week that was available beforehand and during the week. When asked about the general outcome of the week half the students answers are in the category not OK and the other half are in the category OK When asked to which degree the interprofessional week has increased their competences to participate in interprofessional collaboration 2/3 of the students gives this issue a rating from 6 10. 2/3 of the students point out the interprofessional dialogue in the group as the most beneficial element, whereas the sparring from the lecturers gets a score in the 1 5 (not OK) end of the scale from 2/3 of the students. In the written comments a number of students remark that the presentations of issues in practical interprofessional collaboration by visiting professionals were among the highlights of the week. The evaluation by the lecturers stressed that there must be worked on the organisation of the week, this involves among other things better and earlier information to the students. A clearer definition of the objectives of the week, and likewise clarity of the requirements to the students written reports and oral presentations is wanted by the lecturers. It is also stressed that the lecturers who participate in the interprofessional week must have time to develop their own knowledge about interprofessional collaboration and their competences in facilitating the student s learning processes in the interprofessional groups. We are taking these points made by students and teachers into consideration in the planning of the next interprofessional week that will take place October 2010. For instance we are working on a three day course for the teachers that are going to be involved in the course. International key points 5
From a Danish perspective we would like to learn more from the British and other experiences with interprofessional learning. Bringing the teachers engaged in different fields of interprofessional education together to compare experience could be interesting also on an international level. It could also be interesting to put focus on the issue of innovation in the interprofessional collaboration. How can we prepare our students to participate in the interprofessional innovation processes that are essential in the development of the welfare societies? Barr, H. (2002). Interprofessional education: Today, yesterday and tomorrow. London: Learning and Teaching Support Network, Centre for Health Sciences and Practice Barr, H. & Ross, F. (2006). Mainstreaming Interprofessional Education in the United Kingdom: A Position Paper. Journal of Interprofessional Care, 20, 96 104 Barrett, G., Greenwood, R. & Ross, K. (2003). Integrating interprofessional education into 10 health and social care programmes, Journal of Interprofessional Care 17, 293 301 Buur Hansen, N. & Glerup, J. (ed.) (2004) Videnteori, Professionsuddannelse og Praksisforskning, Syddansk Universitetsforlag CAIPE (1997), Interprofessional Education A Definition. CAIPE Bulletin No. 13 Ejrnæs, M. (2004) Faglighed og Tværfaglighed, Akademisk Forlag Engeström, Y., Engeström, R. & Kerouso, H. (2003) The Discursive Construction of Collaborative Care, Applied Linguistics 24, 286 315. Oxford University Press Hulgaard, E. (2008) Professionsteori og tværprofessionelt samarbejde, Arbejdspapir Hulgaard, E., Krogh, A. & Lyager, M., (2009). Tværprofessionelt Samarbejde, Baggrundsnotat Højholdt, A. (2009) Den tværprofessionelle praktiker, Hans Reitzels Forlag Lauvås, K. & Lauvås, P. (2006). Tværfagligt Samarbejde, Klim Lyager, M. & Helgaard, E., (2010) Tværprofessionalitet som indsatsområde I Pædagogisk Socialfaglig Højskole 2010-2012 Notat PSP, VIA UC Shea, N. & Clarke, J. (2008) Bringing down the Berlin Wall in academia, Journal of Interprofessional Care 22, 213 215 Weinstein, J.,Whittington, C. & Leiba, T. (2003). Collaboration in Social Work Practice, Jessica Kingsley Publishers Whittington, C. (2003). A Model of Collaboration, in Weinstein, J.,Whittington, C. & Leiba, T. (2003) Professioner på tværs (2009), http://www2.viauc.dk/projekter/professionerpaatvaers09/ 6