The ideal model for achieving the Quadruple Aim (enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers) is team-based care when multiple health professionals collaborate to provide and improve care.
Critical to achieving this is interprofessional education (IPE) in a clinical context.
In the first of this IPE blog series, Brenda Zierler defined IPE and discussed its importance. In the second post, Meg Zomorodi described an innovative immersion experience for students from seven health professions.
The focus of this post is the learning environment for IPE – the physical, social, psychological and technologic attributes of the settings in which IPE occurs.
The learning environment can either facilitate or create barriers to interprofessional learning, collaboration and professional identify formation.
What makes the rural interprofessional immersion experience described in the Meg Zomorodi’s post so remarkable is that IPE typically occurs in the classroom and uses case-based or problem-based learning involving learners from multiple health professions.
True interprofessional engagement of learners in a real-life clinical context is still rare. Coordinating the schedules of multiple health professions is cited as the biggest challenge.
Learning activities in the classroom create a “frontstage” where the formal curriculum is taught, and the social learning environment in real-life clinical settings should reinforce these concepts. Yet clinical settings can create “backstage” settings where informal and hidden curricula are communicated that may be counter to IPE learning aims.
This makes it important to prepare learners as they move from classroom and case-based IPE activities to the clinical world, to help them deal with perceived differences in status, hierarchy and power expressed in interactions among learners and faculty.
Teachers should reinforce IPE concepts in the social learning environment to avoid the undermining of core concepts like collaboration, teamwork and situational leadership.
The physical space for teaching and care plays a role in this. Changing from small “dedicated” spaces for each profession to shared common areas avoids the segregation of professions. This is particularly helpful for informal spaces where interaction and socialization can occur to deepen the shared engagement of learners from different health professions.
When one health professions school created a common space for learners from different health professions, students reported that “we now meet fellow students from other programs we never saw before although we were in the same building.”
Most educators will never have the opportunity to design a new building or preside over a major remodeling, yet there are some easy ways to improve the physical environment for IPE by creating informal spaces that serve as social nodes that that can facilitate serendipitous encounters among learners from different health professions to complement the formal learning activities.
Evaluating the IPE Learning Environment
In her post, Brenda Zierler noted that the importance of IPE is the focus on teams and teamwork.
This raises the question whether tools exist that could be applied to assess the IPE learning environment in classroom and clinical settings. After 20 years at an accrediting organization, I continue to be interested in effective and useful approaches to evaluate the settings in which learning occurs. One candidate is the Attitudes Toward Health Care Teams Scale. It consists of 14 items to assess team member’s perception of the process and quality of care and 6 items to assess team member’s attitudes toward physicians’ authority and their control over information.
A related instrument is the Team Skills Scale, a 17-item tool with a 5-point scale that is used to assess interprofessional team skills patients, with subscales including interpersonal skills, discipline-specific skills, and geriatric care skills.
The Interprofessional Attitudes Scale was developed to assess attitudes related to the Core Competencies for Interprofessional Collaborative Practice mentioned in the first IPE blog. Its 27 items encompass 5 subscales that relate to Teamwork, Roles, and Responsibilities, Patient-Centeredness, Interprofessional Biases, Diversity & Ethics, and Community-Centeredness.
The Inteprofessional Socialization and Valuing Scale assesses beliefs and practices toward collaborative care, with three subscales: ability to work with others, value in working with others and comfort in working with others.
For classroom settings, the Interprofessional Education Facilitation Scale can assist teachers in enhancing their IPE teaching skills, with a shift from didactic teaching with passive learners to facilitation and leaner activation. The tool has two subscales: IP facilitation and collaborative patient centered practice.
These and other tools and resources for IPE can be found on are web site of the National Center for Interprofessional Practice and Education. The tools can be used to evaluate the effect of learning interventions and the climate for IPE in the classroom and in real-life clinical contexts.
To sum it up….
Attention to the learning environment for IPE is necessary for effective learning and team-based care.
Creating an effective IPE learning environment requires the ongoing challenging of assumptions about physical, professional and intellectual “turf” in curricula for individual health professions and in clinical learning environment.
This includes perceived power and status differentials among different health professions and among learners and teachers.
Practical strategies include helping learners from different health professions understand the concept of the “learning environment” and how it shapes their thinking and values, professional identity, sense of self-worth, and how their desire to engage in collaborative team learning and team care.
About the Author: Ingrid Philibert, PhD, MA, MBA spent 20 years directing the accreditation field staff of the Accreditation Council for Graduate Medical Education. She is visiting faculty at the Frank H Netter MD School of Medicine at Quinnipiac University, and works with the Tracking and Evaluation Core at the Great Plains IDeA CTR at the University of Nebraska Medical Center.
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