Changing Attitudes - Health Sciences Students Working Together.

Is it possible to alter limiting stereotypic attitudes of health professionals toward each other? Perhaps a first step might be an undergraduate interdisciplinary course that brings students from different faculties together to work on scenarios of common interest? The Inter-professional Health Development, Education & Activities Group (IHDEA) at the University of Alberta believe that their innovative INTD 410 course addresses the goal of changing attitudes. Over a five-week period, more than 700 students attend this required course. They are supported by some fifty facilitators who are drawn from the community and from six different university faculties. Students interact in small interdisciplinary teams and in the process deepen their knowledge of the role of each health professional, and come to a greater understanding of the contributions of their own discipline to the team. Data gathered suggest that the course cultivates respect among the professions and that students feel better able to function within the health team. This paper describes how the course was developed. Goals of the course from within the university environment “The feature that distinguishes the best health organizations is their culture.” (Sir Liam Donaldson) Health care world-wide is constantly in transition, and thus education around the training of its professionals must also be subject to change. 1-3 A key feature of change in health care delivery and in health promotion has been the recognition that professionals interacting as interdisciplinary teams often make the most useful contribution. 4 This concept however must be translated into practice. It is reasonable to believe that teamwork needs to be specifically taught, and should be introduced early in the students’ education. In health curricula, students are usually trained in discipline-specific isolation, and upon graduation are expected to work together with patients in a successful inter-professional team. Indeed, our experience at the University of Alberta suggests that in health education, rather than working together, health faculties tend to compete for available funds and facilities, and this professional allegiance tends to permeate student behaviour after graduation Changing Attitudes Health Sciences Students Working Together 2 © The Internet Journal of Allied Health Sciences and Practice, 2004 Common sense thus dictates that we should lay the foundations of effective inter-professional collaboration during the education of all those who will work in the health field. While there are few published examples of attempts to achieve this objective, the literature does suggest the importance of moving to this type of practice and delineates the difficulties in teaching it. 5,6 Certainly there have been interdisciplinary courses in the health field, but they have almost always been electives or have consisted of didactic presentations with little opportunity for students to experience actual teamwork. Faculties of Medicine, in particular, have seldom been heavily involved in collaborative programs. Indeed, when we first started to discuss our plans with other universities, we were told that it was wonderful in theory, but logistically impossible. The IHDEA group at the University of Alberta took on this challenge, and has successfully instituted an inter-professional course. The Beginning of the Process “Snowflakes are one of nature’s most fragile things, but just look what they do when they stick together.” (Vista M. Kelly) Since 1992, members of the academic staff from Nursing, Occupational and Physical Therapy, Medical Laboratory Science, Medicine and Dentistry, and Pharmacy have offered a course focused on the health care team. In its first year Interdisciplinary 410 enrolled twenty-four students, and year-by-year the enrolment grew to over one hundred and forty registrants. The course was offered in the evening, and consisted primarily of small group work. Initially an elective in all faculties, it gradually became a required course, with Dentistry leading the way in 1996. In 1997, the Coordinating Council of Health Sciences (the council is comprised of the Executive Director for Health Sciences and the Deans of each of the Faculties of Agriculture/Forestry/Home Economics, Medicine/Dentistry, Nursing, Pharmacy, Physical Education/Recreation and Rehabilitation Medicine) recommended the formation of a committee to consider inter-professional or as it was more commonly known then as interdisciplinary education. Around the same time, students in the Faculties of Medicine and Pharmacy formed a Society dedicated to interdisciplinary collaboration called the Alberta Collaborative Health Interdisciplinary Learning Initiative (ACHILI), which has since expanded to include students from other health programs. Under the aegis of the Executive Director of Health Sciences, a group was formed comprising members of the Health Science Faculties, instructors in the existing Interdisciplinary 410 course, community practitioners, and members of ACHILI. The primary objective of that group was the furthering of inter-professional education at the University of Alberta. A smaller, less unwieldy committee, including a representative from each of the undergraduate programs, was formed to develop an appropriate initiative. This committee was later christened the Administrative Group on Interdisciplinary Health Sciences Education. The name has now been changed to Interprofessional Health Development, Education and Activities Group (IHDEA). IHDEA has remained essentially stable from its inception. IHDEA developed the framework for establishing the InterProfessional Initiative (IPI), which now has three formalized positions: Director, Course Coordinator, and Team Placement Coordinator. IHDEA provides leadership, administrative support and visionary guidance to IPI. The Administrative Group decided that the program of inter-professional education should include a mandatory course for all health sciences students that would introduce them to knowledge, skills and attitudes that would support effective functioning within a health-care team. Unquestionably, the group benefited immeasurably from the experience of the members who had taught the previous interdisciplinary course. However, since no other University appears to have created a required credit course in this area involving all the Health Faculties, we were essentially beginning a new endeavour. Oops, It is Actually going to Happen “The roots of education are bitter, but the fruit is sweet.” (Aristotle). To begin, the IHDEA team members had to learn how to work together on a common project. Working together meant diminishing allegiance to our own faculties in favour of loyalty to the principles of Team Education. Even this was initially very difficult until the working group designed explicit rules for making decisions: we would develop and adhere to guidelines for process and deliberation. In addition, since the chances of receiving any tangible reward for our efforts seemed minimal, we would do our utmost to enjoy the process. These decisions have sustained us through some periods of intense frustration and helped form a team that usually models the behaviours we hope that our cadre of 700+ students will adopt. Changing Attitudes Health Sciences Students Working Together 3 © The Internet Journal of Allied Health Sciences and Practice, 2004 An issue that emerged early was: “During which university year should the course be offered?” The clinical field placements that occupy many students in the latter stages of their education present seemingly insuperable logistical problems (but see “Future Developments”, below). On the other hand, offering the course early means students have less background with which to represent their disciplines in a inter-professional group. A compromise between logistics and pedagogy provided us with the following distribution of the enrolment over the last two seasons (see Table 1.1 below). Table 1.1: Enrolment and year of study for registrants in the Interdisciplinary program