The need to address healthcare system quality and safety has been well documented for several years (1). The Institute of Medicine, in its 2003 report Health Professions Education: The Bridge to Quality (2) advocated the preparation of practitioners with knowledge and skills to deliver patient-centered care, apply quality-improvement, use information technology, employ evidence-based practice, and function as effective interprofessional team members. This preparation for interprofessional teamwork, now commonly referenced as “interprofessional education,” is rapidly expanding in significance and growth in the United States because of the increased recognition that significant improvement in the healthcare system remains important. The goal of interprofessional education is to prepare professionals who are ready to collaborate effectively with other health professions, patients, families, and communities to deliver the highest quality care; that is, interprofessional collaborative practice. Given the complexities of treatment and rehabilitation for mentally ill patients, psychiatry should adopt interprofessional education and collaborative practice for medical students, residents, and practicing physicians, as well as learners of other professions.
“Interdisciplinary education,” “interdisciplinary care,” and “multidisciplinary care” were terms used for many years to describe educational and clinical efforts that brought individuals of different disciplines and/or professions together for purposes of improved patient care. Nomenclature can be confusing, and the standard term today to describe collaboration of individuals from different professions is “interprofessional.” This is to be distinguished from collaborative efforts involving persons within the same profession, that is, interdisciplinary (such as the general internist, cardiologist, and cardiovascular surgeon managing someone with severe heart disease). A commonly agreed-upon definition of interprofessional education is from the World Health Organization (3): “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.” Inherent in the definition of interprofessional education is that learning involves interaction among participants of different professions and that, through this interaction, competencies for effective collaboration are fostered.
Interprofessional education in the United States has been characterized since the 1970s by periods of heightened awareness and activity, followed by periods of little attention (4). The momentum for increased attention to interprofessional learning in the U.S. was propelled forward last year with the publication of interprofessional core competencies. In May 2011, the Interprofessional Education Collaborative (IPEC) sponsored by six national associations of the schools of the health professions, including the Association of American Medical Colleges, the American Association of Colleges of Nursing, the American Association of Colleges of Pharmacy, and others, published core competencies for interprofessional collaborative practice (5). The publication of these competencies was a significant advance for interprofessional education in the U.S., bringing a unified focus and broad national attention to the need for interprofessional education within health-professions training. Written by an expert panel on behalf of IPEC, the competencies, grouped under four broad competency domains: 1) values and ethics for interprofessional practice; 2) roles/responsibilities; 3) interprofessional communication; and 4) teams and teamwork, are intended to prepare health professionals to intentionally and effectively work together. The competencies build on each profession’s discipline-specific competencies and purposefully link to the five core competencies identified by the Institute of Medicine 2003 report (2).
For psychiatry, the national focus on interprofessional education and collaborative care may appear, to some practitioners, to be “old news,” given the discipline’s history of relying on multiple professionals working together to address patients’ treatment and rehabilitation needs. In 1969, Sifneos reported (6) on the results of an interdisciplinary public health and social science educational program designed to address mental health issues. George Engel, in writing about the biopsychosocial model, recommended, in 1979, the need for improved collaboration and communication among the health professions (7).
More recent authors also recognize that mental health treatment benefits from the contributions of multiple professionals and describe interprofessional learning experiences. Roberts et al (8) report efforts for graduate-level nursing students to learn interprofessional care within the context of an integrated mental health team. Steiner et al (9) describe a seminar for trainees from multiple professions to enhance their knowledge of interdisciplinary recovery-oriented care for mentally ill patients. Also, several authors have described characteristics of effective multidisciplinary (e.g., interprofessional) teams for psychiatric rehabilitation and inpatient treatment (10–12). However, additional current models of explicit interprofessional learning in the field are needed. The national emphasis placed on interprofessional collaboration offers psychiatry education at all levels of training the opportunity to advance itself as a leader in the growing field of interprofessional education.
Common challenges in interprofessional education often appear daunting, such as non-synchronous academic calendars and schedules for students from various professions, curricula with multiple content needs because of profession-specific accreditation standards, the traditional hierarchy and issues of power and territoriality in healthcare, faculty development needs, need for leadership support and commitment, and issues of geography when learners are on multiple campuses and clinical sites (13, 14). As interprofessional education programs are being developed within the U.S., examples of approaches that address and work around these challenges exist and provide models for institutions initiating interprofessional education. The IPEC Competencies Report (5) references several exemplars, and a special issue of the Journal of Allied Health in Fall 2010 (15) features several interprofessional education programs.
The availability of the interprofessional collaborative competencies provides a useful common framework for developing interprofessional education curricula and assessment strategies and offers psychiatry educators a starting-point for the development of interprofessional learning experiences. In Table 1, we present the four interprofessional core competency domains, the corresponding general-competency statements, and examples of how psychiatry could address the domain within education. Our examples are meant to be illustrative starting-points and not a comprehensive list. Furthermore, a single learning activity can address multiple competency domains.
TABLE 1.Example Learning Activities by Interprofessional Collaborative Competency Domain
| Add to My POL
|Interprofessional Competency Domain||General-Competency Statement||Learning-Activity Examples|
|Values and Ethics for Interprofessional Practice||Work with individuals of other professions to maintain a climate of mutual respect and shared values.||Interprofessional case discussions of ethical issues in psychiatric care
Interview other mental health professionals about their role in care
Interprofessional care rounds in inpatient or outpatient settings|
|Roles/Responsibilities||Use the knowledge of one’s own role and of other professions’ roles to appropriately assess and address the healthcare needs of the patients and populations served.||Shadow other mental health professionals
Interview other mental health professionals about their role in care|
|Interprofessional Communication||Communicate with patients, families, communities, and other health professionals in a responsible manner that supports a team approach to the maintenance of health and the treatment of disease.||Interprofessional group projects:
Analyze fictional sentinel events about a psychiatric patient and provide recommendations
Simulation scenarios, such as a psychotic episode, involving team care and communication
Interprofessional care rounds in inpatient or outpatient settings|
|Teams and Teamwork||Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, and equitable.||Interprofessional group projects:
Quality-improvement projects to improve psychiatric patient care-delivery
Case conference in which each profession presents aspects of the case and treatment plan|
As a component of the Medical University of South Carolina’s overall interprofessional education program (14), we have been successful in introducing behavioral science concepts and psychiatric education for medical students within interprofessional learning contexts. Using a hybrid format that combines on-line and face-to-face sessions, first-year allied health, dental, medical, nursing, and pharmacy students work in small groups of 12 in a required interprofessional course (16). Behavioral science concepts related to cultural competency and social determinants of health are introduced to students through readings and videos; interprofessional class discussions of case examples offer students the opportunity to learn from, with, and about other professions’ perspectives on these issues. Analysis of a fictional sentinel event provides them with the opportunity to apply interprofessional teamwork skills. During our third-year psychiatry clerkship, students attend their assigned hospitalized patients’ therapy and consultation sessions with other professions (and associated learners); these include nurses, occupational therapists, pharmacists, physical therapists, psychologists, and social workers. They interact with these other professions in shared problem-solving and decision-making about the patient, raising what is often “parallel play” in the clinical environment to a new level of interprofessional teamwork through purposeful interaction for improved patient care. Students then reflect upon their interprofessional interaction and document what they learned and how the patient benefited from the interprofessional collaboration. This experience, part of an interprofessional education requirement across the third-year clerkships, reinforces students’ knowledge of interprofessional collaboration and allows them to practice and demonstrate interprofessional communication and teamwork in the clinical setting. We share our experience in order to provide examples of interprofessional learning activities.
As referenced above, only a few reports in the literature describe specific approaches to interprofessional education within the psychiatric and mental health context. Given the breadth of behavioral and mental health needs in this country, as well as the established presence of interprofessional care for mentally ill patients, interprofessional education approaches are clearly relevant for psychiatric and other health-professions training. Within medical student education, psychiatry should take the opportunity to provide innovative learning models that prepare the future physician of any specialty with improved knowledge of collaborative patient care. Within its own learning continuum, the inclusion of interprofessional learning and collaborative practice models in residencies and fellowship training will provide psychiatrists and other professionals with the skills to engage in effective collaborative practice to the betterment of patient care and safety.