Module 1: Roles and Responsibilities

Objectives

1. Define attributes of a profession 
2. Identify the educational and licensure requirements for selected health professions.
3. Explain the professional roles, responsibilities, scope of practice and skills of selected healthcare providers.
4. Describe skills and abilities common to multiple disciplines.
5. Review benefits, barriers and facilitators to interprofessional education.
6. Describe interprofessional education exemplars.
7. Describe teaching strategies and learning activities for use with health professions students.

Overview

The purpose of this module is to introduce the roles, responsibilities, educational requirements, and scope of practice of health care practitioners. This knowledge forms the basis of functioning effectively in health care teams.  The General Competency Statement this module addresses is “use of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served” (Interprofessional Education Collaborative, 2011, p. 21). 

Module 1: Roles and Responsibilities

Although we might be familiar with the care delivery process, so often we are less familiar with the education base, roles, or range of functions of members of other disciplines. Our unfamiliarity is due, in part, to the manner in which each group is trained –a unique professional environment with its own language, terminology, problem-solving methods, and professional behaviors, sometimes called a “silo”. This approach to training coupled with a general lack of knowledge about other health professionals leads to under-utilization of skills and capabilities and to disputes about areas of overlapping practice. In order to function competently in team-based care, practitioners must have a working understanding of what other disciplines can provide. ….”teamwork requires a shared acknowledgement of each participating member’s roles and abilities. Without this acknowledgement, adverse outcomes may arise from a series of seemingly trivial errors that effective teamwork could have prevented” (Baker, et al, 2005, p. 14).

Interprofessional education (IPE) is defined by the World Health Organization (WHO) as: “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (Centre for Advancement of Interprofessional Education, 2002, p. 2). This definition also emphasizes disciplines learning with, from, and about each other and implies that healthcare education does not happen in silos. Through shared educational experiences, students from various health professions work together to assess, problem-solve, develop interventions, or treatment plans, or discuss ethical issues related to patient care scenarios.   Learning how to work together for collaborative practice requires an IPE process. The focus is on teaching students how to collaborate. It begins with learning how to effectively communicate with members of other disciplines in an open, honest, and respectful manner. Students learn not only of the common knowledge and skills that disciplines share but also of the specialized knowledge and skills that each discipline brings to the care of the patient.  Stereotypes and false ideas about other professions are eliminated through this honest interchange.  This information about the specialized skills and knowledge creates the foundation for team decision-making about how to work together most efficiently to promote optimal patient outcomes by maximizing the contributions of team members while eliminating duplication of effort (Way, Jones. & Busing, 2000). 

IPE is viewed as the next necessary step in preparing a healthcare workforce that is “collaborative practice-ready” that has learned how to work competently in interprofessional teams. This kind of practice only occurs when multiple health professionals work together with patients, families, caregivers, and communities to provide the highest quality care possible. 

The best time and place to provide exposure to other health professions is not when employment in the profession begins, rather, IPE should be an integral part of the curricula of every health care professions program. IPE is becoming an expectation of health professions programs. IPE specific accreditation standards are in place for the following disciplines: dental, medicine, nursing, occupational, therapy, pharmacy, physical therapy, physician assistant studies, and public health (Greer et al, 2014). This definition adapts an inclusive view of the word ‘professional’ to include members of any discipline who interacts with the patients. This viewpoint of a professional creates a more level playing field and eliminates power gradients or perceptions of superiority of one discipline over another and recognizes that each discipline contributes to patient care. 

Important concepts that are taught as part of IPE include the idea of social capital, professionalism, collaboration, and communication. Social capital is the collective social or economic benefits of cooperation between individuals and groups; the structure of social relationships within the group, the flow of information within the group, and solidarity available to the member (Adler, 2002).  Professional characteristics for effective interprofessional practice include how to be trustworthy, reliable, honest, professionally credible, respectful, and respected. Collaboration is relevant to all health care professions and students need to learn how to apply collaborative practice skills in the health care system and must have opportunities to engage with other professions in order to understand what true collaboration is (Bainbridge, 2014, p. 229). Clear communication, including how to communicate clearly with others through attention to choice of words to promote caring and prevent alienation, avoidance of misunderstanding, and how to be present and attentive to every conversation, is essential for IPP (Bainbridge, 2014). 

Review of Specific Roles and Skills of Team Members

Healthcare does not occur in a vacuum. People entering the healthcare environment to receive care will most likely encounter a variety of health care professionals from various disciplines.  Physicians, nurses, occupational therapists, physical therapists, social workers, laboratory technicians, pharmacists, respiratory therapists, dieticians, or dentists among others, may be contributing to their care. Without coordination and planning by members of the healthcare team, the patient’s experience may seem fragmented; conflicting recommendations may be made, and quality of care or patient safety may suffer. For this reason, it is imperative that healthcare professionals work together and understand the contributions that each team member can make to the patient’s care. Each discipline brings their special knowledge and skills to the collective. By working together as a team, where contributions of each team member are recognized and valued, more effective care can happen for the patient.

Click here for an overview of different health professionals, as well as paraprofessionals, who can comprise a health care team. This table provides a synopsis of educational requirements, licensure and credentials, and roles and responsibilities for select professional and paraprofessionals. Review the content for your own profession as well as six other professions that you are not familiar.

Please note that all providers have certain team responsibilities that do not differ according to discipline. These responsibilities include being cooperative, participating in the tasks at hand, modeling effective team functioning, and respecting the contributions of others. However, there are some specific functions that are unique to specific disciplines, and are clearly not within the scope of practice of others. Some examples include:

• Physician, Advance Practice Nurse, or Physician Assistant:  The physician, advanced practice nurse, or physician assistant should ensure that medical/diagnostic issues are given proper weight in the decision-making process. He or she can accomplish this by describing the relevant medical aspects of cases, so that they are fully understood by the team members responsible for developing the interprofessional care plan. This group also makes decisions about medications to be ordered often with input from a pharmacist.

• Social Workers: Even though many disciplines complete what they would term a psycho-social assessment, if there is a licensed clinical social worker on the team, this person can provide a thorough assessment of mental health problems that may contribute to physical health.

• The Patient, Family and/or Caregiver: The role of the patient, the family, or the caregiver as a member of the health care team can be described in terms of their contributions to care planning process of the interprofessional team:
• Understanding and commitment to self-determination and rights
• Commitment to the care management plan
• Understanding the goals and components of the treatment plan

Benefits of IPE

Benefits of incorporating IPE into health professions education are that it applies to the common educational goals of all disciplines: IPE is an effective practice model, it improves communication, and enhances teamwork (Smith et al., 2009). It also opens up opportunities for faculty scholarship and research collaboration.

When healthcare professional students have IPE experiences they learn the communication and team skills necessary to work as an effective interdisciplinary team. IPE helps students learn the contributions that other disciplines bring to patient care and where their own discipline fits within the health care team. IPE assists students to form their own professional identity (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011).

IPE not only is beneficial to students but has tremendous benefits to the healthcare system as well.  As these students learn IPE and then move into the healthcare workforce as professionals, their experiences with IPE translates to more cost effective care. Duplication of effort is avoided when the team members share information and each brings their specialized skills to patient care and quality of care is improved. 

Barriers to IPE

While learning about how to work as an interprofessional team with members of other health care disciplines is imperative in healthcare professional education today and is becoming part of accreditation standards for most health care professions education programs, many health care professions faculty have not yet begun to incorporate it into the curriculum.  Poirier & Wilhelm (2013) suggest that students are more ready to have IPE experiences than faculty.

Some barriers to IPE may include lack of geographical proximity to other health professions programs, faculty, or students (Griner, 2007).  Another barrier can be variability in length and educational level of different programs. For example some programs may be at an undergraduate level while others are at a graduate level and each level functions at a different level and has different learning objectives. Rigidity in program curricula and scheduling of classes can make scheduling of IPE activities between several programs problematic.  Different programs may have different ideas of how to incorporate interprofessional activities into the curricula.  Power struggles and issues of hierarchy may occur between disciplines, especially if one program believes they are superior to others and try to take unilateral control. The result may be resistance to team teaching or to struggles among faculty from various disciplines to gain control. To promote a successful IPE program, faculty will need to let go of their professional egos and work together cooperatively (Poirier & Wilhem, 2013).

Administration and faculty can also be barriers to IPE. Lack of administrative support or funding for IPE activities can be a barrier to implementation of IPE. Funding limitations can limit development of IPE activities (Blue et al., 2010). Funding can impact availability of physical space to support IPE activities between students from several healthcare disciplines.  Lack of institutional leadership may slow down the process of adoption of IPE.  

Faculty barriers include negative attitudes towards IPE or a lack of knowledge of how to teach IPE. Faculty may not be involved in strategic planning for IPE so may lack buy-in. They may lack knowledge of curriculum or the pedagogy used by other disciplines to educate their health professions students.  Many faculty may lack established connections with faculty from other disciplines, even if working on the same campus. There may not be any faculty incentives for planning IPE activities in their courses. Faculty might think IPE takes more time and effort or that IPE could increase their teaching workload with the addition of students from other disciplines to their own students.

A final barrier is that while IPE is being incorporated into health professions education, it is still not the standard in the practice world. Even though they receive IPE, they may not see positive examples of IPP in the workplace. It will take time for IPP to be translated as an expectation and to become the status quo. While there are many barriers that could interfere with getting started with IPE initiatives, none of them are insurmountable. 

Facilitators to IPE

Organizational commitment from the top down is a key facilitator to launching a successful IPE program. Funding and support of the infrastructure and necessary resources to support IPE such as a simulation lab, expanded space for IPE activities to occur, or a centralized office to guide IPE policy and faculty development and research show organizational commitment to IPE.

Faculty development is perhaps the most effective facilitator for IPE (Greer et al, 2014).    Participation in live or online IPE faculty development where faculty from all disciplines learn about and with each other enhances understanding of their respective professions, their curricula, and their pedagogy used to educate students. During these IPE faculty educational sessions, faculty can gain a better understanding of the aims of other professions, clarify assumptions made about other professions, and make and strengthen connections with faculty from other disciplines.  Faculty who learn together will be more willing to collaborate with others to develop creative and realistic IPE learning activities and overcome barriers such as scheduling of classes or workload concerns.

Finally, faculty dedication and a positive attitude towards making IPE a reality is a necessity for IPE to succeed.  IPP is the emerging model for the future of health care. Faculty from all disciplines should role model positive working behaviors with their interprofessional colleagues when teaching IPE.  Paraphrasing from Margaret Mead, never doubt that a group of thoughtful, committed, interprofessional faculty can change the way we educate students. Indeed, it is the only thing that ever will.  

IPE Exemplars

One aim of IPE is to provide realistic opportunities for exchange between disciplines.  Some examples of successful IPE teaching models include interprofessional student encounters, interprofessional classes or courses, interprofessional clinical or community experiences, or interprofessional simulations. For realism, the mix of students or practitioners engaging in IPE needs to resemble actual clinical situations.  IPE should be careful about, “Creating IPE models in which the case is too contrived, or which require the participation of members of professions that would rarely play a role in the case, not only risks ineffective learning but may also perpetuate negative stereotypes and indifference to the concept of IPE” (Bainbridge, 2014, p. 230). Two exemplars are from the University of Oklahoma Health Sciences Center.  If you would like to share your exemplars with us to use on future updates, please complete the following survey:  IPE4Faculty Website Evaluation and Exemplar Sharing

IPE Activity:  Interprofessional Speed Dating

• Divide students from different health professions into groups of 8-10 students
• Students will “Date” each person in the group for 4 minutes
• Students will ask their “date” specific questions for 2 minutes and then answer the questions for 2 minutes.
• Use a buzzer to let students know when it is time to move on to their next “date”
• Students will go on 7-9 “dates” (depending on the size of the group) in a 45 minute timeframe.