Transformative Education
for Health Professionals

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IPE: research from the Western Cape, South Africa

We continue our series of interviews with speakers who are participating in WHO co-hosted sessions at the Prince Mahidol Award Confernce in Bangkok, Jan 2014.

Linda Shuro will be presenting in session 3.5 (Thursday 30th January); Implementing Interprofessional Education for Health Equity; Challenges and Solutions

Linda Shuro is a University of Western Cape MPH Graduate (2012) based in South Africa and also involved as Africa Outreach Coordinator for the People's Health Movement www.phmovement.org  

She is passionate and interested in health and human rights issues. She has been part the People's Health Movement since 20008. She was born in Zimbabwe and studied for a Bachelor of Science in Health Education and Health Promotion with the University of Zimbabwe. Prior to moving to South Africa, Linda worked in Zimbabwe for the Community Working Group on Health. 

She completed her Masters in Public Health with the University of Western Cape (UWC) in South Africa in 2012 and her research was based on the Interprofessional Education Programme implemented at the University of Western Cape.

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JF: What was the impact of national policy primary health care (PHC)” (SOPH, 2005-2006) ? could you comment on health profession regulation / accreditation requirements and their impact on implementing in pre-service IPE / CP ?

LS: There were no regulations or requirements about IPE implementation at the time the programme was introduced at the University of Western Cape (UWC), South Africa. The interdisciplinary core courses were introduced at UWC as it was apparent that the current training needed to incorporate Public Health and Primary Health Care, as well as more knowledge about other health profession’s roles. This was initiated by local drivers because of the new policies which emerged which had a strong focus on Primary Health Care. Therefore the initiative was not due to any specific regulations or forced, but because students were ill-prepared. This was clear within the study as highlighted by the key informants as mentioned below:

“Both the coordinator and the course convener elaborated that the IPE programme was formed as an attempt for students to learn about other disciplines and to be responsive to South African health needs in line with the primary health care approach”(Mashingaidze, 2012:).

  

JF: what have been some of your findings of a qualitative study on Interdisciplinary Core Courses as an innovative way to infuse Public Health and PHC into the undergraduate curricula of several health professions

LS: Looking to debate the statement in the abstract “The 2010, the World Health Organization (WHO) Framework for Action on Interprofessional Education and Collaborative Practice stressed the significant role that interprofessional education and collaborative practice could play in mitigating many of the challenges of the global health workforce crisis”

In 1994, the UWC’s initial efforts in primary health care were made when the Faculty of Community and Health Sciences (CHS) reviewed “its undergraduate curricula in the light of the government’s new health policy based on primary health care” (SOPH, 2005-2006).

The then Public Health Programme (later the School of Public Health) was given responsibility for leading the development of this initiative. Over the years the interdisciplinary primary health care modules have been introduced into the undergraduate curricula for all health disciplines. The introduction of the IPE initiatives at UWC was also in line with the changes in the health situation in South Africa and internationally.

Four core interdisciplinary modules have been developed as follows: Introduction to Philosophy of Care for first year (IPOC); Health, Development and Primary Health Care (PHC) for first year; Interdisciplinary Health Promotion (HP) for second year, Measurement of Health and Disease (MHD) for third year and Interprofessional Community Based Practice (ICBP) for fourth year. These modules’ aims and objectives implicitly advocate for the cultivation of collaboration and involve the following disciplines (undergraduate programmes): dietetics, physiotherapy, human ecology, occupational therapy, social work, nursing, sport recreation and exercise sciences, psychology, and natural medicine. Students in these disciplines are placed in various disadvantaged and rural community settings as interprofessional teams to work together on different projects. The university has formalized partnerships which exist within rural and marginalized communities to create opportunities for placements and projects. CHS students work as interprofessional teams in the different health care settings which include clinics and schools.

The qualitative study explored the insights of the current third and fourth year undergraduate CHS students involved in the IPE programme regarding their appreciation of the other students’ profession and their attitude to future interdisciplinary collaboration. The objectives of the study were as follows: to explore the experiences of students with regard to interprofessional work; to explore the extent to which the IPE programme provided students with an insight into the role of and association between their profession and other health professions; and, to explore the extent to which the IPE influenced students‟ attitudes towards collaboration in future work.

The findings revealed that the UWC IPE programme is very useful and important and can be potentially beneficial in health professional training especially in fostering collaboration. The results show that students appreciate the value of the programme but a lot of changes need to be done to ensure an effective programme. The interdisciplinary interaction through learning and working together specifically in health promotion resulted in creating a deeper understanding of the exclusive and overlapping role of health professions as well as an appreciation of each other’s profession.

Firstly, it is evident from these results and from literature that if there is lack of clarity of the programme or unclear course organisation it leads to or reinforces negative perceptions of students towards the IPE programme. Secondly, as supported by literature there is still a debate among people if it is beneficial for early entry into the IPE programme or at a later stage when students are more aware of their own profession. As results show, there was a shift in attitude by the students over the years towards a more positive/healthy attitude and a greater interest to be in the IPE programme. There is a need to do further investigation on the best level for entry into IPE.

The results brought out the importance of IPE as there were a lot of benefits associated with the programme. Firstly, students expressed a realization and appreciation of the other profession’s role by having an interdisciplinary association with other professions. Secondly, having understood or learned about the other professions gave them an insight into the importance of team work (collaboration) among professions. This also points to the fact that the programme is very useful in building skills among students as it gives them a practical experience before the real world to engage with other professions. As a result, students build more personal skills such as confidence, patience, communication, assertiveness and team work. Thirdly, the students highlighted the relevance of the modules of the IPE programme in their day to day work as the programme provided an opportunity to apply theory to work. However, it came out clearly that the modules needed to be more practical, citing the example of the Health Promotion module as a practical module. There was a clear need for the modules to have more content on roles and responsibilities of other professions.

It is however clear that it is not easy to implement the IPE programme as evident by the challenges faced in the UWC IPE programme. The first aspect is the logistical issues in running the programme - linked to the different time frames of departments, inadequate orientation of the students and lecturers, inappropriate selection of interdisciplinary groups, lack of a budget dedicated to the programme, limited venues for students and lack of communication when activities take place. The second aspect is linked to the lecturing process. The study brought out that having one lecturer from the department affects the interdisciplinary learning as there is constant reference to one discipline. Therefore there is need for regular orientation on IPE goals.

The results also highlighted that students reported back informally that they did not necessarily encounter what they learnt in the real world. There is no formal system to obtain feedback from alumni of the programme regarding their experience in the real world.

The study has attempted to contribute toward an understanding of the insights of students that experience the IPE programme and how the programme is conducted at UWC. In this regard, a qualitative study using focus group discussions and semi-structured interviews was suitable to explore these insights.

The study gave an insight into students‟ interaction with other professionals and how this has an impact on future collaboration. It highlighted that exposure of students to interdisciplinary learning can have a positive impact in professionals learning about each other’s professions and therefore allowing a change of attitude towards a holistic and more collaborative effort towards patients care. To enhance collaboration reduces duplication of effort, and makes better use of scarce resources more effectively, so as to meet the complex needs of patients. However there is need for a well -coordinated programme which takes into account the input of all sectors involved (students, lecturers, supervisors, departments, community and other partners).

 

JF: From your study could you identify any good / best practices, do faculty development programmes increase confidence in IPE teaching ?

LS: Faculty development in the early days prepared lecturers for IPE teaching as they were encouraged to attend the course of Primary Health Care and restructuring for PHC provided within the SOPH and some of them undertook the MPH programme. As years passed, this collapsed into a short orientation workshop which does not adequately prepare the teachers.

From the study, the most positive component of the faculty development for IPE teaching was the orientation workshops provided to the teachers before IPE teaching. It was generally acknowledged within the study that the orientation was insufficiently in-depth and sustained. The IPE programme also involves contracted tutors from outside the University who go through the orientation workshop. Since these tutors are not part of the university, the orientation in the beginning did not prepare them enough. However staff who attended the MPH course and courses within the SOPH mentioned that the experience prepared them well to teach IPE. This is supported as highlighted in an extract from the study findings;

“The lecturers expressed that they received orientation on the course at the beginning but both concurred that having gone through the Masters in Public Health assisted them to lecture and to understand IPE better”(Mashingaidze, 2012:44-45).