Challenges and constraints
It is clear from the wide range of literature available on IPE that the potential benefits are great, not only to patients and clients, but also to learners, educators and other stakeholders. It would seem that the workplace, including the clinical environment, would be an appropriate place to bring learners together in interprofessional groups or teams. After all, they are working together collaboratively and so learning together would seem logical. But is it so easy?
‘Although IPE has been strongly advocated as improving interprofessional communication and integrated services and there is a growing body of evidence of its effectiveness in some contexts, there remain significant questions concerning its implementation. These questions include the management of interprofessional learning and logistics, the preparation of teachers and mentors in the workplace, the mix of disciplines and transferability of learning, and resistance from established hierarchical uni-professional training programmes’ (EIPEN, 2008).
Headrick et al. (1998, p. 773) list a number of barriers to interprofessional collaboration and education:
- Differences in history and culture
- Historical intraprofessional and interprofessional rivalries
- Differences in language and jargon
- Differences in schedules and professional routines
- Varying levels of preparation, qualifications and status
- Differences in requirements, regulations and norms of professional education
- Fears of diluted professional identity
- Differences in accountability, payment and rewards
- Concerns regarding clinical responsibility.
Finch (2000) is positive in suggesting that IPL is a ‘good thing’, she cites a number of barriers to shared learning (and IPL) at the pre-registration stage, including:
- Different requirements from professional bodies
- Universities not necessarily providing programmes for all the professions
- Different entry requirements and lengths of programme.
She makes a strong case that IPE must reflect real working practices, not just those happening now, but in perhaps five or ten years hence – as these are the lead-in times for developing new programmes and new schools.
In clinical and professional learning contexts, IPE may well involve challenging differential power relations and differences (the ‘us and them’) between health professions with different status and power dynamics. Many studies note that participants can feel that their learning is compromised and there is varying evidence around whether professional stereotypes are changed through early IPE or whether it is through longer positive exposure in the clinical setting that different health professionals learn to understand and respect ‘others’ for what they do.