IPE at the Tipping Point

In this month’s Charting Progress, Dr. Rick Valachovic reflects on the remarkable progress made by those who have championed interprofessional education and where this effort stands today.

Last month, many of us woke to the sad news that Harrison Spencer, my counterpart at the Association of Schools and Programs of Public Health (ASPPH), had died. If you were not privileged, as I was, to know Harrison, this tribute will give you some sense of the extent of our loss. Harrison had a stellar clinical and research career before devoting himself full time to academic public health. In that capacity alone he leaves a rich legacy, including as a champion of interprofessional education (IPE).

Alongside ADEA and four other sister associations, ASPPH was one of the founding members of the Interprofessional Education Collaborative (IPEC). IPEC has seen tremendous growth since its inception in 2009, and its influence in establishing IPE as an integral part of health professions education has become more marked with each passing year. In 2012, the IPEC founders helped sponsor two influential workshops on IPE, organized by the Global Forum on Innovation in Health Professional Education at the National Academy of Medicine (formerly the Institute of Medicine). In 2014, the independent educational accreditation bodies of the six health professions represented within IPEC formed the Health Professions Accreditors Collaborative to further facilitate the ability of our schools to prepare graduates for collaborative practice. Last month, the National Center for Interprofessional Practice and Education recognized IPEC with  a Pioneer Award for creating the IPEC Core Competencies for Interprofessional Collaborative Practice. And this coming year, the Summer Medical and Dental Education Program will become more broadly interprofessional, engaging the schools and students of other health professions under a new name: the Summer Health Professions Education Program. (If you aren’t familiar with this outstanding preparatory program for students who are underrepresented in the health professions, take a look at this earlier issue of Charting Progress.)

Last month I spoke to Lucinda Maine, Ph.D., RPh, Executive Vice President and CEO of the American Association of Colleges of Pharmacy, another IPEC founder, to take stock of where we stand with IPE.

“I believe IPE is at the tipping point,” she said, invoking author Malcolm Gladwell. “Students like it, our accrediting bodies say we will do it, and selectively employers are telling us they need more team-ready clinicians to hire. The demand side will pull us further and further along the path.”

Indeed, that demand is growing, and the progress we’ve made to date suggests we will be able to meet it. Our schools no longer view IPE as an optional luxury, and the proof is that required IPE learning experiences are rapidly supplanting elective ones. A full 92% of medical schools reported having a mandatory IPE experience in 2014, and that same year, 69% of dental schools reported requiring IPE. That is double the figure from just two years earlier.

Other professions have taken note, and they are eager to join us in this endeavor. IPEC responded this year by expanding its ranks to include an additional nine institutional members, most of which had been supporting members of the collaborative since 2011. We held our inaugural Council meeting in June, and the level of engagement was remarkable, reminding me of the energy we founding members felt at the start of this journey.

Back then, two ADEA Past Presidents, Sandra Andrieu, M.Ed., Ph.D., and Leo Rouse, D.D.S., FACD, carried the IPE torch for our Association. Both were involved in drafting the IPEC Core Competencies, which have become the gold standard for developing IPE initiatives since they were published in 2011. To ensure this influential document’s continued relevance, IPEC recently revised it to organize the competencies within a single domain of Interprofessional Collaboration and broaden them to better achieve the Triple Aim framework that is guiding health care reform.

The competencies have been instrumental in firmly grounding IPE in the curricula of numerous health professions schools, but we have another IPEC initiative as well to thank for recent progress. Since 2012, the collaborative has been hosting a series of IPEC Institutes, where teams from participating schools develop curricular ideas they can implement when they return home. To date, these teams have included members from an almost unimaginable diversity of professions—60 at last count—which speaks yet again to the enthusiasm we’re seeing for interprofessional collaboration. (If you’re curious about the non-health professions among our IPE collaborators, see The Changing Face of IPE and Collaborative Care.)

Another ADEA Past President, Ron Hunt, D.D.S., M.S., has been to so many IPEC workshops that the organizers call him a “frequent flier.” His attendance at six workshops in four years says a lot about the challenges of getting IPE off the ground and about the ability of the IPEC Institutes to jumpstart the process.

As Associate Dean for Academic Affairs, Midwestern University College of Dental Medicine-Arizona, Ron was on the first interprofessional team his university assembled in 2012. With an IPE accreditation standard “pointing the way,” the then Dean of the College of Pharmacy funded the expedition of Midwestern senior administrators to attend an IPEC Institute that fall. Ron told me they returned with plans for a first-year course that were “overly ambitious” and soon scuttled when the representative of the medical faculty left the university.

Following a subsequent institute, plans were derailed yet again. The creation of a new college at Midwestern-Arizona and the adoption of a new university accreditation theme shifted university priorities and resources, leaving IPE with limited institutional support. Nevertheless, the pressure on the College of Pharmacy and others to address IPE-related program accreditation standards propelled the process forward.

At a third IPEC Institute, Ron and his colleagues finally hit on a winning idea they could sell back home. The IPE module they developed fit neatly into an existing introduction to the health professions course, and after a successful pilot, the module was expanded to include all entering students on campus.

Building on this initial success, Midwestern sent three more teams to IPEC Institutes. They have developed an IPE experience that brings pharmacy students into the dental clinic to consult with dental students on patient care, and an innovative elective on patient safety that combines online, classroom and community-based learning.

“We could not have done it without the IPEC workshops,” Ron told me. “You get the expertise of the keynote speakers, but probably even more important, you get the concentrated, unobstructed time to work with your team. There are no distractions from students or anything else. Each of the times we attended, we got a lot accomplished.”

The IPEC Institutes are still going strong, with the next one scheduled to begin on October 5.

These developments all suggest that IPE has indeed reached a tipping point. Nevertheless, realizing our collective vision of a flourishing IPE enterprise throughout health professions education will take more time, energy, thoughtful action and resources.

“Many institutions have done a good job of creating classroom and simulation-based interprofessional learning opportunities, but we need to do more to assess IPE and make sure it is relevant to students,” says Jeff Stewart, D.D.S., M.S., Associate Professor in the Department of Pathology & Radiology at the Oregon Health & Science University School of Dentistry. Jeff chaired OHSU’s Interprofessional Initiative Steering Committee for the past five years, and he believes the next push will be to provide more clinical opportunities for interprofessonal learning through patient care.

In October, Jeff will be joining ADEA as Senior Director for Institutional Innovation and Development. In that capacity, he wants to play a role in ensuring that dental and allied dental education remain prominent participants and leaders in the future evolution of IPE, a goal I share.

When I asked Lucinda about the challenges before us, she pointed out that at most of our institutions, the responsibility for IPE still rests on the backs of willing volunteers. “Upper-level administrators need to see IPE as a mission-related activity that requires financial and human resources to sustain over time,” she said.

I couldn’t agree more. Meanwhile, champions like Lucinda, Jeff, Ron, Leo, Sandra and Harrison have been critically important in bringing us to where we stand today. With students, employers and accreditors as our allies, full IPE implementation is no longer a matter of if, but of when.

Related content from previous issues of Charting Progress

The Changing Face of IPE and Collaborative Care
Interprofessional Collaboration Benefits ADEA and Its Partners
Recent Developments on the IPE Front
IPE Is Here to Stay
Paving the Road to Interprofessional Practice
Crossing the Interprofessional Divide 
Interprofessional Practice Can Play Leading Role in an Academic Setting