VIEWPOINT COMMENTARY

Interprofessional Education: The Magical Mystery Tour Now

Less of a Mystery
Ronald M. Harden*
Association for Medical Education in Europe (AMEE), Dundee, United Kingdom

Interprofessional education (IPE) is on today’s agenda in medical education as a response

to advances in medicine, the changes that have taken place in healthcare delivery, and
pressures from the public and the profession. Although attention has focused on IPE in
the later stages of the education program, there are benefits to be gained from the intro-
duction of IPE in the early years. Curriculum developments supporting this include the
adoption of outcome-based education and vertical integration. There is also a recognition
that students’ attitudes and biases are formed early in their education and the appropri-
ate learning environment in the early years is important. Interprofessional education in
the early years can also be seen as a part of a more general trend to greater collaboration
in the delivery of an education program in the healthcare professions. Anatomy by incor-
porating IPE can help shape the future of medical education as well as being shaped by
it. The possibility of success or failure with IPE can be captured with the equation
IPE 5 (V 3 I)/N, where V 5 the IPE vision, I 5 the implementation strategy and
N 5 negative perceptions of the approach. Success is more likely where there is a well
thought out and shared vision for what is to be achieved, an appropriate implementation
strategy and a plan to counteract a negative mind-set. Anat Sci Educ 8: 291–295. V C 2015

American Association of Anatomists.

Key words: interprofessional education; IPE; medical education; gross anatomy educa-
tion; undergraduate education; curriculum; integration

Seventeen years ago, writing in Medical Teacher I suggested, education is on today’s agenda. Books have been written on
in the words of the Lennon and McCartney song, we might the topic, a journal—The Journal of Interprofessional Care is
wish to join the “magical mystery tour” of interprofessional devoted to the theme, a Best Evidence Medical Education
education—magical because, in the context of the changing (BEME) Systematic Review has examined the evidence in
nature of clinical practice and the implications for medical favor of the approach (Hammick et al., 2007), one AMEE
education, it offered the possibility of miraculous results; a Guide, Learning in Interprofessional Teams, looks at the
mystery because the outcome was uncertain and the seas to implementation in practice (Hammick et al., 2009), and
be travelled were relatively uncharted (Harden, 1998a). another provides theoretical insights (Hean et al., 2012).
While there was general consensus about the potential bene- Papers on the theme feature prominently at international
fits of interprofessional education (IPE), there was an active meetings on medical education such as the AMEE Confer-
debate about its value in practice and how it could be imple- ence. Kirch and Ast (2015) suggest that today the importance
mented. Since then the importance of interprofessional educa- for health professions education to embrace interprofessional
tion has been widely recognized as highlighted in this issue of learning is greater than ever and anatomy educators can play
Anatomical Science Education. With the aim of improving a leading role. There are good reasons why IPE is of current
patient outcomes and the quality of care, interprofessional importance (Fernandes et al., 2015; Herrmann et al., 2015;
Kirch and Ast, 2015; Thistlethwaite, 2015). If we expect a
*Correspondence to: Prof. Ronald M. Harden, Association for Medi- doctor on qualification to practice effectively as a member of
cal Education in Europe (AMEE), 12 Airlie Place, Dundee DD1 4HJ, a team and to have the required team and communication
United Kingdom. E-mail: r.m.harden@dundee.ac.uk skills and an understanding and respect for other healthcare
Received 15 May 2015; Accepted 20 May 2015. professionals, we need to reflect this in the curriculum and
Published online 11 June 2015 in Wiley Online Library the educational strategies adopted.
(wileyonlinelibrary.com). DOI 10.1002/ase.1552 For the most part attention has focused on IPE in the later
years of the undergraduate curriculum and in the postgradu-
C 2015 American Association of Anatomists
V ate education program (Thistlethwaite, 2015). There are

Anatomical Sciences Education JULY/AUGUST 2015 Anat Sci Educ 8:291–295 (2015)
benefits to be gained, however, from the introduction of IPE only locally, nationally and internationally in the different
in the early years (Hammick et al., 2007, Hamilton et al., phases of the curriculum, but also between the different pro-
2008). The results have been encouraging where interprofes- fessions (Harden, 2014). Interprofessional education in the
sional learning has been implemented in the early years in early years can be seen as part of this general trend to greater
anatomy courses (Mitchell et al., 2004). Papers in this issue collaboration.
of Anatomical Sciences Education provide further support for A further rationale for the introduction of IPE earlier in
the introduction of IPE in the early years, in particular in the curriculum rather than later, relates to a recognition that
relation to the teaching and learning of anatomy. There are a students’ attitudes and biases are formed early in their educa-
number of powerful reasons why developments in medical tion and an appropriate learning environment such as IPE,
education favor such a move. One such development is the that encourages team skills and an appropriate attitude to
move to outcome-based education (OBE), where the empha- other healthcare professions, is important before professional
sis in the education program is on the expected learning out- biases are established. Opportunities early in the curriculum
comes and competences that the student will have mastered for students from different professions to learn together may
at the time of graduation (Harden et al., 1999). Indeed, this avoid the development of entrenched attitudes and negative
move to OBE has been identified as the most important trend stereotypes towards other professions (Areskog, 1988). Atti-
in medical education in the past decade. In OBE it is not suf- tudes of respect and trust can be fostered when professions
ficient to simply specify the expected learning outcomes learn together. Fernandes et al. (2015) describe how a ten
including competences such as communication and team week anatomy course involving students from different
skills. The outcomes must also be reflected in the adoption in healthcare professions had a positive effect on the attitude
the curriculum of educational strategies such as interprofes- and perceptions of students towards interprofessional collab-
sional education designed to achieve the specified outcomes. oration and towards anatomy as a venue for IPE. Medical,
Each course, regardless of whether the emphasis is on the midwifery, occupational therapy, physician assistant, physio-
basic sciences such as anatomy or on clinical medicine such therapy and nursing students, all felt that the course was an
as surgery or pediatrics, must have clearly specified for the effective method both in learning about anatomy and about
students and teachers, how the course contributes to the exit health professionals’ scope of practice.
learning outcomes for the curriculum. Thus it is not sufficient A combination of these four factors supports the introduc-
in the anatomy course to identify the learning outcomes in tion of IPE as an educational strategy in the early years of
terms of mastery of an understanding and knowledge of anat- the course with students from different professions learning
omy and even how the subject contributes to clinical medi- anatomy alongside each other, and at the same time acquiring
cine. How the course contributes to more generic outcomes generic teamwork and communication skills together with an
such as communication and team skills and recognition of understanding and respect for other professions. The intro-
the role of other professionals must also be specified (Evans duction of IPE in the curriculum, however, is not easy and
and Pawlina, 2015). Interprofessional education is a powerful there are many obstacles to be overcome. The possibility of
approach that, if adopted in an anatomy course, can not only success or failure can be captured with the equation, IPE 5 (V
facilitate the student’s mastery of anatomy but at the same 3 I)/N where V 5 the IPE vision, I 5 the implementation
time contribute to the more general course learning strategy and N 5 negative perceptions of the approach. Suc-
outcomes. cess is more likely where there is a well thought out and
A second factor that has facilitated the adoption of IPE in shared vision for what is to be achieved, an appropriate
the early years of the course is the move to a vertically inte- implementation strategy and a plan to counteract a negative
grated curriculum where students are introduced to clinical mind-set.
medicine from the first year of the course. In a review of the For IPE to be successful we require a clear agreed vision
evidence, Dornan et al. (2006) concluded that the early intro- with achievable goals. Mattessich et al. (2001) in a review of
duction of clinical experiences helps the student to socialize the research literature on factors that influence the success of
to their chosen profession and to acquire a range of subject collaboration, identified as key to the success a shared vision
matter. The integration of the basic and clinical sciences in with concrete, obtainable goals and objectives. Interprofes-
the curriculum offers great potential for IPE and IPE can help sional education should have a vision, as described by Kotter
to contextualize the learning of anatomy in clinical practice. (1996), that is imaginable, flexible, feasible, desirable,
Such contextualization may improve the learning of anatomy focused and communicable. Course organizers, teachers and
and its later retention (Willhelmson et al., 2010). students need to have a common sense of purpose and a clear
A third factor that has contributed to the use of IPE in the understanding of the rationale for the IPE and in their con-
early years is the unprecedented increase in interest in the text what constitutes IPE. An important feature of their anat-
exploration of new approaches to medical education. Over omy IPE case study at Bern, Switzerland (Herrmann et al.,
the past ten years the number of papers with a medical edu- 2015) was that before starting the project the Faculties of
cation theme submitted for the AMEE Annual Conference on Medicine and Nursing institutions developed a shared vision
medical education has increased from less than 300 to almost of the goal for the IPE program. In considering a vision for
3,000. Both interprofessional education and teaching and IPE it is not a matter of being for or against the principle of
learning anatomy feature prominently in the program. Devel- IPE. A decision needs to be taken where the school wishes to
opments in technology and educational approaches such as be on the interprofessional education ladder as described by
the flipped classroom allow greater flexibility in curriculum Harden (1998b) with eleven steps from isolation at the bot-
planning that can be used to explore and implement initia- tom of the ladder to a fully implemented IPE program across
tives such as IPE (Kirch and Ast, 2015). A feature of develop- the curriculum at the top. As one moves up the ladder, IPE
ments in medical education has been a move to greater becomes a more prominent feature of the curriculum and
collaboration between the different stakeholders and the rec- there is a greater emphasis on shared planning of the educa-
ognition of the value of collaboration between teachers not tion program with associated shared authority. While schools

292 Harden
may not be willing to commit to a fully integrated IPE pro- their achievement of the other more generic learning out-
gram, they may well agree to locate at a step lower down the comes such as communication and teamwork skills. It is
ladder and with confidence and experience move to a greater important that students are reassured that valuable time is
degree or higher level of IPE. It can be argued that no school not being taken up by what they perceive as non-vital topics
should locate itself at the bottom isolation rung of the lad- (Thistlethwaite, 2015).
der—the question should not be whether they wish to accept In implementing IPE there needs to be a clear statement of
IPE or not but where they want to be on the IPE ladder as a the expected learning outcomes for the curriculum and how
vision for their education program. the IPE contributes to achievement of the learning outcomes.
Following agreement about a shared a vision for IPE, A range of frameworks have been adopted for specifying
attention needs to be paid to the implementation strategies if learning outcomes (Harden and Laidlaw, 2013) and an estab-
high quality IPE is to be achieved. A key requirement is to lished framework can be adopted or modified for use locally
organize the program in such a way that the assets of all the or a new framework created. A curriculum map demonstrates
professions involved are utilized. Simply putting students how the learning outcomes are related to the IP and other
from different professions together and hoping that they will learning opportunities and to the assessment (Harden, 2001).
learn from each other does not work. Each profession must It is helpful also to look at the curriculum map for each of
have a clear contribution to make. Freeth (2010) has argued the professions involved and identify where the learning out-
that activities that do not allow each participating group to comes are common to the different professions and where
contribute are unlikely to be a good foundation for effective there are differences. It is important that not only is IPE rec-
IPE. Students must learn through balanced exchanges and ognized but finances and resources are made available to sup-
learning from the experiences of others. As Carpenter and port a program. This may seem difficult at a time of financial
Hewstone (1996) highlighted simply putting students from stringency but rather than this being an inhibitor of change,
different professions together in mixed classes may be unpro- it can be used as an opportunity to fundamentally review the
ductive: at best they ignore each other but more usually they approach to education. As suggested by Calvo and Miles
resent the other groups and feel that their learning opportuni- (2011–2012) “budget constraints may actually force us to be
ties are being diluted. In an IPE initiative at the University of more creative and think about resources in different ways.”
Dundee, one factor that contributed to the success of the pro- It is important in the implementation of IPE that it is
gram was that the problems in the PBL sessions were so delivered in a way that highlights clinical relevance (This-
designed that to tackle the problem successfully the groups of tlethwaite, 2015). In the report by Fernandes et al. (2015) a
medical and midwifery students needed to make use of the key feature of the program was the focus on intentional, pro-
theoretical perspective and understanding of the medical stu- fessional, role focused discussions round scope of practice
dents and the more practical experience of the midwifery stu- presentations and case-based discussions early in each ses-
dents (Mires et al, 1999). Previous experience in a different sion. These set the stage for the next part of the session.
context had demonstrated that where the sessions were In the implementation of an IPE program, the contribu-
arranged so that the input of both groups was not valued, tion by staff to IPE should be recognized by the leaders in
there was a distinct focus on the biomedical aspects of the the medical school and university. Staff need to be committed
topic, the midwifery students had negative feelings about the to the initiative with some staff playing a lead role. In Dun-
value of the sessions and tensions emerged between the two dee, the Vice Principal of the university wrote a personal let-
sets of students. In the Bern anatomy case study (Herrmann ter to all staff concerned. All of the stakeholders including
et al., 2015) both nursing and medical students could actively basic scientists and clinicians and representatives from the
contribute in the context of the use of simulated patients, different professions should be involved. In planning and
ultrasonography and the insertion of a stomach tube. While implementing the IPE program it is important to include stu-
medical students had more theoretical knowledge, the nursing dents in both the planning and delivery of the program. The
students had more experience of practical procedures. This concept of students’ engagement and contribution to the cur-
contributed to the success of the programme. riculum as partners rather than just consumers has attracted
It is important in the implementation of IPE that an edu- increasing attention and indeed is one of the areas where
cation environment is created where IPE is valued. This can excellence in education in a medical school is recognized in
be achieved in a number of ways and should be clearly the ASPIRE-to-Excellence initiative (ASPIRE, 2015). Student
reflected in the school’s vision and mission statement. In cre- led interprofessional sessions in a study from the Mayo Medi-
ating a supportive education environment, Willhelmson et al. cal School involved medical and physical therapy students
(2010) suggested that “the most fundamental issue is that the (Hamilton et al, 2008). At the University of Iowa, physical
organization and faculty sympathize with IPE. A positive atti- therapy students designed and taught a focus session on mus-
tude to IPE within the faculty from dean to professors, lec- culoskeletal clinical anatomy to medical and physiotherapy
turers and teachers, is one of the main pre-requisites for a students (Shields et al., 2015). Peer learning as part of an IPE
favorable reception of the IPE project amongst students.” initiative allows students to develop confidence in teaching in
Interprofessional education ideally should be embedded in their area of expertise and this fosters mutual respect and
the curriculum as a core program and should preferably fea- knowledge of other students’ repertoire of anatomical knowl-
ture throughout the curriculum from year one to the final edge and passion (Youdas et al., 2015). Student involvement
year. Learning opportunities and learning resources should be in the planning and delivery of the IPE program is a feature
made available that facilitate interprofessional learning and it of the reports in this issue (Herrmann et al., 2015; Fernandes
is essential that the assessment reflects the interprofessional et al., 2015).
experience. As Knight (1995) has argued “Assessment is a Not only must there be a clear vision relating to the incor-
moral activity. What we choose to assess and how shows poration of IPE and a carefully planned and executed imple-
quite starkly what we value.” We need to assess not only the mentation strategy, any negative mind-set of both staff and
student’s knowledge and understanding of anatomy, but also students must be tackled. The potential barriers to IPE need

Anatomical Sciences Education JULY/AUGUST 2015 293

to be addressed at a leadership level (Kirch and Ast, 2015). 2006, AMEE Lifetime Achievement Award in 2010, and
Views that must be rebutted and which contribute to an Cura Personalis Award by University of Georgetown in 2013.
image problem for IPE include academic elitism, that IPE
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