Yes, interprofessionalism is a real thing, with a body of knowledge and behaviors that can and should be taught—providing, of course, that physical therapist (PT) education programs truly understand it and make room for it, which may depend on how it is used in practice, which may have something to do with how the real-world models do and don't incorporate PTs, which may mean that programs need to retool their efforts, which may require a new approach to how it's measured, which may have something to do with … well, it's complicated.
This year's Rothstein Roundtable on June 13 offered an engaging dialogue around the multidisciplinary team. Titled "Interprofessionalism: Is It Campfire Kumbaya or the Means to the Triple Aim (Better Health, Better Care, Lower Cost)?" the session touched on the constellation of issues that must be considered if PTs are to take a truly meaningful role in a concept deeply intertwined with the health care system's move toward value-based models of care.
Led by moderator Anthony Delitto, PT, PhD, FAPTA, roundtable panelists Mary Knab, PT, DPT, PhD, Holly Wise, PT, and Arron Friedman, MD, shared their own experiences and insights as Delitto walked them through a series of questions that moved beyond the debate over whether interprofessionalism skills should be incorporated into PT practice and into just how that might happen.
Panelists quickly agreed that interprofessionalism itself isn't mere feel-good sentiment, but rather an increasingly important reality of current practice. Given that reality, the discussion turned to just how interprofessional skills could be taught. Everyone seemed to be in agreement about 1 thing: most current efforts aren't up to snuff, with Delitto describing a particular "interprofessionalism" class that simply put students from multiple health care majors into "1 big room," gave them a case, and asked them to talk about it. "We received less than stellar reviews from the students," he wryly added.
Friedman pointed out that to approach the issue in a useful way, it's important to rethink interprofessionalism not as a discrete concept but as a foundational element that needs to be woven and reinforced throughout an education program. "The question of when [to introduce interprofessionalism] doesn't really get to the point," he said. "This should be … a part of the curriculum that begins right from the beginning."
So, Delitto asked, does that mean that interprofessional instruction needs to be rebuilt from scratch? Friedman said no, but programs would need to create some curriculum space in order to make a genuine effort. This shouldn't be too difficult, he said, because "They have plenty of room—they just have to figure out what they're willing to get rid of."
Knab agreed with Friedman, but she wondered if the real challenge would be for faculty and even students to reevaluate their own attitudes about program content. "I think there are faculty [and students ]who have trouble letting go," she said. The real problem may have more to do with how to change expectations and assumptions.
Next Delitto asked the panelists to imagine that they've cleared those hurdles, made room, and were ready to create an approach to interprofessionalism. What next?
Wise, who had emphasized the importance of communication early on in the discussion, said that "bringing together all stakeholders" is crucial. Friedman advised, however, that health care programs "don't have to reinvent this" and suggested that some business schools provide good models. The bottom line, he said should be that "we're not going to make school longer" in order to include interprofessionalism. "There's only 1 way to do it—you've got to offload something else."
So, Delitto asked, if it's truly a matter of getting stakeholders across disciplines involved in interprofessional skills development, does that mean that physical therapist programs should encourage teaching from other professions "without a PT there?"
"That's a really interesting concept that bears discussion," said Wise. The other panelists agreed, with Knabb saying that "yes, [students] can be mentored" by non-PTs, but programs need to be attuned to what these mentors are teaching.
Delitto's final question was how to best back up the claim that interprofessionalism improves outcomes and lowers cost—just how is that to be measured?
Knabb pointed out that most of the measurement activities that have occurred so far within physical therapy have been more about PT attitudes about interprofessionalism and their satisfaction with what they've been taught. Wise agreed, saying that in doing research for the interprofessional program she's developing, she's found a lot of "perception research," and information that's more anecdotal and less about actual care.
Audience comments and questions tended to focus on how PTs could be brought to the interprofessionalism table. Delitto acknowledged that this was a challenge—when PTs aren't included in interprofessional teams, their effectiveness can't be demonstrated. Without a demonstration of effectiveness, it's hard to be included in a team. The key, Delitto believes, is to continue to demonstrate quality through documentation of outcomes in the profession. When it comes to getting included in interprofessional models, "I think practice does this rather than knocking on the door and trying to scream loud enough," he said.
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