This is an excerpt from Interprofessional Education and Collaboration by Jordan Utley,Cindy Mathena & Tina Gunaldo.
By Cindy Mathena
Just as enablers or opportunities have been outlined in the literature as being necessary for success, some barriers exist as well. Many are obvious and include professional cultures promoting silos or stereotypes, use of different language and terminology, accreditors, and a required prescribed curriculum.5,7 Students are educated as they always have been, in schools of nursing, colleges of social work, and departments of athletic training. One can walk into any hospital or medical facility and find that tribalism is still alive and well.13 Nurses are still holding nursing meetings, OTs still have their own department, and PTs are still working at their desks next to each other. This solo work commonly leads one to think of working in a silo. Socialization, communication, IPE, and IPCP are some of the more obvious solutions to this barrier.9,14
Collaboration by the health care team can come at a cost and is difficult to achieve in a hierarchical team where some are seen as the leaders (physicians) and others as the team. A large number of studies validate the presence of professional stereotypes and cultures in the health care workplace.9,13,14 Many argue the solution to silos rests on the shoulders of the educational institution. Learning environments must be created that encourage real-life scenarios where students can learn the complexities of communication and problem solving with other professionals and as a team.
Accreditation requirements can be another barrier, though it should be pointed out that accreditors are also in a position to enable IPE. In the same way we see health care professionals working in a silo, accrediting agencies that certify educational institutions and programs have also historically worked alone. Standards for accreditation are often so prescriptive that little room is left in the curriculum to explore the roles and language of other professionals. Several studies cite limitations in curricula focused on discipline-specific skills and knowledge as a barrier to IPE. Because curricula are often well defined by professional accreditors, integrating other professions and competencies can be challenging.10,15 If universities and institutions play a primary role in the integration of IPCP into the preparation of students in health care, accreditors may have the biggest opportunity to create impactful IPE. It has been suggested that this would include an intersection of accreditors with overlapping standards.
Accreditors occupy a unique position, working within and across professions and health care delivery settings to promote interprofessional collaboration in education and care. Those who work within individual health professions and those accreditors working in different health care delivery domains should look to cross professional and delivery divides for more integrated approaches to the evaluation and regulation of education and clinical practice.15(p2)
Inconsistent and varying terminologies have been recognized as a barrier to IPCP and IPE. In the authors' experience, we have encountered students across health care professions who claim this to be the most significant barrier to IPCP in the health care setting. And while the terminologies used by each discipline may widely vary, our students state that it is important to begin discussions about these differences in the classroom.
Separate to this conversation about terminology is the need to understand that the interpretation of IPCP and IPE may vary by discipline. One study found that nurses and physicians in the operating room defined collaboration very differently. Nurses interpreted it to mean influencing team decisions, whereas physicians interpreted it as meaning their directions would be followed by the other disciplines on the team.16
Additional barriers to IPE implementation were noted in a study of nursing and medical students' perceptions of enablers and barriers. Those barriers included varying knowledge levels, low mutual respect between professions, and capacity and legal issues.7