Centralized and Decentralized Organizational Models of Interprofessional Education for Physical Therapist and Medical Students

Abstract

Background and Purpose. Although there has been extensive discussion on the need for interprofessional education (IPE), available literature that addresses organizational models for its structure and implementation is limited. The purpose of this article is to describe the implementation of IPE at the University of South Florida (USF) College of Medicine, through the lens of organizational structure and change. Model Description and Evaluation. The University of South Florida College of Medicine has employed IPE for students in the medicine and physical therapy programs since the fall of 2005. This article describes the IPE program at USF, the 2 underlying organizational models-centralized and decentralized-of IPE, and the advantages and disadvantages of each model. The authors make the case that interprofessional organizational structures and decision-making processes are necessary for the long-term sustainability of IPE. Like learning experiences, organizational support is a part of the interprofessional continuum and can be classified as unprofessional, multiprofessional, or truly interprofessional. Outcomes. Preliminary results indicate that centralized and decentralized models have both benefits and drawbacks. Organizational decision-making processes in our program have become more interactive and interprofessional, resulting in fewer logistical barriers, a greater number of champions, and more IPE opportunities for students. Results from the disability experiences suggest that the learning experiences have been successful in stimulating interaction between students from different professions around the shared issue of disability, but not as effective in stimulating discussion around profession-specific perspectives on disability, which is vital to future teamwork. Discussion and Conclusion. Implementation of a centralized model of IPE requires organizational commitment and culture change, but holds the greatest potential for sustainable long-term change for students, faculty, the implicit curriculum, and educational outcomes. Key Words: Physical therapy education, Medical education, education, Implicit curriculum, Organizational change. BACKGROUND AND PURPOSE As defined by the Centre for Advancement of Education (CAIPE), Interprofessional education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care.1 education (IPE) is often contrasted to uniprofessional education (the focus on a single profession with no or little interaction) and multiprofessional education (a parallel education with some interaction between professions).2,3 Schmitt4,5 has described the cyclical rediscovery of interprofessional or interdisciplinary education within health care over the last 60 years. She notes that the Institute of Medicine (IOM) issued one of the early calls for IPE in the report of its first meeting in 1972.4,5 Within this historical context, there appears to be renewed focus on the need for interprofessional competence and practice, as well as IPE to develop these competencies. In 2003, IOM issued a call for enhanced IPE: All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.6 Hammick et al7,8 reviewed literature on IPE for the purpose of identifying high-quality studies, classification of outcomes (ie, positive, negative, or neutral), and discussion of the mechanisms associated with positive and negative outcomes. In the 2007 review,7 they classified the studies according to the model proposed by Freeth and Reeves2 and adapted from a model of learning developed by Biggs.9 The 3-P model proposes 3 major components for consideration in the development of interprofessional-learning experiences: Presage, Process, and Product Table 1 summarizes the types of factors involved in each component. …