Considering the History of Interprofessional Education and Practice in the United States.

Abstract

In recent years, a number of historians of nursing and have asked whether our field might more appropriately and inclusively be renamed the history of health care.1 To outsiders, history of medicine appears to reinforce conceptual and professional silos that have historically privileged the role of physicians, Western medicine, and disease over more integrative accounts of caregiving, diverse epistemologies of healing, and health. Today, the mantra that interprofessional education and practice are the future of health care offers an explicit invitation to move beyond the disciplinary and professional silos often replicated in our approach to health-care history. While nurse-physician relationships have received considerable attention from historians, this section expands on that base to explore the history of the development of interprofessional education and practice more broadly.Five of the seven papers in this special section were presented at a lunch session on the history of interprofessional education and practice at the annual meeting of the American Association for the History of Medicine (AAHM) in 2014. As the authors document, the concepts of teamwork and interprofessionalism are not new, although, as Julie Fairman points out, the term interprofessional is of more recent coinage. The case studies here help establish the range of precedents and the varied contexts across the twentieth century for both informal learning and working together and more formal interprofessional teams that arose in response to the efficient organization of care, workforce issues, and demands for health-care delivery. This timeline departs from the tendency of practitioners to locate interprofessionalism primarily as a post-World War II movement best characterized by the development of advanced practice nursing, physician assistant programs, and specialized units and teams in hospitals.2 Taken together, and supplemented by the lively discussion at the AAHM session, these articles elucidate key themes emerging from the historical examples of interprofessional education and practice and suggest an agenda for further exploration.Inherent in the appeals for interprofessional education and practice, as Fairman notes, is the assumption that changes in education and practice will be a magic bullet producing new epistemologies and increasing quality of care. This must be disaggregated into more specific questions about what interdisciplinarity and interprofessionalism mean in practice. Are there problems that require a particular combination of knowledge and skill that cannot be solved any other way, such as the physiology and diet research questions posed by Ancel Key's Laboratory of Physiological Hygiene or the treatment decisions that benefit from bringing together pharmacists and clinicians at the bedside? To what extent must members of health-care teams master the knowledge base of the other professions represented, as exemplified by the clinical pharmacist curriculum and training for nurses in a range of medical skill sets as preparation for team practice? Can interprofessional teams function purely with the combination of individual professional expertise, on the model of rehabilitation? Where and why are new hybrid professions like nurse practitioners and physician assistants required? Is there a secondary implication that interprofessional practice will also be more holistic or ecological in its approach? Daniel Brauner's article on the cardiac arrest protocol suggests that interprofessional teamwork in the hospital can also produce greater biomedical reductionism, running against the trend toward holism fostered by interprofessional teams for family and community-based patient care.The articles also engage the reciprocal, shaping relationship between interprofessional practice and sites of care-the containers for health-care delivery. Beth Linker discusses the spread of rehabilitation units in hospitals, and Jennifer Gunn looks at the rise of community health centers, as an alternative to rural hospitals, designed to accommodate the need for a different interprofessional mix in the face of scarce physician labor. …