Interpretation and Implementation: Victim Advocates’ Perceptions and Experiences Working with Marsy’s Law

PurposeAs the response to sexual assault victims proved to be shattered and substandard, sexual assault centers were set up to improve care by providing the victims with medical, psychosocial and legal care. The Dutch Centers for Sexual Assault were launched in 2012. We wished to examine the challenges in interprofessional collaboration experienced in a long-running Dutch Sexual Assault Center.MethodsIn this qualitative study, data was collected via semi-structured explorative interviews which were analyzed using thematic analysis in an iterative process. The semi-structured interviews were held with fifteen professionals from medical, psychosocial and legal disciplines. An interview guide was developed based on expert opinion and the Bronstein Index of Interprofessional Collaboration. Qualitative analyses were done using the method of thematic analysis in ATLAS.ti and were reported according to the COREQ criteria. The themes of the experienced challenges in interprofessional collaboration were further clarified using quotations.ResultsParticipants mentioned three themes that challenged interprofessional collaboration: 1. discrepancies in professional involvement, 2. conflicting goals and 3. a lack of connection. Discrepancies in motivation and affinity to work with victims of sexual violence between professionals proved to be the most pivotal challenge to collaboration, leading to disturbing differences in professional involvement. A low caseload and time restraints complicated gaining expertise, affinity and motivation. Conflicting goals and confidentiality issues arose between the medical and legal disciplines due to their contrasting aims of caring for victims versus facilitating prosecution. Some professionals felt a lack of connection, particularly due to missing face-to-face personal contact, which hindered the sharing of complex or burdensome cases and gaining insight into the other discipline’s competences.ConclusionBuilding collective ownership and equal professional involvement are crucial for interprofessional collaboration. Professional involvement should be increased by training courses to clarify conflicting goals and to improve reciprocal personal contact between professionals. Training courses should be facilitated with organizational financial support.

The purpose of this study was to examine the role of victim alcohol use and partner-perpetrator on interprofessional collaboration on Sexual Assault Response Teams (SART). Telephone surveys with 78 medical, criminal justice, and victim advocacy professionals were conducted. When asked to identify case factors that pose challenges to interprofessional collaboration, 48.7% mentioned victim characteristics and 28.2% mentioned situation characteristics. Significantly more victim advocates identified aspects of the victim's behavior before the sexual assault as a challenge to collaboration compared to criminal justice professionals. Using vignette methodology, professionals anticipated more disagreement between SART professionals on the hypothetical case involving victim alcohol use and a partner-perpetrator compared to a hypothetical stranger/no alcohol case, with victim advocates rating agreement significantly lower than other professionals. Finally, professionals who perceived of more disagreement between professionals when discussing the vignettes also perceived of lower interprofessional collaboration on their SART. Implications for practice and research are discussed.

Patients' engagement in interprofessional telehealth collaboration for chronic diseases management in primary care: A patient perspective.

Sexual and family violence are problems that affect many women and men, and the negative health consequences of violence are numerous. As adequate acute interprofessional care can prevent negative health consequences and improve forensic medical examination, a Centre for Sexual and Family Violence was set up. We aimed to improve our understanding of the challenges in interprofessional collaboration in a newly set-up centre for sexual and family violence. We conducted a qualitative study with semi-structured interviews about the experiences with interprofessional collaboration of 16 stakeholders involved in the Centre for Sexual and Family Violence Nijmegen. Participants were selected by purposive sampling. Participants found that the interprofessional collaboration had improved communication and competences. However, there were challenges too. Firstly, the interprofessional collaboration had brought parties closer together, but the collaboration also forced professionals to strongly define their boundaries. Mutual trust and understanding needed to be built up. Secondly, a balance had to be struck between pursuing the shared vision - which was to improve quality of care for victims - and giving space to organizations' and professionals' own interest. Thirdly, care for victims of sexual and family violence could be demanding on healthcare providers in an emotional sense, which might jeopardize professional's initial motivation for joining the Centre for Sexual and Family Violence Nijmegen. The interprofessional collaboration in an assault centre improves quality of care for victims, but there are also challenges. The tasks of an assault centre are to create opportunities to discuss professional roles and professional interests, to build up good interpersonal relations in which trust and understanding can grow, to formulate a strong and shared victim-centred vision and to support care providers with training, feedback and supervision.

BackgroundThe implementation of effective interventions targeting problematic drinking in healthcare and social care remains limited, leading to fewer people changing their problematic drinking patterns. Improving interprofessional collaboration could enhance implementation of interventions targeting problematic drinking, yet a comprehensive understanding of interprofessional collaboration in the Netherlands regarding these interventions is currently lacking. This study set out to identify perceptions and experiences with interprofessional collaboration and the implementation of interventions targeting problematic drinking among professionals working in healthcare, social care and public sectors in a region of the Netherlands where problematic drinking is a known challenge.MethodsGuided by a phenomenological perspective, we conducted a cross-sectional interview study with 22 professionals. Semi-structured interviews were recorded and transcripts were analysed for themes using Atlas.ti.ResultsParticipants described their roles in interprofessional collaboration as minimalists (i.e., working strictly task oriented), brokers, or skilled networkers depending on their function and their perception of task and role fulfilment as a professional. Accessibility, clear role definitions, and leadership were identified as key to initiating and maintaining interprofessional collaboration. Challenges in interprofessional collaboration included regional, financial, or professional boundaries. Additionally, participants who were insiders of regional collaboration structures found these structures beneficial to interprofessional collaboration, while outsiders perceived them to be an impediment to collaboration and information exchange.ConclusionsInterprofessional collaboration structures seem to enhance collaboration among professionals, and, as a result, enhance the implementation of interventions targeting problematic drinking. Management of healthcare, social care, or public sector organizations should recognize that outsider-organizations may have limited access to these structures. They should therefore appoint network-oriented professionals to act as brokers, linking external organizations to enhance collaboration and information exchange. Additionally, organizations should provide flexible scheduling for their professionals so that they can concentrate on tasks beyond their immediate responsibilities, which will contribute to interprofessional collaboration and early detection of problematic drinking. Lastly, further research on intervention implementation should focus on expertise-development within teams to improve interprofessional collaboration, and consider how the perspectives of populations at risk for problematic drinking can be incorporated into collaboration-structures.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13552-5.

So Long, Silos

Pursuing Excellence: Innovations in Designing an Interprofessional Clinical Learning Environment.

The effectiveness of interprofessional education in university based health professional programs: A systematic review.

The effectiveness of interprofessional education in university based health professional programs: A systematic review

Interprofessional collaboration (IPC) among professionals in occupational health (OH) services is crucial when rendering a service to clients and customers. The aim of this study was to describe and compare perceptions relating to IPC among professionals working as OH providers in Sweden. This cross-sectional study with a descriptive and comparative design included 456 respondents representing different OH professions in Sweden. Data were collected using the Swedish short version of the Assessment of Interprofessional Team Collaboration Scale adapted for OH ([AITCS]-SII[OH]), with its 3 subscales Partnership, Cooperation, and Coordination, and were analyzed and presented descriptively. Items and sum scores were dichotomized into inadequate and adequate and compared between sexes, workplaces, types of employment, and professions. According to the responses, items related to openness, honesty, and trust were perceived as adequate among the respondents. The findings show that perceptions about IPC differed among the professions. The perception of IPC also differed between different types of organizations. The results show diverse perceptions between professionals and organizations. The perception of IPC may be influenced by the professional's education in occupational safety and health. Study findings may be used to support further development of IPC in the OH service for the benefit of the clients. To develop IPC in the best interests of both professionals and customers/clients, further studies need to be performed to gain a deeper understanding of IPC in the OH context.

The Norwegian Correctional Service is well known for its focus on rehabilitation and the humane treatment of offenders. However, welfare issues and comorbidity are overrepresented among offenders, and recidivism rates remain unacceptably high. Mental health problems, substance abuse and a lack of housing suggest that offenders need support from a range of services in their reintegration processes. This calls for collaboration between frontline workers, welfare agencies and non-governmental organizations, especially in the transition from prison back into society. In the present study, we aim to explore frontline workers’ views of interprofessional and interagency collaboration among frontline workers working with offenders suffering from substance abuse issues in their reintegration after prison. Semi-structured interviews were conducted with nine frontline workers employed in welfare agencies and the correctional service, with workers directly engaged in supporting offenders´ reintegration after prison. Findings suggest that interprofessional collaboration is perceived as multifaceted. The participants in the study perceived the welfare needs of offenders as complex, and the transition phase from prison as particularly vulnerable. Finally, findings suggest that frontline workers’ individual values and engagement in the work, as well as a lack of shared knowledge and shared information among frontline workers, are perceived as important factors in how collaboration processes unfold. We further argue that there is a need for additional knowledge, such as theoretical frameworks and conceptual models, to increase the understanding of interprofessional collaboration in the interface between prison and welfare services. We discuss substance abusers’ transition from prison into society and interprofessional collaboration in this context, using relational coordination as a theoretical framework. This study shows that relational coordination contributes to a greater understanding of interprofessional collaboration in the prison-welfare context, but an understanding of this phenomenon may be further developed by expanding the theory of relational collaboration, and by using other relevant theories and models. New insights are presented and illustrated, combining the theoretical and practical aspects of interprofessional collaboration.

Understanding how previous experiences with interprofessional education and collaboration inform health care provider perspectives is important for developing interprofessional interventions at the graduate level. The purpose of this study was to examine how previous work experiences of graduate level health professions students inform perspectives about interprofessional education and collaboration. Drawing from program evaluation data of two separate graduate level interprofessional education interventions based in primary care and home health care, we conducted a qualitative secondary data analysis of 75 interviews generated by focus groups and individual interviews with graduate students from 4 health professions cadres. Using directed content analysis, the team coded to capture descriptions of interprofessional education or collaboration generated from participants’ previous work experiences. Coding revealed 173 discrete descriptions related to previous experiences of interprofessional education or collaboration. Three themes were identified from the analysis that informed participant perspectives: Previous educational experiences (including work-based training); previous work experiences; and organizational factors and interprofessional collaboration. Experiences varied little between professions except when aspects of professional training created unique circumstances. The study reveals important differences between graduate and undergraduate learners in health professions programs that can inform interprofessional education and collaboration intervention design.

BackgroundCoordinated, multidisciplinary care is essential when addressing the complex needs of an aging population, with prehospital emergency care providers often serving as a common point of contact. Addressing complex care needs while maintaining continuity of care necessitates seamless collaboration between diverse healthcare providers. Despite this, there is limited research on interprofessional collaboration in prehospital care of older patients with complex needs. Understanding what influences interprofessional collaboration and identifying areas for improvement are vital for optimizing prehospital care for this vulnerable population. This study aimed to explore ambulance clinicians' perspectives on interprofessional collaboration in prehospital emergency care for older patients with complex care needs and to identify key factors influencing collaboration.MethodsAn explanatory sequential mixed-methods design was employed in this study, conducted in southern Sweden. In Phase 1, quantitative data were collected via an online survey completed by 118 ambulance clinicians (ACs). Descriptive statistics, chi-square tests, and Kruskal–Wallis tests were used to analyze the data. Qualitative responses were analyzed through inductive content analysis, informing the development of an interview guide. In Phase 2, semi-structured interviews were conducted with 20 ACs and analyzed using inductive content analysis. Findings from both phases were integrated using a joint-display matrix, combining quantitative patterns with qualitative insights for a comprehensive interpretation.ResultsQuantitative findings revealed that although collaboration with patients' families and care staff was generally rated as satisfactory by ACs, significant challenges were reported in coordinating care with other healthcare actors, especially home care nurses. About 89% of respondents reported insufficient access to patient information, highlighting difficulties in retrieving such information. Qualitative data underscored the importance of comprehensive patient information for effective decision-making and alignment with patient preferences and care goals. The integrated analysis identified three key factors influencing interprofessional collaboration: defined goals of care, access to information, and clarity in roles and responsibilities. Challenges in maintaining continuity and responsiveness, particularly during night shifts, were emphasized as barriers to effective collaboration.ConclusionAddressing deficiencies in nighttime care coordination, improving access to comprehensive patient information, and strengthening communication pathways between healthcare providers are essential steps in improving interprofessional collaboration to strengthen prehospital care of older patients with complex care needs.

Interprofessional collaboration (IPC) in primary healthcare is important because each patient's health needs are complex, and one health professional can't meet all of the patient's needs.1 However, IPC isn't usually an option because individual work is perceived to be easier, although it may not optimally meet the needs of the patient. Previous studies have described IPC in Indonesian healthcare settings. One study that used mixed methods identified perceptions of IPC among practitioners in the Depok area.2 A qualitative research study in South Sulawesi found that IPC was being practiced in the management of nutrition problems.3 Other studies have identified the factors influencing IPC in East Java and East Nusa Tenggara.4,5 The purpose of this study is to use a phenomenologic design to evaluate healthcare professionals' experience with IPC and to answer the research question: What are the processes for, barriers to, and expectations of IPC in family health services? The family health program in Indonesia's primary healthcare is an essential program of the public health center that has been supported since 2016 by the policy of the Minister of Health to improve health coverage. It uses a cross program and sector collaboration approach; however, it doesn't yet include a collaboration guideline. Method This research uses a descriptive phenomenologic approach. The researcher described the research process to the person in charge of the family health program during an in-person meeting and then, during an online meeting, explained it to members of the family health team who were potential participants at three health centers in East Jakarta. The inclusion criterion for this study was that the health workers (nurses, physicians, midwives) had to have worked as a team for at least 6 months. The person in charge of the family health program recruited potential participants and distributed the G form link. The researcher had created the G form, which contained an explanation of the research process and a section for willingness or unwillingness to participate. When a potential participant voluntarily agreed to participate, a researcher contacted them via WhatsApp and asked about an appropriate time and method for the interview. A researcher conducted semi-structured in-depth interviews via video call, using guidelines that focused on the processes, barriers, and expectations of collaborative practice (See Table 1). Almost all of the interviews took place in the participants' offices; a few took place in their homes. The interviews lasted for 34 to 100 minutes; they were recorded and stored on a laptop. Table 1: - Interview questions General question: Could you tell us about the team's experiences in interprofessional collaboration in implementing the family health program? Specific questions: How did the team carry out interprofessional collaboration? How was the process? What were the barriers? What were your hopes for the continuation of the collaboration process? Researchers used Colaizzi's seven stages for data analysis.6 The data are considered valid because the study was carried out according to the criteria of credibility, dependability, confirmability, and transferability. This study received ethical approval from the Research Ethics Committee, Faculty of Nursing, Universitas Indonesia, number SK-284/UN2.D1.2.1/2020ETHICS. Results Of the 53 potential participants who voluntarily stated a willingness to participate, 35 participants agreed to the time and method of interview via video. The other 18 potential participants didn't state a clear time to be interviewed. Saturation occurred with the 22nd participant. These 22 participants consisted of 5 nurses, 11 physicians, and 6 midwives, all 27 to 35 years old, with team experience ranging from 1 to 5 years (see Table 2). Through these interviews, researchers found four themes that describe the experiences of the healthcare workers using IPC. Table 2: - Demographics data for participants (N = 22) Characteristics Categories Frequency Percentage (%) Profession Doctor 11 50 Nurse 5 22.7 Midwife 6 27.3 Total 22 100 Sex Female 20 90.9 Male 2 0.1 Total 22 100 Age (years) <30 10 45.5 ≥ 30 12 54.5 Mean/Total Mean = 29.6 22 100 Experience (years) < 6 22 100 ≥ 6 0 0 Mean/Total Mean = 3.8 22 100 Theme 1: Perception of collaboration The participants associated collaboration mostly with activities in which they worked together. Some participants emphasized responsibility carried out according to the duties, roles, and functions of each profession; others focused on helping each other complete team tasks. Four participants indicated that tasks were completed by a competent professional with appropriate responsibility. Five participants perceived that collaboration meant duties were carried out together to achieve the objectives of these projects. Participant statements included: "...according to our respective tasks... I [a doctor] do the anamnesis and inquiry... nurses do physical examination; midwives perform other assessment if there is a pregnant woman." (P.9) "Teamwork...the nurse...has the role of...physical examination; ...midwives...are very needed...so that pregnant women...everyone is healthy...until the time to give birth; ... physicians also have the roles [of]...prescribing medicine...[and] establishing [a] diagnosis...everyone has their own role but are interrelated and [indeed] need and complement each other." (P.19) "We work as a team... work together...I involve all, so everyone participates in the activity." (P.13) Therefore, collaboration is perceived as two or more different processes aimed at completing team tasks. Theme 2: Teamwork mechanism Most participants mentioned that teamwork was implemented through a series of coordinated activities that not only involved the health team and the health center leader, but also community leaders, informal health workers, and families. Participant 13 said: "Coordinating with the head of the health center, with my team ... with other health center [village level] ... coordinating with the sub-district health center because ... they are the ones I have to report every month...cross-sectoral coordination... to informal community leaders, informal care workers." These coordinated activities included task orientation, program socialization, preparation, data collection, initial interventions, dissemination of data collection results, follow-up interventions, evaluation, and dissemination of implementation and evaluation results. Each stage reflected coordination and communication among teams and with related programs and sectors. Personal perceptions and the health center system were found to be barriers to teamwork. Theme 3: Internal and external barriers Some participants noted that selfishness was the major internal barrier, whereas limited support was said to be the major external barrier to working as a team. Selfish behavior was shown in several ways: not communicating, not handling input well, reluctance to help with the main task, and individualism. Participants described this behavior as: "...not being open to talk about, from their attitude...not being open or not talking... Their attitude is unpleasant ..." (P.9) "The kind of attitude are the most stubborn, egoist ..." (P.13) "... he/she didn't want to go down [carrying out home visit or health services outside the building]... For various reasons it is not going down" (P.19) "Big egos. Even though we work as a team...stubborn...and individualist." (P.20) These characteristics contributed to a negative view of IPC. Misperceptions of the program and limited health personnel were the major causes of a lack of support from the health center system. Participants mentioned that other health personnel didn't think that family services were mandatory for the health center. Participants also said that if a team manages one program, this makes the workload fall disproportionately to the health workers in other programs. Specific comments included: "Because the tasks are different...the team...like, one task can be done by many people." (P.10) "Many people don't know about it (family health program) ...they only know that we just go down the field and collect data...not familiar with our roles." (P.21) "They (other health workers) think that our program (family health) is not an essential program for the health center..." (P.9) "...family health program is a program of the Head of Department...the assumption is that when a Head of Department changes, the regulation will also change..." (P.21) Members of the team were also given additional tasks in both individual and community services. These additional tasks prevented the team from performing their main tasks, as stated by the participants: "... (It) disturbed because ... double job... not purely [doing one main job] ... I [am] responsible to [the] community program and health promotion too..." (P.13) "Limited human resources...while there are lots of programs ...lots of activities... it's written in the decree as family health team [tasks], but in reality, it's not like that..." (P.20) "What the health center lacks of [health staff] ...we can't promise [that we can do] home visits." (P1) "...sometimes there's a shortage of staff to do indoor activities...so those who went down [to] the field [weren't] a complete [team]..." (P.10) These barriers to IPC implementation prompted questions about its sustainability. How can teams become dynamic and tough? What can teams do to make themselves stronger? How should this program be integrated and socialized? Theme 4: Expectations for a dynamic and tough team, team strengthening, and program integration and socialization Participants mentioned that a dynamic and tough team was needed to sustain IPC in family services because they faced challenges related to the personal characteristics of team members and having so many different client needs. Many participants mentioned that the team required each member to be strong mentally and physically, handle various needs, and respond quickly to meet patients' needs. Participants said: "We really have to back each other up, keep [each] other mentally and physically strong." (P.18) "We have to handle [many needs]...similar to [an] octopus [with many] tentacles, it can do anything." (P.19) The team's ability to deal with these demands can be fostered by providing training and education to build various skills, so the team can become stronger and more resilient. These requirements also highlighted the need for self-development to strengthen the team's capacity. Some participants mentioned that training was needed for self-development, both in the context of clinical skills and teamwork skills: "Training about teamwork or leadership...seems necessary to improve our skills..." (P.19) ".. training for skills...in the field...we have to rack our brains. We really want to...have our own ... tools..." (P.21) Team members' experience of IPC along with their additional assignments generated expectations related to program management in the form of program integration and socialization. The purpose of the family service team is that the family is the smallest unit in society and public health services should include family health. Participants expected that there would be program integration in terms of data and management. Some participants said that data from the families became necessary for all programs, which would require integration of the data collection and utilization system. Participants also hoped that management of the public health service would be integrated with family services, along with the integration of teams and activities. They stated: "By collecting data...it can be useful for other health programs...between the data and the existing programs should be connected." (P.10) "...the data should have been integrated from the health center database for all program chief[s]......[I] want everyone to know too..." (P1) "We can collaborate on almost all activities...almost all public health programs have family program member[s] who go down...also helping the health center performing outdoors activities..." (P.13) "Public health programs really need the family health team. Because the family health team has the data..." (P.10) Integration doesn't mean fusing into one but getting to know one another and supporting each other to help achieve the goals of the institution. This requires program socialization, as mentioned by the participants: "Socialization about the program...to the health center staff...should be increased...with one specific name that people know." (P.9) "... [increase] socialization that we are truly official, staff from the health center..." (P4) Getting to know each other promotes mutual respect and has an impact on the strength of the organization as a program entity. Discussion Exploring experience of IPC practices in family services at the three health centers in East Jakarta resulted in interrelated themes. Perception of collaboration. The nurses, physicians, and midwives who participated in this study perceived IPC as a process of cooperation to complete team tasks. Coordination is used if the professional authority says that it's needed. IPC is used with the terms "multidisciplinary and interdisciplinary."7 In a multidisciplinary approach to patient care, practitioners and nurses each carried out specific tasks to provide comprehensive services; in an interdisciplinary approach, practitioners and nurses worked together to provide effective care.7 Results of a literature review indicated that cooperation is relevant to an interdisciplinary approach. Teamwork mechanism. To organize a family health service, the teamwork mechanism involved nine steps: task orientation, program socialization, preparation, data collection, initial interventions, dissemination of data collection results, follow-up interventions, evaluation, and dissemination of implementation and evaluation results. This teamwork process is in line with the mandate of Program Indonesia Sehat Pendekatan Keluarga (PISPK), Family Approach Program, initiated by the Ministry of Health, which includes the following six activities: data collection; creating and managing databases; analyzing the data, formulating interventions, and developing plans; carrying out home visits; carrying out health services inside and outside the building; and implementing an information and reporting system.8 Internal and external barriers. In the practice of teamwork, the challenges for practitioners include the adjustment to collaborative work, which depends on the willingness and commitment of members.9 Selfish attitudes can occur because the healthcare professionals are used to working alone and aren't ready to work together. Being responsible for more than one program can also be a hinderance for collaborative work because additional tasks can prohibit team members from carrying out the main task of providing family services. The root of this problem is that there aren't enough health workers to adequately support the number of programs. Another barrier is the perception that the family services program isn't mandatory, so it's not a priority. Conflicts centered on professional disputes are also obstacles to IPC and usually occur due to a lack of understanding of the role of the profession.10 This is in line with one study that says that IPC requires management support, which includes the number and quality of health workers, as well as regulations.3 Expectations for dynamic and tough teams, team strengthening, and program integration and socialization. The complexity of family and community needs demands that the teams be physically and mentally strong and that they can master skills and adapt to the needs of their environments. When two professions collaborate, support is needed for the negotiation of space, place, and rules.11 The team's expectations illustrate that self-preparation is needed to adapt to teamwork and that this transition involves their families and the community. Collaboration and the complexities of family and community needs also demand that the team master leadership and professional clinical skills. Important factors for successful collaboration are trust, respect, and competence in each profession.12 Factors influencing IPC related to treatment plans were patient, professional, interpersonal, organizational, and external factors.13 The expectations for strengthening teams in this study are in accordance with the identified personal and professional factors.13 Expectations for program integration were fulfilled because the team identified program overlaps. The focus of the teamwork is on family-based services, and Program Indonesia Sehat Pendekatan Keluarga is also carried out with a family approach. It's hoped that program integration can be an alternative to overlapping programs. Expectations for program integration are in accordance with the definition of integrated services from the perspective of policy makers and organized management, which focuses on the alignment of policies and management systems applied at the service level.14 Integrated services have implications for the provider and the profession. For providers, integrated services mean that there needs to be a multidisciplinary system that unifies services for clients, so common treatment goals can be achieved. For the profession, integrated services mean that professionals from different healthcare areas work together to provide services. Misperceptions of other staff members regarding the characteristics of family health services have triggered hopes for socialization of legal aspects of the program. Unfortunately, the program isn't a priority because it's not considered to be essential, and there's less personal responsibility because one program is managed by three professions. To ensure IPC in the public health sector, the different roles must be understood.15 Another important principle of implementing effective IPC is understanding each other's perspectives. The limitation of this study was the unequal number and the discrepancy in educational background of participants, that is, physicians, nurses, and midwives; the experiences as a team of less than 6 years; and the relatively young age of the participants. Implications and conclusion Nurse leaders need to be aware that the effective application of IPC practices must be based on the correct understanding of the role of each discipline, organization of mechanisms and processes, and support for implementation. The process of IPC is perceived as an activity of cooperation, oriented to the completion of tasks. Teamwork is carried out for task completion but doesn't necessarily indicate IPC. The main barriers to IPC are self-interest and limited support. When participating in IPC, team members' expectations included having a dynamic and tough team, developing team members' qualities and skills to build a stronger team, integrating programs, and promoting socialization among the different programs. Creating IPC implementation guidelines can be a solution for improving service practices.

Key Points A competent, collaborative, interprofessional team centered on the patient is necessary for quality pain care; however, interprofessional collaborative practice is not yet an integral part of all health professions education programs. Interprofessional education involves 2 or more professions learning "with, from, and about" to enable effective collaborative practice and improve health outcomes. Core competencies and curricular resources are available for interprofessional education and pain and can be adapted for use at all levels of health professions education. 1. Introduction Pain is a complex experience that impacts health, productivity, and well-being. It requires a collaborative team approach with a common language and clear understanding of roles and responsibilities. With few exceptions, a minimum amount of pain content has been documented in health sciences curricula, and much of that has been fragmented by profession and delivered within a crowded agenda of conventional course topics such as anatomy and physiology.21 Most health professionals learn pain management on the job and are often ill-prepared to function as a team member in the real world. Despite documentation of the need for improved education on pain of all types, consistent professional training in pain is not widespread and innovation is warranted. The 2018 IASP Global Year for Excellence in Pain Education is a call to action on multiple levels. The purpose of this report is to describe opportunities for mutual learning through interprofessional (IP) pain education. Interprofessional education (IPE) is a growing trend across health professions and has been defined (Table 1) as when 2 or more professions learn with, from, and about each other to improve collaboration and the quality of care.16 For IP learning to occur, all 3 "with, from, and about" must be present.11Table 1: Operational definitions.2. With others–learning together to facilitate interprofessional collaborative practice The complexity of health care across the globe, technological advances, and modern models of care delivery has created demand for a practice-ready workforce and effective teamwork.31 Medical errors often result from poor communication within and across teams; high functioning teams improve outcomes of care.18 Professional education has not kept pace with increasing demands for collaboration-ready health workers in part because of disjointed, outdated, and static curricula; furthermore, a glaring mismatch of competencies to patient and population needs persists.12 We educate students most often in uniprofessional settings (silos) with little opportunity to learn and practice together. Although learning experiences in the clinic or on a ward offer more opportunities to learn with, from, and about other health care professionals, there may be few role model IP teams in the real environment. Uniprofessional education is inadequate to prepare health care trainees to work in teams and can spur competition rather than cooperation between the professions. Recognizing this struggle, the World Health Organization (WHO) issued a Framework for Action on Interprofessional Education and Collaborative Practice in 2010.34 The report contextualizes existing health systems, commits to implementing principles of IPE and collaborative practice, and champions the benefits of IP collaborations with regional partners, educators, and health workers. Contemporaneously, the Lancet Commissions issued a foundational report12 developed by 20 health profession leaders from diverse countries advancing a common strategy for educational reform in medicine, nursing, and public health. The Lancet Commission calls for education reform that is guided by the desired outcomes of transformative learning and interdependence in education. Transformative learning involves fundamental shifts from fact memorization to synthesis of information for decision making; from seeking professional credentials to achieving core competencies for effective teamwork in health systems; and adaptation of global resources to address local priorities.12 Interdependence stresses the system approach that offers insights into the dynamic and nonlinear nature of a complex system that cannot be gained by studying components of the environment in isolation. This report also underscores the pace, scale, and intensity of globalization impacting interactions of health systems and education. In several countries, collaboration of national associations of health profession regulatory bodies has given rise to recommendations for core competencies for IP collaborative practice designed to guide curriculum development in interactive learning. For example, competencies16 developed by the Interprofessional Education Collaborative (IPEC) in the United States have become part of the global conversation (Table 2). The Global Forum on Innovation in Health Professional Education has hosted a series of meetings engaging stakeholders and policymakers through linked projects and networks in Uganda, South Africa, India, and Europe.8 Updated in 2016, the IPEC competencies integrate explicit population health outcomes with individual care competencies to form an expanded model that targets desirable health system goals. Interprofessional collaboration, in this framework, is the central domain under which the original competencies are arranged. Similarly, the Canadian IP Health Collaborative developed the National Interprofessional Competency Framework in 2010, which has been used in various countries and academic settings.5Table 2: Interprofessional collaborative competency domains.Interprofessional collaboration occurs when learners/practitioners, patients/clients/families, and communities develop and maintain working relationships that enable optimal health outcomes.5 Interprofessional collaborative practice occurs when multiple health workers from different professional backgrounds work together with patients, families, and communities to deliver the highest quality of care. Interprofessional core competencies build on modern educational theory and practice to bring together all health professions with shared language, vision, and goals (Table 3). These competencies are important for positive outcomes, including those we aim for in quality pain care.Table 3: Characteristics of health-focused interprofessional core competencies.10,163. From others—learning from different professions to facilitate collaboration and communication Collaborative approaches are invaluable when pain management is complex, requiring the knowledge and skills of more than one profession. It is logical then, that to work together, future health care workers would benefit from learning together to understand each other's roles and responsibilities and how to communicate using common language. The provision of opportunities for student interaction is fundamental to the learning experience to develop an understanding of the perspective of various professions and to foster a climate of mutual respect and relationship-building values. Interprofessional education requires active learner participation and case-based content that is authentic and foundational to many health professionals.6,26 Although most IPE is focused on prelicensure students, literature is emerging in post graduate clinical education. Themes in the context of back pain in a primary care setting included the context, value of involving the patient, listening, time and learning together.7 The intent is to impact practice and improve quality of health care. 4. About others–attaining competence to use knowledge of one's own role and those of other professions to address pain care needs Pain experience is multidimensional; therefore, pain education draws on not only mechanisms but also a variety of theories such as relational, professionalism, and social constructivism and is grounded in adult learning theory.31,33 The concept of communities of practice and situated learning is also important as students move from learning about their own profession to other professions and members of a team.31 These concepts reinforce a model of multiprofessional team management of pain championed long ago by John Bonica. Learners need to become self-directed, critical thinkers and reflective practitioners, able to function as members of teams, and be good communicators, adaptable to change and continuing to learn through professional experiences.3,22 Interprofessional education is not a replacement for education specific to each profession, a reason to lose individual professional identity, the only innovation needed in the health system, and an end in itself. We do not do IPE for its own sake; we do it to help understand each other's roles and contributions to work together in a real-world practice setting. 5. Barriers to overcome A number of significant barriers must be overcome to successfully implement and sustain a culture of IPE.22,32 Leadership at the highest level is needed for a culture change to be successful. For example, licensure and accreditation requirements do not currently reinforce preparation for collaborative practice in most countries. A survey of 41 countries from WHO's 6 regions representing various income economies reported IPE was often voluntary.27 Moreover, the lack of compulsory IPE and pain competencies for entry-to-practice graduates has implications for advancing skillful and ethical practice; it can limit the capacity of health care professionals to alleviate suffering, foster autonomy, and use resources justly.32 As well, many faculty are trained and familiar with the didactic teacher role rather than how to be an effective IPE facilitator and are not comfortable teaching pain content4; faculty education and development are needed. Faculty and clinician composition in the development and implementation of IPE activities may influence the outcomes of the learning activities.25,33 Evidence is scarce in developing countries, but challenges may be similar including curriculum structure and complexity. It has been suggested that barriers be taken as opportunities to transform approaches to core health problems in developing countries.30 Modifications in physical classroom space, competition for curriculum hours, and coordination of schedules can be challenging. Ideally, students should be introduced to IPE early with learning activities that build on competencies. Curriculum design is an iterative process necessitating modifications of complexity in patient cases and also the challenges of integrating clinical content to meet the needs of all levels of learners.33 Perceived differences in hierarchy, power status, and unequal participation rates among certain health professions have also been described as challenges.24 However, IPE can provide an opportunity to transform the way we socialize students by improving the understanding and respect of each other's unique roles and responsibilities within the team. Of course, the ultimate challenge is to harmonize learning experiences with well-functioning IP teams in clinical practice. Involvement of clinicians in curriculum development and implementation can help to insure real-world pain care and patient-centered modeling.33 6. Defining components of interprofessional education–competencies (learning outcomes), curriculum (learning plans), and content (learning objectives) Competency is the desired outcome of education. Distinct from learning objectives that emphasize gains in factual knowledge, attitudes, and skills, competency places emphasis on students' capacity to act effectively in relevant clinical situations.10 Competency generally includes observable phenomena such as being able to demonstrate the ability to explain a treatment or educate a patient about relevant treatment adverse effects. It also includes appropriate attitudinal and affective qualities to the extent that such are observable, eg, being able to maintain perceptibly compassionate communication while examining a painful part, potentially gauged through the use of interpersonal skills checklists. Core competencies in pain management for health professional education have been established.10 These pain competencies address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models (Fig. 1). A set of values and guiding principles is embedded within each domain. These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of IP learning activities across health professions designed to advance care that effectively responds to pain.Figure 1.: Core competencies for pain management. These core competencies pain assessment and management were developed through an interprofessional consensus process10 to address prelicensure pain management education in all major health care professions that are consistent with the IASP pain curricula outlines. Graphic created by Ian Koebner, PhD. Used with permission University of California Regents or Graphic courtesy of University of California Regents.Pain curricula outlines provide the template that helps to structure learning. Curricula include considerations of sequencing material, developmental appropriateness, and coordination of different health professions' learning activities, so that students from different health profession programs will learn about for IPE at the same time. The IASP Pain Curriculum Outlines15 provide recommended curricula for pharmacy, psychology, physical therapy, occupational therapy, nursing, medicine, dentistry, social work, and IPE. Each is arranged to address 4 main domains and related core competencies including (1) the multidimensional nature of pain, (2) pain assessment and measurement, (3) the management of pain, and (4) pain in specific clinical conditions. The outlines are helpful for establishing courses that provide an integrated foundation in pain at both the undergraduate and graduate levels. With this foundation, students are prepared to understand and approach patients with many forms of pain, as well as provide support to families and caregivers. All IASP curricula outlines including IPE were updated in 2017 for the Global Year for Excellence in Pain Education. Content is the description of what is being taught at the most granular level, eg, what are the learning objectives. Content serves as an important common language necessary to effectively communicate with each other about the specific elements of our uniprofessional and IP learning plans. Three teaching modules that address a number of IASP topics and are adaptable for IPE are available on the Portal of Geriatric Online Education (POGOe.org).20 In the United States, the National Institutes of Health has created a freely accessible portal of pain education online learning modules. Based on a variety of local models of IP collaboration, these modules demonstrate that IPE can take various forms depending on the specific professions engaged and the goals for learning.23 A unique and perhaps most comprehensive program is the 20-hour University of Toronto's Pain IP Curriculum involving students from 7 professional programs. The program's design and implementation components are described in the Pain IP Curriculum Model as (1) dynamic, (2) competency-based, (3) interrelated, and (4) collaborative with the patient focus at the center.33 Experience with the program has informed the creation of an eLearning Pain Education Interprofessional Resource that is internet accessible and available on request.19 As a blended eLearning program, Pain Education Interprofessional Resource has been designed as a self-learning resource to be coupled with facilitated small group, IP, collaborative discussion. 7. Outcomes of interprofessional education Measuring outcomes of IPE can be quite challenging. Large gaps regarding methods, theory, and context remain, and most studies focus on short-term results. The heterogeneity of contexts, variety of interventions, and methodological limitations makes it difficult to draw generalizable inferences about key elements and effectiveness of IPE.17,26 Evaluation should ideally link to clinical practice, but there is a paucity of contextually and synthesized literature regarding outcomes, particularly for pain management.24 University-based IPE using patient scenarios and group work in small teams, as contrasted to didactic lectures, has been shown to be feasible and has led to improved attitudes toward IP interaction and teamwork and improved understanding of health professional roles.24 Studies of IPE have found differences between professions, with students in professions deemed psychosocial were more positive about IPE than students in biomedical career tracks.13 Similarly, Erickson et al.9 found that IP mentorship and group participation improved first year medical students' pain management skills but did not have the same effect on fourth year nursing student performance. Differences were attributed in part to experience in clinical settings but also suggested that combining different levels of students is acceptable if they are of similar age and life experience. A significant positive shift in the pain knowledge and attitudes toward collaboration has been demonstrated through IPE.14,28 Simko et al.29 reported an increased knowledge and understanding of the importance of other profession's role in pain management in an IPE course for nursing and pharmacy students. Other studies have reported high student satisfaction and significant improvement in self-efficacy1 as well as respect for each other's roles and responsibilities.2 Positive changes have also been reported in pain assessment and documentation behaviors from IPE.17 8. Summary The delivery of effective pain management can be complex, requiring collaborative, team approaches that exceed the expertise of any one profession. Interprofessional collaboration is increasingly recognized as a core skill for all clinicians and is beginning to be required by some accrediting bodies for medical, nursing, pharmacy, physician assistant, and social work programs. However, IP collaborative practice is not yet an integral part of all health professions education programs. Recommendations of the WHO34 and other leading organizations recognize IP collaborative practice and education as a central component of transformative improvements in health care. Based on work in a number of global settings, recommendations for educational change to incorporate IP collaboration into practice are available and undergoing further development. Creating IPE learning opportunities is important. The intent of IPE is to produce a collaborative practice-ready workforce to improve the quality of health care. Students should be introduced to IPE early and have developmentally appropriate opportunities throughout a curriculum program. Students can change agents in the real world to continuously improve the way health professionals work together, mentor students and improve the quality of pain care. The quality and rigor of IPE research is inadequate, and research needs to move beyond feasibility and attitudes toward long-term improvements in clinical care. When focused on pain, IPE is likely to provide substantive benefits in the real-world practice setting, but barriers to IPE adoption, including slow adoption of pain-focused competencies and cultural habits, limit uptake. When able to overcome these obstacles, IPE has the capacity to harmonize learning experiences and promote patient-centered socialization of health profession trainees at all levels. Importantly, communicating and assessing innovation in IPE relies on understanding the conceptual education framework built on key elements of competencies (learning outcomes), curriculum (learning plans), and content (learning objectives). Although more work is needed to identify the most effective approaches, and even fundamentally to define meaningful approaches to outcomes assessment, models of education such as IP workshop training and online education exist with positive impact. We leave readers with a brief table of actions they can take to advance and transform health professions' education (Table 4).Table 4: Suggested actions individuals can take to promote IPE.Disclosures The authors have no conflict of interest to declare. D.B. Gordon and B. Hogans hold positions of leadership in their University's NIH Pain Consortium designated Centers of Excellence in Pain Education (CoEPEs). J.Watt-Watson is a principal leader in the University of Toronto's IP curriculum program.