Interprofessional Learning: An Old Idea in a New Package.

Abstract

Interdisciplinary education is a modern term that started to appear in the medical and nursing literature between the late 1960s and early 1970s. Its meaning has changed over time from one profession teaching another, to learning together or from each other in informal settings, to our current, more structured, and formal understanding. In 2001, the Institute of Medicine (IOM) report, To Err is Human, reignited interest in the concept as a way to provide better quality care to the American public. The report identified the need for a common vision across professions that could only be achieved if health professionals learned and worked together in a more defined and structured way.1 Picking up on the recommendations of To Err is Human, the 2003 IOM report, Health Professions Education: The Bridge to Quality further refined the definition of interdisciplinary education. The report suggested that when different disciplines learned together, knowledge and practice changed. The report also recommended formal courses and structured joint clinical experiences as part of an interdisciplinary curriculum.2Recently, interdisciplinary education has become the new magic bullet for improving the quality of care to patients. The Affordable Care Act, the IOM report on the Future of Nursing, as well as multiple reports and workshops have used the idea of working in teams as a proxy for interdisciplinary care, and indirectly, reinforced the need for interdisciplinary education.3 Although the concept is typically nested in the relationships of nurses and physicians, in its broadest and perhaps most usable form, interdisciplinary education should encompass multiple providers of health services, such as social workers, physician assistants, and physical therapists, and the patient.4 Even so, in this article I will focus on interdisciplinary learning (rather than formal education) between nurses and physicians and will use historical examples from my earlier work on critical care nurses and nurse practitioners to illustrate how interdisciplinary learning is an historical idea that has been reshaped to meet modern health-care concerns.5From an historical vantage point, interdisciplinary learning is not a new idea. Nurses and doctors learned from each other across time and place. They practiced together on an informal basis sometimes out of necessity, other times out of preference. There are many examples, and a number of common themes emerge that characterize informal interdisciplinary learning: The process could be multidirectional even in the presence of power differentials, learning was opportunistic and time and place dependent, and it was risky. Intentions of interdisciplinary learning also differed, sometimes significantly, from reality.Multidirectional LearningThe early intensive care units of the 1950s fostered multidirectional learning- physicians learned from nurses and nurses learned from physicians, sometimes individually and sometimes as a group. The units were small spaces where physicians and nurses worked closely together both spatially and intellectually. Nurses and physicians sat together and learned how to read electrocardiograms, interpret laboratory studies, and associate what they saw on the tracings and reports to the status of the patient in the bed. Physicians learned firsthand how nurses could determine a change in patient status without looking at the monitors, how nurses worked, what they did, and how they managed patients. As nurses learned how to read cardiac tracings, they also taught physicians how to think about stress and how to evaluate a patient's pain. These informal learning sessions were critical in an environment rapidly integrating new therapies and providers experimenting to see what new drugs and treatments would do. Having the data on treatment response and accurate patient updates helped nurses and physicians develop a sense of trust and logistical capability to give patients the care they needed. …