On the morning of July 2, 1881, Charles Julius Guiteau paced nervously around the now-demolished Baltimore and Potomac train depot in Washington, DC, with his newly purchased revolver held snugly in his possession. The unwitting President Garfield, on his way to Williamstown, Massachusetts, for a college reunion, met with two of Guiteau’s bullets as he crossed the station preparing to board the train. The first bullet grazed his arm while the second struck him in the back, completely missing his spinal cord. Neither wound was life threatening. But, as was the norm for physicians of the day, a lack of sterile technique resulted in overwhelming sepsis as doctors repeatedly attempted to locate and remove the bullet from Garfield’s back using their fingers and unwashed probing devices. Garfield died 11 weeks later weighing 80 pounds less than when he entered the train station that fateful morning (CBS News, 2012; Millard, 2011).
This was the setting within which Abraham Flexner sought to redesign the medical educational system with his 1910 Flexner Report. That report formed the foundation for medical education as it was needed in the early 20th century. During that time, Goldmark and Welch-Rose published two other reports that had a similar impact, revolutionizing nursing and public health education, respectfully.
Much of the landscape has changed over the past 100 years with regard
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1 The planning committee’s role was limited to planning and convening the workshop. The views contained in the report are those of individual workshop participants and do not necessarily represent the views of all workshop participants, the planning committee, or the Institute of Medicine.
to the health professions and the setting within which these professionals work. First, there are many more types of health specialists addressing the treatment and prevention of disease. When contributions from each specialty field are well coordinated, the individual person or patient benefits from the communication among all the providers, resulting in improved health and better care as well as less duplication of services and cost savings. Working in this way—keeping the whole person at the center of co-ordination and education—is advantageous to all and can have particular impact when non-health professionals, such as policy makers, city planners, and religious leaders, assist in delivering specific health messages. These messages can be crafted by representatives of the community with acknowledgment of the important role played by patients, families, caregivers, and nonprofessional and paraprofessional workers, as well as professionals.
A second way in which the landscape surrounding health professionals have changed over the past century is that the demographics of societies have changed through globalization, and the epidemiology of disease has shifted to a greater prevalence of chronic illnesses as many individuals around the world are living longer and adapting to more urban, “Westernized” lifestyles.
Finally, the advent of the Internet combined with greater information access through innovations in technology and mobile devices has made health education more accessible than ever before.
Because of these societal shifts and information-related innovations that have occurred over the past century, changes to the health professions are under way in many parts of the world that are gradually influencing how health professionals are educated. In recognition of the desire for educational changes that better match the needs of the local health care system and of the patients themselves, the global independent Commission on Education on Health Professionals for the 21st Century launched a study on transforming education to strengthen health systems in an interdependent world. This study called for national forums as a way of bringing together “educational leaders from academia, professional associations, and governments to share perspectives on instructional and institutional reform” (Frenk et al., 2010). That recommendation led to the formation of the Institute of Medicine’s Global Forum on Innovation in Health Professional Education.
GLOBAL FORUM ON INNOVATION IN HEALTH PROFESSIONAL EDUCATION
Every year the Global Forum hosts two workshops whose topics are selected by the more than 55 members of the Forum. It was decided in this first year of the Forum’s existence that the workshops should lay the
BOX 1-1
Statement of Task
An ad hoc committee of six to eight health professional education experts will plan, organize, and conduct a 2-day, interactive public workshop exploring issues related to innovations in health professions education (HPE). Membership of the committee will involve educators and other innovators of curriculum development and pedagogy and will be drawn from at least four health disciplines. The workshop will follow a high-level framework and serve to establish an orientation for the future work of the Global Forum on Innovation in Health Professional Education. This public workshop will feature invited presentations and small group discussions that will focus on innovations in five areas of HPE:
1. Curricular innovations— Concentrates on what is being taught to health professions’ learners to meet evolving domestic and international needs;
2. Pedagogic innovations— Looks at how the information can be better taught to students and WHERE education can takes place;
3. Cultural elements— Addresses who is being taught by whom as a means of enhancing the effectiveness of the design, development, and implementation of interprofessional HPE;
4. Human resources for health— Focuses on how capacity can be innovatively expanded to better ensure an adequate supply and mix of educated health workers based on local needs; and
5. Metrics— Addresses how one measures whether learner assessment and evaluation of educational impact and care delivery systems influence individual and population health.
The committee will plan and organize the workshop, select and invite and discussants, and moderate the discussions. A single individually authored summary of the workshop will be prepared by a designated rapporteur.
foundation for the future work of the Forum and that the topic that could best provide this base of understanding was “interprofessional education.” The first workshop took place August 29—30, 2012, and the second was held on November 29—30, 2012. Both workshops were structured using the Statement of Task found in Box 1-1, and both focused on linkages between interprofessional education (IPE) and collaborative practice. The difference between them was that Workshop I set the stage for defining and understanding IPE, while Workshop II brought in speakers from around the world to provide living histories of their experience working in and between interprofessional education and interprofessional or collaborative practice.
CONTEXT OF THE REPORT
Because of the close linkages between the August and November workshops, the two workshops are being summarized together in this single report. Both workshops emphasized the importance of engaging students and patients in the dialogue on interprofessional education and also the value of learning from experiences gathered around the world and applied locally. This point was made by a number of the IPE innovators who presented at the workshops and who are cited in the following chapters. These early adopters of IPE formed their programs after studying other national and international IPE initiatives and shared their experiences freely with other participants. This atmosphere of open sharing of ideas and of a mutual genuine interest in the goal of achieving global innovation in IPE set the tone for both workshops and also shaped the approach of this report, which is a modified summary of the presentations and the rich discussions that took place at the workshops. However, it should be noted that, in order to create a smooth flow of the ideas from the two workshops within this one summary report, the report does not follow the chronological order in which statements and presentations were made.
The next chapter begins by describing what IPE is and the value that it adds to societies, universities, education, health, and health care systems as well as to nations struggling with maintaining sufficient faculty for educating students in the health professions. Chapter 3 describes the challenges to initiating IPE. This section is mainly designed to help those individuals seeking to construct or redesign interprofessional education at their schools to learn from the experiences and challenges of others who participated in designing IPE experiences at their own universities. Chapter 4 looks into how educators measure IPE using the currently available tools and how groups are considering new ways of improving these measurements to more accurately assess learners’ knowledge, skills, and understanding of IPE. These first four chapters provide the backdrop for the two subsequent chapters. Chapter 5 looks at IPE as part of a larger educational and health system continuum. And Chapter 6 explores students’ reactions to IPE and examines what might be learned or gained by engaging patients, caretakers, and communities in improving collaborations and developing interprofessional education experiences. The seventh and final chapter describes speakers’ reflections on what they learned and what they heard while participating in the workshops.
REFERENCES
CBS News. 2012. How doctors killed President Garfield. http://www.cbsnews.com/8301-3445_162-57464503/how-doctors-killed-president-garfield (accessed March 12, 2013).
Frenk, J., L. Chen, Z. A. Bhutta, J. Cohen, N. Crisp, T. Evans, H. Fineberg, P. Garcia, Y. Ke, P. Kelley, B. Kistnasamy, A. Meleis, D. Naylor, A. Pablos-Mendez, S. Reddy, S. Scrimshaw, J. Sepulveda, D. Serwadda, and H. Zurayk. 2010. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet 376(9756):1923–1958.
Millard, C. 2011. Destiny of the republic: A tale of madness, medicine and the murder of a president. New York: Anchor Books.
