The Extent of Interprofessional Education in the Clinical Training of Integrated Health and Medicine Students: A Survey of Educational Institutions

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1 Rsarch Th xtnt of Intrprofssional ucation th lical Trag of Intgrat Halth an Mic Stunts: A Survy of ucational Institutions Bth Rosnthal, MPH, MBA, PhD 1, Anthony J. Lisi, D 2 Arss: 1 Assistant Dirctor, Acamic onsortium for omplmntary an Altrnativ Hath ar, hicago, IL, USA, 2 Associat Profssor, Univrsity of Brigport ollg of hiropractic, Brigport, T, USA. -mail: Bth Rosnthal, MPH, MBA, PhD brosnthal@accahc.org *orrspong author Topics Intgrativ Halth ar 2015, Vol. 6(1) ID: Publish on March 31, 2015 Lk to Documnt on th Wb Abstract Toay s halthcar nvironmnt rquirs collaboration an coopration among halthcar profssions, whthr workg a virtual tam or an tgrat clical sttg. Patints ar bst srv whn halthcar provirs unrstan an rspct ach othr s profssions an ar abl to work wll togthr. Th Acamic onsortium for omplmntary an Altrnativ Halth ar (AAH) conuct a survy to assss th xtnt an charactristics of trprofssional ucation (IP) th clical trag of stunts at accrit programs, collgs an univrsitis of th licns tgrativ halth an mic iscipls (chiropractic, acupunctur an Orintal mic, naturopathic mic, massag thrapy, irct-ntry miwifry). Th survy was snt to 134 clical trag amistrators, an w rciv rsponss from 88 for an ovrall rspons rat of 66%. Thr was much variation th rport amount of IP an th particular iscipls ngag IP activitis with othr iscipls urg clical trag. hiropractic stitutions rport th most IP, whras irct-ntry miwifry rport th last. Across all iscipls, multiisciplary stitutions gnrally rport mor IP clical trag than sgl iscipl stitutions. Furthr work assssg th quality of such trag, an its ffct on subsqunt practic, may hlp form futur ucational stratgis for th tgrativ halth an mic iscipls. 1 P a g

2 Introuction Toay s halthcar nvironmnt rquirs collaboration an coopration among halthcar profssions, whthr workg a virtual tam or an tgrat clical sttg. Intrprofssional collaboration (IP), th fforts of iffrnt profssions workg togthr to positivly impact halthcar 1 has bn shown to improv halthcar procsss an outcoms. 2 Patints ar bst srv whn halthcar provirs unrstan an rspct ach othr s profssions, an ar abl to work wll togthr. 3,4 IP is of particular rlvanc to th tgrativ halth an mic (IHM) iscipls (also known as complmntary mic, complmntary an altrnativ mic, or complmntary an tgrativ mic). Sc ths profssions hav historically function sparatly from mastram halthcar an sparatly from ach othr th xtnt to which thy now ngag IP can hav important ramifications for thir futur rols tam-bas clical, acamic an rsarch activitis. Thr is vinc that th most common antcnt to trprofssional collaboration is trprofssional ucation (IP), 5 f as occasions whn mmbrs (or stunts) of 2 or mor profssions larn with, from an about on anothr to improv collaboration th quality of car. 1 Morovr, IP itslf has bn lk to improv tamwork an nhanc quality of car. 1 Although som cass ucational accritation stanars of th licns IHM iscipls rquir that stunts know how to communicat, rfr to, co-manag, an collaborat with practitionrs profssions iffrnt from thir own, thr ar not yt firm, spcific rquirmnts about how this is to b achiv. 3,4 Sc ucational stanars among th IHM iscipls hav fw, if any, spcific rquirmnts arssg IP an/or IP, it is not known how or vn if stunts ar bg ucat an tra to practic with provirs from iffrnt iscipls. A basl unrstang of th currnt IP status at licns IHM ucational stitutions can b an important stp assssg ucational quality an ffctivnss with rgar to IP. Th purpos of this stuy is to assss th xtnt to which stunts licns IHM iscipls ar rcivg clical trag from provirs of iscipls othr than thir own. Mthos This stuy was a scriptiv survy of amistrators at accrit acamic stitutions of fiv licns IHM iscipls with US Dpartmnt of ucation rcogniz accritg agncis: acupunctur an Orintal mic (AOM), chiropractic mic (D), irct ntry miwifry (DM), massag thrapy (MT), an naturopathic mic (ND). 3 Ths iscipls compris th cor mmbrship of th Acamic onsortium for omplmntary an Altrnativ Halth ar (AAH). Oprational fition For th purposs of this work w focus on th prson-to-prson aspct of IP, that is, w sought to intify th frquncy with which stunts a givn iscipl, urg th cours of thir clical trag, ar likly to hav -prson tractions with provirs from othr iscipls. 2 P a g

3 Stuy Population Th stuy population was amistrators rsponsibl for clical trag (i.. clic irctors / ans of clics) at th accrit IHM acamic stitutions. W intifi th stitutions through wbsits an othr public formation of th ouncils of ollgs an/or Accritg Agncis for th fiv fils qustion. Institutions with accrit programs mor than on iscipl wr f as a Multi- Disciplary Institutions (MDI). Institutions with accrit programs only on iscipl wr f as Sgl-Discipl Institutions (SDI). W intifi th prson(s) rsponsibl for g clical trag at ach of th stitutions by public wbsit formation an tlphon contact with stitutions as ncssary. At th tim of stuy prparation th fall of 2013, w intifi a total of 161 potntial subjcts from th rspctiv iscipls as follows: 58 AOM, 19 D, 67 MT, 9 DM, an 8 ND. Potntial subjcts wr contact by mail an vit to participat. Th survy was launch March 10, mail rmrs wr snt on ays 7, 14 an 20 aftr stuy commncmnt to thos who ha not complt th survy. Survy sign Th survy was mol off of prior stuis assssg charactristics, xprincs an ucational ns of provirs various tgrat sttgs. 6-8 Qustions wr vlop by th vstigators through an itrativ procss clug put from subjct mattr xprts th fiv targt iscipls. Qustions assss faturs of trprofssional ucation at ach school clug 1) th vnus which th majority of clical trag is provi; 2) th various provir typs clical trag at ths vnus; an 3) th clical trag activitis which ths provir typs participat. MDI sits rciv a survy vrsion with two slightly moifi qustions to account for th multipl iscipls bg tra. Th survy was pilot tst among a convninc sampl of clician ucators who wr not subsqunt subjcts, an foun to b clar an abl to b complt muts. Th full txt of th survy is availabl at Th survy was amistr lctronically via SurvyMonky ( softwar. Rsponss wr collct by th onl systm an anonymous, confintial, an scur mtho. Th vstigators i not know th IP arss or mail arss of iviual rsponnts. Th ata wr xport to a sprasht (Microsoft xcl) for tabulation an analysis with scriptiv statistics. All rsponnts provi form consnt bfor participatg. Th stuy was approv by th Institutional Rviw Boar of th Univrsity of Brigport. Rsults W intifi an itial group of 161 accrit IHM schools. Whn thr wr multipl campuss for th sam school, with th sam prson g th clical trag of stunts, this was collaps to on program an only on survy was snt. This was th cas for 5 AOM schools an 19 MT schools. Aitionally 2 AOM an 1 MT school ha prviously opt out of AAH survys an wr xclu. This yil a fal population of 134 participants that wr vit, an w rciv rsponss from 88 for an ovrall rspons rat of 66% (Tabl 1). Btwn iscipls, th highst 3 P a g

4 rspons rat was from ND (100%) an th lowst was from AOM (57%). Across all iscipls, th rspons rat for MDIs (100%) was gratr than that of SDIs (59%). Tabl 1: Population an rspons rat. Discipl Accrit schools Opt out Total vit Ovrall rspons rat Rspons rat of SDI Rspons rat of MDI AOM * 57% (29/51) 50% (22/44) 100% (7/7) D % (17/19) 83% (10/12) 100% (7/7) MT * 60% (28/47) 56% (24/43) 100% (4/4) DM % (6/9) 63% (5/8) 100% (1/1) ND % (8/8) 100% (4/4) 100% (4/4) Total % (88/134) 59% (65/111) 100% (23/23) *Multipl campuss for th sam school wr collaps Across all iscipls, th most common rport clical trag vnu was a clic own an oprat by th school, locat on th school s campus. This was th cas for 82% of th SDIs an 55% of th MDIs. Th scon most common clical trag sttg at SDIs was aga a clic own an oprat by th school, locat on th school s campus (28%), follow closly by partnrships with on or mor hospitals/mical cntrs (25%). For MDIs, th scon most common clical trag sttg was a clic own an oprat by thir school, locat off sit from th school s campus (42%). Among SDIs 72.9% of rsponnts rport that thir stitution i not oprat unr any policis that rquir IP clical trag, whras 18.6% rport that thirs i. Among MDIs 77.3% of rsponnts rport that thir stitution i not oprat unr any policis that rquir IP clical trag, whras 22.7% rport that thirs i. For ach of th fiv IHM iscipls, w ask which provir typs othr than th school s own iscipl wr stunt clical trag. W also quri as to th rols play by ths othr provirs. For ach iscipl w rport 4 catgoris of rsponss rgarg othr iscipls ngagmnt: not clical trag; communicatio an othr activitis; shar cas nt cision makg; or irctly g stunts livr. Th rsults ar shown Tabls 2 through Tabls 6. W crat a ratg schm to compar th frquncy of IP-rlat activitis rport btwn ach iscipl. W f low as 0-24% rport mnt of th givn othr iscipl; morat as 25-74% mnt; an high as % mnt. To facilitat comparison, w thn graphically pict ths ratgs on a chart as sha boxs (Figur 1). In situations whr rsults wr consistnt btwn th first an scon most common clical sttgs th rspctiv boxs ar split. 4 P a g

5 Figur 1: Ratg of rport frquncy of traction among iffrnt iscipls Tabl 2: Rols of othr iscipls th clical trag of stunts AOM programs Sgl Discipl, Most ommon Sttg (n= 18) Multi-Discipl, Most ommon Sttg (n= 6) Othr Discipl an othr nt cision makg stunts livr an othr nt cision makg HIRO 100% 0% 0% 0% 0% 33% 33% 33% NATURO 75% 25% 0% 0% 13% 38% 25% 25% MT 47% 33% 0% 20% 50% 50% 0% 0% stunts livr 5 P a g

6 82% 18% 0% 0% 100% 0% 0% 0% MD/DO 67% 33% 0% 0% 50% 50% 0% 0% NURSS 100% 0% 0% 0% 50% 50% 0% 0% 90% 10% 0% 0% 67% 0% 0% 33% Sgl Discipl, 2 n most common sttg (n= 16) Multi-Discipl, 2 n most common sttg (n= 6) Othr Discipl an othr nt cision makg stunts livr an othr nt cision makg HIRO 78% 11% 11% 0% 0% 40% 40% 20% NATURO 54% 23% 15% 8% 14% 43% 29% 14% MT 45% 36% 9% 9% 100% 0% 0% 0% 89% 0% 11% 0% 33% 33% 33% 0% MD/DO 55% 27% 18% 0% 0% 100% 0% 0% NURSS 78% 11% 11% 0% 0% 100% 0% 0% 70% 20% 10% 0% 0% 75% 25% 0% stunts livr Tabl 3: Rols of othr iscipls th clical trag of stunts D programs Othr Discipl AUPUN Sgl Discipl, Most ommon Sttg (n= 10) an othr nt cision makg stunts livr Multi-Discipl, Most ommon Sttg (n= 7) an othr nt cision makg stunts livr 43% 29% 14% 14% 11% 56% 22% 11% 6 P a g

7 NATURO 63% 25% 13% 0% 43% 29% 29% 0% MT 100% 0% 0% 0% 17% 33% 33% 17% 70% 20% 10% 0% 100% 0% 0% 0% 67% 22% 11% 0% 60% 20% 0% 20% MD/DO 60% 30% 10% 0% 20% 50% 30% 0% NURSS 67% 22% 11% 0% 25% 25% 50% 0% 36% 45% 18% 0% 50% 25% 25% 0% Othr Discipl AUPUN Sgl Discipl, 2 n most common sttg (n= 10) an othr nt cision makg stunts livr Multi-Discipl, 2 n most common sttg (n= 7) an othr nt cision makg 56% 22% 11% 11% 25% 38% 13% 25% NATURO 100% 0% 0% 0% 50% 50% 0% 0% MT 75% 25% 0% 0% 40% 40% 0% 20% 100% 0% 0% 0% 75% 0% 0% 25% MD/DO 44% 33% 11% 11% 0% 70% 20% 10% NURSS 44% 33% 11% 11% 33% 33% 33% 0% 13% 63% 25% 0% 67% 33% 0% 0% stunts livr Tabl 4: Rols of othr iscipls th clical trag of stunts ND programs Othr Discipl Sgl Discipl, Most ommon Sttg (n= 4) nt cision stunts Multi-Discipl, Most ommon Sttg (n= 4) nt cision stunts 7 P a g

8 AUPUN an othr makg livr an othr makg livr 50% 25% 0% 25% 25% 0% 25% 50% HIRO 50% 0% 0% 50% 0% 33% 0% 67% MT 75% 0% 0% 25% 33% 0% 0% 67% MD/DO 50% 50% 0% 0% 0% 50% 0% 50% NURSS 50% 25% 0% 25% 33% 0% 0% 67% Othr Discipl AUPUN Sgl Discipl, 2 n most common sttg (n= 4) an othr nt cision makg stunts livr Multi-Discipl, 2 n most common sttg (n= 4) an othr nt cision makg stunts livr 75% 0% 0% 25% 0% 0% 0% 100% HIRO 75% 0% 0% 25% 33% 0% 33% 33% MT 75% 25% 0% 0% 100% 0% 0% 0% MD/DO 75% 25% 0% 0% 0% 67% 0% 33% NURSS 75% 25% 0% 0% 67% 33% 0% 0% 75% 25% 0% 0% 100% 0% 0% 0% Tabl 5: Rols of othr iscipls th clical trag of stunts MT programs Sgl Discipl, Most ommon Sttg (n= Multi-Discipl, Most ommon Sttg (n= 4) 8 P a g

9 Othr Discipl AUPUN 20) 80% an othr nt cision makg stunts livr an othr nt cision makg 7% 7% 7% 50% 33% 0% 17% HIRO 79% 7% 14% 0% 9% 45% 27% 18% NATURO 92% 0% 8% 0% 25% 25% 25% 25% 100% 79% 0% 0% 0% 100% 0% 0% 0% 14% 7% 0% 50% 25% 0% 25% MD/DO 87% 7% 7% 0% 100% 0% 0% 0% NURSS 87% 0% 13% 0% 100% 0% 0% 0% 79% 7% 14% 0% 25% 50% 25% 0% stunts livr Othr Discipl AUPUN Sgl Discipl, 2 n most common sttg (n= 15) an othr nt cision makg stunts livr Multi-Discipl, 2 n most common sttg (n= 4) an othr nt cision makg 80% 20% 0% 0% 100% 0% 0% 0% HIRO 80% 20% 0% 0% 20% 60% 0% 20% NATURO 89% 11% 0% 0% 50% 50% 0% 0% 89% 11% 0% 0% 100% 0% 0% 0% MD/DO 64% 36% 0% 0% 33% 67% 0% 0% NURSS 55% 36% 0% 9% 50% 50% 0% 0% 56% 33% 0% 11% 50% 50% 0% 0% stunts livr 9 P a g

10 Tabl 6: Rols of othr iscipls th clical trag of stunts DM programs Othr Discipl AUPUN Sgl Discipl, Most ommon Sttg (n= 4) an othr nt cision makg stunts livr Multi-Discipl, Most ommon Sttg (n= 1) an othr nt cision makg HIRO stunts livr NATURO 17% 33% 17% 33% 0% 0% 0% 100% MT MD/DO 100% 0% 0% 0% 0% 100% 0% 0% NURSS 0% 50% 0% 50% 0% 0% 100% 0% Othr Discipl AUPUN Sgl Discipl, 2 n most common sttg (n= 4) an othr nt cision makg stunts livr Multi-Discipl, 2 n most common sttg (n= 0) an othr nt cision makg 100% 0% 0% 0% NA NA NA NA HIRO 100% 0% 0% 0% NA NA NA NA NATURO 100% 0% 0% 0% NA NA NA NA MT 100% 0% 0% 0% NA NA NA NA 100% 0% 0% 0% NA NA NA NA stunts livr 10 P a g

11 MD/DO 67% 33% 0% 0% NA NA NA NA NURSS 67% 33% 0% 0% NA NA NA NA 100% 0% 0% 0% NA NA NA NA Discussion This work prsnts an ovrviw of th currnt status of IP th clical trag of IHM stunts th US. Prvious work assssg aspcts of IP a sampl of anaian schools foun varyg grs of structional tim vot to trprofssional collaboration. 9 Our work as to th litratur by scribg IP at US IHM stitutions, an by focusg on -prson trprofssional clical trag activitis. Across an with ach of th fiv iscipls, schools rport a varyg rang of IP frquncy from low to high. Across an with ach iscipl, th MDIs wr mor likly to rport high frquncy IP than th SDIs. This fg suggsts that tr-stitutional collaboration may b important for sgl iscipl schools prparg stunts for collaborativ practic tgrat sttgs. Th AOM an D iscipls ha th most rsponnts rportg high IP, an D ha th fwst rsponnts rportg low IP. DM was th iscipl with th gratst stancs of low IP, an th fwst stancs of high IP. Ovrall, D stitutions rport th highst xposur to both othr IHM iscipls an to convntional mical provirs. AOM an ND stitutions wr similar to ach othr an both slightly highr than MT with rspct to convntional an othr IHM provirs. DM gnrally rport th last xposur to any othr iscipl. IP is an unrpng for IP an itslf may la to improv clical outcoms. 1 In th ucation of halthcar profssionals, th clical trag prio is a formativ tim that fluncs futur clical practic. 10,11 Sc clical trag typically ntails mntorship an othr on-on-on mnt btwn tras an clicians, th rsultant collaboration an socialization xrt flunc on futur provir bhavior. 12,13 Thrfor, th scop of IP occurrg clical trag at IHM stitutions may hav an impact on th futur IP capacity of grauats from thos stitutions. Th rsults of this work provi an itial pictur of th currnt IP nvironmnt at licns IHM acamic stitutions. Furthr rsarch is n to assss mor tail of this IP, clug lmnts such as frquncy an uration of IP activitis, ffct on patint car, an stunt prcption of quality. Limitations As with all survys, this work is subjct to rsponnt rcall an rportg rror. W ask rsponnts to rport on th most common an scon most common clical trag sits, thrfor our rsults likly rflct th IP that th majority of th stunt boy at ach school xprincs, howvr w i not attmpt to gathr formation on th numbr of stunts bg xpos to any rport IP at ach 11 P a g

12 school. It is possibl that othr clical trag sits livr mor IP, howvr ths woul likly b availabl to smallr proportions of stunts. It was byon th scop of this work to iscrimat btwn IP xposurs to sgl-tra provirs vs. ual-tra provirs. Lastly, w i not attmpt masur th uration or quality of any rport IP, nor of th ffct of any rport IP on grauats practic pattrns. onclusion This work scribs variation th rport xtnt of IP occurrg th clical trag of th 5 licns IHM iscipls. D stitutions rport th most IP, whras DM rport th last. Across all iscipls MDIs gnrally rport mor IP than SDIs. Furthr work assssg th quality of such trag, an its ffct on subsqunt practic, may hlp form futur ucational stratgis for th IHM iscipls. Acknowlgmnts This stuy was support by a grant from th Lo S. Guthman Fun. Lgn AAH -- Acamic onsortium for omplmntary an Altrnativ Halth ar AOM -- acupunctur an Orintal mic D Doctor of hiropractic DM -- irct ntry miwifry IHM -- tgrativ halth an mic IP -- trprofssional collaboration IP -- trprofssional ucation MDI Multi-Disciplary Institutions: Institutions with accrit programs mor than on iscipl MT -- massag thrapy ND -- Naturopathic Doctor SDI -- Sgl-Discipl Institutions: Institutions with accrit programs only on iscipl Rfrncs 1. Hammick M, Frth DI, Koppl I, Rvs S, Barr H. A bst vinc systmatic rviw of trprofssional ucation: BM, gui #9. M Tachr 2007;29(8): Zwarnst M, Golman J & Rvs S. Intrprofssional collaboration: ffcts of practic-bas trvntions on profssional practic an halthcar outcoms. ochran Databas Syst Rv 2009;Jul 8(3):D oi: / Golblatt, Snir P, Rosnthal B, Qun S, Wks J. licians' an ucators' Dsk Rfrnc on th Licns omplmntary an Altrnativ Halthcar Profssions (2n.). Sattl: Acamic onsortium for omplmntary an Altrnativ Halth ar, P a g

13 4. Brtt J, Brimhall J, Haly D, Pfifr J, Prngubr M. Accritation stanars of complmntary an altrnativ mic iscipls. xplor 2013;9(5): Ptri L. oncpt analysis of trisciplary collaboration. Nursg Forum 2010; 45(2): Lisi AJ, Gortz, Lawrnc DJ, Satyanarayana P. haractristics of vtrans halth amistration chiropractors an chiropractic clics. J Rhabil Rs Dv 2009;46(8): VanGst JB, umms DS. An ucational ns assssmnt for improvg patint safty: Rsults of a national stuy of physicians an nurss. National Patint Safty Founation; Mar 20. Whit Papr Rport 3, Turnr AP, Mart, Williams RM, Gourau K, Bown JD, Hatzakis M, Whitham RH, Bourtt DN, Walkr L, Haslkorn JK. xplorg ucational ns of multipl sclrosis car provirs: Rsults of a car-provir survy. J Rhabil Rs Dv 2006;43(1): Toup AK, Gaboury I. A survy of anaian rgulat complmntary an altrnativ mic schools about rsarch, vinc-bas halth car an trprofssional trag, as wll as contug ucation. BM omplmntary Altrnat M 2013;13(374), oi: / Jolly B, Maconal MM. ucation for practic: th rol of practical xprinc unrgrauat an gnral clical trag. M uc 1989;Mar 23(2): Stahmr S, Kuhn G. Optimizg rsint trag: rsults an rcommnations of th 2009 ouncil of Rsincy Dirctors consnsus confrnc. Aca mrg M 2010;17(Suppl 2):S Omr TY, Suliman WA, Thomas L, Josph J. Prcption of nursg stunts to two mols of prcptorship clical trag. Nurs uc Pract 2013;May 13(3): Rvs S, Frth D, Mcrori P, Prry D. 'It tachs you what to xpct futur... ': Intrprofssional larng on a trag war for mical, nursg, occupational thrapy an physiothrapy stunts. M uc 2002;Apr 36(4): P a g