Articulating the ideal: 50 years of interprofessional collaboration in Medical Education.

CONTEXT: Health care delivery and the education of clinicians have changed immensely since the creation of the journal Medical Education. In this project, we seek to answer the following three questions: How has the concept of collaboration changed over the past 50 years in Medical Education? Have the participants involved in collaboration shifted over time? Has the idea of collaboration itself been transformed over the past 50 years? METHODS: Starting from a constructionist view of scientific discourse, we used directed content analysis to sample, code and analyse 144 collaboration-related articles over the 50-year life span of Medical Education. We developed an analytical framework to identify the key components of varying articulations of 'collaboration', with a focus on shifts in language and terminology over time. Our sample was drawn from an archive of 1221 articles developed to celebrate the 50th anniversary of Medical Education. RESULTS: Interprofessional collaboration is conceptualised in three primary ways throughout our sample: as a psychometric property; as tasks or activities, and, more recently, as 'togetherness'. The first conceptualisation articulates collaboration as involving knowledge or skills that are teachable to individuals, the second as involving the education of teams to engage in structured meetings or task distribution, and the third as the building of networks of individuals who learn to form team identities. The 'leader' of collaboration is typically conceptualised as the doctor, who is consistently articulated by authors as the active agent of collaborative care. Other clinicians and students of other professions are, as the wording in this sentence suggests, usually positioned as 'others', and thus as more passive participants in, or even observers of, 'collaboration'. CONCLUSIONS: In order to meet goals of meaningful collaboration leading to higher-quality care, it behoves us as a community of educators and researchers to heed the ways in which we teach, think and write about interprofessional collaboration, interrogating our own language and assumptions that may be betraying and reproducing harmful care hierarchies.

Misalignments of purpose and power in an early Canadian interprofessional education initiative.

Interprofessional education (IPE) has been widely incorporated into health professional curricula and accreditation standards despite an arguably thin base of evidence regarding its clinical effects, theoretical underpinnings, and social implications. To better understand how and why IPE first took root, but failed to grow, this study examines one of the earliest documented IPE initiatives, which took place at the University of British Columbia between 1960 and 1975. We examined a subset of 110 texts (academic literature, grey literature, and unpublished records) from a larger study that uses Critical Discourse Analysis to trace the emergence of IPE in Canada. We asked how IPE was promoted and received, by whom, for what purposes, and to what effects. Our analysis demonstrates that IPE was promoted as a response to local challenges for the Faculty of Medicine as well as national challenges for Canada's emerging public healthcare system. These dual exigencies enabled the IPE initiative, but they shaped it in somewhat divergent ways: the former gave rise to its core component (a health sciences centre) and the latter its ultimate purpose (increasing the role of non-medical professions in primary care). Reception of the initiative was complicated by a further tension: nurses and allied health professionals were sometimes represented as independent experts with unique knowledge and skills, and sometimes as assistants or substitutes for medical doctors. We relate the successes and frustrations of this early initiative to particular (mis)alignments of purpose and relationships of power, some of which continue to enable and constrain IPE today.