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© 2008 Elizabeth Howkins and Julia Bray
Elizabeth Howkins and Julia Bray have asserted their right under the Copyright,
Designs and Patents Act 1998 to be identified as the authors of this work.
All rights reserved. No part of this publication may be reproduced, stored in a
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ical, photocopying, recording or otherwise, without the prior permission of the
copyright owner.
British Library Cataloguing in Publication Data
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ISBN-13: 978 1 84619 098 8
Typeset by Phoenix Photosetting, Chatham, Kent
Contents
Foreword vii
Preface ix
About the editors xi
About this book xii
List of contributors xiv
Acknowledgements xvi
List of abbreviations xvii
Glossary xviii
1 Perspectives of interprofessional learning and teaching 1
ELIZABETH HOWKINS
2 A learning and teaching framework for interprofessional
learning 13
KATY NEWELL-JONES AND MAGGIE LORD
3 Interprofessional facilitation skills and knowledge:
evidence from a Delphi research survey 27
JULIA BRAY
4 Embedding interprofessional learning in postgraduate
programmes of learning and teaching 41
KATY NEWELL-JONES
5 Preparing facilitators for interprofessional learning 55
BEE WEE AND JAN GOLDSMITH
6 Curriculum development for interprofessional learning 69
MAGGIE LORD AND GILL YOUNG
vi CONTENTS
7 Collaboration beyond champions 87
ANN EWENS AND GILL YOUNG
8 Through the PIPE 97
ELIZABETH HOWKINS AND JULIA BRAY
Appendix 1: The PIPE project 107
ELIZABETH HOWKINS AND JULIA BRAY
Appendix 2: PIPE three research methodology and
methods 113
JULIA BRAY
Appendix 3: PIPE two research process using the
Radnor framework 119
KATY NEWELL-JONES
References 127
Index 135
Foreword
More than a PIPE dream
Early writing about interprofessional education was inspired by the singleness of
purpose and unswerving certainty of its pioneers, intent upon winning hearts and
minds for the cause that they espoused. It would be hard to imagine the progress
made during the early years had it not been for their inspiration. That progress
prompted calls for closer scrutiny to convince employers, professions, pressure
groups, universities, commissioners, regulators and government itself that inter-
professional education will deliver what its exponents claimed. That is the
challenge to which the new generation of interprofessional educators is rising as
they record and document their projects, expose them to critical review, and share
their experience openly and honestly. Less evangelical and more critical than their
forebears, they are painstakingly assembling the emerging evidence base.
So far, so good, but interprofessional education is only as effective as its teach-
ing, as students are quick to point out. Enter PIPE, which for three years explored
different ways in different programmes in different settings to facilitate interpro-
fessional learning. ‘Facilitation’, for the PIPE team, is not as a gratuitous addition
to an already jargon-ridden vocabulary, but captures the distinctive qualities that
engender dialogue and mutual learning between students from different profes-
sions to modify reciprocal attitudes and behaviour, heighten awareness of self and
others, and cultivate co-working.
Readers in search of topical tips, techniques and quick fixes look elsewhere!
Read on and you will find approaches, frameworks, models and theories to help
you to understand interprofessional facilitation in all its complexity. Then, but
only then, may you enjoy the liberation which is interprofessional learning to the
full, for students and facilitator alike
Happily, PIPE was more than just another short-lived, locally-based interpro-
fessional project whose experience was lost when funds ran dry. Evaluation was
built in from the outset with the clear intention that lessons learned would be
published, exposed to peer-review and accessible to others. This book is the
outcome.
Its publication coincides with growing commitment to the improvement of
interprofessional teaching and learning backed, like PIPE, by the Higher Education
vii
viii FOREWORD
Funding Council for England. The Higher Education Academy is in the forefront
of these developments, working through three of its teaching and learning centres
and complemented by many of the Centres of Excellence in Teaching and
Learning (CETLs). The Centre for the Advancement of Interprofessional
Education (CAIPE), to my pleasure, is working with former members of the PIPE
team to update its rolling programme of workshops for those who will prepare
and sustain the next generation of facilitators.
This book will reinforce all those endeavours. More than that, it will be an
indispensable resource wherever, at home and abroad, universities and service
agencies are intent upon building up a cadre of facilitators upon whose sensitiv-
ity and skill, establishing and maintaining the quality and credibility of interpro-
fessional education depends.
Hugh Barr
President, CAIPE
Professor Emeritus in Interprofessional Education
University of Westminster
October 2007
Preface
Interprofessional education is an essential process for improving collaborative
practice and the quality of patient/client care. Collaborative practice in the form
of teamwork needs nurturing and supporting if it is to achieve its full potential
to improve the health and well being of patients and service users. An opportun-
ity to evaluate the teaching of interprofessional education and to use this evidence
to examine and promote improvements in the quality of teaching inter-
professional education was made possible through the PIPE project (Promoting
Interprofessional Education), on which this book is based.
The book will address teaching interprofessional education from a variety
of perspectives, offer some answers and raise many questions. It also provides
a welcome addition to the growing body of knowledge that seeks to promote
and improve the evidence base for interprofessional education. It does not
intend to offer a ‘how to do it teacher manual for interprofessional teaching
and learning’, nor an application of theory to practice. It does however, offer
theories, frameworks and models of teaching interprofessional education (IPE)
which we hope will make a contribution to the complex theoretical field of
IPE. The PIPE team acknowledge that there are no simple solutions or one
theory for IPE, but by using the evidence from the PIPE research project we
expect to develop the thinking of both theory and practice for teachers
involved in IPE. This book should help teachers to further understand their
practice, clarify complex areas and to build their own theories of teaching inter-
professional education.
The background to the PIPE project, some factual and historical details can be
found in Appendix 1.
The main aims of the book are:
to provide a critical exploration of practice issues relating to teacher prepara-
tion for interprofessional learning
to propose frameworks for interprofessional learning and teaching
to contribute to the emerging evidence base of teacher/facilitator preparation
for interprofessional learning.
We hope that this book will be read by both teachers and practitioners working
with health and social care professionals. It should provide the reader with a
ix
x PREFACE
balanced view on teacher preparation for interprofessional education, offer some
new ideas and stimulate debate.
Elizabeth Howkins
Julia Bray
October 2007
About the editors
Elizabeth Howkins was involved in setting up the PIPE project and then became
PIPE three scheme leader. She was senior lecturer at University of Reading and
Head of Department for Health and Social Care for six years. Her published
academic work has been in the field of ‘interprofessional work and learning’. She
has co-edited two other books; one on community nursing and the other on
managing and leading innovation in healthcare. She now has a consultancy role
and is an Honorary Fellow of the University of Reading. She was board member
of the Centre for Advancement of Interprofessional Education (CAIPE) for six
years.
Julia Bray directed the PIPE project from 2003 to its finish in 2006. As well as
project lead she was also an active participant in scheme three and the Delphi
research.
During this time Julia also carried out the roles of community practice lecturer
in primary care at the University of Reading and as a specialist nurse in child
protection for Windsor, Ascot and Maidenhead Primary Care Trust. Her research
interests are in interprofessional education and she has been very involved with
the setting up and leading of multi-agency training programmes. Julia has currently
returned to her job as specialist nurse full time and remains a co-opted member
of the CAIPE board of directors.
xi
About this book
Chapter 1 Perspectives of interprofessional learning and teaching provides a
framework for the book. It clarifies terminology associated with interprofessional
education, discusses the need to improve teaching in interprofessional education,
and addresses some of the aspects of the learning and teaching process.
Chapter 2 A learning and teaching framework for interprofessional learning
explores some of the challenges faced by teachers of interprofessional learning at
both the micro and macro levels. The work of Knud Illeris1 will be examined and
his use of the Tension Triangle as a model of understanding some of the tensions
that arise when planning and facilitating interprofessional learning.
Chapter 3 Interprofessional facilitation skills and knowledge: evidence from the
Delphi research survey addresses the issues from the workplace perspective,
exploring the development of skills and teaching methods needed for the prepa-
ration of facilitators undertaking interprofessional learning for work based learn-
ing. It outlines and presents findings from the research methodology using a
Delphi survey to discover what, if any, facilitation skills are needed to promote
effective interprofessional learning in the workplace.
Chapter 4 Embedding interprofessional learning in postgraduate programmes of
learning and teaching discusses the findings from a research project which used
a qualitative, interpretative approach to investigate incorporating interprofessional
learning in postgraduate programmes of education. Implications for curriculum
development and planning teaching are addressed.
Chapter 5 Preparing facilitators for interprofessional learning: the overview of
the evaluation and the findings from the four schemes are brought together in
this chapter, to show that even though different evaluation approaches and
research strategies were used the results showed a high degree of overlap and
similarity. Some practical suggestions are made on how facilitators of interprofes-
sional learning can gain confidence and experience.
xii
ABOUT THIS BOOK xiii
Chapter 6 Curriculum development for interprofessional learning discusses
findings used in the PIPE scheme two research projects, where four higher educa-
tion institutions implemented a common learning outcome related to interpro-
fessional learning. The complexity of curriculum development for the preparation
of teachers for interprofessional learning is presented through the use of sustain-
able frameworks. This chapter provides substantial information for curriculum
planners of interprofessional learning, either on large or short programmes of
study.
Chapter 7 Collaboration beyond champions addresses the interesting dynamics
of setting up and working with partner organisations of the PIPE project. The role
of champions played a pivotal role in getting the projects off the ground and
engaging senior staff, but the chapter argues that in reality the interprofessional
education projects will not be sustained without major policy change supported
by core funding to allow the institutions to embed sustainable changes.
Chapter 8 Through the PIPE. In this final chapter the learning and evidence from
the PIPE project is brought together to address the question:
What needs to be in place to develop, sustain and embed the preparation
of facilitators of IPL for health and social care, both in the formal educa-
tion setting and in practice?
A set of principles for IPL facilitation and an IPL facilitator strategy are outlined
in the chapter.
List of contributors
Ann Ewens was the driving force behind setting up the PIPE project and was
PIPE project director from 2002 to 2003. She was a lecturer in primary health-
care at the University of Reading where she was awarded a PhD for her thesis on
interprofessional education. She is now Director of Continuing Professional
Development at the School of Health and Social Care, Oxford Brookes University.
She is an elected member of the CAIPE board of Directors.
Jan Goldsmith was a member of PIPE scheme two. During much of the time of
the PIPE project she was a lecturer at the University of Reading and course direc-
tor of the masters in education programme. In 2006 she took up the post of
education, training and staff development programmes’ manager at Slough
Primary Care Trust. In 2007 she moved to a new post as Professional Advisor in
Education at the Nursing and Midwifery Council.
Maggie Lord was a member of PIPE scheme two. She is Principal Lecturer in the
Faculty of Society and Health, at Buckinghamshire Chilterns University College.
Her particular interest is in curriculum studies. She is course leader for the MA
in education, which is an interdisciplinary programme. Her main teaching role is
the preparation of practitioners as mentors and facilitators.
Katy Newell-Jones, led PIPE scheme two, she was also a member of scheme one,
three and four. She was, until March 2006 a principal lecturer in education in the
School of Health and Social Care at Oxford Brookes University. In 2005 she was
awarded the honour of National Teaching Fellow by the Higher Education
Academy. She has worked extensively in Africa and now South America on educa-
tion projects. She is a Supernumerary Fellow of Harris Manchester College and
Honorary Visiting Research Fellow of the Nuffield Department of Medicine,
Medical Sciences Division, and Oxford University.
Bee Wee was the PIPE four scheme leader. She is the senior lecturer in palliative
medicine at Sir Michael Sobell House, Oxford. She has developed, evaluated and
published on interprofessional learning in palliative care at undergraduate and
postgraduate level, some of these involving lay family carers as educators. She is
xiv
LIST OF CONTRIBUTORS xv
Associate Director of Clinical Studies and Fellow of Harris Manchester College
at Oxford University and the Head of the WHO Collaborating Centre for
Palliative Care.
Gill Young was a member of both PIPE scheme two and three. Until September
2005 she was a reader in educational development in the Faculty of Health and
Human Sciences at Thames Valley University. She represented the faculty on the
evaluation group of the Joint Universities Multiprofessional Education Programme
(JUMP). She was chair of the evaluation group in 2001 and continued in this role
until the end of the project phase in 2005. In 2005 she was elected to the CAIPE
Board. She now works as an educational consultant.
Acknowledgements
The journey of the PIPE project and the production of this book has been helped
in many ways and by many people. The contributions and continued support from
these people has meant the PIPE project was able to achieve its goals. We are
particularly grateful to Ann Ewens and Julie Hughes for spotting an opportunity
to secure funding, setting up the project team and getting the consortium together.
We would also like to pay thanks to all members of our hard working steer-
ing group. This group made inter-organisational collaboration a reality, gave the
project credibility and support at a senior level. The efficiency of the steering
group was greatly assisted by its excellent chair, Professor Ginny Gibson, Director
of Teaching and Learning at the University of Reading.
The project had four schemes which ran throughout its life; each of these was
led by a scheme leader heading up a group of people who gave their time and
expertise well beyond any requirements and/or expectations. To all of the scheme
leaders and the group members we extend our heartfelt thanks.
The evaluation of the project was an essential requirement and to this, we are
grateful for the expertise, support and commitment from our evaluator Dr Marilyn
Hammick. Although many more people could be named for all their work over
the project and preparation of the book, we would like to pay a special tribute
to the two PIPE project directors, Ann Ewens in the first year and Julia Bray for
the rest of the project’s life. They both brought an element of enthusiasm, deter-
mination and excellent organisation to the project which ensured that it stayed
on track and remained financially viable.
As with all large projects the time given by the PIPE team has been on the
margins of their already heavy workloads, encroaching on family life, friends and
social activities.
We want to end by saying a really big thank you to our husbands, partners,
children and close friends for supporting and encouraging us to carry out this
work.
xvi
List of abbreviations
BCUC Buckinghamshire Chiltern University College
CAIPE Centre for the Advancement of Interprofessional Practice and
Education, UK
DoH Department of Health
FDLT Fund for the Development of Teaching and Learning (part of
HEFC)
GP General practitioner
HEFC Higher Education Funding Council
HEI Higher education institution
IL Interdisciplinary learning
IPE Interprofessional education
IPL Interprofessional learning
JET Joint evaluation team
LTSN Learning and Teaching Support Network
MA Higher degree qualification of Master of Arts
MD Multidisciplinary
MP Multiprofessional learning
MSc Higher degree qualification of Master of Science
NHS National Health Service
OBU Oxford Brookes University
OPGMDE Oxford Postgraduate Medical Deanery for Education
QAA Quality Assurance Agency
PIPE Promoting Interprofessional Education
PCT Primary care trust
PHCT Primary healthcare team
RAE Research assessment exercise
SHA Strategic Health Authority
SL Shared learning
TVU Thames Valley University
TSD Training and Service Development Agency
UO University of Oxford
UR University of Reading
UK United Kingdom
WHO World Health Organisation
xvii
Glossary
Collaboration is an active ongoing partnership based on sharing, cooperation and
coordination in order to solve problems and provide a service, often between
people from very different backgrounds.
Continuing professional development is learning undertaken after initial qualifi-
cation in order to maintain competence and develop professional capability.
Curriculum includes all the aspects that contribute to the learning: aims, content,
mode of delivery, assessment, evaluation.
Facilitator is someone who embraces the notion of dialogue, is self aware, learns
with the group but is able to provide the appropriate learning resources and create
an environment for effective interprofessional education.
Interdisciplinary learning (IL) involves integrating the perspective of two or more
professionals, by organising the education around a specific discipline, where each
discipline examines the basis of their knowledge. (CAIPE (Centre for
Advancement for Interprofessional Education) definition in Vanclay 1997).
Interprofessional education (IPE) Occasions when two or more professionals learn
with, from and about each other together to improve collaboration and the quality
of care (CAIPE 2007).
Interprofessional learning (IPL) a process in which different professionals learn
from each other through interaction to develop collaborative practice. This may
be in a formal education setting or opportunistically in the workplace.
Multidisciplinary (MD) involves bringing professionals with different perspectives
together in order to provide a wider understanding of a particular problem.
Multiprofessional education (MP) describes a process by which a group of health-
related professions with different educational backgrounds learn side by side for
whatever reason.
xviii
GLOSSARY xix
Reflective learning is the ability to use reflection to make sense of an experience,
to be able to verbalise thoughts, share with others and learn from the experience.
Shared learning (SL), a common term used to describe professional groups learn-
ing together.
Staff development continued professional development of staff through activities
to enhance their knowledge and skills and change attitudes. It is sometimes
referred to as faculty development in higher education.
Steering group is a group of people who support and advise a project.
Teacher. The PIPE team sees the teacher as part of the more formal structured
delivery of education but they do acknowledge that the term facilitator and
teacher are often interchanged.
Teamwork. A process whereby a group of people work together with a common
goal.
Uniprofessional education is where members of a single profession learn together.
