Interprofessional learning…bridging the paradigm gap by @burnham1john

It would be around 20 minutes

In the past few days we have been lucky enough (in the East anyway) to experience the first glimpses of a potential summer ahead. Bright sunshine, relatively warm weather and early sunrises lifting people’s spirits and encouraging them to make the most of the outdoors. It’s not surprising then, that this also marks a change in the type and frequency of out door accidents we also encounter. 

This was brought into sharp contrast for me whilst on leave last week when I found myself coming across a two car head on collision.  Three patients, two trapped and one with multiple injuries. The police had just arrived on scene but otherwise we were on our own.  A quick call to the ambulance control and I was able to confirm that two land ambulances, the air ambulance and a Special Operations Response Team were all en-route but would be around 20 minutes.

Competing priorities – hot debrief

A quick triage of patients, discussion with the police officer, and the fire crew (that had just arrived), determined our plan for scene control, patient priorities, treatment, extrication and onward transfer to the most appropriate hospital.  At the height of the incident there were 31 responders on scene (15 ambulance, 10 fire and six police), working on two separate vehicles, with patient treatment, vehicle cutting to effect extrication and investigation work all occurring simultaneously, and each a distinct priority for the relevant agency.

Despite these competing priorities and the various challenges encountered, the last patient was conveyed from the scene just over an hour after the collision occurred.  As is always the case in these incidents the fire service conducted a “hot debrief” with their crews at the road side, and I was fortunate enough to be able to take part in this.  This provided an opportunity to feed in the ambulance perspective and also to consider across professional and organisational boundaries what learning points (if any) could be taken away to improve our response in the future.

Having been involved in these debriefs previously, what is always such a striking feature is the culture of learning that this creates, and the normality of this simple and informal approach to learning and improving care.

Protecting our uniqueness

For the casual observer then, it would be logical to conclude that this demonstration of non-technical skills, epitomised through leadership, team work, good communication, situational awareness and safe systems was the norm and somehow just evolved.  Yet of course we are all aware of situations where this doesn’t always happen, and despite everyone working in the best interests of the patient, there is a loss in translation or understanding that creates a far from utopic learning and clinical environment.  Whilst not always the case, often these areas of conflict occur at the fringes of our professional scope of practice due to the understanding that we have developed of our own and others roles.  This is understandable given that traditional pre-registration education has largely been delivered in uni-professional silos; perhaps as a by product of professionalisation in which we seek to protect our uniqueness and value in society.  Thistlethwaite and Moran (2010) in reviewing the literature on interprofessional education (IPE) identify 6 key emerging and overlapping themes from the literature, namely:

• Teamwork
• Roles/responsibilities
• Communication
• Learning/reflection
• The patient
• Ethics/attitudes.

Moreover in their conclusion, the authors also raise the question as to how learning outcomes relating to these themes can be achieved through uni-professional learning. Specifically they site, “opportunities for modelling of collaboration, role negotiation and prioritization of service delivery” (Thistlethwaite and Moran 2010, page 512) as examples of areas of teamwork that would be difficult to achieve by a single profession alone.

Interprofessional practice – Interprofessional learning

So is it the case as we focus on developing our non-technical or human factors skills that these must be underpinned by not only interprofessional practice but also interprofessional learning both pre and post registration? and what benefit might this bring in developing “… mutual value and respect between different staff groups and all organisations across social health and care…to focus on listening to staff and enabling them to influence decisions that affect the services and care they deliver”? (Department of Health 2013, page 70)

Department of Health, 2013. Patients First and Foremost – The Initial Response to the Report of the Mid-Staffordshire NHS Foundation Trust Public Enquiry. London: UK Government. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170701/Patients_First_and_Foremost.pdf [Accessed 1st May 2013]

Thistethwaite, J. and Moran, M. 2010. Learning outcomes for interprofessional education (IPE):Literature review and synthesis. Journal of Interprofessional Care. 24(5), 503-513