Louder than words: power and conflict in interprofessional education articles, 1954–2013

Abstract

ContextInterprofessional education (IPE) aspires to enable collaborative practice. Current IPE offerings, although rapidly proliferating, lack evidence of efficacy and theoretical grounding.ObjectivesOur research aimed to explore the historical emergence of the field of IPE and to analyse the positioning of this academic field of inquiry. In particular, we sought to investigate the extent to which power and conflict – elements central to interprofessional care – figure in the IPE literature.MethodsWe used a combination of deductive and inductive automated coding and manual coding to explore the contents of 2191 articles in the IPE literature published between 1954 and 2013. Inductive coding focused on the presence and use of the sociological (rather than statistical) version of power, which refers to hierarchies and asymmetries among the professions. Articles found to be centrally about power were then analysed using content analysis.ResultsPublications on IPE have grown exponentially in the past decade. Deductive coding of identified articles showed an emphasis on students, learning, programmes and practice. Automated inductive coding of titles and abstracts identified 129 articles potentially about power, but manual coding found that only six articles put power and conflict at the centre. Content analysis of these six articles revealed that two provided tentative explorations of power dynamics, one skirted around this issue, and three explicitly theorised and integrated power and conflict.ConclusionsThe lack of attention to power and conflict in the IPE literature suggests that many educators do not foreground these issues. Education programmes are expected to transform individuals into effective collaborators, without heed to structural, organisational and institutional factors. In so doing, current constructions of IPE veil the problems that IPE attempts to solve.

Leveling the Playing Field: An Interprofessional Rural Preceptorship Pilot for Students of Nursing and Medicine

“…Moreover, all participants-students, staff and faculty-acknowledged the experience obliged them to confront the tacit, hierarchical discourse between nursing and medicine, and to reflect on their own attitudes and behaviours. The pilot thus promoted critical thinking and dialogue about power-a longstanding deficit in IPE curricula (Kuper & Whitehead, 2012;Paradis & Whitehead 2015). The participants occasionally experienced power differential between doctors and nurses as a barrier to IP interaction (Baker et al, 2011;Pecukonis, Doyle, & Bliss, 2008;Whitehead, 2007).…”

“…These authors do pertinently remark, "unfortunately, most of the rest of the IPE literature pays very little overt attention to power" (p. 348). Paradis and Whitehead (2015), in a comprehensive review of IPE literature, are more direct in criticizing a systemic blind spot to the hierarchical, disciplinary disconnects IPE purports to address:…”

“…Classroomand theory-based IPE interventions can do little to inoculate students in these disciplines against these pervasive and persistent cultural barriers in health care workplaces (Paradis & Whitehead, 2015). The researchers set out to determine if collaborative, practice-based experiences, wherein students of nursing and medicine could undergo precepted, clinical rounds together, would have an appreciable effect on these students' attitudes, knowledge and behaviours pertaining to interprofessional (IP) teamwork.…”

Examining Interprofessional Education Through the Lens of Interdisciplinarity: Power, Knowledge and New Ontological Subjects

“…While professional culture and identity are acknowledged as mediating inter-group rivalries (D'Amour and Oandasan 2005), there is seldom a focus in IPE studies on power relationships across the health professions (Baker et al 2011;Olson 2015;Paradis and Whitehead 2015). This is despite the well-known hierarchies that exist between professional groups in health care.…”

“…Michalec and Hafferty (2015: 181), for example, describe IPE as 'uncharted territory among medical sociologists'. Most IPE scholarship evaluates the effectiveness of shortterm interventions, rather than their broader social significance (Olson and Bialocerkowski 2014;Cooper and Geyer 2008;Paradis and Whitehead 2015). Reeves and Hean (2013: 2) argue that: the limited use of sociological perspectives [in IPE scholarship] limits our sociopolitical and economic understanding of how important dimensions such as imbalances in power/status, gender and ethnic differences are enacted in daily practice and how they can affect the delivery of effective interprofessional care.…”