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

Abstract

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 We examined a subset of 110 texts (academic literature, grey literature, and unpublished records) from a larger study that uses Critical Discourse Analysis to trace the emergence of IPE in Canada.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.

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

“…Our authorship team is composed of an interdisciplinary group that includes one clinician (a physician with previous training in history [CRW]), two sociologists (EP and JCR), an epidemiologist (CC) and a linguist (MP). Collectively, we are committed to more egalitarian relationships in health care, and four of us (CC, CRW, EP and MP) have published accounts critical of doctors’ dominance . Our structured coding scheme and analytic approach were developed to distance ourselves from our previous beliefs and to allow us to look with empirical detachment at the data excerpted from selected articles.…”

The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future

“…Work that does highlight such power dynamics is often conducted by sociologists, like Oh's (2014) ethnographic study of hospitalists, which focused on professional jurisdiction and boundary work within medical specialties. Notably, sociologists have provided evidence for the counterintuitive argument that IPE may in fact increase professional boundaries and hierarchical divides rather than foster collaborative relationships (Whyte et al 2017).…”

Beyond the Lamppost: A Proposal for a Fourth Wave of Education for Collaboration

“…An article we recently published with colleagues documented a case that exemplifies the first wave of IPE: that of the Division of Interprofessional Education at the University of British Columbia (UBC), in Vancouver, Canada. 11 The UBC experiment was one of only a few IPE initiatives at the time, along with experiments at the University of Florida and the University of Kentucky in the United States, neither of which has been studied retrospectively. 12…”

“…Yet as McCreary sought to enlist colleagues from across the university for his interprofessional project, tension arose because of disagreements about the purpose of IPE. 11 Some colleagues wanted to validate the vision that all the health professions are unique and complementary contributors and experts in their own particular domain; others, however, saw the purpose of IPE as the training of more affordable substitutes or aides to physicians, given the anticipated care needs of the population and the associated health care costs.…”