Professional equipoise: Getting beyond dominant discourses in an interprofessional team

Abstract

In 2011, the US Department of Veterans Affairs established five Centers of Excellence to study training in the patient-centered medical home clinical microsystem. Early on, our center began a discourse analysis in order to better understand each profession's assumptions about roles, responsibilities, and the basis for "truth" in clinical care. We discovered that these different discourses were pervasive and led to unhelpful stereotypes of each other. This article describes the evidence we identified that led us to hypothesize these conflicting discourses and stereotypes. Specifically, we report on our attempts to identify the traditional discourses of four post-graduate professions--medicine, nurse practitioner, psychology, and pharmacy. We also share lessons from our efforts to defuse participants from their identified discursive assumptions, and develop appreciation and value for the discursive contributions of other professions--a process we call professional equipoise. We conclude that we can change these discourses and the professional identity formation of novices if we provide sustained, integrated interprofessional education curriculum. This implies that we need: embedded, longitudinal training; faculty role modeling of inquisitiveness, respectful relationships, and risk taking; and safe and honest discussion about our differences.

Counseling Psychology Model Training Program

“…In preparation for such work, counseling psychology students will benefit from training in an inclusive and flexible range of quantitative and qualitative research methods, as well as hybrid designs (Chor, Olin, & Hoagwood, 2014; Tebes et al, 2014). Program evaluation, quality assurance and/or improvement, outcomes assessments, nonlinear/dynamic systems evaluations, population health management strategies, community-based research, and critical research perspectives, are all likely to be in demand (Beacham et al, 2017; Smith et al, 2015; Teo, 2015). Counseling psychology program faculty can assist students in learning grant writing skills and in accessing funding outlets for interprofessional work (see Chor et al, 2014 for several examples of the Health Resources & Service Administration’s Mental and Behavioral Health Education and Training Grants; also see the National Institutes of Health “Clinical and Translational Science Awards,” 2017).…”

“…Whether in the practice or research domains, studies show that interprofessional experiences seem to work best when power hierarchies can be reduced or eliminated, when team members have a shared mental model/superordinate goal, when joint work can be approached from a position of curiosity and nonjudgment, and stereotypes about other professionals are suspended or better yet, directly discussed and processed (Smith et al, 2015; Tebes et al, 2014). Counseling psychology training, with its focus on systemic, holistic, diversity, and social justice perspectives, is well-positioned to foster such attitudes and behaviors for effective collaboration.…”

Shared leadership and group identification in healthcare: The leadership beliefs of clinicians working in interprofessional teams

“…Despite the potential benefits of shared and distributed leadership, few studies have explored the leadership beliefs of healthcare clinicians and whether differences exist between professional groups in interprofessional teams. This is surprising since interprofessional teams, particularly in mental health, are comprised of professions from distinct training backgrounds and diverse philosophical stances (Clark, 1997;Smith et al, 2015). Through processes of group formation, socialisation and identification, healthcare professions are likely to have developed their own specific norms and stereotypes about other professional groups (Stull & Blue, 2016).…”

The nature and benefits of team-based reflection on a patient death by healthcare professionals: a scoping review

“…The management of the interprofessional nature of the reflection on participants was rarely considered. There was no study that considered a set of ground rules to acknowledge concerns of hierarchy, status, identity and language (Pietroni, 1992;Smith et al, 2015).…”