The Rise and Rise of Interprofessional Competence

By | 28th June 2012
In the past few years, we have seen a continued growth in the use of competency frameworks for the traditional health and social care professions (e.g. nursing, medicine) as well as the emerging professions such as physician assistants. In this editorial, I attempt to explore the continued rise of competence, with a focus on the use of competency frameworks in the interprofessional field. In doing this, I initially outline the growth of interprofessional competency frameworks and discuss some of the benefits they offer before examining their current shortcomings. The overall aim of this editorial is to argue that, while our efforts in identifying and synthesizing interprofessional competence have taken some important steps forward in defining the key attitudes, knowledge, skills and behaviors for effective interprofessional practice, collectively there are still areas in which we need to improve to ensure the interprofessional competency frameworks we produce are done so in as robust a fashion as possible.

In the past 5 years or so, especially in North America, we have witnessed a growth in the number of interprofessional competency frameworks both from national organizations. We have also seen a number of publications that discuss and explore how competences can contribute to the development of more effective interprofessional practitioners. As I previously argued, the use of competences and competency frameworks has a wide appeal as they help provide consistent standards of professional and interprofessional practice, help validate areas of health care work which are regarded as important (e.g. patient-centered care), can provide observable indicators of performance and also offer an indication of the complex interplay between knowledge, skills and behaviors.

When one reviews the interprofessional frameworks, it is encouraging to note that they have a degree of consistency with the core domains of competence they identify.  In addition, from the perspective of interprofessional education in the USA, it appears that the focus on interprofessional competence has engaged a number of policy-makers and funders into re-investing into the field. As noted above, one of the strengths of the competency movement, which arguably appeals to policy-makers and funders, is the use of competency statements that can potentially provide observable indicators of collaborative performance across an array of clinical contexts.

Nevertheless, the interprofessional competency frameworks produced so far contain two main issues which need some further thought. The first is conceptual. When one reads the various competency statements within the domains of these frameworks, an extremely popular focus is on “teams” and “teamwork”. While interprofessional teams are a very common arrangement in the delivery of health care, they are not the only division of labour. This almost exclusive focus on teams overlooks the fact that there are other forms of interprofessional work which learners also need to have competence in working together effectively when delivering care.

Recently, with colleagues I published a typology of interprofessional work which classified activities into four forms: teamwork, collaboration, coordination and networking (Reeves et al 2010 – Interprofessional Teamwork for Health and Social Care).  We differentiated these forms of interprofessional work as follows: teamwork was seen as encompassing a number of elements such as shared team identity, clarity of roles, interdependence between team members, integration of tasks and shared responsibility. In contrast, collaboration was a “looser” form of interprofessional work, as shared identity and integration of individuals were less important, but there were some shared accountability and interdependence between professions. For coordination, while there was some sense of shared identity, integration and interdependence were less important; there was also little shared accountability or clarity of roles, tasks and goals. Lastly, networking was a relationship in which shared team identity, clarity of roles/goals, interdependence and shared responsibility were less essential; networks were therefore seen as virtual, whereby none of the members necessarily needed to meet face to face, as they could communicate online in an asynchronous manner.

The aim of presenting this topology here is to provide a reminder that we have, so far, neglected to incorporate other forms of interprofessional work, which occur across a range of health and social care settings. Teamwork is one form, but we also need to think about developing competency statements that reflect these wider forms of interprofessional work.

The second issue is focused on measurement. At the moment, we are not clear about how to robustly measure (assess) the many different statements which make up the interprofessional competency frameworks. Importantly, each of the competency statements is very complex in its composition. Each statement can combine multi-faceted attributes related to collaborative attitudes, values, knowledge, skills and behaviors – packaged together in a single sentence. However, it is difficult to see how to tease apart each of the embedded attributes and measure them in a rigorous manner.
Efforts to date, which have used self-assessment approaches, only provide a limited form of evidence. We therefore need to embrace other assessment methods, such as observation of performance.

Another measurement difficulty is that the unit of analysis for these interprofessional competency frameworks is focused on the individual learner. Although this focus is appropriate, as assessment of individuals is extremely important, it overlooks any measurement of the shared learning experience. We fail to assess collectively the interprofessional group or team of learners. This oversight is arguably an important limitation, as we are not focusing on a key element of interprofessional education – its shared, collective approach. We therefore need to better understand, through measurement, this dimension.

Finally, we have little evaluation data, to date, which provide an insight into whether any of these interprofessional frameworks are being implemented. We have no empirical evidence into how effective (or not) they are in capturing the essence of effective interprofessional collaboration. This is another area where we need data to help us understand the broader issues linked the use of interprofessional competence and the frameworks which aim to synthesize its core elements.

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