It is a privilege and a joy to help celebrate Rick, a leader I admire and a friend I cherish. But he tested our friendship by giving me a hard assignment to talk about the virtue of interprofessional education (IPE). IPE is a passion for him, so I felt pressure to cover it well. And the connection between IPE and virtue was not immediately obvious to me, adding to the pressure. However, when virtue is framed as “consistent practices or habits that promote human flourishing,” the connection is crystal clear.
Four virtuous interconnections link collaborative practice, IPE, and virtue to Rick, and those will be the framework for my remarks. First, interprofessional collaborative practice (IPCP) promotes flourishing for the people for whom we provide health care. Second, if IPCP is to flourish among the rising generation of health care professionals, we must create a solid foundation of IPE focused on the essential competencies for such practice. Third, the Interprofessional Education Collaborative (IPEC) has been instrumental in putting IPE on the path to flourishing in dentistry and many of the other health professions, though there is much still to be done. Finally, IPEC has flourished with Rick’s leadership.
Interprofessional collaborative practice is defined by the World Health Organization as “multiple health workers from different professional backgrounds work[ing] together with patients, families, and communities to deliver the highest quality of care.”1 Today, all health professionals must practice collaboratively with those from other professions. Many will also participate in small interprofessional teams that have a collective identity and shared responsibility for a patient or group of patients.
IPCP requires persistent practice of a set of habits that promote flourishing, defined as physical, emotional, intellectual, and spiritual well-being. In its full expression, IPCP may encompass all of these dimensions. Although measurement of the impact of IPCP remains challenging, there is growing evidence that the habits of IPCP do promote flourishing for individuals under our care and for the health professionals providing that care. For example, a systematic review of 36 randomized controlled trials assessing impact of coordinated care demonstrated a 19% reduction in readmission rate.2 In another study, potential adverse drug events were reduced by two-thirds when a pharmacist was added to ICU rounds.3 Once initial resistance is overcome, many health professionals report greater satisfaction when responsibilities are shared and quality of care improves. And you know well the benefits of coordinating oral health with primary and preventive care, especially for children and people with chronic illness.
While there are examples of longstanding collaborative practice in areas such as mental health, geriatrics, and the care of children with multiple genetic disorders, the need for expansion of IPCP became steadily more apparent with the increased emphasis on quality, cost, and access in the first decade of this century. But schools of the health professions were not prepared to meet this need. And there was no common definition of collaborative practice habits. In order for IPCP to flourish, systematic preparation of health professionals in a set of core competencies was needed. Enter IPEC.
In 2010, leaders from associations of schools of dentistry, medicine, nursing, osteopathic medicine, pharmacy, and public health met and quickly committed themselves to work together to ensure that all graduates of those six professions would be prepared for collaborative practice and team-based care. This was the beginning of IPEC. For at least some of the founding principals, this commitment required courage, as many of their member institutions quickly anticipated new accreditation requirements.
IPEC’s first effort was to build on existing practices to define a set of foundational competencies for IPCP and team-based care. An expert panel defined the Core Competencies for Interprofessional Collaborative Practice.4 These competencies provide the foundation for defining and developing the knowledge, skills, attitudes, and values that must undergird the virtuous habits of IPCP. The IPEC competencies are now the dominant framework for IPE in the U.S. and have been translated into Japanese and Spanish. They are considered by many to be an essential contribution to reforming health care by transforming education about practice. Publication of the competencies established a clear direction for IPE at the pre-professional degree level.
IPE—defined as the process by which individuals from different professions learn about, from, and with each other—is essential for effective collaboration in the patient’s interest and for effective performance as members of an interprofessional team. Effective IPE engages learners from different health professions in patient-focused learning experiences, real or simulated, that incorporate knowledge, skills, values, and attitudes. Effective IPE also exposes learners to practitioners who model the virtues essential for IPCP.
What are those virtues? First and foremost is humility. My favorite definition of humility comes from spiritual leader Joan Chittester, who describes it as “a proper sense of self in a universe of wonders.”5 With a proper sense of self, individuals are more able to learn from others; acknowledge their own faults; let go of ego, the great obstructer; seek direction from others; and be kind to all. These behaviors are critical for optimal collaboration. Humility makes it easier to practice other essential virtues, such as respect, patience, compassion, and honesty. Indeed, humility has been described as the basis for right relationships in general. Effective IPE can also cultivate the virtues of openness and hospitality. We all have biases that arise from our mental models. They are as much a part of our human nature as is growing old or falling ill. Our brains cannot function without mental models, but they limit our vision and often close us to a wider range of experiences. IPE requires faculty and learners to recognize their own unavoidable biases, thereby creating the opportunity for greater openness, inclusion, and hospitality and new, potentially joyful life experiences. And these virtues enrich life beyond professional practice.
Interest in IPE waxed and waned over 50 years, but in less than a decade, IPEC has promoted the flourishing of IPE across many health professions. Since 2014, 17 additional associations, representing a broad variety of professions, have joined the six founding members in IPEC. In 2017, these 17 also joined the original six in the Health Professions Accreditors Collaborative, committing to work together to advance IPE, interprofessional practice, and quality. At least ten professions now have accreditation standards relating to IPE.
Advancing IPE required the virtues of patience and perseverance and the skills of diplomacy and persuasion. After launching the core competencies, IPEC moved quickly to begin providing faculty members with the learning resources and skills they needed to develop new curricula. IPEC promoted sharing of learning resources across institutions, and there are now 175 peer-reviewed learning modules available at no charge through the interprofessional portal on MedEdPORTAL. Some of you may have contributed to resources such as the oral health curriculum for physicians and other clinicians.
IPEC faculty development institutes helped fuel diffusion of IPE. The 15 institutes convened since 2012 have engaged 429 teams comprising 1,819 individuals from 49 states, the District of Columbia, and Puerto Rico. The second IPEC Leadership Development Program, held in February 2019, attracted 55 institutional leaders from 11 health-related professions, learning together about ways to advance IPE. In 2012, only 34% of dental schools had required IPE experiences; two years later, 69% did.6 Now, virtually all dental and medical schools have a required IPE curriculum, although there is considerable variation in scope and focus. Most academic health centers and many free-standing health professions schools have IPE programs. There are at least five scholarly academic centers for IPE and several doctoral programs in interprofessional education. There is still much to be done. For example, the number of learners far exceeds the availability of practice sites—academic or community-based—that can provide a meaningful, patient-focused experience of interprofessional collaborative practice.
Our honoree, Rick, brought a number of gifts to IPEC that promoted its flourishing. During the early years of IPEC, his energy and deep commitment helped propel the group, and his sense of humor and inimitable laugh often helped diffuse the inevitable differences of opinion among the six principals. As IPEC matured, he brought values-based leadership, serving as president for two years before becoming board chair in 2018. Throughout his service, Rick has brought integrity, trustworthiness, and a generous tenacity to the work. Most importantly, he has practiced the virtue of charity, which Karl Haden aptly describes as “loving others in an active and meaningful way.” Rick was always willing to give his time, attention, and energy to the work. He rarely missed our weekly calls at 8 a.m. Monday, even though that often meant calling from the airport or some hotel in an earlier time zone. He was also generous with his ideas, never seeking the spotlight or diminishing the work of others.
In summary, our leader, colleague, and friend Rick has brought many virtues to the development of IPEC, which helped it flourish. And the virtuous IPCP of the rising professionals in dentistry and the other health professions will someday help many of us to flourish.