Dr. Jones, a small-animal general practice veterinarian, sees an 8-year-old golden retriever for a 3-month follow-up examination after the dog has been diagnosed with hypothyroidism and initiated on synthetic thyroxine replacement therapy. However, the dog does not seem to have improved since the start of the drug therapy; in fact, it seems quite a bit worse. The client was provided with a written prescription for the drug after diagnosis and had the prescription filled at a neighborhood retail pharmacy. She has brought the medication with her to the veterinary visit, and when Dr. Jones reads the label she realizes that the prescription was filled at one-tenth the dose that was prescribed. She quickly blames the pharmacist for making a mistake, unaware that the pharmacist’s scope of practice allows for alterations in dosage if they suspect an error on the part of the prescriber. Both professions believe that the other is to blame.

Dr. Smith is in the exam room with a mom, her 5-year-old daughter, and their pet rat. The rat is freely climbing over the girl’s shoulders and the child repeatedly kisses the rat every time it crosses in front of her face. Dr. Smith notices a sizable pustule on the girl’s upper lip. She asks the mom if she has seen her pediatrician for it. The mom replies yes, and that the pediatrician referred the child to her dentist, since she thought it was an oral health issue. The dentist has since prescribed two different antimicrobials, but neither has made any difference. Dr. Smith asks the mom if she mentioned to the dentist that her daughter has a pet rat that she regularly kisses. The mom responds that she hasn’t. “Is that important?” she asks. Dr. Smith calls the dentist to talk about the normal flora of the rat, and to suggest perhaps selecting a different antimicrobial that might be more efficacious.

Just as the One Health initiative can trace its roots back to the 1960s, IPE had its early beginnings in 1972 after an Institutes of Medicine (IOM) report entitled “Educating for the Health Team” called on academic institutions to begin educating students in the health professions to practice collaboratively. The IOM called on healthcare teams to share common goals and incorporate the patient, family, and communities as members of the team. Moreover, the report noted that the existing educational system was not adequately preparing health professionals for such teamwork. Initially, not much changed in how health professions students were educated; the same educational silos remained common throughout the 1970s, 1980s, and 1990s. Universities and health professions colleges remained rather insular, establishing their own cultures and educational practices without conferring much with other health professions. It was not until students entered the clinical environment that they even encountered other health professions, and then contact was brief and focused on specific functions. Even healthcare records were kept separate, with rarely a chance for sharing patient goals and treatment plans across professions.

The IOM (2000, 2001, 2003) published further reports identifying the need for healthcare delivered by interprofessional teams. These new reports largely cited preventable errors as the impetus for better collaboration, noting that communication failures are major obstacles in delivering quality care across the professions, and calling for systematic changes in order to create cultures of cooperation and coordination.

In 2003 the IOM sponsored a summit on health professions education where five competencies central to the education of all health professions were identified. The IOM competencies recommend that students should be able to provide patient-centered care; apply quality improvement; employ evidence-based practice; utilize informatics; and work in interdisciplinary teams. Every one of these competencies is just as relevant to the practice of veterinary medicine. In veterinary medicine, patient-centered care not only includes a focus on the individual animal patient, but also incorporates a client-centered focus, where the specific goals of the client/animal owner are addressed and the client is embraced as a member of the veterinary healthcare team.

The World Health Organization (WHO) has also noted the need for collaborative practice in mitigating the global health workforce crisis by publishing the “Framework for Action on Interprofessional Education and Collaborative Practice” in 2010. The WHO defines IPE as occurring when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. From a global health perspective, this describes the One Health initiative to a tee.

Setting the One Health perspective aside, veterinary medicine still needs interprofessional practice and education to meet the ongoing needs and demands of society. In the developed world, increased veterinary specialization and vast improvements in diagnostic capabilities and treatment strategies are de rigueur. Just step into any general or specialty veterinary clinic in the United States to see the array of diagnostic equipment and therapeutic tools that are commonly used. Computed tomography (CT) scans, magnetic resonance imaging (MRI), digital radiography, endoscopy, arthroscopic and laparoscopic surgeries, chemotherapy regimens, ventilators, portable complete blood cell (CBC) and serum chemistry machines – the list goes on and on. All of these technologies and advances require special knowledge, skills, and behaviors. As a result, more veterinarians are pursuing advanced training, certifications, and specialty boards. With these advances comes an increased need for veterinary care delivered by teams. Often, educators will suggest that because veterinary students do not deliver human care, they need not participate in IPE. Yet this is the wrong assumption. IPE is not about human healthcare; rather, it is about team-based healthcare, regardless of the species of focus. As the WHO has defined it, IPE occurs when students learn about, from, and with one another to enable effective collaboration and improve health outcomes. Such students need not be treating the same patients, or even practicing in the same settings. Collaboration skills are universal, and can be learned and practiced across settings. When students are challenged to learn and practice such skills together, they will gain the added benefits of learning about all the health professions, and be better prepared to coordinate care when their professions do in fact intersect.

Veterinary medicine has continued to change in ways very similar to how human healthcare has evolved over the past three or four decades, with increased specialization and, unfortunately, fragmented healthcare delivery as a consequence. Let us face the challenge of providing coordinated, collaborative care by learning from the other health professions, examining their systems, and proactively shaping the future of veterinary practice so as not to repeat those professions’ past errors. IPE can help with this too, by providing veterinary students and faculty with insights into the systems that have driven and shaped the human healthcare system.

Collaborative care saves lives. Plainly and simply, creating healthcare that is coordinated and collaborative can prevent suffering and premature deaths. Based on 1984 data, the IOM estimated that up to 98 000 Americans die each year from medical errors, with most of those errors a result of communication failures. An updated analysis published in 2013 estimated that more than 400 000 human patients experience premature deaths annually associated with preventable harm in healthcare (Interprofessional Education Collaborative Expert Panel, 2011; James 2013). While such a high number of incidents does not occur in veterinary practice, increased specialization and the challenges that it poses to care coordination and communication mean that it is not unreasonable to assume that veterinary patients may also experience preventable harm. While most veterinary curricula incorporate communications skills, these are largely focused on doctor–client communication, with less time devoted to building communication skills within the veterinary or interprofessional healthcare team. Even the veterinary primary literature notes the incidence of patient harm due to communication failures between veterinarians and pharmacists (Cima, 2014; Wells et al., 2014). Such examples of preventable errors in veterinary practice are the reason that IPE is needed universally across veterinary education today.

In 2011 a multidisciplinary health professions panel (IPEC) convened to define and establish educational competencies to be used across health professions and IPE programs throughout the United States. Four competency domains and specific competencies within each domain were established. IPEC published its report, findings, and recommendations that same year (Interprofessional Education Collaborative Expert Panel, 2011). A similar effort in Canada had already published a national interprofessional competency framework the year before (Canadian Interprofessional Health Collaborative, 2010). A similar report was published in the United Kingdom even earlier (UK Centre for the Advancement of Interprofessional Education, 2007). All of these reference similar core competencies across the health professions, yet individual national reports are necessary considering the differences in how both health professions education and healthcare delivery are regulated, accredited, funded, and delivered in each nation. This section will refer primarily to the US publication.

In the United States, the four core competency domains for IPE that have been established are (Interprofessional Education Collaborative Expert Panel, 2011):

• Values and ethics for interprofessional practice.
  
• Professional roles and responsibilities.
  
• Interprofessional communication and collaboration.
  
• Teams and teamwork.

The competency domains and the specific competencies that follow are purposely general in nature and are meant to function as guidelines, allowing flexibility within the professions and at the institutional level. The desired principles of the interprofessional competencies are (Interprofessional Education Collaborative Expert Panel, 2011):

• Patient/client/family centered.
  
• Community/population oriented.
  
• Relationship focused.
  
• Process oriented.
  
• Linked to learning activities, educational strategies, and behavioral assessments that are developmentally appropriate for the learner.
  
• Able to be integrated across the learning continuum.
  
• Sensitive to the systems context/applicable across practice settings.
  
• Stated in language common and meaningful across the professions.
  
• Outcome driven.

As is evident in Box 7.2, the overarching goals of the IPE competencies reach beyond educational methods and professional behaviors. The general nature of these competencies therefore poses significant challenges in assessment, since the specific competencies describe skills more than they do knowledge. Likewise, specific curriculum components tend to focus on skills development, such as communication, rather than on knowledge acquisition, which requires more complex assessment strategies. Other competencies are more knowledge based and can be assessed with traditional multiple-choice format exams, for instance professional roles and responsibilities.

As this is an educational endeavor that crosses professions and universities, it is important to note that the stated goals aim for changes in systems and policy as well as in the education of health professions students. While this is very useful in the formative years of interprofessional education globally, it makes it particularly difficult to design and evaluate curricula. Suddenly, designing curricula around the basic sciences seems easy! Specific strategies for designing curricula around these competencies will be described later in this chapter.

As it is a relatively new educational endeavor, there is no one single formula for creating and implementing an IPE curriculum. Although many of the health professions accrediting bodies now require IPE as an accreditation standard, they do not specify during which years of the curriculum or even how much IPE is required. There are many logistical challenges that must be met and each individual academic institution has unique needs and cultures to be considered. The approach used at Western University of Health Sciences (WesternU) to overcome these challenges is highlighted in Box 7.3. This is just one example of the work that is sometimes necessary to create an educational program that spans multiple professions in various colleges and programs.

Some academic institutions introduce learners to IPE during the clinical years of instruction, while others begin during the preclinical stages of the curriculum. There are advantages and disadvantages to both approaches. Beginning early in the preclinical years allows learners to begin thinking differently and critically about their own roles and responsibilities as well as those of the other health professions. Students will then enter their clinical years with new ideas about how their profession fits into the healthcare team. On the other hand, if IPE is offered during the clinical years, learners can apply new concepts and collaboration strategies right away while they rotate in the clinics; such an approach may cement the learning more deeply.