The current trend to increase interprofessional education is best understood by looking at the evolution of the health professions. Historically, both medicine and nursing developed as apprenticeships, with a transition to a science-based educational approach in the early 20th century, with medicine driven by the 1910 Flexner Report,1 and nursing, by the 1923 Goldmark Report.2 Rapid advances in care, trends toward increased subspecialization in both fields, and the emergence of "turf wars" driven by professional prestige and financial rewards characterized the remainder of the 20th century. There can be little doubt that the development of both professions has been steeped in issues of gender roles and biases as well.3

Although both medicine and nursing emerged from efforts to bring comfort and healing to people in their homes and communities, the evolution of medicine and rise of technology created our current acute care-based, technology-driven, super-specialized health care system. This system is all too often fragmented, competitive, and focused on the needs of the system and its providers, rather than those of patients and families. Furthermore, the aging of our population and anticipated increase in newly insured Americans mean that the primary focus of health care is no longer curing acute illness but rather prevention and management of chronic conditions. The delivery and manner in which care is delivered also will change because comprehensive care is best provided by a team of health care providers rather than by individual practitioners.4 Thus, the 21st century will be marked by the use of highly effective interprofessional teams that are patient centered and holistic and are focused on safety and quality care delivery.

Interestingly, the use of interprofessional team-based care is not a new phenomenon: interprofessional education and interprofessional collaborative practice have experienced ebbs and flows since the 1970s.5 The recent resurgence stems from the recognition by the Institute of Medicine (IOM) that interprofessional teams are best positioned to deliver safe and effective patient-centered care.6-8 The triple aim of improving health, enhancing the patient care experience, and reducing or controlling costs will be realized only by effective teamwork. Furthermore, the 2010 World Health Organization (WHO) report acknowledges the importance of interprofessional health care teams to meet the needs of the developing as well as the developed world.9

The clinician of tomorrow will need to be trained in teams. "To meet the public's health needs, health professions educators must teach and model collaborative practice and team-based models of care.[horizontal ellipsis] By putting forward these competencies, we hope to accelerate efforts to transform health professions education in the United States."10 Today's students who graduate from well-intended, well-accredited institutions are simply unprepared for the practice environments in which they will work. This reality has led to an increasing recognition that health care delivery, and therefore health professions education, must be based in highly effective teams. The hope is that students who are trained together in team-based models will seek and engage in a team approach to care when they are in practice. Although most health professionals and educators agree that the use of team approaches to learning and solving health care problems is the best way to teach, the clinical and educational environment frequently remains prohibitive to team training and tends to support silo learning and practice. The student (nursing, medical, etc), therefore, is faced with the unintended consequences of an educational system designed in the "old" health care system, void of the opportunity to practice teamwork skills and shared decision making. Persistent biases and hierarchies too often prohibit learning the roles and responsibilities of other professionals or the positive impact of soliciting and valuing every team member's expertise, opinion, and suggestions.

As previously noted, this task can be daunting because most clinicians themselves have been prepared as a "silo practitioner" and may not recognize their own biases or the relative lack of effective teamwork in their daily work. Furthermore, most clinical educators, while expert clinicians, have not been prepared as educators. Clinicians and educators who recognize the limitation of tradition should challenge the "old ways" and create a deliberate curriculum rooted in a fundamental interprofessional core curriculum that will promote team-working skills. Using the Interprofessonal Education Collaborative core competencies as a framework11 and crafting purposeful team language found in curricula such as TeamSTEPPS,12 clinicians and educators can begin to create a culture shift. But interprofessional education and subsequent collaborative practice initiatives must have the full support of the organization's leadership in bringing about culture change.13

Health care reform in the United States and the patient safety movement has spurred revitalization of research into best practices for interprofessional education and collaborative practice. Increasingly, the focus of research has moved from short-term, program-specific outcomes to the impact on patient experience and outcomes, quality and safety, and cost of care.5 This is coupled by an increased recognition that effective education must be grounded in and informed by highly effective clinical practice environments and must solve real-world clinical and health system challenges.

Just as the digital age has changed the way we conduct our everyday lives, it continues to change how we deliver care. New technologies, new therapeutic modalities, telehealth, and enhanced recognition of the need to integrate mental and behavioral health and understand the social determinants of health require a longitudinal, team approach-not only nurses and physicians of all the specialties but also all established and emerging health professionals. As the health care system evolves to a population-based, accountable care system, technology will be used to create longitudinal interventions that focus on safety, communication, and patient-centered approaches. Telehealth systems can support the consumer-driven, self-management health care environment of tomorrow and allow patients and their families to be integral members of the health care team. Using mobile devices, families can join and be a member of early morning patient rounds; patients and consumers can have access to specialist or their health care provider from across the country or globe; many professionals can collaborate in real time; and teams of health care providers can virtually manage patients with chronic illnesses. Our educational methods must evolve in recognition of this rapidly changing clinical environment. Increasingly, health professionals need to be prepared to collaborate effectively not only with other professionals but also with paraprofessionals, community agencies, and, most importantly, with patients and their families as key members of the health care team.

It is a time to go back to the future by implementing the lessons of the IOM and WHO reports. The time has come to create real clinical and educational interprofessional opportunities so that the practitioner of today and tomorrow is able to effectively leverage new technologies and techniques to improve the experience of health care, improve health outcomes, and decrease costs. Students cannot learn what they do not experience; thus, faculty must engage in and role model interprofessional collaboration in meaningful ways in our care and teaching. Integrating interprofessional education and collaborative practice opportunities does not mean designing a center; it requires engaging students in existing teams to understand each other's roles and responsibilities, and their values and ethics, as well as be effective communicators. This needs to be a natural part of our curricula. We should not think of teaching any other way, and our students should not think of learning in any other way.

Challenge yourself to find 1 effective, highly functioning interprofessional team in which you can engage with your students in your next course. To meet the public's health needs, health professions educators must teach and model collaborative practice and team-based models and include other established and emerging health professionals and paraprofessionals as part of the team such as community health workers, lay health workers, and public health professionals in social work. The ability to function in a team, as a team member and as a team leader, and to recognize advances in technology for managing chronic illness in a fundamentally changed health care arena is the only way to prepare students. "Progress is always the result of visionaries and leaders who, in critical moments of need and opportunity, seized the initiative and charted a way forward."14^(p4)

References