Interprofessional Education and Ethics: introduction

Ethics SIG 11 November 2006

Dr Marion HelmeUK Higher Education

Academy

European Interprofessional Education Network

Learning together to work together

Uczyc sie razem i od siebie aby razem racowac

Az együttes tanulástól a közös munkáig

Lära tillsammans för att arbeta tillsammans

Opimme yhdessä työskentelemään yhdessä

Μαθαίνουμε μαζί για να δουλέψουμε μαζί

IPE and ethics: discussion points

• Definition of interprofessional education• IPE - what works• IPE - problems• IPE and ethics • Differences between professions (theorising)• Ethics as a focus of interprofessional learning

– IPE as ‘opportunity to debate professional ethics’ – Example (1) A code of ethics for students from

different professions learning together– Example (2) A code of ethics in interprofessional

practice for praction– Example (3) Topics for learning together

• Challenges for ethics in IPE

Definition of interprofessional education

‘Interprofessional Education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care’

CAIPE 2002 (Reflection on this definition just published on www.caipe.org)(improve and quality imply value judgements)

Doing it (IPE) – what works (from

research) Parity of esteem between learners – sustained and maintained by ground rules and facilitation

The right time (for the particular learning opportunity)

Good questions (not showing up differences in academic proficiency or leading to competition or implicitly stereotyping – eg. which of you knows most about the other profession)

Connecting IPE and the rest of the curriculum (integration)

Respecting students’ choice of profession

Facilitators as “fire-stokers” (enthusiastic)

Related to practice learning and involving patients or simulated patients. IPE “needs an idea that matters to people”.

Skilled facilitators/teachers in HEIs and practice

Doing it –problems (what doesn’t work –

from research) • “Lack of detailed attention to field specific content” *• Limited opportunity for interactive learning• ‘Curriculum creep’ (adding to rather than integrating

in the curriculum) and duplication (especially in terms of student assessment)

• Insufficient integration between classroom and practice learning experiences (contextualisation)

• (Not recognising) Limitations in transferability of learning and need for reinforcement, development, ‘stages’ etc.

• Assessment (no assessment, an ‘option’)• Lack of attention to language (different terminology,

same terms different meaning, omissions (health and social care) …)

*Aveyard, H., S. Edwards, et al. (2005). "Core topics of health care ethics. The identification of core topics for interprofessional education." Journal of Interprofessional Care 19(1).

Sometimes neglected in IPE: conceptualisations and explanations of

differences between professions:

In terms of traditions, epistemologies, languages, ‘cultures’:

Values … constrain, and sometimes control, much of what the people in any culture do and do not do. Moreover the values vary enormously from one culture to another. (Kline, S. J. (1995). Conceptual Foundations for Multidisciplinary Thinking. Stanford, CA, Stanford University Press)

In terms of each other (decision-making hierarchies, spheres of responsibility, ‘power over …’, legitimate actions)

In terms of purpose and task (the needs/circumstances of the patient/service user/carer (‘patient-centred care’, ‘power to …’) and community)

Differences in professional orientiations with regard to ethical practice and values (a

characterisation)

Social work: social justice, anti-discriminatory practice, inclusion

Nursing: the ethics of care and ‘virtue ethics’*

Medicine: the Hippocratic Oath and the World Medical Declaration of Helsinki (‘It is the mission of the physician to safeguard the health of the people‘)

*Eg. Armstrong, Alan E (2006) Towards a strong virtue ethics for nursing practice Nursing Philosophy Volume 7 Issue 3 Page 110 

Codes of practice and IPE as ‘opportunity to debate professional ethics’

A personal starting point (used in teaching social workers):

“Social Workers should stop using social work values as a set of rules and start using them as markers of problematic areas on the map of social work ... Social work values emerge from disputation about practice - not from the ‘deep soul of social work’, however they have become rules used to present an image of social work to the world. Instead they should provide a duality - ‘a statement of conflict rather than a guide on where to go’. In areas such as anti-discrimination there is not one simple rule - judgements still have to be made ...”

Malcom Payne, Professor of Social Work, Manchester Metropolitan University, quoted in ‘Professional Social Work’ May 1995.

A Code that takes into account the position of students

King’s College London: Code of Ethics and Professional Conduct for Healthcare Professional Students (2006) (written

by Dr Elaine Gill), applied by health profession students in first term first year interprofessional module As a healthcare professional student you must:

• Acknowledge/recognise your learning needs for knowledge, skills and attitudes and participate in learning opportunities to develop understanding, insight and competencies throughout training.

• When in contact with patients and members of the public you are to dress smartly and appropriately (in or out of uniform) and have your personal identification with you.

• Do not discriminate against student or professional colleagues or patients.• Respect others beliefs and values and avoid forcing your own beliefs on others.• Work with colleagues in ways that promote effective teamwork and acknowledge individual

disciplines contribution to best serve patients’ interests and care.• Respect the rights of patients and others to information, confidentiality and contribution to

decision making. • Demonstrate effective communication skills with patients, carers and colleagues.• Respect the rights of patients and others to dignity in the learning environment and clinical

practice.• Recognise the level of your own capabilities and ensure the safety of patients at all times

seeking help and advice when needed.• Seek advice if you are concerned about issues of professional misconduct in the clinical

setting. Do not remain silent.• Be aware of the professional boundaries in relationships with patients and clients.• Be responsible for your own behaviour and develop appropriate professional integrity.• Be familiar with your own discipline’s professional code of ethics, conduct and duties.

Draft statement of interprofessional values underpinning work with children and young people

This statement is being developed by the General Teaching Council – in final draft for publication early 2007.

It includes statements concerning:Valuing contributions made by colleaguesTransparency and reliability Being supportive of each other’s well being

It states that:Sharing responsibility does not mean acting beyond competence or responsibilitiesKnowledge,understanding and skills may be different for interprofessional work than own specialism

Core topics for interprofessional ethics teaching in health and social care (Aveyard,

H., S. Edwards, et al. (2005)). • Ethical theory• The professional duty of care, codes of

practice and accountability• Informed consent and patient refusal• Confidentiality• The vulnerable patient• Research ethics• Rationing

Other topics identified in discussion included ‘end of life’, ‘truth telling’ …

Challenges for ethics in interprofessional education

• Fitting ‘interprofessional’ with ‘uniprofessional’ values and the perspectives of service users and carers (problematising the ‘professional’)

• Developing appreciation of the gap between the same code and different practice (enactment)

• Working with differences in terms and meanings (languaging)

• Including different orientations – Hippocratic Oath/Helsinki, ethics of care/social justice