Misalignments of purpose and power in an early Canadian interprofessional education initiative

Abstract

Interprofessional education (IPE) has been widely incorporated into health professional curricula and accreditation standards despite an arguably thin base of evidence regarding its clinical effects, theoretical underpinnings, and social implications. To better understand how and why IPE first took root, but failed to grow, this study examines one of the earliest documented IPE initiatives, which took place at the University of British Columbia between 1960 and 1975. We examined a subset of 110 texts (academic literature, grey literature, and unpublished records) from a larger study that uses Critical Discourse Analysis to trace the emergence of IPE in Canada. We asked how IPE was promoted and received, by whom, for what purposes, and to what effects. Our analysis demonstrates that IPE was promoted as a response to local challenges for the Faculty of Medicine as well as national challenges for Canada’s emerging public healthcare system. These dual exigencies enabled the IPE initiative, but they shaped it in somewhat divergent ways: the former gave rise to its core component (a health sciences centre) and the latter its ultimate purpose (increasing the role of non-medical professions in primary care). Reception of the initiative was complicated by a further tension: nurses and allied health professionals were sometimes represented as independent experts with unique knowledge and skills, and sometimes as assistants or substitutes for medical doctors. We relate the successes and frustrations of this early initiative to particular (mis)alignments of purpose and relationships of power, some of which continue to enable and constrain IPE today.

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Notes

  1. 1.

    For example, McCreary established an interprofessional public health clinic on campus, advocated for a “multidisciplinary approach” to caring for children with chronic disabilities, chaired the Western Society for Rehabilitation, and helped to bring diverse disciplines together for a national conference on “the physical health, mental development, spiritual and emotional growth of children in Canada” (Hill 2006, p. 56). For a comprehensive biography on McCreary, see Hill (2006).

  2. 2.

    Our contemporary equivalent term, “health human resources,” signals a shift of interprofessionalism from emergent to dominant discourse, not to mention considerable progress in gender equality. The change of metaphor from “power” (suggesting force, action, and agency) to “resource” (suggesting a collectively-owned commodity) is also significant.

  3. 3.

    Grants were secured internationally from The Rockefeller Foundation (COFM 1960; McCreary 1962a, b), The John and Mary R. Markle Foundation (McCreary 1962a, b), The Leverhulme Trust (Szasz 1967; UBC Information Office 1967), The Nuffield Foundation (Interdisciplinary Group 1964a), and The Kellogg Foundation (Hill 2006, p 84). Donations were also secured within British Columbia from the Leon and Thea Koerner Foundation (The Leon and Thea Koerner Foundation 1972) and from P. A. Woodward, a local philanthropist.

  4. 4.

    Our analysis is based upon the views that are apparent within published literature and unpublished planning documents collected in the archives of the HSC and John McCreary. Our archive does not include unpublished records that may have been kept by the other professional schools.

  5. 5.

    When funds were finally made available, after McCreary’s retirement and his death, they were used to construct the Extended Health Care Unit (1979) and an Acute Care Unit (1980) (Pitblado and Hines 1991). These were intended to pursue the IPE vision but were not built according to the original plans (Hill 2006; D’Avray 2008).

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Acknowledgements

This work was supported by the Canadian Institutes of Health Research (MOP-126178). We are grateful for the historical insights shared by George Szasz and John Gilbert and for the helpful assistance that we received from the UBC Library.

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Correspondence to Cynthia R. Whitehead.

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Whyte, S., Paradis, E., Cartmill, C. et al. Misalignments of purpose and power in an early Canadian interprofessional education initiative. Adv in Health Sci Educ 22, 1123–1149 (2017). https://doi.org/10.1007/s10459-016-9746-x

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Keywords

  • Interprofessional education
  • Healthcare team
  • Health professions
  • Health workforce
  • Critical discourse analysis
  • Historical analysis
  • Rhetorical analysis
  • Canada