The need for multiprofessional health education in undergraduate studies

The World Health Organization's target of ‘Health for all by the year 2000’ (HFA 2000) presents a challenge to all health educators since it presupposes considerable changes in current education and curricula for health personnel, which fail to focus upon patients' needs, which do not favour teamwork between the different categories of health personnel and which relate to hospital care rather than to primary health care (PHC). In order to achieve HFA 2000, WHO has emphasized the need for more PHC not only in the medical curricula but also in curricula for other health professions. WHO stresses the need for learning together, for working together for health, i.e. a team approach within PHC. The team approach is also applicable in many situations from intensive care to rehabilitation within hospital care. Multiprofessional education (MPE) has long been part of postgraduate and continuous education but considerable difficulties have been experienced in establishing it in undergraduate education. In Europe only the Bobigny University in Paris and Linköping University have been implementing these ideas. After many years of planning and pilot projects the Health University (the Faculty of Health Sciences of Linköping University) introduced six new curricular programmes in August 1986 for laboratory technicians, nurses, occupational therapists, doctors, physiotherapists and supervisors of social services in community care. All begin first year with a 10-week multiprofessional study period called ‘Man and Society’, which aims to form a common base for teamwork and to give perspectives on health and influences on health of environmental factors and the interplay between man, society and health care. At the Health University there is also a common educational strategy of problem-based learning. This is introduced during the initial 10 weeks and is carried out in small groups, each group consisting of a tutor and six or seven students from all six programmes. During the 10 weeks four themes are highlighted concerning children, adolescents, adults and old people. Teaching takes place in group sessions, seminars, a few lectures and field-studies in the PHC setting. The problems are chosen from PHC and after problem-solving within each theme three groups unite to form a seminar where they report and exchange experiences. In order to broaden the students' health perspectives the Health University employs teachers from other faculties, e.g. science theory and philosophy, health economics, theology and anthropology. The tutors, who are members of the teaching staff of the different programmes, have passed a compulsory tutor course. They are not usually specialists in the different theme problems. Student and tutor evaluation is performed after the study period. After three such study periods with more than 500 students, feedback is on the whole very positive and encouraging from both students and teachers. After this introductory period the different curricula contain intermittent multiprofessional sessions, seminars and theme days. A 3-week team training course in a PHC setting ends the study period, facilitating the transition from the student role to the occupational role for the medical, nursing, physiotherapy and occupational therapy students. By the time of this 3-week course the students should have sufficient theoretical knowledge and practical experience to be able to identify their own occupational roles and test them within the frame of the PHC team. In order to maximize formal MPE it should be introduced early in the undergraduate programme and continue throughout the curriculum in sessions or themes where two or more different health curricula can contribute. MPE should develop the skill to identify specific occupational roles and to create a common reference-frame basis and preparation for teamwork. The objectives are to understand connections between health, disease and social and environmental conditions and to understand how humanitarian evaluations and attitudes and ethical norms influence the receiver-donor relationship within the health and social care systems. MPE should develop communication skills, capabilities and readiness to handle conflict situations as well as an aptitude for group work, critical thinking, analysis, creativity and self-learning. MPE should increase self-knowledge and understanding of the patient's situation and should develop the ability to work as part of a team, understanding of patients' needs and positive attitudes independent of current thinking about scientific and health care approaches. In 1984 and 1986 WHO's Regional Office for Europe arranged two MPE meetings which discussed and analysed the MPE concept and outlined a strategy for team training (Areskog 1984, 1986). The WHO headquarters formed a study group on multiprofessional education which met in Geneva in 1987 and drafted a report ‘Learning together to work together for health. The team approach’ (WHO Technical Report Series 1988). Despite the inherent difficulties there is no reason for further delay in planning and implementing MPE or at least in establishing closer collaboration between different schools for the range of health professions. In conclusion, MPE is one way of preparing future health professionals for the 21st century. The problems in implementing it can be overcome. It is essential to prepare the minds and attitudes of teachers in the traditional system. There is a need for devoted and skilled enthusiasts from all involved health professions believing in MPE and willing to plan for curricular innovation, implementation and evaluation. In order to overcome some of the constraints a European Network for Development of Multiprofessional Education in Health Sciences (EMPE) was constituted in April 1987 in Paris after two preparatory sessions in Copenhagen in 1984 and 1986. The aim of the network is to support implementation of multiprofessional education and to spread MPE information. The network will support evaluation and investigate possibilities for collaborative research studies between different active MPE institutions. Collaboration will also be established regarding exchange of students and teachers for both educational and research purposes.