Challenging Intraprofessional Workplace Education Norms

The story of one Publication, two Commentaries, an AMEE Symposium and an Agenda. Health professions education and research have an important mission: to better prepare future healthcare professionals for providing better and safer healthcare. But what if we as a field are unintentionally doing the opposite?

This year, together with Lara Varpio from the University of Uniformed Services, I made a claim towards stating that the field of medical education is inadvertently preventing medical trainees from becoming effective healthcare professionals in a paper entitled ‘The wolf you feed: Challenging intraprofessional workplace-based education norms.¹

Although a bold statement at first sight, the publication welcomed two very supportive commentaries,^2,3 and a successful AMEE Symposium⁴ that all underlined the same message: if we are to better prepare our trainees for future healthcare practice, we need both intra- AND interprofessional approaches to training them.

One Publication

The trajectory towards becoming a health professional is largely situated within the clinical workplace. There, like in the formal education setting, training is often mostly siloed: physicians train physicians, nurses train nurses, physiotherapists train physiotherapists.

In our publication¹ we argued that if the field of medical education is to better prepare their trainees for future practice, a change of perspective is needed regarding what we are training these trainees to become and who should be involved in this process.

We used the theories of Communities of Practice⁵ and Landscapes of Practice⁶ to illustrate that a healthcare trainee needs to simultaneously become an expert healthcare professional, AND an excellent member of the healthcare team who understands how to best collaborate with their colleagues to provide patient care.

That healthcare is a team effort, is universally recognized: patient care is too complex and multi-dimensional to be managed by one, individual professional or professional group. But, the focus of explaining and enabling workplace learning and guidance has been predominantly intraprofessional. If patient care requires interprofessional collaboration, how can medical education remain strictly intraprofessional?

We concluded the paper by stating that ‘training to become a health professional is a collective, interprofessional effort and should be recognised, supported and formalised as such’ (p.899).¹

Two Commentaries

Morris and Eppich² wholeheartedly agreed with this in their commentary to our paper. Referring to the work of Alan Bleakley⁷, they advocated for fostering ‘collaborative intentionality’ in trainees. As Morris and Eppich write ‘collaborative intentionality requires deliberate connectedness and thoughtful collaboration through adaptation, flexibility and tolerance from all team members’ (p.886). They suggest four strategies to attain this: identifying explicit interprofessional clinical learning moments, fostering team inclusiveness, formalising cross-professional educational structures, and embedding boundary-crossing behaviours in simulation-based education.

Another commentary was written by Gillespie and Dornan³ who augmented our argument by addressing the power issues that are at play in inviting an interprofessional perspective to workplace learning and guidance. By using the lens of Cultural, Historical Activity Theory and Knotworking⁸, they highlighted that ‘no single profession, alone, has the power to facilitate [members of different professions to unite in benefiting patient care and student learning]’ (p.884). They underline the importance of a shared, interprofessional effort towards preparing trainees for interprofessional practice.

An AMEE Symposium

The importance of that shared, interprofessional effort was echoed during a symposium at AMEE 2021.⁴ Pim Teunissen, Sayra Cristanchio (University of Western Ontario), Iris Janssen (Amsterdam Medical Center), Lara Varpio and myself provided different theoretical and empirical perspectives to point out what effective healthcare really needs: health care professionals that can effectively collaborate, can distribute leadership when needed, all while staying focused on that which unites them – patient care. One important conclusion of the symposium was the need for our field to explore how to aid in creating a culture that feeds the interprofessional learning and guidance perspective.

An Agenda for Research & Education

One paper, two commentaries, and an AMEE Symposium, they all say it loud and clear:

If we are to better prepare our trainees for future healthcare practice, we need both an intra- AND an interprofessional approach to training them. This sets us with a challenging research and educational agenda; an agenda that requires many people and perspectives to address it. I hope you will join me in pushing this agenda forward!

Renée Stalmeijer, PhD, SHE Staff-member

1. Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. Med Educ. 2021;55(8):894-902.
2. Morris M, Eppich WJ. Changing workplace-based education norms through 'collaborative intentionality'. Med Educ. 2021;55(8):885-887.
3. Gillespie H, Dornan T. The wolf shall dwell with the lamb: The power dynamics of interprofessional education. Med Educ. 2021;55(8):883-885.
4. Stalmeijer RE, Teunissen PW, Cristanchio S, Jansen I, Varpio L. Symposium 7: Challenging Intraprofessional Education Norms. Paper presented at: AMEE; 29 August 2021, 2021; Online.
5. Wenger E. Communities of practice: Learning, meaning, and identity. Cambridge university press; 1999.
6. Wenger-Trayner E, Wenger-Trayner B. Learning in a landscape of practice. In: Wenger-Trayner E, Fenton-O’Creevey M, Hutchinson S, Kubiak C, Wenger-Trayner B, eds. Learning in Landscapes of Practice. Abingdon: Routledge; 2015:14-29.
7. Bleakley A. Learning and identity construction in the professional world of the surgeon. In: Fry H, Kneebone R, eds. Surgical Education: Theorizing an Emerging Domain. Dordrecht, the Netherlands: Springer Science + Business Medica; 2011:183-189.
8. Engeström Y. From design experiments to formative interventions. Theoretical Psychology. 2011;21(5):598-628.