Multiprofessional education--a future focus in dietetics education?

The last decade has seen the rise of multiprofessional teams (1) and the introduction of multiprofessional education programs. These aim to introduce students to the skills and expertise of other professions during the learning process, with the hope of a more cooperative and collaborative approach to healthcare after graduation. Such approaches require not only dedicated and enthusiastic staff to implement, but the recognition that elements of the curriculum can be modified or omitted so that topics can be included that lend themselves to a multiprofessional approach. This runs counter to the thinking of many in the profession who often seek to increase the more specialised aspects of nutrition and dietetics at the expense of more generic or broad topics. It is also very difficult to include such learning in programs where the professional studies follow prescribed generic degrees, unless those degrees are broad-based health degrees. These questions then arise. Is there a risk in embracing multiprofessional education for dietetics as this will reduce the available time for dedicated learnings? Or is there a risk in not embracing multiprofessional education as the failure to expose other professionals to dietetics reduces opportunity in the workplace? Is the higher degree of overlap between professions that might occur with multiprofessional education a potential threat?

The concept that a team manages health care is not new, nor is the concept of multiprofessional of interprofessional education for future members of the healthcare team. This issue now centres on when such education should occur, what its goals should be and how effective it is in breaking down barriers in the workplace. At the same time, there is a need to recognise that the clients of healthcare have changed--they are older, better informed and hold higher expectations than in years past. This is expected to continue as the 'baby boomers' utilise more health services. Do multiprofessional teams leave clients disempowered and do they reduce effectiveness through multiskilling and perhaps even deskilling?

Can the wanted goals be achieved by short courses including students from a variety of professions? Leaviss (2) explored the value of short courses in the final year of professional education. The studied course was aimed, not at delivering common content but, at 'explaining' the roles and responsibilities of a variety of health professions. She concluded that attitudes have become too ingrained by the final year of undergraduate programs to be readily altered by short courses, but that any increased knowledge can be built upon in the workplace. Shared learning from an early stage in courses may hold more promise, but must adopt different foci, as roles are not yet established and students would be unlikely to have experience of their chosen fields at such an early stage. A study conducted in New Zealand (3) adopted this approach. Its authors identified that health students held positive attitudes to shared learning early in their programs. They concluded that focussing on teamworking skills reinforced positive attitudes. A third approach was used by Oneha et al. (4), where students from four different professions were assigned a community project to undertake as a multiprofessional team. They found this experience to be positive in affecting attitudes and practice.

We need to be aware of changes in roles, expectations and healthcare systems as well as clients and prepare our professionals appropriately. The literature available supports either the introduction of shared or multiprofessional learning in first or second year of undergraduate studies, or the use of multiprofessional professional practice in later years if the goal is improved understanding of, and working in, multiprofessional contexts. This need is not currently reflected in the way that dietetics programs are assessed for accreditation in Australia. It may be that graduate programs for entry level need to ask for multiprofessional education programs in the prior degree, or seek to develop multidisciplinary professional practice. The risk of doing nothing, or allowing an ad hoc approach may be that the skills and roles of dietitians may be less well known in healthcare settings. It may be that graduates from those programs, able and willing to overcome the numerous obstacles to this new way of teaching, may be better prepared for the workplace of tomorrow. For dietetics education, balancing the needs of the profession with the needs of students requires insight and innovation if the potential and real risks are to be managed successfully.

References

(1.) Scholes J, Vaughan B. Cross-boundary working: implications for the multiprofessional team. J Clin Nurs 2002;11:399-408.

(2.) Leaviss J. Exploring the perceived effect of an undergraduate multiprofessional educational intervention. Medical Education 2000;34:483-6.

(3.) Horsburgh M, Lamdin R, Williamson E. Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning. Medical Education 2001;35:876-83.

(4.) Oneha MF, Yoshimotot CM, Bell S, Enos RN. Education health professional in a community setting: what students value. Education for Health 2001;14:256-66.