我说的是跨专业合作。

IF 5.2 1区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Zubin Austin, Walter Eppich, Tina Brock
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Various practices of learning about, from and with other professions are meant to win the hearts and minds of students with respect to the intrinsic value and importance of <i>interprofessional collaboration</i> in both learning and practice. Unfortunately, the god-term status of ‘collaboration’ has narrowed opportunities for critical reflection and drawn attention to IPE curricula that meet mandatory accreditation standards without a clear-eyed focus on the value the relational process of interprofessional collaboration creates.</p><p>Haddara and Lingard have raised a critical voice that highlights the lack of a single, coherent definition of interprofessional collaboration in HPE.<span><sup>2</sup></span> In addition, varied and disparate mental models create tensions in IPE's conceptualisation, implementation and assessment. These divergent foundations, described as emancipatory and utilitarian visions of collaboration, foster mixed messaging and confusion at the coalface. Gunaldo et al. also suggest lack of clarity in terminology has impeded progress and potentially lead to confusion about research in the interprofessional field.<span><sup>3</sup></span></p><p>IPE proponents seek to enhance collaborative practice through system-level solutions—expanding scopes of practice, removing legal barriers, improving shared records, or updating reimbursement models. While valuable, so far, the evidence that IPE leads to meaningful, sustainable changes in practice is limited.<span><sup>4, 5</sup></span> For many health professionals, experiences of interprofessional collaboration remain suboptimal.</p><p>IPE emphasises concrete models of collaboration, making it more practical than theoretical, which helps students envision day-to-day collaborative practice. However, presenting collaboration as an idealised ‘destination’ reinforces unrealistic expectations. Non-physician professionals may expect their opinions to be instantly valued due to IPE principles, then feel disillusioned when they must first earn trust from physician colleagues. Conversely, physicians may feel burdened by the extra time and emotional effort required to engage across professions, sometimes with limited perceived benefit.</p><p>This disconnect may stem from framing interprofessional collaboration as a fixed state achieved through education, rather than a fluid, evolving process refined with deliberate practice and feedback. Unlike citizenship or tenure, collaboration is not bounded or permanent. It fluctuates, influenced by external factors—good on some days, strained on others. 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Contextual knowledge (e.g., roles and boundaries) is important, but success depends on nuanced interpersonal skills. Thus, collaboration is enacted by teachable and observable communication and team learning skills that learners can practice, enact and refine.<span><sup>7</sup></span> The interactional nature of these interpersonal skills makes the nuanced use of contextualised language even more important.</p><p>Effective interprofessional collaboration requires emotional intelligence; verbal, gestural and paraverbal communication skills; conflict management; self-regulation; and empathy. As no one relationship model suits everyone, no one-size-fits-all approach to interprofessional collaboration will meet the needs of every practitioner or patient. Educators should avoid promoting a singular vision of collaboration, much like parents should not dictate their child's career pathway.</p><p>Instead, interprofessional activities should help learners develop the necessary interpersonal skills to navigate diverse professional relationships across the collaboration continuum. Highly productive teams may not appear ‘collaborative’ in traditional terms yet function effectively. A relational approach to IPE emphasises skills like self-awareness, constructive conflict, negotiation and emotional regulation—areas often underrepresented in competency-based curricula. This relational focus can help to prevent conflict and also help to address conflict when it occurs.</p><p>An interprofessional collaboration curriculum focused on relational skills poses challenges. It resists standardisation, requiring flexibility, customisation and deeper engagement. And it takes more time—the currency of contemporary curricula. 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For over a generation, educators have reinforced the god-term status of collaboration and its undisputed value through growing efforts in curricula, experiential learning and professional socialisation. Alongside this, interprofessional education (IPE) has become an accreditation requirement for most programmes. Various practices of learning about, from and with other professions are meant to win the hearts and minds of students with respect to the intrinsic value and importance of <i>interprofessional collaboration</i> in both learning and practice. 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Gunaldo et al. also suggest lack of clarity in terminology has impeded progress and potentially lead to confusion about research in the interprofessional field.<span><sup>3</sup></span></p><p>IPE proponents seek to enhance collaborative practice through system-level solutions—expanding scopes of practice, removing legal barriers, improving shared records, or updating reimbursement models. While valuable, so far, the evidence that IPE leads to meaningful, sustainable changes in practice is limited.<span><sup>4, 5</sup></span> For many health professionals, experiences of interprofessional collaboration remain suboptimal.</p><p>IPE emphasises concrete models of collaboration, making it more practical than theoretical, which helps students envision day-to-day collaborative practice. However, presenting collaboration as an idealised ‘destination’ reinforces unrealistic expectations. Non-physician professionals may expect their opinions to be instantly valued due to IPE principles, then feel disillusioned when they must first earn trust from physician colleagues. Conversely, physicians may feel burdened by the extra time and emotional effort required to engage across professions, sometimes with limited perceived benefit.</p><p>This disconnect may stem from framing interprofessional collaboration as a fixed state achieved through education, rather than a fluid, evolving process refined with deliberate practice and feedback. Unlike citizenship or tenure, collaboration is not bounded or permanent. It fluctuates, influenced by external factors—good on some days, strained on others. It is deeply relational, shaped by emotions, interpersonal dynamics, hierarchy and questions of professional identity and self-worth,<span><sup>3, 6</sup></span> which traditional descriptions of IPE may only partially address.<span><sup>3</sup></span> At its core, collaboration represents human interaction within a specific social context. IPE has focused heavily on context—roles, systems and structures—without also providing students with interpersonal skills that underpin interprofessional collaboration. This focus has been necessary but insufficient.</p><p>Viewing interprofessional collaboration as a relational process—not a destination—highlights that while there are some useful conceptual approaches, there is no universal model. Collaboration is dynamic, negotiated moment-to-moment, shaped by individual needs, expectations and personalities. Teaching interprofessional collaboration, then, is akin to preparing someone for any high stakes human relationship. 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引用次数: 0

摘要

在《修辞学伦理》一书中,韦弗引入了“上帝术语”的概念,即被认为具有内在说服力且不容争辩的陈述在卫生专业教育(HPE)中,“合作”已经达到了神圣的地位,被视为学科内部和跨学科的普遍良好做法。整整一代人以来,教育工作者通过在课程设置、体验式学习和专业社会化方面不断努力,强化了合作的神圣地位及其无可争议的价值。除此之外,跨专业教育(IPE)已成为大多数课程的认证要求。从其他专业中学习,从其他专业中学习以及与其他专业合作的各种实践旨在赢得学生对学习和实践中跨专业合作的内在价值和重要性的尊重。不幸的是,“合作”的神圣地位缩小了批判性反思的机会,并将注意力吸引到满足强制性认证标准的IPE课程上,而没有清晰地关注跨专业合作的关系过程所创造的价值。Haddara和Lingard提出了一种批评的声音,强调在IPE中缺乏一个单一的、连贯的跨专业合作的定义。此外,不同的、不同的心理模型在IPE的概念化、实施和评估中造成了紧张。这些不同的基础,被描述为解放和功利的合作愿景,在采煤工作中造成了混杂的信息和混乱。Gunaldo等人还认为,术语缺乏清晰性阻碍了进展,并可能导致跨专业领域研究的混乱。3IPE的支持者寻求通过系统层面的解决方案——扩大实践范围、消除法律障碍、改善共享记录或更新报销模式——来加强合作实践。尽管有价值,但迄今为止,证明IPE在实践中带来有意义的、可持续的变化的证据有限。4,5对于许多卫生专业人员来说,跨专业合作的经验仍然不够理想。IPE强调具体的合作模式,使其更具实践性而非理论性,这有助于学生设想日常的合作实践。然而,将合作呈现为一个理想化的“目的地”会强化不切实际的期望。非医生专业人士可能期望他们的意见会因为IPE的原则而立即得到重视,然后当他们必须首先获得医生同事的信任时,他们会感到幻灭。相反,医生可能会因为跨专业参与所需的额外时间和情感努力而感到负担,有时感知到的好处有限。这种脱节可能源于将跨专业合作视为一种通过教育实现的固定状态,而不是通过刻意练习和反馈完善的流动、不断发展的过程。与公民身份或任期不同,合作没有界限,也没有永久性。它是波动的,受外部因素的影响——有时很好,有时很紧张。它是深刻的关系,由情感、人际动态、等级制度和职业认同和自我价值问题所塑造,而传统的IPE描述可能只能部分地解决这些问题协作的核心是特定社会环境下的人类互动。IPE主要关注情境——角色、系统和结构——而没有为学生提供支撑跨专业合作的人际交往技能。这种关注是必要的,但还不够。将跨专业合作视为一个关系过程——而不是一个目标——强调了虽然有一些有用的概念性方法,但没有通用的模型。协作是动态的,是时刻协商的,受个人需求、期望和个性的影响。因此,教授跨专业合作类似于让某人为任何高风险的人际关系做好准备。背景知识(例如,角色和界限)很重要,但成功取决于微妙的人际交往能力。因此,协作是通过可教的、可观察的沟通和团队学习技能来实现的,学习者可以实践、制定和完善这些技能这些人际交往技能的互动性使得语境化语言的微妙使用变得更加重要。有效的跨专业合作需要情商;语言、手势和语言外沟通技巧;冲突管理;自律;和同情心。因为没有一种关系模式适合所有人,所以没有一种适合所有人的跨专业合作方法可以满足每个医生或患者的需求。教育工作者应该避免提倡一种单一的合作愿景,就像父母不应该规定孩子的职业道路一样。 相反,跨专业活动应该帮助学习者发展必要的人际交往能力,以便在合作连续体中驾驭不同的专业关系。高生产率的团队可能并不像传统意义上的“协作”,但却能有效地发挥作用。国际政治经济学的关系方法强调自我意识、建设性冲突、谈判和情绪调节等技能——这些领域在以能力为基础的课程中往往没有得到充分体现。这种关系焦点可以帮助防止冲突,也有助于在冲突发生时解决冲突。专注于人际关系技能的跨专业合作课程带来了挑战。它抵制标准化,要求灵活性、个性化和更深入的参与。而且这需要更多的时间——这是当代课程的主流。然而,它的好处不仅仅是促进合作,它还培养了更多有同情心、适应性和弹性的卫生保健专业人员。由于这方面一直不是HPE的传统重点,教育工作者将需要大量的培训和准备,以设计和汇报有意义的学习经验,并将关系技能作为主要的学习成果。通过围绕关系管理重新构建跨专业协作,学习者将能够驾驭挑战理想协作概念的复杂医疗保健环境。适应能力、沟通技巧和情商反映了改善团队合作和病人护理的关键能力。将跨专业合作重新定义为关系而不是目标并不激进,但它会让教育者将关注点从背景和结构扩展到人际动态。虽然现有的IPE框架仍然很有价值,但我们还必须关注关系技能,以支持和维持专业内部和跨专业的实际合作。随着医疗保健的发展——随着人工智能的兴起、政治两极分化的加剧和持续的劳动力挑战——让从业者为灵活、适应性强的跨专业合作做好准备变得更加重要。通过将跨专业合作从其神圣的基座上移除,并将其置于关系现实中,我们承认其细微之处-不是毫无疑问的理想,而是由联系形成的日常实践。通过这样做,我们不仅可以更诚实地教授跨专业合作,而且我们也尊重其复杂性及其真正改变护理的潜力。Zubin Austin:概念化;原创作品草案;写作-审查和编辑。Walter Eppich:概念化;写作-审查和编辑。蒂娜·布洛克:概念化;写作——审阅和编辑;项目管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

When I say … interprofessional collaboration

When I say … interprofessional collaboration

In The Ethics of Rhetoric, Weaver introduced the concept of a ‘god-term’—statements deemed inherently persuasive and beyond debate.1 In health professions education (HPE), ‘collaboration’ has reached god-term status, regarded as a universally good practice within and across disciplines. For over a generation, educators have reinforced the god-term status of collaboration and its undisputed value through growing efforts in curricula, experiential learning and professional socialisation. Alongside this, interprofessional education (IPE) has become an accreditation requirement for most programmes. Various practices of learning about, from and with other professions are meant to win the hearts and minds of students with respect to the intrinsic value and importance of interprofessional collaboration in both learning and practice. Unfortunately, the god-term status of ‘collaboration’ has narrowed opportunities for critical reflection and drawn attention to IPE curricula that meet mandatory accreditation standards without a clear-eyed focus on the value the relational process of interprofessional collaboration creates.

Haddara and Lingard have raised a critical voice that highlights the lack of a single, coherent definition of interprofessional collaboration in HPE.2 In addition, varied and disparate mental models create tensions in IPE's conceptualisation, implementation and assessment. These divergent foundations, described as emancipatory and utilitarian visions of collaboration, foster mixed messaging and confusion at the coalface. Gunaldo et al. also suggest lack of clarity in terminology has impeded progress and potentially lead to confusion about research in the interprofessional field.3

IPE proponents seek to enhance collaborative practice through system-level solutions—expanding scopes of practice, removing legal barriers, improving shared records, or updating reimbursement models. While valuable, so far, the evidence that IPE leads to meaningful, sustainable changes in practice is limited.4, 5 For many health professionals, experiences of interprofessional collaboration remain suboptimal.

IPE emphasises concrete models of collaboration, making it more practical than theoretical, which helps students envision day-to-day collaborative practice. However, presenting collaboration as an idealised ‘destination’ reinforces unrealistic expectations. Non-physician professionals may expect their opinions to be instantly valued due to IPE principles, then feel disillusioned when they must first earn trust from physician colleagues. Conversely, physicians may feel burdened by the extra time and emotional effort required to engage across professions, sometimes with limited perceived benefit.

This disconnect may stem from framing interprofessional collaboration as a fixed state achieved through education, rather than a fluid, evolving process refined with deliberate practice and feedback. Unlike citizenship or tenure, collaboration is not bounded or permanent. It fluctuates, influenced by external factors—good on some days, strained on others. It is deeply relational, shaped by emotions, interpersonal dynamics, hierarchy and questions of professional identity and self-worth,3, 6 which traditional descriptions of IPE may only partially address.3 At its core, collaboration represents human interaction within a specific social context. IPE has focused heavily on context—roles, systems and structures—without also providing students with interpersonal skills that underpin interprofessional collaboration. This focus has been necessary but insufficient.

Viewing interprofessional collaboration as a relational process—not a destination—highlights that while there are some useful conceptual approaches, there is no universal model. Collaboration is dynamic, negotiated moment-to-moment, shaped by individual needs, expectations and personalities. Teaching interprofessional collaboration, then, is akin to preparing someone for any high stakes human relationship. Contextual knowledge (e.g., roles and boundaries) is important, but success depends on nuanced interpersonal skills. Thus, collaboration is enacted by teachable and observable communication and team learning skills that learners can practice, enact and refine.7 The interactional nature of these interpersonal skills makes the nuanced use of contextualised language even more important.

Effective interprofessional collaboration requires emotional intelligence; verbal, gestural and paraverbal communication skills; conflict management; self-regulation; and empathy. As no one relationship model suits everyone, no one-size-fits-all approach to interprofessional collaboration will meet the needs of every practitioner or patient. Educators should avoid promoting a singular vision of collaboration, much like parents should not dictate their child's career pathway.

Instead, interprofessional activities should help learners develop the necessary interpersonal skills to navigate diverse professional relationships across the collaboration continuum. Highly productive teams may not appear ‘collaborative’ in traditional terms yet function effectively. A relational approach to IPE emphasises skills like self-awareness, constructive conflict, negotiation and emotional regulation—areas often underrepresented in competency-based curricula. This relational focus can help to prevent conflict and also help to address conflict when it occurs.

An interprofessional collaboration curriculum focused on relational skills poses challenges. It resists standardisation, requiring flexibility, customisation and deeper engagement. And it takes more time—the currency of contemporary curricula. However, its benefits extend beyond fostering collaboration—it cultivates more empathetic, adaptive and resilient health care professionals. And since this aspect has not been a traditional focus of HPE, educators will require significant training and preparation to design and debrief meaningful learning experiences with relational skills as the main learning outcome. By reframing interprofessional collaboration around relationship management, learners will be able to navigate complex health care environments that challenge ideal notions of collaboration. Adaptability, communication skills and emotional intelligence reflect key competencies that improve teamwork and patient care.

Reframing interprofessional collaboration as relational rather than destinational is not radical but invites educators to expand the focus beyond context and structure to interpersonal dynamics. While existing IPE frameworks remain valuable, we must also attend to relational skills that support and sustain real-world collaboration within and across professions. As health care evolves—with the rise of AI, increased political polarisation and persistent workforce challenges—preparing practitioners for flexible, adaptive interprofessional collaboration becomes even more important. By removing interprofessional collaboration from its god-term pedestal and grounding it in relational realities, we acknowledge its nuance—not as an unquestioned ideal, but as a daily practice shaped by connections. In doing this, we can not only teach interprofessional collaboration more honestly, but also we honour its complexity and its potential to truly transform care.

Zubin Austin: Conceptualization; writing—original draft; writing—review and editing. Walter Eppich: Conceptualization; writing—review and editing. Tina Brock: Conceptualization; writing—review and editing; project administration.

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来源期刊
Medical Education
Medical Education 医学-卫生保健
CiteScore
8.40
自引率
10.00%
发文量
279
审稿时长
4-8 weeks
期刊介绍: Medical Education seeks to be the pre-eminent journal in the field of education for health care professionals, and publishes material of the highest quality, reflecting world wide or provocative issues and perspectives. The journal welcomes high quality papers on all aspects of health professional education including; -undergraduate education -postgraduate training -continuing professional development -interprofessional education
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