Feasibility Study: A Proposed Model of a
‘Healthy Ageing Clinic’ and Team Based
Curricular for Clinical Placement of
Healthcare Students
Faculty of Health and Medicine
University of Newcastle
Prepared by:
Associate Professor Chris Kewley
Dr Sharyn Hunter
Mr Wayne Jeffree, Project Officer
Acknowledgement
The study has been supported through funding received from the NSW Health
Education and Training Institute (HETI), NSW Interdisciplinary Clinical Training
Network (ICTN) and Health Workforce Australia (HWA).
Project Team
Professor Kichu Nair, Clinical Professor of Medicine and Director of Continuing Medical Education
and Professional Development.
Dr Sharyn Hunter, Senior Lecturer, School of Nursing and Midwifery, UoN
Ms Marie Larkings, Faculty Director Health and Community Services Hunter TAFE
Professor Michael Hazelton Head, of School/Professor of Mental Health Nursing
Professor Darren Rivett, Head of School, Health Sciences
Dr Mark Foster, CEO Hunter Medicare Local
Professor Dimity Pond, School of Medicine and Public Health
Associate Professor Chris Kewley, Director of Post Graduate Studies Course Work School of
Nursing and Midwifery UoN, and Health Systems Leadership
2
Executive Summary
While we strive to promote a positive view of ageing the reality is that the majority of health
services and training institutions remain locked in a disease model. As with all aspects of
health care, promotion of wellness in ageing requires a well-qualified inter-professional
team-based approach and yet we continue to train our future health professionals in
discipline specific programs, devoid of authentic inter-professional education or team-based
training.
The intention of this project was to consider the feasibility of developing the concept of a
‘healthy ageing clinic’ based within a primary healthcare model, and supported through a
team-based inter-professional practice curriculum. Promotion of wellness requires a
multisectoral approach to address the complexity of social determinants and social
engagement across the life-span. Social determinants for wellness touch on all aspects of
life including housing, welfare, education, community connectivity and rights of citizenship.
Broad community consultation across public and private organisations critical to the
promotion of wellness in ageing, endorsed their support and willingness to participate in an
authentic primary health model. These agencies covered all aspects required to address
the social determinants vital to healthy living including city councils, Medicare Locals, aged
care providers, faith based and multicultural organisations, Aboriginal health providers, and
other training institutions.
Health professionals work in teams and yet we continue to train within single discipline
curricular. A comprehensive review of national and international literature on the subject of
inter-professional education and team-based training revealed a plethora of literature, and a
number of exemplar models albeit nothing directly related to wellness in ageing. From an
international perspective there are some excellent examples lead by the University of
Southampton in the United Kingdom, Canadian Inter-professional Health Collaborative,
World Health Organisation and a significant number of medical schools in the United
States. Outside of Health Workforce Australia’s beginning dialogue on the subject of interprofessional education and team-based training, Curtin University appears to be the only
Australian University or health education provider that has strategically consolidated interprofessional education into its undergraduate curriculum.
On the policy front there is evidence of a convergence if not yet a nexus between health
reform and education reform awareness, and direction to change the way health
professionals are educated as a key to building effective health care teams, and improving
the experience and outcomes for patients.
From the broad community consultation and international literature search, there is no
doubt that the concept of a healthy ageing clinical supported through an inter-professional
team-based curricular is not only feasible, but strategically fits with the changes in global
demographics, policy reform and therefore is a perfect vehicle for introducing authentic
inter-professional team-based training.
3
Table of Contents
1
2
3
4
Introduction ............................................................................................................................................... 5
Background ............................................................................................................................................... 5
Project Process ......................................................................................................................................... 7
Literature Review ...................................................................................................................................... 8
4.1 Wellness in Ageing .................................................................................................................................... 8
4.2 Health Service Reform, Model of Care and Health Workforce Capacity ................................................ 11
4.3 Inter-professional Education, Practice & Health Workforce Competency............................................... 16
4.4 Student Inter-professional Practice Initiatives Relevant to Healthy Ageing Clinics ................................ 25
4.5 Health and Education Policy Nexus ........................................................................................................ 29
5
6
7
Examples of Inter-professional Education in Practice in Australasia ............................................... 32
Stakeholder Consultation ...................................................................................................................... 33
Project Outcomes ................................................................................................................................... 35
7.1 Specific Project Outcomes ...................................................................................................................... 35
7.2 Strategic Outcomes ................................................................................................................................. 37
8
9
4
Bibliography ............................................................................................................................................ 39
Appendix .................................................................................................................................................. 45
1 Introduction
The Healthy Ageing Clinic Feasibility Project commenced late last year through funding
from the N.S.W. Health Education Training Institute (HETI) and Health Workforce Australia
(HWA). The project was facilitated through the Faculty of Health and Medicine in
partnership with the Hunter Medicare Local and Hunter Institute of TAFE. The project
addressed the feasibility of establishing a community based, inter-professional, student
managed Healthy Ageing Clinic.
The project examined contemporary health services and policies, health professional
education and operational considerations, which underpin a model of wellness in ageing for
the community. Experts and other relevant stakeholders were consulted and field trips to
institutions where inter-professional practice was being conducted also occurred.
2 Background
The current aged care system is primarily focused on disease management and ageing is
often associated with disease and disability. Accumulating evidence about ageing enables
age-related changes to be differentiated from disease and illness. Although many problems
affecting older people are caused by diseases, it is often the combination of aged-related
changes and diseases that produce ill health and negative functional consequences.
Importantly, ageing changes can be delayed or even prevented (Watson, 2008).
There is increasing awareness of the importance of maintaining the health of older people.
To support an older person’s health, they require information about the ageing process,
diseases and risk factors for ill health and how they can maintain or improve their health.
World Health Organisation (2002) recommends global community health care programs
focusing on measures to assist older people to remain healthy. Despite this level of
knowledge and understanding, translation into health care has not occurred. One reason is
that healthy ageing requires a level of health literacy. Maintenance of health and wellness
requires functional literacy and awareness in three related areas including health
promotion, disease prevention, and health system navigation. A study which examined
health literacy in Australian older people found that most were below average (<3) on the
health literacy scale (Australian Bureau of Statistics, 2008).Another is the lack of accessible
health care about healthy ageing. There are very few healthy ageing clinics and the clinics
that do exist tend to be issue-focused and not multi-disciplinary (Kong, 2007; Helping Hand
Aged Care, 2012).
The above reasons and the experience of an initiative at the University of Newcastle where
undergraduate nursing students interact with older persons living in the community using a
healthy ageing approach (Hunter, 2012), led to the idea of a ‘healthy ageing clinic’ for
healthcare students. A model was developed for a community based, inter-professional,
5
student managed Healthy Ageing Clinic (see Figure 1) (Hunter & Kewley, 2012). The model
had seven strategic intents:
 Older person health (core intent)
 Community promotion of healthy ageing
 Provision of quality and innovative clinical student placement
 Student managed
 Inter-professional and team based training and team readiness testing
 Community based within an integrated primary health care model
 Curricular delivered within an experiential learning and reflective model that allows for
seamless translation of learning to action.
Figure 1: The Model of the Healthy Ageing Clinic
A submission was accepted in late 2012 by HETI to fund a project to explore the feasibility
of this innovative clinical placement model to increase quantity and quality of clinical
placement experiences for healthcare students. It was anticipated that this project would
provide a strategic road map aligned to contemporary pedagogy and clinical thinking
through:
1.
Establishment of an innovative approach to expanding clinical placement and
supervision within a model of care that is aligned to international trends, changes
in clinical demographics, and the national health reform agenda.
2.
Addressing the need for educators, clinical providers and students to integrate
undergraduate training into an inter-professional and team-based model.
3.
Expanding training in care for older persons beyond secondary and tertiary levels
into a ‘wellness model’ that provides life-scripts for healthy ageing in partnership
with other primary health care providers.
4.
Introduction of healthy ageing into the curricular through expanding primary
health care placements designed to move student thinking beyond the traditional
profiling of older persons care – demography, morbidity and mortality; to
6
5.
6.
considering the socioeconomic determinants of health and wellness such as
income, social position, housing, environment healthy life choices and behaviour.
Creating a value-proposition that focusses on authentic inter-professional teambased clinical placements, training and supervision.
Inter-agency collaborative approach to clinical placement that brings together
undergraduate level nursing, medicine, physiotherapy, occupational therapy,
nutrition and dietetics, podiatry and vocational students into one integrated
training model.
3 Project Process
This project addressed “a community based inter-professional student managed Healthy
Ageing Clinic” by asking the following questions:
1. What is the evidence base to support the capability of the proposed model to
achieve the following outcomes:
 Wellness in Ageing
 Inter-professional and inter-sectoral collaboration between Health, Education,
relevant agencies and consumers
 Develop service/workforce capacity to address emerging health concerns.
1.
These are the outcomes which together underpin a paradigm for the
advancement of health and against which the feasibility of the proposed model is
measured.
2.
How does the policy environment align with and enable the implementation of the
proposed model?
3.
What are the systemic enablers/challengers of the proposed model?
4.
What is the cost/benefit of implementation? What would be required for
sustainability?
The approaches undertaken to address these questions were:
 A comprehensive literature review of demographic and epidemiological information;
relevant Australian and international policy directions; and published evidencedbased exemplars.
 The development and implementation of a methodology which could adequately
assess the feasibility of a healthy ageing clinic and team-based curricular for clinical
placement of healthcare students
 Consultation and engagement of expert sponsors, local project partners and
community stakeholders.
 Field trips to Curtin University of Technology and Auckland University of Technology
to confer with academic and field staff who are actively engaged in developing and
implementing a number of inter-professional, student led health initiatives.
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4 Literature Review
A review of international and national published research and contemporary strategic
policies was conducted and occurred in the areas of:
o the advancement of the health of individuals and the ageing population;
o health service models, initiatives and provision;
o strategic directions for the education and health sectors to enable increased
health workforce and service capacity particularly inter-professional education
theory and practice
o student inter-professional practice initiatives relevant to healthy ageing
clinics.
4.1 Wellness in Ageing
The concept of “wellness in ageing” as a vehicle for inter-professional education is at the
heart of this study and while no-one could argue against the concept as a value statement;
community perceptions of ageing along with illness based health service models perpetuate
a conflict with both the vision and advancement of wellness in the ageing population. The
inevitability and association of ageing with a reduction in individual capability and capacity
does not easily reconcile with an optimal notion such as wellness. Some fundamental
questions and precepts need to be examined in order to reconceptualise wellness in
ageing:
 Why is wellness in ageing a priority?
 What constitutes wellness in ageing?
 Is wellness in ageing achievable?
 What determines wellness in ageing?
 How can wellness in ageing be advanced and promoted?
In most countries of the world the population is ageing in terms of the absolute numbers of
and relative proportion of older people. This has resulted from economic, scientific and
medical progress. However, it poses challenges for health and social services (Watson,
2008). Already, advances in treating conditions commonly associated with old age have
changed our demography (Institute of Medicine, 2001; Wagner et al., 2001). In most of the
developed world, population ageing was a gradual process following steady socioeconomic growth over several decades and generations. In developing countries, the
process is being compressed into two or three decades (WHO, 2002).
Australia’s population is growing. Increasing fertility rates and numbers of migrants has led
to a significant increase in the Australian Bureau of Statistics (ABS) population projection,
which has grown from 28.2 million people in 2051 (2004 estimates) to 34.2 million people
(2006 estimates). This, together with demographic trends, suggests that while there will be
a growing need for primary health care services targeted at children, teenagers and young
families, the predominant influence will remain ageing, which will cause most change in the
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use of primary health care services (National Primary Health Care Strategy (NPHCS),
2009).
The prevalence and burden of chronic disease is significant and will increase with the
ageing of the population. Chronic diseases, including cancers, are estimated to be
responsible for more than 80% of the burden of disease and injury. The World Health
Organisation (WHO) warns that the global burden of chronic disease is increasing rapidly
and predicts by the year 2020 that chronic disease will account for almost three quarters of
all deaths (WHO, 2002).
While we strive to promote a positive view of ageing, it is simply a reality that, for many, it is
associated with greater degrees of disability and illness. Traditionally, old age has been
associated with retirement, illness and dependency. Policies and programmes that are
stuck in this out-dated paradigm do not reflect reality. Indeed, most people remain
independent into very old age (WHO, 2001). With regard to rising public expenditures for
medical care, available data increasingly indicate that old age itself is not associated with
increased medical spending. Rather, it is disability and poor health associated with old age
that are costly (National Chronic Disease Strategy(NCDS), 2006).
The ageing of Australia’s population is a profound social shift which requires an equally
profound shift in society’s mind set about ageing. This is neither a problem nor an
inconvenience; it’s an historic achievement that human society has strived for over
centuries and presents a range of economic and social opportunities. More people live
longer, although lifespan is not increasing. In addition, as some of the more intractable
physical aspects of ageing become amenable to intervention, if not treatment, then the
advice to promote a positive image of ageing and to encourage health promotion in ageing
move from being abstract, almost ideological propositions, to being practical realities
(Commonwealth of Australia (CoA), 2012).
As individuals age, non-communicable diseases (NCDs) become the leading causes of
morbidity, disability and mortality in all regions of the world, including in developing
countries. NCDs, which are essentially diseases of later life, are costly to individuals,
families and the public purse. But many NCDs are preventable or can be postponed (WHO,
2002).
Ultimately, the worldwide shift in the global burden of disease toward chronic diseases
requires a shift from a model which relies on diagnosis and responds to episodes of illness,
to a coordinated and comprehensive continuum of care model which addresses the
complexities of risk factors is grounded in the promotion and advancement of health. This
will require a reorientation in health systems that are currently organized around acute,
episodic experiences of disease. The present acute care models of health service delivery
are inadequate to address the health needs of rapidly ageing populations
9
Healthy ageing is influenced by a variety of interacting determinants within and outside the
health sector. According to Dahlgren & Whitehead (2006), these determinants are:
individual lifestyle factors, social and community networks, living and working conditions,
and general socioeconomic, cultural and environmental factors. These determinants apply
to the health of all age groups, although the emphasis here is on the health and quality of
life of older persons. At this point, it is not possible to attribute direct causation to any one
determinant; however, the substantial body of evidence on what determines health
suggests that all of these factors (and the interplay between them) are good predictors of
how well both individuals and populations age. Because no one agency can tackle all these
determinants, the promotion of healthy ageing requires an inter-sectoral approach (Yach,
1996).
The term “active ageing” was adopted by the World Health Organization in the late 1990s. It
is meant to convey a more inclusive message than “healthy ageing” and to recognize the
factors in addition to health care that affect how individuals and populations age (Kalache
and Kickbusch, 1997). It shifts strategic planning away from a “needs-based” approach
(which assumes that older people are passive targets) to a “rights- based” approach that
recognizes the rights of people to equality of opportunity and treatment in all aspects of life
as they grow older.
If ageing is to be a positive experience, longer life must be accompanied by continuing
opportunities for health, participation and security (WHO, 2002). Active ageing is the
process of optimizing opportunities for health, participation and security in order to enhance
quality of life as people age. It allows people to realize their potential for physical, social,
and mental wellbeing throughout the life course and to participate in society according to
their needs, desires and capacities, while providing them with adequate protection, security
and care when they require assistance (WHO, 2002).
The word “active” refers to continuing participation in social, economic, cultural, spiritual
and civic affairs, not just the ability to be physically active or to participate in the labour
force. Older people who retire from work and those who are ill or live with disabilities can
remain active contributors to their families, peers, communities and nations.
Whereas in the past the emphasis was on disease and disease prevention (Hansen-Kyle
2005, Nygren et al. 2005, Lindstrom & Eriksson, 2006) nowadays, health promotion is
oriented more often to more positive processes, like for example healthy ageing (Eriksson &
Lindstrom, 2008). Such a positive approach is based on the theory of salutogenesis, in
which the focus is on the causes of health, instead of on the causes of disease
(pathogenesis).
Active ageing aims to extend healthy life expectancy and quality of life for all people as they
age, including those who are frail, disabled and in need of care. “Health” refers to physical,
mental and social wellbeing as expressed in the WHO definition of health. Thus, in an
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active ageing framework, policies and programmes that promote mental health and social
connections are as important as those that improve physical health status (WHO, 2002).
Active ageing policies and programmes are needed to enable people to continue to work
and participate according to their capacities and preferences as they grow older, and
although ageing per se cannot be prevented, the prevention or delay of disabilities and
chronic diseases that are costly to individuals, families and the health care system is within
our grasp.
To promote active ageing, health systems need to take a life course perspective that
focuses on health promotion, disease prevention and equitable access to quality primary
health care and long-term care. When the risk factors (both environmental and behavioural)
for chronic diseases and functional decline are kept low while the protective factors are kept
high, people will enjoy both a longer quantity and quality of life; they will remain healthy and
able to manage their own lives as they grow older; fewer older adults will need costly
medical treatment and care services (WHO, 2002).
Increasingly, both in Australia and overseas, there is recognition that strengthening and
improving the way in which primary health care is provided is vital in determining how well
the health system responds to current and emerging pressures. Research shows that those
health systems with strong primary health care are more efficient, have lower rates of
hospitalisation, fewer health inequalities and better health outcomes including lower
mortality, than those that do not (NPHCS, 2009).
The recently released World Health Organization (WHO) Report, Primary Health Care: now
more than ever, calls for a return to primary health care to help align health systems to
deliver better performance and equity. The WHO Report found that where countries at the
same level of economic development are compared, those that were organised around the
tenets of primary health care produced a higher level of health for the same investment.
Around the globe, many nations are grappling with how best to address similar issues. In
response, many industrialised countries including Australia, New Zealand, the United
Kingdom and Canada have undertaken significant investment and reform processes
directed at strengthening the primary health care sector (WHO, 2012). These reform
processes have predominantly focussed on encouraging a population health focus, greater
use of multi-disciplinary teams, increased accountability for performance, and improved
access to services.
4.2 Health Service Reform, Model of Care and Health Workforce Capacity
The World Health Organisation, international and national health policy environment is in
substantial agreement around the following considerations with respect to health service
reform and propose:
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 A people-centred primary health care model, with a strong focus on addressing
inequities, prevention of chronic disease, a population health focus, greater use of
multi-disciplinary teams, increased accountability for performance, and improved
access to services.
 The health sector needs to refocus on wellness, prevention and primary health care
if it is to be sustainable in the future (Health Workforce Australia (HWA), 2011).
 Sustainability will require re-balancing many aspects of the current system: making
decisions based on consumer and community need and focusing on the most costeffective and efficient workforce arrangements to provide care (HWA, 2011).
 This will mean re-configuring the workforce and the education and training programs
that prepare and support them (HWA, 2011).
 Inter-professional education and collaborative patient-centred practice are key to
building effective health care teams and improving the experience and outcomes of
patients (Canadian Inter-professional Health Collaborative (CIHC), 2007).
As outlined previously, evidence that risk factors (both environmental and behavioural) for
chronic diseases and functional decline occur throughout the life-course, and can be
prevented or postponed, has influenced a reorientation of health systems from a model
based on treatment of resultant illness to a strengthened primary health care model. The
increasing incidences of chronic illness and life-style diseases have placed even greater
demands on already stretched health services. These changes have necessitated a shift in
focus from acute service delivery to a chronic care model that emphasises among other
system changes, interactions between practice team and patient, and support for selfmanagement (Bodenheimer, Wagner & Brumbach, 2002).
In response, many industrialised countries including Australia, New Zealand (NZ), the
United Kingdom (UK) and Canada have undertaken significant investment and reform
processes directed at strengthening the primary health care sector. These reform processes
have predominantly focussed on encouraging a client centred population health focus,
health promotion, greater use of multi-disciplinary teams, and improved access to services.
While the primary health care sector delivers services that meet the needs of most people
requiring treatment for isolated episodes of ill-health, it is less successful at dealing with the
needs of people with more complex conditions or in enabling access to specific population
groups that are ‘hard to reach’.
Increasingly, both in Australia and overseas, there is recognition that strengthening and
improving the way in which primary health care is provided is vital in determining how well
the health system responds to current and emerging pressures. Research shows that those
health systems with strong primary health care are more efficient, have lower rates of
hospitalisation, fewer health inequalities and better health outcomes including lower
mortality, than those that do not.
12
The health sector needs to focus on wellness, prevention and primary health care if it is to
be sustainable in the future. Sustainability will require re-balancing many aspects of the
current system: making decisions based on consumer and community need and focusing
on the most cost-effective and efficient workforce arrangements to provide care (HWA,
2011).
The recently released World Health Organization (WHO) Report, Primary Health Care: now
more than ever (2008), calls for a return to primary health care to help align health systems
to deliver better performance and equity. The WHO Report found that where countries at
the same level of economic development are compared, those that were organised around
the tenets of primary health care produced a higher level of health for the same investment.
To cope with the increasing complexity of health, organisations are recognising the need for
effective teamwork between the health professions (Institute of Medicine, 2001).There is
greater awareness that one profession alone can no longer meet the needs and
expectations of the patient, nor can professions continue to work in silos, being reliant on
the complementary skills of their colleagues to provide optimal care. There is also growing
patient and community expectation of greater partnership and inclusion in the healthcare
process. There is increasing emphasis on new ways of visualising the patient-professional
relationship, where patients are recognised for their expertise and health care practitioner
and patient roles are negotiated within the patient-professional relationship. There is
growing recognition that the task of the health practitioner is to help patients manage their
own health (NPHCS, 2009)
In recognition of the growing burden of chronic disease on individuals, communities,
organisations and governments, a national policy approach has been adopted to improve
chronic disease prevention and care across Australia (National Health Priority Action
Council (NHPAC), 2006). The National Chronic Disease Strategy report (2006)
incorporated an inter-professional approach to care, not only between individual
practitioners but also in promoting collaboration between the various health care sectors, as
evident in Principle 5:
Health care practitioners operating in effective primary health care networks are best
placed to provide a team based approach (NHPAC), 2006. p10). Integrated care means
that health services work collaboratively with each other, and with patients and their
families and carers, to provide person centred optimal care (NHPAC), 2006. p11).
National health care reform is a strategic priority for the Council of Australian Governments
(COAG). In 2007 the National Health Workforce Taskforce was established to progress
health care reform with an aim of addressing priority issues identified in the National
Workforce Strategic Framework. A key strategic action suggested is the development of
‘workplace, professional and education and training practices that facilitate team
approaches and multidisciplinary care’ (Australian Health Ministers’ Conference, 2004).
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The National Health Agreement (2008) affirms the agreement of all governments that
Australia’s health system should:
 be shaped around the health needs of individual patients, families and their
communities;
 focus on prevention of disease and the maintenance of health, not simply the
treatment of illness;
 support an integrated approach to the promotion of healthy lifestyles, prevention of
injury and diagnosis and treatment of illness across the continuum of care; and
 provide all Australians with timely access to quality health services based on their
needs, not ability to pay, regardless of where they live in the country.
The health sector needs to focus on wellness, prevention and primary health care if it is to
be sustainable in the future. Sustainability will require re-balancing many aspects of the
current system, making decisions based on consumer and community need and focusing
on the most cost-effective and efficient workforce arrangements to provide care. It will mean
re-configuring the workforce and the education and training programs that prepare and
support them (HWA, 2011).
The National Primary Health Care (Draft) Strategy 2012 identified the following key priority
areas:
 improving access and reducing inequity;
 better management of chronic conditions;
 increasing the focus on prevention;
 improving quality, safety, performance and accountability.
Underpinning these key priority areas is the recognition that a patient-centred focus, and
well educated and distributed workforce are key to all future reforms in primary health care.
In meeting the ongoing and future needs of the Australian population, the Draft National
Primary Health Care Strategy aims to build on the undertakings agreed through the
National Healthcare Agreement to improve the level of cooperation, coordination and
integration of service delivery across Commonwealth and state and territory governments
and to refocus the primary health care system on meeting the needs of individual patients,
being responsive to changing population needs, and operating effectively in a broader
social system.
In response to these challenges, health systems in general, and health services in
particular, are increasingly emphasising the critical importance of improved and increased
levels of inter-professional practice: that is, health professionals working together, often in
teams, to manage complex practice situations. Changing the way health professionals are
educated is a critical step to achieving broader system change and ensuring that health
practitioners have the necessary knowledge and training to work effectively within a
complex and evolving health care system
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Recognising the association between education and health reform, education and training
was one of the key portfolios of the National Health Workforce Taskforce Objectives for this
portfolio focused on maximising capacity of health and education systems to meet the
projected workforce demands, and ensuring that education and training was appropriate,
responsive and relevant to the changing health system needs.
What is required is a paradigm shift in ways of thinking about workforce design and
planning, one that works backwards from outcomes for communities, consumers and
population need, versus the current thinking that is generally focused on working forward
from the base of existing professions and their interests and skills, demarcations and
responsibilities (The National Health Workforce Innovation and Reform Strategic
Framework for Action 2011-2015).
One of the key recommendations of the Australia’s Health Workforce report was to call for a
national and systematic dialogue on health education and training to: facilitate consideration
of education and training issues on an integrated rather than profession-by-profession
basis. Amongst other things, this could provide greater scope to identify common education
and training requirements across particular professions, and consequent opportunities to
further develop inter/multi-disciplinary training approaches (Productivity Commission, 2005).
In recent years, there has been a continuous shift in the healthcare system towards
collaboration and patient-centred care. Patient-centred care demands that healthcare
professionals work together in an effective manner. The evidence suggests, however, that
often these professionals do not collaborate well. Inter-professional education (IPE) offers a
possible way to improve this through the education of healthcare students in
multidisciplinary settings during their professional training. The goal of IPE is to cultivate
knowledge of and establish collaboration with other professionals early on in the career of
healthcare providers in order to enhance future practices.
The service/workforce capacity to address emerging health concerns links a
multidisciplinary primary health service with an inter-professional health workforce
education strategy in order to promote the health of populations throughout their life-course.
The WHO Framework for Action on Interprofessional Education and Collaborative Practice
report (World Health Organisation, 2010) emphasises the role of inter-professional
education in underpinning the development of a collaborative practice-ready health
workforce, where health workers work together and rely on one another in delivering quality
healthcare. The report summarised the evidence regarding the positive impact of interprofessional education on collaborative practice, and the impact of collaborative practice in
addressing local health needs and improving healthcare delivery and patient outcomes.
This report noted that a high level of synergy between the health workforce planning
sector and health education systems was critical, particularly for supporting the
15
transition of learners from the classroom to the workplace and enhancing the
sustainability of inter-professional education and collaborative practice initiatives
generally.
The National Health Workforce Innovation and Reform Strategic Framework for Action
2011-2015 is a national call to action for workforce reform that will involve and link the
health and education sectors. The Framework has been designed to provide an
overarching, national platform that will guide future health workforce policy and planning in
Australia. It sets out key priority areas and five essential domains that create the foundation
for an integrated, high performing workforce fit to meet Australia’s health care needs. A key
finding of the strategy is that a major shift is required towards inter-professional education
and practice to improve collaborative team-based practice and the quality of care delivered.
4.3 Inter-professional Education, Practice & Health Workforce Competency
In as much as the international and national health strategic directions have called for
health system reform with respect to emerging health needs, models of care and workforce
capability, the health workforce education sector is undergoing considerable change with
respect to the organisation of health professional education and learning models required to
support and ensure the work readiness of health professionals for client centred interprofessional practice.
Globally, policy drivers for inter-professional education (IPE) reflect the increasing
pressures on the healthcare system. Within the Australian context, the need for new forms
of educational thinking and practice aimed at addressing the above health issues and
challenges through inter-professional learning have been increasingly articulated within the
policy and practice literature.
Inter-professional education seeks to encourage different health professions to interact and
learn together during their training process which will eventually lead to collaborative
healthcare practices and improved care for patients. Inter-professional education (IPE), a
process whereby health professionals learn from, with and about each other is advocated
as a response to widespread calls for improved communication and collaboration between
healthcare professionals (WHO, 2010).
A report commissioned by the US Institute of Medicine highlighted the anomaly between
healthcare practice and education settings in that, although health professionals are
expected to engage in collaborative practice in teams, they are not trained together or
trained in team-based skills (Institute of Medicine, 2003). As such, this report identified: that
all health professionals should be educated to deliver patient-centred care as part of an
interdisciplinary team.
16
The first documented Australian IPE initiatives in the education of health professionals
dates back to the late 1960s with Piggott (1975) describing a community-focused program
developed and implemented through the Community Care Teaching Unit of Royal Prince
Alfred Hospital, Sydney. This program was based within a community setting, allowing
students the opportunity to become part of a student multidisciplinary team in planning the
health care of community based patients.
The focus on primary health care in the 1970s and the Declaration of Alma Ata
(World Health Organisation, 1978) had a major impact on policy in Scandinavian countries,
and provided the foundations for IPE in many ways. Linköping University in Sweden first
implemented an inter-professional curriculum in 1986 (Areskog, 1988) when it launched its
new Faculty of Health Sciences, two years before the WHO Learning Together to Work
Together for Health report was released.
Linköping University is widely acknowledged as one of the forerunners for embedding IPE
within curricula. Following its lead, other universities within the region responded with their
own IPE initiatives. For example, the Karolinska Institute has implemented similar wardbased IPE training programs (Ponzer et al., 2004).
The University of Alberta in Canada has a relatively long history of IPE, first offering an
interdisciplinary course in 1992 (Philippon, Pimlott, King, Day, & Cox, 2005). Initially an
elective, this course is now embedded within curricula as a mandatory and assessed
component for all healthcare students.
Davidson and Lucas (1995) also described two programs at the University of Adelaide,
which included students from several different health professions. This Working in Health
Care program focused on concepts of primary health care and the potential contributions of
the different professions to the health system, and was mandatory for second year
students; and the Community Practice Workshop was an elective for final year students and
focused on translating community health principles into practice. State funding for these
programs continued up until the mid-nineties, but these initiatives ceased once grant
funding was withdrawn.
The United Kingdom Department of Health publication Working Together – Learning
Together: a framework for lifelong learning for the NHS(2001) emphasised pthat core skills,
particularly communication skills, undertaken on a shared basis with other professions,
should be included from the earliest stages in professional preparation in both theory and
practice settings
In 2003 in Canada, the First Ministers Health Accord identified that changing the way health
professionals are educated was a key requisite for an integrated and interdisciplinary
approach to care (Health Canada, 2003). Health Canada committed to a program of interprofessional research and service delivery and allocated funding of over nineteen million
Canadian dollars. The Canadian Inter-professional Health Collaborative (CIHC) was
17
established to facilitate the coordination and dissemination of information from funded
projects. CIHC views that: inter-professional education and collaborative patient-centred
practice are key to building effective health care teams and improving the experience and
outcomes of patients (CIHC, 2007).
4.3.1 Education Sector Reforms
Within the context of economic globalisation, national systems of higher education are
being brought more closely into alignment with international standards and modes of
provision (Marginson, 2007; 2010). In Australia, reforms collapsed the binary system of
tertiary education (with its division into universities that were discipline-based and the
vocationally oriented colleges and institutes of technology), and established a ‘unified
national system’ that eventually produced thirty-eight public universities (Dawkins, 1988).
One significant turning point was the arrival of a variety of health professions hitherto
located in colleges of advanced education and institutes of technology into the newly
configured universities. Notable among these were the nursing and various allied health
professions, such as occupational therapy and speech pathology. This created a new
environment for a wider conception of health professional education than that provided by
the earlier binary system in which only medicine, dentistry, physiotherapy and pharmacy
were typically located in universities. It is within this environment that IPE developments
within Australian higher education need to be situated and understood.
4.3.2 Student Learning Theories
University teaching has been substantially reshaped, and a field of research and
development has emerged that has focused attention emphatically on student learning.
Most notably, the concepts of ‘deep’ and ‘surface’ learning approaches in higher education
that influence implicit or explicit approaches to teaching were widely established within a
new field of educational development (Lee, 2005).
A similarly influential development has been the work of Biggs and colleagues on
‘constructive’ alignment (Biggs, 1999; Biggs & Tang, 2007). Constructivism comprises a
family of theories that have in common the centrality of the learner’s activities in creating
meaning. Biggs made a further distinction between ‘declarative knowledge’ and ‘functioning
knowledge’ with the latter providing a means of conceptualising education for professional
practice, and leading to the development of educational pedagogies and practices such as
problem-based learning, case-based learning, lifelong learning and work-based learning,
which foster collaborative and team learning.
More recently, an emphasis on what are called ‘threshold concepts’, has seen a more
collaborative process of discipline scholars and educational developers working together to
determine concepts critical for the development of understanding within disciplines and
professional fields (Meyer & Land, 2003). A growing emphasis on aligning curriculum to
outcomes, as shaped by a range of changing pressures from governments, the economy,
and accrediting bodies, has meant that the ideas of constructive alignment and threshold
18
concepts have become more systematically linked to policy agendas in the last five years.
This has led to a concern within curriculum design for defining the capabilities that
graduates are required to have upon completing their courses and entering the workforce
and taking up social responsibilities. Recent research and development in what have
become known as ‘graduate attributes’ (Barrie, Hughes, & Smith, 2009) has built on a prior
focus in the vocational sector on skills, competencies and capabilities.
In a paper generated for WHO, Thistlethwaite & Moran (2010) reported on the learning
objectives, learning outcomes, competencies or capabilities most frequently associated with
IPE. The key words found within the literature most commonly associated with IPE learning
outcomes were:
 teamwork,
 roles and responsibilities,
 communication, learning/ reflection,
 the patient, and
 ethical/attitudes.
Development of evidenced-based assessments of inter-professional learning outcomes
remains a major challenge for inter-professional educators. Health professional students
are almost always assessed for individual achievement and their registration depends on
meeting defined standards in knowledge and skills. While it is possible to assess
knowledge of teamwork, roles and responsibilities, teamwork skills should at some point be
assessed in the context of students working in teams. Some writers have drawn attention to
the difficulty of assessing team attitudes regarding the values of inter-professional practice’
(Hammick & Anderson, 2009).
Consistent with the core definition of IPE teaching strategies utilised for inter-professional
learning must include interactive methods. Small group formats and interactive sessions
have the potential to encourage students to learn with, from, and about one another as
students are dependent upon each other for at least part of their learning (Freeth et al.,
2005).
A core underpinning assumption of adult learning theory is that learning experiences need
to be relevant to the student (Knowles, 1980). In the context of IPE, Oandasan and Reeves
(2005) suggested that, by incorporating some form of clinical exposure, relevance is
enhanced, and hence motivation of learners to engage in IPE activities is also increased.
There is considerable debate and little consensus concerning the stage at which prequalification healthcare students should be introduced to inter-professional learning. Some
have argued that it should begin early in the training programs of individual professions
before any misconceptions are formed or stereotyping occurs (Anvaripour, Jacobson,
Schweiger, & Weissman, 1991; Horak, O’Leary, & Carlson, 1998). Others have proposed
that students must first gain knowledge and confidence within their chosen field before
19
interacting effectively with other professions (Mariano, 1989; Petrie, 1976). Harden (1998)
has suggested that “when” is not as important as ensuring that the learning activities are
appropriate for the level of experience and stage at which the student is at within their
program. For example, IPE clinical placements involving students exchanging and applying
profession specific clinical knowledge, are best suited for senior students.
The New Generation Program at Southampton University incorporates three pedagogical
approaches:
 guided discovery learning;
 inter-professional learning; and
 collaborative learning within their IPE model (O’Halloran et al., 2006).
The first of these approaches enables students to develop their self-directed learning skills,
while the second requires that students have the opportunity to learn not only with each
other, but also from each other. This links with the third approach of collaborative learning.
Learning activities are designed to promote authentic interdependence and equal
contributions from all group members (Craddock et al., 2006).Increasingly, literature related
to health service delivery and health workforce planning focuses on the need for
collaborative inter-professional work practices.
For example, the National Patient Safety Education Framework Report (2005) identified
that the development of IPE and inter-professional practice (IPP) capabilities across all
sections of the Australian health workforce was essential for enabling effective
collaboration, effective team work, and increased levels of quality and safety (Australian
Council for Safety and Quality in Health Care, 2005, p.6).
Until recently, IPE curriculum initiatives have been piecemeal and have existed on the
margins of mainstream curriculum in different professional fields. While there is now an
array of IPE-related publications, and a rapidly increasing number of IPE initiatives
underway within pre-qualification education programs, what is less common is a ‘whole of
curriculum’ approach where IPL is part of the vision for the future, and is practically
integrated and embedded within mainstream curricula as a mandatory, assessed
component.
The WHO Framework for Action (2010) also identified an important number of mechanisms
shaping and supporting how inter-professional education is developed and delivered. These
include elements related to the training of personnel involved in developing and delivering
curricula, institutional and environmental support mechanisms such as a working culture
that is conducive to practicing collaboratively, and governance mechanisms which
emphasise patient safety.
20
4.3.3 Inter-professional Health Workforce Competency
Competence can be defined as the ability to handle a complex professional situation by
combining relevant knowledge, skills and attitudes (Miller, 1990). Inter-professional
competence, according to this view, refers to students’ ability to function effectively as a
member of an inter-professional health care team.
One task undertaken by the Canadian Inter-professional Health Collaborative (CIHC) was
to consolidate and reach consensus across the nation on a competency framework. An
initial review of the literature identified a number of common terms used in these core
competencies related to IPE including problem solving; decision making; respect;
communication; shared knowledge and skills, and patient centred practice (Canadian Interprofessional Health Collaborative, 2007).
Linköping University has developed a framework defining a common set of professional
values, which underpin a common set of inter-professional competencies include knowing
roles and capabilities of other professionals, cooperation with other professionals, and
awareness of skills and competence of other professions (Areskog, 2009; Fallsberg &
Hammar, 2000; Wilhelmsson, et al., 2009).
From the initial review, the CIHC (2010) have developed a national inter-professional
competency framework detailing core knowledge, skills, attitudes and behaviours required
for collaborative practice applicable to all health professions and clinical settings. Six
competency domains which are thought to be developmentally incremental are identified,
including two underpinning domains of inter-professional communication and patient/
client/family/community-centred care which influence four other competency domains of
role clarification, team functioning, collaborative leadership, and inter-professional conflict
resolution.
These competencies are similar to those listed in the WHO (2010) framework for action on
inter-professional education and collaborative practice. The CIHC report also identifies that
the complexity of the practice situation, the context of local practice, and the need for
quality improvement are elements which need to be taken into account when applying the
framework (Canadian Inter-professional Health Collaborative, 2010).
What is less clear from the CIHC report, however, is the differentiation between core
competencies that could be related to,
 learning in common (e.g. evidence-based practice; quality improvement practice;
and information), and
 Collaborative capabilities- those that add value by being addressed using interprofessional approaches.
This differentiation underpins and proposes a content area of core competencies for
learning in common along with the development of collaborative competencies which
translate to patients, communities and other sectors as well as inter-professionally.
21
The National Chronic Disease Strategy Report (2006) also specified in one of its key
direction statements, the development of core chronic disease prevention and care
competencies within undergraduate and postgraduate health professional education.
Included in this skill set are:
communication skills, which enable service providers to collaborate
effectively at three levels: not only with patients and their families and
carers, but also to be able to work closely with other service providers,
and to join with communities to improve outcomes for people with chronic disease
(National Health Priority Action Council (NHPAC) 2006) p36.
A major objective of the recommendations made in the Garling (2008) report on Acute Care
Services in New South Wales Public Hospitals is the creation of an effective hospital
workforce. The report recommended that health professional ‘clinical education and training
should be undertaken in a multi-disciplinary environment which emphasises inter
disciplinary team based patient centred care’ and that a central body such as an Institute of
Clinical Education and Training be established to design, deliver, assess and evaluate
clinical training across the professions. This report also sent a strong message about
developing the capacity of the health workforce to work within a multidisciplinary
environment as a member of, or as a contributor to an interdisciplinary team.
Similarly, the recent National Health and Hospitals Reform Commission (2009) report
recommended the development of a new framework for the education and training of our
health professionals which moves towards a flexible, multi-disciplinary approach, and
incorporates an agreed competency-based framework as part of a broad teaching and
learning curriculum for all health professionals.
The updated Tomorrow’s Doctors report (General Medical Council, 2009) has outlined that
medical graduates will need to demonstrate the capacity to:
 learn effectively within a multi-professional team
 understand and respect the roles and expertise of health and social care
professionals in the context of working and learning as a multi-professional team;
 understand the contribution that effective interdisciplinary team working makes to the
delivery of safe and high-quality care;
 work with colleagues in ways that best serve the interests of patients, including
passing on information and handing over care, demonstrating flexibility, adaptability
and a problem solving approach;
 build team capacity and positive working relationships and undertake various team
roles including leadership and the ability to accept leadership by others.
Despite the various IPE activities documented in the literature, its integration within
healthcare education curricula is not occurring in a systematic fashion within Australia.
Inter-professional education presents many challenges for educational organisations, health
22
care providers and professional associations and these are summarised in the next section
(Gardner, Chamberlin, Heestand, & Stowe, 2002; Headrick, Wilcock, & Batalden, 1998).
The need remains to identify, agree on, and strengthen core competencies for interprofessional collaborative practice across the professions. Competency domains and
specific competencies should remain general in nature and function as guidelines, allowing
flexibility within the professions and at the institutional level.
Principles of inter-professional competencies include:
 Patient/family centred (hereafter termed “patient centred”)
 Community/population oriented
 Relationship focused
 Process oriented
 Linked to learning activities, educational strategies, and behavioural assessments
that are developmentally appropriate for the learner
 Able to be integrated across the learning continuum
 Sensitive to the systems context/applicable across practice settings
 Applicable across professions
 Stated in language common and meaningful across the professions
 Outcome driven
Core competencies are needed in order to:
 create a coordinated effort across the health professions to embed essential content
in all health professions education curricula,
 guide professional and institutional curricular development of learning approaches
and assessment strategies to achieve productive outcomes,
 provide the foundation for a learning continuum in inter-professional competency
development across the professions and the lifelong learning trajectory,
 acknowledge that evaluation and research work will strengthen the scholarship in
this area,
 prompt dialogue to evaluate the “fit” between educationally identified core
 competencies for inter-professional collaborative practice and practice needs/
 demands,
 find opportunities to integrate essential inter-professional education content
consistent with current accreditation expectations for each health professions
education program (see University of Minnesota, Academic Health Center, Office of
Education, 2009),
 develop a common set of accreditation standards for inter-professional education
(see Accreditation of Inter-professional Health Education: Principles and practices,
2009; and Accreditation of Inter-professional Health Education: National Forum,
2009)
 inform professional licensing and credentialing bodies in defining potential
 testing content for inter-professional collaborative practice
23
(Interprofessional Education Collaborative Expert Panel (IPEC),2011. p7)
Currently, the transformation of health professions education is attracting widespread
interest. The transformation envisioned would enable opportunities for health professions
students to engage in interactive learning with those outside their profession as a routine
part of their education. The goal of this inter-professional learning is to prepare all health
professions students for deliberatively working together with the common goal of building a
safer and better patient-centred and community/population oriented health care system.
Achieving that vision for the future requires the continuous development of interprofessional competencies by health professions students as part of the learning process,
so that they enter the workforce ready to practice effective teamwork and team-based care
(IPEC, 2011).
4.3.4 Enablers and Challenges of Inter-professional Education and Practice.
Key enablers and challengers identified in the literature that influence the use of research
evidence, knowledge transfer and inter-professional education and practice are
summarised in Tables 1 and 2.
Table 1: Key Enablers Identified in Literature
 Partnerships within and between academic institutions, health care facilities
and stakeholders
 Identification of additional sources of support and resources
 Support and incentives for inter-professional collaboration, facilitated by
horizontal integration of medical, nursing and allied health training activities
 Vertical integration across undergraduate, postgraduate and vocational health
training
 The need for staff to model inter-professional collaboration and ensure that
curricula make explicit the rationale for inter-professional learning
 Structuring learning activity toward developing inter-professional competence
for contemporary health service delivery
 Ensuring that the espoused values of inter-professional practice and learning
are reflected in assessment events.
 Ensuring inter-professional learning is not extracurricular or non-credit
 Valuing faculty time dedicated to this work
 Realising the potential to initiate systems change at the clinical level
 Ensuring the pursuit of educational goals does not compromise patient care
 Engagement with clinicians in the clinical practice setting who are
instrumental in assisting students make sense of their knowledge through
practice
24
Table 2: Key Challengers Identified in Literature
 The negotiation of competing curricula, clinical supervision, timetabling,
resistance to change
 Logistical incompatibilities within and between academic institutions and
healthcare facilities including scheduling difficulties and faculty workloads
 Discontinuity in student availability -students can neither make up for staffing
shortages nor be expected to maintain programs
 Negotiating conflicts i.e. response to community needs vs careful curricular
development.
 Sustaining inter-professional collaboration is challenging- historical interprofessional and intra-professional rivalries
 Differing expectations of each profession. This is seen at an academic level,
as well as with site-based educators and placement supervisors and often a
result of differences in requirements and regulations between the professions
 The fear that inter-professional practice will lead to a loss of status, a loss of
professional identity, and a dilution of the role of individual professions in
patient care
 Heavily committed curriculum and clinical placement schedule for each
profession.
 Lack of availability of suitably trained academic staff and clinical placement
supervisors to facilitate inter-professional programs
 Lack of facilities and resources to deliver campus based inter-professional
programs e.g. tutorial rooms
 Lack of geographical co-location of individual schools/ faculties
4.4
Student Inter-professional Practice Initiatives Relevant to Healthy Ageing
Clinics
4.4.1 Description of Student Inter-professional Practice Initiatives
A literature search about student inter-professional practice initiatives relevant to healthy
ageing clinics yielded 183 published studies and papers at first instance from which 46
were subsequently selected for their relevance to the proposed Model for analysis
(Appendix 2). These papers revealed that there has been substantial growth in the number
of student managed health initiatives over recent years. For instance in 2007, there were 49
Medical Schools in USA operating 110 medical student-run health clinics offering chronic
disease management. Other exemplars were identified from the literature which embraced:
 mental health(depression screening)
 maternity nursing practice
 falls prevention
 Medication management
 geriatrics
 autism
 communicable disease
 adolescents – young adults
 disabled people
25

rural outreach.
Significantly, there was only one student run health initiative which addressed the outcome
of healthy ageing and this was conducted in the early 80’s and was not inter-professional.
The literature also reported evaluations of the student-run, inter-professional initiatives and
provided evidence of significant impacts in the following areas:
 Consumer health interventions
 Improved access to disadvantaged/underserved consumers
 Improved management of chronic disease
 Consumer satisfaction
 Inter-professional student learning outcomes
 Improved supervision/innovative clinical placements
 Work readiness
 Curriculum development
 Systems change
 Cost effectiveness.
4.4.2 Alignment of Student Inter-professional Practice Initiatives with Health,
Education and the Proposed Model.
A qualitative thematic analysis of the 46 studies was conducted looking for themes that
were relevant to the proposed Model (see Table 3). Thirty six recurrent themes were
identified falling into four broad domains:
 Evidence of Need
 Health System/ Service directions
 Health Profession Education System directions
 Outcomes.
The recurrent themes (characteristics) emerging from the studies represent innovative
collaborations of health professional educators, health professionals and, students which,
 address the evidence of health needs and priorities
 propose a health promotion and population health approach
 adopt a client centred, interdisciplinary, team based model of healthcare
 develop inter-professional/practice based learning and work readiness
 conduct consumer, service and student evaluations.
Additionally, all other literature reviewed from health, policy and education was examined
for these recurrent themes. It was revealed that the other literature also contained these
themes.
In summary, the thematic analysis provides evidence of substantial alignment of and
between:
 Reforms and strategic directions for Ageing, the Health Service Systems and Health
Professional Education Systems
26


Health Service models of care and models of inter-professional education
The student led service initiatives reviewed from research literature and the model of
a student led inter-professional healthy ageing clinic which is proposed.
For the purpose of this project the evidence to support the proposed Model may be
conceptualised from three inter-reliant perspectives,
 Health Outcomes for consumers and communities,
 Health system reform and service delivery outcomes,
 Student education, learning and practice outcomes,
but progress will require reconceptualising and reconciling the entire paradigm.
Importantly, one of the four domains, the Outcomes, which contains the three themes,
wellness focus, inter-professional/inter-sectoral collaborative learning and practice, and
building workforce capacity, defines the paradigm shift which is required to address the
current and emerging health needs of the population. These three themes are also the
pillars of the reform agendas; the studies from the literature search; and the model which is
the subject of this project.
Further from the student interprofessional practice initiatives reviewed several themes from
the Evidence of Need section in Table 3:
 Underserved Groups/Service Gaps,
 Chronic Disease/outcomes ,
 Health Promotion/prevention,
 Population health approach,
 Health equity, and
 Cost benefit/effectiveness,
underline the core areas of education, learning and practice undertaken by students and
clinical supervisors. These themes proposed core areas of “learning in common” which are
being facilitated collaboratively and they likewise underpin the international health reform
agenda.
27
Table 3: Domains and themes identified from the literature
Evidence of Need
Demography
Epidemiology
Policy Alignment
Underserved
Chronic Disease/outcomes Health
Groups/Service Gaps
Promotion/prevention
Population health
Health equity
Cost benefit/effectiveness
approach
Health System/Service Directions
Service Model
Primary Healthcare
Client centred
Consumer health capacity Health literacy
Inter-agency collaboration
Multidisciplinary/team
skills/consultation
Student led
Outcomes
Health Paradigm shift
(pathogenic>salutogenic/)
Wellness focus
Health and Academic
Partnership
Service location
Inter-professional learning
Health, and Education
Paradigm shift
(inter-professional/intersectoral collaborative
learning and practice)
Health Service/Workforce
(building capacity to meet
emerging needs)
Education System Directions
Competency
Curriculum development
development/assurance
Health Practice
Shift in Service demand
modification
Replication
Research
28
Pilot initiatives/evaluation
Simulation/resource
development
Evaluation
Barriers, enablers, ethics
4.5 Health and Education Policy Nexus
This section presents the results of a further analysis of the international and national health
and education policy literature. The policies were evaluated for convergence. Boxes 1, 2, 3,
and 4 detail the extent of the alignment found.
Box 1: Policy Alignment- WHO and Health Reforms
WHO Health Frameworks, International and National Health Reform(s) converge to
propose healthcare systems/services with the following features:
 People-centred primary health care model
 Accessible, clinically and culturally appropriate, timely and affordable
 Strong focus on addressing inequities in access to health services
 focus on disease prevention and preventive care, including support of healthy
lifestyles
 Greater use of population health approaches
 Well-integrated, coordinated, and providing continuity of care, particularly for
those with multiple, ongoing, and complex conditions
 Interdisciplinary teamwork and inter-sectoral collaboration
 Supportive of health literacy, self-management and individual preference
 Safe, high quality care which is continually improving through relevant research
and innovation
 Responsive to the needs of local communities.
 Inter-professional education and training arrangements for both new and existing
workforce
 Fiscally sustainable, efficient and cost-effective.
Box 2: Policy Alignment- WHO and IPE
WHO, International and National Frameworks for Inter-professional Education and
Knowledge Translation reveal and propose:
 Globally, the policy drivers for inter-professional education (IPE) reflect the
increasing pressures on the healthcare system
 There is greater awareness that one profession alone can no longer meet the
needs and expectations of the patient, nor can professions continue to work in
silos
 Changing the way health professionals are educated is a critical step to achieving
broader system change and ensuring that health practitioners have the
necessary knowledge and training to work effectively within a complex and
evolving health care system
 Inter-professional education and collaborative patient-centred practice are key to
building effective health care teams and improving the experience and outcomes
of patients
 IPE focuses on maximising capacity of health and education systems to meet the
projected workforce demands, and ensuring that education and training is
appropriate, responsive and relevant to the changing health system needs
 IPE facilitates consideration of education and training issues on an integrated
29







rather than profession-by-profession basis and provides greater scope to identify
common education and training requirements across particular professions
all health professionals should be educated to deliver patient-centred care as part
of an interdisciplinary team
IPE incorporates an agreed competency-based framework as part of a broad
teaching and learning curriculum for all health professionals
core skills undertaken on a shared basis with other professions, should be
included from the earliest stages in professional preparation in both theory and
practice settings
IPE core skills can facilitate the development of, amongst others, skills in the
areas of communication, problem solving, multidisciplinary teamwork,
consultation, chronic disease management, population health, planning and
evaluation, health promotion and prevention.
IPE supports the transition of learners from the classroom to the workplace and
enhances the sustainability of inter-professional education and collaborative
practice initiatives generally.
Inter-professional education underpins the development of a practice-ready
health workforce
Health care workers who are educated and trained to work together can reduce
risks to patients, themselves and their colleagues
Box 3: Policy Alignment- Health Workforce
Implementation of COAG Health Workforce package includes consideration of the
following issues:
 Students experience clinical education in primary health care, early and often, in
a supportive working environment;
 Supporting inter-disciplinary learning across primary health care professions
through streamlining organisational infrastructure at the regional level;
 Testing models of vertically integrated training whereby different stages of clinical
training are aligned;
 Infrastructure requirements for community-based clinical training (where
appropriate) and boosting teaching capacity; and
 Financing arrangements that can better support training of primary health care
professionals within the sector.
Box 4: Policy Alignment- WHO and Ageing
WHO and National Frameworks for Ageing
A number of propositions can be drawn from the foregoing review of International
and National Health Service Reforms and Health Education Reforms which strongly
support the feasibility and pertinence of the establishment of “a community based
inter-professional student managed Healthy Ageing Clinic” as is proposed by this
study, but even beyond that particular application, there is a critical need to address
the promotion of inter-professional education and practice initiatives per se within a
strengthened primary healthcare model. These propositions are outlined below:

30
International and National Health Service Reforms and Health Education
Reforms are calling for both a strengthened model of primary healthcare to deal




with present and emerging health concerns, and agree that,
Changing the way health professionals are educated is a critical step to achieving
broader system change and ensuring that health practitioners have the
necessary knowledge and training to work effectively within a complex and
evolving health care system.
The predominant influence will remain ageing, which will cause most change in
the use of primary health care services.
Active ageing policies and programmes are needed to enable people to continue
to work according to their capacities and preferences as they grow older, and to
prevent or delay disabilities and chronic diseases that are costly to individuals,
families and the health care system.(WHO, 2002)
The above reform directions focus on:
o A people-centred primary health care model, with a strong focus on
addressing inequities, prevention of chronic disease, a population health
focus, greater use of multi-disciplinary teams, increased accountability for
performance, and improved access to services.
o The health sector need to refocus on wellness, prevention and primary
health care if it is to be sustainable in the future.
o Sustainability will require re-balancing many aspects of the current system:
making decisions based on consumer and community need and focusing
on the most cost-effective and efficient workforce arrangements to provide
care. (HWA)
o This will mean re-configuring the workforce and the education and training
programs that prepare and support them.
o Inter-professional education and collaborative patient-centred practice are
key to building effective health care teams and improving the experience
and outcomes of patients
o A major shift towards inter-professional education and practice, where
health professionals from different backgrounds learn with, from and about
one another to improve collaborative team-based practice and the quality
of care delivered.
o core skills undertaken on a shared basis with other professions, should be
included from the earliest stages in professional preparation in both theory
and practice settings
o Strong partnerships across the health and education sectors is critical to
effectively plan the pipeline from education to work, especially clinical
training placements that involve collaborative planning with service
providers.
In summary, international and national health service and health education reforms are
calling for both a strengthened model of primary healthcare to deal with present and
emerging health concerns, and agree that, changing the way health professionals are
educated is a critical step to achieving broader system change and ensuring that health
practitioners have the necessary knowledge and training to work effectively within a
complex and evolving health care system. The predominant influence will remain ageing,
which will cause most change in the use of primary health care services.
31
5 Examples of Inter-professional Education in Practice in Australasia
Majority of advanced models of integrated inter-professional education are aggregated in
the northern hemisphere and primarily in the United Kingdom, Canada and the United
States of America. The Canadian system is the most unified, advanced and mature
supported through national policy and recurrent funding. There is a strong interprofessional education movement in the United States led by a number of Medical Schools.
External to Curtin University and the Auckland University of Technology, inter-professional
practice is at an embryonic stage across Australasia.
5.1 Curtin University, Western Australia
Curtin University’s transformation to inter-professional learning and education commenced
with pilot programs as recently as 2009 and has progressed to an Inter-professional based
curriculum and clinical placement program. The program covers the disciplines of nursing,
occupational therapy, pharmacy, and physiotherapy. Medical students from the University
of Western Australia and Notre Dame University participate in the program. Partners in this
initiative include a consortia of education providers, Western Australian Health Department
and Health Consumer Council.
Current inter-professional initiatives:
 A student managed general medical ward at Royal Perth Hospital.
 Campus based inter-professional clinics
 Aged care facility in partnership with Uniting Church
 Early childhood service
 Rural based mental health service
Curtin University has received a number of national and international awards, and
maintains ongoing collaboration with national and international leaders in inter-professional
education including the Karolinska Institute in Sweden.
5.2 Auckland University of Technology
Auckland University of Technology (AUT) hosts the National Centre for Inter-professional
Education and Collaborative Practice and has been successful in implementing a number of
inter-professional initiatives through their Faculty of Health and Environmental Sciences.
AUT has a developing and integrated program of initiatives in collaboration with educational
institutions, hospitals and district health boards.
Current inter-professional initiatives:
 Akoranga Integrated Health Clinic
 Healthcare Team Challenge
32



Inter-professional rural and primary health care placement - Wellsford
Inter-professional education workshops and lectures
Currently developing an inter-professional summer school project with the
Waitemata District Health Board
Three inter-professional first year courses (Papers) have been developed in:
 Lifespan Development and Communication
 Knowledge, Enquiry and Communication
 Health and Environment
6 Stakeholder Consultation
Significant consultation and engagement of clinical and academic experts, project partners
and community stakeholders occurred throughout the course of the project
A clinical expert panel was established from the onset. This expert panel consisted of
clinical leaders, educators and researchers in specialist fields relevant to healthy ageing
and inter-professional education.
Broad stakeholder consultation was undertaken across the following relevant community
organisations who were agencies developing and implementing innovative services for
older people and/or inter-professional initiatives and advocacy bodies representing the
interests of older people (see Box ).
Box 5: Stakeholders Consulted
Hunter Medicare Local
New England Medicare Local
Awabakal Newcastle Aboriginal Cooperative Ltd
Newcastle City Council
Lake Macquarie City Council
Mercy Services
TAFE NSW Hunter Institute
NovaCare
Central Coast Medicare Local
Central Coast Aged Care Taskforce
Port Stephens Council
Men’s Sheds Australia
Uniting Care
Anglicare
The Whiddon Group
Calvary Silver Circle
Maitland City Council
Veterans Affairs
Gosford Aged Care Task Force includes Central Coast Medicare Local
Curtin University of Technology
Auckland University of Technology
33
Briefings to all Local, State and Federal Members also occurred, which culminated in two
proposals by members for presentations to State and Federal Governments.
34
7 Project Outcomes
7.1. Specific Project Outcomes
From the outset the project’s aim was to answer 4 questions to determine feasibility of a
community based, inter-professional, student managed Health Ageing Clinic, which were
identified in the Project Process section. In answering each question specific project
outcomes are provided.
1. What is the evidence base to support the capability of the proposed model to achieve the
following outcomes?
•
•
•
Wellness in Ageing
Inter-professional and inter-sectoral collaboration between Health, Education,
relevant agencies and consumers
Develop Service/workforce capacity to address emerging health concerns,
From the broad community consultation and international literature search, there is no
doubt that the concept of a healthy ageing clinic supported through an inter-professional
team-based curricular is not only feasible but strategically fits with changes in global
demographics, policy reform and is therefore a perfect vehicle for introducing authentic
inter-professional team-based training
2. How does the policy environment align with and enable the implementation of the
proposed model?
The World Health Organisation and the international and national health policy environment
is in substantial agreement that the health sector needs to refocus on wellness, prevention
and primary health care and identifies inter-professional education and collaborative
patient-centred practice as key foundational steps to building effective health care teams
and improving the experience and health outcomes for the community
3. What are the systemic enablers/challengers of the proposed model?
It has been identified that there is a professional tendency to be educated and to work in
silos. Inter-professional learning presents many challenges for educational organisations,
health care providers and professional associations. The following was identified from the
literature search:
Enabling factors
 Partnerships within and between academic institutions, health care facilities and
stakeholders
 Identification of additional sources of support and resources
 Support and incentives for inter-professional collaboration, facilitated by horizontal
integration of medical, nursing and allied health training activities
35

Vertical integration across undergraduate, postgraduate and vocational health
training
 The need for staff to model inter-professional collaboration and ensure that curricula
make explicit the rationale for inter-professional learning
 Structuring learning activity toward developing inter-professional competence for
contemporary health service delivery
Challenges
 Differing expectations due to requirements and regulations between the professions
 The fear that inter-professional practice will lead to a loss of status, a loss of
professional identity, and a dilution of the role of individual professions in patient care
 Historical inter-professional and intra-professional rivalries
 An already full course curriculum and clinical placement schedule for each
profession.
 Conflicting academic calendars and timetables offering very few opportunities for
inter-professional activities (e.g. clinical placements)
 Differing ability and interests across students.
 Lack of availability of suitably trained academic staff and clinical placement
supervisors to facilitate inter-professional programs
 Time and resource commitments involved in establishing inter-professional programs
 Lack of dedicated inter-professional learning spaces
 Lack of geographical co-location of individual schools/ faculties
4. What is the cost/benefit of implementation? What would be required for sustainability?
Whilst there is a financial cost to setting up community based clinics, stakeholders including
city councils, community based-aged care providers and others indicated a willingness to
support ‘in-kind’ with resources such as accommodation, transport and programs
contingent on the model being authentically based in primary healthcare.
Older community members will be able to discuss their health status, lifestyle issues, and
concerns and receive quality and evidenced-based advice either free or for minimal cost
without overburdening their local GP service.
Promote ageing in good health, minimise the burden of disease, improve health literacy and
maintain optimal health
Introduce students at an early stage in their professional development to team-based
practice, enhance inter-professional respect, improve inter-professional communication and
create team work readiness on graduating. Learning gained in the clinic will be further
enhanced through the use of established simulation facilities.
36
Teamwork readiness will create a more rounded graduate who is able to ‘hit the ground
running’ offering greater productivity to the employer during their transition to work year and
thereafter
Create new and exciting clinical placements. Number of placements will depend on the size
and number of the clinics and length of placements. Similar inter-professional programs at
Curtin University and the Auckland University of Technology proved to be very popular.
Sustainability will be achieved through blending team-based learning and discipline specific
learning embedded across the suite of undergraduate programs commencing at year 1.
The model could accommodate students studying health and aged related subjects from
across the Australian Qualifications Framework from certificate through to bachelor
degrees.
7.2 Strategic Outcomes
The project has also achieved, influenced and aligned to a number of major strategic
initiatives that have the potential to provide a high return on investment (ROI) for future
inter-professional education, team-based training and clinical placement:
1. University of Newcastle-Faculty of Health and Medicine
The Faculty of Health and Medicine is strategically committing to developing a
framework for blending inter-professional team-based with discipline specific
learning.
It is anticipated that the blended model will consist of three sequential levels of
theory and exposure supported through a series of titrated inter-professional
competencies designed to develop the students’ ability to function effectively as
members of an inter-professional health care team.
Level 1 Exposure (First Year)
Level 1 Exposure is an introductory level to team-based function focusing on interprofessional learning for all undergraduate health disciplines. Learning at this stage
of the curricular blends discipline specific with fundamental inter-personal skills and
competencies directed at respect, communication, understanding other discipline
roles and shared knowledge.
Level 2 Immersion (Second Year)
Level 2 Immersion draws on the skills gained through Level 1 exposure and moves
the students’ attention to team functioning and inter-professional education blended
with their discipline specific curricular learning objectives. Level 2 introduces the
student to inter-professional team-based clinical placement and is supported through
37
competencies focusing on pertinent team-skills of collaborative leadership; team
functioning, role clarification and inter-professional conflict resolution. It is at this
level that the concept of a healthy ageing clinic will be introduced.
Level 3 Integration
Level 3 Integration through inter-professional clinical placement and extracurricular
activities, extends the students’ capacity to strengthen their collaborative leadership
2. Central Coast Aged care Task Force and Medicare Local
The Central Coast Aged Care Task Force is a combined public and private provider
group led by the Central Coast Medicare Local. The task force have given their solid
commitment to supporting our clinic model for healthy ageing and team-based
curricular for clinical placement of healthcare students. This group are primed and
offer a wonderful opportunity to pilot such a model incorporating all significant health
disciplines and providing significant quality student placement opportunity.
Discussions have also commenced with the New England Medicare Local and the
Mid North Coast Local Health District based in Port Macquarie.
3. Political Support
Federal and State members of Parliament have been consulted and vouched their
commitment to advocating for funding and support promoting the healthy ageing
clinic model as a service to the public and clinical training initiative. The project lead
team have been invited to maintain a dialogue on progress and opportunity with local
members.
4. Andrew Fisher Applied Policy Institution for Ageing
The Federal Government has sought application from the University of Newcastle for
the establishment of the Andrew Fisher Applied Policy Institute for Ageing. The
Institute will provide an opportunity for Australia to be at the forefront of world
leadership in terms of political and strategic responses to population ageing. The
model of a healthy ageing clinic and team based curricular would form a foundation
training program of the Institute.
38
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9 Appendix
Appendix 1: Qualitative analysis on 42 studies selected from literature search
Report
Themes
Beck, E. (2005). "The UCSD student student-run free clinic,
run free clinic project: Transdisciplinary
 managed by health professional
health professional education." Journal
students, supervised by licensed
of Health Care for the Poor and
health professionals, offering free
Underserved 16(2): 207-219
health services to those without
health access
 the purpose of this article is to
describe the UCSD Student-Run
Free Clinic Project, its history,
mission, partners, clinical services,
curriculum, funding, replicability,
outcomes, elements of success,
transdisciplinary nature, and hopes
for the future.
Bennard, B., Wilson, J. L., Ferguson, K.
 student-run outreach clinic series
P. & Sliger, C. (2004). "A student-run
that addresses health care needs of
outreach clinic for rural communities in
communities
Appalachia." Academic Medicine 79(7):
 the clinics link academic family
666-671.
physicians and students with
community health care providers
 Identified weaknesses are
attributed to the fact that the
outreach clinics were established in
response to community needs and
did not follow a careful curricular
development.
 joint student-faculty initiative in
Berman, R., Powe, C., Carnevale J.,
post-health-care-reform
Chao A., Knudsen J., Nguyen A., &
 goal of attracting medical students
Edgman- Levitan, S.(2012). "The
to primary care
crimson care collaborative: A student student-run clinics, providing
faculty initiative to increase medical
evening access to primary care
students' early exposure to primary
services for patients
care." Academic Medicine 87(5): 651 plus aim of decreasing emergency
655
department use
 integrated into the mainstream
health care structure of an existing
primary care clinic
 can bill for its services
 student-run research team
evaluates the quality of care and
the patients' experiences
 how medical schools can expose
students early in their training to
primary care and clinic operations
45
Buchanan, D. & Witlen, R. (2006).
"Balancing service and education:
Ethical management of student-run
clinics." Journal of Health Care for the
Poor and Underserved 17(3): 477-485.










Cadzow, R. B., Servoss, T. J., & Fox,
C. H. (2007). "The health status of
patients of a student-run free medical
clinic in inner-city Buffalo, NY." Journal
of the American Board of Family
Medicine 20(6): 572-580





Cashman, S. B., Hale, J.F., Candib,
L.M., Nimiroski, T.A., & Brookings, D.
(2004). "Applying service-learning
through a community-academic
partnership: depression screening at a
federally funded community health
center." Education for Health 17(3):
313-322
46






balancing service and education
ethical management of student-run
clinics
medical schools across the United
States
provide health benefits to patients
students operate free clinics
unique educational opportunities for
students
collaborate with faculty
to ensure that their clinics attain
high standards
ensure educational goals don’t
compromise clinics' patient care
actively supporting clinic organizers'
applications for external funding
explores the health status and the
social and economic correlates of
adults 20 years of age and older
who presented at an urban free
medical clinic in Buffalo
health risk assessment
questionnaire (469) that addressed
their chronic disease and illness
history, mental health, social
support, substance use, income,
education, and housing
identified prevalent health
conditions in this patient population
and compared these rates to
regional and national data
the data reflect the health disparity
experienced by low-income minority
populations in the United States
findings also serve as an
introduction to the patient
population for volunteer medical
students who have limited exposure
to urban, low-income populations.
safety-net services
challenged to meet patients' needs
additional resources for needed
initiatives.
develop and initiate a depression
screening and treatment project.
meet the needs of patients
community health centre
partnership with an academic
medical/nursing institution








Chen, S. & Bhimji-Hewitt, S. (2012).
"Enhancing the clinical experience with
interprofessional education (IPE)dA
radiation therapy student's
perspective." Journal of Medical
Imaging and Radiation Sciences 43 (2):
144.






Clark, D.L., Melillo, A., Wallace, D.,
Pierrel, S., Buck, D. S. (2003). "A
multidisciplinary, learner-centered,
student-run clinic for the homeless."
Family Medicine 35(6): 394-397.

Conway, J. (2009). "Implementing
interprofessional learning in clinical
education: findings from a utility-led
evaluation." Contemporary Nurse: A
Journal for the Australian Nursing
Profession 32(1-2): 187-200.




47
enhancing students' education
initiate systems change at the
clinical level
service-learning framework
curricula
students help implement or pilot
discontinuity in student availability
logistical incompatibilities
schedules and length of
commitment
continuous shift in the healthcare
system towards collaboration and
patient-centred care
Patient-centred care demands that
healthcare professionals work
together in an effective manner
often these professionals do not
collaborate well
Inter-professional education (IPE)
offers a possible way to improve
this
cultivate knowledge of and
establish collaboration with other
professionals early on in the career
of healthcare providers in order to
enhance future practices
current IPE curriculum in the MRS
program and student-led interprofessional activities.
Conclusions: Student participants,
especially basic science medical
students, value the program due to
its contributions to their professional
and personal education, as well as
their increased understanding of
biopsychosocial issues. Learners
develop empathy, compassion, and
heightened social awareness.
clinical practice provides the
stimulus for students and
practitioners alike to recognise best
practice and enhance and modify
existing practice
need for collaborative interprofessional work practices
inculcating among those students a
desire to work collaboratively and
collegially in practice
inter-professional learning in a
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Cooksey, N. R. (2010). Bridging the
Gap Between Textbook and Maternity
Patient: A Nurse-Developed Teaching
Model for First-Year Medical Students."
Birth 37(4): 325-333.
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Davenport, B. A. (2000). "Witnessing
and the medical gaze: How medical
students learn to see at a free clinic for
the homeless." Medical Anthropology
Quarterly 14(3): 310-327
Dvoracek, J. J., Cook, K. M., & Klepser,
D. G. (2010). "Student-run low-income
family medicine clinic: controlling costs
while providing comprehensive
medication management." Journal of
the American Pharmacists Association
50(3): 384-387.

Dort, S., Coyle, J., Wilson, L., Ibrahim,
H.M.(2013). "Implementing the World
Report on Disability in Malaysia: A
student-led service to promote
knowledge and innovation."
International Journal of SpeechLanguage Pathology 15(1): 90-95.
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48
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single ward of a public hospital in
New South Wales
need for staff to model interprofessional collaboration
ensure that curricula make explicit
the rationale for inter-professional
learning
structure learning activity toward
developing inter-professional
competence for contemporary
health service delivery
ensure that the espoused values of
inter-professional practice and
learning are reflected in
assessment events
opportunities for first-year medical
students to interact with patients in
clinical settings
medical student education reform
bridge the gap between textbook
and patient
patient-centred care
develop the skills needed to work
cooperatively as members of a
multidisciplinary health care team
a component of a non-credit
extracurricular, student-run
perinatal program
analyses doctor-patient
communication as it is taught to
medical students in a student-run
free clinic for the homeless
medication management with a
closed formulary in a diverse
uninsured population reduced
expenditures, with the largest
savings coming from using
prescriptions more efficiently while
also providing a similar level of
medical care.
this research evaluated a studentled service in community-based
rehabilitation that supplemented
existing and more typical institutionbased services
emphasis on increasing the
equitability and accessibility of
services for people with disabilities
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(2006). "Erratum: Students in the
Community: An interprofessional
student-run free clinic (Journal of
Interprofessional Care (2006) vol. 20
(3) (254-259))." Journal of
Interprofessional Care 20(6): 692.
Frutiger, A. D. & Eakes, G. B. (1985).
"The developmental evaluation center
as a clinical setting for mental health
nursing students." Perspectives in
Psychiatric Care 23(1): 27-32.
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Gray, B. & MacRae, N. (2012).
"Building a sustainable academiccommunity partnership: Focus on fall
prevention." Work-a Journal of
Prevention Assessment &
Rehabilitation 41(3): 261-267.
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49
expanding awareness-building,
education, and training activities
about communication
to provide students with experience
of working in such settings, and
facilitate their development as
advocates for broadening the scope
of practice of speech-language
pathology services
findings pertaining to the
collaborative process and the
learning experiences of the adult
participants
developmental evaluation centre
a viable option to the more
traditional clinical settings used for
psychiatric/mental health nursing
students
placement affords students the
opportunities for direct involvement
with individuals, families, and
communities in the application of
theoretical concepts within the
framework of the nursing process
interdisciplinary nature of the DEC
assists students in more clearly
identifying their role and function as
nurses within the larger health care
team
developing and utilizing collegial
relationships to more effectively
meet the needs of clients
inter-professional/interdisciplinary
education
develop a 6 week fall reduction
program
elder volunteers who were
independently living in the
community
opportunities for inter-professional
student learning,
faculty practice and development
improve the health of the
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
Guirguis, L. & Sidhu, K. (2011). "An
exploration of pharmacist preceptors'
and pharmacy students' experiences at
an interprofessional student-run clinic."
Canadian Pharmacists Journal 144(4):
179-184.
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Hamso, M., Ramsdell, A., Balmer, D., &
Boquin, C. (2012). "Medical students as
teachers at CoSMO, Columbia
University's student-run clinic: A pilot
study and literature review." Medical
Teacher 34(3): e189-e197.
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50
participants
sustaining inter-professional
collaboration is challenging
scheduling difficulties and faculty
workloads
developing the team skills of
students
knowledge of the contributions each
discipline
holistic view of elders
this study examines pharmacist
preceptors' and pharmacy students'
experiences at an inter-professional
student-run clinic
students and preceptors from
medicine, dentistry, pharmacy,
nursing, social work and nutrition
work together to care for
adolescents and young adults from
Edmonton inner city areas
pharmacist preceptors and
pharmacy students were invited to
participate in open-ended
interviews to explore their
experiences at the SHINE clinic
three themes arose: dynamic team
roles, inter-professional role
understanding and personal
benefits
benefits of the SHINE clinic
experience included enhancing
preceptor skills, inter-professional
relationships and confidence
working in teams
the SHINE clinic provided a
beneficial experience, where
preceptors and students could learn
with, from and about each other
while caring for a vulnerable
population
although medical students are
expected to teach as soon as they
begin residency, medical schools
have just recently begun adding
teacher training to their curricula.
Student-run clinics (SRCs) may
provide opportunities in clinical
teaching before residency
the practical experiences in clinical
Hastings, J., Zulman, D. & Wallis, S.
(2007). "UCLA Mobile clinic project."
Journal of Health Care for the Poor and
Underserved 18(4): 744-748

Henderson, A.J., O'Keefe, M.F., &
Alexander, H.G. (2010).
"Interprofessional education in clinical
practice: Not a single vaccine."
Australian Health Review 34(2): 224-22

Heravi, M. & Bertram, J.E. (2007). "A
novel resource model for
underprivileged health support:
Community Medical Outreach." Rural
and remote health 7(1): 668.
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51
teaching that students have at
SRCs can supplement classroombased trainings. Medical schools
might revisit their SRCs as places
for exposure to clinical teaching
we report on a man seeking care at
the UCLA mobile clinic, illustrating
and then discussing the challenges
of caring for people who are
homeless (especially mental illness
and potential distrust of providers).
Student-run free clinics can be
beneficial but further research must
examine how well such clinics meet
homeless patients' needs
in increasingly complex health
service environments, the quality of
teamwork and co-operation
between doctors, nurses and allied
health professionals, is 'under the
microscope'. Inter-professional
education (IPE), a process whereby
health professionals learn 'from,
with and about each other', is
advocated as a response to
widespread calls for improved
communication and collaboration
between healthcare professionals.
Although there is much that is
commendable in IPE, the authors
caution that the benefits may be
overstated if too much is attributed
to, or expected of, IPE activities.
The authors propose that clarity is
required around what can
realistically be achieved.
Furthermore, engagement with
clinicians in the clinical practice
setting who are instrumental in
assisting students make sense of
their knowledge through practice, is
imperative for sustainable
outcomes. AHHA 2010.
Community Medical Outreach is a
student-run organization that
provides healthcare access to
medically underprivileged farm
workers
all of the partners benefit from the
interchange.
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Howell, D. M. & Wittman, P. (2012).
"Interprofessional clinical education for
occupational therapy and psychology
students: A social skills training
program for children with autism
spectrum disorders." Journal of
Interprofessional Care 26(1): 49-55.
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Hunter, D. C., Brustrom, J., & Garrett,
K. (2010). "Motivating an underserved
African American population to seek
breast and prostate cancer screening
utilizing a coalition of 11 communitybased organizations." Journal of
Clinical Oncology 1).
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52
students gain from a unique firsthand medical experience that
demonstrates their leadership,
management skills, commitment to
a healthcare team, and focus on
care at the community level
shaping students in the process of
becoming physicians, shaping
those involved with the process of
admitting students, shaping training
experiences, and shaping new
models of health care
inter-professional clinical learning
experience
occupational therapy (OT) and
psychology graduate students
inter-professional teams to plan and
implement a social skills training
program for children with autism
spectrum disorders (ASD)
student-led clinical experience
facilitate inter-professional
collaborative learning
faculty performed qualitative
research to explore how the
students worked together to provide
intervention
four themes emerged: learning who
I am as a professional, learning to
appreciate our professional
differences, learning to
communicate with each other and
figuring it out
ensure that students are adequately
prepared to represent their
profession as part of a diverse interprofessional health care team.
African Americans (AAs) suffer a
higher mortality rate due to breast
and prostate cancer compared to
Caucasians for multiple reasons
evidence that partnering with
trusted community-based
organizations can successfully
motivate underserved AA
populations to seek preventive
services
Community Cancer Coalition was
formed to increase the number of
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Jakobsen, F., Larsen, K., & Hansen,
T.B. (2010). "This is the closest I have
come to being compared to a doctor:
views of medical students on clinical
clerkship in an Interprofessional
Training Unit." Medical Teacher 32(9):
e399-406.
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Jiminez, M., Tan-Billet, J., & Babineau
J. (2008). "The promise clinic: A service
learning approach to increasing access
to health care." Journal of Health Care
for the Poor and Underserved 19(3):
53
underserved AA individuals in the
Sacramento, California area
receiving age-appropriate breast
and prostate cancer screening
one-day health fair at a student-run
free clinic in which breast and
prostate cancer screening
examinations were offered free of
charge
the health fair was successful at
encouraging AAs to attend the
event
the need for inter-professional
education has been apparent for
decades
in 2004, we established the first
Inter-professional Training Unit
(ITU) in Denmark.
nursing, occupational therapy and
physiotherapy students were in the
ITU for its first 2 years and in 2006,
medical students joined in
students in collaboration run a ward
with eight beds under the
supervision of trained personnel
our results showed that the medical
students in the ITU developed their
professional knowledge and
capability simultaneous with the
learning of inter-professional
collaboration. The students valued
the teaching methods because the
students were in the forefront and
treated as professionals. The
students demanded more
homogeneous instruction and a
better introduction to the ITU
a stay in an ITU with a safe learning
environment can increase both uniprofessional and inter-professional
learning for medical students. The
students stressed the importance of
supervision before and after
carrying out a hospital task
The goal of the Promise Clinic (a
project of an academic medical
centre and a local social services
group) is to increase access to
primary care for an underserved
935-943.
Kelley, A. & Aston, L. (2011) An
evaluation of using champions to
enhance inter-professional learning in
the practice setting Nurse Education in
Practice 11 (2011) 36-40
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Liang En, W., Koh, G. C-H., Lim, V. K.
G. (2011). "Caring for underserved
patients through neighborhood health
screening: outcomes of a longitudinal,
interprofessional, student-run home
visit program in Singapore." Academic
Medicine 86(7): 829-839.
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54
population while addressing
deficiencies in medical education.
Students manage common primary
care problems, creating access for
this mostly uninsured population.
the promotion of inter-professional
working is a key government target
for healthcare professionals
by utilising current unprofessional
support systems for developing the
learning environment, interprofessional learning opportunities
were created for students
inter-professional 'champions' in a
targeted number of placements selfselected themselves to participate
in a new innovation
these healthcare professionals
were given preparation, support
and facilitator training
inter-professional learning
opportunities were developed using
a variety of formats.
evaluations of the innovation
demonstrated the usefulness of this
approach for qualified staff as well
as for students
sustainability was achieved and
expansion of the initiative has been
guaranteed through further funding
service learning, an effective
vehicle for teaching undergraduate
public health while providing
underserved communities with
medical care
medical and nursing undergraduate
students provided in-home medical
services to patients in a low-income
neighbourhood
assessed student-reported
pedagogical effectiveness in nine
domains
most students felt NHS was
beneficial across all domains
after a single year, amongst
patients with known hypertension,
treatment increased from 63% to
93% (P < .001), and blood pressure
control amongst those who were on
Mathys, M., & Bakshi, R. (2011).
"Utilizing 4th year pharmacy students
as the primary pharmacy members
within mental health interdisciplinary
teams." Journal of Pharmacy Practice
24 (2): 247.
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Meah, Y. S., Smith, E. L. & Thomas D.
C. (2009). "Student-run health clinic:
novel arena to educate medical
students on systems-based practice."
Mount Sinai Journal of Medicine 76(4):
344-356.
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55
treatment improved from 42% to
79% (P < .001).
the Dallas VA Medical Center
inpatient mental health unit is a 42bed facility with an average daily
census of 36 patients. Veterans
admitted to the facility are assigned
to 1 of 5 interdisciplinary treatment
teams
without the use of fourth year
students, clinical pharmacy services
would not be available to the 5
treatment teams and their patients
each student is assigned to serve
one of the interdisciplinary teams
the students have helped meet one
of the National Patient Safety Goals
by providing medication reviews
and reconciliations for more than
90% of patients admitted to
inpatient mental health in 2009 and
2010
utilizing fourth year pharmacy
students to serve as the pharmacy
member within interdisciplinary
mental health teams has expanded
clinical pharmacy services beyond
what was possible
provided the pharmacy students
with a positive rotation experience
the current practice has improved
patient care within mental health.
substantial growth in the number of
student-run clinics for the indigent
over 49 medical schools across the
country operate over 110 studentrun outreach clinics that provide
primary care services to the poor
and uninsured
it highlights the student-run clinic as
a unique enhancement of medical
education that may supplant current
curricular arenas in teaching
students about systems-based
practice principles such as cost
containment and financing,
resource allocation, interdisciplinary
collaboration, patient advocacy, and

Moskowitz, D., Glasco, J., Johnson, B.
& Wang, G.(2006). "Students in the
community: an interprofessional
student-run free clinic.[Erratum appears
in J Interprof Care. 2006
Dec;20(6):692]." Journal of
Interprofessional Care 20(3): 254-259.
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Pham, H.H., Simonson, L., Elnicki, D.
M., Fried, L. P., Goroll, A. H., Bass, E.
B.(2004). "Training U.S. Medical
Students to Care for the Chronically Ill."
Academic Medicine 79(1): 32-41.
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56
monitoring and delivery of quality
care.
this article underscores the studentrun clinic as a potentially ideal
experiential learning method for
preparing young physicians to
confront a US healthcare system
currently facing crises in cost,
quality of care, and high rates of
uninsurance
students in the Community (SITC)
is an inter-professional
collaboration of health science
students at the University of
Washington
SITC runs a weekly free clinic at the
Aloha Inn, a transitional housing
facility for 70 homeless men and
women
focus of this clinic is on health
education, chronic disease
management, and re-integration of
patients into the healthcare
infrastructure
valuable service learning
opportunity for students
in addition to direct clinical services,
students gain experience in
planning health education
strategies, community collaboration,
and evaluating intervention
outcomes
SITC also oversees a lecture and
discussion-based elective course at
the University of Washington
focused on health issues of the
homeless community and provides
formal teaching which complements
the service-learning component of
the endeavour
growing prevalence of chronic
illness has important implications
for the training of all physicians.
assessed the degree to which
undergraduate medical curricula
explicitly address chronic care
competencies
interviewed directors of required
medical school courses
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Reeves, S., Freeth, D., McCrorie, P. &
Perry, D.(2002). "It teaches you what to
expect in future...': interprofessional
learning on a training ward for medical,
nursing, occupational therapy and
physiotherapy students." Medical
Education 36(4): 337-344.
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Robinson, W. D. & Barnacle, R. E. S.,
(2004). "An interdisciplinary student-run
diabetes clinic: Reflections on the
57
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all 70 eligible course directors
responded
course directors agreed about the
importance of many competencies
in chronic care but reported
considerable variation in how they
addressed competencies in their
courses
medical schools can improve
training in chronic care by paying
greater attention to specific
methods for addressing important
chronic care competencies.
inter-professional training ward
placement for medical, nursing,
occupational therapy and
physiotherapy students
students, under the supervision of
practitioners, to plan and deliver
inter-professional care for a group
of orthopaedic and rheumatology
patients
enabled students to develop
profession-specific skills and
competencies
also allowed them to enhance their
teamworking skills in an interprofessional environment
student teams were supported by
facilitators who ensured medical
care was optimal, led reflective
sessions and facilitated students'
problem solving
students valued highly the
experiential learning
the ward prepared them more
effectively for future practice
many encountered difficulties
adopting an autonomous learning
style during their placement
facilitators were concerned that the
demands of their role could result in
'burn-out'
patients scored higher on a range
of satisfaction indicators than a
comparative group of patients
because of the complexity of
diabetes, researchers have found
collaborative care for diabetic
collaborative training process."
Families, Systems and Health 22(4):
490-496.
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Sheu, L. C., Toy, B. C., Kwahk, E., Yu,
A., Adler, J., & Lai, C. J. (2010). "A
model for interprofessional health
disparities education: student-led
curriculum on chronic hepatitis B
infection." Journal of General Internal
Medicine 25 Suppl 2: S140-145.
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Sheu L.C., Zheng, P., Coelho, A.D.,
Lin, L. D., O'Sullivan, P. S., O'Brien,
B.C., Yu AY, Lai, C.J.(2011). "Learning
through service: Student perceptions on
volunteering at interprofessional
hepatitis B student-run clinics." Journal
of Cancer Education 26(2): 228-233
58
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patients to be effective.
interdisciplinary student-run clinic to
provide treatment to low-income,
noninsured, diabetic patients.
including medicine, nursing,
pharmacy, dietetics, and medical
technology.
medical family therapy was added
to the team after a need for more
holistic treatment arose
biopsychosocial perspective from
which to view treatment
foundation for future collaboration
an opportunity for cross training,
and immediacy of on-site
consultation.
health professional students
designed a preclinical servicelearning curriculum on hepatitis B
viral (HBV) infection
integrating lectures, skills training,
and direct patient care at studentrun clinics
organized a preclinical didactic and
experiential elective, and
established two monthly clinics
offering HBV screening,
vaccination, and education to the
community
between 2004 and 2009, 477
students enrolled in the student-led
HBV curriculum
student-led didactic and experiential
elective can serve as an interprofessional curricular model for
learning about specific health
disparities while providing important
services to the local community
student-run clinics (SRCs) are
widespread, but studies on their
educational impact are limited
student responses revealed positive
perceptions of the volunteer
experience
benefits included interacting with
patients, developing clinical skills,
providing service to disadvantaged
populations, and collaborating with
health professional peers

Sheu, L., Lai, C. J., Coelho, A. D., Lin,
L. D., Zheng, P., Hom, P., Diaz, V>, &
O’Sullivan, P. S.(2012). "Impact of
student-run clinics on preclinical
sociocultural and interprofessional
attitudes: A prospective cohort
analysis." Journal of Health Care for the
Poor and Underserved 23(3): 10581072.
Randall, D., Lammers, C., Hegge, K.,
Shiyanbola, O., Richards, A.,Clem, J.,
Pollard, M., & Brunick, A. (2011).
"Development, implementation, and
evaluation of an innovative health
promotion model for an underserved
population with diabetes: A pilot
project." Journal of the American
Pharmacists Association 51 (2): 231232.
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Shiyanbola, O. O., Lammers, C.,
Randall, B., & Richards, A. (2012).
"Evaluation of a student-led
interprofessional innovative health
promotion model for an underserved
population with diabetes: A pilot
project." Journal of Interprofessional
59
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students who participated in clinic
reported enhanced skills compared
to those who did not attend.
descriptive studies suggest studentrun clinics (SRCs) positively affect
preclinical students' sociocultural
and inter-professional attitudes, but
few studies use validated measures
multidisciplinary student-led
diabetes clinic
underserved patient population
demonstrate an improvement in
clinical outcomes
health literacy
serve indigent medically
underserved patients
five health career disciplines
(medicine, pharmacy, nursing,
nutrition, and dental hygiene)
six educational sessions designed
to demonstrate critical components
of diabetes management
patients completed surveys and
tests assessing their knowledge of
diabetes, diabetes care, health
behaviours, health literacy, and
perceptions of the health care
system
assessments were repeated to
determine if there were
improvements in these outcomes
potential value of an interprofessional team approach to
diabetes education
could be applied to other practice
settings and used for the
management of other chronic
diseases
inter-professional education
interact and learn together during
their training process
collaborative healthcare practices
improved care for patients
implementation of an
interprofessional health promotion
Care. 2012 26(5):376-82.
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Simpson, S. A. & J. A. Long (2007).
"Medical student-run health clinics:
Important contributors to patient care
and medical education." Journal of
General Internal Medicine 22(3): 352356.
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Simmons, B. B., DeJoseph, D.,
Diamond, J., & Weinstein, L. (2009).
"Students who participate in a studentrun free health clinic need education
about access to care issues." Journal of
Health Care for the Poor and
Underserved 20(4): 964-968.
60
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program
sixty-three students from five health
professions led six educational
sessions
there were significant improvements
in students' knowledge of diabetes
care, understanding of the roles of
healthcare professionals and ability
to work with other healthcare
professionals
could be applied to other practice
settings and used for the
management of other chronic
diseases
the prevalence and operation of
medical student-run health clinics
nationwide.(USA)
ninety-four schools responded
(76%); 49 schools had at least 1
student-run clinic (52%).
nationally, clinics reported more
than 36,000 annual patientphysician visits,
most student-run health clinics had
resources both to treat acute illness
and also to manage chronic
conditions
clinics were most often funded by
private grants
medical student-run health clinics
offer myriad services to
disadvantaged patients and are
also a notable phenomenon in
medical education
wider considerations of community
health and medical education
should not neglect the local role of
a student-run health clinic.
we surveyed first-year medical
students about preparedness for
work at student-run clinics, and for
addressing patients' access to care,
and social issues. Most students did
not know how to get uninsured
patients ongoing care or
medications outside of the studentrun clinic. A large majority of
students desired an orientation
addressing these issues.
Stark, R., G. Yeo, et al. (1984). "An
interdisciplinary teaching program in
geriatrics for physician's assistants."
Journal of Allied Health 13(4): 280-287.

Strowd, R., & Strowd, L. (2011).
"Comprehensive care at a student-run
health clinic: a unique partnership."
Medical Teacher 33(5): 422
Taylor, L., & Holubar, M. (2011).
"Stroke risk assessment and education
in the underserved community." Journal
of the American Pharmacists
Association 51 (2): 220.
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Thomsen, L. & Lisby, H. (2011).
"Professionalism is a prerequisite for
multiprofessionalism [Danish]."
Sygeplejersken / Danish Journal of
Nursing 111(15): 66-68.
61
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through a series of Saturday
classes held in community facilities
serving seniors, physician's
assistant students had the
opportunity to learn clinical
geriatrics from a faculty team
including a physician's assistant,
physician, nurse, physical therapist,
social worker, gerontologist, and
health educator. Local seniors
served as consumer consultants
and models of health and vigour.
This interdisciplinary approach was
modelled by the faculty to
demonstrate the need for a team
approach to deliver quality care to
seniors.
partnering a SRC with an
established community clinic
promotes student education and
facilitates quality of care
goal of the Stroke Prevention
Patient Care Project is to improve
stroke risk awareness and access
to screening tools in underserved,
uninsured communities
the project will also introduce a
follow-up component whereby
student pharmacists will evaluate
patient adherence to risk-lowering
recommendations
this project connects to
underserved communities by
hosting free screenings in local
community centres and churches,
and by addressing a highly
prevalent health risk that is
complicated by poor nutrition, lack
of education, and minimal access to
quality medical care
follow-up is completed 2 weeks
after screening
integrating an interdisciplinary
approach in clinical aspects of
nurse training
create an authentic learning
environment for students from
disciplines that include occupational
therapy, physiotherapy and nursing,
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Welsh, K. J., Patel, C. B., Fernando, R.
C., Torres, J. D., Medrek, S. K.,
Schnapp, W. B., Brown, C. A., & Buck,
David, S.(2012). "Prevalence of Bipolar
Disorder and Schizophrenia in Houston
Outreach Medicine, Education, and
Social Services (HOMES) Clinic
Patients: Implications for StudentManaged Clinics for Underserved
Populations." Academic Medicine 87(5):
656-661.
Westra, R., Skube, S., & Zant, M..
(2011). "HOPE clinic: a place to care."
Minnesota medicine 94(11): 49-51.
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Zucker, J., Gillen, J., Ackrivo, J.,
Schroeder, R., & Keller, S.(2011).
"Hypertension management in a
student-run free clinic: Meeting national
standards?" Academic Medicine 86(2):
239-245.
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as well as social and healthcare
assistant students
promotes individual student
competencies and provides optimal
opportunities for development of
interdisciplinary competencies in
order to provide beneficial patient
outcomes
an interdisciplinary approach gives
nursing students a greater
awareness of their own
professionalism, and optimises their
use of this in cooperation with the
other professions
results in a greater understanding
and respect between the individual
professional groups
improve nursing students' ability to
deal with the highly complex tasks
within the health care system.
determine the prevalence of certain
mental illnesses and comorbid
conditions among the patients of a
student-managed free clinic for the
homeless
clinic is a student-run, facultyorganized effort that offers students
an opportunity to develop their
clinical skills and learn how to work
in inter-professional teams while
providing needed care to people
who are underserved or uninsured.
evaluate, using national care
guidelines and quality standards,
the quality of care provided at the
Student Family Health Care Center
SFHCC patients with hypertension
received pharmacotherapy as
recommended by JNC 7 guidelines
and were at the blood pressure goal
set by Healthy People 2010.