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AMEE Guide No. 12: Multiprofessional

education: Part 2 - promoting cohesive
practice in health care
a
ANNE PIRRIE VALERIE WILSON R.M. HARDEN JOHN ELSEGOOD
a
University of Edinburgh, UK
Published online: 23 May 2015.

To cite this article: ANNE PIRRIE VALERIE WILSON R.M. HARDEN JOHN ELSEGOOD (1998) AMEE Guide No.
12: Multiprofessional education: Part 2 - promoting cohesive practice in health care, Medical Teacher, 20:5,
409-416

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AM EE Guide No. 12:
M ultiprofessional education:
Part 2Ð promoting cohesive
practice in health care
A N NE PIR RIE , VA L E RIE W IL SON , R.M . H A RD E N & JO H N E LSE GO O D
U niversity of Edinburgh, U K
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SUM M ARY The recom m endations contained in this guide are
derived from a two-year qualitative study of perceptions of
m ultidisciplinary education in health care, funded by the
D epartm ent of Health. The study w as conducted by a multidis-
ciplinary team at the Scottish Council for Research in Edu-
cation (SCRE), the School of Health at the U niversity of East
Anglia, and the Centre for M edical Education at the University
of D undee. Interviews were conducted with course organizers
and students, and with health professionals in tw o contrasting
clinical settings: general m edical practice and accident and
em ergency medicine. The evidence suggests that multidisci-
plinary education is neither an easy, nor a cheap option. It
needs to be adequately resourced; the rationale for its develop-
m ent needs to be m ade explicit to both staff and students; and
clear and achievable objectives need to be set for each stage. It
requires careful planning throughout, and there should be
adequate re¯ ection upon the relative advantages and disadvan-
tates of its inclusion at pre- and post-registration levels respect-
ively. Finally, its success w ill ultim ately depend upon the sup-
port and comm itm ent of all staff involved.
Introduction
In M arch 1996, the Scottish Council for Research in
Education (SCRE) was com missioned by the Department
of Health to undertake a two-year evaluation of percep-
tions of multidisciplinary education in health care. The
study was undertaken in association with the School of
Health (Nursing and M idwifery) at the University of East
Anglia and the Centre for Medical Education at the Uni-
versity of Dundee. The project had three broad objectives,
namely:
· to ascertain the extent of multidisciplinary provision
throughout the UK (Phase 1);
· to investigate perceptions of multidisciplinary education
at both undergraduate/pre-registration and postgrad u-
ate/post-registration levels (Phase 2);
· to identify factors which either facilitated or inhibited its
developm ent (Phase 2).
0142-159X/98/050409-08 $9.00 Ó 1998 Carfax Publishin g Ltd
M edical Teacher, V ol. 20, N o. 5, 1998
The guidelines below are derived from data gathered dur-
ing Phase 2 of the project. Unlike many previous evalua-
tions, which have focused on single initiatives based in
individual institutions (for exam ple, Jones, 1986;
Leathard, 1992; Carpenter, 1995; M acLeod & Nash,
1994; Bisits & Haertsch, 1994; Forman et al. , 1994; Hilton
et al. , 1995; Greene et al. , 1996; Pryce & Reeves, 1997),
Phase 2 of the current study com prised 42 individual
interviews, ® ve focus groups with course organizers, and
10 with students in 10 HE-based sites throughout the UK.
The sites chosen included four courses at pre-registration
level and six at post-registration level.
To complement the data gathered from education
providers and students, we also gathered information in
four work-based sites: two accident and emergency (A&E)
units, and two general m edical practices, in which we
conducted 19 individual interviews with a range of health
care professionals; and one focus group discussion with a
group of nurses who had attended an Advanced Trauma
Nursing Course (ATNC). The rationale for the inclusion
of these sites was to illustrate that learning to work together
effectively is an iterative process which is not con® ned to
formal learning opportunities.
In addition, we sought the views of a sample of six
purchasers and commissionersÐ those responsible for edu-
cation and training in NH S Executives, and in the local
consortia, since as of April 1998 these have form ally
assum ed some of the responsibilities for education and
training.
The guidelines below stem from our analysis of the
qualitative data. Our ® ndings relating to the survey of
provision have been reported elsewhere (Pirrie et al. , 1997;
Pirrie et al. , 1998).
Corresponde nce: Dr Anne Pirrie, Research Fellow , U niversity of Edinburgh,
Faculty of Education at M oray H ouse Institute, H olyrood Road, Edinburgh
EH 8 8NQ , UK. Tel: (0131) 558 6376. Fax: (0131) 558 6978. Em ail:
Anne.Pirrie@ m hie.ac.uk
409
 A. Pirrie et al.
T he research in context
M uch has been written over the last few years about how
changes in patterns of health care delivery and in the
structure of the NHS itself have impacted upon the devel-
opment of the health professions (e.g. Biggs, 1993, p. 151;
Poulton & West, 1993, pp. 918± 920; Shaw, 1993,
pp. 256± 262; Leathard, 1994, pp. 7± 23; W einstein, 1994,
pp. 7± 12; Hugm an, 1995, pp. 31± 45; M ackay et al., 1995,
pp. 5± 10; Tope, 1996, pp. 57± 71). It is beyond the scope
of this paper to document these in detail. Nevertheless, it
is clear that the development of a prim ary-care-led NH S,
which looks set to continue under the present government,
has led to a signi® cant reappraisal of working practices and
a renewed emphasis on collaboration and teamwork
between health and social care professionals in the best
interests of the patient.
In the twin domains of clinical practice and pro-
fessional education, the focus has gradually shifted from a
concentration on the ª speci® c combinations of skills,
knowledge and valuesº (Hugm an, 1995, p. 41) that char-
acterize any one health profession to the ways in which
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health and social care professionals can deploy a range of
skillsÐ many of which are complementary or overlappingÐ
in the interests of ef® cient and effective patient care. This
new emphasis on skills and competences which cut across
existing professional boundaries has perhaps found its ulti-
m ate expression in the development of National Occu-
pational Standards for health care professionals (NVQs
and SVQs). This has lent further impetus to the develop-
m ent of a `seamless’ service (Hevey, 1992; Barr, 1994;
M athias & Thom pson, 1997).
From the comm issioners’ perspective, the integration
of workforce planning has necessitated a shift from occu-
pation-based manpower planning (traditionally supported
by uniprofessional education and training) to service-based
planning (which, it may be argued, is best supported by
m ultiprofessional education and training).
These developm ents are occurring at a time when
ª there seems no limit to our ability to `consume’ health
careº (Mackay et al. , 1995, p. 6). Increasing dem ands on
the service, linked in part to a greater `client-centredness’ ,
a rise in patients’ expectations, and the particular demands
of an ageing population, have further fuelled attempts to
deploy resources more effectively. M any such initiatives
have focused on the division of labour between different
occupational and professional groups. O ne example from
primary care is the suggestion that:
¼ some current GP workload could be managed
differently through initiatives such as nurse prac-
titioners ¼ and patient triage at the ® rst point of
contact. ( The F uture H ealthcare W orkforce , Report
of the Project Steering Group, 1996, p. 8)
S upporting changes in health care delivery
So how can professional education respond to these
changes and further in¯ uence the development of collabo-
rative and cohesive practice in health care? Multi-
1
disciplinary education is widely perceived as one way of
equipping health professionals to provide a service which is
to all intents and purposes `seamless’ , although delivered
410
by health and social care workers who have retained their
distinct professional identities:
¼ professional education should ¼ prepare indi-
vidual practitioners for ¼ collaborative working
¼ to enable each professional to retain certain
unique areas of skill and knowledge, while
sharing overlapping aspects of knowledge and
skills¼ . The lack of early interdisciplinary train-
ing helps to perpetuate misunderstandings about
different professional approaches and their
underlying values. (In the Patient’ s Interest. M ulti-
Professional W orking Across Organisational
Boundaries , A Report by the Standing M edical
and Nursing & Midwifery Advisory Committees,
1996, p. 16)
Each therapist should be aware of the speci® c
skills of others in order to achieve effective and
cohesive collaborative working¼ . The philoso-
phy of integration should start at undergraduate
level and can be progressed throughout the career
development of all therapists. ( Prom oting C ollabo-
rative Practice , Joint Statement by the Councils of
the College of Occupational Therapists, Char-
tered Society of Physiotherapy, College of Speech
and Language Therapists, nd)
The study reported here, and upon which these guidelines
are based, explores the tensions inherent in such injunc-
tions to `retain unique areas of skill and knowledge’ and yet
to `share overlapping aspects of knowledge and skills’ . The
in-depth interviews conducted in Phase 2 indicate that
many course providers and students think that this balance
is singularly dif® cult to achieve, particularly in a period of
rapid change in patterns of service delivery and educational
provision. It is possible that injunctions to `share’ , `blend’
and `m erge’ m ay have a muted reception as the implica-
tions of the integration of nursing and Professions Allied to
Medicine (PAMS) education into the higher education
sector becom e clear. As one Phase 1 respondent put it, the
move into higher education has encouraged nurses to:
¼ professional[ize] themselves in a way that’ s
analogous with the medical profession. So nurs-
ing research is becoming a marker of status and
professionalism.
This would appear to run counter to much of the rhetoric
about dismantling professional boundaries. Another
respondent, working in m edical education, gave a cogent
exposition of some powerful institutional inhibitors to the
development of what he term ed an `integrated pattern of
learning’ :
I work in a university that prides itself in educat-
ing people in a research environm ent. And
research is discipline-based, research is what
some heads of department in disciplines would
say rejuvenates the practitioner and keeps the
® eld m oving forward. Professionalism doesn’ t do
that. Practitioners don’ t do that. Researchers
within disciplines do that. And that’ s where the
tension lies because we could move our students
into an integrated pattern of learning quite sim-
ply, but the research base wouldn’ t let us do that.

Yet such tensions are rarely addressed in the literature,
som e of which is characterized by ideologically sanguine
assertions that `learning together’ (effectively) is a necess-
ary and suf® cient pre-condition for `working together’
2
(effectively).
However, the evidence gathered in the course of Phase
2 of this project strongly suggests that the gradual breaking
down of professional boundaries which has followed in the
wake of changes in patterns of health care delivery has not
been universally welcomed. It appears that some health
professionals consider that the pace of change in the NH S
and the development of new working practices pose a
threat to their (in some cases new-found and jealously
guarded) professional autonomy. In som e cases, this has
led to a degree of re-entrenchm ent, a retreat behind pro-
fessional `boundaries’ and a degree of confusion about
what terms such as `m ultidisciplinary’ and `interprofes-
sional’ mean.3 This has done little to foster the principles
and practices of multidisciplinary education. As the follow-
ing quotation makes clear, there are negative as well as
positive dimensions to the evolving context of health care
delivery, both of which impact upon multidisciplinary edu-
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cation and practice:
¼ the workplace is changing ¼ the word `inter-
professional’ ¼ no longer has much meaning ¼
all these words have come to mean something
and nothing to everybody, and they’ re thrown
about ¼ that’ s actually what’ s happening in the
workplace ¼ because there are pressures from
different directions to require ¼ organizations to
work together ¼ to cut costs ¼ people are being
moved and shunted from A to B ¼ people who
have been trained as doctors and nurses and
social workers are having to assume new roles as
the purchaser/provider split moves and m odi® es
into new formations, and so in a way the pro-
fessional base begins to lose its m eaning. (MSc
course organizer)
There is, it appears, a very ® ne line between `assuming new
roles’ and `being shunted about’ . At one level, our own
m ultidisciplinary research endeavour comprised drawing
out that ® ne line.
Perceptions of m ultidisciplinary education and prac-
tice
There is ample evidence in the literature that the perceived
bene® ts of multidisciplinary education at pre- and post-
registration levels are widely appreciated in Europe
(Areskog, 1988, 1992, 1994; Goble, 1994) and in the USA
(for exam ple, Clark, 1993; Casto, 1994; Casto & Julia,
1994) and further a® eld (W HO , 1988). Nevertheless, as
Carpenter (1995) points out, ª none of these program mes
seems to have been satisfactorily evaluatedº (p. 265). It
appears to be easier to adduce evidence for the impact of
m ultidisciplinary education on attitudes (towards both
patient care and collaborative practice) than it is on out-
com es such as improved patient care.
The qualitative data gathered during Phase 2 indicate
that many of the course organizers we interviewed were
also convinced that multidisciplinary education could
AM EE Guide No. 12, Part 2
indeed in¯ uence `stereotypical attitudes’ , and saw a direct
correlation between a satisfactory experience of learning
with other professional groups and working together effec-
tively as a team. The net result was perceived to be a
reduction in the duplication of service provision. Dis-
cussion tended to focus upon the stage at which m ultidisci-
plinary provision was included in the curriculum, rather
than on an assessment of its perceived advantages or
disadvantages. This appears to indicate that despite the
lack of `hard’ evidence in terms of measurable effects on
patient outcome, course providers were generally con-
vinced of the rationale for its inclusion. The following
quotations from the Phase 2 data provide clear illustrations
of this:
The literature and the seminars I’ ve been to at
CAIPE (Centre for the Advancement of Inter-
professional Education) ¼ all seem to advocate
that the sooner you start shared learning to break
down stereotypical attitudes, and to develop
interpersonal skills, comm unication skills, team-
working skills, that this should begin as soon as
possible. (Undergraduate course organizer)
I hope that they take on board the perception ¼
that by working as groups in college it is easier to
work in teams in departments. (Undergraduate
course organizer)
. . . it’ s important because we’ re working together
and the work environment is com monly multidis-
ciplinary. So therefore shouldn’ t our postgrad u-
ate education also be on a m ultidisciplinary basis?
(Posgraduate course organiser)
I think people have been forced to acknowledge
each other’ s contribution, and to stop being terri-
torial and to see things in a much wider way.
(ATNC course organizer)
I think it is important that students get that
concept of working in teams and that they will
always work in teams, passing inform ation back-
wards and forwards to other agencies such as
social services, and so it is important to inculcate
this into their learning and development. (Under-
graduate course organizer)
I do think that there has been an awful lot of
waste of time and effort in health care so far
because I’ m sure you and I ¼ can think of all
sorts of times when treatment’ s been covered by
more than one person and it’ s been duplicated.
(Postgraduate course organizer)
So what are the perceived bene® ts of multidisciplinary
education? Despite the tensions outlined above, the evi-
dence from this study suggests that it has the potential to:
· enhance personal and professional con® dence;
· promote mutual understanding between health and
social care professionals;
· facilitate intra- and inter-professional comm unication;
· encourage re¯ ective practice.
Nevertheless, the extent to which these can be achieved
411
 A. Pirrie et al.
depends, of course, upon the ability of course organizers to
m ake informed choices about the stage (pre- and/or post-
registration) at which to introduce multidisciplinary edu-
cation. It is only by making informed choices of this order
that some of the inhibiting factors outlined below can be
m itigated.
Policy makers and education commissioners also have a
key role to play in overcoming these pitfalls. Before we turn
to the recommendations, let us consider what the evidence
suggests is the m ost appropriate time to introduce multi-
disciplinary education.
Pre- or post-registration?
At what stage is multidisciplinary education perceived to
have most impact? And in what areas of the curriculum is
it likely to be m ost successful? On balance, the course
organizers and students we interviewed considered that it
had a greater impact at post-registration level, or at a later
stage in pre-registration curricula.
It is evident that it is only at post-registration and
continuing education level that students can be encour-
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aged to re¯ ect upon their practice. The potential for multi-
disciplinary education to enhance personal and pro-
fessional con® dence was also greater at the
post-registration stage. M any pre-registration students’
understanding of their own practice and value system s was
perceived to be fairly rudimentary. This meant that they
were unable to extrapolate from the experiences of other
professionals and use them as a basis upon which to re¯ ect
on their own practice.
There was widespread recognition that no single pro-
fession had a m onopoly of the knowledge base required to
deliver effective patient care. As a result, post-registration
students in particular felt empowered to change their prac-
tice, or to initiate change. The extent to which they were
able to do this, of course, depended upon the willingness of
their colleagues to cooperate. Perhaps the most compelling
example of cohesive teamworking facilitated by multidisci-
plinary education was in accident and emergency medicine
(A&E), where, as a registrar explained:
Because all the nursing staff here have done
ATLS and we all work on the same system,
almost invariably when we have a major trauma
resuscitation everything com es to hand. The
nursing staff are there thinking of the same things
as you’ re thinking of ¼ I would say our
Advanced Trauma Life Support has a very strong
implication there because it means that we all
speak the same language ¼ .
In the case of the pre-registration students, we were unable
to ascertain the extent to which these perceived bene® ts
were sustainable in a practice environm ent.
On balance, course organizers though t that pre-regis-
tration students had not yet developed a `relatedness to the
discipline they were going to join’ , and had insuf® cient
clinical experience to envisage how they might draw upon
the knowledge base and skills of other groups in the
workplace. Nor did the students themselves consider that
they had had tim e to develop their own professional roleÐ
to become, in the words of one pre-registration nursing
412
student, `established in themselves’ . This was their prior-
ity, and in some instances they seemed unclear as to the
rationale for the inclusion of a m ultidisciplinary elem ent in
an essentially uniprofessional degree course. Some pre-
registration course organizers believed it important to hon-
our their students’ preconceptions of what their profession
might be, however naive these were. As one nurse educator
explained:
I think som e of it’ s about professional identity,
that they feel that they cam e to be nurses and
they want to be on som ething that is clearly
de® ned as a nursing course. W hich I think links
up a bit with what I was saying earlier about the
stereotypical viewpoint or the misconceptions
about what you should be studying when you are
learning to be a nurse and we are thinking we
need to address that to some extent perhaps in
the new degree perhaps by increasing the amount
of time they have as a nursing group in that ® rst
year and looking at perhaps trying to thread
shared learning through the degree and not have
this big bulk of it at the beginning. I think that is
causing some problem s, not massive ones, but
things that we think can be improved around
that¼ . It’ s not a problem of the shared learning
per se, but is a problem of how we’ ve got it in our
programm e at the moment.
The evidence suggests that multidisciplinary education at
pre-registration is qualitatively very different from that at
post-registration levels. As one Director of Education and
Training in an NHS Executive put it:
¼ my perception is ¼ that multidisciplinary edu-
cation tends to be limited to groups of people
who are doing different courses, attending joint
sort of training sem inars, and, you know, you put
them all in a room together and listen.
There was a view expressed by some course organizers
that such an approach entailed `diluting single professional
inputs’ and was dif® cult to reconcile with the `m oral obli-
gation to produce safe practitioners’ . It would appear from
the data that there is a variety of motives for `putting
students all in a room together’ , signi® cant among which
is, in the words of one pre-registration course organizer,
the `imperative to pack as many in as possible, you know,
and conserve staff tim e for research’ . It is thus perhaps not
surprising that many pre-registration students we inter-
viewed were often rather unclear as to the rationale for the
inclusion of m ultidisciplinary course elements. Nor is it
surprising that in some cases such initiatives ª may simply
reinforce the barriers that exist for the very purpose of
de® ning different professionsº (Clark, 1993, p. 218).
At pre-registration level, teaching styles appeared to
vary considerably, and included both large-scale didactic
variants and interactive, small-group teaching approaches:
for exam ple in one site (A), there were various initiatives:
some `shared teaching’ in core modules (social and
behavioural sciences, anatomy, physiology, clinical skills
training, research methods and statistics) between nursing
students and students from the Professions Allied to M edi-
cine (PAM s). In addition, there was som e interactive prob-

lem-based shared learning in sm all groups. This was in an
early stage of developm ent, and involved students from a
variety of professional groups (nursing, medicine, and
PAM S), all of whom had had som e clinical experience.
This second variant was generally considered the most
productive teaching style, as it facilitated greater exchange
between students from different professional groups.
In another pre-registration site (B), sm all mixed groups
of medical and nursing students shared a clinical skills
teaching facility. Shared courses in communication skills
and cardio-pulmonary resuscitation (CPR) were also being
developed for nursing students and medical students in the
early stages of their curricula. A course organizer in site B
outlined the rationale for selecting these areas of the cur-
riculum as follows:
[we thought] medical students and nursing stu-
dents might usefully come together because they
did certain things that didn’ t require possibly
very much pre-knowledge on either of their parts
¼ things like communication ¼ certain clinical
skills. Ethics was another one.
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However, his counterpart in site A drew our attention to
som e of the limitations of bringing together students with
neither `pre-knowledge’ nor clinical experience in order to
consider ethical issues:
¼ . ethical and m oral issues could be taught
together, but I think you can only teach those to
people who’ ve got som e knowledge of what prac-
titioners are going to do in practice, they must be
people who’ ve had clinical experience, or else
you’ re not going to relate to it, unless you took
something like euthanasia, but even then, the
naive person might think you should never kill
anybody, but when you see other circum stances
in your clinical practice, you might think well in
these circumstances I would ¼
It would appear from the foregoing examples that multidis-
ciplinary course development, particularly at pre-regis-
tration level, represents a som ewhat uneasy balance
between rationale and expediency. It is dif® cult to envisage
how this could be anything but the case. Nevertheless, we
hope that our recomm endations will make such a balance
m ore robust and sustainable.
We will now set these in context by outlining the
factors which inhibit successful course development.
F actors inhibiting m ultidisciplinary course develop-
m ent
Internal inhibitors
Respondents in the HE-based sites identi® ed a range of
logistical factors which they considered impeded multidis-
ciplinary course implementation and development. M any
of these affected pre-registration courses in particular, as
the number of students was greater. In several cases, entry
gates were not compatible, which m eant that course orga-
nizers were faced with the problem of identifying the
correct level at which to pitch their teaching. This problem
was exacerbated by the fact the pre-registration students
with little or no clinical experience upon which to draw
AM EE Guide No. 12, Part 2
were frequently unable to extrapolate from examples
drawn from the clinical practice of other groups. In many
cases, it was not possible to achieve an optimum balance in
numbers of students from different professional groups. In
some teaching situations, a single professional group dom-
inated, which had the unfortunate effect of reinforcing
negative stereotypes. In addition, it was often dif® cult to
® nd suitable accom modation for large- and small-group
teaching. Library and IT facilities were severely stretched;
and timetabling across groups with discrete, discipline-
speci® c timetables sometim es presented problems for
course organizers.
It appears from our data that the development of mul-
tidisciplinary provision, particularly at pre-registration
level, is often piecemeal and opportunistic. This in part
explains the wide range of forms of course organization
and development; teaching styles (whether large-scale and
overtly didactic or small-scale, problem-based and interac-
tive); and range of participants.
It also appears that key individuals with a strong per-
sonal com mitment to the principles and practices of m ulti-
disciplinary education play an important role in identifying
opportunities and initiating course development in their
home institutions. It is signi® cant that in some cases the
success of an initiative was attributed to one individual’ s
contribution. Although such individuals are undoubtedly
great assets to their institutions, it is possible that an
initiative will not be sustained if such a `product champion’
moves on, or that the rationale for including a m ultidisci-
plinary element may not be clear to their colleagues. If this
is the case, it seems unlikely that students will be clear as
to the rationale for m ultidisciplinary learning, and that the
success of any such initiative will be jeopardized.
This ad hoc pattern of implem entation may be success-
ful in the short term. However, the absence of an overarch-
ing, strategic vision as regards the future developm ent of
such provision may ultimately compromise the degree to
which such initiatives can be sustained in the longer term.
We might add that it also makes it dif® cult to identify
examples or models of good practice that are applicable
across a range of sites and circumstances.
External inhibitors
In addition, respondents identi® ed a range of external
factors which they considered inhibited the development of
multidisciplinary education. We have already drawn atten-
tion to the perceived need to maintain professional ident-
ity, standards and value systems. To varying degrees,
course organizers and students saw this as con¯ icting with
the perceived drive to `go multidisciplinary’ . This issue was
also raised in the general practice sites, but was not such a
signi® cant issue in the data gathered in the two A&E units.
Allied to the maintenance of professional standards is
the role professional bodies play in maintaining distinctive
professional cultures. The requirements of professional
bodies in terms of the number of hours of clinical practice
required also provided course organizers with logistical
problem s. These were exacerbated by the fact that vali-
dation cycles were unsynchronized. In one institution,
course organizers pressed for the introduction of more core
413
 A. Pirrie et al.
courses involving nursing and the professions allied to
m edicine (PAM S) in an attempt to mitigate the effects
on multidisciplinary course development of individual
uniprofessional courses coming up for validation at
different times.
In addition, the existence of separate levies for medical
and dental education and training (MADEL) and non-
m edical education and training (NM ET) was perceived to
do little to promote attem pts to break down the boundaries
between professions and to facilitate educational initiatives
involving a range of different professional groups. How-
ever, a Director of Education and Training in one NH S
Executive put forward one possible way of obviating some
of the dif® culties posed by the existence of separate train-
ing levies:
¼ we still have a raft of contracts for physiother-
apy, occupational therapy, diagnostic thera-
peutic, radiography, which had just grown, like
Topsy. So they’ re a ragbag of contracts¼ . So
what we agreed, through the Regional Education
Development Group ¼ is that we would com-
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mission all those for professional, educational
and those people in professional groups collabo-
ratively.
Prom oting collaborative and cohesive practice in
health care
W e recognize that m ultidisciplinary education is constantly
evolving, and that there are no hard and fast models of
good practice that can be successfully implemented across
the board.
Nevertheless, the following set of recommendations is
designed to help pre-and post-registration course organiz-
ers overcome some of the dif® culties we have outlined, and
to make an effective contribution towards the promotion of
collaborative and cohesive practice in health care.
Recom mendations for course organizers
The evidence gathered during this project suggests that
course organizers should:
· make explicit the rationale for the inclusion of multidis-
ciplinary provision, particularly at pre-registration level;
· convey this rationale to the students as they embark
upon the course, e.g. in course documentation and
introductory sessions;
· set clear objectives which relate to how multidisciplinary
education should evolve throughout pre-registration
courses as a whole, and at what point they should begin;
· consider how the objectives for the unidisciplinary and
multidisciplinary elements m ight be mutually reinforcing
and sustaining;
· ensure that staff sympathetic to the aim s of multidisci-
plinary education are involved in the delivery of the
multidisciplinary elements of courses;
· develop problem-based multidisciplinary case study
material which could be taught by members of different
professions;
· involve students in the formative assessment of multidis-
ciplinary practice;
414
· honour pre-registration students’ apparent desire to
develop what they consider a profession-speci® c knowl-
edge and skills base;
· make students aware of the degree of interdependence
between the uni- and multidisciplinary elements of their
course in order to increase their understanding of and
com mitment to multidisciplinary education;
· re¯ ect further on the advantages and disadvantages of
introducing multidisciplinary education at pre- and post-
registration levels respectively.
Recom mendations for policy m akers and education com-
missioners
It is widely acknowledged in the literature that m any health
professionals have complementary and overlapping skills
which can be deployed in new ways in the patients’ best
interests.
This renewed emphasis on collaboration and teamwork
may present new challenges for those in clinical practice. It
also has clear implications for education comm issioners
and providers, who must ensure that workforce planning
meets the changing dem ands of the service, and that
practitioners are adequately prepared for their changing
roles in health care delivery.
W e therefore recommend that NH S policy makers:
· make explicit the policy for promoting multidisciplinary
education and practice;
· de® ne term s used to describe various forms of `multidis-
ciplinary’ provision;
· specify aim s and objectives for each type of initiative;
· convey strategic policy on multidisciplinary education to
education commissioners by providing examples of good
practice in their local area;
· recognize that effective multidisciplinary education
requires more rather than fewer resources and provide
adequate resources for such courses;
and that:
· both policy m akers and education comm issioners make
explicit the rationale for the promotion of m ultidisci-
plinary education;
· education commissioners clearly de® ne roles and
responsibilities in relation to the promotion of multidis-
ciplinary education;
· re¯ ect upon the advantages and disadvantages of intro-
ducing multidisciplinary education at pre- and post-
registration levels respectively.
It is clear that there are considerable bene® ts associated
with multidisciplinary education in health care. Neverthe-
less it is neither an easy, nor a cheap option. Successful
multidisciplinary provision needs to be adequately
resourced. The rationale for its development needs to be
made explicit to both staff and students, and clear and
achievable objectives need to be set for each stage. It
requires careful planning throughout, and there needs to
be adequate re¯ ection upon the relative advantages and
disadvantages of its inclusion at pre-and post-registration
levels respectively. Finally, as with all educational initia-

tives, its success will ultimately depend upon the support
and comm itment of all staff involved.
A ck nowledgem ents
This guide could not have been written without the help
and support of a great many people. W e are particularly
indebted to Joan Stead in the Faculty of Education at the
University of Edinburgh, Sheila Hamilton at SCRE, and
Diana Lee in the School of Health (Nursing and M id-
wifery) at the University of East Anglia for their invaluable
help with data collection and analysis.
N otes on contributors
A NNE P IRRIE is a research fellow in the Faculty of Education at the
U niversity of Edinburgh.
V ALERIE W ILSON is Principal Research Of® cer in the Educational
Research Group at the Scottish Of® ce Education and Industry
Departm ent.
R ONALD M. H ARDEN is director of the Centre for M edical Edu-
cation at the U niversity of Dundee.
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J OH N E LSEG OOD is a senior lecturer in the School of H ealth (N urs-
ing and Midw ifery) at the University of East Anglia.
N otes
[1] We use the expression `m ultidisciplinary education’ as
a generic term to describe a range of situations in
which students from different health and social care
professions com e together to enhance their knowledge
and understanding of particular elements of their pro-
fessional practice
[2] See for example Jones (1986) W orking TogetherÐ
Learning Together , O ccasional Paper No 33 (Exeter:
Royal College of General Practitioners); W HO (1988)
Learning Together to W ork Together for H ealth , Techni-
cal Report Series 769 (Geneva: WHO).
[3] For a full discussion of issues surrounding the use of
terms such as `multidisciplinary’ and `interdisciplinary,
see Pirrie et al. (1998).
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