VIEWPOINT COMMENTARY

Interprofessional Education and the Basic Sciences:

Rationale and Outcomes
Jill E. Thistlethwaite*
University of Technology Sydney, School of Communications, Ultimo, New South Wales, Australia

Interprofessional education (IPE) aims to improve patient outcomes and the quality of
care. Interprofessional learning outcomes and interprofessional competencies are now
included in many countries health and social care professions accreditation standards.
While IPE may take place at any time in health professions curricula it tends to focus on
professionalism and clinical topics rather than basic science activities. However generic
interprofessional competencies could be included in basic science courses that are offered
to at least two different professional groups. In developing interprofessional activities at
the preclinical level, it is important to define explicit interprofessional learning outcomes
plus the content and process of the learning. Interprofessional education must involve
interactive learning processes and integration of theory and practice. This paper provides
examples of IPE in anatomy and makes recommendations for course development and
evaluation. Anat Sci Educ 8: 299304. V
C 2015 American Association of Anatomists.

Key words: interprofessional education; interprofessional learning; gross anatomy educa-

tion, medical education; allied health education, integration, basic sciences; common
learning; shared learning

INTRODUCTION questions remain as to the effectiveness of IPE in meeting its

Interprofessional education (IPE) aims to improve patient
outcomes and the quality of care. This article refers to IPE as
defined by the Centre for the Advancement of Interprofes-
sional Education (CAIPE): Interprofessional education
occurs when two or more professions learn with, from and
about each other to improve collaboration and the quality of
care (CAIPE, 2002). In the United States IPE and interpro-
fessional collaborative practice are being evaluated in particu-
lar to see how they may impact on the triple aim, whose
three dimensions are: (1) Improving the patient experience of
care (including quality and satisfaction); (2) Improving the
health of populations; and (3) Reducing the per capita cost
of health care (Berwick et al., 2008).
Enhanced patient care is, of course, the goal of health pro-
fessions education and training in general and therefore IPE
should potentially have the same scope and integration into a
curriculum as any other educational intervention. However
*Correspondence to: Dr. Jill E Thistlethwaite, University of Technol-
ogy Sydney (UTS), 15 Broadway, Ultimo, NSW 2007, Australia.
E-mail: j.thistlethwaite@uq.edu.au or jill.thistlethwaite@uts.edu.au
Received 2 January 2015; Revised 16 January 2015; Accepted 17
January 2015.
Published online 16 February 2015 in Wiley Online Library
(wileyonlinelibrary.com). DOI 10.1002/ase.1521
C 2015 American Association of Anatomists
V cussed below.
aim and whether this effectiveness is dependent on timing,
length of study, pedagogical methods, and number and type
of professionals, including students, involved. The literature
and evaluation wrestling with these questions at the prequali-
fication level focuses primarily on IPE within clinically
focused settings or through clinically based activities for
more senior students, as these are the location and methods
for most IPE at the present time. For example, a United King-
dom audit spanning the years from 1997 to 2012 reported
that at least two thirds of British universities offering pro-
grams in health and social care include IPE with topics most
frequently including clinical simulation, communications and
clinical effectiveness, with team or partnership working and
clinical skills also being highlighted (Barr et al., 2014). A
recent national audit undertaken in Australia showed that
while about 40% of interprofessional activities took place
solely on campus (compared to 27% solely in clinical prac-
tice), the majority were introduced late in the curriculum
(ICRC, 2013). While this audit did not capture the specific
topics of the learning, the educational methods were mainly
case-based or problem-based (ICRC, 2013). Neither of these
audits suggests that IPE as an interactive learning approach
takes places within basic science education for health or
social care, though modules taught across several disciplines
and professions may include anatomy and physiology. Such
common learning is not necessarily shared learning as dis-

Anatomical Sciences Education JULY/AUGUST 2015 Anat Sci Educ 8:299304 (2015)
 Dr. Darrel Kirch, the president of the Association of
American Medical Colleges (AAMC), has advocated for IPE
as a critical component in health care, while recognizing its
importance in basic science education particularly anatomy
(Kirch and Ast, 2015). However, in the United Kingdom
audit one of the case study sites (Canterbury Christ Church
University), which has a major commitment to IPE, reported
that shared learning has been successful across many pro-
grams except those classroom-based focusing on anatomy
and physiology (Barr et al., 2014). The course conveners sug-
gest this may be due to the different requirements of the
pathways in these basic sciences (Barr et al., 2014). Indeed,
interprofessional champions may wonder whether, when IPE
has such logistical barriers to overcome as large student
numbers at multiple sites and with different professional
accreditation standards, trying to interprofessionalize the
curriculum in anatomy, physiology etc. is worth the addi-
tional organization for such little educational gains.
This article explores the nature of early preclinical inter-
professional education including what it may achieve and
why. The term preclinical is in itself problematic. It derives
from the time when the medical curriculum was obviously
divided into learning without, and learning in the presence of
and through interaction with, real patients. Preclinical
included the basic sciences (anatomy, physiology, biochemis-
try, etc.) and those clinical sciences that could be class-room
taught. Students then donned their white coats and were initi-
ated into clinical environments, predominantly hospital
wards.
INTERPROFESSIONAL EDUCATION:
CONTENT AND PROCESS
Interprofessional education can potentially take place at any
time in a health professionals career. It should not be limited
by location or seniority. However, the main requirements are
that there are defined learning outcomes for any stage of the
interprofessional process, whether this is in a dissection room
or an operating theatre. Educators need to consider what is
the added value of bringing two or more health professional
students together to learn with, from and about each other.
It is useful to think of the desired content and process of an
interprofessional learning activity. The content is the subject
matter or topics to be learnt. The professions need to have
such content in common, for common learning to be appro-
priate. Preclinically the topics recommended for students
have tended to be those relating to soft skills such as com-
munication, ethics and professionalism. These three areas are
complex and challenging for learner and educator alike. The
process is how learning is facilitated through the chosen
teaching methods. The definition of IPE indicates that learn-
ing is through an interactive and shared process rather than a
didactic transmission of knowledge through lectures or indi-
vidual e-learning.
COMPETENCIES FOR
INTERPROFESSIONAL EDUCATION
When considering any form of educational intervention it is
important to define the learning outcomes and consider how
these will align with the proposed learning activities (Biggs
and Tang, 2007). Learning outcomes are derived from both
content and process. In addition to the basic sciences content
300
of knowledge and skills outcomes, thought must be given to
the added value of the interprofessional interactive process.
Content is learned with others (i.e., common learning) while
the added value of interprofessional learning is the learning
from and about (i.e., shared learning). This added value
relates to generic learning outcomes that should be met by all
professions but which require an interprofessional process to
do so (Thistlethwaite and Moran, 2010).
There are a number of interprofessional competency
frameworks which can be used to set learning outcomes for
nonclinical activities by careful selection of appropriate com-
petencies (Thistlethwaite et al., 2015). For example the Inter-
professional Education Collaborative of the United States
(IPEC Expert Panel, 2011) has defined interprofessional com-
petencies within four domains: (1) Values and ethics for inter-
professional practice (VE); (2) Roles and responsibilities
(RR); (3) Interprofessional communication (CC); and (4)
Teams and teamwork (TT).
In the first domain the IPEC Expert Panel (2011) states
that: these values and ethics are patient centered with a
community/population orientation, grounded in a sense of
shared purpose to support the common good in health care,
and reflect a shared commitment to creating safer, more effi-
cient, and more effective systems of care and mutual
respect and trust are foundational to effective interprofes-
sional working relationships for collaborative care delivery
across the health professions (IPEC Expert Panel, 2011). All
health professional education from the first day of a program
is working towards these aims, though they may not seem
specifically relevant during an anatomy tutorial or an inte-
grated session on the functions of the heart. However, if the
outcomes are included in the course materials this highlights
the importance of respect and trust for good working rela-
tionships during learning as well as in clinical practice.
For each domain there are associated competencies. While
the majority of these relate to practice and patient care, those
in Table 1 can be adapted to fit with preclinical and nonpa-
tient exposure learning activities. These competencies focus
on respect, communication between team members, active lis-
tening and discussion, feedback, teamwork processes and
reflection. Such outcomes can be achieved through problem-
based, case-based or group-based learning in which students
are working in small groups that require teamwork, coopera-
tion, and collaboration. Such teamwork is a feature of
whole-body dissection and surface anatomy sessions. The
facilitator helps not only with the acquisition of science
knowledge but also with the development of team process
and reflection on learning and working together.
Students from different health professions even at an early
stage of their programs will have some sense of professional
identity and their professional role (Carpenter and Dickinson,
2011). Facilitators can compare and contrast the knowledge
and skills base of the various professions to highlight how no
one professional group knows, or will know, everything, at
the same breadth or depth. Just as a division of responsibility
helps with group learning, so the diverse roles of health pro-
fessionals complement each other in patient care delivery. In
group learning it is important to draw students attention to
the process of the learning and well as the content. For stu-
dents the process includes defining and discussing the inter-
professional learning outcomes and the means of achieving
them by agreeing on goals, division of responsibilities and
group tasks, timing of meetings, and discussion of group
dynamics.
Thistlethwaite
Table 1.
Examples of the Interprofessional Education Collaborative of the United States Competencies for Basic Science Education (IPEC
Expert Panel, 2011)

Specific competencies

Competency Domain 1: Values/Ethics for Interprofessional Practice (VE)

VE4. Respect the unique cultures, values, roles/responsibilities, and

expertise of other health professions

Competency Domain 2: Roles/Responsibilities (RR)

RR6. Communicate with team members to clarify each members

responsibility in executing components of a treatment plan or pub-
lic health intervention.

Competency Domain 3: Interprofessional Communication (CC)

CC1. Choose effective communication tools and techniques, including

information systems and communication technologies, to facilitate
discussions and interactions that enhance team function.

CC4. Listen actively, and encourage ideas and opinions of other team
members.

CC5. Give timely, sensitive, instructive feedback to others about their

performance on the team, responding respectfully as a team mem-
ber to feedback from others.

CC6. Use respectful language appropriate for a given difficult situation,

crucial conversation, or interprofessional conflict.

Competency Domain 4: Teams and Teamwork (TT)

TT1. Describe the process of team development and the roles and prac-
tices of effective teams.

TT6. Engage self and others to constructively manage disagreements

about values, roles, goals, and actions that arise among healthcare
professionals and with patients and families.

TT7. Share accountability with other professions, patients, and com-

munities for outcomes relevant to prevention and health care.

TT8. Reflect on individual and team performance for individual, as well

as team, performance improvement.

TT11. Perform effectively on teams and in different team roles in a variety

of settings.

LEARNING ANATOMY studying anatomy, suggests that learners create meaning in

Anatomy is a content-rich subject with a high burden of
learning. Even with modern methods of teaching, which may
include lectures, dissection, problems and cases as triggers to
integrate clinical aspects, and computer-based diagrams and
virtual bodies, students still need to memorize structures and
three-dimensional relationships (Johnson et al., 2012). While
the depth of knowledge required may vary across the profes-
sions, this learning process is similar for all students learning
anatomy.
A phenomenographic study from Sweden, which involved
interviewing medical students about their experiences of
the subject in three ways: through memorizing; by contextu-
alizing; and when experiencing (Wilhelmsson et al., 2010).
Memorizing is likened to learning a new language and cram-
ming in facts (Wilhelmsson et al., 2010). Contextualization
involves a whole body approach with the purpose of under-
standing structural relationships. Some students also contex-
tualized through a trans-disciplinary process, relating
structure to function, both of individual organs and of the
body as a whole. Furthermore contextualization was linked
to patient care and how knowledge of anatomy would be
useful in the clinical setting. Learning through the experience
of anatomy occurred through visualization and connecting to

Anatomical Sciences Education JULY/AUGUST 2015 301

living people, by using dissection, pictures and models. In
particular dissection was seen as important as the work of
anatomy, being an experiential and hands-on method aiding
learning through sensation. Wilhelmsson et al. (2010) com-
pare these approaches to the educational theory around sur-
face and deep learning. They stress that students do not stick
to one approach but move between them to differing degrees.
However they also acknowledge that anatomy knowledge is
lost as students progress through their programs and suggest
that this may be due in part to a lack of sufficient contextual-
ization to help students retain their learning (Wilhelmsson
et al., 2010). This lack of retention of anatomy learning has
also been demonstrated more recently and the use of interac-
tive learning modules is being explored to help improve stu-
dents clinically relevant knowledge as they transition into
clinical rotations (Jurjus et al., 2014).
INTEGRATION OF LEARNING
Contextualization and linkage to clinical problems may be
achieved through case-based learning (Thistlethwaite et al.,
2013), which as the two audits referred to above demon-
strated, is a common learning approach in IPE at all levels.
Unfortunately, the Flexner report of 1910 (Flexner, 1910)
had a major effect on how medical curricula were developed
and, while highlighting the need for medical students to have
a firm grounding in science, led to a separation of theory and
practice, as well as basic and clinical sciences, and thus con-
textualization for many decades. However that learning in
the basic sciences should not be confined to the early years of
any health professional health education program has been
argued for a long time. The introduction of the spiral curricu-
lum in health professions education (Harden and Stamper,
1999) has meant that core topics are now revisited several
times with increasing depth and complexity, linking theory to
practice and basic to clinical sciences. This vertical integra-
tion approach enhances the probability of students retaining
knowledge and skills learned earlier and applying basic sci-
ence principles to clinical scenarios (Brynhildsen et al., 2002).
Horizontal integration is the process of combining individ-
ual scientific disciplines into body systems, problems and
cases. We may also consider IPE as a horizontal professional
integration mechanism to avoid the educational segregation
that leads to silos in which the various health professions are
kept apart during training. One of the pioneers of IPE in the
United States, Dr. DeWitt C. Bud Baldwin Jr. (currently a
scholar-in-residence at the Accreditation Council for Gradu-
ate Medical Education in Chicago, IL) describes introducing
a horizontal common core curriculum in the basic scien-
ces for multiple professions to promote interprofessional
learning in the 1970s (DAvray, 2007). The competencies
gained through early classroom interprofessional learning
should benefit students in terms of teamwork and collabora-
tive practice competencies later in clinical settings.
EXAMPLES OF INTERPROFESSIONAL
LEARNING IN THE BASIC SCIENCES
There are far fewer published articles on preclinical basic sci-
ence interprofessional learning opportunities. This, of course,
does not mean that such learning does not exist. However,
care needs to be taken as some courses are described as inter-
302
professional when teachers from one profession lecture to
students from another or when mixed students learn along-
side each other (Lapkin et al., 2012). Again the differences
between common and shared learning much be distinguished.
There are a number of higher education institutions that host
several health professions schools that offer common first
years where all the professions study core content together.
Such common learning may be compared to multiprofes-
sional or parallel learning which involves little formal interac-
tion between and across the professions; or if such
interaction is facilitated the purpose is for the achievement of
generic outcomes or competencies which does not rely on the
need to bring the professions together. In other words there is
no added value from the professional mix and the students
would learn uni-professionally to the same extent. However,
having learning places in common, where all basic and life
sciences academic departments are housed in the same build-
ing and there is a commitment to the philosophy of IPE
throughout programs (see for example Wessles and Rennie,
[2013], and their discussion of IPE in Namibia), may foster
serendipitous interprofessional learning. Serendipitous IPE is
defined as unplanned learning between professional practi-
tioners or between students on uni-professional or multi-
professional program, which improves interprofessional
practice (Freeth et al., 2005).
The added value of diverse professional contact with
defined learning outcomes enables interprofessional learning
to take place and for the interprofessional competencies
shown in Table 1 to be developedif there is exemplary
facilitation. Thus there are two requirements in the basic sci-
ences: a common set of generic content specific learning out-
comes AND a set of interprofessional learning outcomes. The
generic learning outcomes are important to ensure student
engagement as students are focused on content and assess-
ment and need to be reassured that valuable time is not being
taken up by what they may perceive as nonvital topics. The
mix of students is important in terms of engagement and
there needs to a similar level of required learning and assess-
ment. Thus medical and physical therapy (PT) students fit
well together for interprofessional learning in anatomy.
An example of this is the gross anatomy dissection course
run between the Mayo Medical School and the Mayo School
of Health Sciences at Mayo Clinic in Rochester, MN. The
learners are medical students and doctoral physical therapy
students. Both groups require knowledge of anatomy. Both
groups will work together at some point following qualifica-
tion. As well as a positive evaluation in terms of learner satis-
faction, this short (under 12 hours) course resulted in the
students setting up their own interprofessional study groups
to prepare for assessments (Hamilton et al., 2008). The inter-
professional learning was evaluated by means of a validated
attitudinal scale: RIPLS, the readiness for interprofessional
learning scale (Parsell and Bligh, 1999). The outcome there-
fore was whether the students attitudes towards IPE were
affected by the intervention. Students were also asked to
complete a survey to give feedback on the IPE. While the
majority of students (92%) agreed that interprofessional
learning would help them develop effective teamwork skills,
what is not known is whether the students developed any of
the competencies shown in Table 1 as no formal assessment
of such competencies is discussed. We may extrapolate from
the outcome that students continued to work in interprofes-
sional study groups that they did indeed respect each other,
and that for the groups to be successful they would need to
Thistlethwaite
communicate effectively. They could also be asked to reflect
on team performance.
In Roy J. and Lucille A. Carver College of Medicine at
the University of Iowa in Iowa City, IA the combination of
medical and physical therapy (PT) students has a slightly dif-
ferent focus in that senior PT students act as near-peer teach-
ers for the more junior medical students specifically for
musculoskeletal content. Learning outcomes for both sets of
students included the development of professional behaviors
with the opportunity to practice these through engagement
with another profession (Shields et al., 2015). The objectives
of the sessions (rather than the learning outcomes for stu-
dents) were evaluated and included satisfaction with the near-
peer activity, whether the PT students were prepared to teach,
and whether the content could be developed to involve areas
other than the shoulder. Both sets of students found this to
be a worthwhile experience as based on evaluation findings
(Shields et al., 2015). However there is no discussion about
any achieving of specific interprofessional learning outcomes.
This is not to detract from the success of the interaction but
to highlight probable difficulties in defining interprofessional
outcomes and assessing whether students have learned inter-
professional competencies from such interventions. The medi-
cal students did see the activity as an opportunity to learn
about another profession but it is not clear what they learned
and how useful this was. The medical students did ask for
further opportunities to learn more about the profession of
physical therapy and how PTs approach clinical problems,
suggesting that the added value of bringing the two sets of
students together could be enhanced by more in-depth defini-
tion of the interprofessional learning outcomes.
A pilot study from the University of Bern, Faculty of Med-
icine in Switzerland differed in involving medical and nursing
students learning anatomy during two modules: one in first-
year and one in second-year (Herrmann et al., 2015). The
authors present the learning in terms of the about, with and
from of the definition of IPE. First year students learned
about each other in terms of exchanging details about their
curricula; they learned with and from first by practicing nurs-
ing skills together in the skills laboratory and then by learn-
ing anatomy together. Moreover the medical students taught
the nursing students how to use a microscope. In the second
year the focus was on ultrasound and the gastrointestinal sys-
tem. The specific interprofessional learning outcomes are not
discussed. Again RIPLS was used as an evaluation tool. Over-
all the intervention was well received and was seen as con-
tributing to a mutual understanding between the two
professions (Herrmann et al., 2015).
At McMaster University, Faculty of Health Sciences in
Hamilton, Canada the mix of students is more ambitious and
involves 28 volunteer medical, nursing, midwifery, occupa-
tional therapy, physical therapy, and physicians assistant stu-
dents undertaking an interprofessional, problem-based gross
anatomy dissection course in groups of seven (Fernandes
et al., 2015). One learning outcome is for students to under-
stand each others scope of practice by each profession
educating the other members of their group about their roles
through discussion of clinical scenarios. The evaluation of
this project indicates that the process does enhance knowl-
edge of anatomy and physiology, while also having a posi-
tive effect on students attitudes to and perceptions of
interprofessional collaboration. While RIPLS was one tool
used to look at attitudinal change, richer data were collected
through focus group interviews. That the course took place
Anatomical Sciences Education JULY/AUGUST 2015
over 10 weeks and 30 hours facilitated group formation and
thus group working. As the authors state this type of learn-
ing approach is resource intensive and there is no discussion
of how it may be possible to run it for all students.
However it provides evidence IPE is possible within the
basic sciences.
These four studies have in common, as with many evalua-
tions of IPE (Thistlethwaite et al., 2015), only short-term
evaluation, i.e., evaluation directly after the intervention.
While this is important we need more longer term feedback
on effects and impact in terms of what is retained from the
experiences and how further learning and interaction are
affected by the interactions. Does learning at the basic scien-
ces stage translate into a greater facility for interprofessional
collaboration during clinical rotations?
CONCLUSION AND
RECOMMENDATIONS
Interprofessional learning outcomes and interprofessional
competencies are now included in many countries health
and social care professions accreditation standards. While
IPE may take place at any time in health professions curric-
ula it tends to focus on professionalism and clinical topics
rather than basic science activities. The generic interprofes-
sional competencies could be included in basic science
courses that are offered to at least two different professional
groups. To be truly interprofessional I offer the following
recommendations for course development, and for subse-
quent evaluation:
 The planning and development committee should be
interprofessional
 The added value of overcoming any logistical barriers such
as student numbers and adequate space for activities
should be rationalized
 Interprofessional learning outcomes for interprofessional
competencies need to be defined as well as discipline-
specific content
 The outcomes, learning activities and assessment need to
be aligned
 Each profession needs to be engaged and the relevance of
the learning outcomes obvious for each profession
 Careful thought needs to be given to the development of
appropriate assessment tasks for the interprofessional as
well as the knowledge outcomes
 The interprofessional outcomes should be seen as part of a
spiral curriculum to be revisited in subsequent courses
 As there is a lack of literature in this area, plan the evalua-
tion at the same time as the educational intervention and
build in longer term follow-up
 Do not rely solely on attitudinal tools such as RIPLS to
evaluate change as it is important to consider how and
why change occurs as well as the outcomes
NOTES ON CONTRIBUTOR
JILL E. THISTLETHWAITE, M.B.B.S., Ph.D., F.R.C.G.P.,
F.R.A.C.G.P., is an adjunct professor, health professions edu-
cation consultant, and family physician, affiliated with the
University of Technology Sydney (UTS) and the University of
Queensland, Sydney, Australia. She provides support for the
development of interprofessional education globally and is
303
co-editor-in-chief of The Clinical Teacher and an associate
editor of the Journal of Interprofessional Care.
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