Russell, A. (2003). Social Innovations: Interprofessional knowledge building in health care. In C. Bereiter (Ed.), Learning Technology Innovation in Canada: A supplement to Journal of Distance Education TeleLeanring Special Issue, 17(3), 73-74. Ottawa: Canadian Association for Distance Education.

CHAPTER 6 – SOCIAL INNOVATIONS

Interprofessional knowledge building in health care, Ann Russell, Institute for Knowledge Innovation & Technology, Ontario Institute for Studies in Education, University of Toronto

How do health care practitioners learn to become continuous learners and reflective practitioners? A variety of continuous professional development (CPD) initiatives in health care attempt to foster learning and reflection through means ranging from hospital-based grand rounds and in-service education to online courses offered by professional colleges and associations. For example, the Royal College of Physicians and Surgeons of Canada is in their second iteration of an online ‘Maintenance of Certification’ program that enables physicians to complete online accredited courses used for the purpose of re-licensure. These initiatives, whether face-to-face or web enabled, tend to be profession specific and rely on traditional models of learning and education that deliver prepackaged content to the learner. In contrast the CPD design challenge undertaken by the Toronto Rehabilitation Institute (Toronto Rehab) was to embed opportunities for interprofessional CPD in the daily practices of a group of health care practitioners. These professionals worked in an online communal space so that colleagues separated by time and distance could collaborate in the construction of a shared resource. Rather than focus on acquisition of content, they sought to learn practices and processes that would lead to improved health care, deepened understanding and better knowledge models.

A group of approximately twenty educators, mentors and organizational change agents from bioethics, nursing, occupational therapy, physiotherapy, and psychology undertook a two-year interprofessional knowledge building design experiment. Their purpose was to transform a hierarchical and static CPD documentation activity into a dynamic opportunity for interprofessional collaboration and learning. The first step was moving the activity from e-mail to their communal knowledge space in Knowledge Forum (see Chapter 3). The prior practice was for participants to submit individual e-mail professional development activity reports (Monthly Reports) to the Vice President Professional Practice who, as the arbiter of the groups’ information and knowledge, directed practitioners work activity and connected them along lines of interest and mutual responsibility. Their new CPD initiatives changed all that. They now placed all Monthly Reports in Knowledge Forum. Responsibility for their knowledge work shifted from one person, the Vice President, to a community of practitioners. The technology helped to support the social innovation of interprofessional monthly reflection. Discourse in the communal space focused on shared problems of practice ranging from organizational change to catheter care and pain management. Problems were championed by ‘epistemic agents’(Scardamalia, 2002) who called themselves ‘game masters’ and solved problems at more complex levels of analysis. For example, one interprofessional discussion identified the need to understand how evidence-based research (EBR) methodology, considered the benchmark of medical research, could be applied to answer clinical questions. This discourse generated many views (communal workspaces) where epistemic agents tried to dig deeper into the problem and create better models of practice. In the first iteration of design, the problem space or view was called Evidence Based Practice. Later, a professional practice problem of defining ethical issues surrounding patient-clinician boundaries became the focus of their knowledge building. Through their collective research efforts and review of the literature they concluded that traditional EBR approaches did not adequately address research questions concerning the range of behavioural issues that they had identified. In the final iteration of this work, participants created a model of evidence-based clinical practice called the ‘Academic Practice Model,’ in which a broad range of evidence, including EBR as well as qualitative evidence, addressed a range of clinical and professional practices.

To conclude, the social innovation in this project was to focus CPD on inteprofessional problems in the daily practice of hospital workers and to use a communal computer medium for reflection, discussion and continuous problem solving. The CPD design served to democratize knowledge work as well as situate learning and CPD in a communal and interprofessional context. This new model of CPD is called interprofessional knowledge building.

Ann Russell

For more information:

Russell, 2002

Russell, Campbell, Scardamalia, & Bereiter, 2002

Russell, A., Campbell, C., Scardamalia, M., & Bereiter, C. (2002). Interprofessional knowledge building in health care. Ontario Hospital Association Annual Conference.

Scardamalia, M. (2002). Collective cognitive responsibility for the advancement of knowledge. In B. Smigh (Ed.), Liberal Education in a Knowledge Society (pp. 76-98). Chicago: Open Court.

Schön, D. A. (1983). The reflective practitioner: How professionals think in action (paperback ed.). USA: Basic Books.

Schön, D. A. (1987). Educating the reflective practitioner: Toward a new design for teaching and learning in the professions. San Francisco, CA: Jossey-Bass Inc., Publishers.