This thesis is concerned with the concept of undergraduate Interprofessional Education (IPE) as a possible model of practice for the education of health care professionals at the Faculty of Health Sciences, University of Malta. In 2010, the World Health Organisation published its Framework for Action on IPE and Collaborative Practice outlining a vision for a “collaborative practice-ready workforce” emphasising the importance of the health and educational systems as supporting pillars of IPE and collaborative practices (WHO, 2010, p.7). The concept of IPE had been mentioned in policy documents in Malta but no such model had ever been tried or tested at the University. This study aimed to explore stakeholders’ perspectives and perceptions of IPE and to encourage debate of adopting such an approach at the Faculty of Health Sciences.
This thesis starts by tracing a history of IPE internationally, teasing out the diversity of policy drivers and motivating factors behind its inception and highlighting the lessons learnt for its development and sustainability into curricula; which, inter alia, include the importance of political drivers, national coherent policies, organisational support and earmarked central funding. This was crucial to underscore as it brought to the fore the paucity of such triggers for IPE within this research study. The study then adopts a qualitative case study approach underpinned by a social constructionist and interpretative stance designed to explore the possibility of IPE at the University of Malta. The purposive sample totalled sixty four participants and these included academics at the Faculty of Health Sciences, key informants from the education/health sectors and newly qualified health professionals. Data was gathered through a combination of focus group discussions and one-to-one interviews, and analysed using Ritchie and Spencer’s (1994) ‘Framework’ analysis supported by NVivo software. Findings yielded rich insights into participants’ perceptions of IPE; while they lauded the notion in principle, they identified a multiplicity of factors that would pose barriers to its enactment in practice. Some barriers might be described as symbolic while others were rooted in the practical domain of operational systems and structures. On a symbolic level, participants were particularly concerned that IPE would pose a threat to their professional identities and to the maintenance of boundaries that define the conceptual territories of the various professions. Participants also pointed to traits and behaviours they perceived as endemic in Maltese culture that would conflict with the enactment of IPE; these were especially relevant as the influence of macro cultural determinants has been largely overlooked in the interprofessional literature.
These findings were interpreted through an interdisciplinary conceptual framework drawing on sociological discourses of professionalism and Bourdieu’s theories of societies and social practices. The framework also drew on concepts in anthropological discourses, focusing in particular on Hofstede’s theory of cultural dimensions as a means of theorising about the role that national culture can play in shaping perceptions and behaviours.
The originality of this study lies in its a priori approach by exploring perceptions of an interprofessional model of practice when this philosophy had not yet been considered, and which in the process, identified contextual variables which could impact on the design and delivery of IPE. It is unique in employing various theoretical perspectives so as to transcend the factual findings and engage in higher order reconceptualisation. It is also the first study of IPE to be conducted in Malta; significant to consider for any potential interprofessional initiatives. This research contributes to the body of evidence underpinning IPE in two ways. It highlights again the existence of embedded hierarchies and power struggles across health systems and how these impact on IPE, and it uncovers the potential impact of national culture as a tangible determinant in the planning, development and delivery of IPE initiatives.
|Date of Award||Mar 2016|