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Be Ransom ance et mctnay epca e ocons Fe std nia of he War oa Sens Learning together to work together for health Report of a WHO Study Group on Multiprofessional Education of Health Personnel: the Team Approach World Health Organi Technical Report Si 769 @® ——worta Heattn organization, Geneva 1988 ISBN 924 120709 8 (© World Heath Organization 1988 Peblcatons of the World Halth Orzaization enjoy copyright proteton in accordaner withthe provision of Protocol of tbe Univeral Copyright Convention, For rights of rproducon or ramition of WHHO pubeaton a part or Yt, Spplaton should be mae tothe Ofice of Pubestion, Worl Healt Organ ‘ion, Geneva, Swteviand. The World Health Oration necomes ich app “The designations employed and the presertation of dhe material in this poblice- ‘ion do not ily the expression of any opinion wilscever othe past of the ‘Scurotasat ofthe World Health Organization somsring the lal tas of 2) county teitry lyr aie or of ts euthocts, or coucening the dbiitaton of As rombers of boundae “The mention of pet companies or of certain manufacturers rods does not ‘ply that they ae endorser rosmmendd the Weld Health Orpanzation Drlerene outers ofa similar natore tha re nl mentioned. Ector ad omissions reseed, the sumee of proprtryprodacts re dngsshed by nal cal Tener 4705-4909 CONTENTS. Inerodtion 1, Defi nnn 7 2, Relevance of mulprofesonal education co community nea 3, The mtionae of maltiprofesonal edcation LD ‘Advantages of muluprofessional education 42. Ned or research ito mulpotessona education 4, Qusiatve apes of multipofesional education 1 ‘$1 Coowsination and cooperation tutnesn the esis and elucaton stems » 442 The ntersctoral approach » 45. Coramunity involvement 2 ‘44 Edtcationel pints Es 45 The concept of compeicnc. based edition 2% 46 The problem-solving approach. m 47 The Concept of communty.tased education » ‘4B Student ech projet 2 49. The ethics of ath sae : cM ‘Lo Pestrmancessesment M ‘£11 Muliprofesionaledveaton at den pass inthe evaton of 5. Conditions for successfal mutiprfesional education =) So" General condone > £2 Beaton planing and appropiate we of tooutes & 53 The eduation of wachers 2 6, Dificaltes and consti : * 1. Designing and launching a programme of mtprofesiona euation. 53 4. Promoting the concep of muliprfessonal edeaton @ AY esiuinal eel @ 2. Nationale prosacal ova : oo Acknowgemens a) References 6 ‘Annex 1 Terminology used in his report o ‘Ane 2. Institutions refered to i the report » Annet 3 The pote ofa good teacher n WHO STUDY GROUP ON MULTIPROFFSSIONAI. EDUCATION ‘OF HEALTH PERSONNEL: THE TEAM APPROACH Geneva, 12-16 October 1987 Member De N-IL Areskog Deparment of Cinkal Physiology, Medical Foeulty, Univesity of Lnkoping, Sweden (Vie-Charman) Miss A. Bhattacharya, Maharsjgun) Nuse Campus, Insitute of Medicine, aman, Nepal eB. Fzzat, Dean, Fuclty of Medicine, Suez Canal Unversity, Ismailia, Fay (Chair) Me\A.E Lin, Departeat of Metical Technology, Divine Word University, ‘Taclobn City, Papin (Reppert) Representatives of ther organtaton*® "Mis K. Meloseny, Nurse Consultant, Internationa Council of Nuss, Geneva, ‘Swizeriand Mre B. Rabenron, Chrsian Medial Commision, World Coun of Church, “Gener, Switcland Mss. Van der Vek Divison of Since, Techical and Vocational Education, United Nasons Educators, Ssentic and Callural Organon, Pas France 1 JR. D'Wverois, Department of Health Ssicaes Education, Unit of Training Sod Researh, Universi of Pas North, Baagay, ance (Temporary Adis) De T- Fulop, Director, Dssion of Heath Manpower Dovelopnent, WHO, Gener, Switzerland Del. Galegher, Gener, Switeland (Constant) ‘De J Gultert, Chet Meaical fect, Faveatonl Panning, Methodology and sition, Divison of Health Maypower Development, WHO, Gene, Switselid (Secreta) De) Mom, Depurent of Community Maticine, University of Adelaide, Royal ‘Adsaide Hospital, Adelie, South Austaba: Aastra (Temporary ther) -MsK: OrnosSeretay-Gener, International Federation of Medea Salen Asocatins, Vienna, Austta (Temporary Ader) “Unable to atens: Dr F. Mora, Divison of Bilal Sines and Health, Autonomous Metropolitan University, Xochimieo, Mexico City, Mico; Me ‘W:Mutavobe, rincpal, Water Resources Institute, Dare Salaam, United Republic oF Taneani a Umble to atend: De. Neuf, Chainman, Newort of Community rented BdacatonalTasttions for Heal Sciences, MeMaster University, Tlamlion, Onato, Cana * Ato represented the Word Federation for Medical Eduction + ino ropreented the tatcnatonal Federation of Mall Students Assocasons LEARNING TOGETHER TO WORK TOGETHER FOR HEALTH Report of a WHO Study Group on Multiprofessional Education of Health Personnel: the Team Approach A WHO Study Group on Multiprofessional Education of Health Personnel: the Team Approach met in Geneva from 120 16 October 1987. The meeting was opened on behalf of the Director-General by Dr Farouk Partow, Assistant Director-General INTRODUCTION Itisa policy of the World Health Organization to foster a type of educational programme for health personnel that will enable them £0 respond to the needs of the populations they serve as part of efforts to achieve the goal of health for all through primary health care Multiprofessional education oriented to the priority health needs ‘of popillations is one such type of programme. During certain periods of their education students of diflerent health professions learn together the skills necessary for solving the priority health problems of individuals and communities that are known to be particularly amenable to team-work. The emphasis is on learnit hhow to interact with one another. Multiprofessional education does not replace but complements the part of a curriculum concerned essentially with one particular profession. Its based on ascertained priority health problems of communities; learning takes place in direct contact with the people and indifferent kinds of health service setting 1. DEFINITIONS In the present report, the educational experience shared by members or students of ifferent health professions is called “multiprofessional education”. Somewhat similar approaches are 5 variously described in the literature as multidisciplinary or interdiseiplinary education, Since these words may mean something different (eg, “discipline” in medical and nursing education corresponds to subjects such as anatomy, physiology, immunology), the Study Group recommended the use of the term ultiprofessional”. The term “interprofessional” is also found in the literature and has the same meaning as *multiprofessional”. For the purposes of this report the Study Group accepted the following definitions: Health personnel: All persons who carry out health care tasks (promotive, preventive, curative, and rehabilitative) within the health system (whether they are community health workers, heart surgeons, dentists, nurses, chiropodists, sanitary engineers, social Workers or any other manpower category), Health team: A group of people who share a common health goal and common objectives, determined by community needs, to the achievement of which each member of the team contributes, in accordance with his or her competence and skill, and in coordination with the functions of others (J). The manner’ and degree of such cooperation will vary and has to be determined by each society according to its own needs and resources. There can be no universally applicable composition of the health team, ‘Team approach: Preference for the use of teams to solve health problems. In this paper “team-work” and. “multiprofessional education” are treated as two manifestations ofthe team approach. ‘Feam-work: Coordinated action, carried out by two or more individuals jointly, concurrently or sequentially. It implies commonly agreed goals; a clear awareness of, and respect for, others’ roles and functions on the part of each’member of the team: adequate human and material resources; supportive cooperative relationships and mutual trust effective leadership; open, honest and sensitive communications; and provision for evaluation, ‘Team-work is a process rather than an end in itself and occurs, whenever two or more workers interact to solve problems, whether ina formally constituted team or informally. It entails the ability to work as colleagues rather than ina. superior-subordinate relationship, Multiprofessional education: The process by which a group of students’ (or workers) from the health-related occupations with different educational backgrounds lean together during certain periods oftheir education, with interaction as an important goal, to 6 collaborate in providing promotive, preventive, curative, rehabilitative and other health-related services. ‘Other terms used in this report are discussed in Annex 1 2. RELEVANCE OF MULTIPROFESSIONAL EDUCATION ‘TO COMMUNITY NEEDS. Maltiprofessional education is not an end in itself but a means of ensuring that different types of health personnel can work together {0 meet the health needs of the people. It must never be forgotten that the concept of community orientation must underlie the design of any curriculum: community orientation is designed to ensure that ‘the competencies of health personnel are relevant to the health nesdls of the people. Multiprofessional education for primary health care should be & part of a community-oriented curriculum: ‘While multiprofessional education is clearly needed ducing all phases of the education of health personnel, the Study Group focused on multiprofessional education in undergraduate or basic education, The aims of the Study Group were to clarify the meaning of multiprofessional education, to deseribe its rationale and purposes, 1o determine ils implications, to suggest how it ean be put {into practice, and to recommend’ ways of promoting and implementing it In considering how health care might be developed in subsequent decades, a WHO Expert Committe in 1977 noted a worldwide trend towards teamwork. Tt recognized that health workers could carry ‘out their numerous tasks and responsibilities more efficiently if they were members of carefully composed teams of people with various types and degrees of skill and knowledge. A team as a whole had an {impact greater than the sum ofthe contributions ofits members. The concept of tcam-work implied a coordinated delivery of health care in the form of preventive, promotive, curative, and rehabilitative services including nutrition programmes, environmental control, fertility programmes, and communicable disease control (2) Edueation programmes should stress ways of enabling health team members to learn how to work efficiently together and to understand: (1) the responsibilty ofthe team as @ group; (2) the role ‘of each member in carrying out the team's responsibilities; 3) the extent to Which roles of team members overlap; (4) the processes 7 needed for working together; and (5) the part played by the team ia the overall delivery system (2). ‘The specific team competencies (Annex 1) needed to ensure effective team functioning are the objectives of multiprofessional ‘education, Team effectiveness is not ensured merely by training its, members individually in the techniques of community health care (the doctor for medical tasks, the nurse for nursing tasks, the sanitarian for environmental health tasks, the social worker for Social-work tasks) but rather in the processes through which the team as a whole is led and supervised and approaches problems. ‘Those processes are characterized by: (I) adaptability —the ability of the team as a whole to solve problems, to react flexibly to changing environmental demands and to incorporate different professions, community representatives and patients, all of whom have essential contributions to make to the restoration of individual or community health; (2) a sense of identity, based on knowledge and insight of ‘what the team is and what it isto do, and on a personal commitment ‘byeeach member to the common goais; and (3) the ability to discover, perceive accurately and interpret correctly those properties of the environment that are relevant to the purposeful functioning of the team. Those characteristics have implications for team leadership and for the evaluation of team performance and effectiveness, and hence for education (3) ‘Some health care problems other than those commonly regarded as community health problems are also usually managed by teams eg, child psychiatric or behavioural disorders, managed by child ‘guidance teams; and acute life-threatening conditions, dealt with by intensive care teams or specialized surgical teams. This report, hhowever, is concerned with teamwork in primary health care. Examples of problems in this category are malnutrition, infectious diseases of infancy and childhood, and disorders of pregnancy and childbirth, To deal with such problems a coordinated, collaborative effort is needed, involving team-work, often with an intersectoral component; different kinds of teams are needed in different circumstances and their training will lso differ. The following could serve as examples for educational purposes: fen Egypt 2 necwork of collaborative programmes wat ‘Stahished dhroughout the count in 1980 1968 Fach network programe isles pinay and peepratory school, hal Ui vlernary uni, social scan unit ad an apis Selopment unit under the dvecton of & pissin Sehootmaste, and is designed to coordinate cto eared to Ihe socal od evosome development of Is service area OM 10.00 iababitant). Most rural heath programes employ tn sgreulurlengnce, 4 sunaryengiuer, «Socal Work, a Srroamenal bela’ specs, = cost and ¢ medi Tepresentatve. Teams ave reponsitie for rector” coal (Gradcation of rats mosquitos and fie), provision of clean ‘wale supply and sewage dipos. Family planing tans Const of physica soeal Ware's, 2 pharmacst, a eligious Tender ind” media representatives (E-Ezal personal ‘Sommoniction, 187, ‘beat care teams have now been successfully established. They conse of two nubs, ¢ pin, to aula Mu, ah fccupationl therapist and physical therapist. in some Dew elihcenzcr socal worker end ropreentatve of helt Jmurnose orpaiztions and public employment suiborie

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