Terminology for interprofessional collaboration: definition and current practice.

OBJECTIVES: Interprofessional collaboration leads to an improvement in health care. This call for increased interprofessional collaboration has led to national and international recommendations for interprofessional learning and education. The GMA has taken up this challenge and has implemented a working group on "interprofessional education in the health professions" to address this topic. The terminology used to describe collaboration among the health professions seems to vary and does not reflect any clear consensus. The aim of this paper is to identify the different terms used to describe collaboration between health professions and to analyse their use in German journals.
METHODS: The terms frequently used to describe collaboration between health professionals were identified and defined. German medical journals were then pragmatically analyzed regarding the use of the terms interprof* and interdiszip*.
RESULTS: The German terms for interprofessional and interdisciplinary were not used consistently in the journals reviewed.
CONCLUSION: There seems to be no agreement on the use of terms to describe the collaboration between health professions. Consistent terminology should be used as a basis for promoting collaboration and improving understanding among the parties involved.

Introduction

Collaboration among the health professions is increasingly becoming a focal issue in health care since it plays a significant role in high-quality, patient-oriented care [1]. Productive cooperation between occupational groups representing different professions and disciplines is necessary to provide optimal and effective patient care [2]. To accomplish this successfully, interprofessional collaboration must be promoted during medical education. Recommendations for interprofessional learning and education have been addressed by various expert groups, from which national recommendations were derived for future collaboration and education in the health professions, for example from the Sachverständigenrat in 2007 and 2009 [1], [3] and the memorandum of the Robert Bosch Stiftung [4]. International guidelines for interprofessional collaboration have existed for some time and can be found in the reports of the WHO [2], [5], the Lancet Commission Report [6], and at various organizations dealing with issues concerning education and collaboration (e.g. http://www.caipe.org.uk).

In Germany, several projects have been undertaken to examine collaboration between the health professions [7], [8], [9], [10], [11], [12], [13], [14]. It is noticeable that the terms used to denote collaboration in the health professions are varied and show little consensus in how they are used.

In particular, the German words for interdisciplinary and interprofessional cooperation are used, but also other expressions such as multiprofessional cooperation, intraprofessional cooperation and teamwork also appear. The very first two terms are frequently used synonymously.

In English-speaking countries, criticism has been expressed that there is no consistent usage of terms [15], [16], [17]. Agreement on terminology to describe collaboration in the health professions, however, seems essential to serve as a shared basis not only for education and research, but also practice.

The Gesellschaft für medizinische Ausbildung (GMA) has turned its attention to the issue of collaboration among the health professions during medical education and created a committee representing the different professions. Among these committee members consensus has been reached that although no uniform terminology exists, it is deemed necessary for shared understanding.

The question arises as to which terms are used to refer to collaboration among the health professions in journal articles. The observations presented here are meant to provide a basis for discussion about using a uniform terminology to signify the collaboration between health professions.

Methods

To address this issue, the first step was to research the definitions of frequently used terms and prefixes in German, such as Disziplin, Profession, multi, inter, trans, and intra in the academic literature and on the internet.

As a second step, a pragmatic analysis of German-language medical journals was carried out. Journals listed in the MEDLINE database and which, in the authors’ opinion, address the current political debate on the collaboration of the health professions were selected for this. The following journals were selected: Zeitschrift für Medizinische Ausbildung (GMA ZMA), Deutsches Ärzteblatt, (Das) Gesundheitswesen und die Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen (ZEFQ). The aim of this investigation was to ascertain whether the terms were used in the defined way.

Searches were conducted in MedPilot with the terms interprof* OR interdiszipl* and the ISSN of the particular journal.

Search strategy:

Interdiszip* [free search] or interprof* [free search] and ISSN

Interdiszip* [free search] and ISSN

interprof* [free search] and ISSN

Interdiszip* [free search] and interprof* [free search] and ISSN

Definitions of terms

Discipline vs. profession

In the sociology lexicon [18], disciplines are described as individual sciences that study different subjects independently of each other. The individual sciences pursue the goal of developing theories as a means of scientifically understanding the world. Accordingly, interdisciplinary collaboration means that researchers from different scientific disciplines work together.

A profession is based on applying the scientific knowledge of a particular discipline [19] and thus mediates between theory and practice [20]. The sociology lexicon [18] defines profession as a service occupation relevant to society, such as that of physician or lawyer, which is associated with a high level of prestige and income and involves applying, in a relatively autonomous and collectively oriented manner, highly specialized knowledge that has been acquired over a long period of study. The term profession is thus used for practically applied disciplines: medicine is a discipline, a physician represents a profession.

The prefixes multi, inter, trans, and intra

In this context, the prefixes multi, inter and trans refer to the nature or intensity of the collaboration [21]. Accordingly, multiprofessional collaboration describes the work of the professions alongside each other and for the most part independently of each other. In the case of interprofessional collaboration, the skills of the different professions overlap. Analogous to this, interdisciplinary collaboration denotes the overlapping of the scientific fields. With transprofessional collaboration, the distinctions between the separate professions disappear and the skills can be mutually interchangeable [8]. According to Jakobsen [22], different forms of professional collaboration can be described on a spectrum that covers multiprofessional, interprofessional, and transprofessional collaboration.

In combination with adjectives, the prefix intra expresses that the thing being described lies, exists, or takes place within something [http://www.duden.de/rechtschreibung/intra_, Zugriff 14.3.2014]. Intraprofessional collaboration thus designates cooperation within a profession.

Interprofessional cooperation or collaboration in the context of the health professions has been described as follows by Kälble in 2004 [23]: interprofessional cooperation means that members of different professional groups with different specialties, a different sense of self-perception and ways of being perceived by others, different areas of expertise and work, and a different level of status all work directly together to provide high-quality, patient-oriented care, so that the patient benefits from the specific skills of each individual profession ([23], pg. 40).

Use of the German terms for interdisciplinary and interprofessional:

The search for the terms interprof* and interdiszip*, the terms that seemed to be most often used as synonyms, yielded the following hits per journal (see Table 1 (Tab. 1)).

Table 1

Overview of the number of instances in the various journals

The German term for interdiscip*(linary) was used most frequently in the journal articles examined here. The terminology used in the various journals is described in the following by means of examples:

If one views the health professions whose collaboration is described using the term interdisciplinary, it usually involves collaboration between health professions in the same discipline – medicine/medicine [24], [25], [26], [27]. According to the set definitions above, an intradisciplinary collaboration is what is actually being referred to in these articles. Here, the German term for “discipline” appears to be understood by authors as different fields of medical specialty and not as separate scientific disciplines.

Articles that focus on the collaboration of medical doctors with other health professions use the definitions in an inconsistent manner – sometimes identifying this as interdisciplinary [28], [29], [30] and other times as interprofessional [31], [32], [33]. There are also cases in which the professional cooperation of medical doctors with other health professions is described in the same article as being both interdisciplinary and interprofessional [34], [35], [36].

Discussion

Overall, the terminology concerning collaboration among health professions used in the German academic journals selected here displays a low level of uniformity. Already in 2006, Stössel [37] had pointed this out and recommended the use of a uniform terminology. He particularly emphasized the differences in definition between interdisciplinary and interprofessional collaboration in the health professions. The cooperation between physicians is predominantly described as being interdisciplinary collaboration, although according to scientific theory this only involves one discipline – medicine. This corresponds with the observations made by Lützenkirchen, who determined that from the perspective of medical doctors, the field of medicine consists of multiple disciplines [38]. In contrast, for care givers it means the collaboration of all occupational groups and institutions in health care ([38] pg. 321) and for social workers, interdisciplinarity means the collaboration between the coordinating points of the various organizations and sectors with community health workers and coordinating duties [38].

If the given definitions are taken into account, it seems that for the collaboration between different professions within their occupational context, the German term for interprofessional is applicable. This definition appears appropriate considering its proximity to the internationally used terms of interprofessional collaboration for cooperation [5], [6], [17] and interprofessional education for learning [15].

Conclusion

The increasing attention paid to the topic of collaboration in the health professions is also reflected in the formation of a committee by the GMA to address interprofessional education in the health professions. Particularly the use of the German terms for interdisciplinary and interprofessional must be clarified. There appears to be different points of view between those in medicine and those in other disciplines, such as the social sciences.

Critical to the collaboration between the health professions is a shared discourse for better understanding, which can take place once a shared vocabulary of terms has been established. We view the use of the term “interprofessional” as appropriate to designate the collaboration between different health professions.

Competing interests

The authors declare that they have no competing interests.