Interprofessional education after the pandemic: lessons learned and future considerations

The COVID-19 pandemic impacted delivery of interprofessional education across the world; this eighth paper concludes the series published by the UK Centre for the Advancement of Interprofessional Education (CAIPE) Research Subgroup, consolidating lessons learned from earlier papers in the series, and offering ways to inform future interprofessional education. By considering the practicalities of emergency remote teaching in the series, including the preparation, delivery and proposed outcomes of delivering interprofessional education, the article is written to guide, sustain and inform future provision of interprofessional education in midwifery and other fields of health and social care.

The preceding articles in the interprofessional education series, written by UK and international authors, captured the diverse and shared experiences of adapting and sustaining interprofessional education. Case studies were used to offer a unique and rich data source to explore and advance interprofessional education, highlighting the benefits and challenges of interprofessional learning in lockdown. The series recognised the rapid global movement to fully online interprofessional education, while adapting to lockdown measures and maintaining learning outcomes. Through sharing insight and authentic experiences of the global impact of the COVID-19 pandemic on interprofessional education provision, and by reporting rich and unique data in case studies, this publication series contributes to the global interprofessional community, offering the opportunity to build resilience, capacity, resourcefulness and readiness for managing the future of interprofessional education and collaborative practice.

Interprofessional education and the COVID-19 pandemic

Before lockdowns were enforced during the COVID-19 pandemic, interprofessional education as part of midwifery education was undertaken primarily using face-to-face methods (Luyben et al, 2020; Sy et al, 2022a). The pandemic necessitated the closure of universities because of national lockdowns, leading to rapid and significant changes in education delivery and assessment (Furuta, 2020; McLarnon et al, 2022). The delivery of the curriculum required a rapid pivot to digitalised curricula, underpinned by theoretically informed pedagogical approaches and teaching methods (Wetzlmair et al, 2021; Sy et al, 2022a).

Bromage et al's (2010) treatise on interprofessional e-learning and collaborative work showcased a wide range of UK and international developments, and other papers have discussed the role of technology in enabling interprofessional learning prior to the pandemic (Pulman et al, 2009). Therefore, while the use of digital technology in interprofessional education is not new and has been previously advocated by the World Health Organization (WHO, 2010) as an effective means of delivering interprofessional education, the scale and speed of the move to emergency remote teaching in the pandemic was unprecedented and prompted a global movement.

Drivers for interprofessional collaboration in midwifery practice

The importance of interprofessional collaboration to improve maternity teamworking and maternal and neonatal outcomes is emphasised in national reports (Kirkup, 2015; Cumberlege, 2016; Ockenden, 2022). The Ockenden report identified failures in leadership and teamwork, as well as not listening to service users, as contributory factors in poor midwifery practice (Vize, 2022). This led to stipulations for interprofessional education and the development of associated professional identity, collaboration and communication skills, in the drive to enhance patient safety (Sy et al, 2022a).

Further theoretically informed research is needed to identify the most appropriate blends of relationally oriented service user involvement and partnership, working to achieve optimum outcomes for interprofessional learning and midwifery education. This recommendation is even more pressing in UK midwifery practice, following repeated calls for partnership working and interprofessional learning for training maternity teams. The WHO (2022) recently published a global competency and outcomes framework for universal health coverage, which identified collaboration as a core competency, further calling for interprofessional collaboration to improve quality of care.

Throughout this series, reference has been made to the centrality of the relationship between higher education institutions and professional statutory regulatory bodies in the delivery of midwifery education. This relationship is key in the determination of standards, expected levels of competence and proficiency in key areas of practice to improve clinical outcomes for service users. Midwives, at the point of registration, are expected to work interprofessionally in pursuit of high-quality care (Nursing and Midwifery Council (NMC), 2019) to optimise maternal and neonatal outcomes. The expectation of being interprofessional is mirrored across the range of professional regulators such as the General Medical Council (2014; 2016) and the Health and Care Professions Council (2016; 2017). Therefore, the promotion of a culture of interprofessionalism is clear across the health and social care landscape.

However, it should be noted that each profession undertakes different educational programmes aligned to their speciality, and finding ways for professions to learn together can be complex to organise. No matter when or how interprofessional education initiatives are delivered, their importance and centrality to contemporary curricula have never been stronger; this was reinforced in the emergency standards for midwifery education, published at the beginning of the pandemic, in which interprofessional education was not removed from midwifery programmes (NMC, 2020).

Park (2022) noted that interprofessional education aligns professional statutory regulatory bodies requirements with legislation, workplace demands, educational strategies, research and evidence-based practice, ‘bridging the liminal space between practice and theory’. Therefore, interprofessional education is recognised as a key educational approach in improving collaboration, teamwork and learning in health and social care practice and in the promotion of safe, high-quality and holistic care. The pandemic simultaneously emphasised the fundamental need to work and learn effectively with, from and about other colleagues while forcing the redesign and evaluation of the educational pedagogies and technologies that facilitate interprofessional education, which the interprofessional education series explores.

The interprofessional education publication series

The first article in the series considered the historical context of interprofessional education, providing an overview of the impact of the pandemic, considering Edelbring's (2010) threefold framework of learning from, with, and about technology, and the NMC emergency standards introduced to maintain education during the pandemic (Power et al, 2021). The second paper was informed by the application of core learning design principles (the 3Ps: presage, process, product), focusing on the process, design and delivery of interprofessional education. The international case studies included suggested that enablers of emergency remote teaching for interprofessional education outweigh the barriers encountered (Wetzlmair et al, 2021). The concepts ‘interprofessional education’ and ‘emergency remote teaching’ are explored in the first two papers, comparing online learning with emergency remote teaching in the context of interprofessional education (Power et al, 2021; Wetzlmair et al, 2021). Box 1 provides definitions used throughout the publication series.

Box 1.DefinitionsInterprofessional education:Defined by CAIPE (2002): ‘occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care’.Emergency remote teaching:Defined as ‘an unexpected, planned move from face-to-face education to online provision, where learning activities designed to be delivered face-to-face are quickly adapted to be delivered in an online environment’ (Sy et al, 2022a).

In addition, the series considered the radical shift in the delivery of interprofessional education and associated opportunities and challenges from the experiences of students (Sy et al, 2022a), academics (Power et al, 2022) and service users as partners in education design and delivery (Coleman et al, 2023). The influence on assessment for interprofessional learning (McLarnon et al, 2022) and practice-based learning (Hutchings et al, 2022) are also explored. Table 1 summarises the key messages from all papers in the series and can be used as a guide to inform future interprofessional education.

Lessons learned from the pandemic

Moving forward into the post-pandemic era, it is essential that educators use the insights and knowledge gained from midwifery practice and emergency remote teaching to enhance interprofessional educational provision for future midwives and other healthcare professions.

Lessons learned from midwifery practice

To relate the impact of the COVID-19 pandemic on midwifery education and interprofessional education, midwifery practice must also be considered. A case study in Box 2 provides an example of how maternity services adapted to the social distancing restrictions imposed by the pandemic. When exploring interprofessional education and collaborative practice, service users must be at the centre, and evidence suggests that there is currently a dearth of service user engagement in education (Sy et al, 2022b); therefore, case studies are useful to consider service users' experiences in education.

Box 2.Case study from an East Midlands maternity unitThe maternity unit reduced face-to-face contact with women and their families during the pandemic. For example, antenatal physical contacts were reduced with the introduction of telephone booking appointments, supplemented with 30-minute face-to-face booking completion appointments to assess height, weight, body mass index, blood pressure, bloods tests and to send off a mid-stream urine sample. To offer an alternative to ‘preparation for birth’ classes usually delivered by midwives, parents were signposted to an external website offering courses and resources for a fee.During the pandemic, first day postnatal visits were only conducted at home for ‘high-risk’ service users, with additional measures (such as restricting the visit to mother and baby in the room, windows being open, and surgical mask, apron and gloves being worn) implemented to reduce the risk of infection. All other first day appointments were carried out by telephone, which had limitations as midwives could not assess the home environment, safe sleeping or pet safety in person.Further postnatal care included a telephone contact on day 3 to assess feeding (which meant the newborn was not weighed as per pre-COVID-19 practices). On day 5, appointments were given to attend a community clinic for newborn blood spot screening (only one parent was allowed to attend and asked to wait in the car in the car park to be telephoned to enter the building). If this was the father (some mothers find it difficult to witness the screening), this meant the mother missed the opportunity for a face-to-face postnatal examination. From day 10 onwards, discharges were completed via telephone.Emerging from the pandemic, preparation for birth classes have resumed in person. Staff members who were required to shield at the height of the pandemic were supported to work from home, completing telephone consultations, some of whom continue to work from home to undertake telephone bookings. This has several benefits, one being that it enables high-risk women to be ‘triaged’ sooner. The 30-minute booking completion appointments are still required for this group; however, logistically there is a positive net effect, as three women can now been ‘seen’ in a slot that previously would have been occupied by just one face-to-face booking appointment pre-pandemic.All postnatal visits have been reinstated as face-to-face appointments, which has been seen as positive. However, because of the significant loss of staff during and after the pandemic, this has created challenges to achieve continuity of care and subsequently, midwives have not yet regained ownership of their own caseloads. The biggest benefit to arise from new ways of working in the pandemic was leaving GP surgeries and moving to community hubs, in line with the better births directive. These central community hubs have a great sense of camaraderie, and provide improved support for colleagues and opportunities to learn from each other.

Experiences in maternity practice illustrated in the case study (Box 2) resonate with some experiences in academia explored in this series, where face-to-face provision was reduced, the potential of remote learning and working was acknowledged, and increased pressure and challenges were experienced by both the workforce and service users. The case study highlights how midwives were working increasingly remotely, and at times in isolation, during in-person appointments; this was the same for academics adhering to lockdown policies and social distancing rules. Opportunities for interprofessional learning and collaboration for midwives and their colleagues were therefore greatly reduced during the pandemic in education and practice environments.

The fifth recommendation of Cumberlege's (2016) ‘National Maternity Review, Better Births’ (referred to in the case study), clearly states that ‘those who work together should train together’. This should be core to midwifery and obstetric pre-registration training and continue as standard through continuing professional development. This has been recently reinforced in the Ockenden (2022) report, which recommended practitioners train and learn together in practice.

As indicated in the case study (Box 2), in the current post-pandemic climate, where there is a workforce crisis in healthcare, the fact that there are fewer health professionals available to work collaboratively because of staff shortages is of principle concern. These shortages pose wider implications for education beyond interprofessional education provision and midwifery practice. The challenge presented for future interprofessional education and collaborative practice is to restore midwives' collaborative practices, to regenerate and strengthen midwifery teams and to balance the use of technology and interprofessional learning in pre- and post-registration training, while working closely with professionals, mothers, families, and their babies.

Lessons learned from emergency remote teaching

The nature of the pandemic created a period of disruption and liminality in practice and education, and educators were forced to evaluate and rapidly adapt their approaches to move all educational delivery (including interprofessional education) to emergency remote teaching, which was an unforeseen and exceptional situation (Rapanta et al, 2021). For educational institutions that had not invested in or developed extensive use of learning technologies before the pandemic, there was therefore a rapid increase in innovative instructional approaches.

The pandemic acted as a catalyst for change and development; it tested the limits of established learning technology systems but also afforded opportunities for engagement with interprofessional education activities for those that may have been precluded previously, for example, through geographical constraints (Bennie et al, 2022). As a result, higher education institutions offered different mixes of technology-enhanced learning for their interprofessional education provision, and innovations included using virtual learning environments to deliver elements of content, to facilitate online communication, collaboration and assessment tasks, such as virtual wards, online quizzes, e-portfolios, group blogs and wikis (Power et al, 2021; Wetzlmair et al, 2021, McLarnon et al, 2022; Park and Holland, 2022).

Online provision of interprofessional education and assessment has been shown to be an effective method of enabling students to learn and demonstrate achievement of interprofessional education related learning outcomes (McLarnon et al, 2022; Power et al, 2022). While the pivot accelerated the advancement of technology enhanced learning, there is still limited evaluation as to its use in the delivery of interprofessional education during the pandemic. The articles in this series highlighted some of the opportunities and challenges encountered (Table 2).

It is clear, that while online provision of interprofessional education helps overcome some of the known logistical challenges with delivery, it presents others in terms of equitable access. Going forward, it is essential that educators have appropriate training and support in place to develop digital capability to design online curricula. Module teams must consider student digital capabilities and appropriate access to technology to ensure inclusion and fair access for all.

Future delivery and sustainability

Now that the emergency nature of remote delivery has abated, this has meant a return to some pre-pandemic interprofessional education practices and approaches in delivery. It has also offered opportunities to reflect and capitalise on the learning and innovation gained during this period (Khalili et al, 2022; Park, 2022). We continue to live with COVID-19, while concurrently planning for a new post-COVID-19 era, and this requires all stakeholders involved in interprofessional education delivery to work creatively and collaboratively to ensure its sustainability.

Many of the challenges faced in the ongoing delivery and enhancement of interprofessional education will be centred around continuing pressures on practice-based learning capacity (Hutchings et al, 2022). Researchers, academic institutions, health and social care organisations, corporations and governments must work together to provide sufficient solutions to the problems created by the global pandemic experience. For policymakers in various nations, including those in Europe and the rest of the world, online learning and emergency remote teaching should continue to be evaluated. Lessons from the pandemic will allow us to identify challenges and solutions for policymakers, so that they can address some of the challenges encountered (Ferri et al, 2020).

Co-creating education and partnership working with mothers and families

Partnership working is a policy directive for improving care delivery and is fundamental to patient-centred team working (Department of Health and Social Care, 2021). Midwives are expected to develop respectful relationships with mothers, listening to their concerns and considering their preferences. These relationships extend to partners and their families and involve all members of the interprofessional and interdisciplinary team. Learning how to develop and value partnership working starts in training and continues throughout the professional's career; therefore, educators are expected to involve mothers in teaching design and delivery.

Shared understanding results in women's care needs being met and service user involvement in education has been shown to develop expansive learning; mother's insights hold the key to advancing high quality interprofessional care (Renfrew et al, 2014). In this way, mothers can share their lived experiences in the hope that new learning results, which has the potential to be translated into shaping high-quality care. The aspiration in midwifery education to represent service user experiences to inform curricula development can also be achieved through research on maternity and midwifery care, which can inform the education and training of healthcare professionals.

Moving forward, it is important that when innovating or adapting practices—in teaching, learning, service delivery, research and policy development—service users are intentionally involved, as well as the people who will benefit directly or indirectly from interprofessional education; they should be involved from the beginning to the end of the co-creation process (Sy et al, 2022b). In this series' seventh article, experiences of service user involvement in interprofessional education were explored further (Coleman et al, 2023). Additionally, this article exploring service users' experiences was co-written with a mother, who joined the writing team of health and social care professional academics. She shared her story and reflections about joining a carer group online and her experiences about teaching online and face-to-face. This is an example of interprofessional collaboration in action, where a service user provided equal and valuable contributions to improving the delivery of a health service (Coleman et al, 2023). The mother's experiences showed that online teaching methods can be beneficial for those with babies, as it removes travel barriers with small children, and involving service users requires work to develop safe, supportive relationships with women who feel able to share their stories.

Storytelling and partnership working with mothers and families

Designing opportunities where learners and educators can learn with, from and about service users, mothers and their families, and have the opportunity to witness the lived experiences of patients and carers through authentic interactions, is a vital component in interprofessional and midwifery education (Coleman et al, 2023). UK policy drivers have recommended service user involvement as central to increased quality and safety and learning how to improve care delivery in the NHS (Francis, 2013). Service user involvement through storytelling and partnership working can help to address these policy drivers. However, there remains diversity in the service user role in healthcare education (Towle et al, 2010; Towle and Godolphin, 2011), and Bennett-Weston et al (2023) emphasised the need for improved clarity about service user partnerships in the academic community.

Despite the challenges of partnership working in healthcare education, there is evidence that sharing service user stories has been embraced in healthcare and midwifery education, and that storytelling can be influential in shaping the lifeworld experiences of students (Pulman et al, 2012; Taylor and Hutchings, 2012). Service user involvement and storytelling, when grounded in psychosocial and philosophical perspectives, can contribute to the development of embodied relational understanding for humanising healthcare and improving midwifery practice (Todres, 2008; Johnson, 2015). In the seventh article of the interprofessional education series, the story of a mother whose baby needed intensive care and subsequent lifelong support was shared, and deeper understandings were found when students were with mothers in person (Coleman et al, 2023).

Bennett-Weston et al (2023) argued that much of interprofessional education and service user involvement remains a-theoretical. This is an area ripe for further consideration, offering opportunities for midwives to conduct further theoretically underpinned research on the benefits for learning, where education design is focused on working in partnership with mothers.

Underpinning interprofessional education with theory

Online learning can provide students with more flexible access to interprofessional education, enabling opportunities to study and learn remotely using virtual learning environments and video communication platforms, which can be less constrained by space and time. The interprofessional education curriculum can embrace these opportunities by continuing to embed pedagogy with digitalisation, informed by active experiential learning design principles (Dewey, 1938; Kolb, 1984), which seek to demonstrate constructive alignment between learning strategies, learning activities and assessment (Biggs and Tang, 2011; Hutchings et al, 2022; McLarnon et al, 2022).

This series explored a wide variety of initiatives and experiences for stakeholders to draw on, demonstrating that one size does not fit all, during and beyond the period of disruption created by the pandemic. Prior to the pandemic, strategic change and decision making, underpinned by a shared vision and interprofessional culture, and steered by favourable leadership and sound pedagogic principles, were at the heart of securing effective interprofessional education in higher education and clinical practice settings. The recommendation to design interprofessional learning encounters of varying duration within a framework guided by the 3P model of teaching and learning (presage, process, and product) (Biggs, 1993), applied to the context of interprofessional education by Freeth and Reeves (2004), and demonstrated at work in this series by Wetzlmair et al (2021), holds true as we emerge from the pandemic.

The 3P model facilitates consideration of the benefits of online and blended approaches for interprofessional education, weighed against barriers to engagement. Presage factors associated with the different contexts for interprofessional education, with its time, space, logistical and resourcing constraints, need to be considered in association with recognition and management of students' and facilitators' characteristics and resources to secure adequate levels of preparedness and digital literacy capabilities for students and educators alike. Education institutions and educators must be cognisant of the training and support infrastructure required to mitigate technical issues and internet connectivity, which can impact student satisfaction and educator confidence and impede progress.

Disseminating interprofessional education knowledge and research

After the changes precipitated by the pandemic, it is important that knowledge and information continue to be shared in various ways, including through less traditional dissemination. This will give practitioners easier access to the latest evidence-based information about how interprofessional education competencies can be applied across midwifery practice. For instance, the use of podcasts, vlogs, blogs, live streaming, social media and webinars to disseminate interprofessional education information are sustainable resources that midwives could use to learn more about interprofessional education and apply its principles to their practice. Doing so can allow the integration of reflective practice (Power et al, 2022), which is important for personal and professional growth.

Examples of innovative international dissemination from the CAIPE Research Subgroup are available via YouTube (and can be found on the Interprofessional Global channel), where two virtual international presentations were delivered at Interprofessional. Global cafés. Key findings from the first paper were converted into an IPR. Global Pearl, which is an infographic of key points shared over social media platforms and via the Interprofessional Research. Global website (IPR.Global, 2023).

Translating interprofessional education curricula into the practice environment

The question of how midwifery educators, practitioners and regulators can address the situatedness of interprofessional education remains a conundrum. The NMC (2022) confirmed in current recovery programme standards that ‘practice learning in direct contact with healthy or ill people and communities in audited practice learning placements is considered optimal’. Yet continuing pressures on practice-based learning capacity, together with changes in clinical practice, such as telehealth and video consultations (Penny et al, 2018), challenge the locus of practice for achieving optimal levels of clinical practice experience required by professional and regulatory bodies.

Moving forward, the experiences and changes wrought by the COVID-19 pandemic call for critical re-examination and further research into what can be recognised as interprofessional practice-based learning. Simulation offers an interprofessional educational opportunity to promote effective collaboration between students. This could include, for example, experiencing obstetric or neonatal emergencies, such as newborn resuscitation, or practical obstetric multi-professional training (PROMPT) (Renwick et al, 2021). Simulation may also help to prepare midwives and obstetricians to collaborate, particularly taking into consideration that the two professions may work together infrequently and only in specific clinical contexts. The argument of Jarvis et al (2003) that every experience is ‘real’, even though it may be indirect or mediated, lends credence to the potential for building on the simulation initiatives and adaptations identified in this series (Hutchings et al, 2022); preparing the way for designing and researching further creative and innovative approaches for interprofessional service user and family-focused case-based practice learning, which can take place outside the clinical setting.

Considering national and international policy

The call for effective interprofessional education continues to be propelled by failures in team working (Ockenden, 2022). The emphasis on more post-qualified, practice-based interprofessional education cascades into pre-registration learning. Current policy expects higher education institutions to align themselves with practice so that future practitioners emerge ready and prepared to serve the needs of the communities where they will work (WHO, 2022).

CAIPE works to advance interprofessional education and collaborative practice, and in so doing seeks to influence health and social care policy. In a recent survey of members and stakeholders, a new CAIPE strategy for 2022–2027 confirmed the scholarly work required to advance interprofessional education and collaborative practice. The CAIPE (2022) strategy is cognisant of changes in UK NHS systems where integrated care requires effective teamworking and collaborative practice, placing service users at the centre of service design and delivery of care (NHS England, 2020).

Key considerations and recommendations

This series of articles, through analysis of literature, case studies and shared reflections, can inform future interprofessional education and collaborative practice. Key considerations and recommendations for midwifery from the interprofessional education series are summarised in Box 3 to further advance the field of interprofessional education and collaborative practice.

Box 3.Recommendations for midwifery educators, clinicians and researchers

• Emerging from the pandemic, adapted interprofessional education needs to be evaluated to inform future provision.
• Enablers and barriers of emergency remote teaching and learning must be recognised to sustain commitment to the transformative impact of interprofessional education.
• Digital equity among students must be ensured with access to technology and digital literacy.
• Case studies can be used as a unique and rich data source to explore and advance interprofessional education.
• Online interprofessional education needs robust technical infrastructure, competent confident facilitators and proactive students with access to technology.
• Educators require appropriate training and support to develop digital capability to design online curricula.
• Research is needed to explore interprofessional practice-based learning and assessment of interprofessional learning, including assessing higher order thinking and practical skills.
• Further theoretically informed research is needed to identify the most appropriate blends of relationally oriented service user involvement and partnership working, to achieve optimum outcomes for interprofessional learning and midwifery education.
• When exploring interprofessional education and collaborative practice, service users must be at the centre and education should be co-created with mothers and families.
• Storytelling can be used to work in partnership with service users and others.
• Interprofessional education should be underpinned by theory and pedagogy should be embedded with digitalisation.
• Interprofessional education knowledge and research should be disseminated in diverse and accessible ways.
• Interprofessional education curricula need to be translated into practice.
• Simulation should be explored for its potential as an opportunity to promote effective collaboration between students.
• The health and social care workforce needs to train together to be able to effectively work and learn with, from and about each other to provide safe, high-quality care.
• National and international policy should inform and be informed by interprofessional education.
• Researchers, academic institutions, health and social care organisations, corporations and governments must work together to provide sufficient solutions to the problems created by the global pandemic experience.

Conclusions

There is global consensus that the health and social care workforce need to be able to effectively work and learn with, from and about each other to provide safe, high-quality care. This series has captured the wide-ranging impact of the COVID-19 pandemic on the delivery of interprofessional education, in the pursuit of achieving a collaborative ready workforce. The pandemic presented an opportunity to reimagine team working and collaborative practice, offering adaptability and creativity for interprofessional education, while preparing health and social care students for future technological advances. It is essential that we take stock of the lessons learned during this challenging time and use them to inform future interprofessional education provision and collaborative practice.