Interprofessional Education and One Health: Focus on an Offshore Caribbean School
Veterinary Epidemiology and Veterinary Public Health
St. George's University
“Make no mistake, they are connected, these disease outbreaks coming one after another. … They reflect the convergence of two forms of crisis on our planet. The first crisis is ecological, the second is medical.” David Quammen, 2012.
The World Health Organization (WHO), World Organization for Animal Health (OIE, Historical acronym in French:Office International des Epizooties), and other agencies involved in global health optimization (e.g. CDC, ECDC, CIRAD, Ministries of Health across numerous foreign countries), are increasingly recommending the importance of a One Health approach by professionals across the nexus of animal health, environmental health, and human health, to address key regional and global health threats. Tackling a range of issues on the UN 2030 Agenda for Sustainable Development goals such as Ebola, Severe Acute Respiratory Syndrome (SARS), food security, antimicrobial resistance, climate change and poverty in all forms are a few examples of some challenges that may be halted through this transdisciplinary collaborative approach to practice. Interprofessional collaboration that draws on the expertise of individuals across the environmental, medical, veterinary, economic, and public health disciplines can provide a holistic approach to identifying the multiple causal factors responsible for these threats that is critical to eliminating them. There are “17 Sustainable Development Goals and 169 targets … They are integrated, indivisible and balance the three dimensions of sustainable development: the economic, social and environment.”
To highlight the need for innovative approaches, Interprofessional Education (IPE) as a pedagogical tool for familiarizing medical and veterinary students with the principles of One Health. IPE has been advocated as a way to merge traditional siloes that have historically existed across the health disciplines and instead facilitate collaborative efforts. Unique gaps have been identified in the curricula and practices of each discipline across the literature that can evidently benefit from IPE that includes One Health to address these gaps. Indeed, gaps pertaining to an awareness of zoonotic diseases on a differential diagnostic list for human patients have been reported in medical practice; veterinarians often neglect to consider the role of social and behavioral factors on the public health. By overlooking these social and behavioral determinants, future physicians and veterinarians may be limited in their own initiatives to advocate against and mitigate or eventually eliminate current threats to international health (i.e. pandemics). In the current climate of a globalized world, a collaborative approach to practice is crucial for optimizing the health of all species and the environment in which they co-exist.
Educational Research on Interprofessional Education and One Health
The institution where the below presented research thesis was based, is a unique higher education medical institution that caters predominantly students from North America but is based offshore in the Caribbean. The veterinary program has dual accreditation both by the American Veterinary Medical Association (AVMA), and, most recently by the Royal College of Veterinary Surgeons (RCVS) in the United Kingdom, the Master of Public Health (MPH) program is accredited by the Council on Education for Public Health (CEPH). The medical school produces hundreds of students annually who are matched in a diverse array of residencies across the United States.
In my thesis, for the Doctorate of Education (Higher Education), I decided to explore the readiness of medical and veterinary students for at my institution for IPE that includes One Health with the ultimate aim of the study being to inform the development of IPE and One Health at this institution. Students were required to complete a survey that included a validated scale, the Readiness for Interprofessional learning Scale (RIPLS), and two open-ended questions, requiring them to define One Health and its relevance to their practice. Dual degree medical and veterinary students pursuing a concurrent MD/MPH and DVM/MPH were also included in this study to provide further insight into the reasons for differences in comparative readiness for IPE and by extension collaborative practice across the groups. I also looked at how they varied in their definition and perceived relevance of One Health for practice. Faculty and administrators across the medical, veterinary, and public health programs were also co-opted into focus groups to determine the strengths and opportunities for developing IPE that includes One Health at my institution.
Of the total 428 participants, 237 were medical students, 78 were veterinary students, 94 were dual degree MD/MPH, and 19 were dual degree DVM/MPH students. Faculty across the medical, veterinary, and public health programs participated in two focus groups with a senior administrator in the medical school contributing to an interview reflecting on the relevance of One Health to the medical program. As I reflect below upon my research journey, I realize that it has led to many lessons learned that have promoted both my personal and professional growth as a One Health educator and advocate.
Reflections of the Research Journey
The research journey enabled me to greatly widen my knowledge on a variety of research approaches that can be used to determine how we can address diverse educational practitioner issues and approach a variety of research questions. Action research, ethnographic methods, phenomenological analysis, and mixed methods research approaches provide a large toolbox to expand on the conventional and quantitative approaches used to research institutional curricula and program gaps in medical and veterinary education. Importantly, lessons learned on the use of theory to explain research findings provided a depth of insight that I have often found lacking in the predominantly survey-based quantitative approaches to research in public health and veterinary medicine.
This research provided a unique contribution to the literature on IPE and One Health as it significantly expanded on the specific nature of gaps already identified within the curricula of each discipline and used various theoretical lenses for understanding the comparative differences in student and faculty perspectives on IPE and One Health. Recommendations emerging from the research illustrate how students’ view of their professional roles and professional identity related to how they perceived the relevance of One Health to their future practice as well as the importance of interprofessional collaboration. The responses of the dual degree students on the relevance of IPE and One Health brought clarity to the gaps that are evident in the curricula of the medical and veterinary programs that must be closed in order for driving change in favor of collaborative practice. Gaps identified in their understanding of One Health led to recommendations for modifying the curricula of the medical and veterinary programs for preparing graduates for global practice by incorporating content pertaining to impacts of climate change on human mental and physical health as well as animal health. The medical and veterinary curricula could also benefit from incorporating content that enables future graduates to consider the impact of social and cultural factors on the occurrence of zoonoses. The medical curricula would benefit from content that enables students to contemplate, but not limited to, the importance of food security on human health, the role of the human-animal bond on mental health, and the implications of antimicrobial resistance for public health. Altering the occurrence of these threats requires medical and veterinary health workers to be aware of their roles in driving policy changes.
These experiences also provided a novel insight into the diverse perspectives of faculty and administrators across the disciplines on the opportunities and challenges for developing IPE that includes One Health with implications for informing the development of these initiatives at this institution. Most importantly, the research allowed me to delve into the perspective of a community of IPE and One Health practitioners and stakeholders across the institution and begin the dialogue for engaging reflective perspectives, which are crucial for driving organizational change and curricula and program reform.
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Roopnarine, R. (2020). Factors that influence the development of interprofessional education and One Health for medical, veterinary and dual degree public health students at an offshore medical school. Doctor of Education thesis, University of Liverpool. http://livrepository.liverpool.ac.uk/id/eprint/3073226