Current best evidence in clinical practice supports the implementation of interprofessional management in populations of patients suffering from chronic pain (Sanders et al., 2005). An example detailing a current example of IPE in Health Science Education is shown in Video 1. Guidelines suggest integrating goal-oriented psychological, physical, and medical therapies, with an emphasis on patient education in self-management. While suggestions for collaborative management in medicine aren’t isolated to populations suffering from chronic pain, this is of personal interest to me, given that I am a practicing clinician who specializes in the management of chronic pain syndromes. As an educator, I am personally invested in finding ways to challenge traditional methods of information consumption and student engagement. This comes from a growing frustration with current educational models in the health sciences that fail to produce effective and evidence-based faculty. I firmly believe that the solution to some of the pressing challenges facing health care in the United States can be resolved through trained educators who use intentional design in entry-level education for professionals in the Health Care Sciences, such as interprofessional management.

Video 1: An example of interprofessional management: (National Center for Health Interprofessional Practice and Education, 2017).

As a basis for my work, the common challenges facing appropriate integration of these interprofessional treatment models in practice range from lack of knowledge on professional roles, differences in prioritization of care between providers, institutional resources, as well as inadequate educational training through Interprofessional Experience (IPE) and virtual Interprofessional Experiences (VIPE) in clinicians and patients (Gatchel, 2014; Li et al., 2023). For this project, IPE is defined as: “when two or more professions learn with, from and about each other to improve collaboration and the quality of care” (CAIPE, 2002). As illustrated in the image below, there is a distinct difference between traditional methods of instruction (i.e., uniprofessional and mutli-professional) and interprofessional. A key difference is the agency that is given to students in not only creating knowledge, but actively facilitating a learning environment that helps others learn.

Figure 1: Individual vs Interprofessional Education: (Center for Advancing Collaborative Medicine, n/d)

This project aims to leverage Cope and Kalantzis’ (2022) Agenda for New Learning, and its associated Principles, to create a resource for faculty development in the successful implementation and application of VIPE, with careful consideration for barriers that face both virtual learning and IPEs. Additionally, this project will attempt to lay the groundwork for future research into assessing the effectiveness of the Seven Principles of New Learning as a framework for inclusive learning in VIPEs. This paper will first establish the history of IPE in Health Science Education, then discuss the theoretical and practical context of these experiences. A recommendation on how the Seven Principles can be leveraged to mitigate barriers facing virtual education and IPEs will be given, along with suggestions for future work in this area.

The need for interprofessional management in medical care arises from growing rates of deaths attributed to medical error in the United States (Makary & Daniel, 2016). Best practice supports that proper communication and collaboration between medical providers is a key factor in improving patient outcomes (World Health Organization, 2010). As early as the 1970s, discrete initiatives on IPE were developed in both the United Kingdom (UK) and the United States (US) (Franzworth et al., 2015). However, formal efforts were not made until the 1980’s when the World Health Organization (WHO) produced two papers that highlighted the importance of collaborative health care (i.e., Continuing Education for Physicians; Learning Together to Work Together). The impetus of this work later resulted in several national accreditation boards in the US mandating IPE in graduate-level health science education (e.g., pharmacy, medical, nursing, physical therapy (PT), etc.). 

Within my own field, Physical Therapy Education (PTE), interprofessional management is recognized as a core component of effective health care. However, historically, a large majority of PTs maintain that they did not receive adequate training in IPE during their graduate education (Mueller et al., 2007). More recently, Wise et al. (2007) reported that 58% of PT programs are offering IPE or VIPE. While not specific to the United States, Correa et al. (2019) offer evidence that both clinical experiences that offer IPE and mandatory courses on IPE within PTE are limited (Correa et al., 2019).

The traditional structure of IPE and VIPE in health sciences includes two or more types of professional students that engage in patient simulation and case studies. As mentioned earlier, the intent is to mimic interdisciplinary engagement in ways that traditional didactic pedagogy struggles to accomplish. To prepare students for real healthcare scenarios, these experiences emphasize student-led and problem-based learning; in effect, students are learning “from, about and with” other students. (Hopkins, 2010; Touchette et al., 2024). It should be noted that in-person IPE do face considerable barriers in implementation, ranging from logistical challenges, perceived value, as well as system-level barriers (Najjuma et al., 2024). Virtual settings see many of the same barriers as in-person IPE, with the addition of student engagement, assessment, and quality control (Nyman et al., 2024).

Within PTE, the Commission on Accreditation in Physical Therapy Education (CAPTE) mandates the incorporation of interprofessional education through experiences that emphasize Interprofessional experiences (IPE) and virtual IPE (VIPE). Generally, these experiences are thought to improve active professional skills such as communication, working in a team, knowledge of professional roles, as well as conflict resolution (Fedor, 2020). Associated with this, it’s supported that IPE and VIPE can also positively impact a clinician’s attitude towards collaboration with other professionals, individual competencies, and feelings of autonomy (Arth et al., 2018).

The development of IPEs incorporates a method of general interprofessional education for students (i.e., virtual or in-person), activities aimed at pre-determined skill development (i.e., competencies), and then supportive artefacts of learning often in the form of personal or group reflection. Adopted in 2011 by Health Science educational programs, the Interprofessional Education Collaborative (IPEC) established a set of these professional competencies to help educational programs “prepare future health professionals for enhanced team-based care of patients...”. To access these competencies, please visit this hyperlink: IPEC Core Competencies for Interprofessional Collaborative Practice: Version 3.

These competencies are aimed at engaging the allied health student to develop skills that will help them succeed within the health care setting. Figure 2 illustrates the functional relationship between the educational and health systems. Note that while this flowchart emphasizes a fundamental 'supply and demand' conceptual framework, rooted in this is the expectation that the health workforce has attained competency in interprofessional skillsets. 

Figure 2: Systemic relationship of the labor market between educational and health systems: (IPEC, 2023).

From a pedagogical perspective, these experiences are a paradigm shift in professional health science education. By attempting to simulate clinical practice in the classroom, IPE  inherently challenges traditional pedagogy (e.g., I-R-E, textbook assignments, standardized testing,g etc.) (CAIPE, 2021) through experiential and studen-to-student learning. In the case of VIPE, communication technologies allow for additional affordances in educational practices that might not be seen in traditional educational environments (e.g., recordings, asynchronous group work, AI-assisted case work, etc.). I believe with proper faculty training can achieve Cope and Kalantsiz’s (2022) New Learning Agenda. This agenda is made up of seven principles: ubiquitous learning, active knowledge making, multimodal meaning, recursive feedback, collaborative intelligence, metacognition, and differentiated learning. Also known as the Seven Affordances of New Learning, these principles act as a pedagogical framework for how to leverage technology in learning environments and form the basis for Reflexive Pedagogy (Cope and Kalantzis, 2022). 

Two relevant challenges that currently face the implementation of this model include both the faculty’s knowledge and appreciation of IPE. These include limitations in both faculty training in technological modalities for learning, as well as what Cope and Kalantzis (2022) would call Reflexive Pedagogy.  In this model, learning is dependent on student agency and supported through social sources of knowledge, as well as dynamic knowledge activities (e.g., argument, student-led creations, collaborative projects, practical artefacts of knowledge, etc.). As a review of our coursework, this theory of learning is an evolution of didactic and progressive pedagogy, focusing on student-centered learning in an ever-changing technological landscape. Practical barriers to faculty training include accessibility of faculty development resources, allocation of administrative support, poor buy-in from faculty, as well as associated faculty interest and involvement. (Wise et al., 2015). Returning to the purpose of this project and in response to these challenges, I would like to work towards providing faculty with an evidence-based developmental resource to implement Reflective Pedagogy in VIPEs.

Within the architectonic domain of New Learning, the virtual implementation of IPE presents with unique opportunities and challenges for both the learner and the educator. Online learning has been praised for its ability to promote innovation in the application of technology and supported for its accessibility and convenience in building learning environments (Mintz et al., 2023; Samelli et al., 2023). However, with these opportunities come challenges. Somewhat confounding is the thought that online learning may cause barriers to accessibility, especially regular and consistent access to the internet. Additional obstacles include technological fluency, practical skill development (e.g., hands-on skill sets, professional-specific skill sets, etc.), student socialization, and learner distractions (Mintz et al., 2p023; Samelli et al., 2023). In addition to technical barriers, suspicion of virtual learning environments seems to be a particularly insidious factor.

Contrary to qualitative reports, students generally see no change in the quality of virtual education when compared to in-person, while faculty demonstrate a lack of interest in leveraging online education or question its effectiveness (Gerber, Jee, and Depson, 2023). I found this particularly interesting given that a similar challenge faces the implementation of IPE in professional health science programs (i.e., faculty buy-in and knowledge). There may be a few reasons for this: 1) lack of incentive; 2) perception barriers; 3) faculty development (Lash et al., 2014; Doll, Maio, & Potthoff, 2018; Lloyd, Byrne & McCoy, 2012). In both instances, inadequate faculty incentives and education seem to be directly tied to negative feelings of preparedness and motivation for participation. Another confounding factor affecting the perception of virtual learning is a consequence of the speed of transition to online learning and the lack of technological and pedagogical support during the COVID pandemic. (Gerber, Jee, and Depson, 2023).

As I have mentioned, I believe that many of the challenges that face IPE and virtual learning, including faculty perception, can be resolved through intentional design of the Domains of New Learning (e.g. social engagement, learning tools and outcomes, methods of knowledge acquisition, learner roles etc.) using Cope and Kalantzis’ (2022) Principles of New Learning. Same examples of this may include the incorporation of evidence-based strategies for students and faculty such as: active learning experiences, choices for individual or group work, synchronous material focusing on ‘know-how,’ technical support, clear learning objectives and roles, emotional and pedagogical support, and purposeful socialization between students and faculty (Mintz et al., 2023; Samelli at al., 2023). Before delving into these principles, I wanted to quickly speak about the relationship between the Seven Affordances and the Domains of New Learning, as this touches on some of the theoretical relevance for this project.

Over the course of the past couple of Semesters, I have come to realize that each of the Seven Affordances has a conceptual and practical relationship with the Domains of New Learning. For example, Ubiquitous Learning or learning embedded into everyday lives, may have ties to Architectonic Domains through virtual formatting, the Discursive Domain through student-on-student learning, activity-based or experiential learning as part of the Intersubjective Domain, and so on. While I believe that an appreciation for these relationships offers key insights into how an educator can leverage these principles from a theoretical and practical perspective, as shown later in this paper, I recognize that there are additional organizational, curricular, and infrastructure barriers to the implementation of Ubiquitous Learning (O’Doherty et al., 2018) that fall outside the purview of Reflexive Pedagogy. Regarding these barriers, the WHO’s “Framework for Action on Interprofessional Education & Collaborative Practice” (2010) offers some actions to plan for financial, technical support, staff training, and systemic advocacy.

Within each of the Domains of New Learning, I believe that practical considerations can be made to meet the Seven Affordances while addressing identified challenges to both virtual learning and VIPEs. Let’s consider student engagement as a challenge within a virtual learning environment. The literature maintains that having structured learning activities, meaningful peer interactions, intrinsic and extrinsic motivational factors, as well as the appropriate incorporation of technology, can enhance student engagement (Peters et al., 2023; Nyoti et al., 2023). In each strategy, within the lens of Reflexive Pedagogy, the affordances are being leveraged in one form or another. By meeting these affordances, the educator works to actively change the learning environment (i.e., Domains of New Learning) to mitigate challenges associated with student engagement.

Theoretically, let’s take structured learning activities as an example. According to Nyoti et al in 2023, these may include small group breakouts ,case-based simulation, or role-playing exercises. For each of these examples, in keeping with the Seven Affordances, considerations must be made for the following in their development:

1. Self-reflection
2. Accessibility of the activity
3. Role or agency of the student in their learning
4. Mode of implementation
5. Form(s) of reference material and tools
6. Sources of feedback
7. Method(s) of knowledge artefact

By leveraging evidence-based examples within the framework of New Learning, we would then act on these items in a formulaic manner. If our goal is to build an environment that would improve student engagement by focusing on small group breakouts during VIPE, there are both pedagogical and curricular factors that must be considered. Within the context of curricular development of IPE, according to the Centre for the Advancement of Interprofessional Education (CAIPE), steps should include: 1) Identifying a need; 2) Identifying IP collaborators; 3) Establishing goals and expectations; 4) Creation of content (i.e., learning activities); 5) Incorporation of inclusive language; 6) Event logistics (e.g., venues, technology, expert involvement etc.); 7) Means for program evaluation. This framework is illustrated as a flowchart in  Figure 3. 

Figure 3: CAIPE Flowchart for IPE Development: (Ford, J. & Gray, R., 2017)

It should be noted that this guide doesn’t consider virtual implementation. Additionally, the recommendations put forth by CAIPE are intended for use in a professional environment. For VIPE development and application, anecdotal evidence suggests additional curricular factors to mitigate barriers:

• The ‘how, what and when; of asynchronous and synchronous material. (Grace et al., 2023)
• Virtual social and emotional support systems to enhance professional dynamics. (Azim et al., 2022)
• Clarification of roles, objectives, and expectations (Grace et al., 2023; Azim et al., 2022)

As part of my own experience, I would recommend redundant communication tools, as well as embedding IPE elements throughout a curriculum, whether it be traditional or hybrid platforms (Boet et al., 2014)

Returning to our original problem – how could we use the Seven Principles of New Learning as a pedagogical framework to develop a structured group-based learning event? An example is given here in Table 1 (note that this is a rough representation of a comprehensive process built off of numerous iterations and supporting evidence):

In keeping with CAIPE Guidelines and with considerations for both pedagogical and curricular factors, the following (i.e., Figure 4) is a pre-liminary flowchart for the successful implementation of VIPE in PTE, while emphasizing student engagement:

Figure 4: Proposed curricular flowchart using CAIPE guidelines as a template for VIPE based on New Learning Agenda and evidence-based learning activities to promote student engagement.

From a cautionary lens, much of the current literature on the development and successful implementation of VIPE in health science fails to account for each of the agendas of New Learning. Peter et al. (2023) speaks to five key strategies to the successful implementation of VIPE in medical education. They are: 1) limit the number of students in a learning group; 2) make accessible virtual learning tools to students; 3) create dynamic virtual artefacts of knowledge; 4) purposeful design through guiding prompts, clear objectives, and student role assignments; 5) appropriate teacher training. While insightful, the article fails to speak to strategies for ubiquitous learning, avenues for metacognition, or differentiated learning through varying forms of knowledge artefacts.

In other cases, these affordances are addressed, but they are not teased out as a developmental tool or framework for educators. To this point, Withers et al. (2024) give a perspective on models of virtual experiential education initiatives in global health. In their paper, they briefly speak to strategies aligned with these principles but fail to highlight their interconnected roles in creating a ‘New Learning’ environment. Au and Au (2022), suggest an approach to IPE in nursing education that follows IPEC competencies and CAIPE recommendations. Their work emphasized case-based and peer-to-peer instruction, online discussion boards, and simulation-based learning. This is further expanded upon in Figure 5. However, the paper fails to provide directions on how to develop a curriculum based on IPEC and CAPIE guidelines into a curriculum while following a pedagogical framework, as I illustrated earlier in this paper. 

Figure 5: Nursing Curricular Flowchart for IPE: (Au & Au, 2022)

It is important to note that no current literature assesses the effectiveness of Cope and Kalantzis’ New Learning Agenda as a structured framework for learning, much less in virtual hybrid PTE IPEs. However, there does exist a growing body of literature supporting specific, measurable, achievable, relevant and time-bound (SMART) technologies (e.g., AI, artificial reality, virtual reality, interactive digital working spaces, speech-to-text interfaces, etc.) to support inclusive and personalized educational environments (Sungkur & Maharaj, 2022; Kumar et al., 2024; Ghergulescu et al., 2019; McDonald et al., 2014). One example of available SMART services for educators is SMART Lab by Creative Learning Systems.

Within the context of available frameworks for virtual learning platforms that leverage New Learning pedagogy, SMART Lab is a comprehensive project-based STEM learning environment for K-12 education. The SMART Lab learning centers are built to support and guide educators and students through technology-mediated activities. The service takes students through a set curriculum while offering personalized and inclusive strategies (e.g., modifiable artefacts of knowledge, multiple challenge levels, socio-emotive learning (SEL) principles and both self and educator feedback). Included in this framework are resources for student reflection, technological support, as well as developmental training for educators (Smart Lab, n/d). While there is evidence to show that virtual education in STEM can promote student creativity and engagement, such as with NEWTON’s Atomic Structure Virtual Lab (Lync & Ghergulescu, 2018), no rigorous empirical evidence has validated the Creative Learning System’s SMART Lab for inclusive and student-specific K-12 education.

As may be evident from my work on this project, there is a relative dearth of supporting evidence for validating pedagogical and curricular frameworks for VIPE in health science education, much less PTE. Ultimately, I hope to validate a pedagogical framework for inclusive learning environments using the IPEC competencies and CAIPE’s curricular guidelines in VIPE.

CAIPE is an organization based in the United Kingdom that promotes the development of interprofessional education. This ‘think-tank’ has developed tools for creating interprofessional educational environments, including IPE. Their most recent publications, including Interprofessional Education Guidelines (2017) and the Interprofessional Education Handbook (2021) attempt to ensure a common understanding of: 1) IPE principles; 2) identification of relevant stakeholders in curricular design; 3) preparation of social and technical support for implementation of IPE. From a pedagogical perspective, the guide speaks to problem-based and student-led learning experiences, with a focus on reflection. However, no additional information or framework is given to the theoretical context and application of educational modalities (i.e., technology) outside of virtual reality, augmented reality, and simulation. While not validated in the application of VIPE, it is grounded in a long history of collaboration with academic and healthcare institutions. Much of their work has been spent aligning their framework with WHO’s Framework for Action on Interprofessional Education and Collaborative Practice (2010). Their work has included iterative feedback from experts in the field of IPE and continues refinement through research.

“The IPEC Core Competencies for Interprofessional Collaborative Practice…reflects the vision that interprofessional collaborative practice is key to safe, high-quality, accessible, equitable, person/client-centered care and enhanced population health outcomes desired by all.”

(IPEC, 2023)

IPEC competencies were developed to provide a standard framework for IPE. These competencies have undergone several revisions, which have included literature reviews, expert opinion, two rounds of Delphi exercises, as well as stakeholder collaboration. These competencies have been widely adopted by professional health science education institutions both in the United States and internationally. A 2023 revision of the framework was designed to be adaptable, relevant and measurable in virtual formats. (IPEC, 2023). While effective for its intended use, the framework is a supplementary tool in the development of VIPEs. It does not provide either curricular or pedagogical guidelines for IPEs for educators. An example of one of IPEC's core competency domains is illustrated in Video 2. 

Video 2: Description of the Core Competency Domain of 'Value and Ethics'. (Center for Health Interprofessional Practice and Education, n/d)

Both the development and impact of CAIPE and IPEC guidelines were due to, in part, to WHO’s Framework for Action on Interprofessional Education and Collaborative Practice (2010). According to IPEC, “The WHO framework highlights curricular and educator mechanisms that help IPE succeed, as well as institutional support, working culture, and environmental elements that drive IPCP. The WHO framework incorporates actions that leaders and policymakers can take to bolster IPECP to improve health care (2023).” While not giving direct guidance in curricular development, it does push for the development of curricular frameworks for holistic integration into programs. Related to this, the WHO does not speak to the use of pedagogy tied to IPE. Albeit, it does have passing comments on a couple of the Domains of New Learning, namely the use of reflection and technology as integral parts of IPE (WHO, 2010).

Future work in assessing the effectiveness of Cope and Kalantzis’ Seven Principles of New Learning in VIPE for hybrid health science education programs must start with careful evaluation and considerations made for existing guidelines through a pilot project. As part of this work, a needs assessment and contextual analysis will need to occur, whereby identified IPEC competencies are used. Consideration of pedagogical frameworks will need to be aligned with set learning objectives and implemented through activities and knowledge artefacts. Additionally, assessment of the learning environment and student outcomes will need to be done through validated outcome tools.

Using both quantitative and qualitative data, I hope to begin work on the effectiveness of the Seven Principles of New Learning as a pedagogical framework for inclusive VIPE. Program evaluation for improvement will be done in subsequent versions, emphasizing relevance to real-world interprofessional collaboration and feedback, learner outcomes (i.e., attitude towards IPE and confidence with demonstrated competencies). A holistic assessment will also include an Equity Review Tool, which is a framework to ensure that programs promote equity, inclusion and fair access for all learners. Here is one example of such a tool: https://equity.uwmedicine.org/equity-impact-review-tool/

In light of the many challenges that face online learning and VIPE in health science education, both CAIPE and IPEC have created invaluable resources for the faculty. However, pedagogical frameworks to guide faculty are almost entirely absent from these resources. I hope to create a resource for faculty development in the successful implementation and application of VIPE. As detailed by this project, I intend to make careful considerations as to the barriers that face both virtual learning and IPEs. While not expanded upon in this work, additional challenges facing the implementation of these learning environments include institutional support, administrative support, cost, and interest. Regardless, I do believe that Cope and Kalantzis’ work lays the foundation for an effective and inclusive learning environment. The next steps in supporting faculty growth are in its longitudinal application and assessment.