Dr. Haddara is assistant professor, Division of Critical Care Medicine and Division of Endocrinology & Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. Dr. Lingard is director, Centre for Education Research & Innovation, and professor, Department of Medicine, Schulich School of Medicine & Dentistry and Faculty of Education at Western University, London, Ontario, Canada.
Acad Med. 2013 Oct;88(10):1509-15. doi: 10.1097/ACM.0b013e3182a31893.
Interprofessional collaboration (IPC) has become a dominant idea in both medical education and clinical care as reflected in its incorporation into competency-based educational frameworks and hospital accreditation models. This study examined the published literature to explore whether a shared IPC discourse underpins these current efforts.
Using a critical discourse analysis methodology informed by Michel Foucault's approach, the authors analyzed an archive of 188 texts published from 1960 through 2011. The authors identified the texts through a search of PubMed and CINAHL.
The authors identified two major discourses in IPC: utilitarian and emancipatory. The utilitarian discourse is characterized by a positivist, experimental approach to the question of whether IPC is useful in patient care and, if so, what features best promote successful outcomes. This discourse uses the language of "evidence" and "validity." The emancipatory discourse is characterized by a constructivist approach concerned primarily with equalizing power relations among health practitioners; its language includes "power" and "dominance."
This study suggests that IPC is not a single, coherent idea in medical education and health care. At least two different IPC discourses exist, each with its own distinctive truths, objects, and language. The extent to which educators and health care practitioners may tacitly align with one discourse or the other may explain the tensions that have accompanied the conceptualization, implementation, and assessment of IPC. Explicit acknowledgment of and attention to these discourses could improve the coherence and impact of IPC efforts in educational and clinical settings.
正如其在基于能力的教育框架和医院认证模式中的应用所反映的那样，专业间合作（IPC）已成为医学教育和临床护理领域的主导理念。本研究通过考察已发表的文献，探索当前这些努力是否有一个共同的 IPC 话语作为基础。
本研究采用米歇尔·福柯（Michel Foucault）方法指导的批判性话语分析方法，对 1960 年至 2011 年间发表的 188 篇文本进行了分析。作者通过在 PubMed 和 CINAHL 上进行搜索，确定了这些文本。
作者在 IPC 中确定了两个主要话语：功利主义和解放论。功利主义话语的特点是对 IPC 是否有助于患者护理的问题采用实证、实验的方法，如果有帮助，哪些特征能最好地促进成功的结果。这一话语使用“证据”和“有效性”的语言。解放论话语的特点是建构主义的方法，主要关注医疗从业者之间权力关系的平等；其语言包括“权力”和“支配”。
本研究表明，IPC 在医学教育和医疗保健领域不是一个单一的、一致的理念。至少存在两种不同的 IPC 话语，每种话语都有其独特的真理、对象和语言。教育工作者和医疗保健从业者可能在多大程度上默许地认同其中一种话语，可能解释了伴随 IPC 的概念化、实施和评估而来的紧张局势。明确承认和关注这些话语可以提高 IPC 在教育和临床环境中的一致性和影响力。
