It would be deceptively straightforward to adopt a positivist, empiricist philosophy to interpreting the research related to the outcomes of IPE and deem that the evidence indicates no justification for such activity. Indeed, the much cited Cochrane systematic review by Zwarenstein et al
, published in 2000, reviewed 89 papers and found none meeting stringent methodological standards for inclusion.4
As a consequence the review found no conclusive evidence of the effectiveness of IPE in relation to professional practice and/or health care outcomes. Given the fact that in medical education overall there is a relative neglect of such traditionally robust research design, it would tempting to accept the findings of this systematic review and conclude that this is where the IPE story ends.5
However, further enquiry about the evolution of research activity following the Cochrane review reveals a slightly less pessimistic picture.
Over the last 5 years several of the researchers (IPE Joint Evaluation Team—JET) who conducted the original Cochrane review have engaged in a further ongoing review of educationalist research on IPE, commissioned by CAIPE (UK Centre for the Advancement of Interprofessional Education).6
At the end of 2005 the review selected 107 out of 353 papers as methodologically robust (though the authors admit these are less stringent methodological standards than the original Cochrane review). The vast majority of the papers were from the US or the UK and 80% involved interventions for postgraduate learners with a reasonably even distribution between primary and secondary care. The JET reports evaluations across the Kirkpatrick range7
Most of the evaluation reports are not surprisingly focused on learner reaction and the review found that there was a very significant positive reporting bias. Because the report was compiled on behalf of an organisation focused on delivering IPE and that the positive reporting bias was so pronounced, these findings are not presented here. However, despite these reservations about the strength of new evidence in support of IPE, the review is important because it demonstrates that the IPE movement is continuing to evolve and develop and has not been deterred by the rebuff of empiricism through the Cochrane study. Interestingly, the authors themselves do not promote a quantitative report of their findings but instead highlight the potential of IPE and the importance of continued research. Indeed, in a second paper the JET group issues guidance on constructing methodologically robust evaluation of IPE interventions so that the evidence base can expand further.8
The research relating to IPE provides a fascinating illustration of the core themes underpinning wider debate about best evidence medical education (BEME). Harden's impassioned declaration of the need for good quality evidence upon which to evolve educational policy was the subject of a thought‐provoking critique by Norman.9,10
One of the central tenets of Norman's article was that there was clear evidence that adult educational teaching processes were effective but that empiricist, positivist methodology was not infrequently too blunt a tool to capture the essence of successful educational outcomes. Norman highlighted the need to supplement more conventionally powerful experimental designs with robustly gathered qualitative material. Norman's critique thus sought to challenge the assumption that “quantitative is best”.
It is clearly justifiable to observe that there is a paucity of powerful experimental design support for IPE. However, it is equally true that even allowing for the potential conflict of interest inherent in the JET review, evidence exists from less traditionally powerful research designs in support of IPE across a range of Kirkpatrick evaluative levels. As Norman's critique highlights, the lack of robust empirical support for IPE is not unique, given the problems of establishing the effectiveness of other educational interventions, and yet somehow the literature regarding IPE seems to have been reported with more certainty and pessimism. Here it would appear that the political context in which IPE is being developed is extremely pertinent.
If one assumes the somewhat defensive and reductivist perspective that IPE is being used solely as a means to generate cheaper generic health care workers to replace existing traditional professionals, then one can begin to understand why the research base can be interpreted with such veracity. IPE in such a context is a threat and the reassuring transparency of the objective positivist paradigm provides a powerfully persuasive rejection of the movement. However, if one instead appreciates the potential political dangers of developing IPE while at the same time seeking to embrace the inherent advantages of more integrated IPE (as community care for chronic conditions in particular becomes ever more complex and team reliant), then the need to evaluate adequately IPE's effectiveness using a range of complementary research methodologies becomes more powerful. In this context it would not be justifiable to claim from the literature that there was no support for the benefits of IPE in terms of challenging professional attitudes/behaviours and organisational practice. Admittedly there is as yet little methodologically robust evidence for benefit in terms of patient outcome, but as outlined above this is not unique to IPE within the context of BEME overall.