A Common Language for Interprofessional Education: The World Health Organization’s International Classification of Functioning, Disability and Health (ICF)

Publication ID Published Volume
9321 January 28, 2013 9

Abstract

The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) was adopted in 2001 as a common language among health professionals to measure health and disability. This classification system allows for health and wellness to be viewed on a continuum and mainstreams disability as an integral part of the human experience. The ICF model shifts the focus of patient encounters from the biomedical model to the biopsychosocial model, enabling healthcare providers to gain a better understanding of the person. The ICF also provides an ideal language for interprofessional education (IPE) by allowing students from multiple backgrounds to communicate more effectively using a common set of terms and allowing students to appreciate how collaboration with others optimizes patient care.

The attached ICF curricular resources serve as training modules for both faculty and students and can be used in any simulated or case-based IPE activity. These resources include a faculty development workshop, student reading material, a PowerPoint lecture to be presented to students and accompanying lecture guide, case-based exercises for students, and examples of the application of the ICF in an existing IPE curriculum.

Students are surveyed at the end of each of the two years of the Health Mentors Program. They rate the following statement on a 5 point Likert scale: “Applying the ICF framework to my health mentors condition(s) and/or impairment(s) helped me to better understand the impact of these conditions on his/her quality of life”. The overall 2012 response rate for first year students was 74%; for second year students it was 67%.

The percent of first year students (by profession) who chose strongly agree, agree, or neutral are:

Medicine = 84% (N=216)
Nursing = 92% (N=88)
Pharmacy = 98% (N=67)
Occupational Therapy = 91% (N=53)
Physical Therapy = 89% (N=44)
Couple and Family Therapy = 100% (N=5)

The percent of second year students (by profession) who chose strongly agree, agree, or neutral are:

Medicine = 78% (N=152)
Nursing = 94% (N=60)
Pharmacy = 85% (N=58)
Occupational Therapy = 95% (N=41)
Physical Therapy = 93% (N=36)
Couple and Family Therapy = 88% (N=9)

Formal, qualitative analysis of reflection papers evaluating students’ identification of how a person’s health conditions and impairments interact with personal and environmental factors was completed on reflection essays from the 2011-2012 first year students. They had the choice of three prompts. The essays analyzed answered the following prompt: “Describe how your Health Mentor’s functional status and quality of life were affected by his/her health condition(s) and/or impairment(s)? Was the impact similar or different than you anticipated?” The number of essays that answered this prompt was approximately a third of the entire cohort. Essays analyzed originated from the disciplines of couples and family therapy, medicine, nursing, occupational therapy, pharmacy, and physical therapy. Essays were reviewed until thematic saturation was achieved in each discipline, and coding was done using Nvivo9® software. In order to achieve thematic saturation, 91 essays were reviewed including 39 from medicine, 20 from nursing, 13 from pharmacy, 9 from physical therapy, 8 from occupational therapy, and 2 from couples and family therapy. This disciplinary distribution closely matched that of the whole program cohort. The 4 themes most frequently identified were “Realization that some aspect of the health mentor’s life is different than initially expected,” “Student identification that a positive attitude allows their health mentor to function despite disease,” “Student identification of the health mentor as a source of inspiration,” and “Realization that the health mentor’s health condition does not define their capabilities.” These themes are overwhelmingly related to the third goal of the Health Mentors Program which is: “students will appreciate how a person’s health conditions and impairments interact with personal and environmental factors.” In addition, when all the themes related to the third goal are taken into account, 91% of the essays coded referred to such themes. A limitation of this analysis is the quality of the initial reflection paper prompt, as it is leading in its design. In addition, anecdotally, when analyzing the papers submitted for this particular prompt for themes, it appeared that a disproportionate percentage of the papers were about a small number of mentors with physical disability.*

Anecdotally, through faculty grading of both team and individual assignments, interprofessional teams of students participating in this curriculum have demonstrated a clearer understanding of the ICF; students have been able to identify elements of the ICF in the context of the health mentor’s life, use the ICF to understand barriers and facilitators to wellness, apply the worldview of the ICF to the health mentor’s home environment, and are able to apply what they have learned about their health mentor to assist in the creation of patient-centered health and wellness goals to maintain and promote change.

*Unpublished data from Panichelli A, Brown K, Krizman S, Ankam N, Jerpbak C, Collins L, Speakman E, Umlaud E, and Arenson C.

Citation

Ankam N, Levinson M, Jerpbak C, et al. A common language for interprofessional education: the World Health Organization’s international classification of functioning, disability and health (ICF). MedEdPORTAL Publications. 2013;9:9321. http://dx.doi.org/10.15766/mep_2374-8265.9321

Educational Objectives

  1. Define key WHO-ICF concepts, including health conditions, impairments, activity and participation.
  2. Apply the structure, language, and concepts of the ICF in describing how a person’s health conditions and impairments interact with their personal and environmental factors.
  3. Incorporate ICF concepts into team-based interviews and assignments as part of the longitudinal IPE curriculum.

Keywords

  • ICF, Common Language, IPE, Interprofessional Education Collaboration (IPEC), Conditions, Impairments

Prior Scholarly Dissemination

  1. Ankam NS, Levinson M, Melvin JL. Teaching Medical Students the ICF: An Interprofessional Education Partnership. Am J Phys Med Rehabil Volume 90, Issue 4. a13. Scientific Paper Presentation at Association of Academic Physiatrists Annual Meeting, April 2011. 
  2. Levinson M, Ankam N. The Role of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) in Interprofessional Education: The Jefferson Experience. Discussion Section at Collaborating Across Borders, III: 3rd Biennial International Conference, Tucson, AZ, November 2011. 
  3. Levinson M, Ankam, N, Jerpbak C. Introducing a Common Language in Interprofessional Education: The World Health Organization's International Classification of Functioning, Disability and Health (ICF): What, Why, and How. Workshop at Jefferson InterProfessional Education Center 2012 Conference: Interprofessional Care for the 21st Century: Redefining Education and Practice, Philadelphia, PA, May 2012.

References

  1. World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization; 2001. Training materials are available at http://www.who.int/classifications/icf/icfapptraining/en/index.html. 
  2. Steiner WA, Ryser L, Huber E, Uebelhart D, Aeschlimann A, Stucki G. Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Phys Ther. 2002 Nov;82(11):1098-107. 
  3. Allan CM, Campbell WN, Guptill CA, Stephenson FF, Campbell KE. A conceptual model for interprofessional education: the international classification of functioning, disability and health (ICF). J Interprof Care. 2006 Jun;20(3):235-45. http://dx.doi.org/10.1080/13561820600718139
  4. Kearney PM, Pryor J. The International Classification of Functioning, Disability and Health (ICF) and nursing. J Adv Nurs. 2004 Apr;46(2):162-70. http://dx.doi.org/10.1111/j.1365-2648.2003.02976.x
  5. Huber M. How should we define health? BMJ 2011;343:d4163. 
  6. Unpublished data from qualitative analysis of Health Mentors reflection papers: Panichelli A, Brown K, Krizman S, Ankam N, Jerpbak C, Collins L, Speakman E, Umlaud E, and Arenson C. 

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ISSN 2374-8265