Perspective Chapter: Opportunities and Barriers to Effective Multi-Disciplinary Teamwork in the Education and Training of Allied-Healthcare Students

Abstract

Collaboration between different allied-healthcare professionals through multi-disciplinary teamwork can help lead to integrated care and subsequently better outcomes for patients. Based on their experiences, the authors reflect upon both the advantages and the challenges to effective teamwork in a healthcare setting. They consider how higher education and training of allied-healthcare students could benefit from greater cross-professional collaboration, and they give their perspectives on the barriers and constraints to collaboration across disciplines. Within this chapter, the three authors who are all both university educators and allied-healthcare professionals, also deliberate on a specific example of head injury/concussion where there is potential opportunity to improve collaboration across their respective professions of Audiology, Physiotherapy and Optometry. They explore how cross-professional collaboration may help to provide improved patient-centred care.

1. Introduction

This chapter considers both the opportunities and barriers to employing multi-disciplinary approaches in both healthcare settings and in the training of allied healthcare students. The authors’ experiences of multi-disciplinary approaches in healthcare and cross-professional collaboration in education will be examined. They discuss some examples within their own specialisms of cross collaboration in the academic setting. This discussion is set in the context of the continued importance of allied healthcare professionals providing individualised patient-centred care.

2. Multi-disciplinary approaches within healthcare settings

The World-Health Organisation (WHO) [1] states that current health services are not sufficient for 21st century challenges and that half the world’s population does not have access to essential health care. It is evident that even in developed first world countries, healthcare settings are posing ever more challenging for medical, nursing and allied-healthcare professionals for multiple contributing reasons including but not limited to: the ageing population; increases in waiting lists for assessments, diagnoses, and interventions/treatments; shortage of resources; difficulties recruiting staff and difficulties retaining staff; sometimes ineffective training pathways for some professions; lack of funding and variation in referral pathways. Therefore, it is particularly important to continue to develop more effective and streamlined processes and procedures in healthcare. There is a gradual move towards increasing holistic and multidisciplinary approaches in healthcare [2].

A multidisciplinary team (MDT) is defined by the United Kingdom’s (UK) National Health Service (NHS) as a group of health and care staff from different organisations and professions that work together to make decisions regarding the treatment of individual patients and users [3]. Typically, patients want efficient organised healthcare suited to their needs [4]. The main driving force in introducing multi-disciplinary approaches in healthcare is to help to provide patient-centred care [4]. Such multi-disciplinary approaches in healthcare settings are becoming increasingly more important because they can also potentially help with ever increasing cost and waiting list challenges. Additionally, for more complex pathologies, one may argue that a multi-disciplinary approach is the most efficient and useful way to manage such patients [5]. A MDT can come together to achieve a common goal for patients with complex pathologies [5].

3. Multi-disciplinary approaches within higher education

Traditionally, students studying healthcare programmes were educated in “silos” throughout their studies [6]. Yet when they graduated, they were expected to function as part of a wider MDT where they would have to collaborate with other medical, nursing and healthcare professionals [6].

As a result of ever expanding scientific, technological, research, and other discoveries, there needs to be a reflection on the entire professional training curriculum [2]. It is important that future generations of healthcare professionals are encouraged to engage in MDT working from early on in their studies. Many allied healthcare professional subjects/specialisms are taught at tertiary, higher education level. Amongst these different subjects, there is considerable variation in the level of cross subject and/or multi-disciplinary learning and teaching. Often, it is the case that the level of collaboration is limited in the respect that it is typically more generic topics such as research methods, professional skills, clinical governance, and so forth that may be taught to multiple groups of students across multiple disciplines at once. It is often the case, that the subject specific items are taught by the subject specialists to students in that particular subject area. In many cases, students are taught within the confines of a discipline-specific curriculum and students studying these programmes have little exposure to working with other disciplines [6]. Over time, there has been a shift to try and provide more interactive learning between and amongst individuals from various health professions [6]. Yet, there is potential scope for much more collaboration amongst teaching professionals across multiple subject areas. This increased collaboration amongst teaching professionals could potentially enhance the learning experience for the learners. An example of this type of first-hand reflection on collaboration in healthcare education is the current first author whose specialism is Audiology being invited by the second author whose specialisms is Physiotherapy, to deliver lectures on head injury and the audio-vestibular system to a group of Physiotherapy and Sports Medicine students. Other allied healthcare professionals such as Optometrists and Dentists were also invited to deliver topics on head injury and the effects on the visual and oral systems. Having other allied healthcare professionals teach the Physiotherapy and Sports Medicine students resulted in giving the students, who are future allied healthcare professionals, a deeper understanding of the possible effects of head injury on the auditory, vestibular, oral and visual systems. It also gave them more of an awareness of the role of these other professionals and how and when these professionals can help in the patient pathway for head injury patients. This example is discussed in more detail later in this chapter. One may argue that by introducing teaching from other allied healthcare professionals at the stage of education and training is optimum as it encourages trainees from an early stage in their profession to understand, appreciate and be aware of the roles that other professionals can play in the patient care pathway.

In order to enhance cross-professional collaborative practice in healthcare training, there needs to be more innovative strategies devised, these must be developed and implemented [6]. One such strategy to help promote more collaborative practice is by introducing more multidisciplinary, team-based learning activities [6]. These can help promote effective communication, increase teamwork and critical thinking skills [6].

The authors pose that increased multi-professional collaboration across education would be possible if embedded at early educational design stages at the programme and curriculum development stages of setting up new programmes or at programme review stages of existing programmes. This could be achieved in a variety of different ways: one mechanism would be when designing new programmes or reviewing existing programmes to consider if there are any modules which overlap across professions and would benefit from being taught by multiple educators of different professions. To some extent this is sometimes already executed particularly in larger universities for generic subject areas, which allows students from different programmes the opportunity to engage with each other, and also has other added benefits of reducing staffing needs and costs. Often though, a singular lecturer may be in charge of the generic subject as opposed to there being an actual MDT approach to teaching.

Another point of introducing multi-disciplinary teaching and learning could be later in the design process at modular level when designing individual modules or reviewing them. The level of cross collaboration could vary dependent on the subject and scope for collaboration. At a minimal level this could be something similar to the example above where Audiology, Optometry and Dentistry academic staff lectured Physiotherapy and Sports Medicine students. However, it would be more beneficial if this was at a much more enhanced deeper level. For example, when designing the module, academics from these different professions could converge and all be involved in the module design. They could design the module in a way that could be relevant to multiple professions and allow multiple student groups to be taught together. This MDT approach would mean that the training itself was tailored to work for multiple groups of students who would benefit from becoming more aware of the roles of professions other than their own and understanding how they could work together with these professions. This type of MDT in module design would have the added advantage of reduced staffing and costs in the mid to long term. Nevertheless, there are a number of envisaged constraints of trying to introduce multi-disciplinary teaching and learning strategies in the design stages including: the practicality, for example, different programmes develop and have reviews at different stages so the timelines which may suit one profession well may not be ideal for all other professions; most allied healthcare professions are accredited by their individual regulatory bodies which have stringent requirements and the priority of meeting these requirements would typically supersede other needs such as MDT needs; such programmes nowadays can be delivered in different modes of delivery so one group of students from one profession may be taught face-to-face when others are taught online- so there may be a mis-match in mode of delivery requirements and scheduling needs; such programmes often incorporate a placement or work-based learning element and again these schedules may be different across subjects.

3.1 Third level education examples promoting cross professional collaboration

3.1.1 Reflection on a module on concussion and the opportunity to involve other professions

This reflection is set in the context of a three-day block taught module that is delivered within a MSc Sports Medicine programme at a university in the UK. The 20-credit module ‘Concussion, Head and Neck Injuries in Sport’ was initially included within the MSc Sports Medicine programme as the prevalence of concussive injuries are increasingly being recorded within sport [7]. At the time of module delivery (May 2022), the Consensus Statement from the Berlin 2016 International Conference on Concussion in Sport [7] was the most current recognised guidance on concussion management, and it refers to the ‘11 Rs’ of sports related concussion (recognise, reduce, remove, refer, re-evaluate, rest, rehabilitate, recover, return-to-learn/return-to-sport, reconsider and residual effects). The content of the module had to reflect these aspects within its learning outcomes, delivery content and assessment as part of constructive alignment [8].

To be able to achieve the module learning outcomes and cover the ‘11Rs’, internal and external guest speakers to the university were invited to deliver sessions as outlined in Figure 1. In addition to the delivery content, assessments were held the following week to assess students learning from the module with a reactive practical demonstration to a case study and a viva oral examination. These two assessment methods were chosen to assess practical skill demonstration with clinical reasoning (practical demonstration) and to assess wider knowledge around specific subject areas taught on the module (viva). The inclusion of both assessment types would reflect and promote Vygotsky’s structural learning theory [9] (practical demonstration) and Paiget’s cognitive development theory [10] (viva).

Figure 1.

Initial management of concussion, head and neck injuries in sport module content and delivery timetable academic year 2021–2022.

Once the module was completed, feedback from educators and students indicated that the dental injuries talk was very interesting as it provided wider learning and taught additional acute pitch side management skills to that of conventional concussion, head and neck pitch side management. These skills would include tooth avulsion management with immediate re-implantation or tooth storage advice for subsequent re-implantation in clinical dental settings. The session also discussed the wider MDT members that could be required if an athlete was subjected to facial injuries and required dental or maxillofacial input. This would have extended the perception of MDT members within Sports Medicine when supporting athletes.

This feedback led to a discussion within the academic postgraduate medical team on how the programme team could further improve the ‘Management of Concussion, Head and Neck Injuries in Sport’ module with crossover from other departments of the medical school. It was discussed how the sport concussion assessment tool 5th edition (SCAT5) included questions around vestibular and vestibular-ocular symptoms but did not directly assess with relevant tests or provide reasoning for why such symptom questions are included. Therefore, knowledge around visual and audiological impairments as a result of concussive type injuries, would provide deeper knowledge opportunities to the students supporting the pedagogical approach of deep learning [11].

3.1.2 Enhancing cross collaboration in the delivery of head injury/concussion module

When designing the module for the subsequent year, the programme team decided to include sessions on ‘concussion and visual impairment’ and ‘concussion and audiology’ to incorporate knowledge around the audio-vestibular and vestibular-ocular systems as discussed previously. The programme team also added a session on ‘review and critique of latest guidelines’ as a considerable amount of literature was being published from the International Concussion in Sport Conference held in Amsterdam 2022, which would feed into the release of the Amsterdam Consensus Statement and new SCAT 6th edition [12]. New evidence [13] suggested that athletes with delayed concussion symptoms of dizziness and balance problems for 10 days or greater, should receive vestibular rehabilitation to reduce symptoms and aid return to sport. This recommendation was added to the Amsterdam Consensus Statement [12] which was later released. The updated block module was scheduled as in Figure 2, to include the additional sessions.

Figure 2.

Updated management of concussion, head and neck injuries in sport module content and delivery timetable academic year 2022–2023.

During preparations of the teaching materials for the delivery of the visual and audiology sessions, one of the barriers encountered was presenting the knowledge at the correct level for healthcare professionals who had little prior knowledge of these subject areas. Although students were masters level students, the content had to start at a basic level, then progress into making links to concussion pathology and understanding how symptoms present the way they do. By using Bloom’s taxonomic ordering of cognitive skills [14], students would firstly start off with remember and understanding of basic eye and ear anatomy and physiology. Later in the session they would then translate that knowledge into interpretation of light and sound changes with concussion pathophysiology, and how visual and audiological pathologies can occur with direct and indirect blows to the head. These links would challenge student learning with the upper orders of Bloom’s taxonomic levels of apply, analyse and evaluate [14] over a very short time span. It was decided by the teaching team that to be most effective, less content would achieve more understanding and application of the knowledge.

Another challenge observed within the session was the lack of pre-reading students had completed due to the compacted schedule of the block taught module with the additional sessions. Student feedback reported that although content was good and applicable, students had far too much content delivered within a short period of time, limiting their ability to pre-read before sessions and process teaching content once delivered. The use of block delivery modules supports a ‘block and blend’ approach where immersive scheduling provides face-to-face activity-based learning alongside blended learning of online learning materials [15]. Students may not have been familiar with this style of delivery, but the additional sessions from last year did make the schedule more concentrated. To support students, the assessments were held one week later than the previous year to allow students more time to prepare and drop-in revision sessions were timetabled to allow further support if needed.

As students completed the block taught module, an appreciation of visual and audiological pathologies in relation to concussion onset was established as evidenced in their viva assessment. Specific questioning around vestibulo-ocular symptoms allowed students to demonstrate their understanding and show links to the anatomy they had learned. Students also had the opportunity to discuss visual and audiological pathologies that would require referral following recognition of their signs and symptoms. This achieved the goal of widening the MDT approach with concussion management and allowed further understanding of the symptom checklist used in the SCAT 6th edition.

3.1.3 Digital devices, vision and ergonomics: the collaborative role of Optometrists and Musculoskeletal clinicians in digital vision

The current ways in which people use their vision and eyes has changed faster that the visual system is evolving. This means that Optometrists are having to provide care to patients whose daily living demands are greater than what the eyes and the body can cope with. One of the main changes has been in the use of digital devices which are electronic units that can send, receive, generate, and display communications [16] Access to internet and digital devices has changed the way in which we interact with each other and our work-life. There has been nearly 50% increase of internet users since 2005 [17].

Between 1992 to 2000, the percentage of workers using a computer all the time at work increased from 7.6% to 11.9% [18]. It appears that before the 2000s, most of the digital device use was in workplaces [18]. As the years progressed, use of digital devices became more common place in social situations as well as the workplace. Since the Covid-19 pandemic, there has been increase in digital device use in education [18]. Globally, in 2023 79% of ‘youth’ compared to 65% of the ‘rest of the population’ use the internet [19]. The term ‘Youth’ is referring to people between 15 and 25 years of age who use the internet as a percentage of the total population aged between 15 and 25, the ‘rest of the population’ is referring to and includes all people under 15 or over 24 years old [19].

In addition to the shift from a typical working age group using digital devices to broader age groups, which includes school aged children, the traditional display screen equipment (DSE) or visual display units (VDUs) have been replaced with more mobile units. There has been a shift from just using the static (desktop computers) or hand-held devices (tablets or mobiles) to wearable devices such as smart watches, smart home devices or smart glasses [17].

The following are the potential impacts on how Optometrists care for their patients:

Ergonomics and posture

The advice on setting up a workstation has been based on the traditional desktop computers where the patient’s eyes need to be 50–70 cm from the screen, the top of the screen needs to be at eye level and the arms need to be straight when using the keyboard. This set-up ensures that patients’ eyes can focus (accommodate) comfortably for the distance that the screen was set. The visual system (eyes) will need between 1.5 dioptres to 2.0 dioptres to focus on a target which is set at 50–70 cm. It has been theorised that to reduce overstrain of the visual system, one third of the patient’s accommodative/focus power needs to remain in reserve [20]. It was this theory which has been used to set out the workstation requirements and the continued clinical advice that Optometrists give their patients in terms of digital screen use related eye strain. The alignment of the screen to the eyes is based on the posture of the spine and the angle of the arms to the keyboard. In relation to the ergonomics of the desk and chair.

As the Global Overview 2023 report [17] indicates, the use of traditional desktop computers is falling, and most people will have a set up where they are looking at a laptop on a desk as well as looking at a held-held device such as a smartphone or a tablet. This means that the viewing distance for the held-held device is around 40 cm away from the eyes whilst the laptop screen is around 55 cm away. The laptop screen is usually closer than the static desktop monitor as the keyboard is attached to the screen on a laptop. This means that when someone is using a laptop, they need to arrange their arms in a comfortable position to allow them to type using the attached keyboard making the viewing distance of the screen closer. The position of the screen is below eye level and patients have to bend their heads downwards and maintaining this position for a prolong period of time can cause muscular strain in the neck and the base of the head.

As the viewing distances of mobile phones and tablet is much closer to a viewing distance with a computer screen, the constant moving of focus between these different distances throughout the day can cause eye strain. Visual fatigue in VDU users has been reported for many years [21] and this has since been renamed as Digital Eye Strain (DES). A recent review in 2022 showed that the prevalence of DES in children rose to 50–60% [22]. The review discussed management options to reduce the symptoms of DES but it only considered the role of the eye care practitioner rather than looking at it holistically.

Optometrists regularly hear patients report both symptoms of DES and an increase in neck and back ache, therefore the advice given by Optometrists to their patients’ needs to include guidance about good musculoskeletal health. 47% of computers users have complained of low back pain after three to four hours of use [23]. This means that there is a need for Optometrists and Musculoskeletal specialists to collaborate when advising patients on good habits around digital device use to ensure that patients do not experience prolonged/sustained problems which can affect the quality of life. Setting up an optometry programme within a university’s medical school, meant that Optometry staff had the opportunity to deliver a programme with input from different disciplines such as Musculoskeletal specialists.

Outside of the academic setting and multi-disciplinary teaching of clinicians, the importance of these professions working together can be seen in the 2023 “Love Your Eyes at Work” World Sight Day campaign by the International Agency for the Prevention of Blindness where a poster which indicates 6 ways to reduce eyestrain mentions ergonomics [24].

The posture of optometrists

As digital devices become part of everyday life, they are also changing the work environment of Optometrists. Due to the strange sitting positions that Optometrists need to work, and the repeated nature of these tasks, there is a history of complaints of back pain amongst these professionals [25]. Optometrists must be sat to one side of the patient but be able to stretch to reach across the patients’ eyes, stand over the patient to look into the eye to assess the health of the eye and to swing machinery around to bring it in front of and away from the patients, and this is typically repeated many times a day for each patient.

In addition to the existing musculoskeletal issues, the digital screen use within the consulting rooms has increased – vision testing charts are now often either LCD screens or computer screens, often nowadays, record cards are computerised, and referrals are electronic. This means that alongside the usual awkward positions that an Optometrist has to adopt to assess a patient’s eyes, compounding this they now have to use digital devices on a daily basis. Most digital devices are added to the consulting rooms after the clinical equipment has been installed and therefore the working distances and set-up required for use of computers is not followed making it an uncomfortable working environment.

In the authors’ current university, as part of the training of Optometry students, students are taught about digital eye strain and posture recommendations for their own self-care. This is to reduce the risk of musculoskeletal pain in terms of the postures the students need to adopt to carry out specific clinical tests using the guidance/advice from Physiotherapy lecturers. This is the same advice that Optometrists offer patients about digital eye strain. A few years ago, an ergonomic specialist sat in for a day to observe Optometrists in their work environment and the ergonomic specialist provided some stances and sitting positions which would reduce the strain. These stances and positions are now included in the clinical skills teaching of Optometry students at the university and represents a positive impact of a multi-disciplinary working.

The involvement of eye care (Optometrists, Dispensing Opticians, Ophthalmologists and Orthoptists) and Musculoskeletal professionals is intertwined, and thus the there is a need to further explore the collaborative working partnership between these two disciplines. As technology changes and how people work and live is constantly evolving, multidisciplinary working is going to be paramount for offering quality care to patients.

3.1.4 Further opportunities for enhanced cross collaboration approaches in healthcare and higher education

Working within a multi-disciplinary setting within the university has the benefit of giving staff the opportunity to learn from other professions; an example for Optometry staff is the learning from colleagues within the Physiotherapy and Sports Medicine courses. This collaboration has had a positive impact as when teaching Optometry students about prescribing for DES/VDU users in the sub-topic of occupational Optometry, the ergonomic advice and good posture guidance is taught alongside the optical theories. It is envisaged that this initial exchange of specialist experiences and learning will be developed into an interprofessional module where Optometry, Ophthalmic Dispensing and Physiotherapy students can be taught about digital eye strain and ergonomics. As discussed earlier, there is already a unit within the Concussion module where a multi-disciplinary approach between Optometry, Audiology, Dentistry, and Sports Medicine is being utilised for teaching students. Continued collaboration is planned in this area with the planning to grow the joint teaching sessions in several different programmes.

Due to the ageing population, the incidence of falls is increasing. Falls are one of the most common problems in older adults [26]. The prevention and management of falls is a global challenge [27]. Managing patients with falls is another area where the authors of the current chapter feel there is scope to cross collaborate across their three respective professions to help better manage patients with falls. Policymakers and healthcare providers need to seriously consider and focus on both prevention of falls and intervention [26]. Simple changes can help reduce the risk falls including; providing assistive equipment, proper lighting within homes, regular eye examinations in the elderly, and proper footwear [26]. This type of prevention would require a MDT including Physiotherapists, Social Workers, Optometrists and Podiatrists. Whilst prevention is key, for those who do have falls, diagnosis and intervention and rehabilitation can significantly impact the quality of life of an individual. Audio-vestibular Physicians, Audiologists and Physiotherapists can work together in the diagnosis and rehabilitation of those with vestibular problems who may have had falls or are at risk of falling. As discussed in the example earlier in the chapter in an educational setting there has been some cross professional teaching in this area. However, there are many more opportunities for this to evolve in the future whereby at the next programme review Medical, Audiological and Physiotherapy professional academics could consider how they could teach and design these modules together. In the healthcare setting, for patients with problems in the balance system, there is a lot of cross-over work between the professions particularly in the rehabilitation of these patients, therefore it would be advantageous to consider the elements of training of some elements for these professions together. Falls is just one example where the authors of this current chapter and their respective professions could collaborate.

There are many other areas in ageing where MDT would enhance care of this population. For example, one particularly challenging area is cardiovascular disease. It accounts for 17,500 deaths globally and this represents nearly half of all non-communicable disease (NCD) deaths [28]. Jennings poses that it the collaboration between multiple professionals including Physicians, Nurses, Pharmacists, Psychologists and other allied healthcare professionals which will help to win the battle against NCDs [28].

Alzheimer’s Disease (AD) is another common occurrence in the older population. AD is the most common form of dementia affecting the ageing population [29, 30]. The eye has been shown to be an early biomarker for AD [29, 30]. There is also an indication that there are links between dementia and hearing loss [31, 32] and that Presbyacusis (age-related hearing loss) can be an indicator for dementia [31]. Although a lot more research is needed to get a consensus on the association between hearing loss and dementia, it is clear that it would be advantageous if there was more collaboration amongst Audiology, Optometry and other professions in the patient pathway for patients with dementia. Multidisciplinary approaches adopted for AD so far have made substantial contributions in helping to understand both the cognitive and physiological changes associated with it [33].

4. Opportunities and barriers to MDT within healthcare settings

Huddles are short briefings which are designed to give healthcare staff opportunities to meet, they help professionals to stay informed, evaluate things that have happened, and make plans which helps to result in well-coordinated patient care [34]. A systematic review in 2021 has demonstrated that daily multi-disciplinary huddles can help improve both teamwork and healthcare professionals’ job satisfaction [35]. Collegiality is important for both staff and patients [35]. Multidisciplinary huddles can help teams to address issues such as safety concerns and staffing issues [35]. Huddles are a mechanism to look at an individual patient’s goals of care collaboratively [35]. Introducing daily multidisciplinary huddles into healthcare are an opportunity to increase collaboration amongst professionals. However, often time constraints and increasing waiting lists can make this difficult. Therefore, even if daily huddles are difficult to schedule, weekly huddles may be another option, which could help facilitate more MDT.

Other barriers to MDT in healthcare settings are typically: financial constraints; lack of flexibility in systems; reluctance to collaborate; hierarchical systems; time constraints; having a designated organisational lead to arrange MDT meetings/huddles; logistical issues such as a mis-match in different professionals’ rotas; adversity to change; and a lack of motivation as MDT set-up may require time in the initial stages. Therefore, the authors pose the question that in order to overcome/address some of these challenges, whether MDT should be incorporated at a higher strategic management stage of healthcare organisations as a target/goal so that when this filters down into individual departments, it is easier to accommodate MDT and in turn MDT becomes the “normal” way of working? Therefore, there needs to be a shift or movement towards prioritising MDT in healthcare settings. The collaboration between specialisms and reducing “silo” working should be encouraged from the top of organisation down to those working “on the ground” directly with or for patients. Having this “buy-in” from higher up would help create protected MDT times which would overcome one of the main current barriers to collaboration.

5. Opportunities and barriers to cross professional collaboration in higher educational settings

The authors believe that with the ever changing and demanding healthcare environments, that the education of allied healthcare students could be further enhanced and modernised in order to help meet the growing and challenging workforce needs. As discussed earlier, for many years often generic transversal skills have often been taught in universities to multiple groups of students in the same session. However, there are many more opportunities to develop and increase the level of MDT between academics teaching different healthcare subjects. One such way is to introduce modules on “hot” topics such as ageing, one such example may be a module on Multidisciplinary Approaches to Ageing Processes. This type of module could be designed and taught by MDT and would benefit the students’ training. Additionally, by gaining this training from different professionals will aid trainees in the future, as by the time they become graduates they will already have seen how to work as part of teams across disciplines. It will make them more aware from an early stage of training/career how other professionals contribute to a patient’s care pathway. The authors envisage that one of the main challenges would be accommodating such modules in often already tight time constraints of a programme delivery. This type of module would work well for primary training of healthcare students, the level of this primary training can differ, in some professions it may be at foundation level, in others at bachelors level or other healthcare training is at masters level.

The collaboration within the professions mentioned is slowly developing for students studying these disciplines but there is scope to develop a further range of continuous professional development (CPD) courses for clinicians who are already providing care for their patients. One such example as discussed earlier is the growth of the use of digital devices which is on an exponential growth and the prevalence of digital eye strain and musculoskeletal issues will increase. In the near future combined clinics where a patient can have an eye examination as well as a physiotherapy appointment with a combined management plan is a strong possibility.

CPD is a key lifelong component of a healthcare professionals working life. Micro-credentials are a key mechanism to support ongoing CPD for the busy healthcare professional. The impact of the acceleration of online learning post the Covid-19 pandemic has widened a world of training opportunities including the increased volume of micro-credentials available or employees wishing to enrol on CPD courses [36]. Having short courses available online makes CPD training more accessible and with an ever-increasing international focus on both population health and public health, it is timely to start to widen the CPD opportunities for healthcare professionals. As well as having subject specific short CPD courses, there is a potential growth for more generic multidisciplinary modules that would be attractive to different healthcare professionals, modules could be around evolving areas such as: Multidisciplinary Challenges and Complexity of Healthcare Provision for Older Adults; Innovation in Support of Active and Healthy Ageing; and Innovation in Healthcare Technologies. These suggestions are all topics which are emerging and of use to the modern allied healthcare professional.

6. Conclusion

It is evident that the future of healthcare and meeting ever complex healthcare needs is a continuing global challenge. However, the authors pose that more MDT working may help alleviate some of the current burdens and challenges on health services. More strategic and streamlined processes encouraging MDT are needed. There are also many new and current developments which may further assist/ support healthcare challenges. Modern technological developments and innovations may complement implementation of multidisciplinary approaches. One such development which may be used to positively contribute to more streamlined healthcare processes is Artificial Intelligence (AI) [37]. Sezgin poses that AI is creating a paradigm shift in healthcare by complementing and enhancing the skills of medical and healthcare professional [37]. In addition, to increasing MDT in the healthcare setting, it is crucial to look at opportunities to increase more MDT in the training of future allied healthcare professionals. In order for this MDT to be effective, it is better to incorporate this at a higher early stage of programme design and module design in higher education so that MDT is not just an “add-on” or “after thought”, but instead an overarching ethos of all allied healthcare programmes and in turn all healthcare professionals of the future.