Shared goals, shared learning: evaluation of a multiprofessional course for undergraduate students

Twenty-eight undergraduate degree students from seven health care professions attended a two-day pilot course. Using small multiprofessional groups, final-year students from occupational therapy, orthoptics, therapy radiography, nursing, physiotherapy, medicine and dentistry explored professional roles and clinical problem-solving using a theme-based approach. A balance of didactic and interactive small-group learning enabled them to identify issues surrounding multiprofessional teamworking and collaboration in the National Health Service. Evaluation results showed that the course increased knowledge and understanding of other health care professions, developed more positive attitudes and demonstrated the importance of multiprofessional teamwork and communication. Participating students believed that both early and regular opportunities for shared learning should be essential aspects of undergraduate courses.     

Validating the Readiness for Interprofessional Learning Scale (RIPLS) in the postgraduate context: are health care professionals ready for IPL?

AIMS: This paper describes the process of validating the Readiness for Interprofessional Learning Scale (RIPLS) for use with postgraduate health care professionals. CONTEXT: The RIPLS questionnaire has proved useful in the undergraduate context, enabling tutors to assess the readiness of students to engage in interprofessional learning (IPL). With the drive in the National Health Service (NHS) to deliver health care in interprofessional teams, it seems logical to ask whether postgraduate education should, or could, be delivered successfully in interprofessional contexts. As a preliminary to undertaking an extended IPL project, the researchers tested the validity of the RIPLS tool in the postgraduate health care context. METHOD: A modified version of the RIPLS questionnaire was administered to all general practitioners, nurses, pharmacists and allied health professionals in the Dundee Local Health Care Cooperative (LHCC) (n = 799). A total of 546 staff responded (68%). RESULTS: Three factors, comprising 23 statements, emerged from the statistical analysis of the survey data, namely, teamwork and collaboration, sense of professional identity and patient-centredness. The internal consistency measure was 0.76. Analysis of variance suggested some key differences between the different professions in respect of the factors. CONCLUSIONS: The RIPLS questionnaire was validated for use in the postgraduate context, thus providing researchers with a tool for assessing health professionals' attitudes towards interprofessional learning at practice level, community health partnership level or at a national level of education and training. Significant differences between professional groups should be taken into account in designing any interprofessional learning programme.     

Measuring the effect of interprofessional problem-based learning on the attitudes of undergraduate health care students

OBJECTIVES: This study aimed to measure the improvement in attitudes towards interprofessional collaboration of undergraduate health care students who have a single module of interprofessional problem-based learning (PBL) using real patients as triggers integrated into their curricula. DESIGN: A dedicated module, consisting of 5 PBL seminars, was integrated into the undergraduate medical, nursing and physiotherapy curricula at the participating institutions. Seminar groups consisted of students from a single profession in the control group, and of evenly distributed students from the participating professions in the intervention group. The Interdisciplinary Education Perception Scale was used to measure improvements in attitudes towards interprofessional co-operation. Patients, faculty members and students were included in the evaluation of the interprofessional module and their comments examined for indications of adverse effects of the use of patients in this setting. RESULTS: A total of 177 students were recruited into the study and assigned to 1 of 16 seminar groups, all of which attended the complete module, 8 in control mode and 8 in intervention mode. Statistically significant improvements could be identified in the overall attitudes of male students in the intervention group, and in attitudes pertaining to the competence and autonomy of individuals in one's own profession in the intervention group as a whole. No significant improvements were detected in the control group. No adverse effects of the use of real patients came to light. CONCLUSIONS: The integration of an interprofessional educational module that requires limited student and faculty time in undergraduate health care curricula may be proven to have an effect. The Interdisciplinary Education Perception Scale may be suitable for measuring such effect. Real patients may continue to contribute to education in this setting.     

Impact of an interprofessional community-based educational experience on students' perceptions of other health professions and older adults

Caring for older adults has become increasingly complex due to multiple health and societal factors. The purpose of this study was to evaluate the impact of an interprofessional community-based educational project on students' attitudes toward other health care professions and older adults. A pretest and posttest quasi-experimental research design was implemented with 64 participating students from four health care professions (nursing, occupational therapy, physical therapy, and pharmacy). These students completed the Interdisciplinary Education Perception Scale (IEPS) and Survey of Attitudes on Aging Scale (SAAS) before and following an educational experience with older adults. Qualitative data were collected through student reflection journals and focus groups with participating students. The results of the study showed that interprofessional community-based learning had a significant impact on some students' attitudes toward older adults. The difference between pretest and posttest reached a statistically significant level on the SAAS in occupational therapy (p = 0.013) and physical therapy students (p = 0.044). No significant differences, however, were found between the pretest and posttest in pharmacy (p = 0.097) or nursing students (p = 0.144). Similarly, the experience also had a positive impact on some students' perceptions of other health care professions as measured by the IEPS. A significant difference was found between the pretest and posttest in occupational therapy (p = 0.000) and physical therapy students (p = 0.028). This study indicates that interprofessional community-based learning can be an effective method for some students to increase their understanding and respect toward other health professionals and older adults.     

A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention

A longitudinal quantitative study in an English faculty of health and social care explored the effects of a pre-qualifying interprofessional curriculum for students from 10 professional programmes. Students on the interprofessional curriculum completed questionnaires containing four attitude scales on entry to the faculty, during their second year and at the end of their final year. At qualification, 581 students (76.9% of those qualifying) completed scales concerning their communication and teamwork skills, their attitudes towards interprofessional learning, their perceptions of interaction between health and social care professionals, and their opinions about their own (inter)professional relationships. Questionnaires were completed at both entry and qualification by 526 students (69.8% of those qualifying), and at all three points by 468 students (61.9% of those qualifying). A comparison group of 250 students (67.6% of those qualifying) on the previous uniprofessional curricula also completed questionnaires at qualification. Students on the interprofessional curriculum showed no significant change in their self-assessment of their communication and teamwork skills between entering the faculty and qualification. However, there was a negative shift in their attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own professional relationships at qualification. Students with previous experience of higher education were comparatively positive about their communication and teamwork skills, as were female students about interprofessional learning. However, the strongest influence on students' attitudes at qualification appeared to be professional programme. This suggests that interprofessional education does not inhibit the development of profession-specific attitudes. Students who qualified on the interprofessional curriculum were more positive about their own professional relationships than those who qualified on the previous uniprofessional curricula. These data suggest that experiencing an interprofessional curriculum has an effect on students' attitudes at qualification, particularly with regard to their positive perception of their own professional relationships.     

Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning

OBJECTIVES: The belief that the effectiveness of patient care will improve through collaboration and teamwork within and between health care teams is providing a focus internationally for 'shared learning' in health professional education. While it may be hard to overcome structural and organizational obstacles to implementing interprofessional learning, negative student attitudes may be most difficult to change. This study has sought to quantify the attitudes of first-year medical, nursing and pharmacy students' towards interprofessional learning, at course commencement. DESIGN: The Readiness for Interprofessional Learning Scale (RIPLS) (University of Liverpool, Department of Health Care Education), was administered to first-year medical, nursing and pharmacy students at the University of Auckland. Differences between the three groups were analysed. SETTING: The Faculty of Medical and Health Sciences, University of Auckland. RESULTS: The majority of students reported positive attitudes towards shared learning. The benefits of shared learning, including the acquisition of teamworking skills, were seen to be beneficial to patient care and likely to enhance professional working relationships. However professional groups differed: nursing and pharmacy students indicated more strongly that an outcome of learning together would be more effective teamworking. Medical students were the least sure of their professional role, and considered that they required the acquisition of more knowledge and skills than nursing or pharmacy students. CONCLUSION: Developing effective teamworking skills is an appropriate focus for first-year health professional students. The timing of learning about the roles of different professionals is yet to be resolved.     

Interprofessional training in the context of clinical practice: goals and students' perceptions on clinical education wards

AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.     

Student attitudes towards anatomy teaching and learning in a multiprofessional context

CONTEXT: We carried out a survey of attitudes to learning anatomy amongst students from a range of health care disciplines in a multiprofessional context. SETTING: A joint course called the Common Foundation Programme (CFP) presented by a hospital medical school and a joint university faculty of health and social care sciences in the UK in the first term of the students' courses. PARTICIPANTS: Students following degree courses in biomedical science, medicine, nursing, physiotherapy, diagnostic radiography and therapeutic radiography. OBJECTIVES: To assess student attitudes to cadaveric work, learning anatomy and multiprofessional learning, and to compare student performance between degree courses in an anatomy assessment. DESIGN: A questionnaire was designed that requested demographic information and the students' attitudes to cadaveric work, anatomy learning and multiprofessional learning on a Likert scale. All students sat the same anatomy assessment at the end of the first term. RESULTS: The biomedical science and medical students were the most apprehensive about entering the dissecting room. The biomedical science students enjoyed working in a multidisciplinary group the most. Assessment results varied widely and the physiotherapy and medical students scored more highly than students in other disciplines, although all students had participated in the same course. CONCLUSIONS: It was possible to teach anatomy in the context of the shared learning experience of the CFP, although performance varied widely. Reasons for the differences are discussed and suggestions for the design of multiprofessional courses involving anatomy are made.     

Dietetics students’ perceptions and experiences of interprofessional education

Background: Interprofessional education (IPE) is a process through which students are provided with learning opportunities with other professions aiming to improve client care. The need to include effective IPE in preregistration programmes for health professionals is increasingly being recognised. The overall aim of the present study was to explore the perceptions and experiences of final‐year dietetics students of IPE delivered through interactive online learning groups. Methods: A questionnaire was developed to evaluate the students’ satisfaction with the IPE modules, including importance to their clinical placements, and their understanding of the roles of other professions. Six dietetics students took part in a focus group that addressed the impact of participating in the IPE modules. The focus group discussion was recorded, transcribed and subjected to content analysis. Results: Twenty students completed the questionnaire (77% of the cohort). Satisfaction with the IPE modules increased as the programme progressed, with 65%, 90% and 95% of the respondents, respectively, being satisfied with the content, assessment and access of the final module. Participating in the programme enhanced the students’ opinions on the value of the roles of other professionals (80%) and enhanced their awareness of interprofessional issues (75%). Four key areas of interest emerged from the focus group analysis: key impressions; understanding the role of the dietitian and other professionals; the advantages and disadvantages of online delivery; and interprofessional working in the work environment. Conclusions: The most important outcome of participating in IPE was that students’ knowledge of other professions was enhanced, which had a positive impact on placements. An effective information technology infrastructure and appropriate scenarios are key requirements for the online delivery of IPE.     

Interprofessional learning involving medical students or doctors

AIMS: There is a belief that interprofessional learning among health care professionals promotes teamwork and collaboration, leading to improved patient care, but supporting data have not been available. Our aim was to identify recent studies on interprofessional learning involving medical students or doctors. METHODS: The medical education literature was searched for relevant publications since 1998 and the studies were subsequently classified according to various criteria. RESULTS: A total of 24 'research papers' and 36 'literature review/editorial-type papers' were identified. Research papers generally described interprofessional learning initiatives and evaluated their success in terms of knowledge or attitudes by data collection. Seven collected qualitative data, 4 collected quantitative data and 11 collected both. None of the studies identified conformed to the Cochrane Collaboration guidelines for a rigorous source of quantitative information on an intervention's effectiveness. DISCUSSION: The authors suspect that significantly more studies have been performed than those published. This may indicate research of variable quality, leading to a large proportion of papers being rejected for publication. More and better quality research is required as more resources become available to academic and health care organisations for interprofessional learning.     

Should professional ethics education incorporate single-professional or interprofessional learning?

Since ethical issues in the contemporary delivery of health care involve doctors, nurses, technicians, and members of other health professions, the authors consider whether members of diverse health care occupations might benefit from studying ethics in a single classroom. While interprofessional courses may be better at teaching the ethics of the relationships between and among the various health professions, single-professional courses may be better at teaching the ethics of relationships between particular kinds of professionals and patients. An ethics instructor’s professional discipline affects his/her credibility with the students, and the course readings may not always be relevant to the actual work of a given discipline. With these challenges in mind, the authors suggest that the boundaries of ethics education in the health professions be reconceived to accommodate the professional mission of a specific discipline as well as the interdependence and collaboration that marks high quality health care.     

Characteristics of doctors and nurses as perceived by students entering medical school: implications for shared teaching

INTRODUCTION: Debate continues with respect to when to introduce interprofessional education for maximal potential benefit. One perspective is that interprofessional education should be introduced early in the undergraduate curriculum before students develop stereotyped impressions of other professional groups. However, it may be that students at entry to medical school have already developed these stereotypical impressions. This study examines perceived professional characteristics of doctors and nurses by students entering medical school. METHODOLOGY: Year 1 medical students in 4 consecutive years completed a questionnaire on their perceptions of the characteristics and backgrounds of nurses and doctors and on their attitudes to shared teaching. RESULTS: Year 1 medical students were found to perceive the characteristics of doctors and nurses differently. They considered nurses to be more caring and doctors to be more arrogant. They considered nurses to have lower academic ability, competence and status, although comparable life experience. They were generally very positive about beginning shared learning at an early stage of training. DISCUSSION: Whilst it is encouraging that medical students are positive about shared teaching, it is of concern that they have a poor perception of the academic ability, status in society and professional competence of the nurse at entry to medical school. These perceived impressions, which may reflect societal misconceptions regarding the roles and responsibilities of nurses within a modern health care system, may have an impact on the success of early interprofessional teaching initiatives in undergraduate curricula.     

From being a nurse to becoming a ‘different’ doctor

Using interpretative phenomenological analysis to make meaning of the experiences of three highly qualified registered nurses who had enrolled in an undergraduate medical programme, this study provides insight into their personal journeys of wanting to become ‘different’ doctors. In so doing, they conceptualised their future selves as adding clinical reasoning and diagnostic skills to the patient-centred caring ethic of their nursing practice, becoming a multi-skilled community member or helping to fix the health care culture. By customising their identities, e.g. by splinting (aligning with their stronger nursing identity), by enriching current nursing practice with newly acquired theory as medical students or by patching a perceived deficiency (i.e. patient-centredness) in medicine, they tailored their identities. Their journeys had, however, not been the natural progression they had anticipated, threatened by perceived and/or real intrinsic (e.g. working as nurses whilst studying medicine) and extrinsic (e.g. interprofessional rivalry) factors. Rather than being accepted as legitimate newcomers to the medical profession, the women sometimes felt like intruders. Some nursing colleagues accused them of desertion. In response, they generally withheld their identities as nurses or medical students, compartmentalising their group membership. This study has highlighted the role of personal (e.g. prior experience; agency; resilience; personality) and contextual factors in ‘becoming’ a doctor. A recommendation emerging from this study is the need for interprofessional learning in the medical curriculum to cultivate a health care culture of collaboration rather than competition. Future research is required in terms of how allied health professionals transition to medicine.     

Instructional Insight into Interprofessional Education (IPE)

ABSTRACT

Working with other health science professionals in order to promote positive client outcomes is common practice in many rehabilitation delivery areas. The evolution of health care delivery seems to expect more efficient and cost effective client care, therefore the introduction of blended professional teams is moving to the forefront of professional education. As such, providing opportunities to health science students to experience the roles and practice of other professions during the academic portion of their education, Interprofessional Education (IPE), has become and expectation of accrediting bodies.

The Accreditation Council for Occupational Therapy Education (ACOTE) has included standards related to IPE (ACOTE, 2012). The most recent ACOTE standards, effective July 2013, require occupational therapy educators to provide interprofessional collaborative situations to increase student awareness of and participation in interprofessional learning (ACOTE, 2012). This article describes some of the IPE experiences of one small university as well as provides suggestion for other occupational therapy educational programs to move forward to meeting the newly established accreditation standards.     

The doctor dilemma in interprofessional education and care: how and why will physicians collaborate?

CONTEXT: Interprofessional educational (IPE) initiatives are seen as a means to engage health care professionals in collaborative patient-centred care. Given the hierarchical nature of many clinical settings, it is important to examine how the aims of formal IPE courses intersect with the socialisation of medical students into roles of responsibility and authority. OBJECTIVES: This article aims to provide an overview of doctor barriers to collaboration and describe aspects of medical education and socialisation that may limit doctor engagement in the goals of interprofessional education. Additionally, the paper examines the nature of team function in the health care system, reviewing different conceptual models to propose a spectrum of collaborative possibilities. Finally, specific suggestions are offered to increase the impact of interprofessional education programmes in medical education. DISCUSSION: An acknowledgement of power differentials between health care providers is necessary in the development of models for shared responsibility between professions. Conceptual models of teamwork and collaboration must articulate the desired nature of interaction between professionals with different degrees of responsibility and authority. Educational programmes in areas such as professionalism and ethics have shown limited success when formal and informal curricula significantly diverge. The socialisation of medical students into the role of a responsible doctor must be balanced with training to share responsibility appropriately. Doctor collaborative capacity may be enhanced by programmes designed to develop particular skills for which there is evidence of improved patient outcomes.     

" 'Just think of TB and Asians', that's all I ever hear": medical learners' views about training to work in an ethnically diverse society

The case for being able to respond effectively to cultural and ethnic diversity in health care is attracting increasing debate in medical education. However research exploring the perspectives of learners is lacking. AIMS: We sought medical learners' perceptions and their perceived training needs in relation to cultural and ethnic diversity in health care. METHODS: A series of nine focus group interviews was conducted with 55 medical learners, including undergraduate students in a UK medical school and a group of postgraduate general practitioners in training. Interview data were analysed using qualitative methods. RESULTS: Participants had a broad but superficial awareness of multicultural issues. This focused upon "difference" with students emphasizing their need to acquire knowledge of different beliefs and practices. Current teaching was perceived as inadequate and limited largely to ethnic patterns of disease. Most felt a need for greater training. They regarded development of particular communication skills, such as working with interpreters as helpful. Beyond avoiding stereotyping, learners rarely identified reflecting upon their attitudes or the issue of racism as important. Students anticipated a range of potential problems for further training, but sought learning that was relevant, practically oriented and stimulating. CONCLUSIONS: The study points to learners' experience of inadequate training but suggests a willingness to learn more. The possible predominance of a "difference" perspective might drive a narrow focus upon learning cultural knowledge at the expense of promoting a balance with self-reflection upon attitudes and developing generic skills. Educators might heed learners' views about how they should be taught successfully.     

Knowledge translation in interprofessional education: what difference does interprofessional education make to practice?

Cancer Care Nova Scotia developed an Interprofessional Core Curriculum for Nova Scotia health professionals, using a provincial educational needs assessment of health professionals caring for patients with cancer. This paper reports on the educational outcomes of the Interprofessional Core Curriculum programme, particularly the translation of learning into changes in practice and interprofessional interaction, and factors influencing change. The evaluation was guided by Kirkpatrick's model for assessing educational outcomes and Green and Kreuter's PRECEDE model of factors promoting and impeding change. In total, 411 participants attended the sessions, including nurses (54%), pharmacists (23%), and physicians (11%). We used self-report questionnaires to assess the transfer of learning into changes in practice and interprofessional interactions. High percentages of participants reported changes in both clinical practice and interprofessional interactions 3 months after the sessions. Frequently reported changes to interprofessional interactions were improved communication, increased confidence and assertiveness in interactions with other health professionals and being more respectful of other professions. Participants identified time and work-load as major barriers to change as well as lack of micro- and macro-system level support. The most common reported enabler of change was having attended the educational session. Overall, participants were highly supportive of interprofessional education, although when compared to nurses and pharmacists, physicians were less supportive and had proportionately lower attendance.     

The roles of healthcare professionals in implementing clinical prevention and population health

Across the health disciplines, clinical prevention and population health activities increasingly are recognized as integral to the practice of their professions. Most of the major clinical health professions organizations have begun incorporating clinical prevention and population health activities and services into educational curricula, the accreditation process, and training to affect clinical practice. Students in each health profession need to understand the roles played by those in other health professions. This understanding is a prerequisite for better communication and collaboration among the professions and for accomplishing the educational objectives included in Healthy People 2020 and organized using the Education for Health framework. To help accomplish these goals, this article summarizes each health profession's contributions to the field of prevention and population health, explains how the profession contributes to interprofessional education or practice, reviews specific challenges faced in the provision of these types of services, and highlights future opportunities to expand the provision of these services. Several general themes emerge from a review of the different health professions' contributions to this area. First, having well-trained prevention and population health professionals outside of the traditional public health field is important because prevention and population health activities occur in almost all healthcare settings. Second, because health professionals work in interprofessional teams in the clinical setting, training and educating all health professionals within interprofessional models would be prudent. Third, in order to expand services, reimbursement for health promotion counseling, preventive medicine, and disease management assistance needs to be appropriate for each of the professions.     

Evaluation of an interprofessional continuing professional development initiative in primary health care

INTRODUCTION: Interest in collaborative care approaches and in interprofessional education (IPE) to prepare providers for interprofessional collaboration is increasing and particularly so in the field of primary health care. Although evidence for the effectiveness of IPE is mixed, Barr et al. (2005) have proposed a useful framework for evaluating six levels of IPE outcomes. The Building a Better Tomorrow Initiative (BBTI) was a continuing professional development (CPD) program established to enhance the collaborative competencies of primary health care providers and foster interprofessional collaboration in primary health care settings. This article describes the evaluation design, specific measures, and educational outcomes of the BBTI program using Barr and colleagues' evaluation framework. METHODS: We used a mixed method approach. The evaluation research design was a one-group, pre- to poststudy utilizing a combination of quantitative and qualitative evaluation instruments and methods to collect data for the six levels of the Barr et al. evaluation framework. Evaluation focused especially on the following levels: participant satisfaction (reaction), confidence change (attitudes), performance change, and organizational impact. RESULTS: Participants were very satisfied with the BBTI modules and reported significant increases in their confidence and interprofessional collaborative competencies upon return to their primary health care practice sites. Interviews and focus groups with participants and administrators suggest that the BBTI modules were also effective in promoting and fostering interprofessional collaboration within primary health care settings. DISCUSSION: Results suggest that interprofessional CPD is effective in enhancing understanding of the roles of other professions, fostering respect and positive attitudes toward interprofessional collaboration, developing collaborative competencies, and promoting organizational change.     

The definition and deployment of differential core professional competencies and characteristics in multiprofessional health and social care teams

There has been an increasing focus on delivering health and social care services through multiprofessional and inter‐agency teams. This study, undertaken in 2011, explores how different professionals within multiprofessional teams define their own and other professions’ core professional competencies, characteristics and contributions. It then compares these definitions with how different professionals deploy their time and what tasks they undertake. Sixty‐four workers in four multiprofessional teams in England, within four different health and local authority areas, participated in the study. Using role repertory grids to generate constructs, which were then converted into Likert scales, and with diaries recording activities undertaken, the study compares the deployment of time and task with the views about the differential core competencies and characteristics of each profession. The study highlights important issues for consideration by multidisciplinary teams, the managers and commissioners of these teams, and by professional associations.