Student attitudes to undergraduate interprofessional education

From students to professionals: results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom

During a longitudinal evaluation of a pre-qualifying interprofessional curriculum, health and social care students completed questionnaires concerning communication and teamwork skills and interprofessional learning and working. Data were collected on entry to their educational programme, during the second year of study, at qualification and after 9-12 months' qualified practice. This paper presents results from practice data from 414 professionals; 275 were educated on the interprofessional curriculum, 139 on previous uniprofessional curricula. The former were more confident at qualification about their communicative skills, their interprofessional relationships and other professionals' interaction, and showed positive correlations between perceptions of their relevant skills and their interprofessional relationships. They were also more positive about their interprofessional relationships than practitioners educated on uniprofessional curricula. Age and previous experience of higher education influenced professionals' attitudes negatively: mature individuals may require more support when entering the workforce. Between qualification and practice, respondents from the interprofessional cohorts grew more critical of interprofessional education. However, experience of interprofessional education appears to produce and sustain positive attitudes towards collaborative working, suggesting that individuals' perceptions of their own educational experience are inadequate as an evaluative measure of interprofessional learning initiatives. This study reinforces the argument for including IPE in pre-qualifying curricula.

Applying aspects of generalizability theory in preliminary validation of the Multifacet Interprofessional Collaboration Model (PINCOM)

OBJECTIVE

Empirical assessment of the Interprofessional Collaboration (IPC) model within the framework of Generalizability Theory (GT).

DESIGN AND PARTICIPANTS

A multifacet data collection design served the purpose of examining the relationships between observed indicators representing a defined construct. Professionals working with children and adolescents (n=134), in the context of mental health care, completed a 48 item questionnaire addressing 12 aspects of interprofessional collaboration.

RESULTS

Estimated variance components from two G-studies are presented. The relative impact of different sources of variance was estimated 1) for the full design, and 2) for three groups of informants (schools, primary care and specialist services). Differences between groups were found regarding the relative impact of the level - and context facets with respect to perception of IPC.

CONCLUSIONS

The methodology of generalizability theory is well suited for data with a complex facet structure as displayed in the present study. We recommend researchers to give domain specifications thorough attention when measuring IPC.

Early interprofessional interactions: does student age matter?

In this mixed-method evaluation we report on student responses to an introductory interprofessional learning event, accessed by ten professions within six months of commencing their chosen professional curricula. Of 898 students, 754 (84%) completed pre and post course questionnaires, and 81 took part in uni-professional focus groups. Student responses were compared with those of 14 facilitators. Younger students entering straight from school achieved more learning outcomes and were more positive about the learning than older students (e.g., undergraduate medics, range p = 0.001-0.011; graduate medics, range p = 0.001-0.819). Mature entrants valued interprofessional education, but preferred to interact with students of a similar age demanding a more challenging and relevant set of learning resources, sensitive to their prior life experience. Positive and negative stereotyping was differently constructed between younger and older students. The views of facilitators endorsed the lack of engagement of mature learners compared to their younger counterparts. The study highlights the need to consider age when bringing together large numbers of different professions for their first taste of interprofessional education.

Student leadership in interprofessional education: benefits, challenges and implications for educators, researchers and policymakers

Context Interprofessional collaboration is gaining increasing prominence as a team-based approach to health care delivery that synergistically maximises the strengths of each health professional to enhance patient care, decrease medical errors and optimise efficiency. The often neglected role that student leaders have in preparing their peers, as the health professionals of the future, for collaboration in health care should not be overlooked. Objective This paper offers the foundational arguments supporting the integral role that student leadership in interprofessional education (IPE) can play and its comparative advantages. Methods Evidence from previous literature and the National Health Science Students' Association in Canada was reviewed and a questionnaire on student-initiated IPE was administered among Canada's top student leaders in this area. Results Student leadership is essential to the success of IPE because it enhances students' willingness to collaborate and facilitates the longterm sustainability of IPE efforts. Student-initiated IPE, a subset of student leadership, is particularly important to achieving the aforementioned goals and offers a number of benefits, comparative advantages and associated challenges. Conclusions Successful student leadership in IPE will yield significant benefits for everyone in the years to come. However, it requires the support of educators, researchers and policymakers in fostering an enabling environment that will facilitate the efforts and contributions of student leaders.

The potential advantages and disadvantages of introducing interprofessional education into the healthcare curricula in Spain

The complexity of contemporary clinical practice demands that increasingly skilled high quality health and social care is provided to individuals. However, the failure of health and social care professionals to work collaboratively has been widely reported in the international literature. Hence, interprofessional education has been suggested as a means of improving both interprofessional understanding and respect across a diverse range of practice disciplines. In this way, functional barriers can be challenged or broken down; teamwork enhanced and healthcare outcomes improved. Lack of conclusive evidence to substantiate the above healthcare benefits has been attributed to weak methodological approaches when evaluating such educational initiatives. In Spain barriers to implementing interprofessional education are potentially less challenging. Recent legislative demands following the Bologna Agreement on European Higher Education is compelling Spanish higher education institutes to engage in radical educational reforms. Consequently, this paper examines some of the advantages and disadvantages of introducing interprofessional education into health and social care curricula in Spain to see when and how interprofessional initiatives might be assimilated into the health care curricula. In this way lessons learned from a thorough review of the relevant literature might help to inform such educational reforms across mainland Europe and beyond.

A best evidence systematic review of interprofessional education: BEME Guide no. 9

BACKGROUND AND REVIEW CONTEXT: Evidence to support the proposition that learning together will help practitioners and agencies work better together remains limited and thinly spread. This review identified, collated, analysed and synthesised the best available contemporary evidence from 21 of the strongest evaluations of IPE to inform the above proposition. In this way we sought to help shape future interprofessional education and maximize the potential for interprofessional learning to contribute to collaborative practice and better care.

OBJECTIVES OF THE REVIEW

To identify and review the strongest evaluations of IPE. To classify the outcomes of IPE and note the influence of context on particular outcomes. To develop a narrative about the mechanisms that underpin and inform positive and negative outcomes of IPE.

SEARCH STRATEGY

Bibliographic database searches as follows: Medline 1966-2003, CINAHL 1982-2001, BEI 1964-2001, ASSIA 1990-2003 which produced 10,495 abstracts. Subsequently, 884 full papers were obtained and scrutinized. In addition, hand searching (2003-5 issues) of 21 journals known to have published two or more higher quality studies from a previous review.

TOPIC DEFINITION AND INCLUSION CRITERIA

Peer-reviewed papers and reports included in the review had to be formal educational initiatives attended by at least two of the many professional groups from health and social care, with the objective of improving care; and learning with, from and about each other.

DATA COLLECTION, ANALYSIS AND SYNTHESIS

Standard systematic review procedures were applied for sifting abstracts, scrutinizing full papers and abstracting data. Two members of the team checked each abstract to decide whether the full paper should be read. A third member was consulted over any discrepancies. Similarly, each full paper was read by at least two members of the team and agreement sought before passing it to one member of the team (SR) for data abstraction. Other members of the team checked 10% of the abstraction records. Coding into a Statistical Package for Social Scientists (SPSS) data base led to collection of different outcome measures used in the primary studies via the common metric of an adapted Kirkpatrick's four-level model of educational outcomes. Additionally, a narrative synthesis was built after analysis of primary data with the 3-P model (presage-process-product) of education development and delivery.

HEADLINE RESULTS

Government calls for enhanced collaboration amongst practitioners frequently leads to IPE that is then developed and delivered by educators, practitioners or service managers. Staff development is a key influence on the effectiveness of IPE for learners who all have unique values about themselves and others. Authenticity and customization of IPE are important mechanisms for positive outcomes of IPE. Interprofessional education is generally well received, enabling knowledge and skills necessary for collaborative working to be learnt; it is less able to positively influence attitudes and perceptions towards others in the service delivery team. In the context of quality improvement initiatives interprofessional education is frequently used as a mechanism to enhance the development of practice and improvement of services.

The merit of mandatory interprofessional education for pre-health professional students

BACKGROUND

Since the World Health Organization identified interprofessional education (IPE) as an important component of primary health care in 1978, health sciences educators continue to debate when it might be best to introduce IPE into the academic training of health professionals. While IPE continues to be offered at increasingly early stages in students' professional development, few if any IPE initiatives have targeted undergraduate pre-health professional students who are likely to enter health professional programs.

OBJECTIVES

To design, execute and evaluate the effectiveness of a mandatory IPE initiative targeting students in their first year of a general undergraduate health science education.

METHODS

An integrated exercise was created to introduce students to eight health professions and the underlying concepts of interprofessionalism through self-directed independent research, problem-based learning and collaborative group discussions. A two-part questionnaire was developed using a seven point Likert scale to assess the participants' perceived changes in knowledge, interests, and attitudes.

RESULTS

A total of 161 students (99.4%) completed both instruments. Pre and post-exercise responses (n = 161) indicated meaningful improvements in students' knowledge on the specific roles of different health professionals (p < 0.001), knowledge on the value of interprofessionalism (p < 0.001), interests in pursuing the various health professions as future careers (p = 0.075), and attitudes towards IPE (p < 0.001). Post-exercise data also revealed that students acquired valuable knowledge and gained a strong interest in learning more about the various health professions as a result of this exercise.

CONCLUSIONS

Participation in this short, one-time IPE exercise resulted in profound changes in attitudes, interests, and knowledge amongst participating students. Based on these changes, mandatory IPE for pre-health professional students is merited but additional research on this topic is necessary.

Exploring physiotherapy students' experiences of interprofessional collaboration in the clinical setting: a critical incident study

Effective interprofessional collaboration is considered essential for optimum healthcare delivery. Studies have investigated interprofessional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for interprofessional learning (IPL). Little is known, however, about the aspects of clinical practice that students perceive as meaningful to their IPL. This study explores physiotherapy students' experiences of collaborative working, and identifies their perceptions of the skills used and factors affecting interprofessional interactions in the clinical setting. Twenty second-year physiotherapy students studying in London provided written critical incident reports describing good and poor interprofessional collaborative encounters in the clinical setting. The data were subjected to thematic content analysis. Students identified communication and interprofessional relationships as the main factors affecting collaboration and perceived teamwork in formal contexts (e.g., team meetings) as generally effective with positive outcomes for professionals and patients. Informal collaboration was perceived to be poor and attributed primarily to insufficient direct contact and communication. The wide range of described experiences and learning outcomes indicate that clinical placements provide potentially valuable IPL opportunities. Facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing IPE in this setting.

Exploring perceptions of interprofessional collaboration in child mental health care

PURPOSE

This paper proposes a tentative theoretical model (PINCOM) and a measure of mental health and school professionals' perception of interprofessional collaboration (IPC).

THEORY

The model is based on twelve constructs derived from a pilot study, organizational and social psychology. The main aim of the model is to capture central aspects of IPC.

METHOD

A forty-eight item self-report questionnaire (PINCOM-Q) was designed to explore professionals' perceptions of IPC. The sample (n=134) included professionals who worked in primary care, specialist services and in elementary schools. Exploratory factor analyses and reliability testing were conducted to reduce the large number of variables in the questionnaire.

RESULTS

RESULTS INDICATE THAT CENTRAL ASPECTS OF IPC IN THE CONTEXT OF SERVICE DELIVERY AND CASE WORK ARE: interprofessional climate, organizational culture, organizational aims, professional power, group leadership and motivation.

CONCLUSION

Preliminary empirical testing of the questionnaire demonstrated that it is possible to measure perceptions of IPC, with reasonable levels of construct validity and reliability.

DISCUSSION

Further, revision of the questionnaire is discussed to make it fit for use in large scale studies with the purpose of enhancing (a) the validity of the PINCOM model, and (b) the quality of mental health services that are based on IPC.

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.

Interprofessional education in palliative care: a pilot project using popular literature

A need to introduce the concepts of death and dying to the medical and health sciences undergraduate curriculum was identified at the University of Ottawa, Ontario, Canada. As care of the terminally ill is complex and requires the collaborative involvement of a diverse group of health care professionals, an interprofessional educational approach was utilized to address this need. A seminar course was developed using popular literature as the basis for learning, and offered to first and second year medical students, fourth year nursing students and graduate students in spiritual care. The discussion of roles and the provision of care within the context of works of selected literature provided a focus that enabled the students to transcend their disciplinary barriers, and to better understand the perspectives and contributions that other team members bring to patient care. Evaluation findings suggest that meaningful interprofessional education can be introduced effectively to students either prior to or while they are maturing in their professional roles.

Case-based learning in cross-professional groups - the development of a pre-registration interprofessional learning programme

This paper describes the development and evaluation of an interprofessional learning (IPL) programme at the pre-registration level. The principal aim of the study was to investigate whether case-based learning in cross-professional groups is a feasible and an effective way to conduct interprofessional education (IPE). Student volunteers from five different health professional training programmes were allocated to two groups: an intervention group and a control group. Interprofessional attitudes of all students were measured at the beginning and at the end of the study. Group members fed back their views about their learning experience after the 9-week long intervention. The study reports significant effects of the intervention on students' attitudes to different health professions. For example, students in the intervention group tended to view each profession as more 'caring' when compared to the control group. Student feedback was positive, with the main message to integrate the programme in the timetable and to introduce an opportunity for IPE in future years. The initial findings reported in this paper show that this is a feasible and an effective way to deliver IPE across the wide range of professions in the study and that the learning programme was viewed positively by the students who took part.

Interprofessionality as the field of interprofessional practice and interprofessional education: an emerging concept

This paper proposes a new concept and a frame of reference that should permit the development of a better understanding of a phenomenon that is the development of a cohesive and integrated health care practice among professionals in response to clients' needs. The concept is named "interprofessionality" and aims to draw a clear distinction with another concept, that of interdisciplinarity. The utilization of the concept of interdisciplinarity, which originally concerns the development of integrated knowledge in response to fragmented disciplinary knowledge, has caused some confusion. We need a concept that will specifically concern the development of a cohesive practice among different professionals from the same organization or from different organizations and the factors influencing it. There is no concept that focuses clearly on this field. Interprofessionality concerns the processes and determinants that influence interprofessional education initiatives as well as determinants and processes inherent to interprofessional collaboration. Interprofessionality also involves analysis of the linkages between these two spheres of activity. An attempt to bridge the gap between interprofessional education and interprofessional practice is long overdue; the two fields of inquiry need a common basis for analysis. To this end, we propose a frame of reference, an interprofessional education for collaborative patient-centred practice framework. The framework establishes linkages between the determinants and processes of collaboration at several levels, including links among learners, teachers and professionals (micro level), links at the organizational level between teaching and health organizations (meso level) and links among systems such as political, socio-economic and cultural systems (macro level). Research must play a key role in the development of interprofessionality in order to document these linkages and the results of initiatives as they are proposed and implemented. We also believe that interprofessionality will not be pursued without the requisite political will.

The case for educating health care students in professionalism as the core content of interprofessional education

BACKGROUND

Professional teams are becoming more central to health care as evidence emerges that effective teamwork enhances the quality of patient care. Currently, health care professionals are poorly prepared by their education for their roles on the team. In parallel, there are increasing demands from consumers for health care professionals to serve the interests of society and patients through engaging in effective professional partnerships. Professionalism for health care providers is now being defined as a commitment to standards of excellence in the practice of the profession that are designed primarily to serve the interests of the patient and to be responsive to the health needs of society. Yet, there are multiple barriers impeding the development of professionalism beyond a uni-professional frame of reference.

METHOD

Incorporating teamwork and professionalism into health care professional curricula at pre-registration level is proving to be challenging. These 2 areas of learning are brought together in this paper through a discussion of the role of interprofessional education in preparing all health care professional students for the workforce.

CONCLUSION

Interprofessionalism is presented as a pre-registration curriculum framework that includes values shared by all health care professionals, which should be learned in order to more adequately prepare students for working in health care teams. It will be argued that interprofessional education provides appropriate methods by which to learn interprofessionalism, and that this will ultimately contribute to overcoming uni-professional exclusivity.

Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students

This paper presents the initial findings from a longitudinal quantitative study of two cohorts of students who entered the 10 pre-qualifying programmes of the Faculty of Health and Social Care, University of the West of England (UWE), Bristol, UK. The overall aim of the study is to explore students' attitudes to collaborative learning and collaborative working, both before and after qualification. On entry to the faculty, 852 students from all 10 programmes completed the UWE Entry Level Interprofessional Questionnaire, which gathered baseline data concerning their self-assessment of communication and teamwork skills, and their attitudes towards interprofessional learning and interprofessional interaction. Comparative analysis of these data was undertaken in terms of demographic variables such as age (i.e. older or younger than 21 years), experience of higher education, prior work experience and choice of professional programme. The results indicate that most students rated their communication and teamwork skills positively, and were favourably inclined towards interprofessional learning, but held negative opinions about interprofessional interaction. Some student groups differed in their responses to some sections of the questionnaire. Mature students, and those with experience of higher education or of working in health or social care settings, displayed relatively negative opinions about interprofessional interaction; social work and occupational therapy students were particularly negative in their responses, even after adjustment for confounding demographic variables. The paper concludes by considering the implications of the findings for interprofessional educational initiatives and for professional practice.