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Students’ attitudes towards IPE across professional groups: Lessons learnt from a national study

Students’ attitudes towards IPE across professional groups: Lessons learnt from a national study. Deborah Craddock, PhD University of Southampton. Introduction. Pre-registration IPE is a mandatory requirement in the UK (DOH & QAA 2006).

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Students’ attitudes towards IPE across professional groups: Lessons learnt from a national study

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  1. Students’ attitudes towards IPE across professional groups: Lessons learnt from a national study Deborah Craddock, PhD University of Southampton

  2. Introduction • Pre-registration IPE is a mandatory requirement in the UK(DOH & QAA 2006). • Interprofessional education (IPE) aims to reinforce collaborative practice(Glen and Reeves 2004; Carpenter, 2005; WHO, 2010). • Cultural barriers exist to the successful development of IPE(Barr et al. 2005; Morison et al. 2008). • Stereotypical views of other professions are held by students upon entry to their respective programmes(Hean et al. 2006; Adams et al. 2006) • Students assign differing hierarchical statuses to other students depending on their level of academic qualifications or their ability(Adams et al. 2006; Nisbet et al. 2008). • Can such stereotypical views change?(Carpenter 1995; Carpenter & Hewstone, 1996)

  3. Viewed traditionally as: Different from other professional groups; Possessing unique bodies of experience; Using their knowledge for the public good; Acting rationally, objectively and impartially Viewed critically as: Self seeking monopolies in the market; Insufficiently accountable/ responsive; Having a mystified knowledge base. > doubts Professionalism (Saks, 2009) Professional socialisation processes are likely to develop students’ perceptions of other professions during their pre-registration training (Adams et al. 2006)

  4. Research Questions* -Does professional representation in IPE groups increase knowledge of professional roles? -Do health and social work students’ readiness for IPL differ across professions? -What factors influence students’ commitment to IPE? *Sample 1: students at the start of their IPE initiative at FHEQ4; Sample 2: students on completion of their IPE initiative at FHEQ4

  5. Methodology • Two parallel studies-prospective cross-sectional surveys • Ethical approval • Multi-stage sampling:- (1) sampling of HEIs & (2) sampling of students Questionnaires were administered to a volunteer sample of pre-registration health and/ or social work students in Higher Education Institutions within the UK at 2 separate time points. Inclusion criteria: Students registered on a health or social care programme participating in an IPE initiative that involved podiatry students.

  6. Questionnaire Pack • Questionnaire pack- informed by (1) key informant interviews and (2) research evidence • Validated tool – Readiness for Inter-professional Education Scale (RIPLS) (Parsell and Bligh, 1999) & Generic Role Perception Questionnaire (GRPQ) (Mackay, 2004) • Face validity • Content validity • Pilot Study [test (i) n=67; test (ii) n=62] • Test re-test reliability • Internal consistency Key informant interviews

  7. Sample 1: 1151 students participated in the Sample 1 phase [81.1% (933) female, 18.9% (218) male]: mean age 24.38 (SD=8.167) years in 6 HEIs Sample 2: 1060 students participated in the Sample 2 phase [81.2% (861) female, 18.8% (199) male]: mean age 24.32 (SD=7.84) years in 5 HEIs. Sample: Female : Male (Parsell and Bligh 1999; Cassidy 2007)

  8. Learning about professions represented in IPE groups- exemplar: podiatry Objective 1 • Students’ knowledge of podiatrists’ roles was better if they had participated in an IPE group that involved a podiatry student (Sample 1 Md=7; Sample 2 Md=8) than if they had not/ unsure (Sample 1 Md=6; Sample 2 Md=6) (Sample 1: U=101791.00, Z=-2.596, n-964, p=0.009; Sample 2: U=72529.5, z=-10.272, n=967, p<0.001). • In Sample 2: There was a significant difference in students’ total GRPQ scores between health and social care students who participated in an IPE group that involved a podiatry student (Md=94, n=497) and students who had not/ unsure (Md=99, n=470) (U=101817.50, z=-3.451, p=0.001, r=-0.11).

  9. Readiness for Inter-professional Learning Scale Principle Component Analysis • Kaiser-Meyer-Oklin value = Sample 1: 0.932; Sample 2: 0.938 • Bartlett’s Test of Sphericity (p<0.001) • Oblimin rotation with Kaiser Normalisation • Sample 1 and 2: 2 component solution • Comparisons with Parsell and Bligh (1998; 1999) & McFadyen et al. (2005) • Component 1 Teamwork and collaboration • Component 2 Professional identity and roles

  10. RIPLS Subscale Comparisons

  11. Cronbach Alpha Measure of Internal Consistency of Each Sub-scale

  12. Comparison of Students’ Total RIPLS Scores by Profession Objective 2 Lower median scores observed in Sample 2

  13. In Sample 1 and Sample 2 the Kruskal-Wallis test shows that there are significant differences between the professions and students’ total RIPLS scores (Sample 1: χ2 (14, n=1151) =56.803, p<0.001; Sample 2: χ2 (13, n=1060) =83.085, p<0.001). Medical (Sample 1: 75; Sample 2: 71.5) and paramedical science (Sample 1: Md=74; Sample 2: Md= 71) students recorded the lowest median scores compared with students in other professions. In Sample 2, nursing (Md=81) and occupational therapy (Md=79) students had a greater readiness for IPL than students in other professions. In Sample 1 audiology (Md=86) and social work (Md=84) students had a greater readiness for IPL than students in other professions.

  14. Statistically significant differences between student professional groups:

  15. Teamwork and Collaboration Sub-scale 1

  16. Students’ attitudes towards teamwork and collaboration: Overall Lower median score Higher median score

  17. In Sample 1 and Sample 2 the Kruskal-Wallis test shows that there are significant differences between the professions and students’ RIPLS scores for sub-scale 1 (Sample 1: χ2 (14, n=1151) =54.137, p<0.001; Sample 2: χ2 (13, n=1060) =74.618, p<0.001). In Sample 2: Dietetic (Md=65) and nursing (Md=57) students held more positive views towards teamwork and collaboration. Paramedical science (Md=48) and medical students (Md=51.5) – least positive. In Sample 1: Audiology (Md=60.5) and social work (Md=60) students held more positive attitudes towards teamwork and collaboration Paramedical science (Md=51) students- least positive.

  18. Comparison of Students’ RIPLS Sub-Scale 1 Scores by Profession Teamwork & collaboration

  19. Sub-scale 2 Professional Identity & Roles

  20. Students’ attitudes towards professional identity & roles: Overall

  21. Kruskal-Wallis test: significant differences between the professions and students’ RIPLS scores for sub-scale 2. Sample 1: χ2 (14, n=1151) =56.793, p<0.001; Sample 2: χ2 (13, n=1060) =79.489, p<0.001. Sample 1: Medicine (Md=20) and dietetic (Md=20) students- strongest attitudes towards professional identity and roles. Speech and language therapy students (Md=17) - weakest attitude towards professional identity and roles. Sample 2: Medicine (Md=15.5) but also pharmacy (Md=16) students- strongest attitudes towards professional identity and roles. Occupational therapy and nursing students (Md=12)- weakest views towards professional identity and roles than other professional groups represented in this sample.

  22. Comparison of Students’ RIPLS Sub-Scale 2 Scores by Profession Higher median scores

  23. Commitment to IPE: Objective 3 • Positive correlation - age and level of commitment to IPE (Sample 1: spearman’s rho = 0.243, p<0.001; Sample 2: spearman’s rho = 0.165, p<0.001 for a one tailed test) • Modal response of 6 - the majority of participants were only fairly committed (Sample 1: 49.5%, 570; Sample 2: 46.9%, 497) to IPL. Commitment was strongly influenced by: • facilitators’ attitudes towards IPE (Sample 1:75.5%, 835; Sample 2: 74%, 784) • working practices of staff (72.4%, 833; Sample 2: 66%, 700); • Students induction to the IPE initiative (62.2%, 716; 56.2%, 596)

  24. UTILITY OF RESEARCH FINDINGS

  25. Lessons Learnt Enhancing knowledge of professional roles

  26. Sample 1 Students showed positive attitudes towards teamwork and collaboration and IPL from the outset of their studies. -Hind et al. 2003; Tunstall-Pedoe et al., 2003 Sample 2: Students’ attitudes towards teamwork and collaboration skills became statistically less positive for those studying physiotherapy (PT), occupational therapy (OT), radiography, medicine, midwifery and social work (SW). Students’ overall readiness for IPL was lower in each profession for PT, OT, medicine, midwifery, SW, podiatry and audiology. Comparisons by Profession

  27. Sample 1 Audiology and social work students Sample 2 Nursing and dietetic students -teamwork and collaboration Nursing and occupational therapy students -IPL Supports: Hean et al. (2006) Sample 1 & Sample 2 Medical and paramedical science students Findings align: Tunstall-Pedoe et al. (2003) Morison et al. (2004) Supports: Hean et al.’s (2006) findings & Conflicts: Hanson et al. (2005 Hallikainen et al. (2007) Most Positive Views Least Positive Views Professional programme appeared to affect students’ responses to IPE - Conflicting with Pollard et al. (2005)

  28. Professional Identity and Roles Sample 1: + • Strongest views: medical and pharmacy students • (Miller et al., 2006) • Ratings for being good independent workers (Hean et al., 2006) • Weakest views: speech and language therapy students (Sample 1); occupational therapy & nursing students (Sample 2) Physiotherapy Occupational Therapy Podiatry Radiography Medicine Nursing Midwifery Social work Pharmacy Audiology Paramedical Science Prosthetics and Orthotics Sample 2

  29. Medical students Pharmacy students Radiography Samples 1&2: PT, OT, podiatry Sample 1: radiography, midwifery Sample 2: nursing and social work Sample 2: PT, OT, nursing Sample 2: nursing, OT Statistically: > WHY? Confidence in professional competence and practical skills; perceived role independence

  30. Students with a strong sense of professional identity and roles were less ready to engage in IPL and had weaker attitudes towards teamwork and collaboration. Curriculum Developers:- Reflect on professional differences; Curricula content, implementation & evaluation Target factors influencing students’ attitudes

  31. Key factors influencing students’ attitudes towards IPE

  32. References • Adams, K., Hean, S., Sturgis, P. and Macleod Clark, J. (2006) Investigating the factors influencing professional identity of first year health and social care students. Learning in Health and Social Care, 5(2): 55–68. • Barr, H., Koppel, I., Reeves, S., Hammick, M. and Freeth, D. (2005) Effective Interprofessional Education: Arguments, Assumptions and Evidence. Oxford, Blackwell Publishing Ltd. • Carpenter, J. (1995) Doctors and nurses stereotype change in interprofessional education. Journal of Interprofessional Care, 9: 151–161. • Carpenter, J. (2005) Evaluating the Outcomes of Social Work Education. London and Dundee: Social Care Institute for Excellence and Scottish Institute for Excellence in Social Work Education. • Carpenter, J., Barnes, D. and Dickinson, C. (2003) Making a Modern Mental Health Care Force: Evaluation of the Birmingham University Interprofessional Training Programme in Community Mental Health 1998–2002. Durham: Centre for Applied Social Studies, University of Durham. • Carpenter, J. and Hewstone, M. (1996) Shared learning for doctors and social workers. British Journal of Social Work, 26: 239–257. • Department of Health and QAA (2006) Department of Health Phase 2 Benchmarking Project – Final Report. London: Department Of Health; and Gloucester: Quality Assurance Agency for Higher Education. • Glen, S. and Reeves, S. (2004) Developing interprofessional education in the pre-registration curricula: Mission impossible? Nurse Education in Practice, 4: 45–52. • Hallikainen, J., Vaisanen, O., Resenberg, P.H., Silfvast, T. and Niemi-Murola, L. (2007) Interprofessional education of medical students and paramedics in emergency medicine. Acta Anaesthesiologica Scandinavica, 51: 372-377. • Hammick, M., Freeth, D., Koppel, I., Reeves, S. and Barr, H. (2007) A best evidence systematic review of interprofessional education (Best Evidence Medical Education Guide No 9). Medical Teacher, 29(8): 735–751. • Hanson, L., Tillett, J. and Kirby, R.S. (2005) Medical students’ knowledge of midwifery practice after didactic and clinical exposure. Journal of Midwifery and Women’s Health, 50: 44-50. • Hean, S., Macleod Clark, J., Adams, K., Humphris, D. and Lathlean, J. (2006) Being Seen By Others As We See Ourselves: The Congruence Between The Ingroup And Outgroup Perceptions Of Health And Social Care Students. Learning In Health and Social Care, 5(1): 10–22.

  33. References: (continued) • Hind, M., Norman, I., Cooper, S., Gill, E., Hilton, R., Judd, P. and Jones, C. (2003) Interprofessional perceptions of healthcare students. Journal of Interprofessional Care, 17: 21–34. • Lidskog, M., Lofmark, A. and Ahlstrom, G. (2008) Students’ learning from interprofessional collaboration on a training ward in municipal care. Learning in Health and Social Care, 7(3): 134–145. • MacKay, S. (2004) The role perception questionnaire: A tool for assessing undergraduate students’ perceptions of the role of other professions. Journal of Interprofessional Care, 18(3): 289–302. • Miller, C., Woolf, C. and Mackintosh, N. (2006) Evaluation of Common Learning Pilots and Allied Health Professions Sites: Final Report. London, Department of Health. • Morison, S., Boohan, M., Moutray, M. and Jenkins, J. (2004) Developing pre-qualification interprofessional education for nursing and medical students: Sampling students’ attitudes to guide development. Nurse Education Practice, 4: 20-29. • Morison, S., Marley, J., Stevenson, M. and Milner, S. (2008) Preparing for the dental team: Investigating the views of dental and dental care professional students. European Journal of Dental Education, 12: 23–28. • McFadyen, A.K., Webster, V., Strachan, K., Figgins, E., Brown, H. and McKechnie, J. (2005) The readiness for interprofessional learning scale: A possible more stable sub-scale model for the original version of RIPLS. Journal of Interprofessional Care, 19(6): 595–603. • Parsell, G. and Bligh, J. (1998) Shared goals, shared learning: Evaluation of a multi-professional course for undergraduate students. Medical Education, 32(3): 304–311. • Parsell, G. and Bligh, J. (1999) The development of a questionnaire to assess the readiness of healthcare students for interprofessional learning. Medical Education, 33: 95–100. • Pollard, K., Miers, M.E. and Gilchrist, M. (2004) Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students. Health and Social Care in the Community, 12(4): 346-358.

  34. Pollard, K., Miers, M.E. and Gilchrist, M. (2005) Second year scepticism: Pre-qualifying health and social care students’ midpoint self-assessment, attitudes and perceptions concerning interprofessional learning and working. Journal of Interprofessional Care, 19(3): 251-268. • Pollard, K.C., Miers, M.E., Gilchrist, M. and Sayers, A. (2006) A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a three year intervention. Health and Social Care in the Community, 14(6): 541-552. • Saks, M. (2009) Leadership challenges: Professional power and dominance in health care, in V. Bishop (eds.) Leadership for Nursing and Allied Health Care Professions. Maidenhead, OUP. • Tunstall-Pedoe, S., Rink, E. and Hilton, S. (2003) Students’ attitudes to undergraduate interprofessional education. Journal of Interprofessional Care, 17: 161–172. • WHO (2010) Framework for Action on Interprofessional Education & Collaborative Practice. Geneva, WHO.

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