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).

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)

Professionalism (Saks, 2009)

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

Professional socialisation processes are likely to develop students’ perceptions of other professions during their pre-registration training (Adams et al. 2006)

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

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.

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 interview

s

Sample:

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.

Female : Male (Parsell and Bligh 1999; Cassidy 2007)

Learning about professions represented in IPE groups- exemplar: podiatry

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).

Objective 1

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

Factor Analysis Sub-scale 1


Sub scale 2

Professional Identity (1999) and Negative Professional Identity (1998)

Subscale 3

Roles and Responsibilities (1999) + Roles (1998)

Parsell and Bligh (1999) (n=120)

42% variance explained

Items 1-9 Items 10-16 Items 17-19

Parsell et al., (1998) (n=914)

48% variance explained

Items 1-9

Item 11

Items 13-16

Item 12

Item 17

Item 19

Item 18

McFadyen et al (2005) (n=308)

(n=308) 44% variance explained

Items 1-9; 10, 11

Items 13-16

Item 12

Item 17

Items 18-19

Craddock Sample 1: n=1151 45.4% variance explained

Craddock Sample 2: n-1060 52.7% variance explained

Items 1-9

Items 13-16

Items 10-12

Items 17-19

RIPLS Subscale Comparisons

Study Sub-scale 1


Sub scale 2

Professional Identity (1999) and Negative Professional Identity (1998)

Subscale 3

Roles and Responsibilities (1999) + Roles (1998)

Parsell and Bligh (1999) (n=120)

0.88 0.63 0.32

Parsell et al., (1998) (n=914)

0.85 0.46 -

McFadyen et al (2005) (n=308)

0.80 0.21 0.40

Craddock (n=1151) 0.88 0.66

Craddock (n=1060) 0.92 0.79

Cronbach Alpha Measure of Internal Consistency of Each Sub-scale

Profession Sample 1 Md

N Sample 2 Md

N U Z P R

Physiotherapy 79 236 76 216 20201.5 -3.814 <0.001 0.1

Occupational Therapy

82 122 79 92 4674.5 -2.092 0.036 0.05

Podiatry 78 187 75 93 7105 -2.495 0.013 0.06

Radiography 78.5 96 75 70 2571.5 -2.581 0.010 0.07

Medicine 75 75 71.5 90 2444.5 -3.047 0.002 0.08

Midwifery 81 43 74 51 572.5 -3.981 <0.001 0.1

Social Work 84 56 77.5 60 1205.5 -2.624 0.009 0.07

Audiology 86 10 74 13 30.0 -2.175 0.03 0.06

Comparison of Students’ Total RIPLS Scores by Profession

Lower median scores observed in Sample 2

Objective 2

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 1 audiology (Md=86) and social work (Md=84) students had a greater readiness for IPL than 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.

Sample 1

Total RIPLS Analysis

Profession¹ Profession² Md¹ N¹ Md² N² U Z P R


Podiatry 82 122 78 187 8421.5 -3.892 <0.001 0.22


Radiography 82 122 78.5 96 4208 -3.568 <0.001 0.24


Medicine 82 122 75 75 2971 -4.131 <0.001 0.29

Podiatry Nursing 78 187 82 229 16821.5

-3.766 <0.001 0.2

Radiography Nursing 78.5 96 82 229 8365 -3.402 0.001 0.19

Radiography Social Work 78.5 96 84 56 1850.5 -3.202 0.001 0.26

Medicine Nursing 75 75 82 229 6001.5 -3.917 <0.001 0.22

Sample 2 Total RIPLS Analysis


Physiotherapy Occupational therapy

76 216 79 92 7662.5 -3.181 0.001 0.18

Physiotherapy Medicine 76 216 71.5 90 6961 -3.915 <0.001 0.22

Physiotherapy Nursing 76 216 81 273 22469 -4.523 <0.001 0.2


Radiography 79 92 75 70 2258.5 -3.254 0.001 0.26


Medicine 79 92 71.5 90 2143.5 -5.622 <0.001 0.42


Midwifery 79 92 74 51 1491 -3.606 <0.001 0.3

Podiatry Nursing 75 93 81 273 9507 -3.620 <0.001 0.19

Radiography Nursing 75 70 81 273 6712.5 -3.843 <0.001 0.2

Medicine Nursing 71.5 90 81 273 6555 -6.641 <0.001 0.35

Medicine Social Work 71.5 90 77.5 60 1702.5 -3.829 <0.001 0.31

Nursing Midwifery 81 273 74 51 4484 -4.037 <0.001 0.22

Nursing Pharmacy 81 273 75 50 4878 -3.209 0.001 0.18

Statistically significant differences between student professional groups:

Teamwork and Collaboration

Sub-scale 1

Students’ attitudes towards teamwork and collaboration:


N Sample 2 Md

N U Z P R

Physiotherapy 56 236 52.5 216 19793 -4.112 <0.001 0.12


58 122 55 92 4635 -2.186 0.029 0.06

Radiography 54 96 52.5 70 2698 -2.171 0.03 0.06

Medicine 54 75 51.5 90 2577 -2.615 0.009 0.08

Midwifery 55 43 52 51 728.5 -2.800 0.005 0.08

Social Work 60 56 56 60 1321 -1.995 0.046 0.06

Higher median scoreLower median score

Overall

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 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.

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.

Comparison of Students’ RIPLS Sub-Scale 1 Scores by Profession

Sample 1Sub-scale 1 Analysis



Podiatry 58 122 54 187 8271 -4.096 <0.001 0.23


Radiography 58 122 54 96 4210.5 -3.569 <0.001 0.24

Podiatry Nursing 54 187 58 229 16675 -3.894 <0.001 0.2

Radiography Nursing 54 96 58 229 8511.5 -3.219 0.001 0.18

Radiography Social Work 54 96 60 56 1806 -3.380 0.001 0.27

Teamwork & collaboration



Physiotherapy Occupational therapy

52.5 216 55 92 7363.5 -3.603 <0.001 0.21

Physiotherapy Nursing 52.5 216 57 273 21329.5

-5.266 <0.001 0.24


Medicine 55 92 51.5 90 2681 -4.113 <0.001 0.3


Midwifery 55 92 52 51 1514 -3.519 <0.001 0.29

Podiatry Nursing 53 93 57 273 9672.5 -3.440 0.001 0.18

Radiography Nursing 52.5 70 57 273 6830.5 -3.691 <0.001 0.2

Medicine Nursing 51.5 90 57 273 7931 -5.056 <0.001 0.27

Medicine Social Work 51.5 90 56 60 1824.5 -3.364 0.001 0.27

Nursing Midwifery 57 273 52 51 4465.5 -4.078 <0.001 0.23

Professional Identity & Roles

Sub-scale 2


N Sample 2 Md

N U Z P R

Physiotherapy 18 236 13 216 5218 -14.67 <0.001 0.31


18 122 12 92 1065.5 -10.18 <0.001 0.22

Podiatry 19 187 13 93 2066 -10.43 <0.001 0.22

Radiography 18 96 14 70 1249.5 -6.938 <0.001 0.15

Medicine 20 75 15.5 90 1574 -5.911 <0.001 0.13

Nursing 19 229 12 273 5797.5 -15.76 <0.001 0.34

Midwifery 18 43 14 51 461.5 -4.841 <0.001 0.1

Social Work 19 56 13 60 557 -6.218 <0.001 0.13

Prosthetics & Orthotics

18 23 14 31 200 -2.75 0.006 0.06

Pharmacy 19 29 16 50 353 -3.796 <0.001 0.08

Audiology 19.5 10 14 13 20.5 -2.774 0.006 0.06

Paramedical Science

18 7 13 7 8.5 -2.077 0.038 0.04

Students’ attitudes towards professional identity & roles:

Overall

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.



Physiotherapy Medicine 18 236 20 75 6080.5 -4.125 <0.05 0.23


Medicine 18 122 20 75 3297 -3.320 0.001 0.24

Podiatry Medicine 19 187 20 75 4932 -3.784 <0.001 0.23

Radiography Medicine 18 96 20 75 2101.5 -4.710 <0.001 0.36

Medicine Midwifery 20 75 18 43 847.5 -4.312 <0.001 0.4

Midwifery Social Work 18 43 19 56 742.5 -3.297 0.001 0.33

Comparison of Students’ RIPLS Sub-Scale 2 Scores by Profession

Higher median scores



Physiotherapy Medicine 13 216 15.5 90 5781.5 -5.610 <0.001

0.32

Physiotherapy Pharmacy 13 216 16 50 3624.5 -3.638 <0.001

0.22


Radiography 12 92 14 70 2260.5 -3.256 0.001 0.26


Medicine 12 92 15.5 90 2068 -5.848 <0.001

0.43


Prosthetics & Orthotics

12 92 14 31 875.5 -3.220 0.001 0.29


Pharmacy 12 92 16 50 1337.5 -4.122 <0.001

0.35

Podiatry Medicine 13 93 15.5 90 2688.5 -4.193 <0.001

0.31

Radiography Nursing 14 70 12 273 7116.5 -3.306 0.001 0.18

Medicine Nursing 15.5 90 12 273 6580.5 -6.627 <0.001

0.35

Medicine Social Work 15.5 90 13 60 1847.5 -3.280 0.001 0.27

Nursing Pharmacy 12 273 16 50 4177.5 -4.374 <0.001

0.24

Commitment to IPE:

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)

Objective 3

UTILITY OF RESEARCH FINDINGS

Lessons Learnt

Allocation of students

Student Preparation

&Induction

Make-up of IPE groups -Hammick et al. (2007);

Lidskog et al. (2008) Enhancing knowledge

of professional

roles

Comparisons by Profession

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.

Most Positive Views Least Positive Views

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)

Professional programme appeared to affect students’ responses to IPE - Conflicting with Pollard et al. (2005)

Professional Identity and Roles 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)

Sample 1: +

Sample 2

Physiotherapy


Podiatry

Radiography

Medicine

Nursing

Midwifery

Social work

Pharmacy

Audiology

Paramedical Science

Prosthetics and Orthotics

Statistically: 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, OTConfidence in professional competence and practical

skills; perceived role independence

>

WHY?

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

Key role of facilitators- staff training

Working practices of staffInduction process

Key factors influencing students’

attitudes towards IPE

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.

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.

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.

students attitudes towards ipe across professional groups: lessons learnt from a national study...

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