Perceptions of Health Sciences Students on an Introductory
Interprofessional Education Course
Joe Paul Castillo, Trent Gahl, Liz Torrez, Joua Vang, Jessica Womack, Joy Doll, Ann Ryan Haddad, Anna Maio, Katie Packard, Meghan Potthoff
Creighton University Center for Interprofessional Practice, Education
and Research (CIPER) and Creighton Department of Occupational Therapy
Introduction
Healthcare is a
complicated, critical, and ever changing environment in which health
professionals are faced with diverse populations with a variety of conditions (Royeen,
Jensen, & Harvan, 2011). The current healthcare environment requires
health professionals to work interprofessionally to promote effective
communication to treat and advocate for patients and communities in a team-based
matter (Royeen et al., 2011). IPE requires health professionals to learn
and work together to promote beneficence for patients and communities as
outlined in the core competencies (Interprofessional Education Collaborative,
2011; Royeen et al., 2011). With healthcare moving towards interprofessional
collaboration as a desired approach, higher education institutions need to
prepare students on how to work together as an interprofessional team prior to
entering the clinical environment (Pardue, 2015). Making such educational
shifts involves changes in accreditation, policy, and implementing IPE core competencies
(Pardue, 2015).
Often, universities face
the challenge of when interprofessional learning should be offered to students
(Sheldon et al., 2012). Conflicting research exists on whether IPE should
be implemented early in the students’ academic career or later, just prior to
taking board exams (Sheldon et al., 2012). One study suggested that IPE could
be best experienced once students have a strong identification in their
professional identity, claiming that lack of professional identity while
experiencing IPE education can lead to role insecurity (Mandy, Milton, &
Mandy, 2004). However, Foster and Macleod Clark (2015) suggested that IPE
education should be introduced and given to undergraduates before entering
their chosen profession.
Therefore, this study
addressed students’ perceptions on an introductory IPE course that was given to
health science students within their respected disciplines during their first
year of study. The purpose of this study was to identify health sciences
students’ perceptions of an introductory IPE course taken at Creighton
University in Omaha, Nebraska entitled IPE 400 Introduction to Collaborative
Practice. With the emerging importance of IPE, it is important to assess
students’ perceptions relating to their own knowledge, attitudes and beliefs.
Background
As the gap between current
health professions training and the actual realities of practice have
increased, health systems are now seeking graduates who are experienced in
teamwork as well as in their own disciplinary knowledge (Pardue, 2015). Working
in a healthcare profession, individuals rarely act alone; they are always
working within teams or groups. The Interprofessional Education Collaborative
Expert Panel (IPEC) (2011) claims that IPE is necessary to inform all
healthcare professionals to work collaboratively to produce better patient-centered
care. Not only must professionals be able to work with others, but also they
must understand the logistics of teams and teamwork, and must be proficient in
problem solving, managing conflict, and relaying information in an
understanding manner (Doll et al., 2013).
According to the core competencies
of interprofessional collaborative practice, IPE accreditation, curriculum, and
policy differ in every organization. These aspects of IPE undergo constant
development across many healthcare and educational settings (IPEC, 2011). To
promote collaborative-based care, core competencies of interprofessional collaborative
practice related to IPE must be implemented in order to create a coordinated
structure between current education standards and curriculum development (IPEC,
2011). When using the core competencies of interprofessional collaborative practice,
results have showed that students understand the values that the competencies
represent (IPEC, 2011). From this, students develop the ability to gain
knowledge, build skills, and construct relevant ideas related to the core
competencies and apply it to interprofessional practice (IPEC, 2011). The core competencies
of interprofessional collaborative practice also help identify educational
themes that can serve as a plan for educational facilities to implement IPE
(Doll et al., 2013).
Experience and perceptions
of students is an important factor to consider when trying to implement,
evaluate and modify an IPE course. Students may be exposed to many aspects of interprofessional
education through prior learning experiences, workshops, courses, and events
(Curran, Sharpe, & Forristall, 2008; Mellor, Cottrell, & Moran, 2013).
Many students possess positive feelings towards IPE, but feelings can vary
based on gender, profession, and year of study (Curran et al., 2008).
Overall, students who have been exposed to IPE better appreciate
professional roles in the team approach to patient-centered care and have
further developed necessary skills pertaining to communication and teamwork
(Sheldon et al., 2012).
After completing an IPE
course, students state that they developed a sense of worth and respect for the
other team members (Curran et al., 2008; Ruebling et al., 2014; Sheldon et al.,
2012). Based on several studies, students exposed to IPE developed a new
appreciation and positive attitude towards other professionals, and learned
skills pertaining to team oriented care (Curran et al., 2008; Ruebling et al.,
2014; Sheldon et al., 2012). It was suggested that learning about other
professions through IPE could influence how students feel and contribute to a
healthcare team (Mellor et al., 2013). Therefore, it is important to contribute
to a student’s knowledge of IPE to help them become collaboration ready
practitioners (Ruebling et al., 2014).
Recent studies have
suggested that students who lack interprofessional skills training in their
university curriculum had to through trial and error in practice (Arenson et
al., 2015; Fouche, Kenealy, Mace, & Shaw, 2014). In addition, studies often
revealed many students were unsure of their own role when approaching an IPE
experience (Arenson et al., 2015; Fouche et al., 2014). Although, Watters et
al. (2015) argued through written reflections of an IPE experience students
revealed an “awareness of and respect for the scope, practice, and rigor of
other programs" (p. 5) and felt more prepared to face the realities of
working in the health system. This is supported by another study, which noted
that integrating IPE in a university’s curriculum enhanced personal and
professional confidence, facilitated a reflective practice, and allowed
continued education by providing role models for collaboration (Illingworth
& Chelvanayagam, 2007).
Overall, interprofessional education,
even with identified core competencies, still struggles to become part of the
mainstream educational core requirements. A host of implementation barriers and
challenges has been cited throughout the literature, which include cost,
incompatible curriculum, and inadequate faculty engagement (Sheldon et al.,
2012). Additional challenges in successfully implementing an IPE program
include the logistics of the program and educational setting (Sheldon et al.,
2012). According to Cain and Chretien (2013), a lack of strategies may be an
impairment when it comes to educating students from different health
disciplines. Some impairments include poor grouping of interprofessional
professions, time constraints, and lack of effort from facilitators, faculty,
and students. Ultimately, if there is no structure for an IPE program, an
unsuccessful IPE experience with little interprofessional collaboration is
mostly likely the outcome (Cain & Chretien, 2013). Therefore, since IPE and
interprofessional practice has yet to be fully recognized, it is important to
continue research on this matter. Without continued research, IPE
implementation into professional programs cannot be tested and developed, which
can cause further delay in producing practitioners that can provide successful
collaborative patient-centered care (D'Amour & Oandasan, 2005).
Methods
In this
study, a qualitative focus group design was used to explore the perceptions of
health sciences students regarding their experience in an introductory IPE
course. This design was chosen because it allows for open communication and
clarification as well as encourages researchers to explore, further develop
insight into the specific issues, and to observe how participants interact and
discuss the issue amongst themselves (Liamputtong, 2011). Additionally, since
there is a lack qualitative research to measure the effectiveness of IPE the
Institute of Medicine is currently pushing for more qualitative IPE data
collection to use in measuring outcomes. (Institute of Medicine, 2015).
Participants
The target population for this study
consisted of approximately 700 students from the following disciplines:
medicine, nursing, emergency medical services, occupational therapy, pharmacy,
and physical therapy. To be considered to participate in the study, the
health sciences students must have been from one of the five specific health
science disciplines, have at least one course on campus and had completed the
IPE 400 Introduction to Collaborative Care course at Creighton University by
December 1, 2015. Exclusion criteria for the study included students that did
not complete a participant disclosure and confidentiality agreement, who were
under the age of 19, did not agree to have their comments used for research
purposes, and who had not completed the IPE 400 course by December 1. Lastly,
participants were not considered if they were not health science students with
at least one class on campus.
One researcher handled recruitment for
the study. This researcher had access to a list of students who had completed
the course. The researcher sent out three emails to the target population of
students who met the inclusion criteria to invite them to participate in the
study. To increase the number of participants, the first email was sent out
three weeks in advance, and one every week after leading up to the focus group
date. The email the students received provided them with an opportunity to
volunteer to participate in a focus group, along with a participant disclosure,
and a confidentiality agreement for the participants to review. The sample for
this study consisted of five health sciences students, from a variety of
disciplines, who voluntarily participated in one focus group. The final
participants were from the disciplines of medicine (n = 3), occupational
therapy (n = 1), and emergency medical services (n = 1).
Data Collection
Eight self-developed
focus group questions were used for data collection. The research mentor, also
involved in the development and implementation of IPE 400 Introduction to
Collaborative Care, helped the researchers create these questions. Questions
were given in a consistent order to begin the focus group and to increase
dependability of the study by preventing biased question order. Questions were
asked from simple to more in-depth, as well as in a neutral form to prevent
participants from being influenced to answer a certain way. The focus
group followed a semi-structured interview format. A Creighton employee with previous
experience in focus group facilitation, CITI trained and IRB approved who was
not a member of the primary research team, led and recorded the focus group
using a digital tape recorder. A professional transcriptionist, outside
the research team and found online, transcribed the initial data.
By attending
the focus group, students agreed to have their responses anonymously recorded.
Each student signed a participant disclosure and confidentiality agreement at
the focus group session upon check-in. The CITI trained and IRB approved focus
group facilitator used provided pre-scripted, open-ended questions created by
the research team to guide the discussion and to encourage conversation and
participant involvement. The focus group facilitator utilized probes for
further clarification from emerging conversations.
Data Analysis
Before data
analysis, three researchers reviewed the transcribed data to ensure accuracy.
After that, each researcher independently conducted a content analysis and then
collaborated to confer findings (Portney & Watkins, 2015). Researchers
began the process by independently reading the transcribed data repetitively to
obtain an understanding of the overall perceptions of students, and to
determine recurring ideas and themes and/or discrepancies from the focus group.
Researchers then read the transcription word-by-word and highlighted words and
phrases and created themes. Next, the three researchers collectively
categorized repeated words, and created labels that became the initial coding
scheme. Triangulation of the multiple reviewers occurred to ensure accuracy of
themes (Shenton, 2004). Researchers then separated codes into categories based
on content relativity. Lastly, researchers finalized categories and matched
corresponding data to create finalized themes. These finalized themes
represented overall students’ perceptions; student quotations were selected to
exemplify these themes.
Results
The
research team was able to identify four common themes from the transcription of
the focus group, which were benefits of the course, efficiency of the course,
challenges of the course, and recommendations.
Benefits of the course
After
completion of the IPE course, the participants reported many benefits of the
course such as the importance of teamwork, having a greater understanding and
appreciation towards other professionals’ roles and expertise, and how
interprofessionalism can benefit the patient or client for best overall care.
In regards to the importance of teamwork and related goals of a team:
“Working as part of a team is almost a comfort because
you have people that you can discuss
your ideas.”
In
addition, many of the participants reported a benefit of the course was
learning about what other healthcare professions did and how they contributed
differently to the team for continuity of care:
“I
think the biggest thing I learned from specifically the IPE course, was just
the knowledge of what specifically fit under different healthcare professions.”
Furthermore,
participants were also able to gain insight on how IPE along with teamwork and
communication can increase quality of care:
“Communication between the different physicians,
specialists, and other people is huge because...
the patient might get more like duplicate information and that’s always frustrating for a patient and they think,
‘oh none of these people are communicating.’”
Efficiency of the Course
Participants
reported several different aspects of the course that worked well for them.
Many participants agreed on the positives of the course being online,
self-paced and modules required to be completed in an established order. As one
individual noted, “I appreciated the fact that it was online.” while another
added that, “I like doing it at my own pace.”
Both
statements were mutually agreed upon by all participants shortly after. In
regards to how the course was set up:
“I think it was important that they kind of made you
do it in order because you couldn’t get
to the next step without finding a way to complete the previous one, which I
thought that was kind of a smart thing to
do in setting up this whole course online.”
Challenges of the Course
Even
though several benefits came out of the course, several challenges presented
themselves through the eyes of the participants. A few participants found
challenges in the online experience with technical difficulties arising when
navigating the online interface. As one participant stated, “I’m not very
technically savvy and I got lost a lot.” Another challenging aspect to the course is that
it was not immediately applicable, and generic:
“I think it’s extremely superficial, you know, ‘this
is what my team does, this is how we can
work together. Until you are thrown into the situation or until you see it done
as well, you are not really going to
know how it works.”
Recommendations
As
the participants in the focus group reflected on their experience, many had
suggestions to make the IPE experience better such as timing of the class,
meeting other students in the class face to face, and having the leaders in
their schools discuss the importance of interprofessional education. Many of
the participants stated that they would have enjoyed the class more if it had
been given to them prior to school starting:
“I think maybe offering it before you even begin your
graduate school would sort of introduce
you to it. This is something Creighton truly believes in and we want to instill
it now,’ so that when you do have
that first clinical experience or that first outpatient or whatever you already know that is something
that is expected and something to look out for.”
Another
suggestion that was repeated by participants was to interact with other
students in other professions:
“I feel like I don't get any communication with other
schools apart from the volunteer stuff
I do. I mean that’s a huge undertaking for a curriculum,”
Lastly,
many of the participants wanted leaders or professors in their department to
frame the interprofessional experience:
“During orientation or at some point to have all of
the professional schools come together and
have one person from each graduate program, just give a paragraph of why they
think it’s important. I think it would
be more meaningful.”
Discussion
Studies have shown that
interprofessional collaborative practice strengthens health systems, is cost
efficient, and most importantly, improves outcomes for the patient as
determined by the Triple Aim (Berwick, Nolan, & Whittington, 2008; Hoffman,
Rosenfield, Gilbert, & Oandasan, 2008; Watters et al., 2015). In this
study, students acknowledged how interprofessionalism can benefit the patient
or client for best overall care, as well gain a greater understanding and
appreciation towards other professionals’ roles and expertise. Suter et al.
(2009) believed that understanding and valuing other professionals’ roles is a
prerequisite for collaboration and teamwork to occur. If professionals lack the understanding of
roles, it can lead to tension, role blurring, and inability to strike a balance
between interdependence and professional autonomy (Suter et al., 2009). With
clear roles and communication, working on a team can increase the quality of
patient care and outcomes (D’amour & Oandasan, 2005; Suter et al., 2009).
When working in a healthcare profession, individuals rarely act alone; they are
always working within teams or groups. Some components of successful teamwork
include open communication, clear direction, known roles and tasks,
acknowledgment and processing of conflict, and the ability to evaluate outcomes
and adjust accordingly (O’Daniel & Rosenstein, 2008). Students in this study acknowledged the roles
of different health care professionals, and appreciated the emphasis on
teamwork.
From the current study, students
reported many positive aspects that worked well for them such as the course
being online, self-paced and in module format. Self-paced online learning is an
option for implementing IPE because it helps address geographic, time allotment
and scheduling barriers frequently faced when coordinating activities across
multiple health disciplines (Solomon et al., 2010). According to Casimiro,
MacDonald, Thompson, and Stodel (2009), students from different healthcare
programs are more than often taught in different locations and having a
self-paced format of an online course can help encourage reflection and
generate critical thinking.
However,
there is little in literature to help determine the optimal length of time
required for students to develop online relationships and to learn with, from,
and about each other relating to IPE. The main challenges found from the
current study were technological difficulties, the generic nature of the
developed scenarios, and the lack of availability to apply newly acquired
knowledge and skills. Cain and Chretien (2013) identified other possible challenges
related to online learning, such as scenario development, technical proficiency
of faculty and students, and technology services gaining or providing access to
online content. Additionally, Cain and Chretien (2013) states that face-to-face
interactions between students provides a much more collaborative and realistic
approach to solve realistic problems.
Students in this current study recommended having face-to-face interactions for
a more meaningful experience.
According to Cain and Chretien (2013), the design of the IPE curriculum
and the experience of the facilitator are key factors in determining the
breadth and depth of learning. Students in this study suggested facilitators
from different professions frame the interprofessional experience.
Students said they would like to see their faculty and staff contribute to the
lectures, and course content to represent each profession equally. Feedback
collected from the students will be used to rearrange course content to allow
for equal representations of roles, and will be used to influence when the course
will be offered within each discipline's curriculum.
In
this course, the online learning environment will be most students’ first
introduction to IPE. It can be assumed that specific disciplines will offer
more face-to-face interaction experiences throughout their curriculum. Overall,
the Core Competencies of Interprofessional
Collaborative Practice
supports the use of educational technologies such as online learning to
overcome barriers relating to time and space (IPEC, 2011).
This information of students’
perceptions will add to the discourse of IPE by contributing to the development
of a conceptual framework for measuring the impact of IPE, strengthening the
evidence for IPE, and ideally effectively link IPE with changes in
collaborative practice (Institute of Medicine, 2015). This study has informed
students of the benefits of IPE on patient outcomes, preparing them to work
more effectively in a healthcare team.
Students reflected on the importance of collaborative practice,
effective communication, and their preparedness for team-based care. This
information will also help influence professional schools in meeting
accreditation standards related to interprofessional practice.
There are various limitations
identified in this study. Students’ knowledge base in interprofessionalism was
not quantitatively assessed, limiting data collected to only reflect on
students’ perceptions of the course. Data of this study were collected through
focus groups, which may not be a good representation of a larger population due
to small sample size. The focus group used in this study had five participants,
vastly smaller than the 700
students enrolled in the course IPE 400 Intro to Collaborative Care. In
addition, not all health disciplines were represented in our focus group. Nursing, pharmacy, and physical therapy students
did not participate in the focus group. It is also possible for individuals in
the focus group to be influenced by other participants, affecting their
responses and behaviors. In this study, there was interest from distance
students to participate, but this did not fit into the inclusion criteria for
participants. This likely contributed to
the small sample size. Lastly, this study is specific to Creighton University;
therefore, the results may not be generalized to students in other IPE
programs. Although there are limitations to this study, the results
are encouraging to those interested in using online learning for IPE. Student
examples of sharing professional knowledge demonstrated successful
interprofessional learning online.
As
interprofessional education courses become part of the accreditation standards
for healthcare education, it is important to reflect on student perceptions.
Students’ perceptions are necessary to understand the knowledge that they
gained taking the course, the structure and format of the course, and their
recommendations to improve the course. This study will provide feedback for
Creighton University about health science students’ perceptions pertaining to
the introductory IPE course. In addition, quantitative research in the area of IPE is already being
collected as an effort to follow the International Institute of Medicine
initiative to expand the IPE evidence base. Comparably, there are few studies
of IPE that have been explored using a qualitative design to address the
important contextual issues and broad consensus of IPE (Institute of Medicine,
2015). Future research should focus on
examining both qualitative and quantitative data to analyze students’
perceptions, and knowledge in the area of IPE. Future studies should attempt to
gather data from a bigger and equal sample of different health professions.
For future health professionals,
introduction to IPE while in school will allow students to become
collaboration-ready practitioners (Ruebling et al., 2014). Experiencing IPE
prior to beginning a career will allow students to have experience in teamwork
as a part of an interprofessional team, and will allow for higher levels of
confidence in their skills (Anderson
& Thorpe, 2008; Pardue, 2015).
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