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
Teamwork and collaboration
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
Teamwork and collaboration
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
Occupational Therapy
Podiatry 82 122 78 187 8421.5 -3.892 <0.001 0.22
Occupational Therapy
Radiography 82 122 78.5 96 4208 -3.568 <0.001 0.24
Occupational Therapy
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
Profession¹ Profession² Md¹ N¹ Md² N² U Z P R
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
Occupational Therapy
Radiography 79 92 75 70 2258.5 -3.254 0.001 0.26
Occupational Therapy
Medicine 79 92 71.5 90 2143.5 -5.622 <0.001 0.42
Occupational Therapy
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:
Profession Sample 1 Md
N Sample 2 Md
N U Z P R
Physiotherapy 56 236 52.5 216 19793 -4.112 <0.001 0.12
Occupational Therapy
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
Profession¹ Profession² Md¹ N¹ Md² N² U Z P R
Occupational Therapy
Podiatry 58 122 54 187 8271 -4.096 <0.001 0.23
Occupational Therapy
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
Sample 2Sub-scale 1 Analysis
Profession¹ Profession² Md¹ N¹ Md² N² U Z P R
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
Occupational Therapy
Medicine 55 92 51.5 90 2681 -4.113 <0.001 0.3
Occupational Therapy
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
Profession Sample 1 Md
N Sample 2 Md
N U Z P R
Physiotherapy 18 236 13 216 5218 -14.67 <0.001 0.31
Occupational Therapy
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.
Sample 1Sub-scale 2 Analysis
Profession¹ Profession² Md¹ N¹ Md² N² U Z P R
Physiotherapy Medicine 18 236 20 75 6080.5 -4.125 <0.05 0.23
Occupational Therapy
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
Sample 2Sub-scale 2 Analysis
Profession¹ Profession² Md¹ N¹ Md² N² U Z P R
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
Occupational Therapy
Radiography 12 92 14 70 2260.5 -3.256 0.001 0.26
Occupational Therapy
Medicine 12 92 15.5 90 2068 -5.848 <0.001
0.43
Occupational Therapy
Prosthetics & Orthotics
12 92 14 31 875.5 -3.220 0.001 0.29
Occupational Therapy
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
Occupational Therapy
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
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