Improving interprofessional competence in undergraduate studentsusing a novel blended learning approach

Eleanor Riesen, Michelle Morley, Debra Clendinneng, Susan Ogilvie and Mary Ann Murray

Algonquin College, School of Health and Community Studies, 1385 Woodroffe Avenue, Ottawa, Ontario, Canada

Interprofessional simulation interventions, especially when

face-to-face, involve considerable resources and require that all

participants convene in a single location at a specific time.

Scheduling multiple people across different programs is an

important barrier to implementing interprofessional education

interventions. This study explored a novel way to overcome the

challenges associated with scheduling interprofessional

learning experiences through the use of simulations in a virtual

environment (Web.Alivee) where learners interact as avatars.

In this study, 60 recent graduates from nursing, paramedic,

police, and child and youth service programs participated in a

2-day workshop designed to improve interprofessional

competencies through a blend of learning environments that

included virtual face-to-face experiences, traditional face-to-

face experiences and online experiences. Changes in learners’

interprofessional competence were assessed through three

outcomes: change in interprofessional attitudes pre- to post-

workshop, self-perceived changes in interprofessional

competence and observer ratings of performance across three

clinical simulations. Results from the study indicate that from

baseline to post-intervention, there was significant

improvement in learners’ interprofessional competence across

all outcomes, and that the blended learning environment

provided an acceptable way to develop these competencies.

Keywords: Blended learning, evaluation research,

interprofessional competence; interprofessional education

INTRODUCTION

There is a national mandate in Canada to provideinterprofessional learning opportunities for undergraduatehealth and social care students. Theoretically, students wholearn how to work together should be better equipped tocollaborate with each other when encountering stressfulclient situations in their professional practice and better teamcollaboration can result in better client outcomes andimproved job satisfaction for clients and providers

(D’Amour & Oandasan, 2004; Reeves et al., 2008). Break-down in team collaboration can have important negativeeffects on patient safety thereby compounding the need tofocus on interprofessional team competencies (World HealthOrganization, 2009). It would therefore be beneficial forsuggest that it would be beneficial for undergraduate health,public safety and social care students to learn how toeffectively work together during their educational programs.

Simulation has been proposed as an effective method fordelivering interprofessional education (IPE) interventions byhelping students to develop interprofessional competence(van Soren, Macmillan, Cop, Kenaszchuk, & Reeves, 2009).Simulation exposes students to complex, often stressfulsituations, allowing them to practice their communication,teamwork, problem solving and psychomotor skills withoutendangering clients. Moreover, a simulation environmentallows instructors to focus specifically on interprofessionalcompetencies required in the practice setting (Medley &Horne, 2005; Stewart, Kennedy, & Cuene-Grandidier, 2010).This is especially useful at the undergraduate level wherestudents are rarely afforded the opportunity to activelyengage in complex clinical cases in a setting comprised ofa diverse interprofessional group of their peers (Stewart,Kennedy, & Cuene-Grandidier, 2010).

Despite known benefits, interprofessional simulationinterventions, especially those that are face-to-face, involveconsiderable resources and require that all participantsconvene in a single location at a specific time. Thus, face-to-face simulations are costly and difficult to coordinate. Ourteam recognized that it would be beneficial to explorecreative ways to overcome the challenges associated withscheduling through the use of novel approaches to IPEsimulation.

Some creative methods of simulation have shown promisein helping learners develop their interprofessional compe-tencies. Attack et al. (2009) found that a combination ofonline gaming, discussions and face-to-face simulation helpedlearners improve their attitudes toward interprofessionalism

Correspondence: Eleanor Riesen, Algonquin College, School of Health and Community Studies, 1385 Woodroffe Avenue, Ottawa, Ontario, CanadaK2G 1V8. E-mail: riesene@algonquincollege.com

Received 27 April 2011; revised 22 December 2011; accepted 19 January 2012

Journal of Interprofessional Care, 2012, 26: 312–318q 2012 Informa UK, Ltd.ISSN 1356-1820 print/ISSN 1469-9567 onlineDOI: 10.3109/13561820.2012.660286

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and self-reported competence in disaster management. Kinget al. (2009) suggest that Web 2.0 technologies and othersocial networking tools should be integrated into inter-professional curricula to help students to learn how tocommunicate in both face-to-face and virtual learningenvironments. Merging simulation with Web 2.0 technol-ogies may offer to learners engaging and relevantopportunities to enhance their collaboration skills.

In response to the needs for more undergraduate IPEopportunities, the benefits of simulation and the challengesof scheduling, our team developed a 2-day IPE workshopincorporating Web 2.0 technologies that allow for learningactivities in a virtual environment. The workshop wasplanned as a precursor to an eventual three-credit IPE course.

This study had two objectives: to assess whether a blendedlearning environment that includes virtual face-to-faceexperiences, traditional face-to-face experiences and onlineexperiences is a useful method for improving students’interprofessional competencies and to solicit participants’feedback about the content and process of the interventions.

It was hypothesized that participants who completed the2-day workshop using the blended learning environmentwould show improvement in their interprofessional compe-tence (knowledge, skills, attitudes and behaviors). Morespecifically, change in interprofessional competence waspredicted in three different outcome measures. First,interprofessional attitudes were predicted to improve asmeasured by pre- and post-workshop questionnaires com-pleted by learners. Second, self-perceived improvement waspredicted in learners’ interprofessional competency asmeasured by a retrospective questionnaire administeredpost-workshop. Third, improvement was predicted inobserver ratings of learners’ performance in three clinicalsimulations over the course of the workshop.

BACKGROUND

Web.Alivee is a 3D world that students navigate in real timeby becoming a personalized avatar. Students are able to accessa wide range of learning content in the Web.Aliveeenvironment, such as videos, slide presentations and otherweb-based resources. They are also able to convene as avatarsin the Web.Alivee environment to hold meetings anddiscussion groups. This type of virtual world interaction isherein referred to as virtual face-to-face interaction. Itinvolves being able to see other avatars and use avatargestures to visually communicate with others, in addition tousing microphone-enabled audio links for verbal communi-cation. Scheduling challenges are overcome because inter-professional student groups can meet at anytime they choose,from any location where there is Internet access.

The Web.Alivee world appears to the user as an onlineversion of the real world. It is complete with detailedbuildings (e.g. police station, fire hall, public health office,amphitheater and private homes) and landscaping. Studentscan select uniforms for their avatar that are associated withtheir own profession. The immersive nature of Web.Aliveecreates an attractive candidate environment in which to run

virtual face-to-face simulations with interprofessional studentteams. Students have the benefit of participating insimulation experiences while having full scheduling flexi-bility. The intent is that such an environment would providea balance between traditional face-to-face learning andsimulation experiences, and less immersive web-basedlearning environments such as BlackBoarde.

INTERPROFESSIONAL WORKSHOP

The IPE workshop consisted of a 2-day (16 hour) blendedlearning, mixed-simulation workshop that was administeredto half of the sample (n ¼ 30). The 2-day workshop was thenrepeated with identical content for the remaining30 participants. The workshop was designed to mimic thecontent and flow of a full three-credit IPE course. It includedall of the main elements of a planned longer course, but insmaller doses due to the shorter time frame. These mainelements included interprofessional interaction, real-lifesimulation, real-life debriefing, virtual simulation, virtualdebriefing and a didactic learning component focused oninterprofessional competencies and communication.Workshop participants were on site for the entireworkshop. For portions involving virtual world interaction,students accessed Web.Alivee from a variety of computerlaboratories within the college.

ParticipantsThe participants were drawn from recent graduates from theFaculty of Health, Public Safety and Community Studies atAlgonquin College, Ontario, Canada. The participantsincluded students from the following programs: bachelor ofscience in nursing (a 4-year program), child and youthworker (a 3-year program), basic care paramedic (a 2-yearprogram) and police foundations (a 2-year program).Approximately, 300 students were approached to participatein the study. The inclusion criterion was successfulcompletion of one of the four chosen programs of study toensure that all students were equal in their preparation toperform their respective roles. This excluded unsuccessfulstudents, students from other programs and students fromother years of study. Participants who met the criteria wererecruited on a first come first serve basis. Recruitment yieldeda total of 60 recently graduated, pre-licensure students whohad just completed their program but had not yet startedworking in their respective profession. Sixty participantswere deemed an appropriate number with enough power todetect differences in repeated measures statistical tests.

Of the 60 participants, 31.7% were from the nursingprogram (n ¼ 19), 25% were from the police foundationsprogram (n ¼ 15), 23.3% were from the paramedic program(n ¼ 14) and 20% were from the child and youth workerprogram (n ¼ 12). Sixty-three percent of the participantswere female (n ¼ 38) and 37% were male (n ¼ 22). Of the60 participants, 48 reported their age. The age of theparticipants by age group, for those who reported age, wasas follows: 18–20 years (n ¼ 9), 21–25 years (n ¼ 23),26–30 years (n ¼ 10) and 31 years and above (n ¼ 6).

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Thirty-four participants stated that they had previouslyworked in interprofessional teams, 13 reported no suchexperience and 2 were unsure.

ProcedureParticipants were placed into groups consisting of at least onerepresentative from each profession. Group sizes rangedfrom five to seven participants. Participants remained in thesame group for the duration of the workshop.

Three simulations, each using the same scenario, were runduring each workshop. Groups completed (1) an initial face-to-face simulation, (2) a virtual environment simulation inWeb.Alivee and (3) a final face-to-face simulation. Thescenario was focused on domestic violence, and involveda female standardized patient (SP) who had just arrivedhome 3 days after giving birth, and had a 6-year-old son(low-fidelity mannequin). Her husband, who had since leftthe scene, had been physically abusive. The SP had obviousphysical injuries and was emotionally distraught. Participantswere presented with a brief written description of thescenario, and then immediately were told to respond to thesituation in their professional role. Each simulation wasrecorded on video, and observers using the team objectivestructured clinical examination (TOSCE) rating form ratedeach participant’s performance in the scenario.

Following each simulation, all groups debriefed theirperformance in the domestic violence scenario. The debrief-ing was designed to emphasize key concepts of interpro-fessionalism based on the Canadian InterprofessionalCompetency Framework (2010), such as communication,leadership, conflict resolution, role clarification, patient/family-centered care and team functioning.

During the workshop, participants were also formallyintroduced to the Web.Alivee environment in an on-sitecomputer laboratory. They were provided with a structuredintroduction to Web.Alivee and given 1 hour to practicenavigating the environment. In developing the workshop, itwas assumed that participants would be unfamiliar withnavigating such an environment. Giving participantsstructured time to develop a familiarity with the navigationcontrols was considered an important aspect of theworkshop design. Lack of familiarization with the technologycould have led to negative bias in the TOSCE scores for thevirtual environment simulation induced solely by partici-pants’ comfort level with the technology.

Between each TOSCE scenario, participants weresubjected to various IPE activities. Participants used astandard electronic courseware package (BlackBoarde) toaccess and watch a didactic learning component, consistingof a video lecture with accompanying slideshow. The didacticcomponent was intended to introduce and familiarizeparticipants to interprofessional (IP) concepts such asinterprofessional competencies, interpersonal theory andeffective communication strategies with clients and teammembers. Participants also completed a team communi-cation activity designed to improve their communicationskills, watched various videos reinforcing interprofessional

competencies and attended a classroom-based lecture oninterprofessional teamwork.

Most of the IPE activities included a critical thinkingcomponent where participants were asked to discuss or“debrief” the content. The same faculty member facilitatedall of the debriefing sessions.

METHODS

A mixed methods before-and-after study design was used.Both quantitative and qualitative data were collected beforeand after the delivery of a 2-day IPE workshop. The focus ofthis paper is on the quantitative data (findings from thequalitative analysis are planned to be published elsewhere).The Research Ethics Board of Algonquin College approvedthis study, and all participants provided informed consent.

Data collectionEach participant completed a demographic questionnaire aswell as two self-report questionnaires (interdisciplinaryeducation perception scale, IEPS and interprofessionalcollaborative competencies attainment survey, ICCAS) toassess changes in interprofessional attitudes and self-perceived competence. In addition, observer ratings ofthree clinical simulations were made using a standardizedrating tool (McMaster–Ottawa TOSCE) to assess behavioralchanges in interprofessional competence. Finally, two self-report questionnaires (W(e)learn interprofessional programassessment and course evaluation) were administered toassess the learners’ impressions of the workshop. Thesemeasures are described in detail below.

Demographic information tool. Basic demographic informationwas collected using a survey including age, sex, type and lengthof program. Participants completed the demographic surveyat the beginning of the workshop.

Interdisciplinary education perception scale. The IEPS is an18-item survey-based tool that is separated into four factors:professional competence and autonomy, perceived need forprofessional cooperation, perception of actual cooperationand resource sharing within and across professions andunderstanding the value and contributions of otherprofessional/professions (Luecht, Madsen, Taugher, &Petterson, 1990). The IEPS is scored for each individualfactor as well as a total score out of 108. It was used as a pre–post measure in this study.

Interprofessional collaborative competencies attainment survey.The ICCAS (MacDonald et al., 2010) is a 20-item survey-based tool divided into six areas of interprofessionalcompetencies: communication, collaboration, roles andresponsibilities, collaborative family-centered approach,conflict management/resolution and team functioning. Thetool measures participants’ reflections of how they havechanged during the intervention using a Likert scale. Thistool is currently in the process of being validated (Archibald,personal communication, 2010, http://owl.english.purde.edu/owl/resource/560/03/). Learners completed the ICCAS

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survey at the end of the IPE workshop to assess self-perceivedchange in their own interprofessional competencies.

McMaster–Ottawa TOSCE. The TOSCE (McMaster–OttawaUniversity 2007; Solomon et al. 2011) was developedand validated as an observer rating tool for measuringinterprofessional teams’ competencies in a simulated clinicalenvironment. It assesses six competencies: communication,collaboration, roles and responsibilities, collaborativefamily-centered approach, conflict management/resolutionand team functioning. Each competency is rated on anine-point Likert scale.

W(e)learn interprofessional program assessment. TheW(e)learn tool (MacDonald et al., 2010) was used torate participants’ post-intervention perceptions of theinterprofessional aspects of the workshop. This tool has30 items rated from 1 (strongly disagree) to 7 (stronglyagree). Items are focused on gauging how effectively thecontent and delivery of the workshop targeted learningobjectives. Some items focus on interprofessional concepts,while others focus on the general delivery of the workshop.

Course evaluation. Our team developed an evaluation toolto measure participants’ overall impressions of the course.The primary goal of this tool is to gain insight intoparticipants’ opinion of four aspects of the course: theface-to-face components, the (traditional web based) onlinecomponents, the Web.Alivee virtual environment and theease of use navigating the virtual environment. The toolconsists of 16 items. Four items ask the participant to rateeach aspect of the course using a Likert scale from 1 (poor)to 6 (excellent). Participants are also asked what they likedabout each component and how it could be improved.

AnalysisData were analyzed using Statistical Packages for the SocialSciences (SPSS, version 18, Chicago, IL, USA). An alpha levelof 0.05, two tailed was used for statistical tests. Demographicdata were analyzed with descriptive statistics. Descriptive

statistics and paired t-tests were used to analyze the surveydata. One-way repeated-measures ANOVAs were used toanalyze the differences between the three TOSCE ratings.There are both positively and negatively worded items on thesurveys. All of the negatively worded items were calculated byreversing their scores.

RESULTS

Interprofessional collaborative competencies attainmentsurveyFifty-six participants completed all of the categories inthe ICCAS. There was improvement in the total score ofthe ICCAS and in each of the six individual competencies(see Table I). There was a significant difference between thetotal pre-workshop ICCAS score (M ¼ 98.75, SD ¼ 3.54)and the post-workshop score (M ¼ 128.98, SD ¼ 10.56),t (55) ¼ 29.30, p , 0.001.

Interdisciplinary education perception scaleAll of the participants completed the IEPS survey (N ¼ 60).There was statistically significant improvement in thetotal score of the IEPS from pre-workshop (M ¼ 88.67,SD ¼ 7.52) to post-workshop (M ¼ 91.18, SD ¼ 7.06,t (59) ¼ 23.33, p ¼ 0.002). Factor 1 of the IEPS,Professional Competence and Autonomy, examines parti-cipants’ views of their own perceived competence andautonomy and others’ inferred perceptions of theirprofession (Luecht et al., 1990). The pre-workshop scoresfor Professional Competence and Autonomy (M ¼ 39.98,SD ¼ 4.26) were significantly lower compared to post-workshop scores (M ¼ 41.95, SD ¼ 4.06), t (59) ¼ 23.72,p , 0.001. There was no significant difference between theremaining factors from pre- to post-workshop (see Table II).

Team objective structured clinical encounterData of 58 participants were incorporated into thefinal TOSCE results. Data pertaining to two of theparticipants were excluded due to incomplete data. Analyses

Table I. ICCAS scores reflecting self-perceived change from pre- to post-workshop (n ¼ 56).

Item Pre-mean/SD Post-mean/SD Change value p

Communication 26.14/6.20 32.54/2.27 6.40 ,0.001Collaboration 14.35/4.01 19.43/1.74 5.08 ,0.001Roles and responsibilities 19.28/5.88 25.84/3.86 6.56 ,0.001Collaborative patient/family-centered approach 13.91/5.27 19.11/3.25 5.21 ,0.001Conflict management/resolution 16.37/4.32 19.35/3.13 2.98 ,0.001Team functioning 9.33/2.94 12.89/2.29 3.56 ,0.001Total 98.75/23.54 128.98/10.56 30.23 ,0.001

Table II. IEPS scores pre- and post-workshop (n ¼ 60).

Item Pre-mean/SD Post-mean/SD Change value p

Professional competence and autonomy 39.98/4.26 41.95/4.06 1.97 ,0.001Perceived need for professional cooperation 11.17/0.94 11.40/0.83 0.23 0.104Perception of actual cooperation and resource sharing within and across professions 25.23/2.96 25.33/2.93 0.10 0.401Understanding the value and contributions of other professionals/professions 12.28/2.55 12.50/2.71 0.22 0.538Total 88.67/7.52 91.18/7.06 2.51 0.002

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using repeated-measures ANOVA indicated statisticallysignificant improvement across the three simulations in allcompetency areas for individual and group TOSCE ratings.The results for the TOSCE data are summarized in Table III.

W(e)learn interprofessional program assessmentThere were 39 participants who completed all aspects of theW(e)learn survey. The total mean score for all items was 6.47(SD ¼ 0.45), out of seven points. The scores ranged from 4.6to 7.00 across all items. These results are summarized inTable IV.

Overall program ratingStudents rated each component of the course using theCourse Evaluation Survey (N ¼ 60). The face-to-facecomponent was rated good (3.3%), very good (53.3%) andexcellent (43.3%). The traditional online component (Black-boarde) was rated as fair (16.7%), good (50%), very good(28.3%) and excellent (5%). The virtual environment

component (Web.Alivee) (N ¼ 59) was rated as poor(5.1%), fair (6.8%), good (40.7%), very good (37.3%) andexcellent (10.2%). Participants were asked to rate the ease ofnavigating in the Web.Alivee virtual world (N ¼ 57). It wasrated as poor (1.8%), fair (5.3%), good (42.1%), very good(22.8%) and excellent (28.1%).

DISCUSSION

The purposes of the study were to determine whetherparticipation in an IPE workshop augmented by virtualworld teaching tools improved health, public safety andcommunity studies students’ interprofessional competence(knowledge, skill, attitudes and behaviors), and to determinewhether the blended learning environment provided anacceptable way for developing these competencies. Overall,our findings add to the growing evidence base for theusefulness of virtual worlds in training health and social care

Table III. Individual and group TOSCE ratings of three clinical simulations (n ¼ 58).

Item TOSCE 1 mean/SD TOSCE 2 mean/SD TOSCE 3 mean/SD p

Communication 4.60/0.76 5.07/1.04 5.88/1.86 ,0.001Collaboration 4.55/0.70 5.12/1.14 5.62/0.82 ,0.001Roles and responsibilities 4.41/0.76 5.16/1.25 5.65/0.84 ,0.001Collaborative patient-/family-centered approach 4.54/0.84 5.02/1.10 5.66/0.93 ,0.001Conflict management/resolution 4.51/0.70 5.00/1.06 5.39/0.77 ,0.001Team functioning 4.48/0.78 5.03/1.30 5.68/0.91 ,0.001Global team rating 4.45/0.89 5.03/1.11 5.60/0.87 ,0.001Total team rating 4.39/0.45 5.06/0.66 5.57/0.69 ,0.001

Table IV. W(e)learn interprofessional (IP) program assessment.

Item n Min Max Mean SD

The facilitator promoted an open atmosphere in which all participants could be heard 54 5.00 7.00 6.85 0.41The facilitator promoted collaboration among learners 54 5.00 7.00 6.78 0.46The learning experience provided opportunities to learn about each other’s professions 54 5.00 7.00 6.88 0.37The learning experience provided opportunities to learn with and from each other 54 5.00 7.00 6.80 0.45The learning experience provided opportunities to practice IP collaborative approaches to patient-centered care 54 5.00 7.00 6.48 0.69The learning experience took into account learners’ previous knowledge and experiences 53 4.00 7.00 6.28 0.89The learning activities promoted the application of IP competencies 54 4.00 7.00 6.24 0.89The learning activities promoted collaborative problem solving 54 5.00 7.00 6.52 0.61The learning activities reflected situations encountered in practice 54 1.00 7.00 5.74 1.36The learning activities promoted mutual trust and respect among learners 54 5.00 7.00 6.63 0.62The learning activities contributed to achieving the learning objectives 53 4.00 7.00 6.34 0.78The content was consistent with my professional interests and needs 54 3.00 7.00 6.19 0.93The content included policies and regulations relevant to IP practice 52 3.00 7.00 5.79 1.19The content included knowledge and skills necessary for IP teamwork 54 3.00 7.00 6.35 0.78The content was applicable to a wide variety of healthcare contexts (e.g. hospital, community, etc.) 54 1.00 7.00 5.81 1.51The facilitator provided useful feedback 50 1.00 7.00 6.30 1.15My organization adequately supported my participation in the IP learning environment 44 3.00 7.00 6.48 0.90I enjoyed the IP learning experience 52 3.00 7.00 6.71 0.67I have learned knowledge that I will apply in practice 53 2.00 7.00 6.60 1.01I have learned skills that I will apply in practice 53 2.00 7.00 6.30 1.23The learning activities were well organized 53 4.00 7.00 6.36 0.83The facilitator modeled effective IP collaboration 51 4.00 7.00 6.53 0.70The learning activities were engaging 54 4.00 7.00 6.63 0.68The facilitator was knowledgeable about IP 52 1.00 7.00 6.56 1.07The facilitator was responsive to the learners’ needs 52 4.00 7.00 6.69 0.58The learning objectives were clear 52 3.00 7.00 6.13 1.12I have improved my knowledge of IP competencies that I need to continue to develop 53 3.00 7.00 6.42 0.99I am motivated to change my practice toward providing more effective IP collaborative care 53 2.00 7.00 6.32 1.03I was provided with and/or made aware of useful tools and resources 54 3.00 7.00 6.26 0.99I have a deeper appreciation of the approach to collaborative patient-centered care 51 4.00 7.00 6.71 0.61Total 39 4.60 7.00 6.47 0.45

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professionals (e.g. Carlson-Sabelili, Giddens, Fogg, & Fiedler,2011; Curran, Elfrik, & Mays, 2009; Nowlen, Riesen, Morley,Arya, & Sauriol, in press; Walsh, 2010).

As hypothesized from pre- to post-workshop, there wassignificant improvement in interprofessional competenceacross several methods of measurement (change ininterprofessional attitudes pre- to post-workshop, self-perceived changes in interprofessional competence andimproved observer ratings of performance across threeclinical simulations. A key strength of this study is the use ofobserver ratings to assess changes in interprofessionalcompetence. A general weakness in previous research, asreported by Hammick, Freeth, Koppel, Reeves and Barr(2007), is that much of the evidence of changes ininterprofessional behavior was based on self-report, whichis a weak approach to the measurement of behavioral change.In studies that have used third-party raters to assess behaviorchange resulting from interprofessional interventions, theinterventions led to an improvement in various aspects ofinterprofessional competency including team behavior(Morey et al., 2002), role clarity (Cooke, Chew-Graham,Boggis, & Wakefield, 2003) and communication (Cooke et al.,2003; Kilminster et al., 2004).

The data collected regarding participants’ experience ofthe workshop suggest that participants enjoyed interacting inthe blended learning environment. Participants had positivereports about the overall design of the 2-day workshop. Theyfound that the workshop helped to increase their awarenessand appreciation of interprofessionalism, as well as providingthem a way to demonstrate and improve their teamwork andcollaboration as part of an interprofessional team in achallenging situation. According to Curran, Heath, Kearneyand Button (2010), a “workshop model” seems to be anacceptable approach for pre- and post-licensure trainees tolearn about interprofessionalism and is effective in improv-ing attitudes toward teamwork. The virtual learningapproach in particular holds promise for both pre- andpost-licensure groups who have challenges associated withscheduling, space and geographic distance.

The use of a combination of learning modalities for IPE issupported in the IPE literature for healthcare teams todevelop interprofessional competence. In D’Eon’s (2004)blueprint for IPE, he recommends using a multimodalapproach that has been successfully implemented with otherinterprofessional student groups in IPE courses (Brown et al.,2008). Of particular interest in our study is the suggestion thatstudents can develop interprofessional competence in ablended learning environment that incorporates an immer-sive online virtual world like Web.Alivee. A primaryadvantage of the use of blended learning methods overtraditional face-to-face methods is the flexible delivery ofinterprofessional courses. Providing flexibility in the time andplace of course, delivery can help to overcome basic logisticalbarriers to IPE such as timetabling, geography and physicalspace that are typical challenges for institutions implementingIPE (King, Taylor, Satzinger, Carbonaro, & Greidanus, 2008).Not only does the virtual world allow learners to collaborate inreal time, it can also be used as an environment in which to

evaluate their interprofessional competencies and perform-ance in difficult situations. It is promising to find that studentscan learn and demonstrate interprofessional competencies ina virtual world, and that their performance can also beevaluated in this environment. In this respect, our findings areconsistent with an emerging literature that suggests thatlearner confidence and performance can be assessed andimproved through education delivered in a virtual environ-ment. For example, according to Wiecha, Heyden, Sternthaland Merialdi (2010), a 1-hour intervention in a virtualworld improved practicing physicians’ confidence andperformance related to proper planning and ordering ofinsulin for patients’ with type 2 diabetes.

Learners considered the blended learning environmentacceptable for learning with, from and about each other.Their feedback suggests that it is important to have face-to-face contact, and that they enjoy the face-to-face deliverymethod above others. However, the virtual reality com-ponent was rated more favorably overall than the traditionalonline component. Using a combination of methods,therefore, appears useful in delivering IPE course content.Wiecha et al. (2010) also found similar results in theiruniprofessional intervention in virtual worlds. Virtual worldsprovide convenience and an added sense of “presence”compared to other online methods.

One limitation of the study is that participants stayed inthe same team for the entire 2-day workshop. There is anatural progression for teams to become more proficientover time. It would be beneficial to design studies that mixgroups from task to task.

Another limitation of the current study is that there wasno comparison group of a more “traditional” (i.e. non-blended) type of workshop. For this reason, althoughlearners showed improved levels of interprofessionalcompetence, we cannot conclude that they improved morethan they would have in any other type of learningenvironment. Participants also repeated the same scenarioin each simulation. In future studies, it would be useful toimplement different simulation scenarios and alter the teamsto better isolate the effects of interventions on participants’interprofessional competencies.

Finally, the quantitative data presented here will beextended in the future by an analysis of the qualitative aspectof this pilot project. Qualitative analysis of workshopdebriefing sessions will help to better understand the processof how interprofessional competencies developed during theworkshop and to identify promoters of and barriers tolearning that were experienced in the live and virtualenvironments.

CONCLUDING COMMENTS

Overall, the IPE workshop was a positive experience for theparticipants and there was a significant improvement instudents’ interprofessional competence. Results suggest thatvirtual environments show promise for delivering IPEsimulation interventions. The participants also enjoyed theopportunity to meet face-to-face to discuss their professional

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roles and learn about other professions. The full three-creditcourse that is the extension of the IPE pilot workshop willprovide similar and more in-depth learning opportunities forundergraduate students over a longer time frame. Ongoingevaluation of the course will explore the benefits andchallenges of IPE delivered in the virtual environment, andits capacity to improve interprofessional competence amongundergraduate learners.

ACKNOWLEDGMENTS

The authors would like to acknowledge financial contri-butions from Natural Sciences and Engineering ResearchCouncil of Canada and the Champlain Region AcademicHealth Council. The academic institutions involved in thisproject were Algonquin College, Carleton University and theUniversity of Ottawa. The authors would like to thank AndrewBurr, John Willman, Nuket Nolan, Ali Arya, Melanie Willisand the many students who participated in this project.

Declaration of interestThe authors report no declarations of interest. The authorsalone are responsible for the writing and content of thispaper. Avaya, the company that created Web.Alivee,provided in kind funding for the development of the virtualworld. A doctoral-level research associate provided editorialassistance in the preparation of this article. Neither theauthors nor the research associate have a financial orproprietary interest in Avaya.

REFERENCES

Attack, L., Parker, K., Rocchi, M., Maher, J., & Dryden, T. (2009). Theimpact of an online course in disaster management competency andattitude toward interprofessional learning. Journal of InterprofessionalCare, 23, 586–598.

Brown, B., Warren, N.S., Brehm, B., Breen, P., Bierschbach, J.L., &Smith, R. (2008). The design and evaluation of an interprofessionalelective course with a cultural competence perspective. Journal ofAllied Health, 37(4), e316–e337.

Canadian Interprofessional Health Collaborative (CIHC). (2010). Anational interprofessional competency framework. Vancouver: Author.

Carlson-Sabelli, L.L., Giddens, J.F., Fogg, L., & Fiedler, R.A. (2011).Challenges and benefits of using a virtual community to explorenursing concepts among baccalaureate nursing students. Inter-national Journal of Nursing Education Scholarship, 8(1), ISSN (Online)1548-923X, doi: 10.2202/1548-923X.2136.

Cooke, S., Chew-Graham, C., Boggis, C., & Wakefield, A. (2003). ‘Inever realised that doctors were into feelings too’: Changing studentperceptions through interprofessional education. Learning in Healthand Social Care, 2, 137–146, doi: 10.1046/j.1473-6861.2003.00050.x.

Curran, R., Elfrink, V., & Mays, B. (2009). Building a virtual communityfor nursing education: The town of Mirror Lake. Journal of NursingEducation, 48, 30–35.

Curran, V.R., Heath, O., Kearney, A., & Button, P. (2010). Evaluation ofan interprofessional collaboration workshop for post-graduateresidents, nursing and allied health professionals. Journal ofInterprofessional Care, 24(3), 315–318.

D’Amour, D., & Oandasan, I. (2004). Interprofessionality as the field ofinterprofessional practice and interprofessional education: Anemerging concept. Journal of Interprofessional Care, 1, 8–20.

D’Eon, M. (2004). A blueprint for interprofessional learning. MedicalTeacher, 26(7), 604–609, doi: 10.1080/01421590400004924.

Hammick, M., Freeth, D., Koppel, I., Reeves, S., & Barr, H. (2007).A best evidence systematic review of interprofessional education:BEME guide no. 9. Medical Teacher, 29(8), 735–751, doi:10.1080/01421590701682576.

Kilminster, S., Hale, C., Lascelles, M., Morris, P., Roberts, T., Stark, P.,Sowter, J., & Thistlethwaite, J. (2004). Learning for real life: Patient-focused interprofessional workshops offer added value. MedicalEducation, 38, 717–726, doi: 10.1046/j.1365-2923.2004.01769.x.

King, S., Greidanus, E., Carbonaro, M., Drummond, J., & Patterson, S.(2009). Merging social networking environments and formal learningenvironments to support and facilitate interprofessional instruction.Medical Education Online, 14(5), 1–9.

King, S., Taylor, E., Satzinger, F., Carbonaro, M., & Greidanus, E. (2008).Developing interdisciplinary team competencies in a blendedlearning course: Impact on student learning. The Internet Journal ofAllied Health Sciences and Practice, 6(1), 1–6, Retrieved from http://ijahsp.nova.edu/articles/vol6num1/king.htm.

Leucht, R., Madson, M., Taugher, M., & Petterson, J. (1990). Assessingperceptions: Design and validation of an interdisciplinary educationperception scale. Journal of Allied Health, 19, 181–191.

MacDonald, C.J., Archibald, D., Trumpower, D., Casimiro, L., Cragg, B., &Jelley, W. (2010). Designing and operationalizing a toolkit of bilingualinterprofessional education assessment instruments. Journal ofResearch in Interprofessional Practice and Education, 1(3), 304–316,Retrieved June 14, 2011, from http://www.jripe.org/jripe/index.php/journal/article/view/36/35.

McMaster-Ottawa University. (2007). The team objective structuredclinical encounter. Hamilton, Ottawa, Ontario: Author.

Medley, C.F., & Horne, C. (2005). Using simulation technology forundergraduate nursing simulation. Journal of Nursing Education, 44,31–34.

Morey, J.C., Simon, R., Jay, G.D., Wears, R.L., Salisbury, M., Dukes,K.A., et al. (2002). Error reduction and performance improvement inthe emergency department through formal teamwork training:Evaluation results of the MedTeams Project. Health Services Research,37(6), 1553–1581, doi: 10.1111/1475-6773.01104.

Nowlan, N., Riesen, E., Morley, M., Arya, A., & Sauriol, N. (2011).A framework for an immersive learning environment with telemetricsand simulation. Ubiquitous Learning: An International Journal, 3(1),107–122, Retrieved from http://www.ubi-learn.com/journal/publi-cations/.

Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Hammick,M., & Koppel, I. (2008). Interprofessional education: Effects onprofessional practice and health care outcomes. Cochrane Database ofSystematic Reviews, 1, 1–22, doi: 10.1002/14651858.CD002213.pub2.

Solomon, P., Marshall, D., Boyle, A., Burns, S., Casimiro, L.M., Hall, P., &Weaver, L. (2011). Establishing face and content validity of theMcMaster-Ottawa team observed structured clinical encounter(TOSCE). Journal of Interprofessional Care, 25(4), 302–304, doi:10.3109/13561820.2011.571353.

van Soren, M., Macmillan, K., Cop, S., Kenaszchuk, C., & Reeves, S.(2009). Development and evaluation of interprofessional care practicesthrough simulation. Journal of Interprofessional Care, 23(3), 304–306.

Stewart, M., Kennedy, N., & Cuene-Grandidier, H. (2010). Under-graduate interprofessional education using high-fidelity pediatricsimulation. Clinical Teacher, 7, 90–96.

Walsh, M. (2010). Using a simulated learning environment. EmergencyNurse, 18, 12–16.

Wiecha, J., Heyden, R., Sternthal, E., & Meridaldi, M. (2010). Learningin a virtual world. Experience with using second life for medicaleducation. Journal of Medical Internet Research, 12(1), e1, doi:10.2196/jmir.1337.

World Health Organization (WHO). (2009). Human factors in patientsafety. Topic and tools. Geneva: World Health Organization.

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