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Participation in interprofessional education: An evaluationof student and staff experiences
ANNA FORTE & PATRICIA FOWLER
Faculty of Health and Social Care, London South Bank University, London, UK
AbstractThis study investigates the experiences of staff and students involved in an identified CommonLearning unit (module) named ‘‘Preparation for Practice’’. The unit was studied by those undertakingpre-registration undergraduate pathways in Physiotherapy, Occupational Therapy, Diagnostic Radio-graphy and Therapeutic Radiography at London South Bank University. The study comprised uni-professional, inter-professional and staff focus groups. The main themes that emerged from thestudent focus groups were ‘‘Interprofessional awareness’’, ‘‘Impact on patient care’’ and ‘‘Positive andnegative aspects of unit delivery’’. These themes were reflected in the staff focus group which alsohighlighted the impact of different learning and teaching strategies in working with interprofessionalgroups. Students and staff were able to understand the benefits of interprofessional education but theyalso identified barriers that detracted from the students’ learning. Overall a variety of views wereexpressed which reflected the diversity of the student group and the challenges that this presented inthe delivery of interprofessional education.
Keywords: Interprofessional education, common learning
Introduction
Team working is increasingly considered vital for the delivery of effective Health and Social
Care Services and interprofessional education (IPE) has been advocated by the government
as a strategy to help overcome difficulties in communication and team working encountered
within these settings. It is believed that IPE might help to change attitudes and dispel the
stereotypes that exist between groups by increasing their knowledge and understanding of
other professionals (Parsell & Bligh, 1998). IPE is currently being built into all education for
health and social care professionals throughout the UK and for it to be effective, the
rationale for the development of IPE initiatives needs to be made explicit to both staff and
students (Department of Health, 1998; Parsell et al., 1998; Pirrie et al., 1998; Barr & Ross,
2006). IPE can be defined as ‘‘Occasions when two or more professions learn from and
about each other to improve collaboration and quality of care’’ (Center for the Advancement
of Interprofessional Education [CAIPE], 1997).
Correspondence: Anna Forte, Senior Lecturer, Faculty of Health and Social Care, London South Bank University, 103 Borough
Road, London SE1 0AA, UK. Tel: þ44 (0)20 7815 8450. E-mail: [email protected]
Journal of Interprofessional Care,
January 2009; 23(1): 58–66
ISSN 1356-1820 print/ISSN 1469-9567 online � 2009 Informa Healthcare USA, Inc.
DOI: 10.1080/13561820802551874
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The NHS Workforce Strategy (Department of Health, 2000) called for education and
training which is truly multi-professional to promote:
. Teamworking
. Partnership and collaboration between professionals, agencies and with service users
. Skill mix and flexible working between professional groups
. Opportunities to switch training pathways
. New types of worker.
The aims of IPE are therefore to break down stereotypes, build collaboration and team
working, and ultimately impact positively on the patient experience.
The importance of nurturing an individual professional identity is a tension raised when
considering the timing for IPE in a curriculum, and studies of IPE involving a variety of
combinations of healthcare professionals have shown widespread agreement that it should
begin early in a professional’s education (Parsell et al., 1998; Pirrie et al., 1998; Horsburgh
et al., 2001; Tunstall-Pedoe et al., 2003; Carlisle et al., 2004).
Whether students are actually learning from each other in the academic setting or simply
learning alongside each other by being in the same room as each other is an issue raised by
Carlisle et al. (2004). The learning and teaching methods used have been shown to influence
this, and authors tend to agree that an interactive and problem-based or problem solving
approach with the educator as a positive role model leads to greater degree of inter-
professional learning (Harden, 1998; Pirrie et al.,1998; Parsell & Bligh 1999; Carlisle et al.,
2004).
According to Horsburgh et al. (2001) the barriers to implementation and/of sustainability
of IPE include logistical constraints (e.g., timetabling, numbers of students), internal
constraints (e.g., objectives of individual courses), external barriers (e.g., government
policy, legislation of professional bodies), political/social constraints and hidden barriers
e.g., scepticism, lack of hard evidence of the benefits of IPE.
Background
Since February 2003 the Inter-professional Scheme for Allied Health (IPSAH) at London
South Bank University has provided undergraduate pre-registration education for
Physiotherapy, Occupational Therapy, Diagnostic Radiography and Therapeutic Radio-
graphy students. Students attend on a part-time, in-service or full-time basis dependent on
the professional pathway on which they enrol. A common learning programme of seven units
was an integral part of the IPSAH. Common learning units run alongside uni-professional
units as an integrated whole in all three levels of study. Of particular interest for this study
were the experiences of students and staff relating to the first unit only, namely Preparation
for Practice, as this was the students’ first formal exposure to common learning. It is the
inclusion of part-time, in-service and full-time allied health students with a broad variety of
educational and professional experience that distinguishes this case study from others.
This unit introduced a variety of subjects and skills that are fundamental to all the
professions for example communication, health and safety, reflection and evidence based
practice. The Preparation for Practice unit incorporated a wide range of learning and
teaching methods and this study sought the experiences of staff and students.
The unit has run since February 2003, for two cohorts per year therefore five cohorts of
students had completed the unit prior to commencement of this study. Since February 2003
the delivery of the unit has been modified following staff feedback and comments and views
Participation in interprofessional education 59
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of students received through standard university unit review methods. The feedback
indicated that different professional groups interacted with this unit in different ways. The
aim of this study was to provide a formal in-depth review relating to this unit of study
alone, to enable exploration of the approaches taken by the students and experiences of the
staff.
Aims of the investigation
This study aimed to:
. determine the experiences of the lecturers in the delivery of the Preparation for Practice
unit,
. determine the student experiences of an inter-professional learning forum,
. identify factors which act as barriers to, and facilitate inter-professional learning.
Method
The study was approved by the university ethics committee. Expressions of interest for
involvement in focus groups were requested of all students from the cohorts that had
participated in the unit by the start of the project. The nature of the study was explained to
the groups, participation was not compulsory and completion of the expression of interest
form constituted willingness to participate. The study comprised one staff focus group
involving all staff who participated in the unit, and four uni-professional student groups
aimed at eliciting views, opinions and experiences (Morgan, 1997; Barbour & Kitzinger,
1999). A final multi-professional student group was held drawing participants from the
previous student groups.
From those students who completed expressions of interest forms focus groups of no
more than eight participants were compiled. Final selection for the groups was undertaken
using maximum variation sampling to ensure that a wide variety of characteristics were
represented (Patton, 1990). The characteristics used were: full-time students; part-time
students; gender, and age. There were no exclusion criteria.
The focus groups were facilitated by members of academic staff not directly involved in
current teaching of the unit. An observer was also present. After identification for
participation purposes, participants were assigned letters and identified by these and
professional groups only for recording and transcription purposes.
The question prompts were developed from themes that had emerged from previous
student evaluations. These included students’ expectations and experiences of IPE, barriers
and enablers to learning in this context, and advice to staff and students embarking on IPE.
The prompts used for the staff focus group related directly to the experiences of the teaching
team in delivering this unit and included identification of positive and negative challenges,
stereotyping, what they felt students learnt, possible effects on practice and suggestions for
changes. The multi-professional group question prompts were formulated from the
emerging themes following the transcript analysis of the uni-professional groups.
Data analysis and results
Focus Group tape transcripts together with the observers’ notes were examined for emerging
themes. These were identified on the text and collated. There were three main themes that
emerged from the student focus group interviews namely interprofessional
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awareness, impact on patient care and experiences of unit delivery. These will be considered
in turn.
The first theme was that of ‘‘interprofessional awareness’’. This encompassed increased
understanding of differences within role, learning and thinking styles, viewpoint,
preconceived ideas, stereotyping and relevance to clinical practice. An issue that emerged
with some strength was that of the difficulty some students had in valuing the relevance of
sessions that were facilitated by a lecturer from a different discipline to their own. In
addition, profession-based differences in approach were noted by students; for example two
physiotherapy students commented:
. . . it is quite marked the differences in thought processes of the physios, OTs and the
radiographers.
It is interesting to see how we all approach things from those different angles.
The second emerging theme was that of the ‘‘impact on patient care’’. Students identified
greater confidence in interactions with patients; improved communication between
professional groups; greater awareness of care pathways; application of reflective practice;
greater empathy developed from group work, role plays and discussion. This is summarized
by a comment from occupational therapy and diagnostic radiography students, however it
was recognized the inter-professional education could take development of the health care
professional further than this:
. . . you’re all there at the end of the day for the same person and that’s the person you’re
caring for . . .. . . there is a core set of things that we have to do, regardless of who we are or
what profession. But I think there’s more to be learnt from inter-professional learning
than just that. (Occupational Therapy student)
It’s more about the fact that you’re building up a relationship with another team member
who does a completely different job but you’re both aiming for the same thing . . .. . . I
mean it’s more about trying to build up a relationship with a professional and realising
that you’ve got to work together as opposed to oh yes, you do your little bit and I’ll do
mine later. (Diagnostic Radiography student)
The third theme related to ‘‘experiences of unit delivery’’. These included both positive and
negative aspects. The positive aspects included the benefits of group work activities and
multi-professional group presentations; an experiential video exercise in communication
skills; group work within sessions and the introduction to reflection. For example a
radiotherapy student stated:
I don’t think that the prep for practice unit could have been done just with our group
because I think there would have been – well, I don’t know – I just don’t think it would
have been practical. I don’t think we would have learnt anywhere near as much had it been
done with just our RT group.
This was qualified by the recognition that the student experience was dependent on the
maturity and motivation of the students involved in the small group work.
The less positive aspects of the delivery tended to be more structural. Some students
sometimes perceived uni-professional units as having greater relevance and importance.
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There were mixed views on the amount that students expected to achieve during sessions.
Some thought too much was included and others felt that the activities required less time.
The view tended to vary depending on professional group, and this was also supported by
student evaluation forms. A diagnostic radiography student verbalized it in this way:
We do all have to learn to communicate properly in our jobs and how to reflect, but I just
think it can be a bit wishy washy at times, and a bit too long and drawn out.
Some aspects of the final theme were reinforced in student unit evaluations. Occupational
Therapy students described sessions as: ‘‘Rushed’’; ‘‘Too much material’’; ‘‘Enjoyed it!’’
‘‘Time went quickly’’. Diagnostic Radiography students described the same sessions as:
‘‘Too centred on reflection’’; ‘‘Too much group work’’; ‘‘Too much feedback time’’;
‘‘Sessions dragged’’.
Although these comments appear to contradict each other students were attending the
same sessions, facilitated by the same tutors. Staff identified that the differences within the
student groups probably related to learning and thinking styles which, although not fixed,
may have informed their original career choice (Kolb, 1984). This had not been so apparent
to the staff group prior to the implementation of IPE.
Meeting the needs of part-time or in-service students, some of whom had extensive
experience and skill in defined areas of practice, as well as full-time students of another
discipline posed a challenge. Some students (mainly from the in-service part-time groups)
expressed frustration at the attitude of some of the full-time students who did not appear as
motivated or engaged in the unit. Students with experience wanted to build on their
knowledge, desiring knowledge and skill beyond the academic level at which this unit was
delivered. Some admitted to appreciating the opportunity to check they had a correct
foundation of knowledge, but the group identity sometimes led to opinions being expressed
in a more strident manner within the cohort. When students were asked what advice they
would give to others studying the unit, they agreed that they should start the unit with an
open mind, and that they would get out of it what they put in.
Four themes were identified from the staff focus group. Firstly, differences between student
groups including variations in thinking styles, comfort zones and approaches to learning:
Radiographers find it quite difficult to engage in things which we call ‘touchy feely’
subjects, like communication.
The second theme was awareness of the differing professional groups, incorporating
learning about the roles of the groups and their professional identities:
Spending time with other professional groups which aren’t my own I find immensely
rewarding because they see things differently and look at things differently.
I see nothing intrinsically wrong about people understanding their difference as well as
their similarities. What would be wrong is only understanding the differences.
. . . students see you almost like a role model.
The staff also perceived value in being prompted to find out more about other professions.
This happened in the context of team teaching, unit development and session planning. One
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of the benefits identified by the staff group was that staff members felt more confident in
approaching colleagues from different disciplines. In meetings and discussions unrelated to
the unit it was easier to understand the approach being taken by different professional
groups leading to increased tolerance and ultimately productivity.
Approach to teaching was raised by the group and formed the third theme. This included
teaching styles, expectations and resources.
I think much more deeply about how I am going to deliver the information because I
know it’s not just my professional group so it’s challenging . . ..
. . . it keeps us thinking and we start to see relationships that we didn’t think were there.
The teaching team identified that student groups responded differently to the teaching styles
used and it was noted that the lecturers exhibited different preferred teaching styles within
their uni-professional units of study. Sometimes this happened because of the size of the uni-
professional group or the type of material being taught. It was suggested that students may
perceive that the styles used within their uni-professional groups are the most appropriate for
them, so when a different style is encountered in the multi-professional settings it is not
immediately embraced as relevant.
The combination of professions within the teaching and student groups formed the last
theme. This addressed the challenge that the relationship between the professions raised,
both in the classes and in application to practice.
OTs and radiographers wouldn’t really work together [in practice] . . ..
. . . according to the HPC Standards . . . we have a lot in common . . .. . .. . . the entire first
part of the standards are identical . . . and those are the type of things that we’re actually
trying to get them, engaging in . . .. . ..
Staff initially reported that compiling case studies to include professional groups that don’t
normally work together was challenging. Authenticity was ensured by using a patient
pathway approach in developing case material. It was noticeable that when an
interprofessional teaching team was delivering a session the students appeared more readily
able to apply material to their own profession as well as to understand the relevance for other
professions.
Discussion
The student group for this common learning unit was diverse in age, attitude to
learning, experience in health and social care, life experience, expectation and tolerance
of differences, and awareness of this context is important whilst considering the issues
raised.
The sample for the focus groups was self selecting prior to maximum variation sampling
being applied. This meant that only those students who were interested in participating were
considered and therefore the views of those who did not express such an interest may not
have been represented.
The assertion of the students that their understanding of the differences between
professional groups had been increased by working together on this unit is considered a
positive outcome and in keeping with the Department of Health (2000) aims. Students
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agreed that their knowledge of the role of other professional groups had increased, which is
consistent with other studies of health and social care courses (Nisbet et al., 2008).
Improved communication between professional groups was identified by students as a
positive outcome from interprofessional learning. Students said they had learned more
about what is important to other groups and there was improved knowledge about
professional priorities for each group. Greater confidence in interacting with patients was
also identified, which students considered to be a result of both discussion and role play.
Both these aspects are in harmony with the government’s aims for improved patient care and
echo findings by Bjorke and Haavie (2006) who identified that IPE broadened students’
perspectives and better prepared them for their future careers.
The improved interprofessional team working identified by staff enhanced the delivery
and development of the unit and provided clear role models for students, which Clark
(2006) identified as a important factor in IPE.
Differences in thinking style were identified by the students, the most marked difference
being between the occupational therapy students and those studying radiography. OTs and
radiographers have been identified as having tendencies towards different learning style
preferences (Kolb, 1984; Fowler, 2002) and this may explain why the radiography students
found the OTs’ preferences for longer discussion times within sessions frustrating, stating
that issues could be dealt with in less time. The OT students said they admired the
radiography students’ scientific abilities, an example cited was in preparing electronic group
presentation material.
Engagement with different styles of thinking often pushed students to the edge of their
own comfort zone, but staff realized it was important not to collude with engrained
preferences and to encourage students to challenge their own boundaries. Rees and Johnson
(2007) acknowledged that staff themselves may be working outside their disciplinary
comfort zone which was initially identified by the staff team in this study. Additionally the
facilitation skills of the tutor may also influence the student experience and their response to
different teaching methods (Rees & Johnson, 2007).
Although differences were identified and students attributed approaches and preferences
to particular groups, an appreciation of these differences was expressed.
This may not have always led to harmony in group-working but understanding of the need
for collaboration was reported. Clark’s (2006) view of the experiential learning process in
IPE is that it is likely to be one of conflict and that out of this conflict students can potentially
develop greater understanding and insight. Therefore professional groups may retain their
differences but greater appreciation of these is essential to enable them to be understood and
valued. Negative stereotyping was not raised as a particular issue within this student group,
and this may have been attributable to the mix of professions. Nisbet et al. (2008) found
evidence of stereotyping but this study included a broader range of professional groups.
The diversity of age, experience and motivation within the student group, which at times
led to some students reporting frustration, could be considered as an internal constraint
(Horsburgh et al., 2001) which has the potential to prevent interprofessional education from
achieving its aims. Bjorke and Haavie (2006) identify that in this type of situation the tutor
role becomes essential to ensure that learning is supported.
The most enjoyable aspects of the unit that students identified were the interprofessional
group activities. Groups were allocated randomly and ensured a mix of professions. The
students’ appreciation of this style of learning reinforces the views of Carlisle et al. (2004)
who suggest this to be a successful strategy in IPE. Elsewhere, process-based (Clark, 2006),
enquiry–based (Rees & Johnson, 2007) and interactive learning (Nisbet et al., 2008) have
also been identified as beneficial.
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IPE and the theory behind generic practice issues, for example, communication styles,
were not always seen as relevant and some students reported interacting with the unit
because they had to, seeing their uni-professional study as more relevant. This may be due
to some students not yet having fully developed their professional identity, whilst others
appeared already to be so entrenched in theirs that they were unwilling to consider the
perspectives of other professional groups. Although Carlisle et al., (2004) and Nisbet et al.
(2008) promote starting IPE as early as possible in the curriculum there may be a tension
with students not having had opportunity to establish their own professional identity before
being required to embrace and understand another. Bjorke and Haavie (2006) also noted
this resistance but also found that this reduced as students progressed through their courses.
Although staff expected a level of uni-professional identity they were surprised at the
strength of this expressed within the in-service student group.
It is clear from student feedback that not all students enjoy interprofessional learning and
some still struggle with its relevance. Students did not always seem to understand that the
group processes and dynamics were as important as the content, particularly experiential
sessions; and staff felt this needed to be made more explicit.
Other studies on IPE have identified major organizational issues related to timetabling
and integration (Nisbet et al., 2008; Lumague et al., 2006; Rees & Johnson 2007), however
because of the formal embedded nature of common learning in the IPSAH curriculum this
was not a finding in this study.
Following on-going student evaluations and the findings from the study, modifications to
the unit delivery were made. These included ensuring that from the launch of the unit the
students understood the importance of embracing its interprofessional nature. The
interprofessional group work was valued so this was adopted as one of the main teaching
strategies. Roles and responsibilities of the different professional groups were also further
emphasized as was the care pathway approach.
Conclusion
The main challenges which became barriers for some, were identified by both staff and students
as working with people who think in a different way, varying levels of maturity and motivation
within the student group, and equally valuing both the process and content of the unit.
Although some students were readily able to identify the benefits of interprofessional education
and were able to make a clear link to practice, this was more of a challenge for others.
Some of the opportunities identified by both staff and students were the development of
more effective communication between professional groups in practice, greater under-
standing of how to break down barriers and reduce stereotyping, working interprofessionally
in a structured and safe environment and increased appreciation of diversity.
The findings from this study have informed the on-going development of interprofessional
education within the allied health department of London South Bank University.
Substantial changes have been made to unit structure and delivery with an increased
recognition of the essential role of interprofessional processes. Interprofessional units of
study remain embedded in the IPSAH curriculum although there is now a clearer
differentiation between units where students learn alongside each other and those where
students learn with and from each other. The importance of interactive and experiential
teaching methods to enhance the student learning experience is considered essential to
successful delivery of IPE within student groups with diverse levels of experience. Staff and
students expressed a preference for clear role models of interprofessional working within
unit delivery both through team teaching and relevant examples from practice.
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Additionally a stronger emphasis has been placed on IPE in practice placement with
elements on collaborative practice and reflection on multidisciplinary working embedded
within the professional development portfolio.
Acknowledgements
Thanks are extended to colleagues who helped in facilitating and observing focus groups,
and also the students without whom this research would not have been possible.
Declaration of interest: The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of the paper.
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