http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, Early Online: 1–2 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.969836
SHORT REPORT
Student perceptions about interprofessional education after an elective course J Interprof Care Downloaded from informahealthcare.com by University of California San Francisco on 03/27/15 For personal use only.
Tina Patel Gunaldo, Sandra Carlin Andrieu, Deborah Garbee, Lauren K. Giovingo, Donald E. Mercante, Stephanie Tortu, and Robin English LSU Health Sciences Center, New Orleans, LA, USA
Abstract
Keywords
A growing body of evidence indicates interprofessional collaborative practice improves patient care. With this in mind, Louisiana State University Health Sciences Center formally committed to expanding interprofessional education (IPE) initiatives. Thirty-eight self-selected students enrolled in an IPE elective course during the fall of 2012. Students completed the Readiness for Interprofessional Learning Scale (RIPLS) pre- and post-course and also completed a post-course survey. Results indicated a significant change in the roles and responsibilities scale of the RIPLS. Analysis of the data from the post-course survey demonstrated students were able to identify key terms of an IPE definition, as related to their learning experience. In addition, themes of communication, learning/increased knowledge, and collaboration/contribution of other health care professionals were noted across all questions in the post-course survey. Based on the results of this study, an elective course is a promising educational opportunity to increase awareness and knowledge of IPE within academic medical centers.
Academic medical centers, interprofessional education, readiness for interprofessional learning scaleroles and responsibilities, student perceptions
Introduction
Methods
There is a growing body of evidence that interprofessional teams improve health outcomes, and students trained on an interprofessional basis are more likely to form collaborative practice patterns after graduation (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011). Recently, Louisiana State University Health Sciences Center (LSUHSC) in New Orleans implemented interprofessional education (IPE) initiatives. In 2012, a committee of faculty members from each of the five LSUHSC schools, Allied Health, Dentistry, Medicine, Nursing and Public Health, was appointed to expand IPE initiatives. The committee developed and implemented an IPE elective course to increase awareness, knowledge and application of interprofessional collaborative practice within all schools and programs. Thirty-eight self-selected students from five schools participated in the course. Students represented the following professions: dentistry (n ¼ 6), medical technology (n ¼ 2), medicine (n ¼ 7), nursing (n ¼ 3), occupational therapy (n ¼ 5), physical therapy (n ¼ 3), public health (n ¼ 1), and speech-language pathology (n ¼ 11). The students were from various levels in their professional educational careers, ranging from first to fourth year.
Design
Correspondence: Dr. Tina Patel Gunaldo, PT, PhD, DPT, MHS, LSU Health Sciences Center – New Orleans, SAHP – Office of the Dean, 1900 Gravier, 6th Floor, New Orleans, LA 70112, USA. E-mail: [email protected]
History Received 24 February 2014 Revised 16 July 2014 Accepted 23 September 2014 Published online 13 October 2014
A pre/post-formative evaluation design was employed to gather student interprofessional attitudes and perceptions about their course. Data collection The Readiness for Interprofessional Learning Scale (RIPLS; McFadyen et al., 2005) was distributed to participating students. The RIPLS is a valid tool designed to assess students’ attitudes towards IPE. It has 19 questions and uses four subscales: teamwork and collaboration (items1-9), negative professional identity (items 10–12), positive professional identity (items 13–16), and roles and responsibilities (items 17–19; McFadyen et al., 2005). A Likert-type scale ranging from strongly disagree to strongly agree (1 to 5) measured the responses. In addition to the RIPLS, students were asked three questions targeting their knowledge of IPE and the impact of the IPE elective. Analysis The mean changes from pre-test to post-test for each of the four subscales were compared using paired t-tests. McNemar’s test was used to detect proportions of responses that changed from pre- to post-test for each of the 19 items of the RIPLS. Statistical analyses were performed using PROC FREQ, PROC GENMOD and PROC TTEST in SAS, version 9.3. Statistical significance was conservatively based on a Bonferroni corrected Type I error rate determined by dividing the nominal Type I error rate of 5% by the number of comparisons.
2
T. P. Gunaldo et al.
J Interprof Care, Early Online: 1–2
Table I. Quantitative RIPLS results.
a
RIPLS Roles and responsibilities subscale I am not sure what my professional role will be (Question 18)
Mean pre-test
SD
Mean post-test
SD
p Value
Test Statistic
3.95 9.4 2.23
0.25 1.92 0.97
3.94 8.5 1.40
0.25 1.59 0.72
0.170 0.0019* 0.0000215*
t ¼ 0.39 t ¼ 3.4 2 ¼ 18.05
a
J Interprof Care Downloaded from informahealthcare.com by University of California San Francisco on 03/27/15 For personal use only.
Denotes questions 10–12 reverse scored. *Denotes significance.
Responses to the open-ended questions in the post-course survey were analyzed for themes. No software was used in the coding and analysis of the free-text. Three course faculty members reviewed the data independently, coded comments, and identified predominant themes for each question. Consensus was reached on themes, narrative comments were independently coded and frequency counts of coded responses were calculated for each theme. A fourth-course faculty member agreed with the coding and themes. Ethical considerations Students were asked to participate in the research portion. Consent was implied by completing the RIPLS before and after the course and a post-course survey. The research portion was anonymous and approved by the Institutional Review Board at LSUHSC in New Orleans.
Results The RIPLS (pre and post) and the post-course survey were offered to thirty-eight students. After the data were cleaned for missing items, missing pre-post tests and incomplete pre-post tests, 30 corresponding pre- and post-RIPLS data sets remained. On the pre-test, the majority of responses to RIPLS questions (considering reverse scoring of questions 10–12) were a 5 at 64.4% and on the post-test students selected a score of 5, 67.5% of the time. Question 18 indicated a statistically significant difference between the pre- and post-test. Paired t-test results also indicated the Roles and Responsibilities subscale was the only scale with a significant pre–post difference (Table I). Representative quotes from the post-course survey data included ‘‘IPE is healthcare professionals working together by keeping communication open and productive with the explicit goal of improving patient care’’ and ‘‘I realized how much every discipline has to offer in caring for a patient’’. Member checking was conducted with medical, dental and allied health student participants to increase credibility, and all agreed with the thematic analysis.
Discussion The results of this research suggest positive changes in student perceptions of interprofessional education and practice. Results from the RIPLS indicated students increased their comfort and/or knowledge level in their professional role as it relates to interprofessional learning. This result differs from other IPE pre-post studies where a significant change in the teamwork and collaboration and professional identity scales were found (Bradley, Cooper, & Duncan, 2009; Saini et al., 2011; Wakley, Brown, & Burrows, 2013). To the best of our knowledge, a significant change in the role and responsibility subscale has not been demonstrated in previous student research with a similar intervention. It is difficult to determine the contributing factor(s) related to the significant change noted in the roles and responsibility
subscale, but the structure of the three case discussions likely played a role. Prior to class, students were given brief information about a case with questions that focused on their professional approaches (e.g. what history is important to you and why?). During class sessions, students shared their perspectives and worked through further details of the case to develop a team approach to the patient’s care. Facilitators asked questions that emphasized the roles and responsibilities that each profession would contribute. Even though this study found significance in the roles and responsibility subscale, this finding should also be interpreted with caution due to the sole significant question and small sample size. Themes from the post-course survey indicated students believe teamwork, collaboration, respect and communication are essential components of interprofessional collaborative practice. When the quantitative and thematic results are combined, they are reflective of three interprofessional collaborative practice competency domains as defined by the Interprofessional Education Collaborative: roles/responsibilities, communication, and teams and teamwork (Interprofessional Education Collaborative, 2011). The results do not support student competence in these behavioral domains. The results simply relate student learning to established IPE standards. In summary, as academic medical centers expand IPE initiatives, this study indicates that an IPE elective course is a promising, short-term method to introduce students to foundational components of interprofessional collaborative practice. The IPE Committee will use the results and feedback from this course to improve upon instructional delivery of other foundational IPE content, such as teamwork and collaboration.
Declaration of interest The authors report no declarations of interest. The authors are responsible for the writing and content of the paper.
References Bradley, P., Cooper, S., & Duncan, F. (2009). A mixed-methods study of interprofessional learning of resuscitation skills. Medical Education, 43, 912–922. Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V., & Tomkowiak, J. (2011). Interprofessional collaboration: three best practice models of interprofessional education. Medical Education Online, 16, doi: 10.3402/meo.v16i0.6035. Interprofessional Education Collaborative. (2011). Core competencies for interprofessional collaborative practice. Washington, D.C.: Interprofessional Education Collaborative. McFayden, A.K., Webster, V., Strachan, K., Figgins, E., Brown, H., & McKechnie, J. (2005). The readiness for interprofessional learning scale: A possible more stable sub-scale model for the original version of RIPLS. Journal of Interprofessional Care, 19, 595–603. Saini, B., Shah, S., Kearey, P., Bosnic-Anticevich, S., Grootjan, J., & Armour, C. (2011). An interprofessional learning module on asthma health promotion. American Journal of Pharmaceutical Education, 75, 1–10. Wakley, L., Brown, L., & Burrows, J. (2013). Evaluating interprofessional learning modules: Health students’ attitudes to interprofessional practice. Journal of Interprofessional Care, 27, 424–425.
SHORT REPORT
Student perceptions about interprofessional education after an elective course J Interprof Care Downloaded from informahealthcare.com by University of California San Francisco on 03/27/15 For personal use only.
Tina Patel Gunaldo, Sandra Carlin Andrieu, Deborah Garbee, Lauren K. Giovingo, Donald E. Mercante, Stephanie Tortu, and Robin English LSU Health Sciences Center, New Orleans, LA, USA
Abstract
Keywords
A growing body of evidence indicates interprofessional collaborative practice improves patient care. With this in mind, Louisiana State University Health Sciences Center formally committed to expanding interprofessional education (IPE) initiatives. Thirty-eight self-selected students enrolled in an IPE elective course during the fall of 2012. Students completed the Readiness for Interprofessional Learning Scale (RIPLS) pre- and post-course and also completed a post-course survey. Results indicated a significant change in the roles and responsibilities scale of the RIPLS. Analysis of the data from the post-course survey demonstrated students were able to identify key terms of an IPE definition, as related to their learning experience. In addition, themes of communication, learning/increased knowledge, and collaboration/contribution of other health care professionals were noted across all questions in the post-course survey. Based on the results of this study, an elective course is a promising educational opportunity to increase awareness and knowledge of IPE within academic medical centers.
Academic medical centers, interprofessional education, readiness for interprofessional learning scaleroles and responsibilities, student perceptions
Introduction
Methods
There is a growing body of evidence that interprofessional teams improve health outcomes, and students trained on an interprofessional basis are more likely to form collaborative practice patterns after graduation (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011). Recently, Louisiana State University Health Sciences Center (LSUHSC) in New Orleans implemented interprofessional education (IPE) initiatives. In 2012, a committee of faculty members from each of the five LSUHSC schools, Allied Health, Dentistry, Medicine, Nursing and Public Health, was appointed to expand IPE initiatives. The committee developed and implemented an IPE elective course to increase awareness, knowledge and application of interprofessional collaborative practice within all schools and programs. Thirty-eight self-selected students from five schools participated in the course. Students represented the following professions: dentistry (n ¼ 6), medical technology (n ¼ 2), medicine (n ¼ 7), nursing (n ¼ 3), occupational therapy (n ¼ 5), physical therapy (n ¼ 3), public health (n ¼ 1), and speech-language pathology (n ¼ 11). The students were from various levels in their professional educational careers, ranging from first to fourth year.
Design
Correspondence: Dr. Tina Patel Gunaldo, PT, PhD, DPT, MHS, LSU Health Sciences Center – New Orleans, SAHP – Office of the Dean, 1900 Gravier, 6th Floor, New Orleans, LA 70112, USA. E-mail: [email protected]
History Received 24 February 2014 Revised 16 July 2014 Accepted 23 September 2014 Published online 13 October 2014
A pre/post-formative evaluation design was employed to gather student interprofessional attitudes and perceptions about their course. Data collection The Readiness for Interprofessional Learning Scale (RIPLS; McFadyen et al., 2005) was distributed to participating students. The RIPLS is a valid tool designed to assess students’ attitudes towards IPE. It has 19 questions and uses four subscales: teamwork and collaboration (items1-9), negative professional identity (items 10–12), positive professional identity (items 13–16), and roles and responsibilities (items 17–19; McFadyen et al., 2005). A Likert-type scale ranging from strongly disagree to strongly agree (1 to 5) measured the responses. In addition to the RIPLS, students were asked three questions targeting their knowledge of IPE and the impact of the IPE elective. Analysis The mean changes from pre-test to post-test for each of the four subscales were compared using paired t-tests. McNemar’s test was used to detect proportions of responses that changed from pre- to post-test for each of the 19 items of the RIPLS. Statistical analyses were performed using PROC FREQ, PROC GENMOD and PROC TTEST in SAS, version 9.3. Statistical significance was conservatively based on a Bonferroni corrected Type I error rate determined by dividing the nominal Type I error rate of 5% by the number of comparisons.
2
T. P. Gunaldo et al.
J Interprof Care, Early Online: 1–2
Table I. Quantitative RIPLS results.
a
RIPLS Roles and responsibilities subscale I am not sure what my professional role will be (Question 18)
Mean pre-test
SD
Mean post-test
SD
p Value
Test Statistic
3.95 9.4 2.23
0.25 1.92 0.97
3.94 8.5 1.40
0.25 1.59 0.72
0.170 0.0019* 0.0000215*
t ¼ 0.39 t ¼ 3.4 2 ¼ 18.05
a
J Interprof Care Downloaded from informahealthcare.com by University of California San Francisco on 03/27/15 For personal use only.
Denotes questions 10–12 reverse scored. *Denotes significance.
Responses to the open-ended questions in the post-course survey were analyzed for themes. No software was used in the coding and analysis of the free-text. Three course faculty members reviewed the data independently, coded comments, and identified predominant themes for each question. Consensus was reached on themes, narrative comments were independently coded and frequency counts of coded responses were calculated for each theme. A fourth-course faculty member agreed with the coding and themes. Ethical considerations Students were asked to participate in the research portion. Consent was implied by completing the RIPLS before and after the course and a post-course survey. The research portion was anonymous and approved by the Institutional Review Board at LSUHSC in New Orleans.
Results The RIPLS (pre and post) and the post-course survey were offered to thirty-eight students. After the data were cleaned for missing items, missing pre-post tests and incomplete pre-post tests, 30 corresponding pre- and post-RIPLS data sets remained. On the pre-test, the majority of responses to RIPLS questions (considering reverse scoring of questions 10–12) were a 5 at 64.4% and on the post-test students selected a score of 5, 67.5% of the time. Question 18 indicated a statistically significant difference between the pre- and post-test. Paired t-test results also indicated the Roles and Responsibilities subscale was the only scale with a significant pre–post difference (Table I). Representative quotes from the post-course survey data included ‘‘IPE is healthcare professionals working together by keeping communication open and productive with the explicit goal of improving patient care’’ and ‘‘I realized how much every discipline has to offer in caring for a patient’’. Member checking was conducted with medical, dental and allied health student participants to increase credibility, and all agreed with the thematic analysis.
Discussion The results of this research suggest positive changes in student perceptions of interprofessional education and practice. Results from the RIPLS indicated students increased their comfort and/or knowledge level in their professional role as it relates to interprofessional learning. This result differs from other IPE pre-post studies where a significant change in the teamwork and collaboration and professional identity scales were found (Bradley, Cooper, & Duncan, 2009; Saini et al., 2011; Wakley, Brown, & Burrows, 2013). To the best of our knowledge, a significant change in the role and responsibility subscale has not been demonstrated in previous student research with a similar intervention. It is difficult to determine the contributing factor(s) related to the significant change noted in the roles and responsibility
subscale, but the structure of the three case discussions likely played a role. Prior to class, students were given brief information about a case with questions that focused on their professional approaches (e.g. what history is important to you and why?). During class sessions, students shared their perspectives and worked through further details of the case to develop a team approach to the patient’s care. Facilitators asked questions that emphasized the roles and responsibilities that each profession would contribute. Even though this study found significance in the roles and responsibility subscale, this finding should also be interpreted with caution due to the sole significant question and small sample size. Themes from the post-course survey indicated students believe teamwork, collaboration, respect and communication are essential components of interprofessional collaborative practice. When the quantitative and thematic results are combined, they are reflective of three interprofessional collaborative practice competency domains as defined by the Interprofessional Education Collaborative: roles/responsibilities, communication, and teams and teamwork (Interprofessional Education Collaborative, 2011). The results do not support student competence in these behavioral domains. The results simply relate student learning to established IPE standards. In summary, as academic medical centers expand IPE initiatives, this study indicates that an IPE elective course is a promising, short-term method to introduce students to foundational components of interprofessional collaborative practice. The IPE Committee will use the results and feedback from this course to improve upon instructional delivery of other foundational IPE content, such as teamwork and collaboration.
Declaration of interest The authors report no declarations of interest. The authors are responsible for the writing and content of the paper.
References Bradley, P., Cooper, S., & Duncan, F. (2009). A mixed-methods study of interprofessional learning of resuscitation skills. Medical Education, 43, 912–922. Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V., & Tomkowiak, J. (2011). Interprofessional collaboration: three best practice models of interprofessional education. Medical Education Online, 16, doi: 10.3402/meo.v16i0.6035. Interprofessional Education Collaborative. (2011). Core competencies for interprofessional collaborative practice. Washington, D.C.: Interprofessional Education Collaborative. McFayden, A.K., Webster, V., Strachan, K., Figgins, E., Brown, H., & McKechnie, J. (2005). The readiness for interprofessional learning scale: A possible more stable sub-scale model for the original version of RIPLS. Journal of Interprofessional Care, 19, 595–603. Saini, B., Shah, S., Kearey, P., Bosnic-Anticevich, S., Grootjan, J., & Armour, C. (2011). An interprofessional learning module on asthma health promotion. American Journal of Pharmaceutical Education, 75, 1–10. Wakley, L., Brown, L., & Burrows, J. (2013). Evaluating interprofessional learning modules: Health students’ attitudes to interprofessional practice. Journal of Interprofessional Care, 27, 424–425.
