SHORT COMMUNICATION
Student Perceptions of an Interprofessional Educational Experience: The Importance of Goal Articulation Jennifer M. McBride,* Richard L. Drake Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
The education of future health care professionals must involve activities where interprofessional collaboration and the functioning of interdisciplinary teams are the goals and not the exceptions. This type of interprofessional education (IPE) will benefit students as they will be better able to communicate with and mobilize the skills of other health care workers, work toward common goals related to patient care, and develop a more costeffective treatment strategy in the long term. Such an IPE program was initiated in the clinical anatomy course for physician assistant students from the University of Mount Union that was taught, in part, by medical students from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Surveys of both student groups at the end of the course indicated that although this was a useful IPE experience, the value of this program as an IPE experience was not entirely appreciated by the participating students. It turned out that although the goals and importance of these types of IPE activities are clear to the faculty, they must also be made clear to all of the students. C 2015 American Association of Anatomists. Anat Sci Educ 8: 381–385. V
Key words: gross anatomy education; medical education; physician assistant education; undergraduate education; interprofessional education; IPE; student perception of IPE
INTRODUCTION Modern health care must involve an interprofessional team approach (Kirch and Ast, 2015). For this to occur, practitioners at all levels must be comfortable working together. The logical place for this type of relationship building to be initiated is in the educational environment of students in the health care professions. At this foundational level, the respective groups can establish a collective appreciation for their scope of practice. Additionally, the Liaison Committee on Medical Education of the Association of American Medical Colleges and American Medical Association has clearly demonstrated the current and future importance of interprofessional education (IPE) by including this topic in one of its standards by which all accredited medical schools in the United States are judged (LCME, 2015).
*Correspondence to: Dr. Jennifer M. McBride, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic/NA24, 9500 Euclid Avenue, Cleveland, OH 44195, USA. E-mail: [email protected] Received 23 April 2015; Revised 5 May 2015; Accepted 6 May 2015. Published online 3 June 2015 in Wiley (wileyonlinelibrary.com). DOI 10.1002/ase.1547 C 2015 American Association of Anatomists V
Anatomical Sciences Education
JULY/AUGUST 2015
Online
Library
Interprofessional education occurs “when students from two or more professions learn about, from and with each other to enable effective collaboration” (WHO, 2010). These types of IPE programs have been started in numerous academic centers (Hamilton et al., 2008; Fernandes et al., 2015; Herrmann et al., 2015) and have begun to break down barriers. Interprofessional education has to become a more consistent part of the educational programs for students in the health care professions. In Cleveland, a unique situation arose when a local university, the University of Mount Union (Alliance, OH), was interested in starting a Physician Assistant (PA) Program, but they did not have the appropriate facilities for a cadaver-based clinical anatomy course. They contacted the Cleveland Clinic, which had recently started a medical school program in association with Case Western Reserve University School of Medicine (Fishleder et al., 2007), to evaluate the possibility of using available facilities at the Cleveland Clinic for this course. An agreement was reached and plans were formalized to start a Clinical Anatomy course for University of Mount Union’s PA students at the Cleveland Clinic. As the course was being planned, it was realized that this would be an excellent opportunity to initiate an IPE program involving medical students and PA students. Thus, using the anatomy course developed for medical students at the Cleveland Clinic Lerner College of Medicine as a model (Drake, 2007; McBride and Drake, 2011a, 2015), the PA clinical anatomy course was developed.
Anat Sci Educ 8:381–385 (2015)
Physician Assistant Clinical Anatomy Course The Physician Assistant Clinical Anatomy Course is part of the University of Mount Union’s PA Program. The course is offered on Mondays during the first semester of the PA program, mid-May to early August, and is taught at the Cleveland Clinic main campus in Cleveland, OH. Each class at the University of Mount Union PA program has between 35 and 40 students, mostly women, whose ages range from 21 to 42 years. The anatomy course occurs during the first summer semester of year one, and accounts for four credit hours of the 15 allocated to that semester. The course begins in midMay and concludes during the first week of August. The class meets every Monday for a total of 10 or 11 sessions (depending on the summer holidays), with each session consisting of morning classroom and afternoon laboratory components (McBride and Drake, 2011b). Prior to class, the students receive a list of learning objectives and reading assignment from the required textbook (Drake, et al., 2012). The morning classroom component consists of a didactic portion with self-assessment questions that are answered using an audience response system. This activity gives students immediate feedback on how effective their pre-class studying has been and forms the basis for continued discussions throughout the morning session. After a break for lunch, the PA students gather in the anatomy laboratory for the two and a half- to three-hour afternoon session. The laboratory component consists of fresh tissue cadaver prosections prepared and demonstrated by first- and second-year medical students (McBride and Drake, 2011b) enrolled in the Cleveland Clinic Lerner College of Medicine (CCLCM), an imaging station, using selected images viewed on a high-definition monitor, which will reinforce the anatomy being viewed on the prosected cadavers, and a station that varies between models, bones, or question sets. During this session, the PA students spend 15– 20 min at each of the five stations. Additionally, after the PA students have completed their rotations through each station, they have the opportunity to return to the cadaver stations to review the dissections and ask the medical students additional questions (McBride and Drake, 2011b).
METHODS Surveys Two different surveys were developed to answer the question of whether having medical students demonstrate and teach anatomy to PA students was a useful IPE activity. The CCLCM student survey had three questions using a fourpoint Likert scale and was distributed to CCLCM students who had the opportunity to participate as anatomy demonstrators in the PA Clinical Anatomy Course. The University of Mount Union PA student survey also had three questions using the same four-point Likert scale and was distributed to University of Mount Union PA students who participated in the course. The surveys were distributed using REDCapTM (Research Electronic Data Capture Consortium, Vanderbilt University, Nashville, TN), which is a “secure, web-based application designed to support data capture for research studies” (Harris et al., 2009). Student participation in the survey was completely voluntary. Surveys returned were anonymous other than knowing that a response came from a medical student 382
or a PA student. The surveys received approval from the Cleveland Clinic Lerner College of Medicine IRB (IRB#141465: EXEMPT) under expedited review as exempt research to collect data without recording subject identifiers.
RESULTS Data Interpretation/Evaluation This study uses two questionnaires to gather information related to the value of an IPE experience. Each has three questions using a four-point Likert scale as a response mechanism. Usually with this type of data, frequency distributions are reported with some statistical analysis. However, for this study, it was felt that the most useful approach would be an evaluation and interpretation of the raw data. Additionally, in many studies using surveys or questionnaires, a Cronbach’s alpha (Cronbach, 1951) is calculated as a measure of reliability. However, this project uses a short three-item questionnaire with open- and closed-ended items to obtain participants reactions rather than measure a scale or single dimension. Because of the short test length, it is not appropriate to report a Cronbach’s alpha (Tavakol and Dennick, 2011).
Survey Responses The CCLCM student survey was distributed to 30 students who participated as anatomy demonstrators in the PA Clinical Anatomy course over a four-year period (2011–2014). Of these, 29 returned the survey, for a response rate of 97%. The University of Mount Union PA student survey was distributed to 60 students who had participated in the PA Clinical Anatomy course over a two-year period (2013–2014). Of these, 48 returned the survey, for a response rate of 80%.
Survey Results Results of the University of Mount Union PA student survey are summarized in Table 1. In general, the vast majority of respondents either agreed or strongly agreed with each statement that was asked. For example, the first statement, “The opportunity to learn anatomy from a CCLCM medical student was a valuable educational experience,” had 90% of the responses in these two categories. Similarly, 88% of the responses for Statement 2, “Learning anatomy using an unembalmed cadaver was a valuable educational experience” and 90% of the responses for Statement 3, “Interacting with medical students from the Cleveland Clinic Lerner College of Medicine was a useful interprofessional educational experience” were in the agree or strongly agree category. In addition to responding to the survey questions, several PA students also included comments in the “Additional comment” section of the survey, indicating the positive nature of the experience: “Many times the medical students provided very valuable learning tips and tricks,” “Also was a great opportunity to learn with future physicians we may work with,” and “I enjoyed the experience of interacting with medical students because they shared many of their techniques for memorizing the anatomy with us.” Results of the CCLCM student survey are also summarized in Table 1, and the majority of the responses to the three statements are in the agree or strongly agree category. For McBride and Drake
Table 1. Students Survey Results Statement
Strongly agree (%)
Agree (%)
Disagree (%)
Strongly disagree (%)
Learning anatomy from CCLCM students was a valuable educational experience
44
46
4
6
Learning anatomy using unembalmed cadavers was a valuable educational experience
75
13
8
4
Interacting with CCLCM students was a useful IPE experience
46
44
6
4
Reviewing anatomy while teaching PA students was a valuable educational activity
76
17
0
7
Opportunity to teach anatomy to PA students was a valuable educational experience
72
21
0
7
Teaching and interacting with PA students was a useful IPE experience
35
55
3
7
a
University of Mount Union PA Students Survey
CCLCM Medical Students Surveyb
a
Response rate was 80% (48 of 60). Response rate was 97% (29 of 30). CCLCM, Cleveland Clinic Lerner College of Medicine; IPE, interprofessional education; PA, physician assistant.
b
Statement 1, “The opportunity to review anatomy while teaching the physician assistant students was a valuable educational activity,” 93% of the responses were in these two categories. Similarly, Statement 2, “The opportunity to teach anatomy to the physician assistant students was a valuable educational experience,” and Statement 3, “Teaching and interacting with physician assistant students was a useful interprofessional educational experience,” had 93% and 90%, respectively, in the top two categories. In addition to responding to the survey questions, several CCLCM students also included comments in the “Additional comment” section of the survey, again indicating the positive nature of the experience: “One of the primary reasons this was an effective learning opportunity was the questions posed by the PA students,” “It was very helpful for my education to review this anatomy and teach it to the PA students!,” and “It is helpful to have an understanding of the knowledge base PAs will be entering the workforce with in order to evaluate what responsibilities they can be entrusted with.” Finally, although most surveys using a Likert scale look at grouped responses in these types of studies (strongly agree/ agree vs. strongly disagree/disagree), a closer look at responses to the survey questions in the individual categories (strongly agree vs. agree) indicates that all was not positive during this educational experience. Breaking the data down to this level of detail suggests that at least one aspect of being taught by the medical students was problematic for the PA students. A look at a few of their written comments may be enlightening in this regard: “I don’t think they understand how we were tested over the material,” and “I wish that the medical students would have known more on how we were evaluated with our weekly practical.” Anatomical Sciences Education
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Similarly, looking at the detailed results of the final survey question to both groups of students as to whether this was a useful IPE suggests that it may not have been. The opinions are that nearly half (actual 46% strongly agree and 44% agree responses) in the case of PA students and well below half (actual 35% strongly agree and 55% agree responses) in the case of CCLCM students felt that it was not, suggesting that there is a problem with the approach.
DISCUSSION Educational programs for students in the health care professions are going to continue to increase the opportunities for IPE experiences. The hope is that these types of programs will enhance professional respect, collaboration, and teamwork among health professionals when they enter the clinical arena (Nandan and Scott, 2014; Sullivan et al., 2015). However, this will occur only if educators make these IPE activities valuable, useful, and meaningful learning experiences. Similar to existing reports in the literature (Hamilton et al., 2008; Gunaldo et al., 2014; Herrmann et al., 2015), it is clear that the two groups of health profession students involved in this study were satisfied with the IPE activity they participated in as measured by the high percentage of respondents to survey questions in the agree and strongly agree categories. However, a closer look at the specific data raises two important issues. First issue, in the PA student’s surveys, for the first statement (“The opportunity to learn anatomy from a CCLCM medical student was a valuable educational experience”), more students indicated agree than strongly agree. Breaking the data down to this level of detail suggests that some aspect 383
of being taught by the medical students was problematic for the PA students, and the written comments presented in the Results section provide some insight into this area. In this case, the medical students did not keep in mind how the PA students were going to be evaluated. This is an important point because the medical students had an entirely different evaluation system than the PA students. Students at CCLCM utilize a portfolio-based system, which uses narrative feedback and competency building rather than examinations, quizzes, or grades (Altahawi et al., 2012). Had both groups been exposed to the same evaluation system, it is possible that the medical students would have structured their presentations to the PA students in different ways and also offered insight on successfully preparing for upcoming laboratory practicals and written examinations. The take-away message from this is that it is the responsibility of the instructors to make sure that the students involved in the educational process are fully aware and reminded of the educational environment of the other group(s) of interprofessional students. Additionally, as with problem-based learning, team-based learning, and other educational approaches, faculty development must be a part of any attempt to expand IPE offerings so that instructors are fully aware of potential problems or issues that may arise and how they can be dealt with (Hean et al., 2012; Poirier and Wilhelm, 2014). Second issue, a closer look at the results related to statement 3 in both surveys: PA student survey, “Interacting with medical students from the Cleveland Clinic Lerner College of Medicine was a useful interprofessional educational experience,” and CCLCM student survey, “Teaching and interacting with physician assistant students was a useful interprofessional educational experience,” requires further exploration. In both groups, the opinions expressed are at or below 50% strongly agree and 50% agree responses. The message from this result is that the instructors must be sure that the various groups participating in the IPE activity have a clear understanding of the purpose of the IPE activity. Not only should learning outcomes be clearly defined, but interprofessional outcomes must be clearly stated and understood by all participants (Coster et al., 2008; Michalec et al., 2013; Thistlethwaite, 2015). Although the instructor may be clear on the benefits of the IPE, our survey data from statement 3 in both the PA student survey and the CCLCM student survey clearly suggest that the goals and values of working/learning with a different group of health care professions students was not clearly conveyed to or retained by the participants in this IPE activity.
Study Limitations As mentioned previously, a limitation of this study were the two vastly different assessment methods used to evaluate the two different groups of students and their progress in their respective curriculums. Had the medical students experienced an assessment environment similar to the PA students, it is conceivable that their interactions with the PA students would have been more highly rated because they would have been able to offer insight on successfully preparing for upcoming laboratory practicals and written examinations.
CONCLUSION The single most important point that can be learned from this study is that the goals of an IPE experience, although 384
they may be clear to the instructor(s), must be clearly articulated and reiterated to participants in the IPE experience or the point/importance of the experience may be lost before it begins.
ACKNOWLEDGMENTS The authors thank Beth Bierer, Ph.D., Director of Evaluation in the Education Institute at the Cleveland Clinic for her guidance during the development of the surveys used in this study and the statistical evaluation of the data.
NOTES ON CONTRIBUTORS JENNIFER M. MCBRIDE, Ph.D., is an associate professor in the Department of Surgery and Director of Histology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. She teaches gross anatomy, neuroanatomy, and histology to first- and second-year medical students. RICHARD L. DRAKE, Ph.D., is a professor in the Department of Surgery and Director of Anatomy at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. He teaches gross anatomy, embryology, and neuroanatomy to first- and secondyear medical students. LITERATURE CITED Altahawi F, Sisk B, Poloskey S, Hicks C, Dannefer EF. 2012. Student perspectives on assessment: Experience in a competency-based portfolio system. Med Teach 34:221–225. Coster S, Norman I, Murrells T, Kitchen S, Meerabeau E, Sooboodoo E, d’Avray L. 2008. Interprofessional attitudes amongst undergraduate students in the health professions: A longitudinal questionnaire survey. Int J Nurs Stud 45:1667–1681. Cronbach L. 1951. Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334. Drake RL. 2007. A unique, innovative, and clinically oriented approach to anatomy education. Acad Med 82:475–478. Drake RL, Vogl AW, Mitchell AWM. 2012. Gray’s Basic Anatomy. 2nd Ed. Philadelphia, PA: Elsevier Churchill Livingstone. 632 p. Fernandes AR, Palombella A, Salfi J, Wainman B. 2015. Dissecting through barriers: A mixed methods study on the effect of interprofessional education in a dissection course with health care professional students. Anat Sci Educ 8: 305–316. Fishleder AJ, Henson LC, Hull AL. 2007. Cleveland Clinic Lerner College of Medicine: An innovative approach to medical education and the training of physician investigators. Acad Med 82:390–396. Gunaldo TP, Andrieu SC, Garbee D, Giovingo LK, Mercante DE, Tortu S, English R. 2014. Student perceptions about interprofessional education after an elective course. J Interprof Care 14:1–2. Hamilton SS, Yuan BJ, Lachman N, Hellyer NJ, Krause DA, Hollman JH, Youdas JW, Pawlina W. 2008. Interprofessional education in gross anatomy: Experience with first-year medical and physical therapy students at Mayo Clinic. Anat Sci Educ 1:258–263. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. 2009. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. Hean S, Craddock D, Hammick M. 2012. Theoretical insights into interprofessional education. Med Teach 34:158–160. Herrmann G, Woermann U, Schlegal C. 2015. Interprofessional education in anatomy: Learning together in medical and nursing training. Anat Sci Educ 8: 324–330. Kirch DG, Ast C. 2015. Interprofessionalism: Education to meet patient needs. Anat Sci Educ 8:296–298. LCME. 2015. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree. 1st V Ed. Washington, DC: Liaison Committee on Medical Education (LCME ). 34 p. URL: http://www.lcme.org/publications/2016-17-functions-and-structureapril-2015.doc [accessed 5 May 2015]. McBride JM, Drake RL. 2011a. Rewarding the resident teacher. Anat Sci Educ 4:227–230. McBride JM, Drake RL. 2011b. Student-directed fresh tissue anatomy course for physician assistants. Anat Sci Educ 4:264–268. R
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McBride JM, Drake RL. 2015. Use of unembalmed/fresh cadavers in anatomy teaching. In: Chan LK, Pawlina W (Editors). Teaching Anatomy: A Practical Guide. 1st Ed. New York, NY: Springer International Publishing. p 223–226. Michalec B, Giordano C, Arenson C, Antony R, Rose M. 2013. Dissecting first-year students’ perceptions of health profession groups: Potential barriers to interprofessional education. J Allied Health 42:202–213. Nandan M, Scott PA. 2014. Interprofessional practice and education: Holistic approaches to complex health care challenges. J Allied Health 43:150–156. Poirier T, Wilhelm M. 2014. An interprofessional faculty seminar focused on interprofessional education. Am J Pharm Educ 78:80.
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Sullivan M, Kiovsky RD, Mason DJ, Hill CD, Dukes C. 2015. Interprofessional collaboration and education: Working together to ensure excellence in Health Care. Am J Nurs 115:47–54. Tavakol M, Dennick R. 2011. Making sense of Cronbach’s alpha. Int J Med Educ 2:53–55. Thistlethwaite JE. 2015. Interprofessional education and the basic sciences: Rationale and outcomes. Anat Sci Educ 8:299–304. WHO. 2010. Framework for Action on Interprofessional Education and Collaborative Practice. 1st Ed. Geneva, Switzerland: World Health Organization Press. 64 p. URL: http://whqlibdoc.who.int/hq/2010/WHO_HRH_ HPN_10.3_ eng.pdf?ua51 [accessed 28 February 2015].
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Student Perceptions of an Interprofessional Educational Experience: The Importance of Goal Articulation Jennifer M. McBride,* Richard L. Drake Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
The education of future health care professionals must involve activities where interprofessional collaboration and the functioning of interdisciplinary teams are the goals and not the exceptions. This type of interprofessional education (IPE) will benefit students as they will be better able to communicate with and mobilize the skills of other health care workers, work toward common goals related to patient care, and develop a more costeffective treatment strategy in the long term. Such an IPE program was initiated in the clinical anatomy course for physician assistant students from the University of Mount Union that was taught, in part, by medical students from the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Surveys of both student groups at the end of the course indicated that although this was a useful IPE experience, the value of this program as an IPE experience was not entirely appreciated by the participating students. It turned out that although the goals and importance of these types of IPE activities are clear to the faculty, they must also be made clear to all of the students. C 2015 American Association of Anatomists. Anat Sci Educ 8: 381–385. V
Key words: gross anatomy education; medical education; physician assistant education; undergraduate education; interprofessional education; IPE; student perception of IPE
INTRODUCTION Modern health care must involve an interprofessional team approach (Kirch and Ast, 2015). For this to occur, practitioners at all levels must be comfortable working together. The logical place for this type of relationship building to be initiated is in the educational environment of students in the health care professions. At this foundational level, the respective groups can establish a collective appreciation for their scope of practice. Additionally, the Liaison Committee on Medical Education of the Association of American Medical Colleges and American Medical Association has clearly demonstrated the current and future importance of interprofessional education (IPE) by including this topic in one of its standards by which all accredited medical schools in the United States are judged (LCME, 2015).
*Correspondence to: Dr. Jennifer M. McBride, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic/NA24, 9500 Euclid Avenue, Cleveland, OH 44195, USA. E-mail: [email protected] Received 23 April 2015; Revised 5 May 2015; Accepted 6 May 2015. Published online 3 June 2015 in Wiley (wileyonlinelibrary.com). DOI 10.1002/ase.1547 C 2015 American Association of Anatomists V
Anatomical Sciences Education
JULY/AUGUST 2015
Online
Library
Interprofessional education occurs “when students from two or more professions learn about, from and with each other to enable effective collaboration” (WHO, 2010). These types of IPE programs have been started in numerous academic centers (Hamilton et al., 2008; Fernandes et al., 2015; Herrmann et al., 2015) and have begun to break down barriers. Interprofessional education has to become a more consistent part of the educational programs for students in the health care professions. In Cleveland, a unique situation arose when a local university, the University of Mount Union (Alliance, OH), was interested in starting a Physician Assistant (PA) Program, but they did not have the appropriate facilities for a cadaver-based clinical anatomy course. They contacted the Cleveland Clinic, which had recently started a medical school program in association with Case Western Reserve University School of Medicine (Fishleder et al., 2007), to evaluate the possibility of using available facilities at the Cleveland Clinic for this course. An agreement was reached and plans were formalized to start a Clinical Anatomy course for University of Mount Union’s PA students at the Cleveland Clinic. As the course was being planned, it was realized that this would be an excellent opportunity to initiate an IPE program involving medical students and PA students. Thus, using the anatomy course developed for medical students at the Cleveland Clinic Lerner College of Medicine as a model (Drake, 2007; McBride and Drake, 2011a, 2015), the PA clinical anatomy course was developed.
Anat Sci Educ 8:381–385 (2015)
Physician Assistant Clinical Anatomy Course The Physician Assistant Clinical Anatomy Course is part of the University of Mount Union’s PA Program. The course is offered on Mondays during the first semester of the PA program, mid-May to early August, and is taught at the Cleveland Clinic main campus in Cleveland, OH. Each class at the University of Mount Union PA program has between 35 and 40 students, mostly women, whose ages range from 21 to 42 years. The anatomy course occurs during the first summer semester of year one, and accounts for four credit hours of the 15 allocated to that semester. The course begins in midMay and concludes during the first week of August. The class meets every Monday for a total of 10 or 11 sessions (depending on the summer holidays), with each session consisting of morning classroom and afternoon laboratory components (McBride and Drake, 2011b). Prior to class, the students receive a list of learning objectives and reading assignment from the required textbook (Drake, et al., 2012). The morning classroom component consists of a didactic portion with self-assessment questions that are answered using an audience response system. This activity gives students immediate feedback on how effective their pre-class studying has been and forms the basis for continued discussions throughout the morning session. After a break for lunch, the PA students gather in the anatomy laboratory for the two and a half- to three-hour afternoon session. The laboratory component consists of fresh tissue cadaver prosections prepared and demonstrated by first- and second-year medical students (McBride and Drake, 2011b) enrolled in the Cleveland Clinic Lerner College of Medicine (CCLCM), an imaging station, using selected images viewed on a high-definition monitor, which will reinforce the anatomy being viewed on the prosected cadavers, and a station that varies between models, bones, or question sets. During this session, the PA students spend 15– 20 min at each of the five stations. Additionally, after the PA students have completed their rotations through each station, they have the opportunity to return to the cadaver stations to review the dissections and ask the medical students additional questions (McBride and Drake, 2011b).
METHODS Surveys Two different surveys were developed to answer the question of whether having medical students demonstrate and teach anatomy to PA students was a useful IPE activity. The CCLCM student survey had three questions using a fourpoint Likert scale and was distributed to CCLCM students who had the opportunity to participate as anatomy demonstrators in the PA Clinical Anatomy Course. The University of Mount Union PA student survey also had three questions using the same four-point Likert scale and was distributed to University of Mount Union PA students who participated in the course. The surveys were distributed using REDCapTM (Research Electronic Data Capture Consortium, Vanderbilt University, Nashville, TN), which is a “secure, web-based application designed to support data capture for research studies” (Harris et al., 2009). Student participation in the survey was completely voluntary. Surveys returned were anonymous other than knowing that a response came from a medical student 382
or a PA student. The surveys received approval from the Cleveland Clinic Lerner College of Medicine IRB (IRB#141465: EXEMPT) under expedited review as exempt research to collect data without recording subject identifiers.
RESULTS Data Interpretation/Evaluation This study uses two questionnaires to gather information related to the value of an IPE experience. Each has three questions using a four-point Likert scale as a response mechanism. Usually with this type of data, frequency distributions are reported with some statistical analysis. However, for this study, it was felt that the most useful approach would be an evaluation and interpretation of the raw data. Additionally, in many studies using surveys or questionnaires, a Cronbach’s alpha (Cronbach, 1951) is calculated as a measure of reliability. However, this project uses a short three-item questionnaire with open- and closed-ended items to obtain participants reactions rather than measure a scale or single dimension. Because of the short test length, it is not appropriate to report a Cronbach’s alpha (Tavakol and Dennick, 2011).
Survey Responses The CCLCM student survey was distributed to 30 students who participated as anatomy demonstrators in the PA Clinical Anatomy course over a four-year period (2011–2014). Of these, 29 returned the survey, for a response rate of 97%. The University of Mount Union PA student survey was distributed to 60 students who had participated in the PA Clinical Anatomy course over a two-year period (2013–2014). Of these, 48 returned the survey, for a response rate of 80%.
Survey Results Results of the University of Mount Union PA student survey are summarized in Table 1. In general, the vast majority of respondents either agreed or strongly agreed with each statement that was asked. For example, the first statement, “The opportunity to learn anatomy from a CCLCM medical student was a valuable educational experience,” had 90% of the responses in these two categories. Similarly, 88% of the responses for Statement 2, “Learning anatomy using an unembalmed cadaver was a valuable educational experience” and 90% of the responses for Statement 3, “Interacting with medical students from the Cleveland Clinic Lerner College of Medicine was a useful interprofessional educational experience” were in the agree or strongly agree category. In addition to responding to the survey questions, several PA students also included comments in the “Additional comment” section of the survey, indicating the positive nature of the experience: “Many times the medical students provided very valuable learning tips and tricks,” “Also was a great opportunity to learn with future physicians we may work with,” and “I enjoyed the experience of interacting with medical students because they shared many of their techniques for memorizing the anatomy with us.” Results of the CCLCM student survey are also summarized in Table 1, and the majority of the responses to the three statements are in the agree or strongly agree category. For McBride and Drake
Table 1. Students Survey Results Statement
Strongly agree (%)
Agree (%)
Disagree (%)
Strongly disagree (%)
Learning anatomy from CCLCM students was a valuable educational experience
44
46
4
6
Learning anatomy using unembalmed cadavers was a valuable educational experience
75
13
8
4
Interacting with CCLCM students was a useful IPE experience
46
44
6
4
Reviewing anatomy while teaching PA students was a valuable educational activity
76
17
0
7
Opportunity to teach anatomy to PA students was a valuable educational experience
72
21
0
7
Teaching and interacting with PA students was a useful IPE experience
35
55
3
7
a
University of Mount Union PA Students Survey
CCLCM Medical Students Surveyb
a
Response rate was 80% (48 of 60). Response rate was 97% (29 of 30). CCLCM, Cleveland Clinic Lerner College of Medicine; IPE, interprofessional education; PA, physician assistant.
b
Statement 1, “The opportunity to review anatomy while teaching the physician assistant students was a valuable educational activity,” 93% of the responses were in these two categories. Similarly, Statement 2, “The opportunity to teach anatomy to the physician assistant students was a valuable educational experience,” and Statement 3, “Teaching and interacting with physician assistant students was a useful interprofessional educational experience,” had 93% and 90%, respectively, in the top two categories. In addition to responding to the survey questions, several CCLCM students also included comments in the “Additional comment” section of the survey, again indicating the positive nature of the experience: “One of the primary reasons this was an effective learning opportunity was the questions posed by the PA students,” “It was very helpful for my education to review this anatomy and teach it to the PA students!,” and “It is helpful to have an understanding of the knowledge base PAs will be entering the workforce with in order to evaluate what responsibilities they can be entrusted with.” Finally, although most surveys using a Likert scale look at grouped responses in these types of studies (strongly agree/ agree vs. strongly disagree/disagree), a closer look at responses to the survey questions in the individual categories (strongly agree vs. agree) indicates that all was not positive during this educational experience. Breaking the data down to this level of detail suggests that at least one aspect of being taught by the medical students was problematic for the PA students. A look at a few of their written comments may be enlightening in this regard: “I don’t think they understand how we were tested over the material,” and “I wish that the medical students would have known more on how we were evaluated with our weekly practical.” Anatomical Sciences Education
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Similarly, looking at the detailed results of the final survey question to both groups of students as to whether this was a useful IPE suggests that it may not have been. The opinions are that nearly half (actual 46% strongly agree and 44% agree responses) in the case of PA students and well below half (actual 35% strongly agree and 55% agree responses) in the case of CCLCM students felt that it was not, suggesting that there is a problem with the approach.
DISCUSSION Educational programs for students in the health care professions are going to continue to increase the opportunities for IPE experiences. The hope is that these types of programs will enhance professional respect, collaboration, and teamwork among health professionals when they enter the clinical arena (Nandan and Scott, 2014; Sullivan et al., 2015). However, this will occur only if educators make these IPE activities valuable, useful, and meaningful learning experiences. Similar to existing reports in the literature (Hamilton et al., 2008; Gunaldo et al., 2014; Herrmann et al., 2015), it is clear that the two groups of health profession students involved in this study were satisfied with the IPE activity they participated in as measured by the high percentage of respondents to survey questions in the agree and strongly agree categories. However, a closer look at the specific data raises two important issues. First issue, in the PA student’s surveys, for the first statement (“The opportunity to learn anatomy from a CCLCM medical student was a valuable educational experience”), more students indicated agree than strongly agree. Breaking the data down to this level of detail suggests that some aspect 383
of being taught by the medical students was problematic for the PA students, and the written comments presented in the Results section provide some insight into this area. In this case, the medical students did not keep in mind how the PA students were going to be evaluated. This is an important point because the medical students had an entirely different evaluation system than the PA students. Students at CCLCM utilize a portfolio-based system, which uses narrative feedback and competency building rather than examinations, quizzes, or grades (Altahawi et al., 2012). Had both groups been exposed to the same evaluation system, it is possible that the medical students would have structured their presentations to the PA students in different ways and also offered insight on successfully preparing for upcoming laboratory practicals and written examinations. The take-away message from this is that it is the responsibility of the instructors to make sure that the students involved in the educational process are fully aware and reminded of the educational environment of the other group(s) of interprofessional students. Additionally, as with problem-based learning, team-based learning, and other educational approaches, faculty development must be a part of any attempt to expand IPE offerings so that instructors are fully aware of potential problems or issues that may arise and how they can be dealt with (Hean et al., 2012; Poirier and Wilhelm, 2014). Second issue, a closer look at the results related to statement 3 in both surveys: PA student survey, “Interacting with medical students from the Cleveland Clinic Lerner College of Medicine was a useful interprofessional educational experience,” and CCLCM student survey, “Teaching and interacting with physician assistant students was a useful interprofessional educational experience,” requires further exploration. In both groups, the opinions expressed are at or below 50% strongly agree and 50% agree responses. The message from this result is that the instructors must be sure that the various groups participating in the IPE activity have a clear understanding of the purpose of the IPE activity. Not only should learning outcomes be clearly defined, but interprofessional outcomes must be clearly stated and understood by all participants (Coster et al., 2008; Michalec et al., 2013; Thistlethwaite, 2015). Although the instructor may be clear on the benefits of the IPE, our survey data from statement 3 in both the PA student survey and the CCLCM student survey clearly suggest that the goals and values of working/learning with a different group of health care professions students was not clearly conveyed to or retained by the participants in this IPE activity.
Study Limitations As mentioned previously, a limitation of this study were the two vastly different assessment methods used to evaluate the two different groups of students and their progress in their respective curriculums. Had the medical students experienced an assessment environment similar to the PA students, it is conceivable that their interactions with the PA students would have been more highly rated because they would have been able to offer insight on successfully preparing for upcoming laboratory practicals and written examinations.
CONCLUSION The single most important point that can be learned from this study is that the goals of an IPE experience, although 384
they may be clear to the instructor(s), must be clearly articulated and reiterated to participants in the IPE experience or the point/importance of the experience may be lost before it begins.
ACKNOWLEDGMENTS The authors thank Beth Bierer, Ph.D., Director of Evaluation in the Education Institute at the Cleveland Clinic for her guidance during the development of the surveys used in this study and the statistical evaluation of the data.
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