Presentation on theme: "Deborah Craddock, PhD University of Southampton"— Presentation transcript:
1Deborah Craddock, PhD University of Southampton Students’ attitudes towards IPE across professional groups: Lessons learnt from a national studyDeborah Craddock, PhDUniversity of Southampton
2IntroductionPre-registration IPE is a mandatory requirement in the UK (DOH & QAA 2006).Interprofessional education (IPE) aims to reinforce collaborative practice (Glen and Reeves 2004; Carpenter, 2005; WHO, 2010).Cultural barriers exist to the successful development of IPE (Barr et al. 2005; Morison et al. 2008).Stereotypical views of other professions are held by students upon entry to their respective programmes (Hean et al. 2006; Adams et al. 2006)Students assign differing hierarchical statuses to other students depending on their level of academic qualifications or their ability (Adams et al. 2006; Nisbet et al. 2008).Can such stereotypical views change? (Carpenter 1995; Carpenter & Hewstone, 1996)
3Professionalism (Saks, 2009) Viewed traditionally as:Different from other professional groups;Possessing unique bodies of experience;Using their knowledge for the public good;Acting rationally, objectively and impartiallyViewed critically as:Self seeking monopolies in the market;Insufficiently accountable/ responsive;Having a mystified knowledge base.> doubtsProfessional socialisation processes are likely to develop students’ perceptions of other professions during their pre- registration training (Adams et al. 2006)
4Research Questions*-Does professional representation in IPE groups increase knowledge of professional roles?-Do health and social work students’ readiness for IPL differ across professions?-What factors influence students’ commitment to IPE?*Sample 1: students at the start of their IPE initiative at FHEQ4;Sample 2: students on completion of their IPE initiative at FHEQ4
5Methodology Two parallel studies-prospective cross- sectional surveys Ethical approvalMulti-stage sampling:- (1) sampling of HEIs & (2) sampling of studentsQuestionnaires were administered to a volunteer sample of pre-registration health and/ or social work students in Higher Education Institutions within the UK at 2 separate time points.Inclusion criteria: Students registered on a health or social care programme participating in an IPE initiative that involved podiatry students.
6Key informant interviews Questionnaire PackQuestionnaire pack- informed by (1) key informant interviews and (2) research evidenceValidated tool – Readiness for Inter-professional Education Scale (RIPLS) (Parsell and Bligh, 1999) & Generic Role Perception Questionnaire (GRPQ) (Mackay, 2004)Face validityContent validityPilot Study [test (i) n=67; test (ii) n=62]Test re-test reliabilityInternal consistencyKey informant interviews
7Sample:Sample 1:1151 students participated in the Sample 1 phase [81.1% (933) female, 18.9% (218) male]: mean age (SD=8.167) years in 6 HEIsSample 2:1060 students participated in the Sample 2 phase [81.2% (861) female, 18.8% (199) male]: mean age (SD=7.84) years in 5 HEIs.Female : Male (Parsell and Bligh 1999; Cassidy 2007)
8Learning about professions represented in IPE groups- exemplar: podiatry Objective 1Students’ knowledge of podiatrists’ roles was better if they had participated in an IPE group that involved a podiatry student (Sample 1 Md=7; Sample 2 Md=8) than if they had not/ unsure (Sample 1 Md=6; Sample 2 Md=6)(Sample 1: U= , Z=-2.596, n-964, p=0.009; Sample 2: U= , z= , n=967, p<0.001).In Sample 2: There was a significant difference in students’ total GRPQ scores between health and social care students who participated in an IPE group that involved a podiatry student (Md=94, n=497) and students who had not/ unsure (Md=99, n=470) (U= , z=-3.451, p=0.001, r=-0.11).
9Readiness for Inter-professional Learning Scale Principle Component AnalysisKaiser-Meyer-Oklin value = Sample 1: 0.932; Sample 2:Bartlett’s Test of Sphericity (p<0.001)Oblimin rotation with Kaiser NormalisationSample 1 and 2:2 component solutionComparisons with Parsell and Bligh (1998; 1999) & McFadyen et al. (2005)Component 1Teamwork and collaborationComponent 2Professional identity and roles
10RIPLS Subscale Comparisons Factor AnalysisSub-scale 1Teamwork and collaborationSub scale 2Professional Identity (1999) and Negative Professional Identity (1998)Subscale 3Roles and Responsibilities (1999) + Roles (1998)Parsell and Bligh (1999) (n=120)42% variance explainedItems 1-9Items 10-16Items 17-19Parsell et al., (1998) (n=914)48% variance explainedItem 11Items 13-16Item 12Item 17Item 19Item 18McFadyen et al (2005) (n=308)(n=308) 44% variance explainedItems 1-9; 10, 11Items 18-19Craddock Sample 1: n= % variance explainedCraddock Sample 2: n % variance explainedItems 10-12
11Cronbach Alpha Measure of Internal Consistency of Each Sub-scale StudySub-scale 1Teamwork and collaborationSub scale 2Professional Identity (1999) and Negative Professional Identity (1998)Subscale 3Roles and Responsibilitie s (1999) + Roles (1998)Parsell and Bligh (1999) (n=120)0.880.630.32Parsell et al., (1998) (n=914)0.850.46-McFadyen et al (2005) (n=308)0.800.210.40Craddock (n=1151)0.66Craddock (n=1060)0.920.79
12Comparison of Students’ Total RIPLS Scores by Profession Objective 2ProfessionSample 1 MdNSample 2 MdUZPRPhysiotherapy7923676216-3.814<0.0010.1Occupational Therapy82122924674.5-2.0920.0360.05Podiatry7818775937105-2.4950.0130.06Radiography78.596702571.5-2.5810.0100.07Medicine71.5902444.5-3.0470.0020.08Midwifery81437451572.5-3.981Social Work845677.5601205.5-2.6240.009Audiology86101330.0-2.1750.03Lower median scores observed in Sample 2
13In Sample 1 and Sample 2 the Kruskal-Wallis test shows that there are significant differences between the professions and students’ total RIPLS scores (Sample 1: χ2 (14, n=1151) =56.803, p<0.001; Sample 2: χ2 (13, n=1060) =83.085, p<0.001).In Sample 2, nursing (Md=81) and occupational therapy (Md=79) students had a greater readiness for IPL than students in other professions.In Sample 1 audiology (Md=86) and social work (Md=84) students had a greater readiness for IPL than students in other professions.Medical (Sample 1: 75; Sample 2: 71.5) and paramedical science (Sample 1: Md=74; Sample 2: Md= 71) students recorded the lowest median scores compared with students in other professions.
14Sample 1 Total RIPLS Analysis Profession¹Profession²Md¹N¹Md²N²UZPROccupational TherapyPodiatry82122781878421.5-3.892<0.0010.22Radiography78.5964208-3.5680.24Medicine752971-4.1310.29Nursing229-3.7660.28365-3.4020.0010.19Social Work84561850.5-3.2020.266001.5-3.917
15Sample 2 Total RIPLS Analysis Statistically significant differences between student professional groups:Sample 2Total RIPLS AnalysisProfession¹Profession²Md¹N¹Md²N²UZPRPhysiotherapyOccupational therapy7621679927662.5-3.1810.0010.18Medicine71.5906961-3.915<0.0010.22Nursing8127322469-4.5230.2Occupational TherapyRadiography75702258.5-3.2540.262143.5-5.6220.42Midwifery74511491-3.6060.3Podiatry939507-3.6200.196712.5-3.8436555-6.6410.35Social Work77.5601702.5-3.8290.314484-4.037Pharmacy504878-3.209
16Teamwork and Collaboration Sub-scale 1Teamwork and Collaboration
17Students’ attitudes towards teamwork and collaboration: OverallProfessionSample 1 MdNSample 2 MdUZPRPhysiotherapy5623652.521619793-4.112<0.0010.12Occupational Therapy5812255924635-2.1860.0290.06Radiography5496702698-2.1710.03Medicine7551.5902577-2.6150.0090.08Midwifery435251728.5-2.8000.005Social Work601321-1.9950.046Lower median scoreHigher median score
18In Sample 1 and Sample 2 the Kruskal-Wallis test shows that there are significant differences between the professions and students’ RIPLS scores for sub-scale 1 (Sample 1: χ2 (14, n=1151) =54.137, p<0.001; Sample 2: χ2 (13, n=1060) =74.618, p<0.001).In Sample 2:Dietetic (Md=65) and nursing (Md=57) students held more positive views towards teamwork and collaboration.Paramedical science (Md=48) and medical students (Md=51.5) – least positive.In Sample 1:Audiology (Md=60.5) and social work (Md=60)students held more positive attitudes towards teamwork and collaborationParamedical science (Md=51) students- least positive.
19Comparison of Students’ RIPLS Sub-Scale 1 Scores by Profession Teamwork & collaborationSample 1Sub-scale 1 AnalysisProfession¹Profession²Md¹N¹Md²N²UZPROccupational TherapyPodiatry58122541878271-4.096<0.0010.23Radiography964210.5-3.5690.24Nursing22916675-3.8940.28511.5-3.2190.0010.18Social Work60561806-3.3800.27
22Students’ attitudes towards professional identity & roles: OverallProfessionSample 1 MdNSample 2 MdUZPRPhysiotherapy18236132165218-14.67<0.0010.31Occupational Therapy12212921065.5-10.180.22Podiatry19187932066-10.43Radiography9614701249.5-6.9380.15Medicine207515.5901574-5.9110.13Nursing2292735797.5-15.760.34Midwifery4351461.5-4.8410.1Social Work5660557-6.218Prosthetics & Orthotics2331200-2.750.0060.06Pharmacy291650353-3.7960.08Audiology19.51020.5-2.774Paramedical Science78.5-2.0770.0380.04
23Kruskal-Wallis test: significant differences between the professions and students’ RIPLS scores for sub-scale 2. Sample 1: χ2 (14, n=1151) =56.793, p<0.001; Sample 2: χ2 (13, n=1060) =79.489, p<0.001.Sample 1: Medicine (Md=20) and dietetic (Md=20) students- strongest attitudes towards professional identity and roles.Speech and language therapy students (Md=17) - weakest attitude towards professional identity and roles.Sample 2: Medicine (Md=15.5) but also pharmacy (Md=16) students- strongest attitudes towards professional identity and roles.Occupational therapy and nursing students (Md=12)- weakest views towards professional identity and roles than other professional groups represented in this sample.
24Comparison of Students’ RIPLS Sub-Scale 2 Scores by Profession Higher median scoresSample 1Sub-scale 2 AnalysisProfession¹Profession²Md¹N¹Md²N²UZPRPhysiotherapyMedicine1823620756080.5-4.125<0.050.23Occupational Therapy1223297-3.3200.0010.24Podiatry191874932-3.784<0.001Radiography962101.5-4.7100.36Midwifery43847.5-4.3120.4Social Work56742.5-3.2970.33
26Commitment to IPE: Commitment was strongly influenced by: Objective 3 Positive correlation - age and level of commitment to IPE (Sample 1: spearman’s rho = , p<0.001; Sample 2: spearman’s rho = 0.165, p<0.001 for a one tailed test)Modal response of 6 - the majority of participants were only fairly committed (Sample 1: 49.5%, 570; Sample 2: 46.9%, 497) to IPL.Commitment was strongly influenced by:facilitators’ attitudes towards IPE (Sample 1:75.5%, 835; Sample 2: 74%, 784)working practices of staff (72.4%, 833; Sample 2: 66%, 700);Students induction to the IPE initiative (62.2%, 716; 56.2%, 596)
28Enhancing knowledge of professional roles Lessons LearntEnhancing knowledge of professional roles
29Comparisons by Profession Sample 1Students showed positive attitudes towards teamwork and collaboration and IPL from the outset of their studies.-Hind et al. 2003; Tunstall-Pedoe et al., 2003Sample 2:Students’ attitudes towards teamwork and collaboration skills became statistically less positive for those studying physiotherapy (PT), occupational therapy (OT), radiography, medicine, midwifery and social work (SW).Students’ overall readiness for IPL was lower in each profession for PT, OT, medicine, midwifery, SW, podiatry and audiology.
30Most Positive Views Least Positive Views Professional programme appeared to affect students’ responses to IPE - Conflicting with Pollard et al. (2005)Sample 1 & Sample 2Medical and paramedical science studentsFindings align: Tunstall-Pedoe et al. (2003) Morison et al. (2004)Supports: Hean et al.’s (2006) findings& Conflicts: Hanson et al. (2005Hallikainen et al. (2007)Sample 1Audiology and social work studentsSample 2Nursing and dietetic students-teamwork and collaborationNursing and occupational therapy students-IPLSupports: Hean et al. (2006)
31Professional Identity and Roles Sample 1: +Strongest views: medical and pharmacy students(Miller et al., 2006)Ratings for being good independent workers (Hean et al., 2006)Weakest views: speech and language therapy students (Sample 1); occupational therapy & nursing students (Sample 2)PhysiotherapyOccupational TherapyPodiatryRadiographyMedicineNursingMidwiferySocial workPharmacyAudiologyParamedical ScienceProsthetics and OrthoticsSample 2
32Statistically: > Medical students Pharmacy students Radiography Samples 1&2: PT, OT, podiatrySample 1: radiography, midwiferySample 2: nursing and social workSample 2: PT, OT, nursingSample 2: nursing, OTWHY?Confidence in professional competence and practical skills; perceived role independence
33Students with a strong sense of professional identity and roles were less ready to engage in IPL and had weaker attitudes towards teamwork and collaboration.Curriculum Developers:-Reflect on professional differences;Curricula content, implementation & evaluationTarget factors influencing students’ attitudes
34Key factors influencing students’ attitudes towards IPE
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