1. The application and future of key learning theories in interprofessional education
Sarah Hean,
Bournemouth University
Deborah Craddock,
University of Southampton
Cath O’Halloran,
University of Huddersfield

2. Current theory
IPE Curriculum design and evaluation accused of being theory less.
Scene changed over past 5 years
Turn to established disciplines: sociology, psychology and education, for theories that have utility in IPE,
Superabundance of theories of potential use in IPE research, each author with a pet approach to articulate his/her own understanding.
Theory must go beyond a list of theories and their individual application.
A heuristic, critical comparison and prioritisation of these theories is needed.
ESRC seminar series: Evolving theory in IPE
Before such prioritisation can take place, and to foster a heuristic comparison of these, the range of theories and the relationship between them must first be established.

3. Focus and Definitions
Review of all IPE theories is overambitious and a potentially unwieldy exercise.
Focus on learning theories.
Discussion confined to theories that seek to explore learning as defined as:
a relatively permanent change in behaviour with behaviour incorporating both observable activities along with internal processes such as thinking, attitudes and emotions (Burns 1995).
Curriculum and evaluation poorly underpinned by theory (Craddock, 2007; Payler, 2008)

4. Objectives
Identify key contemporary learning theories from education and used in IPE.
Explore their explicit application in IPE literature in either curriculum design or programme evaluation.
Present overview of learning theories as applied in IPE and their relationships with one another.
Identify areas for future theoretical development in IPE.
To achieve tool kit, need to lie tools down next to each other. Therefore need to position them in relation to one another.
Emphasise that we arenot the experts. The experts come later. We need to work as a group to identify key theories with which to progress and tehn to evolve these furhter with experts in practice,.

5. Methodology Search strategy on interprofessional (Freeth et al., 2002)
From educational literature, identified contemporary key theories of learning.
Search IPE literature (curriculum and evaluation) for explicit use and application of these theories (e.g. learning theor*; behaviour*)
Medline ; CINAHL , BNI
Hand search JIPC, Learning in Health and Social care

6. Selection Abstracts reviewed and selected on following criteria:
article related to interprofessional education, using the definition:
Members (or students) of two or more professions associated with health or social care, to be engaged in learning with, from and about each other (Freeth et al., 2002).
Explicit use of key learning theory to articulate learning in interprofessional context.
Focus on student and formal education (particularly problematic at macro level of analysis)
Papers in which the learning of two or more groups with, from and about each other
Learning in HEI and practice contexts and at an individual and organisational level were included.

7. Reviewer extracted information on:
learning theory applied;
application to curriculum design or evaluation
unit of analysis: micro or macro level of learning

8. Our overview of contemporary learning theories (used in IPE)
MICRO
BEHAVIOURISM
interprofessional competencies A
ADULT LEARNING
Self directed, experiential,
problem based,
discovery
interprofessional, collaborative
B-1-1
CONSTRUCTIVISM B
MACRO
Cognitive
Developmental/stage theory
Self directed, experiential,
problem based,
discovery
B-1
Social
Social conflict theory
Socio-cultural learning
Situated learning
Collaborative learning
Interprofessional learning B2
I WILL ONLY PRESENT OUR WORKING WITH BEHAVIOURISM AND CONSTRUCTIVISM TO ILLUSTRAE OUR THINKING
Not sure whether really tp include cpmplexity theroy. Coooper describes this a s a theory of learning whereas I think it is more a theory to describe the complexity of introducig an IPE intervention. However, in sayong this I think I may have missed their point as indicated by the following quote: “the perfect policy or learning strategy does not exist: only continual adaptation and exploration (and hence necessary mistakes) can bring about generally satisfying outcomes. The point is not to find the best learning strategy, but to evolve systems longitudinally that continually search, explore, and test out these strategies Cooper (2004)p 187; Howver in this we are moving towards theroeis of teaching, what cooperquotes as inquiry based teaching in which we reflect on the best learning we will facilitate rather than theories explaing how sudents learn in an interprofessional environment.
Two central branches of theory of contemporary importance have arisen to explain learning processes (Biggs 2003; Shermis XXXX). Behaviourism focuses on behavioural outcomes of learning. Learning only occurs if a behavioural outcome of that learning has taken place. Outocme orientated. Constructivism based on prior and learning experience of student is key to learning. Intersted in the processes that take place during learning.
PUT AUTHORS ON IPE WHO HAVE INCLUDED THESE THEORIES IN THEIR WRITING.
Self directed learning, collaborative learning, discovery learning, problem based learnin.g often appear under the opsices of adult learning but in fact, are forms of constructivist learning
Expansive learning B3

9. Overview of Behaviourism
Early version of behaviourism described by Thorndike’s early experiments with hungry cats.
Learning occurs through experiencing the consequences of one’s own behaviour.
Trial and error may be part of such learning.
Less interested in thought processes and how learning has occurred, but focus on learning outcomes.
Early version of behaviourism described by Thorndike. Here hungry cats were kept in boxes in sight of a food stimulus. They could free themselves and access food through trigger of a door mechanism. Cats would through a series of trial and error attempts eventually trigger the mechanism and be released. They progressively released themselves more rapidly as they learnt from the consequences of their own behaviour (Thorndike, 1898, Psi Cafe 2004).”
From a behaviourist tradition, therefore, learning occurs through experiencing the consequences of one’s own behaviour. Trial and error learning may be part of such learning. . All behaviour is learned and all learning involves an observable change in behaviour. Extreme behaviourists take a very positivist approach by believing that only what can be measured can be regarded as learning (Armitage). They tend to be less interested in thought processes and how learning has occurred, but focus in on learning outcomes.

10. Contribution of behaviourism
Outcome based curricula and evaluation
Students’ own activity is central
Criticisms
Focus on the outcomes or products of learning ignores processes.
Emphasises learning by doing. Students become involved in practicalities of experience, and fail to reflect on their actions during this process
Students may also become overly focussed on the assessment and achieving the stated behavioural objectives.

11. work in challenging situations managing change resolve conflict
Application to IPE
“..need to build a set of competencies that reflect interprofessional education and practice. At the present there is no commonly agreed on set of such competencies” (Gilbert, 2008).
Norris et al. (2005): The ability to:
work in challenging situations
managing change
resolve conflict
Negotiate
Arrendo et al. (2004)
Foundational knowledge e.g. theories of interprofessional collaboration, theories of organizational behaviour).
an awareness of their own beliefs and values.
Be able to distinguish between what they know and do not know in different and contexts in terms of their abilities to collaborate.
appreciate and act on different, conflicting world views
Norris: Some writers have begun to clarify what behaviours IPE hopes to develop.Norris et al. (2005), for example, considered the competencies required and the training requirements of the interprofessional environment. They worked specifically in the interprofessional environments of managed care networks, networks aimed at coordinating and integrating the varied services required by cancer patients. Within this environment they identified desirable interprofessional behavioural outcomes as the ability to:
work in challenging situations
managing change
resolve conflict
negotiate
Arrendo (et al.): also identifies competencies for interprofessional collaboration from the perspective of professional psychology. These authors believed that there are various components to competency in interprofesisonal collaboration. The first is some foundational knowledge that may include theories of interprofessional collaboration, theories of organizational behaviour and theories of group dynamics. Their understanding of competence therefore goes beyond an understanding of competence as the acquisition of skill or behavioural ability alone. This kind of knowledge may lend it self to teacher centric lectures as it involves simple transfer of knowledge to the student.
Another competency component includes the acquisition of levels of cultural self awareness. Students would be expected to demonstrate:
an awareness of their beliefs and values,
that they can distinguish between what they know and do not know in different settings and contexts in terms of their abilities to collaborate,
that they can maintain or update these competences throughout their careers
an appreciation of different and perhaps conflicting world views and be able to act in accordance with this.
Barr: Similar competencies have been identified by Barr (1998) (hornby and engel quoted in Freeth and Reeves get refs)Question are these interprofessional competencies therefore?. However, these are more explicit in the interprofessional rather than generic focus outlined by Norris et al. (2006). They highlight that students should be able to:
Work with other professions to assess, plan and provide care.
Describe their roles and responsibilities to other professions;
Recognise and respect the roles, responsibilities and competence of other professions;
Cope with uncertainty and ambiguity;
Facilitate interprofessional case conferences and meetings;
Handle conflict with other professions;

12. Barr (1998): The ability to:
Work with other professions to assess, plan and provide care.
Describe their roles and responsibilities to other professions;
Recognise and respect the roles, responsibilities and competence of other professions;
Cope with uncertainty and ambiguity;
Facilitate interprofessional case conferences and meetings;
Handle conflict with other professions;
Curriculum
Explicit application of IPE competencies rather than competencies in an interprofessional manner: Nil
Comments
Grey literature
Role of traditional uniprofessional staff development in curriculum design
If key behavioural changes (or wider key competences and learning outcomes) have been identified, the behaviourist is then interested in identifying the stimuli required to foster these behavioural changes. As identified in the wider literature (ref), simulations, demonstration and modelling are key teaching techniques used in this field. Examples of these types of IPE models will be analysed, in the lack of explicit underlying learning, through a behaviourist lens.
Use of simulation training
Simulations of real practice scenarios provide students with the opportunity to work through real life events, learning through experience how to handle interpofessional working in a controlled environment, in which time pressures and the safety of real patients are not compromised as students learn. These environments provide students with a stimulus through which they will learn, largely through the processes of trial and error, appropriate and specific collaborate behaviours. These behaviours can be reinforced by facilitators observing these simulation events. Clear behavioural objectives, and foundational knowledge to support behavioural change, should be included. To confirm learning within these environments has taken place, behavioural change should be observed and measured.

13. Evaluation
Kirkpatrick’s model of evaluation (Freeth et al., 2002). E.g. one of levels is measurement of change in attitudes, acquisition of knowledge. (McNair et al 2005)(Carpenter et al. 2005)
If broader definition of competencies includes student attitudes and knowledge as well as behaviour then there are several instances in which competences have been incorporated into evaluations. E.g., changes in students’ attitudes are seen as IPE learning outcome monitored in several evaluations (Hean et al, 2006; Mandy et al, 2005; Hind et al., 2003).
Model of evaluation focusing on measurement of learning outcomes alone and any process measures are excluded.
A focus on behavioural and other learning outcomes in ones theoretical leanings, will have an impact not only on the way in which one develops the curriculum but also in the way the impact of the curriculum is evaluated.
The Kirkpatrick model of evaluation
Freeth et al (XXX), for example, proposed an adaptation of Kirkpatrick’s model of evaluation. Summarise the model here. There are four levels of outcome which are…. McNair et al 2005 and Carpenter et al also use this model of evaluation. This model focuses evaluation to the measurement of learning outcomes alone and any process measures are excluded. As such, this is in line with any behaviourist approach but can be seen as mechanistic, the usual criticism made against behaviourist approaches to education..
The evaluation of competence
If a broader definition of competencies is taken to include changes in student attitudes and knowledge as well as behaviour then there are several instances in which competences have been incorporated into evaluations. Carpenter review (2008) summarises examples of IPE evaluation in which each of the outcome levels of the Kirkpatrick model have been addressed in an IPE evaluation. For example, changes in students attitudes are seen as IPE learning outcome monitored in several evaluations (Hean et al, 2006; Mandy etc; Hind).

14. Gaps Lack of measurement of actual behaviour (Barr et al., 2006):
Much on changing attitudes but little on changing students’ actual behaviour.
some few exceptions include:
Self reports of their developing interprofessional competencies and interprofessional confidence and involvement (Mcnair et al., 2005).
suggest that facilitator observation of student working be included in future measurement of behavioural change
collects students ‘self reports of their own communication skills (Pollard et al (2006) )
Dearth because measurement of behavioural change in IPE programmes (team work behaviours) are hard to identify and measure effectively.
Transformational, experiential learning, reflective practioner maybe effectively applied here. Overlap?

15. Overview of Constructivism
Articulate the processes of learning
Emphasise the importance of personal experience and interpretation of learning.
Students construct new concepts based on current knowledge
Curriculum should build on what they have already learned.
cognitive constructivism
concerned with how learners comprehend things/cognitive structures (Dewey (1966) and Piaget (1973).
higher order skills such as problem solving and the development of insights (Burns 1995). (Atherton 2005)
social constructivism.
Social constructivism emphasises how social encounters influence learners’ meanings and understanding (Atherton 2005).
Learner is more actively involved in the of constructing new meaning in a collaborative enterprise with the tutor (Atherton 2005).
All of the cognitive theories are concerned in a range of ways, with human development (Jarvis et al 2003). These theories articulate the processes of learning and emphasise the importance of personal experience and interpretation of learning.
In accordance with Bruner (1973) students construct new concepts based on current knowledge in which the following principles apply:
instruction should be commensurate with the experiences that make students willing and able to learn;
the curriculum should have a spiral organisation to enable students to build on what they have already learned.
Constructivist theories are divided into two strands: cognitive constructivism and social constructivism. Cognitive constructivism is concerned with how learners comprehend things in relation to developmental stages and learning styles (Atherton 2005) within which theorists such as Dewey (1966) and Piaget (1973) were influential. Dewey (1966) believed that knowledge could only emerge from situations in which learners have to draw out meaningful experiences. In Piaget’s (1973) case the psychological development of children formed the focus of constructivism where understanding was believed to be developed step by step via active participation and involvement. Social constructivism emphasises how social encounters influence learners’ meanings and understanding (Atherton 2005).
Curriculum
The development of higher order skills such as problem solving and the development of insights are central to a cognitive approach (Burns 1995). Constructivism, particularly in its social forms, suggests that the learner is more actively involved in the of constructing new meaning in a collaborative enterprise with the tutor (Atherton 2005).

16. Contribution of Cognitive Constructivism
Curriculum needs to take account of students’ existing knowledge.
Advocated importance of activity, experience and self direction in development.
Adult learning theories (Experiential learning (Kolb, 1984); Inquiry based learning)
Developmental/stage theories and processes of assimilation, conflict and accommodation, social conflict (Piaget)
Stages translated into moral and ethical development

17. Application to IPE Curricula:
Cognitive constructivist approach manifest in numerous descriptions of experiential, inquiry based learning etc in IPE curricula .
Hughes et al. (2004) describes a third year undergraduate online interprofessional module, UWE.
An inquiry based learning approach was taken to this initiative but the theories of Piaget, Vygotsky and Schon are integrated into the design.
Good example of using bits of theory from tool kit
Students given the opportunity to revisit and rework initial submissions of group work in an iterative process.
Hereby successive layers of knowledge added to existing knowledge through each cycle of the process.
In keeping with Piaget’s processes of assimilation or accommodation of new knowledge.
Clark (2006):issues he talks of the epistemology of inter disciplinary enquiry. The knowledge of essence here is professional knowledge and the value systems that may be unique to each profession or what Clarke calls the cognitive and normative maps of different professional groups. He suggests that students need to progress to levels of development whereby they not only appreciate the cognitive and normative maps of their own professions but that they be helped to grow to a stage where they are able to appreciate the maps of other professions and relate these to their own.
He elaborates on these ideas through discussion of cognitive and ethical student development. In a fashion similar to that proposed by Kohlberg, students may be seen moving along a continuum, progressing to ever higher levels of moral/ethical development. Clarke has chosen to run with alternative developmental theories to explore these stages of development that could take place in IPE students. He quotes Perry’s work (1970) with college students in which students were shown to progress through 4 stages in their development of knowledge and values. These stages were termed dualism, multiplicity, relativism and commitment to relativism. Dualism at one end of the continuum is a phase were students see the world in absolutes or dichotomies. Something is either right or wrong. Students may then move to a state of multiplicity and later relativism in which they become aware of the perspective of others or that ambiguities may occur when dealing with the morality of a situation. Finally they may reach a commitment to relativism, in which they are prepared to take a stand or a particular perspective but are aware that this perspective is governed by a system of value and belief systems and recognise that others may also have committed to a different but equally valid perspectives based on their own value and belief systems. For the health professional at this level, they may be committed to the skills, perspectives and approaches of their own profession but be aware that their approach is governed by the processes of socialisation and experience within their own group. Simultaneously they should recognise that other professions have different but equally valid approaches and skills, a result of their own separate educational and professional experiences. Clark proposes that IPE programmes should be designed to help students achieve the final stage of development i.e. a commitment to relativism. He provides practical suggestions that may facilitate the assimilation of new information and accommodation of this to reach this final stage by asking questions such as who am I (my own profession) and what do I know: who are others (other professions) and what do they know and what do we know as a team?

18. Evaluation
Realistic method of evaluation (Pawson and Tilley, 1997) in which mechanisms and processes are addressed in the evaluations of IPE modules (Clarke et al., 2005).

19. Application to IPE of developmental theories
Theoretical development of theory
Daghlen(2006): Stages of interprofessional development and decentering.
Clark (2006): 4 stages in their development of interprofessional knowledge and values. These stages were termed dualism, multiplicity, relativism and commitment to relativism.
a commitment to relativism, in which they are prepared to take a stand or a particular perspective but are aware that this perspective is governed by a system of value and belief systems and recognise that others may also have committed to a different but equally valid perspectives based on their own value and belief systems.
Explicit reference in curriculum design and evaluation to measure of stages of development: Nil;

20. Contribution of Social constructivism
Socio cultural learning theory
Developed mainly through work of Vygotsky
Student Learning is mediated by through socio cultural tools such as language
Description of Zone of Proximal Development
Scaffolding
Sociocultural learning theory
Vygotsky gave his name to sociocultural-historical theory of the development of higher psychical functions focussing now with greater emphasis than had Piaget on the connections between individual functioning and development on the one hand and the sociocultural practices on the other (van Huizen et al. 2005).
To determine the actual relations of the developmental process to eventual learning capabilities, Vygotsky (1978) determined two varying developmental levels: the actual developmental level which equated to mental age (see Piaget); and the zone of proximal development (ZPD). The latter is characterised by the level of development that the student can achieve via facilitated problem solving or in collaboration with more able peers. In other words, the ZPD is the difference between what a child can learn alone and what they can learn with the assistance of an external another. This external other may be their teacher or facilitator.
To undertake tasks within the ZPD, and allow learners to transcend this zone, scaffolding systems can be employed. Scaffolds may take the form of more knowledgeable people or cultural resources external to the student which support their leaning. This enables them to build on their own existing knowledge and internalise new information. Scaffolds, by their nature are temporary support structures and will be slowly be removed as the student masters the concepts in question and becomes an independent learner. (chang, Vygotsky 1978; Jarvis et al., 2003).
Because of the centrality of the social environment in allowing a learer to achieve their true potential, and in contrast to cognitive theorists who promoted self-directed learning, Vygotsky (1978) emphasised the significance of collaboration as opposed to complete independence when evaluating achievement levels or intelligence.
Concepts such as ‘scaffolding’ and the ZPD are pivotal to including both tutor-student and student- student discussions in curriculum design and providing students with opportunities to apply them to genuine examples of educational discourse relevant to their practice.

21. How have theories been applied in IPE
Zorga (2006)
describes a developmental–educational model of professional supervision in practice.
The supervisor mediates the learner’s reflection on a work issue from which they wish to learn/develop. The process of supervision is seen as a cultural product that can accelerate learning across the ZPD, a form of scaffolding for the learner under supervision.
Inter-dependnce is not encouraged and the supervision sessions are finite in order that scaffolding can be removed once the subject has developed sufficiently.
Hughes et al (2004)
Describe the interactions between peers and peer review activity within a virtual IPE programme.
Describe this in terms of Vygotsky’s ZPD.
KEY QUESTIONS TO ASK IN GROUP WORK:
How can students in IPE transcend the ZPD in their IPE initiatives? What are the scaffolds in IPE? What support structures need to be put in place to enhance student learning? Are e-learning tools, facilitators and peers key to this development? .
In IPE, explicit reference to Vygotsky and sociocultural learning, the zone of proximal development and scaffolding are few and far between.
There are some exceptions (Payler, Clark, Deon, Zorga). THree exaomples are described below.
Zorga (), for example, writes in the Journal of Interprofessional Care of the ZPD in their description of a developmental–educational model of professional supervision in practice. They describe this as supervision organized between two individuals or within a group, a process supports the individual professionally as well as in personal learning and development. The supervisor’s role is to mediate the learner’s reflection on a work or life issues through and from which they wish to learn and develop. The process of supervision is seen as a cultural product that can accelerate learning across the ZPD, a form of scaffolding for the learner under supervision. Interdependnece is not encouraged and the supervision sessions are finite in order that scaffolding can be removed once the subject has developed as a result of the sessions.
The authors describe interprofessional sessions as particularly useful and this approach is a feasible approach within a formal IPE programme. Facilitators, tutors or peers may help student reflect and learn from interprofessional issues they have experienced in practice. Relying on this kind of student experience, however, may mean this approach is most appropriate for students later in their training once they have experienced practice placements or who are undertaking postgraduate CPD programmes of IPE.
Hughes et al in their description of the interaction between peers and peer review within their virtual IPE programme are also ware of the theoretical underpinnings of Vygotsky’s ZPS, describing how by including peer review into the curriculum that this emulates proximal learning. In other words, that the significant other that allows them to learn are fellow students part of their IPE group.
D’eon describes a practical means of scaffolding that may be applied to IPE. They propose a range of increasing complex learning tasks which students must work through. These tasks become progressively more complex in two ways. Firstly the scenario begins as being a paper based scenario of an particular patient and progresses to a simulated patient or volunteer patient, and finally to a real life setting. The interprofessional nature of these tasks also becomes more comlex beginning as a simple interaction between two professionals, to a case in which a range of professionals are involved. The most complex situation trherfore invoves a experience of a patient in a real life setting treated by a wide range of professinals. Facilitators/tutors guide students through these tasks using the tasks as scaffolding upon which ” students..…build on successes, increase their prior learning, and become prepared to transfer their learning to new and different situations”. When scaffolding is removed (i.e., the tasks are completed) students should be able to apply or transfer their interprofessional learning “to novel cases and situations”.
Include tableVygotsky

22. D’eon (2005)
Practical means of scaffolding applied to IPE.
They propose a range of increasing complex learning tasks for students must work through.
These tasks become progressively more complex in two ways:
from paper based scenario to real life setting.
From simple interaction between two professionals, to a case in which a range of professionals are involved.
When scaffolding is removed (i.e., the tasks are completed) students should be able to apply or transfer their interprofessional learning “to novel cases and situations”.
Evaluation: Nil

23. Gaps
Move adult learning theory theories from a “how to” to a “ a why to”?
Need to develop ideas of stages of IPE development beyond theoretical applying this to curriculum development and evaluation.
Need to increase prevalence and develop ideas of scaffolding, ZPD into curricula design and evaluation, e.g. e-learning as a scaffolding, an exploration of peer lead or tutor lead discussions.

24. Criticism
Concentrated on individual as unit of analysis

25. Macro level of analysis:
Communities of Practice (CoP): situated learning
Activity theory: expansive learning
Chose not to search for cOP as I wanted to focus

26. CoP and Situated learning
Communities of practice are groups of individuals engaged in joint activity, one that is mutually recognised, an activity which binds them together and one in which common cultural resources are shared. Situated learning occurs within these CoP.
Focus of study was learning and student learning, therefore initial searches on situated learning. Broadened search to include “Communities of practice”
Showed increasing popularity to describe working in health and social care in terms of CoPs
Frequently CoPs used structurally to articulate how people work together rather than specifically addressing knowledge creation or learning that occur within them.
If student learning is a focus, and employed to frame student learning experiences in practice, then it focuses on professional learning of a single profession rather than the interprofessional takes place in practice simultaneously.
Work based learning and practcie based learning drifts from original theory of communities of practice

27. Greater complexity
An evolution of Vygotsky’s triangle of individual activity (mediated by cultural tools) into a description of collective human activity (2nd and third generation).

28. Expansive learning takes place within these collective activity frameworks.
Expansive learning takes place when contradictions in activity system occur.
Knowledge is unstable, unidentifiable and not understood. Is generated by joint activity

29. Application to IPE Curricula:
Moving away from issues of curricula as no longer about individual learning;
Engestrom (2001) (Child care in Helsinki)

30. Examples of situated learning and expansive learning
Research
Robinson and Cottrell (2005): (not strictly speaking student learning)
An investigation of evaluation of decision making and knowledge sharing in multi-agency teams.
Explore the professional knowledge generated, learning and ways of working created as result of being part of this activity system.
Phase1 applies Wenger’s (1998) constructs of participation and reification; Phase 2 and 3 guided by learning cycles, conflicts and resolutions in service delivery.
Evaluation:
Payler et al., 2007
Evaluation of a IPE CPD intervention;
Used activity theory in relation to other theories to create a matrix with which a pedagogic evaluation of the latter was to be constructed.

31. Criticism
Ignores processes within the individual
Over simplistic (CoP).
Cop does not look at dimensions of Power
Practice learning can be idealised
itself. (but another story)Idealistic/romantic notions asociated with situated learning-work based lening is always good: e.g. find themselves in situations for which ill prepared or learing opportunitie just not there

32. Conclusions
Conclusion: there is scope to apply theories of situated learning and CoPs; expansive learning and activity theory more rigorously to articulate student’s interprofessional learning in practice.
Should guide curriculum design as well as evaluation

33. Overall conclusions
Understanding of evolution and connectedness of theories helps position ourselves as practitioners.
Lack of theoretical underpinning limits potential of educational interventions (e.g. assessment opportunities) and their evaluation (see Mikkelson Kyrkebo et al., 2007)
Contemporary learning theories in education are being reflected in interprofessional education also
Theory as a political tool
Theories are not mutually exclusive but have a different emphasis
Much overlap between theories: learning by doing, student centeredness are key

34. Cont…. Positivist back ground Outcome orientated: behaviourist
IPE evaluation focussed on measurement of stereotype change
Positivist back ground
Outcome orientated: behaviourist
Moved into social psychology
Focussed on the individual
Theories in which the social context of learning and working is recognised are key. E.g., activity theory and socio-cultural learning took precedence over other learning theories. It is this nature of this component that differentiates interprofessional from uniprofessional learning.

35. Specific conclusions
Interprofessional competencies not translated into curriculum design
Need to increase and improve measurement of interprofessional behaviours and competencies
Adult learning can be subsumed under constructivism:
cognitive (e,g, experiential learning)
sociocultural learning (e.g. collaborative learning)
Adult learning theories need to progress from “how” to “why” application.
Theory needs to go beyond absence or the single sentence with no further development
Altogether better health conference encouraging.
Ideas of interprofessional stage development needs to move from theoretical to curriculum and evaluation applications e.g. how to measure students’ stage of interprofessional development and enable them to progress to a stage of commitment to relativism.

36. And finally…
After some neglect, theory is moving towards socio cultural and more meso level stages of analysis but this is changing.
Ideas of scaffolding and ZPD could progress further to explore, understand and improve our educational practice using scaffolds such as e-learning and mediating learning through peer and tutor facilitated e-learning;
Greater application of issues of expansive learning and third generation activity systems to IPE curricula and evaluation (see Payler et al., 2007)