T2W10-Rosenfield Et Al 2011 STUDENT Case Study Seminar

interprofessional education
Perceptions versus reality: a qualitative study of

students’ expectations and experiences of
interprofessional education
Daniel Rosenfield1, Ivy Oandasan2,3 & Scott Reeves4,5
CONTEXT Interprofessional education (IPE) their initial IPE event had been implemented.
has been gaining traction in post-secondary In particular, students felt that delivering IPE as
institutions. Many schools introduce IPE early a large-scale activity limited the amount of
to their health professional students, often in meaningful interprofessional interaction that
the context of a large-scale event in Year 1. This could be achieved. A number of students also
paper presents findings from a study under- expressed concern about the ‘artificial’ nature
taken by a medical student (a classmate of the of some of their interprofessional activities,
research participants) and details Year 1 which again limited their value. Students went
students’ initial perceptions of IPE. on to offer various suggestions to improve their
first exposure to IPE.
METHODS Using an exploratory case study
approach, eight focus groups of medical, CONCLUSIONS Our findings reinforce the
pharmacy, dental, occupational therapy and notion that students value IPE, but offer some
social work students were gathered over new insights into how introductory IPE
2 years (2007 and 2008). All participants had programming might be organised. Although
attended an IPE event delivered to nearly 1200 large-scale activities can provide IPE activities to
students each year. All data were analysed using a wide range of students, which is advantageous
an inductive thematic approach. from a specifically administrative perspective,
students’ opinions reveal that this form of IPE
RESULTS The data indicated that, although involves a number of challenges in their initial
students were generally positive towards IPE, engagement with concepts of interprofessional
many expressed dissatisfaction with the way teamwork and collaboration.
Medical Education 2011: 45: 471–477

doi:10.1111/j.1365-2923.2010.03883.x
1
Faculty of Medicine, University of Toronto, Toronto, Ontario, Correspondence: Daniel Rosenfield, c ⁄ o University of Toronto Centre
Canada for Interprofessional Education, Med West Medical Centre, 750
2
Department of Family and Community Medicine, Faculty of Dundas Street West, Suite 3-302, Toronto, Ontario M6J 3S3,
Medicine, University of Toronto, Toronto, Ontario, Canada Canada. Tel: 00 1 416 603 5800; Fax: 00 1 416 603 5580;
3
Centre for Interprofessional Education, University of Toronto, E-mail: daniel.rosenfield@utoronto.ca
Toronto, Ontario, Canada
4
Centre for Faculty Development & Keenan Research Centre, Li Ka
Shing Knowledge Institute of St. Michael’s Hospital, Toronto,
Ontario, Canada
5
Wilson Centre for Research in Education, Centre for
Interprofessional Education, Department of Psychiatry, University
of Toronto, Toronto, Ontario, Canada
ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 471–477 471
D Rosenfield et al
13652923, 2011, 5, Downloaded from https://asmepublications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2010.03883.x by Trent University Thomas J Bata, Wiley Online Library on [14/03/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
different health care programmes experience IPE in
INTRODUCTION
their first year of study. This approach was selected in
view of its ability to provide in-depth information
Interprofessional education (IPE) is gaining increas-
about complex issues and to, for example, explore
ing recognition worldwide as a way to enhance the
complementary as well as contradictory behaviours,
ability of health care students to practise collabora-
perceptions and opinions.12 The study was based on a
tively.1 Given ballooning health care costs, increasing
single research aim: to elicit a qualitative account of
chronic disease and diminished health care-related
how students in different health care programmes
human resources worldwide, a body of literature has
experience their first exposure to IPE.
identified the need to deliver IPE to health care
professionals as a means of training them to work
Setting
together to help address these issues.1–3
This study took place in a large urban university
Interprofessional education occurs in a variety of
located in Ontario, Canada. This university is
settings, including universities, colleges and hospitals.
responsible for providing education in 10 health
The question of when to implement IPE has yet to be
profession disciplines (dentistry, medical radiation
definitively answered; however, a number of educa-
sciences, medicine, nursing, occupational therapy,
tors believe that it should be introduced early in
pharmacy, physical education and health, physical
training before students are licensed in their respec-
therapy, social work, and speech and language
tive professions.4 Although a number of studies have
pathology) spanning five faculties (medicine,
quantitatively examined the conflicting attitudes of
nursing, dentistry, social work and physical
pre-licensure students participating in IPE initia-
education).
tives,5–9 few qualitative studies have explored in depth
how students perceive IPE after their first exposure.
As an introduction to IPE, all Year 1 students attended
a formal 3-hour IPE seminar to introduce the rationale
This paper describes the initial perceptions of
for and concepts behind interprofessional collabora-
students in relation to their first IPE experiences in
tion and education. The event took place in a large
health professional education programmes and offers
auditorium and was attended by nearly 1200 students.
insights to educators for enhancing the design and
It featured various speakers and a number of scenarios
implementation of IPE initiatives. The study also adds
that were presented onstage (i.e. as skits), which
a rare perspective to the IPE literature as one of the
depicted both positive and negative interprofessional
authors (DR) was a classmate of the research partic-
interactions. Students also engaged in group discus-
ipants. This approach supports recent calls for
sions to explore pertinent interprofessional issues that
increased student involvement in the design, imple-
arose from the scenarios.13
mentation and evaluation of IPE events10 because
student involvement has been found to increase
Sample
students’ willingness to collaborate with one another,
as well as to facilitate the long-term sustainability of
Pre-entry-to-practice medical students (MD) who had
IPE.10 The nature of student involvement in this
completed Year 1 of training were recruited to take
study is elaborated upon later in the paper.
part in this study. An e-mail was sent out to the
undergraduate medical class of 2011 electronic
Theoretical framework
mailing list to recruit participants. Three focus
groups, each consisting of four medical student
The study employed an interactionist approach to
participants, were held in 2008, with a total of 12
provide a theoretical framework for the qualitative
participants. Lunch was offered to all participants. To
data collection and analysis activities. Given the
increase the depth of analysis, the data that emerged
study’s focus on understanding individuals’ percep-
in the focus groups were analysed with data obtained
tions and experiences, this framework was regarded
from an earlier programme evaluation undertaken
as highly suitable for this empirical work.11
(by SR) in 2007, which had explored the IPE
experiences of all 10 student groups in their first year
at this university. These data were sourced from five
METHODS
focus groups including a total of 23 students. These
23 students had participated in separate, profession-
An exploratory case study approach12 was employed
specific focus groups which examined students’
to capture an understanding of how students in
perceptions of IPE and their experiences of the Year
472 ª Blackwell Publishing Ltd 2011. MEDICAL EDUCATION 2011; 45: 471–477
Students’ expectations of interprofessional education
1 IPE event. The respective groups included four Year Data collection
2 medical students (class of 2010), eight Year 2
dentistry students (class of 2010), two Year 1 social Focus groups were chosen as the primary method to
work students (class of 2008), six Year 1 occupational attain data for this study as they can be effective in
therapy students (class of 2008) and three Year 2 eliciting broad overviews of issues of concern to
pharmacy students (class of 2010). Anonymised groups or subgroups represented.14 Focus groups can
transcripts were obtained with permission. Table 1 also capitalise on the dynamic communication
shows a full comparison of the 2007 and 2008 between participants and are an efficient way of
cohorts. gathering information on participants’ perceptions
and experiences.
Role of the student-researcher
Before each focus group was held, written consent
At the time this research was conducted, the medical was obtained from all participants. Participation was
student (DR) had just finished his first year of voluntary. Explanations of audiotaping were provided
medicine. This project was conducted with the support and anonymity and confidentiality were stressed.
of a year-long programme designed to encourage Field notes and a reflective diary were used to capture
student research at the university and was conceptua- observations and non-verbal information during the
lised and implemented after the first author met with focus groups. Audiotapes of each focus group were
supervisors with similar interests. The first author transcribed and analysed sequentially before the next
completed both formal and informal research training focus group. The focus group guide was modified
by attending seminars and carrying out assignments between sessions to allow for concentration on areas
and presentations in preparation for data collection requiring further exploration. The focus group
and interpretation. In addition, further background guides for both 2007 and 2008 employed similar
training in running focus groups was acquired by questions related to students’ first-time exposures to
running ‘mock’ focus groups which were videotaped IPE and their general sentiments about the concept.
and analysed with the senior researchers. Table 2 outlines questions asked in each focus group.
Analysis
Table 1 Comparison of research subjects in 2007 and 2008
An inductive thematic approach was used to analyse
the data collected from the medical student focus
Year 2007 2008
groups in 2008. Primary analysis was undertaken by
Purpose To evaluate student To evaluate
DR. Following the primary analysis, all authors
reviewed and discussed the initial emerging themes.
experiences of IPE student
Using the constant comparative approach, the
with specific focus perceptions
authors derived, modified, refined and agreed upon a
on the Year 1 event and
coding scheme that captured major themes in the
experiences data. This inductive process ensured that findings
of IPE were grounded in the data collected. Field notes and
Type of Secondary; anonymised Primary; the reflective diary were used to complement the
data transcripts obtained obtained via transcribed data and to document underlying senti-
with permission conducting ments or emotions that emerged during the focus
focus groups groups.
Sample 23 students 12 students
size Themes generated from the 2008 analysis were
Professional Medicine (n = 4) Medicine
compared with themes from the 2007 data (which
employed an identical approach to analysis). A
groups Dentistry (n = 8) (n = 12)
synthesis of both datasets was undertaken by merging
represented Social work (n = 2)
(broadly similar) themes from both datasets.
Occupational
therapy (n = 6) Ethics
Pharmacy (n = 3)
Ethics approval was sought and obtained from the
IPE = interprofessional education university research ethics board for the data collec-
tions of both 2007 and 2008.
D Rosenfield et al
for this paper focus on exploring students’ general
Table 2 Questions asked in the 2007 and 2008 focus groups perceptions of IPE, their perceptions of their initial
exposure to IPE, and their ideas for making IPE more
effective in their respective curricula.
Focus Focus
group group General perceptions of IPE
questions questions
in 2007 in 2008 In general, the data indicated that students felt IPE
had both value and merit for their professional
What do you think were What does IPE mean education. Many noted that IPE was important
the most valuable aspects to you? What sentiments because of the team-based nature of patient care and
of the introductory are associated with the term believed that it could serve to strengthen and
IPE day? ‘interprofessional education’? improve existing health care teams. Students also
noted that IPE might be useful for ‘tapping into the
Are you interested in What interprofessional expertise of different professions’ (medical student,
interprofessionalism or interactions have you had Focus Group 2).
curious about other to date? Any illustrative
professions? anecdotes to share? Students across the professions also felt that a key
purpose of IPE was to educate them about their
Are there opportunities How would you classify
respective future roles and scopes of practice as
for students to socialise your interactions with health professionals. This sentiment was succinctly
and interact with students in other health summarised by a student who said that IPE should be
students in other health professions? designed to ‘educate other people on what our role is
professions? in the health care system’ (Student 2 [occupational
therapy]). Students therefore felt that IPE was crucial
What are the benefits of What role do you think IPE
to enable team members to work together in an
IPE for students? Patients? will have in your future
effective manner. Another student remarked:
The health care system? careers?
What would you like How well do you think ‘[IPE is] really about knowing what other people do,
to see next in IPE IPE is implemented at
so that you can tap into what other people know to
help treat the patient, and also not to duplicate
for yourselves? this university?
people’s work.’ (Medical student, Focus Group 2)
How do you see your How would you improve
profession portrayed? IPE at this university? Students also expressed less positive perceptions
about IPE. Although their general notions of IPE were
What do you see as When do you think IPE positive, as noted above, many students expressed a
potential barriers to should be implemented in range of negative views about their first actual
interprofessional practice? the curriculum? exposure to IPE in the form of the ‘Year I IPE event’.
Do you see any Have you had any This theme is elaborated upon below.
gaps in IPE between negative IPE interactions?
theory and practice? Elaborate
Perceptions of first-time exposure
Are there things that In general, focus group data indicated that students
should be changed had largely negative recollections of their first IPE
to improve the IPE experience. The most commonly identified reasons
curriculum? for these views concerned: (i) the size of the event,
and (ii) the poor fidelity of the interprofessional
IPE = interprofessional education scenarios employed.
When discussing the size of the event, nearly all the

students interviewed agreed that this IPE experience
RESULTS was too large in nature. As a result, attempts to
engage in interprofessional discussion between the
Findings from the analysis and synthesis of data are students were fraught with difficulty, as interaction
presented under three themes. The themes selected was rather cursory in nature:
‘It [the Year 1 IPE event] was just so awkward and year. This, it was felt, would facilitate the establish-
there’s no meaningful contact with people in the ment of meaningful relationships which could not
group.’ (Student 3 [occupational therapy]) develop at one-off events. When this suggestion was
made, all participants expressed agreement by all
Although the size of the event was reported to detract talking at once and acknowledging that longitudinal
from the quality of the students’ interprofessional events would be desirable. Indeed, one student
experiences, it was also noted that elements of the summed up the general sentiment when she offered
event, particularly the scenarios (skits) presented, this suggestion for the nature of future IPE:
were too simplistic in nature. As a result, students
reported that this IPE event felt like: ‘I would envision small groups meeting not too
frequently, but not once a year… like once a month…
‘…junior high or high school, because you’d watch and doing a variety of experiences… I think it would
the skit, and they had these questions and you were be beneficial to have the same group meet for a longer
supposed to turn to the person next to you and period of time… just so you can get to know each
discuss the questions.’ (Medical student, Focus Group other a little bit.’ (Medical student, Focus Group 2)
3)
Students were also quite vocal about the fact that they
Indeed, when referring to the skits on stage, students did not have time to partake in additional IPE
noted that they appeared ‘limited and forced’ experiences as their timetables were already crowded
(medical student, Focus Group 2). As a result, many with profession-specific coursework and extracurric-
students noted that the ‘message’ (the need to ular activities. They noted that the integration of IPE
improve interprofessional collaboration) embedded into existing curricula is paramount and that there
in these interprofessional scenarios may have been are ample opportunities for this to occur.
‘lost in that process’ (medical student, Focus Group
3).
DISCUSSION
Effective IPE
This study provides a rare qualitative insight into how
Although the students noted a number of concerns students perceive their initial exposure to IPE. It
about their first IPE event, many went on to provide a indicates that medical students, as well as students in
range of suggestions for how the delivery of this form other health professions, in general appreciate the
of learning might be improved in the future. Most importance of IPE even after being exposed to it for
comments were focused on the following four the first time at an early stage in their academic
elements and specifically suggested that future IPE careers. Additionally, the study suggests that although
should: our students understand the underlying purpose
of IPE (i.e. to promote interprofessional collabora-
• employ more small-group sessions (as opposed to tion), their actual first experience of IPE was
large-group sessions); problematic as its large-scale nature limited oppor-
• be less reliant on didactic ‘lecture-based’ tunities for meaningful interaction with students in
learning; other professions. Indeed, as reported elsewhere,15
• form a regular, longitudinal part of undergrad- IPE activities can generate some resistance from
uate education (as opposed to ‘one-off’ events), students when their shared learning experience
and offers only a low level of realism.
• be well integrated into existing curricula.
It has been argued that educators need to create
Indeed, small-group sessions (e.g. seminars, case- relevant learning experiences for students in an
based and problem-based learning sessions) were appropriate small-scale format, utilising a wide variety
highly valued by the students, who felt such sessions of interactive teaching strategies.16 However, the
allowed learning to be integrated with that of data that emerged from our study suggest that the
students from other professions and helped to create size of the initial IPE event, which delivered IPE to
‘a more interactive and engaging learning environ- over 1000 students simultaneously, generated a range
ment’ (medical student, Focus Group 1). of poor perceptions. This created some difficulties for
some students in their efforts to connect interpro-
Other medical students suggested that small inter- fessionally and to learn ‘with, from and about’17 peers
professional groups should meet throughout the from different professional groups. In addition, the
D Rosenfield et al
data suggest that the low fidelity of the learning tion, despite the use of a small sample of students in
modalities utilised was also of concern. A number of the study, the complementary nature of the themes
the students interviewed did not view the scenarios generated by interviewing students from diverse
employed in the event as ‘realistic’ or ‘relevant’ to programmes, over a period of 2 years, helps to
their future professional practice. Creating relevant indicate that these findings provide a reasonably
learning experiences, an integral component of faithful representation of sentiments felt by students
Knowles’18 adult learning principles, is essential to across the university. Another limitation of this study
having learners integrate the lessons taught in a concerns the fact that it took place within a single
particular educational initiative. The issue of rele- institution in a Canadian setting. As a result, the
vance to professional practice and the need for applicability of its findings may be limited in other
realism has also been noted by other authors as key to settings. However, various institutions worldwide uti-
the successful delivery of IPE.19,20 lise introductions to IPE that involve large-group
settings.
In addition, as noted above, one of the authors
(DR) was a Year 1 medical student at the time the
2008 focus groups were conducted. We regard the CONCLUSIONS
involvement of a student in this study as an
important component as it can help demonstrate As IPE activities increase across university campuses
how students can become involved in IPE, which is worldwide, many educators are struggling to
a relatively new form of education. This, in turn, define the types of IPE programmes that should
may support the provision of student role models be run and how they should be conducted. Educators
in interprofessional collaboration, which may help engaged in IPE should ensure that they create
to facilitate the long-term sustainability of IPE.10 meaningful and relevant interprofessional experi-
Other benefits of using a classmate of the research ences, which emphasise clinical correlates. Careful
participants included ease of recruitment and attention should be paid to the size of the event and
increased candour from participants when the relevance of learning activities. As this study
responding to research questions. Indeed, it was demonstrates, students appear to show a genuine
noted that the groups frequently had to be interest in collaborating in the future; however,
reminded of the professional nature of the educators need to give them the tools to do so in a
interviews because it was evident that none of the way that will excite them about, not turn them off
students were hesitant to express a candid range of from, collaborative practice.
sentiments to the student-researcher.
A final key outcome of this study concerns how Contributors: all authors (DR, IO, SR) contributed to the
important it is that educators elicit student perspec- overall design, data acquisition, drafting and revision of the
tives beyond those obtained from responses to manuscript. All authors (DR, IO, SR) approved the final
attitudinal questionnaires to inform future directions version of the manuscript for publication.
in planning and implementing IPE. Although the Acknowledgements: we would like to acknowledge the work
of Dale Dematteo, who graciously gathered data from the
logistics of providing IPE in small interprofessional
2007 focus groups.
groups longitudinally within health professional
Funding: this research was supported by the
education curricula seem daunting, students consider Comprehensive Research Experience for Medical Students
that this format would enhance the impact of IPE (CREMS) programme and the Office of Interprofessional
on their learning. Many institutions worldwide are Education at the University of Toronto.
making strides to integrate IPE, rather than to Conflicts of interest: none.
provide it in large, isolated learning events to Ethical approval: this study was approved by the University
students, and are succeeding in overcoming seem- of Toronto Research Ethics Board.
ingly impossible logistical barriers.21–23
The study has a number of limitations. Although its REFERENCES

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Methods: A Data Collector’s Field Guide. Durham, NC: 2010; accepted for publication 18 September 2010
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interprofessional education

Perceptions versus reality: a qualitative study of

Medical Education 2011: 45: 471–477

When discussing the size of the event, nearly all the

The study has a number of limitations. Although its REFERENCES

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