Attitudes of health sciences students towards interprofessional teamwork and education

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<ul><li><p> 2008 The AuthorsJournal compilation 2008 Blackwell Publishing Ltd. </p><p>Learning in Health and Social Care</p><p>, </p><p>7</p><p>, 3, 146156</p><p>Original article</p><p>Blackwell Publishing Ltd</p><p>Attitudes of health sciences students towards interprofessional teamwork and education</p><p>Vernon R.</p><p>Curran</p><p>PhD</p><p>,</p><p>1</p><p>*</p><p>Dennis</p><p>Sharpe</p><p>PhD</p><p>,</p><p>2</p><p>Jennifer</p><p>Forristall</p><p>MASP</p><p>3</p><p>&amp;</p><p>Kate</p><p>Flynn</p><p>MASP</p><p>4</p><p>1</p><p>Director, Academic Research and Development, Associate Professor of Medical Education, Faculty of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland, Canada A1C 5S7</p><p>2</p><p>Professor of Post-Secondary Education, Co-Director, Centre for Collaborative Health Professional Education, Memorial University of Newfoundland, St. Johns, Newfoundland, Canada A1C 5S7</p><p>3</p><p>Program and Policy Development Specialist, Department of Human Resources, Labour and Employment, Government of Newfoundland and Labrador, Canada A1B 4J6</p><p>4</p><p>Research Coordinator, Centre for Collaborative Health Professional Education, Memorial University of Newfoundland, St. Johns, Newfoundland, Canada A1C 5S7</p><p>Keywords</p><p>attitudes, health </p><p>occupations, </p><p>interprofessional </p><p>education, </p><p>interprofessional </p><p>relations, students</p><p>*Corresponding author. Tel.: 709-777-7542; fax: 709-777-6576; e-mail:</p><p>Abstract</p><p>Relatively little is known about the specific attributes of health professional students </p><p>which may influence their attitudes towards both interprofessional teamwork and </p><p>interprofessional education. A survey was distributed to all pre-licensure health </p><p>professional students from medicine, nursing, pharmacy and social work programmes </p><p>at our institution. Respondents were asked to rate their attitudes towards </p><p>interprofessional healthcare teams and interprofessional education using validated </p><p>and reliable scales reported in the literature. Information on the respondents gender, </p><p>profession, year of study and prior experience with interprofessional education was </p><p>also collected. There was no significant difference between attitudes of medicine and </p><p>nursing students towards interprofessional teamwork; however, both these student </p><p>groups report significantly less positive attitudes towards interprofessional teams than </p><p>pharmacy and social work students. Medicine students reported significantly less </p><p>positive attitudes towards interprofessional education than nursing, pharmacy and </p><p>social work students. Female students and senior undergraduate students reported </p><p>significantly more positive attitudes towards interprofessional teamwork and </p><p>interprofessional education, while students reporting prior experience with </p><p>interprofessional education reported significantly more positive attitudes towards </p><p>interprofessional teamwork. Profession, gender and year of study appear to be </p><p>attributes which were related to more positive attitudes towards both interprofessional </p><p>teamwork and education.</p></li><li><p> Interprofessional education attitudes 147</p><p> 2008 The AuthorsJournal compilation 2008 Blackwell Publishing Ltd.</p><p>Introduction</p><p>Most healthcare reform proposals advocate the</p><p>concept of the interprofessional healthcare team as</p><p>one means for containing costs, expanding services</p><p>to the underserved, and improving quality of care</p><p>(Hojat </p><p>et al</p><p>. 1997). Interprofessional approaches to</p><p>patient care are believed to have the potential for</p><p>improving professional relationships, increasing</p><p>efficiency and coordination, and ultimately enhancing</p><p>patient and health outcomes (Wee </p><p>et al</p><p>. 2001;</p><p>Reeves &amp; Freeth 2002; Cullen, Fraser &amp; Symonds</p><p>2003; Mu </p><p>et al.</p><p> 2004). Despite its merits, problems</p><p>do arise when implementing interprofessional</p><p>healthcare services. One obstacle may be the limited</p><p>awareness and understanding of the scope of practice</p><p>of other providers as well as the significance of</p><p>collaboration in enhancing the quality of healthcare</p><p>(Mu </p><p>et al</p><p>. 2004). Barriers to collaboration have also</p><p>been linked to differences in education, culture,</p><p>social status, legal jurisdiction, language or</p><p>communication style as well as professional elitism,</p><p>sex-role stereotypes, role ambiguity and incongruent</p><p>expectations between professions (Hojat </p><p>et al</p><p>.</p><p>1997).</p><p>It is believed that large numbers of healthcare</p><p>professionals lack adequate training in interprofes-</p><p>sional skill and adequate understanding of the</p><p>contributions of varied healthcare professions, and</p><p>tend to preserve traditional role concepts and</p><p>territoriality concerns (Mu </p><p>et al</p><p>. 2004). Hind </p><p>et al</p><p>.</p><p>(2003) suggest that effective interprofessional</p><p>working is largely influenced by the attitudes of</p><p>healthcare professionals towards their own and</p><p>other professional groups. Tensions arising from the</p><p>display of negative attitudes are believed to contribute</p><p>to work dissatisfaction and poor communication</p><p>between healthcare professions, with negative</p><p>implications for patient care (Ryan &amp; McKenna</p><p>1994). Carpenter (1995) found that effective working</p><p>relationships within multi-disciplinary clinical</p><p>healthcare teams were influenced by intergroup</p><p>stereotyping; with positive stereotyping enhancing</p><p>collaborative team-work.</p><p>A number of studies have examined health</p><p>professional students attitudes towards interprofes-</p><p>sional collaboration and perceptions of the roles of</p><p>other professions. Several of these have reported</p><p>that medical students and postgraduate medical</p><p>residents hold significantly less positive attitudes</p><p>towards interprofessional collaboration than students</p><p>from other professions (Hojat </p><p>et al</p><p>. 1997; Leipzig</p><p>et al</p><p>. 2002; Pollard, Miers, &amp; Gilchrist 2004; Tanaka</p><p>&amp; Yokode 2005). Pollard </p><p>et al</p><p>. (2004) also observed</p><p>that mature students, and those with experience of</p><p>higher education or of working in health or social</p><p>care settings, displayed relatively negative opinions</p><p>about interprofessional interaction.</p><p>Studies have also examined the attitudes of health</p><p>science students towards the roles and competencies</p><p>of other professions. Spence &amp; Weston (1995) found</p><p>that medical students were less clear about com-</p><p>petencies important for nursing than nursing</p><p>students were in their perceptions of competencies</p><p>important for medicine. Rudland &amp; Mires (2005)</p><p>reported that medical students perceived nurses to</p><p>be of lower academic ability, competence and status.</p><p>Tunstall-Pedoe, Rink &amp; Hilton (2003) suggest that</p><p>health science students arrive at university with</p><p>stereotypical views of each other. In their study, the</p><p>overall attitude of medical students towards students</p><p>of other disciplines was less positive. Similarly, the</p><p>allied health professional and nursing students</p><p>perceived doctors to be less caring, less dedicated,</p><p>more arrogant and not good team players or com-</p><p>municators. Hojat </p><p>et al</p><p>. (1997) observed significant</p><p>attitudinal disparities between medical and nursing</p><p>students in the areas of power and authority, including</p><p>professional dominance and medical responsibilities</p><p>in serving patients needs. Medical students reported</p><p>traditional views of physician authority and medical</p><p>responsibility in these areas.</p><p>Interprofessional teamwork has traditionally not</p><p>been a clear focus in the training and education of</p><p>health professionals, nor have student attitudes</p><p>toward it been adequately explored (Leipzig </p><p>et al</p><p>.</p><p>2002). McCahan (1986) and Fagin (1992) argue</p><p>for increased interprofessional course work in</p><p>professional education programmes to improve</p><p>understandings of different healthcare roles. Leipzig</p><p>et al</p><p>. (2002) suggest that increased emphasis must</p><p>be placed on interprofessional collaboration for</p><p>physicians in training and on the development and</p><p>refinement of educational in-service programmes</p></li><li><p> 148 V. R. Curran </p><p>et al.</p><p> 2008 The AuthorsJournal compilation 2008 Blackwell Publishing Ltd. </p><p>for practicing professionals. Students themselves</p><p>have also reported that they need interprofessional</p><p>education early in their first year of undergraduate</p><p>training, before professional prejudice has had a</p><p>chance to develop (Parsell, Spalding &amp; Bligh 1998;</p><p>Horsburgh, Lamdin &amp; Williamson 2001; Rudland &amp;</p><p>Mires 2005).</p><p>Although there is evidence to suggest that inter-</p><p>professional learning enhances interprofessional</p><p>collaboration (Atwal &amp; Caldwell 2002), there</p><p>remains debate about when is the best time to</p><p>introduce these initiatives (Horsburgh </p><p>et al</p><p>. 2001).</p><p>A number of authors suggest that interprofessional</p><p>education should be introduced early in the</p><p>undergraduate curriculum before students develop</p><p>stereotyped impressions of other professional</p><p>groups which can negatively influence attitudes</p><p>towards interprofessional collaboration (Hojat </p><p>et al</p><p>.</p><p>1997; Tunstall </p><p>et al</p><p>. 2003; Rudland &amp; Mires 2005).</p><p>However, the early introduction of interprofessional</p><p>education, designed to have an impact on negative</p><p>stereotype development, may not be beneficial if</p><p>stereotypes have already been formed. Rudland &amp;</p><p>Mires (2005) suggest that medical students enter</p><p>medical school with clear differences in their</p><p>perceptions of the characteristics and backgrounds</p><p>of nurses and doctors. According to Hojat </p><p>et al</p><p>.</p><p>(1997) there is clearly unplanned socialization and</p><p>learning of physician and nurse roles which begins</p><p>before any formal professional training.</p><p>The purpose of the study reported in this paper</p><p>was twofold: first, to examine the attitudes of health</p><p>sciences students towards interprofessional teams</p><p>and interprofessional education; and second, to</p><p>identify specific attributes of students which might</p><p>influence these attitudes.</p><p>Methodology</p><p>A survey was distributed to all pre-licensure</p><p>students from medicine, nursing, social work and</p><p>pharmacy at our institution between September</p><p>and December 2005. Follow-up was conducted</p><p>with respondents by e-mail and phone, and</p><p>non-responders were provided with an option to</p><p>complete a Web-based version of the survey. The</p><p>survey instrument included sections on respondent</p><p>characteristics (e.g. profession, gender, and year of</p><p>study), attitudes towards interprofessional healthcare</p><p>teams, and attitudes towards interprofessional</p><p>education. A 14-item Likert scale (1, strongly</p><p>disagree to 5, strongly agree) adapted from</p><p>Heinemann, Schmitt &amp; Farrell (2002) was used to</p><p>measure attitudes towards interprofessional healthcare</p><p>teams. In the original scale (Heinemann </p><p>et al</p><p>. 1999),</p><p>the authors identified three main factors namely</p><p>quality of care</p><p>, </p><p>costs of team care</p><p> and </p><p>physician</p><p>centrality</p><p>, having 14, 7 and 6 items, respectively. For</p><p>the purpose of our study, we selected 11 items from</p><p>the </p><p>quality of care</p><p> factor and 3 items from the </p><p>costs</p><p>of team care</p><p> factor. These items were selected based</p><p>on their appropriateness and relevance for</p><p>undergraduate health science students who would</p><p>have little or no experience with items relating to</p><p>physician centrality</p><p> (factor 3). The 14 items of the</p><p>attitudes towards interprofessional healthcare team</p><p>scale were subjected to a factor analysis using </p><p>spss</p><p>version 14.0. Before performing this analysis, the</p><p>suitability of data was assessed. The correlation</p><p>matrix revealed numerous coefficients of 0.3 and</p><p>greater which supported its factorability. Maximum-</p><p>likelihood analysis with oblique rotation was then</p><p>conducted to determine the make-up of these</p><p>factors. Any item with a factor loading of 0.4 or</p><p>greater was considered to contribute to that factor.</p><p>Measures of internal consistency (Cronbachs alpha)</p><p>were then determined for the responses to the items</p><p>making up each factor.</p><p>A 15-item Likert scale adapted from Parsell &amp; Bligh</p><p>(1999) (1, strongly disagree to 5, strongly agree) was</p><p>additionally used to assess attitudes towards inter-</p><p>professional education. In their original scale, the</p><p>authors Parsell &amp; Bligh (1999) identified three main</p><p>factors namely </p><p>team-work and collaboration</p><p>,</p><p>professional identity</p><p> and </p><p>roles and responsibilities</p><p>,</p><p>having 9, 7 and 3 items, respectively. For the purpose</p><p>of our study, we selected all nine items from the</p><p>team-work and collaboration</p><p> factor, and six items</p><p>from the </p><p>professional identity</p><p> factor. Once again,</p><p>these items were selected for their appropriateness for</p><p>undergraduate health science students. The 15 items</p><p>from the attitudes towards interprofessional educa-</p><p>tion scale were then subjected to a factor analysis</p><p>using the same procedure as previously described.</p></li><li><p> Interprofessional education attitudes 149</p><p> 2008 The AuthorsJournal compilation 2008 Blackwell Publishing Ltd.</p><p>Ethics approval was received from the Human</p><p>Investigations Committee (HIC) of Memorial</p><p>University of Newfoundland.</p><p>Results</p><p>Overall, 1179 respondents of a possible 1359 completed</p><p>the survey for a total response rate of 86.8%. Table 1</p><p>summarizes the response rate for each programme.</p><p>Table 2 summarizes the characteristics of survey</p><p>respondents. The majority of respondents (85%) were</p><p>female and age ranged from 18 to 54 years with a median</p><p>age of 22 years. Approximately 46.7% of respondents</p><p>reported one or more prior experiences with a large</p><p>majority of medicine students (72.8%) reporting</p><p>prior experience with interprofessional education.</p><p>Attitudes towards interprofessional healthcare teams</p><p>The factor analysis revealed the presence of two</p><p>components with eigenvalues exceeding 1, explaining</p><p>34.1% and 9.8% of the variance, respectively.</p><p>Examination of the scree plot confirmed this as it</p><p>showed a clear break after the second component.</p><p>Based on the results of this factor analysis, two main</p><p>factors were extracted, namely </p><p>quality of care</p><p> (factor</p><p>1) and </p><p>time constraints</p><p> (factor 2). Combined, these</p><p>two factors contained 14 items and had an internal</p><p>consistency measure of 0.83. The internal consistency</p><p>measures for each of the two factors are displayed in</p><p>Table 3 along with the factor loadings for each item.</p><p>Factor 1, quality of care</p><p>A total of 11 items comprised this factor, with the</p><p>strongest item being the interprofessional approach</p><p>improves the quality of care to patients/clients</p><p>which had a factor loading of 0.68. This was</p><p>followed closely by five items all with factor loadings</p><p>of 0.60 or higher.</p><p>Factor 2, time constraints</p><p>The second factor was comprised of only three</p><p>items, with all three having high factor loadings. The</p><p>most dominant statement was working in an</p><p>interprofessional manner unnecessarily complicates</p><p>things most of the time (0.65), followed by in most</p><p>instances, the time required for interprofessional</p><p>consultations could be better spent in other ways</p><p>(0.59) and developing an interprofessional patient/</p><p>client care plan is excessively time-consuming</p><p>(0.42).</p><p>The two factors resulting from the analysis in our</p><p>study were almost identical to the factors established</p><p>by the authors of the original scale (Heinemann</p><p>et al</p><p>. 1999). Only two items from our findings</p><p>appeared in different factors as compared to the</p><p>original scale. The first item in most instances, the</p><p>time required for interprofessional consultations</p><p>could be better spent in other ways was included</p><p>with the </p><p>quality of care</p><p> factor in the original scale;</p><p>however, in our analysis it loaded more heavily on</p><p>our second factor (</p><p>time constraints</p><p>). Further con-</p><p>sideration of this item did merit its placement with</p><p>the second factor as it...</p></li></ul>