attitudes of health sciences students towards interprofessional teamwork and education

© 2008 The AuthorsJournal compilation © 2008 Blackwell Publishing Ltd.

Learning in Health and Social Care

,

7

, 3, 146–156

Original article

Blackwell Publishing Ltd

Attitudes of health sciences students towards interprofessional teamwork and education

Vernon R.

Curran

PhD

,

1

*

Dennis

Sharpe

PhD

,

2

Jennifer

Forristall

MASP

3

&

Kate

Flynn

MASP

4

1

Director, Academic Research and Development, Associate Professor of Medical Education, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada A1C 5S7

2

Professor of Post-Secondary Education, Co-Director, Centre for Collaborative Health Professional Education, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada A1C 5S7

3

Program and Policy Development Specialist, Department of Human Resources, Labour and Employment, Government of Newfoundland and Labrador, Canada A1B 4J6

4

Research Coordinator, Centre for Collaborative Health Professional Education, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada A1C 5S7

Keywords

attitudes, health

occupations,

interprofessional

education,

interprofessional

relations, students

*Corresponding author. Tel.: 709-777-7542; fax: 709-777-6576; e-mail: [email protected]

Abstract

Relatively little is known about the specific attributes of health professional students

which may influence their attitudes towards both interprofessional teamwork and

interprofessional education. A survey was distributed to all pre-licensure health

professional students from medicine, nursing, pharmacy and social work programmes

at our institution. Respondents were asked to rate their attitudes towards

interprofessional healthcare teams and interprofessional education using validated

and reliable scales reported in the literature. Information on the respondents’ gender,

profession, year of study and prior experience with interprofessional education was

also collected. There was no significant difference between attitudes of medicine and

nursing students towards interprofessional teamwork; however, both these student

groups report significantly less positive attitudes towards interprofessional teams than

pharmacy and social work students. Medicine students reported significantly less

positive attitudes towards interprofessional education than nursing, pharmacy and

social work students. Female students and senior undergraduate students reported

significantly more positive attitudes towards interprofessional teamwork and

interprofessional education, while students reporting prior experience with

interprofessional education reported significantly more positive attitudes towards

interprofessional teamwork. Profession, gender and year of study appear to be

attributes which were related to more positive attitudes towards both interprofessional

teamwork and education.

Interprofessional education attitudes 147


Introduction

Most healthcare reform proposals advocate the

concept of the interprofessional ‘healthcare team’ as

one means for containing costs, expanding services

to the underserved, and improving quality of care

(Hojat

et al

. 1997). Interprofessional approaches to

patient care are believed to have the potential for

improving professional relationships, increasing

efficiency and coordination, and ultimately enhancing

patient and health outcomes (Wee

et al

. 2001;

Reeves & Freeth 2002; Cullen, Fraser & Symonds

2003; Mu

et al.

2004). Despite its merits, problems

do arise when implementing interprofessional

healthcare services. One obstacle may be the limited

awareness and understanding of the scope of practice

of other providers as well as the significance of

collaboration in enhancing the quality of healthcare

(Mu

et al

. 2004). Barriers to collaboration have also

been linked to differences in education, culture,

social status, legal jurisdiction, language or

communication style as well as professional elitism,

sex-role stereotypes, role ambiguity and incongruent

expectations between professions (Hojat

et al

.

1997).

It is believed that large numbers of healthcare

professionals lack adequate training in interprofes-

sional skill and adequate understanding of the

contributions of varied healthcare professions, and

tend to preserve traditional role concepts and

territoriality concerns (Mu

et al

. 2004). Hind

et al

.

(2003) suggest that effective interprofessional

working is largely influenced by the attitudes of

healthcare professionals towards their own and

other professional groups. Tensions arising from the

display of negative attitudes are believed to contribute

to work dissatisfaction and poor communication

between healthcare professions, with negative

implications for patient care (Ryan & McKenna

1994). Carpenter (1995) found that effective working

relationships within multi-disciplinary clinical

healthcare teams were influenced by intergroup

stereotyping; with positive stereotyping enhancing

collaborative team-work.

A number of studies have examined health

professional students’ attitudes towards interprofes-

sional collaboration and perceptions of the roles of

other professions. Several of these have reported

that medical students and postgraduate medical

residents hold significantly less positive attitudes

towards interprofessional collaboration than students

from other professions (Hojat

et al

. 1997; Leipzig

et al

. 2002; Pollard, Miers, & Gilchrist 2004; Tanaka

& Yokode 2005). Pollard

et al

. (2004) also observed

that mature students, and those with experience of

higher education or of working in health or social

care settings, displayed relatively negative opinions

about interprofessional interaction.

Studies have also examined the attitudes of health

science students towards the roles and competencies

of other professions. Spence & Weston (1995) found

that medical students were less clear about com-

petencies important for nursing than nursing

students were in their perceptions of competencies

important for medicine. Rudland & Mires (2005)

reported that medical students perceived nurses to

be of lower academic ability, competence and status.

Tunstall-Pedoe, Rink & Hilton (2003) suggest that

health science students arrive at university with

stereotypical views of each other. In their study, the

overall attitude of medical students towards students

of other disciplines was less positive. Similarly, the

allied health professional and nursing students

perceived doctors to be less caring, less dedicated,

more arrogant and not good team players or com-

municators. Hojat

et al

. (1997) observed significant

attitudinal disparities between medical and nursing

students in the areas of power and authority, including

professional dominance and medical responsibilities

in serving patients’ needs. Medical students reported

traditional views of physician authority and medical

responsibility in these areas.

Interprofessional teamwork has traditionally not

been a clear focus in the training and education of

health professionals, nor have student attitudes

toward it been adequately explored (Leipzig

et al

.

2002). McCahan (1986) and Fagin (1992) argue

for increased interprofessional course work in

professional education programmes to improve

understandings of different healthcare roles. Leipzig

et al

. (2002) suggest that increased emphasis must

be placed on interprofessional collaboration for

physicians in training and on the development and

refinement of educational in-service programmes

148 V. R. Curran

et al.


for practicing professionals. Students themselves

have also reported that they need interprofessional

education early in their first year of undergraduate

training, before professional prejudice has had a

chance to develop (Parsell, Spalding & Bligh 1998;

Horsburgh, Lamdin & Williamson 2001; Rudland &

Mires 2005).

Although there is evidence to suggest that inter-

professional learning enhances interprofessional

collaboration (Atwal & Caldwell 2002), there

remains debate about when is the best time to

introduce these initiatives (Horsburgh

et al

. 2001).

A number of authors suggest that interprofessional

education should be introduced early in the

undergraduate curriculum before students develop

stereotyped impressions of other professional

groups which can negatively influence attitudes

towards interprofessional collaboration (Hojat

et al

.

1997; Tunstall

et al

. 2003; Rudland & Mires 2005).

However, the early introduction of interprofessional

education, designed to have an impact on negative

stereotype development, may not be beneficial if

stereotypes have already been formed. Rudland &

Mires (2005) suggest that medical students enter

medical school with clear differences in their

perceptions of the characteristics and backgrounds

of nurses and doctors. According to Hojat

et al

.

(1997) there is clearly ‘unplanned’ socialization and

learning of physician and nurse roles which begins

before any formal professional training.

The purpose of the study reported in this paper

was twofold: first, to examine the attitudes of health

sciences students towards interprofessional teams

and interprofessional education; and second, to

identify specific attributes of students which might

influence these attitudes.

Methodology

A survey was distributed to all pre-licensure

students from medicine, nursing, social work and

pharmacy at our institution between September

and December 2005. Follow-up was conducted

with respondents by e-mail and phone, and

non-responders were provided with an option to

complete a Web-based version of the survey. The

survey instrument included sections on respondent

characteristics (e.g. profession, gender, and year of

study), attitudes towards interprofessional healthcare

teams, and attitudes towards interprofessional

education. A 14-item Likert scale (1, strongly

disagree to 5, strongly agree) adapted from

Heinemann, Schmitt & Farrell (2002) was used to

measure attitudes towards interprofessional healthcare

teams. In the original scale (Heinemann

et al

. 1999),

the authors identified three main factors namely

quality of care

,

costs of team care

and

physician

centrality

, having 14, 7 and 6 items, respectively. For

the purpose of our study, we selected 11 items from

the

quality of care

factor and 3 items from the

costs

of team care

factor. These items were selected based

on their appropriateness and relevance for

undergraduate health science students who would

have little or no experience with items relating to

physician centrality

(factor 3). The 14 items of the

attitudes towards interprofessional healthcare team

scale were subjected to a factor analysis using

spss

version 14.0. Before performing this analysis, the

suitability of data was assessed. The correlation

matrix revealed numerous coefficients of 0.3 and

greater which supported its factorability. Maximum-

likelihood analysis with oblique rotation was then

conducted to determine the make-up of these

factors. Any item with a factor loading of 0.4 or

greater was considered to contribute to that factor.

Measures of internal consistency (Cronbach’s alpha)

were then determined for the responses to the items

making up each factor.

A 15-item Likert scale adapted from Parsell & Bligh

(1999) (1, strongly disagree to 5, strongly agree) was

additionally used to assess attitudes towards inter-

professional education. In their original scale, the

authors Parsell & Bligh (1999) identified three main

factors namely

team-work and collaboration

,

professional identity

and

roles and responsibilities

,

having 9, 7 and 3 items, respectively. For the purpose

of our study, we selected all nine items from the

team-work and collaboration

factor, and six items

from the

professional identity

factor. Once again,

these items were selected for their appropriateness for

undergraduate health science students. The 15 items

from the attitudes towards interprofessional educa-

tion scale were then subjected to a factor analysis

using the same procedure as previously described.



Ethics approval was received from the Human

Investigations Committee (HIC) of Memorial

University of Newfoundland.

Results

Overall, 1179 respondents of a possible 1359 completed

the survey for a total response rate of 86.8%. Table 1

summarizes the response rate for each programme.

Table 2 summarizes the characteristics of survey

respondents. The majority of respondents (85%) were

female and age ranged from 18 to 54 years with a median

age of 22 years. Approximately 46.7% of respondents

reported one or more prior experiences with a large

majority of medicine students (72.8%) reporting

prior experience with interprofessional education.

Attitudes towards interprofessional healthcare teams

The factor analysis revealed the presence of two

components with eigenvalues exceeding 1, explaining

34.1% and 9.8% of the variance, respectively.

Examination of the scree plot confirmed this as it

showed a clear break after the second component.

Based on the results of this factor analysis, two main

factors were extracted, namely

quality of care

(factor

1) and

time constraints

(factor 2). Combined, these

two factors contained 14 items and had an internal

consistency measure of 0.83. The internal consistency

measures for each of the two factors are displayed in

Table 3 along with the factor loadings for each item.

Factor 1, quality of care

A total of 11 items comprised this factor, with the

strongest item being ‘the interprofessional approach

improves the quality of care to patients/clients’

which had a factor loading of 0.68. This was

followed closely by five items all with factor loadings

of 0.60 or higher.

Factor 2, time constraints

The second factor was comprised of only three

items, with all three having high factor loadings. The

most dominant statement was ‘working in an

interprofessional manner unnecessarily complicates

things most of the time’ (0.65), followed by ‘in most

instances, the time required for interprofessional

consultations could be better spent in other ways’

(0.59) and ‘developing an interprofessional patient/

client care plan is excessively time-consuming’

(0.42).

The two factors resulting from the analysis in our

study were almost identical to the factors established

by the authors of the original scale (Heinemann

et al

. 1999). Only two items from our findings

appeared in different factors as compared to the

original scale. The first item ‘in most instances, the

time required for interprofessional consultations

could be better spent in other ways’ was included

with the

quality of care

factor in the original scale;

however, in our analysis it loaded more heavily on

our second factor (

time constraints

). Further con-

sideration of this item did merit its placement with

the second factor as it and the other two items relate

to the time required to complete certain tasks. It

should also be noted that all three items are

negatively worded. The second item ‘the interpro-

fessional approach makes the delivery of care more

efficient’ appeared in the

costs of team care

factor in

the original scale; however, in our analysis it loaded

more heavily on the first factor (

quality of care

).

Table 1 Response rates

Response rates

Medicine Nursing Pharmacy Social Work Total

Number of respondents n = 195 n = 762 n = 113 n = 109 n = 1179Response rate 81.6% 87.3% 94.7% 83.2% 86.8%

150 V. R. Curran

et al.


Upon consideration, placement of this item with the

first factor was merited as it addresses the delivery

and quality of care.

Table 4 summarizes overall mean ratings across

academic units on both factors (

quality of care

and

time constraints

) for the overall attitudes towards

interprofessional healthcare teams scale. For factor 1

(

quality of care

), the overall mean scores for social

work and pharmacy respondents were the highest at

4.06 and 4.05, respectively, followed by nursing

(3.93) and medicine (3.86). A one way analysis of

variance (

anova

) was conducted to explore the

effect of profession on

quality of care

. The analysis

revealed a significant difference between the overall

scores of respondents from different professional

programmes (

F

3,1172

= 7.79,

P

= 0.000). Post-hoc

comparisons using the Scheffe test indicated that the

overall mean score for medicine respondents

(M = 3.86, SD = 0.462) was significantly lower from

that of pharmacy respondents (M = 4.05, SD = 0.358)

and social work respondents (M = 4.06, SD = 0.437).

The overall mean score for nursing respondents

(M = 3.93, SD = 0.442) was also significantly lower

from that of pharmacy and social work respondents.

Table 2 Respondent characteristics

Gender


n Percentage n Percentage n Percentage n Percentage n Percentage

Female 113 57.9 702 92.4 82 73.2 99 91.7 996 84.8

Male 82 42.1 58 7.6 30 26.8 9 8.3 179 15.2

Age


Age range 21–45 18–46 19–53 20–54 18–54

Median age 25 21 22 22 22

Year of study

Medicine Nursing Pharmacy Social work Total


1 55 28.2 232 30.4 40 35.4 39 35.8 366 31.0

2 47 24.1 213 28.0 36 31.9 38 34.9 334 28.3

3 49 25.1 181 23.8 37 32.7 32 29.4 299 25.4

4 44 22.6 136 17.8 0 0.0 0 0.0 180 15.3

Prior experience with interprofessional education

Medicine Nursing Pharmacy Social work Total


One or more

Experiences

142 72.8 322 42.3 38 33.6 48 44.0 550 46.7

None 53 27.2 439 57.7 75 66.4 61 56.0 628 53.3



Despite the significant differences, the magnitude of

the differences in the means was quite small (eta

squared = 0.02).

An

anova

using factor 2 (

time constraints

)

revealed similar results with a significant difference

between the overall scores of respondents from the

different professional programmes (

F

3,1172

= 3.95,

P

= 0.008). Despite the significant difference, the

magnitude of the differences in the means was

extremely small (eta squared = 0.01) and a post-hoc

comparison using the Scheffe test revealed no signi-

ficant differences between the individual professions.

Table 3 Factor loadings for the items contributing to the two principal factors of the adapted attitudes towards interprofessional

healthcare teams scale

Statement

Factor 1:

quality of care

(α = 0.82)

Factor 2:

time constraints

(α = 0.56)

The interprofessional approach improves the quality of care to patients/clients 0.68 –0.39

The interprofessional approach permits health professionals to meet the needs of family

caregivers as well as patients

0.64

Having to report observations to a team helps team members better understand the work of

other health professionals

0.63

The interprofessional approach makes the delivery of care more efficient 0.61 –0.38

Hospital patients who receive interprofessional team care are better prepared for discharge

than other patients

0.61

Team meetings foster communication among team members from different professions

or disciplines

0.60 –0.36

The give and take among team members helps them make better patient/client care decisions 0.54

Patients/clients receiving interprofessional care are more likely than others to be treated

as whole persons

0.52

Health professionals working as teams are more responsive than others to the emotional

and financial needs of patients/clients

0.51

Working in an interprofessional environment keeps most health professionals enthusiastic

and interested in their jobs

0.51

Developing a patient/client care plan with other team members avoids errors in delivering care 0.49

Working in an interprofessional manner unnecessarily complicates things most of the time –0.36 0.65

In most instances, the time required for interprofessional consultations could be better spent

in other ways

–0.43 0.59

Developing an interprofessional patient/client care plan is excessively time-consuming 0.42

Table 4 Student attitudes towards interprofessional healthcare teams

Mean scores

Medicine Nursing Pharmacy Social work Overall

n Mean SD n Mean SD n Mean SD n Mean SD F P

Factor 1 – quality of care 192 3.86 0.462 762 3.93 0.442 113 4.05 0.358 109 4.06 0.437 7.80 0.000

Factor 2 – time constraints 192 3.55 0.618 762 3.56 0.579 113 3.71 0.487 109 3.70 0.490 3.95 0.008

152 V. R. Curran

et al.


A two-way between-group

anova

was conducted

to explore the effect of gender and prior experience

with attitudes towards interprofessional healthcare

teams for both factors. For factor 1 (

quality of care

),

the results indicated a main effect of gender

(

F

1,1168

= 12.686,

P

= 0.000), with female respond-

ents reporting higher mean scores (M = 3.96,

SD = 0.446) than male respondents (M = 3.83,

SD = 0.398). The magnitude of this difference was

quite small as eta squared = 0.01. There was also a

main effect of prior experience (

F1,1168 = 8.881,

P = 0.003) with respondents reporting one or more

experiences with interprofessional education

reporting significantly higher mean scores (M = 4.00,

SD = 0.461) than respondents reporting no prior

experience (M = 3.89, SD = 0.417). Once again,

the magnitude of this difference was very small

(eta squared = 0.01) and the interaction effect

(F1,1168 = 0.012, P = 0.913) did not reach signifi-

cance. For factor 2 (time constraints), the results

showed only a significant main effect of gender

(F1,1168 = 10.395, P = 0.001), with female respondents

once again reporting higher mean scores (M = 3.61,

SD = 0.564) than their male counterparts (M = 3.45,

SD = 0.596). Despite this significant difference, the

extent of the difference was rather small (eta

squared = 0.01). Neither the main effect of gender,

nor the gender/experience interaction reached

significance.

A one-way between group anova was conducted

to explore the effect of year of study on the two

different factors. For this analysis, students in their

first and second year of study were categorized as

junior students, while third and fourth year students

were categorized as senior students. For factor 1

(quality of care), senior students reported signifi-

cantly higher mean scores (M = 4.01, SD = 0.446)

than junior students (M = 3.89, SD = 0.432)

(F1,1174 = 19.89, P = 0.000). Eta squared was found to

equal .02, showing the size of the significant differ-

ence was fairly small. For factor 2 (time constraints),

senior students (M = 3.63, SD = 0.586) once again

reported significantly higher mean scores

(F1,1174 = 5.64, P = 0.018) than their junior counter-

parts (M = 3.55, SD = 0.560), however, the magnitude

of the difference was virtually-non-existent (eta

squared = 0.00).

Among medicine respondents, results of a one-

way anova exploring the effect of gender on factor

1 (quality of care) revealed that female medicine

respondents (M = 3.94, SD = 0.488) reported

significantly higher mean responses than male

medicine respondents (M = 3.75, SD = 0.397)

(F1,190 = 8.92, P = 0.003). The extent of this differ-

ence was moderate (eta squared = 0.04). On factor 2

(time constraints), females (M = 3.64, SD = 0.595)

once again had significantly higher mean scores

(F1,190 = 6.81, P = 0.010) than their male counter-

parts (M = 3.41, SD = 0.628), with a somewhat

moderate effect (eta squared = 0.03). Medicine

respondents with prior experience (M = 3.97,

SD = 0.453) also reported significantly higher mean

scores than those without this experience (M = 3.58,

SD = 0.360) on factor 1 (F1,190 = 30.65, P = 0.000),

with a large effect (eta squared = 0.14). There were

no significant difference between the mean scores of

those with experience (M = 3.56, SD = 0.653) and

those without (M = 3.50, SD = 0.517) on factor 2.

Attitudes towards interprofessional education

The factor analysis of the attitudes towards

interprofessional education scale revealed the

presence of three components with eigenvalues

exceeding 1, explaining 44.1%, 7.5% and 6.9% of

the variance, respectively. Examination of the scree

plot did not confirm this as it showed a clear break

after the first component. Additionally, the factor

correlation matrix showed very high correlations

between factor 1 and 2 (0.526) and between factor 1

and 3 (0.778) suggesting that all three factors were

measuring the same general concept. Based on these

results we forced the 15 items into a one factor

solution; however, one of the items ‘Clinical

problem-solving can only be learned effectively

when students are taught within their individual

department/school’ did not load at all on the factor

and was very poorly correlated with the other 14

items. In addition, when this item was removed

from the scale, measures of internal consistency

increased from 0.89 to 0.91. Therefore, it was

decided that this item would be removed from the

scale, leaving 14 items in total. The factor loadings

for each item are displayed in Table 5.



Table 6 summarizes overall mean ratings across

academic units on attitudes towards interprofes-

sional education. An analysis of responses to this

scale revealed high internal consistency with a

Cronbach’s alpha of 0.91. The mean scores for social

work and pharmacy respondents were the highest at

4.18 and 4.07, respectively, followed by nursing

(4.03) and medicine (3.70). A one-way between-

group anova was conducted to explore the effect of

profession on attitudes towards interprofessional

education. The analysis revealed a significant

difference between the overall mean scores of the

different professions (F3,1169 = 33.332, P = 0.000).

The extent of this difference was moderate (eta

squared = 0.08). Post-hoc comparisons using the

Scheffe test indicated that the overall mean score

for medicine respondents (M = 3.70, SD = 0.592)

was significantly lower from that of nursing students

(M = 4.03, SD = 0.456), pharmacy students (M = 4.07,

SD = 0.396) and social work respondents (M = 4.18,

SD = 0.418). These comparisons also revealed that

the overall mean score for nursing respondents

was significantly lower from that of social work

respondents.

A two-way between-groups anova was conducted

to assess the effect of gender and prior experience

with interprofessional education on attitudes

towards interprofessional education. There was a

Table 5 Factor loadings for the items contributing to the main factor of the adapted attitudes towards interprofessional education

scale

Statement (α = 0.91)

Interprofessional learning among health professional students will help them to communicate better with patients

and other professionals

0.78

Interprofessional learning among healthcare students will increase their ability to understand clinical problems 0.78

Learning between healthcare students before qualification would improve working relationships after qualification 0.76

Learning with students in other health professional schools helps undergraduates to become more effective

members of a healthcare team

0.75

Students in my professional group would benefit from working on small group projects with other healthcare students 0.70

Interprofessional learning will help to clarify the nature of patient problems for students 0.68

Interprofessional learning before qualification will help health professional students to become better team-workers 0.66

Patients would ultimately benefit if healthcare students worked together to solve patient problems 0.66

Interprofessional learning will help students think positively about other healthcare professionals 0.66

Interprofessional learning will help students to understand their own professional limitations 0.62

Communication skills should be learned with integrated classes of healthcare students 0.59

It is not necessary for undergraduate healthcare students to learn together –0.54

For small-group learning to work, students need to trust and respect each other 0.47

Team-working skills are essential for all healthcare students to learn 0.45

Table 6 Student attitudes towards interprofessional education

Mean scores

Medicine Nursing Pharmacy Social work Overall

n Mean SD n Mean SD n Mean SD n Mean SD F P

Total scale 191 3.70 0.592 762 4.03 0.456 112 4.07 0.396 108 4.18 0.418 3.99 0.491

154 V. R. Curran et al.


significant main effect of gender (F1,1165 = 39.730,

P = 0.000), with female respondents (M = 4.03,

SD = 0.470) reporting significantly higher mean

scores than male respondents (M = 3.79,

SD = 0.561). The magnitude of this difference was

fairly small as eta squared = 0.03. There was a

significant main effect of prior experience with

interprofessional education (F1,1165 = 12.968, P = 0.00)

with respondents reporting no prior interprofes-

sional education (M = 4.01, SD = 0.426) having

significantly higher mean scores than those with

prior experience (M = 3.96, SD = 0.556). The

magnitude of this difference was quite small as eta

squared = 0.01. There was also a significant

interaction between gender and prior experience

with interprofessional education (F1,1165 = 9.776,

P = 0.002) with female respondents reporting no

prior experience with interprofessional education

reporting the highest mean scores. Once again,

the magnitude of this difference was small (eta

squared = 0.01).

Among medicine students, results of a one-way

anova exploring the effect of gender on attitudes

towards interprofessional education revealed that

female medicine respondents (M = 3.81, SD = 0.518)

reported significantly higher mean responses than

male medicine respondents (M = 3.53, SD = 0.653)

(F1,189 = 10.893, P = 0.001). The magnitude of this

difference was moderate (eta squared = 0.05). A

similar analysis was used to explore the effect of

prior experience with interprofessional education

on attitudes towards interprofessional education;

however, no significant difference was found between

respondents reporting prior experience (M = 3.69,

SD = 0.644) with interprofessional education and

those who reported no prior experience (M = 3.71,

SD = 0.430) (F1,189 = 0.013, P = 0.910).

Discussion

The findings from the study reported here suggest

that health science students across professions tend

to generally report positive attitudes towards the

concept of interprofessional healthcare teamwork as

indicated by above average scores on the measures

used. Medicine and nursing students did report

significantly less positive attitudes towards

interprofessional healthcare teams than pharmacy

and social work students; however, no significant

difference was found between the attitudes of medicine

and nursing students towards interprofessional

teamwork. Gender and prior experience with

interprofessional education appeared to be

significant attributes related to overall health science

student attitudes towards interprofessional teamwork.

Female students and students reporting prior

experience with interprofessional education across

professions reported more positive attitudes towards

interprofessional teamwork. The magnitude of both

gender and prior experience effects was more

evident for medical students where females reported

more positive attitudes towards interprofessional

teamwork than male students, and medicine students

having prior experience with interprofessional

education reported more positive attitudes towards

interprofessional healthcare teams than those with

no such experience.

Several studies have observed that health science

students tend to report generally positive attitudes

towards interprofessional education (Tunstall-

Pedoe et al. 2003; Pollard et al. 2004). The findings

from this study appear to support these findings as

well. Health science students across professions

tended to report positive attitudes towards inter-

professional education; however, medicine students

reported significantly less positive attitudes towards

interprofessional education than nursing, pharmacy

and social work students. Gender also appeared to

be a significant attribute related to overall health

science student attitudes towards interprofessional

education. Female students across professions reported

more positive attitudes towards interprofessional

education. Within medicine, female medicine students

reported more positive attitudes towards interpro-

fessional education than male students.

The results also indicate that although experience

with interprofessional education appears to be

related to attitudes towards interprofessional

teamwork, it does not appear to be related to more

positive attitudes towards interprofessional education

itself. In other words, although previous participa-

tion in interprofessional education activities may

not enhance attitudes towards it, the findings from

our study do suggest that such participation is



associated with more positive attitudes towards

interprofessional teamwork.

Pollard et al. (2004) report that mature students,

and those with experience of higher education

display relatively negative opinions about inter-

professional interaction. Tanaka & Yokode (2005)

found that residents expressed significantly less

positive attitudes towards the quality of care

provided by interdisciplinary teams than medical

students. They attribute this finding to the fact that

clinical experience may strengthen beliefs in

physician centrality. The findings from our study

indicate that senior undergraduate students across

professions reported significantly more positive

attitudes towards interprofessional healthcare teams

than junior students. Senior students were more

likely to have reported more experience with

interprofessional education, yet year of study was a

more significant indicator of attitudes towards

interprofessional healthcare teams.

The survey results summarize the self-reported

attitudes of student respondents towards inter-

professional teams and interprofessional education

enrolled in health professional education programmes

at our institution. As such, the results need to be

interpreted within that context. The institution is a

comprehensive university located in eastern Canada

and interprofessional education was first introduced

on a formal level beginning in 1999. Several inter-

professional education modules for health sciences

students have been introduced across the curricula

of each academic unit since that time. These

modules have been based upon interprofessional

small group case-based learning. The main goals for

the modules were to increase awareness and

understanding of other professions, promote the

value of interprofessional collaboration, and enhance

understanding of the process of interprofessional

teamwork. At the time of the survey, a major

initiative to expand and promote interprofessional

education curricula across the health sciences

programmes was underway at the institution with

support from the federal government. This survey

study preceded the introduction of any new curricula

associated with that initiative and the results are

serving as baseline data in support of the evaluation

of that initiative.

The findings from the study indicate that significant

differences in the attitudes of health sciences

students from different professions continue to

persist. This raises important questions regarding

the factors influencing these attitudes. Are societal

attitudes towards the health professions responsible

for influencing the attitudes of health professional

students before they even enter health professional

education programmes? What are the implications

of admitting students to the health professions with

incorrect stereotypes or unsupportive attitudes

towards other professions when societal expectations

favour greater collaboration across professions?

Rudland & Mires (2005) have suggested that

attributes not associated with academic ability are

important in selecting appropriate future doctors

and that the assessment of attitudes conducive to

interprofessional collaboration should form part of

this admission assessment. What is important is that

health professional students are exposed to positive

role modelling during their education which

values interprofessional collaboration. Exposure and

immersion in experiences and practice placements

which promote such vales are also important. Inter-

professional collaboration is touted as a significant

strategy for reforming and renewing health systems,

and as such, it is important that students are pro-

vided with the opportunity to develop competencies

which will enable them to be contributing members

of these teams.

Acknowledgements

This study was funded by Health Canada through the

Interprofessional Education for Collaborative Patient-

Centred Practice (IECPCP) initiative.

References

Atwal A. & Caldwell K. (2002) Do multidisciplinary

integrated care pathways improve interprofessional

collaboration? Scandinavian Journal of Caring Sciences

16, 360–367.

Carpenter J. (1995) Doctors and nurses: stereotypes and

stereotype change in interprofessional education.

Journal of Interprofessional Care 9, 151–161.

Cullen L., Fraser D. & Symonds I. (2003) Strategies for

156 V. R. Curran et al.


interprofessional education: the interprofessional team

objective structured clinical examination for midwifery

and medical students. Nurse Education Today 23,

427–433.

Fagin C. (1992) Collaboration between nurses and

physicians: no longer a choice. Nursing and Health Care

13, 354–363.

Heinemann G.D., Schmitt M.H. & Farrell M.P. (2002)

Attitudes toward health care teams. In: Team

Performance in Health Care: Assessment and

Development (eds G.D. Heinemann & A.M. Zeiss),

pp. 155–159. Kluwer Academic/Plenum Publishers,

New York.

Heinemann G.D., Schmitt M.H., Farrell M.P. & Brallier

S.A. (1999) Development of an attitudes toward health

care teams scale. Evaluation and the Health Professions

22, 123–142.

Hind M., Norman I., Cooper S., Gill E., Hilton R., Judd P.

& Jones S. (2003) Interprofessional perception of health

care students. Journal of Interprofessional Care 17,

21–34.

Hojat M., Fields S., Rattner S., Griffiths M., Cohen M. &

Plumb J. (1997) Student attitudes in evaluating courses,

faculty, and peers. Academic Medicine 72, S1–S3.

Horsburgh M., Lamdin R. & Williamson E. (2001)

Multiprofessional learning: the attitudes of medical,

nursing and pharmacy students to shared learning.

Medical Education 35, 876–883.

Leipzig R., Hyer K., Ek K. et al. (2002) Attitudes toward

working on interdisciplinary healthcare teams:

a comparison by discipline. Journal of the American

Geriatrics Society 50, 1141–1148.

McCahan J. (1986) Education in medicine. In: Issues in

Collaborative Practice (ed. J. Steel), pp. 129–138. Grune

& Stratton, Orlando, FL.

Mu K., Chao C., Jensen G. & Royeen C. (2004) Effects of

interprofessional rural training on students’

perceptions of interprofessional health care services.

Journal of Allied Health 33, 125–131.

Parsell G. & Bligh J. (1999) The development of a

questionnaire to assess the readiness of health care

students for interprofessional learning (RIPLS).

Medical Education 33, 95–100.

Parsell G., Spalding R. & Bligh J. (1998) Shared goals,

shared learning: evaluation of a multiprofessional

course for undergraduate students. Medical Education

32, 304–311.

Pollard K., Miers M. & Gilchrist M. (2004) Collaborative

learning for collaborative working? Initial findings

from a longitudinal study of health and social care

students. Health and Social Care in the Community 12,

346–358.

Reeves S. & Freeth D. (2002) The London training ward:

an innovative interprofessional learning initiative.


Rudland J. & Mires G. (2005) Characteristics of doctors

and nurses as perceived by students entering medical

school: Implications for shared teaching. Medical

Education 39, 448–455.

Ryan A. & McKenna H. (1994) A comparative study of the

attitudes of nursing and medical students to aspects of

patient care and the nurse’s role in organizing that care.

Journal of Advanced Nursing 19, 114–123.

Spence Laschinger H. & Weston W. (1995) Role

perceptions of freshman and senior nursing and

medical students and attitudes toward collaborative

decision making. Journal of Professional Nursing 11,

119–128.

Tanaka M. & Yokode M. (2005) Attitudes of medical

students and residents toward multidisciplinary team

approach. Medical Education 39, 1255–1256.

Tunstall-Pedoe S., Rink E. & Hilton S. (2003) Student

attitudes to undergraduate interprofessional education.


Wee B., Hillier R., Coles C., Mountford B., Sheldon F. &

Turner P. (2001) Palliative care: a suitable setting for

undergraduate interprofessional education. Palliative

Medicine 15, 487–492.

attitudes of health sciences students towards interprofessional teamwork and education

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