A single learning activity for large interprofessional group can boost the perception of value of interprofessional education
10.13135/1971-8551/5253
Introduction. The interprofessional education activity consisted in a single 4 hours meeting and it was built on three theoretical pillars: the framework of Core Competencies for Interprofessional Collaborative Practice (IPEC), Kolb’s model of experiential learning, and Vygotsky’s concept of social learning. The objectives of the activity were to enable students to identify the elements of IPEC framework in a healthcare situation and to show awareness of the value of interprofessional collaborative practice.
Materials and methods. The meeting was composed by different phases: introduction and sharing of objectives and methods, followed by two cycles of short lecture, small group activity and large group discussion. At the beginning and at the end of the meeting, a questionnaire with items exploring students’ attitude on interprofessional collaboration was administered. A questionnaire of satisfaction was also administered at the end of the meeting. Eighty-four students at the last year of different degree course of health care professions (nursing, midwifery, psychiatric rehabilitation) joined the meeting.
Results. The pre-post test mean values for the items of the questionnaire of assessment significantly increased for all students. The Cronbach alpha value of the questionnaire was 0.75, indicating an acceptable level of internal reliability. The scores of the satisfaction questionnaire were largely positive.



Conclusion. This study shows that single learning activity for a large interprofessional group can be effective in increasing a positive attitude and provides some data on students&amp;#39; perceptions on interprofessional learning in an Italian context.



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Fabrizio Consorti
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students’ attitudes
A single learning activity for large interprofessional group can boost the perception of value of interprofessional education
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Original articles
2020-11-05
2020-11-05
2020-11-05
2020-11-05
1
Fabrizio Consorti
2020/11/05
10.13135/1971-8551/5253
Sapienza University, Rome, Italy
1971-8551
1
students’ attitudes
A single learning activity for large interprofessional group can boost the perception of value of interprofessional education
https://ojs.unito.it/index.php/tutor/article/download/5253/4720
20
      A single learning activity
      for large interprofessional
      group can boost the
      perception of value of
      interprofessional education
      Anna Marchetti1, Anna Teresa Giallonardo2, Antonella Conestà3, Fabrizio Consorti4

      1   RN, MSN, PhD, Campus Bio Medico University, Rome, Italy, e-mail: a.marchetti@unicampus.it
      2   MD, Sapienza University, Rome, Italy, e-mail: annateresa.giallonardo@uniroma1.it
      3   RN, Ped, Sapienza University, Rome, Italy, e-mail: antonella.conesta@uniroma1.it
      4   MD, Sapienza University, Rome, Italy, e-mail: fabrizio.consorti@uniroma1.it


ABSTRACT

Introduction. The interprofessional education activity consisted in a single 4 hours meeting and it was
built on three theoretical pillars: the framework of Core Competencies for Interprofessional
Collaborative Practice (IPEC), Kolb’s model of experiential learning, and Vygotsky’s concept of social
learning. The objectives of the activity were to enable students to identify the elements of IPEC
framework in a healthcare situation and to show awareness of the value of interprofessional
collaborative practice.
Materials and methods. The meeting was composed by different phases: introduction and sharing of
objectives and methods, followed by two cycles of short lecture, small group activity and large group
discussion. At the beginning and at the end of the meeting, a questionnaire with items exploring
students’ attitude on interprofessional collaboration was administered. A questionnaire of satisfaction
was also administered at the end of the meeting. Eighty-four students at the last year of different
degree course of health care professions (nursing, midwifery, psychiatric rehabilitation) joined the
meeting.
Results. The pre-post test mean values for the items of the questionnaire of assessment significantly
increased for all students. The Cronbach alpha value of the questionnaire was 0.75, indicating an
acceptable level of internal reliability. The scores of the satisfaction questionnaire were largely positive.




                                                                                                            17
                                              A single learning activity for large interprofessional group
                                         can boost the perception of value of interprofessional education




Conclusion. This study shows that single learning activity for a large interprofessional group can be
effective in increasing a positive attitude and provides some data on students&#39; perceptions on
interprofessional learning in an Italian context.
Keywords. Practice educator, collaborative practice, interprofessional education, students’ attitudes.


BACKGROUND                                            pillars: the framework of Core Competen-
The World Health Organization (WHO) ad-               cies for Interprofessional Collaborative
vocates for healthcare professional stu-              Practice [7], Kolb’s model of experiential
dents have to engage in Interprofessional             learning [8], and Vygotsky’s concept of so-
education (IPE) to develop Interprofessional          cial learning. The Interprofessional Educa-
collaboration (IPC) competencies useful in            tion Collaborative (IPEC) framework is ar-
real-world practice [1]. Therefore, Interpro-         ranged according the four domains of val-
fessional Education within healthcare pro-            ues and ethics, roles and responsibilities,
fessional programs is an expectation within           interprofessional communication, team and
the curriculum [2,3]. The international liter-        teamwork [9]. These elements were taken
ature supports the effectiveness of IPE in            into account in designing the activity and
healthcare professional programs to pre-              the instrument of assessment. In greater
pare new graduate professionals able to               detail, Kolb’s model inspired the sequence
participate effectively as members of inter-          of learning activities, which started with a
professional healthcare teams [4]. Moreover,          visual experience and with the recall of a
students seem to value early exposure to              lived experience (see the activity descrip-
the roles of other healthcare professionals           tion section and Figure 1 and 2 for details),
[5]. In fact, learning within interprofessional       followed by a socially shared construction
student teams provides students with the              of meaning and was concluded by a theo-
opportunity to experience how healthcare              retical synthesis by one of the teachers. The
professionals learn collaboratively within            social dimension of learning was activated
and across professions in order to improve            both by dividing the whole group in small
patient care [6].                                     groups for part of each activity and by a
                                                      shared feedback from the large group
INTERVENTION                                          about the product of the small groups’ ac-
This learning activity for large interprofes-         tivity.
sional group consists in a single 4 hrs               The activity is addressed to any group of
meeting and it is built on three theoretical          interprofessional students, and it is partic-
                                                      ularly suited to start an interprofessional

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Volume 20, numero 1



program, with a special focus on interpro-      •   a first short lecture;
fessional collaboration during clinical in-     •   a second small group activity, followed
ternship. It requires that the students al-         by a large group discussion;
ready have a certain amount of clinical ex-     •   a final short lecture.
perience.                                       The first warm-up activity started with the
This first test of the activity was held on     observation of two photographs, taken in
April 2018 in Viterbo, where one of the pe-     real life situations (an operating room and
ripheral university campuses of Sapienza        an emergency room during a high-fidelity
University of Rome is located and where         simulation), showing an interprofessional
some of the three years long curricula for      and interdisciplinary team in action. The fol-
healthcare professions are held. Students       lowing questions were asked:
from the third year of the curricula of nurs-   What’s happening in this photograph?
ing, midwifery and assistants for psychiatric   •   Who are the actors?
rehabilitation were gathered in a lecture       •   Which are their roles, scope and re-
hall and a 4 hours meeting was conducted.           sponsibility?
The specific learning objectives of the ac-
tivity were to make students able:
•   to identify the elements of IPEC frame-
    work in a healthcare situation;
•   to show awareness of the value of in-
    terprofessional collaborative practice.
To accomplish these learning objectives, we
aimed to make students able to use the
                                                Figure 1. An example of photographs used in the
IPEC framework and the critical incident
                                                warm-up activity
technique to interpret and give a meaning
to their clinical experience.


Activity description
The whole meeting was composed by:
•   introduction and setting of objectives
    and methods;
•   a warm-up activity with large group
                                                Figure 2. An example of photographs used in the
    discussion;                                 warm-up activity


                                                                                              19
                                           A single learning activity for large interprofessional group
                                      can boost the perception of value of interprofessional education




Participants were asked to briefly discuss         4. Use the “Critical incident form” to de-
with the student sitting near to them              scribe in details what happened in the cho-
(“think-pair-share” technique) [10,11,12],         sen situation (Table 1).
then the answers were discussed in the
large group.                                        •   Describe the context and the protagonists of
                                                        situation
After the discussion, a short oral presenta-
                                                    •   Reconstruct emotions, actions, climate and
tion of the main concepts of interprofes-
                                                        work modalities by providing clear and con-
sional practice was given, the IPEC frame-              crete examples of behaviors or words ob-
work introduced and a handout distributed.              served
The whole group was then divided in 10              •   Explain why the incident is critical from your

interprofessional small groups of 8-9 com-              point of view
                                                    •   Describe the feelings and thoughts of that
ponents and a “critical incident” session
                                                        moment
was run. The critical incident technique is
                                                    What could be done different?
used to collect and analyze behaviors in de-
fined situations [13]. The term “critical” in-     Table 1. Critical incident form

dicates that the behavior described in the
incident plays an important role in deter-         The ten narratives were shared in a final

mining an outcome [14]. This technique has         plenary session and freely commented by

been effectively used by health services re-       the participants. Academic staff joined the

searchers in studies of health care quality        discussion and - when appropriate - re-

[13]. The instructions for this session were:      called the IPC framework as the best con-

1. Introduce yourself to the rest of the           text to give a meaning and interpret the sit-

group and then choose a name for the               uations. A final short lecture summarized

group;                                             and discussed the main emerged themes

2. Individually, recall a significant situation    and their relationship with the IPC frame-

in your clinical practice as a student, in         work.

which a problem in at least one of the four
domain of the IPC framework arose;                 What could be done different?

3. Everyone shares a brief narrative of their      Assessment and Evaluation
episode. The group will then choose the            At the beginning and at the end of the

one to be presented in the final plenary           meeting, a questionnaire was administered,

session;                                           with the following four statements:




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Volume 20, numero 1



1. I feel the need to meet and discuss with     Table 4 shows the pre-post test mean val-
students from other healthcare professions      ues for the four items of the questionnaire
to improve my proficiency in study and          of assessment.
learning;                                       The mean value significantly increased for
2. I feel the need to meet and work with        all of them. The Cronbach alpha value of
students from other healthcare professions      the questionnaire was 0.75, indicating an
during my practice;                             acceptable level of internal reliability. The
3. I have knowledge of the basics of inter-     scores of the satisfaction questionnaire
professional collaboration;                     were largely positive, showing interest and
4. I have knowledge of the competencies         appreciation of the activities.
of the other healthcare professions. Stu-
dents graded the statements from 1 (com-         •     Were you interested in the topic of this les-

plete disagreement) to 9 (complete agree-              son?
                                                 •     Was the lesson well organized?
ment). A questionnaire of satisfaction was
                                                 •     Were you involved in learning activities?
also administered at the end of the meet-
                                                 •     Overall, were you satisfied with this lesson?
ing (Table 2). It was derived from the stand-
ard questionnaire used at Sapienza Univer-      Table 2. Questionnaire of student’s satisfaction, four

sity.                                           grades from 1 (absolutely no) to 4 (absolutely yes).


                                                     Personal data                       No. (% of
RESULTS
                                                     (84 students)                          total)
Eighty-four students at the last year of dif-    Sex                  F                  57 (67.8)
ferent degree course of health care profes-                           M                  27 (32.2)
sions (nursing,                                  HC profession        Nursing            58 (69.0)

midwifery, psychiatric rehabilitation) joined                         Midwifery          13 (15.5)
                                                                      Psychiatric        13 (15.5)
the meeting. Table 3 shows the distribution
                                                                      rehabilitation
for sex and healthcare profession.
                                                Table 3. Composition of the sample




                                                                                                       21
                                               A single learning activity for large interprofessional group
                                          can boost the perception of value of interprofessional education



                       Items                            Mean           Std. deviation         p value1
 Item 1                            pre              5,45            2,17                  < 0.001
 meet and discuss with students    post             6,55            2,11
 from other professions
 Item 2                            pre              6,07            2,02                  < 0.001
 meet and work with students       post             7,19            1,71
 from other professions
 Item 3                            pre              4,42            2,33                  < 0.001
 Knowledge of basics of            post             6,88            1,72
 interprofessional collaboration
 Item 4                            pre              4,35            1,59                  < 0.001
 Knowledge of the                  post                      6,13                  1,76
 competencies of other
 healthcare professions

Table 4. Pre-post score of the questionnaire of assessment

DISCUSSION AND CONCLUSION                              subtheme. Recalling, narrating and dis-
The assessed outcome of this learning                  cussing critical incidents is in fact in line
activity was an increase in students’ per-             with such an outcome. As already
ception of the value of interprofessional              showed         by       other       researchers
collaboration for their development as                 [16,17,18], our experience showed also
future healthcare professionals. A sys-                that active interprofessional learning ac-
tematic review of learning outcomes of                 tivities for large group are feasible and
IPE [15] classified the outcomes in six                effective.
themes: teamwork, roles/responsibili-                  Our experience does not confirm a de-
ties, communication, learning/reflection,              crease of some of the components of
the patient, ethics/attitudes.                         interprofessional learning, mainly in the
The performed learning activity and its                area of professional image and attitude
outcome fit mainly in the Roles/respon-                to teamwork after an IPE activity, ob-
sibilities theme, but also in the Eth-                 served in other studies [18,19]. We did
ics/attitudes theme, in considering the                not explicitly explore the areas of pro-
“Tolerate difference, misunderstandings                fessional image and attitude to team-
and shortcomings in other professionals”               work, with instruments like Readiness
                                                       for Interprofessional Learning Scales


 22
Volume 20, numero 1



(RIPLS) questionnaire [20] but the post-       plan [25] established interprofessional
assessment test showed an increase in          integration as one of the goals in hu-
the perceived usefulness of IPE activi-        man       resources    development.     The
ties, like in other studies [21]. Our sam-     Age.Na.S. - the national agency for con-
ple was constituted by a group of the          tinuous professional development - lists
last year of the degree course. Probably       interprofessional collaboration as one
they had an already developed profes-          of the national objectives of profes-
sional identity [22].                          sional development [26].
They met for the first time in an IPE ac-      IPE should start early and a variety of
tivity and we have no evidence that the        active-learning and small group peda-
described decrease in their attitude           gogies should be used [27] including
could not appear after other IPE activi-       simulation [28]. Research on IPE in Italy
ties in the future.                            is still in a starting phase, with few pub-
This reflection raises the importance of       lished articles reporting on the effec-
the curricular design and of timing of         tiveness of IPE interventions [16,17],
IPE activities [23].                           others     reporting    preliminary    work
Thistlethwaite et al. [24] classified 5 dif-   about IPE on groups from the same pro-
ferent types of curricular integration for     fessions [29,30] or instruments and the-
IPE: one or more modules inserted into         oretical premises [31,32,33].
new or existing curricula, within clinical     Italian    curricula   of   medicine   and
practice as one element, a common cur-         healthcare professions are often com-
riculum across all professions, eLearn-        posed by large groups of students and
ing in parallel with other courses, work-      lecture hall is still a pivotal component
based [24]. Our test was meant to vali-        of the educational system. Hence, be-
date a possible module to be inserted          sides the use of simulation centers and
in already existing curricula, as an intro-    small group activities, active pedagog-
duction to IPE or an accompanying              ies for IPE of large groups of students
module during clinical practice.               should be tested. If their effectiveness
The design and implementation of IPE           is proved, it may encourage a wider in-
is a challenge for all Italian healthcare      volvement of faculty members in IPE
curricula. The 2014 national healthcare

                                                                                         23
                                       A single learning activity for large interprofessional group
                                  can boost the perception of value of interprofessional education




programs with a cohesive efforts by ad-        represented. The study should be ex-
ministration and faculty [34].                 tended to students from other profes-
Moreover, our results are coherent with        sions. Furthermore, the study involved
the findings of a recent BEME system-          only the students of a peripheral univer-
atic review [35]. The authors of this re-      sity campus of Sapienza University of
view organized their results according         Rome. To obtain greater completeness
the 3P model of learning and teaching          of data and a comparison between re-
[36]: presage (the overall context of          sults, it could be interesting to involve
learning), process (methods and educa-         the entire University and other Italian
tional processes) and product (associ-         Universities.
ated outcomes). Part of the success of         Despite positive outcomes of the edu-
our activity could be due to the location:     cational intervention of IPE courses in
for both the faculty and the students of       various disciplines of healthcare, more
a peripheral campus, located in a small        research is needed to explore other fac-
town 80 km far from Rome, being the            tors that may determine specific educa-
forerunners in an innovative learning ac-      tional outcomes for health care profes-
tivity could have been particularly moti-      sions students about the effectiveness
vating. As to the process component,           of IPE programs. This study shows that
we adopted a theory-based approach in          single learning activity for a large inter-
which a particular emphasis was given          professional group can be effective in
to the shared interprofessional reflec-        increasing a positive attitude and pro-
tion. Also the role of teachers acting as      vides some data on students’ percep-
facilitators during the discussion of the      tions on interprofessional learning in
critical incidents was important, push-        an Italian context.
ing the students to use the IPC model
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only three healthcare professions were            2010.

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Volume 20, numero 1



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