1. Deborah Craddock, PhD University of Southampton
Students’ attitudes towards IPE across professional groups: Lessons learnt from a national study
Deborah Craddock, PhD
University of Southampton

2. Introduction
Pre-registration IPE is a mandatory requirement in the UK (DOH & QAA 2006).
Interprofessional education (IPE) aims to reinforce collaborative practice (Glen and Reeves 2004; Carpenter, 2005; WHO, 2010).
Cultural barriers exist to the successful development of IPE (Barr et al. 2005; Morison et al. 2008).
Stereotypical views of other professions are held by students upon entry to their respective programmes (Hean et al. 2006; Adams et al. 2006)
Students assign differing hierarchical statuses to other students depending on their level of academic qualifications or their ability (Adams et al. 2006; Nisbet et al. 2008).
Can such stereotypical views change? (Carpenter 1995; Carpenter & Hewstone, 1996)

3. Professionalism (Saks, 2009)
Viewed traditionally as:
Different from other professional groups;
Possessing unique bodies of experience;
Using their knowledge for the public good;
Acting rationally, objectively and impartially
Viewed critically as:
Self seeking monopolies in the market;
Insufficiently accountable/ responsive;
Having a mystified knowledge base.
> doubts
Professional socialisation processes are likely to develop students’ perceptions of other professions during their pre- registration training (Adams et al. 2006)

4. Research Questions*
-Does professional representation in IPE groups increase knowledge of professional roles?
-Do health and social work students’ readiness for IPL differ across professions?
-What factors influence students’ commitment to IPE?
*Sample 1: students at the start of their IPE initiative at FHEQ4;
Sample 2: students on completion of their IPE initiative at FHEQ4

5. Methodology Two parallel studies-prospective cross- sectional surveys
Ethical approval
Multi-stage sampling:- (1) sampling of HEIs & (2) sampling of students
Questionnaires were administered to a volunteer sample of pre-registration health and/ or social work students in Higher Education Institutions within the UK at 2 separate time points.
Inclusion criteria: Students registered on a health or social care programme participating in an IPE initiative that involved podiatry students.

6. Key informant interviews
Questionnaire Pack
Questionnaire pack- informed by (1) key informant interviews and (2) research evidence
Validated tool – Readiness for Inter-professional Education Scale (RIPLS) (Parsell and Bligh, 1999) & Generic Role Perception Questionnaire (GRPQ) (Mackay, 2004)
Face validity
Content validity
Pilot Study [test (i) n=67; test (ii) n=62]
Test re-test reliability
Internal consistency
Key informant interviews

7. Sample:
Sample 1:
1151 students participated in the Sample 1 phase [81.1% (933) female, 18.9% (218) male]: mean age (SD=8.167) years in 6 HEIs
Sample 2:
1060 students participated in the Sample 2 phase [81.2% (861) female, 18.8% (199) male]: mean age (SD=7.84) years in 5 HEIs.
Female : Male (Parsell and Bligh 1999; Cassidy 2007)

8. Learning about professions represented in IPE groups- exemplar: podiatry
Objective 1
Students’ knowledge of podiatrists’ roles was better if they had participated in an IPE group that involved a podiatry student (Sample 1 Md=7; Sample 2 Md=8) than if they had not/ unsure (Sample 1 Md=6; Sample 2 Md=6)
(Sample 1: U= , Z=-2.596, n-964, p=0.009; Sample 2: U= , z= , n=967, p<0.001).
In Sample 2: There was a significant difference in students’ total GRPQ scores between health and social care students who participated in an IPE group that involved a podiatry student (Md=94, n=497) and students who had not/ unsure (Md=99, n=470) (U= , z=-3.451, p=0.001, r=-0.11).

9. Readiness for Inter-professional Learning Scale
Principle Component Analysis
Kaiser-Meyer-Oklin value = Sample 1: 0.932; Sample 2:
Bartlett’s Test of Sphericity (p<0.001)
Oblimin rotation with Kaiser Normalisation
Sample 1 and 2:
2 component solution
Comparisons with Parsell and Bligh (1998; 1999) & McFadyen et al. (2005)
Component 1
Teamwork and collaboration
Component 2
Professional identity and roles

10. RIPLS Subscale Comparisons
Factor Analysis
Sub-scale 1
Teamwork and collaboration
Sub scale 2
Professional Identity (1999) and Negative Professional Identity (1998)
Subscale 3
Roles and Responsibilities (1999) + Roles (1998)
Parsell and Bligh (1999) (n=120)
42% variance explained
Items 1-9
Items 10-16
Items 17-19
Parsell et al., (1998) (n=914)
48% variance explained
Item 11
Items 13-16
Item 12
Item 17
Item 19
Item 18
McFadyen et al (2005) (n=308)
(n=308) 44% variance explained
Items 1-9; 10, 11
Items 18-19
Craddock Sample 1: n= % variance explained
Craddock Sample 2: n % variance explained
Items 10-12

11. Cronbach Alpha Measure of Internal Consistency of Each Sub-scale
Study
Sub-scale 1
Teamwork and collaboration
Sub scale 2
Professional Identity (1999) and Negative Professional Identity (1998)
Subscale 3
Roles and Responsibilitie s (1999) + Roles (1998)
Parsell and Bligh (1999) (n=120)
0.88
0.63
0.32
Parsell et al., (1998) (n=914)
0.85
0.46 -
McFadyen et al (2005) (n=308)
0.80
0.21
0.40
Craddock (n=1151)
0.66
Craddock (n=1060)
0.92
0.79

12. Comparison of Students’ Total RIPLS Scores by Profession
Objective 2
Profession
Sample 1 Md N
Sample 2 Md U Z P R
Physiotherapy 79
236 76
216
-3.814
<0.001
0.1
Occupational Therapy 82
122 92
4674.5
-2.092
0.036
0.05
Podiatry 78
187 75 93
7105
-2.495
0.013
0.06
Radiography
78.5 96 70
2571.5
-2.581
0.010
0.07
Medicine
71.5 90
2444.5
-3.047
0.002
0.08
Midwifery 81 43 74 51
572.5
-3.981
Social Work 84 56
77.5 60
1205.5
-2.624
0.009
Audiology 86 10 13
30.0
-2.175
0.03
Lower median scores observed in Sample 2

13. In Sample 1 and Sample 2 the Kruskal-Wallis test shows that there are significant differences between the professions and students’ total RIPLS scores (Sample 1: χ2 (14, n=1151) =56.803, p<0.001; Sample 2: χ2 (13, n=1060) =83.085, p<0.001).
In Sample 2, nursing (Md=81) and occupational therapy (Md=79) students had a greater readiness for IPL than students in other professions.
In Sample 1 audiology (Md=86) and social work (Md=84) students had a greater readiness for IPL than students in other professions.
Medical (Sample 1: 75; Sample 2: 71.5) and paramedical science (Sample 1: Md=74; Sample 2: Md= 71) students recorded the lowest median scores compared with students in other professions.

14. Sample 1 Total RIPLS Analysis
Profession¹
Profession²
Md¹ N¹
Md² N² U Z P R
Occupational Therapy
Podiatry 82
122 78
187
8421.5
-3.892
<0.001
0.22
Radiography
78.5 96
4208
-3.568
0.24
Medicine 75
2971
-4.131
0.29
Nursing
229
-3.766
0.2
8365
-3.402
0.001
0.19
Social Work 84 56
1850.5
-3.202
0.26
6001.5
-3.917

15. Sample 2 Total RIPLS Analysis
Statistically significant differences between student professional groups:
Sample 2
Total RIPLS Analysis
Profession¹
Profession²
Md¹ N¹
Md² N² U Z P R
Physiotherapy
Occupational therapy 76
216 79 92
7662.5
-3.181
0.001
0.18
Medicine
71.5 90
6961
-3.915
<0.001
0.22
Nursing 81
273
22469
-4.523
0.2
Occupational Therapy
Radiography 75 70
2258.5
-3.254
0.26
2143.5
-5.622
0.42
Midwifery 74 51
1491
-3.606
0.3
Podiatry 93
9507
-3.620
0.19
6712.5
-3.843
6555
-6.641
0.35
Social Work
77.5 60
1702.5
-3.829
0.31
4484
-4.037
Pharmacy 50
4878
-3.209

16. Teamwork and Collaboration
Sub-scale 1
Teamwork and Collaboration

17. Students’ attitudes towards teamwork and collaboration:
Overall
Profession
Sample 1 Md N
Sample 2 Md U Z P R
Physiotherapy 56
236
52.5
216
19793
-4.112
<0.001
0.12
Occupational Therapy 58
122 55 92
4635
-2.186
0.029
0.06
Radiography 54 96 70
2698
-2.171
0.03
Medicine 75
51.5 90
2577
-2.615
0.009
0.08
Midwifery 43 52 51
728.5
-2.800
0.005
Social Work 60
1321
-1.995
0.046
Lower median score
Higher median score

18. In Sample 1 and Sample 2 the Kruskal-Wallis test shows that there are significant differences between the professions and students’ RIPLS scores for sub-scale 1 (Sample 1: χ2 (14, n=1151) =54.137, p<0.001; Sample 2: χ2 (13, n=1060) =74.618, p<0.001).
In Sample 2:
Dietetic (Md=65) and nursing (Md=57) students held more positive views towards teamwork and collaboration.
Paramedical science (Md=48) and medical students (Md=51.5) – least positive.
In Sample 1:
Audiology (Md=60.5) and social work (Md=60)
students held more positive attitudes towards teamwork and collaboration
Paramedical science (Md=51) students- least positive.

19. Comparison of Students’ RIPLS Sub-Scale 1 Scores by Profession
Teamwork & collaboration
Sample 1
Sub-scale 1 Analysis
Profession¹
Profession²
Md¹ N¹
Md² N² U Z P R
Occupational Therapy
Podiatry 58
122 54
187
8271
-4.096
<0.001
0.23
Radiography 96
4210.5
-3.569
0.24
Nursing
229
16675
-3.894
0.2
8511.5
-3.219
0.001
0.18
Social Work 60 56
1806
-3.380
0.27

20. Sample 2 Sub-scale 1 Analysis
Profession¹
Profession²
Md¹ N¹
Md² N² U Z P R
Physiotherapy
Occupational therapy
52.5
216 55 92
7363.5
-3.603
<0.001
0.21
Nursing 57
273
-5.266
0.24
Occupational Therapy
Medicine
51.5 90
2681
-4.113
0.3
Midwifery 52 51
1514
-3.519
0.29
Podiatry 53 93
9672.5
-3.440
0.001
0.18
Radiography 70
6830.5
-3.691
0.2
7931
-5.056
0.27
Social Work 56 60
1824.5
-3.364
4465.5
-4.078
0.23

21. Professional Identity & Roles
Sub-scale 2
Professional Identity & Roles

22. Students’ attitudes towards professional identity & roles:
Overall
Profession
Sample 1 Md N
Sample 2 Md U Z P R
Physiotherapy 18
236 13
216
5218
-14.67
<0.001
0.31
Occupational Therapy
122 12 92
1065.5
-10.18
0.22
Podiatry 19
187 93
2066
-10.43
Radiography 96 14 70
1249.5
-6.938
0.15
Medicine 20 75
15.5 90
1574
-5.911
0.13
Nursing
229
273
5797.5
-15.76
0.34
Midwifery 43 51
461.5
-4.841
0.1
Social Work 56 60
557
-6.218
Prosthetics & Orthotics 23 31
200
-2.75
0.006
0.06
Pharmacy 29 16 50
353
-3.796
0.08
Audiology
19.5 10
20.5
-2.774
Paramedical Science 7
8.5
-2.077
0.038
0.04

23. Kruskal-Wallis test: significant differences between the professions and students’ RIPLS scores for sub-scale 2. Sample 1: χ2 (14, n=1151) =56.793, p<0.001; Sample 2: χ2 (13, n=1060) =79.489, p<0.001.
Sample 1: Medicine (Md=20) and dietetic (Md=20) students- strongest attitudes towards professional identity and roles.
Speech and language therapy students (Md=17) - weakest attitude towards professional identity and roles.
Sample 2: Medicine (Md=15.5) but also pharmacy (Md=16) students- strongest attitudes towards professional identity and roles.
Occupational therapy and nursing students (Md=12)- weakest views towards professional identity and roles than other professional groups represented in this sample.

24. Comparison of Students’ RIPLS Sub-Scale 2 Scores by Profession
Higher median scores
Sample 1
Sub-scale 2 Analysis
Profession¹
Profession²
Md¹ N¹
Md² N² U Z P R
Physiotherapy
Medicine 18
236 20 75
6080.5
-4.125
<0.05
0.23
Occupational Therapy
122
3297
-3.320
0.001
0.24
Podiatry 19
187
4932
-3.784
<0.001
Radiography 96
2101.5
-4.710
0.36
Midwifery 43
847.5
-4.312
0.4
Social Work 56
742.5
-3.297
0.33

25. Sample 2 Sub-scale 2 Analysis
Profession¹
Profession²
Md¹ N¹
Md² N² U Z P R
Physiotherapy
Medicine 13
216
15.5 90
5781.5
-5.610
<0.001
0.32
Pharmacy 16 50
3624.5
-3.638
0.22
Occupational Therapy
Radiography 12 92 14 70
2260.5
-3.256
0.001
0.26
2068
-5.848
0.43
Prosthetics & Orthotics 31
875.5
-3.220
0.29
1337.5
-4.122
0.35
Podiatry 93
2688.5
-4.193
0.31
Nursing
273
7116.5
-3.306
0.18
6580.5
-6.627
Social Work 60
1847.5
-3.280
0.27
4177.5
-4.374
0.24

26. Commitment to IPE: Commitment was strongly influenced by: Objective 3
Positive correlation - age and level of commitment to IPE (Sample 1: spearman’s rho = , p<0.001; Sample 2: spearman’s rho = 0.165, p<0.001 for a one tailed test)
Modal response of 6 - the majority of participants were only fairly committed (Sample 1: 49.5%, 570; Sample 2: 46.9%, 497) to IPL.
Commitment was strongly influenced by:
facilitators’ attitudes towards IPE (Sample 1:75.5%, 835; Sample 2: 74%, 784)
working practices of staff (72.4%, 833; Sample 2: 66%, 700);
Students induction to the IPE initiative (62.2%, 716; 56.2%, 596)

27. UTILITY OF RESEARCH FINDINGS

28. Enhancing knowledge of professional roles
Lessons Learnt
Enhancing knowledge of professional roles

29. Comparisons by Profession
Sample 1
Students showed positive attitudes towards teamwork and collaboration and IPL from the outset of their studies.
-Hind et al. 2003; Tunstall-Pedoe et al., 2003
Sample 2:
Students’ attitudes towards teamwork and collaboration skills became statistically less positive for those studying physiotherapy (PT), occupational therapy (OT), radiography, medicine, midwifery and social work (SW).
Students’ overall readiness for IPL was lower in each profession for PT, OT, medicine, midwifery, SW, podiatry and audiology.

30. Most Positive Views Least Positive Views
Professional programme appeared to affect students’ responses to IPE - Conflicting with Pollard et al. (2005)
Sample 1 & Sample 2
Medical and paramedical science students
Findings align: Tunstall-Pedoe et al. (2003) Morison et al. (2004)
Supports: Hean et al.’s (2006) findings
& Conflicts: Hanson et al. (2005
Hallikainen et al. (2007)
Sample 1
Audiology and social work students
Sample 2
Nursing and dietetic students
-teamwork and collaboration
Nursing and occupational therapy students
-IPL
Supports: Hean et al. (2006)

31. Professional Identity and Roles
Sample 1: +
Strongest views: medical and pharmacy students
(Miller et al., 2006)
Ratings for being good independent workers (Hean et al., 2006)
Weakest views: speech and language therapy students (Sample 1); occupational therapy & nursing students (Sample 2)
Physiotherapy
Occupational Therapy
Podiatry
Radiography
Medicine
Nursing
Midwifery
Social work
Pharmacy
Audiology
Paramedical Science
Prosthetics and Orthotics
Sample 2

32. Statistically: > Medical students Pharmacy students Radiography
Samples 1&2: PT, OT, podiatry
Sample 1: radiography, midwifery
Sample 2: nursing and social work
Sample 2: PT, OT, nursing
Sample 2: nursing, OT
WHY?
Confidence in professional competence and practical skills; perceived role independence

33. Students with a strong sense of professional identity and roles were less ready to engage in IPL and had weaker attitudes towards teamwork and collaboration.
Curriculum Developers:-
Reflect on professional differences;
Curricula content, implementation & evaluation
Target factors influencing students’ attitudes

34. Key factors influencing students’ attitudes towards IPE

35. References
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36. References: (continued)
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37. Pollard, K. , Miers, M. E. and Gilchrist, M
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