A descriptive qualitative study using thematic analysis of content was conducted to explore the inter-professional learning experience of Clinical Psychology and Psychiatry Residency students. In-depth interviews were conducted with 9 participants, including 5 clinical psychology students and 4 psychiatry residency students.
Table 1.
Description of demographic characteristics of participants
Participants
|
Characteristics
|
Year of education
|
|
Gender
|
Age
|
Clinical psychology students
|
F
|
4
|
23-25
|
2nd year
|
M
|
1
|
2nd year
|
Psychiatry residency students
|
F
|
2
|
31-35
|
2, 2nd year
2, 3rd year
|
M
|
2
|
Three themes and five sub-themes emerged from the data describing the inter-professional experience of clinical psychology students and psychiatry residency students. The themes were: (a) Inter-professional experience, (b) Factors affecting active engagement, and (c) Professional identity and Inter-professional experience.
Inter-professional experience (IPE)
Joint learning vs. Uni-professional
Most of the participants expressed their joint learning experience as useful and fruitful. The majority of clinical psychologists and psychiatry residents saw the opportunity they would lose if they took their courses Uni-professionally. They also expressed how the two professions are interrelated and the joint learning experience is more valuable than a course they took in classrooms.
A 23- year-old female clinical psychology student said:
What I have learned in the process is how much of our course content and how their lessons are integrated. What I understand is… if we study clinical psychology alone, things might be different. We may have not got the chance to know the medical terms. They also may not pay close attention to what the psycho-social thing is. So, I think learning together enables us to practice this bio-psychosocial thing.
Another 34- year-old male psychiatry resident added:
The experience was very useful they know about therapy during classes they share that information with us. For example, we didn't take cognitive behavioral focused therapy, so when a patient who needs cognitive behavioral focused therapy came, we learn from them how to manage and what should be our major goal.
The participants further elaborated on the many opportunities they get from the inter-professional experience in terms of knowledge and skill than learning with their profession only. They indicated the professional difference has opened the opportunity to learn from one another, skills related to the patient interview, diagnosing a patent, and the like.
A 23-year-old female clinical psychology student said
The important thing is, I think we learned how to clerk at the clinical Interview. One of the first things we learned is about how to do the interview.
A 25-year-old male clinical psychology student added:
Clinical psychology has some relation with medicine so I think we take a lot from them, for example, presenting at the morning session and interviewing patients we learn this and the other thing.
However, for a few in both professions, despite the benefits they gained from the inter-professional learning experience, they report that differences in professional backgrounds have given them a negative experience. Besides, they explained this as a result of the different structural positions of their profession within the department and society.
A 24-year-old clinical psychology student said:
The title they are doctors and we are clinical psychology students; we don’t have any title. They specialized in practical as a resident but we practice as training not certified as specialization during practice. It creates a difference.
A 23 years old female clinical psychology student added:
As a clinical psychologist, there is something that affects our confidence. Learning with them creates a feeling of inferiority. Maybe, if we are not leaning with them, I always think about what could we achieve and how we reach our potential. But as I told you it has its good and bad sides.
Mutual vs One-way learning during IPE experience
As noted above, Joint interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration. More specifically, such learning requires the presence of mutual learning experiences. In terms of a learning experience about, from, and with each other, in this study, clinical psychology students and psychiatry residence students reported different experiences. To make the IPE experience fruitful the majority of psychiatry residents and clinical psychology students believe in the importance of mutual learning experience but it was found out that most of the time learning experiences occur from one profession. The majority of clinical psychology students and psychiatry residents indicated majority of the time clinical psychology students observe and learn from psychiatry residents and few times psychiatry resident students learn from clinical psychology students by asking them questions informally.
A 23-year-old female clinical psychology student said:
They didn't observe us but when we do therapy some residents might be in the room. If everyone has an interest and if they can watch us while doing therapy as we do things might be better.
A 33-year-old male psychiatry residence student added:
Maybe it is important to observe therapy given by seniors. I didn't get a chance to see therapy made by a senior clinical psychologist. I saw Videos of psychotherapy on interpersonal psychotherapy but it is only limited. It's important to see another focus on psychotherapy by seniors to understand better about clinical psychology and psychotherapy.
Moreover, few psychiatry residents indicated how IPE could be enhanced by involving both clinical psychology and psychiatry residency program instructors in creating a relationship with students of both fields of study. They reported that they noticed the existence of a strong relationship between Psychiatry instructors with clinical psychology students but a limited relationship exists between clinical psychology instructors and psychiatry residents.
A 34-year-old male psychiatry residence student said:
The senior clinical psychology instructors' relation with us is somehow weak but our seniors have a strong relationship with the clinical psychology students. Maybe it's because our seniors gave them courses. I don't know the exact reason sometimes some people are more eager to know. However, more of the relationship we have with a senior clinical psychologist is somehow challenging, which affects our experience.
Timing of experience
In inter-professional education, the time of encounter and the change in experience through time is important in influencing the collaborative competency of students in their future practice. In terms of inter-professional experience, participants experience it in various ways through time. Clinical psychologists and psychiatry residents reported distinctive experiences through time. In the initial encounter, it was found that for all of the clinical psychology students the IPE experience starts with attending clinics with psychiatry residents in observing them while they clerk patients. In the initial IPE experience, clinical psychology students reported even if observing psychiatry residents is helpful for them, it is a confusing and frustrating experience. They further reported in the initial IPE experience that they are confused about what they are expected to do and view themselves as subordinate to psychiatry residents.
A 24- year-old female clinical psychology student said:
I think there is a difference in the professions because they are doctors for specialization. There is a difference in viewing one another since we are from social science at the initial phase of our training. I see myself as a student and as a teacher, even if we are both students in the department.
Similarly, the majority of psychiatry residence students believe that the initial IPE experience is confusing and especially challenging to clinical psychology students. They also believe that the problem is because of the professional background and lack of clinical exposure to clinical psychology students.
A 33-year-old psychiatry residency student said:
It's almost making two different curriculums in one because the history taking experience is completely different. In the morning session when they are presenters it's a different perspective for us and it had gaps. They study psychology, they don't have a clinical background. We see them when they are struggling.
But for the majority of psychiatry residents, it was found out that the initial experience depends on the clinic they are attached to because there are clinics where there is no clinical psychology student. It also depends on the year of education of clinical psychology students. If the student clinical psychologist is in the first year, the first encounter is in the clinic while they observe them. If it is with second-year clinical psychology student when they refer the patient to them and talk about it. They also described the experience in different hospital is different because of the physical setting not be able to accommodate both professional, the service provided in the hospitals related to specialized service requiring special training and involvement of clinical psychology students in the clinics.
A 34-years old psychiatry residency student said:
We started to study together after the second year. We refer patients for therapy to them and the other thing is when we attach at Black Lion Hospital and Yekatit Hospital.
Also, the majority of them stated in either initial or later experience that the IPE experience depended on the individual behavior of the psychiatry resident. If he/she is friendly, he/she can work with clinical psychologist student, and not miss the opportunity. It is also similar to clinical psychologists.
A 30-year-old psychiatry residency student said:
Sometimes it depends on individual interest some students have a good interest to work with clinical psychology students' others not. In clinical psychology this is more open the teachers suggest them to work with us but there is no rule or system to follow that, so it's better to work together and evaluate how joint learning goes with both professionals.
At later experience it was found that both majority of clinical psychology students and psychiatry residence students similarly experience IPE through working together, communicating, patient referral, informal patient case discussion, and joint morning session presentations. Clinical psychology students expressed that through time interpersonal relation is created and the more balanced relationship starts which resulted for them an increase of confidence since they started working independently and seeing patients. For both the majority of clinical psychology students and psychiatry residents the best later IPE experience is participation in joint morning sessions and patient case presentations because it gives equal opportunity for both of the professionals as reported by clinical psychology students and it is a very good learning opportunity for psychiatry residence students too.
A 35- year- old male psychiatry residency student said:
I remember we had one patient……... At that time, I didn't know about interpersonal psychotherapy then we decided to bring up the case in the morning session. During the morning we discussed interpersonal psychotherapy in detail and I got concrete knowledge from it during that I learned a lot about how to make a connection with them.
Opportunity vs challenges of IPE experience
IPE gives a lot of opportunities for participating students in the learning process. In this study, it was found that the majority of clinical psychology students and psychiatry residence students reported one of the opportunities they get from the experience is the knowledge they gained about the other profession and the other professional. They explained their realization of how the two professionals are interrelated and how they think about the other professional is changed through the IPE.
A 23-year-old female clinical psychology student said:
You can't learn together with them. I think medicine students' attitude is difficult for example when I see it as an outsider. I used to believe that they see themselves as superior to other fields of study and they have a close circle that wouldn't let other professionals enter. Now I understood their burden and changed my thought about it.
Another 28-year-old male psychiatry resident added:
Before the class, I didn't know clinical psychologists are involved in clinics. What I thought was that they are only involved in social aspects. But now I see they know about clinical things and they know basics so we interact with the one who understands. Our relationship with them is different from the interactions we have with other professions.
The second opportunity they get form the IPE as reported by the majority of the participants in the knowledge exchange between the two professions in a formal learning environment, like morning session presentations, and in an informal learning environment, through the interactions they have created through the process of socialization, friendship and sharing of experience.
A 23-year-old female clinical psychology student said:
I think we add psychological thing more to them, as we learn together because we know a lot of psychological things while they tend more of physiological or biological. I think there is something that they can learn from us.
A 28-yer-old male psychiatry residency student added:
When you go from 1st year to 2nd year you start to understand that the biological issues and the psycho-social are related. If you didn’t understand it, it becomes difficult to give treatment so they help us to achieve this.
The other opportunity stated by the majority of both psychiatry residence students and clinical psychology students is the belief that this experience will help them in their future practice. Most clinical psychologist and psychiatry residence students believe that the experience would help them to be better collaborators with other professionals in the future and their patients would benefit from it.
A 23-year-old female clinical psychology student said:
I think it enables us to work collaboratively with another professional. It also enables us to network with people in another profession. And if anyone needs help from them, I'll recommend them. In return, if there's something I can help with. So, I’m creating a network here.
A 32-year-old female psychiatry residency student added:
I think it has a lot of advantages. When I go to the hospital after I finished my class, I will promote clinical psychology. When I treat patients, I know there is a team that can help me in psychosocial management.
Despite the opportunity created through IPE, a lot of challenges are reported both by clinical psychology students and psychiatry students. The majority of clinical psychologists and psychiatry residents identified their educational background (natural and social science) which result in a different orientation. For example, psychiatry residents focus on biology and clinical psychologists focus on the psychosocial aspect of the patient. Specifically, this was explained by the majority of clinical psychology students because their role is to observe psychiatry residents at the initial stage of their IPE experience. It created a challenge to be able to enjoy the IPE experience. The majority of psychiatry residents also agree that it is challenging for them too because the clinical psychologists have no background knowledge about the biological aspect of mental illness.
A 28-year-old psychiatry residency student said:
If you are a doctor you had experience before so you will not fear because the approaches of treatment are almost similar. If severe mentally ill patients come how can they manage unless they have some biological knowledge. I think it’s better if they take some medical courses.
Another 23-year-old female clinical psychology student added:
The title they are doctors and we are clinical psychology students we don't have any title. They specialized in practicing medicine as a residence but we practice as training not certified as specialization during practice it creates a difference.
The other challenge is an organizational problem related to the developmental stage of the programs in the department of psychiatry. The majority of clinical psychology students reported, unlike the psychiatry residence students that their program has organizational limitations that hinder equal involvement in the IPE experience.
A 25-year-old clinical psychology student said:
The Teaching-learning system should give a clear role for clinical psychology. This may help us to understand our specific role. Their system is more structured than ours so we want our system to be organized like theirs. I think it is a good thing to wish this.
The majority of clinical psychologists explained that the challenge improved through time but has required a strong effort from them. They also suggest that culture change takes place when they enter the room and should be embraced for the benefit of the IPE experience.
A 23-year-old female clinical psychology student said:
There is a culture change when we come here, we are a social student and I think most of the time, we are not like them in many aspects and I think we have learned the medical world in a hard way which was a challenging experience for us.
Factors affecting active engagement in IPE
Internal vs external motivation
In terms of what motivates professionals to actively participate in IPE experience, the majority of clinical psychology students and psychiatry residency students believe that individual personality (sociability), curiosity, and the value one gives to teamwork are motivating factors. From external motivating factors, the educational system which places them to learn together and the instructors' (the departments) encouragement of the two professionals to work together are the main motivating factors.
A 23-year-old female clinical psychology student said:
Some things motivate us. One of the things is the way we have been learning together by itself is inspiring. The discussion in the morning sessions is also very nice.
In another dimension majority of clinical psychologists and psychiatry residency students believe that their educational background different and creates a problem not to engage actively in the IPE experience.
Professional identity and IPE experience
The majority of clinical psychologists and psychiatry residency students believe that the IPE experience has a positive effect in developing their professional identity. The majority of them described knowing the other profession let them understand their difference and identify themselves with their profession.
A 24-year-old clinical psychology student said:
The courses are interrelated and sometimes they may overlap. I think it helps me to better identify who I am, and I think learning with them will help us develop better and to identify our focus area well and to identify which belong were, enable us to define and develop our identity better.
However, a few clinical psychology students believe prolonged exposure to IPE would interfere in the development of their professional identity by limiting their focus areas in their profession and recommends a limited exposure is better with a clear objective.
A 24-year-old female clinical psychology student said:
The learning process with them is great but it shouldn't be for a prolonged period... If it is limited to two or one month, then we need to focus more on therapy and talk therapy which would give us our identity.
Also, the majority of clinical psychology students unlike psychiatry residency students believe unclear role assignment and weak supervision in the program affect growth in their professional identity.
A 23-year-old clinical psychology student said:
As a clinical psychologist as I told you during this two year our role was not clear so I couldn't explain my identity because at first, they shape us as a psychiatrist. If you ask me to define, I will give you a psychiatric definition due to we spend a lot of observing them almost for one year.
Moreover, the majority of clinical psychology and psychiatry residence students believe that there are positively growing towards their ideal clinical psychology and psychiatry residence student identity. The majority also believes that developing a professional identity is a continuous process and realized their change throughout their years of education.
A 34-year-old male psychiatry residency student said:
I put all my effort to achieve but it doesn't mean we will be like our seniors within three years; however, we start to develop that direction. The environment and senior instructor help us shape our self in that direction. I think I am on a good road.