We sought to describe and evaluate trainees’ knowledge on HIV care and their assessment of a novel IPE training programme involving final year pre-service students and practitioners of the common health professions in Ghana. There were significant increases in the overall post-training median score and across most categories. Most trainees felt very confident to perform most of the module-related tasks after the training and were satisfied with the delivery and facilitation of the training.
In agreement with previous studies on IPE training [8, 9], we observed a significant increase in the overall post-training median score, compared to the pre-training median score. With the exception of the physician assistants, similar significant increases were observed across all the other professions. The non-significant difference in median scores for the physician assistants could be related to the experience of the trainers. While the facilitators from PUC were only involved in two training workshops, their counterparts facilitated 10 training workshops making the latter more experienced in delivering the workshops. It is also possible that students from PUC may have had less exposure to such training workshops (compared to students from KNUST), thus influencing their understanding and subsequent post-training median scores[10]. These arguments are also supported by the fact that the pre- and post-training median score for PUC students (physician assistantship and nursing students) remained unchanged, after stratifying the median scores by training institution/facility (Table 2). The pre-training median scores differed significantly across professional categories, with Medicine and Dentistry, and Pharmacy having the highest median scores. A similar trend was observed in the post-training median scores. It is worth noting that the greatest improvement in post-training median scores was attained by the Medical Laboratory Science students. As observed by Erickson and colleagues in a similar study on IPE [11], we contend that the ranking of the pre-training median scores could relate to prior exposure to HIV course content by the various categories of health care students. Medical and Pharmacy students and practitioners would have had more in-depth formal education relating to HIV management in their training curricula and clinical practice compared to the other professions, thus accounting for the higher pre-training median scores. This prior exposure and clinical experience subsequently enhanced their understanding of the workshop content, resulting in the trend observed in the post-training scores[11].
We observed significant differences in pre-training median scores across the three training levels; pre-service students, house officers/interns and professionals with prior work experience. Interestingly, the house officers/interns had the highest pre-training median scores than the professionals who had been working in HIV care. This could be attributed to the fact that house officers/interns were recent graduates who may have learnt rigorously for their final exams thus covering some of these topics in their preparation for the final exams. All the post-training median scores improved with significant increases for students and house officers/interns. The post-training median scores were not significantly different across the training levels, indicating that the training improved the knowledge of all trainees on HIV management regardless of the training level of the participants. Predictably, there was a non-significant increase in post-training median scores for health professionals who had been working in HIV care. Since the training largely reflected common scenarios in HV-related clinical care, it is plausible that most of these professionals would have been exposed to similar clinical scenarios and would have also had some previous training in HIV management, thus accounting for the non-significant increase in post-training median scores. Similarly, the increases in post-training median scores were not significant for trainees from the district hospitals supported by PEPFAR and the Agogo Presbyterian Hospital, since these professionals had been working in HIV care. The median scores for the four core modules increased significantly after the training suggesting that the training improved participants knowledge in the aspects of HIV care covered by these modules. Modules 3 (HIV and TB co-infection) and 17 (paediatric HIV) recorded the lowest pre- and post-training median scores, possibly because these modules appeared to be technically more difficult to understand, in our view, and also required much longer training time.
Apart from acquisition of knowledge, IPE has also been found to have multidimensional gains including; appreciation of the values and significance of other health professions, playing a key role in dispelling stereotypes, establishing effective working relationship in health care delivery, building professional relationships, improving patient-centered communication and attaining health care quality improvement goals [8, 12–14]. These ultimately result in improved clinical outcomes for patients and increased job satisfaction for health care workers[8, 14]. While up to 27% of trainees were not comfortable with performing specific module-related tasks prior to the training, this reduced remarkably to less than 6% after the training. Furthermore, the proportion of trainees who were confident in carrying out these tasks almost doubled after the training. Hence the training increased the confidence level and ease of performing these essential module-related tasks among participants. It is worthy of note that a vast majority of the trainees rated the training sessions highly in terms of the content, mode of delivery and facilitation. It is also commendable that the workshops encouraged interprofessional collaboration and emphasized quality improvement. Consistent with results of a previous study in Canada [15], an overwhelming majority of the trainees were satisfied with the training.
Implementing effective IPE requires resources, innovative curricula to generate interest, competent faculty to lead interprofessional trainings, and committed leadership for spearheading and coordinating across professional training programmes, academic calendars, schedules and timetables [5, 7]. Key stakeholders should be involved from the onset and throughout the planning and implementation stages[5], as was done in this study. Existing faculties and experienced practitioners were also involved in the implementation, thereby reducing cost. Despite these challenges, IPE is important for low-income countries, and the necessity of this modality of training cannot be overemphasized [5, 7]. We are optimistic that the knowledge and skills acquired in this IPE training would translate into improved team-based and patient-centered care and ultimately better health outcomes for patients.
Key strengths of our study were inclusion of the common health professions as well as pre-service and in-service personnel. As much as possible, training sessions were stratified by the training level of participants; pre-service students, interns and professionals who had been working in HIV care. However, the study had some limitations. In one training site largely consisting of students with very few in-service personnel (interns and experienced professionals), it was not possible to organize separate training sessions for the in-service trainees due to their small number. It is conceivable that some students would have felt intimated by the presence of their senior colleagues who teach or provide guidance during practical clinical sessions. The use of different sets of facilitators at the training sites could have influenced the delivery of the modules and hence the understanding of the trainees and the outcomes. However, this strategy was adopted to the build the capacities of the partner institutions and training sites.
Conclusion
The programme presented a unique opportunity to provide pre-service and in-service team-based interprofessional training for health care professions in Ghana. To our knowledge, this IPE training for pre-service health students from universities in Ghana is novel. The programme improved students’ and practitioners’ knowledge in HIV care. Although the focus of the training was on improving HIV care, the principles could be applied to most clinical scenarios. Given the positive feedback from this training programme, IPE should be incorporated into the pre-service curricula for health students and continuing professional education for health professionals. The clinical impact of the knowledge and teamwork skills acquired needs to be investigated.