The data yielded two themes namely A) the formal IPECP curriculum and B) teamwork between stakeholders (see Figure 1). Each theme is supported by categories to provide insights for developing the IPECP curriculum at the university. At the end of each subsection a textbox is included to summarize practice considerations that could promote the development of collaborative IPECP curricula.
Theme A: Formal IPECP curriculum
Three categories were identified within theme A, namely: A1) An embedded curriculum, A2) IPECP core competencies and curriculum content and A3) Teaching, learning and assessment methods.
Category A1: An embedded curriculum
An embedded curriculum refers to the curriculum content and logistics of IPECP, and how it integrates into the professions’ curricula.
Subcategory A1.1: Buy-in from management is essential
The success of an IPECP curriculum is dependent on the position taken by university and faculty management. The Lecturer Lens indicated that buy-in from all levels of management is essential:
“… the moment it comes from management it [support for an IPECP curriculum] proves the relevance of it. And, if the relevance is clear … people follow and … more willingly do it.” (Focus_group_Pharmacy_ lecturer)
“…[We] need a strong top-down approach to ensure commitment. Deans and HOD’s should find ways of letting [commitment to IPECP] cascade down into the Schools. It cannot happen at [lecturer] level”. (Focus_group_Oral_ Health Sciences_ lecturer)
From the PI Lens the IPECP curriculum at this university started from a bottom-up approach, with lecturers from four professions designing a single IPECP event. The PI reflected that the need for a more formalised IPECP curriculum gained recognition through a publication [9], successful award of funding (2018) and an institution wide project organised by the Deputy Vice Chancellor (DVC, 2021) that included the IPECP Indaba with internal and external presenters, followed by an IPECP Strategic Planning session. This resulted in the top-management incorporating IPECP in the University’s Strategic Plan and Performance Management system (2022). This process created buy-in for the IPECP curriculum allowing the PI to initiate the development of a more comprehensive IPECP curriculum and investigate the possibilities for integration across all professions.
The literature lens supports this premise that management buy-in is essential to an IPECP curriculum [16]; [17].
Sub-category A1.2: Year levels to initiate IPECP
The Literature Lens revealed a lack of consensus on when to initiate IPECP. Rotz et al. [18] suggested starting IPECP in first year before there are any negative associations between the professions, while Wilbur and Kelly [19] indicated that in first year, the students do not know enough of their chosen profession to participate optimally with students from other professions. In support of IPECP starting only in the final year, Imafuku et al. [20] indicated that students need to understand their own profession and have gained knowledge and skills before engaging in collaborative work. The scoping review [15] found that in the majority of studies, IPECP were initiated in the final year of study (49%), as opposed to 28% initiated in the first-year, while 23% of studies scoped did not specify the year for IPECP initiation.
The Student Lens revealed the need to start from first year to build up knowledge, skills, and attitude regarding cooperative learning with other students. The IPECP needs survey showed that 59.6% of students felt that IPECP should be included at all year levels, whereas only 24.7% felt that only senior/final year students should participate.
“So, if [IPECP] starts in first year, at least you … build up knowledge until you graduate…to have a clearer understanding [of the roles of professions]”. (Focus_group_Health_Care_Sciences_students)
“It is hard to change a habit like [working with own profession only]. So, if you start by teaching them from first year they will get used to working with other people [in other professions] and take those systems to the clinical site”. (Focus_group_ Medical_ and_Radiography_student)
The Lecturer Lens supported students’ suggestion to start at a first-year level; 78.7% of lecturers indicated in the needs survey that IPECP should include all year levels, with only 14.9% indicating it should focus on senior/final year students.
“I think it should be taken from first year so that the importance of group work and the links of different professionals to care for a patient is understood well from first year. This mode of learning should form part of the orientation of first years and should be included from this level to the final year”. (Needs_survey_lecturer)
The PI’s perspective was shifted by the students’ and lecturers’ consensus that a longitudinal curriculum should be developed (PI Lens). The PI initially believed that students need to have a strong personal sense of professional identity before exposure to IPECP. One of the PI’s primary concerns were that a longitudinal curriculum would be more resource-intensive and complex to logistically implement than offering a module for only final year students.
Subcategory A.1.3: Curriculum management
The Literature Lens cautions that embedding IPECP across all profession’s curricula needs careful logistical considerations. Focused effort is required to provide resources and infrastructure, including strong administrative support [21]. The scoping review [15] findings highlights that the number of professions that participate in a specific event varies and is often dependent on the variety of professions trained at the same university. Events also vary in size and duration, with some events having up to 1000 participants. Findings suggest the optimal size of small groups were three to 10 students, depending on the availability of students and lecturers [15]. Time allocation in the curriculum is also controversial as IPECP is resource and time intensive and requires significant coordination. Attention to delivery-capacity may overcome the perceived time and resource challenges[22]. Centralized planning could address the logistics of implementation [23].
From the PI Lens, there are both advantages and disadvantages when trying to include all students in the same event. At this university, there are 11 professions from four schools included in the curriculum which includes about 650 students and ideally requiring 65 lecturers. Managing such high number of students and lecturers in a single event requires a lot of preparation, planning, coordination, financial support and facilities. A complicating factor experienced during the pilot IPECP events was the differences in year levels and number of students per profession. Medical students outnumber other students five to one, and they are sixth year students compared to most students from the other professions who are fourth- and third-year degrees. Power imbalance and hegemony inhibited optimal participation in discussions. It was, however, satisfying to be able to expose students to ten other professions, where they learned to value each profession’s contribution.
One of the challenges expressed through the Lecturer Lens remains the synchronization of timetables and coordination of IPECP activities, accentuating the need for an interprofessional coordinating committee or an IPECP unit as indicated by 85.1% of the lecturers in the needs survey.
“…not everybody’s clinical curricula run at the same time and not all our students are at the same clinical areas, so it is difficult for them to also get there and practice what they have learnt in terms of collaborating with other team members”. (Focus_group_Health_ Care_Sciences_lecturer)
“I feel that the staff is overwhelmed with preparing and implementing this week - we need a dedicated IPECP Unit to be able to optimally implement this program”. (Feedback_IPEC _week_lecturer)
Textbox A1 summarises practice considerations that could promoted the development of IPECP embedded curricula.
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Box A1. Practice considerations to promote IPECP Embedded Curricula
• Requires buy-in from the institutional management.
• The IPECP curriculum should start in the first year and continue throughout the undergraduate training, to develop of role understanding and collaboration between professions.
• Formation of an IPECP unit, as an institutional IPECP unit can address logistics such as coordinate the curriculum, plan and present the content, and manage the resource allocation.
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Category A2. IPECP core competencies and curriculum content
At this university, the IPECP pilot module was designed around achieving the IPECP core competencies [24] and to ensure that the IPECP curriculum content was tailored to meet local healthcare needs [15]).
Subcategory A.2.1. Scaffolded approach
According to the Literature Lens, it is important to build skills over time, that is offering IPECP as a longitudinal course from first to final year, so that when students graduate, they are practice-ready [25]. Building skills can be achieved through a scaffolded approach and backward curriculum design, where each year levels’ achievements, forms the basis for the next year level, and where the IPECP core competencies, guide planning [26]. This is in line with the previous suggestions in theme 1 of offering IPECP to all year levels
The Student Lens confirmed that IPECP requires repeated and re-enforced exposure:
“not just be stuck on at the end of your studies when you are ready to move on, …[needs to] allow for continuous repetition, establish a habit and encourage students to invest more effort.” (Focus_group_Medical_ and_ Radiography_student)
The Lecturer Lens encouraged more longitudinal engagement of students, rather than limited exposure in a once-off event:
“We need to find a way to have students working together on a project throughout the year or on a quarterly basis and submit work done on those case studies. In this way we ensure that there is continuous interprofessional learning and teaching.” (Needs_survey_lecturer)
While a longitudinal, scaffolded approach is indicated in the other lenses, the PI Lens advocates for caution as longitudinal projects requires additional lecturers’ and students’ time investment. During previous IPECP projects at this university e.g., portfolio submission, students and lecturers were reluctant to respectively submit, and mark submitted work, as it was seen as superfluous addition to their workload.
Subcategory A2.2 IPECP core competencies and learning activities
The Literature Lens indicated the need for integration of IPECP core competencies in the curriculum of health care professions. IPECP competencies include roles and responsibilities, teams and teamwork, interprofessional communications and values and ethics [24] and need to form the basis for all learning activities [27].
The Student Lens’ highlighted how IPECP contributed to their skills:
“…everyone individually gains that knowledge [role clarification] in their own professions but only during IPECP and during your collaborative practice, can you really interpret it.” (Focus_group_Health_Care_Sciences_student)
Seventy-six percent of students supported the need for alignment of IPECP core competencies with learning activities. Students specified that simultaneous interaction with students from a variety of professions optimizes appreciation of roles and responsibilities, as well as of teams and teamwork.
Students found different aspects of learning activities meaningful. For example, some enjoyed the educational games, others learned most through the role-play, specific presentations on pain management and ethics. From the PI Lens, one explanation for the students appreciating specific activities more, may be due to students’ different learning styles. Accommodating different learning styles enhances learning [28].
Formulating learning activities that resonates with 11 different professions is complex and time-consuming and needs collaborative input from all professions. Within this current curriculum there was a need either to develop of a very complex case study, or to focus on a general condition, to ensure each profession have a significant role in the case study. The PI experienced the benefits of collaborative development of a suitable complex case study, as is done in African Virtual Interprofessional Education (AfriVIPE), where lecturers from a variety of international institutions and professions contributed the development of virtual interprofessional learning process and offer a once-a-year event. Collaborative case development ensured the case study was realistic for lecturers and students.
Subcategory A2.3 Benchmarking against national and international practice
Through the PI Lens it became evident that planners of a new IPECP curriculum need to be cognizant of the standards of IPECP at other universities. Through international exposure, the PI became sensitised to how the local context and access to learning and financial resources, largely influenced the content and implementation of an IPECP curriculum. Building relationships and sharing resources with other universities facilitates benchmarking the curriculum. While universities in the global north often have well-developed IPECP curricula, many universities in sub-Saharan Africa and even in South Africa, are still in the early implementation phase of IPECP curriculum development.
Both the Student and Lecturer Lenses confirmed the importance of benchmarking where 85% of students and 93% of lecturers indicated in the needs survey that they want to know about IPECP curricula at other universities.
Textbox A2 summarises practice considerations that could promote the development of IPECP core competencies in curricula.
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Box A2. Practice considerations to promote IPECP core competencies and curriculum content
• Plan the content of the curriculum around achievement of IPECP core competencies.
• Use scaffolded curriculum approach to gradually build-up and re-enforce learning.
• Present a variety of learning activities for students with different learning styles, to make learning meaningful.
• Benchmark with other institutions to establish and align with national and international standards.
• Foster national and international relationships to create opportunities to share resources and learning opportunities.
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Category A3 Teaching, learning and assessment methods
Teaching, learning and assessment methods that facilitated collaborative competencies may require strategies that differ from profession-specific subjects.
Subcategory A3.1 Lecturers preparation to facilitate
The Literature Lens emphasize the value of facilitator preparation for both lecturers and students, as an integral part of the preparation for IPECP modules [29]; [30]). Lecturers may feel threatened in a situation where they need to incorporate their profession-specific roles as well as role model interprofessional behaviour [31], due to the perceived loss of professional identity and concerns in relation to the erosion of professional boundaries[32].
The Lecturer Lens confirmed the value of, and need for, thorough facilitator preparation:
“Because you know when there is no training and you are pushed to do a curriculum and you do not understand first, it will be very difficult.” (Focus_group_Oral_Health_Sciences_lecturer)
Through the PI Lens, the PI acknowledged that lecturers often experience fear and uncertainty when they need to facilitate a group of students from different professions or where their field of practice differs from the presented case. Involving both novice and experienced lecturers in training and presentation allows all to benefit from shared learning. Incorporating co-facilitation in allocating lecturers to small groups is valuable in terms of adding additional in-service learning, enriching experiences for students and lecturers, helping to share workload and boost confidence. Lecturer training in facilitation enriches personal and professional growth. The PI noticed that lecturers’ exposure to the use of simulated patients in IPECP, created skills transfer to the lecturers’ profession-specific teaching.
The Lecturer Lens further accentuated the benefits of co-facilitation, for not only IPECP but even overflowing into benefits in profession-specific teaching:
“oh, another lecturer does something else”, and “I could incorporate that into my teaching methodology”, “…and that in itself should form, or start forming a culture of lecturers or facilitators…, that teach in such a way that the students benefit a lot more than just being giving a lecture..” (Focus_group_Medical_and_Radiography_lecturer)
In developing the IPECP curriculum there is an additional need for preparing and involving clinical supervisors, as they should guide the application of IPECP knowledge in clinical practice:
“Clinical supervisors need to be made aware of students’ exposure to IPECP and the expectations of implementing collaborative care during clinical blocks.” (Focus_group_Clinician_lecturer)
The Student Lens supported the need for clinical facilitator preparation and buy-in.
“Even if students are taught not to work in silos, clinical placements may derail the process [if clinicians are not practicing collaboratively].” (Focus_group_Medical_and_Radiography_students)
Subcategory A3.2 Teaching methods for IPECP learning
The PI lens acknowledges that teaching methods in IPECP is different from teaching a profession–specific subject, as IPECP focuses more on facilitating learning than on being a content-expert. Therefore, the students and lecturers need to be constantly reminded that the focus needs to remain on providing opportunities to learn with, from and about each other and achieving IPECP core competencies.
In the Lecturer Lens, lecturers elaborated on how alternative teaching methods differed in IPECP, especially the use of role-play and multi-facetted, interprofessional team-developed case studies,
“The fact that role-play and the SP’s (simulated patients) are a part of it…role-play in itself is a phenomenal dynamic, teaching method, because it’s a safe space where students can test and try and receive feedback.” (Focus_group_Medical_and_Radiography_lecturer)
“The reality is that when many different professions are involved, either case studies should be complex, requiring intervention from multiple professions, or more than one case study may be needed, to ensure an overt role for each of the involved profession.” (Focus_group_Health_Care_Sciences_lecturer)
At the University, the students are actively involved in the planning, promotion and presentation of IPECP events. The Students Lens highlights the value of student involvement in planning and presenting the IPECP curriculum. Students indicated some very relevant expectations e.g. activities that are novel and encourage interaction or have new content:
“Like [during the IPECP curriculum] play games at some point. Or maybe during that week or that time, there is just something to interact.” (Focus_group_Health_Care_ Sciences_student)
“...one of the things we did was disaster management, …. something very new to us, … we did not even know that in an emergency situation we could play a role.” (Focus_group_Health_Care_ Sciences_student)
Through the Lecturer Lens it became evident that lecturers became more confident in and recognised the benefits of using technology such as learning management systems (LMS) through their COVID19 emergency remote online teaching.
“I think blended learning will work in the second, third and fourth years, where you then not only have class but you can on [the university’s LMS] … have assignments to do, online questionnaires…for them to complete.” (Focus_group_Pharmacy_lecturer)
Parts of the curriculum is presented online, however, 73% of students wanted to have more face-to-face sessions. The Student Lens highlighted the following advantages of face-to-face learning:
“Face-to-face encourage students to participate more and form better relationships between professions” (Feedback_IPECP_week_student)
“I had no idea that I preferred face-to-face, as it allowed me to bond with my group mates on a more personal level.” (Feedback_IPECP_week_student)
After two years of mostly online learning, students however acknowledged the advantages of learning online such as convenience, availability of recordings and accommodation of large groups.
“… online sessions are good for both shy and outspoken students e.g., value of anonymity to ask questions, it is convenient, sessions were always recorded so you would go though it time and again, while face–to-face ensure all students are on the same page” (IPECP_week_student)
Through the Lecturer Lens, 65% of lecturers indicated, in the needs survey, that IPECP opportunities for both face-to-face and online learning is preferable to only face-to-face learning. This lens also highlighted the disadvantages of online teaching and learning in IPECP as connectivity issues, as well as lack of engagement of students in online sessions. Large groups on the university’s LMS created some additional challenges e.g., chat function is not available in a large session. However, most lecturers, 76%, reported that students do use blended learning opportunities e.g., accessing information on in preparation for learning.
The Literature Lens supports the use of blended learning with synchronous and asynchronous online activities to implement a successful IPECP curriculum [33], [34].
Subcategory A3.3 Assessment
Assessment of learning in IPECP is controversial. The Literature Lens cautions that IPECP is about achieving team skills, and therefore assessment of individual student’s work is not necessarily the most effective method. The assessment activities are often poorly aligned to the instructional methods and learning outcomes in IPECP curricula [35]. Common practice is to provide students with surveys to assess their professional and personal growth e.g. to assess either their Readiness for Interprofessional Learning (RIPLS) [36] or alternatively achievement of Interprofessional Collaborative Competencies Attainment Survey (ICCAS) [37], but this reflects the lack of constructive alignment of the assessment. Reflection as an assessment opportunity has the dual role of providing evidence of the student’s achievement of the IPECP competencies and forms a record of the students’ growth over time [38].
The PI Lens revealed that students benefit from feedback on the daily reflections. Students’ personal and professional growth is seen when lecturers are committed to mark the daily reflections. Most students and lecturers require training on critical reflection. Surveys and feedback on the curriculum may yield some valuable information for curriculum planning but cannot replace assessment of learning with allocated marks.
The Student Lens raised concerns regarding the time and effort spent on IPECP without allocated marks. When IPECP is not included in assessment, students are less committed to participate and to appreciate the value of IPECP. Students showed less conviction than the lecturers that IPECP activities should contribute to marks (56.3%: value IPECP if it contributed to marks; 29.2%: it should continue to be non-compulsory and not for marks).
The Lecturer Lens supported the student lens with 84.8% of lecturers indicated that students would value IPECP if it contributes to marks, whereas only 8.7% felt that there was no need for a formal IPECP assessment - it should continue to be non-compulsory.
Textbox A3 summarises practice considerations that could promote teaching and learning.
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Box A3: Practice considerations for teaching, learning and assessment methods
• Prepare lecturers to accept the role as facilitator rather than teacher and to learn through co-facilitation.
• Incorporate different teaching methods, including blended learning.
• Students provide valuable input in planning and presenting the IPECP curriculum that contributes to buy-in by the student cohort.
• Assessment strategies that are suitable for IPECP needs to assess teamwork rather than individual performance.
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Theme B Teamwork between stakeholders
Theme B yielded three categories, namely: B1) Importance of role modelling teamwork, B2) Patient-centered practice and B3) Diversity of professions.
Category B1: Importance of role modelling teamwork
Subcategory B1.1 Engagement of all stakeholders
From the PI Lens it became apparent that even though educational theory and facilitator preparation is important, is remains vital for all stakeholders to collaborate to prepare workplace-ready graduates. Planning the curriculum needs to be a collective process, which encourages teamwork rather than individual achievement.
The Lecturer Lens further encourages transformation of the teaching culture, with more collaborative practice amongst clinicians and academics, from different professions and health care facilities.
“……that could also establish a teaching culture… where people are beginning to work a lot more on a level, aiming for something bigger than just my little area of expertise and my little knowledge…” (Focus_group_Medical_and_Radiography _lecturer)
Subcategory B1.2 Importance of role models
The Student Lens emphasized the importance of role models in preparing students to work collaboratively, rather than competitively.
“They [clinicians] lead by example [as a way of teaching]. The people who teach us set that example, so we know what we are meant to do.” (Focus_group_Medical _and _Radiography_student)
“It [IPECP] allows students from different professions to learn from each other and understand that they are team members rather than each other's competition” (Needs_ survey_student)
Textbox B1 summarises practice considerations that could promote role modelling teamwork.
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Box B1: Practice considerations for role modelling teamwork
• Engage all stakeholders during planning to foster collaboration.
• Students benefit from having role models for teamwork
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Category B2: Patient-centred practice
The Lecturer Lens indicated that IPECP could play a vital role in the development of skills to work holistically and in a team, in meeting patients’ needs. They emphasized that exposing students to collaborative treatment of real patients during clinical practice, could improve patient-centred care and enhanced patient outcomes.
“The students learn very early in their careers that they have a role to play in ensuring that the patient’s health needs are holistically met, collaboration with other health team members is key.” (Needs_survey_students)
The PI Lens recognised that working on real patients is an important progression from practicing in class, and in simulation using trained simulated patients. The university is linked to a large academic hospital; however, it is logistically challenging to find suitable patients, where all professions are involved in the treatment. The PI suggests that patient interaction is more feasible and realistic during clinical practice, than as part of the IPE sessions. During clinical practice, lecturers need to expect students to treat patients for whom they are responsible, collaboratively.
The Literature Lens, Ntsea et al. [39] demonstrated that at another South African university using live streamed real patients was a good IPECP learning experience, but students also felt it was invasive having a group of students around the patient as well as live streaming to a much larger remote group. These students commented that a simulated patient group consultation could be crafted to accommodate all involved professions.
Textbox B2 summarises practice considerations that could promote patient-centred care
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Box B2: Practice considerations for patient-centered practice
• Provide opportunities for students work collaboratively during clinical practice to ensure patient-centered care.
• While simulated patients offer broader role exposure, there is a recognized benefit to having real patient contact.
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Category B3: Diversity of professions
IPECP prepares students for the reality of the work environment, where they will need to cope with diversity in terms of professions, competence, and professional vernaculars.
Subcategory B3.1: Expectations of the professions and accreditation bodies
From the Literature Lens accreditation bodies expect students to be exposed to IPECP during undergraduate training. Thistlethwaite [40] and Steketee et al.[41], concluded that lack of uniform guidelines across different professions on how to incorporate IPECP into curricula, hampers implementation. To address the lack of uniform guidelines in South Africa, the Academy of Science report [42] recommended a national working group to develop and guide the implementation of a strategic plan, to make IPECP more sustainable.
The PI Lens found that three different accreditation bodies accredit the professions included in the IPECP curriculum. Even within the major accreditation body, the Health Professions Council of South Africa (HPCSA), that accredits nine of the eleven professions, there are different professional boards, each with its own criteria for incorporating IPECP. The developers of a curriculum need to ensure that the curriculum meets the needs of all accreditors to ensure students are allowed to participate.
Subcategory B3.2: IPECP competence and preparedness at the start of curriculum
The Student Lens provided valuable inputs by comparing what they learnt in their own professions, with IPECP. Students suggested that an understanding of their profession-specific scope of practice was important before contributing during IPECP case studies. Students suggested that, as prerequisite to IPECP, the teaching content should include the roles of other team members; especially when considering specific conditions/diagnoses (e.g., head injury or asthma). The pharmacy students specifically felt disadvantaged during IPECP activities due to their limited knowledge of other professions and their overall lower exposure to patient contact
“I think before they could come to the IPECP curriculum, they should be informed of what other professions do in their own Schools” (Focus_group_Pharmacy_student)
“…most medical students, nurses and radiographers actually experienced the benefits of… interacting with the patients... speaking from experiences and things they have worked on before. (Focus_group_Pharmacy_student)
Subcategory B3.3 Vernacular of the professions
The Student Lens indicated that students realized the professional terminology from one profession might not be familiar to other professions. For example, if an occupational therapist uses the term occupational deprivation, other professions may not know what they were referring to. Students had to transition from using profession-specific terminology, to using more generic medical terminology during IPECP, combined with lay terms, to make themselves understood. The clarification of common terminology was required when students communicated with other team members and patients during patient interactions:
“…we can actually learn more as we go by different terms that we use [during role clarification exercise] … everyone was trying to talk in the most layman’s terms, but with regards to certain medical things [general medical terminology] everyone there could basically understand what was being said.” (Focus_group_Health_Care_Sciences_ student)
The Lecturer Lens confirmed the importance of terminology as baseline when interacting with other professions during patient discussions:
“We talk [speak] the same language; the more everybody is really on track with the whole prognosis of the patient, from the very beginning to the end” (Focus_group_Clinician_ lecturer)
The PI Lens contributed to addressing the discrepancies in terminology used by professions by acquainting students and lecturers with the International Classification of Function, Disability and Health (ICF) [43]. The ICF offers a universal terminology and teaches students and lecturers a valuable method for holistic patient-centered care classification. Integrating the ICF into the case study analysis, and expecting students to complete combined ICF forms, as part of their clinical performance, enhanced collaborative patient care.
Textbox B3 summarises practice considerations that could promote relationships between diverse students and lecturers.
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Box B3: Practice considerations for diversity of professions
• Focus on building relationships, both personal and professional, to prevent and overcome challenges.
• Foster more egalitarian relationships, to build respect and trust between professions and individuals.
• Engagement with other professions’ lecturers and students afford opportunities to form new relationships and resulting in diminished prejudice.
• Lecturers guide students to bring their professional expertise to team-based care, in order to adopt a dual identity of uni-professional and of interprofessional team member.
• The diversity of professions includes different expectations from accreditation bodies that needs consideration during planning.
• The level of preparedness, especially in terms of exposure to patients, with which students arrive to engage in the IPECP curriculum, could influence student’s competence during participation in discussions of case studies and planning patient-centered care.
• The ICF can address diversity and the differences in vernacular between profession as it not only presents a uniform terminology but also contributes to holistic, patient centered care.
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Category B4. Affordances and challenges in relationships
The IPECP curriculum provides positive opportunities, that are the affordances of relationships. However, inherently there are also some challenges or more negative integral consequences for example challenges that planners of the IPECP curriculum need to consider, such as hegemony and conflict. Recognition of both affordances and challenges can foster the growth of the IPECP curriculum
Subcategory B4.1. Fostering egalitarian relationships led to respect and recognition.
The PI Lens highlighted the importance of relationships between stakeholders, that forms the foundation for obtaining IPECP curriculum sustainability. Many challenges to IPECP curriculum implementation can be overcome by fostering both personal and professional relationships, building on a culture of caring, and the recognition and respect of every person’s valuable contribution. It takes time and a community-of-practice to build relationships between lecturers of different professions, however, building relationships could have long lasting positive effects in terms of increased collaboration, even culminating in interprofessional collaborative presentations and research.
The Literature Lens indicates a number of barriers to developing relationships between lecturers, including power undercurrents, negative communication patterns, unclear roles and responsibilities and conflicts related to disparate approaches to patient care [44]. Khalili et al. [45] refer to ‘‘turf protection’’ behaviours that are deeply rooted in socialization and education of healthcare professionals. Interprofessional socialization [45], [46] need to be fostered to develop trust, respect and positive interprofessional relationships with colleagues across professional borders [31]; [11]. Unlike the difficulties in shifting the power balance in interprofessional relationships, trust and respect can be fostered by building personal relationships and establishing agreed rules that govern collaborative care and that are perceived as fair [47]. Profession-specific socialization may be hindering the development of interprofessional relationships[32]. In addition, there is a need to gradually initiate professionals to work within interprofessional teams needing insight into the socialization processes, as well as a culture of interprofessional respect [48]. Health professions students can be guided by lecturers to adopt a dual identity of the uni-professional and of the interprofessional team member, thus bringing their uni-professional expertise to team-based care [49], [45]. The hegemony of uni-professional beliefs and practices poses a possible barrier to interprofessional relationship development.
The Student Lens emphasized the importance of students learning to respect the contribution of their own and other students’ professions, specifically highlighting the following:
“Respect for one's profession; this will enable the students to easily work together in a healthcare environment, without being biased towards one another.” (Needs_survey_ student_comment)
It was also interesting that students anticipate the long-term benefit of IPECP in terms of professional recognition and building professional identity:
“… [in IPECP] make every single profession to feel how important they are…if every single profession [is made] to feel important, they [students in the IPECP curriculum] will bring value into the health care system” (Focus_group_Pharmacy_student)
The Lecturer Lens highlighted opportunities for students to form more egalitarian relationships because they have more insight in the contribution of students from other professions:
“… not only do you gain more insight into what they [other professions] do, but you actually meet the person behind the professional, and in doing so you realize that the professional is one thing, but the person is another…. (Focus_group_Medical_and_ Radiography_lecturer).
Sub-category B4.2. Conflict within and between professions
Within professions, lecturers often experience disapproval from peers, when they spend time preparing to participate and while participating in IPECP events because it is seen as neglecting their profession-specific duties. The Lecturer Lens indicated: “Commitment of staff members … gets impacted upon because of time and other responsibilities that they have”. (Focus_group_Medical_and_Radiography _lecturer)
“…it’s a lack of insight. They don’t realize the value [of IPECP], and [how it] links to the training.” (Focus_group_Pharmacy_lecturer)
“…if the responsibility was maybe spread …everybody taking ownership and the same amount of responsibility, sharing the load will definitely help.” (Focus_group_Clinician_ lecturer)
The IPECP curriculum needs to identify champions and leaders, that can overcome conflict and create a change of institutional culture to work more as a collaborative team:
“A culture change for the university should focus on collaboration between professions and using the available champions and leaders, who are already convinced of the value of teamwork, to move IPECP to the next level.” (Focus_group_Oral_Health_Sciences_ lecturer)
During IPECP small group participation the Student Lens noted that friction and resistance may occur which may limit participation:
“Conflicts may arise within the group regarding role play and role overlap which might make the other members of the profession not want to participate anymore” (Feedback_IPECP_week_student)
“…you get people who are very resistant… but they always feel they are so superior to everyone” (Focus_group_Pharmacy_student)
Through the Literature Lens explains how diversity, friction, and harmonization influences teamwork, especially if an aspect is missing or out of balance, indicating that each of these three aspects are important [50] .
The Student Lens pointed out that IPECP created opportunities to address negative feelings by exposing students to the reality of conflict and learning strategies to deal with such conflict, in other words harmonisation. An example offered was racial tensions that could potentially be explored through IPECP, to prepare students for the reality of the world of work:
“You will be taken to a set-up where we are practicing with people of different races …IPECP can potentially make things better” (Focus_group_Pharmacy_student)
Textbox B4 summarises practice considerations that could promote affordances and overcome challenges in relationships.
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Box B 4: Practice considerations for affordances and challenges in relationships
• Focus on building relationships, both personal and professional, to prevent and overcome challenges.
• Foster more egalitarian relationships, to build respect and trust between professions and individuals.
• Engagement with other professions’ lecturers and students affords opportunities to form new relationships that diminish prejudice.
• Lecturers guide students to bring their professional expertise to team-based care, in order to adopt a dual identity of uni-professional and of interprofessional team member.
• Consider how to address hegemony and attitudinal resistance to change during interaction with and between students, as well as between lecturers.
• Address the cause of negative emotions such as fear, friction and rivalry through showing respect and recognition of the value of each contribution.
• Engagement in IPECP can provide an opportunity to teach students how to deal with conflict.
• While conflict and negative attitudes may occur, engagement in IPECP can provide an opportunity for harmonization and provide balance to diversity and friction.
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Critical reflection shapes IPECP curriculum development
According to Brookfield [51], the purpose of critical reflection in education is to: illuminate the assumptions of power and dominant ideologies; and uncover assumptions about the hegemony of our own teaching practice. In this critical reflection, the themes that emerged were theme A) the formal IPECP curriculum and theme B) teamwork between stakeholders. Theme A largely interrogates the illumination of power while theme B exposes and challenges the hegemony of IPECP practices within this South African university. The major changes in the PI’s initial thinking in response to the reflection include aspects related to theme A in terms of envisaging a curriculum that can meet the needs of the university and in theme B the fostering of teamwork and relationships required for implementation of the curriculum.
In terms of the curriculum (theme A), firstly the recognition of the importance of buy-in from management for the growth of the curriculum and ensuring the availability to ring-fenced time and access to resources. The PI also initially set out to develop only a module for final year students. The input from lecturers, students, own experience as well as confirmation from a more comprehensive literature search convinced the PI that all year levels need to be included in a scaffolded approach to the curriculum development. Through interaction and benchmarking with national and international IPECP programmes the PI recognised the importance of including a variety of learning activities, teaching methods and preparation.
Theme B guided the PI to acknowledge power and challenges associated with diversity during IPECP, and how these differences could enrich the IPECP curriculum. The challenges in establishing egalitarian relationships should not be underestimated, to not only ensure collaboration between students but also between colleagues. The foundations for successful implementation of the curriculum lie within the stakeholder cohesion and supportive team culture.
Limitations
The paper is a critical reflection on the pilot IPECP module in one South African university and compares the perspectives of the PI, students’ and lecturers to literature. The singular as very specific focus of the project did not attempt to report on other curricula in the country. Due to the extensive range of factors that could influence curriculum planning, only the most common factors were addressed and some factors, that may influence other curricula significantly, could have been excluded. The project’s focus is limited to the perspectives of its participants. Even though reminded on several occasions via different platforms, not all students and lecturers provided input into in the feedback and needs survey.