A Mixed Methods Exploration of Values and Attitudes of Healthcare Students towards Interprofessional Education involving an Inpatient in an Acute Hospital Setting

doi:10.21203/rs.3.rs-3024272/v1

Background

Interprofessional education (IPE) occurs when students from two or more professions learn about, from, and with each other. Involving an inpatient in IPE in an acute hospital setting with patient-centred education may encourage movement between individual communities of practice, improving navigation of the broader clinical landscape of practice.

Methods

Four pilot workshops involving inpatients in an acute hospital occurred. Nine students from later years of their programmes were selected for each workshop by purposive sampling, three each from medicine, nursing and physiotherapy. Each workshop involved three subgroups of mixed disciplines with final full group discussion resulting in documentation of an overall picture of the patient, their clinical care to date and future clinical plan. One subgroup interacted directly with the patient. The other groups accessed relevant hospital documentation about the patient and their admission. A concurrent mixed methods research approach was taken. Semi-structured focus groups occurred with each discipline after each workshop, with subsequent analysis using Braun & Clarke’s reflexive thematic analysis process. Students completed the validated ‘Interprofessional Socialisation and Valuing Scale’ (ISPV) pre and post intervention. Inferential statistics compared overall scale and subscale scores pre- and post- intervention.

Results

Three major themes were identified: How are we currently relevant to one another? Who are we in our future professional context and in relation to one another? How do we align our activities and collaborate to develop into practice-ready healthcare professionals? These themes mirror landscapes of practice’s modes of identification of engagement, imagination and alignment, highlighting growth in knowledgeability of the students of the clinical landscape of practice. There was a statistically significant increase in overall interprofessional socialisation levels post-intervention, p < 0.001, with a statistically significant increase in all 3 subscales of the ISPV: Value - p < 0.001; Comfort - p < 0.001; and Ability - p < 0.001.

Conclusions

Through mixed methods research, the values and attitudes of healthcare students towards IPE involving an inpatient in an acute hospital setting were explored. A statistically significant increase in interprofessional socialisation and valuing was demonstrated. Furthermore, students grew in knowledgeability of the clinical landscape of practice, with inpatient involvement central to this growth.

Interprofessional Education

Patient-centred Education

Mixed methods Research

Landscapes of Practice

Acute Hospital Setting

Physiotherapy

Nursing

Medicine

Interprofessional education (IPE) occurs when students from two or more professions learn about, from, and with each other (1). IPE is vital for enabling effective collaboration, reducing medical errors, improving patient outcomes and ensuring effective multi-disciplinary team (MDT) based patient care (2–5). Working effectively in an MDT requires individuals to move beyond their Communities of Practice (CoP) into larger Landscapes of Practice (LoP). A CoP is a collection of people who share a common goal (6, 7), defined by its own inherent shared history, mutual engagement and joint enterprise (7, 8), with these elements differentiating each CoP (6, 7). LoP addresses the journey across boundaries between communities (6, 8). Interactions with and experiences of other CoP affect a learner’s identity, with resultant development of knowledgeability (8). Being knowledgeable about another CoP and its relevance in a broader landscape of practice helps a practitioner locate themself beyond their individual CoP (6).

The literature describes three modes of identification in LoP: Engagement, Imagination and Alignment (6, 9). Engagement involves recognising how, and developing a sense of why, different professions are relevant to one another (6, 9). Imagination refers to students gaining an understanding of who they are in the LoP, in their own role and in relation to each other (6, 9). Alignment involves a two-way process of negotiating with the other landscape to ensure that activities are co-ordinated, and intentions implemented (6). The complementarity of these three modes of identification at multiple levels of scale between CoP enables one to locate oneself in a landscape beyond one’s base CoP, allowing effective productivity in a landscape (6).

Developing future healthcare practitioners demands attention to negotiating borders and identity formation across different landscapes of practice. Educators need to actively create and pursue LoP opportunities (8). A 2019 study (9) found that junior doctors, while situating themselves well in their physician CoP, struggled to bridge the gap between themselves and their interprofessional colleagues in their relevant LoP. A lack of understanding of the roles, attitudes and expectations of healthcare practitioners beyond their own CoP resulted in them being unable to engage as an effective member of an LoP. The 2019 study advocates for interprofessional collaboration as an explicit learning goal. Looking at imaginative ways to support the bridging of CoP boundaries in the LoP is important, with effective IPE representing a possible way forward in this regard.

While much has been written on IPE in healthcare education (10–12), many of these sessions take place in a classroom or simulated environment (13–18) rather than a real-life clinical setting. The importance of patient involvement in undergraduate education is well acknowledged (19, 20). While IPE sessions involving real patients are increasing, these often involve patients living with chronic illnesses (20–22), with few, if any, IPE sessions involving an inpatient in an acute hospital setting. IPE sessions centred around an inpatient in an acute hospital setting can help mirror and promote a muti-disciplinary approach to patient care and may encourage better navigation of the clinical LoP. This mixed methods study explored the values and attitudes of healthcare students towards Interprofessional Education involving an inpatient in an acute hospital setting.

A pragmatic paradigm was utilised, where the research question takes priority over methodology or worldview (23), utilising a pluralist approach to understanding and solving it (24, 25). This results in a balanced axiology, a symbolic realism, an epistemology and methodology that represent a continuum between positivism and interpretivism.

A concurrent mixed methods research (MMR) approach was utilised, the aim being to produce results that are greater than either qualitative or quantitative used separately (26)drawing on the strengths of each to effectively research the area for investigation, thereby ensuring the best interpretation of findings (26). One method may predominate(27) denoted by capital letters (24); they may occur sequentially (denoted by ‘→’) or concurrently (denoted by ‘+’) (28). In this case a concurrent mixed methods research approach was utilised with qualitative predominating (QUAL + quant).

Methods

Ethical considerations

Ethical approval was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals, CREC Review Reference Number: ECM 4 (hh) 10/03/2020 & ECM 3 (j) 07/09/2021. NMC and HH are medical doctors with roles in an undergraduate medical programme. AS is a qualified nurse with a role in an undergraduate nursing programme. JD is a physiotherapist with a role in a graduate physiotherapy programme. The wellbeing of participants and patients was considered throughout, with no need for support or intervention occurring.

Workshop Design

In line with guidelines and placement profile for IPE (29), clinical IPE sessions at Mercy University Hospital Cork were informed by the presage-process-product (3P) educational theory. This ensured that the clinical IPE sessions were underpinned by educational theory, in line with best educational practices (30). Four pilot workshops occurred, each involving an inpatient, with nine students selected for each workshop by purposive sampling, three from each discipline in each workshop (total n students = 36). The selected students were from the later years of their respective programmes to ensure appropriate knowledge and familiarity with a hospital environment. The inpatients involved were a frail older adult, two respiratory cases and one post-operative case. Each session involved three subgroups, with a student from each discipline allocated to each subgroup, similar to a practice already in place in that hospital between final year medical and pharmacy students(31). Following a facilitator-led introductory session outlining the aims and objectives of the workshop, the students were divided into their three subgroups. One subgroup saw the patient, another accessed the medical chart. The medical chart contained all the information from the current admission, apart from the nursing notes which were filed in a separate nursing notes folder. While nursing notes were separate, the medical chart included notes from all other healthcare professionals involved in the patient’s care, as well as investigations past and present, past admissions, outpatient attendances, and correspondence. The final subgroup accessed the current nursing notes, drug kardexes and end-of-bed notes. Each group completed a worksheet incorporating medical, nursing and physiotherapy assessments. All students then met to discuss the findings from their assigned area and to build an overall picture of the patient, their clinical care to date and the future clinical plan. Experienced facilitators guided this conversation as necessary. To enhance understanding of each other’s disciplines, input from each discipline on the findings, care and management of the patient was encouraged.

Qualitative Data Collection and Analysis

From a qualitative side, semi-structured focus groups occurred with each discipline after each workshop. The focus groups were audio recorded, transcribed verbatim, and anonymised, maintaining details of the students’ discipline and which workshop they had attended (numbered 1 to 4: for example ‘Med 1’ was a medical student from workshop 1). The interviews were anonymised prior to analysis, and pseudonyms were used in the reporting of results. Data was analysed using Braun & Clarke’s six phase process of reflexive thematic analysis (32, 33). An initial inductive and subsequent deductive, constructionist approach was employed, with both semantic and latent coding used. The research team of NMC, HH, AS and JD met regularly throughout the data analysis. Following transcription and anonymisation of the focus groups, phase 1 of data familiarisation and immersion was followed by generation of initial codes in phase 2. The first focus group transcripts were analysed by all four members of the research team for coding purposes. Collaboration aimed for rich interpretation of meaning rather than consensus, with all codes generated openly and organically. No coding reliability was enforced, nor was a codebook created. The remaining focus groups were coded by two team members at a time. No a priori codes were used. The coded data was reviewed and analysed in phase 3 with collaboration of all four researchers to generate initial themes, through the amalgamation of codes that shared a common underlying meaning according to the researchers involved. Thereafter, in reviewing the potential themes in phase 4, the codes within themes were reviewed and refined by the four researchers. After this point, the links with potential knowledgeability in LoP were explored by the researchers, with three overarching themes being subsequently generated in phase 5. NVIVO was used to document and facilitate this reflexive thematic analysis.

Reflexivity

Reflexivity in qualitative research is the process of reflecting critically on oneself as a researcher and is the acceptance that the researcher’s prior experiences and their approach to reality have a bearing on the outcome of the research (34). This has been widely described in educational and social research (35–37). Banister (38) says that reflexivity is “acknowledging the central position of the researcher in the construction of knowledge.” In fact, it is argued that an awareness of the position and views that one brings to a research question should be viewed as a strength of the research (35–37, 39). In this paper the authors acknowledge their prior experiences as healthcare students and their current positions as health professionals and educators and consider themselves as co-constructors of knowledge together with the study participants.

Quantitative data Collection and Statistical Analysis

From a quantitative viewpoint, the validated 9-item ‘Interprofessional Socialisation and Valuing Scale’ (ISVS: ISVS-9A & ISVS-9B) was completed pre and post workshops respectively, each consisting of nine items scored on an 8-point Likert scale (40). Preliminary analysis shared in an email from H. Khalili, PhD ([email protected]) in October 2021 suggests that the ISVS A and B identifies within its items the original three subscales of the 24-item ISVS of value, ability and comfort in working with each other. With less than 10 items in the overall scale, it is sometimes difficult to get a high Cronbach alpha value (41). Thus, reliability of the scales/subscales was assessed using the mean inter-item correlation. A mean inter-item correlation within the range 0.15 to 0.50 was considered acceptable(42). Inferential statistics were used, with Wilcoxon signed-rank test used to compare scale and subscale scores pre- and post- intervention. The Null Hypothesis (H0) states that there is no difference between scales pre- and post- workshop for students participating in the workshops. The alternative hypothesis (H1) states that there is a difference between scales pre- and post- workshop for students participating in the workshops. To investigate if changes between pre- and post-intervention differed by Degree group, a linear mixed model was used. The fixed effects included in the model were group, time and interaction of group by time. A statistically significant interaction would indicate that the change over time differed by group. Subject identification was included as a random effect in the model. As scale and subscale scores were not normally distributed, normal score transformations were performed with transformed data used in the mixed model analyses. All statistical analysis was performed using IBM SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). All tests were two-sided and a p-value < 0.05 was considered to be statistically significant.

Descriptive Data

The characteristics of the participants are presented in Table 1.

Table 1. Characteristics of participants, n=35*

	n	(%)
Gender
Female	27	(77.1)
Male	8	(22.9)
Nationality
Irish	33	(94.3)
EU	1	(2.9)
North American	1	(2.9)
Degree
Nursing	12	(34.3)
Physio	12	(34.3)
Medicine	11	(31.4)
*n=36 in study but demographics only available for n=35

Qualitative Discussion:

3 major themes were identified, namely-

How are we currently relevant to one another?
Who are we in our future professional context and in relation to one another?
How do we align our activities and collaborate to develop into practice-ready healthcare professionals?

How are we currently relevant to one another?

The first identified theme, namely ‘How are we currently relevant to one another?’, mirrors the element of engagement in terms of identification in an LoP. It addresses the recognising how, and developing a sense of why, different professions are relevant to one another. Students reflected on their own place in the clinical setting. The medical students in general thought that the physiotherapy and nursing students contributed more in terms of clinical care, as physiotherapy and nursing students have a responsibility to get a job done in the clinical care of a patient. This contrasts with medical students who follow a team along rather than actively being involved in the care of a patient, stating that it was ‘not our place’ [Med 1 Brian].

All student disciplines recognised the gaps in their prior learning in terms of awareness of each other’s roles and what a multidisciplinary team actually means.

I feel like in college most of the time they emphasise like, work as a MDT, but maybe don’t specify what that means, it’s kind of like a buzz sentence that you kind of learn to say and learn to be familiar with, but I feel, like, when I came on placement, I didn’t fully know what that meant. Physio 2: Veronica

Students discussed how they have learned separate to other healthcare disciplines, operating in silos in their healthcare education, which negatively impacts on developing a sense of each profession’s relevance to the other.

When you are going through college there is almost a bit of a disconnect really, do you know, because all those disciplines are very separate as you are going through college.  Med 3: Ian 

Students recognised the need for good team dynamics in healthcare and healthcare education; they thought that the IPE session involving a patient helped to develop a sense of knowledge of the different roles and their relevance in an MDT approach, with good communication fostering better patient care.

This time next year we will be qualified so we will have to be doing this kind of stuff this time next year, discussing patients with doctors, nurses and everyone else in the MDT, so I think it is really more preparation for that and kind of give you a bit more confidence in knowing the role of everyone in the MDT and how important it is to have appropriate communication to ensure that the patient gets the best care.  Physio 1: Kate 

Students from each discipline stressed that patient care was better when they currently worked as, and contributed to, a team. They expressed that clinical IPE sessions, with the patient at the centre, can reduce apprehension and grow a realisation that every discipline is relevant and focussed on doing the best they can, helping and working together, for the best patient outcome.

I suppose it’s not as scary anymore, I think it kind of took away the fear. Nursing 1: Vicki

You just realise a lot more that everybody has to work together for a person to be cared for, for the best outcome of a patient to happen.   Nursing 3: Susan

I think it was great, it was something that I was probably a little apprehensive about because, again, you kind of feel like, oh God, I don’t know as much as the doctor or the nurse about certain stuff, but when you actually meet them and sit down and everyone is just kind of focusing on doing the best that they can and helping each other, it was actually great. Physio 4: Paula

You’re learning how to work with them in a team, the dynamic I’d say, that would be the biggest thing that I think and when I think about it, it is just learning how to work with them in a team and figuring out who has what responsibilities and what you are each meant to do, what each of you are meant to contribute to the team, that kind of thing. Med 2: Fergal 

Who are we in our future professional context and in relation to one another?

The second overarching theme, namely, exploring ‘who are we in our future professional context and in relation to one another?’ sits well with the element of imagination, which refers to students gaining an understanding of who they are in the LoP, in their own role and in relation to each other. This involves reflecting on themselves in terms of how they view each other and how they feel they are seen from the perspectives of other professions. It involves developing an awareness of their roles and responsibilities in relation to the roles of others within their future LOP. The students realised that a holistic interprofessional approach leads to better patient care, with patient involvement in IPE helping this to come to the fore.

I thought it was really helpful to be able to work with the other disciplines as well and put all our knowledge together and all the different perspectives of the patient. Nursing 1: Wendy 

And then how important it is to obviously work together for the patient’s best interest to make sure that we are all singing from the same hymn sheet, because, yeah, if we are not all looking at the same thing it’s not going to work really good for the patient, I suppose.  Physio 2: Ursula 

While interprofessional healthcare students and practitioners might each approach a patient differently, reflecting on what they have in common and how they can collaborate enabled them to learn about, from and with each other, thus developing a more comprehensive picture of the patient involved and their complete care needs.

I think it opens up topics to a wider range of knowledge that we maybe wouldn’t have been exposed to without mixing with other disciplines, and also, maybe it gives a scope for us to be able to actually not only, like, learn from other disciplines but actually also teach other disciplines as well, and they can teach us things that they know that we wouldn’t know ordinarily, so it kind of widens just the scope and the variety of information that comes available then from a situation. Med 1: Conor

The most important thing that I learned is that it takes everybody to try and get through to a patient and help him. Med 1: Abbie 

You can get such a wealth of knowledge from each other and then it is so much more efficient working towards the goals that you want to reach for your patients. Physio 2: Veronica 

Students expressed a greater sense of confidence in their role in an MDT, their interactions with different healthcare disciplines, and a reduction in fear, in response to the IPE session involving the inpatient.

I suppose it’s not as scary anymore I think it kind of took away the fear. Nursing 1: Vicky 

It is just really beneficial just to, as she said, just know where our role stands in the MDT and then just giving much more confidence in dealing in those kind of situations rather than being qualified and that being your first time having to really discuss a patient, when it’s, like, a doctor really having to discuss a patient with a nurse then, so it is much better to get the practice in there and get the confidence so that you are well prepared then for the future.  Physio 1: Kate 

How do we align our activities and collaborate to develop into practice-ready healthcare professionals?

The third overarching theme, ‘how do we align our activities and collaborate to develop into practice-ready healthcare professionals?’, fits well into the area of alignment. This involves working together and ideally with the patient to develop the most suitable care plan to meet the patient’s needs. It means aligning with and coordinating one another’s different professional backgrounds and different priorities through safe communication and an understanding of the language of the different professionals involved.

I got a great insight to see what the other students, like the medical and the nursing students, what they asked the patients. Physio 4: Rita

I was reading the history thinking of a differential diagnosis, it’s just like the automatic thing that we think of, whereas the nursing student was more ‘oh, I wonder what the social situation is here or, like, how are we going to take care of this patient as an inpatient, and then the physio was very concerned with the shortness of breath and what that meant for discharge. It was interesting that we were all reading the same thing but thinking of different things. Med 3: Hilda

Clinical IPE sessions, with the patient at its core, encourages this reflection on the different roles of other healthcare students in clinical settings and promotes/facilitates learning from each other.

I would have presumed that the doctors and the medical staff have more of an input, but they actually rely on us a lot to get feedback from us to see how the patient is in terms of physiotherapy and how important our role actually is in that regard.  Physio 2: Ursula 

I found it interesting that we had the same information within our groups, but then each of the different disciplines picked up on different parts as being the most relevant bit. Med 3: Hilda 

Based on our different kind of backgrounds, I suppose, we had all different priorities on what we wanted to mention, so it was a bit challenging to do that in a kind of nice cohesive way, but I think that just represents why we need to do more Interprofessional learning and understand each other better. Med 2: Eoin 

Quantitative Results:

The ISVS-A overall scale and its three subscales were shown to be reliable with mean inter-item correlations ranging from 0.270 to 0.446. The ISVS-B overall scale and its three subscales were shown to be reliable with mean inter-item correlations ranging from 0.255 to 0.352, see table 2.

Table 2: Reliability measures of the overall scales and subscales

Scale/Subscale	Number of participants	Number of items	Mean inter-item correlation
Pre-intervention
*Overall scale*	34	9	0.310
ISVS-A
*Subscales*
Value	34	4	0.270
Comfort	36	3	0.446
Ability	36	2	0.357
Post-intervention
*Overall scale*
ISVS-B	35	9	0.277
*Subscales*
Value	35	4	0.255
Comfort	36	3	0.287
Ability	36	2	0.352

Scale scores were calculated as the mean of the answered items if at least two-thirds of the items within a scale/subscale were answered, with a higher score indicating greater interprofessional socialisation and valuing. Comparisons of the scale and subscale scores pre- and post-intervention using median and inter quartile range (IQR) are presented in Table 3 and Figures 1-4.

Table 3: Comparison of scale and subscale scores pre- and post-intervention

		Pre-intervention		Post-intervention
	n	median	(IQR)	median	(IQR)	p-value*
Overall scale	36	4.9	(4.2-5.2)	6.3	(5.9-6.6)	<0.001
Subscales
Value	35	5.0	(4.5-5.5)	6.5	(6.3-6.8)	<0.001
Comfort	36	4.5	(4.0-5.3)	6.0	(5.4-6.3)	<0.001
Ability	36	5.0	(4.5-5.9)	6.5	(5.5-6.9)	<0.001
*from Wilcoxon signed rank test

Figure 1. Distributions of ISVS total scores pre- and post-intervention, n=36

Figure 2. Distributions of ISVS Value subscale scores pre- and post-intervention, n=3

Figure 3. Distributions of ISVS Comfort subscale scores pre- and post-intervention, n=36

Figure 4. Distributions of ISVS Ability subscale scores pre- and post-intervention, n=36

There was a statistically significant increase in the overall ISVS scale score from pre-intervention (median (IQR): 4.9 (4.2-5.2)) to post-intervention (median (IQR): 6.3 (5.9-6.6)), p<0.001. There was also a statistically significant increase in the Value subscale score from pre-intervention (median (IQR): 5.0 (4.5-5.5)) to post-intervention (median (IQR): 6.5 (6.3-6.8)), p<0.001; the Comfort subscale score from pre-intervention (median (IQR): 4.5 (4.0-5.3)) to post-intervention (median (IQR): 6.0 (5.4-6.3)), p<0.001; and the Ability subscale score from pre-intervention (median (IQR): 5.0 (4.5-5.9)) to post-intervention (median (IQR): 6.5 (5.5-6.9)), p<0.001. Thus, the alternative hypothesis (H1), that states there is a difference between scales pre- and post- workshop for students participating in the workshops, is proven.

Scale and subscale scores pre- and post- intervention group are described in Table 4. Changes in scale/subscale scores between pre- and post- intervention did not differ by Degree group (p>0.05 for all), Table 4.

Table 4. Comparison of scale and subscale scores pre- and post-intervention by enrolled Degree

Degree Group		Pre-intervention	Post-intervention		Degree Group
	n	median	(IQR)	median	(IQR)	p-value*
Total score						0.429
Nursing	12	5.2	(5.1-5.8)	6.4	(6.2-6.6)
Physio	12	4.6	(4.1-5.1)	6.1	(5.8-6.5)
Medicine	11	4.7	(4.0-5.2)	6.3	(5.6-6.6)
Value subscale						0.099
Nursing	11	5.5	(5.0-5.8)	6.7	(6.5-6.8)
Physio	12	4.8	(4.1-5.3)	6.5	(6.3-6.8)
Medicine	11	4.8	(4.0-5.3)	6.8	(5.8-7.0)
Comfort subscale						0.558
Nursing	12	4.7	(4.7-5.6)	6.2	(5.7-6.6)
Physio	12	4.2	(3.8-4.9)	6	(5.3-6.0)
Medicine	11	4.3	(3.7-5.7)	5.7	(5.3-6.7)
Ability subscale						0.733
Nursing	12	5.5	(5.0-5.9)	6.5	(6.5-7.0)
Physio	12	4.8	(4.1-5.4)	5.8	(5.5-6.4)
Medicine	11	5	(4.5-6.0)	6.5	(5.5-7.0)
from interaction term (grouptime) in linear mixed model with normal transformation of scale and subscale scores

This empirical study demonstrates that growth in interprofessional socialisation and valuing occurs following the involvement of an inpatient in an acute hospital setting in interprofessional workshops. Furthermore, the core element of inpatient involvement in an acute hospital setting led to a growth in knowledgeability in the clinical landscape of practice for students from all three disciplines involved in the workshops, moving them beyond their own individual communities of practice. This study thus adds greatly to the body of knowledge already existing on interprofessional education. More than just adding to this knowledge, it advances this knowledge by demonstrating the important role that an inpatient in an acute hospital setting plays in interprofessional education. The mixed methods research approach allowed for triangulation of data, adding strength to the study.

A number of potential limitations can be considered. The numbers involved in each specific discipline may have been too small to find a statistically significant difference in scores from pre- to post- intervention based on participants’ Degree programme. Repeating the study with higher numbers per discipline may show if the intervention was more beneficial for certain Degree programmes.

Only three disciplines were involved in the study, future research would ideally involve other regular members of an acute hospital multidisciplinary team. The study took place in one hospital only. This was inevitable as the experienced facilitators involved in the workshops worked in one hospital only. While this may have potential for wider applicability of conclusions drawn in this study context, the rich data provided in terms of methodology and evaluation should allow the reader to consider transferability. Future research should also explore the view of the patient on the clinical IPE experience centred around the inpatient, to ensure that the IPE experience met the patient’s needs and expectations.

Through mixed methods research, the values and attitudes of healthcare students towards interprofessional education involving an inpatient in an acute hospital setting were explored. Quantitatively, participating in a workshop involving an inpatient in an acute hospital setting led to a statistically significant increase in interprofessional collaborative practice in terms of the overall interprofessional socialisation and valuing scale ISVS, and its subscales of value, ability and comfort in working with each other. Qualitatively, the involved students developed an insight into the clinical LoP through growing in knowledgeability in that clinical LoP. This was enabled by involvement of an inpatient in the workshops.

It is well recognised in modern times that healthcare involves multiple stakeholders collaborating, with interprofessional working being necessary for best patient care. Each profession comes with existing preconceptions of other healthcare professions; these stereotypes are not conducive to effective collaboration. One way of addressing this is through better IPE (9). In line with de Nooijer et al., 2022 (9), IPE design that promotes the learning theory of LoP can stimulate successful collaboration across different CoP in an LoP. The healthcare students in this study developed an insight into the clinical LoP in line with the three modes of identification of landscapes of practice. This helped them to build their knowledgeability of the clinical LoP, where meaningful moments of service can occur (6). It allowed each student in the landscape to move effectively from their individual CoP into the broader LoP, and thus negotiate and optimise their contribution.

A key element in the growth of identification was the active involvement of an inpatient in an acute hospital setting. Involving the patient in this clinical IPE was core to stretching students beyond their own limited clinical CoP and developing knowledgeability and identification in the broader clinical LoP. The patient was the common denominator in all three modes of identification in the clinical LoP, thus the patient should be the core feature of clinical IPE. The patient will help to centre each individual CoP while facilitating traversing and exploration of boundaries by different CoP members into the broader LoP. Working through concrete clinical education examples, and involving inpatients in the education, facilitates collaboration and sharing of ideas that can enable the discovery of shared interests and help formulate a workable entry point to learning in the complex area of clinical LoP.

Recognising the difficulties of negotiating the complex and multi-scale world that is the clinical LoP, it is important that clinical IPE plays a more prominent role in education to achieve growth in knowledgeability for healthcare professionals. It is only through joint exploration and shared working between educators, experienced facilitators, and patients that trust can develop to build a solid foundation for IPE in a clinical LoP. Learning partnerships need to be established at policy and program level, as well as at operational level, to ensure that IPE progresses in the clinical environment, where the patient remains front and centre to IPE and the clinical LoP. Joint exploration and shared working between educators and patients will help to develop trust and a solid foundation for IPE in a clinical LoP. This will help bring about real and sustainable change in healthcare education and future clinical practice.

Ethics approval and consent to participate: All methods were performed in accordance with the relevant guidelines and regulations of Declaration of Helsinki. Ethical approval was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals, CREC Review Reference Number: ECM 4 (hh) 10/03/2020. Informed consent to participate was obtained from all participants as per ethical approval.

Consent for publication: NA

Availability of data and materials: The datasets analysed during the current study are available from the corresponding author on reasonable request.

Competing interests: None

Funding: Learning and Teaching Innovation Award, University College Cork. The funding body played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Authors' contributions: NMC contributed to the conception of the work; the acquisition, analysis, and interpretation of data; the writing and revising of the work. AS contributed to the conception of the work; the acquisition, analysis, and interpretation of data; the revising of the work. JD contributed to the conception of the work; the acquisition, analysis, and interpretation of data. HH contributed to the analysis, and interpretation of data; the writing and revising of the work. All authors approved the submitted version and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Acknowledgements: Not applicable

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No competing interests reported.

A Mixed Methods Exploration of Values and Attitudes of Healthcare Students towards Interprofessional Education involving an Inpatient in an Acute Hospital Setting

Status:

Journal Publication

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Introduction

Methodology

Methods

Results

Descriptive Data

Qualitative Discussion:

How are we currently relevant to one another?

Who are we in our future professional context and in relation to one another?

How do we align our activities and collaborate to develop into practice-ready healthcare professionals?

Quantitative Results:

Strengths and Limitations

Conclusion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1