Increases in Graduate Students’Interprofessional Competence Associated with Clinical Training Activities

Interprofessional education is a critical and recommended element in most allied health training programs as it prepares emerging practitioners to work with professionals in other disciplines. The purpose of this study was to examine graduate students’ interprofessional (IP) attitudes and perceived competence prior to and after they participated in a yearlong IP curriculum consisting of both educational and clinical activities. In addition, the study sought to determine if competence was related to the number or perceived value of the educational or clinical activities and if there was a correlation between attitudes and competence. METHODS Participants were 45 graduate students in speech-language pathology (MS) and clinical psychology (PsyD) who completed self-report questionnaires at three time points during their first year of graduate school. RESULTS Students participated in an average of 4.8 IP educational and 3.6 IP clinical training activities. Across the year, attitudes toward IP practice remained high. Students reported an increase in their IP competence, particularly associated with participation in clinical, rather than educational, activities. Attitudes and competence were only somewhat related, as students with better attitudes toward teamwork and shared roles reported an increase in competence. DISCUSSION Students perceived that clinical training has a more positive impact on their knowledge and skills than didactic training; this pattern is consistent with practice guidelines that emphasize the importance of practical training. CONCLUSION Future research should examine whether particular IP experiences are associated with increases in competence, and whether self-reported competence is associated with IP performance in practice. Received: 08/14/2017 Accepted: 12/19/2017 © 2018 Coiro & Preis. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Erratum: Fixed layout error 6/8/18 H IP & Increases in Graduate Students’ Interprofessional Competence ORIGINAL RESEARCH 3(3):eP1142 | 2 Introduction Health care professionals are increasingly called upon to work collaboratively in order to provide more effective, cost-efficient, and patient-centered care (Interprofessional Education Collaborative Expert Panel [IECEP], 2011). Graduate training programs may play a key role in developing their students’ interprofessional (IP) competence through a combination of educational and clinical activities. Through the presentation of interprofessional education, “when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” (World Health Organization [WHO], 2010, p. 13), students may develop skills necessary to engage in interprofessional collaborative care. Such care, defined as “Multiple health workers from different professional backgrounds provide[ing] comprehensive services...to deliver the highest quality of care across settings” (WHO, 2010, p. 13), is the current state of health care into which most of our graduates will enter. However, there is a widening gap between the training and actual practices for collaborative work in health care (IECEP, 2011). Without appropriate training, new clinicians may not be adequately prepared to move beyond their specific and individual scope of practice. To this end, the current study examined the effects of a year-long IP curriculum which exposed students to a variety of both educational and clinical activities, specifically evaluating IP attitudes and competence, as well as the extent to which the various training activities contributed to that competence. Literature Review Increasingly, professional organizations, including the American Psychological Association (2013) and American Speech-Language-Hearing Association (2015), recommend IP training models as best practice for graduate programs, in order for students to enter the workforce prepared to practice collaboratively. Graduate programs may incorporate a range of IP activities into their curricula, including formal educational activities such as courses, seminars, workshops or simulations; and supervised clinical experiences which may be delivered in an inpatient, outpatient, or community setting (see Institute of Medicine [IOM], 2013, 2015) for reviews). The IOM (2015) recently suggested that the impact of these activities can be assessed across five potential learning outcomes: reactions, attitudes/perceptions, knowledge/skills, collaborative behavior, and performance in practice. Although a number of measures and research projects have been developed to assess the effects of IPE (e.g., Canadian Interprofessional Health Collaborative, 2012; National Center for Interprofessional Practice and Education, 2017; Thannhauser, Russell-Mayhew & Scott, 2010), the majority of these focus on the first three areas described by the IOM, with fewer studies or instruments designed to examine changes in behavior or practice (see Canadian Interprofessional Health Collaborative, 2012; Hammick et al., 2007; and IOM, 2015 for reviews). Furthermore, research has typically examined only a single IP activity, rather than whether different IP activities contribute more or less to students’ perceived IP competence. For example, Bridges et al. (2011) described the benefits of didactic, community-based, and simulation models Implications for Interprofessional Practice • Clinical training in small IP teams may be more effective than lecture-based IP education. • IP training programs may wish to standardize the number and type of clinical activities that students experience. • Education about teamwork, roles and responsibilities may be particularly important early in training. H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu.edu/hip 3(3):eP1142 | 3 of IP education, but did not directly compare these three methods in relation to student knowledge or competence. Similarly, Aston et al. (2012) described the IPE programs at three academic health centers, each of which included multiple educational activities (e.g., courses, simulations); however these authors did not examine the separate impact of these different activities. An exception is one of Olson and Bialocerkowski’s (2014) conclusions following a review of 17 studies examining university-based IPE, that students’ perceptions were more positive when they worked in small and stable groups rather than large lectures. Although there is strong evidence that IPE works, as noted by Olson and Bialocerkowski, the “understanding of the relationship between different modes of IPE and outcomes is limited” (p. 242). Even though the specific developmental progression of IP competence has not been clearly established, there is a logical connection and continuum across reaction, attitude, perception, knowledge, skill, and, ultimately, behavior change (IECEP, 2011). Educational approaches to enhance interprofessional competence vary from inadvertent exposure (e.g., students from two different disciplines separately treating the same client) to active, clinically integrated practice (e.g., working in a community based health setting with a variety of professions). Pedagogies involving active, situational-based learning should support the development of interprofessional competence, in particular if the graduate training program is purposeful in the engagement between education and practice (IECEP, 2011). In the current study, the following hypotheses were examined among a sample of graduate students participating in a year-long IP curriculum that consisted of both educational (IPE) and clinical (IPC) activities: (a) students’ attitudes toward IP practice will improve over the course of their first year in graduate school; (b) students’ perceived IP competence will improve over the course of their first year in graduate school; (c) improvements in students’ perceived IP competence will be related to the number, and perceived value, of the IPE and IPC in which they participated; and (d) attitudes will be correlated with changes in perceived competence. Methods