developing positive attitudes toward interprofessional collaboration among students in the health...
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Developing Positive Attitudes TowardInterprofessional Collaboration AmongStudents in the Health Care ProfessionsJuyoung Park a , Michele Hawkins a , Elwood Hamlin a , WesleyHawkins a & Jo Ann M. Bamdas ba School of Social Work , Florida Atlantic University , Boca Raton ,Florida , USAb Office of Interprofessional Education , Florida Atlantic University ,Boca Raton , Florida , USAAccepted author version posted online: 01 Apr 2014.Publishedonline: 21 May 2014.
To cite this article: Juyoung Park , Michele Hawkins , Elwood Hamlin , Wesley Hawkins & JoAnn M. Bamdas (2014) Developing Positive Attitudes Toward Interprofessional CollaborationAmong Students in the Health Care Professions, Educational Gerontology, 40:12, 894-908, DOI:10.1080/03601277.2014.908619
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Developing Positive Attitudes TowardInterprofessional Collaboration AmongStudents in the Health Care Professions
Juyoung Park, Michele Hawkins, Elwood Hamlin, and Wesley Hawkins
School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
Jo Ann M. Bamdas
Office of Interprofessional Education, Florida Atlantic University, Boca Raton, Florida, USA
This study examined whether attitudes toward interprofessional collaboration (Physician-Nurse,
Physician-Social Worker, Nurse-Social Worker) held by medical, social work, and nursing students
changed after completing an interprofessional curriculum consisting of (a) Interprofessional
Education Development Session and (b) the Senior Aging and Geriatrics Educator mentoring pro-
gram. The 15-item original and two modified versions of the Jefferson School of Attitudes Toward
Physician-Nurse Collaboration (JSAPNC) were administered as pretest=posttest. Of the 186 parti-
cipants who completed the pretest, 156 (84%) completed the posttest. Results showed that the
medical students (n¼ 52) reported the most positive change in attitude toward all three pairs of inter-
professional collaboration. Social work students (n¼ 55) reported the least positive attitudes toward
Physician-Social Worker collaboration and nursing students (n¼ 49) reported the least positive atti-
tudes toward Physician-Nurse collaboration. It is recommended to evaluate the interprofessional cur-
riculum and other factors, such as the possible influence of the facilitator in group discussions, and
that future studies include a rigorous design that monitors content of each educational session to
ensure integrity across groups. Postgraduate follow-up measures could be used to enhance positive
attitudes toward interprofessional collaboration.
Interprofessional collaborative practice in geriatric care settings is a critical component of
coordinated and comprehensive care services for patients in the community (including home
health care services), as well as in hospital and hospice (Berkman, 1996; Naylor et al., 2004;
Reese & Sontag, 2001; World Health Organization [WHO], 2010). Successful interprofessional
teamwork is effective in producing positive clinical outcomes for older patients in acute or
rehabilitative care (McPherson, Headrick, & Moss, 2001; Naylor et al., 2004; Zwarenstein
et al., 2001) by reducing incidence of patient complications, length of hospital stay, hospital
readmission rates, functional decline, and mortality rates among vulnerable older adults (Brener,
The authors acknowledge Dr. Mario Jacomino of the College of Medicine, Dr. Beth King of the College of Nursing,
and Drs. Allan Barsky and Paulina Martinez of the School of Social Work, all at Florida Atlantic University, for their
support in conducting pretests and posttests and collecting demographic information about the participants.
Address correspondence to Juyoung Park, Florida Atlantic University, School of Social Work, 777 Glades Road,
Boca Raton, FL 33431. E-mail: [email protected]
Educational Gerontology, 40: 894–908, 2014
Copyright # Taylor & Francis Group, LLC
ISSN: 0360-1277 print / 1521-0472 online
DOI: 10.1080/03601277.2014.908619
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Wheeler, Wolfe, Vernon-Smiley, & Caldart-Olson, 2007; Jencks, Williams, & Coleman, 2009;
MacDonal et al., 2010; Naylor et al., 2004; Rosenstein, 2002; WHO, 2010). Effective collabora-
tive practice can also increase professional practitioners’ level of job satisfaction (Rosenstein,
2002).
A randomized controlled study was conducted to evaluate the integrated care model Geriatric
Resources for Assessment and Care of Elders ([GRACE], Bielaszka-Du Vernay, 2011) that
targets low-income older adults with multiple chronic conditions. The study began with a com-
prehensive in-home assessment by a social worker and a nurse practitioner, followed by at least
monthly telephone interventions and subsequent home visits. The visiting teams reported assess-
ment information to a GRACE team that included geriatrician, pharmacist, physical therapist,
community resource expert, and mental health care manager for intensive care services. The
GRACE team developed a care plan including medication management, depression treatment,
mobility improvement, and other geriatric care services. Concurrently, the nurse practitioner
and social worker visited the patient’s primary care physician to review the care plan and obtain
the physician’s recommendations. If the GRACE patient was admitted to the hospital, the social
worker-nurse practitioner collaborated with the hospital team to develop a transition care plan
before discharge. The program resulted in lower rates of hospitalization and readmission, higher
levels of social functioning, improved physical and mental health, and lower hospital costs
compared to the control group.
Social workers are key members of geriatric health care teams, working closely with physi-
cians, nurses, and other professionals to assess and plan services for older adults and respecting
the contributions made by each discipline (Council on Social Work Education [CSWE], n.d.).
Social workers’ skills in collaborative practice are critical to effective functioning by interprofes-
sional teams (Howe, Hyer, Mellor, Lindeman, & Luptak, 2001). For example, hospital-based
geriatric social workers on interdisciplinary care teams assess high-risk patients, develop dis-
charge plans, and coordinate postdischarge follow-up services (Soskolne, Kaplan, Ben-Shahar,
Stanger, & Auslander, 2010).
Although social workers play a significant role in interprofessional health care settings, few
social work educational programs have incorporated interprofessional learning as an integrated
component of course work and field experience (Pecukonis et al., 2013; Reeves, 2010;
Weinstein, Whittington, & Leiba, 2003). The topic of interprofessional collaboration has been
addressed rarely in traditional social work practice courses (Barnsteiner, Disch, Hall, Mayer,
& Moore, 2007; Bonifas & Gray, 2013; Hojat et al., 2001; Leipzig et al., 2002).
The CSWE Gero-Ed Center stated in a teaching module on interdisciplinary teamwork that
social workers should demonstrate skills and leadership in collaborative practice with other pro-
fessions in work with elders and their caregivers in diverse service settings (CSWE, n.d.). How-
ever, social workers have reported that they need more intensive training in interprofessional
collaboration in order to understand the roles of their collaborating partners from other disci-
plines (Bronstein, Kovaks, & Vega, 2007). In addition to social work education, nursing and
medicine have expressed a significance of interdisciplinary practice. The code for nurses of
the American Nurses Association emphasizes the need for interprofessional collaborations by
stating, ‘‘Certified Registered Nurse Anesthetists (CRNAs) collaborate with members of the
health professions and other citizens in promoting community and national efforts to meet
the health needs of the public’’ (American Association of Nurse Anesthetists, 2006). The
American Geriatrics Society (AGS) Education Committee also emphasized the importance of
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interprofessional collaboration in caring for older adults; and the Task Force on Resident
Training in Geriatrics Interdisciplinary Team Care recommended intensive training in interpro-
fessional team care for all residents in internal medicine and family practice as an element of the
geriatrics curriculum (Counsell, Kennedy, Szwabo, Wadsworth, & Wohlgemuth, 1999).
A study project (Fitzgerald et al., 2006) developed a four-day interprofessional educational
program for medical, pharmacy, and social work students to examine the impact of an inter-
professional training program that focused on knowledge and attitudes about geriatric care.
Students’ posttest scores indicated improvement in both knowledge and attitude, and the parti-
cipants reported a positive training experience. It is important for students to be exposed to an
interprofessional environment and to understand the importance of interdisciplinary collabor-
ation in geriatrics before they work in the field (Howe et al., 2001).
A recent study (Bonifas & Gray, 2013) analyzed two curriculum models: (a) an interprofes-sional model designed for students from social work, medicine, nursing, pharmacy, and nutrition
in interactive sessions; and (b) a uniprofessional approach designed to prepare social work studentsfor interdisciplinary collaboration in geriatric health care. The study indicated that participants in
the interprofessional curriculum improved in attitudes and values related to interprofessional col-
laboration, although their improvement in understanding the roles and training of other disciplines
was not statistically significant. Participants in the uniprofessional curriculum showed incremental
changes in attitudes and values related to interdisciplinary collaboration but showed significant
improvement in understanding individual team members’ professional roles. The researchers con-
cluded that the interprofessional approach was more effective for generating students’ appreciation
for, and understanding of, the significance of interdisciplinary collaboration and that personal
engagement with learning interdisciplinary roles and training is necessary (Bonifas & Gray, 2013).
There is a need for students in training for the health professions, such as social work, nurs-
ing, and medicine, to gain understanding about interprofessional collaboration and to develop
interprofessional communication skills before they complete their educational program. Inter-
professional education is necessary to prepare students in the health care professions with
competencies for working collaboratively to provide comprehensive services for older adults
(Coleman, Roberts, Wulff, Zyl, & Newton, 2008; WHO, 2010).
Although previous research has evaluated the effect of interprofessional collaboration, few
studies have evaluated the effectiveness of curriculum designed to teach interprofessional
collaboration and to increase knowledge and confidence about it (e.g., Bonifas & Gray, 2013;
Pecukonis et al., 2013; Villadsen, Allain, Bell, & Hingley-Jones, 2012). Even fewer studies have
measured whether students from medicine, nursing, and social work have positive changes in
attitudes toward interprofessional collaboration after completing educational programs (Park,
Hawkins, Hawkins, & Hamlin, 2013).
THEORETICAL FRAMEWORK
The Interprofessional Education for Collaborative Patient-Centered Practice (IECPCP), developed
by D’Amour and colleagues (D’Amour & Oandasan, 2004), was designed to facilitate and support
the implementation of interprofessional educational programs for collaborative patient-centered
practice across all health care sectors (Herbert, 2005). The IECPCP was utilized as the theoretical
framework to determine whether students from various health care professions would show
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positive attitudes toward interprofessional collaboration and increase collaborative practice after
completing the interprofessional curriculum designed by Florida Atlantic University (FAU). The
original IECPCP (D’Amour & Oandasan, 2004) was modified in the current study by the authors.
The original framework highlights micro (teaching), meso (institutional=organizational), andmacro (systematic) factors. However, the modified IECPCP in the current study used only the
micro level (teaching). This is because the study examined whether students in health care
disciplines would change their attitudes toward interprofessional collaboration through interprofes-
sional curriculum (teaching method) developed by FAU to increase knowledge and influence
attitudes toward interprofessional collaboration, instead of institutional and systematic factors
(e.g., administrators=administrative process, or structures of health care delivery).
The framework includes two processes, the first for education and the second for practice.
The two processes are complex, as interactions between professionals from different disciplines
within a health care environment are complex. Students enter health professional programs with
formed stereotypes of their own professional identity and of the roles of other health care pro-
fessionals (Tunstall-Pedoe, Rink, & Hilton, 2003). They tend to lack knowledge of, and hold
negative attitudes toward, interprofessional collaboration (Leipzig et al., 2002).
The first process includes factors influencing a student’s ability to become a competent col-
laborative practitioner after attending the interpofessional curriculum (D’Amour & Oandasan,
2005). The curriculum developed by FAU was designed so that students would increase their
knowledge about interprofessional collaboration and understand the roles and responsibilities
of other health care professionals. The interprofessional curriculum requires collaborative
practice settings in which students from diverse disciplines can be exposed to educational experi-
ences (D’Amour & Oandasan, 2005). It is intended that the students will enhance skills (e.g.,
communication skills) and form positive attitudes (e.g., mutual respect, open to trust, willingness
to collaborate) toward interprofessional collaboration (D’Amour & Oandasan, 2004).
The second process influences patient care outcomes in collaborative practice settings. In prac-
tice, patient health care outcomes are influenced by professionals’ collaborative practice. Thus, in
the second process, professionals form positive attitudes toward interprofessional collaboration
and increase their collaborative practice with providers from other disciplines (D’Amour &
Oandasan, 2005). In this process, the competencies, skills, and attitudes addressed in the interpro-
fessional curriculum are shared with collaborative practitioners. By identifying health profes-
sionals who are working collaboratively, they learn from each other and operationalize ways
of teaching and practicing collaboration based on the practice setting in which they work.
The current study was a prospective study that examined the effectiveness of an interpro-
fessional curriculum in enhancing students’ attitudes about collaboration with other health care
professionals as they prepare for careers in health care.
THE INTERPROFESSIONAL CURRICULUM
The School of Social Work, College of Nursing, and College of Medicine at FAU in south Florida
developed an interprofessional curriculum to bring social work, nursing, and medical students
together into small teams (three–four students) for collaborative practice-based learning. Master
of social work foundational students, first-year medical students, and bachelor-level nursing
students participated in a six-month curriculum that had two components: (a) Interprofessional
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Education Development Session (IPEDS), and (b) the Senior Aging and Geriatrics Educator
(SAGE) mentoring program. The IPEDS program (three sessions over a period of six months)
was designed to engender knowledge, attitudes, and behaviors that enable participants to work col-
laboratively throughout their careers. Students attended the SAGEmentoring program (three visits
over a period of six months) after they had completed the IPEDS. The curriculum provided an
opportunity for the students to collaborate on interprofessional teams as they participated in role
play during IPEDS and fulfilled assignments, including debriefing, during SAGE mentor visits.
The students were awarded credit for internship hours. The programs contained four core compe-
tency domains: (a) value=ethics for interprofessional practice, (b) roles=responsibilities, (c) inter-professional communication, and (d) interprofessional teams=teamwork for collaborative practice
(Interprofessional Education Collaborative Expert Panel, 2011).
The learning objectives of the programs were that the students would be able to (a) develop a
method for medical, nursing, and social work students to work together in small teams by learn-
ing about the four core competencies and demonstrating understanding of the key elements of
interprofessional education and collaboration; (b) describe roles and responsibilities of each pro-
fessional member in a case scenario; and (c) demonstrate understanding of patient-centered care
and health care policy and quality from a team perspective.
The IPEDS sessions were composed of brief lectures, small group discussions with case
analysis, role play, and debriefing. Each small group included students from all three professions
and one or two faculty facilitators. In the SAGE mentoring program, the student teams learned
about aging and geriatrics from seniors living in a local retirement community who volunteered
to serve as mentors to share their wisdom about aging. A mentor was defined as an experienced
and trusted advisor and role model who shares expertise to advance another’s education. The
students made three visits during the three-month program. The core competencies in the SAGE
program were to (a) respect the dignity and privacy of patients while maintaining confidentiality
in the delivery of team-based care; (b) communicate one’s roles and responsibilities clearly to
patients, families, and other professionals; (c) recognize one’s limitations in skills, knowledge,
and abilities; (d) listen actively and encourage sharing of ideas and opinions of other team mem-
bers; and (e) reflect on individual and team performance with a focus on performance improve-
ment. In small group meetings, the participants discussed cases related to interprofessional
education roles, responsibilities, collaboration, and care.
PURPOSE OF THE STUDY AND RESEARCH QUESTION
The purpose of the current study was to determine whether students from medicine, nursing, and
social work would report positive changes in attitudes toward interprofessional collaboration
after completing the interprofessional curriculum that contained the IPEDS and SAGE mentor-
ing programs. The study addressed two research questions:
1. Do students’ attitudes toward three interprofessional collaboration pairs (physician
and nurse, physician and social worker, and nurse and social worker) differ after they
complete the interprofessional curriculum?
2. Is there a significant difference in attitudes held by students of medicine, social work,
and nursing toward the three interprofessional collaboration modes between pretest
and posttest?
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METHOD
Study Design and Procedure
A pretest=posttest design was used to determine whether students’ attitudes toward interprofessional
collaboration changed after attending the IPEDS and SAGE mentoring programs. The study was
approved by the FAU Institutional Review Board of the university. With permission from instruc-
tors, the researchers visited one class each in the College of Medicine, the College of Nursing, and
the School of Social Work to administer a pencil-and-paper survey described below. The survey
was administered as a pretest in September 2012 and as a posttest in April 2013. Students were
informed that they could decline to complete the survey with no adverse consequences. Students
did not provide names or other identifying information. Researchers explained the study purpose,
benefits, voluntary nature of participation, and potential risks. For students who agreed to partici-
pate, a consent form and survey questions were provided, and completed surveys were collected.
Measure
The Jefferson School of Attitudes Toward Physician-Nurse Collaboration (JSAPNC) was used
to measure attitudes toward nurses and nursing services (Hojat & Herman, 1985). The original
20-item scale was modified to study attitudes toward physician-nurse alliances (Hojat et al.,
1999). Because five items of the original scale did not have a significant factor coefficient on
any of the extracted factors (Hojat et al., 1999), the revised version of JSAPNC with 15 items
was utilized in the current study. The 15-item JSAPNC uses a four-point Likert-type scale
(4¼ Strongly Agree to 1¼ Strongly Disagree); Items 14 and 15 reflect a negative attitude toward
physician-nurse collaboration and these items were reverse scored. A total score on the 15-item
JSAPNC ranges from 15 to 60, with higher scores indicating a more positive attitude. The scale
has four subscales: (a) shared educational and collaborative relationships (7 items), (b) caring
as opposed to curing (3 items), (c) nurse’s autonomy (3 items), and (d) physician’s authority
(2 items). Reliability coefficients for this revised scale were .84 and .85 (Hojat et al., 1999).
The 15-item JSAPNC addressing Physician-Nurse collaboration was used in the present
study, along with two modified versions, one of which used the term Physician-Social Workercollaboration and one of which used the term Nurse-Social Worker collaboration. Reliabilitywas established in an earlier study (Park et al., 2013). The Cronbach’s alpha for the 15-item
JSAPNC was .80 (Hojat et al., 1999); alpha for the modified version Social Worker=Nursewas .90 and alpha for the modified version Physician=Social Worker was .91 (Park et al.,
2013). In the current study, reliability estimates of three versions were then reported in the pre-
vious studies (Hojat et al., 1999; Park et al., 2013): .82, .98, and .92, respectively.
Data Analysis
The collected data were entered into SPSS1 software, version 21.0 for Windows (IBM Corp.,
Summers, NY) for analyses to measure changes across time within and between groups.
Descriptive statistics included frequencies for categorical variables (e.g., gender, ethnicity=race,education, current major, volunteer experience with older adults). To address Research Question 1,
regarding change in attitude toward interprofessional collaboration, three paired-samples t tests
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were conducted to evaluate the impact of the IPEDS program on students’ scores on the original and
modified versions of the JSAPNC. To address Research Question 2, a repeated measures analysis of
variance (ANOVA) was performed to measure changes in attitude toward the three interprofessional
collaborations from pretest to posttest as the within-subjects (time) factor among the three groups
(Group 1¼Medicine, Group 2¼ Social Work, Group 3¼Nursing).
RESULTS
Among 190 students who attended the IPEDS and SAGE programs, 186 provided demographic
information and completed the pretest (97.8% response rate), and 156 (84%) completed the
posttest. Sample characteristics of the 186 participants are presented in Table 1 by discipline.
The participants ranged in age as follows: 66.7% (n¼ 124) were 20-to-29 years old, 18.3%(n¼ 34) were 30-to-39 years old, 5.9% (n¼ 11) were 40-to-49 years old, and 4.8% (n¼ 9) were
50-to-59 years old. A majority of the participants were women (73.1%, n¼ 136). More than half
(61.8%, n¼ 115) self-reported as Caucasian=White, and two thirds (67.2%) were college grad-
uates. In terms of disciplines, 29.0% (n¼ 54) were medical students, 32.8% (n¼ 61) were social
work students, and 33.4% (n¼ 62) were nursing students. In terms of experience, 71.5%(n¼ 133) reported experience with people from other disciplines, and half (51.1%, n¼ 95)
reported volunteer experience in senior centers and other community centers. More than half
(51.6%, n¼ 96) reported having spent extensive time with older relatives.
TABLE 1
Demographic Characteristics by Profession: Frequencies (Percentages)
Characteristic and category Total (N¼ 186) Medical (n¼ 54) Nursing (n¼ 62) Social Work (n¼ 61)
Gender
Male 42 (22.6) 23 (42.6) 8 (12.9) 10 (16.4)
Female 136 (73.1) 31 (57.4) 54 (87.1) 51 (83.6)
Missing 8 (4.3)
Race=ethnicity
African American 21 (11.3) 2 (3.7) 5 (8.1) 14 (23.0)
Caucasian=White 115 (62) 43 (79.6) 37 (59.7) 34 (55.7)
Hispanic=Latino 25 (13.4) 4 (7.4) 14 (22.6) 7 (11.5)
Asian=Pacific Islander 9 (4.8) 4 (7.4) 3 (4.8) 2 (3.3)
Other 6 (3.2) 1 (1.9) 2 (3.2) 3 (4.9)
Missing 10 (5.4)
Highest education
High school 6 (0.3) 0 (0.0) 6 (9.7) 0 (0.0)
Associate degree 20 (10.8) 0 (0.0) 20 (32.3) 0 (0.0)
College 124 (66.7) 43 (79.6) 26 (41.9) 55 (90.2)
Graduate degree 27 (14.5) 11 (20.4) 10 (16.1) 6 (9.8)
Missing 9 (4.8)
Volunteer experience w=elders
Yes 95 41 (75.9) 33 (53.2) 21 (34.4)
No 82 13 (24.1) 29 (46.8) 40 (65.6)
Missing 9
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Paired-Samples t Tests
To address Research Question 1, three paired-samples t tests were conducted to measure the
mean differences in students’ attitudes toward interprofessional collaborations from pretest to
posttest: (a) Physician-Nurse, (b) Physician-Social Worker, and (c) Nurse-Social Worker.
Results for the pretest and posttest are reported in Table 2. There was a statistically significant
decrease in mean attitude scores from pretest (M¼ 23.3, SD¼ 3.9) to posttest (M¼ 24.6, SD¼5.1, p¼ .019) regarding Physician-Nurse collaboration but no statistically significant change in
mean attitude scores regarding Physician-Social Worker collaboration (M¼ 26.4, SD¼ 12.2;
M¼ 25.1, SD¼ 6.3, p¼ .278) or Nurse-Social Worker collaboration (M¼ 22.5, SD¼ 8.8;
M¼ 21.2, SD¼ 5.0, p¼ .093).
Repeated Measures ANOVA
Repeated measures ANOVA was calculated to measure changes in mean attitude scores from
pretest to posttest in each professional group. Results for each pair of groups are reported in
Table 3. There was a statistically significant change in mean attitude score from pretest to post-
test regarding all three collaborations: (a) Physician-Nurse collaboration (F¼ 7.634, df¼ 2,
p¼ .001); (b) Physician-Social Worker collaboration (F¼ 4.682, df¼ 2, p¼ .011); and (c)
Nurse-Social Worker collaboration (F¼ 4.583, df¼ 2, p¼ .012).
There was a large increase in score from pretest (M¼ 21.9, SD¼ 4.0) to posttest (M¼ 26.2,
SD¼ 5.1) by medical students regarding Physician-Nurse collaboration (4.3 points). Nursing
students showed a decrease in mean score by 0.9 points from pretest (M¼ 24.5, SD¼ 4.3) to
posttest (M¼ 23.6, SD¼ 6.6). Medical students obtained the lowest score at pretest but the high-
est score at posttest (Table 3 and Figure 1). Nursing students had the highest score at pretest and
the lowest score at posttest.
Regarding attitudes toward Physician-Social Worker collaboration, medical students showed
the most positive change, with an increase of 3.4 points from pretest (M¼ 24.5, SD¼ 4.1) to
posttest (M¼ 27.9, SD¼ 6.2). In contrast, social work and nursing students showed decreases
TABLE 2
Means, Standard Deviations, t, and p for Participant Attitudes Toward Interprofessional
Collaboration at Pretest and Posttest (N¼156)
Variable and type of intervention Mean SD t df p
Physician-Nurse Collaboration �2.4 142 .019�
Pretest 23.3 4.0
Posttest 24. 6 5.1
Physician-Social Worker 1.1 138 .278
Pretest 26.4 12.2
Posttest 25.1 6.3
Nurse-Social Worker 1.7 143 .093
Pretest 22.5 8.8
Posttest 21.2 5.0
�p< .05, two-tailed, paired-samples t test, comparing the mean scores at pretest and posttest.
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TABLE 3
Repeated Measures Analysis of Variance (N¼156)
Variable Student group Mean SD n F p
Physician-Nurse (Pretest) Medical 21.9 4.0 46 7.634 .001
Social Work 23.8 3.6 50
Nursing 24.5 4.3 37
Total 23.3 4.1 133
Physician-Nurse (Posttest) Medical 26.2 5.1 46
Social Work 24.2 3.3 50
Nursing 23.6 6.6 37
Total 24.7 5.1 133
Physician-Social Worker (Pretest) Medical 24.5 4.1 46 4.682 .011
Social Work 27.9 19.3 49
Nursing 27.4 5.9 36
Total 26.6 12.5 131
Physician-Social Worker (Posttest) Medical 27.9 6.2 46
Social Work 22.6 3.1 49
Nursing 25.3 8.5 36
Total 25.2 6.5 131
Nurse-Social Worker (Pretest) Medical 21.4 4.0 47 4.583 .012
Social Work 23.0 13.5 52
Nursing 23.8 5.2 36
Total 22.7 9.1 135
Nurse-Social Worker (Posttest) Medical 23.4 4.8 47
Social Work 19.1 2.9 52
Nursing 21.4 6.4 36
Total 21.2 5.1 135
FIGURE 1 Physician-nurse collaboration. (Color figure available online.)
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in mean score; social work student scores had the largest decrease in mean score (5.3 points)
from the highest score of the three groups at pretest (M¼ 27.9, SD¼ 19.3) to the lowest score
at posttest (M¼ 22.6, SD¼ 3.1; Table 3 and Figure 2). Regarding attitudes toward Nurse-Social
FIGURE 2 Physician-social worker collaboration. (Color figure available online.)
FIGURE 3 Nurse-social worker collaboration. (Color figure available online.)
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Worker collaboration, medical students showed a score increase by 2 points from pretest
(M¼ 21.4, SD¼ 4.0) to posttest (M¼ 23. 4, SD¼ 4.8); nursing and social work students showed
decreased scores from pretest to posttest (Table 3 and Figure 3). Social work students showed
the greatest decrease in score (3.9 points) from pretest (M¼ 23.0, SD¼ 13.5) to posttest (M¼19.1, SD¼ 2.9) for this collaboration. Medical students showed the lowest score at pretest but
the highest at posttest, whereas social work students showed the second highest score at posttest
and the lowest score at posttest.
DISCUSSION
The study results indicated a significant change in participant’s attitudes toward all three pairs of
collaboration (Physician-Nurse, Physician-Social Worker, Nurse-Social Worker) after complet-
ing the IPEDS and SAGE programs. The medical students recorded the most positive change in
attitudes toward all three pairs of interprofessional collaborations. They also had the highest
scores in all three pairs of collaborations after attending the two programs. The posttest findings
from the current study are not congruent with previous studies (e.g., Curran, Mugford, Law, &
Macdonald, 2005; Hawk et al., 2002; Hojat et al., 2001; Leipzig et al., 2002; Park et al., 2013)
that indicated that—among students in medicine, nursing, and social work—the medical stu-
dents demonstrated the least positive attitude toward interprofessional collaboration. In parti-
cular, internal medicine and family practice residents consistently rated collaboration lower
than did advance practice nursing and master-level social work students (Leipzig et al., 2002).
However, in the current study, medical students showed the most positive changes in attitude
toward all three pairs of collaborations after exposure to the interprofessional curriculum. It is
plausible that this curriculum provided the medical students with knowledge and understanding
about interprofessional collaboration, as well as information about values and ethics of nursing
and social work. In addition, by interacting with social work and nursing students, the medical
students appeared to have learned more about the social worker’s or nurse’s roles and respon-
sibilities on the interprofessional health care team. Most important, they appear to have gained
understanding regarding how to communicate effectively with other team members to develop
patient-centered care using a team approach. There seems to be limited focus on interprofes-
sional collaboration in medical students’ educational curriculum (Leipzig et al., 2002), and
the American Medical Association ([AMA], 1996) Code of Medical Ethics does not include a
discussion of interdisciplinary teamwork (Leipzig et al., 2002). Therefore, an interprofessional
curriculum such as the one used in the current study is necessary for medical students in their
first year of medical school to learn about interprofessional collaboration by interacting with
students from other disciplines. This is because positive attitudes toward the interprofessional
collaboration that are established early in the educational program will be more likely to be
accepted than exposure to collaboration issues in later years—such as during residency.
The social work students showed the least positive attitudes toward Physician-Social Worker
collaboration after completing the program; they had the highest score at pretest and lowest score
at posttest, with a decrease in attitude scores from pretest to posttest. The findings may indicate
that these social work students were less enthusiastic about collaborating with physicians after
completing the program. It is possible that the social work students may not have had a favorable
learning experience in collaborative relationships with medical students while participating in
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small group discussions based on the scenarios and role play during the IPEDS program and in
completing assignments during the SAGE mentor visits. For example, the medical students
could have dominated group discussions, role play, or other activities. Also, it is conceivable
that the roles and responsibilities of medical students and nursing students created fewer oppor-
tunities for social work students to work cohesively during the activities. It is also possible that
the faculty-developed curriculum did not show a strong enough social work student presence in
interprofessional collaboration and teamwork. Because the participants met as a student team
only five times during the six-month period in each program (the first IPEDS session was not
conducted in teams), the social work students may not have understood the medical students’
roles and terminology during role play, case analysis, or group discussions. And=or they may
lack skills for interprofessional communication. Social work students tend to focus on the
emotional and psychological perspective of patients, while medical students focus more on
the physical aspects (Lam, Chan, & Yeung, 2013).
The nursing students had the least positive attitude toward Physician-Nurse collaboration,
which is inconsistent with previous studies (Curran et al., 2005; Hojat et al., 2001). Regarding
Physician-Nurse collaboration, the nursing students had the highest mean score at pretest and the
lowest mean score at posttest. These results could be attributed to the level of nursing students in
the study. For example, some nursing students may have had more real-world experience in a
variety of settings—as well as higher levels of education in their nursing programs—than the
first-year medical students, who came into the program from many diverse fields.
The social work students had the least positive attitude toward Nurse-Social Work collabor-
ation. The length and intensity of the curriculum (three IPEDS sessions and three visits with a
SAGE mentor over a period of six months) may not have been sufficient for the social work and
nursing students to change attitudes toward interprofessional collaboration. There is no assur-
ance that all students will enjoy an interprofessional learning experience with students from
other disciplines. Other factors, such as scheduling difficulties and time conflicts (dates, times,
and locations of sessions), may have contributed to the lack of change in attitudes toward
interprofessional collaborative practices.
A review of the interprofessional curriculum is suggested to identify whether the curriculum
was designed to provide more benefits to medical students than to social work or nursing stu-
dents, which could affect changes in attitude toward interprofessional collaboration among social
work and nursing students. It is suggested to examine interprofessional collaboration practices
between faculty and staff in the IPEDS working groups to ensure that each profession is equally
seen and heard. It is also proposed to review other environmental factors, such as dates, times,
and locations of sessions, that may have had an influence on the results. In addition, the
facilitators’ influence in small group discussions should be reviewed because a tendency some-
times exists to teach rather than to guide adult students in their interprofessional collaborations.
Further, it should be noted that the posttest evaluation was administered near the end of the term
for the social work and nursing students. The medical students were on a different calendar; the
administration of the posttest occurred at the same time as for the other two groups but not
during the medical students’ finals week. This may have influenced the nursing and social work
students’ attitudes.
Further studies, including a longitudinal approach, are needed to explore whether interprofes-
sional education programs can improve attitudes toward interprofessional collaboration among
students in health care fields. This study has shown a need for researchers to collect qualitative
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data from social work, nursing, and medical students on their attitudes toward interprofessional
collaboration, which may further validate and extend the quantitative studies. Future research
could focus on nurses’ level of experience with physicians and social workers’ level of experi-
ence with nurses. These study findings can be used as pilot data to conduct a study with rigorous
design, including control groups and randomized controlled trials, to measure changes in atti-
tudes toward interprofessional collaboration. Longer duration and increased intensity of the
interprofessional curriculum (e.g., every two weeks for at least six months) should be con-
sidered. Future studies should monitor content of each education session to ensure integrity
across groups and to measure follow-up outcomes after students graduate to track whether the
effects of the interprofessional education were sustained. There is still little research on attitudes
toward collaboration among these three professions and the effectiveness of an interprofessional
curriculum (Park et al., 2013). Thus, more empirical studies on collaboration between social
workers and other health care professionals as members of the health care team could improve
understanding of the role of social workers as members of interdisciplinary teams (Black, 2005).
CONCLUSION
The university interprofessional curriculum described in this report contained appropriate
components to formulate an effective interdisciplinary learning experience. Interprofessional
collaboration by health professionals is significant in serving the complicated physical and men-
tal health needs of older adults (Brener et al., 2007). The curriculum provided in this study gave
students the opportunity to interact with students and faculty from other health care disciplines.
The earlier students are exposed to such interdisciplinary curriculum, the more likely they are to
practice in an interdisciplinary model after graduation (Cooper, Carlisle, Gibbs, & Watkins,
2001).
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