Interprofessional education and collaborative practice: Psychometric analysis of the Readiness for Interprofessional Learning Scale in undergraduate Serbian healthcare student context
Introduction
In a modern healthcare system, there is an implicit expectation for medical sciences students to work together effectively as healthcare team members. This expectation is based on the premise that effective teamwork, carried out through coordinated and collaborative practice, reduces the traditional stereotypes, promotes better understanding of professional roles and responsibilities, boosts confidence within team members, improves communication and provides patient care in the best manner. Accordingly, it implies improvement in healthcare quality and patient safety, as well as reductions in medical errors (World Health Organization, 2010).
However, the effective interprofessional teamwork in the health arena is difficult to achieve due to social and cultural factors. Among the possible barriers often cited are: unclear roles and responsibilities of employees, conflicting power relationships arising from the different educational qualifications and professional status of certain health professions (Coster et al., 2008).
Additionally, collaboration and teamwork are influenced by the attitudes of healthcare professionals towards their own profession, and also towards other professions within their healthcare team (Hood et al., 2014). As a form of social identity, professional identity is significantly related with group interactions in the workplace and how people compare themselves with other professional groups and make distinctions accordingly (Adams et al., 2006).
In Serbia, nursing professional identity, unlike physicians', has different meaning due to history of higher professional education, which was influenced by socio-economic factors. Presently, nursing education in Serbia comprises secondary medical schools, two levels for the bachelor's degree (a three and a four-year nursing programs), master's and doctoral degrees. A four-year bachelor's, master's and doctoral degrees in nursing can be obtained only at one educational institution and that is the Faculty of Medicine of the University of Novi Sad (Vlaisavljević et al., 2014).
Due to a higher percentage of nurses with secondary medical education and deeply rooted negative social prejudices in the minds of physicians, patients and their families towards nursing profession, nursing is seen as a much less valuable profession. Unfortunately, the current professional practice reinforces the traditional concept which regards physicians as being the undisputed team leaders in charge of patient care, and nurses as being subordinate to physicians (Dargahi et al., 2012; Milutinović et al., 2011). What is more, in today's segregated education, medical and nursing students are prone to perceive other professions as aliens, creating a mental imagery “we” versus “them”. Consequently, this is transmitted into a clinical setting where lack of collegial understanding can result in disagreements and compromised patient safety (Williams and Webb, 2015).
World Health Organization (2010) considers interprofessional education (IPE) as a significant factor in promoting good working relationships among different professions by developing positive interprofessional attitudes and collaborative practice. Thus, it is not surprising that the need to introduce strategies for interprofessional learning is widely accepted, both by the governments of individual countries and universities alone, whereas in some countries, according to accreditation standards of medical schools, it is mandatory (Talwalkar et al., 2016).
Although numerous factors affect the successful implementation of this educational strategy, students' attitudes are considered as the most important. Students' attitudes may be affected by several different factors, among which: age, gender and work experience (Hammick et al., 2007). Accordingly, it is crucial for educators to get informed about students' attitudes towards interprofessional learning before designing programs in order to take into account their value orientations and beliefs.
The original version of the Readiness for Interprofessional Learning Scale (RIPLS) developed by Parsell and Bligh (1999) has been one of the first and most frequently applied instruments for the assessment of attitudes towards interprofessional education. The scale was translated according to international guidelines into several different languages: Japanese, French, German, Danish, Turkish (Cloutier et al., 2015; Mahler et al., 2014; Nørgaard et al., 2016; Onan et al., 2017; Tamura et al., 2012), and Serbian (Simin et al., 2010), and therefore indicating application in different cultural contexts. The original version of RIPLS comprised items grouped into three subscales. However, a version, published by McFadyen et al., 2005, McFadyen et al., 2006, noted as having performed the first subsequent psychometric testing of the instrument comprising four subscales, proved to be more superior. Since then, both versions of the scale have been widely applied, and their popularity can be illustrated by many papers available in databases, such as PubMed and CINAHL. However, there were very few researchers who, besides reliability, investigated scale's validity and its factor structure. Those who conducted it by using exploratory or confirmatory factor analysis showed a different underlying factor structure of the RIPLS (Mahler et al., 2015).
Historically, the predominant model of a Serbian higher health education was uniprofessional and mainly biomedical in its orientation, indicating that students rarely collaborate with students from other healthcare disciplines. Through activities of Erasmus + KA2 projects “Reinforcement of the Framework for Experiential Education in Healthcare in Serbia” (ReFEEHS), which started in 2015, different actions were initiated for the introduction to interprofessional education. Since successful development of interprofessional education at a national level depends on value orientation and readiness of students for shared learning with other professionals a valid instrument for assessing students' attitudes is required. However, a review of literature has revealed a lack of universally applicable instruments in the Serbian context; hence, there is an urgent need for this gap to be bridged.
Section snippets
Aim
Therefore, the aim of the research presented in this paper was to describe the psychometric properties, validity and reliability of the Serbian cross-culturally adapted version of original RIPLS scale (Simin et al., 2010), in order to assess the attitudes of undergraduate health science students towards this educational strategy and evaluate whether a professional group and student's characteristics have influence on attitudes towards collaborative practice and shared learning.
Study Design and Sampling
The research was carried out in the form of a descriptive/analytical and comparative cross-sectional study, by interviewing undergraduate students who attended two different professional programs at the University of Novi Sad, during 2016/17 school year. Only those students who had completed their first clinical rotations met the criteria for participation in this study. Accordingly, medical students started clinical rotations after completing their fourth year of study, whereas nursing
Results
Full students' demographic distribution is shown in Table 1.
Discussion
It has long been established that professionals who work together should learn together and that interprofessional collaboration and co-operation are fundamental to maintaining high-quality care and patient safety (Lui et al., 2015). However, developing and evaluating interprofessional education at the national levels differs a lot, and a constructive debate has recently been triggered on the validity of the Readiness for Interprofessional Learning Scale (RIPLS) in the published editorials (
Conclusion and Implications for Educational Practice
According to our findings, it is the first time the RIPLS construct validity and reliability has been tested in undergraduate Serbian healthcare student context. This RIPLS version has shown good construct validity and reliability on “teamwork, collaboration and shared learning” subscale, while the “role and responsibilities” subscale has showed lower stability. However, further scale development should be stimulated in order to generate new items. In this respect, the present study has made a
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