Evaluation of an interprofessional education program involving medical and pharmacy students: a mixed-method study | BMC Medical Education

Study design

To evaluate the impact of the IPE program focused on pharmacotherapy, a mixed-method study was conducted. Initially, data were collected using a survey, which provided a broad overview of the program’s effects. To gain deeper insights into students’ perceptions of IPC between physicians and pharmacists, semi-structured interviews were then carried out. Our approach was grounded in a constructivist paradigm [15]. The results are reported using the Mixed Methods Appraisal Tool (MMAT) (Appendix 1) [16].

Setting

In the Netherlands, both the medical and pharmacy curricula span six years, and are divided into a three-year bachelor’s and a three-year master’s curriculum. The bachelor’s curricula focus on theoretical knowledge, while the master’s curricula for both disciplines include multiple internships in diverse healthcare settings, interspersed with weeks of classroom-based teaching. The IPE program, involving both medical and pharmacy students, was initially designed in 2017 at the Leiden University Medical Center (LUMC) and has been gradually developed and implemented in both master’s curricula at this faculty. Integrated throughout their curricula, the program covers a range of clinical areas, increasing in complexity and autonomy. This structured progression is considered relevant for allowing students to develop competencies in various clinical situations over time, providing multiple perspectives on the importance of IPC and its application in real-world settings. Table 1 outlines the three mandatory activities, detailing the estimated time and learning objectives. In the first activity, in the first year of their master’s, students are tasked with developing healthcare plans for paper-based patient cases related to myocardial infarction, type 2 diabetes mellitus with hypertension, and kidney failure, using the WHO-6-step method [17]. These three cases, created through discussions with medical and pharmacy experts, are aligned with topics previously covered in their curricula. In small groups, students address one case and present their findings to the others, while actively participating in discussions about the cases presented by the other groups. For the second activity, in their second master’s year, students engage in discussions on two paper-based patient cases focusing on pharmacogenetics via digital consultation. For the third activity, students conduct a medication review when visiting a polypharmacy patient in primary practice. This activity takes place when pharmacy students are in their third master’s year, and medical students are at the end of their second master’s year, where they conclude their mandatory internships. They collaboratively present their healthcare plan to other students and educators from both professions. Subsequently, the healthcare plan is discussed with the patient, their general practitioner, and their community pharmacist. Due to the greater number of medical students than pharmacy students, medical students participate in the described activities both inter- and uniprofessionally, while pharmacy students participate exclusively in interprofessional activities. Despite some activities being performed uniprofessionally, all learning activities focus on IPC. In each concluding group activity, educators from both professions are present to provide content feedback and facilitate reflection on collaboration. Particularly in instances where no pharmacy student is present, educators elaborate on the pharmacy profession and the role of the pharmacist in these activities in clinical practice.

Study population

The study population consisted of medical and pharmacy students who held a bachelor’s degree in medicine or pharmacy, ensuring (partial) professional identity formation. Both groups of students began the program in their first year of their three-year master’s curricula. A group of no more than 25 medical students commenced the program every four weeks. Depending on their schedules and alignment with the pharmacy curriculum, they participated in the learning activity either interprofessionally with pharmacy students or uniprofessionally with only medical students. Given that the LUMC admits only 50 pharmacy students annually, the allocation of pharmacy students to activities was strategically planned to maximize opportunities for interaction with medical students. This approach resulted in eight pharmacy students joining 25 medical students to work on cases in the first IPE activity (IPE1), which occurred six times per year. Similarly, UPE1 also occurred six times per year. For the second activity, 75% of the scheduled activities involved six pharmacy students working with 25 medical students (IPE2). The remaining 25% of activities involved medical students only (UPE2). Four to six medical students from each group of 25 (approximately 20%) conducted a medication review in collaboration with a pharmacy student (IPE3), while the remaining medical students performed a medication review uniprofessionally, with the option of consulting a community pharmacist in clinical practice (UPE3). While it cannot be guaranteed, it is assumed that all medical students participate in at least one interprofessional activity with pharmacy students at some point during their curriculum.

Surveys

Over a ten-month period (September 2022 to June 2023), all participants of the three mandatory activities received the Interprofessional Collaborative Competency Attainment Scale (ICCAS), a validated 21-item self-report tool designed to assess the perceived development of interprofessional core competencies [18]. Based on the competencies reflected in the Canadian Interprofessional Health Collaborative (CIHC) framework [19], this scale evaluates proficiency in the following competency domains: Communication, Collaboration, Roles and Responsibilities, Collaborative Patient-Centered Approach, Conflict Management, and Team Functioning. The ICCAS employs a retrospective pre-test and post-test self-assessment design, in which participants rate their competence development after the learning activity, reflecting on their levels both before and after the experience. The ICCAS underwent translation from English to Dutch using scale names familiar to the students. Four students tested the comprehensibility of the translated ICCAS, resulting in minor textual adjustments. In addition to the ICCAS, demographic data were collected including gender, age, study type, and prior involvement in mandatory IPE Pharmacotherapy learning activities to assess the impact of this program throughout the curricula. To further evaluate learning outcomes, three open-ended questions were incorporated into the survey, prompting participants to reflect on their learning experiences, their contributions to the learning experiences of peers, and the application of acquired knowledge and insights in practice. Conducted at the end of each activity (UPE or IPE), the paper-based survey aimed to maximize response rates and facilitate accurate recollection by capturing participants’ immediate feedback. The English survey is included in Appendix 2.

Survey data analysis

The demographic data were subjected to descriptive analysis. To compare the development in interprofessional competency (pre-test vs post-test) at the level of each specific item for the entire cohort of students, paired student’s t-tests were conducted using SPSS version 27. A predetermined significance level of p < 0.05 was considered statistically significant. Effect sizes were determined using Cohen’s d, with values exceeding 0.8 interpreted as indicating a large effect size, values between 0.5 and 0.79 indicating a moderate effect size, and values below 0.5 indicating a small effect size. These effect size interpretations were comparable with those observed in the validation study of the revised ICCAS tool [20]. For a Cohen’s d of 0.5, 33 participants is sufficient to reach a power of 80%. To compare the scores on each item across all IPE activities between medical and pharmacy students, independent samples t-tests were conducted to compare the means of two independent groups (medical and pharmacy students) regarding a continuous variable (ICCAS scores). Linear regression analysis was conducted to explore the relationship between ICCAS scores and the number of IPE activities followed, with the number of activities as the independent variable. This method can establish a linear relationship between continuous dependent variables (ICCAS scores) and a continuous independent variable (number of IPE activities), helping to quantify how the number of activities influences changes in students’ perceived competencies. Sensitivity analysis was performed to assess the impact of missing data, which were assumed to be missing completely at random. To assess the internal consistency of the translated ICCAS, Cronbach’s Alpha was calculated, with a value above 0.7 considered acceptable [21]. Qualitative data from open-ended questions about students’ perceived learning outcomes were analyzed inductively using thematic analysis, informed by the AMEE Guide on thematic analysis of qualitative data [22]. Themes were identified through systematic (re)reading and independent parallel coding by JM and student KK. Discrepancies in code names were resolved through discussion, either between the coders or with a third researcher (MH). Themes were constructed by JM by analyzing, combining, and comparing codes, and were then discussed with MH and TK. Atlas.ti version 22 was used to support the analysis process. The information power to evaluate perceived learning outcomes was anticipated to be achieved with the planned number of participants for the quantitative analysis [23]. Due to the absence of personally identifiable data, it was not possible to link responses across multiple surveys. As a result, the potential for clustering of responses from students taking the survey multiple times was not accounted for in the data analysis.

Interviews

To gain deeper insights into how this program involving multiple IPE activities influenced students’ perceptions of IPC, semi-structured interviews were conducted with medical and pharmacy students who had participated in multiple activities. Invitations were randomly sent to students who participated in IPE activities between October 2023 and April 2024. Participants were invited by a research student after the activity to avoid influencing their participation or experience during the activity. The interviewed students did not participate in the survey study. The face-to-face interviews were conducted as soon as possible after the IPE activity in a private room on campus or via video call using Microsoft Teams. The interviews were conducted by research students (RV and LN) with experience in conducting interviews under the guidance of JM and MH. Based on the obtained quantitative and qualitative survey data, a semi-structured interview guide was developed (Appendix 3). This guide included questions about how multiple IPE activities influenced students’ perceptions of IPC in clinical practice. After the first two interviews, the interview guide was evaluated and minor adjustments were made. The interviews were audio recorded, transcribed verbatim manually, and anonymized by the research students, with a pseudonym assigned to each participant to ensure confidentiality. Transcripts were randomly checked by JM at intervals, with each transcript reviewed twice.

Interview data analysis

The interview transcripts were analyzed inductively using thematic analysis, guided by the AMEE guide on thematic analysis of qualitative data [22]. Themes were identified through systematical (re)reading and independent parallel coding by JM and either MH or research student RV. Discrepancies in coded text passages and code names were resolved through discussion, either between the coders or with a third researcher. Themes were constructed by JM by analyzing, combining, and comparing codes, and were then discussed with MH and TK, followed by further refinement with CW, AN, and TvK. Atlas.ti version 23 was used to support the analysis process. After identifying themes from the data, these were then categorized into four competency domains from the most recent IPEC framework: Values and Ethics, Communication, Roles and Responsibility, and Teams and Teamwork [14]. This deductive step allowed us to align the emergent themes with a widely recognized framework, facilitating comparison with the literature and providing clearer insight into how this program influenced students’ perceptions in essential collaborative domains. The categorized themes are presented in a table alongside supporting responses. Sampling continued until JM and MH determined that data sufficiency to evaluate students’ perceptions of interprofessional collaboration had been reached [23]. This decision ensured representation from at least two pharmacy students and two medical students immediately following IPE2, and two students from each discipline following IPE3.

Reflexivity

The research team for this study comprises two pharmacists (JM, TK), two medical doctors (CW, TvG), one biomedical scientist (MH), one biomedical data scientist (SB), and one educational specialist (AN). Working within a constructivist epistemology [24], the team was carefully assembled to ensure a diverse range of perspectives. Each member has prior research experience and is actively engaged in health professions education. To mitigate the potential for socially desirable answers, the data was collected by research students. Specifically, survey data collection was conducted by a pharmacy research student, while interviews were conducted by a research student specializing in pharmaceutical business administration at the Utrecht University of Applied Sciences and a medical student from the LUMC, both of whom are in the Netherlands. None of the research students had direct educational relationships with the participants, encouraging them to openly share their experiences and perceptions.