http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, Early Online: 1–3 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.991911
SHORT REPORT
Indonesian students’ participation in an interprofessional learning workshop Desak Ketut Ernawati1,2, Ya Ping Lee2 and Jeffery Hughes2 Faculty of Medicine, Udayana University, Denpasar, Indonesia and 2School of Pharmacy, Curtin University, Perth, Australia
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
1
Abstract
Keywords
Interprofessional learning activities, such as workshops allow students to learn from, with and about each other. This study assessed the impact on Indonesian health students’ attitudes towards interprofessional education (IPE) from participating in a workshop on medication safety. The students attended a two-day IPE workshop on medication safety. Thirty-five (48.6%) students completed pre-/post-workshop surveys using a modified Readiness for Interprofessional Learning Scale (RIPLS) survey. The post-workshop survey also had a series of open-ended questions. Students’ responses to each RIPLS statement pre-/post-workshop were compared, whilst their responses to open-ended questions in post-workshop survey were thematically analysed. Students reported positive attitudinal changes on statements of shared learning and teamwork sub-scale (Wilcoxon p value 50.05). Analysis of the open-ended questions indicated that students perceived the workshop as having improved their understanding on the importance of teamwork and communication skills. This study found that learning with other health students through an IPE workshop improved medical, nursing and pharmacy students’ attitudes towards the importance of shared learning, teamwork and communication in healthcare service.
Communication, interprofessional education, interprofessional learning, RIPLS, teamwork History Received 12 January 2014 Revised 29 September 2014 Accepted 22 November 2014 Published online 12 December 2014
Introduction
Background
Although research on interprofessional education (IPE) has been reported extensively in the literature, there is limited integration of IPE into the health curricula of Indonesian universities (e.g. Directorate of Tertiary Education Institution in Indonesia, 2012). However, debate still remains as to the most appropriate types of IPE to be incorporated into the curricula to achieve the desired outcome. Buring et al. (2009) recommended the inclusion of quality assurance to ensure patient safety as a curriculum topic suitable within IPE. This topic reflects the interprofessional approach which is essential to ensure patient safety in healthcare delivery. Effective interprofessional teamwork amongst physicians, nurses and pharmacists are critical in ensuring medication safety because they are the key healthcare providers involved in a medication delivery process. Interprofessional education may bridge existing gaps in communication and improve teamwork amongst healthcare providers. Although there have been studies describing educational interventions in IPE, many of the studies do not include specific outcome measures (e.g. Thistlethwaite & Moran, 2010). This study aimed to assess the attitudinal changes toward IPE among undergraduate health students in Indonesia after attending an IPE workshop on medication safety with the use of a modified Readiness for Interprofessional Learning Scale (RIPLS) survey.
Workshop learning strategy was selected because it allowed students to participate interactively. Thus, they could exchange information and share their experiences during the learning process. The modules and modified RIPLS survey were adapted from a workshop on the same topic undertaken at Curtin University, Perth, Western Australia (Stafford, 2008). The workshop modules were translated into Bahasa Indonesia, which is the delivery language in universities of Indonesia. Further, the content and case studies of the workshop were adapted to Indonesian practice. The modules consisted of cases on medication errors and steps in the assessment of the root cause analysis.
Correspondence: Desak Ketut Ernawati, Faculty of Medicine, Udayana University, Jl PB Sudirman, Denpasar 80232, Indonesia. E-mail: [email protected]
Methods Final year undergraduate students from the medical, nursing and pharmacy schools in one of the universities in Bali, Indonesia, were selected to participate in the workshop. This was a quasiexperimental study to identify whether participation in an IPL workshop could influence health students’ attitudes towards IPE. The RIPLS survey was chosen as it has been validated for eight health professions, including medicine, nursing and pharmacy (Lie, Fung, Trial, & Lohenry, 2013). Data collection On the first day of the workshop, three experts gave lectures on topics relating to quality and safety in healthcare, root cause analysis, developing interventions, medication safety and errors versus violations. Before the session started, the students completed a pre-workshop RIPLS survey. On the second day,
2
D. K. Ernawati et al.
the students participated in a group-based interprofessional learning activity. In their individual groups, the students discussed cases related to medication errors. At the end of the session, the students completed a post-workshop RIPLS with additional open-ended questions. Data analysis Wilcoxon’s test p value was used to analyse overall students’ attitudes in the pre- and post-surveys. Fisher’s exact test was also employed to identify differences on student’s attitudinal changes from each school. Themes derived from students’ responses on open-ended questions were analysed using an inductive approach (Braun & Clarke, 2006).
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
Ethical approval Ethical approval for the study was obtained from the Curtin Human Research Ethic Committee (HREC) and Ethic Committee of the study university.
Results Twenty-one medical, 16 nursing and 22 pharmacy students attended the first day of the workshop. While on the second day, 10 medical, 10 nursing and 15 pharmacy students completed the post-workshop survey. These respondents were made up of 22 (63%) female and 13 (37%) male students. Wilcoxon’s test indicated that RIPLS statements 1, 3, 6, 10, 11, 12 and 13 were significantly different pre-post workshop, p50.05 (Table I). These statements were components of shared learning and teamwork sub-scale of the modified RIPLS survey in the current study. This showed that the interprofessional learning workshop had changed students’ attitudes towards agreement on the importance of shared learning and teamwork with other health students. Despite the fact that students’ attitudes toward shared learning and teamwork moved toward agreement, students from the three schools showed significant differences toward the importance of learning teamwork skills. This was shown from students’
J Interprof Care, Early Online: 1–3
responses to RIPLS statement 4 ‘‘Team working skills are essential for all healthcare students to learn’’. Fisher’s exact test value (p ¼ 0.011) for this statement was significantly different across the three cohorts of students before and after attending the workshop (Table I). Medical students’ responses moved towards disagreement on this statement in the post-workshop survey, whilst those of pharmacy students became more positive, and those of nursing students’ remained unchanged. This may suggest that medical students had less agreement on the necessity to learn teamwork skills after the workshop. However, some of the major themes identified from the analysis of the open-ended questions suggested an agreement towards the importance of learning teamwork skills. These themes include ‘‘realised the importance of teamwork and gained understanding of the roles of other healthcare professionals’’, and ‘‘understood responsibility and limitations of healthcare professionals’’. As indicated in the following response: I had more understanding on the roles of each health professional and on the importance of working with others to improve healthcare service after attending this workshop (Pharmacy student-01) Students who participated in the study also stated that they have gained teamwork experience and communication skills in the workshop, as reflected in the comments below: The workshop has improved my understanding on the importance of other healthcare professionals and I gained experiences on how to communicate and to work in a team (Medical student-05).
Discussion This study indicated that an IPE workshop on medication safety involving medical, nursing and pharmacy students improved students’ attitudes towards shared learning and teamwork. Participants also stated that they obtained an understanding on
Table I. Mean and differences of students’ attitudes on RIPLS statements before and after IPL workshop on medication safety.
RIPLS Statement 1. Learning with other students will help me become a more effective member of a health care team 2. Patient would ultimately benefit if health care students worked together 3. Shared learning with other health care students will increase my ability to understand clinical problems 4. Team working skills are essential for all healthcare students to learn 5. Shared learning will help me understand my own professional limitations 6. Learning between healthcare students before qualification would improve working relationships after qualification 7. Shared learning will help me think positively about other healthcare professionals 8. It is not necessary for undergraduate healthcare students to learn together 9. Shared learning with other healthcare students will help me communicate better with patients 10. Shared learning with other healthcare students will help me communicate better with other professionals 11. I would welcome the opportunity to work together with other healthcare students 12. Shared learning will help me clarify the nature of patient problems 13. Shared learning before qualification will help me become a better team worker 14. The function of allied health professionals is mainly to provide support for doctors 15. I am not sure what my professional role will be 16. I have to acquire much more knowledge than other healthcare students 17. I have to acquire many more skills than other healthcare students *Significant difference between medical, nursing and pharmacy students, p 5 0.05
Pre-test (X ± SD)
Post-test (X ± SD)
Wilcoxon’s Fisher’s exact test between p value groups (n ¼ 35)
1.63 ± 0.490 1.26 ± 0.423
50.01*
0.640
1.46 ± 0.505 1.31 ± 0.471 1.63 ± 0.490 1.34 ± 0.482
0.197 50.05*
0.162 0.643
1.40 ± 0.497 1.31 ± 0.471 1.77 ± 0.598 1.71 ± 0.519 1.60 ± 0.497 1.29 ± 0.458
0.439 0.480 50.01*
0.011* 0.899 0.101
1.63 ± 0.490 1.49 ± 0.507 3.46 ± 0.482 3.46 ± 0.701 1.83 ± 0.453 1.66 ± 0.684
0.225 0.617 0.186
0.052 0.103 0.165
1.74 ± 0.443 1.49 ± 0.562
50.05*
0.901
1.71 ± 0.458 1.71 ± 0.458 1.71 ± 0.458 3.00 ± 0.686 3.29 ± 0.710 2.03 ± 0.568 2.03 ± 0.568
50.01* 50.01* 50.01* 0.248 0.439 0.096 0.052
0.700 1.000 0.319 0.265 0.356 0.174 0.768
1.46 ± 0.505 1.40 ± 0.497 1.31 ± 0.471 3.11 ± 0.676 3.40 ± 0.604 2.17 ± 0.707 2.23 ± 0.731
Interprofessional learning workshop
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
DOI: 10.3109/13561820.2014.991911
the roles, responsibility and limitations of other health professions, as well as gained teamwork and communication experiences with other health students during the activity. The finding that medical students’ perceptions towards the need to learn to work in a team was less important following the workshop may be related to the strong professional identity of medical students in general. This needs further investigation prior to implementing IPE in the study university. This study suggested an increased positivity towards shared learning, teamwork and communication after attending an interprofessional learning workshop; however, there were some limitations to the study. Although the primary investigator recruited the students randomly, students’ participation was entirely voluntary. Due to the nature of voluntary participation, it is likely that those who participated in the study were supportive of IPE. The other limitation was lower than expected student participation rate. Although class coordinators had supported students’ participation in the workshop, less than 50% of randomly selected students actually attended the two-day workshop. Further, there was a significant drop in the number of students’ participation on the second day. The investigators were unable to explain the drop in student participation. In summary, an IPE workshop conducted on medication safety involving Indonesian pharmacy, medical and nursing students improved students’ attitudes toward shared learning, teamwork and communication with other health professional students. This supports the use of this type of workshop as an instrument to increase students’ readiness for IPE which is seen as key facilitator for effective interprofessional practice in the future.
3
Acknowledgements The authors would like to thank speakers, students and facilitators who participated in the workshop and Dr Richard Parson for his assistance with data analysis.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Quality Research Psychology, 3, 77–101. Buring, S. M., Bhushan, A., Brazeau, G., Conway, S., Hansen, L., & Westberg, S. (2009). Keys to successful implementation of interprofessional education: Learning location, faculty development, and curricular themes. American Journal of Pharmaceutical Education, 73, 60. Directorate of Tertiary Education Institution in Indonesia. (2012). Persepsi dan kesiapan mahasiswa dan dosen profesi kesehatan terhadap pendidikan interprofesi: Kajian nasional mahasiswa ilmu kesehatan Indonesia. Jakarta. Lie, D.A., Fung, C.C., Trial, J., & Lohenry, K. (2013). A comparison of two scales for assessing health professional students’ attitude toward interprofessional learning. Medical Education Online, 18. Stafford, L. (2008). Interprofessional learning pilot workshop: Final report. Perth: Curtin University of Technology. Thistlethwaite, J., & Moran, M. (2010). Learning outcomes for interprofessional education (IPE): Literature review and synthesis. Journal of Interprofessional Care, 24, 503–513.
SHORT REPORT
Indonesian students’ participation in an interprofessional learning workshop Desak Ketut Ernawati1,2, Ya Ping Lee2 and Jeffery Hughes2 Faculty of Medicine, Udayana University, Denpasar, Indonesia and 2School of Pharmacy, Curtin University, Perth, Australia
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
1
Abstract
Keywords
Interprofessional learning activities, such as workshops allow students to learn from, with and about each other. This study assessed the impact on Indonesian health students’ attitudes towards interprofessional education (IPE) from participating in a workshop on medication safety. The students attended a two-day IPE workshop on medication safety. Thirty-five (48.6%) students completed pre-/post-workshop surveys using a modified Readiness for Interprofessional Learning Scale (RIPLS) survey. The post-workshop survey also had a series of open-ended questions. Students’ responses to each RIPLS statement pre-/post-workshop were compared, whilst their responses to open-ended questions in post-workshop survey were thematically analysed. Students reported positive attitudinal changes on statements of shared learning and teamwork sub-scale (Wilcoxon p value 50.05). Analysis of the open-ended questions indicated that students perceived the workshop as having improved their understanding on the importance of teamwork and communication skills. This study found that learning with other health students through an IPE workshop improved medical, nursing and pharmacy students’ attitudes towards the importance of shared learning, teamwork and communication in healthcare service.
Communication, interprofessional education, interprofessional learning, RIPLS, teamwork History Received 12 January 2014 Revised 29 September 2014 Accepted 22 November 2014 Published online 12 December 2014
Introduction
Background
Although research on interprofessional education (IPE) has been reported extensively in the literature, there is limited integration of IPE into the health curricula of Indonesian universities (e.g. Directorate of Tertiary Education Institution in Indonesia, 2012). However, debate still remains as to the most appropriate types of IPE to be incorporated into the curricula to achieve the desired outcome. Buring et al. (2009) recommended the inclusion of quality assurance to ensure patient safety as a curriculum topic suitable within IPE. This topic reflects the interprofessional approach which is essential to ensure patient safety in healthcare delivery. Effective interprofessional teamwork amongst physicians, nurses and pharmacists are critical in ensuring medication safety because they are the key healthcare providers involved in a medication delivery process. Interprofessional education may bridge existing gaps in communication and improve teamwork amongst healthcare providers. Although there have been studies describing educational interventions in IPE, many of the studies do not include specific outcome measures (e.g. Thistlethwaite & Moran, 2010). This study aimed to assess the attitudinal changes toward IPE among undergraduate health students in Indonesia after attending an IPE workshop on medication safety with the use of a modified Readiness for Interprofessional Learning Scale (RIPLS) survey.
Workshop learning strategy was selected because it allowed students to participate interactively. Thus, they could exchange information and share their experiences during the learning process. The modules and modified RIPLS survey were adapted from a workshop on the same topic undertaken at Curtin University, Perth, Western Australia (Stafford, 2008). The workshop modules were translated into Bahasa Indonesia, which is the delivery language in universities of Indonesia. Further, the content and case studies of the workshop were adapted to Indonesian practice. The modules consisted of cases on medication errors and steps in the assessment of the root cause analysis.
Correspondence: Desak Ketut Ernawati, Faculty of Medicine, Udayana University, Jl PB Sudirman, Denpasar 80232, Indonesia. E-mail: [email protected]
Methods Final year undergraduate students from the medical, nursing and pharmacy schools in one of the universities in Bali, Indonesia, were selected to participate in the workshop. This was a quasiexperimental study to identify whether participation in an IPL workshop could influence health students’ attitudes towards IPE. The RIPLS survey was chosen as it has been validated for eight health professions, including medicine, nursing and pharmacy (Lie, Fung, Trial, & Lohenry, 2013). Data collection On the first day of the workshop, three experts gave lectures on topics relating to quality and safety in healthcare, root cause analysis, developing interventions, medication safety and errors versus violations. Before the session started, the students completed a pre-workshop RIPLS survey. On the second day,
2
D. K. Ernawati et al.
the students participated in a group-based interprofessional learning activity. In their individual groups, the students discussed cases related to medication errors. At the end of the session, the students completed a post-workshop RIPLS with additional open-ended questions. Data analysis Wilcoxon’s test p value was used to analyse overall students’ attitudes in the pre- and post-surveys. Fisher’s exact test was also employed to identify differences on student’s attitudinal changes from each school. Themes derived from students’ responses on open-ended questions were analysed using an inductive approach (Braun & Clarke, 2006).
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
Ethical approval Ethical approval for the study was obtained from the Curtin Human Research Ethic Committee (HREC) and Ethic Committee of the study university.
Results Twenty-one medical, 16 nursing and 22 pharmacy students attended the first day of the workshop. While on the second day, 10 medical, 10 nursing and 15 pharmacy students completed the post-workshop survey. These respondents were made up of 22 (63%) female and 13 (37%) male students. Wilcoxon’s test indicated that RIPLS statements 1, 3, 6, 10, 11, 12 and 13 were significantly different pre-post workshop, p50.05 (Table I). These statements were components of shared learning and teamwork sub-scale of the modified RIPLS survey in the current study. This showed that the interprofessional learning workshop had changed students’ attitudes towards agreement on the importance of shared learning and teamwork with other health students. Despite the fact that students’ attitudes toward shared learning and teamwork moved toward agreement, students from the three schools showed significant differences toward the importance of learning teamwork skills. This was shown from students’
J Interprof Care, Early Online: 1–3
responses to RIPLS statement 4 ‘‘Team working skills are essential for all healthcare students to learn’’. Fisher’s exact test value (p ¼ 0.011) for this statement was significantly different across the three cohorts of students before and after attending the workshop (Table I). Medical students’ responses moved towards disagreement on this statement in the post-workshop survey, whilst those of pharmacy students became more positive, and those of nursing students’ remained unchanged. This may suggest that medical students had less agreement on the necessity to learn teamwork skills after the workshop. However, some of the major themes identified from the analysis of the open-ended questions suggested an agreement towards the importance of learning teamwork skills. These themes include ‘‘realised the importance of teamwork and gained understanding of the roles of other healthcare professionals’’, and ‘‘understood responsibility and limitations of healthcare professionals’’. As indicated in the following response: I had more understanding on the roles of each health professional and on the importance of working with others to improve healthcare service after attending this workshop (Pharmacy student-01) Students who participated in the study also stated that they have gained teamwork experience and communication skills in the workshop, as reflected in the comments below: The workshop has improved my understanding on the importance of other healthcare professionals and I gained experiences on how to communicate and to work in a team (Medical student-05).
Discussion This study indicated that an IPE workshop on medication safety involving medical, nursing and pharmacy students improved students’ attitudes towards shared learning and teamwork. Participants also stated that they obtained an understanding on
Table I. Mean and differences of students’ attitudes on RIPLS statements before and after IPL workshop on medication safety.
RIPLS Statement 1. Learning with other students will help me become a more effective member of a health care team 2. Patient would ultimately benefit if health care students worked together 3. Shared learning with other health care students will increase my ability to understand clinical problems 4. Team working skills are essential for all healthcare students to learn 5. Shared learning will help me understand my own professional limitations 6. Learning between healthcare students before qualification would improve working relationships after qualification 7. Shared learning will help me think positively about other healthcare professionals 8. It is not necessary for undergraduate healthcare students to learn together 9. Shared learning with other healthcare students will help me communicate better with patients 10. Shared learning with other healthcare students will help me communicate better with other professionals 11. I would welcome the opportunity to work together with other healthcare students 12. Shared learning will help me clarify the nature of patient problems 13. Shared learning before qualification will help me become a better team worker 14. The function of allied health professionals is mainly to provide support for doctors 15. I am not sure what my professional role will be 16. I have to acquire much more knowledge than other healthcare students 17. I have to acquire many more skills than other healthcare students *Significant difference between medical, nursing and pharmacy students, p 5 0.05
Pre-test (X ± SD)
Post-test (X ± SD)
Wilcoxon’s Fisher’s exact test between p value groups (n ¼ 35)
1.63 ± 0.490 1.26 ± 0.423
50.01*
0.640
1.46 ± 0.505 1.31 ± 0.471 1.63 ± 0.490 1.34 ± 0.482
0.197 50.05*
0.162 0.643
1.40 ± 0.497 1.31 ± 0.471 1.77 ± 0.598 1.71 ± 0.519 1.60 ± 0.497 1.29 ± 0.458
0.439 0.480 50.01*
0.011* 0.899 0.101
1.63 ± 0.490 1.49 ± 0.507 3.46 ± 0.482 3.46 ± 0.701 1.83 ± 0.453 1.66 ± 0.684
0.225 0.617 0.186
0.052 0.103 0.165
1.74 ± 0.443 1.49 ± 0.562
50.05*
0.901
1.71 ± 0.458 1.71 ± 0.458 1.71 ± 0.458 3.00 ± 0.686 3.29 ± 0.710 2.03 ± 0.568 2.03 ± 0.568
50.01* 50.01* 50.01* 0.248 0.439 0.096 0.052
0.700 1.000 0.319 0.265 0.356 0.174 0.768
1.46 ± 0.505 1.40 ± 0.497 1.31 ± 0.471 3.11 ± 0.676 3.40 ± 0.604 2.17 ± 0.707 2.23 ± 0.731
Interprofessional learning workshop
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
DOI: 10.3109/13561820.2014.991911
the roles, responsibility and limitations of other health professions, as well as gained teamwork and communication experiences with other health students during the activity. The finding that medical students’ perceptions towards the need to learn to work in a team was less important following the workshop may be related to the strong professional identity of medical students in general. This needs further investigation prior to implementing IPE in the study university. This study suggested an increased positivity towards shared learning, teamwork and communication after attending an interprofessional learning workshop; however, there were some limitations to the study. Although the primary investigator recruited the students randomly, students’ participation was entirely voluntary. Due to the nature of voluntary participation, it is likely that those who participated in the study were supportive of IPE. The other limitation was lower than expected student participation rate. Although class coordinators had supported students’ participation in the workshop, less than 50% of randomly selected students actually attended the two-day workshop. Further, there was a significant drop in the number of students’ participation on the second day. The investigators were unable to explain the drop in student participation. In summary, an IPE workshop conducted on medication safety involving Indonesian pharmacy, medical and nursing students improved students’ attitudes toward shared learning, teamwork and communication with other health professional students. This supports the use of this type of workshop as an instrument to increase students’ readiness for IPE which is seen as key facilitator for effective interprofessional practice in the future.
3
Acknowledgements The authors would like to thank speakers, students and facilitators who participated in the workshop and Dr Richard Parson for his assistance with data analysis.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Quality Research Psychology, 3, 77–101. Buring, S. M., Bhushan, A., Brazeau, G., Conway, S., Hansen, L., & Westberg, S. (2009). Keys to successful implementation of interprofessional education: Learning location, faculty development, and curricular themes. American Journal of Pharmaceutical Education, 73, 60. Directorate of Tertiary Education Institution in Indonesia. (2012). Persepsi dan kesiapan mahasiswa dan dosen profesi kesehatan terhadap pendidikan interprofesi: Kajian nasional mahasiswa ilmu kesehatan Indonesia. Jakarta. Lie, D.A., Fung, C.C., Trial, J., & Lohenry, K. (2013). A comparison of two scales for assessing health professional students’ attitude toward interprofessional learning. Medical Education Online, 18. Stafford, L. (2008). Interprofessional learning pilot workshop: Final report. Perth: Curtin University of Technology. Thistlethwaite, J., & Moran, M. (2010). Learning outcomes for interprofessional education (IPE): Literature review and synthesis. Journal of Interprofessional Care, 24, 503–513.
