http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2014; 28(5): 478–480 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2014.911722
SHORT REPORT
Interprofessional ethics learning between schools of pharmacy and dental medicine Miranda Wilhelm1, Therese Poirier1, Allen Otsuka2 and Sarah Wagner1 1
SIUE School of Pharmacy, Edwardsville, IL, USA and 2SIU School of Dental Medicine, Alton, IL, USA
Abstract
Keywords
A case-based interprofessional education (IPE) ethics activity between pharmacy and dental students was developed and evaluated. Eighty-two third-year pharmacy and 51 first-year dental students were divided into teams for two sessions. The IPE activity involved the student teams analyzing two cases at each session utilizing an ethical decision-making process followed by debriefing of each case. Assessments included pre-/post-Readiness for Interprofessional Learning Scale (RIPLS), pre-/post-individual ethics knowledge quiz, pre-team ethics knowledge quiz and post-student perception survey. The results indicated no significant differences in RIPLS scores although scores indicated a high readiness for interprofessional learning including teamwork and collaboration among pharmacy and dental students. When comparing pre-/ post-ethics knowledge quiz scores a significant difference was found between individual and team scores as well as between professions. Perception survey results were highly favorable toward the value of interprofessional learning activities. The sessions resulted in enhanced knowledge about ethical decision-making.
Case study, dental medicine, ethics, evaluation, interprofessional education, interprofessional ethics, pharmacy
Introduction Developing models for interprofessional education (IPE) is necessary for the health professional programs including pharmacy and dental medicine. Previous literature has described interprofessional health care ethics courses but not between pharmacy and dental medicine students and with limited evaluations (Banks & Janke, 1998; Lennon-Dearing, Lowry, Ross, & Dyer, 2009; Yarborough, Jones, Cyr, Phillips, & Stelzner, 2000). Challenges were presented which limited the effectiveness of these endeavors. These challenges included developing relevant ethics cases for both professions; identifying common schedules; locating physical space for meeting; student perceptions about purpose of sessions; and lack of time to get to know the other profession. Southern Illinois University Edwardsville (SIUE) which has a School of Pharmacy located in Edwardsville, Illinois and a School of Dental Medicine located in Alton, Illinois developed and evaluated an IPE ethics model between the pharmacy and dental medicine programs. The goals of the model were to develop an IPE activity using ethics as a thematic area and address the challenges previously reported in the literature. Interprofessional ethics model Addressing the challenges of curricular structure, schedules and availability of facilities, two 2 h sessions with 82 third-year
Correspondence: Dr. Miranda Wilhelm, Pharm. D., SIUE School of Pharmacy, Pharmacy Practice, 200 University Park Drive, Campus Box 2000, Edwardsville, IL 62026, USA. E-mail: [email protected]
History Received 28 August 2013 Revised 25 February 2014 Accepted 1 April 2014 Published online 28 April 2014
pharmacy and 51 first-year dental students were scheduled in the University ballroom on the main campus. The students were divided into 16 teams, each team consisted of generally five pharmacy and three dental students. The first 2 h session consisted of an icebreaker to inform students about the knowledge base of the other profession and the analysis of two ethics cases. The second 2 h session held 3 weeks later consisted of a faculty member-led debriefing on the ethical cases from the previous session and teams analyzing two new cases. Ethical dilemmas were developed to address the issues of veracity, autonomy, beneficence and non-maleficence. Case topics included: providing care in a fraudulent manner to a patient with the inability to pay for care; addressing when the family does not want a patient to be told what a medication is used for; disclosing a medical condition to a patient’s partner; and committing insurance fraud by billing for a covered dental procedure when a non-covered procedure was performed.
Methods This study employed a pre–post intervention quasi-experimental research design to examine student perceptions and knowledge of interprofessional ethical decision-making processes. Data collection Students completed pre-assessments consisting of individual and team ethics knowledge quizzes on pre-assigned readings, and the Readiness for Interprofessional Learning Scale (RIPLS) (Parsell & Bligh, 1999). During the second and final session, students completed post-assessments consisting of individual ethics knowledge quiz, post-RIPLS and a perception
IPE ethics evaluation
DOI: 10.3109/13561820.2014.911722
survey. The perception survey consisted of 13, five-point Likert scale statements along with two open-ended questions. Students responded to statements relating to the IPE core competencies about how the sessions enhanced their knowledge of ethical issues, roles/responsibilities, teamwork and communication skills. Analysis Pre-/post-individual ethics knowledge quiz scores and pre-individual versus pre-team ethics knowledge quiz scores were analyzed using a matched paired t-test. Scores by profession were analyzed using a one way ANOVA. RIPLS scores were analyzed comparing pre-/post-sessions as well as by profession using a one way ANOVA. Perception survey data was evaluated by calculating mean responses for the quantitative data. The assessment instruments were reviewed and approved as exempt research by the SIUE Institutional Review Board.
Results Significant differences, i.e. p50.05, in ethics knowledge quiz scores were noted for all comparisons between the pre- and post-sessions. The RIPLS scores were not significantly different between the pharmacy and dental students at baseline or post-sessions (Table I). The perception survey indicated a favorable attitude toward the IPE ethics sessions. Mean responses were generally in agreement with the positive statements. Students frequently commented that they learned both professions face similar ethical issues approaching them in a similar manner. Student comments from the perception survey indicated that the case discussions, teamwork and getting to know the other professional students were most useful in their learning. Areas for improvement include having more varied cases as well as cases that apply to both professions. The students also wished to learn more about each other both personally and professionally.
479
Discussion The challenges for implementation of IPE between a pharmacy and dental medicine program were addressed. A common schedule and vector for IPE were logistically identified. The SIUE IPE sessions addressed the issues raised by Banks and Janke (1998) by including an icebreaker activity, allowing time for teams to get to know more about the other profession and by scheduling during regular daylight time frames. Another challenge in this interprofessional learning experience was developing cases that both professions would find relevant (Yarborough et al., 2000). Like Lennon-Dearing et al. (2009), SIUE faculty from both pharmacy and dental medicine collaborated to develop and facilitate the interprofessional case-based discussions. Two of the cases were non-specific dealing with patient care interactions. The other two cases were more profession-specific such as one that focused on the care of a dental patient and the other that focused on patient counseling on the use of a specific medication. This is one of the reasons why the new health care ethics course being developed at SIUE will include both interprofessional and single professional learning as recommended by Caldicott and Braun (2011). Yarborough et al. (2000) found in their offering that students perceived an emphasis on the interprofessional nature of the course where the interprofessional themes overshadowed the ethics themes. In contrast with our IPE ethics model, students were able to recognize that the focus was to develop ethical decision-making abilities. It is noted that this IPE activity was the first structured one for both pharmacy and dental students. The results from the pre-/post-assessment of knowledge revealed that students enhanced their learning about ethical decision making. Dental students performed better than the pharmacy students on the ethics knowledge assessment. This could be attributed to the dental students being enrolled in an ethics course while participating in the IPE ethics sessions.
Table I. Ethics knowledge quiz and readiness for interprofessional learning scale scores. Ethics knowledge quiz scores Mean (Maximum score was 10)
p Value
8.45 9.82 8.20 8.72 8.45 9.08 8.93 9.25
0.000
Pre-individual Pre-team Pre-pharmacy individual Pre-dental individual Pre-individual Post-individual Post-pharmacy individual Post-dental individual Readiness for interprofessional learning scale scores Meana p Value Factor 1b Pre Post Pre-pharmacy Pre-dental Post-pharmacy Post-dental Pre-pharmacy Post-pharmacy Pre-dental Post-dental a
81.82 81.22 82.18 81.02 80.76 82.48 82.18 80.76 81.02 82.48
0.930 0.634 0.381 0.440 0.460
40.47 40.62 40.61 40.25 40.40 41.27 40.61 40.40 40.25 41.27
Maximum score is 95 (RIPLS). Maximum score is 45 (Factor 1 is teamwork and collaboration). c Maximum score is 40 (Factor 2 is professional identity). d Maximum score is 10 (Factor 3 is roles and responsibilities). b
0.044 0.000 0.107
p Value
Factor 2c
p Value
Factor 3d
p Value
0.854
33.92 33.41 34.26 33.37 33.28 33.79 34.26 33.28 33.37 33.79
0.309
7.43 7.19 7.32 7.61 7.07 7.42 7.32 7.07 7.61 7.42
0.075
0.035 0.035 0.681 0.054
0.763 0.711 0.685 0.920
0.874 0.500 0.157 0.044
480
M. Wilhelm et al.
The pharmacy students would not have ethics until the following semester and there was minimal incentive other than attendance. Both pharmacy and dental students were at a comparable level of readiness for interprofessional learning. The feedback received indicated that both groups of students enjoyed the experiences and desired to have more IPE with other healthcare professional students. No significant changes in RIPLS could be demonstrated as a result of the two IPE sessions. This may be due to the limited scope of the interprofessional learning with only two sessions and/ or the short 3-week timeframe between the two sessions. It is also possible that the RIPLS scale is not sensitive enough to detect changes after an educational intervention as both groups of students were already at a high level of readiness for interprofessional learning. In conclusion, the IPE ethics sessions were positively received by both pharmacy and dental students. Even though effects on IPE learning were not fully demonstrated, students desired more interprofessional learning. Using an interprofessional structure to teach ethics is promising and ethics is a useful vector to develop interprofessional skills.
J Interprof Care, 2014; 28(5): 478–480
Declaration of interest The authors report no declaration of interest. The authors are responsible for the writing and content of this paper.
References Banks, S., & Janke, K. (1998). Developing and implementing interprofessional learning in a faculty of health professions. Journal of Allied Health, 27, 132–136. Caldicott, C., & Braun, E. (2011). Should professional ethics education incorporate single-professional or interprofessional learning? Advances in Health Science Education: Theory and Practice, 16, 143–146. Lennon-Dearing, R., Lowry, L., Ross, C., & Dyer, A. (2009). An interprofessional course in bioethics: Training for real-world dilemmas. Journal of Interprofessional Care, 23, 574–585. Parsell, G., & Bligh, J. (1999). The development of a questionnaire to assess the readiness of health care students for interprofessional learning (RIPLS). Medical Education, 33, 95–100. Yarborough, M., Jones, T., Cyr, T., Phillips, S., & Stelzner, D. (2000). Interprofessional education in ethics at an academic health sciences center. Academic Medicine, 75, 793–800.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
SHORT REPORT
Interprofessional ethics learning between schools of pharmacy and dental medicine Miranda Wilhelm1, Therese Poirier1, Allen Otsuka2 and Sarah Wagner1 1
SIUE School of Pharmacy, Edwardsville, IL, USA and 2SIU School of Dental Medicine, Alton, IL, USA
Abstract
Keywords
A case-based interprofessional education (IPE) ethics activity between pharmacy and dental students was developed and evaluated. Eighty-two third-year pharmacy and 51 first-year dental students were divided into teams for two sessions. The IPE activity involved the student teams analyzing two cases at each session utilizing an ethical decision-making process followed by debriefing of each case. Assessments included pre-/post-Readiness for Interprofessional Learning Scale (RIPLS), pre-/post-individual ethics knowledge quiz, pre-team ethics knowledge quiz and post-student perception survey. The results indicated no significant differences in RIPLS scores although scores indicated a high readiness for interprofessional learning including teamwork and collaboration among pharmacy and dental students. When comparing pre-/ post-ethics knowledge quiz scores a significant difference was found between individual and team scores as well as between professions. Perception survey results were highly favorable toward the value of interprofessional learning activities. The sessions resulted in enhanced knowledge about ethical decision-making.
Case study, dental medicine, ethics, evaluation, interprofessional education, interprofessional ethics, pharmacy
Introduction Developing models for interprofessional education (IPE) is necessary for the health professional programs including pharmacy and dental medicine. Previous literature has described interprofessional health care ethics courses but not between pharmacy and dental medicine students and with limited evaluations (Banks & Janke, 1998; Lennon-Dearing, Lowry, Ross, & Dyer, 2009; Yarborough, Jones, Cyr, Phillips, & Stelzner, 2000). Challenges were presented which limited the effectiveness of these endeavors. These challenges included developing relevant ethics cases for both professions; identifying common schedules; locating physical space for meeting; student perceptions about purpose of sessions; and lack of time to get to know the other profession. Southern Illinois University Edwardsville (SIUE) which has a School of Pharmacy located in Edwardsville, Illinois and a School of Dental Medicine located in Alton, Illinois developed and evaluated an IPE ethics model between the pharmacy and dental medicine programs. The goals of the model were to develop an IPE activity using ethics as a thematic area and address the challenges previously reported in the literature. Interprofessional ethics model Addressing the challenges of curricular structure, schedules and availability of facilities, two 2 h sessions with 82 third-year
Correspondence: Dr. Miranda Wilhelm, Pharm. D., SIUE School of Pharmacy, Pharmacy Practice, 200 University Park Drive, Campus Box 2000, Edwardsville, IL 62026, USA. E-mail: [email protected]
History Received 28 August 2013 Revised 25 February 2014 Accepted 1 April 2014 Published online 28 April 2014
pharmacy and 51 first-year dental students were scheduled in the University ballroom on the main campus. The students were divided into 16 teams, each team consisted of generally five pharmacy and three dental students. The first 2 h session consisted of an icebreaker to inform students about the knowledge base of the other profession and the analysis of two ethics cases. The second 2 h session held 3 weeks later consisted of a faculty member-led debriefing on the ethical cases from the previous session and teams analyzing two new cases. Ethical dilemmas were developed to address the issues of veracity, autonomy, beneficence and non-maleficence. Case topics included: providing care in a fraudulent manner to a patient with the inability to pay for care; addressing when the family does not want a patient to be told what a medication is used for; disclosing a medical condition to a patient’s partner; and committing insurance fraud by billing for a covered dental procedure when a non-covered procedure was performed.
Methods This study employed a pre–post intervention quasi-experimental research design to examine student perceptions and knowledge of interprofessional ethical decision-making processes. Data collection Students completed pre-assessments consisting of individual and team ethics knowledge quizzes on pre-assigned readings, and the Readiness for Interprofessional Learning Scale (RIPLS) (Parsell & Bligh, 1999). During the second and final session, students completed post-assessments consisting of individual ethics knowledge quiz, post-RIPLS and a perception
IPE ethics evaluation
DOI: 10.3109/13561820.2014.911722
survey. The perception survey consisted of 13, five-point Likert scale statements along with two open-ended questions. Students responded to statements relating to the IPE core competencies about how the sessions enhanced their knowledge of ethical issues, roles/responsibilities, teamwork and communication skills. Analysis Pre-/post-individual ethics knowledge quiz scores and pre-individual versus pre-team ethics knowledge quiz scores were analyzed using a matched paired t-test. Scores by profession were analyzed using a one way ANOVA. RIPLS scores were analyzed comparing pre-/post-sessions as well as by profession using a one way ANOVA. Perception survey data was evaluated by calculating mean responses for the quantitative data. The assessment instruments were reviewed and approved as exempt research by the SIUE Institutional Review Board.
Results Significant differences, i.e. p50.05, in ethics knowledge quiz scores were noted for all comparisons between the pre- and post-sessions. The RIPLS scores were not significantly different between the pharmacy and dental students at baseline or post-sessions (Table I). The perception survey indicated a favorable attitude toward the IPE ethics sessions. Mean responses were generally in agreement with the positive statements. Students frequently commented that they learned both professions face similar ethical issues approaching them in a similar manner. Student comments from the perception survey indicated that the case discussions, teamwork and getting to know the other professional students were most useful in their learning. Areas for improvement include having more varied cases as well as cases that apply to both professions. The students also wished to learn more about each other both personally and professionally.
479
Discussion The challenges for implementation of IPE between a pharmacy and dental medicine program were addressed. A common schedule and vector for IPE were logistically identified. The SIUE IPE sessions addressed the issues raised by Banks and Janke (1998) by including an icebreaker activity, allowing time for teams to get to know more about the other profession and by scheduling during regular daylight time frames. Another challenge in this interprofessional learning experience was developing cases that both professions would find relevant (Yarborough et al., 2000). Like Lennon-Dearing et al. (2009), SIUE faculty from both pharmacy and dental medicine collaborated to develop and facilitate the interprofessional case-based discussions. Two of the cases were non-specific dealing with patient care interactions. The other two cases were more profession-specific such as one that focused on the care of a dental patient and the other that focused on patient counseling on the use of a specific medication. This is one of the reasons why the new health care ethics course being developed at SIUE will include both interprofessional and single professional learning as recommended by Caldicott and Braun (2011). Yarborough et al. (2000) found in their offering that students perceived an emphasis on the interprofessional nature of the course where the interprofessional themes overshadowed the ethics themes. In contrast with our IPE ethics model, students were able to recognize that the focus was to develop ethical decision-making abilities. It is noted that this IPE activity was the first structured one for both pharmacy and dental students. The results from the pre-/post-assessment of knowledge revealed that students enhanced their learning about ethical decision making. Dental students performed better than the pharmacy students on the ethics knowledge assessment. This could be attributed to the dental students being enrolled in an ethics course while participating in the IPE ethics sessions.
Table I. Ethics knowledge quiz and readiness for interprofessional learning scale scores. Ethics knowledge quiz scores Mean (Maximum score was 10)
p Value
8.45 9.82 8.20 8.72 8.45 9.08 8.93 9.25
0.000
Pre-individual Pre-team Pre-pharmacy individual Pre-dental individual Pre-individual Post-individual Post-pharmacy individual Post-dental individual Readiness for interprofessional learning scale scores Meana p Value Factor 1b Pre Post Pre-pharmacy Pre-dental Post-pharmacy Post-dental Pre-pharmacy Post-pharmacy Pre-dental Post-dental a
81.82 81.22 82.18 81.02 80.76 82.48 82.18 80.76 81.02 82.48
0.930 0.634 0.381 0.440 0.460
40.47 40.62 40.61 40.25 40.40 41.27 40.61 40.40 40.25 41.27
Maximum score is 95 (RIPLS). Maximum score is 45 (Factor 1 is teamwork and collaboration). c Maximum score is 40 (Factor 2 is professional identity). d Maximum score is 10 (Factor 3 is roles and responsibilities). b
0.044 0.000 0.107
p Value
Factor 2c
p Value
Factor 3d
p Value
0.854
33.92 33.41 34.26 33.37 33.28 33.79 34.26 33.28 33.37 33.79
0.309
7.43 7.19 7.32 7.61 7.07 7.42 7.32 7.07 7.61 7.42
0.075
0.035 0.035 0.681 0.054
0.763 0.711 0.685 0.920
0.874 0.500 0.157 0.044
480
M. Wilhelm et al.
The pharmacy students would not have ethics until the following semester and there was minimal incentive other than attendance. Both pharmacy and dental students were at a comparable level of readiness for interprofessional learning. The feedback received indicated that both groups of students enjoyed the experiences and desired to have more IPE with other healthcare professional students. No significant changes in RIPLS could be demonstrated as a result of the two IPE sessions. This may be due to the limited scope of the interprofessional learning with only two sessions and/ or the short 3-week timeframe between the two sessions. It is also possible that the RIPLS scale is not sensitive enough to detect changes after an educational intervention as both groups of students were already at a high level of readiness for interprofessional learning. In conclusion, the IPE ethics sessions were positively received by both pharmacy and dental students. Even though effects on IPE learning were not fully demonstrated, students desired more interprofessional learning. Using an interprofessional structure to teach ethics is promising and ethics is a useful vector to develop interprofessional skills.
J Interprof Care, 2014; 28(5): 478–480
Declaration of interest The authors report no declaration of interest. The authors are responsible for the writing and content of this paper.
References Banks, S., & Janke, K. (1998). Developing and implementing interprofessional learning in a faculty of health professions. Journal of Allied Health, 27, 132–136. Caldicott, C., & Braun, E. (2011). Should professional ethics education incorporate single-professional or interprofessional learning? Advances in Health Science Education: Theory and Practice, 16, 143–146. Lennon-Dearing, R., Lowry, L., Ross, C., & Dyer, A. (2009). An interprofessional course in bioethics: Training for real-world dilemmas. Journal of Interprofessional Care, 23, 574–585. Parsell, G., & Bligh, J. (1999). The development of a questionnaire to assess the readiness of health care students for interprofessional learning (RIPLS). Medical Education, 33, 95–100. Yarborough, M., Jones, T., Cyr, T., Phillips, S., & Stelzner, D. (2000). Interprofessional education in ethics at an academic health sciences center. Academic Medicine, 75, 793–800.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
