Accepted Manuscript Measuring Students’ Perceptions Of Interprofessional Clinical Placements: Development Of The Interprofessional Clinical Placement Learning Environment Inventory Amanda Anderson , MNutDiet, GradDipHealthProfEduc APD Robyn Cant , PhD, MHlthSc, GradDipHlthEduc Kerry Hood , BN, MNurs(Res), GradDipSimulation, RN PII:
S1471-5953(14)00058-4
DOI:
10.1016/j.nepr.2014.05.009
Reference:
YNEPR 1879
To appear in:
Nurse Education in Practice
Received Date: 5 July 2013 Revised Date:
11 February 2014
Accepted Date: 9 May 2014
Please cite this article as: Anderson, A., Cant, R., Hood, K., Measuring Students’ Perceptions Of Interprofessional Clinical Placements: Development Of The Interprofessional Clinical Placement Learning Environment Inventory, Nurse Education in Practice (2014), doi: 10.1016/j.nepr.2014.05.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title page
RI PT
MEASURING STUDENTS’ PERCEPTIONS OF INTERPROFESSIONAL CLINICAL PLACEMENTS: DEVELOPMENT OF THE INTERPROFESSIONAL CLINICAL PLACEMENT LEARNING ENVIRONMENT INVENTORY Short title ICPLEI: assessing students’ interprofessional learning
SC
AUTHORS
Amanda Anderson MNutDiet, GradDipHealthProfEduc APD
M AN U
Project officer Southern Clinical School, Monash University Monash Medical Centre, 246 Clayton Road, Clayton Vic 3168 Australia Corresponding author:
Robyn Cant PhD, MHlthSc, GradDipHlthEduc Research Fellow
TE D
School of Nursing and Midwifery Monash University Wellington Road
Clayton VIC Australia 3168
e-mail: [email protected]
EP
Ph +61 438 363634
Kerry Hood BN, MNurs(Res), GradDipSimulation, RN Project Manager
AC C
School of Nursing and Midwifery Monash University Wellington Road Clayton VIC Australia 3168
Word count 3750
Acknowledgements The Increased Clinical Training Capacity Project at Southern Clinical School, Monash University was funded by a grant from the Australian Government: Commonwealth Department of Health and Ageing.
ACCEPTED MANUSCRIPT
Competing interests
AC C
EP
TE D
M AN U
SC
RI PT
The authors declare there were no competing interests.
ACCEPTED MANUSCRIPT
RI PT
MEASURING STUDENTS’ PERCEPTIONS OF INTERPROFESSIONAL CLINICAL PLACEMENTS: DEVELOPMENT OF THE INTERPROFESSIONAL CLINICAL PLACEMENT LEARNING ENVIRONMENT INVENTORY
ABSTRACT
Pre-professional healthcare courses, including nursing, are increasingly focused on
SC
interprofessional learning and experimentation with clinical education in ‘training wards’. This involves students from at least two disciplines who, under supervision, are responsible for patients’ care. There is no consensus on how students’ clinical learning experiences in this
M AN U
context are evaluated. We report the development and testing of the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI) in the Australian context. A question set was developed to measure student’s perceptions of key variables in an interprofessional clinical learning environment: orientation, supervision, roles, learning and autonomy. An expert nursing panel rated items for a Content Validity Index of .93. . Reliability was tested with 38 students.. After a 2-week interprofessional ward placement nursing, medical and allied health students (n=38) rated their learning environment highly,
TE D
with median responses 4 or 5 of five (mean total 83%). The scale was reliable with a Cronbach alpha of .80 and moderate item-to-total correlations for 22/26 items. The Interprofessional Clinical Placement Learning Environment Inventory is a reliable, feasible, fast to complete tool, suitable for use with pre-registration healthcare students in this setting.
AC C
Keywords
EP
Further testing of the tool’s psychometric properties is recommended.
Content validity; healthcare; instrument development; interprofessional clinical education; students, nursing; undergraduate students; validity testing
1
ACCEPTED MANUSCRIPT
Manuscript
INTRODUCTION The educational preparation of healthcare students is under a spotlight because of
RI PT
recognition of a need to improve teamwork and collaboration amongst healthcare professionals (World Health Organization and Health Professions Network Nursing and Midwifery Office 2010). Efforts to improve training have focused on enabling pre-registration students from various disciplines to learn together, with the intent that this will assist them to
SC
work together collaboratively in the future (Thistlethwaite and Moran 2010). In Australia, there is a requirement in nursing and in medicine for students to experience interprofessional
M AN U
education during their training (Australian Nursing and Midwifery Accreditation Council (ANMAC) 2011, Australian Medical Council 2009). This also extends to other professions allied to medicine such as physiotherapy, occupational therapy, dietetics and others, where some have instituted this type of education (Fitzmaurice et al. 2011). The medicine degree is of five years in university, with concurrent experience of clinical practice in health services in
TE D
years 3-5. The nursing degree comprises three years with clinical practice experience in health services during each year.
Interprofessional learning (IPL) occurs when there is active learning ‘with’ and ‘from’
EP
other disciplines: ie., when two or more students learn with, from and about each other with the aim of improving collaboration (Centre for Advancement of Interprofessional Education
AC C
(CAIPE) 2002). For example, nursing students may learn clinical skills from a curriculum that is common to nursing, medicine and physiotherapy. Each learns how to assess a patient and when learning together, all three disciplines focus on their contributory, but different roles. Interprofessional learning has benefits that include assisting students to communicate with other disciplines and to better understand teamwork, their professional roles and the roles of others (Ponzer et al. 2004). Interprofessional education can take a variety of forms including interactive academic seminars, workshops or simulation events. Authentic clinical settings are optimal (Lapkin et
2
ACCEPTED MANUSCRIPT
al. 2012) and ‘training wards’ offer students an ideal experience of interprofessional clinical learning. We conducted a trial of student-led interprofessional clinical placements in wards of a large health service in Melbourne, Australia that provided acute hospital care to public
RI PT
patients. The settings were an emergency department and a rehabilitation ward. Under supervision, student teams comprising final year healthcare nursing and medical students were responsible for managing patients in allocated beds over a period of two weeks. This formed a part of more lengthy final year clinical placements which both disciplines were
SC
required to complete in addition to their university-based academic learning. While the student teams always comprised nursing and medicine representation, other disciplines
M AN U
such as pharmacy and allied health were involved when available and advisable. The student teams were responsible for assessing patients, arranging investigations and making decisions about patient care whilst also consulting with clinical educators at key points in the patient care trajectory. Over 40 students participated in a pilot program during 20 team placement rounds in 2012. The training ward experiences were almost universally well
TE D
received by students who perceived positive benefits to their learning based on being able to practice clinical care and rehearse their future professional roles (Leech et al. 2013). As the study was a preliminary investigation, student experiences were not assessed and did not form part of their academic progress. It was necessary, however, to evaluate the
EP
programme’s impact because the atmosphere that students experience during clinical placements can help or hinder their learning. In both nursing (Dunn and Hansford 1997) and
AC C
in medicine (Hoff et al. 2004), the clinical learning environment operates as an interactive network of forces and social factors that impact on students and influences their learning outcomes. Apart from key opportunities for learners to observe skilled role models and to interact with patients and clinical staff, an overall welcoming or positive environment assists students to learn (Lindahl et al. 2009, Henderson and Tyler 2011). Students also expect that clinical learning is seen by ward staff to be of value (Brown et al. 2011). Although there are numerous survey instruments that inform about interprofessional learning in academic programs, there is a lack of published tools that rate the learning
3
ACCEPTED MANUSCRIPT
environment of a training ward when students learn together over an extended period. To fill this gap, we developed a fit for purpose instrument that is the subject of this report. The current report forms part of a study conducted by researchers from Monash
RI PT
University and Southern Health (Victoria, Australia) which aimed to extend the range of clinical placement opportunities for pre-registration healthcare students (Leech et al. 2013). Whole of program evaluation was multi-method and multi-level, considering feedback from students, clinical teachers, patients and organizational sources. The aim of this report is to
SC
describe the development and testing of an instrument to evaluate students’ perceptions of the clinical learning environment during interprofessional training ward placements with a
M AN U
view to improving their educational experience. METHODS
The evaluation framework for this phase of the project was based on a training evaluation concept to assess reaction, learning, behaviour and impact (Alliger and Janak
stages.
TE D
1989). A self-completed questionnaire for student participants was developed over several
EP
Literature review
A search of literature was undertaken to explore published instruments that examined
AC C
student perceptions of the interprofessional clinical learning environment. The majority of instruments identified assessed individual nursing students’ views of the clinical learning environment in uni-professional nursing placements under direct supervision of trained staff (Dunn and Burnett 1995, Chan 2003, Salamonson et al. 2009, Saarikoski and Leino-Kilpi 2002, Sand-Jecklin 2009). These studies measured a number of factors including some factors that were of value to interprofessional learning (such as the quality of supervision, access to teachers) and hence the studies were included in a summary of instruments
4
ACCEPTED MANUSCRIPT
shown in Table 1. Additionally, one primary study was located based on a training ward in Sweden that reported on a specially developed interprofessional assessment tool (Ponzer et al. 2004). This evaluated a broader range of factors in the clinical environment such as
RI PT
attitude towards learning interprofessionally, achievement of learning objectives and knowledge of professional roles (Table 1). Other instruments focused on more specific issues, for example the Health Care Teams Scale measured staff attitudes towards team functioning (Heinemann et al. 1999, Hyer et al. 2000). Additional studies reported utilization
SC
of the various published tools (Brown et al. 2011, Chan 2004, Dunn and Hansford 1997, Newton et al. 2010, Midgley 2006). No tools exemplified all types of experience and attitudes
M AN U
that were intended to be surveyed in the current training ward study, in particular the value of the interprofessional teaching and the learning environment to students.
Insert Table 1 about here: Table 1 Published measures for evaluating the clinical learning environment in clinical training wards or clinical field placements
TE D
Developing a question set
Two authors (AA; RC) with experience in education developed a draft question set based on the approaches to questions found in published studies, and around nine domains
EP
of interest. These domains were: orientation to the ward; quality of teaching; optimal workload, achieving learning objectives, belonging, collaborative learning, role clarification,
AC C
communication and patient centredness. We placed emphasis on teaching strategies and facilitation by the interprofessional teachers and added components around role clarification, team functioning and interprofessional communication because that is unique to IPL. Some questions from published scales were included because these were already tested as applicable, otherwise new questions were drafted.
5
ACCEPTED MANUSCRIPT
The intelligibility of the questions was reviewed by three clinical nurse teachers with experience in IPE and changes were made over several drafts. As a result of this early
RI PT
synthesis, a set of 27 questions (shown in Table 2) were drafted for further testing.
Insert Table 2 about here: Table 2 Domains and draft items for inclusion in
SC
interprofessional clinical placement survey
M AN U
Content validity testing
Face and content validity of the question set were formally tested via feedback from four experts: registered nurse nursing faculty who had conducted interprofessional education. All held postgraduate qualifications and were experienced as clinical educators in the fields of nursing and in medicine, with on average, >10 years of teaching practice.
TE D
Following the technique described by Polit and Beck (2006) each individual independently rated the clarity and relevance of the draft items. The response scales were Clarity: 1 (not clear at all) to 5 (totally clear); and Relevance: 1 (not at all relevant), to 5 (most relevant).
EP
Items were required to achieve a clarity rating of 4-5 (clear/totally clear) and all except one item did so (as explained below). Agreement on relevance was determined by calculating a
AC C
content validity index (CVI) based on the response score for each individual item and the combined rating for the 27 items. All but one item had a CVI of greater than the benchmark of 0.78 (15.6 of a possible
20) and when this item was removed, the average total content validity of 0.93 exceeded an expected >0.90. Thus 26 items were retained. The item not seen as relevant or clear and subsequently removed was: ‘Please estimate the percentage of your work and study time that was dedicated to activities of this placement’. The final 26-item tool was formatted with a 5-point response scale on agreement and an additional question giving opportunity for open-
6
ACCEPTED MANUSCRIPT
ended comments (as shown in full in an appendix). The instrument was named the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI) to signpost its purpose.
RI PT
Ethical approval The study was conducted with the approval of ethics committees in the health service and the university. All students were provided with a participant information statement about the study at the beginning of the placement and gave their written consent to participate.
SC
Live testing
In a final stage of development, healthcare students in multiple disciplines who were on
M AN U
interprofessional clinical placements were invited to complete the survey to test the practicality and reliability of the tool when administered to the target group. Twenty rounds of placement, each of two weeks duration, were conducted in a training ward over the period April to October 2012 and students completed the survey on the last day of each placement. Data analysis
TE D
The survey responses were entered into a database: IBM-SPSS Statistics version 20 (Armonk, NY: IBM Corp 2011). Single missing data in two response items were imputed. To prevent response bias, six question items with a negative question stem were transformed
EP
by reversing the question and reverse-coding the responses to match the question set. These were items: 2, 7, 9, 10, 22 and 23. Thus, all scores in the final dataset were uni-
AC C
directional and when at the high end of the response scale on agreement (4; 5) indicated a positive response, with ability to compute a valid total score. Data were collated using descriptive and inferential statistics (sum, mean, percentage)
and measures of dispersion. Non-parametric statistics were used to examine differences between groups, with p
S1471-5953(14)00058-4
DOI:
10.1016/j.nepr.2014.05.009
Reference:
YNEPR 1879
To appear in:
Nurse Education in Practice
Received Date: 5 July 2013 Revised Date:
11 February 2014
Accepted Date: 9 May 2014
Please cite this article as: Anderson, A., Cant, R., Hood, K., Measuring Students’ Perceptions Of Interprofessional Clinical Placements: Development Of The Interprofessional Clinical Placement Learning Environment Inventory, Nurse Education in Practice (2014), doi: 10.1016/j.nepr.2014.05.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title page
RI PT
MEASURING STUDENTS’ PERCEPTIONS OF INTERPROFESSIONAL CLINICAL PLACEMENTS: DEVELOPMENT OF THE INTERPROFESSIONAL CLINICAL PLACEMENT LEARNING ENVIRONMENT INVENTORY Short title ICPLEI: assessing students’ interprofessional learning
SC
AUTHORS
Amanda Anderson MNutDiet, GradDipHealthProfEduc APD
M AN U
Project officer Southern Clinical School, Monash University Monash Medical Centre, 246 Clayton Road, Clayton Vic 3168 Australia Corresponding author:
Robyn Cant PhD, MHlthSc, GradDipHlthEduc Research Fellow
TE D
School of Nursing and Midwifery Monash University Wellington Road
Clayton VIC Australia 3168
e-mail: [email protected]
EP
Ph +61 438 363634
Kerry Hood BN, MNurs(Res), GradDipSimulation, RN Project Manager
AC C
School of Nursing and Midwifery Monash University Wellington Road Clayton VIC Australia 3168
Word count 3750
Acknowledgements The Increased Clinical Training Capacity Project at Southern Clinical School, Monash University was funded by a grant from the Australian Government: Commonwealth Department of Health and Ageing.
ACCEPTED MANUSCRIPT
Competing interests
AC C
EP
TE D
M AN U
SC
RI PT
The authors declare there were no competing interests.
ACCEPTED MANUSCRIPT
RI PT
MEASURING STUDENTS’ PERCEPTIONS OF INTERPROFESSIONAL CLINICAL PLACEMENTS: DEVELOPMENT OF THE INTERPROFESSIONAL CLINICAL PLACEMENT LEARNING ENVIRONMENT INVENTORY
ABSTRACT
Pre-professional healthcare courses, including nursing, are increasingly focused on
SC
interprofessional learning and experimentation with clinical education in ‘training wards’. This involves students from at least two disciplines who, under supervision, are responsible for patients’ care. There is no consensus on how students’ clinical learning experiences in this
M AN U
context are evaluated. We report the development and testing of the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI) in the Australian context. A question set was developed to measure student’s perceptions of key variables in an interprofessional clinical learning environment: orientation, supervision, roles, learning and autonomy. An expert nursing panel rated items for a Content Validity Index of .93. . Reliability was tested with 38 students.. After a 2-week interprofessional ward placement nursing, medical and allied health students (n=38) rated their learning environment highly,
TE D
with median responses 4 or 5 of five (mean total 83%). The scale was reliable with a Cronbach alpha of .80 and moderate item-to-total correlations for 22/26 items. The Interprofessional Clinical Placement Learning Environment Inventory is a reliable, feasible, fast to complete tool, suitable for use with pre-registration healthcare students in this setting.
AC C
Keywords
EP
Further testing of the tool’s psychometric properties is recommended.
Content validity; healthcare; instrument development; interprofessional clinical education; students, nursing; undergraduate students; validity testing
1
ACCEPTED MANUSCRIPT
Manuscript
INTRODUCTION The educational preparation of healthcare students is under a spotlight because of
RI PT
recognition of a need to improve teamwork and collaboration amongst healthcare professionals (World Health Organization and Health Professions Network Nursing and Midwifery Office 2010). Efforts to improve training have focused on enabling pre-registration students from various disciplines to learn together, with the intent that this will assist them to
SC
work together collaboratively in the future (Thistlethwaite and Moran 2010). In Australia, there is a requirement in nursing and in medicine for students to experience interprofessional
M AN U
education during their training (Australian Nursing and Midwifery Accreditation Council (ANMAC) 2011, Australian Medical Council 2009). This also extends to other professions allied to medicine such as physiotherapy, occupational therapy, dietetics and others, where some have instituted this type of education (Fitzmaurice et al. 2011). The medicine degree is of five years in university, with concurrent experience of clinical practice in health services in
TE D
years 3-5. The nursing degree comprises three years with clinical practice experience in health services during each year.
Interprofessional learning (IPL) occurs when there is active learning ‘with’ and ‘from’
EP
other disciplines: ie., when two or more students learn with, from and about each other with the aim of improving collaboration (Centre for Advancement of Interprofessional Education
AC C
(CAIPE) 2002). For example, nursing students may learn clinical skills from a curriculum that is common to nursing, medicine and physiotherapy. Each learns how to assess a patient and when learning together, all three disciplines focus on their contributory, but different roles. Interprofessional learning has benefits that include assisting students to communicate with other disciplines and to better understand teamwork, their professional roles and the roles of others (Ponzer et al. 2004). Interprofessional education can take a variety of forms including interactive academic seminars, workshops or simulation events. Authentic clinical settings are optimal (Lapkin et
2
ACCEPTED MANUSCRIPT
al. 2012) and ‘training wards’ offer students an ideal experience of interprofessional clinical learning. We conducted a trial of student-led interprofessional clinical placements in wards of a large health service in Melbourne, Australia that provided acute hospital care to public
RI PT
patients. The settings were an emergency department and a rehabilitation ward. Under supervision, student teams comprising final year healthcare nursing and medical students were responsible for managing patients in allocated beds over a period of two weeks. This formed a part of more lengthy final year clinical placements which both disciplines were
SC
required to complete in addition to their university-based academic learning. While the student teams always comprised nursing and medicine representation, other disciplines
M AN U
such as pharmacy and allied health were involved when available and advisable. The student teams were responsible for assessing patients, arranging investigations and making decisions about patient care whilst also consulting with clinical educators at key points in the patient care trajectory. Over 40 students participated in a pilot program during 20 team placement rounds in 2012. The training ward experiences were almost universally well
TE D
received by students who perceived positive benefits to their learning based on being able to practice clinical care and rehearse their future professional roles (Leech et al. 2013). As the study was a preliminary investigation, student experiences were not assessed and did not form part of their academic progress. It was necessary, however, to evaluate the
EP
programme’s impact because the atmosphere that students experience during clinical placements can help or hinder their learning. In both nursing (Dunn and Hansford 1997) and
AC C
in medicine (Hoff et al. 2004), the clinical learning environment operates as an interactive network of forces and social factors that impact on students and influences their learning outcomes. Apart from key opportunities for learners to observe skilled role models and to interact with patients and clinical staff, an overall welcoming or positive environment assists students to learn (Lindahl et al. 2009, Henderson and Tyler 2011). Students also expect that clinical learning is seen by ward staff to be of value (Brown et al. 2011). Although there are numerous survey instruments that inform about interprofessional learning in academic programs, there is a lack of published tools that rate the learning
3
ACCEPTED MANUSCRIPT
environment of a training ward when students learn together over an extended period. To fill this gap, we developed a fit for purpose instrument that is the subject of this report. The current report forms part of a study conducted by researchers from Monash
RI PT
University and Southern Health (Victoria, Australia) which aimed to extend the range of clinical placement opportunities for pre-registration healthcare students (Leech et al. 2013). Whole of program evaluation was multi-method and multi-level, considering feedback from students, clinical teachers, patients and organizational sources. The aim of this report is to
SC
describe the development and testing of an instrument to evaluate students’ perceptions of the clinical learning environment during interprofessional training ward placements with a
M AN U
view to improving their educational experience. METHODS
The evaluation framework for this phase of the project was based on a training evaluation concept to assess reaction, learning, behaviour and impact (Alliger and Janak
stages.
TE D
1989). A self-completed questionnaire for student participants was developed over several
EP
Literature review
A search of literature was undertaken to explore published instruments that examined
AC C
student perceptions of the interprofessional clinical learning environment. The majority of instruments identified assessed individual nursing students’ views of the clinical learning environment in uni-professional nursing placements under direct supervision of trained staff (Dunn and Burnett 1995, Chan 2003, Salamonson et al. 2009, Saarikoski and Leino-Kilpi 2002, Sand-Jecklin 2009). These studies measured a number of factors including some factors that were of value to interprofessional learning (such as the quality of supervision, access to teachers) and hence the studies were included in a summary of instruments
4
ACCEPTED MANUSCRIPT
shown in Table 1. Additionally, one primary study was located based on a training ward in Sweden that reported on a specially developed interprofessional assessment tool (Ponzer et al. 2004). This evaluated a broader range of factors in the clinical environment such as
RI PT
attitude towards learning interprofessionally, achievement of learning objectives and knowledge of professional roles (Table 1). Other instruments focused on more specific issues, for example the Health Care Teams Scale measured staff attitudes towards team functioning (Heinemann et al. 1999, Hyer et al. 2000). Additional studies reported utilization
SC
of the various published tools (Brown et al. 2011, Chan 2004, Dunn and Hansford 1997, Newton et al. 2010, Midgley 2006). No tools exemplified all types of experience and attitudes
M AN U
that were intended to be surveyed in the current training ward study, in particular the value of the interprofessional teaching and the learning environment to students.
Insert Table 1 about here: Table 1 Published measures for evaluating the clinical learning environment in clinical training wards or clinical field placements
TE D
Developing a question set
Two authors (AA; RC) with experience in education developed a draft question set based on the approaches to questions found in published studies, and around nine domains
EP
of interest. These domains were: orientation to the ward; quality of teaching; optimal workload, achieving learning objectives, belonging, collaborative learning, role clarification,
AC C
communication and patient centredness. We placed emphasis on teaching strategies and facilitation by the interprofessional teachers and added components around role clarification, team functioning and interprofessional communication because that is unique to IPL. Some questions from published scales were included because these were already tested as applicable, otherwise new questions were drafted.
5
ACCEPTED MANUSCRIPT
The intelligibility of the questions was reviewed by three clinical nurse teachers with experience in IPE and changes were made over several drafts. As a result of this early
RI PT
synthesis, a set of 27 questions (shown in Table 2) were drafted for further testing.
Insert Table 2 about here: Table 2 Domains and draft items for inclusion in
SC
interprofessional clinical placement survey
M AN U
Content validity testing
Face and content validity of the question set were formally tested via feedback from four experts: registered nurse nursing faculty who had conducted interprofessional education. All held postgraduate qualifications and were experienced as clinical educators in the fields of nursing and in medicine, with on average, >10 years of teaching practice.
TE D
Following the technique described by Polit and Beck (2006) each individual independently rated the clarity and relevance of the draft items. The response scales were Clarity: 1 (not clear at all) to 5 (totally clear); and Relevance: 1 (not at all relevant), to 5 (most relevant).
EP
Items were required to achieve a clarity rating of 4-5 (clear/totally clear) and all except one item did so (as explained below). Agreement on relevance was determined by calculating a
AC C
content validity index (CVI) based on the response score for each individual item and the combined rating for the 27 items. All but one item had a CVI of greater than the benchmark of 0.78 (15.6 of a possible
20) and when this item was removed, the average total content validity of 0.93 exceeded an expected >0.90. Thus 26 items were retained. The item not seen as relevant or clear and subsequently removed was: ‘Please estimate the percentage of your work and study time that was dedicated to activities of this placement’. The final 26-item tool was formatted with a 5-point response scale on agreement and an additional question giving opportunity for open-
6
ACCEPTED MANUSCRIPT
ended comments (as shown in full in an appendix). The instrument was named the Interprofessional Clinical Placement Learning Environment Inventory (ICPLEI) to signpost its purpose.
RI PT
Ethical approval The study was conducted with the approval of ethics committees in the health service and the university. All students were provided with a participant information statement about the study at the beginning of the placement and gave their written consent to participate.
SC
Live testing
In a final stage of development, healthcare students in multiple disciplines who were on
M AN U
interprofessional clinical placements were invited to complete the survey to test the practicality and reliability of the tool when administered to the target group. Twenty rounds of placement, each of two weeks duration, were conducted in a training ward over the period April to October 2012 and students completed the survey on the last day of each placement. Data analysis
TE D
The survey responses were entered into a database: IBM-SPSS Statistics version 20 (Armonk, NY: IBM Corp 2011). Single missing data in two response items were imputed. To prevent response bias, six question items with a negative question stem were transformed
EP
by reversing the question and reverse-coding the responses to match the question set. These were items: 2, 7, 9, 10, 22 and 23. Thus, all scores in the final dataset were uni-
AC C
directional and when at the high end of the response scale on agreement (4; 5) indicated a positive response, with ability to compute a valid total score. Data were collated using descriptive and inferential statistics (sum, mean, percentage)
and measures of dispersion. Non-parametric statistics were used to examine differences between groups, with p
