Providing interprofessional learning throughinterdisciplinary collaboration: The role of ‘‘modelling’’

KATIE M. SELLE1, KATHLEEN SALAMON2, REGINA BOARMAN3, &

JANET SAUER4

1Department of Nursing and Health, Clarke College, Dubuque, Iowa, 2Department of Physical Therapy,

University of the Pacific, Stockton, California, 3Department of Social Work, Clarke College, Dubuque,

Iowa, and 4Department of Education, Clarke College, Dubuque, Iowa, USA

AbstractFaculty from four disciplines at a small Liberal Arts College in an American Midwestern citycollaborated on an interdisciplinary pre-service project. Students in nursing, physical therapy, socialwork and special education voluntarily participated in one of two group methods of teaching. Thepurpose of this study was to examine whether students learn interprofessional teaming more effectivelyfrom (i) discussion of research, faculty modeling and role-playing, or from (ii) discussion of researchand role-playing. Results from the evaluation suggested both groups benefited from discussions androle-playing related to interprofessional team meetings. A significant difference between students whoobserved faculty modeling and those who did not was found. The paper discusses the importance ofpreparing college students for interprofessional collaboration in light of current research.

Keywords: Interprofessional education, interprofessional collaboration, modeling, evaluation

Introduction

Public schools across the United States are faced with challenges arising from students in

need of specialized services, often related to health care. Research suggests these

challenges often go beyond the scope of ‘‘teaching’’ (Bronstein, 2003). Health care

professionals may find themselves teamed with educators in care-planning for young

clients in school while also addressing the needs of families, schools and communities.

Educators in professional programs struggle with the necessity to advance college curricula

to keep pace with societal, financial and cultural changes (Brown et al., 2003; Duchardt

et al., 1999). It is now apparent that the biomedical model of health care has given way to

a broader definition, and provision of care may be needed from a variety of sources (Dyer,

2003; Irvine et al., 2002; Richardson & Montemuro, 1999). Proactive educational

changes are needed to acquaint students in education and health care professions with the

potential for working collaboratively toward quality outcomes as part of interprofessional

teams (Atwal & Caldwell, 2002; Cobin et al., 1997; Freeth & Reeves, 2004; Gilbert et al.,

2000).

Correspondence: Katie M. Selle, RN, CMA, Associate Professor of Nursing, Department of Nursing and Health, Clarke College,

1550 Clarke Drive, Dubuque, IA 52001, USA. Fax: þ1 563 584 8684. E-mail: Katie.selle@clarke.edu

Journal of Interprofessional Care,

January 2008; 22(1): 85 – 92

ISSN 1356-1820 print/ISSN 1469-9567 online � 2008 Informa UK Ltd.

DOI: 10.1080/13561820701714755

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This paper describes preliminary results from an interprofessional pre-service project at a

small, Liberal Arts College in a medium-sized Midwestern city in the United States.

Originally two faculty members in nursing and special education recognized their shared

learning goals for their pre-service and entry level students, effective communication and

collaboration skills. Through informal conversations, the faculty members began to envision

a potential interprofessional educational experience, as defined by Barr (2002) where two or

more professionals come together to learn from and about each other to improve

collaboration. Colleagues from two additional disciplines (physical therapy and social

work) were recruited to the project with the idea that these disciplines might share similar

student outcomes. The faculty felt that although professional roles of the team members

could be taught, modeling the actual roles and interaction amongst members would

demonstrate the learning to and from each other. Without funds or release time for the

faculty, an evening program was organized and student volunteers were recruited from all

four of the disciplines; education, nursing, physical therapy and social work. This initial

project exposed students to a ‘‘model’’ of a school-based interprofessional team meeting as

presented by the instructors from these disciplines. In other words, the faculty members

modeled an Individualized Education Plan (IEP) meeting for a hypothetical elementary-

aged student with a traumatic brain injury. The college students were then asked to discuss

what they had witnessed and how they might professionally apply the information.

Discussions took place in small groups where disciplines were equally represented.

The IEP meeting refers to any gathering of school or district employees where children

with disabilities (those who meet eligibility criteria or who are being evaluated for eligibility)

for special education services are discussed (Iowa Department of Education, 2005). In the

US and most European countries, laws concerning the rights to an education for children

with disabilities include specific requirements concerning how meetings are conducted and

who must be present. According to US federal law, the Individuals with Disabilities

Education Act (IDEA), attendance is required for persons knowledgeable about the child

and areas of suspected need in such meetings (Office of Special Education Programs, 1997).

Therefore, the authors’ meeting included professionals from the various disciplines as a

realistic way to address the hypothetical student’s special educational needs.

The success of this project was first realized when, after three hours of volunteer time,

students verbally expressed disappointment with having to discontinue discussions; they

wanted more time to continue to talk within their groups. They openly expressed a desire to

have the opportunity to be more involved and suggested that in the future students might

conduct a simulation of a team meeting amongst themselves. From this experience arose the

concept of a future interdisciplinary teaching experience to assist students in developing

skills of communication and collaboration.

Background

College and university faculty are challenged with ongoing pressure to ensure undergraduate

and post-graduate students achieve outcomes based upon practical skills. This is

compounded by increasing amounts of information to be included in curricula as the

result of evidence-based practice and technological advances (Bronstein, 2003; Hall &

Weaver, 2001; Mogensen et al., 2002). Traditionally, teachers and allied health

professionals have been trained in specialized skills within defined areas. Traditional

curriculum relies on profession-specific content with little emphasis placed on interprofes-

sional problem-solving. Knowledge of how and why specialized teams of professionals

function is stressed during didactic learning (Erickson et al., 1998; Richardson &

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Montemuro, 1999). This may be particularly true with institutions that have difficulty

establishing relationships with collaborative community practices or settings. Instruction in

multidisciplinary collaboration and communication is further complicated by a lack of

interaction amongst different disciplines prior to field practicum or clinical training.

In Britain, Canada and the United States, educators are aware that students becoming

teaching specialists require exposure to health care providers and their diverse services to

better understand how individual students’ special needs may be met (Annadale et al.,

2000; Dyer, 2003; Gilbert et al., 2000; Tucker, 2002). In addition, allied health students

need to understand educational systems to be better able to offer appropriate assistance.

The more exposure to other disciplines, the greater the knowledge of each others’ pro-

fessions and of specific roles each can play in students’ lives. The value of interprofessional

teams working together has been established (Richardson & Montemuro, 1999; Ryan,

2001). Overall, interprofessional teams working toward common goals may provide a better

overall quality of service delivery (Fosnaught, 2002; Freeth & Reeves, 2004; Lymbery,

1998).

What makes an effective service providing team?

Being an effective team member involves experiencing and participating in collaboration.

According to Olson (2003), collaboration is the ability to reach goals that cannot be

reached by working alone within one’s singular discipline. Berg-Weger & Schneider

(1998) define interdisciplinary collaboration as an interpersonal process with participants

from different disciplines contributing and agreeing upon a common goal or product.

Interdependence, flexibility and collective ownership of goals are participant character-

istics within interprofessional collaboration (Bronstein, 2003). Moving from parallel

relationships as service providers to active collaborators from differing backgrounds often

involves challenges. These can include lack of understanding with regard to service

providers’ abilities, experience, values and organizational missions. In addition, team

collaboration may be slowed as a result of perceptions of power imbalance and an

underlying sense of competition, rather than cooperation between providers (or

organizations).

Various research has shown that establishment of effective, interprofessional teams

involves gaining knowledge of other team members, and validating each other’s roles,

dealing with conflict, and working with other professionals to provide care for others

(Anderson-Butcher & Ashton, 2004; Barr, 1998; Olson, 2003; Soler & Shauffer, 1993).

Creating team collaboration invites practice in establishment of trust and respect outside

one’s own professional group. Communication skills must be in place to encourage

connectedness between team members. This environment allows for awareness of equal

power and fosters shared decision making, responsibility and authority. Successful teams

ultimately focus on establishment of common goals. Such focus demands flexibility of team

members as to how such goals will be achieved. Overall, putting aside individuality to

achieve positive outcomes for service users requires an interprofessional approach that is

characterized by learning with and from other professionals (Barr, 2002).

Teaching students interprofessional awareness and collaboration through appropriate

communication has been left, in the past, to clinical or field experience and exposure (Atwal

& Caldwell, 2002; Bronstein, 2003). Effective clinical models for teaching teamwork are not

always available (Strohschein et al., 2002). Experiential learning appears to be the most

positive, as opposed to traditional classroom lecture; however, clinical experience may not

always be available due to time constraints and/or environmental limitations.

The role of ‘‘modelling’’ 87

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Evaluation

The project was evaluated by the use of a pretest and posttest quasi-experimental design in

which students were randomly assigned to receive two different interprofessional teaching

approaches. The evaluation aimed to address the following question: ‘‘do students learn

interprofessional collaborative teaming more effectively from (i) discussion of research,

faculty modeling and role-playing or from (ii) discussion of research and role-playing

alone?’’

The first interprofessional teaching approach consisted of students (Group A) reading

three articles on interdisciplinary collaboration (Anderson-Butcher & Ashton, 2004; Ries,

2002; Tucker, 2002) prior to coming together; they discussed the articles in small

groups, with each discipline being represented, and then observed an interprofessional

team meeting in which faculty ‘‘role modeling’’ occurred. Team members consisted of

faculty members from the four disciplines involved in the study; Nursing, Physical

Therapy, Social Work, and Special Education. The students subsequently role played a

second case (representing their individual disciplines as a team member). The second

approach, consisted of students (Group B) reading the same articles on interdisciplinary

collaboration prior to coming together, discussing the articles in a group, and then role

playing as a team member without observing an interprofessional team meeting

demonstrated by faculty members.

Sampling

A sample of convenience was utilized for the study with the goal of identifying ten students

per discipline, a total of 40 students, who met the minimum requirement of junior (third

year student) standing or above. The students were then invited to attend an evening

meeting. Students were randomly assigned by their profession to two groups (A or B) and

placed at a table with students from other disciplines. There were 19 students in Group A

and 18 students in Group B, totaling 37 students who completed the study.

Data collection and analysis

Students completed a pretest at the beginning of the evening asking them to give their

understanding of each of the four professions. Using a Likert scale, they were asked to what

extent they agreed that the articles were helpful, that interprofessional collaboration was

valuable to their preparation for their chosen profession, and to what extent they agreed that

they felt prepared to participate in an interprofessional team meeting. Students were then

given a post-test to complete at the end of the evening’s activities. The pretest and posttest

instruments were not validated as this was seen as a first step in understanding student

experience of collaboration. Data were analyzed using the statistical package for the social

sciences (SPSS).

Results

Thirty-seven students participated in the study. Thirty-two percent (n¼ 12) of those who

participated in the study were nursing students, 30% (n¼ 11) were physical therapy

students, 22% (n¼ 8) were social work students, and 16% (n¼ 6) were special education

students. One hundred percent of the students strongly agreed or agreed that reading

research articles prior to the evening was helpful in their understanding of interprofessional

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collaboration and 73% strongly agreed and 26% agreed that the topic of interprofessional

collaboration was valuable in their preparation for their chosen profession (see Table I).

Using Chi-square as a test of significance there were no differences between Group A (the

group that experienced the team modeling by faculty members) and Group B (the group

that did not experience the team modeling by faculty members) in participating in the role-

playing and in the discussion related to the articles. Both groups strongly agreed that the

role-playing and the discussion was helpful in their understanding of interprofessional

collaboration. However, Group A felt more prepared to participate in a team meeting than

did Group B (Chi-square¼ 23.49, df¼ 2 p5 0.01) (n¼ 37). Sixty-seven percent of group A

strongly agreed that they felt prepared to participate in a interdisciplinary team meeting,

while only 33% of group B strongly agreed that they felt prepared to participate in an

interprofessional team meeting (see Table II).

The articles, discussion, and role playing were equally helpful to both groups. The group

that experienced the modeling of an interprofessional team meeting by faculty members felt

more prepared to participate in a team meeting than those who did not experience the

modeling. A qualitative analysis of the perception of each others’ profession both prior to the

meeting and at the end of the meeting is currently underway. It is hypothesized that Group

A will be able to articulate the depth of others’ roles after observing the faculty model an

interprofessional team meeting.

As part of the questionnaire, students in Group A were provided with an open-ended

question asking for their impression of the modeling. Overwhelmingly, their comments

reflected a deeper understanding of the importance of bringing together multiple

perspectives. One student responded: ‘‘I learned how important it is for collaboration

among the team members. Each discipline had something to offer about the child’’.

Another student used the metaphor of a puzzle to describe the dynamics of the faculty

modeling an interdisciplinary meeting: ‘‘with one piece (discipline) missing, you might not

get the results you wanted; kind of the same way a puzzle works, it’s not complete’’. Several

students mentioned the issue of terminology and the need to ‘‘be on the same page’’. They

also expressed an increased sensitivity to using ‘‘language that all members can

Table I. Post-test Questionnaire responses.

Interdisciplinary Collaboration is helpful Frequency (n) Percent (%)

Strongly Agree 27 75.0

Agree 10 25.0

Disagree 0 0

Total 37 100

Table II. Students preparedness to participate in an interdisciplinary team meeting.

Feels prepared

Group A Group B Total

% (n) % (n) % (n)

Strongly Agree 47 (9) 28 (5) 38 (14)

Agree 53 (10) 56 (10) 54 (20)

Disagree – 16 (3) 8 (3)

Total 100 (19) 100 (18) 100 (37)

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understand’’. The comments from these students suggest their observation of an

interdisciplinary meeting provided them with an opportunity to ‘‘see how each team

member contributes’’. These students were therefore given one more avenue (beyond the

reading of articles and discussion) for learning how interdisciplinary team meetings might

play out, and this avenue might have contributed to their higher confidence level in their

own preparation for participating in such meetings than those in Group B who did not

observe the role play.

Discussion

Academic settings in the United States are continually challenged to provide competent

professionals in the fields of education, nursing, physical therapy and social work. Delivery

systems within many environments demand interprofessional collaboration and appropriate

communication. These are areas alluded to, but not often experienced during academic

learning. A range of strategies for teaching young professionals the art of collaboration and

communication are now under investigation to prepare graduates for team-based work

environments.

In this evaluation, college students entering the fields of nursing, physical therapy, social

work and education were exposed to learning situations dealing with collaboration and

communication in an experiential format. Prior to the evening of research, students were

assigned to read articles related to interdisciplinary teaming. They were encouraged to

discuss information prior to role playing as team members. All students who were involved

felt they would be better able to participate in an interprofessional team meeting, during a

clinical rotation or practicum placement, more than they did previous to the start of this

project. Students, who participated in Group A, experiencing ‘‘modeling’’ as a means of

teaching, appeared to be more confident and felt more prepared in their ability to participate

in interprofessional groups. In addition, initial analysis of open-ended questions suggests

qualitative gains have occurred for all participants.

The value of modeling can be expanded by use of variety in scenarios. In the present

research, the ‘‘model’’ demonstrated learning of each others’ roles, elements of mutual

respect, active listening, compromise, client-centered concern, and client-centered goals.

Scenarios might be conceived to show the exact opposite or to bring out specific hurdles

faced in an assortment of situations. Different dimensions of the ‘‘model’’ might be created

by utilizing faculty from other professions (or disciplines). Adding ‘‘family members’’ to the

team could also create other opportunities for student learning.

Further investigation and evaluation of timeliness is necessary as to when this sort of

training might occur within various curricula. There is evidence that early exposure to

interprofessional learning is beneficial (e.g., Cooper et al., 2001). We questioned whether

students benefited from early exposure to the concept of interprofessional teaming or should

some clinical/field experience have taken place prior to this experience? Do students benefit

as a result of additional knowledge near the end of their academic training or are

professional stances already entrenched nearing the end of didactics? The question of adding

information at any point becomes important when curricula are already experiencing severe

time constraints.

One of the challenges in using ‘‘modeling’’ as part of curriculum is the initial time

commitment needed for creating appropriate scenarios. Weekly planning sessions were

helpful and necessary in keeping the team on track as was email communication about many

of the details connected to the learning experience. Initial discussions positioned planning

based on hierarchical categorizations of learning, yet without scenario details (Beck et al.,

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1988). Once detailed information was created, less meeting time was necessary, although

ongoing assessments and revisions took place via emails and brief face to face discussions.

Another addition to this project might have been follow-up studies done by all disciplines

to discover the value of the readings, discussion, modeling, and team role-playing events to

students during actual clinical rotations. Ideally, transfer of learning (knowledge, attitudes,

skills, beliefs) into results (effects within an environment) occurs as students grow

professionally (Beck et al., 1988; Cooper et al., 2001). Repeated use of modeling scenarios

as a teaching tool would most probably be necessary to enable licensed entry level

professionals faced with adverse relationships within a team situation to be equipped to work

toward greater collaboration. Follow-up with students exposed to ‘modeling’ learning could

show such transfer. Of course, the proximity of the learning experience to actual practical

application for students after graduation would be a consideration in longitudinal follow up

studies. Any such efforts at tracking would be appropriate for future projects undertaken to

determine significance of pre-licensure education to the students professionally.

Conclusion

‘‘Modeling’’ may be a way to introduce interprofessional interactions. A minimum of one

exposure to interprofessional teaming prior to actual graduation appears valuable for a

smoother transition to post-graduate work experiences. Additional learning situations of the

same type could reinforce learning. This evaluation indicates students’ desire to experience

interprofessional collaboration within the academic setting in preparation for entry into their

individual professions. Although the requirements for professional disciplines continue to

increase, the importance of interprofessional collaboration cannot be minimized. This

research identifies one strategy for teaching such collaboration. On-going research is

indicated to explore the further use of ‘‘models’’ integrated into already existing curricula.

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