The impact of course design features, gender, and academic level on student attitudes towards “Introduction to IPE” course: Mixed-methods analysis / Der Einfluss von Kursgestaltung, Geschlecht und akademischem Niveau auf die Einstellungen der Studierenden zum Kurs „Einführung in IPE: Mixed-Methods-Analyse”

Interprofessional education (IPE) and interprofessional education and collaborative practice (IPECP) have been increasingly emphasized as a potential key factor in high-quality and patient-family centered health care delivery (Ateah et al., 2011). IPE is also valued for its potential to prepare students for collaborative practice and promotion of the quadruple aim of improving population health, improving the patient experience of care, reducing the per capita cost and improving provider satisfaction and wellness (Cox et al., 2017; National Center for Interprofessional Practice and Education).

A primary goal of introductory IPE offerings is to support health professional students in gaining foundational knowledge about IPE and developing an appreciation for their own and other professions by learning about it from and with students across disciplines (Gross et al., 2022; Guraya & Barr, 2018). Thus, offering an introductory IPE course at an early stage of health professionals’ education is often seen as beneficial (Coster et al., 2008; Guraya & Barr, 2018). Introductory IPE experiences have been offered with a variety of pedagogical approaches in both in-person and online formats (Beard et al., 2015; Shaw-Battista et al., 2015; Smith et al., 2019). Generally, both formats are evaluated positively by learners while also producing expected results in learning outcomes including a positive impact on interdisciplinary collaboration and teamwork, reduction in preconceptions of other healthcare disciplines and promotion of professional competencies (Al-Qahtani, 2016; Barr & Ross, 2006; Cusack & O’Donoghue, 2012; Gross et al., 2022). Recent studies point to an increasing trend in offering IPE courses in online formats (Jones et al., 2020; Khalili, 2020; Poirier et al., 2016; Singh & Matthees, 2021), yet there has been less attention regarding how specific types of learning and interactional formats intersect with a variety of learner characteristics and thus impact learning outcomes.

In a meta-analysis exploring similarities and differences between face-to-face classroom learning and distance learning, Bernard et al. (2009) noted that “Instructional designs that foster higher quality interactions focus on course features that promote high-quality learning activities” (p. 1266). The authors identified three general types of “interaction treatments” (ITs): 1. Student–Student (SS) interaction, 2. Student–Teacher (ST) interaction, and 3. Student–Content (SC) interaction. SS interaction refers to interaction among individual students or among students working in small groups. These interactions can be synchronous, as in videoconferencing and chatting, or asynchronous, as in discussion boards or e-mail messages. ST interaction focuses on classroom-based dialogue between students and the instructor. ST interaction may be also expanded to online-based formats with synchronous student–instructor interaction such as telephone calls, videoconferencing, and chats, or asynchronous through correspondence, e-mail, and discussion boards. SC interaction refers to students individually interacting with the subject matter. Some examples of SC interaction include reading informational texts, using study guides, watching videos, interacting with computer-based multimedia, using simulations, using cognitive support software (e.g., statistical software), as well as searching for information, completing assignments, and working on projects. Among these three interaction types in distance education, SS and SC interactions have been found to have a higher impact on students’ achievements and attitude than ST interactions (Bernard et al., 2009).

Hallam et al. (2016) advocate for the necessity of attending to “the inherent diversity of students” rather than delivering “generic programs suited for the whole” (p. 8). Further exploration regarding the effectiveness of types of instructional design may inform effective instructional and interactional design of both the content and format of IPE courses to best meet the learning needs of diverse student learners.

The primary purpose of this study was to examine the impact of an introductory IPE experience using an existing instructional design framework exploring the impact of two types of interaction treatments on student attitudes about IPE: SC and SS. A secondary aim was to identify the impact of specific instructional course components on learners with respect to different academic levels and gender. A mixed-methods analysis was used to associate shifts in student attitudes about IPE with student perceptions of the value of different course components.

Using a mixed-methods analysis, our findings analyzed shifts in student attitudes toward IPE as well as student perceptions of the value of different course components. Evaluation of this online introductory IPE course supported two primary findings: (1) the course comprised of two interaction treatments, SC and SS, had a significant, positive impact on all students’ attitudes about IPE in all subdomains and (2) specific instructional course components were experienced and perceived differently among learners with respect to learners’ different academic levels and gender. Female students and undergraduate students reported higher perceptions of valuing all course components as well as the specific SC course components than male students and graduate students.

The online introductory IPE course had a significant, positive impact on all students’ attitudes toward IPE. Although student attitudes about IPE improved for all students in all subdomains, the greatest changes occurred for Roles. This finding may be related to students starting the course with attitudes toward Roles’ scores being the lowest among all of the subdomains, and thus had the most potential for improvement. Also, course activities offered multiple opportunities for students to learn more about other professional roles. In considering two independent variables, gender, and academic levels, along with their potential interaction effects on attitudes toward IPE, the data unveiled a noteworthy influence of academic levels on such attitudes. Specifically, undergraduate students demonstrated greater improvement in attitudes towards IPE than graduate students. This finding is consistent with previous studies showing younger (undergraduate) learners as more open to and willing to engage in new learning compared to older (graduate) learners (Anderson & Thorpe, 2008; Gross et al., 2022). However, improvement in attitudes does not necessarily predict a deeper level of understanding of IPE (Shah et al., 2019). While graduate students had less improvement in positive attitudes regarding IPE after the course compared to undergraduates, they reported deeper levels of understanding and application of IPE to their practice. Mixed methods analysis of the Teamwork subdomain showed that while undergraduate and graduate students reported “Confirmation” learning (agreement with IPE concepts), graduate students more often than undergraduate students expressed both “Confirmation” learning as well as “Expansion” learning (application of IPE Teamwork to their own practice). It is possible that graduate students have more exposure to interprofessional experiences and higher levels of critical thinking, and thus had more developed skills and knowledge resulting in their ability to link benefits of IPE Teamwork to patient outcomes (Sulaiman et al., 2012). Hayward et al. also noted that graduate students often prefer to learn quickly and prefer learning activities and content that has immediate and pragmatic application (2021). These academic level differences raise questions regarding the impact on learning of mixing graduate and undergraduate students in IPE courses without attention to their different learning experiences, preparedness, and needs.

This online course was designed to enable students to interact with the course materials in one of two ways: SC and SS interactions. SC interaction activities were composed of watching videos with real-life scenarios and didactic information. SS interaction activities with each other included interaction on a discussion board regarding one’s own and other professions. When comparing students’ perceived value of SC activities to SS activities, the former was higher rated by all students. Among the SC components, the “real-life” scenario video was rated as having the highest value by all students. Grober et al. (2020) and Luke et al. (2009) supported this finding as IPE videos explicitly showing professionals from different professions and real-life examples demonstrate advantages such as evoking new perspectives for learners at all levels, fostering interprofessional collaboration in clinical practice, and being more engaging and illustrative of concepts. Bernard and colleagues noted that, besides SC and SS formats, ST formats are also available for fostering classroom interaction, but may be less effective and harder to implement consistently, and suggested that the quality of ST interactions could be improved by emphasizing comprehensive and higher order thinking skills, rather than lower-level information, procedural details, or assessment-related issues (Bernard et al., 2009). Other studies have supported the benefits of incorporating interactions between students and facilitators into some parts of the course (Evans et al., 2020; Khalili, 2020; Luke et al., 2009). This suggests SS learning may be enhanced by the addition of an instructor facilitating student interactions. Significant differences in responses to learning content were found based on learner gender and academic levels. Overall, female students had higher positive perceptions of the value of all course components than male students. Female students had higher perceptions of both SC course components and SS course components than male students. These findings are consistent with other studies suggesting that females prefer “connected” learning involving listening to the views and perspectives of others (Coster et al., 2008) and a focus on process-oriented interactions (Oever & Haans, 2020). Zhang and Yang noted that women communicated more, experienced higher social presence, and performed better than men in a web-based introductory information systems course or e-learning environment (Zhang & Yang, 2022). It is notable that an alternative was suggested by males in this course to replace SS learning discussion boards in which students exchange information about their disciplines with an informational short video presenting information on each profession. This suggests a preference by males for more informational content-focused learning over collaboration process, as interactional team learning previously noted (Behrend et al., 2020; Bell et al., 2014; Lindh Falk et al., 2015; Wilhelmsson et al., 2011). These differences alert course designers to intentionally consider formats to deliver content and instructor skills to navigate potential gender-based preferences. Undergraduate students had higher perceptions of the value of all course components than graduate students. This aligns with research suggesting younger learners exhibit greater openness and engagement with new learning experiences compared to older learners (Anderson & Thorpe, 2008; Gross et al., 2022). Additionally, findings from a study conducted by Gonsar and colleagues indicated that undergraduate students expressed a keen interest in augmenting opportunities for collaborative activities outside of class with their peers (Gonsar et al., 2021). This suggests a potential avenue for enhancing their engagement and perceived value of the learning experience.

This study offers practical insights regarding an intentional focus on design and delivery of IPE courses with consideration of learner’s gender and academic levels. Results suggest that learning elements focusing on real-life patient experience was the most valued and thus impactful course component. SC learning was preferred by students over SS learning suggesting the potential value of instructor facilitation to enhance SS interactions. The ANOVA results emphasized the pivotal role of academic levels in shaping attitudes toward IPE. Moreover, the mixed-method findings highlighted important awareness of the impact of learner characteristics (academic level and gender) on the perceived value of course components.

Strengths of this study include a large data set from students who participated in the course, completed measurement instruments, and the representation of diverse professions. However, the study’s limitations are notable, particularly the identification of small effect sizes, indicating minor differences with limited implications for educational practice or policy. Future investigations are advised to incorporate potentially impactful individual learner characteristics (i.e., personality, extraversion/introversion, emotional stability), learning styles, cultural preferences, and psychological factors. The study also had no control group to compare attitudes toward IPE of students with no exposure to IPE-focused courses. Gender findings are also limited due to binary male-female categories.

Both challenges and opportunities exist for IPE course development and implementation to further improve IPE learning experiences and outcomes. Our findings support that while a “generic one size” approach may appear more efficient, it may not “fit all” nor be as effective as more tailored courses. Our online course demonstrated efficacy in improving overall attitudes toward IPE among all students. Moreover, implementing the IPE course during earlier stages of education (undergraduate) appeared to have a more pronounced impact on overall IPE attitudes. Additionally, our findings indicate that inherent differences of individual learners related to gender and academic level impact perceptions of and response to various delivery formats of IPE online course content. Thus, intentional consideration and tailoring of IPE course design and content delivery to meet diverse individual learners’ needs and expectations can inform more effective design of non-generic, specialized IPE experiences for a diverse range of students.