1. bookVolumen 9 (2022): Edición 1 (January 2022)
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Revista
eISSN
2296-990X
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19 Nov 2014
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Inglés, Alemán
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Socialisation into interprofessional teams: A mixed-methods study among early health professional learners who engaged in a teams and teamwork module / Sozialisierung in interprofessionellen Teams: Eine Mixed-Methods-Studie zum Effekt eines Team- und Teamwork-Moduls bei Auszubildenden im Gesundheitswesen

Publicado en línea: 09 Nov 2022
Volumen & Edición: Volumen 9 (2022) - Edición 1 (January 2022)
Páginas: 164 - 173
Recibido: 24 Jul 2022
Aceptado: 08 Sep 2022
Detalles de la revista
License
Formato
Revista
eISSN
2296-990X
Primera edición
19 Nov 2014
Calendario de la edición
1 tiempo por año
Idiomas
Inglés, Alemán
INTRODUCTION

Early Interprofessional Education (IPE) interventions were structured to introduce students to the core competency domains set forth by the Interprofessional Education Collaborative (IPEC) to help students build foundational knowledge and awareness of: 1) teams and teamwork, 2) roles and responsibilities, 3) values and ethics, and/or 4) communication (IPEC, 2016). The earlier the introduction of IPE, the more likely that health profession learners will form positive attitudes surrounding interprofessional collaboration and will inherently integrate it as normal practice (Stull & Blue, 2016; Price et al., 2021). However, the fact that early IPE interventions are vehicles for the development of an interprofessional identity is often overlooked and under-assessed, leaving a significant gap in the literature.

Interprofessional socialisation (IS) is a critical but often disregarded component of successful interprofessional collaborative practice (IPCP). IS is defined as the development of an interprofessional identity in tandem with an individual's professional identity through meaningful IPE experiences (Khalili et al., 2013; King et al., 2016). Students progress through three key stages to complete IS: breaking down barriers, interprofessional role learning, and dual identity development (Khalili & Price, 2022). Addressing the first stage is particularly important for early IPE since professional identity begins developing prior to beginning pre-licensure education and continues to develop as students are acculturated into their disciplines. In fact, students enter their education with predetermined stereotypes regarding both their own and other healthcare disciplines, which serve as the foundations of their professional identities (Hean et al., 2006; Ateah et al., 2011; Weller et al., 2014). These perceptions are frequently not grounded in actual experience as part of that discipline, but rather are founded entirely on stereotypes (Khalili et al., 2013; Ateah et al., 2011). Such uniprofessional identities and stereotypes can be self-fulfilling and create significant barriers to IPCP, underscoring the importance of the early integration of IPE experiences for health professions students (Khalili et al., 2013; Ateah et al., 2011; Reeves, 2016)

Early and continued exposure to IPE experiences can break down professional stereotyped barriers and can reinforce the value of interprofessional roles by contributing to interprofessional team effectiveness and, thus, counteract the development of a strong uniprofessional identity (Rosen et al., 2018; Weller et al., 2014; Khalili et al., 2013; Hean et al., 2006; Ateah et al., 2011) Therefore, ensuring students are socialised early in their training through opportunities during which they collaborate with learners from other disciplines will cultivate their professional and interprofessional identities (King et al., 2016). The literature strongly indicates that IPE, team-based interventions promote learning through social constructs and contexts through teamwork (Lairamore et al., 2018; Hean et al., 2009).

Furthermore, measuring socialisation by evaluating students' beliefs and values regarding interprofessional collaboration can reveal whether IPE is having the intended impact on the development of professional and interprofessional identities (King et al., 2016). Across IPE interventions, especially at the introductory level, student evaluations are focused on their attitudes towards IPE or their perceived satisfaction with the experience (Curran et al., 2010; Cameron et al., 2009; Khalili et al., 2013; Simko et al., 2017; Gross et al. 2022). Although it is important to understand whether health profession students have positive attitudes towards their IPE experiences, established tools exist that measure outcomes beyond attitudes such as team collaboration, team behaviour skills, and socialisation (Hayward et al., 2014; Stock et al., 2013). As IPE interventions continue to be incorporated into health profession curricula, IS must be assessed to determine its long-term impact on the development of an interprofessional identity.

As IPE interventions continue to be integrated across health professional curricula, there continues to be a gap in evaluating the development of IS and interprofessional identity among students early on. The purpose of this mixed-methods study was to assess whether an introductory-level Teams and Teamwork IPE module is effective in IS and in beginning the creation of an interprofessional identity among early health professional learners.

METHODS
Overview of the IPE Teams and Teamwork Module

The IPE Teams and Teamwork module was a 3-week virtual IPE intervention that took the learner a total time of 3–4 hours to complete. The module was at the introductory level and offered to students early in their training to ‘attain a deeper understanding of their own profession and interprofessional identities by gaining experience communicating with other professions on the healthcare team to enhance teamwork and learn about its connection to and impact on patient care delivery and population health’. The module was incorporated into existing health science courses as a required assignment. This module was one of the first experiences in a continuum of IPE for health profession students across the course of their studies.

Participants

For this project, we measured outcomes from the Winter 2021 cohort. Students were advised in writing that work in the course will be deidentified and analysed, but that they could opt out of having their work included in the analysis. Students across three health science schools and two campuses of a large midwestern university were randomly assigned to teams of 3–4 students resulting in 55 interprofessional teams. Students represented undergraduate nursing, undergraduate kinesiology, and doctoral physical therapy (PT) programs. Teams were kept to a maximum of four students because the literature shows that smaller teams lead to greater participation and learning (Lairamore et al., 2018; Shiang-Shaw, 2013). The students worked with the same team throughout the duration of the experience. Students were required to complete a module that introduced them to IPE, specifically the IPEC competencies and IPE opportunities at their respective institutions, before enrolling in the Teams and Teamwork module.

Module activities and points of data collection

The module was designed around an IS framework, to break down barriers and practice interprofessional roles by gaining knowledge of effective teamwork that can be applied to collaborations with peers in an interprofessional scenario. We utilised the Tuckman's stages of team formation (Tuckman, 1965) as the framework for interprofessional team development throughout this module. The trajectory of team development with this framework goes from the simplest stage of ‘forming’, when students are learning how to put a team together, to the most high-functioning stage of ‘performing’, when team members are able to adapt to meet the needs of one another, which indicates an understanding of each other's interprofessional roles. The Teams and Teamwork module scaffolded assignments and self-evaluations for students to learn about and have continuous deep reflections on their team's development. The learning outcomes of the module included: 1) describe the practices of effective teams; 2) apply strategies to navigate disagreements about values, roles, and behaviours that arise among health care teams; and 3) provide feedback and reflect on individual and team performance.

Prior to starting the module activities during week one, students completed a pre-survey that included the validated Interprofessional Socialisation and Valuing Scale (ISVS) (King et al., 2016). The ISVS allows for measurement of interprofessional socialisation and readiness to function in an interprofessional team (interprofessional identity) across three subscales: 1) Self-Perceived Ability to Work with Others, 2) Value in Working with Others, and 3) Comfort in Working with Others. Students rated the extent to which a belief, behaviour, or attitude was present using a 7-point Likert scale (1 = not at all; 7 = to a very great extent). After the pre-surveys were completed, the students then engaged in individual preparatory work that included readings about team formation (Tuckman, 1965) and attributes of a high-functioning team (Eggenberger et al., 2014). Following the readings, students completed and documented an inventory covering conflict management styles (Whetton & Cameron, 2019). Then, students watched a video of a simulated interprofessional healthcare team meeting and engaged in a discussion board conversation about the behaviours, both negative and positive, that they observed. Finally, students read a case scenario pertaining to a cell phone use policy in a healthcare unit. Each student prepared for a virtual interprofessional team discussion by answering reflections pertaining to how they would handle conflict that arose within the case scenario. Of note, the case was intentionally created to be nonclinical given the introductory level of students enrolled in the module.

During week two, the student teams discussed the case scenario in a synchronous meeting collectively scheduled by the team within a remote meeting platform such as Zoom or Google Meet. They worked together to answer specific case questions using their own individual reflections from week one as a guide. Following the discussion around the case scenario in week two, the students reflected on two prompts: 1) How well do you think your team functioned? and 2) What will you change next time you work within a team?

During week three, the student teams virtually and synchronously engaged in a ‘Team Effectiveness Exercise’ during which they were challenged to evaluate and articulate one another's performance as a team member within the context of their interprofessional team by reflecting on both significant contributions and areas for improvement for each student. Specifically, students engaged in what was called a ‘round robin’ method during which they selected a team member to go first. Then, every other member of the team provided feedback to that individual, commenting on the most important contribution they made to the team as well as one area the individual could improve upon to improve team functioning. At the end of the meeting, the teams were asked to: 1) collectively decide what stage of team development they were at according to Tuckman's (1965) Model of Team Development that they read about in week one (i.e., Forming, Storming, Norming, Performing) and 2) describe key moments that impacted their team's development over the course of the module. At the end of week three, students completed a post-module survey that included the ISVS instrument.

Data analysis

A mixed-methods approach including written reflection and a validated IS instrument was used to offer greater insight into the IS perspectives and the ideation of interprofessional identity in students.

The students' demographics, specifically gender, race/ethnicity, health profession, and education level were summarised for frequencies.

At each time (pre- and post-module), the ISVS scores were averaged to create three outcome variables corresponding to the three subdomain scores noted as: Self-perception of Working Together (Q1, Q2, Q4, Q8, Q10), Comfort (Q3, Q5, Q6, Q11) and Values (Q7, Q9, Q12, Q13). Students with data at one time point have been included in the analysis. For data completeness, missing data was handled by mirroring responses from the available time point. Students with no data at either time point (baseline or post) were excluded from this analysis.

Qualitative data gathered from the open-ended reflective prompts that students engaged in during Weeks 2 and 3, included the following: 1) how well do you think your team functioned, 2) what will you change next time you work in a team, and 3) describe key moments that impacted team development. The responses were analysed based on grounded theory (Charmaz, 2006). Students were also asked to give their perspective on which stage of Tuckman's model (forming, storming, norming, performing) they felt their team had reached. We implemented a data-led thematic analysis approach in which emerging themes were determined a posteriori rather than with preconceived themes (Boeije, 2002; Charmaz, 2006). Two researchers used inductive reasoning to code the reflections. Specifically, one researcher (OSA and DF analysed different prompts) individually segmented data into codes (i.e. a single word or phrase). After independent analyses were completed, the codes were discussed amongst members of the research team (OSA, DF, VB). The codes were summarised into themes to gain insight and provide an overall picture of student participants': 1) perceptions of team functioning, 2) sense of what the students would change next time they are in a team, and 3) experience of key moments that impacted their team functioning.

Paired t-tests were used to detect differences in pre- and post-module scores. A one-way ANOVA was performed to compare the effects of gender, education level and health profession on the difference between the mean scores between pre- and post-module. We used Python 3.9.0 and RStudio version 1.1.463 (RStudio Inc., Boston, MA) for quantitative analysis. The themes from the thematic analyses were tallied for frequencies. The significance level for all statistical analyses was set at p<0.05.

RESULTS
Student demographics

A total of 221 students were enrolled in the IPE Teams and Teamwork module. Seventy-four percent (n=164) of the participating students were undergraduate kinesiology and nursing students, and 26% (n=57) were doctoral PT students (Table 1). A total of 206 students responded to ISVS at baseline (pre-module; 93% response rate). The post-module response rate was 87% with 192 students of the 221 students completing the ISVS. Most students were white (79%) and predominantly female (70%).

Characteristics of the student participants (n=221).

Demographic variable Count (%)
Gender Female 154 (70%)
Male 67 (30%)
Race/Ethnicity White 172 (79%)
Asian 11 (45%)
Hispanic or Latino 12 (5%)
Black or African American 7 (3%)
2 or More 3 (1%)
American Indian or Alaska Native 1 (0.5%)
Not indicated 15 (7%)
Discipline Nursing 86 (39%)
Kinesiology 78 (35%)
Physical therapy 57 (26%)
Education Graduate 57 (26%)
Undergraduate 164 (74%)
Overall student socialisation within interprofessional teams

Students reported an increase in their interprofessional socialisation and readiness to function in interprofessional teams across all ISVS items (Table 2). Accordingly, there was an average increase from pre- to post-module self-reported socialisation and readiness across all three subscales: Self-perception of working together (+0.91; p<0.001), Values (+0.69; p<0.001), and Comfort (+1.05; p<0.001).

Students perceived socialisation to IPE teams pre- to post-module measured by ISVS (n=192).

ISVS Item Pre-Module Score Post-Module Score P-value
I am aware of my preconceived ideas when entering team discussions 4.42 5.23 <0.001
I feel able to act as a fully collaborative member of the team I have gained an enhanced awareness of my own role on a team 4.69 5.69 <0.001
I am able to share and exchange ideas in a team discussion 5.15 6.08 <0.001
I have gained an enhanced perception of myself as someone who engages in inter-professional practice 4.42 5.52 <0.001
I feel comfortable in describing my professional role to another team member 4.63 5.63 <0.001
I am able to negotiate more openly with others within a team 4.68 5.64 <0.001
I have gained an enhanced awareness of roles of other professionals on a team 4.3 5.23 <0.001
I feel comfortable in accepting responsibility delegated to me within a team 5.25 5.97 <0.001
I have gained greater appreciation for the importance of a team approach 5.14 5.75 <0.001
I feel able to act as a fully collaborative member of the team 5.16 6.08 <0.001
I am comfortable sharing decision making with other professionals on a team 5.03 5.97 <0.001
I have gained more realistic expectations of other professionals on a team 4.55 5.5 <0.001
I have gained an appreciation for the benefits in interprofessional teamwork 5.12 5.76 <0.001
Student socialisation within interprofessional teams by demographic variables

The difference in mean ISVS scores was not statistically significant by gender. There was an increase in mean scores across all three subscales of ISVS by education level (data not shown; all p<0.05). Nursing and kinesiology undergraduate students reported an increase in socialisation within interprofessional teams across all three subscales from pre- to post-module (Table 3), whereas physical therapy students reported an increase for Self-perception of working together and Comfort.

Students' perceived socialisation to IPE teams pre- to post-module measured by ISVS by health profession (n=192).

Ability to work with others Values Comfort
Pre-Module Score Post-Module Score P-value Pre-Module Score Post-Module Score P-value Pre-Module Score Post-Module Score P-value
Nursing 4.59 5.55 <0.001 4.72 5.55 <0.001 4.63 5.63 <0.001
Kinesiology 4.82 5.92 <0.001 4.73 6.01 <0.001 4.77 5.97 <0.001
Physical Therapy 4.99 5.59 <0.001 5.24 4.99 0.27 4.97 5.89 <0.001
All schools 4.79 5.7 <0.001 4.87 5.56 <0.001 4.78 5.83 <0.001
Team functioning

After reflecting on the question ‘how well do you think your team functioned?’, the majority of individual students felt their teams functioned well (n=192, 87%), while just 4% (n=10) felt their team did not work well together. One student's comment seemed to synthesise the general theme of working well together by stating, ‘I think our team functioned well. We were able to work together without conflict and share ideas fluently, without judgment. We were able to communicate well with the members who were not able to attend the meeting and get them involved’. The comments of those who felt their team did not work well together, underscored the importance of communication and roles/responsibilities for a high-functioning team. These less positive comments tended to focus on one or more team members either not being present or not responding to various modes of communication. One group commented, ‘But one of our group members did not attend our meeting. We attempted to contact him multiple times and he didn't respond, so we did the assignment without him’, while another stated, ‘¾ of my team functioned very well. The last member did not respond to emails nor Canvas notifications of us trying to reach her’.

Key moments impacting team development

When asked about key moments that impacted their team's development, seven main themes emerged (Table 4). Many teams indicated that getting time and space to get to know each other was significant for team development (n=23, 42%). About one-third of the teams indicated that allowing the opportunity for all team members to contribute to discussion fostered team development (n=17, 31%). Other themes that emerged included specific events like the first team meeting, engagement in individual and group reflections, and the ‘round robin’ exercise as well as specific tasks like attending the meetings.

Main themes and related excerpts from students after being asked to reflect on the key moments that impacted their team's development (n=55 teams).

Themes Count (% of Teams) Excerpts from Reflection
Getting to know each other 23 (42%) At the beginning of last week, we took time to get to know each other, which helped promote a collaborative environment.
Allowing everyone to contribute 17 (31%) All of us sharing our viewpoints and listening to each other's viewpoints have positively impacted our team's development.
First team meeting 12 (22%) At the end of the first meeting, we all began to feel more comfortable sharing our ideas with each other, and we think this really helped us become a better working team.
Reflection assignments/activities 8 (15%) Reflecting on our performance during the previous assignment and today helped to impact our team's development.
Meeting attendance 8 (15%) A key moment that impacted our team's development was when a team member did not show up to contribute to the meeting this week. We worked well together the first time to delegate roles but had to compromise because one member did not show up the second time. As a result of the member's absence, this ultimately impacted our reasoning and team development.
Responsibility (as a team) to schedule meetings 5 (9%) This activity was helpful for our team because not everyone was able to meet last week.It was more difficult to coordinate times to meet. We think it influenced our team's development because it was challenging to find times, and it taught us more about each other's personalities. We learned patience and understanding and how to coordinate with a team with different schedules because of this exercise.
Round robin exercise 4 (7%) Sharing our perceptions of each other's strengths and weaknesses (i.e. round robin exercise) allowed for honesty and self-reflection between team members, which helped make us more comfortable with each other.
What students would change next time in an interprofessional team

Many students indicated that they would focus more on communication and engage more in personal self-assessments when asked what they would change when they work in a team next, as reflected by the responses, ‘I will participate more in the team meetings and speak out more’, and ‘I will let others speak first. Sometimes I talk a lot and I think I should let others speak more’, indicating an understanding of their individual part in creating a solid team dynamic (Table 5). Many responses centred around the concept of familiarity with comments including, ‘It was a little awkward, just because none of us know each other.... But I think if we were more familiar before we start it would help conversation to follow more fluently’; ‘We didn't take time to really introduce ourselves and our backgrounds…’. See more themes and related excerpts in Table 5.

Main themes and related excerpts from the students after reflection on ‘what would you change next time you worked on an interprofessional team?’ (n=192 individual students).

Themes Count (percent) Excerpts from Reflection
Communication/Listening 87 (45%) Next time I work on a team I would try to find the easiest form of communication as soon as possible because email was not the most efficient way to reach my teammates when they were available to meet. We found that exchanging phone numbers was far more helpful for communication.
I will be a more active listener.
I will let others speak first. Sometimes I talk a lot and I think I should let others speak more.
I will enforce a better level of communication and take initiative.
Maybe discussion from more facets. We were all very much in agreement, so we didn't come from many different angles.
Make time to discuss ideas that oppose our own ideas to get a better sense of how others may feel and react to the rules we decided upon.
Preparation/Organisation 48 (25%) Review the assignment individually to allow for a more efficient meeting.
Assign what we want to have done prior to the beginning of the meeting.
I will be sure I am more prepared next time.
Come more prepared to talk about the issue at hand. None of us really looked at the information prior so it took a little longer to get started because we had to read it prior to starting.
Ensure each team member is prepared for the meeting.
Establish everything we have to do before the next team meeting and confirm that everyone has completed what they have to do.
Team Familiarity/Team Building 35 (18%) I will make sure to ask people about themselves instead of just jumping into the work so that way I will be able to make more personal connections that would also help the group.
Next time I work on a team, I will make sure to do a brief introduction for the group.
Maybe next time we will spend a little bit more time getting to know each other better.
Learning who my team members are and what their backgrounds are before meeting.
It would be helpful to increase team connection by having introductions and casual conversations aside from the group assignment. By knowing each other more personally, group members can have increased communication and respect for each other.
Next time I work with a team, I will make sure to include casual conversation, such as asking how everyone is doing or how everyone's day has been. This casual conversation will help the team feel more friendly and open, helping with communication skills.
Team stage development

By the end of the module, the majority of the interprofessional student teams perceived their team as being at the ‘performing’ level of team stage development (n=33 teams, 60%), as represented by one team stating, ‘We all actively give input on each decision which we then discuss and agree/disagree on. We were able to come to ‘group’ decisions by all giving our input so not one person overpowered another’. Fifteen teams (27%) indicated that they were at the ‘norming’ stage of team development, as one team described, ‘We are still establishing clear roles and responsibilities, and discussing our team expectations, yet we have also started working together as a cohesive group as we complete tasks’. Two teams (4%) indicated that they were at the ‘forming’ stage as represented by one team noting, ‘Our team believes that we are in the forming stage since we have not worked together for very long yet. We are still getting to know each other and learning how each member works best’. None of the teams (0%) made an indication that they thought they were at the ‘storming’ stage of team development, and five teams did not answer this question.

DISCUSSION

This work provides insight that health profession students can foster not only their own professional identity, but also their identity as a member of an interprofessional team early on in their training. The IPE Teams and Teamwork module engaged introductory level health profession students in an IPE experience early in their training. Importantly, the module provided opportunities for students to collaborate with one another and to explicitly reflect on their socialisation into an interprofessional team. Early socialisation within an IPE setting can have implications for how a student identifies, not only as a professional within their field, but also as a professional within an interprofessional team, breaking down barriers, and disrupting disciplinary stereotyping (Khalili & Price, 2022).

For interprofessional teams to be effective, it takes a process that can occur in stages. Utilising Tuckman's framework of stages and team formation has been shown to support students develop into and understand what it entails to be an effective team (Shirey et al., 2019). The IS framework dovetails with Tuckman's framework, to break down barriers, introduce interprofessional role learning, and promote dual identity development. In an educational setting, especially among more novice learners, this occurs most effectively with relevant tools to support the team trajectory (Posten et al., 2017). The teams and teamwork module scaffolded assignments and self-evaluations for students to learn about and have continuous deep reflections on their team's development. Further, the module gave students the opportunity to address common challenges as an interprofessional team. For example, some groups encountered challenges with some members of the team not contributing, missing meetings, or not communicating as expected. Most teams were able to develop solutions such as obtaining input from missing team members prior to or after team meetings that ensured contribution to team assignments and the inclusion of all team members. Thus, the majority of teams collectively agreed they were at the most high-functioning stage of ‘performing’ by the end of the module. However, the progress made and challenges encountered by the teams during this module underscore the vital importance of team formation as a continuum or a process rather than as a one-time experience.

The various shifts in socialisation and readiness for interprofessional practice within disciplines may be due to several factors. For example, the pre-survey to post-survey decrease in the ratings of physical therapy students towards ‘value in working with others’ is consistent with Mishoe et al. (2021), where physical therapy students reported lower scores than other disciplines. The physical therapy students were early doctoral students, while the kinesiology and nursing students were undergraduates, thus perhaps placing groups with these age and actual experience differentials within the discipline may have contributed to this decrease. The students' perceptions of socialisation also parallel those reported in the literature in which women and the nursing discipline showed more positive attitudes towards teamwork (Gross et al., 2022; Mishoe et al., 2021; Mishoe et al., 2018; Hood et al., 2014). Furthermore, the nursing discipline is shown to have higher engagement and emphasis on IPE, which may also contribute to the socialisation findings (Herath et al., 2017; Mishoe et al., 2021).

IS is an integral part of overcoming the barriers to IPCP introduced by professional identities that are established early on (King et al., 2016). Therefore, specifically measuring the beliefs, attitudes, and behaviours regarding IP collaborative team practice, and whether participants have learned to value both their own role and those of other disciplines on an interprofessional team is imperative. When students were asked what they would change the next time they are part of an interprofessional team, getting to know each other was their priority. Perhaps students realised that once they were able to understand the perspectives and contributions of everyone on the team, including their own, they were able to build trust with one another and share knowledge, which are key elements of an effective team (Alsharo et al., 2017). The necessity of IS early in pre-professional health education is reinforced in this work as these students experienced first-hand the significance of role clarification that helped them to value both their own and the role of others in creating a high functioning interprofessional team.

Implications for future interprofessional collaboration

Early and sustained IPE opportunities ensure that practicing health professionals are ready and able to work collaboratively in clinical practice. Early exposure to IPE concepts and competencies socialises students into interprofessional culture, preparing them for experiential IPE in clinical settings. Theoretically, these clinical IPE experiences socialise students to an interprofessional team, resulting in improved healthcare delivery and outcomes for the patients (Reeves et al., 2013). Thus, integrating IPE longitudinally throughout health profession education not only impacts health profession training, but also the patient experiences.

Limitations

This work has a few limitations to point out. The quantitative data collected from the ISVS were self-reported. The investigators did not collect data on each student's previous IPE experience, which could potentially affect pre-module (baseline) data. Also, this IPE experience was short-term. To capture long-term impacts on the learners, it would be ideal to provide continuous engagement in IPE for them to fully develop an interprofessional identity and allow for continuous evaluation. Finally, the data were only collected at one midwestern university. Expanding data collection to various types of institutions and a larger number of health disciplines could help differentiate how IPE is valued across diverse institutional types.

CONCLUSION

Health profession students early on in their training who engaged in the Teams and Teamwork module were able to deeply reflect on how their team functioned as well as identify what helped them work as a team and what they would change in future team experiences. By bringing awareness of their teammates' roles and their own roles within the team and discussing together how they functioned as a team led to evidence of the process of socialising into an interprofessional team and the beginnings of an interprofessional identity early on in their training. Health profession students must be challenged early in their training to socialise into an interprofessional team and continue the process throughout their training to internalise a sense of the value of collaboration and practice across professions as a norm.

Students' perceived socialisation to IPE teams pre- to post-module measured by ISVS by health profession (n=192).

Ability to work with others Values Comfort
Pre-Module Score Post-Module Score P-value Pre-Module Score Post-Module Score P-value Pre-Module Score Post-Module Score P-value
Nursing 4.59 5.55 <0.001 4.72 5.55 <0.001 4.63 5.63 <0.001
Kinesiology 4.82 5.92 <0.001 4.73 6.01 <0.001 4.77 5.97 <0.001
Physical Therapy 4.99 5.59 <0.001 5.24 4.99 0.27 4.97 5.89 <0.001
All schools 4.79 5.7 <0.001 4.87 5.56 <0.001 4.78 5.83 <0.001

Characteristics of the student participants (n=221).

Demographic variable Count (%)
Gender Female 154 (70%)
Male 67 (30%)
Race/Ethnicity White 172 (79%)
Asian 11 (45%)
Hispanic or Latino 12 (5%)
Black or African American 7 (3%)
2 or More 3 (1%)
American Indian or Alaska Native 1 (0.5%)
Not indicated 15 (7%)
Discipline Nursing 86 (39%)
Kinesiology 78 (35%)
Physical therapy 57 (26%)
Education Graduate 57 (26%)
Undergraduate 164 (74%)

Students perceived socialisation to IPE teams pre- to post-module measured by ISVS (n=192).

ISVS Item Pre-Module Score Post-Module Score P-value
I am aware of my preconceived ideas when entering team discussions 4.42 5.23 <0.001
I feel able to act as a fully collaborative member of the team I have gained an enhanced awareness of my own role on a team 4.69 5.69 <0.001
I am able to share and exchange ideas in a team discussion 5.15 6.08 <0.001
I have gained an enhanced perception of myself as someone who engages in inter-professional practice 4.42 5.52 <0.001
I feel comfortable in describing my professional role to another team member 4.63 5.63 <0.001
I am able to negotiate more openly with others within a team 4.68 5.64 <0.001
I have gained an enhanced awareness of roles of other professionals on a team 4.3 5.23 <0.001
I feel comfortable in accepting responsibility delegated to me within a team 5.25 5.97 <0.001
I have gained greater appreciation for the importance of a team approach 5.14 5.75 <0.001
I feel able to act as a fully collaborative member of the team 5.16 6.08 <0.001
I am comfortable sharing decision making with other professionals on a team 5.03 5.97 <0.001
I have gained more realistic expectations of other professionals on a team 4.55 5.5 <0.001
I have gained an appreciation for the benefits in interprofessional teamwork 5.12 5.76 <0.001

Main themes and related excerpts from the students after reflection on ‘what would you change next time you worked on an interprofessional team?’ (n=192 individual students).

Themes Count (percent) Excerpts from Reflection
Communication/Listening 87 (45%) Next time I work on a team I would try to find the easiest form of communication as soon as possible because email was not the most efficient way to reach my teammates when they were available to meet. We found that exchanging phone numbers was far more helpful for communication.
I will be a more active listener.
I will let others speak first. Sometimes I talk a lot and I think I should let others speak more.
I will enforce a better level of communication and take initiative.
Maybe discussion from more facets. We were all very much in agreement, so we didn't come from many different angles.
Make time to discuss ideas that oppose our own ideas to get a better sense of how others may feel and react to the rules we decided upon.
Preparation/Organisation 48 (25%) Review the assignment individually to allow for a more efficient meeting.
Assign what we want to have done prior to the beginning of the meeting.
I will be sure I am more prepared next time.
Come more prepared to talk about the issue at hand. None of us really looked at the information prior so it took a little longer to get started because we had to read it prior to starting.
Ensure each team member is prepared for the meeting.
Establish everything we have to do before the next team meeting and confirm that everyone has completed what they have to do.
Team Familiarity/Team Building 35 (18%) I will make sure to ask people about themselves instead of just jumping into the work so that way I will be able to make more personal connections that would also help the group.
Next time I work on a team, I will make sure to do a brief introduction for the group.
Maybe next time we will spend a little bit more time getting to know each other better.
Learning who my team members are and what their backgrounds are before meeting.
It would be helpful to increase team connection by having introductions and casual conversations aside from the group assignment. By knowing each other more personally, group members can have increased communication and respect for each other.
Next time I work with a team, I will make sure to include casual conversation, such as asking how everyone is doing or how everyone's day has been. This casual conversation will help the team feel more friendly and open, helping with communication skills.

Main themes and related excerpts from students after being asked to reflect on the key moments that impacted their team's development (n=55 teams).

Themes Count (% of Teams) Excerpts from Reflection
Getting to know each other 23 (42%) At the beginning of last week, we took time to get to know each other, which helped promote a collaborative environment.
Allowing everyone to contribute 17 (31%) All of us sharing our viewpoints and listening to each other's viewpoints have positively impacted our team's development.
First team meeting 12 (22%) At the end of the first meeting, we all began to feel more comfortable sharing our ideas with each other, and we think this really helped us become a better working team.
Reflection assignments/activities 8 (15%) Reflecting on our performance during the previous assignment and today helped to impact our team's development.
Meeting attendance 8 (15%) A key moment that impacted our team's development was when a team member did not show up to contribute to the meeting this week. We worked well together the first time to delegate roles but had to compromise because one member did not show up the second time. As a result of the member's absence, this ultimately impacted our reasoning and team development.
Responsibility (as a team) to schedule meetings 5 (9%) This activity was helpful for our team because not everyone was able to meet last week.It was more difficult to coordinate times to meet. We think it influenced our team's development because it was challenging to find times, and it taught us more about each other's personalities. We learned patience and understanding and how to coordinate with a team with different schedules because of this exercise.
Round robin exercise 4 (7%) Sharing our perceptions of each other's strengths and weaknesses (i.e. round robin exercise) allowed for honesty and self-reflection between team members, which helped make us more comfortable with each other.

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