Previous medical undergraduate interprofessional learning sessions had been evaluated with a validated attitude to interprofessional learning questionnaire. 15
This consisted of 9 questions () with response options on a 5-point modified Likert scale on which 1 = strongly disagree and 5 = strongly agree. We added a second section that contained 5 additional items to assess confidence in prescribing skills for adults and children (). Finally, students were asked to list 2 perceived strengths and weaknesses of interprofessional learning and to add further comments if they wished.
Changes in Attitude Towards Interprofessional Learning Before and After Attending a Prescribing Workshopa
Changes in Perceived Confidence in Prescribing Before and After Participation in a Prescribing Workshopa
All students were asked to complete a questionnaire immediately before and after the workshop. For the analysis, the scores were reversed for questions 3, 6, 9, and 13. Thus, high scores on questions 1-9 indicated a more positive attitude towards interprofessional learning, and high scores on questions 10-14 indicated a greater confidence in prescribing. Changes in response to each question from pre- to post-training were assessed using non-parametric, Wilcoxon matched-pairs signed-ranks tests (with adjustment for tied ranks). Medians and ranges were used for data summary but, because of the tied observations, means were added to better indicate the direction of change.
Medical students’ knowledge of prescribing was assessed using extended matching questions, which formed part of their standard end-of-year written examination. The range of grades for a test using extended matching questions was 0 to 5. Each extended matching question had a lead-in phrase. For example: “for each of the following patients with chest pain, please select the most appropriate treatment from the 26 options above.” There were 5 questions, or stems, for which the candidate had to select an answer from the options list. Each option could be used once, more than once, or not at all. The questions required the student to use the Medicines for Children Formulary to select the correct medication and calculate the appropriate dose.
The objective structured clinical examination (OSCE) contained a station that assessed students’ prescription-writing skills. Using the Medicines for Children Formulary provided, the student had to select an appropriate medication for a given clinical situation (for example an antibiotic for a urinary tract infection in a child with a penicillin allergy) and enter it on a standard hospital prescription chart.
The EMQ and OSCE scores of the interprofessional learning and non-professional learning medical students were compared using Mann-Whitney U tests. A student’s scores were eliminated from the analysis if either the pre- or post-workshop questionnaire was not completed or if the student’s name was missing from either of the questionnaires.
The pharmacy students’ knowledge of pediatric prescribing was not assessed by the same EMQ and OSCE method because of the inability to change pharmacy assessment procedures within the timeframe of the study. Prescribing knowledge for pharmacy students was assessed during final dispensing examinations.
Two hundred thirty students participated in 19 workshops. Nine sessions were interprofessional learning and attended by 96 medical students and 68 pharmacy students, with 10 or 11 medical and 7 or 8 pharmacy students at each workshop. The other 10 workshops were non-interprofessional learning (only medical students attended). The 2.4 ratio of medical students to pharmacy students meant that there were usually 1 pharmacy student and 2 or 3 medical students in each small group.
Of the 230 students, 211 completed the pre- and post-workshop questionnaires (92% response rate); 11 (5%) completed 1 of the questionnaires, and 8 did not submit either questionnaire. However, not all students completed every question on the questionnaires. The changes from pre- to post-workshop for individual attitude questions (questions 1-9) and the total overall change in attitude to interprofessional learning are shown in .
After the workshop, the participants were more likely to think that interprofessional learning would enhance communication skills, especially with regard to patients (p=0.044 and p=0.036, respectively, for medical and pharmacy students). After interprofessional learning, medical students were less likely to prefer to work only with other medical students (p=0.003) and both medical and pharmacy students reported increased enjoyment with working with other professions (p=0.001). Medical students were more likely to think interprofessional learning improved team-working skills (p=0.002).
Overall, attitudes toward interprofessional learning significantly improved among medical and pharmacy students in the interprofessional learning group (p<0.001 for both; ). There was no significant change in the scores of medical students who were in the non-interprofessional learning groups (p=0.191).
One of the learning outcomes was to determine whether there was a change in students’ confidence in skills such as writing prescriptions. The prescribing workshops significantly increased overall confidence in prescribing among students in both the interprofessional and non-interprofessional learning groups (p<0.001; ). The changes in scores from pre- to post-workshop for individual skill-related questions (questions 10-14) and overall change in scores are shown in .
Medical students’ knowledge about prescribing for children was tested on the end-of-year examinations. No differences in scores on prescribing questions were apparent between students who attended interprofessional and non-interprofessional learning workshops ().
Assessment of Medical Students’ Knowledge After Participation in a Pediatric Prescribing Workshop
Written comments on the post-workshop feedback forms highlighted students’ perceived strengths and weaknesses of interprofessional learning. Some of the strengths of interprofessional learning identified by a medical student included its ability to break down stereotypes and facilitate future relationships, while a pharmacy student described feeling pride in being able to share knowledge about prescribing and the issues surrounding drug selection and dosage.
Weaknesses identified by the students centred on the lack of “a horizontal and vertical approach” to interprofessional learning within each profession’s curricula. Students stated they would prefer that interprofessional learning be included in each year of the curriculum (horizontal), with each year’s content increasing in difficulty (vertical) and covering a range of clinical areas. One medical student commented that interprofessional learning should be included much earlier in the curriculum, when learning basic sciences and clinical skills.