RESEARCH ARTICLE
 Dissecting First-Year Students’ Perceptions of
Health Profession Groups:
Potential Barriers to Interprofessional Education
Barret Michalec, PhD
Carolyn Giordano, PhD
Christine Arenson, MD
Reena Antony, BSN, MPH
Molly Rose, FNP, PhD
these negative perceptions. J Allied Health 2013;
42(4):202–213.
BACKGROUND: Previous research has shown that health
profession students enter interprofessional education
(IPE) programs with negative perceptions of health disciplines other than their own, which could serve as possible barriers to engagement with interprofessional
principles. Yet, past studies have not fully dissected
these perceptions, nor have they examined how these
perceptions may contrast with how students view their
own future profession. METHODS AND FINDINGS: A total
of 638 students from six different health profession
training programs completed surveys assessing their
perceptions/stereotypes of their own and other health
professions. ANOVA and MANCOVA analyses
showed a high degree of variability in how each profession is perceived by the students, but that the students,
regardless of discipline (except medical students), rated
their own profession the highest on almost every attribute listed. CONCLUSIONS: The data provide evidence for
the tenets of Social Identity Theory raised in the relevant literature. The authors also suggest that the lack of
adequately formulated “professional-in-training” identity, as well as the formidability of anticipatory socialization, help to foster and perpetuate these stereotypes
and that IPE programs have the potential to exacerbate
TEAM-BASED, COLLABORATIVE CARE has been
argued to improve patient outcomes and foster safer
and more effective (i.e., patient outcomes and costs)
health care.1–3 A key component to efficient interprofessional team-based health care delivery is the dissolution of the traditional hierarchical structure nested
within the culture of health care delivery.4,5 Despite the
overwhelming literature regarding the positive effects
and benefits of team-based care, not only for the patient
but also for health care professionals, there is evidence
to suggest that health care professionals maintain and
even exhibit negative perceptions and stereotypes of
each other, especially regarding clinical knowledge and
ability.6–9 Such attitudes when exercised in the health
care setting could negate the potential positive elements
of interprofessional care and even prevent effective
delivery teams from developing.10,11
To promote the qualities and practices of collaborative care within the next generation of health care professionals, a number of health profession education
institutions have constructed and implemented elaborate, multi-year interprofessional education (IPE) programs aimed at bringing together students from multiple health care disciplines during their years of training
to increase patient-centeredness, develop a team
approach, foster communication and respect among
the various health professions, promote an understanding of each others’ roles, and breakdown the hierarchy
within health care delivery.12 However, despite the
increasing awareness and momentum of IPE and continued development and inclusion of IPE programs into
the curriculum of various health professions, previous
studies have spotlighted the existence and resiliency of
negative stereotypes of health disciplines that are also
held and exercised among students.
Education and training are significant mechanisms
of the socialization and professionalization of health
Dr. Michalec is Assistant Professor, Department of Sociology, University
of Delaware, Newark, DE, and Department of Family and Community
Medicine, Thomas Jefferson University, Philadelphia, PA; Dr. Giordano is
Director of the Office of Institutional Research, Thomas Jefferson University; Dr. Arenson is Co-Director of the Jefferson Interprofessional Education Center, and Department of Family and Community Medicine,
Thomas Jefferson University; Ms. Antony is Instructor/Education Specialist, Interprofessional Institute, Rosalind Franklin University of Medicine & Science, Chicago, IL; and Dr. Rose is Professor, Jefferson School of
Nursing, Thomas Jefferson University, Philadelphia, PA.
RA01275—Received Dec 14, 2012; accepted May 11, 2013
Research was supported in part by the Jefferson Center for Interprofessional Education (JCIPE), Thomas Jefferson University, Philadelphia, PA.
Address correspondence to: Dr. Barret Michalec, Department of Sociology, University of Delaware, Smith Hall, 18 Amstel Ave., Newark, DE
19716, USA. Tel 302 831 1205, fax 302 831 2607. bmichal@udel.edu.
© 2013 Association of Schools of Allied Health Professions, Wash., DC.
202
profession students,13,14 and although studies have
shown that IPE programs can indeed have a positive
impact on how students perceive the abilities and
attributes of other health professions,7,15-19 there is also
evidence that suggests IPE programs have little to no
effect on altering students’ attitudes and perceptions of
the abilities and attributes of health professions. Nisbet
et al. noted that their designed interprofessional learning (IPL) program was “not entirely successful”20(p66) in
breaking down negative stereotypes, in that some students maintained negative attitudes towards particular
professions despite their immersion in the program.
Similarly, Tunstall-Pedoe, Rink, and Hilton21 suggested
that the students’ stereotypes of each profession featured in their sample (medicine, nursing, and allied
health) may have actually become more exaggerated
during an interprofessional program. Hansson, Foldevi,
and Mattson22 found no significant changes in future
doctors’ (medical students’) views on collaborating with
nurses or their attitudes toward the nursing profession
following their experiences in an IPE progam. Also,
Ajjawi et al.23 reported that dental students still felt
marginalized and stereotyped by medical students
despite both disciplines’ involvement in a shared-learning program.
These and other studies suggest that students actually come into IPE programs with negative stereotypes
of other health professions. As described earlier, negative stereotypes at the professional level can impede
and thwart interprofessional and collaborative care,
and therefore the existence and practice of negative
stereotypes at the pre-professional level could clearly
foil the goals and directives of IPE programs, and as the
studies cited above suggest, these attitudes and perceptions have the potential to perpetuate despite exposure
to IPE programs. In order to properly champion collaborative, interprofessional, team-based care (at the preand post-licensure levels), researchers and IPE administrators must spotlight the presence and perpetuation of
these negative attitudes so as to construct programs
(within and outside IPE) that can effectively assuage
these debilitating perceptions. Yet to date, studies examining students’ stereotypes of various health professions have not fully explored the depth and robustness
of these perceptions. Questions still remain regarding
the degree of these negative perceptions in terms of how
various health disciplines are actually viewed by entering students, how these views differ between health profession students, and how they compare to how students view their own profession.
Given these gaps in the literature, this study
explored the attitudes and perceptions of health profession students entering their education programs (preIPE exposure) concerning the abilities and attributes of
their own, as well as other, health professions. This indepth exploration of students’ stereotypes may offer
Journal of Allied Health, Winter 2013, Vol 42, No 4
insight into the potentially strenuous uphill battle IPE
programs face in terms of instilling team-based principles in the next generation of health professionals, and
possibly spotlight how IPE programs can be more efficient in creating a team/collaborative environment
that dismantles, or at least dilutes, possibly vibrant
stereotypes that can detract from the goals and directives of interprofessionalism.
Methods
The study participants were first-year health profession
students (who entered in 2011) within the first 1 to 2
months of matriculation and enrolled in a required 2year longitudinal IPE program at a large northeastern
university. Students (n= 638,* 97% of the enrolled students of that cohort) represented the academic disciplines of medicine (245), nursing (159), pharmacy (102),
occupational therapy (72), physical therapy (51), and
couple and family therapy (9). They were surveyed via
pen and paper at the onset of their first year (August
2011) of their IPE program. The use of human subjects
was approved by the institutional review board.
STUDENT STEREOTYPES RATING QUESTIONNAIRE †
The scale assessing students’ perceptions of the other
health professions, as well as their perceptions of their
own discipline/profession, was the Student Stereotypes
Rating Questionnaire (SSRQ)6 as adapted by Hean et
al.24 for use with pre-licensure health professions students. Participants rated six health profession programs
(the professions they would come into contact with
during their IPE program) on nine separate positive
attributes (academic ability, professional competence,
interpersonal skills, leadership abilities, ability to work
independently, ability to be a team player, ability to
make decisions, practical skills, and confidence) using a
5-point Likert scale (1 = very low, 5 = very high). For
example, students were asked, “How would you rate
pharmacy on…” and each of the attributes were listed
below the question. A higher rating relates to a more
positive perception of that profession regarding each
*As the primary directive of this study was to show potential differences in programs’ perspective of occupational groups (rather than
differences among individual students), the demographic information of the sample (i.e., sex, race, age) is not featured. However, given
that 97% of the enrolled grade cohort participated in the study, it can
be assumed that the sample featured in this study was representative
of the population of the enrolled grade cohort.
† This specific study was part of a much larger project that employed
various other scales in the initial survey. Although 638 students did
complete more than half of the initial survey, not all students completed the SSRQ for each profession, and therefore there are different
n’s for each MANOVA run for each profession. This is reported in
the df for Tables 3a–3f.
203
TABLE 1. Highest and Lowest Rating for Each Profession and Attribute
Ratings of attributes in each profession
Couple and family therapy
Occupational therapy
Medicine
Pharmacy
Nursing
Physical therapy
Ratings of professions for each attribute
Academic ability
Professional competence
Interpersonal skills
Leadership ability
Ability to work independently
Ability to be a team player
Ability to make decisions
Practical skills
Confidence
Highest
Lowest
Interpersonal skills
Interpersonal skills
Academic ability
Academic ability
Ability to be a team player, practical skills
Practical skills
Academic ability
Leadership ability
Interpersonal skills
Interpersonal skills
Leadership ability
Leadership ability
Medicine
Medicine
Couple and family therapy
Medicine
Medicine
Nursing
Medicine
Medicine
Medicine
Couple and family therapy
Couple and family therapy
Pharmacy
Pharmacy
Nursing
Medicine
Couple and family therapy
Couple and family therapy
Couple and family therapy,
Occupational therapy
particular attribute. This instrument has shown exceptional levels of test-retest reliability, and content validity
was established by a panel of academics, health care professionals, and pre-registration (pre-licensure) students.24
ANALYSIS
A repeated-measures ANOVA was performed to compare: a) if ratings on each attribute differed significantly
within each profession (i.e., was the rating for medicine
on academic ability significantly different from the rating
for medicine on interpersonal skills), and b) if professions
significantly differed on how they were rated for each
attribute (i.e., was the rating for nursing on Ability to
Make Decisions significantly different than the rating for
pharmacy on Ability to Make Decisions). These tests were
run using the entire sample. The assumption of sphericity was checked using Mauchly’s test, and the post hoc
analysis was performed using the Bonferroni method.
In order to explore how each program rated each profession on each of the attributes in the SSRQ, a series of
multiple analysis of variance (MANOVA) tests were
executed. In the presence of a significant difference, post
hoc comparisons were performed using the GamesHowell test because there were unequal variances.
Findings
The overall test for differences in means between attributes, within each discipline, showed that a) there were
significant differences between the ratings on each attribute within each discipline for each profession, and b)
there were significant differences between each discipline
on their ratings of each attribute. Pairwise comparisons
for both investigations yielded an overwhelming number
204
of significant differences but little in terms of captivating
data. These tests did, however, highlight a) the highest
and lowest rated attribute for each profession and b) the
highest and lowest rated profession for each attribute
(Table 1, the top and bottom half, respectively).
As shown in Table 1, nursing’s highest rated attributes were both ability to be a team player and practical
skills (and nursing was the profession that received the
highest rating for ability to be a team player compared to
the other professions), indicating that many students,
regardless of their own discipline, perceived nurses as
integral elements of team-based health care delivery.
Yet, nursing’s lowest rated attribute was leadership ability, suggesting that although nurses are seen as able to
integrate into a team, they are not seen as able to lead
that team. Similar to nursing, leadership ability was the
lowest rated attribute for occupational and physical
therapy, yet pharmacy was found to be the profession
rated the lowest for leadership ability.
Table 1 shows that Couple and Family Therapy‡ is
the profession often rated the lowest on many positive
attributes. Given that only 9 participants of the entire
sample were couple and family therapy students, these
findings must be interpreted with some caution (see Discussion). Medicine was rated by all students as the top
profession for all but two attributes (see Table 1), yet
rated the lowest in ability to be a team player. This is troubling and potentially problematic for IPE programs
given that students perceived Medicine as the top pro‡ In the sections that follow, capital letters are used when discussing
a profession (e.g., Couple and Family Therapy, Nursing, etc.), but
lower case letters are used when discussing an academic program or
the students of that program (e.g., couple and family therapy, medical
students, etc.).
MICHALEC ET AL., Students’ Perceptions of Health Profession Groups
TABLE 2. Significant Differences Between Subjects for Ratings of Each Profession
Profession being Rated
Couple and family therapy
Occupational therapy
Medicine
Pharmacy
Nursing
Physical therapy
F
Hyp. df
Error df
Sign.
Wilk’s λ
2.79
3.40
2.24
5.13
3.41
4.47
45
45
45
45
45
45
2396.29
2458.91
2539.43
2494.70
2503.65
2508.12
0.000
0.000
0.000
0.000
0.000
0.000
0.80
0.76
0.84
0.67
0.77
0.71
fession in terms of their leadership capability and workrelated qualities, but did not see physicians (and perhaps physicians-in-training) as being able to work
within a team. This negative perception of Medicine is
also evident in Medicine’s low rating in interpersonal
skills (see Table 1).
The MANOVA tests revealed significant differences between how each program rated each profession
(Table 2). Tables 3a–3f show the mean ratings for each
profession by each program for each specific attribute,
and any significant differences between those ratings.
Table 3a shows how each program (including couple
and family therapy) rated the profession of Couple and
Family Therapy on each of the 9 attributes. These series
of tables (3a–3f) also depict if the rating was significantly different from the ratings from other programs,
which program it was significantly different from, and
which program gave the highest (+) and lowest (–) rating
on each attribute. For example, Table 3a shows that
medical students’ mean rating for Couple and Family
Therapy on academic ability was 3.68, that this was the
lowest rating for Couple and Family Therapy on academic ability given by any of the programs (–), and that
this rating on academic ability given by medical students
was significantly different (lower) than the ratings given
by couple and family therapy, occupational therapy,
and nursing students. Table 3a also shows that couple
and family therapy students rated their own profession
higher on all 9 attributes compared to the ratings from
students of other programs. Similar to the finding presented in Table 1 that Couple and Family Therapy was
rated lowest in ability to make decisions, Table 3a shows
that although couple and family therapy students rated
their own profession the highest in ability to make decisions, this rating was significantly different (higher) than
the ratings offered by each of the other professions.
Lastly, it should be noted that medical students gave
Couple and Family Therapy the lowest rating on 7 of
the 9 attributes.
Table 3b shows how the students from each discipline rated Occupational Therapy on the 9 attributes of
the SSRQ. Again, we see that students of the profession
in question rated it the highest on all attributes. (Couple
and family therapy students actually rated Occupational Therapy highest on a majority of the attributes,
as they did for each of the other professions as well.
Journal of Allied Health, Winter 2013, Vol 42, No 4
However, given that only 9 of the 638 participants were
couple and family therapy students, their “highest” ratings are only considered regarding the evaluation of
their own program.) The table also shows that medical
students not only rated Occupational Therapy the
lowest on 8 out of the 9 attributes, but also that these
ratings were significantly lower than those given by students from other disciplines. As shown in Table 3c,
medical students gave the lowest ratings to Medicine for
academic ability, professional competence, ability to work
independently, practical skills, and confidence, and ranked
their future profession highest only in leadership abilities. Moreover, the low rating in professional competence
was actually found to be significantly lower than the
rating given by students from couple and family therapy, pharmacy, nursing, and physical therapy.
Regarding the mean ratings for Pharmacy, pharmacy
students rated their chosen profession highest on 7 of
the 9 attributes (Table 3d). There was slight disagreement
between the students regarding Pharmacy’s interpersonal
skills as well as their ability to be a team player, as pharmacy students’ ratings were significantly higher than
that those given by occupational therapy, medical, nursing, and physical therapy students. Table 3e shows that
nursing students rated the Nursing profession highest in
all 9 categories, although there appears to be significant
variation in the ratings among students from the other
disciplines, especially medical and pharmacy (except in
regards to Nurses’ ability to be a team player). Consistent
with the trend, physical therapy students rated their
own future profession highest in all 9 attributes (Table
3f), and medical students were the harshest critic of the
profession, rating it the lowest in 7 of the 9 attributes.
Discussion
These data represent students’ perceptions of particular
health professions at the inauguration of their education;
these are the attitudes and views with which the students
came into their respective educational programs. When
these data were collected, these students had not had any
formal interprofessional training (unless they had
received such training at a prior institution). Therefore,
it should be clear that this study does not feature any
“intervention” of sorts or reflect the effects of IPE.
Rather, the impetus of this paper is to spotlight the per205
TABLE 3a. Mean Ratings on SSRQ Elements by Each Program for Couple and Family Therapy
Academic
Ability
F (5, 543)
Adj. R2
Ability
Ability to
Professional Interpersonal Leadership
to Work
be a Team
Competence
Skills
Abilities Independently
Player
Ability
to Make
Decisions
Practical
Skills
Confidence
5.23***
0.07
1.60**
0.02
2.21
0.01
5.04***
0.04
6.34***
0.05
2.57*
0.01
6.19***
0.06
9.34***
0.07
8.38***
0.06
CFT
4.75+ (0.46)
Med**
Pharm**
PT*
4.88+ (0.35)
OT*
Med**
Pharm**
Nursing*
PT**
5.00+ (0.00)
4.50+ (0.54)
4.75+ (0.46)
4.75+ (0.46)
Med*
4.88+ (0.35)
OT**
Med**
Pharm**
Nursing*
PT**
4.88+ (0.35)
Med**
PT*
4.88+ (0.35)
OT*
Med**
Pharm*
PT*
OT
4.03 (0.75)
Med*
4.29 (0.64)
CFT*
4.79 (0.51)
4.21 (0.78)
Med**
4.22 (0.84)
4.21 (0.74)
4.19 (0.80)
CFT**
4.21 (0.76)
Med**
4.38 (0.67)
CFT*
Med*
Med
3.68– (0.72)
CFT**
OT*
Nursing***
4.13– (0.66)
CFT**
Nursing*
4.62 (0.62)
3.83– (0.76)
OT**
Nursing**
4.05 (0.75)
Nursing***
3.99– (0.77)
CFT*
3.94– (0.73)
CFT**
Nursing***
3.78– (0.81)
CFT**
OT**
Pharm*
Nursing***
4.06– (0.71)
CFT**
OT*
Pharm*
Nursing***
Pharm
3.80 (0.85)
CFT**
Nursing**
4.19 (0.74)
CFT**
4.62 (0.63)
3.92 (0.78)
4.00- (0.89)
Nursing**
4.19 (0.84)
4.12 (0.80)
CFT**
4.10 (0.82)
Med*
4.37 (0.73)
CFT*
Med*
Nursing
4.15 (0.74)
Med***
Pharm**
4.36 (0.63)
CFT*
Med*
4.61– (0.55)
4.13 (0.74)
Med**
4.43 (0.71)
Med***
Pharm**
4.19 (0.83)
4.33 (0.72)
CFT*
Med***
4.25 (0.79)
Med***
PT**
4.48 (0.61)
Med***
PT
3.84 (0.74)
CFT*
4.26 (0.66)
CFT*
4.79 (0.51)
4.14 (0.76)
4.36 (0.72)
4.16 (0.80)
4.18 (0.75)
CFT**
3.78 (0.89)
CFT**
Nursing**
4.28 (0.67)
CFT*
*p < 0.05; **p < 0.01; ***p < 0.001: all two-tailed tests. + = highest rating given on that particular attribute; – = lowest rating given on that
particular attribute.
ceptions of entering health profession students of their
own and other health professions, and suggest how these
perceptions could impact their willingness and ability to
engage in IPE and possibly even future collaborative care
post-licensure. Although previous studies have shown
that students enter their respective health care education
programs with negative stereotypes of various health
professions,7,17,24 this study is the first to fully dissect the
extent of these stereotypes and how students perceive
other health professions compared to their own future
role in health care delivery.
Hean et al.24 reported on a sample of 1,256 students
entering the health professions programs in audiology,
medicine, midwifery, nursing, occupational therapy,
pharmacy, physiotherapy, podiatry, radiography, and
social work who completed the SSRQ. In their study,
students did not rate all professions, but were randomly
asked to rate four professions other than their own.
The ratings for each profession on each characteristic
were presented as a whole without delineation of ratings from each student profession. Hean et al. classified
mean ratings of 4.0 or above as high, 3.5 to 3.99 as
medium, and 3.49 and below as low. In the current
study, mean ratings were most commonly in the high
206
range with a few in the medium range and even fewer in
the low range. For example, the overall rating of Pharmacy by the entire sample for interprofessional skills was
3.68; however, the mean fell to the low range with medical student’s rating for Pharmacy of 3.43 and physical
therapy students’ rating for Pharmacy of 3.35. Similar
to the study conducted by Hean and colleagues, Medicine and Pharmacy received the lowest ratings for interprofessional skills and ability to be a team player; but
received the highest ratings for academic ability.
In this specific study, each discipline (besides medical
students) rated its own profession the highest in almost
all of the attributes. This depicts significant in-group
favoritism and high commitment to the students’ own
future profession, even as early as the first few weeks of
their education (when these data were collected). In previous studies, researchers have utilized Social Identity
Theory (SIT)25 to explore the attitudes and perceptions
of various health professionals and health profession
students, and how these individuals compare their own
group (profession/discipline) with other groups.11,15,26
The tenets of SIT suggest that individuals desire to see
themselves and the social groups they subscribe to (as
these groups, in turn, “define” them as individuals) in a
MICHALEC ET AL., Students’ Perceptions of Health Profession Groups
TABLE 3b. Mean Ratings on SSRQ Elements by Each Program for Occupational Therapy
Academic
Ability
F (5, 557)
Adj. R2
Ability
Ability to
Professional Interpersonal Leadership
to Work
be a Team
Competence
Skills
Abilities Independently
Player
Ability
to Make
Decisions
Practical
Skills
Confidence
15.06***
0.11
9.77***
0.07
9.64***
0.07
11.14***
0.08
9.94***
0.07
9.50***
0.07
10.26***
0.07
5.24***
0.04
11.70***
0.09
CFT
4.71 (0.49)
Med*
5.00 (0.00)
OT***
Med***
Pharm***
Nursing***
PT***
4.71 (0.49)
4.43 (0.79)
4.86 (0.38)
Med**
Pharm**
4.71 (0.49)
4.71 (0.49)
4.86 (0.38)
Med*
Pharm*
4.71 (0.49)
OT
4.46+ (0.62)
Med***
Pharm**
PT*
4.62+ (0.57)
CFT***
Med***
Pharm**
4.83+ (0.45)
Med***
Pharm***
Nursing***
4.49+ (0.61)
Med***
Pharm***
4.51+ (0.66)
Med***
Pharm**
4.74+ (0.50)
Med***
Pharm***
Nursing**
PT**
4.49+ (0.59)
Med***
Pharm*
4.65+ (0.56)
Med***
Pharm**
4.58+ (0.55)
Med***
Pharm**
Med
3.85– (0.73)
CFT*
OT***
Nursing***
4.15– (0.69)
CFT***
OT***
Nursing***
4.23– (0.75)
OT***
PT***
3.83– (0.75)
OT***
Nursing***
4.05– (0.72)
CFT**
OT***
Nursing***
4.16 (0.68)
OT***
Nursing*
4.00– (0.72)
OT***
Nursing***
PT**
4.25– (0.73)
CFT*
OT***
Nursing*
4.05– (0.68)
OT***
Nursing***
Pharm
4.04 (0.80)
OT**
Nursing**
4.25 (0.77)
CFT***
OT**
Nursing*
4.34 (0.73)
OT***
PT*
3.93 (0.81)
OT***
Nursing*
4.11 (0.79)
CFT**
OT**
Nursing**
4.13– (0.79)
OT***
4.14 (0.74)
OT*
Nursing*
4.26 (0.80)
CFT*
OT**
4.22 (0.75)
OT**
Nursing*
Nursing
4.41 (0.66)
Med***
Pharm**
PT*
4.53 (0.59)
CFT***
Med***
Pharm*
4.39 (0.70)
OT***
4.27 (0.74)
Med***
Pharm*
4.48 (0.64)
Med**
Pharm**
4.39 (0.72)
OT**
Med*
4.41 (0.69)
Med***
Pharm*
4.47 (0.64)
Med*
4.50 (0.60)
Med***
Pharm*
PT
4.06 (0.73)
OT*
Nursing*
4.39 (0.72)
CFT***
4.65 (0.52)
Med***
Pharm*
4.12 (0.79)
4.35 (0.77)
4.37 (0.60)
OT**
4.45 (0.67)
Med**
4.37 (0.66)
4.35 (0.69)
*p < 0.05; **p < 0.01; ***p < 0.001: all two-tailed tests. + = highest rating given on that particular attribute; – = lowest rating given on that
particular attribute.
positive light in comparison to others. Therefore, social
actors seek to exercise and exhibit their group’s positive
distinctiveness and engage in intergroup differentiation
by practicing in-group favoritism and by making favorable comparisons to out-groups that “establish” and/or
feature the superiority of their own in-group.27–29
Adams et al.30 noted, “Professional identity, as one
form of social identity, concerns group interactions in
the workplace and relates to how people compare and
differentiate themselves from other professional
groups.” Attempts to accentuate “positive distinctiveness” are evident in this study, as students are clearly
striving to differentiate their profession (in-group) from
the other professions (out-groups) through highlighting
the number of positive characteristics that they feel are
indigenous to their specific profession. Because many of
these students, regardless of their discipline, have yet to
fully immerse themselves in the actual practice of their
discipline, it is interesting that they feel so positive, confident, and optimistic regarding their chosen profession. It could be argued that at this early stage of their
Journal of Allied Health, Winter 2013, Vol 42, No 4
education, these students had yet to fully develop (or
even begin to develop) a professional identity,31 hence
these ratings of their own professions (and of others)
could merely be the students’ attempts to cling to an
idealized version of their profession. Yet, by exposing
the complexity of students’ perceptions this study
explicitly spotlights students’ attempts to not only positively differentiate their professions from others (and
engage in out-group discrimination), but also make
favorable comparisons between their own future profession and other professions within healthcare.
Parsell and Blight32 have argued that in order for IPE
to be effective, students must be secure in their professional (“in-training”) identities and they must feel as
equals among the other groups/disciplines. In this
sense, IPE certainly faces an uphill battle in having to a)
allow students to develop their own professional-intraining identity within their own discipline, but also b)
provide an equitable, unbiased environment where students from each discipline respect and appreciate the
abilities and attributes of the other disciplines. Further207
TABLE 3c. Mean Ratings on SSRQ Elements by Each Program for Medicine
Academic
Ability
F (5, 575)
Adj. R2
Ability
Ability to
Professional Interpersonal Leadership
to Work
be a Team
Competence
Skills
Abilities Independently
Player
Ability
to Make
Decisions
Practical
Skills
Confidence
0.89
0.00
5.15***
0.04
2.14
0.01
0.45
0.01
1.64
0.01
2.22
0.01
0.65
0.00
1.83
0.01
1.36
0.00
CFT
5.00 (0.00)
5.00 (0.00)
OT***
Med***
Pharm**
Nursing**
PT*
3.87 (1.13)
4.63 (0.52)
4.25 (1.49)
4.13 (0.84)
5.00 (0.00)
5.00 (0.00)
4.88 (0.35)
OT
4.87 (0.42)
4.71 (0.52)
OT***
3.86 (0.88)
4.59- (0.60)
4.70 (0.55)
4.17 (0.80)
4.80+ (0.47)
4.74+ (0.50)
4.81 (0.46)
Med
4.83– (0.43)
4.56– (0.55)
CFT***
Pharm**
Nursing*
PT***
3.93 (0.75)
4.68+ (0.52)
4.55– (0.58)
4.02 (0.76)
4.76 (0.46)
4.57– (0.58)
4.70– (0.51)
Pharm
4.84 (0.37)
4.78 (0.49)
CFT**
Med**
4.15+ (0.85)
4.63 (0.59)
4.62 (0.59)
4.29+ (0.89)
4.72– (0.60)
4.66 (0.56)
4.81 (0.45)
Nursing
4.86 (0.24)
4.72 (0.48)
CFT***
Med*
3.77- (1.13)
4.60 (0.58)
4.64 (0.65)
3.99 (1.12)
4.73 (0.53)
4.67 (0.57)
4.77 (0.49)
PT
4.94+ (0.40)
4.84+ (0.37)
CFT*
Med***
3.86 (0.94)
4.63 (0.56)
4.73+ (0.53)
3.84– (1.08)
4.73 (0.53)
4.61 (0.775)
4.84+ (0.48)
*p < 0.05; **p < 0.01; ***p < 0.001: all two-tailed tests. + = highest rating given on that particular attribute; – = lowest rating given on that
particular attribute.
more, students in the early stages of their training (such
as when these data were gathered) may be unfamiliar
with the role and responsibility of their own specific
profession and therefore may feel somewhat defensive
during IPE programs being introduced to and required
to engage with other professions. It appears that these
directives are somewhat discordant from the tenets of
SIT—individuals feel the need to practice in-group
favoritism and out-group exclusion in order to engage
in positive identity formation, yet IPE programs
attempt to promote understanding and appreciation of
many other professions. This could be cognitively and
emotionally conflictive for students, especially those
just embarking on their education. This juxtaposition
lends to the question of when IPE should be offered to
be most effective in establishing the values and norms
of team-based, collaborative care. Is the first year of
health profession training too early? When have students had adequate time to formulate their own professional-in-training identity? On the other hand, given
the strong reinforcement of traditional biases and
stereotypes in uni-professional education programs and
many practice environments, at what point in health
profession training will it be too late to inculcate a new
paradigm of mutual respect and team-based care?
208
In his work utilizing SIT to examine group processes
within medical education, Buford33 proposed that medical students’ “doctor” identity is more salient during
particular social situations that determine behavior
indicative of this specific identity, “the professional category of ‘doctor’ will be more accessible in a clinical
workplace than elsewhere.” This raises concerns
regarding how students present themselves during IPErelated interactions. If IPE is nested within approaches
to health care delivery, then the IPE setting more than
likely intensifies the students’ own professional-intraining identity (i.e., “nurse,” “doctor,” “physical therapist,” etc.). In their fledgling understanding of what
that their role entails, they may cling to their idealized
version, practicing more out-group exclusion (to assist
in their own identity formation) rather than seeking
understanding of other professions’ roles and attributes. As Buford argues, within IPE programs, students
may identify with their professional groups rather than
the common identity they share with the others in the
program—that of “student”—and this potential lack of
commonality could influence attitudes towards IPE.
In this specific study, students viewed their future profession considerably more favorably than how they
viewed other professions, although all students, regardMICHALEC ET AL., Students’ Perceptions of Health Profession Groups
TABLE 3d. Mean Ratings on SSRQ Elements by Each Program for Pharmacy
Academic
Ability
F (5, 565)
Adj. R2
Ability
Ability to
Professional Interpersonal Leadership
to Work
be a Team
Competence
Skills
Abilities Independently
Player
Ability
to Make
Decisions
Practical
Skills
Confidence
11.39***
0.08
11.91***
0.09
20.57***
0.15
16.31***
0.12
3.93**
0.03
18.59***
0.13
10.79***
0.08
13.57***
0.10
11.53***
0.09
CFT
5.00 (0.00)
OT**
Med***
Pharm***
Nursing***
PT*
5.00 (0.00)
OT***
Med***
Pharm***
Nursing***
PT***
3.87 (0.99)
4.63 (0.74)
Med**
4.38 (0.74)
4.63 (074)
4.38 (0.92)
4.88 (0.35)
Med**
PT**
4.88 (0.35)
Med**
OT
4.73 (0.54)
CFT**
Med**
4.58 (0.63)
CFT***
Med*
3.60 90.91)
Pharm***
3.99 (0.86)
Med*
Pharm*
4.49 (0.66)
4.09 (0.81)
Pharm***
4.46 (0.61)
Med**
4.49 (0.66)
Med***
4.48 (0.64)
Med**
Med
4.40– (0.61)
CFT***
OT**
Pharm**
Nursing***
PT**
4.29– (0.64)
CFT***
OT*
Pharm***
Nursing***
PT**
3.43 (0.82)
Pharm***
3.64– (0.77)
CFT**
OT*
Pharm***
Nursing***
4.31– (0.69)
Pharm*
Nursing*
PT*
3.88 (0.74)
Pharm***
Nursing***
4.08– (0.76)
OT**
Pharm***
Nursing***
4.03– (0.73)
CFT**
OT***
Pharm***
Nursing***
4.14– (0.66)
CFT**
OT**
Pharm***
Nursing***
Pharm
4.64 (0.54)
CFT***
Med**
4.72+ (0.52)
CFT***
Med***
4.48+ (0.70)
OT***
Med***
Nursing***
PT***
4.41+ (0.71)
OT*
Med***
PT**
4.59 (0.66)
Med*
4.67+ (0.55)
OT***
Med***
Nursing***
PT***
4.64+ (0.60)
Med***
4.59+ (0.64)
Med***
PT*
4.62+ (0.59)
Med***
Nursing
4.78+ (0.46)
CFT***
Med***
4.66 (0.53)
CFT***
Med***
3.71 (1.04)
Pharm***
4.18 (0.83)
Med***
4.55 (0.66)
Med*
4.23 (0.72)
Med***
Pharm***
PT*
4.50 (0.71)
Med***
4.50 (0.72)
Med***
4.54 (0.70)
Med***
PT
4.75 (0.52)
CFT*
Med**
4.61 (0.57)
CFT***
Med**
3.35– (0.96)
Pharm***
3.84 (0.83)
Pharm**
4.63+ (0.66)
Med*
3.78– (0.95)
Pharm***
Nursing*
4.37 (0.72)
4.16 (0.86)
CFT**
Pharm*
4.51 (0.61)
Med**
PT**
*p < 0.05; **p < 0.01; ***p < 0.001: all two-tailed tests. + = highest rating given on that particular attribute; – = lowest rating given on that
particular attribute.
less of future profession, appeared to agree on the positive attributes characteristic of the medical profession
(see Table 3c). Given Medicine’s perceived professional
dominance in the health care field,34 it is not surprising
that these students, regardless of their own chosen profession, appear to view Medicine as maintaining almost
all of the positive attributes listed. Yet, medical students
themselves not only rated their future profession lower
than students of other disciplines in academic abilities,
ability to work independently, practical skills, and confidence,
they rated Medicine significantly lower (compared to
couple and family therapy, pharmacy, nursing, and physical therapy students) in professional competence (Table 3c).
This particular finding seems to conflict with the classic
literature depicting medical students as tending to
express high levels of self-confidence and conviction in
the abilities, talents, and overall worth of their future
profession.35–38 Perhaps contemporary medical students
have a more negative view of their profession, or perhaps
these ratings represent a “veil of humility” so as not to
Journal of Allied Health, Winter 2013, Vol 42, No 4
appear egocentric or overly proud in their choice of professions. However, it should be noted that these data
were gathered roughly 1 month into the medical students’ training and therefore these reports may represent
not a “veil of humility” but feeling overwhelmed, possibly even doubt in their own abilities to serve as the successors to the profession. Yet, all health profession students sampled in this study were entering into their own
curricula, and medical students were the only cohort
with such reports regarding their own profession.
Clearly, this is an area for future research.
As outlined above, researchers have debated the
appropriate time to introduce IPE programs to health
professions students, citing the potential lack of a more
fully developed professional-in-training identity and
the power of held stereotypes when arriving to their
own education program. In their study, Tunstall-Pedoe,
Rink, and Hilton21 argued “that any notion that students arrive without preconceived ideas about the other
professions is misplaced.” Such a notion suggests the
209
TABLE 3e. Mean Ratings on SSRQ Elements by Each Program for Nursing
Academic
Ability
F (5, 567)
Adj. R2
Ability
Ability to
Professional Interpersonal Leadership
to Work
be a Team
Competence
Skills
Abilities Independently
Player
Ability
to Make
Decisions
Practical
Skills
Confidence
15.53***
0.11
5.95***
0.04
7.06***
0.05
14.47***
0.11
9.62***
0.07
2.31
0.01
12.06***
0.09
5.53***
0.04
11.70***
0.09
CFT
5.00 (0.00)
OT***
Med***
Pharm***
Nursing***
PT***
4.89 (0.33)
Med**
Pharm*
PT*
4.56 (0.73)
4.22 (0.83)
4.22 (0.83)
4.78 (0.44)
4.56 (0.73)
4.89 (0.33)
Pharm*
4.67 (0.50)
OT
4.49 (0.66)
CFT***
Med***
Pharm*
4.51 (0.61)
4.43 (0.74)
Nursing**
4.10 (0.74)
Nursing*
4.25 (0.76)
4.57 (0.61)
4.31 (0.72)
Med*
4.66 (0.56)
4.38 (0.62)
Nursing**
Med
4.05– (0.68)
CFT***
OT***
Nursing***
4.33– (0.69)
CFT**
Nursing***
4.48 (0.66)
Nursing***
3.86 (0.77)
Nursing***
4.02 (0.72)
Nursing***
4.58 (0.61)
4.00– (0.77)
OT*
Nursing***
4.52 (0.60)
Nursing***
4.20– (0.70)
Nursing***
Pharm
4.10 (0.83)
CFT***
OT*
Nursing**
4.35 (0.76)
CFT*
Nursing***
4.51 (0.78)
PT*
3.79– (0.86)
Nursing***
3.95– (0.86)
Nursing***
4.53 (0.69)
4.03 (0.72)
Nursing***
4.42– (0.75)
OT*
Nursing***
4.20– (0.76)
Nursing**
Nursing
4.60+ (0.63)
CFT***
Med***
Pharm***
PT**
4.67+ (0.54)
Med***
Pharm**
4.79+ (0.48)
OT**
Med***
Pharm*
PT***
4.48+ (0.65)
OT*
Med***
Pharm***
PT***
4.51+ (0.70)
Med***
Pharm***
PT**
4.73+ (0.51)
4.57+ (0.67)
Med***
Pharm***
PT*
4.77+ (0.47)
Med***
Pharm**
4.70+ (0.53)
OT**
Med***
Pharm***
PT**
PT
4.22 (0.64)
CFT***
Nursing**
4.39 (0.64)
CFT*
4.22– (0.83)
Nursing***
3.88 (0.84)
Nursing***
4.00 (0.83)
Nursing**
4.47– (0.64)
4.22 (0.78)
PT*
4.61 (0.57)
4.33 (0.62)
Nursing**
*p < 0.05; **p < 0.01; ***p < 0.001: all two-tailed tests. + = highest rating given on that particular attribute; – = lowest rating given on that
particular attribute.
power and command of anticipatory socialization.
Shields39 refers to anticipatory socialization as “prior
knowledge of cultural aspects of colleges and universities and the student role” and suggests that not only
parental and sibling experiences, but also the student’s
own life experiences before starting college could have
an impact on preparing them for university life.
Although Shields was examining the influence of anticipatory socialization among university students, it is
not difficult to see how anticipatory socialization could
affect health profession students upon entering their
training, especially in terms of how they view other
health professions.
Despite the extensive analysis of these students’
stereotypes of the featured health professions, this
study does have certain limitations. For example, only
one health profession education institution was sampled. Similarly, only six health professions were featured in this study. Furthermore, the sample size is relatively small for a few of the disciplines, especially couple
and family therapy.
210
Although this work provides evidence of health
profession students’ attempts of positive differentiation, in-group favoritism, and out-group exclusion as
early as the first few weeks of training, it may raise
more questions than it answers. If students are entering
their health profession education programs with such
glaring stereotypes of other disciplines (and such optimistic views of their own profession), how can IPE best
attend to these deleterious conditions, especially if
these perceptions are formulated and solidified well
before students enter their training?21 Several
researchers offer the “contact hypothesis,” suggesting
that the mere exposure or “contact” between groups
through IPE has the potential to reduce stereotypes
and negative perceptions.15,40 But could exposure to
other disciplines/professions at such an early stage of
profession-in-training identity formation encourage
students to crawl back into their protective shell of ingroup identity, which could then result in further
resistance to understanding the roles of other professions in health care delivery?
MICHALEC ET AL., Students’ Perceptions of Health Profession Groups
TABLE 3f. Mean Ratings on SSRQ Elements by Each Program for Physical Therapy
Academic
Ability
F (5, 568)
Adj. R2
Ability
Ability to
Professional Interpersonal Leadership
to Work
be a Team
Competence
Skills
Abilities Independently
Player
Ability
to Make
Decisions
Practical
Skills
Confidence
25.44***
0.18
9.90***
0.07
3.57**
0.02
12.70***
0.09
4.62***
0.03
6.16***
0.04
10.26***
0.08
5.14***
0.04
10.63***
0.08
CFT
5.00 (0.00)
OT**
Med***
Pharm***
Nursing***
PT*
5.00 (0.00)
OT***
Med***
Pharm***
Nursing***
PT*
4.75 (0.46)
4.75 (0.46)
Med*
4.75 (0.71)
4.88 (0.35)
Med**
4.75 (0.70)
4.88 (0.35)
5.00 (0.00)
OT***
Med***
Pharm***
Nursing***
PT*
OT
4.59 (0.58)
CFT**
Med**
Pharm***
PT*
4.62 (0.57)
CFT***
Med**
Pharm*
4.34- (0.68)
PT**
4.46 (0.56)
Med***
4.46 (0.63)
4.50 (0.61)
Med*
4.47 (0.61)
Med**
4.60 (0.55)
4.59 (0.58)
CFT***
Med**
Med
4.02– (0.68)
CFT***
OT***
Nursing***
PT***
4.30– (0.62)
CFT***
OT**
Nursing***
PT***
4.37 (0.63)
PT**
3.97– (0.67)
CFT*
OT***
Nursing***
PT***
4.23– (0.66)
Nursing**
PT*
4.24– (0.68)
CFT**
OT*
Nursing*
PT***
4.09– (0.70)
OT**
Nursing***
PT***
4.42 (0.65)
PT***
4.24– (0.63)
CFT**
OT**
Pharm*
Nursing***
PT***
Pharm
4.15 (0.71)
CFT***
OT***
Nursing**
PT***
4.32 (0.69)
CFT***
OT*
PT***
4.48 (0.65)
4.22 (0.78)
OT*
Med***
PT**
4.45 (0.75)
4.41 (0.68)
4.25 (0.76)
PT**
4.41- (0.71)
PT***
4.48 (0.69)
CFT***
Med*
Nursing
4.52 (0.62)
CFT***
Med***
Pharm**
PT***
4.52 (0/62)
CFT***
Med*
PT**
4.48 (0.65)
PT**
4.36 (0.66)
Med***
4.49 (0.63)
Med**
4.48 (0.67)
Med*
4.46 (0.65)
Med***
4.57 (0.60)
PT**
4.56 (0.58)
CFT***
Med***
PT
4.84+ (0.37)
CFT*
OT*
Med***
Pharm***
Nursing***
4.82+ (0.49)
CFT*
Med***
Pharm***
Nursing**
4.73+ (0.49)
OT**
Med**
Nursing**
4.55+ (0.61)
Med***
4.55+ (0.58)
Med*
4.69+ (0.51)
Med***
4.67+ (0.52)
Med***
Pharm**
4.82+ (0.39)
Med***
Pharm***
Nursing**
4.76+ (0.52)
CFT*
Med***
*p < 0.05; **p < 0.01; ***p < 0.001: all two-tailed tests. + = highest rating given on that particular attribute; – = lowest rating given on that
particular attribute.
As entering students may be unsure of the actual
responsibilities and duties of their future professional
role (not to mention the responsibilities and duties of
other health professions) it may be best to expose students to various health care professionals during “realtime” patient/family centered care. Frequent clinical
exposure may not only enhance the students’ learning
the roles of their own and other health professions, as
well as potentially spotlight actual team-based care, but
may also foster students’ professional-in-training identity, all of which would assist with the indoctrination of
interprofessional principles. However, only continued
longitudinal analysis will provide further clarity as to
the persistence and resiliency of these stereotypes, as
well as the impact of IPE programs.
Journal of Allied Health, Winter 2013, Vol 42, No 4
Conclusions
Interprofessional, collaborative care has been shown to
provide safer and more effective health care delivery.
To instill the values and principles of team-based care
in the next generation of health care professionals, a
number of health education institutions have implemented IPE programs. To date, there has been mixed
evidence regarding whether IPE programs are actually
having a positive impact on students’ perceptions of the
attributes and abilities of other health professions. But
what these previous studies do highlight is that health
profession students do maintain negative stereotypes of
other disciplines. Given the potentially negative effects
these stereotypes can have on the students’ absorbance
211
of interprofessionalism principles, this study provides
an in-depth analysis of entering students’ perceptions
of the attributes of six different health professions
(including their own) so as to feature the extent and
sophisticated nature of these perceptions.
As this study shows, students clearly come into their
respective training (and IPE programs) with negative
perceptions of other health professions. Perhaps most
striking, however, is the variability in how these students view each of the other professions, depicted by
the number of significant differences in ratings of the
attributes among the disciplines. However, there are
two notable exceptions to the variability in how students rated each profession on each attribute: a) students consistently rated their own profession the highest for each attribute (sans medical students), and b)
students, regardless of discipline, had little disagreement
regarding the attributes characteristic to the profession
of Medicine. The notion that students consistently
rated their own profession highest on all attributes, as
well as the plethora of lower ratings students offered
regarding other professions provides evidence for the
tenets of Social Identity Theory proposed in previous
research as students in this specific study clearly
attempt to accentuate positive distinctiveness of their
own group, as well as practice intergroup differentiation
by signifying what other professions lack.
Medical students were the only group not to rate
their own future profession the highest on all of the
attributes. Although the entire sample of students rated
Medicine the highest in academic ability, professional
competence, leadership, ability to work independently, ability
to make decisions, practical skills, and confidence (Table 1),
medical students were found to give their own future
profession the lowest ratings (compared to students of
other disciplines, Table 3c) in academic ability, ability to
work independently, practical skills, and confidence, and
rated Medicine significantly lower in professional competence compared to students of couple and family therapy, pharmacy, nursing, and physical therapy. Medical
students did, however, rate each of the other professions significantly lower on almost all of the attributes
listed (compared to other students). It is unlikely that
first-year medical students think so poorly of the health
care field in general to perceive each profession in question (including Medicine) as severely lacking. Therefore, the authors suggest that their reported perception
of Medicine may depict a socially desirable “veil of
humility.”
Although this study does provide an in-depth analysis of entering health profession students’ perceptions
of their future colleagues, and suggests that these stereotypes could be formidable barriers to imparting the
values of team-based, collaborative care to the next generation of health care professionals, only continued
longitudinal analyses will show the resiliency of stu212
dents’ perceptions, the impact of IPE programs on students’ attitudes, and if the perceptions, such as those
depicted in this study, are actual barriers to engagement
with interprofessional principles at the profession and
pre-professional levels. Moreover, future research
should attempt to assess health profession students’
perceptions/attitudes before they enter their respective
training, perhaps during the application phase, to gain
a better understanding of not only why students choose
certain professions, but also why they may not choose
others, and if/how this reasoning affects their stereotypes of other health professions.
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