LESSONS LEARNT FROM A NATIONAL
STUDY OF PRE-REGISTRATION
INTERPROFESSIONAL EDUCATION IN
THE UNITED KINGDOM
Dr. Deborah Craddock
University of Southampton
Introduction
 Crucial ability to learn and work in a multidisciplinary
team (WHO 2008).
 Interprofessional education (IPE) aims to reinforce
inter-professional practice (DOH 2000a; DOH 2000b; Carpenter, 2005).
 IPE is a mandatory requirement in the United Kingdom
(UK) for pre-registration training in health and social
care (DOH & QAA, 2006).
 Varying models of IPE in undergraduate curricula
(Roberts
et al., 2000)
 Evidence base for the effectiveness of such
programmes is growing (Hammick et al., 2007; Hean, Craddock & O’Halloran,
2009).
Research Aim: To explore the potential influence of IPE
at pre-registration level, using podiatry as an exemplar.
Research Objectives:
1. To evaluate health and social work students’
awareness of podiatrists’ roles on two occasions1
across participating HEIs;
2. To explore health and social work students’ views of
interprofessional learning (IPL) on two occasions1
across participating HEIs;
1 Sample 1: students at the start of their Level 1 IPE
initiative;
Sample 2: students on completion of their IPE
Level 1 initiative
Methodology
 Two prospective cross-sectional
surveys
 Ethical approval
 Multi-stage sampling:- (1) sampling of
HEIs & (2) sampling of students
Questionnaires were administered to a
volunteer sample of pre-registration
health and/ or social work students in
Higher Education Institutions within
the UK at 2 separate time points.
Inclusion criteria: Students registered
on a health or social care programme
participating in an IPE initiative that
involved podiatry students.
Questionnaire Pack
 Questionnaire pack- informed
by (1) key informant
interviews and (2) research
evidence
 Validated tools – Readiness for
Inter-professional Education
Scale [RIPLS] & Generic Role
Perception Questionnaire
 Face validity
 Content validity
 Pilot Study [test (i) n=67; test
(ii) n=62]
 Test re-test reliability
 Internal consistency
Key
informant
interviews
Sample:
Sample 1:
Sample 2:
 1151 students participated in  1060 students participated in
the Sample 1 phase [81.1%
the Sample 2 phase [81.2%
(933) female, 18.9% (218)
(861) female, 18.8% (199)
male]:
mean
age
24.38
male]:
mean
age
24.32
(SD=8.167) years in 6 HEIs
(SD=7.84) years in 5 HEIs.
 Excluding students registered
on a BSc (Hons) podiatry  Excluding students registered
on a BSc (Hons) podiatry
programme: Sample 1 sample
size- 964 students [82.2%
programme
967
students
(792) female, 17.8% (172)
[81.7% (790) female, 18.3%
male]:
mean
age
23.62
(177) male]: mean age 23.82
(SD=7.50) years in 6 HEIs
(SD=7.46) years in 5 HEIs.
Female : Male (Parsell and Bligh 1999; Cassidy 2007)
Objective 1
Evaluating health and social work students’
awareness of podiatrists’ roles on two occasions1
across participating HEIs;
1 Sample 1: students at the start of their Level 1 IPE
initiative;
Sample 2: students on completion of their IPE
Level 1 initiative
41.4% (399) participants in
Sample 1 and 51.4% (497)
participants in Sample 2
participated in an IPL
group that included a
podiatry student.
 Of these participants in
Sample 1, only 20.4% (48)
participants who claimed
to be aware of podiatrists’
roles, perceived there to
be no difference between
chiropodists and
podiatrists.
In Sample 2: greater
percentage number42.7% (180).
Perceptions of podiatrists’ roles:
 carrying out nail surgery for
an ingrown toenail (Sample 1:
82.2%, 792; Sample 2: 80%,
774)
 manufacturing shoe devices
(Sample 1: 54.5%, 525;
Sample 2: 54%, 522)
 surgically removing bunions
(Sample 1: 57.2%, 551;
Sample 2: 57.5%, 556)
 At Sample 2 only, podiatrists
were also identified as the
key professional who treats
verrucae (70.2%, 679).
Other roles:
 Managing walking and
mobility problems
 Assessment of patients/
clients for vascular disease
 Managing ulcerations
 Assessing children for gait or
developmental anomalies
 Only at HEI B did students
have a greater understanding
of podiatrists’ roles between
Sample 1 and Sample 2
(Sample 1: Md=8, Sample 2:
Md=10, U=7513, z=-5.294,
p<0.001, r=-0.3)
Note: Higher median scoreSample 2
Educational theory underlying
IPE initiative
Sample 1:
 A Kruskal-Wallis Test
highlighted a significant
 HEI D recorded the highest
difference in students’
median knowledge score
(Md=8.5)
knowledge of podiatrists’ roles
and their institution of origin HEI K and HEI H recorded the
lowest median knowledge
score (Md=6)
 Sample 1: H=38.948, 5df,
p<0.001, n=964;
 Sample 2: H=122.87, 4df,
p<0.001, n=967.
Sample 2:
 HEI D and HEI B recorded the
highest median knowledge
scores (Md=9)
 HEI K recorded the lowest
median knowledge score
(Md=6)
 Students’ knowledge
podiatrists’ roles was better if
they had participated in an IPE
group that involved a podiatry
student (Md=7) than students
who did not or were unsure as
to whether they had
participated in an IPE group
that involved a podiatry
student (Md=6) (Sample 1:
U=101791.00, Z=-2.596, n964, p=0.009; Sample 2:
U=72529.5, z=-10.272, n=967,
p<0.001).
Podiatry students’ awareness
of their own profession’s
roles was greater in Sample 2
than Sample 1 (Sample 1
Md=10, n=187; Sample 2
Md=12, n=93; U=4703.5, z=6.301, p<0.001).
A positive correlation was
evident between age and
knowledge of the podiatrists’
role (Sample 1: spearman’s
rho= 0.097, n=964, p=0.001;
Sample 2: spearman’s rho=
0.059, n=067, p=0.032 for a
one tailed test) respectively.
Generic Role Perception Questionnaire
 A Mann-Whitney U test revealed a
significant difference between
 Scale with 20 items that has good students’ perceptions of podiatrists’
internal consistency (Cronbach
roles in Sample 1 (Md=92, n=964)
alpha=0.7; n=43) (MacKay, 2004)
and in Sample 2 (Md=97, n=967)
[U=404704.5, z=-5.012, p<0.001,
r=-0.11].
 GRPQ (MacKay, 2004)
 Principal Components Analysis
with Oblimin rotation
 In Sample 2 a significant difference
was observed in students’ total
 Sample 1- four components
GRPQ scores between health and
solution (Cronbach alpha=0.776)
social work students who
participated in an IPE group that
involved a podiatry student (Md=94,
n=497) and students who either did
 Sample 2- three components
not or were unsure as to whether
solution (Cronbach alpha=0.78)
they had participated in an IPE group
with a podiatry student (Md=99,
n=470) [U=101817.50, z=-3.451,
p=0.001, r=-0.11].
Objective 2
Exploring health and social work students’ views of
interprofessional learning (IPL) on two occasions1
across participating HEIs;
1 Sample 1: students at the start of their Level 1 IPE
initiative;
Sample 2: students on completion of their IPE
Level 1 initiative)
IPE has been introduced into preregistration curriculum to:
 help health and/or social care
professionals to be able to
work more effectively together  NOT weaken the power of the
professions (Sample 1: 82.7%,
(Sample 1: 97.5%, 1098;
952; Sample 2: 74%, 784)
Sample 2: 94.6%, 1003)
 Increase cost effectiveness of
 enhance the quality of care
patient care (Sample 1: 52.2%,
given to patients (Sample 1:
601; Sample 2: 57.5%, 610)
95.4%, 1098; Sample 2: 92.8%,
984)
 Minimise the risk of any
duplication of health service
 Improve communication skills
delivery (Sample 1: 45%, 518;
(Sample 1: 94.4%, 1086;
Sample 2: 53.8%, 570)
Sample 2: 91.3%, 968)
 Increase confidence in
professional roles (Sample 1:
87.3%, 1005; Sample 2: 82%,
869)
Students’ Perceptions of IPE
 Disagreement that campus based IPE opportunities
were perceived as being more meaningful than
placement based learning opportunities (Sample 1:
46.3%, 533; Sample 2: 51.1%, 542)
 Rivalries exist in placement locations that expose
students to stereotypical views of professions
(Sample 1: 43.5%, 500; Sample 2: 47.2%, 501)
Key Motivational Influence:  use of clinical/ social scenarios in group-work
activities (Sample 1: 81.6%, 939; Sample 2: 71.1%,
753)
Commitment to IPE:
 Positive correlation - age and
level of commitment to IPE
(Sample 1: spearman’s rho =
0.243, p<0.001; Sample 2:
spearman’s rho = 0.165,
p<0.001 for a one tailed test)
Commitment was strongly
influenced by:
 facilitators’ attitudes
towards IPE (Sample
1:75.5%, 835; Sample 2:
74%, 784)
 Modal response of 6 - the
majority of participants were
 working practices of staff
only fairly committed (Sample
(72.4%, 833; Sample 2: 66%,
1: 49.5%, 570; Sample 2: 46.9%,
700);
497) to IPL.
 Students induction to the
IPE initiative (62.2%, 716;
56.2%, 596)
Commitment to IPE
 Yet the majority of respondents
had not read any information
about IPE (Sample 1: 65.7%, 756;
Sample 2: 60.8%, 644)
Primary information sources accessed by students who
had read information about IPE:
Sample 1
N (21%;
242)
Sample 2
n (21.8%,
231)
Websites
47.5%, 115
Course
materials
40.7%, 94
Course
materials
47.1%, 114
Websites
30.3%, 70
Books
18.6%, 45
Books
27.3%, 63
Journals
22.5%, 52
Discussions 17.8%, 43
 Students who had read information:
– Developed a better appreciation of the need for multidisciplinary team members to meet on a regular basis in
order to plan and discuss issues (Sample 1: U=99499.5, z=2.569, p=0.01, r=-0.08; Sample 2: U=82170, z=-3.704,
p<0.001, r=-0.11).
– Enabled students to gain an appreciation of the existence of
rivalries in placement locations that may expose students to
stereotypical views of other professions (Sample 2:
U=87109.5, z=-2.223, p=0.026, r=-0.07).
Readiness for Inter-professional
Learning Scale
Principle Component
Analysis
 Kaiser-Meyer-Oklin value =
Sample 1: 0.932; Sample 2:
0.938
 Bartlett’s Test of Sphericity
(p<0.001)
 Oblimin rotation with Kaiser
Normalisation
 Sample 1 and 2:
2 component solution
 Comparisons with Parsell
and Bligh (1998; 1999) &
McFadyen et al. (2005)
 Component 1
Teamwork and collaboration
 Component 2
Professional identity and
roles
RIPLS Subscale Comparisons
Sub-scale 1
Sub scale 2
Subscale 3
Teamwork and
collaboration
Professional
Identity (1999) and
Negative
Professional
Identity (1998)
Roles and
Responsibilities
(1999) + Roles
(1998)
Items 1-9
Items 10-16
Items 17-19
Parsell et al., (1998) (n=914)
Items 1-9
Item 12
Item 18
48% variance explained
Item 11
Item 17
Items 13-16
Item 19
McFadyen et al (2005) (n=308)
Items 1-9; 10, 11
Item 12
(n=308) 44% variance explained
Items 13-16
Item 17
Craddock Sample 1: n=1151 45.4%
variance explained
Items 1-9
Items 10-12
Items 13-16
Items 17-19
Factor Analysis
Parsell and Bligh (1999) (n=120)
42% variance explained
Craddock Sample 2: n-1060 52.7%
variance explained
Items 18-19
Cronbach Alpha Measure of Internal
Consistency of Each Sub-scale
Study
Sub-scale 1
Sub scale 2
Subscale 3
Teamwork and
collaboration
Professional
Identity (1999)
and Negative
Professional
Identity (1998)
Roles and
Responsibilitie
s (1999) +
Roles (1998)
Parsell and Bligh
(1999) (n=120)
0.88
0.63
0.32
Parsell et al.,
(1998) (n=914)
0.85
0.46
-
McFadyen et al
(2005) (n=308)
0.80
0.21
0.40
Craddock (n=1151)
0.88
0.66
Craddock (n=1060)
0.92
0.79
Pre-registration health and social work students’
perceptions of IPL
Significant difference between:
 Students’ total RIPLS scores in Sample 1 (Md=80,
n=1151) and Sample 2 (Md=76, n=1060),
U=498010.00, Z=-7.474, p<0.001, r=-0.16.
– Findings echoed in relation to each sub-scale
– Students’ total RIPLS scores in Sample 1 and Sample 2, for
HEIs B, E, K and H.
 Students at HEIs B and K had the highest RIPL and HEI
F had the lowest.
Lessons Learnt
Student
Preparation
Assessment Task
Enhancing
knowledge of
professional
roles
Focus of learning
outcomes
Make-up of IPE groups
Formal
&
informal learning opportunities
Lessons Learnt
Key role of facilitators- staff training
Key factors
influencing
students’ attitudes
towards IPE
Induction process
Working practices of staff
Lessons Learnt:
 Value of placement based
learning (Guest et al 2002;
Lumague et al., 2006;
Robson and Kitchen, 2007)
Recognised reservations:
 practicability (Cook et al.,
2001)
 Lack of clinical experience
(Young et al., 2007)
Placement Based Learning
not possible?
 Stimulus materials in IPE
initiatives linked to the
practice setting.
 Existence of rivalries in
practice (Robson and
Kitchen, 2007)
Lessons Learnt:
RIPLS (Parsell and Bligh, 1999)
 Timing of IPE
Role of reading about IPE
 Target course materials
where links are incorporated
to key IPE websites
> age of students >
 Target & engage younger
students e.g. induction
level of commitment
– (see, Stephens et al., 2007)
References

Carpenter, J. (2005) Evaluating the Outcomes of Social Work Education. London and Dundee:
Social Care Institute for Excellence and Scottish Institute for Excellence in Social Work
Education.

Cook, A., Davis, J. and Vanclay, L. (2001) Shared learning in practice placements for health
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
Department of Health (2000a) A Health Service of all the Talents: Developing the NHS
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of Health.

Department of Health (2000b) The NHS Plan: A plan for investment, a plan for reform.
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
Department of Health and QAA (2006) Department of Health Phase 2 Benchmarking Project –
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References:
(continued)

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
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
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
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
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
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
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