A series of Cochrane Collaboration review articles evaluating the effects of IPE on professional practice and health care outcomes published since 2001 highlight the evolving evidence base for IPE
[11–13]. The most recent review identified 15 studies of sufficient methodological rigor to meet inclusion criteria
. This represented a marked increase from previous iterations (2001, 0 studies; 2008, 6 studies). Positive outcomes were demonstrated in seven studies, mixed outcomes (positive and neutral) in four studies, and no impact in the remaining studies. The authors’ main conclusion has remained stable throughout the series; specifically, the high variability of IPE interventions and outcomes measured in the included studies preclude their ability to draw generalizable inferences about the effectiveness of IPE.
While the evidence base for IPE continues to grow, the benefits associated with team-based health care delivery are becoming well documented
[14–23]. Specific studies that inspired the creation of the IPCP clinic at TTUHSC demonstrated gains in blood pressure control by physician-pharmacist teams
[16, 20], improvement in quality of care
, and increases in patient satisfaction alongside decreases in health care costs
. Demonstrating the value of team-based health care delivery is critical, and may even supersede the need to demonstrate the value of IPE initiatives via rigorous research methodologies. The assertion that curricula responsible for educating health professional students should incorporate opportunities to learn within a team-based approach is supported if teams of health professionals working collaboratively can improve health outcomes and the experience patients have interfacing with the health care system while decreasing health care costs.
Interprofessional competency development is necessary to guide health professional educators as they attempt to develop and incorporate IPE curricular elements, which underscores the importance of the aforementioned Canadian- and United States-based frameworks
[2, 3]. Increasing health professional students’ understanding of the various roles and responsibilities for different members of the interprofessional team is a core competency of both frameworks. It was thus encouraging to observe in this study statistically significant increases in mean scores for the roles/responsibilities for collaborative practice factor within the SPICE instrument. This finding supports the notion that the IPCP clinic at TTUHSC is a valuable practice site for MS and PS to learn about, from, and with one another. It also provides evidence that the SPICE instrument can be used in a pre-/post-test manner within a longitudinal study to evaluate progress related to this important competency.
The finding that the number of prior IPCP rotations was negatively correlated with change score for understanding roles within the team also supports the notion that IPE initiatives can impact students’ perceptions related to IPCP. This finding confirmed that students with more IPE experience would be further along in their IPE development than their less experienced peers. It also lends credence to calls within the academy for longitudinal studies involving repeated measurements to evaluate progress.
Statistically significant increases in mean scores for the teamwork and team-based practice factor, and the patient outcomes from collaborative practice factor, provide further evidence of the SPICE instrument’s ability to capture change. Given the emphasis within the academy on interprofessional teamwork and the implicit understanding that team-based care improves patient outcomes, this finding provides evidence that the SPICE instrument is capable of detecting and tracking students’ perceptions related to both.
Like the SPICE instrument, the Attitudes Toward Health Care Teams (ATHCT) scale is an IPE measurement instrument with a strong focus on teamwork
. A revised version of this instrument (ATHCT-R), published by Hyer et al., is most comparable to the SPICE instrument, as it has been used to assess health professional students’/trainees’ attitudes toward team learning and teamwork
[25, 26]. The ATHCT-R instrument is composed of 21 items using a 6-point Likert-type response scale. It contains three factors intended to measure attitudes toward (1) team value, (2) team efficiency, and (3) physician’s shared role. Leipzig et al. utilized the ATHCT-R instrument to assess attitudes of trainees in medicine, advanced practice nursing, and social work towards IPCP
. The authors found an overall positive disposition toward teamwork within this population, while also noting several between-group differences (e.g., physician trainees were less positively inclined towards IPCP than the nurse practitioner and social work trainees). This general pattern was observed in the present study, as well.
Researchers have also administered the ATHCT-R instrument before and after exposure to an IPE experience as an assessment mechanism akin to the methodology employed in the present study. Fulmer et al. utilized this tool to measure the impact of the Geriatric Interdisciplinary Team Training program on 537 health professional students representing 20 different professions
. The authors of this study observed statistically significant improvements in attitudes across the three ATHCT-R factors irrespective of profession. Similar to Leipzig et al., they also reported differences between professions. More recently, Curran et al. evaluated the impact of a workshop developed to improve interprofessional collaborator skills in a sample of 82 participants, which included pre-licensure medical residents and a variety of post-licensure allied health professionals (e.g., nurses, social workers, occupational therapists, etc.)
. The investigators administered a 14-item version of the ATHCT instrument in a pre-/post-test study design and reported a significant improvement in pre- to post- overall mean score change for the pre-licensure medical residents.
The one item that demonstrated statistically significant between-group differences before and after the IPE experience described in the present study warrants further discussion in relation to the studies just described. This item asked whether MS and PS should be involved in teamwork during their education (Item 10). Mean scores for PS were significantly higher than for MS. The margin of difference remained stable from pre- to post-test, with PS rating this item much higher than MS. This finding is similar to those described from studies utilizing the various versions of the ATHCT instrument. It is possible that this reflects certain practice realities. For example, pharmacists are reliant on collaborations with physicians in order to impact patient care to the fullest extent. It is also possible that physicians may view IPE negatively within the context of pharmacists’ desires to expand their scope of practice
[29, 30]. Effective interprofessional communication and a synergistic IPE/IPCP design, such as the TTUHSC preventive care clinic described herein, may mitigate this issue. Given the potential for improved health outcomes, it is certainly worth the time and effort.
There are several limitations to this study that warrant discussion. First, the hours of operation of the IPCP clinic dictated the quantity and type of MS and PS eligible for participation. The vast majority of MS enroled were in their third year of school, while all PS enroled were in their fourth year. Curricular restrictions for each of the professional programs led to the majority of MS spending a single day in the clinic while the majority of PS were exposed to the clinic on multiple occasions. As a result, there were over twice as many MS enroled in the study, as well as differences in the number of clinic visits completed between the groups. It was encouraging, therefore, that significant positive change in response scores were observed following the IPE experience despite these curricular restrictions. Additionally, given the small sample size, multivariable analyses controlling for covariates were not conducted. Large-scale studies should be conducted to confirm the findings from this study. The unique nature of the IPE experience and the single site setting also limit the generalizability of the findings. Despite these limitations, this study provided interesting and informative assessment feedback on the effects of an IPCP clinic on students’ perceptions using repeated measurement with the SPICE instrument.