|ORIGINAL RESEARCH ARTICLE
|Year : 2017 | Volume
| Issue : 2 | Page : 103-107
Influence of pharmacy students on the attitudes of medical students following an interprofessional course
Fatemeh Dabaghzadeh1, Bahare Zihayat2, Farhad Sarafzadeh3
1 Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
2 Herbal and Traditional Medicines Research Center, Kerman University of Medical Sciences, Kerman, Iran
3 Research Center for Tropical and Infectious Disease, Kerman University of Medical Sciences, Kerman, Iran
|Date of Web Publication||19-Sep-2017|
Faculty of Pharmacy,
Kerman University of Medical Sciences, P. O. Box: 76175.493, Haft-Bagh High-Way, Kerman
Source of Support: None, Conflict of Interest: None
Background: Clinical interprofessional education (IPE) can promote mutual understanding of other health professions and respectful behaviors among health-care professionals. The aims of this study were to evaluate the effects of IPE on the attitudes of medical and pharmacy students in an inpatient hospital setting and, in particular, the influence of pharmacy students on the attitudes of medical students. Methods: The 6th year doctor of pharmacy students and medical students were enrolled in a prospective cohort study. They were paired and each pair was responsible for three beds and all the patients occupying these mentioned beds over the 2-week course. The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was used to assess the students' attitudes before and after the course. Results: The attitudes of the medical students changed positively after the IPE course based on RIPLS teamwork and collaboration and professional identity subscales. Changes in the attitudes of the pharmacy students were not statistically significant based on the mentioned scale and subscales. Discussion: IPE could improve the attitudes of the medical students regarding interprofessional teamwork, communication, and sharing learning experience. Based on the current investigation, IPE did not have an effect on pharmacy students.
Keywords: Education, interprofessional relations, medical students, pharmacy students
|How to cite this article:|
Dabaghzadeh F, Zihayat B, Sarafzadeh F. Influence of pharmacy students on the attitudes of medical students following an interprofessional course. Educ Health 2017;30:103-7
| Background|| |
Effective teamwork is necessary for safe and successful healthcare, and it was reported that lack of communication was responsible for 70% of adverse events in healthcare. Moreover, clinicians need skills and knowledge of other health professionals for comprehensive care and also for solving patients' complex problems. Hence, it is crucial that members of a health-care team learn how to work in a collaborative manner for optimal outcome.
Interprofessional education (IPE) is defined as occasions when two or more professions learn together with the objective of developing better teamwork and effective communication., In health-care systems, IPE is a necessity for improving services and increasing patients' safety., Moreover, it can promote mutual understanding of other health professions and respectful behaviors among health-care professionals. It also enhances professional confidence and job satisfaction. However, unfortunately, there are barriers against it such as gender, social class, boundary work, interprofessional rivalry, negative stereotyping, and ignorance of the role and contribution of other professions.,
Today, pharmacists have expanded their traditional role of dispensing and compounding medications to involvement in patients' care. In addition, pharmacists' participation in hospitalist teams increases the quality, safety, and efficiency of drug therapy and also reduces treatment costs. Some pharmacists' clinical and management functions in hospitals are giving professional advice to physicians, controlling undesirable drug reactions, avoiding drug interaction, adjusting dosage of drugs, preventing medication errors and other drug-related problems, and monitoring drug therapy., Currently, because of the mentioned benefits, the collaboration between pharmacists and physicians is an important issue. Physicians need to change their attitudes toward pharmacists' roles and accept pharmacists' skills in patients' drug therapy.
Relatively, few studies have focused on the collaboration between pharmacists and physicians in an inpatient setting. Furthermore, studies investigating the changes in medical and pharmacy students' perceptions following an IPE course in an outpatient setting are rare in number,, and there has also been no study in inpatient setting in this regard. While these studies reported promising findings for implementing IPE, they had some limitations. In one study, pharmacy and medical students were from different years of their education and spent different durations in the clinic. In addition, in another study, insufficient time was spent and there was no measure before sessions. In the present study, we tried to overcome these limitations.
It is recommended to introduce IPE early at undergraduate level as it can prevent stereotyped attitudes for IPE., However, in Iran, this is not included in the curricula of pharmacy and medical students. IPE should also be performed in the practice environment, so it can be connected to health outcomes. Considering the above findings in the literature, the present study was designed aiming at evaluating the effects of IPE on the attitudes of medical and pharmacy students in inpatient hospital setting. We examined attitude change of pharmacy and medical students following an interprofessional course.
| Methods|| |
This prospective cohort study was conducted in the infectious diseases ward of an educational hospital, from August 2015 to December 2015. The study protocol was approved by the Ethical Committee of Kerman University of Medical Sciences, and each participant signed informed written consent. The participation in this study was completely voluntary.
The participants of this study were Doctor of Pharmacy (Pharm. D.) students and medical students (Doctor of Medicine). All students were in the 6th year of their education. Medical students were doing medical internship and pharmacy students were doing clinical pharmacy clerkship. None of the participants had previous experience in interprofessional study. In Iran, the clinical pharmacy clerkship is the last course of Pharm. D. students before graduation. In this course, they attend hospital, have direct interactions with patients and other health-care members, and are supervised by clinical pharmacy faculty members. Moreover, in Iran, medical internship is a period of practical training. Medical students must complete this period to graduate and work independently as a Doctor of Medicine.
Before performing this study, an infectious disease specialist and a clinical pharmacy specialist (both were faculty members) informed all participants about the protocol of this study, instructed them to work together, and defined their duties. The major duties of medical students were medical history taking, physical examination, patients' care, and documentation of patients' care. The major duties of pharmacy students included checking ordered medications, detecting possible medication errors, and monitoring efficacy and safety of medication therapy.
Each medical student was paired with one pharmacy student during the IPE course. Both of them worked together for 2 weeks from 8 am to noon. Each pair was responsible for three beds and all the patients occupying these mentioned beds. In addition, an infectious disease specialist and a clinical pharmacy specialist held a ward round for each pair every day.
The validated Persian version of Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was used to assess the students' attitudes about IPE. All the students completed this self-reported questionnaire before and after the 2-week course of IPE. RIPLS includes 19 items and scores from 1 (strongly disagree) to 5 (strongly agree) for each item. This scale has three subscales: teamwork and collaboration (subscale 1) (items 1–9), professional identity (subscale 2) (items 10–16), and roles and responsibility (subscale 3) (items 17–19). Subscale 1 evaluates the attitudes toward the influence of cooperative learning with students from other professions and also toward communication, trust, respect, and professional limitations. Moreover, subscale 2 evaluates the value of sharing learning experience with students of other health disciplines, and subscale 3 is associated with students' own roles and those of other health-care providers., In addition, two items (items 10–11) of subscale 2 were reverse scored because of negative wording, making the comparison of the subscale scores more consistent. A higher score in subscale 1 (teamwork and collaboration) and modified subscale 2 (professional identity) indicates agreement with the content of the mentioned subscales. However, a higher score from subscale 3 (roles and responsibility) would not reveal any distinct conclusion.
The RIPLS was chosen because it was validated in both graduate and undergraduate students in different health-care professions. However, it should be noted that RIPLS may not be able to discriminate the qualitative changes. In addition, Hertweck et al. reported that female students got higher scores than male students according to RIPLS and teamwork and collaboration subscale. Hence, the effect of gender on RIPLS scores was measured in the present study.
At the end of this study, after passing the IPE course, all students were asked open-ended questions to report whether their knowledge increased and also to comment on the duration of this study. The overall emphasis of the questions was on drug information for medical students and on diagnosis of diseases for pharmacy students.
The Statistical Package of Social Science version 20 (IBM Corp., Armonk, NY) was used for all analyses. Descriptive analysis was used for all the variables. Chi-square was used to compare demographic data (such as being in the first course of internship) of the participants. Normality of the variables (scores of RIPLS, subscale 1, subscale 2, and subscale 3) was determined by Kolmogorov–Smirnov test. Because the distribution of data was nonnormal, Wilcoxon signed-rank test was used for comparing the pre- or post-test scores. Mann–Whitney U-test was used for evaluating the effect of different factors (gender, being in the first course of internship, and type of health profession) on changes in the pre- or post-test scores. P < 0.05 was considered statistically significant. Bonferroni correction was performed for multiple comparisons.
| Results|| |
Twenty-five pharmacy students and 25 medical students completed this study. Of the whole participants, 13 (26%) were male and 37 (74%) were female. The mean ± standard deviation age of the students was 24.68 ± 1.67 years. The details of the demographic data of all the students are presented in [Table 1]. There was not any significant difference between medical and pharmacy students in terms of age and being in the first course of internship.
The distribution of data was nonnormal (P < 0.001). The changes in the pre- or post-test scores of RIPLS and subscale 1 and subscale 2 of RIPLS were statistically significant for the medical students and all the students. However, the changes in the attitudes of the pharmacy students were not statistically significant in the mentioned scale and subscales. The details of comparing the pre- or post-test scores for the medical students, pharmacy students, and all students are shown in [Table 2]. The changes in the pre- or post-test scores of no item of RIPLS reached statistical significance. In addition, at baseline, there was a statistically significant difference (P = 0.013) in RIPLS scores between the medical and pharmacy students with the pharmacy students having higher scores. Gender did not have a significant effect on RIPLS (P = 0.506) and its three subscales (P = 0.929, 0.256, and 0.251, respectively). However, after 2 weeks of the interprofessional course, difference in RIPLS scores between the medical and pharmacy students did not reach statistical significance (P = 0.547).
|Table 2: Comparison of pre- and post-test scores for medical students, pharmacy students, and all students|
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Moreover, gender (P = 0.602) and being in the first course of internship (P = 0.77) did not have a significant effect on changes in the pre-/post-test scores. The type of health profession (P = 0.002) had a significant effect on changes in the pre- or post-test scores for all the students based on the results of the Mann–Whitney U-test.
Based on the analysis of the self-reported knowledge instrument, dosage form (20 [80%]), administration (16 [64%]), indications (16 [64%]), contraindications (16 [64%]), side effects (16 [64%]), brand name (16 [64%]), interactions (16 [64%]), storage (13 [52%]) and mechanisms (13 [52%]) of drugs, and new drugs (20 [80%]) were specified by the medical students as fields of increased knowledge. In addition, medical terminology (22 [88%]), diagnosis (18 [72%]), pathophysiology (18 [72%]), laboratory tests (23 [92%]), managements (20 [80%]), paraclinical tests (16 [64%]) and physical examinations (14 [56%]) of diseases, and taking medical history (24 [96%]) were mentioned by the pharmacy students as fields of increased knowledge. Finally, thirty-eight students (21 medical students and 17 pharmacy students) mentioned that the duration of this study was enough for determining the necessity of IPE, and they would participate in a similar course again.
| Discussion|| |
In the present study, the medical students had significantly lower pretest scores than pharmacy students based on RIPLS, and all the three subscales. Gender did not have any effect on RIPLS and its subscales scores. The results of the current study are confirmed by an Iranian study. The lower scores of medical students could be related to physicians' attitudes of having preeminence over other professions. IPE has been suggested to alter this attitude  which is also in line with the results of the present study.
The present study showed that the attitudes of the participants changed positively after the IPE course based on RIPLS, teamwork and collaboration subscale, and professional identity subscale. In addition, the changes in the pre- or post-test scores of RIPLS and subscale 1 and subscale 2 of RIPLS were statistically significant for the medical students but not for the pharmacy students. These findings indicated that IPE had positive effects on the medical students' attitudes but not on the pharmacy students. The reason for this finding could be the fact that IPE course forced pharmacy students to learn useless knowledge and irrelevant skills.
Moreover, we found no statistically significant changes when comparing the pre- or post-test scores at the item level for the RIPLS, based on the results of pharmacy and medical students. It could be that RIPLS was not a good instrument to identify qualitative changes in pre- and post-measures because it was not designed for this purpose.
On the other hand, various studies have investigated IPE activity among different health-care students.,, These studies showed that IPE among different health-care students could lead to better patient care, better teamwork, and positive attitudes toward interprofessional team. Hence, it could be proposed that all health professions' students should have opportunities to experience IPE courses at undergraduate level. Based on the results of the current study and the related studies,,, IPE course between pharmacy students and medical students is recommended as an efficient method to achieve better collaboration and better understanding of other professions roles.
Based on the students' perspectives, the present study showed that the knowledge of the participants was increased in various aspects which were reported previously., Moreover, the participants of the current study were eager to have more IPE courses in their education. Other studies have also reported this tendency.,
The present study had some limitations. One limitation was difficulty of providing a suitable environment for this study because IPE was an extracurricular activity, and also busy clinical schedules of the educational hospital were problematic. In addition, this study was time-consuming (2 weeks for each group), and this issue highlighted the importance of a suitable environment.
| Conclusion|| |
IPE should be a part of pharmacy and medical curricula as it seems to improve the attitudes of the medical students regarding interprofessional teamwork, communication, and sharing their learning experience.
Words of thanks are also offered to Ehsan Mehrabi Kermani for editing the English text.
Financial support and sponsorship
The study was supported by Kerman University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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