Measuring Attitudes of Clinical Laboratory Science Students Toward Interprofessional Education Using the Readiness for Interprofessional Learning Scale (RIPLS) =============================================================================================================================================================== * Michelle Brown * Ana Oliveira * Brianna Miller * Floyd Josephat 1. Michelle Brown(#aff-1) 2. Ana Oliveira(#aff-2) 3. Brianna Miller(#aff-3) 4. Floyd Josephat(#aff-4) 1. University of Alabama at Birmingham 2. University of Alabama at Birmingham 3. University of Alabama at Birmingham 4. University of Alabama at Birmingham 1. **Address for Correspondence: Michelle Brown**
, University of Alabama at Birmingham, michellebrown{at}uab.edu ## ABSTRACT **BACKGROUND:** The current complex environment of health care demands a comprehensive approach where teamwork and communication are paramount. Interprofessional education (IPE) is one avenue to promote collaboration. Our objective was to determine the attitudes of Clinical Laboratory Science (CLS) students toward IPE. **METHODS:** The revised Readiness for Interprofessional Learning Scale (RIPLS) was chosen to assess CLS students’ attitudes toward IPE after participating in an interprofessional simulation. In addition to the RIPLS items, demographics, previous experience in health care, and interprofessional simulation were collected. **RESULTS:** Fifty participants had an average age of 26.7 years (SD = 5.25), 70% were female, and 46% were white. In addition, 26% had experience in interprofessional simulation, while 48% had worked in health care. Students’ scores were high in all questions of RIPLS subscales except for the questions belonging to the negative professional identification (inverted scale) and for the roles and responsibilities subscales. **CONCLUSION:** University of Alabama at Birmingham CLS students have a positive attitude about IPE. Faculty in CLS programs should provide interprofessional experiences for their students. ABBREVIATIONS: * CLS - clinical laboratory science * ICU - intensive care unit * IPE - interprofessional education * RIPLS - readiness for interprofessional learning scale * UAB - University of Alabama at Birmingham ## INTRODUCTION As health care becomes more complex, the need for a more comprehensive, collaborative approach to health care is brought to the forefront. The entire process of health care must be built on a platform of trust, teamwork, and collaboration. This needs to include physicians, nurses, pharmacists, laboratory professionals, respiratory therapists, radiology technicians, social workers, physician assistants, patients, and others.1 The number 1 recommendation by the National Academy of Medicine (formerly the Institute of Medicine) report on *Improving Diagnosis in Healthcare* is to “facilitate more effective teamwork in the diagnostic process among healthcare professionals, patients, and their families.”2 In addition to the National Academy of Medicine, the World Health Organization, in their report *Framework for Action on Interprofessional Education and Collaborative Practice* emphasizes the importance of teamwork in health care by stating: “Interprofessional education and collaborative practice can positively contribute to some of the world’s most urgent health challenges.”3 Working in teams translated to reduced diagnostic error and improved patient safety. Therefore, it is essential for Clinical Laboratory Science (CLS) educators to teach students to work in interprofessional teams.4,5 Interprofessional education (IPE) is defined as people from different vocations learning about, from, and with each other.3 This is in contrast with multiprofessional education, where students learn side-by-side, but interaction or learning from each other is not required. IPE is also distinct from interdisciplinary education where different disciplines work together toward a common goal. As students progress through their curricula, they need to move beyond knowledge and application of knowledge to working on relationships and collaborative behaviors. This includes peers in the laboratory as well as other professionals in the health care system. Introducing learners to IPE early in their curriculum is associated with positive learning outcomes.6,7 Simulation is one option for conducting IPE for health care professionals.8 By coupling IPE and simulation, it is possible to increase students’ view on the value of teamwork.9,10 However, there are many barriers to creating and participating in meaningful, collaborative interprofessional simulation experiences. Simulation is resource-intensive in terms of faculty, equipment, and time. Additionally, there may be a lack of support and funding from administration.11 Laboratory science programs traditionally do not include IPE and simulation. Because of the short nature of many simulation scenarios, which run for a range of 10–20 minutes, there is often not enough time to include laboratory testing. It is important for programs to overcome these barriers so that students learn to be part of an interprofessional team prior to joining the workforce.5 Before implementing IPE into the curriculum, it is important to determine readiness to participate in IPE. Students must first value teamwork and collaboration, have a positive professional identity, and understand their role on the health care team. Given the significant amount of support for IPE in health care and the minimal amount of literature supporting the involvement of the clinical laboratory**,** the objective of this study was to assess the attitudes of University of Alabama at Birmingham (UAB) CLS students toward IPE using the Readiness for Interprofessional Learning Scale (RIPLS). ## METHODS ### Setting and Participants The UAB offers an entry-level master’s degree in CLS. The program is accredited by the National Accrediting Agency for CLS. The study took place at UAB in 2015 and 2016, and a total of 50 students from 2 cohorts participated in the study. Data for this study were generated from an anonymous survey using convenience sampling. Participation in the simulation by CLS students was part of regular course activities. Students provided informed consent prior to the simulation and could opt out of having their data used for research purposes. This study was approved by the UAB institutional review board protocol #E150601001. ### Simulation There were 194 students from 7 professions, both undergraduate and graduate programs, who participated in the intensive care unit (ICU) simulations: CLS, physician assistant, respiratory therapy, nurse practitioner, medicine, nuclear medicine technology, and physical therapy. Each simulation lasted 2 hours and was conducted 6 times to accommodate the number of students. There was a 15-minute prebrief performed at the beginning of each session. The scenarios (Table 1) ran for 45 minutes and concluded with a 3-tiered debriefing: an in-room debriefing to focus on case-specific information, a whole-group debriefing to focus on interprofessional concepts, and a profession-specific debriefing to allow students to discuss the simulation with their faculty. View this table: [Table 1.](http://hwmaint.clsjournal.ascls.org/content/31/4/179/T1) Table 1. Overview of scenarios in the ICU simulations ### Readiness for Interprofessional Learning Scale The adapted RIPLS was chosen to assess CLS students’ attitudes toward IPE after participating in an interprofessional simulation. Even though there are additional instruments available to measure perceptions of IPE, in most cases, these other scales were tailored toward learners outside of the laboratory profession (ie, direct patient care); others included assessment of institutional support, a construct we did not want to measure.12⇓⇓⇓⇓⇓–18 RIPLS was chosen for its application to CLS students and simulation and its frequency in health professions’ educational literature. The original RIPLS scale was developed by Parsell et al19 and had 19 items divided into 4 domains: teamwork/collaboration, negative professional identity, positive professional identity, and roles and responsibilities. RIPLS has been adapted for use with additional professions, a wide variety of situations, and different cultures, resulting in many modified versions.20⇓–22 The version of RIPLS used in this study was adapted by LaTrobe Health Services and the Health and Social Care Interprofessional Network (Victoria, Canada). This adapted RIPLS tool is publicly available on the National Center for Interprofessional Practice and Education website.23,24 ### Data Collection and Analysis Researchers met with students prior to the ICU simulation to discuss the purpose of the study and obtain informed consent. The adapted RIPLS scale was then administered to the group of learners and handwritten anonymous responses were collected. We also asked for the students’ year of birth, gender, and race. In addition to the RIPLS items and demographics, we asked if they had previous experience with interprofessional simulation and if they had previous work experience in health care because previous involvement with interprofessional simulation and experience working in health care may influence their readiness for learning in an interprofessional setting. Data were entered and analyzed using SAS 9.4. Demographic variables were expressed as mean (continuous variable) and SD in case of age and as proportions (categorical variables) in the case of race, gender, previous experience in interprofessional simulation, and experience working in health care (Table 2). Counts of how many students answered at each level of the Likert scale and the median score for each question were computed (Table 3). Mean and median scores were calculated. However, median scores are more appropriate for these data because tests for normality determined these data were not normally distributed. The 95% CIs for median scores were calculated using a distribution-free approach.25 View this table: [Table 2.](http://hwmaint.clsjournal.ascls.org/content/31/4/179/T2) Table 2. Characteristics of UAB CLS students (*N* = 50) completing the RIPLS survey View this table: [Table 3.](http://hwmaint.clsjournal.ascls.org/content/31/4/179/T3) Table 3. Attitude of UAB CLS students (*N* = 50) toward IPE measured by the RIPLS ## RESULTS Our student population had an average age of 26.7 years (SD = 5.25 years) and was 70% female and 46% white. In addition, 26% had experience in interprofessional simulation, while 48% had previous work experience in health care (Table 1). Students’ median responses were high (ranging from 4–5) for all questions of RIPLS, except for questions 10–12, which were related to the negative professional identification (measured in an inverted scale; value of “2”), and for questions 18–19, which were related to the roles and responsibilities (values of “2” and “3,” respectively; Table 2). The majority of students responded with “Strongly agree” or “Agree” to questions 1–9, which relate to teamwork and collaboration, and questions 13–17, which relate to professional identity. Regarding questions 10–12 and 18, which are measured in an inverted scale, the majority of the students responded, “Disagree” or “Highly disagree.” Interestingly, responses for question 19, related to professional role, varied the most with 34% answering “Strongly agree” or “Agree,” 30% responding “Neutral,” and 36% responding “Disagree” and “Strongly disagree” (Table 2). ## DISCUSSION This study, based on self-reported data on perceptions of participation in IPE, determined that CLS students have a positive attitude toward IPE. As mentioned in the methods section, RIPLS has 19 items that can be subdivided into 4 domains that address the concepts of teamwork/collaboration, negative professional identity, positive professional identity, and roles and responsibilities.19 The UAB CLS students had a higher median score (4 or 5) on all questions (1–9 and 13–17) related to teamwork, collaboration, and positive professional identity and a lower median score on questions measured on an inverted scale (10–12 and 18–19) related to negative professional identity and roles and responsibilities. In our CLS program, we regularly discuss the laboratory’s transition from being behind the scenes to a more prominent, vocal role on the larger health care team. These discussions may have influenced the students’ responses with respect to their role. The lower median score may reflect these discussions of changing roles for laboratorians. Item 19 stated, “I have to acquire much more knowledge and skill than other students/professionals in my own faculty/organization.” Interestingly, this item had the widest range of responses. Faculty in the CLS program at UAB do not feel CLS students need to acquire more skills and knowledge than students in other health care professional programs. The wide range of responses to this item could indicate that we need to include more IPE to clarify roles of other professions. CLS students may not understand the roles and scope of practice of other professions well. As mentioned, there is a paucity of reports and research in which IPE has been incorporated into the CLS curriculum. Owing to this scarcity of empirical data, it is difficult to make a comparison between UAB CLS students and students from other CLS programs. However, there have been a few studies published. Al-Qahtani et al26 determined that undergraduate CLS students in Saudi Arabia felt that they were ready to learn in interprofessional teams. Data analyzed as domains and not individual questions, collected from undergraduate students in second, third, and fourth year and with an 88% participation rate, showed that CLS students in this study were reportedly confident in their roles and responsibilities and had a strong positive professional identity. Our study at UAB had similar findings in graduate-level CLS students. In another study using the RIPLS tool, researchers found that students’ attitudes toward IPE in general (not CLS-specific) deteriorated after participating in a semester-long course focused on IPE.27 The prepost response rate for CLS students in that study was 82%. The researchers attributed their findings to early professional identity formation. We feel this could also be because of the type of interprofessional activity that was used: online case studies to be discussed electronically by teams of students from a variety of professions. It is vital that faculty consider strong approaches to IPE such as well-designed simulation, for example. ### Strengths and Limitations To our knowledge, this is the first study to assess the attitudes of CLS students toward IPE. Along with its novelty, another strength of our study is the fact that we had 100% student participation (50 students). Our study also has some limitations. For example, social desirability bias is a possible factor with completion of this scale. Faculty in the UAB CLS program often discuss the importance of working in interprofessional teams. Students in this study were not naïve to the role of the laboratory on the greater medical team. Prior to this large-scale interprofessional ICU simulation, the CLS students had observed an interprofessional panel of professionals demonstrating teamwork in health care through a simulated rounding on a patient. This panel consisted of a clinical laboratory scientist, nurse, physician assistant, physician, respiratory therapist, genetic counselor, and nuclear medicine technologist. The CLS students also participated in an activity during their blood bank course in which they were provided with a brief patient history and an antibody workup. They had to evaluate the panel and determine what additional testing was necessary. This was a single profession simulation demonstrating a handoff among laboratorians. ## CONCLUSIONS Our study demonstrates that the UAB CLS students have a positive attitude toward learning in interprofessional teams. Faculty in CLS programs should reach out to other professions and collaborate to provide interprofessional experiences for their students. Given our sample size, study limitations, and representation of the attitudes of a single CLS program in the United States, more research should be done to better determine the attitudes of CLS students towards IPE. Multiple studies have demonstrated the feasibility and the need for incorporating CLS students into interprofessional simulation.4,5,9,10 However, there is still a lack of CLS-specific data about student readiness for participation in interprofessional simulation. It is vital that we teach our students to emphasize the role of the laboratory in patient care. ## ACKNOWLEDGMENTS We are grateful to the students who participated in the study and to Mrs Tera Webb, MS, MLS(ASCP), and the UAB Office of Interprofessional Simulation for Innovative Clinical Practice for their support; design; and delivery of the complex, interprofessional simulation experience. We are also thankful to Dr David Redden from the UAB Epidemiology and Biostatistics Clinic for Biostatistics analysis consultation. * Received September 11, 2018. * Accepted November 25, 2018. American Society for Clinical Laboratory Science ## References 1. 1.Olson  R, Bialocerkowski  A. Interprofessional education in allied health: a systematic review. Med Educ. 2014;48(3):236–246. doi: [10.1111/medu.12290](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1111/medu.12290) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1111/medu.12290&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=24528458&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 2. 2.Singh  H, Graber  ML. Improving diagnosis in health care—the next imperative for patient safety. N Engl J Med. 2015;373(26):2493–2495. doi: [10.1056/NEJMp1512241](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1056/NEJMp1512241) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1056/NEJMp1512241&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=26559457&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 3. 3.Baker  PG. Framework for action on interprofessional education and collaborative practice. 2010. 4. 4.Morris  S, Otto  CN, Golemboski  K. Improving patient safety and healthcare quality in the 21st century—competencies required of future medical laboratory science practitioners. Clin Lab Sci. 2013;26(4):200–204. doi: [10.29074/ascls.26.4.200](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.29074/ascls.26.4.200) [Abstract/FREE Full Text](http://hwmaint.clsjournal.ascls.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiYXNjbHMiO3M6NToicmVzaWQiO3M6ODoiMjYvNC8yMDAiO3M6NDoiYXRvbSI7czoyMDoiL2FzY2xzLzMxLzQvMTc5LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 5. 5.Roberts  C. Are your medical technology students team players? Clin Leadersh Manag Rev. 2003;17(4):203–207. [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=12945516&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 6. 6.Hawkes  G, Nunney  I, Lindqvist  S. Caring for attitudes as a means of caring for patients—improving medical, pharmacy and nursing students’ attitudes to each other’s professions by engaging them in interprofessional learning. Med Teach. 2013;35(7):e1302–e1308. doi: [10.3109/0142159X.2013.770129](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.3109/0142159X.2013.770129) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.3109/0142159X.2013.770129&link_type=DOI) 7. 7.Nisbet  G, Hendry  GD, Rolls  G, Field  MJ. Interprofessional learning for pre-qualification health care students: an outcomes-based evaluation. J Interprof Care. 2008;22(1):57–68. doi: [10.1080/13561820701722386](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1080/13561820701722386) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1080/13561820701722386&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=18202986&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 8. 8.Decker  SI, Anderson  M, Boese  T, et al. Standards of best practice: simulation standard VIII: simulation-enhanced interprofessional education (sim-IPE). Clin Simul Nurs. 2015;11(6):293–297. doi: [10.1016/j.ecns.2015.03.010](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1016/j.ecns.2015.03.010) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1016/j.ecns.2015.03.010&link_type=DOI) 9. 9.Bond  WF, Kostenbader  M, McCarthy  JFP. Prehospital and hospital-based health care providers’ experience with a human patient simulator. Prehosp Emerg Care. 2001;5(3):284–287. doi: [10.1080/10903120190939805](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1080/10903120190939805) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1080/10903120190939805&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=11446544&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 10. 10.Watts  P, Langston  SB, Brown  M, et al. Interprofessional education: a multi-patient, team-based intensive care unit simulation. Clin Simul Nurs. 2014;10(10):521–528. doi: [10.1016/j.ecns.2014.05.004](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1016/j.ecns.2014.05.004) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1016/j.ecns.2014.05.004&link_type=DOI) 11. 11.Rossler  KL, Kimble  LP. Capturing readiness to learn and collaboration as explored with an interprofessional simulation scenario: a mixed-methods research study. Nurse Educ Today. 2016;36:348–353. doi: [10.1016/j.nedt.2015.08.018](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1016/j.nedt.2015.08.018) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1016/j.nedt.2015.08.018&link_type=DOI) 12. 12.Almås  SH, Barr  H. Common curricula in Norway: differential implementation and differential outcomes in undergraduate health and social care education. J Interprof Care. 2008;22(6):650–657. doi: [10.1080/13561820802380050](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1080/13561820802380050) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1080/13561820802380050&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=19012145&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 13. 13.Curran  V, Hollett  A, Casimiro  LM, et al. Development and validation of the interprofessional collaborator assessment rubric (ICAR). J Interprof Care. 2011;25(5):339–344. doi: [10.3109/13561820.2011.589542](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.3109/13561820.2011.589542) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.3109/13561820.2011.589542&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=21732723&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 14. 14.Forman  D, Nyatanga  L. The process of developing a research questionnaire to measure attitudes to shared learning. Med Teach. 2001;23(6):595–598. doi: [10.1080/01421590127199](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1080/01421590127199) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1080/01421590127199&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=12098482&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 15. 15.King  G, Shaw  L, Orchard  CA, Miller  S. The interprofessional socialization and valuing scale: a tool for evaluating the shift toward collaborative care approaches in health care settings. Work. 2010;35(1):77–85. doi: [10.3233/WOR-2010-0959](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.3233/WOR-2010-0959) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.3233/WOR-2010-0959&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=20164627&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 16. 16.Luecht  RM, Madsen  MK, Taugher  MP, Petterson  BJ. Assessing professional perceptions: design and validation of an interdisciplinary education perception scale. J Allied Health. 1990;19(2):181–191. [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=2365636&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 17. 17.Pollard  KC, Miers  ME. From students to professionals: results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom. J Interprof Care. 2008;22(4):399–416. doi: [10.1080/13561820802190483](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1080/13561820802190483) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1080/13561820802190483&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=18800281&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 18. 18.Sigalet  E, Donnon  T, Grant  V. Undergraduate students’ perceptions of and attitudes toward a simulation-based interprofessional curriculum: the KidSIM ATTITUDES questionnaire. Simul Healthc. 2012;7(6):353–358. doi: [10.1097/SIH.0b013e318264499e](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1097/SIH.0b013e318264499e) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1097/SIH.0b013e318264499e&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=22902608&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 19. 19.Parsell  G, Bligh  J. The development of a questionnaire to assess the readiness of health care students for interprofessional learning (RIPLS). Med Educ. 1999;33(2):95–100. doi: [10.1046/j.1365-2923.1999.00298.x](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1046/j.1365-2923.1999.00298.x) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1046/j.1365-2923.1999.00298.x&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10211258&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) [Web of Science](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=000078765900004&link_type=ISI) 20. 20.Lauffs  M, Ponzer  S, Saboonchi  F, Lonka  K, Hylin  U, Mattiasson  AC. Cross-cultural adaptation of the Swedish version of readiness for interprofessional learning scale (RIPLS). Med Educ. 2008;42(4):405–411. doi: [10.1111/j.1365-2923.2008.03017.x](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1111/j.1365-2923.2008.03017.x) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1111/j.1365-2923.2008.03017.x&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=18338993&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 21. 21.McFadyen  AK, Webster  VS, Maclaren  WM. The test-retest reliability of a revised version of the readiness for interprofessional learning scale (RIPLS). J Interprof Care. 2006;20(6):633–639. doi: [10.1080/13561820600991181](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1080/13561820600991181) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1080/13561820600991181&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=17095441&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 22. 22.Reid  R, Bruce  D, Allstaff  K, McLernon  D. Validating the readiness for interprofessional learning scale (RIPLS) in the postgraduate context: are health care professionals ready for IPL? Med Educ. 2006;40(5):415–422. doi: [10.1111/j.1365-2929.2006.02442.x](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1111/j.1365-2929.2006.02442.x) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1111/j.1365-2929.2006.02442.x&link_type=DOI) [PubMed](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=16635120&link_type=MED&atom=%2Fascls%2F31%2F4%2F179.atom) 23. 23.Parsell  G, Bligh  J. RIPLS: Readiness for Interprofessional Learning Scale. 2013; [https://nexusipe.org/informing/resource-center/ripls-readiness-interprofessional-learning-scale](https://nexusipe.org/informing/resource-center/ripls-readiness-interprofessional-learning-scale). 24. 24.Oates  M, Davidson  M. A critical appraisal of instruments to measure outcomes of interprofessional education. Med Educ. 2015;49(4):386–398. doi: [10.1111/medu.12681](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1111/medu.12681) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1111/medu.12681&link_type=DOI) 25. 25.Conover  WJ. *Practical Nonparametric Statistics**.* John Wiley and Sons; 1980. 26. 26.Al-Qahtani  MF. Measuring healthcare students’ attitudes toward interprofessional education. J Taibah Univ Med Sci. 2016;11(6):579–585. doi: [10.1016/j.jtumed.2016.09.003](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.1016/j.jtumed.2016.09.003) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.1016/j.jtumed.2016.09.003&link_type=DOI) 27. 27.Stull  CL, Blue  CM. Examining the influence of professional identity formation on the attitudes of students towards interprofessional collaboration. J Interprof Care. 2016;30(1):90–96. doi: [10.3109/13561820.2015.1066318](http://hwmaint.clsjournal.ascls.org/lookup/doi/10.3109/13561820.2015.1066318) [CrossRef](http://hwmaint.clsjournal.ascls.org/lookup/external-ref?access_num=10.3109/13561820.2015.1066318&link_type=DOI)