Measuring Attitudes of Clinical Laboratory Science Students Toward Interprofessional Education Using the Readiness for Interprofessional Learning Scale (RIPLS)

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

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.

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.