Introduction

The aim of this section is to clarify and justify why a case study approach was chosen as the methodology for my research. My role as module leader was a principal factor in the decision, as I recognised that my approach as a researcher was almost certainly influenced by my own ontological and epistemological positions (Denzin and Lincoln, 2011). Considering my ontology as being my assumptions about the IPE module (Grix, 2010), I recognised my experiences as module leader (Section 1.4) would be unique and have influenced my beliefs about the reality of the module. I also recognised that my ‘social construction of knowledge’ (Berger and Luckman, 1966: 27) would, perhaps inevitably, be different to that of both students and the members of the teaching team. Key elements of my own perspective originate from working in both the clinical and academic environments and my beliefs in the fundamental importance of health and social care professionals working collaboratively to achieve good patient centred care, and the challenges inherent in successful interprofessional and interagency working.

In the institution where I work there are higher education programmes for twelve health and social care professions. As has been suggested is common in Higher Education in the U.K. (Section 1.1), the institutional structure can be regarded as promoting professional socialisation within, rather than between groups as students from most health and social care professions are educated in isolation from others, generally by members of that particular profession. The only exception to this is nursing where a small percentage of the programme is taught to student nurses from the four nursing fields (adult, child, mental health and learning disability).

My perception is that this relative professional isolation (Ryland et al., 2017) creates, promotes and reinforces each of the professional groups as having specific, and differing ontologies, with their social realities being typically profession specific (Morrison, 2012). Although it might be disputed, this effect perhaps originates with staff (Grix, 2010), and is then shared with, and learned by, the students. It is suggested these ontologies shape students’ values and beliefs which although not exclusive, are emphasised to different extents within specific professions (Cohen et al., 2011) resulting in each of the professional groups having bespoke realities (Merriam, 2009).

33

It is further suggested that these realities are socially constructed (Berger & Luckman, 1966) and potentially unique to each of the professions.

Referring to Becker et al. (1961), it is recognised that these profession specific ways of viewing the world held by staff and students, will not necessarily be identical as there will be

socialisation between students, and between staff, leading to slightly dissimilar cultures and ways of behaving. Although beyond the scope of this thesis, I believe that staff role modelling

appropriate behaviours is fundamental to the students’ education, although this has the potential to be limiting if staff remain isolated within their professional groups.

Similar arguments can be made for professional groups having different, specific epistemologies, where students from different professions are taught in similar, but not identical ways (Grix, 2010). Again, with the assumption that knowledge is socially acquired (Berger & Luckman, 1966) this relative professional isolation, and predominance of within professional dialogue and interaction (Lofland and Lofland,1984), which may be synonymous with communities of practice, it can be suggested that profession specific forms of knowledge will not be the same across the breadth of health and social care professions (Cohen et al., 2011). If the view that no epistemological position is ‘value neutral’ (Grogan and Cleaver Simmons, 2012: 30) is

considered this may reinforce the value differences implicit within varying ontologies as expressed previously.

Thus, although there are areas of knowledge and practice across the health and social care professions that overlap and coincide, differing ontologies and epistemologies suggest that there are likely to be different beliefs, values and ways of behaving in each of these professions. Section 1.10 (page 28) summarises how IPE may be regarded as a complex phenomenon in which multiple realities exist. Using a case study methodology has synergy with the context of the research and will facilitate the weaving of the ontological positions of different participants to maximise what might be learned. The use of an approach which permits a diversity of claims and assumptions to be examined facilitates consideration of different social realities.

This philosophy necessarily has an impact of how this research was both conceived and

implemented (Cohen et al., 2011) as the complexity of investigating how the IPE module might influence the number of differing, and perhaps as yet unrecognised, professional assumptions and beliefs. I thought that no single explicit paradigm would be sufficiently adaptable and

34

flexible (Lofthouse et al., 2012), in order to allow me adequate objectivity to interpret the

complexities within a single approach. Therefore, the approach of a case study methodology was thought to fit well with the focus of the research, to discover any influence of the IPE module on students’ attitudes towards collaboration.

The theories underpinning my own knowledge are based on the elements of my theoretical framework discussed previously (Section 1.9) because they appeared to offer insights into my experiences with IPE. For example, the theory that group membership is intrinsic to an

individual’s self-esteem, seemed to offer a potential explanation of my perceptions of the anxiety within the student group during IPE. From these considerations I realised that my ontological and epistemological position influenced the use of a diverse set of research methods within a case study approach.

An outline of the structure, learning outcomes and content of the IPE module under

consideration has been given previously (Section 1.3). As noted, the role of module leader had been, at times, overwhelming. The challenges that recur stem from both the size of the student cohort and the teaching team, and the complexities of creating a single module that is synergistic with twelve different programmes of study. In addition, the logistical challenges of timetabling, and ensuring that all staff are available and know what is required of them, compound the difficulties. One final challenge of the block delivery design of the module, in that all the arrangements need to be complete and all resources for the whole module have to be available prior to the start of teaching week, which is at the beginning of the semester. The purpose of this research was to discover any validation for aspects of the teaching and learning and student experience that might be regarded as successful, and insights on how to improve areas perceived by staff and/or students as requiring development.

The seminal study by Becker et al. (1961), which employed an ethnographic approach to investigate the transition between students registering on a programme to study medicine and newly qualified doctors, inspired me. My initial intention was to consider whether an

ethnographic research strategy might be adopted, where there could be observation of

participants by immersion within the student group (Burgess, 1982). An impetus for the idea was my perception of the complexity of the links between attitudes and behaviour. In agreement

35

with Van Maanen (1988), I thought an ethnographic study would furnish an increased level of understanding of the students’ perspectives.

However, when attempting to devise an ethnographic method of data collection I was unable to propose a viable strategy that could achieve the desired data while reconciling both the ethical considerations and the requirements of my role as module leader. As module leader, being ultimately responsible for the module assessment process, it was very probable that this would influence the students’ interactions in my presence. Experience on the module has taught me that the students’ conversations generally change, or even stop, as soon as I join a group discussion. I concluded that the power differential would have the consequence that it would not be possible for me to be ethnographically immersed within the student groups without having too significant an effect on the data collected (Measor and Woods, 1991).

Covert observation could have provided a solution to this obstacle but would have had ethical implications. I thought that it might be possible to have an assistant, of a similar age to the student population, who could mix with the groups in a covert manner. However, this still raised ethical issues, such as that of informed consent (de Laine, 2000), and was soon abandoned as a strategy

Robson’s (1993) suggestion that the specific labelling of different research models is not always helpful, as it can preclude responsiveness, was influential in selecting a methodological

approach. However, I believed some identification of specific data collection methods would be useful in the initial stages of my research. I thought it would support the development of a case study strategy that would enable me to formulate an iterative plan of how the research would be conducted.