Summary and implications for future data collection

The questionnaire appears to have been a valuable tool in producing data to inform subsequent elements of the study and has given an indication of changes in respondents’ explicit attitudes. There are some important caveats to be remembered, the limitations implicit in a self-report tool, that any changes cannot be ascribed to the IPE module in isolation and the lack of evidence on the representativeness of the sample. The identified objectives were met in that changes in

participants’ attitudes towards collaboration and other health care professions were identified and discussed.

Analysis of the questionnaire data suggests that there is evidence of a need to influence attitudes towards other professions and collaboration as both professional groups had notably lower opinions of other professions compared to their own. It is possible that these opinions could be barriers to appreciating other professions and therefore a potentially negative influence on attitudes towards collaboration and collaborative behaviours.

Within the limitations of a questionnaire in terms of the measurement of attitudes, this tranche of data appears to have demonstrated that students come to the IPE module with specific attitudes shaped by the professional group to which they belong, and that they value their own, and by extension their group’s, characteristics more highly than those of other groups/professions. This may be compounded by their relatively limited professional experience, and relative youth, limiting the extent of the impact of the module has on their attitudes towards collaborating with other professional groups.

Perhaps inevitably, concomitant with the suggested profession specific epistemologies is the evidence of the in-group bias associated with social identity. The questionnaires demonstrated some attitude change to professions on the module (student pharmacists’ attitudes to nursing and paramedic students) and beyond it (student nurses’ attitudes towards medical students).

The influence of the module appeared to be different for student pharmacists compared to student nurses. The nurses’ responses demonstrated greater change towards the pharmacists than vice versa, illustrating how the impact of IPE cannot be taken for granted for all students, and that perhaps there are trends within specific professions. The pharmacy students’ responses indicated a more pervasive and enduring in-group bias than those of the nurses, perhaps

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evidencing a stronger, or more valued, professional identity and perception of relative places within a hierarchy. The limited amount of clinical placement undertaken by pharmacy students, when compared to other healthcare students may be a factor here. The variation is important when considering how IPE influences students’ attitudes towards collaboration because of the association between group identities, influences on social cues, and by extension, on behaviours. The results suggest that inter-group contact cannot be assumed to be consistently effective, as all students undertook the same activities, and that therefore other influences may be at work. As mentioned previously, the module is mandatory, and this may be a confounding factor for some as it may increase dissonance.

When reviewing the results with respect to the three attitudinal domains, it may be concluded that there was recognition that the cognitive domain had been influenced, i.e. the students knew more about other professions included on the module. It is suggested that the teaching activities up to this point had been insufficient to influence behaviour (the responses to the questionnaire), with social identity potentially being a greater influence. The results suggest that greater

exploration and focus on the affective domain could have the potential to increase the influence of IPE on behaviour, and therefore attitudes.

It is suggested, at this point, that for some students, IPE highlights the salience of

professional/group membership, and the differences between them, and that this may be counter- productive in influencing students’ attitudes towards collaborating with others. This is despite the identification of common goals and the support given by the institution to promote the co- operative influences of intergroup contact. The evidence of any impact of transformational learning and cognitive dissonance seems to be inconsistent, suggesting that these concepts have not been sufficiently examined by the questionnaires and therefore there may be other influences which need to be further investigated

This concluding section has highlighted aspects of the findings from the questionnaire that were either congruent with, or supplementary to, my articulated epistemology and ontology. The impact of social identity theory, with its implication for in-group bias was greater than I had previously recognised despite the questionnaire data being relatively superficial. The varying responses of the two professional groups were somewhat reassuring in affirming my initial

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epistemology, that different groups have dissimilar epistemologies to each other and that there was scope within the study to explore this further.

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4 The students’ drawings

4.1 Introduction

Having completed the questionnaire administration and analysis and achieved formative data that suggested that evidence existed that the IPE module had some influence on students’ explicit attitudes to collaboration, the next step was to examine some of the attitudes in greater detail. As suggested previously, I had the supposition that some health and social care professionals might be prejudiced against each other, or, at the very least, make pre-judgements (Sections 1.9.1 & 2.1.4) which would have the potential to have an impact on collaborative behaviours. Having used a self-completed questionnaire I was minded to implement a data collection method that might give some insight into implicit attitudes.

In 1995, Carpenter published a study on stereotypes that has since become widely cited in work considering interprofessional working and education. The study involved medical and nursing students and suggested that IPE had the potential to decrease these professions’ stereotypical views of each other. Subsequently, the impact of stereotypes in IPE has been explored by other authors, often using a self-completed questionnaire (Foster and Macleod Clark, 2015; Ateah et al., 2011; Hean et al., 2006; Lindqvist et al., 2005).

Being cognisant of some of these studies, a number of years ago I introduced the topic of stereotypes into an initiatory teaching session on the IPE module. The teaching method utilised was based on my preferred style of teaching; this often involves asking the students to undertake activities as I believe this has the potential to increase the extent to which students may engage with the content of a teaching session (Cameron, 2017; McCoy, 2017; Rejno, et al., 2017; Chan, 2014). After deciding that self-completed questionnaires were not particularly suitable as a within-session teaching activity, I devised a drawing activity on the topic of stereotypes that was designed to highlight similar points that might have become apparent in a questionnaire.

The drawing activity appears to have been an enjoyable, engaging and thought-provoking adjunct to teaching about stereotypes for successive cohorts. I thought that the students’ drawings at the start of the module might potentially demonstrate a link with their extant attitudes towards other professions, and so to their attitudes towards collaboration. With this rationale, I included the drawings as a source of data in this study in order to explore this

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construct in depth. This section will explore some of the theoretical aspects of stereotyping, explain the method used to achieve the drawings and outline the results of analysis of the images produced by a single cohort. In conclusion, features of the analysis pertaining to students’ attitudes towards other professions and collaboration will be proposed.