Interprofessional education’s readiness among Brazilian medical students / Interprofessionelle Bildung: Bereitschaft unter brasilianischen Medizinstudierenden

Social inequalities have challenged global health, the elderly population increase, the complexity of health problems, pandemics, and shortages of healthcare professionals (Axelsson et al., 2019; Pype et al., 2016). As a result, in the last decade, global health systems have been encouraged to change their healthcare models for more patient-centered and teamwork-based care (Khalili et al., 2014; Thistlethwaite et al., 2019; Topor et al., 2018). However, in order to improve the healthcare system, the health program’s curriculum must be changed. Medical schools worldwide have been required to design courses with strategies to integrate patient-centered care and teamwork (Alzamil & Meo, 2020; Milutinović et al., 2018; Visser et al., 2018).

To address global health challenges and improve the healthcare system (Guraya & Bar, 2018; Reeves et al., 2016) interprofessional education (IPE) has been intensified to train healthcare professionals in collaborative care skills (World Health Organization [WHO], 2010). Interprofessional education occurs when two or more professions learn about others, with others, and with each other for effective collaboration and improved outcomes in health (WHO, 2010). In addition, collaborative practice happens when health professionals from different areas and with different experiences work together with patients, families, and caregivers to provide high-quality services (WHO, 2010). Studies highlight the importance of IPE opportunities during health care programs to develop better communication skills in a real-life interprofessional team (Nelson et al., 2017). Health care professionals who had IPE opportunities in their courses are more likely to become collaborators at work (Lestari et al., 2016); they also have a better understanding of the roles and the importance of other professionals (Guraya & Bar, 2018; Mukhtar et al., 2018; Sollami et al., 2018; Williams et al., 2015). Gender, age, and different levels of exposure to IPE affect students’ attitudes about interprofessional learning (Milutinović et al., 2018); no studies were found focusing only on students in the last years of the program, that is, while doing their internship.

The concept of interprofessional readiness (Parsell & Bligh, 1999) suggests the student’s willingness to participate in the IPE (Visser et al., 2018). Student attitudes and expectations towards shared learning have been considered the most important predictors of successful implementation of IPE (Milutinović et al., 2018; Hojat et al., 2015; Sciascia et al., 2021). Several instruments to assess IPE readiness have been described; most of them lack psychometric methods, and many were used only once (Hojat et al., 2015; Edelbring et al., 2018). The Readiness Interprofessional Learning Scale (RIPLS), the Interdisciplinary Education Perception Scale (IEPS) (Sciascia et al., 2021; Lie et al., 2013; Peduzzi et al., 2015), and the Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffATIC) (Hojat et al., 2015; Ward et al., 2008) are IPE scales with tested measurement support and are the most extensively used to detect differences in student’s attitudes and curriculum impact (Hojat et al.,2015). Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration and Scale of Attitudes Toward Physician-Pharmacist Collaboration (Hojat et al., 2015; Ward et al., 2008) are more specific to the target population of medical, nursing, and pharmacy but have not been adapted to be used with Brazilian students. RIPLS was the first tool to assess interprofessional learning and attitudes towards collaboration among health care professionals, and has been validated for different languages and cultures, including Brazil (Milutinović et al., 2018; Visser et al., 2018; Edelbring et al., 2018; Peduzzi et al., 2015; Cervantes-Sudio et al., 2021).

Based on the relevance of IPE for training health care professionals in accordance with health demands, this study seeks to contribute scientific evidence for the training of medical students in line with global health and national guidelines for interprofessional training.

Out of 751 medical students from the five medical schools, 642 agreed to participate, representing an 85.48% response rate. Sociodemographic information is presented in Table 1.

We studied the Brazilian medical students’ readiness for interprofessional education by considering a range of variables such as gender, university and work experiences, current clinical practice, previous bachelor’s degree, and teamwork experience. The scores reflecting medical students’ availability for interprofessional education were positive across all factors. This indicates a willingness to work and collaborate within a team, a value of their professional identity (F2) on par with other healthcare professionals, and a commitment to promoting patient-centered care (F3). The variables of gender and medical program semester seem to influence all RIPLS factors. Current clinical practice positively influenced medical students’ teamwork (factor 1) and patient-centered care (factor 3). Previous bachelor’s degrees and the type of university (public or private) had a significant impact on factor 2-professional identity and factor 3 - patient-centered care. Finally, previous teamwork experience seems to positively impact factor 1 - teamwork.

Females scored higher in teamwork (F1) and patient-centered care (F3) and lower in professional identity (F2). Similar results were found in other studies using RIPLS (Camara et al., 2015; Nuto et al., 2017; Judge et al., 2015; Wilhelmsson et al., 2011; Wong et al., 2016) and also with other scales (Wong et al., 2016; Hansson et al., 2010). The F2 factor is related to more competitive attitudes that impact patient-centered care. The F3 factor relates to the willingness to understand the patient’s side of the problem based on relationships of trust and compassion. Thus, the factors present an inverse relationship (Peduzzi et al., 2015). These findings can also be associated with the social construction of communication and maternal attitudes related to the female gender (Prado et al., 2018; Wilhelmsson et al., 2011). Female students show greater receptivity to group work and cooperation with other professions than male students (Nuto et al., 2017; Wilhelmsson et al., 2011; Wong et al., 2016; Hansson et al., 2010). Women are more likely to work with other people, prefer collaborative processes and friendship, and have a greater understanding of the point of view of others (Reynolds, 2003). In combination with other data from the literature, our findings demonstrate the need for intervention strategies with male students for motivation and receptivity to IPE.

The internship semester of the course influenced medical students’ readiness for shared learning. Students at the end of the internship have greater scores in factor 1- teamwork and factor 3- patient-centered care and lower scores in factor 2 - professional identity than those who were starting their internship. Similar findings suggest that exposure to clinical practice may positively alter students’ preferences concerning the interprofessional approach (Wong et al., 2016; Hood et al., 2014; Rajiah et al., 2016; Salih et al., 2019). Because the studied population was placed under the new medical curriculum (Brazil Ministry of Education, 2014), they were exposed to shared experiences throughout their degree; it may have contributed to the student’s clarity about their role and skills within the interprofessional team and changed students’ attitudes in favor of collaborative practice.

Students previously exposed to teamwork experiences were more collaborative, with higher scores on the F1 (Wong et al., 2016; Rajiah et al., 2016). In the same way, students who had previously completed a healthcare program had lower scores on professional identity (F2) and higher scores on patient-centered care (F3); possibly, it is related to familiarity with the work environment or comfortable feelings in collaborative care (Ward et al., 2008). In our study, nursing (diploma/certificate or bachelor’s degree) was the most frequent previous course completed by the participants. Previous professional training in health areas that move away from traditional biomedical models with a more holistic approach to care (Williams et al., 2011) could justify our findings with higher scores in the F3 – patient-centered care. However, there is no consensus in the literature about it. Two studies did not find a significant difference in EIP readiness among students who completed a previous course (Nuto et al., 2017; Barbosa et al., 2021); one study (Ward et al., 2008) showed students who had previous experience in health care had more positive attitudes.

We found a statistical significance in F2 -professional identity and F3 -patient-centered care among students enrolled in public and private universities. The lowest identity scores (F2) were found in the three medical courses that belonged to the same public institution but in three different cities. In this institution, the curriculum defines that medical students should be exposed early to interprofessional experiences, which may justify the lower results in the F2 -professional identity factor.

Students placed in primary care settings had higher F1 -teamwork and F3 -patient-centered care scores than those in hospital and emergency environments. The results can be explained by the essence of the multidisciplinary composition and teamwork of primary care, therefore it is a suitable place for the development of interprofessionality (Camara et al., 2015).

The present study has limitations that suggest directions for future implementations. First, even with the participation of more than 600 students, the data shows a local culture of IPE of six Brazilian medical schools. Second, most of the data collection was made “in loco” in the practical fields; it may interfere with students’ focus on completing the RIPLS. Finally, this study used a cross-sectional approach that did not accompany the same student’s progression throughout their internship. A follow-up of the interprofessional skills among medical students, following their progress during the internship, could demonstrate the gains and gaps in interprofessional training. We suggest further studies to continuously assess the student response to IPE actions throughout the course.

This study brings scientific evidence and practical contributions to the EIP theme among medical students, especially those in internships. It is the first study developed in Brazil that assesses medical students’ readiness for interprofessional learning by identifying the different factors that can contribute to greater readiness.

Acknowledging the factors that influence the student’s readiness for IPE allows medical courses to review their curriculum. In addition, the data can provide resources to develop actions that promote IPE alignment with national guidelines, and worldwide, in promoting collaborative practice. In a local context, this study is the first to analyze all courses in a Brazilian state, which can contribute to training policies in higher education and review of curricula, considering the health interests of local communities.

At the end of this study, we believe that IPE is a potent tool for transforming the training of medical students and meeting the current population health demands.