Interdisciplinary education in undergraduate health programs: A scoping review / Interdisziplinäre Ausbildung in den Gesundheitsberufen. Ein Scoping Review.

At the macro level, elements that justified, thus directly or indirectly facilitating IDE, included recommendations for IDE from national organizations — e.g., calls from the National Science Foundation or National Institutes of Health (USA) (Robeva, 2009); education projects for the National Human Genome Research Institute (USA) (Marx et al., 2021); Canadian federal and provincial policies indicating the expectation of government planning authorities for pre- and post-licensure IPE (Kenaszchuk et al., 2012); the Australian government’s National Action Plan on Education for Sustainability (Noy et al., 2017); or Spanish legislation to include IPE for communication skills (Pumar Méndez et al., 2008). Macro-level barriers also existed — e.g., the scarcity of IPE in health-professions students in Israel (Avrech Bar et al., 2018) or particularities of psychology training programs in Australia that potentially made students perceive IPE as non-relevant due to lack of work placement (Roberts & Forman, 2015).

Meso structures were at the level of academic units (e.g., programs, faculty) and higher-education institutions. These included aims to implement IP competencies within curricula (Snyder et al., 2017; Valaitis et al., 2016); integrative ID or longstanding IPE curricula (Karuguti et al., 2017; Rango, 1981; Wingert et al., 2011); ID centres (Clark & Hoffman, 2019; Sponselee & Van Hoof, 2017) with a transdisciplinary educational framework (LaDuca et al., 2019); ID summer undergraduate research experience programs (Misra et al., 2009); IPE certificates of attendance (Hoffman & Cowdery, 2022); commitment from school administrations (Satterwhite et al., 2020; Waggie & Laattoe, 2014); funding for transdisciplinary work (LaDuca et al., 2019; Satterwhite et al., 2020); recognition of the value of ID or community partnerships (Macdonald et al., 2022; Satterwhite et al., 2020); and training faculty involved in IDE (LaDuca et al., 2019).

Conversely, in some cases, existing structures were the impetus for change — e.g., the realization that faculties lack, or present barriers to, IDE opportunities for competency development (Gilbert et al., 2000; Cleak et al., 2007; Noy et al., 2017). Other studies referred to opportunities for IDE development, e.g., when subjects are shared requirements among program curricula (Cino et al., 2018; Hawley, 2021), or barriers, such as when it was difficult to determine where IPE would fit in curricula (Hinderer & Joyner, 2014) or when cross-listed courses created logistical problems (Hinderer & Joyner, 2014). Lastly, another meso challenge was the location of institutions; rural or remote areas meant no access to collaborative local clinical placements (Hinderer & Joyner, 2014).

At the micro level, studies highlighted structures that supported IDE, including faculty members’ interest and collaboration (Hinderer & Joyner, 2014; LaDuca et al., 2019; Malachowski, 1990; Mulligan et al., 2011; Parker et al., 2022; Reitsma et al., 2019; Wingert et al., 2011). Conversely, the resistance of academic staff to participate in IPE presented a challenge (Hinderer & Joyner, 2014; Waggie & Laattoe, 2014). Within these structures, the physical spaces used to facilitate the interventions were also mentioned (Cino et al., 2018; LaDuca et al., 2019).

There were a variety of disciplines involved in the interventions across the studies. Nursing was the most common discipline, included in 21 interventions (Avrech Bar et al., 2018; Cino et al., 2018; Clark & Hoffman, 2019; Cleak & Williamson, 2007; Gilbert et al., 2000; Hawley 2021; Hendrick et al., 2014; Hinderer & Joyner, 2014; Hoffman & Cowdery, 2022; Karsten et al., 2015; Karuguti et al., 2017; Kenaszchuk et al., 2012; Kerry et al., 2021; Parker et al., 2022; Reitsma et al., 2019; Scrooby et al., 2019; Snyder et al., 2017; Sponselee & van Hoof, 2017; Valaitis et al., 2016; Waggie & Laattoe, 2014; Williams et al., 2008). Other common disciplines included physiotherapy (11 interventions), occupational therapy (10), and social work (8), respectively (Avrech Bar et al., 2018; Cleak & Williamson, 2007; Gilbert et al., 2000; Hendrick et al., 2014; Karsten et al., 2015; Karuguti et al., 2017; Kenaszchuk et al., 2012; Kerry et al., 2021; Reitsma et al., 2019; Snyder et al., 2017; Sponselee & van Hoof, 2017; Valaitis et al., 2016; Waggie & Lattoe, 2014; Williams et al., 2008). Most often the disciplines included in the studies were all health sciences-related, but there were nine studies that also included non-health based disciplines, such as mathematics, commerce, business, engineering, or education (Hawley, 2021; Kenaszchuk et al., 2012; LaDuca et al., 2019; Macdonald et al., 2022; Malachowski, 1990; Marx et al., 2021; Roberts & Forman, 2015; Robeva, 2000, Sponselee & van Hoof, 2017).

Regarding the grouping of learners, only nine studies explicitly stated how students from different disciplines were combined into groups (Cino et al., 2018; Cleak & Williamson, 2007; Gilbert et al., 2000; Hoffman & Cowdery, 2022; Kenaszchuk et al., 2012; Macdonald et al., 2022; Marx et al., 2021; Reitsma et al., 2019; Scrooby et al., 2019). The remainder of studies did not detail how disciplines were combined or how groups were formed (Avrech Bar et al., 2018; Hawley 2021; Hendrick et al., 2014; Hinderer & Joyner, 2014; Karsten et al., 2015; Karuguti et al., 2017; Kerry et al., 2021; LaDuca et al., 2019; Malachowski, 1990; Mirsa et al., 2009; Mulligan et al., 2011; Noy et al., 2017; Parker et al., 2022; Roberts & Forman, 2015; Robeva, 2009; Satterwhite et al., 2020; Snyder et al., 2017; Sponselee & van Hoof, 2017; Valaitis et al., 2016; Waggie & Laattoe, 2014; Williams et al., 2008; Wingert et al., 2011).

Building off the classifications of IP interventions by Sherman et al. (2020), we classified interventions as course, curricular, clinical, or extracurricular initiatives. All the methods/design, exploratory, and evaluation studies included in this review could be classified into the above categories. Commentaries and reviews included in our study could not be classified, as they did not describe interventions (Clark & Hoffman, 2019; Pumar Méndez et al., 2008; Rango, 1981; Rodrigues da Silva Noll Gonçalves et al., 2021).

Course initiatives (n = 15) were interventions that were offered as more than a one-off event (Cleak & Williamson, 2007; Hawley 2021; Hendrick et al., 2014; LaDuca et al., 2019; Malachowski, 1990; Marx et al., 2021; Mirsa et al., 2009; Mulligan et al., 2011; Noy et al., 2017; Reitsma et al., 2019; Robeva, 2009; Satterwhite et al., 2020; Snyder et al., 2017; Valaitis et al., 2016; Wingert et al., 2011). Of the 15 course initiatives, two were research courses, and four were service-learning or community-learning (Marx et al., 2021; Mirsa et al., 2009; Mulligan et al., 2011; Satterwhite et al., 2020; Valaitis et al., 2016; Wingert et al., 2011). Thirteen interventions lasted the duration of a semester (Cleak & Williamson, 2007; Hawley, 2021; Hendrick et al., 2014; Hinderer & Joyner, 2014; Kerry et al., 2021; LaDuca et al., 2019; Malachowski, 1990; Marx et al., 2021; Mirsa et al., 2009; Noy et al., 2017; Robeva, 2009; Snyder et al., 2017; Valaitis et al., 2016; Wingert et al., 2011). Nine interventions were less than one week in duration (Cino et al., 2018; Gilbert et al., 2000; Hoffman & Cowdery, 2022; Karsten et al., 2015; Kenaszchuk et al., 2012; Kerry et al., 2021; Parker et al., 2022; Williams et al., 2008). In three studies, the duration of intervention was not detailed (Satterwhite et al., 2020; Scrooby et al., 2019; Waggie & Laattoe, 2014).

Beyond the course-based initiatives, there were also seven curricular initiatives that offered a structured curriculum or implemented assessments of attitudes toward IDE/IPE, which were then used to inform future curriculum (Avrech Bar et al., 2018; Karuguti et al., 2017; Kerry et al., 2021; Roberts & Forman, 2015; Sponselee & van Hoof, 2017; Waggie & Laattoe, 2014; Williams et al., 2008). Extracurricular initiatives (n = 4) were one-time events or interventions that did not contribute to a degree program (Cino et al., 2018; Gilbert et al., 2000; Hoffman & Cowdery, 2022; Macdonald et al., 2022). Finally, clinical initiatives (n = 5) incorporated patient-care into the intervention. Two of the clinical initiatives were courses with clinical-based initiatives (Hinderer & Joyner, 2014; Scrooby et al., 2019), and three were extracurricular with clinical-based initiatives (Karsten et al., 2015; Kenaszchuk et al., 2012; Parker et al., 2022).

Across the initiatives, there were three main teaching modalities: in-person, online, and blended (in-person and online components). Twenty interventions were conducted in-person (Cino et al., 2018; Gilbert et al., 2000; Hendrick et al., 2014; Hinderer & Joyner, 2014; Karsten et al., 2015; LaDuca et al., 2019; Macdonald et al., 2022; Malachowski, 1990; Marx et al., 2021; Mirsa et al., 2009; Mulligan et al., 2011; Noy et al., 2017; Parker et al., 2022; Reitsma et al., 2019; Robeva, 2009; Satterwhite et al., 2020; Snyder et al., 2017; Sponselee & van Hoof, 2017; Valaitis et al., 2016; Wingert et al., 2011) and only three interventions were conducted online (Hawley, 2021; Roberts & Forman, 2015; Williams et al., 2008). One intervention was in a blended format (Cleak & Williamson, 2007). Seven interventions did not specify their teaching modality (Avrech Bar et al., 2018; Hoffman & Cowdery, 2022; Karuguti et al., 2017; Kenaszchuk et al., 2012; Kerry et al., 2021; Scrooby et al., 2019; Waggie & Laattoe, 2014).

Positive outcomes were consolidated into six themes regarding the impact of IDE: knowledge; skills; attitudes and beliefs; behaviors; applicability and relevance; and outcomes related to the implementation of IDE. An overview of the positive outcomes and challenges reported in the studies is provided in Appendix B.

In terms of outcomes pertaining to knowledge, many students reported improving, learning, or increasing their understanding around the significance of IDE itself (Hinderer & Joyner, 2014; Hoffman & Cowdery, 2022; Kenaszchuk et al., 2012; Robeva, 2009; Sponselee & Van Hoof, 2017). They also reported increased awareness about health-professional roles and responsibilities (Hoffman & Cowdery, 2022; LaDuca et al., 2019; Parker et al., 2022; Reitsma et al., 2019; Rodrigues da Silva Noll Gonçalves et al., 2021; Williams et al., 2008). Students also reported that the interventions offered an opportunity to understand their course curricula from another perspective (Hendrick et al., 2014; Malachowski, 1990; Mulligan et al., 2011) and to learn about what they could achieve, as individuals, with students from other disciplines and with community members (Valaitis et al., 2016). Finally, students reported increased knowledge related to the application of adaptive leadership (Hawley, 2021) and the benefits of team-based care (Cino et al., 2018; Parker et al., 2022).

With respect to skills, students reported that IDE initiatives were beneficial for collaboration with other disciplines. Specifically, the initiatives enhanced communication skills, professional identity-related competencies (Cino et al., 2018; Hinderer & Joyner, 2014; Noy et al., 2017; Macdonald et al., 2022; Reitsma et al., 2019; Scrooby et al., 2019), and increased their ability and confidence in working with other professions (Cino et al., 2018).

Regarding attitudes and beliefs, students held mostly positive views of IDE or related initiatives (Avrech Bar et al., 2018; Cleak & Williamson, 2007; Gilbert et al., 2000; Kenaszchuk et al., 2012; Misra et al., 2009; Noy et al., 2017; Robeva, 2009; Satterwhite et al., 2020; Scrooby et al., 2019; Williams et al., 2008). In some cases, misconceptions about health professional roles were clarified (Hoffman & Cowdery, 2022), with students enjoying multidisciplinary teamwork (Misra et al., 2009) and the initiatives boosting their confidence in their professional identities (Rodrigues da Silva Noll Gonçalves et al., 2021). Positive attitudinal changes in students related to engaging in IPE for Indigenous health were also reported (Hendrick et al., 2014).

In several studies, students commented on the applicability and relevance of IDE to the real world and/or their future education, training or careers (Cleak & Williamson, 2007; Hawley, 2021; Hinderer & Joyner, 2014; Marx et al., 2021; Mulligan et al., 2011; Roberts & Forman, 2015; Valaitis et al., 2016; Williams et al., 2008). Additional benefits to IDE found in the studies were increased participation in the ID classroom (Misra et al., 2009), as well as overcoming different cultures of communication (MacDonald et al., 2022) and power dynamics (Reitsma et al., 2019). Studies also noted that some of these benefits appeared to be strengthened by modeling IDE with an ID team-teaching approach (Robeva et al., 2009); student-based mentoring (Robeva, 2009); and having non-professionally-biased and well-prepared facilitators (Kerry et al., 2021).

Challenges to IDE were also identified across the studies. These challenges were classified into seven categories: support for IDE; resources and logistics; facilitation of IDE; learning; case studies of IDE; ID group dynamics; and attitudes and beliefs (Appendix B).

In terms of planning IDE initiatives, studies reported that a limited number of disciplines were able to participate in the intervention (Cino et al., 2018; Parker et al., 2022), along with other logistical issues, such as coordination between disciplines and professions (Hinderer & Joyner, 2014); scheduling issues (Valaites et al., 2016); curriculum approval difficulties (Hinderer & Joyner, 2014); competing student interest in elective courses (Hinder & Joyner, 2014); and access to resources (e.g., true IP settings) due to an institution’s remote location (Hinderer & Joyner, 2014). One study also reported that IDE had faced initial resistance from staff and faculty (Hinderer & Joyner, 2014).

In terms of implementation of the initiatives, limited attendance was mentioned and was attributed to recruitment challenges (Hinderer & Joyner, 2014; Parker et al., 2022). Challenges around the facilitation of IDE included faculty presenting bias towards their discipline when directing discussions within the intervention, as well as inconsistencies between facilitators in how the intervention was implemented (Reitsma et al., 2019). Students cited the size of the workload as a challenge (Cleak & Williamson, 2007; Mulligan et al., 2011), as well as mismatches between IPE curriculum content and assessment criteria (Karuguti et al., 2017), with differences in assessment weighting between disciplines interfering with a sense of equal ownership in the ID project (Marx et al., 2021). Some case studies also lacked adequate information (or relevancy), which ultimately impacted IP relationships (Reitsma et al., 2019). The dynamics of ID groups also presented challenges for students (Cleak & Williamson, 2007; Malachowski, 1990; Scrooby et al., 2019), with some struggling to integrate their own profession’s scope of practice (Reitsma et al., 2019). Finally, with regard to attitudes and beliefs, some studies reported that students held unfavorable opinions about the value of IDE (Scrooby et al., 2019; Wingert et al., 2011), and that these negative perceptions correlated with their own weakened professional identities (Rodrigues da Silva Noll Gonçalves et al., 2021)

The included studies often offered recommendations around either context-specific implementations of IDE or broader ideas that could be applied to a range of ID contexts, designs, and interventions (Appendix A).

Studies called for the continued implementation or reform of IDE (Clark & Hoffman, 2019; Macdonald et al., 2022; Parker et al., 2022; Rango, 1981; Robeva, 2009; Snyder et al., 2017; Sponselee & Van Hoof, 2017), and emphasized the need for structures that both facilitated and supported it. Proposed ideas included supports for co-instruction of research-based courses; increased funding, time allocations, and administrative support; addressing classroom capacity and faculty workload; acknowledging and incentivizing ID activities; having structures that foster collaboration across faculties; and establishing IPE committees to manage staff development, curriculum planning, and timetabling (Gilbert et al., 2000; Karsten et al., 2015; Parker et al., 2022 Satterwhite et al., 2020; Waggie & Laattoe, 2014).

Another recommendation was related to the timing of IDE, with suggestions that it commence early in a student’s higher-education career (Clark & Hoffman, 2019; Rodrigues da Silva Noll Gonçalves et al., 2021) and be designed in a way that anticipates this earlier participation, as well as the possibility of limited enthusiasm the from student (Kenaszchuk et al., 2012). Pumar Méndez et al. (2008) suggested introducing IDE on a continuum across the academic careers of learners. The importance of IDE in light of expectations for professional standards and program accreditation should also be shared with students (Parker et al., 2022).

Three papers made suggestions for getting more disciplines and professions involved in IDE (Hinderer & Joyner, 2014; Rodrigues da Silva Noll Gonçalves et al., 2021), with Hoffman & Cowdery (2022) specifically citing a lack of representation of public health in IDE initiatives. It was suggested that expanding to more disciplines/professions would favor collaborative work (Rodrigues da Silva Noll Gonçalves et al., 2021) and provide diverse perspectives from which could draw knowledge (Hinderer & Joyner, 2014). Reitsma et al. (2019) suggested that in including different professions/disciplines in an ID team, one should consider the availability of students, the scope of their practice at the undergraduate level, and specific and appropriate case studies — the latter points being about emphasizing IDE’s relevance to learners (LaDuca et al., 2019; Pumar Méndez et al., 2008). Further, studies highlighted the need for IDE to be included in all curricula and integrated into and mapped onto it, rather than being viewed as an add-on (Parker et al., 2022; Reitsma et al., 2019; Waggie & Laattoe, 2014).

In designing IDE, one paper suggested using a constructive perspective — i.e., one where students discover and adapt complex information to internalize new knowledge (Scrooby et al., 2019), and employ causal thinking and reflective skepticism (Rango, 1981). Within the context of sustainability learning, Noy et al. (2017) put together a framework for developing curricula that promote ID knowledge and skills. The framework includes group work, challenging existing worldviews, peer learning, and personal engagement (e.g., developing new skills for working toward ID solutions and linking class experiences to real life) (Noy et al., 2017). The incorporation of team projects in ID training programs was also suggested by Misra et al. (2019). Marx et al. (2021) suggested a generalizable model for the successful integration of ID service-learning involving the following: finding a community partner with tangible needs; identifying courses and learning outcomes that can address those needs; having instructors collaborate to determine how to integrate ID service learning; finding overlapping class times and shared meeting spaces; grouping students and setting processes and project outcomes; fostering joint project ownership among students; and determining assessment strategies.

Recommendations for changes to an ID course embedded within a campus-community partnership were provided by Valaitis et al. (2016), although they were not focused specifically on the ID aspect. Karuguti et al. (2017) suggested using the Depth of Knowledge (DOK) framework to measure cognitive rigor. Cognitive rigor refers to the complexity of content, the level of cognitive engagement with that content, and the scope of planned instructional activities (Hess et al., 2009). Karuguti et al. (2017) specifically suggest the DOK framework can help ID educators align the quality of the learning outcomes with the rigor of the learning activities and assessments.

In terms of format, Waggie & Laattoe (2014) suggested ID programs be four to seven weeks long to optimize collaboration, while Gilbert et al. (2000) recommended a modular format to facilitate knowledge and skill development. When ID experiences are held in a large space, educators should ensure that there are also distraction-free spaces available to student teams (LaDuca et al., 2019).

One study referred to the need for creative approaches in IDE teaching to deliver complex material in a relevant way to the disciplines involved (Hinderer & Joyner, 2014). Clark & Hoffman (2019) recommended using a systems approach in place of a reductionist approach, and using theories such as self-directed and peer-to-peer learning. To support student collaborations, Cleak & Williamson (2007) made an adaptation to their initiative, adding theoretical content about group dynamics and prompts for teams to produce group contracts. Finally, Parker et al. (2022) discouraged those in the field of IDE from assuming that educators understand how to implement it; on a similar note, another study suggested designing train-the-trainer programs for IDE facilitators (Kerry et al., 2021).

Finally, in evaluating the effectiveness of IPE, studies recommended more rigorous methods beyond learner satisfaction (Pumar Méndez et al., 2008). These might include the development of instruments with appropriate psychometric properties, and combining validated quantitative instruments with qualitative data (Rodrigues da Silva Noll Gonçalves et al., 2021), or using objective measures (such as the Kirkpatrick model) for gauging impact (Hawley, 2021).

When reporting on the process, there was often limited information on the educational initiative, the disciplines involved, and student collaboration, as well as its duration and modality. While we were able to classify most initiatives as course-based, curricular, extracurricular, or clinical, there were studies that did not include certain details of the intervention and thus made this challenging — for example, Kerry et al. (2021)’s study when it examined student perceptions of valued facilitator competencies after students completed an IPE course.

Although studies generally listed the disciplines involved, some lacked such information (Misra et al., 2019). Regarding ID collaboration among students, we were not able to qualify the extent to which students were interacting, as the authors of the included studies did not always describe their collaboration in detail. For example, Cleak and Williamson (2007) provided descriptions of ID student grouping, with a minimum of three disciplines working as a team to complete modular tasks and assignments, but in Snyder et al. (2017), the ID groupings of students working on scenarios was not made explicit.

The duration of IDE interventions ranged from one-off occurrences (e.g., Roberts & Forman, 2015; Williams et al., 2008) to semester-long initiatives (e.g., Marx et al., 2021; Wingert et al., 2011) — again, with some studies lacking specifics (e.g., Scrooby et al., 2019), making it difficult for the reader to contextualize their outcomes.

Finally, there was were gaps in the reporting of modality, with some studies (e.g., Avrech Bar et al., 2018; Hoffman & Cowdery, 2022) not providing specific information as to how students interacted. In consulting literature published after our study’s search date, we did identify one article that provided a robust description of the IPE process (Beebe et al., 2025).

With respect to outcomes, there was a lack of evidence (quantitative or qualitative) across the studies on the effectiveness of the initiatives, with author statements being presented as findings. For example, based on course evaluations, Robeva (2009) reported that students were able to grasp concepts more efficiently in the ID intervention. Along the same lines, the included study by Marx et al. (2009) reported an IDE intervention’s impact on student learning without describing methods for data collection and analysis. We caution that for initiatives to be adapted and enhanced by other scholars, evidence of their effectiveness is integral. This evidence may be qualitative and/or quantitative; as an example, in consulting literature published after our study’s search date, we identified a randomized trial that measured the effectiveness of video-assisted debriefing versus oral debriefing in simulation-based interdisciplinary health-professions education (Rueda-Medina et al., 2024).

This scoping review was conducted to provide an overview of the existing evidence around undergraduate IDE in health sciences, irrespective of methodological quality or risk of bias in the sources of evidence. As such, included studies were not critically appraised (Tricco et al., 2018). Notwithstanding, we identified the following limitations cited within the studies: small sample size (Cino et al., 2018; Parker et al., 2022; Reitsma et al., 2019; Scrooby et al., 2019); single-institution study (Avrech Bar et al., 2018); lack of longitudinal results (Avrech Bar et al., 2018; Karuguti et al., 2017; Kenaszchuk et al., 2012; Roberts & Forman, 2015); and voluntary participation or self-selection into groups, resulting in bias (Hawley et al., 2021; Kenaszchuk et al., 2012), with many studies not stating their limitations.

Ross and Zaidi (2019) caution that generic limitations (e.g., sample size or one institution) or the omission of limitations may result in researchers failing to “communicate the relevance of their work, illustrate how their work advances a larger field under study, and suggest potential areas for further investigation” (p. 261). One of the limitations (lack of longitudinal studies) indeed presents an opportunity to improve scholarly inquiry into IDE.

Ross and Zaidi (2019) add that presenting limitations (implications, steps taken to minimize limitations, and possible alternative approaches and explanations) provides transparency, as well as reproducibility and transferability of methods. We believe that gaps in the presentation of limitations combined with the previously mentioned gaps in the reporting of processes and outcomes create challenges for reproducibility and transferability in IDE research. We urge the IDE community to consider the development of checklists or reporting guidelines to support reproducibility and transparency in education research (National Science Foundation and The Institute of Education Sciences, 2018; Keijser et al., 2020 preprint).

In selecting search terms, we excluded medical students, thus potentially impacting the final number of included studies. The reason for excluding the discipline of medicine was because of the variable categorization of medicine in different countries’ education systems, which sometimes treat it as an undergraduate/direct-entry degree and sometimes as a postgraduate degree.

We established early on in the review process that the body of literature was challenging to navigate due to a lack of information on students’ level of study. Although an alternative approach could have been to consult other resources to determine the undergraduate or postgraduate nature of the specific medical education system named in a study, this is beyond the reasonable scope for this project.

Also impacting the number of studies included in the review stems was the fact, due to resource limitations, there was no comprehensive search of grey literature or of citations. In future studies, one category of grey literature that could add to the body of knowledge around the IDE structure and process could be websites of higher education institutions featuring IDE initiatives. Finally, as this review focused on IDE at the undergraduate level and excluded studies that included health professionals, we may have missed studies that explored collaborative learning initiatives across multiple higher education levels.

When used to measure healthcare quality, two known flaws of the Donabedian model are that it does not consider healthcare as a system and that it lacks patient-centredness (Berwick and Fox, 2016). In our study, to mitigate this limitation, we viewed IDE as a system that includes structures at the micro, meso, and macro level, ranging from faculty buy-in to institutional support and embedded within a wide range of contexts (e.g., a single course versus the landscape of health science education in a country).

Within these systems, we considered primarily the student and the instructor. However, we recognize that IDE also operates within systems that were potentially not explicitly named in the included studies (e.g., legislation, hidden curricula, institutional or governmental agendas/priorities). With respect to the student-centeredness part of our model, our data was limited to the outcomes that were present in the studies. However, we also acknowledge this framework was used to analyze the results (instead of for inclusion/exclusion), and thus we included some studies that did not capture the responsiveness of IDE to student needs and interests. Moving forward, consideration should be given as to how quality/effectiveness of IDE should be measured; we recommend authors consider systems-level approaches to designing and reporting their initiatives and the explicit student needs they serve.