Cohort Assessment of Pharmacy and Medical Student Attitudes from Baseline to Program Completion.
Background: United States medical and pharmacy curricula are typically four years, including pre-clinical and clinical components. It is unclear how perceptions of interprofessional collaboration changes over the life cycle of these programs. Pharmacy and medical students participated in three shared interprofessional learning experiences within the first two pre-clinical years, then non-uniform experiences during years 3 and 4. Our specific aim was detection of change in student responses from baseline until program conclusion using the validated 27 item Interprofessional Attitudes Scale (IPAS). The IPAS includes five subscales addressing teamwork, roles and responsibilities, community-centeredness, diversity & ethics, interprofessional biases, and patient centeredness.
Design: a quasi-experimental design was used for the student cohort graduating with the class of 2022. The IPAS was administered five times including (1) the start of the year one, (2) toward the end of year one following delivery of fall and spring interactive interprofessional learning sessions, (3) mid-way through year two following simulated standardized outpatient encounters, then at the end of curricular years three (4) and four (5). Students completed survey responses to items on a scale from 1 (strongly disagree) to 7 (strongly agree). A linear mixed model was used to simulate a repeated ANOVA design to detect differences in mean subscale scores between annual IPAS scores and baseline. Pairwise comparisons were completed using Tukey’s method and p values < 0.05 indicated significant differences.
Results: baseline IPAS completion rates were 93 and 73.5% for pharmacy (n=57) and medical (n=136) students, respectively. Overall mean level of agreement with most IPAS survey subscales was highest at baseline (6.3 to 6.82) and trended down significantly for the subscales of teamwork, roles and responsibilities and community-centeredness. The overall subscale of interprofessional biases was lowest at baseline (4.34) and trended significantly upward by year two, remaining significantly higher for both pharmacy and medical students at the end of the fourth year.
Conclusion: at the start of matriculation, student perceptions in relation to interprofessional dynamics may reflect innate optimism, socially desirable responses and incomplete appreciation for biases. Further research is needed to explore whether changes in attitude impact interprofessional collaboration and community-centered care delivered by pharmacy and medical students participating on interprofessional teams during the clinical education years.
Reflections: the apparent changes in attitude may reflect traditional profession-centric educational models vs. maintenance of a population-centered care model that intentionally incorporates team-based focus on social determinants of health for clinical education years three and/or four.
