Students' perceptions of interprofessional collaboration on the care of diabetes: A qualitative study of focus-group interviews

Background: Interprofessional education (IPE) can promote healthcare professionals’ competence to work in interprof essional collaboration (IPC), whi ch is essential for the quality and safety of care. An interprofessional approach is particularly important in complex, chronic diseases like diabetes. A number of studies have been published on IPE, but only a few with a qualitative approach. Methods: The objective of this qualitative study was to evaluate changes in medical and nursing students’ perceptions of IPC, induced by a novel IPE course on diabetes care. The data from focus-group interviews of 30 students before and after the course were analyzed by using an inductive and deductive content analysis. Findings: The students´ perceptions were illustrated as Elements of interprofessional care (e.g. Elements formulating care team and Quality of professional care relationship ) and Elements of IPC (e.g. Importance of communication and Valuation of collaboration ). The post-course interviews added one subcategory ( Need of resources ) to the pre-course perceptions, and there was improvement in ten areas of self-perceived competence in performing or understanding IPC on diabetes care. Conclusions: The IPE course piloted in this study increased the students’ self-perceived competence and confidence in performing IPC on the care of diabetes, and changed their understanding of IPC towards a more patient centered and holistic perspective. More research is needed to evaluate the generalizability and sustainability of these changes.


Introduction
As today's health care professionals are facing challenges in a fragmented and constantly changing health care system and with complex health issues, interprofessional collaboration (IPC) and interprofessional education (IPE) are highlighted as an essential solution in managing it (Institute of Medicine, 2015;Roing, Holmstrom, & Larsson, 2018;World Health Organization, 2010). There is a growing body of evidence relating the quality of collaboration and teamwork among health professionals to the quality and safety of health care delivery in acute conditions (e.g. Schmutz & Manser, 2013), as well as in chronic diseases (e.g. Körner et al., 2016;Wagner, 2000). Furthermore, failures in collaboration and teamwork are associated with a remarkable amount of preventable patient harm, role boundary conflicts, and staff fatigue and turnover (Kvarnstrom, 2008;Rosen et al., 2018). Therefore, the World Health Organization (2010) highlights interprofessional collaborative practice (IPCP), where "multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities" as a setting, where cost-effective, highest quality care can be delivered (Institute of Medicine, 2015;World Health Organization, 2010).
In particular, an interprofessional collaborative approach is highly important in the care of complex, chronic diseases like diabetes, which is considered to be one of the most serious global health concerns (International Diabetes Federation, 2017, 42, 99). Implementing IPC in diabetes care has been supported, in order to provide cost-effective, patientcentered and optimal care for the large group of people with type 2 diabetes, with fewer diabetes complications and hospital admissions (e.g. Antoine, Pieper, Mathes, & Eikermann, 2014;Johnson & Carragher, 2018a;Tricco et al., 2012). Yet, insufficient collaboration and teamwork are known to weaken the delivery of diabetes care even in today's healthcare (Stuckey et al., 2015), and education, training and collaboration of interprofessional healthcare teams for diabetes management is widely encouraged (Holt et al., 2013;International Diabetes Federation, 2017, 99;Johnson & Carragher, 2018a).
In the past few decades, IPE, where "two or more professions learn about, from and with each other to enable effective collaboration", has been shown to enhance the knowledge and skills necessary to work and collaborate in interprofessional healthcare settings (World Health Organization, 2010). In a review of reviews, Reeves and colleagues (2017) confirmed a positive impact of IPE on the participating students' collaborative knowledge, skills, and attitudes, but only a minor effect on behaviors, collaborative practices and improvements in patient care. In diabetes management, several IPE programs have been implemented with positive results, such as improvement in students' knowledge and skills, confidence and motivation in treating patients with diabetes, and in teamwork competency (Kangas, Rintala, & Jaatinen, 2018). By contrast, IPE´s influence on students' attitudes towards other disciplines has been more variable (Thistlethwaite, 2016), and also weak outcomes have been reported (Kent & Keating, 2015). More research is required to refine health education and thereby the competence of healthcare professionals, to meet the needs of patients and populations (Frenk et al., 2010;Interprofessional Education Collaborative, 2016;World Health Organization, 2010). Qualitative research, in particular, is required to gain holistic understanding of the impact of IPE on current and future healthcare professionals and the care they deliver in IPC (Institute of Medicine, 2015; Reeves et al., 2017).

Aims Of The Study
This study aims to explore changes of medical and nursing students´ perceptions of IPC on diabetes management after an experimental, voluntary course of IPE. The study questions are:

1.
How do medical and nursing students perceive IPC in the care of diabetes before an IPE course on diabetes management?

2.
How do the students' perceptions of IPC in diabetes care change during an IPE course on diabetes management?

Research design
This is a descriptive study, with a qualitative approach to students' perceptions of IPC in the care of diabetes. The data gathered before and after an IPE course through focusgroup interviews were analyzed iteratively in two phases, using inductive and deductive content analysis.

Course identification and participants
A pilot course called "Interprofessional Care of Diabetes" was held in co-operation with the University of Tampere and Tampere University of Applied Sciences. A professor of internal medicine/endocrinology (PJ) and a principal lecturer of nursing (T-MR) formulated the structural design of the course, and the content was produced in collaboration with an interprofessional team of diabetes professionals. This four-month, voluntary IPE course offered an overview and experience of the IPC of diabetes for 15 medical and 15 nursing students, who had previously finished their basic studies in diabetes care.
The course introduced experts in various areas of diabetes care and in guiding the selfcare of people with diabetes, to increase the students' understanding of the role of different disciplines in diabetes management. Endocrinologists, diabetes specialist nurses, a podiatrist, a social worker, a dietitian, and a geriatrician, delivered interactive lectures on subjects selected by the students and covering the main areas of interprofessional care of diabetes. In addition, the course targeted at enhancing knowledge, skills and ability to work in an interprofessional team. Therefore, these skills were fostered for example in small group discussions and participating as a nurse-physician pair of students in two active working visits of half a day each, including clinical work in a gerontological ward and at a diabetes outpatient clinic, and preparing a team presentation. In addition, four 2hour interprofessional seminars were organized, including presentations of the patient cases the students met on their clinic visits. Finally, the students were interviewed in three groups, each of them consisting of an equal number of medical and nurse students.

Data collection
Prior to the course, medical and nursing students were mixed in three groups of ten students each (n=30). An equal number of students of both professions were included in each group, and these groups studied together throughout the course. The interviews were performed in a classroom without outsiders. A moderator specialized in qualitative research, who was also a course author (T-MR), conducted the focus-group interviews before and after the IPE course, with the help of a second course author (PJ). An openended semi-structured interview form, built according to the purpose and goals of the study, was used in all the interviews (Morgan, 1997, 10, 14). The questions concerning the students´ perceptions of IPC in relation to the care of diabetes were: How do you conceptualize teamwork in the care of diabetes? How do you define interprofessionalism in the care of diabetes? How do you estimate your competence in the care of diabetes? The participants were encouraged to interact and talk to each other by additional, probing questions, which enabled them to explore and clarify individual and shared perceptions (Holloway, 2016, 128, 133). One example of the additional questions used in the interviews was: What do you mean by a team leader? The interviews were recorded and written in textual form in a MS Word file. The duration of the interviews ranged from 52 to 70 minutes, and the transcribed text for all interviews comprised a total of 52 pages (1,5spaced). The interviews were performed in Finnish and the quotes presented here were translated into English by the first author (SK) and the translations were revised by a professional translator.

Data analysis
Firstly, an inductive content analysis was chosen to answer the first study question of pre-course interviews, as it presents systematic and objective analysis of previously unknown phenomena (Elo & Kyngäs, 2008). Secondly, a deductive content analysis was used to answer the second study question, as it enables comparing data at different time periods (Elo & Kyngäs, 2008) and can be used when testing previous knowledge in a new context (Catanzaro, 1988). Categories of students' pre-course perceptions were set in a framework, to be tested against the post-course interviews, aiming at discerning possible changes in student perceptions.
In the inductive phase, the first author (SK) listened to the pre-course interviews against the written text and checked the accuracy of the written version. The interviews were read and listened to several times, to obtain an overview of the data. Then, open coding was performed by underlining different meaning units in the text, by framing the study questions, and by making notes of headings in the margins on different aspects of the content. (Bengtsson, 2016.) Repetitive meaning units of the same characteristics were condensed by shortening the units without losing the content, coded and grouped in subcategories. Each code was compared for differences and similarities between subcategories and sorted again to reach agreement of the descriptive content. (Graneheim, U. H. & Lundman, 2004;Graneheim, Ulla H., Lindgren, & Lundman, 2017.) Here we judged the internal homogeneity and external heterogeneity of the subcategories (Patton, 2015, 555). Finally, the subcategories were divided into representative generic categories and named with content-characteristic names. During the analyzing process, these stages were revised back and forth to verify the quality and trustworthiness of the analysis (Bengtsson, 2016). The coding process of the first author (SK) was tested independently by another author (T-MR) and thereafter, an agreement of the categorization was discussed together to foster validity (Elo & Kyngäs, 2008). An example of the analysis process is presented in Table 1.
In the deductive phase, a structured categorization frame (Table 2) was developed, based on the previous categories derived from the pre-course data on student perceptions of IPC on the care of diabetes (Table 3) (Elo & Kyngäs, 2008). The post-course interviews were, similarly to the pre-course interviews, listened to and compared with the text for accuracy. Thereafter, the interviews were read through several times and all meaningful descriptions of phenomena were systematically identified and highlighted in the text, and coded according to the existing categorization frame. The meaningful units that did not fit in the pre-defined categorization frame were collected separately, to be analyzed inductively. The notions of the students' self-perceived improvements in understanding or managing IPC in the care of diabetes were distinguished in the frame after re-assessing the data. In addition, the initial codes of pre-course were compared against the codes in the categorization frame, to reveal changes in descriptive content and distinguished in the frame. Finally, all these findings were abstracted in a summative presentation (Table 4).
Again, the coding and analysis process performed by the first author (SK) was tested independently, discussed together, and agreed on in consensus with another author (T-MR).

Ethical considerations
The IPE course and the associated study protocol were approved by the University of Tampere Planning Committee of the Degree in Licentiate of Medicine. The participants were informed of the study protocol, of their rights and the ensurance of anonymity and confidentiality in the study. An oral consent was obtained prior to the interviews from all the participants. The interviews were a mandatory part of the course.

Findings
The students' perceptions of IPC in the care of diabetes before the IPE course were classified into two main categories: Elements fostering interprofessional care and Elements fostering interprofessional collaboration. Within the main categories, six categories were distributed as presented below and in Table 3. The students' interviews after the course added one subcategory (Need of resources), whereas there were improvements in ten areas of self-perceived competence in performing or understanding IPC on the care of diabetes. The changes and additions in perceptions are summarized in Table 4 and added in the text below.

Elements formulating care team
Competent professionals in liaison. The students understood that the care team in diabetes management required a variety of competent professionals working collaboratively. A common perception was that the core team of care consisted of a pair of professionals, i.e. a nurse and a physician. After the course, the students described their learning about the role of social workers, podiatrists, nutritionists, and physiotherapists.
Following the profession-specific responsibilities and areas in work was evaluated to be the basis of collaborative work in the pre-course interviews: "I think it (teamwork) means that a doctor takes care of the doctor's part and a nurse takes care of the nurse's part." (Pre-course group 1) However, a collaborative perspective was highlighted in the postcourse interviews, and it was considered important that "different professionals do not just take care of their own areas, but they discuss various perspectives together." (Postcourse group 2) In addition, in all of the post-course interviews the students regarded themselves as more competent performing the care of diabetes through added confidence: "A kind of certainty about diabetes care has increased quite a lot. In a way I feel more secure about diabetes care, in general." (Post-course group 1) Patient's and team's role. In the pre-and post-groups the patient's role in the care team was considered to depend on the patient´s own motivation and commitment to care. The patient was considered a responsible member of the team, revealing the possibilities and barriers and success of care in his/her context of life. All the groups considered the patient responsible for the success of diabetes management. The pre-interviews revealed descriptions of the team's passive role, as it was considered to be solely the patient's own decision to seek and use, or not use, the competencies the team has to offer. As it was mentioned in a pre-course interview: "(The patient) really isn´t a member of the team, but the one who seeks professionalism from us. If you don´t play together with the team, you are not a part of it." (Pre-course group 2) In the post-course interviews the team's role was described to be more active and responsible. It was noticed that "You need to take more notice of the patient in diabetes care; You should participate in the care on his/her own terms." (Post-course group 2) A need of the team supporting the patients selfmanagement was mentioned in one post-group discussion, especially when the patient was not able to take full responsibility for his/her diabetes care.

Quality of professional care relationship
A continuous and responsible care relationship. It was considered that a continuous professional care relationship with one or two professionals is important in the care of a chronic disease, and would enhance patient's commitment to care. A continuous professional care relationship was also connected to an aspect of responsibility, when "the patient is really being cared for" (post-course group 1) and it would decrease the attitude "this is none of our business, this (patient) doesn´t need to be treated here." (Pre-course group1) A supportive and holistic professional care relationship. The meaning of a supportive professional care relationship was highlighted in one pre-course interview, and in all three post-course interviews. It was considered that a good, supportive atmosphere in a professional care relationship would decrease the need for care from other professionals, if the patient were treated holistically, as an individual. The students perceived after the course that their competence in supporting the patients was increased, as they could better empathize with the patient and deal with the different aspects of care. The psychological distress due to a chronic illness was recognized better: "I can empathize, if a patient expresses that he/she would like to talk a bit about having this diabetes, I feel I know more." (Post-course group 3)

Factors enabling a functional process of care
Shared goals. It was stated to be crucial that all the members of the care team shared common goals to aim at in diabetes management. "It doesn´t really work if people go different ways; you`ll have to have one shared goal to aim at." (Pre-course group 2) After the course, it was added that the goals, as well as the ways to achieve them and to assess the results, should be collaboratively agreed on and evaluated.
A clear plan of the care pathway. In all of the interviews, the students mentioned the need of a clear care pathway, a practice-specific flow chart of the experts available and a policy frame on how to proceed, as the resources and policies of different practices varied. The students expressed in the post-course interviews having an improved clarity of how IP care can be organized.
An easy referral process. Another aspect perceived important in facilitating IP care of diabetes was a quick and easy referral process. The process of referring the patient to another expert was expected to be fluent, or at best, the referrals would be carried out within the familiar care team, and without any stiff policies. "It (IP teamwork) would be executed with low thresholds, so that you don´t need a referral to see the physiotherapist; it could be the physiotherapist of the diabetes team and it would be somehow more fluent." (Pre-course group 3) The functional environment. In all the interviews the students expressed that interprofessional care would be ideally organized, if various professionals were situated in same premises. Thereby, the care was considered to be more effective enabling "simultaneous doing and talking". (Pre-course group 1) Coffee rooms were found important in fostering informal change of ideas between experts of different professions and building shared trust towards each other, whereas additional technical support for quick consultation was suggested to be worthwhile to develop.

Need of resources.
In the post-course interviews the students evaluated that IPC might need substantial resources, in order to have several professionals available or to have more time to properly discuss with the patient from various perspectives.

Maximal benefit from professional competencies
Awareness of one's own skills and limits. All of the discussions underlined the importance of recognizing one's own skills and limits. The students addressed the fact that sometimes one's skills are not enough, and it is not even necessary to know everything. In all of the post-course interviews students evaluated that they had gained knowledge and skills of various areas in IPC. Moreover, they expressed having gained a more clear and comprehensive understanding of interprofessionality as a whole. They expressed deeper self-evaluation of what they can do, and thereby of their limits, as they felt that: "Knowledge increases your pain; You realize that you actually don´t know so much." (Postcourse group 2) Once the students reached a better awareness of their competence, they also "understood their own value". (Post-course group 1) Awareness of others´ roles and competencies. In all of the interviews, the students recognized the importance of understanding profession-specific roles and tasks. When "you know what you are doing and you know what others will do" (Pre-course group 2) and "when we work together according to each one's responsible areas" (Pre-course group 3), it was considered possible to seek for other professionals' help and to collaborate interprofessionally. Before the course, the students expressed some uncertainty of the boundaries what each profession´s role was. After the course, they expressed deeper understanding of the roles and competencies of various experts, and moreover, better understanding of each other's level of competence and education, as well as their different approach to diabetes care: "I did not know before how diabetes was taught to nurses, but now I somehow know it; I have an idea of their level of competence. Our approach to care and the process of thinking is a bit different; it´s good to be aware of it." (Post-course group 2) Negotiation of task distribution. The distribution of work tasks was considered important, in order to increase the efficiency of care and to minimize excessive patient referrals. The students stated that when there exists "a clear distribution of tasks in the team (Postcourse group 3), then "the same things will not be repeated several times." (Pre-course group 1) Seeing the potential benefit from others. Finally, all student discussions revealed willingness to see others´ competencies and IPC as an advantage to the professionals, and in the end, to the patients. The possibility to consult various experts when needed was regarded to reveal new aspects in diabetes management, leading to the situation where "you can also learn at the same time" (Pre-course group 3) and where "both of them will benefit from each other." (Pre-course group 1) other" (Pre-course group 3) as "there´s no wall between, so you can deal with important things" (Pre-course group 3). In addition, collegiality was underlined in teamwork, "so that you shouldn´t need to think, whether or not you can go and ask this thing." (Post-course 1)

Valuation of collaboration
Respecting other professionals. This category reveals the students' equal respect for other professionals due to their competencies, and the overall appreciation of the other experts' presence in the team. Equality between the professionals was highly valued, and the course was seen as "a good way to decrease a kind of doctor-nurse hierarchy division." (Post-course group 1) Trusting other professionals. Students also expressed in many ways, how important it is to trust other professionals´ work in IPC. When "you can trust the others' competence, both ways… if you kind of trust your team, then everything runs smoothly (Post-course group 3) and thereby you can be sure that "the work won´t be left undone." (Pre-course group 2) Willingness to collaborate. In one pre-interview (Pre-course group 3), there was a conversation on the meaning of professionals' willingness to collaborate. Collaboration was considered important and valuable to aim at. Similarly, if rudeness was present between colleaques, it was noted that "things won´t work then." (Pre-course group 3) After the IP course, all of the interviews included the recognition that you need to have the right attitude towards collaboration and towards your colleagues, in order to work successfully. One student mentioned that due to increased understanding, it was easier to accept that you do not have to work heroically alone, but collaboratively solve the problems the team is faced with.

Discussion
In this qualitative study, we evaluated the perceptions of undergraduate medical and nursing students, regarding IPC in diabetes care, before and after a pilot IPE course with focus-group interviews. After the IPE course, students' understanding of IPC in diabetes care and awareness of other professionals' roles and level of competencies was increased.
Furthermore, we found an increase in students' self-perceived abilities, confidence and willingness to perform IPC in diabetes management, as well as a change in their understanding of IPC towards a more patient-centered and holistic perspective.
There is a growing need to prepare undergraduate health professionals for the interprofessional practices within the health care system, in order to strengthen their competencies and to improve the quality of patient care (Frenk et al., 2010;Interprofessional Education Collaborative, 2016;World Health Organization, 2010).
Moreover, a collaborative approach is widely encouraged in the education and care of diabetes (International Diabetes Federation, 2017;Johnson & Carragher, 2018b;Kangas et al., 2018). The relevance of this study to evaluate perceptions roots from Bandura's social cognitive theory integrating personal, environmental and behavioral determinants in learning process, and the evidence that perceptions and attitudes guide behavior (Bandura, 1977b;Holland, Verplanken, & van Knippenberg, 2002; see also Kauffman & Mann, 2014). Therefore, as the fundamental goal of IPE leans on students' ability to interprofessionally collaborate as professionals, it is meaningful to evaluate the impact of IPE on students' perceptions. to our students' perceptions after the IPE course. As the researchers also pointed out, it is an educational challenge to persuade the individuals to see more aspects relating to the patients' needs and perspectives. (Roing et al., 2018.) It seems that this IPE course had such an impact, but it is somewhat unclear, which aspects of this relatively short course contributed to such a remarkable change. We presume that the broadened views of the students may stem from the clinical experiences during the course, where patients with variable case histories were encountered in a real healthcare environment, and were discussed afterwards in interprofessional seminars and group discussions. This supports the practical element in education, which was also seen as IPE's strength in a systematic review of IPE in diabetes management (Kangas et al., 2018). Furthermore, perhaps the newly included category Need of resources in the post-course data may derive from the practical experience, where the students' previously built vision of IPC was re-adjusted and refined in a busy real-life health care context. This IPE course deepened the students' awareness of themselves as professionals and increased their understanding of other professionals' roles, competencies and different approaches to diabetes care. This is important in order to avoid inappropriate understanding of professions that can interfere with interprofessional communication and collaboration. (Cook & Stoecker, 2014.) In addition, the findings of students' perceptions of increased competence and confidence to treat patients with diabetes interprofessionally can be related to achieved self-efficacy, originally presented by Bandura (1977a). This belief in one's own capability will most likely be beneficial for students, almost ready to step into working life, because it has a positive association with the individual's choice of activities, effort, and persistence. Moreover, a strong perceived self-efficacy increases one's ability to deal with demanding situations. (Artino, 2012;Bandura, 1977a.) Our findings are in several aspects similar to previous IPE outcomes, but some differences exist, as well. Systematic reviews have proved IPE, e.g., to increase knowledge of the roles of other professions (Kent & Keating, 2015;Thistlethwaite & Moran, 2010) and to enhance the learners' confidence and motivation in diabetes management (Kangas et al., 2018). Similarly, Yu and colleagues (2016) (Körner et al., 2016).

Strengths And Limitations
This study comprised both strengths and limitations that need to be considered. The method applied in the present study is a combination of an inductive and a deductive analysis, aimed at revealing changes in the studied phenomena. The analysis method was, in our opinion, suitable for the purpose of the research, enabling a combination of different data and revealing possible changes with time. Moreover, the alternative way of analyzing also the post-course data inductively would have been inadequate, because of the inevitable pre-understanding of the phenomena being studied, due to the previously performed pre-course analysis. When conducting the analyses in the applied manner, the pre-understanding was more likely to enrich the deductive analysis, as the findings were well digested in the repeated analyses. As summarized by Patton (2015, 552), there is no one and only right way to perform a qualitative analysis. After carefully weighing the analytical options available, we chose the combination of inductive and deductive analysis of the focus group interview data, which we regarded as the most appropriate method for our study design and the issues studied.
The focus group interviews were a valuable method for the present study, as they enable reaching variable perspectives of people from fairly similar backgrounds, when the participants reflect their own thoughts against the views of others (Patton, 2015, 475, 477). We decided to interview medical and nursing students in the same focus groups, as we wanted to honour the main interprofessional agenda of the course. We acknowledged the fact that they were not quite similar regarding their background, and therefore, some of the students may have felt less secure to express themselves (Patton, 2015, 61). It is, however, debatable, if interviewing medical and nurse students separately could have given different findings. It has been stated that the focus group is the most suitable method, if the content that interests the research team, interests equally the participants in the groups, as well (Patton, 2015, 10). The students' interest and participation in this voluntary course can be seen as a collective background integrating these students together into a shared focus group.
A possible conflict of interest may entail, when the course authors are acting as moderators in the interviews. Nevertheless, as Patton (2015, 502) emphasizes, a good interviewer is truly interested in what the participants have to say and, undoubtedly, the authors had a genuine interest in the students' experiences of the pilot course they had designed. Similarly, as the author responsible for the analysis was related to the course as a study coordinator, a possible conflict of interest may exist. However, the analyses were performed carefully, according to ethical and methodological principles, to ensure the methodological rigor and trustworthiness of the study (Bengtsson, 2016;The Finnish Advisory Board on Research Integrity, 2012). In addition, as recommended by Elo and colleagues (2014), the trustworthiness was ensured by using one responsible author for the analyses, while the other authors followed the process and expressed their opinion in discussions. The validity of the findings was confirmed, as the authors who conducted the interviews and who, therefore, had preunderstanding of the issue, evaluated the categorizations made by the first author and approved their equivalence with the substance of the interviews (Catanzaro, 1988).

Conclusions
In conclusion, the IPE course piloted in this study increased the students' self-perceived ability and confidence to perform IPC on diabetes care and changed their understanding towards a more patient centered and holistic perspective, supporting further implementation of IPE on health care education. The sustainability of these changes needs to be explored in future studies.

Declaration of Interests
The authors report no conflicts of interest.

Shared goals Fac funct
Every member of the team knows the common goals to aim at in diabetes care (2 groups) Understanding that setting goals, planning the ways to achieve them and assessing them must be done in collaboration (2 groups)

Clear plan of care pathway
Need of a clear plan of the care pathway (2 groups) Achieved clarity of how IP care can be organised in practice (1 group) Easy patient referral process

Functional environment
Need of resources (Added subcategory after the IPE course)

Subcategory
Pre-interviews Post-interviews' addition / difference

Awareness of one's own skills and limits Maxi
Importance of recognizing own skills and limits (3 groups) Active evaluation of one's own competence. Awareness of improved knowledge, skills, limits and own value.
More comprehensive understanding of interprofessionality as a whole.

Awareness of others' roles and competencies
Importance of clear tasks. Unawareness of others' roles and competencies (2 groups Collaboration as a necessity. Need of the right attitude. Increased knowledge facilitates the acceptance of IPC (3 groups) * The number of interview groups where the item was addressed.