Impact of interprofessional education on students of the health professions: a systematic review

Purpose Interprofessional education (IPE) is a concept that allows students from different health professions to learn with and from each other as they gain knowledge about their chosen professions and the professions of their colleagues. The purpose of this systematic review was to determine the effectiveness of IPE in the academic preparation of students of the health professions. Methods A search was conducted of the PubMed and CINAHL databases using the following eligibility criteria: IPE including students from 3 or more healthcare professions, IPE exposure within academic coursework, measurement of attitudes and/or perceptions as outcomes, and quantitative reporting of results. Articles were screened by title, abstract, and full text, and data were extracted. Results The search yielded 870 total articles. After screening, 7 articles remained for review. All studies reported a positive impact of IPE on the education of students of the health professions. Conclusion Evidence showed that IPE activities were an effective tool for improving attitudes toward interdisciplinary teamwork, communication, shared problem-solving, and knowledge and skills in preparation for collaboration within interdisciplinary teams.


Introduction Rationale
The World Health Organization has cited interprofessional education (IPE) activities as a powerful learning tool in efforts to improve healthcare delivery [1]. Effective interprofessional collaborations have resulted in decreased medical errors, increased patient satisfaction, and improved patient care [2,3]. Data collected from IPE studies may be beneficial for improving academic health professional programs, preparing students for their chosen profession outside of the classroom, and refining patient-centered care [3].
Due to the complex nature of the health issues that many pa-tients face, there is an increasing need for interprofessional collaboration among healthcare practitioners. Interprofessional practice contributes to knowledge of effective communication, the importance of distinguishing team roles, and efficient solutions for resolving conflict [4]. Healthcare faculty members across the United States have recognized the importance and benefits of implementing IPE in the academic curriculum [1]. IPE is a concept that allows students from different health professions to learn with and from each other as they gain knowledge about their chosen professions, as well as the professions of their future colleagues [3,5]. Various IPE activities should occur in an environment that supports collaborative learning to better facilitate interprofessional practice in the clinical care of patients [3,5].

Objectives
The objective of this systematic review was to determine the effectiveness of IPE among students of the health professions.

Ethics statement
This report examined previously published work. Therefore, it did not require approval from an institutional review board.

Study design
The preparation of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which outline specific criteria to be included in written format. The PRISMA tool consists of 27 items that have been created to ensure that essential information is expressed [6].

Eligibility criteria
Articles that were included in this review required participation in IPE activities by students from 3 or more healthcare professions, and the IPE exposure must have been included within academic coursework. Additionally, the studies must have reported quantitative measures of student attitudes and/or perceptions about their IPE experiences as outcomes.

Information sources/search
A search of the literature was performed in October 2018 using the PubMed and CINAHL databases. The search included terms related to healthcare, healthcare professionals, students, and IPE. Searches were limited to articles in the English language published within the last 10 years.

Study selection
Duplicate articles in both databases were eliminated from one set of the search results. Titles were screened by 4 of the authors divided into 2 groups. If title screening resulted in a tie, it was pre-sented to the opposite group for a final decision. This process was followed by a screening of the abstracts utilizing the same methodology. After the abstracts were screened, the full text of the remaining articles was screened by all authors in order to determine which articles would be included in the review.

Data collection process and data items
The articles chosen from the screening process were analyzed by the authors for data extraction, and the findings were discussed with the group. The data extracted from the articles included the number of participants and the specific type of health profession training program in which they were enrolled, the type of interprofessional learning activity that was included, the specific outcome measures used, and the authors' findings.

Risk of bias assessment
The quality assessment tool for before-after (pre-post) studies with no control group was used to assess the quality of the articles included [7]. This is a 12-question tool developed to allow reviewers to systematically assess the internal validity of a study. Each question was answered with yes, no, or not reported, and the total number of affirmative responses was recorded.

Study selection
The article search yielded 870 articles, of which 24 were eliminated due to duplication. The titles of the resultant 846 articles were screened; through this process, 632 articles were eliminated, resulting in 214 articles for the abstract screening. Screening of the individual abstracts yielded 14 articles that underwent full-text screening. Following the complete screening process, 7 articles were selected to be included in the review (Fig. 1).  Attitudes Towards Health Care Teams Scale 1st sem: led to significant improvements following the intervention (P = 0.00) 2nd sem: showed no significant improvements Team Skills Scale 1st sem: showed significant improvement in team skills (P = 0.00) 2nd sem: reported significant improvements (P = 0.01) -Between-group comparisons showed more significant improvements in the 1-sem program than in the 2-sem program (P < 0.05) Ruebling et al. [11] (2014) Athletic training (15); clinical laboratory (9); cytotechnology (2); health information management (2); investigative medical sciences (15); nuclear medicine (4) Students completed a questionnaire before the IPE program, after IPE training and upon completion of the IPE consisting of didactic and community service work.

Study characteristics
The 7 studies consisted of participants from a wide variety of health professions who took part in IPE activities within their academic coursework. The number of health professions included within each study ranged from 3 to 11, and the number of participants ranged from 30 to 291 (Table 1).

Risk of bias
The results from the quality assessment tool for before-after (pre-post) studies with no control group are shown in Table 2. The quality scores ranged from 7 to 10 out of 12, with a mean of 8.7.

Summary of evidence
The evidence from this review showed that IPE activities were an effective tool for improving attitudes toward interdisciplinary teamwork, communication, shared problem-solving, and knowledge and skills in preparation for collaboration with other members of interdisciplinary healthcare teams. All 7 studies yielded significant results in regard to IPE among students of the health professions and its positive impact on students' attitudes related to interprofessional teamwork [3,5,[8][9][10][11][12]. Positive results were found among several healthcare professions, supporting the incorporation of IPE in the academic preparation of future healthcare providers across disciplines. Although varied outcome measures were utilized across the studies, each showed some impact on attitudes and self-perceptions of interprofessional teamwork in the delivery of healthcare services.
The works by Ruebling et al. [11] in 2014 and Leithead et al. [8] in 2018 each incorporated outcome measures that included items addressing interpersonal communication and problem-solving, which demonstrated significant changes after IPE activities. Effec-tive communication and collaborative efforts to find solutions to clinical issues across healthcare professions is essential for achieving the best outcomes for patients and establishing a positive work environment. These findings are supported by the works by Paige et al. [9] in 2014 and Cino et al. [5] in 2018, who also found significant improvements in constructs related to communication among the healthcare team, while Paige et al. [9] in 2014 and Stubbs et al. [12] in 2017 suggested that IPE may be beneficial for improvements in shared problem-solving. In addition to benefits in teamwork, communication, and shared problem-solving, the studies by Renschler et al. [3] in 2016 and Cino et al. [5] in 2018 each suggested that IPE activities may improve knowledge and skills among students of the health professions, which may ultimately benefit the consumers of healthcare services.

Limitation
Publications within this review were limited to the English language; therefore, important work published in other languages may not have been represented. Additionally, studies that consisted of participants from only 2 healthcare professions were excluded, which may also have led to the omission of important works.

Conclusion
The information gleaned from these studies supports the incorporation of IPE in the educational preparation of healthcare professionals. Important aspects of healthcare delivery, such as working within a team environment, the ability to work together in a way that promotes shared decision-making to find positive solutions, effective interpersonal communication, and excellent knowledge and skills, may be positively influenced by the utilization of IPE activities across health professions within academic programs.