Research This open-access article is distributed under

Creative Commons licence CC-BY-NC 4.0.

Facilitating community-based interprofessional education and

collaborative practice in a health sciences faculty: Student perceptions
and experiences
A Rhoda,1 PhD; N Laattoe,2 MPhil; G Smithdorf,3 BSc; N Roman,4 PhD; J Frantz,5 PhD

1
Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
2
Interdisciplinary Centre for Sport Science and Development, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
3
Sport, Recreation and Exercise Science Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
4
Child and Family Studies Unit, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
5
Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa

Corresponding author: A Rhoda ([email protected])

Background. Interprofessional education (IPE) aims at facilitating the collaborative practice of healthcare professionals. However, students have varied
experiences with IPE and the collaborative practice initiatives implemented by universities.
Objective. To explore the experiences and perceptions of health science students of an IPE Collaborative practice (IPECP) intervention they had engaged in.
Methods. This qualitative study used two focus group discussions with a conveniently selected group of students who had been part of the intervention.
Two researchers who were not part of the intervention conducted the interviews. The audiotaped interviews were analysed using thematic analysis.
Ethical clearance for the study was received from the University of the Western Cape.
Results. Three main themes emerged from the data: the usefulness of the framework introduced as part of the intervention; engaging in interprofessional
groups; and the overall impact of the intervention. The students reported that they needed introduction to the framework earlier for it to be useful.
It became apparent that students need to be prepared to work in interprofessional groups. The overall intervention was perceived positively, allowing
students to become aware of other students’ roles.
Conclusion. The students experienced a lack of knowledge and therefore struggled with the applications of the International Classification of
Functioning Disability and Health as a framework to facilitate IPECP. However, they experienced the IPECP intervention as providing structure to the
clinical placements, making it a more positive experience.
Afr J Health Professions Educ 2016;8(2 Suppl 2):225-228. DOI:10.7196/AJHPE.2016.v8i2.846

The World Health Organization[1] advocates the promotion of social clinical practice experience is also highlighted, as it enhances respect for
accountability in professional education, with close collaboration with other professionals and provides insight into the value of interprofessional
communities. This advocacy for social accountability is important and care for effective healthcare delivery.[6] The concept of appreciating and
needs fostering during student training. In health professions education, valuing the role of other professions has also been expressed by doctors.[7]
social accountability means that students must have the ability to Primary care settings have been identified as providing opportunities for
adjust to the needs of patients and communities. One of the vehicles learning in an interprofessional manner.[4]
identified to achieve this is the ability to address the needs of patients It is, therefore, clear that IPE and collaborative practice interventions
and communities in an interprofessional manner; this requires the could facilitate the development of competencies of students, which they
training of health professional students in an interprofessional manner could apply as graduates to enhance the health of the population. The
to gain skills in aspects such as collaborative practice. Health science application of interprofessional activities in community settings thus may
faculties implement various interventions to facilitate the development assist in improving the patient experience by providing holistic care and
of interprofessional core competencies, which include the identification assisting in improving the health of the community. The objective of this
of roles and responsibilities, patient-centred care, professional ethics and article is to present the findings of a study that explored the experiences of
interprofessional communication.[2] One key competency and domain of health science students who engaged collaboratively when addressing the
interprofessional education (IPE) and practice is collaborative practice. needs of communities.
Interventions used to promote collaborative education and practice include
the integration of strategies into existing curricula[3] and the placement of Methods
interprofessional students at the same clinical sites.[4] Research setting
The literature mentions a number of positive outcomes with regard to The Faculty of Community and Health Sciences at the University of the
facilitation and/or implementation of IPE strategies. It has been suggested Western Cape (UWC), South Africa, comprises nine entities, including
that interprofessional learning facilitates the ability to work together departments and schools. Undergraduate students from the Faculty rotate
as qualified professionals, while positively affecting service delivery to through a number of community-based settings as part of their clinical
communities.[5] The value of providing students with interprofessional practice modules. One such setting is a rehabilitation project based in

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Mitchell’s Plain, a semi-urban community. To facilitate community-based ‘… we started three weeks ago here, that’s when I first heard about it for
interprofessional practice, a 7-week programme was implemented. Students the first time … .’
placed at the project during the programme implementation met once a ‘I heard about it [before] but I did not actually know it.’
week for a 2-hour session. These sessions were co-ordinated by a facilitator,
who was part of an interprofessional unit based within the Faculty. The One student in particular provided a very detailed description of the ICF
sessions introduced the students to concepts such as the International framework:
Classification of Functioning Disability and Health (ICF), and were further ‘It’s basically like to identify the different needs of the patient … we had to
used to facilitate the IPE core competencies. For the interprofessional identify what was our purpose, how we’re going to change, do the people
practice interventions, students were divided into interprofessional groups, need psychological, do they need motor skills where a physio can come
where each group had to engage with a specific community facility or group. in, are there biokinetics students that need to come in. It’s basically how
to identify and classify their needs, what they need in different aspects of
Research design that, like with your environment, with them alone, abilities, disabilities,
A qualitative approach was chosen to explore the students’ experiences of things like that.’
the programme.
One student was also very positive about the ICF framework:
Population and sampling ‘Also this ICF thing, we got introduced to it a couple of weeks ago, it was
To obtain information about students’ experiences of the intervention, quite interesting. I’d say it was more constructive in that there was an aim
a convenience sample of students (interprofessional group) participated and a point and direction in the programme that we’re following … I’d
in two focus group discussions. A total of 12 participants, comprising say now than before, I’ve learnt more … So, I’d say it’s a good programme.’
physiotherapy, biokinetics and nursing students, formed the focus groups.
The responses from the students highlighted that although some of them
Data collection were introduced to the ICF earlier in their programmes, they still had a
A researcher not involved in the implementation of the programme problem applying the framework in the clinical setting:
conducted the focus group discussions. An interview schedule was designed, ‘It’s something you should maybe incorporate from the 1st year, because I
with open-ended questions intended to elicit qualitative information. spoke to some of the [students who had been introduced to the framework
The questions related to students’ experience of the intervention. The in theory lecture] … frankly and quite not even they could help … .’
focus group discussions were conducted at the end of the rotation and
were audiotaped and transcribed verbatim. The data were then analysed Some students did not experience their engagement with the framework
thematically.[8] Progressing through this process, the use of colour coding as positive and a learning experience but as something forced upon them:
led to the checking of the emergent themes and patterns against the ‘… because it’s not a module that we have taken through, it’s just thrown
categorised data. The checking cross-validated the data sources and at you, “There, you must use it”.’
findings, and created links between the different parts of the data and the
emergent dimensions of the analysis. To facilitate trustworthiness, one of Application of the ICF
the researchers (NR) confirmed the emergent themes and categories. Ethical In terms of how the ICF was applied, students highlighted the usefulness of
clearance was obtained from UWC (ethics number 13/3/9). the framework and the length of time required to apply it. Furthermore, the
students were contradictory in the application of the ICF. This contradiction
Results and discussion was expressed by the way they felt about the ICF and their experiences, as
During the focus group discussions, the students were asked about their well as their attitudes towards its use:
experiences as these related to the intervention. The objective of the ‘I think the ICF … has its perks and its disadvantages but I think you
intervention was twofold, including the use of the ICF framework as need a person that’s seen more over a longer period of time … .’
well as the development of IPE core competencies, which included role
clarification, ethical behaviour and professional communication. Themes It was clear that students did not always find it useful and could not see the
that arose on the use of the ICF as a framework included knowledge about relevance of applying the framework, given the length of time they spent at
the framework, and its applications and usefulness. The theme that arose the clinical rotation and the type of rotation. Students indicated that for the
with regard to core competencies was students’ experiences of working in ICF to be effective in the clinical setting, they need access to patients for a
interprofessional teams, focusing primarily on role clarification. longer period to see the impact:
‘I don’t see the point of doing it for a patient I’m seeing for 4 weeks once
Knowledge of the ICF off. It becomes very boring and I think that’s where people lose interest
From the participants’ responses, it became evident that there was a in it. It’s a different story, however, if I’m seeing a patient over a course of
difference in the knowledge base of the students with regard to the ICF and 4 to 6 months.’
its use in the clinical setting. Some students had only been introduced to the
ICF on the community-based clinical rotation, while others had received However, the application of the framework became clearer as the weeks
theoretical input about it during lectures on campus: progressed and students could apply it further to their clients:
‘So I feel it’s just something that you must incorporate from the very, very ‘So each week it became better, because you literally have to, like …
beginning … .’ see what it is this week what he [the facilitator] wants this week in the

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beginning it was … why do I have to do this … so I think that’s why?’ ‘I just don’t know what to do with them … Two times I took them to the
‘I wanted to say that, the ICF, like, it helps us also as among the things that park, they were just playing … .’
we contribute to … home bases, yes, to the site …what we contributed,
the things that we’ve done because they’ll ask us if we communicated with The students highlighted that this problem could be solved with the
the group, about things like that … .’ guidance of facilitators. Role clarification and teamwork are two important
competencies of IPE.[11] It emerged from the study that students either
The findings clearly indicate a need to introduce a framework to students struggled with the role of their team members or only had a superficial
before expecting its application during a clinical setting. The use of understanding of their role. Previous engagement with students from
authentic learning activities may have addressed the challenges experienced the same profession assisted them in gaining an idea of the role of
with engagement of a framework for the first time during a clinical others. Collaborative practice, which is facilitated by IPE activities, is
rotation. Authentic learning could involve collaborative learning activities, needed to address the health needs of individuals.[11] Therefore, it is
where students engage with cases that mimic real-life cases and therefore important for health professionals to understand the roles of their team
prepare students for clinical placements.[9] The use of facilitators who could members. Although students lacked an understanding of these roles, the IPE
accompany students to the clients could also have assisted in promoting a collaborative practice (IPECP) intervention explored in this study provided
better understanding and application of the framework.[3] students with the opportunity to think about the role of others, thereby
Students seemed only to find the tool useful if they could actually creating an awareness that could be deepened through other educational
see a change in the domains or constructs identified by the ICF. The activities in the various programmes.[1]
students viewed the framework as an instrument that measured outcomes In the context of roles and responsibilities, students were very clear about
and not as one that conceptualises the functioning of individuals or the role of the facilitators. Students indicated that the facilitators should
groups of individuals. There was, therefore, a misinterpretation of the guide the process of interacting with other professions and focusing on the
use of the framework, which led to students’ lack of understanding of its tasks. They should provide clarity on roles and responsibilities. If this is not
relevance. Students often struggle to understand the relevance of aspects provided, confusion prevails:
of a curriculum, and the use of case-based and problem-based learning ‘With our group in the beginning of the term, you had the skills and
approaches could assist with increasing the relevance of curricula.[10] honestly, we had no idea why we were even there … there was no
direction and I think, not to sound horrible, but I think it comes a lot in
Experiences of working with students from other professions with the facilitator … Besides them planning it, we can also plan it but
The study highlighted a number of experiences regarding how the students we’re new to the situation, we come and we’re basically thrown into the
worked with others; these included understanding one’s own role and that deep end and we don’t know anything. I think the facilitators are actually
of others, and group dynamics. supposed to be there to sort of put you in the right direction … .’
‘I think the facilitators are supposed to be there to guide one in the right
Role clarification the direction.’
During the focus group discussions, the students highlighted that they
learnt a great deal about the roles of other professionals. However, some It is important that facilitators of IPE are skilled and knowledgeable.
students did not have a solid understanding of their own roles. This This is important so that skill and knowledge development, as related to
highlights the concept of ‘T-shaped graduates’, i.e. graduates who are deeply competencies and other aspects of IPE, enable or facilitate collaborative
knowledgeable about their own field of specialisation, yet are capable and practice. The facilitators must be able to facilitate students from various
willing to learn other skills and explore fields that may become part of professional groups and believe in and be motivated towards the
their work/study for various reasons. Previous exposure to other groups of transformative teaching and learning initiatives that accompany IPE.[12]
students provided students with some idea of the other professions but not
an in-depth knowledge. The students also distinguished between working Group dynamics
with and simply being in a class together with other students (IPE): In the context of socially responsive and politically relevant professional
‘When it came to a stroke patient I know the basics of what [occupational education, the need for the education sector to engage more seriously
therapy] OT is about but I don’t know the depth.’ with IPE has been highlighted. The underlying assumption of IPE is that
‘Not actually working with them, we were just in the class together.’ enhanced collaboration between professionals will lead to better use of
scarce resources and a more effective response to complex health needs.[13] The
Although students were unclear about the roles of the members of the team, students found that members of other groups of students were not always
they indicated that a combined effort by more than one team member open to sharing and engaging in a group or in teams – an important IPE
improves patients care: component. There was a sense that certain students could not confidently
‘… if we’re all on the same page and we’re all working together on one engage when in groups:
patient we can actually get the patients to a higher level … .’ ‘The second time, one guy [student] just stood there and watched … .’
‘… as to literally see the patient walk out, obtaining their health status and ‘… but otherwise the other students sort of sat in the corner and said
that’s what we are all there to do.’ nothing … .’

With certain community-based groups, the students were, at times, confused The students indicated that some lacked confidence and did not contribute
about what their specific role was: when working in interprofessional teams:

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‘… I think they know what they[’re] suppose to do … but they’re not ‘Before we even come here, they should at least let us know, you’re not
confident to speak about it … .’ only going to be a nursing student, you’re going to be dealing with other
‘… I think if you can almost simplify it, would be that they’re not professional students, you’re going to mix and you’re going to have, you
confident enough to tell you what they’re doing.’ know, to work together.’
‘It’s not a lack of knowledge, it’s more a lack of being able to express
yourself or being afraid to … .’ Although the students had negative perceptions about certain aspects of
the IPE intervention, they had a positive experience overall, especially
In IPE, groups of students from different professions work together to in relation to the structure that the IPE intervention provided to the
address the health needs of individuals or communities.[1] The dynamics of clinical placement. The IPE intervention somehow enforced a level of
working together in these interprofessional groups need to be considered communication between students from different professions that often did
and facilitated, as it cannot be assumed that students will boldly engage not occur during other clinical placements. Students have indicated positive
with those from other professions. The students in this study perceived responses to IPE interventions, both locally[3] and internationally.[4] As
other students as lacking confidence and, therefore, would not engage freely. IPECP does not occur in isolation but needs facilitation, the academic or
This could affect the team approach, which is important in the context of programme co-ordinators need to be sure that certain structures are in place
IPECP.[11] to ensure its success. Students have experienced this positively.

Students’ experiences with the IPE intervention Conclusion

The students struggled with the use of a framework to facilitate IPE in the The students experienced a lack of knowledge and, in turn, struggled with
setting, but they found the IPECP intervention useful in providing structure the applications of the ICF as a framework for the facilitation of IPECP.
to the community placement. Although students struggled with some However, the IPECP intervention appeared to provide structure to the
aspects of working in an interprofessional team, they expressed that the clinical placements, making the experience more positive.
experience was positive. Our findings suggest that students need familiarity with frameworks or
The students highlighted that the IPECP session assisted with learning models applied during IPECP initiatives. Students also need to be prepared
about one’s role and the role of others: to work in groups with students from other disciplines. In addition,
‘There’s a focus and there’s something we[’re] actually looking for … and facilitators need to be sufficiently equipped and skilled to facilitate the
what we[’re] doing and why we[’re] actually doing it … .’ outcomes of the intervention.
‘I learnt more in this short period of time than what I learnt in the
10 weeks that I was here before.’ References
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