THE CORRELATION OF INTERPROFESSIONAL EDUCATION COMPETENCY WITH BURNOUT AND SELF-ESTEEM AMONG IMAGING PROFESSIONALS by David R Broderick Nealynn Doyle Marty Farmer Ashley Mazzuca Jeanette Primich Elliott Reeves Levi B. Sorensen A thesis submitted to the School of Radiologic Sciences in collaboration with a research agenda team In partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN RADIOLOGIC SCIENCES WEBER STATE UNIVERSITY Ogden, Utah April 23, 2020 INTERPROFESSIONAL EDUCATION CORRELATIONS 2 THE WEBER STATE UNIVERSITY GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL This thesis has been read by each member of the following supervisory committee and by majority vote has been found to be satisfactory. ______________________________ Dr. Robert Walker, PhD Chair, School of Radiologic Sciences ______________________________ Dr. Tanya Nolan, EdD Director of MSRS ______________________________ Dr. Laurie Coburn, EdD Director of MSRS RA INTERPROFESSIONAL EDUCATION CORRELATIONS 3 Acknowledgments On behalf of the 2020 graduating class, we thank the esteemed Radiologic Sciences faculty and staff of Weber State University. We thank and recognize our faculty sponsor and committee chair, Dr. Robert Walker. We also want to acknowledge Dr. Tanya Nolan, for her knowledgeable support, expertise and guidance throughout our project. We express our gratitude to committee members including School of Radiologic Sciences Chair Dr. Walker, MSRS Program Director Dr. Nolan, and RA Program Director Dr. Coburn. We acknowledge Dr. Heather Chapman’s valuable role in instructing us in data interpretation and analysis. Lastly, we thank our family and friends who have shown patience and support throughout our educational adventure. Keywords: Self-esteem, self-worth, teamwork, goals, emotional intelligence, self-confidence, security, communication, competence, identity, belonging, motivation, routine, interprofessional education competency (IPEC), problem-based learning (PBL), leadership, mentoring, burnout INTERPROFESSIONAL EDUCATION CORRELATIONS 4 Table of Contents Literature Review...............................................................................................................10 Interprofessional Education Competency (IPEC) ..............................................................11 IPEC Curriculum Teaching Theories and Delivery ...............................................12 IPEC and Keys to Effective Communication ........................................................13 Burnout ..............................................................................................................................15 Cause and Effect of Professional Burnout .............................................................19 IPEC Teamwork and Its Impact on Burnout ..........................................................20 Self-Esteem ........................................................................................................................23 Self-Worth..............................................................................................................23 Self-Confidence and Security ................................................................................24 Goals and Self-Esteem ...........................................................................................25 Emotional Intelligence ...........................................................................................27 IPEC Teamwork and Its Impact on Emotional Intelligence ..................................30 Sense of Belonging ................................................................................................30 IPEC Role Identity and Sense of Belonging ..........................................................32 Purpose ...............................................................................................................................35 INTERPROFESSIONAL EDUCATION CORRELATIONS 5 Methods.............................................................................................................................37 Confidentiality .......................................................................................................37 Design ....................................................................................................................37 Hypotheses .............................................................................................................38 Participants and Sample .........................................................................................38 Instruments .............................................................................................................39 Data Analysis .........................................................................................................42 Risks .......................................................................................................................43 Results ...............................................................................................................................44 Discussion ..........................................................................................................................61 Limitations .............................................................................................................63 Recommendations ..................................................................................................64 Conclusion .............................................................................................................66 References ..........................................................................................................................68 INTERPROFESSIONAL EDUCATION CORRELATIONS 6 List of Figures Figure 1. Percentage of imaging department employees that experienced burnout ..........16 Figure 2. Staff burnout has had a negative impact on the quality of patient care .............17 Figure 3. Which would be most effective in reducing burnout among your staff? ...........18 Figure 4. Age and gender distributions .............................................................................45 Figure 5. Enrolled in a Radiology Program .......................................................................46 Figure 6. Education Level of Study Participants ...............................................................47 Figure 7. Percent Hospital Size .........................................................................................48 Figure 8. Imaging Experience by Percent .........................................................................59 Figure 9. Count of Hospital by Education .........................................................................50 Figure 10. Comparison of Sig. scores from Self-esteem, IPE, and burnout vs gender, age, education, and hospital size ...............................................................................................51 Figure 11. Modality Means compared IPE, Burnout, and Self-esteem Means .................53 Figure 12. Scatter plot of Negative Correlation between IPE and Burnout ......................55 Figure 13. Scatter plot of Positive Correlation between IPE and Self-Esteem .................56 Figure 14. Scatter plot of Negative Correlation between Burnout and Self-Esteem.........57 INTERPROFESSIONAL EDUCATION CORRELATIONS 7 List of Tables Table 1. Pearson Correlation Chart Demonstrating a Negative Correlation between IPE and Burnout ..............................................................................................................................58 Table 2. Pearson Correlation Chart Demonstrating a Positive Correlation between IPE and Self-Esteem .........................................................................................................................59 Table 3. Pearson Correlation Chart Demonstrating a Negative Correlation between Burnout and Self-Esteem .........................................................................................................................60 INTERPROFESSIONAL EDUCATION CORRELATIONS 8 Appendices Appendix A: IRB approval ................................................................................................74 Appendix B: Demographic Survey ....................................................................................76 Appendix C: IPEC Competency self-assessment Survey ..................................................77 Appendix D: Lockman IPEC informed consent ................................................................79 Appendix E: The Bergen Burnout Inventory (BBI) Scale .................................................80 Appendix F: Bergen Burnout Inventory / non-proprietary ................................................81 Appendix G: The Self-Esteem Scale .................................................................................82 Appendix H: Rosenberg Self-Esteem informed consent ...................................................83 INTERPROFESSIONAL EDUCATION CORRELATIONS 9 Abstract The intent of this study is to expand the academic world’s understanding of the impact that Interprofessional Education has on professionals within healthcare. A relatively new term is introduced, “Interprofessional Education Competency (IPEC),” which refers to the practical and skillful application of principles embodied in interprofessional education. The purpose of this study was to ascertain whether Interprofessional Education Competency (IPEC) has interrelationship with the self-esteem and the level of burnout experienced by medical imaging professionals. To this end, a survey was distributed to medical imaging professionals throughout the United States and other countries. Male and female participants of wide-ranging demographics responded, representative of many ages, locations, and levels of education. A generous response was sought in order to ensure statistical power for correlation and regression analysis. A total of 441 individuals responded to the survey, with 359 of those completing the survey sufficiently for their data to be utilized for this study. Based on the responses, a positive correlation was found between Interprofessional Education Competency and Self-Esteem, and a negative - or inverse - correlation was found between Interprofessional Education Competency and Burnout. It is evident that healthcare professionals have a more positive work experience as their interprofessional education competency increases. However, there still remain questions regarding the adequacy and appropriateness of delivery of interprofessional academic content within the medical imaging professions. INTERPROFESSIONAL EDUCATION CORRELATIONS 10 Literature Review Interprofessional education (IPE) continues to garner attention and support within the healthcare disciplines, because multi-faceted care is needed for improved patient care and positive employee experience. IPE “occurs when two or more professionals learn about, from, and with each other to enable effective collaboration and improve health outcomes.” (WHO, 2010). The comprehensive objective of IPE is to build teamwork, disrupt stereotypes, release bias, and improve patient care. An improvement in health and social care can be seen in collaborative efforts and further developments. Identifying barriers that radiologic technologists may encounter can help pave the way to introduce tools to improve IPE. With successful interprofessional education and collaboration between other modalities and departments, teams can join together in a more positive environment. Studies have shown this leads to better patient care and increased work satisfaction, leading to more competent radiography professionals (E. Verhovsek, 2009). Interprofessional education (IPE) results from students and healthcare professionals modeling and practicing appropriate, collaborative behaviors. IPE occurs when there is interaction between students and faculty of different health professions. IPE goals and learning experiences lead to performance skills required for collaborative patient/client centered teamwork. IPE is also manifested in the understanding of - and respect for - the role and unique contributions of each healthcare professional. Interprofessional education needs to lead to interprofessional practice. Consistent practice epitomizes Interprofessional Education competency. This occurs when multiple healthcare workers from different professional backgrounds consistently provide comprehensive health services by working together with INTERPROFESSIONAL EDUCATION CORRELATIONS 11 patients, families caregivers, and communities to deliver the highest quality of care across the settings (WHO, 2010). To teach collaboration, we must practice collaboration. To practice collaboration, we must know how to collaborate. Without effective IPE, job satisfaction and self-esteem can decline, while burnout increases. Several barriers have contributed to the feelings of disconnect and poor IPE practices, including role stress, lack of interprofessional understanding, and a struggle for autonomy. Role stress occurs when a wide variety of duties are added to job expectations, and the increased tasks become more and more difficult or even impossible to complete. Furthermore, different healthcare professionals are educated in completely different areas, which naturally can lead to confusion as various professional roles interact. For example, Verhovsek (2009) found that radiographers felt it was difficult to communicate with nurses dealing with unique health care responsibilities. Misconceptions easily can arise when relationships have preconceived perceptions. Learning about these different roles improves respect for interprofessional disparities. This increases a professional’s ability to fulfill roles as a team member and as an individual. Plus, this enhanced and open perception enhances each person’s capacity to express ideas, collaborate, and be a more vital employee, helping to promote positive change. Interprofessional Education Competency (IPEC) Healthcare systems are large, typically with varying groups and subcultures. Such environments demand competent delivery of IPE principles. If leadership does not utilize IPEC resources efficiently, this diversity has the potential to cause undue conflict. In pursuing a leadership role to implement IPEC, mentors should have a clear vision of what is important for INTERPROFESSIONAL EDUCATION CORRELATIONS 12 their organization to pursue. The mentors must be clear-minded and organized to meet the challenges needed for success of their departments. However, IPEC may require more than leadership mentoring. Mentors also can encourage their technologists to be more involved within their profession via professional organizations, seminars, and even intradepartmental lectures given to colleagues (Gjermundson, 2018). IPEC Curriculum Teaching Theories and Delivery In the world of learning theory, Leonard (2002) describes the generally accepted, broad schools of learning under which all learning theories fall; namely, behaviorism, constructivism, cognitivism, humanism, and organizational learning. Researchers Hean, Craddock, and O’Halloran (2009) suggest that interprofessional education and learning nearly always falls within the behaviorist and constructivist approaches. By their definition, the constructivism paradigm focuses on the process of learning and behaviorism focuses on the outcomes of learning expressed in behaviors. Behaviorists are less interested in how the learning occurred, but focus on outcomes. They believe in consequences, trial and error, measurable outcomes, and observable changes in behavior (Hean, et al. 2009) The direct goal of IPE is interprofessional learning. IPE is a process of teaching and learning that is typically accomplished through interaction rather than teacher centered methods. Different learning theories from cognitive and affective domains can be applied. IPE was described by Billings and Hastings (2015) as “knowledge, ideas, attitudes and values that are developed as a result of relationships with people” (p.2). By this definition, we see the application of different learning theories including cognitivism, constructivism, and humanism. INTERPROFESSIONAL EDUCATION CORRELATIONS 13 Cognitivism focuses on the inner mental processes including memory, thinking, memory and problem-solving. Constructivism is learning from previous experiences through active processes, is personal, and exists in the mind. Humanism learning results from observation of others’ behaviors, while it correlates with one’s own personal needs and objectives. Interactive, student-centered methods of learning incorporate principles from these various theories. With these theories applied as a foundation for learning, there will be less fragmentation in healthcare delivery and a more harmonious healthcare team (Maria Olencik, 2010). Cusack (2012) recommended IPE be taught through methods of problem-based learning (PBL). PBL encourages technologists to take responsibility for controlling their own learning by setting specific goals with a team intended to promote excellent patient care. Instructor modules require and guide students to adapt to solving problems in small multidisciplinary healthcare groups. Group learning alters the dynamics of the typical classroom and teaches health care workers to focus more on building teams and developing relationships necessary to solve real-life problems. IPEC and Keys to Effective Communication The ability to communicate with one another is essential for understanding and learning important life skills and for the skillful implementation of interprofessional education competencies. Communication is a skill that even though done “successfully once does not guarantee mastery for all time. Communication is a highly complex, dynamic, and evolving skill.” (Matos, 2017). It gives confidence and boosts self-esteem to know that one’s message and opinions matter. INTERPROFESSIONAL EDUCATION CORRELATIONS 14 Effective communication is when a message from a sender is received by an active listening receiver, and then the receiver gives feedback to the sender to let the sender know that the message was interpreted correctly. In this way the message can be clarified at the end of the conversation. Both parties involved should be making eye contact so the receiver can pick up on any nonverbal cues. Unfortunately, some messages delivered are not always received or the message is not interpreted correctly. This can apply with all forms of communication: verbal, non-verbal, or written. In healthcare this breakdown of communication can have disturbing results. Ross (2018) stated “when health care providers and patients discuss plans of care, only 40% of patients recalled the information provided to them from their physician, and of that 40% of patients, only half had the correct interpretation of the information” (p. 223). Obviously, that implicates physician-to-physician and other coworker-to-coworker communications. Hence, in 2010, The Joint Commission made “Handoffs” one of its Safety Goals and a Standing Requirement. This “handoff” gives a clear understanding and “a real-time process of passing patient-specific information from one caregiver to another for the purpose of ensuring the continuity and safety of the patient's care” (Ross, 2018, p. 223). In summary, the goal of IPEC in healthcare is to reduce the rate of communication errors, increase knowledge and perception of roles, and improve coordination of healthcare goals within teams, resulting in improvement of patient outcomes, adherence to guidelines regarding standard of care, and increasing patient satisfaction (Lawrence, 2019). The lack of IPEC results in undervaluing or misunderstanding contributions of other healthcare team members and disciplines. IPEC is proposed as a solution to bridge the differences resulting from the separate socialization of health professionals that create a lack of skills in collaboration and teamwork. INTERPROFESSIONAL EDUCATION CORRELATIONS 15 Formal education that includes interprofessional learning about teamwork, collaboration, problem-solving, and decision-making beyond the constraints of disciplines results in improved understanding of the current healthcare environment. In turn, implementing collaborative relationships among health care providers improves patient outcomes (Barnsteiner, 2007). Leaders and frontline employees have the need to enhance their competency in IPE. The need to collaborate in order to provide excellent patient care naturally fuels the tendency towards interaction with other modalities and disciplines in healthcare. By capitalizing on this foundational drive and infusing it with the correct tools of cross-training and problem-based learning, educators and clinical sites can realize the goal set by interprofessional education. This goal is to gain competency by interaction and collaboration, with the ultimate byproduct of improved staff self-esteem and satisfaction, better patient outcomes, and a reduction in burnout in the workplace. Burnout The MarkeTech Group recently surveyed an imagePRO panel of 215-220 to gauge staff burnout and how it can be addressed within imaging departments. In answer to the question, “Is burnout an issue today?” (pg.1). Nearly all respondents reported some degree of burnout in their departments. Burnout takes many forms including fatigue, lack of motivation, and missing work. When asked what percentage of their department had experienced burnout within the last 12 months, 93% of respondents reported at least 1 to 5 %, while 46% responded more than 10%. INTERPROFESSIONAL EDUCATION CORRELATIONS 16 Figure 1. Percentage of radiology/imaging department employees that experienced burnout (MarkeTech Group, 2019, pg.2). When asked to what extent they agreed or disagreed with the following statement: “Staff burnout has had a negative impact on the quality of patient care in my department.” It was found that 72% of respondents somewhat or strongly agreed with the statement, suggesting that burnout affects not just caregivers, but also the patients they treat. INTERPROFESSIONAL EDUCATION CORRELATIONS 17 Figure 2. Staff burnout has had a negative impact on the quality of patient care in my department. (MarkeTech Group, 2019, pg.3). Research shows that burnout for physicians, technologists, and other imaging professionals can lead to lapses in patient care and safety. For example, an overburdened technologist may use an incorrect protocol when preparing a study, which may negatively impact image quality, patient throughput, and study accuracy. Additionally, burnout can result in economic consequences for hospitals. If technologists miss work or reduce hours due to burnout, imaging departments may be left understaffed for delivering needed procedures. INTERPROFESSIONAL EDUCATION CORRELATIONS 18 This study by MarkeTech (2019) also indicates steps that can be taken to address this problem, and the study provides support for possible correlations between interprofessional teamwork and burnout. Of the total respondents, 25% reported that better communication among staff is the most effective solution to burnout. Another 20% noted that automation of non-clinical activities would help reduce burnout, suggesting that excessive administrative work places a strain on the technologist’s ability to provide patients the best care. Figure 3. Which would be most effective in reducing burnout among your staff? (MarkeTech Group, 2019, pg.4) INTERPROFESSIONAL EDUCATION CORRELATIONS 19 Staff burnout in medical imaging departments is a major problem. To curb it, hospitals must implement a plan, likely involving interprofessional teamwork, to improve communication between healthcare professionals and lay a foundation of supporting benefits resulting from this method of patient care (MarkeTech, 2019). Cause and Effect of Professional Burnout Professional burnout is a psychological syndrome arising in a setting of ongoing work-related stress, presenting with emotional exhaustion, callousness, apathy toward patients or peers, and feelings of personal inadequacy. Consequences of burnout affect the individual suffering from burnout and also patients, coworkers, and the healthcare system at large. Increased rates of medical errors, lapses in patient safety, substance abuse, depression, and suicide have been linked to healthcare professional burnout, along with reduction in productivity, nonparticipation, high employee turnover, and early retirement (Nicola, 2015). Most commonly cited factors causing professional burnout include an excessive workload; scheduling demands; challenges balancing personal and professional commitments; diminished sense of autonomy, purpose, and self-efficacy; and financial and job security concerns (Nicola, 2015). Healthcare professionals inherently are exposed to stress daily due to the nature of their work. Recent studies show that healthcare personnel experience high levels of stress and also strong burnout phenomenology (Craiovan, 2014). Although gainful employment is often an essential basis for personal satisfaction, work also can be a source of considerable stress. A recent study by Shanafelt et al (2012), found physicians were more likely to exhibit symptoms of burnout than other professionals, with INTERPROFESSIONAL EDUCATION CORRELATIONS 20 45.8% of all physicians reporting at least one symptom of burnout. According to the 2018 Medscape National Physician Burnout and Depression report, rates of burnout among Radiologists quickly increased from 20th in 2017 to 7th in 2018 among all specialties. Radiology residents have reported more feelings of loneliness, isolation, and lack of personal accomplishment compared to other specialties. Efforts to foster social support and improve camaraderie with other specialties have shown to increase a sense of emotional support, preventing burnout, improving a sense of personal accomplishment, and reducing isolation (Haber, 2019). Perfectionism is a personality trait proven to be associated with a high level of stress and burnout phenomena. Many healthcare professionals have this trait. High perfectionistic tendencies may have a pronounced susceptibility to stress and development of burnout symptoms such as emotional tiredness, anxiety and depression (Craiovan, 2014). Perfectionism can be channeled effectively with proper understanding and direction. Professional self-concepts are the perceptions of one’s skills, knowledge and beliefs that are acquired by evaluating traits and abilities through various experiences and interactions. These concepts are formed through self-reflection and social interaction, affecting the individual’s thoughts, behaviors, and emotions. Research suggests that individuals with strong, positive self-concept have lower levels of burnout compared to colleagues with little professional self-concept (Yu, 2019). IPEC Teamwork and Its Impact on Burnout IPE is not necessarily a new idea or concept. The interprofessional education and collaboration practice in 1960 from The Education of Physicians in Canada stated, INTERPROFESSIONAL EDUCATION CORRELATIONS 21 It has long been accepted that no physician, however able and however highly motivated, possesses all of the skills required to provide complete health services for a population group. Such services can only be provided by a team; the physician, dentist, pharmacist, nurse, psychotherapist, occupational therapist, social worker, clinical psychologist and others. Although lip service has been paid to the team approach to healthcare, little has been done to form the above-mentioned group into a team (McCreary, 1964, p. 1220). In 1970, an external committee on governance of university health science, at the University of Minnesota, stated: Discussions with students disclosed the desire to see far more emphasis on the team approach to providing healthcare. Students assert that if future healthcare delivery systems require a team approach to provide the necessary services, today’s health student must be exposed to the approach in his educational experience (p.8). In the United States in 1972, the Institute of Medicine Journal stated, The purpose of a group or team approach is to optimize the special contribution in skills and knowledge of the team members so that the needs of the persons served can be met more efficiently, effectively, competently, and more considerably than would be possible by independent or individual action. Without question, the patient himself is a member of the team. We face, in the next decade, a national challenge to re-deploy the functions of health professionals in new ways, extending the roles of some, perhaps eliminating others, but more closely mashing the functions of each than ever before (p. 12). If healthcare professionals are expected to work together and share expertise in a team environment, their education and training should prepare them for this type of working arrangement. The goal of IPE should be to prepare all health professional students for deliberately working together with a common goal of building a safer, better, patient-centered and community/population-oriented US healthcare system. “It is no longer enough for INTERPROFESSIONAL EDUCATION CORRELATIONS 22 healthcare workers to be professional. In the current global climate, healthcare workers also need to be interprofessional.” (WHO, 2010). Improving collaboration through IPE is the way to prepare future generations of healthcare professionals to work collaboratively and improve patient care. Some benefits of interprofessional teamwork are: improving professional attitude towards one another, increasing knowledge and skill, improving communication and teamwork, promoting coordination of care, and increasing quality patient care. Creating a culture of interprofessional team-based approach, where individuals are recognized equally for their skill sets and contributions to patient care, helps diminish the effects of professional burnout. Sharing responsibilities in care taking and building a foundation of mutual respect and trust to eliminate undue burden of the healthcare profession is an essential approach for a long lasting interprofessional team with diminished rate of professional burnout (Corbridge, 2019). In summary, burnout has been defined as a psychological syndrome which is a result of the stress and demands of the occupation. Published studies indicate that burnout compounds due to short staffing, workload demands, and the crucial nature of work in the healthcare field. Perfectionism also is inherent in the medical professions and leads to increased burnout. Perfectionism can be a favorable character trait in moderation, but when taken to extremes, it can lead to burnout, emotional weariness, anxiety, and depression. IPEC can lead to the satisfying sense of belonging to a team. A team approach is the embodiment of interprofessional education in action and leads to individuals feeling like they truly contribute. This in turn elevates a person’s feeling of worth and reduces work-related burnout. INTERPROFESSIONAL EDUCATION CORRELATIONS 23 Self-Esteem Self-esteem is often considered synonymous with self-confidence, dignity or morale. However, these synonyms do not correctly state the true meaning of self-esteem or its scholarly definition. A healthcare professional has skills, competency, dignified bearing, positive attitude, eloquent expression and/or some feelings of superiority; yet he or she may still struggle with low self-esteem. Some in psychology define self-esteem as an individual’s experience that they are appropriate to life and to the requirements of life (Branden, 1990). Additionally, self-esteem is confidence in the ability to think; confidence in the ability to cope with the challenges of life; and confidence in the right to be happy (Branden, 1990). Self-esteem is more than valuing self, it is the feeling of being worthy, deserving, entitled to assert one’s needs and wants and to enjoy the fruits of one’s efforts (Branden, 1990). Individuals who are most self-content exhibit certain personality traits and behaviors such as emotional intelligence, self-confidence, feelings of belonging, and competence. In the worlds of healthcare and academia, having these traits of healthy self-esteem will ensure a higher likelihood of satisfaction and success in the workplace. Self-Worth A second aspect of self-esteem is self-worth. Self-esteem requires assessment of one's worth. This emotional assessment consists of judgment, attitude towards physical appearances, and psychological frame of mind, such as one’s thoughts and feelings. Stets and Burke (2014) suggested that “the study of self-esteem has persisted for at least 40 years because many are convinced that high self-esteem produces salutary outcomes and low self-esteem is at the root of INTERPROFESSIONAL EDUCATION CORRELATIONS 24 personal and social problems” (p. 409). There are several degrees of self-esteem. There is high self-esteem (which is normal), low self-esteem, and inflated self-esteem - or a narcissistic view of oneself and life (Back et al., 2013). Consistent levels of self-esteem can be continued throughout life, and on the flip side there is vulnerable self-esteem. One with a stable high self-esteem does not need constant reassurance from others for self-worth; they are secure with themselves. There are those with a defensive self-esteem, characterized by the fact that their self-view can waiver due to criticism, at which point self-doubt comes into play. Self-esteem traditionally increases from the age of 16 to adulthood, peaks around 50, and then decreases in old age. Most commonly, self-esteem is a stable trait, but it can be flexible and even volatile. “High self-esteem prospectively predicts success and well-being in life domains such as relationships, work, and health. Given the increasing evidence that self-esteem has important real-world consequences.” (Orth & Robins, 2014, p. 381). Self-Confidence and Security With increased levels of self-esteem unaffected by public opinion, persons may develop self-confidence and security. Personal routine helps promote feelings of safety, confidence, and well-being. The repetition inherent in a routine tends to promote feelings of being knowledgeable and competent. For example, for someone who is blind, routine is necessary for them to be independent. They can count how many steps lead up to an obstacle, but if they bump into something, this can decrease their sense of confidence in that task. Avni-Babad (2011) studied well-being and confidence in a college class based on the students’ seating locations. The location a student sat in on the first day of class tended to be the INTERPROFESSIONAL EDUCATION CORRELATIONS 25 same throughout the semester. Additionally, students who sat closer to the front of the classroom interacted more frequently with the instructor and did better in class. Avni-Babab (2011) also discussed the well-being and safety of persons flying. First-time flyers tended to be more apprehensive with their new surroundings especially because processes linked to their safety were not in their control. Frequent flyers tended to demonstrate less apprehension and feel secure and safe. Therefore, these examples support the notion that routine and repetition increases confidence, including self-assurance, about the task at hand. More broadly, this theory may lend guidance to overcoming life’s challenges and succeeding on difficult projects, despite inevitable obstacles. In essence, confidence is a characteristic that is developed over time. One might have the confidence in trying new things, and as time goes by, those new things become routine, and confidence increases in those particular functions. Therefore, the more positive experiences and tasks that are performed on a regular basis, the better one’s confidence becomes, leaving less room for self-doubt. Regular routines assist to develop a sense of positive feelings toward oneself including well-being, safety, and confidence (Avni-Babad, 2011). Moreover, routines developed in patient care scenarios assist with overall patient satisfaction and safety. It is important to have many skills, but if the task at hand is not mastered, then the term “Jack of all trades, master of none” may apply. Goals and Self-Esteem “Do or do not; there is no try” (Star Wars: Episode V, The Empire Strikes Back 1981, screenplay by Leigh Brackett and Lawrence Kasdan, story by George Lucas). If only it were that INTERPROFESSIONAL EDUCATION CORRELATIONS 26 simple. At the beginning of every new year, millions of people have certain ambitions and resolve to achieve those ambitions. They set certain goals to obtain an objective, including the most common like weight loss, eating healthier, exercising more, or quitting bad habits like smoking. These are examples of conscious goals. There are also unconscious goals such as a natural desire to feel good throughout the day. Although unconsciously there is a natural goal to have positive emotions, life’s experiences can increase or decrease one’s mood (Bongers, Dijksterhuis, & Spears, 2009). Goal setting is a good way to help meet the end target that is desired. Self-esteem and in turn self-image are impacted by the achievement or failure of goals. Failing at a goal often produces negative emotions like disappointment and sadness, while succeeding at a goal produces positive emotions like peace, pride, and happiness. Bongers, Dijksterhuis, and Spears (2019) stated “success and failure to attain goals not only affects various emotions, it can also influence self-esteem. Success in attaining self-relevant goals can increase self-esteem, whereas failure can decrease self-esteem.” (p. 468). When failure occurs, it often is attributed to external causes instead of internal failings justified by excuses to preserve self-esteem. Do those with high self-esteem become more successful in life or does success in life result in higher self-esteem? Throughout one’s life there are challenges and experiences that test each individual. The after-effects mold one’s behavior, personality, sense of security, view of one’s own worth and the worth of others. When an individual receives love and affection from family and friends, it lifts them higher, inducing a feeling of security and energy. There are different experiences that one can have that affect self-esteem and the feeling of security. “Positive experiences (e.g., receiving sensitive and responsive care) cultivate a self-view as worthy and a view of others as reliable- what is known as attachment security” whereas INTERPROFESSIONAL EDUCATION CORRELATIONS 27 “negative experiences with caregivers (e.g., insensitive and unresponsive care) cultivate a self-view as unworthy and a view of others as unreliable.” (Luke, Sedikides, & Carnelley, 2012). An article written by Stets & Burke in 2014 discusses an equation that was suggested by William James (1890) that our successes and pretensions or aspirations affect our self-esteem. “(Self-esteem = Success/pretensions or aspirations).” If an individual has more aspirations in life than successes then self-esteem would be low. This is due to one not feeling a sense of accomplishment with the successes that they have had. Their aspirations overshadow their successes and therefore their self-esteem would be low. On the other hand, if an individual has more successes in life than aspirations then self-esteem would be high. This high self-esteem is due to one cleaving and enjoying their success instead of always having pretensions of more. Successes should motivate and drive an individual to be better and in turn have a high self-esteem outcome. In the same article it states that “self-competence is the degree to which one can bring about desired outcomes in situations compared with self-liking, which reflects the internalized sense of positive regard from others.” (Stets & Burke, 2014). This suggests that the more self-efficient and self-competent one is in certain situations the more praise or appreciation one will get in return. Emotional Intelligence Emotional intelligence correlates closely with self-esteem, and the act of consciously improving the former naturally will elevate the latter. Emotional intelligence, similar to positive self-esteem, can include feelings of being “comfortable in one’s own skin” and being able to laugh at oneself. It means being secure about one’s belief system and one’s own identity. INTERPROFESSIONAL EDUCATION CORRELATIONS 28 Elevated emotional intelligence will manifest itself in individuals who have healthy relationships, who are content with their physical appearance, who accentuate the positive, and who are comfortable with their belief system and who they are as a person. Emotional intelligence was first defined by Daniel Goleman (1995) as the “abilities such as being able to motivate oneself and persist in the face of frustrations; to control impulse and delay gratification; to regulate one's moods and keep distress from swamping the ability to think; to empathize and to hope” (p. 38). More recently, the concept of emotional intelligence gained tremendous momentum and was popularized by Mayer and Salovey (1997), who gave this definition: “Emotional intelligence involves the ability to perceive accurately, appraise, and express emotion; the ability to access and /or generate feelings when they generate thought; the ability to understand emotion and emotional knowledge; and the ability to regulate emotions to promote emotional intellectual growth” (p. 5). One of the basic concepts of emotional intelligence is the doctrine that emotions are not inherently bad, and that in fact emotions, when understood and managed appropriately, are important and can assist in improving a person’s well-being and overall success in life. Skills associated with emotional intelligence help individuals to understand and deal with unpleasant emotions and to capitalize on pleasant emotions in order to promote both personal growth and well-being (Brackett, et al. 2011). Emotional intelligence is particularly significant in the workplace, because of the social skills needed to successfully navigate in a work setting. Emotional intelligence tends to promote positive and proper social functioning by helping individuals to be able to detect and recognize others’ emotional states and adapt to their condition and perspective. This fosters better communication and more regulated interpersonal behavior (Brackett, et al. 2011). Those who INTERPROFESSIONAL EDUCATION CORRELATIONS 29 score higher on emotional intelligence assessments tend to be more socially competent, have better quality relationships at work, and are usually viewed as more interpersonally sensitive than those who score lower on these assessments (Brackett, et al. 2011). Studies within the nursing profession have shown a positive correlation between emotional intelligence and quality patient care. Nurses who have a better concept of their identity and role and who practice self-awareness and self-reflection typically will see positive results in their work environment. Research ties positive levels of emotional intelligence to better patient outcomes (Codier, 2017). Because emotional intelligence enhances critical thinking, valuable teamwork, and effective leadership, higher levels of emotional intelligence enhance clinical outcomes and patient satisfaction. Emotional intelligence also correlates positively with team performance, morale, nursing engagement, job satisfaction, and retention (Codier, 2017). A study of 6,050 students from the University of Kashan in Iran, showed a significant, positive relationship between students’ emotional intelligence and self-esteem and the students’ academic achievement (Tamannaifar, et al. 2010). Emotional intelligence and self-esteem have a direct positive effect on students’ academic achievement. In an educational setting, students are placed in an environment of uncertainty, where their belief systems and their self-identity are challenged. They are introduced to new surroundings, individuals, and information. Students who exhibit higher levels of confidence and assurance tend to succeed more than students who lack these traits. The healthcare work setting is notoriously challenging and can exact a detrimental toll on caregivers’ emotional and physical resilience. Healthcare employees face a relentless onslaught of high-maintenance patients. Such patients are at their worst, and yet caregivers are expected to INTERPROFESSIONAL EDUCATION CORRELATIONS 30 be at their best at all times - to subordinate their own needs and provide for the needs of others. Despite these demands, individuals with a deeper level of self-esteem and emotional intelligence will cope – and even thrive – in these demanding environments. People who develop higher levels of emotional intelligence will have stronger relationships at work and experience greater career success (Cooper, 1997). Such individuals also will maintain productive energy levels and are healthier than those with lower emotional intelligence (Cooper, 1997). IPEC Teamwork and Its Impact on Emotional Intelligence Teamwork enhances emotional intelligence and vice versa. A certain level of maturity and a great deal of mental and social exertion go into successful relationships. The effort required for individuals to learn how to interact successfully and to cooperate naturally enhances the emotional maturation process. Interprofessional education in academic environments and collaborative undertakings in professional environments promote opportunities for teamwork which in turn improves emotional intelligence and self-esteem. These traits complement each other and foster higher job performance and team effectiveness (Farh, et al. 2012). Individuals with high levels of emotional intelligence value others’ feelings and emotions, and they use that discerning ability to impact and guide their thinking and actions. This helps these individuals to “maintain favorable interpersonal relationships at work and enhance their job performance” (Farh, et al. 2012). Sense of Belonging INTERPROFESSIONAL EDUCATION CORRELATIONS 31 When professionals acquire self-esteem and confidence, they also experience a sense of belonging and the courage necessary to speak and to act. Having a sense of belonging is a natural aspiration to all. Belonging means acceptance as a member or partner. Having this sense of belonging is an important aspect of being successful in the healthcare field. A feeling of not belonging may cause work performance to suffer. Those who feel they do not belong may feel restricted or tend to hesitate when it comes to sharing what they feel or what they know to be true, when it comes to patient care. The resulting reluctance and hesitancy may reflect poorly on patient care and outcomes. There is much more involved patient care than strictly academic knowledge. There is emotional knowledge and gut instinct that cannot always be explained quantitatively. Healthcare professionals can also have a “feeling” that something was not right. That gut instinct, along with clinical experience, can be a powerful combination, and it is most impactful if individuals feel included and valued and comfortable enough with peers to express - and act on - this emotional instinct. The value of an employee feeling like they belong is of great worth in the medical field as well as in any field. When one has a connection to others, they are more willing and able to share experiences and knowledge. They are willing to speak up, and they have confidence that they will be heard. When the employee in the medical field can feel comfortable using their intuition or emotional intelligence as well as their academic intelligence as a result of feeling like they belong and are of worth, there is also a great financial benefit to the hospital or corporation. In fact, in cases where employees feel like they belong, research has shown that companies reap substantial bottom-line benefits. High belonging was linked to an impressive 56% increase in job performance, a 50% drop in turnover risk, and a 75% reduction in sick days. INTERPROFESSIONAL EDUCATION CORRELATIONS 32 For a 10,000-person company, this would result in annual savings of more than $52,000,000.00 (Ashktorab, Hasanvand, Seyedfatemi, Salamani, & Hosseini, 2017). A sense of belonging, a feeling of connectedness, and a belief that one is important and matters to others in an organization, ranks third on most people’s hierarchy of needs, after physiological and safety needs (Maslow, 1955). IPEC Role Identity and Sense of Belonging Everyone has a different background and different experiences. It is not enough to simply include everyone, but to appreciate one another for their unique backgrounds and experiences; these differences should be celebrated, amplified, and utilized. This is key to the IPE competency role identity. At times, varied opinions or perspectives can cause disagreements or differences of opinions. However, it is worth the risk of having some discord if one individual is willing to stand strong and voice their opinion and share their experience. Sometimes this individual’s knowledge of a rare case or disease can make the difference between successful outcomes versus something being missed or misdiagnosed. When one feels that he or she belongs it is easier for them to share their concerns and ideas. Each voice matters. The sum of all experiences matters, and together health care will improve when all caregivers feel a sense of belonging. In 2017, Ashktorab, Hasanvand, Seyedfatemi, Salamani, and Hosseini wrote, Belongingness experience is a deeply individualized experience and depends on the context. When it is used in the context of the workplace it can mean having the feeling of connectedness with coworkers and patients. It can include the experience of mattering or feeling cared about, accepted, respected and being valued. INTERPROFESSIONAL EDUCATION CORRELATIONS 33 Belongingness is often viewed as an effective factor in the prediction of stress, satisfaction with clinical setting, self-esteem and self-directed learning, and finally a valuable and unique element of motivation. This means that in order for a person to feel valuable and confident in their skills, one must feel that they have a purpose and belong to a team. Self-esteem is tied to belonging, as is their motivation and ability to continue learning. There will always be the self-motivated and determined persons independent of their environment, resources, and opportunities. However, for the majority of individuals, that is not the norm, and a healthy environment is where one can actively thrive and experience a sense of belonging. In order for a facility to provide good patient care they must work together as a team. It does not necessarily mean that employees get together for socials, but it does mean that communication is open, knowledge is shared, questions are welcome, and the patient is considered by all to be of utmost importance. In order for healthcare professionals to be able to communicate well and to work well as a team, a broad-based knowledge is required. From there, medical complexities can be further researched and evaluated. Communication must also continue to evolve. With the goal of interprofessional education to result in interprofessional learning, one must continue to learn, continue to evolve and share this process with peers. Since IPE is a process of teaching and learning which is typically accomplished through interaction rather than a definitive content, active participation of each profession in patient care needs to be included, because all have something to contribute. Each hospital or medical facility is sure to run things differently. One model that proved to be successful for a local oncology department was to have bi-weekly tumor boards. Current INTERPROFESSIONAL EDUCATION CORRELATIONS 34 cases are discussed by a radiologist, an oncologist, a general surgeon, as well as nursing staff, mammographers, and ultrasound, MRI, and CT technologists. Topics for discussion include the discovery of rare cancers, positive findings in various cases, cancers that were missed, and different treatment plans. While there are amazing results that come from these board meetings, it is important to note that each person, if possible, must have researched and have insight into the cases that are discussed. It typically takes one or two tumor board meetings for a new person to really sink their teeth into the cases and then provide valuable feedback. Of course, there are a few that feel confident to speak on the cases right away. These individuals jump right in and discuss complex issues, and treatment plans can then be determined and evaluated. What makes the tumor board successful is that each person brings something unique to the table. Each member of the board has had unique knowledge and experience, and they have the confidence to share this knowledge and experience with their colleagues. As a result, the treatment plans that come from these synergistic meetings are thorough and well mapped out. As previously mentioned, self-esteem is confidence in the ability to think; confidence in the ability to cope with the challenges of life; and confidence in the right to be happy. It is the feeling of being worthy, deserving, entitled to assert one’s needs and wants and to enjoy the fruits of one’s efforts (Branden, 1990). A team of medical professionals is most successful when they can communicate with one another, when they feel of worth and comfortable to share their knowledge and experience. Self-esteem plays an important role in being able to accomplish such tasks. In conclusion, self-esteem is an individual’s confidence that they have value and meaning in life. Self-esteem is directly impacted by an individual’s emotional intelligence. Emotional intelligence allows individuals to anticipate, understand, and respond to emotions in a healthy INTERPROFESSIONAL EDUCATION CORRELATIONS 35 way, and it is an important characteristic found in persons who function positively in society and in the workplace. High levels of emotional intelligence also correlate to academic success and even improved patient outcomes in the healthcare setting. Self-esteem is linked to one’s feeling of belonging. Literature has given us a better understanding that it is not only important to have different sets of skills but to appreciate differences in others. By understanding and embracing others’ unique backgrounds and experiences, these differences can actually lead to unification and a sense of belonging and self-worth. Goal-setting and effective communication also impact an individual’s sense of value. Setting and achieving goals can improve an individual’s self-image by building confidence and a willingness to try new things and to tackle new challenges. When successful completion of tasks becomes consistent, self-doubt decreases. Effective communication enhances a person’s feeling that they are understood and appreciated. Best practices involving appropriate communication and handoffs lead to better confidence in the workplace. Interprofessional education competence is the effective implementation of behaviors that improve self-esteem and self-worth. Literature gives ample examples and evidence of this in the healthcare setting, but limited studies exist that apply specifically to diagnostic imaging. Purpose The purpose of this quantitative study is to extend previous research conducted by imaging professionals and correlate dependent variables of interpersonal education to independent variables of burnout and self-esteem. Previously, researchers confirmed the INTERPROFESSIONAL EDUCATION CORRELATIONS 36 importance of the delivery and implementation of IPE. Our current study assumes the premise that IPE is deemed important and seeks to further analyze the significance of adapting and applying IPE in relation to burnout and self-esteem. The skillful, practical implementation of IPE in the workplace is termed interprofessional education competency (IPEC). It is anticipated that the information gained can be applied both academically and professionally in terms of capturing the potential benefits of IPEC in the workplace. To this end, we determined to answer the question: does IPEC correlate with self-esteem and burnout? All surveys and data analyses in our study were focused to solve this interrogative. Additional correlative analyses were run to also find the interrelationship between self-esteem and burnout themselves. We sought to determine if IPEC will improve a worker’s self-esteem and if this will have the concomitant result of reducing burnout. By understanding these correlations, current and future students, healthcare institutions, and healthcare professionals will have a clearer knowledge and broader perspective necessary to implement IPEC policies and practices. Corporate healthcare, administration, and managers will also benefit by comprehending the importance of IPEC in how it relates to their employees to improve self-esteem and mitigate burnout. We ultimately felt that the answers gained through this study can be applied to the universal goal that imaging professionals have to become better caregivers to their patients. Our hypothesis claims that healthcare workers who exhibit a mastery of interprofessional competency have a higher propensity to value their own self-worth than those who do not possess these skills, and in turn there would be a decreased rate of professional burnout in these same, competent individuals. INTERPROFESSIONAL EDUCATION CORRELATIONS 37 Method This quantitative correlational study used a survey method to acquire data necessary to satisfy its correlational design and purpose. An Institutional Review Board at Weber State University reviewed the research as low risk and approved the collection of data December 2019 (see Appendix A). The survey included questions about an individual demographics, Interprofessional Education, Burnout, and Self-esteem. All answers to the survey were kept anonymous and as confidential as possible. No survey responses or individual names are included in this publication. There will be no compensation for any unforeseen injury to participating individuals. This study was conducted from December 11, 2019 until February 7, 2020 and was designed to address the following research questions: Q1. What is the relationship, if any, between IPEC and burnout? H10. There is no relationship between IPEC and burnout. H1a. The association between IPEC and burnout will have a negative correlation. Q2. What is the relationship, if any, between IPEC and self-esteem? H20. There is no relationship between IPEC and self-esteem. H2a. The association between IPEC and self-esteem will have a positive correlation. Q3. What is the relationship, if any, between self-esteem and burnout? H30. There is no relationship between self-esteem and burnout. H3a. The association between self-esteem and burnout will have a negative correlation. INTERPROFESSIONAL EDUCATION CORRELATIONS 38 Hypotheses The proposed hypothesis was that competencies gained through IPEC would provide healthcare professionals with a broader perspective, social support, and emotional hardiness necessary to reduce burnout and increase self-esteem. We hypothesize that the association between burnout and IPEC would have a negative correlation, the association between self-esteem and IPEC would have a positive correlation, and the association between burnout and self-esteem would have a negative correlation. Participants and Sample After IRB approval the graduate students in the Radiologic Science department at Weber State University sent out an invitation by an internet link to imaging professionals through email, social media and word of mouth; the participants were invited to fill out a survey about Interprofessional education competency (IPEC), Self-Esteem and burnout. Qualified individuals possess the credential of RT or other Radiologic certifications that qualify them to work in the Imaging field, or they are currently enrolled in a Radiology program. There were no restrictions according to gender. Radiologic Science students that were enrolled in classes at Weber State University were part of the research study. Before the participants were allowed to take the survey, they were informed of the nature and purpose of the study. All procedures, risks, benefits, costs, and confidentiality of the study were described, and those being surveyed were required to agree to the informed consent. There INTERPROFESSIONAL EDUCATION CORRELATIONS 39 was no compensation for participation within the research study nor recruiting or involvement of subjects or parents/guardians of subjects who are not fluent in English. Our goal for this study was to obtain at least 200 participants and have them complete the survey so that the data was statistically significant for our research (sustaining a power of 0.80 from the multiple regression and correlation analysis). Accordingly, a convenience sample of Imaging professionals were surveyed from many geographical regions within the United States and internationally, thus lending validity to the statistics. Each participant was only permitted to take the survey once. A Total of 441 participants agreed to the consent and started the survey, but only 359 participants completed the survey; the 82 participants who did not complete the survey in its entirety were removed from this study. This left 359 participants who completed the survey completely; the information gained from these surveys was the data which we analyzed. Instruments The survey took 20 minutes to complete through an internet link. Review of an education page of the study was provided and completion of an informed consent by the participant was required before entering the survey. The survey consisted of four sections: demographic section, an Interprofessional Education Competency (IPEC) section, the Bergen Burnout inventory (BBI) section, and a Self-esteem section. The demographic section asked about age, gender, areas of radiologic science experience, education status, practice location, residential setting, and facility size (see Appendix B). The research did not incorporate the utilization of prior data, patients’ documentations, research documentations, and/or human biological samples. The research did INTERPROFESSIONAL EDUCATION CORRELATIONS 40 not incorporate deception or less than full divulgence. The research did not necessitate examining students’ educational information. The research did not contain audio/video recording or photography. The study participants will not be followed after the finalization of the suggested research. The IPEC section was accomplished by delivering the IPEC Competency Self-Assessment Tool, Version 3 (July 2015), that was created by Lockeman, Dow, and Randell, 2018 (see Appendix C). This consisted of 16 questions to assess competency based on healthcare education or experience. Odd number questions were directed toward interprofessional interactions, and the even number questions were directed toward interprofessional values. The 5-point Likert scale with the measurement in agreement was gathered (Lockeman, Dow, & Randell, 2019). Permission to use this survey was acquired (see Appendix D). The Burnout section used The Bergen Burnout Inventory (BBI), 9 items scale (see Appendix E). This is a Multidimensional Non-proprietary Burnout Measure (see Appendix F). This consisted of three core dimensions: Exhaustion at work (EXH), cynicism toward the meaning of work (CYN), and sense of inadequacy at work (INAD). Three questions were asked for each core dimension for the total of 9 questions. I am snowed under with work (EXH1); I often sleep poorly because of the situation at work (EXH2); I constantly have a bad conscience because my work forces me to neglect my close friends and relatives (EXH3). I feel dispirited at work and I think of leaving my job (CYN1); I feel that I have gradually less to give (CYN2); I feel that I am gradually losing interest in my customers (patients) or my other employees (CYN3). I frequently question the value of my work (INAD1); My expectations for my job and INTERPROFESSIONAL EDUCATION CORRELATIONS 41 my performance have reduced (INAD2); Honestly, I felt more appreciated at work before (INAD3). The 6-point Likert scale with the measurement in agreement was obtained ranging from 1 (completely disagree) to 6 (completely agree). This survey was tested and published by Salmelo-Aro, Rantanen, Hyvonen, Tilleman, & Felt (2011). Questions 1, 3, and 7 were directed towards exhaustion at work (emotional component). Exhaustion at work refers to the feeling of strain brought on by overtaxing work. Questions 2, 5, and 8 were directed towards cynicism toward the meaning of work (cognitive component). Cynicism towards work is described as a loss of interest in one's work and not seeing one's work as meaningful; an indifferent or distant attitude towards work and the people with whom one works. Questions 4, 6, and 9 were directed towards the sense of inadequacy at work (behavioral component). The sense of inadequacy refers to the reduced professional efficacy and the lack of achievement within both one’s job and within the organization. (Salmelo-Aro, Rantanen, Hyvonen, Tilleman, & Felt, 2011) The self-esteem section (see Appendix G) uses the Self-Esteem Scale (Rosenberg, 1965). This consisted of 10 questions measuring one’s view of their self-worth. This tool assesses both the positive and negative feelings the surveyee has of himself or herself in order to understand how they view their self-worth. This “Self-Esteem Scale items require the respondent to report feelings about the self directly.” (Rosenberg, 1965). A 4-point Likert scale format was used with the agreement measurement. Five of the questions were reversed scored, thus the positive and negative feelings were assessed. Permission to use the Self-Esteem Scale was granted by Princeton University Press (see Appendix H). This scale was published in a textbook edited by Robison, Shaver, and Wrightsman, 1991. INTERPROFESSIONAL EDUCATION CORRELATIONS 42 Data Collection and Analysis Tool Respondents to the survey were required to have an RT credential, possess other Radiologic certifications to work in the Imaging profession, or currently be enrolled in a Radiology program. If there was missing information in any surveys then that individual's information was omitted for analysis. The data was collected by a third-party internet link to Qualtrics (Qualtrics, Provo, UT). Data cleanup and statistical descriptive analysis of the data was performed using Excel and SPSS. The demographic section was coded for numeric measurement. The student variable code was changed from No to 1 and Yes to 2, and all other values as system missing. The Education variable code was changed from High School Diploma to 1, Associates Degree to 2, Bachelor’s Degree to 3, Master’s Degree to 4, Doctoral Degree to 5, and all other values as system missing. The practice Location variable code was changed from No to 1, Yes to 2, and all other values as system missing. The professional employment location in the Community variable code was changed from Urban to 1, Rural to 2, Other to 3, and all other values as system missing. The Hospital size variable code was changed from Clinic / Instacare to 1, Smaller Hospital to 2, Mid-sized Hospital to 3, Large Trauma Center to 4, Other to 5, and all other values as system missing. The IPE old value 5-point Likert scale of agreement measurement code was changed to a new numeric value scale with Strongly Agree as 5, Agree as 4, Neither Agree nor Disagree as 3, Disagree as 2, Strongly Disagree as 1, and all other values as system missing. The Burnout old value 6-point Likert scale of agreement measurement code was changed to a new numeric value scale with Completely Agree as 6, Agree as 5, Partly Agree as 4, Partly Disagree as 3, Disagree as 2, Completely Disagree as 1, and all other values as system missing. The positively questioned Self-esteem old value 4-point Likert scale of agreement measurement code INTERPROFESSIONAL EDUCATION CORRELATIONS 43 was changed to a new numeric value scale with Strongly Agree as 4, Agree as 3, Disagree as 2, Strongly Disagree as 1, and all other values as system missing. The negative questioned Self-esteem old value was coded in reverse and scored to a new numeric value scale with Strongly Agree as 1, Agree as 2, Disagree as 3, Strongly Disagree as 4, and all other values as system missing. A sum score was created for all three sections and subsections of IPE, Burnout, and Self-esteem by adding the variables located in their individual sections. Risks There were nominal risks to the subjects, and there were no punishments or advantages for the subject for deciding to complete or not complete the survey. The most prominent risk was recognizing a subject based on demographic responses. All responses to the survey were unknown and regarded as restricted as possible. No personal names or responses were contained in the study. Volunteering to engage in the study gave no authority for any researcher to retrieve employee information. No employer did obtain or will obtain identifying data about the participants. The subjects were directed to an online link for the Qualtrics survey. No hard copies were produced. The electronic data obtained from the surveys was transported to SPSS and Excel to be analyzed, and any additional files were kept on a USB drive. The USB drive is locked in the Department Chair’s office. The data from this research study will be preserved for five years and then removed and erased. Data was dispensed among department faculty and groups of Radiologic Sciences students, which were decided and endorsed by the Chair of the INTERPROFESSIONAL EDUCATION CORRELATIONS 44 Department to work on the project. All students and faculty included in the project were mandated to issue their CITI training to the department. These training documents were attached to the IRB through an addendum. Prior to publishing, a statistical consultant may also be recruited to confirm the validity of the results. Results This study was a quantitative descriptive analysis and correlational study correlated IPE independent variables to dependent variables of self-esteem and burnout. The demographics examined include age, gender, enrolled as a student, level of education, and hospital size. This nominal data was analyzed by use of descriptive statistics. Survey data was collected by Qualtrics and analyzed in SPSS and Excel spreadsheets. A total of 441 participants started the survey, but only 359 participants completed the survey 100%; 82 participants did not complete the survey. Therefore the 82 participants who did not completely work through the survey in its entirety were removed from this study. This left 359 participants who completed the survey portion as our database. INTERPROFESSIONAL EDUCATION CORRELATIONS 45 Of the total 359 participants, 335 submitted an age, and 6.6% (n=24) participants did not answer. Participants ages range from 22 to 76 with mode age of 49 and mean age of 44.15. 26.53% (n=95) of the participants responded as male, 73.46% (n= 263) responded as female, and one participant did not answer gender. Figure 4. Age and gender distributions INTERPROFESSIONAL EDUCATION CORRELATIONS 46 Of the 359 survey participants 92% (n=333) responded no to being currently enrolled in a radiology program, 6.7% (n=24) responded yes to being enrolled in a radiology program, and .6% (n=2) did not answer. Figure 5. Enrolled in a Radiology Program INTERPROFESSIONAL EDUCATION CORRELATIONS 47 Of the 359 participants 8.9% (n=32) held a high school diploma, 32.6% (n=117) held an associate's degree, 42.9% (n=154) held a bachelor's degree, 14.2% (n=51) master’s degree, 1.4% (n=5) held a doctoral degree. Figure 6. Education Level of Study Participants INTERPROFESSIONAL EDUCATION CORRELATIONS 48 Questions regarding hospital size produced 10.6% (n=38) who responded to work at a clinic / instacare, 17.8% (n=64) responded to working at a smaller hospital, 29.2% (105) responded to working at a mid-size hospital, 31.2% (n=112) responded to working at large trauma center, 11.1% (n=40) responded to other. Figure 7. Percent Hospital Size Survey participants responded from 42 different US states, with Utah having the most responses (30.1%). Surveys were received from five different countries with the United States having the most responses (98.6%). INTERPROFESSIONAL EDUCATION CORRELATIONS 49 The following reported experience in the given radiology modalities. Radiology 71.3% (n = 256); Computed Tomography (CT) 35% (n = 127); Interventional Radiography (IR) 19.2% (n = 69); Magnetic Resonance Imaging (MRI) 18.7% (n = 67); Mammography 17.8% (n = 64); Sonography (US) 11.7% (n = 42); Nuclear Medicine (NM) 7.0% (n =25); Radiation therapy 3.9% (n = 17). Figure 8. Imaging Experience by Percent INTERPROFESSIONAL EDUCATION CORRELATIONS 50 Demographic of 359 participants on their degree of education and in what type of facility they practice in. Figure 9. Count of Hospital by Education One-way ANOVA was used to determine if a correlation exists within and between gender, age, education, and hospital size data and the study’s core measurements of Self-esteem, IPE Competency, and Burnout. ANOVA of Self-esteem and gender F(2, 356) = 1.42, p = .24; Self-esteem and age F(4, 328) = 0.35, p = .84; Self-esteem and education F(4, 354) = 1.49, p = .20; Self-esteem and hospital size F(4, 354) = 0.23, p = .92. ANOVA of IPE and gender INTERPROFESSIONAL EDUCATION CORRELATIONS 51 F(2, 356) = 0.42, p = .66; IPE and age F(4, 328) = 1.69, p = .15; IPE and education F(4, 354) = 2.39, p = .05; IPE and hospital size F(4, 354) = 0.69, p = .60. ANOVA of burnout and gender F(2, 356) = 0.33, p = .72; Burnout and age F(4, 328) = 0.65, p = .63; Burnout and education F(4, 354) = 0.65, p = .63; Burnout and hospital size F(4, 354) = 1.61, p = .17. These numbers demonstrate no significant correlation at the .05 level, which is the accepted threshold of significant correlation. Figure 10. Comparison of Sig. scores from Self-esteem, IPE, and burnout vs gender, age, education, and hospital size. INTERPROFESSIONAL EDUCATION CORRELATIONS 52 To compare means of IPE, burnout, and self-esteem against modalities of radiography, Computed tomography, interventional radiography, magnetic resonance imaging, mammography sonography, nuclear medicine and radiation therapy, both between groups and within groups, ANOVA was used. The alpha used in these results is based on a significant p value of less than .05. Radiology IPE (m = 68.32, SD = 9.44 n = 256), radiology burnout (m = 25.17, SD = 10.06 n = 256), radiology self-esteem (m = 33.49, SD = 4.93 n = 256). CT IPE (68.28, SD = 9.02, n = 127), CT burnout (m = 26.72, SD = 10.56, n= 127), CT self-esteem (m = 33.49, SD = 4.95, n = 127). IR IPE (m= 68.8, SD = 10.93, n = 69), IR burnout (m = 26.99, SD = 10.65, n = 69), IR self-esteem (m = 33.41, SD = 5.36, n = 69). MRI IPE (m = 66.79, SD = 12.18, n = 67), MRI burnout (m = 27.13, SD = 10.93, n = 67). MRI self-esteem (m= 33.41, SD = 12.8, n = 67). Mammography IPE (m = 69.67, SD = 8.75, n = 64), mammography burnout (m = 24.45, SD = 10.60, n = 64), mammography self-esteem (m = 34.25, SD = 4.8, n = 64). US IPE (m = 66.76, SD = 10.91, n = 42), US burnout (m = 24.52, SD = 10.12, n = 42), US self-esteem (m = 33.43, SD = 4.8, n = 42). NM IPE (m = 70.44, SD = 7.75, n = 25), NM burnout (m = 25.28, SD = 12.53, n = 25), NM self-esteem (m = 32.60, SD = 5.54, n = 25). Radiation therapy IPE (m = 72.14, SD = 6.67, n = 14), radiation therapy burnout (m = 22.86, SD = 8.99, n = 14), radiation therapy self-esteem (m =34.93, SD = 4.18, n = 14). INTERPROFESSIONAL EDUCATION CORRELATIONS 53 Figure 11. Modality Means compared IPE, Burnout, and Self-esteem Means INTERPROFESSIONAL EDUCATION CORRELATIONS 54 According to the Pearson correlation test between burnout and IPE, there was a negative correlation between the two variables, r = -.427, n = 359, p = .000, the p value had a statistically significant value of < .01 (see Table 1). In the Pearson correlation test between self-esteem and IPE, there was a positive correlation between the two variables, r = .382, n = 359, p = .000, the p value had a statistically significant value of < .01 (see Table 2). In the Pearson correlation test for self-esteem and burnout, there was a negative correlation between the two variables, r= -.361, n= 359, p=.000, the p value had a statistically significant value of <.01 (see Table 3). The strength of the relationship in all three correlations is considered moderate due to the absolute value falling in between 0.3 - 0.5. INTERPROFESSIONAL EDUCATION CORRELATIONS 55 Our correlative studies addressed and resolved the hypothesis as follows: Figure 12. Scatter plot of Negative Correlation between IPE and Burnout INTERPROFESSIONAL EDUCATION CORRELATIONS 56 Figure 13. Scatter plot of Positive Correlation between IPE and Self-Esteem INTERPROFESSIONAL EDUCATION CORRELATIONS 57 Figure 14. Scatter plot of Negative Correlation between Burnout and Self-Esteem INTERPROFESSIONAL EDUCATION CORRELATIONS 58 Table 1 Pearson Correlation Chart Demonstrating a Negative Correlation between IPE and Burnout Correlations IPE Burnout IPE Pearson Correlation 1 -.427** Sig. (2-tailed) .000 N 359 359 Burnout Pearson Correlation -.427** 1 Sig. (2-tailed) .000 N 359 359 **. Correlation is significant at the 0.01 level (2-tailed). INTERPROFESSIONAL EDUCATION CORRELATIONS 59 Table 2 Pearson Correlation Chart Demonstrating a Positive Correlation between IPE and Self-Esteem Correlations IPE Self-Esteem IPE Pearson Correlation 1 .382** Sig. (2-tailed) .000 N 359 359 Self-Esteem Pearson Correlation .382** 1 Sig. (2-tailed) .000 N 359 359 **. Correlation is significant at the 0.01 level (2-tailed). INTERPROFESSIONAL EDUCATION CORRELATIONS 60 Table 3 Pearson Correlation Chart Demonstrating a Negative Correlation between Burnout and Self-Esteem Correlations Burnout Self-Esteem Burnout Pearson Correlation 1 -.361** Sig. (2-tailed) .000 N 359 359 Self-Esteem Pearson Correlation -.361** 1 Sig. (2-tailed) .000 N 359 359 **. Correlation is significant at the 0.01 level (2-tailed). INTERPROFESSIONAL EDUCATION CORRELATIONS 61 Discussion It is the authors’ desire that this research will have beneficial, real-life application in academic and occupational settings. We approached this study strongly anticipating that our hypothesis would prove accurate; we anticipated that individuals who apply principles of interprofessional education generally have positive regard for their own value and typically are more content and satisfied with their job. With the added evidence we supply here to validate our hypothesis, we anticipate and hope that the reader will be motivated to teach, learn, and embrace the principles of interprofessional education. Literature review bolstered our assumptions that those who exhibit higher levels of interprofessional and collaborative skills tend to be more socially competent, have better quality relationships at work, and are usually viewed as more interpersonally sensitive than those who assess themselves lower in these qualities (Brackett, et al. 2011). This was proven by our findings that show a positive correlation between IPEC and self-esteem. Our review of published research helped us anticipate and form a hypothesis that competencies and attributes epitomized in interprofessional education would lead to reduced burnout. As Haber (2019) published, teamwork which fosters social support and improves camaraderie with other specialties has shown to increase a sense of emotional support and prevent burnout. The data from our research substantiated and supported our hypothesis. Namely, individuals who scored higher on the interprofessional education competency assessment also report a resulting decrease in professional burnout and an increase in self-esteem. The data supports our supposition that competencies gained through IPE provide healthcare professionals a broader perspective, social support and emotional hardiness necessary to reduce burnout syndrome and increase their self-esteem. INTERPROFESSIONAL EDUCATION CORRELATIONS 62 Survey data validated our assumption that burnout and self-esteem have a negative relationship, such that burnout decreases as self-esteem increases. The survey data compared scores using ANOVA to determine if there was a correlation within and between Self-esteem, IPE, and burnout compared to various demographics including gender, age, education, and hospital size. The results indicated there was not a significant correlation. Examples of this related to our speculation that size of hospital, rural vs urban location, and level of education might affect the incidence of burnout, but the data did not support those conjectures. This examination of demographic data was in response to a naturally piqued interest to find whether traits such as self-esteem or a sense of interprofessional competency or burnout were unique to any particular facet or sector of humanity. We assumed - and indeed we were vindicated by the data in our study - that whether a person had abundant attributes encompassed in IPE or a dearth of these same attributes was not an issue of gender or education or age - these things are, in fact, part of the human condition. Burnout and self-esteem are influenced by IPEC, but they are also part of a person’s life, experience, and personal paradigm, independent of demographics. In describing real-life application of teamwork, gut instinct, individual value, collaboration, and validation of a person’s worth, we share a recent experience in a professional setting observed by one of the authors of this paper; we feel this personal experience does justice in illustrating the values and behaviors just described. The firsthand experience was witnessed by the author at her place of employment and involved a patient that presented with weight loss and abdominal pain. Despite a negative PET scan five months earlier, the patient continued to experience pain, elevated liver enzymes, and weight loss. That prompted a visit to the emergency department, where an abdominal ultrasound was performed. The scan found a INTERPROFESSIONAL EDUCATION CORRELATIONS 63 dilated common bile duct, but no evidence of gallbladder disease or duct obstruction. It was clear to the radiologist and the ER physician that something was wrong, so they pooled their efforts and persisted in their diagnostic examination. Ultimately, an MRI scan revealed a pancreatic mass missed on the other tests, which was the cause of the patient’s symptoms. While this case involved factual reasoning and sound testing, the diagnosis also came as a result of the caregivers’ intuitive feelings that inspired their relentless pursuit for answers. These gut feelings were acted on and became part of the synergistic team solution, because of self-confidence and because of the teamwork that was fostered in this department. Intuition, collaboration, unity, and confidence are valuable tools for healthcare professionals, and having a sense of belonging and a sense of self-worth allows these individuals to feel comfortable enough to act on their intuition and to work together on behalf of their patients. This is the veritable manifestation of all we hope to gain by embracing and implementing the tools and traits incorporated in interprofessional education. Limitations With the comprehensive objective of IPEC being to build teamwork, disrupt stereotypes, release bias, and improve patient care, it is difficult to see how that could provide anything but positive results in regard to self-esteem and to help mitigate burnout. However, upon receipt and review of the survey data, it is apparent that this study had inherent limitations that, if exploited in future research, could yield additional understanding to those applying IPEC principles. The most significant weakness of our research was the inability to analyze data specific to work experience and longevity as well as information regarding those cross trained in multiple INTERPROFESSIONAL EDUCATION CORRELATIONS 64 modalities. The survey was designed and delivered in such a way that it was impossible to measure and differentiate years of service in the various modalities individually and collectively. We feel that this information would be helpful to know and understand in its entirety in an effort to demonstrate the impact of longevity to that of IPEC, self-esteem and burnout. Likewise, the survey tool did not allow proper data extrapolation in order to accurately calculate how many respondents work in multiple modalities within diagnostic imaging. Though we were able to prove that levels of burnout and self-esteem along with IPEC are similar within each modality, we could not conclude the impact on those working in multiple modalities. The survey also showed a skewed population regarding level of education, as the majority of respondents hold a bachelor’s degree. Although pleased with the number of respondents to the survey, it would be beneficial to obtain a larger data set in an effort to determine statistical significance of aspects that merely approached statistical significance. In analyzing every measurable demographic to find any correlations, only one came very close to statistical significance; to be specific, the data demonstrated that IPEC in correlation to level of education was approaching statistical significance. With a larger data set it may be possible to determine if the level of education that a person obtains will indeed relate to their level of IPEC. Recommendations The focus of our research quickly transformed into a compelling quest to discover what individual characteristics and competencies translate into desired behavior and outcomes. The drive for this type of knowledge naturally lends itself to myriad future research opportunities. INTERPROFESSIONAL EDUCATION CORRELATIONS 65 What might lie in an individual’s background and demographics that predisposes them to score higher in interprofessional education competencies or that might elevate self-esteem and diminish burnout? Future research can resolve the limitations of our current study by focusing on IPEC, burnout, self-esteem, and how these might be manifested differently in individuals who work in multiple modalities or who have varying longevity in their work experience. Further exploration might visit specific details such as: In those persons trained in multiple modalities, researchers can measure how frequently imaging professionals spend time in each modality. Measurements can be sought to find how long each person has worked in each modality in which they are trained. Additional data may help gauge how long individuals have worked in any capacity within the imaging professions. Further research can explore how each person might rate their competence in each modality. Investigations could also delve into the motivation that prompted individuals to cross train and ascertain if there was free choice or compulsion involved. A future meta-analysis could apply these types of questions and research across a broad array of medical disciplines to see if any correlative value exists between these various occupations within the larger scope of healthcare professions. Furthermore, a plethora of demographic data can be gathered and analyzed to see if expanded demographics might have any interrelation with the same three areas we measured. Is IPEC, self-esteem, and burnout impacted by prior work and life experience? As previously discussed in this study, there can be increased rates of medical errors, lapses in patient safety, substance abuse, depression, and suicide that have been linked to healthcare professional burnout, along with reduction in productivity, nonparticipation, high employee turnover, and INTERPROFESSIONAL EDUCATION CORRELATIONS 66 early retirement. It is possible that researchers will see correlative results that vary based on life experience, cultural differences, religion, political, or socioeconomic backgrounds. There is potential for inquiries relating to level of education. Our research results contained a majority of health care respondents with a bachelor's degree level of education. Further studies could investigate how customized delivery of IPE, according to academic level might relate to feelings of competence and outcomes. Conclusion The question our study addressed is whether IPEC is beneficial in decreasing one's level of burnout and increasing one's self esteem in performing one’s job. The results of the study showed that a positive correlation exists between Interprofessional Education Competency and Self-Esteem. This would suggest that by equipping individuals with valuable tools and education, these individuals tend to feel more competent in their skills which in turn engenders a higher sense of self-worth, and they are therefore better able to navigate difficult circumstances in the work environment. An inverse correlation was found between Interprofessional Education Competency and burnout in the workplace. Similarly, an inverse correlation exists between self-esteem and burnout. Thus, when interprofessional principles are applied such as collaboration, communication, teamwork, and camaraderie, individuals tend to have higher sense of their own value, and they experience less workplace burnout. There are still a number of questions remaining as to the appropriate and effective delivery of Interprofessional Education and how it might be adapted to different styles of INTERPROFESSIONAL EDUCATION CORRELATIONS 67 learning and levels of understanding. This study provides applicable means for health professionals to become better caregivers to our patients. We assert that the results show that individuals who understand and competently demonstrate principles taught by interprofessional education will experience a safer and more fulfilling and enjoyable workplace. Such capable and skilled individuals will make a positive, lasting impact in the world of healthcare and in the lives of each patient they treat. Declaration of conflicting interests The authors of this article declare no conflict of interest. Funding This research was supported and funded by the Department of Radiologic Sciences at Weber State University. INTERPROFESSIONAL EDUCATION CORRELATIONS 68 References Arlow, J. 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INTERPROFESSIONAL EDUCATION CORRELATIONS 74 Appendix A: IRB approval INTERPROFESSIONAL EDUCATION CORRELATIONS 75 INTERPROFESSIONAL EDUCATION CORRELATIONS 76 Appendix B: Demographic Survey INTERPROFESSIONAL EDUCATION CORRELATIONS 77 Appendix C: IPEC Competency self-assessment, version 3 (July 2015) by Lockman, Dow, & Randall, 2018. Agreement measurement: Strongly Disagree, Disagree, Neither Agree nor Disagree, Agree, Strongly Agree 1. I am able to choose communication tools and techniques that facilitate effective team interactions. 2. I am able to place the interests of patients at the center of interprofessional health care delivery. 3. I am able to engage other health professionals in shared problem-solving appropriate to the specific care situation. 4. I am able to respect the privacy of patients while maintaining confidentiality in the delivery of team-based care. 5. I am able to inform care decisions by integrating the knowledge and experience of other professions appropriate to the clinical situation. 6. I am able to embrace the diversity that characterizes the health care team. 7. I am able to apply leadership practices that support effective collaborative practice. 8. I am able to respect the cultures and values of other health professions. 9. I am able to engage other health professionals to constructively manage disagreements about patient care. 10. I am able to develop a trusting relationship with other team members. 11. I am able to use strategies that improve the effectiveness of interprofessional teamwork and team-based care. INTERPROFESSIONAL EDUCATION CORRELATIONS 78 12. I am able to demonstrate high standards of ethical conduct in my contributions to team-based care. 13. I am able to use available evidence to inform effective teamwork and team-based practices. 14. I am able to act with honesty and integrity in relationships with other team members. 15. I am able to understand the responsibilities and expertise of other health professions. 16. I am able to maintain competence in my own profession appropriate to my level of training. INTERPROFESSIONAL EDUCATION CORRELATIONS 79 Appendix D: Lockman IPEC informed consent INTERPROFESSIONAL EDUCATION CORRELATIONS 80 Appendix E: The Bergen Burnout Inventory (BBI) Scale (Salmelo-Aro, Rantanen, Hyvonen, Tilleman, & Felt, 2011). Agreement measurement: Completely Disagree, Disagree, Partly Disagree, Partly Agree, Agree, Completely Agree 1. I am snowed under with work (EXH) 2. I feel dispirited at work and I think of leaving my job (CYN) 3. I often sleep poorly because of the circumstances at work (EXH) 4. I frequently question the value of my work (INAD) 5. I feel that I have gradually less to give (CYN) 6. My expectations for my job and to my performance have reduced (INAD) 7. I constantly have a bad conscience because my work forces me to neglect my close friends and relatives (EXH) 8. I feel that I am gradually losing interest in my customers (patients) or my other employees (CYN) 9. Honestly, I felt more appreciated at work before (INAD) EXH - exhaustion, CYN - cynicism, INAD - inadequacy INTERPROFESSIONAL EDUCATION CORRELATIONS 81 Appendix F: Bergen Burnout Inventory / non-proprietary INTERPROFESSIONAL EDUCATION CORRELATIONS 82 Appendix G: The Self-Esteem Scale (Rosenberg, 1965). Agreement measurement: Strongly Agree, Disagree, Strongly Disagree 1. I feel that I'm a person of worth, at least on an equal basis with others. 2. I feel that I have a number of good qualities. 3. *All in all, I am inclined to feel that I am a failure. 4. I am able to do things as well as most other people. 5. *I feel I do not have much to be proud of. 6. I take a positive attitude toward myself. 7. On the whole, I am satisfied with myself. 8. *I wish I could have more respect for myself. 9. *I certainly feel useless at times. 10. *At times I think I am no good at all. *Questions are reverse scored INTERPROFESSIONAL EDUCATION CORRELATIONS 83 Appendix H: Rosenberg Self-Esteem informed consent