INTERPROFESSIONAL EDUCATION 2 Acknowledgements On behalf of the 2019 MSRS graduating class, we would like to extend our thanks to all of the Radiologic Sciences faculty and staff. We would like to recognize our committee chairperson, Dr. Nolan for her continued direction, guidance and expertise throughout our proposal and completion. We’d also like to express our profound gratitude to our committee members, Dr. Walker, our program director, as well as Dr. Kawamura for supporting our thesis as she retires this year. Additionally, we would like to thank Dr. Heather Chapman for her significant data instruction, which has been the foundation of this research. Finally, each and every one of us would like to thank our family and friends who have supported us along this educational journey and made this day possible. INTERPROFESSIONAL EDUCATION 3 Table of Contents Literature Review.................................................................................................................8 Values and Ethics in Healthcare ........................................................................................10 Empowering Communication in Clinical Conduct ................................................12 Ethical Dilemmas and Conflict Resolution ............................................................13 Implementing Solutions Through Education .........................................................15 Bloom’s Taxonomy – A Concept of Higher Thinking ..........................................17 Fostering Collaborative Perspectives .....................................................................18 Conclusion .............................................................................................................20 Roles and Responsibilities .................................................................................................21 Why Understanding Roles and Responsibilities Is Important n IPE .....................22 Role Theory ...........................................................................................................23 IPE Best Practice....................................................................................................24 Attitudes, Ownership & Collaboration Practice Patterns Post Graduation ............25 Conclusion .............................................................................................................26 Interprofessional Communication ......................................................................................27 Group Communication Dynamics .........................................................................29 Communication Education in Healthcare ..............................................................29 How IPE Changes Group Dynamics......................................................................32 Value of IPE ...........................................................................................................34 Conclusion .............................................................................................................35 Teams and Teamwork ........................................................................................................35 Structural Components of Teams and Models .......................................................35 Differential Characteristics ....................................................................................36 Team Leadership and Facilitation ..........................................................................37 Team Conflict ........................................................................................................37 Collaboration..........................................................................................................39 Changing Teamwork Attitude with IPE ................................................................39 INTERPROFESSIONAL EDUCATION 4 Conclusion .............................................................................................................40 Purpose ...............................................................................................................................40 Method ...............................................................................................................................41 Risks .......................................................................................................................41 Confidentiality .......................................................................................................41 Design ....................................................................................................................42 Participants and Sample .........................................................................................42 Instruments .............................................................................................................44 Demographics ........................................................................................................44 Data Analysis .........................................................................................................45 Significance of the Study .......................................................................................45 Results ...............................................................................................................................46 Discussion ..........................................................................................................................57 Recommendations ..................................................................................................58 Limitations .............................................................................................................59 Conclusion .............................................................................................................59 References ..........................................................................................................................61 INTERPROFESSIONAL EDUCATION 5 List of Figures Figure 1. Gender of Survey Participants ...........................................................................46 Figure 2. Urban vs Rural Study Participants .....................................................................47 Figure 3. Utah vs Outside Utah Study Participants ...........................................................48 Figure 4. Education Level of Study Participants ...............................................................49 Figure 5. Scatter Plot of Positive Correlations ..................................................................50 Figure 6. Bar Chart of Respondents Answers ...................................................................51 INTERPROFESSIONAL EDUCATION 6 List of Tables Table 1. Independent T-Test Demonstrating Gender Significance to All Domains ..........52 Table 2. Independent T-Test Demonstrating Urban vs Rural in All Four Domains .........53 Table 3. Independent T-Test Demonstrating Significance in Utah vs Outside Utah for All Domains .............................................................................................................................54 Table 4. Pearson Correlation Chart Demonstrating No Correlation Between Years of Experience and the Four Domains ....................................................................................55 Table 5. Significance Numbers Show That There is No Significance Between How People Felt About the Domains Depending on Hospital Size .......................................................56 INTERPROFESSIONAL EDUCATION 7 Abstract The intent of this study was to explore and gather statistics regarding the accessibility and competency of Interprofessional Education available to medical professionals within the field of Radiologic Sciences. Four domains were dissected to determine which factors were most and least imperative when structuring IPE programs to better serve healthcare professionals and their patients. These domains included: values and ethics for IPE practice, roles and responsibilities, interprofessional communication, and teams and teamwork. A 5 point Likert-scale survey created by Alan Dow was distributed to 83 medical imaging professionals, both male and female, with ages ranging from 21-67. Participants resided both in Utah and outside of Utah and practiced in various imaging modalities. Based on respondents’ answers, a positive correlation of importance of all four domains to individuals was displayed. Respondents all strongly agreed or agreed that all four domains are important, with values and ethics being appreciated the most. Herein, multiple studies demonstrate the importance of Interprofessional Education in fostering conductive relationships, however, the question of how to implement proper educational training programs still exists. INTERPROFESSIONAL EDUCATION 8 Literature Review Today in modern medicine, patients have multifaceted difficult needs that typically require or involve more than one discipline to address complex health problems. These complex medical issues can cross lines between specialties and can be best addressed by interprofessional teams. An increasing volume of literature reports that deficiencies in collaboration and communication between healthcare professionals have a negative impact on the provision of healthcare and on patient outcomes. The work of the Institute of Medicine (2003) and many others has clearly demonstrated that when healthcare professionals understand each other’s roles and are able to communicate and work effectively together, patients are more likely to receive safe, quality care. Interprofessional education (IPE) has become a key focal point in medical education across all health care environments during the last decade. There has been a growing interest between policymakers, healthcare managers, as well as clinicians in improving communication and collaboration through IPE. IPE occurs when students from the health profession and related disciplines learn together about the concepts of health care and the provision of health care services toward the goal of providing more effective and higher quality care. IPE promotes improved communication skills, it also provides students with an understanding of the roles and responsibilities of other health professionals, essential for working in patient centered care teams. The uniformity of practices in a healthcare institution is pivotal and directly related to patient safety. Thus, IPE and training can overcome many of the challenges that arise from a diverse workforce in a hospital setting. The consequences of failing to practice good IPE and interprofessional collaboration can reach far beyond stress and frustration levels experienced by professionals; they can result in adverse events such as medication errors and death. In 2003, INTERPROFESSIONAL EDUCATION 9 JCAHO reported that communication failures among team members are a contributory factor in 60% of sentinel events (Hall 2005). Healthcare professionals therefore have a growing interest in intervening through IPE to foster collaboration for the sake of the safety of the patients. Currently, there are few opportunities to bring faculty and students in pre-licensure programs from multiple disciplines together for the purpose of learning about each other’s roles and practicing collaboration and teamwork. Designing and implementing IPE has its challenges; course scheduling, faculty interest and expertise in IPE, a culture of IPE among faculty and students, and institutional policies for sharing course credit among schools are just a few. This research paper explores the concept of IPE by looking at four specific domains: values/ethics for interprofessional practice; roles/responsibilities; interprofessional communication and; team and teamwork. As broad principles, these domains are guiding principles that lack context and specificity. Little is understood about the current professional climate and attitudes related to IPE among separate health providers making it difficult to target the most appropriate and important competencies that are lacking among groups of health professionals and students. By demonstrating weaknesses, strengths, and absent principles, curriculum and training development will be increasingly relevant and significant. Furthermore, by correlating relationships between competencies, one can accurately decipher where bridging concepts and barriers to IPE are present in hopes to prepare graduates to understand each other’s roles, and the importance of teamwork, communication, and collaboration to the delivery of high quality, safe patient care. It is becoming readily apparent that IPE will serve an increasingly important role in health care in the years to come. It is therefore incumbent upon academic health programs and INTERPROFESSIONAL EDUCATION 10 healthcare organizations begin an organized process of aligning curriculum and policies to support and nurture IPE and collaboration among health professionals at all levels. Values and Ethics in Healthcare Values and Ethics play a significant role among health care providers, but it can be difficult to relay the straightforward meaning of these broad terms. Put simply, values are the beliefs that an individual or group considers to be vital or important (National Defense University, n.d.). They are the principles that guide the behavior of professionals in healthcare (Bastable, Gramet, Jacobs, & Sopczyk, 2011), and they do not change with different circumstances. For instance, values such as honesty and integrity are relevant not only in one situation but in every situation. Values are considered stable, unlike opinions or attitudes that could change depending on the behavior of others (Moyo, Goodyear-Smith, Weller, Robb, & Shulruf, 2016). An individual’s “professional identity” may be built on his/her values, which are depicted through the incorporated standards or norms of each profession (Clark, 2006, p. 582). The values of a profession can be defined as the essential and foundational beliefs that the profession is built upon (Aguilar, Stupans, Scutter, & King, 2014). Values “generally require prolonged social or educational processes to change” (Moyo et al., 2016, p. 258). “Five fundamental values” of healthcare have been identified by researchers from the International Charter for Human Values in Healthcare (Rider et al., 2014, Table. 1). The values identified include: “Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare” (Rider et al., 2014, Table. 1). Many people believe that ethics is the same as values, but it is actually taking those individual or organizational values and putting them into action. In other words, ethics is doing INTERPROFESSIONAL EDUCATION 11 what has been deemed to be valuable or important (National Defense University, n.d.). Therefore, a Code of Ethics is a document identifying the standards of conduct or behavior that an organization has adopted. Each medical specialty has its own Code of Ethics, and each one distinguishes specific actions for the indicated field. Even though they are all different, they all share similar sentiments, including a call to have respect for the dignity of individuals, whether it be a patient or a colleague. Direction is also given to act in the best interest of the patient and to protect his or her privacy. The preservation of professional competence is another common theme, which signifies the importance of continued education in the medical field. Additionally, guidance is given toward ethical conduct, such as the significance of responsibility, integrity, and “providing quality patient care” (The American Registry of Radiologic Technologists, n.d.) (American Medical Association, 2001) (American Nurses Association, 2015) (American Association for Respiratory Therapy, n.d.) (The American Society for Clinical Laboratory Science, n.d.). Since the various professions each possess distinct codes of ethics, students in each vocation are socialized into different sets of values that impact their performance as professionals in health care (Clark, 2006). Therefore, ethical training should play a key role in Interprofessional Education (IPE) as well, so students can come to appreciate the resolutions and outcomes that can be gained through teamwork. Students may not fully recognize the benefit of obtaining a fundamental knowledge of ethics as it relates to various health care professions; however, gaining shared ethical training through IPE is believed to foster a “mutual respect and collaboration on moral issues” (Hanson, 2005, p. 168). On the other hand, students who are taught ethics only as it relates to their own profession may lack a broader understanding that could be acquired with a more collaborative approach. It is believed that such one-sided training INTERPROFESSIONAL EDUCATION 12 would most likely produce students who are only able to observe ethical dilemmas “as their own profession perceives it” without consideration for the insight of others (Hanson, 2005, p. 168). When students enter the workforce, they will inevitably face ethical situations that they must be prepared for. Ethical issues are associated with difficult situations in which staff experience uncertainty regarding what is right or good to do, or where they disagree about what should be done (Rasoal, Kihlgren, James, & Svantesson, 2016). A recent article out of Sweden suggested that ethical situations typically fall into three categories: feeling helpless over the management of challenging interactions with patients or their family members, anxiety about care that is not safe and/or not satisfactory, or doubt regarding who ought to have authority to make decisions regarding patient care (Rasoal et al., 2016). Ethical circumstances can be very complex (Rasoal et al., 2016) since there are no laws or official decrees to reference for direction when dealing with such issues (Parelli, 2009). Persons must rely on their ethical education and knowledge to help guide their choices and come to their own conclusions. Empowering Communication in Clinical Conduct Educators must ask themselves how they can empower their students to implement the shared values into their clinical conduct. A broad concept that educators can utilize to influence how students handle ethical issues may be communication. Educators should consider communication as “an essential clinical skill” that can be improved upon rather than “simply a social skill at which [students] are already adept” (Rider et al., 2014, p. 278). Researchers believe that enhancing clinical communication skills would “enhance core values,” (Rider et al., 2014, p. 278) which would bring about better outcomes, such as patient/physician consultations that are more effective, improved rapport among professionals indicated by cooperation and teamwork, as well as “better coordination of care” (Rider et al., 2014, box 2). INTERPROFESSIONAL EDUCATION 13 A breakdown in interpersonal communication has been recognized as a source of conflict. There are multiple types of miscommunication within a group that may lead to this type of failure, such as misinterpreting the motives of others, a lack of appropriate feedback, the absence of well-defined expectations regarding the completion of tasks, and insufficient information sharing (Kim et al., 2017). It is believed that many medical errors could be prevented if there was consistent communication throughout the healthcare team (Kossaify, Hleihel, & Lahoud, 2017). Therefore, students who can clearly communicate may find ethical situations easier to manage than students who struggle with communication. Ethical Dilemmas and Conflict Resolution Being able to communicate is paramount during conflict because each person must be willing to listen to another point of view to come to an understanding. “Listening for understanding” and conveying an idea that is direct, short, and prompt has been “proven essential” when working towards conflict resolution (Sexton & Orchard, 2016, p. 317). Participating in tough conversations allows both parties to see each other’s perspective on the issue at hand. Consequently, it is easy to see why training initiatives created to instruct healthcare professionals regarding effective methods of resolving conflict incorporate communication skills instruction into their lesson plans. As successful communication is integrated, the capacity to process and create a solution to a tough situation (i.e. problem-solving skills) has been acknowledged as crucial by conflict resolution specialists. In a study by Weitzman and Weitzman in 2000, it was proposed that problem-solving capabilities “allows an individual to move past defensive behavior and into an analytical decision-making process” (Sexton & Orchard, 2016, p. 317). According to the literature, healthcare professionals are not sufficiently INTERPROFESSIONAL EDUCATION 14 equipped to resolve conflict. A frequent theme among students in healthcare is “fake it ‘til you make it” (Sexton & Orchard, 2016, p. 321). As inexperienced students face complicated decisions, they are frequently pressured to “play the role” of a “healthcare practitioner” and resolve issues as they come along (Sexton & Orchard, 2016, p. 321). “Because the healthcare environment is by nature often overwhelming for novice practitioners, hiding uncertainty is a skill most healthcare professionals perfect very early in their healthcare careers” (Sexton & Orchard, 2016, p. 321). This mindset shows the great need for effective conflict resolution training so that students are empowered to handle these situations confidently. Conflict resolution instruction is a critical element in assisting healthcare associates acquire the skills required to become effective at solving problems. Successful conflict resolution instruction is documented to bring about more secure patient settings, advancements in the standard of care, and increased self-assurance to resolve issues. On the other hand, when healthcare experts are not instructed on how to resolve conflict, there is a decrease in collaboration in general. Strategies to instruct students regarding conflict resolution should center on fostering harmony and teamwork between groups. These strategies require emphasis on the expansion of interprofessional communication skills and problem-solving tactics to attain conflict resolution. Another way educators can empower students to deal with ethical conflict is simply through providing more opportunities for IPE. Offering joint classes gives students of various medical specialties the opportunity to learn about varied backgrounds, professional roles, and training, not only from the instructor, but also from each other. For students to understand how to work as a team, they must have hands on opportunities of working together with other professionals “in which knowledge is created by the team itself through a social process” (Clark, INTERPROFESSIONAL EDUCATION 15 2006, p. 578). Students come to identify that the process of collaboration (for instance, handling conflict and communication issues) “is the learning experience itself, not a distraction from learning” (Clark, 2006, p. 578). Implementing Solutions Through Education. Educators can help students learn to navigate different circumstances, such as having a difficult conversation with a patient’s family member, by using actors to role-play a variety of challenging situations. Interprofessional students found this type of training useful when learning how to handle ethical dilemmas because the actors provided “a fresh, unbiased perspective” to the various situations they portrayed (Bell et al., 2014, p. 383). Students stated that watching the actors felt more realistic than attempting to act-out the same situation with a co-worker. It allowed the students to see how a stranger may handle different circumstances without the individual feeling a need to respond a certain way because of a possible underlying friendship. The faculty unanimously agreed that the actors made a valuable impact on the students’ learning (Bell et al., 2014). Role-playing enables students to apply the content they have learned right away “in a relevant, real world context” (The American Society of Radiologic Technologists, 2018, p. 13). For faculty, the implications relate in part to instructional style. Rather than being the “sage on the stage,” faculty may be more likely to serve as a “coach on the playing field,” working to model effective teamwork behavior, serve as a resource to deal with problems as they arise, and monitor student and team progress through reading participant journals and attending team meetings” (Clark, 2006, p. 587). Attitudinal elements have been linked as chief determinants on the growth and performing of interprofessional education. A focal point of the literature has been the attitudes INTERPROFESSIONAL EDUCATION 16 of the students, faculty, and various health care workers concerning interprofessional education. The senior academic administrators cannot be left out. They, too, have a great impact on the overall accomplishments in regard to the student’s post-secondary interprofessional education (Curran, Deacon, & Fleet, 2005). A training program has been developed for medical schools that aimed to improve the trainees’ values and communication skills by creating “more humanistic faculty role models” (Rider et al., 2014, p. 278). The methods used to develop the faculty members have been extremely effective at expanding faculty aptitude for the attitudes, communication methods, and values that are recommended by the International Charter for Human Values in Healthcare (Rider et al., 2014). Even though the program was developed for medical schools, a similar approach would benefit IPE programs within other medical specialties. There are three teaching strategies implemented in this program. The first strategy is “mastering communication skills through active learning,” in which simulated scholastic scenarios and patient interviews are used to give faculty members opportunities to improve communication skills and contemplate the values that are involved in these types of interactions (Rider et al., 2014, p. 278). The second strategy is “reflective learning,” in which faculty members participate in exercises, including descriptive writing followed by thoughtful discussion that provides individuals with the chance to delve into different “moral, professional, and value-laden” elements of interactions with students, patients, and others that take place during the “active learning process” (Rider et al., 2014, p. 278). The third strategy is “longitudinal group-process,” in which faculty members participate in consistent meetings of small groups with other faculty members, which bring about feelings of community and trust that are fostered as time goes by (Rider et al., 2014, p. 278). The continual discussions, combined INTERPROFESSIONAL EDUCATION 17 with experimental and philosophical learning, reinforce their sensitivity and commitment to values. Group members’ support for each other strengthens the groups moral beliefs, which adopts communication skills and values such as compassion, respect, empathy, and integrity (Rider et al., 2014). Bloom’s Taxonomy – A Concept of Higher Thinking Bloom’s Taxonomy is another resource for teaching students’ values. This concept was created by Benjamin Bloom in 1956. Bloom was an educational psychologist who encouraged higher thinking in learning, rather than repetition and memorization. The taxonomy categorizes learning types into three different domains: cognitive, psychomotor, and affective. The domains are useful for educators as they write performance objectives which offer guidance for teaching (The American Society of Radiologic Technologists, 2018). The affective domain of Bloom’s Taxonomy is the category of “attitudes, values, emotions, and perspectives” (The American Society of Radiologic Technologists, 2018, p. 5). Therefore, it is related to conduct including “enjoying, accepting, believing, conserving, and respecting” (The American Society of Radiologic Technologists, 2018, p. 4). It is arranged into a hierarchy with five levels. The first “level is receiving,” or being willing to “give attention to an event” (The American Society of Radiologic Technologists, 2018, p. 5). An example of this level is a student who actively listens to the patient while he/she is sharing a medical history (The American Society of Radiologic Technologists, 2018). The “next level is responding,” or being willing to react to or participate in an event (The American Society of Radiologic Technologists, 2018, p. 5). An example of responding to an event would be a student who notices a patient who is shivering and, without being asked, provides the patient with a warm blanket (American Society of Radiologic Technologists, 2018). INTERPROFESSIONAL EDUCATION 18 “The third level is valuing,” which is the ability to evaluate an event using an individual’s own values (The American Society of Radiologic Technologists, 2018, p. 5). An example of this level would be the way students attach value to events or statements that influence patients according to their own views of “the patient’s needs and their own responsibilities” (The American Society of Radiologic Technologists, 2018, p. 5). The fourth level is organization or being willing to “accept some values over others” (The American Society of Radiologic Technologists, 2018, p. 5). This level might involve the student weighing options when difficult circumstances are presented and determining the top solution when the best solution is not achievable. It is critical for medical professionals to learn how to organize decisions in this manner (American Society of Radiologic Technologists, 2018). Lastly, the fifth level of this domain is characterization, which is described as “consistently acting in accordance with accepted values” (The American Society of Radiologic Technologists, 2018, p. 5). Students obtain this level when they internalize the values and use their instincts to “act on the principles they have learned” (The American Society of Radiologic Technologists, 2018, p. 5). Examples of affective domain learning activities involve opportunities of service learning and debates (American Society of Radiologic Technologists, 2018). Fostering Collaborative Perspectives Another skill that can be fostered through IPE experiences is having the aptitude toward collaboration. Empowering students with the ability to work together with other professionals may help to fill the critical need for unity that exists currently within the healthcare system. When members of various medical specialties can identify and make the most of their “shared INTERPROFESSIONAL EDUCATION 19 professional values,” it increases cooperation which can in turn positively affect patient outcomes (Brown, Garber, Lash, & Schnurman-Crook, 2014, p. 472). “Health care professionals and students tend to see the world as they are, not as it is. Physicians, nurses, social workers, pharmacists, and other health care providers have all been socialized to adopt the health care worldview characteristic of their profession” (Clark, 2006, p. 578). Practitioners in healthcare that are part of an interprofessional collaboration carry the values of their specific profession to the group (Aguilar et al., 2014). The real test within IPE is helping students view the world as other professionals do. The hope is that students will begin to identify possible solutions to patients’ issues by discerning the ways other providers may handle the situation. Gaining such aptitudes is necessary for the integration of a health care practice that is focused on patient care and should be the fundamental goal of IPE models (Clark, 2006). Many educational programs for health professionals fail to integrate their curriculum. Each department is distinct, separate, and defined. For this reason, students do not have many opportunities to learn about the values of other professions (Aguilar et al., 2014). This deficiency needs to be resolved so that everyone can be on the same page. The first step in creating a collaborative IPE model is for each medical specialty to identify and clearly communicate their values to one another. Then all health care professionals could get additional training regarding the values of other professions. This would provide a base of understanding for the various groups of professionals to learn from each other. Learning about the values of other professions may also have the added benefit of identifying disparities of preconceived perceptions about the assorted professions. For instance, a study out of Australia explored how well physiotherapists and occupational therapists understood the professional values of the other profession (Aguilar et al., INTERPROFESSIONAL EDUCATION 20 2014). The researchers identified that workers from these two fields did not always recognize the values of the other profession, and it caused tension between them. One example of this confusion was illustrated as a scenario that demonstrated a difference in standard values regarding when a patient should be discharged safely (Aguilar et al., 2014). A physiotherapist might determine the patient is ready for discharge when the wounded limb has achieved the ideal motor function level. Although the occupational therapist would acknowledge the value of limb movement the patient had accomplished, he or she might not feel that the patient is prepared for discharge until they can self-sufficiently perform their vocational duties. From time to time, this variance in values could cause contention because the individuals may not distinguish that the reason they did not agree on the arrangements of a discharge plan was because of the underlying divergence of values. They might instead misinterpret the discord as being caused by “the other person’s self-interest, lack of professionalism and/or lack of concern for the patient,” (Aguilar et al., 2014, p. 21). As you can see, this type of misunderstanding can bring about disharmony between professions. Learning about the values that inspire and motivate the actions of other professions will aid the training of educators and practitioners who will be better able to recognize and appreciate the values of other members of their team (Aguilar et al., 2014). In the future, educators could use this concept to their advantage. Teaching the values of various professions enhances the students’ learning by way of providing a foundation of knowledge that would make it possible for individuals to be aware of the values that would foster cooperation or initiate conflict with other groups. Subsequently, this awareness would have a positive impact as it would grant students the ability to look ahead and consider how these disagreements might be handled, which in turn would positively impact the collaboration between specialties (Aguilar et al., 2014). INTERPROFESSIONAL EDUCATION 21 Conclusion In conclusion, values are the principles and beliefs of an individual or organization and ethics is putting those principles into action. Both should play a vital role in IPE and in healthcare in general. Codes of Ethics are an important standard that each medical specialty can look to for direction. Educators can empower students to improve their communication skills, which leads to better clinical outcomes. Strategies utilizing role-play and communication training methods help students have better attitudes toward collaboration. As conflicts arise, experience becomes key in helping students overcome these dilemmas. Communication skills positively impact students’ abilities to solve problems. Through effective conflict resolution, we know that direct outcomes are as follows: patients are safer, they receive better care, and healthcare professionals are more confident in handling these dilemmas. Through the implementation of IPE, the hope is that students will gain not only an understanding of teamwork but that they would come to recognize that unity enhances all aspects of healthcare. The Bloom’s taxonomy indicated the concept of higher learning that educators could reference for writing learning objectives. The Affective Domain introduced methods for educators to help their students identify perspectives, values, attitudes, and emotions. This type of learning would benefit students in all medical specialties. As various medical specialties identify and convey their professional values, workplace partnership is strengthened, which improves patient outcomes. In the past, we have seen that universities have failed to incorporate methods of interprofessional collaboration. Teaching values and ethics in a combined atmosphere through IPE is crucial to bring about unity in healthcare. There is a great opportunity for educators to integrate IPE practices into the learning environment for the benefit of all. INTERPROFESSIONAL EDUCATION 22 Roles and Responsibilities The medical environment is a complex and sometimes highly stressful work setting that involves ongoing exposure to the complexities of interprofessional team collaboration. Good communication between all team members caring for a specific patient is the key to optimize the care for that patient. Understanding one another’s professional roles can help optimize patient care, enhance team performance, and help develop better strategies to meet specific patient needs. Failures of communication, considered examples of poor collaboration among health care professionals, are the leading cause of inadvertent harm across all health care settings (Rose, 2011). Collaborative practices can be accomplished by maintaining expertise through continued learning and improving, while refining the roles and responsibilities of healthcare professionals working together. This can be accomplished by including innovative undergraduate interprofessional curriculum for students enrolled in the baccalaureate majors in healthcare. IPE training can also be implemented in the professional setting by creating workshops that bring together those healthcare professionals who work most often together and teaching them the roles and responsibilities of one another. Attitudes, ownership, and collaboration practice patterns after graduation are also important aspects of IPE. Why Understanding Roles and Responsibilities Is Important in IPE As mentioned previously, failure in communication is the leading cause of inadvertent harm in health care settings. Interprofessional education of healthcare providers is necessary to foster collaborative practice and improve patient outcomes. The IOM (2003) has reported that patients receive safer, higher quality care when healthcare professionals work together as a team, communicate effectively, and understand each other's roles (Baker, 2013). Effective IPE will enable effective, collaborative practice, and thus will strengthen the healthcare system and INTERPROFESSIONAL EDUCATION 23 provide better health outcomes. As healthcare professionals learn about the responsibilities, communities, identities, and body of knowledge of other healthcare professions, they change and are also transformed by the information (Grapczynski, 2015). Interprofessional practice is a key component of healthcare. Working within interprofessional teams leads to improvement in morale for healthcare professionals, reduction in the incidence of communication breakdowns, promotion of mutual understanding between professions, enhancement of professional confidence, and facilitation of intra- and interprofessional communication (Barr, 2013). But more importantly, patients also benefit when healthcare professionals collaborate to ensure completeness of care, thereby improving patient safety. Role Theory Role Theory has been a vastly researched topic and provides an understanding of one’s behavior within a given context. Role behaviors are associated with three specific settings; social position, where one has expectations of roles due to their place in the social system; behaviors are contextually bound; and specific expectations. The five concepts of role theory are: 1. Behaviors are influenced and predictable of people in certain concepts. 2. Roles are affiliated with groups of people in the same social setting. 3. People are cognizant of their roles and are guided by their cognizance. 4. Roles continue due to their function within larger social systems. 5. People must be taught roles. Role theory implies that behavior is not meaningless or random, it is influenced by the social environment and expectations which have been taught to similar groups of people. Role theory is dynamic and allows for an ample range of variability between people or groups executing the same role (Murray, 1998). INTERPROFESSIONAL EDUCATION 24 IPE Best Practice Many studies have shown that IPE initiatives improve students' understanding of the roles and responsibilities of other professionals. This improves students' attitudes towards other professions, facilitating mutual respect, and interprofessional collaboration. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams (Bianchi, 2018). Education is one way to increase collaboration and communication and is an explicit goal of interprofessional education. Health professionals today are mostly educated in isolation, adhering to courses that are focused solely on their specific skill set. IPE differs from most traditional continuing education in that knowledge is largely socially created through interactions with others and involves unique collaborative skills and attitudes. Students who have participated in interprofessional education have shown an increased knowledge of roles and responsibilities (Baker and Durham, 2013). Nursing, occupational therapy, and respiratory therapy students participated in a research study led by Zamjahn et al. (2018) which integrated an interprofessional education experience and these students demonstrated significant improvements in regard to recognizing their limitations in skills, and knowledge regarding patient transfers, respiratory devices, and medical lines. All students surveyed after the interprofessional education experience deemed the IPE simulation as a positive and meaningful experience. Similarly, a study performed by Lockeman et al. (2017) demonstrated a change in attitudes of interprofessional education, specifically in the domain of roles and responsibilities after interprofessional education learning. Multi-disciplinary healthcare professional students participating in a semester long course demonstrated a greater understanding and appreciation of the expertise of each profession and exhibited more INTERPROFESSIONAL EDUCATION 25 appreciation for the roles of other professions (Peeters, Sexton, Metz, & Hasbrouck, (2017). A pilot test study simulating interprofessional education during employee orientation revealed participants gained a greater understanding and appreciation of the contributions and roles of other healthcare professions (Will et al., 2016). Many recent health care graduates felt ill prepared to work as part of an interprofessional health care team, and attributed this to limited experiences with interprofessional relationships at the undergraduate level. Suggestions from participants regarding what may better prepare them for the workplace included learning with, from and about other health professionals. Observing each other's roles was also suggested as a way to increase mutual respect. Findings from this study indicate that most students recall IPE as an intermittent, largely optional, non-assessable activity and of little value in relation to their roles, responsibilities and practice as graduate health professionals. However, those who voiced positive recollections of their IPE experience within a healthcare team recounted working with others collaboratively over an extended time period with an opportunity to learn about each other’s' roles (Ebert, 2014). Attitudes, Ownership, and Collaboration Practice Patterns Post Graduation There are potential obstacles in IPE when an individual is unable to think outside the realms of his/her personal responsibilities in relation to other health professionals. Many respondents struggled with the "how to" work interprofessionally. When other colleagues are perceived to take over one's role, respondents became protective of their own scope of practice and showed more resistance to collaboration. In addition to causing tensions between individuals, lack of role understanding was also seen as underutilizing professional expertise (Suter, 2009). INTERPROFESSIONAL EDUCATION 26 Understanding and appreciating professional roles and responsibilities and communicating effectively emerged as the two perceived core competencies for patient-centered collaborative practice in the researchers interviews with sixty health professionals. The need to set clear boundaries and demarcations or the ability to strike a balance between interdependence and professional autonomy were stressed as important aspects of role understanding. It is imperative for health care professionals to have a forward-thinking attitude and take ownership to learn the roles and responsibilities of others he works with in the health care environment. Students who demonstrate ownership of their learning by self-identifying improved understanding of collaborative practice goals. They also gained a deeper understanding of their own roles/expertise as well as that of their peers from other health professions, and more effective communication strategies for working on a team. Health care professional students who are trained in an interprofessional manner were more likely to form collaborative practice patterns after graduation (Pecukonis, Doyle, & Bliss, 2008). Therefore, it has become increasingly important to prepare health care professional students to collaborate and work in teams. Conclusion As shown by research, interprofessional education is beneficial for participants, leaving them with a greater understanding of their role in the health care team, while increasing appreciation and awareness of the roles and responsibilities of other health care professionals. Many collegiate institutions are not incorporating IPE into their curriculum, leaving opportunities for improvement in the education course outline. Commitment from departments and colleges, diverse calendar agreements, curricular mapping, mentor and faculty training, a sense of community, adequate physical space, technology, and community relationships were all INTERPROFESSIONAL EDUCATION 27 identified as critical resources for a successful program (Bridges, 2011). Improving collaboration through interprofessional education is the way forward for preparing future generations of health professionals to work collaboratively. Within the standards of education for nursing, medicine and allied health professions, improving interprofessional collaboration is advocated through their recommendations that students should be given the opportunity to learn with other professionals during their programs of study. Students must also show ownership in expanding their knowledge of the roles and responsibilities of the other members of the healthcare team. Recognition of the value of other professionals for patient care is an important prerequisite for collaboration to occur. Interprofessional Communication In order to be successful in any organization, team, business, relationship, effective communication is a necessity. Communication in a healthcare setting is one of the staple tools we utilize to provide great patient care and improve patient satisfaction. However, lines of communication can frequently be crossed and lead to lower patient satisfaction scores, illnesses or worse. Interprofessional communication and collaboration during hospitalization is critically important to provide safe and effective care. Effective communication at hospitals and health systems contributes to the development and sustainability of a culture of safety. Yet, miscommunication remains a consistent and pervasive problem. Healthcare professionals, for the most part, have the ability to be effective communicators, collaborative leaders and team players. So why does communication remain a persistent problem? One study surveyed a total of 68 recent healthcare graduates across a few professions including pharmacy, nursing and general medicine. When assessing the communication between the graduates, patterns recurred. Much of the communication pertained to their specific INTERPROFESSIONAL EDUCATION 28 professions rather than pertaining to the healthcare team and patients’ goals. Other factors that were reported included negative stereotyping, or otherwise, valancing the unknown characteristics that belong to different professions and considering them as less than the characteristics that pertained to their own profession, and a competitiveness for time spent with patients (Thomson, Outram, Gilligan, & Levett-Jones, 2015). Verhaegh, Seller-Boersma, Simons, Steenbruggen & Geerlings found that when sampling a panel of 48 interprofessional healthcare workers, disagreements in care planning coupled with different opinions on a patient’s involvement with their care plan created a barrier in communicating effectively with each other (Verhaegh, et al., 2017). Many other studies have shown unnecessary patient deaths and illnesses, an increase in medical errors and overall negative health-related outcomes (Brock, et al., 2013). Healthcare workers seem to be efficient when communicating within a department but when it comes to interdisciplinary communication, there seems to be a disconnect. Other studies have found that more than a quarter of hospital readmissions could be avoided with improved communication among healthcare teams and between providers and patients (Diaz, 2016). With everyone on the healthcare team striving for the same goals and outcome for each patient under their care, why does communication remain a persistent problem? Every patient who comes to a hospital has a team of people involved in providing care throughout their healing process: from doctors and nurses to housekeeping and culinary teams, and even their family and loved ones. When various professions are involved, coupled with complex healthcare management systems, the focus to uphold effective communication becomes a vital facet to proper patient care. INTERPROFESSIONAL EDUCATION 29 Group Communication Dynamics Our teamwork, leadership, and workplace cultures are all impacted by communication failures and can be linked to larger problems such as sentinel events, workforce harm, poor patient experience or wasted resources. Studies show communication is a reflection of behavior and attitude (Brock, et al., 2013), which is notoriously difficult to change. When referring to the workplace, both individual and organizational behaviors are important. Various factors can be added to this equation such as educational differences, skill level, ethnicity, language, personality and experiences, both personal and professional. Helping individuals master communication skills requires a different approach than the traditional clinical training models. Perhaps communication is not deemed a forefront issue, so not enough educational communication-based classes offered to students and peers (Nasir, Goldie, Little, Banerjee, & Reeves, 2016). Constructive communication takes time and effort, and we have to make it a priority to do it right. Communication Education in Healthcare Healthcare communication is complex. Educational tools for healthcare professionals have been explored as means to increase effective communication among healthcare professionals. Brock, Abu-Rish, Chi, et al. incorporated the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) communication training model, which is not widely used among hospital training programs (Brock, et al., 2013). In reference to this model, 306 fourth-year medical, third-year nursing, second-year pharmacy and second-year physician assistant students participated in this simulation which consisted of a four-hour training session. One hour was didactic material and the other three hours allowed simulation and collaboration (Brock, et al., 2013). Not all students participated in the pre- and post- INTERPROFESSIONAL EDUCATION 30 assessments, but the 48.7% who did complete the examinations showed substantial differences in specific categories including: attitudes towards team communication, motivation, utility of training and self-efficacy (Brock, et al., 2013). Attitudinal changes were displayed in areas such as team structure, situation monitoring, mutual support and communication. Lastly, shifts in knowledge were represented in advocating for patients and communicating in interprofessional teams (Brock, et al., 2013). As result, notable changes occurred when proper training and simulation was implemented across interprofessional students leading to more effective communication resulting in better patient safety. Similarly, another study surveyed medical and nursing students to identify enablers, barriers, expectations and needs to effectively communicate as rationale for IPE education. To detect these variables, the “‘Cooperative academical regional evidence-based Nursing Study in Mecklenburg-Western Pomerania’ (Care-N Study M-V) was conducted” (Homeyer, Hoffmann, Hingst, Oppermann, & Dreier-Wolfgramm, 2018). A Delphi method was utilized and 25 experts, who met specific recruitment criteria, were sampled. The criteria for selection consisted of their capacity to respond to each research question presented. Over a span of three months, data was collected from questionnaires and focused group discussions. The results revealed various enablers and barriers to Interprofessional Education. A few enablers included, but were not limited to: acquisition of shared knowledge, promotion of mutual understanding, reduction of hierarchies, mutual acceptance and respect for one another and the ability to put one’s self in the role of another profession and the ability to view their perspective (Homeyer, Hoffmann, Hingst, Oppermann, & Dreier-Wolfgramm, 2018). Barriers listed but not limited to: different levels of knowledge, low mutual respect between medical and INTERPROFESSIONAL EDUCATION 31 nursing students, standardization of learning content levels and differences in time, financial and personal resources (Homeyer, Hoffmann, Hingst, Oppermann, & Dreier-Wolfgramm, 2018). Granted, if barriers are addressed appropriately, IPE can certainly be beneficial in paving the way to effective communication. Students from mixed disciplines that are provided with the necessary resources to understand other professions will not only increase their knowledge, but sharpen their communication skills as well. Renfro, Ferreri, Barber & Foley implemented an Electronic Health Record (EHR) for communication between an independent community pharmacy and an academic medical center’s physician network. The purpose of an EHR was to make communication between healthcare workers at different locations easily accessible and to gather necessary information without a disruption of workflow (Renfro, Ferreri, Barber, & Foley, 2018). The EHR was designed to be the primary method of communication. The pharmacy and practice location shared a total of six goals that would permit focused collaboration and effective communication via the EHR. Within the system implementation, a team of two ambulatory care pharmacists, one pharmacy resident, one community pharmacist, three physicians, one physician’s assistant, one nurse and one office manager was created to develop a strategy that would be best effective in providing care for patients. Patients were identified that would benefit the most from this collaborative project (Renfro, Ferreri, Barber, & Foley, 2018). All of the care pertaining to each patient was communicated through the Electronic Health Record from beginning to end. This included their patient history, summaries, care plans, prescriptions and any related concerns. Allowing multiple providers to communicate from ancillary sites via the EHR in fact worked to the patients benefit (Renfro, Ferreri, Barber, & Foley, 2018). Physicians were able to play a larger role in the care of their patient without INTERPROFESSIONAL EDUCATION 32 having to be face to face for discussion. Coordination of patient care is undoubtedly difficult when multiple healthcare workers are involved. Utilizing a platform that provides each team member with similar, adequate training, permits communication through an avenue other than direct dialogue and not only benefits patient care but also the practitioners and all others involved (Renfro, Ferreri, Barber, & Foley, 2018). To improve communication, hospitals and health systems must make it clear the patient is the first priority. It's having passion for patient safety and truly infusing communication standards around it. Not only is it teaching people how to have difficult conversations, but skill sets such as active listening and seeking out information between interdisciplinary lines (Didier, et al., 2017). It is important for professionals to consider how both team members and patients are involved in the healing process during the duration of their stay and how current social and spatial structures can affect communication and collaboration between the healthcare team and the patient. How IPE Changes Group Dynamics Understanding one’s professional role and how it fits in for the overall positive patient outcome is an important piece of the puzzle. Healthcare professionals should take the time to understand how their individual role can contribute to the overall positive experience of the patient. As previously mentioned, miscommunication within interprofessional healthcare teams are established causes of medical error and negative health outcomes, including death. In addition, team communication failures have significant economic impacts that may reduce quality, safety, or even access to care. If each healthcare worker considerately delves into their own professional role and understands their place, it will be clearer how each piece works INTERPROFESSIONAL EDUCATION 33 together to produce the final product - substantial patient care based off a foundation of effective communication. Educators have sought to create interprofessional trainings that teach the key elements of effective teamwork in simulated settings which allow for the practice of skills in a stimulus-rich but controlled environment. A review of over 2000 sentinel events analyzed by the Joint Commission on Accreditation of Healthcare Organizations, reported over 70% to be attributed to poor interprofessional communication; 75% of these incidents resulted in patient death (Leonard, 2004). Health professional students who are trained in profession specific ways are required to work in clinical settings as members of interprofessional teams throughout their career. This requires the integration of different professional skill sets, applied across various hierarchical systems. Stereotypes were commonly used to describe members of the ‘‘out-group’’ (professions other than one’s own), where negative experiences with individuals from other professions were generalized to that profession as a whole. Misconceptions about roles, responsibilities and workload were identified by graduates as a barrier to communication and, at times, were said to lead to hostility that further perpetuated the ‘‘us and them’’ workplace culture. It seems that members of each profession build self-esteem and group-esteem by banding together and criticizing other professions. Fear of making mistakes and being blamed is a genuine contributor to workplace stress and interprofessional conflict (Thomson, Outram, Gilligan, & Levett-Jones, 2015). The World Health Organization suggested the initiative for interprofessional education as a means of better and more comprehensive approach to patients’ needs and enhancement of job satisfaction of health care workers (Thistlethwaite & Moran, 2010). Interprofessional education INTERPROFESSIONAL EDUCATION 34 should be distinguished from multi-professional education which relates to circumstances when learners from two or more different professions learn together without deliberate or systematic interaction (students from different study programs sit side by side during lectures) (Thistlethwaite & Moran, 2010). Internationally, the call for interprofessional education, as a means of enhancing interprofessional teamwork and collaboration, is considered an essential feature of professional practice aimed at achieving a more effective system of health care. There are an increasing number of initiatives and new approaches to the assessment of this kind of educational strategy. Facilitation to explore other professions may be achieved by shadowing, studying abroad, service-learning programs or community service. According to research of present studies, the majority of students agreed that collaborating with students of other educational programs before acquiring their qualification or degree would stimulate them to develop a positive point-of-view about other professions. 329 undergraduate students from interprofessional programs including nursing, medicine, pharmacy, midwifery, physician assistant, physiotherapy, occupational therapy, speech, and language therapy, participated in case-based teaching scenarios which earned them an opportunity to collaborate and communicate with other healthcare professionals about patient care. Each student had to attend one session per academic year. 40% of these students reported that was the first time they had ever had any interprofessional based education, and 90% described multiple benefits of the teaching scenarios. 70% vowed they would be altering their behavior following the educational training due to the overwhelming interprofessional insight (Nasir, Goldie, Little, Banerjee, & Reeves, 2016). Value of IPE Managing patient health is a complex task, requiring a magnitude support from an interprofessional healthcare team. Communication and collaboration between healthcare INTERPROFESSIONAL EDUCATION 35 providers across multi-disciplinary modalities are crucial to patient safety and improving patient outcomes saving thousands of lives and billions of dollars. With induction of IPE training programs, students can gain insight to other professions before even beginning their career, leading to collective efficacy and team effectiveness later on (Simin, Milutinovic, Brestovacki, Andrijevic, & Cigic, 2010). This new approach calls for a shared mental model, or collective cognitive responsibility (Zoogah, Noe, & Shenkar, 2015). If true partnership means recognizing our communicative faults within interdisciplinary healthcare professionals, then we can work together in providing the best possible patient care. From a research perspective, many believe that the notions of shared accountability and liability need to be explored further. Conclusion The chaotic healthcare environment makes effective communication difficult, which is why it is so imperative to be cognizant, clear and concise about what pieces of vital patient information can be compartmentalized, and what pieces should be prioritized. However, doing so takes certain skills which require organizational direction to help people understand the need. Teams and Teamwork Interprofessional teamwork is a vital aspect of a quality person-centered care (Schmitt, et al., 2011). The IPE competency aims to enable the healthcare professionals to apply the values of building relationships as well as team dynamic principles vital for effective performance under the diverse team responsibilities to provide a person-centered care that takes into account the six domains of health care quality (Johnson & Freeman, 2014). A broad range of sources of literature describes teams and teamwork and how they might operate to their best level to enhanced quality and efficiency. INTERPROFESSIONAL EDUCATION 36 Structural Components of Teams and Models According to Housley (2017), team structure refers to the members maintaining the beliefs as well as engagement patterns in a team. Team structure is premised on the ability of organizational leadership to fully support as well as promote its teams, and provide support resources for the teams to succeed (Housley, 2017). The effectiveness of teams can be pre-determined by the team composition and context instituted by the organization. Reeves et. al. (2017) outline that there exists within a broad range of teamwork models for varying team formations. Babiker et. al., (2014) asserts that the models that describe effective teamwork is characterized by the principles such as shared objectives, clear roles, effective communication, leadership, measurable processes as well as results. Differential Characteristics Most organizations gravitate to distributed leadership, which are visible in teams and teamwork (Boak, Dickens, Newson, & Brown, 2015). The model is characterized by a less clear hierarchy of structures, and people make decisions through shared processes, which replace, modify, or substitute the traditional vertical leadership style (Avolio, Walumbwa, & Weber, 2009). Literature shows various attributes that characterize a productive and successful interprofessional team. Team models need empowerment for successful and effective functioning and involves aspects such as the structural empowerment where external leadership is shifting responsibilities to the team members through the power of delegation. From a psychological empowerment perspective, teams should believe that they can control their work setting and are responsible for the operationalization of the teams (Proenca, 2007). Psychological collectivism is an essential attribute of a productive and successful teamwork model. According to Jackson et al. (2006), evidence suggests that highly collective employees are perceived to INTERPROFESSIONAL EDUCATION 37 belong to the in-group and exhibit strong connection with the group’s status and its goals. They are substantially aligned with the personal and team goals. Supportive behaviors, which are voluntary help intercede the connection between team goal commitment as well as performance (Reeves et. al., 2017). Self-awareness is a competency omitted in the sub-competency of IPEC although it plays a critical role in the conflict resolution (Houldsworth, 2018). Self-awareness can help to improve team membership as well as the efficacy of team leadership because it determines one’s capacity for accurate self-reflection, exploitation of personality strengths, and management of weaknesses. Team Leadership and Facilitation Zaccaro, Heinen, and Shuffler (2009) discuss that team leadership is fundamental to the team’s effectiveness. Team leaders facilitate effective teamwork as well as interdependence by executing three essential responsibilities (Zaccaro, Heinen & Shuffler, 2009). Their contributions to team performance rely on their ability and extent to help team members attain a synergistic threshold. The team leaders have the prerogative to create, maintain, and ensure accuracy of the teams’ shared mental model by establishing and reestablishing a collective understanding of the goals, resources, limitations, and responsibilities of each of the group members. Evidence suggests that team leaders who provide robust information to the members create a more identical and accurate mental models among the members. Team leaders also promote team effectiveness. They monitor the setting where they work to enhance the adaptability of the teams and use this data to appraise the operational environment (Zaccaro, Heinen & Shuffler, 2009). Lastly, the team leaders establish behavioral and performance expectation of the group taking into account an individual’s strengths and weaknesses (Zaccaro, Heinen & Shuffler, 2009). Facilitative leadership strives to establish teams’ ability to create an inclusive environment as INTERPROFESSIONAL EDUCATION 38 well as achieve team objectives by using collaborative tools and processes. Gopee (2017) contends that facilitative leadership promotes respect and healthy relationships among team members, facilitates the resolution of conflicts productively, and promotes open expression of thoughts and opinions. Team Conflict Facilitative leadership demands adequate addressing and resolution of team conflict. The attributes of a successful and effective team model demonstrated what it takes to address team conflict. According to Paradis and Whitehead (2015), the Canadian Interprofessional Health Collaborative (CHIC) acknowledged the significance of team conflict management because disputes often exist that relates to ambiguity, authority gradients, as well as competing varied goals (Paradis & Whitehead, 2015). Conflicts can emerge in teams that are demotivated as a result of different behaviors like diminishing the performance of a team by discussing the incompetence of the team members (Gardener, 2005). Team conflicts can also emerge from the structural nature of the teams such as competing goals, disputes between team members, or operational managers. Team leaders can identify sources of conflict and develop appropriate approaches to preventing, or resolving them. Gardner (2005) asserts that task level team conflicts can be addressed in a cognitive level mainly if there exists a framework of task-related conflict resolution developed when forming the group. Conflict management can be addressed in two key fronts; preemptive where preventive, control, and guideline for team conflict management is established before the occurrence of the team disputes (Paradis & Whitehead, 2015). On the other hand, reactive conflict management entails managing the task, process, and interpersonal disagreements within the teams. INTERPROFESSIONAL EDUCATION 39 Collaboration Collaboration focuses and emphasizes on what and how members communicate within the various teams. Collaboration competencies recognize others’ roles, responsibilities, as well as competencies, tolerate uncertainties and understand the limitations. Reeves et al. (2017) points out that other scholars and practitioners alike have found recognition and clarity of roles, as well as collective working to enhance collaboration positively. Situations where one profession is better understood than the other improves relationship perception (Reeves et al., 2017). While understanding and appreciating other professions can improve collaboration and that professional culture can bolster care, some scholars argue that it could impede collaborative efforts. A significant source of such constraints can emerge from bottlenecks innate to educational training within healthcare professionals (Reeves et al., 2017). The authors recommend regulatory bodies as well as policy models to manage professional entry and practice landscape. Changing Teamwork Attitude with IPE Brown (2018) conducted a comparative study to examine how time-span of IPE training influences student’s attitudes of professional teams. The author acknowledges that attitude is one of the identified interprofessional collaboration competencies alongside skills and knowledge. Brown (2018) found that team training positively influenced student’s attitude of multidisciplinary teams characterized by increased work attitudes. The study concludes that short, or extended team training can positively influence teamwork attitudes. Groessl and Vandenhouten (2019) also explored the attitudes of students and their readiness for interprofessional learning and practice. The authors found that participants who had previous healthcare experience expressed more positive attitudes towards IPE compared to those with no INTERPROFESSIONAL EDUCATION 40 experience. Work climate, as well as expectations between different professional groups, affect their attitudes towards interprofessional learning. Conclusion Evidence shows the need for healthcare professionals to collaborate and work as teams to provide quality patient-centered care. Research also shows that healthcare professionals have varying degrees of attitudes towards interprofessional learning. There is the need to explore these trends within the context of radiology because not enough studies have focused on interprofessional collaboration among students in radiologic sciences. Purpose The purpose of this quantitative study was to offer a framework to structure the knowledge, attitudes, and behaviors necessary for effective collaboration across health care professions. Health education programs are seeking to collaborate with related fields of medicine and promote interprofessional education (IPE). A medical collaborative expert panel defined IPE as students learning about, with, and from other health care professions as means to effectively improve patient outcomes. They suggest offering a framework to structure the knowledge, attitudes, and behaviors necessary for effective collaboration across health care professions. This panel determined the desired principles of IPE within four competency domains. These domains included values and ethics for IPE practice, roles and responsibilities, interprofessional communication, and teams and teamwork. As a whole, this panel termed these competencies as general goals, and they challenged current and future educators to advance IPE research by experimenting upon these variables within relevant contexts. The purpose of this IPE study is to gather descriptive and comparative statistics regarding IPE competency among a large convenience sample of medical professionals within the Radiologic Sciences. The significance of INTERPROFESSIONAL EDUCATION 41 this study is that educators will have a knowledge of which competencies are valued, absent, weak, and strong within the professional community. With understanding of the current professional collaborative climate, radiologic science educators will be prepared to focus students in meaningful integrated collaborative experiences that foster relevant and specific skills. Furthermore, these results may educate the corporate health care community and supply rationale for corporate goals and training. Method This was a quantitative descriptive correlation study, with the utilization of a demographic survey. The study was designed to address the following research questions: (1) Based on professional experience, how do health care providers within the radiologic sciences rate their educational experience in relation to the four domains of IPE competency? (2) What relationship, if any, exists between aggregate scores of separate IPE domains? (3) What relationship, if any, exists between aggregate scores of separate IPE domains and subjects of varying demographics? The proposed hypothesis for this study was that health care workers in rural communities would value IPE more than those in urban communities. Another hypothesis was that technologists who were newer to the radiology field would value the interprofessional domains more that experienced technologists. The hypothesized association that there would be a difference between IPE domains and varied demographics was not demonstrated. Participants and Sample The Weber State College of Radiologic Sciences distributed personal invitations to health care professionals for the IPE study via: flyers, social media, and emails. Qualified participants INTERPROFESSIONAL EDUCATION 42 had to be older than 18 years of age and younger than 70 years of age. There were no restrictions according to gender. Students that were enrolled in classes at Weber State University were potentially part of the vulnerable populations within the research study. Participants received an informed consent on the first page of the survey. Before the participants were allowed to answer the various questions within the survey itself, they were required to agree to the informed consent. There was no compensation for participation within the research study. The research study did not recruit or involve subjects or parents/guardians of subjects who are not fluent in English. Our goal was to have a convenience sample at least 200 participants, and have them complete the survey so that our data was statistically significant (sustaining a power of 0.80 from the multiple regression and correlation analysis). Each participant was only permitted to take the survey once. One hundred and 23 participants opened the survey, but only 83 participants completed the survey. 36 participants did not sign the consent to participate within the study, and one participant answered no to the consent. Three participants did give consent, but they did not continue the survey. Therefore, these 40 participants’ responses were removed from the study, because their survey was not thoroughly completed. Results of the survey will be made public for viewing through publication presented to Radiologic Sciences professional journals. Invitations to the electronic survey were delivered through social media (Facebook), which were supervised by the Department of Radiologic Sciences. Invitations were transmitted through email to radiologic sciences professionals affiliated with professional organizations (i.e. Association of Collegiate Educators in Radiologic Technology (ACERT)). Finally, private invitations were circulated by the department faculty and students. Consequently, a convenience sample of health professionals within radiologic sciences was approached within the United INTERPROFESSIONAL EDUCATION 43 States. A substantial number of professionals were approached within the Intermountain West, based on the area and the connections of faculty and students harbored at WSU. With WSU outreach and regional programs and faculty national organization associations, multiple supplementary volunteers who live outside of this area completed the survey, thereby strengthening the generalization of the statistics. Instruments The survey included a demographic section and the IPEC Competency Survey Instrument created by Alan Dow. This instrument utilized a 5-point Likert scale to measure the professionals’ educational experiences in their health care associations concerning the 4 domains of interprofessional education (IPE). Authorization to apply the instrument was accepted. The survey took around 20 minutes to complete. There were 42 questions overall that were categorized on a 5-point Likert scale. Participants who took part in the study, could have stopped the survey at any point. If the survey was not finished, we omitted that information from the statistical results. The research did not incorporate the utilization of prior data, patients’ documentations, research documentations, and/or human biological samples. The research did not incorporate deception or less than full divulgence. The research did not necessitate examining student’s 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 demographic component of the survey was utilized to establish if the participants were qualified for the study. The demographic component will also be pertinent to the third research question of, if/when there were discrepancies between inconsistent demographic populations. The IPEC Competency Survey was generated as a response to a panel of INTERPROFESSIONAL EDUCATION 44 professionals on the domains of competency anticipated from IPE education by Dow, Mazamanian, DiazGranados, and Retchin in 2014. This survey was overhauled in 2016 to a condensed model, because the researchers identified that there were only two undeviating and robust elements. Nonetheless, established on the fact that radiologic sciences professionals have not been selected as a subject classification, we detected that it would be essential to confirm the implication of all four domains. 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. Though, this risk was unexpected due to the substantial number of subjects necessary for this study. 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. This survey was stationed on campus labs, which is a secure WSU database. No hard copies were produced. The electronic data was transported to SPSS 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, of which were decided and endorsed by the Chair of the 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 INTERPROFESSIONAL EDUCATION 45 addendum. Prior to publishing, a statistical consultant may also be recruited to confirm the validity of the results. Significance of the Study Subjects benefited from the results of this survey because the results directed the modeling and enrollment of curriculum applied to improve IPE competencies. By labeling the concerns in the current clinical setting, students, as well as new employees had the chance to elevate the level of competency and cooperation among various health care professionals. These efforts may even generate corporate modifications and instructions in assisting to evolve and reinforce IPE domains. With the outcome being, access to superior patient care as every health care professional works to comprehend and appreciate each other. Results This study was a quantitative descriptive and correlational study. According to each specific IPE domain, descriptive statistics were assessed for strengths and weaknesses among IPE education in working professionals. Aggregate scores for each domain were compared through multiple regressions to distinguish the existence of associations among domains and among various demographics. The demographics to be examined encompassed: age, gender, location/region, health care facility size, and years of practice. As we received the data from the 123 participants in an Excel document, we narrowed down the actual number of participants by 40 because their surveys were not completed. This left 83 participants and their responses as our research study data. We then took the information from the Excel worksheet and cleaned up the data. Then we transferred the data into SPSS version 24, where we ran multiple tests, including: multiple T-Tests, ANOVA, and Pearson Correlation. INTERPROFESSIONAL EDUCATION 46 The mean age of the survey participants was 39. The ages ranged from 21-67 years. Of the 83 people who took the survey, 67.5% were female, 31.3% male, and 1.2% chose not to answer (56 female, 25 male, 1 preferred not to answer). Figure 2. Gender of Survey Participants INTERPROFESSIONAL EDUCATION 47 Of the 83 people who took the survey, 90.4% worked in an urban setting, and 9.6% worked in a rural setting (74 urban, 8 rural, 1 did not answer). Of the 83 people who took the survey, 31(39%) respondents worked in a large hospital, 42 (51.2%) worked in mid-sized hospitals, and 8 (9.8%) worked in a small sized facility. One person preferred not to answer. Large hospitals are considered large trauma centers, mid-sized hospitals did not include trauma centers, small sized are considered urgent cares and clinics. Figure 3. Urban vs Rural Study Participants INTERPROFESSIONAL EDUCATION 48 Of the 83 people who took the survey, 65.4% (53 people) practiced in Utah, while 34.6% (30 people) lived outside of Utah. Figure 4. Utah vs Outside Utah Study Participants INTERPROFESSIONAL EDUCATION 49 Of the 83 people who took the survey, the mean was 11.6 and the mode was 3 (12.8%) years of technologist experience. The range of years of experience was 1-42 years. Of the 83 people who took the survey, 53% (44 people) held an associate’s degree, 41% (34 people) held a bachelor’s degree, 3.6% (3 people) held a master’s degree, and 2.4% (2 people) were other. Figure 5. Education Level of Study Participants INTERPROFESSIONAL EDUCATION 50 Figure 5 demonstrates the positive correlation between respondents’ answers and the four domains. Figure 5. Scatter Plot of Positive Correlations INTERPROFESSIONAL EDUCATION 51 Figure 6 demonstrates the specific responses of respondents’ answers per domain based on the Likert scale. Figure 6. Bar Chart of Respondents Answers INTERPROFESSIONAL EDUCATION 52 Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means F Sig. t df Sig. (2- tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference Lower Upper ETHICS Equal variances assumed .198 .657 - .479 79 .633 -.930 1.942 -4.795 2.935 Equal variances not assumed - .471 47.162 .640 -.930 1.974 -4.902 3.042 ROLES Equal variances assumed .257 .614 - .433 79 .666 -.765 1.766 -4.279 2.749 Equal variances not assumed - .439 50.667 .663 -.765 1.744 -4.267 2.737 COMM Equal variances assumed .983 .324 - .166 79 .869 -.359 2.167 -4.673 3.955 Equal variances not assumed - .172 54.438 .864 -.359 2.082 -4.533 3.815 TEAMS Equal variances assumed .458 .500 - .015 79 .988 -.039 2.540 -5.095 5.016 Equal variances not assumed - .016 52.218 .987 -.039 2.480 -5.015 4.936 Table 1. Independent T-Test Demonstrating Gender Significance to All Domains INTERPROFESSIONAL EDUCATION 53 Independent Samples Test Urban vs Rural Independent T Test Levene's Test for Equality of Variances t-test for Equality of Means F Sig. t df Sig. (2- tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference Lower Upper ETHICS Equal variances assumed .104 .748 .008 80 .994 .024 3.041 -6.029 6.076 Equal variances not assumed .008 8.944 .993 .024 2.810 -6.339 6.387 ROLES Equal variances assumed .759 .386 -.957 80 .341 -2.625 2.742 -8.081 2.831 Equal variances not assumed - 1.424 11.660 .181 -2.625 1.844 -6.655 1.405 INTERPROFESSIONAL EDUCATION 54 COMM Equal variances assumed .347 .558 -.955 80 .343 -3.203 3.355 -9.880 3.474 Equal variances not assumed - 1.368 11.180 .198 -3.203 2.341 -8.345 1.940 TEAMS Equal variances assumed .571 .452 - 1.514 80 .134 -5.916 3.907 -13.691 1.860 Equal variances not assumed - 2.279 11.834 .042 -5.916 2.596 -11.580 -.251 Table 2. Independent T-Test Demonstrating Urban vs Rural Significance in All Four Domains. INTERPROFESSIONAL EDUCATION 55 Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means F Sig. t df Sig. (2- tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference Lower Upper ETHICS Equal variances assumed 1.276 .262 .619 78 .538 1.192 1.926 -2.643 5.027 Equal variances not assumed .549 40.015 .586 1.192 2.172 -3.197 5.582 ROLES Equal variances assumed .235 .629 .457 78 .649 .799 1.748 -2.681 4.280 Equal variances not assumed .411 41.325 .683 .799 1.946 -3.129 4.728 COMM Equal variances assumed .005 .945 .463 78 .645 .989 2.138 -3.266 5.245 Equal variances not assumed .428 44.715 .670 .989 2.308 -3.661 5.639 TEAMS Equal variances assumed .142 .707 .077 78 .939 .192 2.511 -4.807 5.192 Equal variances not assumed .071 44.859 .944 .192 2.708 -5.263 5.648 Table 3. Independent T-Test Demonstrating Significance in Utah vs Outside Utah for all Domains. INTERPROFESSIONAL EDUCATION 56 Correlations SUMRR SUMVE SUMIC SUMTT EXPERIENCE ROLES Pearson Correlation 1 .845** .903** .888** .012 Sig. (2-tailed) .000 .000 .000 .916 N 82 82 82 82 77 ETHICS Pearson Correlation .845** 1 .811** .763** .068 Sig. (2-tailed) .000 .000 .000 .559 N 82 82 82 82 77 COMM Pearson Correlation .903** .811** 1 .925** -.051 Sig. (2-tailed) .000 .000 .000 .659 N 82 82 82 82 77 TEAMS Pearson Correlation .888** .763** .925** 1 -.070 Sig. (2-tailed) .000 .000 .000 .548 N 82 82 82 82 77 EXPERIENCE Pearson Correlation .012 .068 -.051 -.070 1 Sig. (2-tailed) .916 .559 .659 .548 N 77 77 77 77 78 **. Correlation is significant at the 0.01 level (2-tailed). Table 4. Pearson Correlation Chart Demonstrating No Correlation Between Years of Experience and the Four Domains. ANOVA Sum of Squares df Mean Square F Sig. SUMVE Between Groups 94.692 2 47.346 .713 .493 Within Groups 5247.552 79 66.425 Total 5342.244 81 SUMRR Between Groups 29.135 2 14.568 .264 .769 Within Groups 4361.987 79 55.215 Total 4391.122 81 SUMIC Between Groups 105.347 2 52.674 .643 .528 Within Groups 6470.165 79 81.901 Total 6575.512 81 SUMTT Between Groups 204.892 2 102.446 .913 .406 Within Groups 8865.499 79 112.222 Total 9070.390 81 Table 5. Significance Numbers Show That There is No Significance Between How People Felt About the Domains Depending on Hospital Size. INTERPROFESSIONAL EDUCATION 57 Based on the survey results, there was no difference between IPE domains and varied demographics. The results indicate that the majority of survey participants strongly agree or agree that all domains are important and valued in the health care profession. Of the four domains, values and ethics was appreciated the most. This study also indicated that there is a positive relationship between aggregate scores of separate IPE domains. The analysis confirms that Radiologic Science healthcare workers value the four domains whether or not they were female or male, worked in a rural vs urban setting, if they worked in Utah or outside Utah, and what their years of experience were. The alpha used in these results is based on a significant p value of less than .05. According to the gender significance t-test results, the Ethics p value had a significance of .657; Roles had a p value of .614; Communication had a p value of .324; Teams had a p value of .500 (see figure 7). These numbers demonstrate no significant correlation at the .050 level which would indicate a significant correlation. In the urban vs rural independent t-test, Ethics had a p value of .748; Roles had a p value of .386; Communication had a p value of .558; Teams had a p value of .452. These results demonstrate no significant correlation among the four domains. In the Utah vs outside Utah independent t-test results, Ethics had a p value of .262; Roles had a p value of .629; Communication had a p value of .945; and Teams had a p value of .707. These results also indicate no significant correlation among health care workers working in Utah vs outside Utah. The scatterplot results demonstrate that all domains are important to all individuals who partook in the survey. In the Anova results, Ethics had a p value of .493; Roles had a p value of .769; Communication had a p value of .528; Teams had a p value of .406. These results INTERPROFESSIONAL EDUCATION 58 demonstrate no significant correlation between Radiologic Science healthcare workers in different size hospitals. Discussion The data suggests that regardless of the demographic, patients should receive the same quality of care. The data also suggests that while these domains are valued by Radiologic Science health care workers, the question remains how to implement Interprofessional Education among medical roles. The data collected from this survey supports the hypothesis that there is a positive correlation between aggregate scores of separate IPE domains. The hypothesized association that there would be a difference between IPE domains and varied demographics was not demonstrated. For example, one of the theories was that health care workers in rural settings would value IPE higher than individuals working in an urban setting based on the variety of roles that are expected to fill in their job descriptions. Another theory in the hypothesis was that technologists who are newer to the Radiology field would value the interprofessional domains more that experienced technologists. From the data supplied, we see that there is no significant correlation between any of these demographics. Recommendations It is recommended that additional research be completed to further evaluate the educational experience of radiologic technologists in relation to IPE. The survey instrument used helped researchers to identify that technologists value the four domains, but it did not allow for the identification of methods of how to implement the domains within IPE models. Therefore, it would be ideal to append the survey instrument to include supplementary questions that focus on the implementation of IPE rather than merely questions concentrating on the domains. If desired, a different survey instrument may be favorable. The survey did not request participants to INTERPROFESSIONAL EDUCATION 59 disclose the total number of years they had worked in radiologic science. For future studies, it is advised to obtain the total number of years participants have worked in the various modalities of radiologic science. It would also be advisable to obtain a larger sample size with participants from a larger geographical area. It is suggested that the survey instrument be available to respondents for a longer period. Lastly, as the subject of study is IPE, it may be advantageous to open the survey to individuals in additional medical specialties rather than simply those within the radiologic science field. Limitations This research, however, is subject to several limitations. The dominant limitation in this study is a small sample size. The original research proposal called for a minimum sample size of 200 respondents. This minimum was to ensure a power of 0.80, and provide statistically significant data in order to run functional correlation and regression analysis. This research study had a sample size of 83 respondents, and failed to find statistical significance in survey responses. Additionally, the timeframe allotted to participate in the survey was relatively short. This may have limited the number of potential survey respondents. Another potential limitation in this study was the inability to break down survey respondent’s actual years of experience. The years of experience was linked to the years of experience in the modality that the respondents’ surveyed designated. This may have underreported the actual years of experience that respondents had indeed achieved in the field of Radiologic Sciences. Lastly, a potential limitation to this study was that the majority of survey respondents were from one state. Due to the lack of survey respondents representing differing demographic populations, the study was unable to attain statistical significance amongst different regions within the United States. Conclusion INTERPROFESSIONAL EDUCATION 60 The results suggest that health care workers highly value Teams and Teamwork, Values and Ethics, Roles and Responsibilities, and Interprofessional Communication. The question remains how to implement teaching this among all diverse roles in the health care environment. As stated in the Interprofessional Experiences of Recent Health Care Graduates study, students acknowledged the importance of interprofessional collaboration and felt it would help them do their jobs better for the ultimate benefit of patients. In order to improve team functioning and to improve patient outcomes, it is imperative that improvements are made in the relationships between health professionals (Thompson, 2015). Many collegiate institutions are not incorporating IPE into their curriculum, leaving opportunities for improvement in the education course outline. Implementing combined courses among different health care careers in a college setting could be one way of enhancing interprofessional education. Improving collaboration through interprofessional education is the way forward for preparing future generations of health professionals to work collaboratively. INTERPROFESSIONAL EDUCATION 61 References Aguilar, A., Stupans, I., Scutter, S., & King, S. (2014). Exploring how Australian occupational therapists and physiotherapists understand each other’s professional values: implications for interprofessional education and practice. 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