Students’ motivation for interprofessional collaboration after their experience on an IPE ward: A qualitative analysis framed by self-determination theory

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Practice points

Authentic assignments and a coaching style of supervision let students experience responsibility for real patients, combining their professional learning goals with IPE goals. Self-Determination Theory for motivation can be used to design IPE that motivates students for IPE/IPC A structured patientcare meeting offers all students the opportunity to “take their turn” without fear of interrupting the thinking processes of others. Sharing clinical reasoning among professions appears to facilitate teamwork. An interprofessional meeting room seems highly effective not only to meet and hear about the work of others but also to have informal contact.

Figure 1. Flowchart analysis and four steps systematic text condensation (STC; Malterud 2012). CLFV, HEW, and RAK are the researchers who were involved in this process. On the left hand side and at the bottom the steps to advance the rigor of the study is mentioned. A: autonomy; C: competence; R: relatedness; SDT: Self-Determination Theory.

Table 1. Demographic distribution of the interview participants.

Profession	Students at IPE ward (n)	Students interviewed (n; (gender))	Percentage of the profession interviewed
Students
Medicine	10	10 (F = 8)	100
Nursing	16	5 (F = 4)	30
Physical therapy	5	4 (F = 2)	80
Dietetics	1	0	0
Pharmacy	4	2 (F = 2)	50
Total	36	21	–
Supervisors
Medicine	8	5 (M = 5)	63
Nursing	6	4 (F = 4)	80
Physical therapy	2	1 (M = 1)	50
Dietetics	2	0	0
Pharmacy	1	1 (M = 1)	100
Total	19	11	–

Table 2. Systematic text condensation of the student interviews^a.

STC Step 1 and 2^b	STC Step 3^c	STC Step 4^d
Quality of care Contributions to the quality of care. IPEC:VE	Students perceived that consultation and collaboration between professions and the contribution from the different professions resulted in improvement of the care (plan) and the communication with the patients.	Students see the benefits from IPE and IPC as they are intended in most healthcare policies: quality of care and patient centeredness
Patient centeredness Patient is center stage instead of the professional(s). IPEC: VE	Combining the perspectives of the different professions and working together at the IP ward resulted in a more patient centered view which improved patient care.
Clinical reasoning Methodological approach of clinical problem solving (by each profession in its typical manner, to determine the problem(s), intervention(s), and evaluate the result of both). IPEC: CC	Students came to realize that all professions do clinical reasoning. Thinking along with other professions and gaining insight into clinical reasoning perspectives of other professions could result in better separation of main and side issues, anticipation on providing the information the others’ need and a lower threshold to consult the other, and in finding solutions together. You do a better job if you understand why you do what you are doing.	Offering a structure for the patient care meeting empowered (non-medical) students to bring forward the clinical perspective of their profession on the patients problems. They saw the need and were willing to adjust their workprocesses to provide informationneeded by another profession.
Professional contribution to patient care Contribution of profession specific expertise / insights to patient care. IPEC: RR	Students were interested in, as well as impressed and surprised by, the - -Complementary- contribution and roles and work of all other professions and the added value for the care plan. All contributions are needed; They realized better what their profession has to offer to others and how they can align the need for information with the way in which they provide it.
Learning environment (Organizational) Arrangements for learning on the IPE ward – the formal as well as the hidden curriculum. IPEC: Closest to TT	Students considered positive aspects of the learning environment: authentic patient situations, which made them feel responsible and work hard; all team members being students created a safe environment for questioning; offering different professional perspectives, and (a lot of) coaching supervision. Threshold for consulting supervisors and others students was low.	Students felt the need to reach competence in their own profession before they could focus their learning on interprofessional competencies.
	Negative aspects: not all professions were present, too many reflection sessions, and directive or frequently changing supervisors. The selection of patients for the IPE is crucial: the level of complexity of each patient and that each profession can contribute. Uni-professional learning goals were not always met (due to time constraints and low complexity patients)	Although some students preferred to achieve profession specific goals or to profile themselves to their supervisors, they were able to value the contribution of other professions to the care plan.
Mono-professional Learning Focus on profession specific learning goals. IPEC: RR	For some, especially medical students, the IPE goals competed with profession specific learning goals. A mono-professional focus took away attention from learning to collaborate. When patients were more complex, students took a mono- professional focus.
Spirit of teamwork Team and teamwork. IPEC: CC or TT	Students gained insights and were considerate about each other’s work processes and work planning. They experienced the importance of unequivocal task assignments and there was a low threshold for collaboration.	Being among other students made asking questions natural. The team room provided opportunities to hear and see the work of other professions.
Hierarchy Perceived difference in power and status between representatives from different professions. IPEC: Opposite of TT	Students experienced difference in status and power, but to a lesser extent than at the regular ward. When the medical student was chairing the IP meeting, other professions were more reluctant to contribute to the discussion, therefore they preferred to get turns. There was some dominance of the medical students in the discussions.	Students valued to get to know one another in their professional and personal capacity. For several students, giving and receiving of feedback is difficult when they disagree with a student from another profession.
IP Patient Care Meeting Interprofessional meeting to develop patient care plans. IPEC: RR	An efficient patient care meeting requires structure and structure does not come automatically. A predefined structure in which all professions “got turns” worked well for students and their perception was that it improved efficiency and optimal use of the contributions of all professions.
Communication Profession specific and interprofessional communication. IPEC: CC	Students acknowledged that interprofessionalcollaboration requires ”low threshold” communication: asking freely, speaking up, reporting back and “being open”, making unequivocal taskassignments, and checking back whether they are well understood.	After the IPE ward, students intended to perform in a more interprofessional way, as in their next ward rotation they proposed to have the structure for the patient care meeting, asked the questions they need in order to attune with the physician and experienced lower threshold to consult other professions.
Feedback Feedback. IPEC: CC	Structural interprofessional feedback is necessary/important, since interprofessional collaboration and learning benefit from it, but students find it difficult to give and receive interprofessional feedback. Good team spirit makes giving feedback easier.
Informal contact Exchange of information between students apart from the scheduled meetings. IPEC: CC	For students, meeting and working together in a room facilitated the interaction and exchange of information and provided insight into each other’s ways of working and thinking.
Future Interprofessional Collaboration	After the IPE ward, students indicated that their threshold to communicate with or consult other professions will be lower.

^a The procedure of systematic text condensation (Malterud 2012) is devised for a thematic, cross-case exploratory analysis consisting of four-steps: (i) getting a total impression by reading all interviews to identify preliminary themes, (ii) identifying meaning units concerning students experiences, establishing themes by sorting the meaning units, (iii) creating condensates from each theme, and (iv) re-conceptualizing these condensates by creating synthesized descriptions of students experiences. Re-contextualization means that the condensates are related to the total text in step (i).

^b Theme, description, and IPEC competency. In this table all steps but the sorted 674 meaning units of STC step (ii) are in the columns.

^c Condensed text of the interview theme based on the meaning units, that were students perceptions, either literally worded, or interpreted as such by the researchers, staying as close as possible with the verbatim interview text.

^d Synthesized results of students experiences.

IPEC: Interprofessional Education Collaborative; VE: values and ethics; CC: communication; TT: teams and teamwork; RR: roles and responsibilities.

Figure 2. Implications of the IPE ward. In this figure, the literature regarding Self-Determination Theory (SDT) is depicted in the boxes with an arrow and our finding of this study are given in the boxes without arrows. Fulfilment of the basis psychological needs is pivotal for autonomous motivation, academic outcomes, and intentions leading to behavioral change.

Malterud K. 2012. Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health. 40:795–805.

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