The perceived impact of the COVID-19 pandemic on interprofessional education and collaborative practice: preliminary results from phase I of a global survey

ABSTRACT

The COVID-19 pandemic has had a sizable effect on interprofessional education and collaborative practice (IPECP) globally, yet much of the available literature on the topic remains anecdotal and locally bounded. This body of literature reflects celebratory and aspirational reports, with many case studies of successful response and perseverance under conditions of extreme pressure. There is, however, a more worrisome narrative emerging that pointed to differences in pandemic response with concerns raised about the sustainability of IPECP during and after the pandemic. The COVID-19 task force of InterprofessionalResearch.Global (IPRGlobal) set out to capture the successes and challenges of the interprofessional community over the pandemic through a longitudinal survey, with a view to inform global attempts at recovery and resilience. In this article, we report preliminary findings from Phase 1 of the survey. Phase 1 of the survey was sent to institutions/organizations in IPRGlobal (representing over 50 countries from Europe, North and South America, Australia, and Africa). The country-level response rate was over 50%. Key opportunities and challenges include the abrupt digitalization of collaborative learning and practice; de-prioritization of interprofessional education (IPE); and rise in interprofessional collaborative spirit. Implications for IPECP pedagogy, research, and policy post-pandemic are considered.

KEYWORDS:

• collaborative practice
• COVID- 19
• interprofessional education
• longitudinal survey

Introduction

Three years after COVID-19 was declared a pandemic, its effects on interprofessional education and collaborative practice (IPECP) remain profound. Pandemic literature from its acute phase painted a complex picture of both disruption and innovation (Aristovnik et al., 2020; Lackie et al., 2020; Langlois et al., 2020). Overall, the international literature on IPECP is celebratory and aspirational, with many case studies of successful response and perseverance under conditions of extreme pressure (Xyrichis & Williams, 2020). However, anecdotal evidence from across the globe also points to differences in pandemic response with some raising concerns about the sustainability of IPECP during and post pandemic (Lackie et al., 2020; Langlois et al., 2020). We set out to capture and map both the successes and challenges of the global interprofessional community over the duration of the pandemic. The goal was to gather international experiences from which to inform global attempts at recovery and resilience, specifically with regard to efforts at restoring IPECP initiatives in years to come. Here, we report preliminary findings from the first phase of a longitudinal global survey.

Background

In mid-2020, it became apparent that the interprofessional community would be at the epicenter of the global pandemic response, with health systems worldwide facing unprecedented pressures to provide services. Among many reports of successful frontline response, interprofessional camaraderie and educational innovation (e.g., Breitbach et al., 2020; Goldman & Xyrichis, 2020; Hales et al., 2020; Stifter et al., 2020), there have also been instances of policy failures and challenges (De Raeve et al., 2021; Nyashanu et al., 2020). To date, much of our understanding concerning the impact of the pandemic specifically on IPECP remains anecdotal. This endangers evidence-informed decisions and initiatives for healthcare and educational institutions to respond successfully to the current and future phases of the pandemic, as well as ensure preparedness for future pandemics or other global crises.

To respond to the need for assessing the impacts of the pandemic on IPECP around the globe, the InterprofessionalResearch.Global (IPRGlobal) set up a COVID-19 task force that among other initiatives, organized a global online survey to map perceptions and reactions from frontline educators, students, and practitioners. IPRGlobal is a special interest group that serves as a global network for IPECP research. The aim of the survey was to collate perceptions about the pandemic-related:

1. impact on IPECP programs

2. changes in IPECP academic or professional policies

3. pedagogic modes of delivering interprofessional education (IPE)

4. lessons learned for future delivery of IPE

5. questions for future research on IPECP

Method

The methodological details of the survey have been reported previously in a study protocol (Khalili & Xyrichis, 2020) and are briefly summarized.

Data collection

The study followed a longitudinal, online, questionnaire survey design. Questionnaire items collected demographic information alongside open-ended questions pertaining to the study’s five objectives. Invitations for participation were shared through the network of IPRGlobal, consisting of 800 members from over 50 countries, as well as social media. Phase 1 of the data collection was completed between May and September of 2020, only a few months after the World Health Organization declared COVID-19 as a pandemic.

Data analysis

Descriptive statistics including means, counts, and percentages were used to summarize participant demographics. Qualitative responses to the open-ended questions were analyzed thematically using Braun and Clarke’s thematic analysis approach (Braun & Clarke, 2006) that involve three main steps: familiarization with the data, coding by applying thematic labels to notable segments of text, and organizing codes under wider categories. To strengthen analytic rigor, the questions were divided among three pairs of analysts. Each analyst coded data independently before agreeing on final codes within their pair. Then, the three pairs met to agree on codes and categories across the dataset; disagreements were resolved through consensus.

Ethical considerations

Data were collected anonymously. An information sheet was available as the first page of the online survey. Respondents were informed that participation in the survey implied consent. The study was reviewed and received minimal risk registration by the King’s College London Research Ethics Committee (ethical clearance reference number: MRA-19/20-19056).

Findings

Phase 1 respondents

The Phase 1 survey received 80 responses, representing over 70 institutions from over 30 countries (Table 1). The majority of respondents were university IPE leads (n = 23, 29%) followed by IPE teachers/facilitators (n = 20, 26%) (Table 1). A further 12 respondents (15%) were practitioners (nurses, physiotherapists, general practitioners, speech and language therapists), 13 respondents (17%) were students participating in IPE, 6 respondents (8%) were researchers in IPECP, and 4 respondents (5%) were associate deans with responsibility for IPE.

Table 1. Respondent’s role/interest in IPECP and its origins.

Respondents	Dean	Lead	Educator	Practitioner	Researcher	Student	Total
Region	n	n	n	n	n	n	n (%)
Africa		3	3	7	2	2	17 (22)
Asia		1	1	1			3 (4)
Australia		1	3				4 (5)
Europe	1	4	4	1	1	1	12 (15)
North America	2	3	2		3	1	11 (14)
South America	1	11	7	3		9	31 (40)
Total n (%)	4 (5)	23 (29)	20 (26)	12 (15)	6 (8)	13 (17)	78 (100)

Phase 1 open responses

The thematic analysis of the data from the Phase 1 open-ended survey questions resulted in 16 themes grouped under five categories: online transition of IPECP, disruption to education and practice, deprioritization of collaborative learning and practice, rise in interprofessional spirit, and IPECP research and evaluation (Table 2). Here, we offer a summary of the most prominent themes; with further details to be provided in the final report on project completion.

Table 2. Emerging themes and subthemes.

Categories	Themes	Example quote
1) Online Transition of IPECP	a) Abrupt and forced shift to virtual learning and practice	This emergency measure of social distance demanded an immediate redirection of the work process of the IPE program, starting to adopt remote communication and working. [Leader, Asia]
	b) Limited resources for virtual education and practice	For larger IPE classroom-based sessions, we would have always broken into smaller groups for interactional activities. Very difficult to do this on-line so although IPE can occur through delivery of lectures, the level of organization required to also facilitate break-out groups within a lecture schedule would be prohibitive. [Educator, Europe]
	c) Challenges with technology	Mode in meetings have changed, and digital meetings are not always easy because of increased expenses and irregularities in electrical power. [Practitioner, South America]
	d) Digital healthcare literacy	It’s very challenging. There is a completely new format to learn and implement. It’s in the context of so much other change. [Educator, Europe]
2) Disruption to education and practice	a) Pause or cancelation of IPE activities	Due to the situation and lock down all normal educational activities have been set on hold for the time being. Because the whole country is under lockdown, students and staff were not on campus, therefore the planned activities had to be canceled. [Leader, Europe]
	b) Shifting roles and responsibilities	ICU nurses expanded responsibility to supervised non-ICU RNs and medical staff; challenges include: out of comfort zone, PPE hampers facial recognition, hierarchy issues with supervision. [Practitioner, Europe]
	c) Family and community care disrupted	From an inpatient perspective – there is no family visitation or carer training prior to discharge, due to the policy of the hospital groups we work with. This places the patients and families at risk. [Practitioner, Africa] My local experience is that community care has failed to collaboratively support people at home. Hospitals while working under strain and working interprofessionally will not meet community needs. [Leader, Europe]
3) Deprioritization of collaborative practice and learning	a) Collaborative practice hindered	Therapists, dietitians and other staff apart from nurses and doctors have been pulled out of communities, NGOs, clinics, schools, centers, etc, to work from home or offices to do COVID-19 case and contact tracing, so there is no teamwork happening in district healthcare in our area. [Leader, Africa] Difficulties working collaboratively in team-based care as all wearing PPE and hard to communicate sometimes. [Practitioner, Europe] Difficulty with continued ward rounds, due to physical distancing; difficulty with attending meetings as not all Allied Health staff have access to virtual meeting tools. [Practitioner, Africa]
	b) Loss of practice-based collaborative learning	There is currently no simulation or clinical placements. This is a huge concern because these are where students learn how to be collaborative. Policies related to pandemic planning are being developed as we progress through the pandemic. [Educator, North America]
	c) IPE not seen as a priority	IPE has not been at the top of anyone’s agenda because faculty are solely focused on transforming face-to-face classes to an online platform. As such, IPE has taken a “back seat.” [Educator, North America]
4) Rise in interprofessional spirit	a) Recognizing the importance of IPE	The opportunities to learn how other professions are trained and the skills and abilities that they develop during their professional training have provided a different perspective on teamwork, communication, different roles and responsibilities. [Student, South America]
	b) Innovations in collaborative learning	Our curriculum went online within 48 hours of university closures. Cohesiveness of the teaching team was the biggest standout and played a crucial part in looking after the wellbeing of isolated students, by use of electronic media, web-based video conferencing/chat groups. Team members adapted scenarios to enact online collaborative meeting spaces. [Educator, Australia] I have been able to connect to courses/seminars from presenters all over the world, something that would not have been arranged by various institutions had this pandemic not caused us to adapt our usual ways of holding seminars and courses in person. [Practitioner, Africa] Even though, face-to-face IPE is preferred, online IPE has many advantages. Online and digital resources might even overcome and improve shortcomings of IPE. An opportunity that should not be ignored. [Leader, Europe]
	c) Valuing interprofessional collaboration	The pandemic has shown how fundamental interprofessional collaboration is to achieving effective results. [Leader, Europe] Interprofessional work at this time, even from the distance, proved to be necessary for the population. [Practitioner, South America]
	d) Innovations in collaborative practice	The state expansion of telehealth providers to include rehabilitation professionals, although temporary for some professions. Changes to billing to allow payment for telehealth services. [Leader, North America] In the practice world, there was a lift on many regulations to allow effective patient care delivery. For example, as a pharmacist I was allowed to be in charge of dispensing proper meds without contacting the PCP if we can’t get any response. Patient care delivery was the main focus and certain regulations were lifted to be fully in charge and make the proper decision. [Practitioner, North America] We are introducing the concept of a virtual home visit by a team, communicating directly (via phone) with a client or working through a community health worker using WhatsApp. [Practitioner, Africa]
5) IPECP research and evaluation	a) Opportunities	It is necessary to reevaluate the ways and means through which interprofessional education works, both in professional training and in continuing education, to guarantee the effectiveness of the processes. [Educator, South America] Most IPE is just passing on information/discussion at this point. No formal training/evaluation as such. Further research needed on COVID-19. [Practitioner, Europe] New spaces and scenarios have emerged for the incorporation of the pandemic as an essential content for the debate on health care and interprofessional teams, and for the expansion and adoption of different types of care. We need to know how to conduct these processes in these new situations. [Lead, South America]
	b) Challenges	Inability to meet with the students is the major challenge. Coordinators need to re-strategize. Research could not be conducted in the clinical settings on IPE. [Researcher, Africa] Much research has been stalled because we cannot complete interviews easily with clinical colleagues who now have other priorities – similarly with our patients. [Leader, Europe]

Given that the majority of our respondents were IPE educators (25%) and leaders (32%), it is not surprising that many of the comments centered around the changes on collaborative learning initiatives, both in academic and practice settings. The embrace of digital and remote learning featured heavily in the responses from across regions, noting both the potential and challenges of new technology. Some respondents reported challenges with the abrupt move to the digital sphere, especially when this was not accompanied by the required resources and training. However, others saw potential in innovating pedagogies and practices for IPECP, capitalizing on the flexibility that online learning, virtual platforms, and videoconferencing can offer.

Major areas of concern were around disruptions to collaborative learning and practice, with challenges reported both in delivering care as a team and in providing opportunities for collaborative learning. Remote and working from home hindered teamwork in practice, as did variation in resource availability among different professions. Reports of IPE no longer being seen as a priority are of concern, especially since some participants indicated that all IPE was paused in their areas of work.

Among the pandemic concerns and anxieties, a rise in interprofessional spirit was also reported from participants across professions, roles, and regions. The importance of IPE was noted by many, including students who recognized the new perspectives that IPE gives about teamwork and collaborative practice. In the same spirit, practitioners used the virtual environment to transform their work and continue with interprofessional practices. Innovations around shifting traditional professional boundaries to enable greater flexibility in care delivery reflect the recognition of the importance of IPECP in the healthcare systems. IPE and collaborative practice were seen as ways through which healthcare can begin to recover after the pandemic.

Discussion

The COVID-19 pandemic and public health measures to mitigate its spread have provoked pervasive intrusion in IPECP training while providing new opportunities for collaboration in practice, knowledge sharing, and research globally (Natale et al., 2020). The forced and rapid closure of onsite education and practice threw students, faculty, practitioners, and researchers into uncharted territory (Lackie et al., 2020). The digitalization of almost every aspect of IPECP, from teaching to providing health care, was perceived to be inevitable (Tabatabai, 2020). The results presented here lend weight to concerns by international commentators regarding the transition from face-to-face to online education. The data clarify that while higher-income countries had the infrastructure, for the most part, to rapidly transition to an online environment, the disruption to health professional education and practice was still felt everywhere, and the prioritization of IPECP lagged. The respondents further highlighted the crucial role of interprofessional collaboration in strengthening their health systems response, and in doing so arguably saving lives; however, many higher education institutions failed to prioritize the online transitioning of their IPE programs.

In the midst of pandemic-induced shortages of resources, the respondents felt the need for flexibility, adaptability, resiliency, and collaboration as predicted by other commentators (Khalili et al., 2021; Ovens & Petrie, 2021; Sundararaman et al., 2021). The various participants in this global survey (including educators, leaders, practitioners, researchers, and students) pointed to a rise in interprofessional spirit and strengthening in comradery. Innovation in collaborative learning and practice flourished, although the extent to which innovations will remain as we transition out of the acute phase of the pandemic remains to be seen.

The disruptive effects of the pandemic created opportunity for healthcare transformation. The initial responses in replicating traditional educational and practice activities virtually – such as switching didactic teaching with virtual lectures, or in-person visits with telehealth visits – were mainly aimed at mitigating disruption in IPECP. However, respondents were not sure whether these short-term replications would be sufficient. We share our participants’ concerns and agree with other commentators in calling for healthcare education and practice to seize newly-found opportunities for transformative, long-term changes to improve quality, access, knowledge sharing, and inclusivity through collaboration and partnership (Khalili, 2020; Tam & El-Azar, 2020; World Health Organization, 2021).

Many changes in the early pandemic period occurred rapidly, with little space for evidence collection and evaluation. As the world is gradually transitioning from the acute phase to the next phases of the pandemic, a space opens up for exploratory and evaluative research into the effects and sustainability of new and current initiatives. Adding to previous calls (Lackie et al., 2020; Langlois et al., 2020; Sy et al., 2020), the respondents to the current survey raised the importance for research evaluating the impact of new IPE pedagogies, teaching strategies, and delivery modalities in assisting students to achieve IPE goals and competencies.

The findings from the Phase 1 IPRGlobal survey offer preliminary evidence of pandemic-related effects on education, research, and practice across the world. These point to a need for greater investment and prioritization in IPECP as a way to move forward as a community, beyond short-term crisis response and toward long-term recovery and resilience in the current and future phases of the pandemic.

Limitations

The results shown here remain preliminary, based on responses to Phase 1 of a longitudinal survey, and must therefore be treated as such. The majority of responses (68%) were from faculty, with student participation at 17%. While subsequent Phases are unlikely to alter the conclusions of Phase 1, it is conceivable that they may offer additional insight concerning the ephemeral or lasting nature of the pandemic effects. Online, global surveys such as our own are vulnerable to inaccurate sample size estimation and generalizability; self-reported surveys more generally are also at high risk of social desirability bias (Ball, 2019; Fang et al., 2021). However, the wide representation of respondents from different institutions and countries serves to counter some of these inherent limitations.

Conclusion

As the global health professions education and practice community proceed into a recovery mode following the disruptions imposed by the pandemic, evidence gathered from six continents as part of this first global analysis will serve as a guide to recommendations regarding next steps. Noteworthy are the observations around flexibility and adaptability across regions, providing rich ground for shared learning. Analysis of international responses for the successive two phases will build on these initial results, refining established and iterative practices to reengage and revise IPECP approaches both globally and locally. Each international context is unique, yet an appreciation of common experiences can foster a strengthened community committed to the advancement of IPECP for stronger and more resilient systems for health.

With thanks to all the regional interprofessional education groups for disseminating and responding to the Phase 1 survey.

Disclosure statement

The authors declare no known financial conflicts of interests relating to this article.

Data availability statement

Data available on reasonable request to [email protected].

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.