Interprofessional students’ experiences of specialization education on the design and development of digital health and social care services

Abstract

The increasing digitalization of working methods require new competencies from health and social care professionals. In addition, the development of person-centered digital health and social services call for interprofessional expertise and a social community with a unified language and culture. This study analyzes how the renewed model of specialization education enables professionals’ monological, dialogical, and trialogical learning. Adopting a qualitative approach and an interpretive descriptive research method, the study aimed to comprehensively interpret the quality, characteristics, and meanings of trialogical learning in online specialization education. The study focused on 10 two-credit specialization courses delivered collaboratively by 14 universities of applied sciences in Finland and monitored students’ reflections on their learning over time. The findings indicate students’ perceptions of their learning activities in specialization education and the occurrence of trialogical learning during the courses. Students described that interactive digital learning tools and webinars supported collaborative learning and the development of new skills and understanding. Students also learned to use new digital platforms and had the confidence to share their views and learn through these platforms. The study concludes that this learning process enables students to change their values and attitudes and apply them to create new healthcare and social care services.

Keywords:

• Digital healthcare services
• social healthcare services
• trialogical learning
• co-creation

Reviewing Editor:

• Darwin Stephen, Universidad Alberto Hurtado, Chile

Subjects:

• Adult Education and Lifelong Learning
• Continuing Professional Development
• Higher Education
• Open & Distance Education and eLearning

Introduction

The increasing digitalization and transformation of working methods require new competencies from health and social care professionals. These competencies are needed not only for the use of new information systems but also for the development of services through interprofessional collaboration (European Commission, 2022; Haverinen et al., 2022; WHO, 2021).

Updating one’s competencies is a prerequisite for managing work life, and continuous learning is a strategy to achieve this (Nicoll et al., 2018). The development of professional education requires a special understanding of adult learning (Murtonen & Lehtinen, 2020). Since 2016, universities of applied sciences (UASs) in Finland have been offering EQF 6-level (Europass, 2022) specialization education to create new digital skills for professionals in social and health care (Act 932/2014/11a1173). The role of specialization education is to proactively respond to future needs for skills in working life. The strengths of this education are its research-based approach, development of expertise, and cooperation with working life.

In different European Union (EU) countries, specialization education is offered in various forms. Several EU countries offer specialized postgraduate education, which typically comprises between 60 and 120 credits (European Commission, 2022). There are differences among these countries in terms of whether this specialization education is organized as short degrees or continuing education (Ranchal et al., 2015).

A Finnish national project has previously defined competencies in health and social care informatics and produced educational materials for use and self-learning by healthcare and social care professionals (Tiainen et al., 2021). Considering the need for interdisciplinary specialization, a follow-up project was developed in 2021 for experts to design and develop digital health and social care services in interdisciplinary teams. This online specialization education was organized and implemented by 14 UASs across Finland (Ahonen et al., 2023).

Background

The development of person-centered digital health and social services requires interprofessional expertise and a functioning social community with a unified language and culture. Courses on the development of digital and social healthcare services should be organized by an interprofessional team of teachers so that students can improve their professional skills when working in interdisciplinary teams (Tremblay et al., 2016). International recommendations for curricula on health and social care informatics and service design provide a competency base for the development of digital health and social care services (Ahonen et al., 2023; Mantas et al., 2010).

The pedagogical framework for the specialization education under study is trialogical learning, which involves the collaborative development of new knowledge, skills, and understanding. Trialogical learning is viewed as a social, active, and student-centered activity that focuses on interactions among student groups (Ahonen et al., 2020; Hmelo-Silver & Chinn, 2015).

The theoretical elements of trialogical learning include the knowledge-building approach (Bereiter, 2002), activity theory, expansive learning (Engestrom, 1987), and organizational knowledge creation (Nonaka & Takeuchi, 1995). Paavola et al. (2002) found seven similarities among the core processes in trialogical learning. To understand modern work and related theories of collaborative learning and human cognition, three types of learning metaphors are required. The co-development of knowledge involves different aspects, including the knowledge-creation process between individuals. However, there is also a need for an organization in which the co-creation process occurs, a community where knowledge is exchanged, and an artifact or action that is used during the knowledge-creation process (Paavola et al., 2012).

This study considered trialogical learning as a framework for learning. Learning can be visualized through three metaphors: monological, dialogical, and trialogical (Paavola et al., 2012). Monologic learning is seen as individual-centered knowledge acquisition, in which learners gather factual and conceptual information. Dialogic learning occurs through social interaction, participation in group activities, and learning experiential knowledge from peers while adopting the cultural practices of the community. Trialogical learning focuses on the purposeful collaborative development of new knowledge beyond the participants’ prior knowledge (Hakkarainen & Paavola, 2009; Paavola et al., 2012; Sansone et al., 2021). These three learning approaches complement each other (Hakkarainen & Paavola, 2009). Figure 1 illustrates the theoretical framework of this study.

Figure 1. The framework of learning metaphors in this study according to Paavola et al., (2012) and (Ahonen et al., 2020).

Learning environments play a significant role in facilitating collaboration between students (Sansone et al., 2021) and are spaces, communities, and practices in which learning and teaching occur. A learning environment includes various equipment, services, and materials that are used for learning (Buder, 2011). Learning environments are designed to promote interaction, participation, and collaborative knowledge-building. They enable active collaboration between communities and experts outside schools (Tammeorg et al., 2019).

Learning is increasingly occurring in digital environments. Digital learning refers to all learning situations that use information and communication technology (Männistö, 2020). These elements facilitate trialogical learning (Paavola et al., 2011). An effective digital learning environment comproses a software platform through which students can collaboratively solve problems and acquire new knowledge (Lin & Lin, 2019).

Teaching methods based on e-learning and digital learning environments have gained popularity and become effective alternatives to traditional teaching tools. Studies on e-learning have shown that digital learning environments promote students’ reflection on their experiences and learning processes, leading to a deeper acquisition of relevant knowledge and skills (Xiong et al., 2015). In addition to pedagogical tools, various technological solutions can be used to promote effective modern working-life skills (Järvelä et al., 2013; Xiong et al., 2015). As such, high-quality digital learning environments are being built and are gradually evolving (Trocky & Buckley, 2016).

Digital solutions extend the learning environment beyond universities and are accessible anywhere and at any time. Digital learning environments include a variety of interactive tools to support learning, such as chat areas, channels, e-learning materials, videos, images, and web links (Cooper et al., 2015; Montayre & Sparks, 2018; Nuninger, 2019). Thus, a wide range of issues are involved when considering the content of digital education and the design of digital learning environments (Herwatis et al., 2016; Terry et al., 2019). Scholars have recently stressed the need to increase the validity of studies that evaluate the efficacy of e-learning tools and optimize their methodologies (Bloomfield et al., 2008).

The benefits of using digital learning environments have long been analyzed. Several studies (Carroll et al., 2009; Männistö, Mikkonen, Kuivila, et al., 2019; Männistö, Mikkonen, Vuopala, et al., 2019; Sheridan & Kelly, 2010) have revealed the advantages of flexible learning offered by these tools. Among them, the main advantages are that access to the educational process is not physically bound to a predetermined place or time and that they allow for immediate feedback on task progress during learning. E-learning through digital learning environments is characterized by a high capacity to generate interest, satisfaction (Alemán et al., 2011; Gerdprasert et al., 2010; Kaveevivitchai et al., 2009), and motivation (Gerdprasert et al., 2010; Kelly, 2007; Lu et al., 2009) in the current generation of students. E-learning has also been championed for its capacity to individualize learning by de-centralizing the teaching process and facilitating students’ independence and self-direction (Männistö, Mikkonen, Kuivila, et al., 2019).

Other recognized benefits include flexibility and the promotion of active learning (Männistö, Mikkonen, Kuivila, et al., 2019; Männistö, Mikkonen, Vuopala, et al., 2019), improvements in students’ motivation and satisfaction (Männistö, Mikkonen, Vuopala, et al., 2019), cost efficiency, reductions in instructional time, consistency of educational delivery, and accessibility to information available via the Internet (Terry et al., 2019). Digital learning environments have also been endorsed for their roles in developing students’ computer skills and confidence (Nuninger, 2019). A digital learning environment can serve as a tool for producing and sharing knowledge and making ideas visible. It provides digital functions and multimedia to support learning and can be used to conduct various tasks and store course materials (Gegenfurtnera & Ebner 2019; Kümmel et al., 2020).

Study aims and research question

This study aimed to describe and interpret how the renewed model of specialization education enables professionals’ monological, dialogical, and trialogical learning. The findings provide novel insights into trialogical learning in fully online-based specialization education and updated knowledge on trialogical learning in short online courses. The study was guided by the following question:

• How do students describe the realization of monological, dialogical, and trialogical learning?

Methods

This study used a qualitative approach and an interpretive descriptive research method (Parahoo, 2014; Sandelowski, 2010) to comprehensively interpret the quality, characteristics, and meanings of trialogical learning in the context of online specialization education. This method was adopted in order to coherently describe the nature of the studied phenomenon (Holloway & Galvin, 2017; Parahoo, 2014). The study focused on describing students’ learning experiences and the learning products they used.

Study design

The study examined specialization education in the form of 10 two-credit courses delivered collaboratively by 14 UASs. One or two UASs were involved in the course implementation. The study design involved continuous monitoring of students’ learning experiences and reflections. Qualitative data was collected from students throughout the specialization education in all study courses and sent to the coordinating UAS.

Participants and sampling

Participants comprised students who were professionals in health and social care services and other professional sectors that use the informatics systems of health and social care services. Data were collected on a voluntary basis from students who participated in specialization education. During the specialization education, students wrote semi-structured learning diaries and provided feedback after each course in which they evaluated the course’s content delivery. The sample included all students who completed learning diaries during the first implementation of specialization education.

Data collection

The students described and reflected on their learning experiences through their learning diaries on specialization education. All participants received written information prior to the study and provided written informed consent to participate. The research data consisted of 458 digital learning diaries (Supplementary Appendix 1), in which students answered open-ended feedback questions about the content of the specialization education courses. The answers to three questions from each learning diary were analyzed, for a total of 1374 answers (458 × 3). The answers were short, mostly about three sentences long. According to Krippendorff (2019), researchers can find essential differences in the field of observation from numerous individual expressions/observations by breaking down the content and combining units. This combination creates multiple observations and informative cases and prepares this multiplicity for later analysis (Krippendorff, 2019).

Students were guided in writing and orally to complete their digital learning diaries and send them to the coordinating UAS (Laurea) no later than two weeks after each course. Students created an anonymous response code so that their identity and UAS could not be identified. They used the same code throughout the study. After each course, students returned a digital form with the same content, in which they answered questions assessing the impact of learning tasks, webinars, learning environments, and online learning. The data were collected via an encrypted collaborative cloud platform.

Data analysis

Data analysis was initiated by transferring data from the cloud platform to a single anonymous Excel spreadsheet. This spreadsheet was shared between two of the researchers, who carefully read the materials and analyzed them using inductive content analysis. The unit of analysis was a sentence or group of thoughts. The categories that emerged from the analysis are described in Table 1 (Burns & Grove, 2009; Elo & Kyngäs, 2008; Gray et al., 2019).

Table 1. Students’ description of the studies.

Main category	Sub-categories	Simplified quotes	Original quotes
Monological Metaphor of Learning	Autonomy of learning	Increased sense of control over studies	‘I was able to progress at my own pace and explore the content at my leisure. I was able to return to the topics as many times as I needed to’.
		Increased sense of self-confidence	‘Studies increased my confidence to work online’.
		To study independently and at a convenient time	‘I had to use different methods to complete the tasks, so I practiced both searching for information and using new software.  On this course, learning was independent, and I liked the way I was able to progress at my own pace.  The links, videos and exercises supported each other nicely’.
	Content of learning	Learning on different platforms and environments	‘I was able to do the exercises more than once.’
		Technical implementation of studies	‘It was especially interesting to make mind maps with a specific program.’
		Appreciation of new digital tools	‘I have learned to use a wide range of software, learning platforms and other digital tools, which I am very happy with. My video editing skills have also improved as I created the final video with images and sound myself.’
	Learning process	Limitations of one’s own knowledge.	‘Studying online contributed to my knowledge in webinars and collaborating with Miro.’
		Strengthened skills in searching for new information	‘I think I benefited from using these programs together.’
		Increased source criticism	‘For the assignment, you had to familiarize yourself with the given sources and look for sources more deeply related to your topic. I got to know the sources in a variety of ways’
		Studying online helped to focus and process new information	‘Studying online greatly contributed to my knowledge on this course.  My theoretical knowledge of the course increased.’
		Reflection on ethical issues.	‘Through the learning tasks, I got a pretty broad picture of ethical perspectives and how much there is to think about in the end.’ ‘Ethical perspectives had to be considered from a broader scope than before’.
		Structural clarity and coherence	‘Meaningful content, structural clarity and coherence of webinars.’
Main Category	Sub-categories	Simplified quotes	Original quotes
Dialogical Metaphor of Learning	Structure of studies	Teacher-led webinars	‘Teacher-led lessons promoted the use of different remote accesses and working platforms.’
		Use of different e-learning platforms.	‘The Miro board was a new acquaintance that was challenging to use at first.’
		Digitalisation of studies	‘I gained more experience using Zoom.’
	Conversations using learning technologies	General factors that affect the functioning of the group	‘The distance learning days among the group went well, the links functioned, and the content of the days was clear.’
		Impact on mood and motivation	‘Group activities and an external lecturer were a nice refreshment on a remote day.  There was plenty of reading material! Interesting discussions took place during the distance learning days. Great! The individual assignment was stimulating.’
		Opportunities for guidance	‘Opportunities to receive guidance and deepen knowledge.’
	Applicability of studies and knowledge.	Knowledge acquired in the webinars	‘The webinars provided good peer feedback and learning from all.’
		Broadly applicable learning environment	‘I now understood much better than before how massive the challenge is. The complexity of information management structures, various perspectives, and starting points even caused anxiety or at least concern about how deeply I would have to delve and consider them in my work.’
Main Category	Sub-categories	Simplified quotes	Original quotes
Trialogical Metaphor of Learning	Creation of new knowledge, skills, and competences	Increased online interaction skills	‘For example, I learned how to use Canva myself. I taught team members how to use Miro.’
		Increased courage to share their own competences	‘The use of miro, WhatsApp and other platforms, familiar from previous studies, is already natural and the grouping process was quick. I didn’t feel that random grouping was a bad thing, the utilization of other students’ professional skills and background was interesting and inspiring.’
		Emphasised the importance of sharing expertise and innovative discussions	‘The discussion areas in the learning environment were a great addition to the course content and learning, the perspectives and comments from other students added a lot of content into the learning.’
	Internalisation of common values and cultures	Peer feedback and peer learning in webinars	‘Working together on a task supports learning, as different views emerge.’
		Discussion areas of the e-learning platform	‘The Miro platform was completely foreign to me. It was frustrating to use at first, but as I got more familiar with it, it was pretty smooth. I think this example shows that getting started with digital solutions can be difficult for anyone, but once you get used to it, it starts to work. Online learning gave me the opportunity to do group work at a time that suits me best.’
		Reflection on how to process new information	‘The course also challenged me to think about my own online behavior and the professional possibilities of online interaction.’
		Networking with other professionals and peer learning	‘The online group work went well. The group members gave me support for my own ideas and also gave me a whole new way of thinking.’
	Goal-oriented co-creation process	Random grouping	‘Engaging in innovative conversations with individuals from across Finland was a wonderful experience. The exchange and collective sharing of knowledge proved to be highly stimulating and enlightening.’
		Open and accepting atmosphere	‘In the final webinar, it was great to go over the feedback from the reflection and discussion exercises. This was particularly memorable for me, as it was a refresher.’

In the first phase of data analysis, the first researcher coded and classified meaningful enunciations related to the first research question, which were tabulated and calculated. An in vivo program was used for data management. Next, the researcher formed and tabulated subcategories based on the content of the enunciations. The subcategories were then compared, refined, and redefined. Finally, the main categories were formed, compared, and refined.

In the second phase of the data analysis, the first researcher coded meaningful enunciations and expressions in the categories and content to describe trialogical learning and its characteristics. Trialogical learning was assessed based on the framework shown in Figure 1. Descriptive enunciations and expressions were tabulated. The second researcher then reviewed all the research data and checked the analysis results. Two changes were made to the results based on the second researcher’s analysis. Both researchers interpreted the categories related to the research context and students’ learning practices (Grove & Gray, 2019).

Ethical considerations

The research design was approved by the [omitted for peer review] (approval number: [omitted for peer review]).

Results

The results summarized students’ descriptions of their learning activities in specialization education in two-credit courses and the occurrence of trialogical learning during these courses.

Inquiry-based learning during specialization education

This section describes students’ experiences and activities and the effects on students’ learning during specialization education.

Monological learning in specialization education learning activities

Participants’ descriptions of online learning were divided into three categories: (1) learning autonomy, (2) learning content, and (3) learning process. Students described the effects of monological learning as follows. First, the specialization education allowed them to study autonomously and at times that were convenient for them. Online learning increased their perception that they could manage their studies and their self-confidence in studying. Quantitatively, the opportunity to study independently and at a convenient time was the most meaningful aspect of online studies (74 statements). Students’ self-direction skills increased when they felt that they could control their studies by choosing the appropriate timing and order of learning.

The effects of the courses’ learning content were divided into two subcategories: (1) learning on different platforms and environments, and (2) technical implementation. Students were required to use new programs on different learning platforms, such as virtual whiteboards. They described the experiences of new types of learning situations on a digital platform and the opportunities to communicate with other students in digital learning situations as meaningful. In terms of content, the students appreciated the new digital tools and found them impressive. These tools included a digital whiteboard, video editor, artificial intelligence programs/software, robotics, and an e-mind map platform. From the students’ perspectives, the most significant facets of the digitalization of education were the use of digital tools, the use of the digital learning environment, the internalization of new information and learning processes in digital form, and the privacy of studying enabled by digitalization.

As students processed new information, they realized the limitations of their knowledge. Their skills of searching for new information improved, and their ability to critique information sources sharpened. Studying online also helped students better focus on and process new information. They positively described the applicability of the tasks to their working lives and reflected on ethical issues. However, students complained most about unprofessional feedback, unclear instructions, simplistic, automated online assignments, and exams.

Dialogical learning in specialized education learning activities

This section presents students’ descriptions of the effects of dialogical learning in webinars and the learning environment. This category was further divided into three subcategories: (1) the structure of the courses, (2) conversation using learning technologies, and (3) applicability of learning and knowledge.

Students described that the structural clarity and coherence of the courses and the meaningful content of learning tasks and webinars positively impacted their learning. Webinars led by teachers promoted the learning and use of different e-learning platforms. The students felt that the clear structure and consistency of the courses made it easier to process the materials and internalize new information. Clear learning structures and meaningful learning content enabled dialogue.

The effects of conversation on learning were categorized as follows: (1) general factors affecting the functioning of the group, (2) impact on mood and motivation, and (3) opportunities for guidance. Being a member of a study group spread over a wide geographical area increased the importance of studying through online interactions. Small online group activities contributed to the acquisition of online interaction skills, and the format of learning tasks enhanced students’ learning. Successful group activities also positively influenced their mood and motivation. Further, communication with other students online promoted peer learning, and the learning platform enabled contact with teachers. According to the students, conversations and the interactivity of the learning tasks increased their motivation, and different perspectives promoted meaningful learning.

In terms of the course content and the applicability of the knowledge provided, the students considered the relevance of the knowledge for their working lives and its applicability to their work important. Students evaluated the knowledge acquired in the webinars and the learning environment as being broadly applicable to both. ‘Excessively expensive learning content, English-language materials, and difficult learning topics proved to be the main challenges in webinars and digital learning environments.’

Occurrence of trialogical learning in specialization education

Achieving trialogical learning through courses is an important pedagogical goal in education. We examined the research data to find evidence of the manifestation of this learning approach. The category ‘manifestation of trialogical learning in specialization education’ described how trialogical learning was reflected in students’ experiences, as recorded in their digital learning diaries. This category was divided into three subcategories: (1) the creation of new knowledge, skills, and competences; (2) internalizing common values and cultures; and (3) a goal-oriented co-creation process.

Creation of new knowledge, skills, and competencies

The students described changes in their online behaviors and learning experiences, which they had not imagined could occur. The courses challenged students to consider their online behavior and the professional possibilities in online interactions. In addition, cooperation among students increased their online interaction skills. Participants felt that working with other students in an online learning environment strengthened their skills, increased their courage to share their competencies, and made the products of their learning visible. Moreover, collaboration in an online learning environment helped students work on content from a broader perspective to deepen their learning. Such collaboration also helped them acquire the technical skills required to study and process new knowledge. The students’ statements emphasized the novelty of their activities and the need for in-depth reflection on information.

With their cross-border knowledge and competencies, students emphasized the importance of sharing expertise and having innovative discussions with other students living in different parts of the country. In terms of technical skills beyond the students’ limits, new technical competencies were emphasized related to their professional skills. Numerous new programs, learning platforms, and digital tools were proposed.

Internalizing common values and cultures

The subcategory of ‘internalizing common values and cultures’ was divided into three further subcategories: (1) deep learning and conversations, (2) technical implementation in cooperation with other students, and (3) processing new knowledge.

For deep learning and conversation, the students emphasized the importance of peer feedback and learning in webinars. The closing webinars of the courses were used to review and discuss the results of the course assignments, which significantly deepened students’ learning. Based on feedback, discussion areas in the e-learning platform were added to the course content and deep learning. According to the students, this type of study required them to be active and present during meetings.

When reflecting on their processing of new information, the students described a better understanding of the scope of digital issues in social and health care services. Information management and different perspectives can cause anxiety because of the large amount of information to be processed and the need for professionals to focus on many things at once and have knowledge of multiple issues related to their work.

The supervision of learning and social activities related to learning during the course implementation, the role of the group in learning, the structure of the course content (e.g., the structure of the group’s outputs on the whiteboard), networking with other professionals, and peer learning were all significant for the students. The participants were selected from across Finland, which provided them with a unique opportunity to network and meet other professionals during the courses. The main challenges of online learning are difficulties in organizing meetings owing to students’ schedules, the excessive number of tasks, the lack of guidance on how to perform these tasks, and the need for occasional additional guidance.

Goal-oriented co-creation process

The subcategory ‘goal-oriented co-creation process’ was divided into three further subcategories: (1) the functionality of the group, (2) the sense of participation and motivation, and 3) opportunities for guidance and deepening knowledge. Regarding the functionality of the group, students described how working together on a task supported learning as different views arose on the related issues. This feedback shows that random grouping is effective for utilizing students’ various professional skills.

In terms of participation and motivation, students emphasized an open and accepting atmosphere in their studies. Group participation was also encouraged throughout the courses. The webinars focused on interesting topics, and participation and interaction were encouraged.

Describing the guidance received, the opportunities to deepen their knowledge, and having the courage to start creating something new, students emphasized teacher-led learning processes, in which they had the opportunity to communicate with their teachers. This increased their motivation to study and supported their feelings of inclusion. Students could also connect with teachers through the learning platform.

Discussion

Analyzing the effects of e-learning and specialization education, this study found that learning occurred at all levels (monological, dialogical, and trialogical) (Paavola et al., 2012). The findings demonstrate that trialogical learning is possible in distance learning and during short two-credit courses. The results also show that the elements of co-creation can be achieved through two-credit courses. These short modules offer opportunities for in-depth learning beyond boundaries. Monological learning tasks are particularly important for many students. Individual learning tasks and independent reflections related to students’ roles in the workplace were described by the students as meaningful (Murtonen & Lehtinen, 2020). In dialogical learning, the importance of webinars and a digital learning environment was emphasized for students’ learning experiences. Webinars and working on common platforms helped students share their expertise and utilize their skills and experiences. Similar results have been reported by Gegenfurtnera and Ebner (2019), Kümmel et al. (2020), and Sugilar (2020). The present study’s results showed that collaborative learning tasks implemented on digital platforms and tools enabled the learning of new technological applications. Further, it facilitated students’ sharing of expertise and joint reflection on knowledge. The results support previous studies that have focused on adult students (Cohen et al., 2023; Vasset et al., 2019). Although other studies have not yet found similar results, no contradictions in this phenomenon have been found (Carroll et al. 2009; Männistö, Mikkonen, Kuivila, et al., 2019; Männistö, Mikkonen, Vuopala, et al., 2019).

During the specialization education process, this study observed that creating new knowledge, skills, and competencies were key issues in trialogical learning. The generation of new knowledge and competencies in an innovative manner is an essential part of trialogical learning. Similar insights have been reported in previous studies (Bereiter, 2002; Männistö, 2020; Paavola et al., 2011). Further, the present study demonstrated that learning outcomes were the result of active interaction between students, which supports the results of previous research (Ahonen et al., 2020; Hmelo-Silver & Chinn, 2015; Scardamalia & Bereiter, 2014a, 2014b).

Following the design principles of trialogical learning (Paavola et al., 2012), the students were tasked with jointly developing new services or products for their clients and were required to take responsibility for their learning and the joint processes and outputs. This study aimed to develop entities that can be used further. The use of different digital tools for learning enables team building and improves the co-creation of knowledge and peer learning. Students who participated in the courses were able to effectively network by using new digital teaching methods. Effective networking then led to the creation of various groups and forms of interaction, which enhanced the students’ ability to acquire and share new information, thus expanding each other’s knowledge (Haleem et al., 2022; Männistö, Mikkonen, Vuopala, et al., 2019).

Learning independently of time and place improved the students’ ability to complete the courses. Peer learning was enhanced by allowing students to study flexibly and effectively in diverse groups. Digital facilities, implementations, and platforms also supported peer learning. These results support those of previous studies on distance learning (Järvelä et al., 2013; Xiong et al., 2015).

Regarding the internalization of shared values and culture, which emerged as important in this study, having a common culture and sharing were found to be facilitated by deep learning and discussion. The two-credit modules of the Uudo Project support this idea (Ahonen et al., 2023). Students emphasized the importance of peer feedback and peer learning in webinars. Based on feedback, webinars and discussion forums on the e-learning platform were a positive addition to the course content and deep learning (e.g., Ahonen et al., 2020; Mantas et al., 2010; Nonaka & Takeuchi, 1995). According to the students, this type of studying requires activity, presence, and emotional control in collaborative meetings. Similar results regarding deep learning have been reported in previous research (Xiong et al., 2015). This study’s findings indicate that collaborative reflection by professionals from different operating environments can have a unifying effect on services.

In the collaborative creation process that takes place during education, a welcoming atmosphere and mutual trust in learning situations were found to be relevant, supporting the results of similar studies on this topic (Paavola et al., 2012). Sharing expertise among professionals in randomized groups and in different geographic areas was essential for the generation of new knowledge (Ahonen et al., 2020; Hmelo-Silver & Chinn, 2015; Scardamalia & Bereiter, 2014b). Moreover, the provision of guidance, the relevance of webinars and online meetings, and teachers’ participation enabled the generation of new knowledge. Embracing change, insights, and changes in attitude was observed to be important.

Strengths and limitations

The strength of this study lies in its extensive research data: In total, 1,374 statements were analyzed. These data were collected throughout a year-long specialization education program. The specialization education was conducted entirely online, and the research data were collected from a geographical area covering the whole of Finland. The students in this study were professionals who had experience in the social and healthcare sectors and other fields. Professional experience and prior education are likely to influence students’ abilities to benefit from interprofessional contexts and learning environments.

Conclusion

Interactive digital learning tools and webinars support collaborative learning and the development of new skills and understanding. In this study, students learned to use new digital platforms and, more importantly, gained the confidence to share their views and learn through these platforms. This learning process enabled students to change their values and attitudes and apply them to create new healthcare and social care services.

Ethical considerations

The research design was approved by the human sciences Ethics committee of the Helsinki Region approval number: OKM/316/522/2020.

Acknowledgments

This study formed part of the UUDO project, ‘New career paths with digital skills in social and health care’.

Data availability statement

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the Ministry of Education and Culture, under the project number OKM/316/522/2020.

Notes on contributors

Päivi Sanerma

Päivi Sanerma (PhD 2009, Education science; PhD 2022, Nursing Science, University of Tampere, Finland) has research interests focusing on nursing practices in home healthcare and digital services and solutions in homecare. She is working as a principal research scientist in HAMK University of applied sciences, HAMK Smart research unit.

Outi Ahonen

Outi Ahonen, PhD in Social and Health Care Information Management, Master of Science in Nursing, RN. She works as a principal lecturer at Laurea University of Applied Sciences (UAS). She is the President of the Board of the Finnish Society for Telemedicine and eHealth.

Anna Rauha

Anna Rauha, MSc in Biology (University of Helsinki). On top of her degree training, she has deepened her expertise in areas as multiculturalism, service design, marketing and completed a diploma in project management. She is a lecturer at Seinäjoki University of Applied Sciences, majoring in human anatomy and physiology.

Hanna Naakka

Hanna Naakka works as a project manager in HAMK Smart Research Unit. She has versatile work experience in HAMK UAS while she has worked as a head of degree program in nursing and a study counsellor in School of Wellbeing.

Sami Perälä

Sami Perälä has degrees in nursing, operating room and anaesthesiological nursing and paramedical nursing (Seinäjoki University of Applied Sciences), as well as Master degree in health sciences (University of Kuopio). Currently he is the Developing Manager of Well-being Technologies at the SeAMK.

Merja Männistö

Merja Männistö, PhD in Health Sciences with strong and diverse competences and experience in higher education development and leadership. She currently works as the Head of Education and Research at Diakonia University of Applied Sciences Diak Master School, leading Diak’s research activities and higher education.