Students’ approaches to learning in clinical interprofessional context

Abstract

Background: Health care professionals are supposed to work in teams. Students in health care need to learn how to collaborate during their undergraduate education. Interprofessional learning environments, where collaboration is necessary, may be differently accepted by students depending on their approach to learning.

Aim: We investigated health care students’ evaluations of interprofessional clinical training in relation to their study orientations.

Methods: The participants were 369 students (40 occupational therapy-, 85 medical-, 52 physiotherapy-, and 192 nursing students) attending an IPE course at a Swedish University Hospital. Data were collected by questionnaires measuring orientations to studying and attitudes towards the clinical training and the IPE concept before and after the training. The response rate was 77 %. Study groups were formed by a cluster analysis on the basis of the students’ learning orientations.

Results: Three clusters were found: Low collaboration-, Collaborative Constructivist-, and Cookbook groups. These clusters were related to different professions and how students perceived their interprofessional learning environment.

Conclusions: Study orientations appear to play a role in the way students evaluate interprofessional training. This should be taken into account in instruction. Students with a ‘Cookbook’ approach to learning showed an increased understanding of interprofessional collaboration after the course.

Introduction

Previous research shows that general study orientations contribute to concrete study activities and there is great variation in terms of how students approach different learning tasks (e.g. Lonka & Lindblom-Ylänne 1996; Vermunt 1996; McManus et al. 1998). Students in different health professions also vary their way of seeing the nature of their expertise (Mäkinen et al. 2007). It is reasonable to assume that such general dispositions also affect the ways in which students approach interprofessional education (IPE). Only quite recently, the collaborative aspect has been added to research on study orientations (Entwistle & McCune 2004; Lonka et al. 2008), It is interesting to see, whether general approaches to studying are related to the ways undergraduate students learn to appreciate interprofessional training.

IPE in different forms has been used as a method to improve collaboration between professions with the final aim of improving health care (Barr 2005). Future doctors, nurses, physiotherapists and other health care professionals are supposed to work efficiently in teams. To achieve interprofessional teamwork in health care, students from various educational programs need to learn how to collaborate already during their undergraduate education (Hylin et al. 2010, submitted). However, these new learning environments, where collaboration is necessary, may not be attractive and easily accepted by students for various reasons, such as their preferred approach to learning.

In the present study we have investigated health care students’ evaluations of interprofessional clinical training in relation to their study orientations.

We hypothesized that since during a mandatory interprofessional clinical course the students are ‘forced’ to cooperate within teams and take responsibility for patient care as well as for their own learning, students with a less cooperative approach might be less satisfied with the course and reach the course goals to a lower extent, compared to students who prefer a more collaborative learning approach, who will be more satisfied with the course and reach the course goals to a higher extent.

The aims of this study were firstly to categorize the students’ learning approaches by using the Conceptions of Knowledge and Learning Questionnaire (Lonka et al. 2001, 2008) and secondly, to relate these to their professions, gender, attitudes towards the course and the course goals, understanding of their own professional role, knowledge of the other professions and their satisfaction with the supervision.

The context of the study

IPE in a clinical context on interprofessional training wards has been described previously (i.e. Wahlström et al. 1997; Wahlström & Sanden 1998; Freeth et al. 2001; Reeves et al. 2002; Ponzer et al. 2004). The interprofessional training ward at the hospital where this study is performed is an orthopaedic ward where patients in need of acute (e.g. ankle fracture) or elective (e.g. hip replacement) orthopaedic surgery are treated. During the two-week mandatory IPE course three student teams, each consisting of one or two medical students, three nursing students, one physiotherapy student and/or one occupational therapy student, work together and provide the patients with medical care, nursing care and rehabilitation supervised by profession specific facilitators. Major educational goals include developing their own professional role, gaining knowledge about the other professions and increasing their skills in communication and teamwork. The pedagogic method used in this interprofessional learning environment follows the principles of adult learning (Barr 2005). The basic idea of Problem Based Learning, with some modification, is applied, i.e. clinical questions and problems that arise from the daily work are the starting point for the students’ learning. They are encouraged to seek information via literature or internet and to solve the problems together, using the team members’ knowledge and skills. Facilitators should ‘stand back’ and let the students act in their professional roles – as far as patient safety is not at risk. The reflective feed-back session in the end of the working day at the ward is also an important tool for learning.

Approaches to learning and study orientations

Research on university student learning identified originally two main approaches to learning: ‘deep approach’, which focuses on meaning and understanding, and ‘surface approach’, which on the other hand focuses on detail memorizing and word replication (Marton & Säljö 1976). Later it was shown that the deep approach was related to success in undergraduate education (Watkins 2001; Zeegers 2001), including medical education (Newble & Entwistle 1986; McManus et al. 1998; Mattick et al. 2004). Approaches to learning are parts of more general study orientations. Usually, approaches to learning are measured by using sum variables of rating scales, whereas orientations are determined by combining the scales with factor or cluster analyses (Lonka et al. 2004).

Entwistle and McCune (2004) summarized four typical orientations in university studying. The reproducing orientation indicated the use of a surface approach with an emphasis on rote memorizing, associated with extrinsic motivation. Meaning orientation indicated a deep approach with an intention to understand for oneself, whereas the achieving orientation involved a strategic approach, i.e. being aware of study requirements and making sure they were achieved. Finally a nonacademic orientation indicated negative attitudes to studying. In medical education, meaning orientation was fused with a strategic orientation, and such combination correlated with success, whereas a nonacademic orientation is rare (Lonka & Lindblom-Ylänne 1996).

Conceptions of knowledge (epistemologies)

Students with dualistic conceptions of knowledge perceive knowledge as a set of clear, absolute and unchanging facts, while a relativist would believe that knowledge is created and evaluated in a specific context and can be scrutinized by presenting relevant evidence and arguments (Perry 1970). Lonka and Lindblom-Ylänne (1996) showed that medical students, especially novices, had quite dualistic ideas of knowledge. Further, surface approach tended to correlate with dualistic ideas of knowledge and externally regulated learning, forming a reproducing orientation (Lonka & Lindblom-Ylänne 1996; Nieminen et al. 2004). In general, students became more relativistic during their studies. Later, Lonka et al. (2008) identified a new version of meaning orientation, labelled collaborative knowledge building orientation, where deep approach and collaborative ideas of learning correlated.

Professional study orientations

In addition to the above mentioned orientations, in some domains a strong professional orientation is also typical. Lonka and Lindblom-Ylänne (1996) showed that a professional orientation was especially typical of advanced medical students. They interpreted students’ appreciation of directly useful and applicable knowledge as reflecting their clinical or practical interest rather than scientific ambition. Professional orientation resembled Vermunt's (1996) application-directed orientation, defined in his qualitative study, where students were interested in concrete applications and using knowledge in vocational settings. Later, Mäkinen et al. (2004) divided all first-year students in a multi-disciplinary Finnish University into three study orientation groups by using a cluster analysis: study-oriented students, work-life oriented students and non-committed students. Regarding study success, work-life oriented students were the most successful Medical students were the most work-life oriented of all domains. Later, Lonka et al. (2008) showed that some medical students developed so called Cookbook orientation to learning, where surface approach was linked with the need to receive certain and practical knowledge in educational settings.

Health care students’ conceptions and interprofessional care

Mäkinen et al. (2007) showed that health care students’ conceptions of expertise were constituted mainly on domain-specific bases and that students who graduated possessed diverse ideas about professional expertise. They concluded that institutions educating health care professionals should increase interdisciplinary activities in their curriculum in order to enrich students’ conceptions of expertise already during the course of studying.

Approaches to learning in an interprofessional context have earlier been reported in Sweden. Fallsberg and Hammar (2000) reported two different learning strategies among the students: ‘equal sharing approach’ and ‘life-long learning approach’. In the equal sharing approach the students regarded the teamwork as just a division of work, but in the life-long learning approach the students used the team for dialogue and reflection, giving a deeper understanding.

Ponzer et al. (2004) showed that the interprofessional training ward provided the students with good clinical practice in terms of training in their own profession as well as in learning about the other professions. The quality of the supervision and the students’ perception of their own professional role were important factors regarding the satisfaction with the course. The IPE course at the training ward seemed to provide the students with an opportunity to develop their own professional role and their function as team members. A two-year follow-up study showed that former students used the experience they had acquired from the course in their present work (Hylin et al. 2007).

Table

Practice points

When investigating health care students’ learning orientations, three clusters were found: a ‘collaborative-constructivist’ group, a ‘low collaborative group’ and a ‘cookbook’ group. Students with the ‘low collaborative’ orientation were less satisfied with interprofessional clinical training than the other groups. Male medical students were the least interested in cooperation compared to the nursing, occupational therapy and physiotherapy students. Regardless of learning orientation, almost all students highly valued the interprofessional training in clinical practice. Students with a cookbook approach showed an increased understanding of interprofessional collaborative work

Methods

Participants

All 369 students attending the IPE course at a major university hospital in Sweden during three terms were asked to participate and all students agreed. Of the 369 students, 40 (11%) were occupational therapy (OT) students, 85 (23%) were medical students, 52 (14%) were physiotherapy (PT) students and 192 (52%) were nursing students. The local Ethical Committee had approved the study and all students gave their informed consent of participation.

Materials and data collection

During a formal introduction to the IPE course 3 days before the course started, the students were asked to complete a questionnaire and on nine-point Likert scales rate their attitudes towards the IPE course and if they considered the goals for the IPE course realistic in relation to the length of the course, their understanding of their own professional role and their knowledge of the other professions (Tables 3 and 4). They were also asked to complete the Conceptions of Learning and Knowledge Questionnaire (CLKQ), which categorizes the student's approaches to learning as collaborative-constructivist approach (‘Collaborative-Constructivist’), externally regulated dualistic approach (‘Certain Knowledge’) or practical application-directed approach (‘Practical Value’). The CLKQ is a validated questionnaire consisting of 19 questions and for each item the students rate themselves on a six-point Likert scale ranging from ‘I fully disagree’ (1) to ‘I fully agree’ (6). The reliability of the scales, measured as internal consistency (Cronbach's Alpha) was 0.63 for the Collaborative-Constructivis scale, 0.77 for the Certain Knowledge scale and 0.57 for the Practical Value scale. The results are presented as mean values of the three sub-scales which are characterized as follows:

• ‘Collaborative-Constructivist’: Students with a collaborative conception of learning, based on shared construction of explanations. The main conception of these students is to build knowledge together with others, teachers as well as other students.

• ‘Certain Knowledge’: Students with an externally regulated conception of learning. The main conception of these students is to acquire definite knowledge from textbooks or from a teacher.

• ‘Practical Value’: Students with an application-directed conception of learning, These students have a pragmatic orientation, and look for applications of knowledge in practical and concrete situations.

At the end of the course, the same questionnaire as before the course was used except that questions regarding the students’ opinion about the supervision and their opinion about the care and rehabilitation they provided for the patients during the course were added (nine-point Likert scales). Thus, every student received questionnaires both before and after the course, and they were asked to put the same anonymous code on both questionnaires. Out of the 738 questionnaires handed out, 652 were returned (88%) and 283 pairs of questionnaires could be identified (77%). For the additional 86 questionnaires (55 ‘before’ and 31 ‘after’) the corresponding questionnaire was missing or could not be identified. Of the 283 complete questionnaires 33 (12%) were answered by occupational therapy students, 60 (21%) by medical students, 39 (14%) by physiotherapy students and the remaining 151 (53%) by nursing students. The response rate was for occupational therapy students 82%, for medical students 71%, for physiotherapy students 75% and for nursing students 79%.

Statistics

The statistical software used was PASW Statistics 17.0 for Windows. The reliability of the scales was measured by calculating the internal consistency as Cronbach Alphas. For the cluster analysis, several clusters were constructed by using different parameters and clustering methods, and the method resulting in clusters with most diverse final cluster centres were chosen. Likert scale data are treated as ordinal data in statistical analyses, but presented as mean values. For comparison of differences between groups the Kruskal–Wallis and Mann–Whitney tests were used, and for comparison between ‘before’ and ‘after’ the Sign test was used. Significance was calculated based on the paired questionnaires. All tests were two-sided. The results were considered significant at p < 0.05. Bonferroni correction was used for multiple analyses.

Results

The results of the CLKQ showed that the students in general preferred a collaborative-constructivist approach to learning. Table 1 shows that the mean score for Collaborative-Constructivist approach was 5.2 compared to 4.0 for the Practical Value approach and 3.3 for the Certain knowledge approach (p < 0.005), but there were several significant differences between the students from the different educational programs mainly regarding the Collaborative-Constructivist approach. The occupational therapy students scored the highest on the Collaborative-Constructivist scale, followed by the nursing students.

Table 1.  The CLKQ categorized according to students’ preferred approach to learning, i.e. Practical value, Certain knowledge and Collaborative-Constructivist, for all students and for each educational program

	Practical value (mean)	Certain knowledge (mean)	Collaborative- Constructivist (mean)
All students (n = 283)	4.0	3.3	5.2
Medical students (n = 60)	3.9	3.2	5.0 (a,b)
Nursing students (n = 151)	4.0	3.5 (c)	5.2 (a)
OT students (n = 33)	4.0	2.9 (c)	5.4 (b,d)
PT students (n = 39)	4.0	3.1	4.9 (d)
Female students (n = 238)	4.0	3.3	5.2 (e)
Male students (n = 43)	4.0	3.5	5.0 (e)
Female medical students (n = 39)	3.8	3.0 (f)	5.2 (f)
Male medical students (n = 20)	4.2	3.6 (f)	4.7 (f)

Notes: Significant differences in comparisons between the student groups are marked (a)–(f).

(a) Between medical and nursing students (p < 0.0125).

(b) Between medical and occupational therapy students (p < 0.001).

(c) Between nursing and occupational therapy students (p < 0.001).

(d) Between occupational therapy and physiotherapy students (p < 0.005).

(e) Between female and male students (p < 0.005).

(f) Between female and male medical students (p < 0.005).

Female students had significantly higher ratings on the Collaborative-Constructivist approach, and for female medical students this difference was even more pronounced when compared to male medical students. Instead, the male medical students rated significantly higher on the Practical Value and Certain Knowledge scales (Table 1). All occupational therapy students and a vast majority of the physiotherapy (85 %) and nursing students (89 %) were females and therefore no gender differences were calculated for these student groups.

Through a cluster analysis three student clusters with different preferences regarding approaches to learning were identified (Table 2). The characteristic of the first group (n = 80) was the lowest value among the cluster groups on the Collaborative-Constructivist approach. The score on the Practical Value approach was relatively high and the value on the Certain Knowledge approach scale was relatively low (‘Low Collaborative’ group). The second group (n = 106) was characterized by the highest score on the Collaborative-Constructivist approach and the lowest scores on the other two scales (‘Collaborative Constructivist’ group) and the third group (n = 97) had the highest scores on the Certain Knowledge approach and the Practical Value approach scales, and a medium score on the Collaborative-Constructivist approach scale (‘Cookbook’ group) in comparison with the other cluster groups.

Table 2.  CLKQ showing the distribution of the three clusters. i.e. ‘Low collaborative’, ‘Collaborative Constructivist’ and ‘Cookbook’ for all students and separately by educational group and gender

	Cluster groups
	Low collaborative	Collaborative- Constructivist	Cookbook
	n	n	n
All students	80	106	97
Medical students	22	22	16
Nursing students	31	55	65
OT students	8	18	7
- PT students	19	11	9
Gender	n	n	n
Females^a	66	91	81
Males^a	14	14	15
Students’ approach to learning according to CLKQ	Mean	Mean	Mean
Practical value	4.3	3.4*	4.4
Certain knowledge	3.0*	2.7*	4.2*
Collaborative-Constructivist	4.8*	5.5*	5.1*

Notes: Characteristics of each cluster according to the CLKQ are shown as mean values. The differences in CLKQ values between the groups are significant (p < 0.005) except for the Low Collaborative and Cookbook groups regarding the sub-scale Practical Value. ^aTwo students did not state their gender in the questionnaire.An asterisk (*) indicates significant difference compared to the other two groups.

One of the goals for the IPE course at the training ward was that the students’ understanding of their own professional role should increase. Table 3 shows that all students in all three clusters rated their understanding of their own professional role to mean value 6.4–6.8 (median 7) before they started the course. After the course the rating was 7.9 (median 8) for all groups indicating a significant (p < 0.005) increase over time for all cluster groups, but no difference between the groups.

Table 3.  Comparison between the cluster groups before and after the IPE course regarding their understanding of their own profession (no difference between the clusters but significant increase within each clusters, p < 0.005), and their knowledge about each others’ professions (no difference between the clusters but significant increase within each cluster, p < 0.005)

	Before the course			After the course
	Cluster groups			Cluster groups
	Low collaborative (mean)	Collaborative- Constructivist (mean)	Cookbook (mean)	Low collaborative (mean)	Collaborative- Constructivist (mean)	Cookbook (mean)
Understanding of own profession	6.8	6.4	6.5	7.9	7.9	7.9
Knowledge about other professions	6.2	6.0	6.1	7.3	7.3	7.2

Table 4.  Comparison between the cluster groups regarding their opinion regarding the goals of the course and the students’ attitudes towards the IPE concept before and after the course ()

	Before the course			After the course
	Cluster groups			Cluster groups
	Low collaborative (mean)	Collaborative- Constructivist (mean)	Cookbook (mean)	Low collaborative (mean)	Collaborative- Constructivist (mean)	Cookbook (mean)
Work load
‘Are/were the goals realistic in relation to the course length?’	5.9	6.0*	5.7*	6.5	6.6*	6.3*
Attitudes
Overall opinion of the course	6.3	7.1*	6.9*	7.1	7.8*	7.6*
Value for future health care
‘Do the goals represent today's healthcare?’	5.4^a	5.8	6.2^a	5.7	5.5^b	6.3^b
‘Should the goals pervade healthcare training to a greater extent?’	6.6^c	7.5^c,d	6.7*^d	7.0^e,f	7.8^e	7.6*^f
‘Should the goals be applied to future healthcare?’	7.3^g	8.0^g	7.7*	7.7^h	8.2^h	8.1*

Notes: (a)–(i) Significant difference between these groups (p < 0.005).

*marks significant differences (p < 0.005) between the cluster groups before and after the course.

Since the IPE course aimed at increasing the students’ knowledge about the other professions, the students were asked to rate their knowledge regarding all other professions except their own (medicine, nursing, occupational therapy and physiotherapy) before and after the course. The students’ knowledge about each others’ professions were rated 6.0–6.2 before the course and 7.2–7.3 after the course (Table 3). For all ratings regarding knowledge about each others’ professions no significant differences between the cluster groups could be seen, but all changes over time were significant (p < 0.005).

The students were asked, both before and after the course, if they thought that the goals of the IPE course were realistic in relation to the course length. As shown in Table 4, the students in the clusters ‘Collaborative Constructivist’ and ‘Cookbook’ considered the goals more realistic after the course while there was no change in the opinion of the ‘Low Collaborative’ cluster. The students were also asked if they thought that the goals represented today's healthcare, if the goals should be applied to future healthcare and if the goals should pervade healthcare training to a greater extent. The ‘Cookbook’ group had a higher score on the question regarding today's healthcare. The ‘Low Collaborative’ group had generally lower scores and the ‘Collaborative Constructivist’ group had generally higher scores on the questions regarding future healthcare and future healthcare training. The ‘Cookbook’ group significantly (p <0.005) increased the scores regarding future healthcare and future healthcare training (Table 4).

They were also asked about their satisfaction with the IPE course and the results showed that the ‘Collaborative Constructivist’ cluster was significantly (p < 0.005) more positive towards the concept already before the course compared to the ‘Low collaborative’ cluster. Further, the ‘Low collaborative’ cluster did not change their opinion during the course while both ‘Collaborative Constructivist’ and ‘Cookbook’ clusters had a significantly more positive attitude at the end of the course (Table 4).

After the course, the students rated the care and rehabilitation they had provided for the patients, and also the supervision they had received from team facilitators and profession-specific supervisors. The students rated the care and rehabilitation high (7.8–8.4) and there were no significant differences between the cluster groups. The supervision was also rated high (7.3–7.7) by all cluster groups, and there were no significant differences between the groups.

Discussion

The main results

Our interest was to see, how approaches to studying were related to how a modern interprofessional ward training was rated by the participating students. More collaborative approaches to learning were hypothesized to be related to better ratings. Collaborative aspects of student learning in such a context are evident (Entwistle & McCune 2004; Lonka et al. 2004), but in a traditional medical curriculum, the most successful students were independent and not interested in cooperation (Lindblom-Ylänne & Lonka, 2001). In the present study, the students scored highest on the collaborative-constructivist sub-scale, but the medical students scored the lowest on that sub-scale. The male medical student group was the group scoring lowest for the collaborative-constructivist approach and highest on both the practical value and certain knowledge approach, implying that male medical students were the least interested in cooperation. However, in contrast to Lindblom-Ylänne and Lonka (2001), the interprofessional clinical training on a training ward was not ‘traditional’ and the academic achievement was not measured either. The student group rating the clinical interprofessional context lowest was the group with relatively high score on the Practical Value approach and the lowest score on the collaborative-constructivist approach (‘Low Collaborative’ group). The rating of the ‘Low Collaborative’ group and the rating of male medical students were similar, but the distribution of male medical students was quite equal among the three cluster groups; seven of the 20 male medical students were found in the ‘Low Collaborative’ group.

The earlier findings that novice medical students had a quite dualistic and surface approach to learning (Lonka & Lindblom-Ylänne 1996) was not verified in this study, but the medical students, and in particular the male medical students scored lower than the other students on the collaborative-constructivist scale. The medical students included were not novices and the findings may imply a change in learning style over time during the medical education.

The ratings of the understanding of professional roles and knowledge about each others’ work increased by 0.6–1.5 points, which is significant for all student groups, but there were no differences between the groups. All three groups, regardless of their learning style according to the CLKQ, reached the goals to develop their own professional role and to gain knowledge about the other professions. There is no support in the results that students with a lesser cooperative learning approach should reach these goals to a lower extent.

On the other hand, the hypothesis that students with a less cooperative approach might be less satisfied with the course and that students who prefer a more collaborative learning approach will be more satisfied, got support in the results. The group with the least collaborative approach (‘Low Collaborative’ group) scored lower on questions regarding the goals for the course. The goal questions address the work load during the course and the value of the IPE goals for future healthcare training and future healthcare. They also scored lower on the overall opinion rating of the course.

The ‘Cookbook’ group, which was the student group scoring highest on both Practical Value and Certain Knowledge approach, showed a significant increase in ratings regarding if the goals should pervade healthcare training to a greater extent and if the goals should be applied to future healthcare. Probably this group of students increased their understanding of interprofessional collaboration during the course.

We also found that the students in this study found the interprofessional course at the training ward very satisfying, independent of their learning style according to the CLKQ. The students’ understanding of their professional roles increased during the course regardless of their learning orientation, and this meets the goals for the course.

Methodological reflections

Strengths of this study is that 100% of the students agreed to participate, and in the end the response rate was 77%, which is good. It is also a strength that the participating students are mixed from four educational programs, which probably decreases bias from profession-specific preconceptions.

All participants were very happy with the course, and this showed as biased distributions in the results. One weakness of this study was therefore the ceiling effect of the Likert scales in students’ ratings. Many students score 7, 8 or 9 on the 9-point scale, thus the mean and median values become high and it makes it harder to detect significant changes.

All goals of the course were not possible to use in this study. One goal for the students was to increase their skills in communication and teamwork. We were not, however, able to measure changes in such concrete skills. Our results were based on self report measures and the results should not be over interpreted. We can simply state that students who scored high on certain scales expressed agreement with certain statements. Future studies may show whether there is a connection between approaches to studying and changes in students’ skills.

The CLKQ had only modest reliability, since at the time of the measurements the instrument was still in progress and only later it was developed towards the MED NORD instrument (Lonka et al. 2008), In general, medical students are not very happy with long questionnaires, and there is always a trade-off between number of questions and the Cronbach's alphas. Reliabilities become better as the test is prolonged (DeVellis 1991). We decided to use very short series of questions, which decreased reliability. In research on higher education, any values of coefficient alpha below 0.6 would be regarded as poor, even for relatively heterogeneous constructs (Richardson 2004). Only one Cronbach's Alpha in our study was slightly below this limit.

Construct validity means that scales measure the things that they are supposed to measure, which is usually determined by factor or cluster analyses. To this extent, our analyses were reasonable. Some criterion validity was also evident, since the clustering was in harmony with the students’ ratings.

Previous research indicates that approaches to learning change quite slowly over time (Zeegers 2001). It was therefore not reasonable to conduct pre-post measurements with the CLKQ. The cluster groups were assumed to be quite stable, and the possible changes were supposed to take place in student ratings before and after the course.

Conclusion

There are several conclusions from this study. Firstly, students with a low collaborative profile in their approach to learning were less satisfied with the goals for the interprofessional clinical training on the training ward, implying that they found interprofessional training less important than the other students, and also less satisfied in their overall opinion of the course. When developing and introducing clinical practice in undergraduate health care educations, it is important to know that a group of students with a low collaborative learning profile exists, since interprofessional collaboration in health care is of increasing importance.

Secondly, the students with a cookbook approach showed an increased understanding of interprofessional collaborative work after the course, implying that the clinical practice at the interprofessional training ward may change students’ opinions towards a more collaborative approach.

Thirdly, almost all students – regardless of their approach to learning – highly valued the interprofessional training in clinical practice.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.