Were there unintended consequences?
Intended consequences are those that are planned to occur as a result of specific interprofessional education design, delivery and facilitation choices (Doucet et al., 2014). The table below (3) outlines some intended consequences present in research on IPE programs.
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IPE Design or Facilitation Choice(s) |
Intended (and Achieved) Consequence |
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Having co-facilitators lead IPE groups
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Sets an example for students to support, respect and collaborate with people from different professions (Hayward et al., 2021). |
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When IPE is online and asynchronous, using small group discussion boards. |
Students appreciated how they could have meaningful conversations with just a few people, and complete posts during times that worked best with their schedule (Hayward et al., 2021). |
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Explanation of roles of all healthcare professionals involved before IPE activity |
Allowed students to foster more respect to each other (Rodrigues da Silva Noll Gonçalves et al., 2023). |
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Introduction of IPE at the beginning of a curriculum. |
Demonstrated to reduce stereotyping (Arth et al., 2018). |
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Introducing students to the space and equipment they may use before beginning IPE. Emphasizing that it is okay to make mistakes and equipment can be restarted if necessary. AND If content could be psychologically overwhelming for some students, providing a disclaimer and accommodation when needed. |
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Clear explanation of activities and interventions prior to IPE, and communicated if there is a confederate participating in IPE upfront. |
Students reported they would find this beneficial for their comprehension (Rodrigues da Silva Noll Gonçalves et al., 2023). Helped facilitate an environment that was psychologically safe (Lackie et al., 2022). |
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Planning IPE goals, using evidence to inform IPE design, and creating groups of students ahead of time. AND Facilitator being comfortable with making mistakes, having a light-hearted spirit and making some appropriate jokes. AND When facilitators provided feedback to students that was constructive and efficient. AND When facilitators motivated quiet students to participate and contribute to discussions. AND When facilitators preface that it is okay to make mistakes, and that the opinions of each student are valued. |
Lead to improved psychological safety (Lackie et al., 2022). |
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The topic of the IPE is something students will encounter post-licensure |
Helps students problem solve and collaborate in ways that will be relevant to their future career (Hill et al., 2019). |
Table 9: Intended Consequences of IPE design and facilitation choices
Unintended consequences are outcomes that are not expected to occur in interprofessional education programs, which can be positive or negative (Doucet et al., 2014). The following table (4) discusses some unintended consequences that have resulted from IPE programs.
|
IPE Design or Facilitation Choice |
Unintended Consequence |
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Having IPE not count for any course credit
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Having no credit attached to IPE was demotivating for students, they wanted to put more of their effort towards activities that were marked (Doucet et al., 2014). Students thought knowing they would be marked would motivate them to work harder (Rodrigues da Silva Noll Gonçalves et al., 2023). |
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Involving students in IPE topics that do not relate to their profession |
Students felt the interprofessional activity was not beneficial for their education (Doucet et al., 2014). |
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A lack of clarity in roles in IPE interventions may cause students to misunderstand their roles and responsibilities with other professionals (Rodrigues da Silva Noll Gonçalves et al., 2023).
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This has triggered tension, difficulties in interprofessional interaction, and dissatisfaction with teamwork (Rodrigues da Silva Noll Gonçalves et al., 2023). It can also inhibit interprofessional collaboration when staff feel overwhelmed with excessive workload (Allen, 2017). |
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Integrated into some health professional curriculums (e.g. 11/16), but not others (e.g. 5/16) |
Scheduling issues- many students had to meet on weeknights or weekends which interfered with their extracurricular responsibilities (e.g. work, family). This was unexpected given most programs involved had curriculum integration. (Doucet et al., 2014) |
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Assignments that do not focus on IPE |
Students felt they were not able to incorporate their individual roles into working together, and instead it felt like a uniprofessional group project to keep them busy (Doucet et al., 2014, p. 26). |
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Hosting too many IPE events |
Students reported it would be better to have two IPE meetings because they felt three meetings let to an unnecessary repetition of information (Doucet et al., 2014). |
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Time pressure |
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Involving students too early in the curriculum (e.g. first year) |
Students felt unprepared because they felt they did not have enough knowledge in their field yet. Older students felt the younger students could not contribute because their professional viewpoints were not developed yet. (Doucet et al., 2014) |
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Involving students too late in the curriculum (e.g. third year) |
Students felt they were too knowledgeable to fully experience all components of the IPE and had too much going on in their program at this stage to have time to engage in additional IPE activities (Doucet et al., 2014). |
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Including every profession OR Having professions work with one another that would not in clinical practice |
This is inconsistent with real-world practice teams that will typically include 5 professions or less. Students are less involved, focused and satisfied if groups are too large, or have too many people from the same program. (Hill et al., 2019) |
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Completing peer evaluations while sitting with peers |
Students were not comfortable being fully honest on evaluations because their peers were next to them, leading to inaccurate evaluation results (Doucet et al., 2014). |
Table 10: Unintended Consequences of IPE design and facilitation choices
IPE Cartoon Visuals:
The “When IPE” debate cartoon [NewTab]
Cartoon depicting the dilemma of when the best time to implement IPE is (Michalec & Sampson, 2018, p. 10)
Role Clarity cartoon [NewTab]
Cartoon depicting the unintended consequences that can arise from a lack of role clarity (Dolighan, n.d.)
Negative Consequences with IPE
Although IPE is generally viewed positively from students, others have negative experiences. It is important to recognize and address these negative experiences, so it does not impact how students learn skills, or how they view future interprofessional experiences while practicing their career (Doucet et al., 2014).
Working with new people while learning your own health profession can be intimidating, and these feelings led some students to feel insecure (Rodrigues da Silva Noll Gonçalves et al., 2023). Other participants experienced insecurity because they felt there was a hierarchy while working with medical students (Lestari et al., 2016). The presence of hierarchies, lack of leadership skills, not knowing what to expect and being purposely misled by a confederate also inhibited psychological safety (Lackie et al., 2022). Rodrigues da Silva Noll Gonçalves et al. (2023) suggests this can be reduced by providing students with an opportunity to get comfortable with one another prior to the IPE activity (e.g. ice-breaker games). Students suggest having a chance to talk about the roles of each health profession before IPE (Arth et al., 2018).
Some students were hesitant to participate in IPE because they felt it may cause them to lose the knowledge they had already learned in their own profession (Rodrigues da Silva Noll Gonçalves et al., 2023). In a survey on attitudes toward IPE, Berger-Estilita et al. (2020) found particularly medical students were concerned that IPE would reduce their sense of identity as a medical student and that sharing knowledge from their speciality would eliminate the need for medical specialization. Addressing these concerns involves education and student reflection on why IPE is important and beneficial, and “debunking” prevalent misconceptions (Berger-Estilita et al., 2020).
Students were also not happy when the IPE learning objectives did not align with the IPE design. For instance, in one program students listened to the experiences of an individual with a chronic disease but were not responsible for providing any medical recommendations. Students left feeling frustrated that this did not feel “interprofessional”, and felt they did not have the opportunity to collaborate using their health education. (Doucet et al., 2014)
Microaggressions are conscious or unconscious biases directed at a minimized group of individuals (Holtschneider & Park, 2021). Some students reported experiencing these during interprofessional education, such as when a student assumed another’s role based on their sex (e.g. female nurse), when a student referred to some professionals by title (e.g. doctor), and others by name; and when some professions were classified as “colleagues” in communication, while other professions were not (Park & Holtschneider, 2021; Holtschneider & Park, 2021). When individuals experience microaggressions, they spent extra time worrying about the incident, completed less work, and avoided the perpetuator- all negatively impacting their experience (Park & Holtschneider, 2021). Park and Holtschneider (2021) suggest ideas to decrease microaggressions in IPE, including: creating a guideline on how to refer to team members so it is consistent (e.g. by title, position and/or name); being mindful during interprofessional practice (e.g. pausing; reflecting on how you feel; and considering the person did not understand the remark was hurtful), and respectfully discussing problematic behaviour when it arises.
When disagreements occurred within an IPE team, some students felt very uncomfortable and that their perspectives were not considered (Rodrigues da Silva Noll Gonçalves et al., 2023). If this created tension in the group, or student would not contribute in fear of offending other members, psychological safety was inhibited (Lackie et al., 2022).
