{"id":71810,"date":"2022-09-26T08:57:11","date_gmt":"2022-09-26T00:57:11","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=71810"},"modified":"2023-01-03T09:03:46","modified_gmt":"2023-01-03T01:03:46","slug":"impact-of-a-longitudinal-student-initiated-home-visit-programme-on-interprofessional-education","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/impact-of-a-longitudinal-student-initiated-home-visit-programme-on-interprofessional-education\/","title":{"rendered":"Impact of a longitudinal student-initiated home visit programme on interprofessional education"},"content":{"rendered":"<p>Submitted: 22 September<span lang=\"EN-GB\">\u00a02021<\/span><br \/>\r\nAccepted: 27 April 2022<br \/>\r\nPublished online: 4 October<span lang=\"EN-GB\">, TAPS 2022, <\/span><span lang=\"EN-GB\">7(4), 1-21<\/span><br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2022-7-4\/OA2785\">https:\/\/doi.org\/10.29060\/TAPS.2022-7-4\/OA2785<\/a><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Yao Chi Gloria Leung<sup>1<\/sup>*, Kennedy Yao Yi Ng<sup>2<\/sup>*, Ka Shing Yow<sup>3<\/sup>*, Nerice Heng Wen Ngiam<sup>4<\/sup>, Dillon Guo Dong Yeo<sup>4<\/sup>, Angeline Jie-Yin Tey<sup>5<\/sup>, Melanie Si Rui Lim<sup>6<\/sup>, Aaron Kai Wen Tang<sup>7<\/sup>, Bi Hui Chew<sup>8<\/sup>, Celine Tham<sup>9<\/sup>, Jia Qi Yeo<sup>10<\/sup>, Tang Ching Lau<sup>11,12<\/sup>, Sweet Fun Wong<sup>13,14<\/sup>, Gerald Choon-Huat Koh<sup>15,16<\/sup>** &amp; Chek Hooi Wong<sup>14,17<\/sup>**<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Anaesthesiology, Singapore General Hospital, Singapore; <sup>2<\/sup>Department of Medical Oncology, National Cancer Centre Singapore, Singapore; <\/span><\/i><i><sup><span lang=\"EN-GB\">3<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of General Medicine, National University Hospital, Singapore; <\/span><\/i><i><sup><span lang=\"EN-GB\">4<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of General Medicine, Singapore General Hospital, Singapore; <\/span><\/i><i><sup><span lang=\"EN-GB\">5<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of General Medicine, Tan Tock Seng Hospital, Singapore; <\/span><\/i><i><sup><span lang=\"EN-GB\">6<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of General Paediatrics, Kandang Kerbau Hospital, Singapore, <\/span><\/i><i><sup><span lang=\"EN-GB\">7<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Psychiatry, Singapore General Hospital, Singapore; <\/span><\/i><i><sup><span lang=\"EN-GB\">8<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Tan Tock Seng Hospital, Singapore; <\/span><\/i><i><sup><span lang=\"EN-GB\">9<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Ng Teng Fong General Hospital, Singapore, <\/span><\/i><i><sup><span lang=\"EN-GB\">10<\/span><\/sup><\/i><i><span lang=\"EN-GB\">National Healthcare Group Pharmacy, Singapore, <sup>11<\/sup>Department of Medicine, NUS Yong Loo Lin School of Medicine, Singapore; <sup>12<\/sup>Division of Rheumatology, University Medicine Cluster, National University Hospital, Singapore; <sup>13<\/sup>Medical Board and Population Health &amp; Community Transformation, Khoo Teck Puat Hospital, Singapore;<sup> 14<\/sup>Department of Geriatrics, Khoo Teck Puat Hospital, Singapore; <sup>15<\/sup>Saw Swee Hock School of Public Health, National University of Singapore, Singapore; <sup>16<\/sup>Future Primary Care, Ministry of Health Office of Healthcare Transformation, Singapore; <sup>17<\/sup>Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">*Co-first authors<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">**Co-last authors<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Introduction: <\/span><\/b><span lang=\"EN-GB\">Tri-Generational HomeCare (TriGen) is a student-initiated home visit programme for patients with a key focus on undergraduate interprofessional education (IPE). We sought to validate the Readiness for Interprofessional Learning Scale (RIPLS) and evaluate TriGen\u2019s efficacy by investigating healthcare undergraduates\u2019 attitude towards IPE.<b><\/b><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Methods: <\/span><\/b><span lang=\"EN-GB\">Teams of healthcare undergraduates performed home visits for patients fortnightly over six months, trained by professionals from a regional hospital and a social service organisation. The RIPLS was validated using exploratory factor analysis. Evaluation of TriGen\u2019s efficacy was performed via the administration of the RIPLS pre- and post-intervention, analysis of qualitative survey results and thematic analysis of written feedback. <b><\/b><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Results: <\/span><\/b><span lang=\"EN-GB\">79.6% of 226 undergraduate participants from 2015-2018 were enrolled. Exploratory factor analysis revealed four factors accounting for 64.9% of total variance. One item loaded poorly and was removed. There was no difference in pre- and post-intervention RIPLS total and subscale scores. 91.6% of respondents agreed they better appreciated the importance of interprofessional collaboration (IPC) in patient care, and 72.8% said MDMs were important for their learning. Thematic analysis revealed takeaways including learning from and teaching one another, understanding one\u2019s own and other healthcare professionals\u2019 role, teamwork, and meeting undergraduates from different faculties.<b><\/b><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Conclusion: <\/span><\/b><span lang=\"EN-GB\">We validated the RIPLS in Singapore and demonstrated the feasibility of an interprofessional, student-initiated home visit programme. While there was no change in RIPLS scores, the qualitative feedback suggests that there are participant-perceived benefits for IPE after undergoing this programme, even with the perceived barriers to IPE. Future programmes can work on addressing these barriers to IPE.<b><\/b><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Interprofessional Education, Student-Initiated Home Visit Programme, RIPLS, Validation<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">We validated the Readiness for Interprofessional Learning Scale (RIPLS) in Singapore, a multi-ethnic Asian country. <\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">A student-initiated, interprofessional, longitudinal home visit program is feasible.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">While there was no significant change in RIPLS scores, participants reported qualitative benefits of the programme in their attitudes towards IPE.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Qualitative feedback highlighted four main barriers to IPE: Time constraints, unmotivated teammates, administrative burden, and unsuitable patients.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Interprofessional education (IPE) aims to prepare healthcare professionals for effective collaboration, and while becoming increasingly common, is challenging to initiate, implement, evaluate and sustain (Fahs et al., 2017). Key challenges include designing a curriculum that integrates IPE with traditional academic frameworks, active engagement of facilitators and students, and accommodating various professions (Sunguya et al., 2014). IPE is context-specific, evolving, and involves continuous interaction and interdependence, and many traditional top-down approaches such as forums and lectures do not effectively teach it (Briggs &amp; McElhaney, 2015). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Experiential IPE programmes employ a ground-up approach and potentially tackle some of the aforementioned challenges. Students involved in on-the-ground interprofessional healthcare visits to older adults showed that such experiences improved student collaboration and students&#8217; self-perception of interprofessional team care-related skills (Blythe &amp; Spiring, 2020; Conti et al., 2016; McManus et al., 2017; <\/span><span lang=\"EN-GB\">Toth-Pal et al., 2020; <\/span><span lang=\"EN-GB\">Vaughn et al., 2014<\/span><span lang=\"EN-GB\">). <\/span><span lang=\"EN-GB\">Therefore, a group of undergraduates from the National University of Singapore (NUS) Yong Loo Lin School of Medicine initiated an experiential student-led IPE programme which is aimed at improving health outcomes in older people with frequent hospital readmissions. This longitudinal service-learning programme was anchored by several educational aims including enhancing students\u2019 IPE outcomes and improving attitudes towards IPE.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Formal evaluation of such programmes and investigating student IPE attitudes after being involved in a longitudinal home visit programmes are lacking in the current IPE literature (Grice et al., 2018). This study aims to evaluate TriGen\u2019s effectiveness by investigating student IPE attitudes through the use of the Readiness for Interprofessional Learning Scale (RIPLS). Since the RIPLS has not been validated in the Singapore context, this study also aims to validate this scale. <\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. Programme Design<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">TriGen is a collaboration between NUS Yong Loo Lin School of Medicine, Khoo Teck Puat Hospital, a Northern regional hospital in Singapore, and North West Community Development Council, a grassroots organisation (Ng et al., 2020a, 2020b). <\/span><span lang=\"EN-GB\">A non-profit ground-up social initiative by healthcare undergraduates, it has the dual aim of i) serving the medical and social needs of older patients by providing longitudinal home visits by interprofessional student teams; ii) educating and empowering undergraduate students through a service-learning approach, with a key focus on improving attitudes towards IPE. <\/span><span lang=\"EN-GB\">The programme was designed under the mentorship of university faculty members, and was earmarked as a co-curricular activity aimed at improving students\u2019 attitudes towards IPE and IPC. Older patients with frequent hospital readmissions (three or more times over six months) were followed up by healthcare undergraduates enrolled in Medicine, Nursing, Pharmacy, Social Work, Physiotherapy or Occupational Therapy courses in Singapore.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The programme begins with healthcare undergraduates undergoing didactic, skill-based training and team-based simulation training covering possible scenarios encountered during home visits (Annex 1). Each team comprising 2-3 interdisciplinary undergraduates conduct fortnightly visits to 1-2 patients over 6 months. At the midpoint and endpoint of the programme, healthcare undergraduates assessed the patients\u2019 needs and presented at multi-disciplinary meetings (MDMs) chaired by healthcare professionals and grassroots staff, who guided the undergraduates to execute a management plan.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This IPE programme was designed based on educational principles for adult learners outlined by Knowles (1984). First, it provided healthcare undergraduates with opportunities for experiential learning anchored in the service-learning approach. Second, it was largely problem-based group learning with most training sessions being team-based and scenario-based. MDMs were also problem-based and encouraged undergraduates to brainstorm ideas to address their patients\u2019 issues. Third, the service they provided in this programme modelled the work they may engage in after graduation. What they learned in this programme was of immediate relevance to their current study and future practice. Lastly, the programme provided autonomy to healthcare undergraduates to direct their own learning. This programme was voluntary and allowed participants\u2019 flexibility for further self-study of topics of interest. Key student outcomes include readiness for IPE (including teamwork and collaboration, professional identity, roles and responsibility), and a better appreciation for IPC.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Evaluation Approach<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study used the framework by Kirkpatrick (1959) expanded by Barr et al. (2005) to evaluate the effectiveness of TriGen in improving healthcare undergraduates\u2019 attitudes towards IPE, particularly in evaluation levels 1, 2a and 2b, which centre on learner\u2019s reactions, attitude perceptions, and acquisition of knowledge or skills (Table 1). The use of quantitative and qualitative data collection in a survey was thought to be most appropriate in capturing the data and making the evaluation richer, and was hence the approach utilised for this research (Figure 1).<\/span><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\" aligncenter\" style=\"width: 100%; height: 504px;\">\r\n<tbody>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"45%\" valign=\"top\" style=\"border-style: solid; width: 45%; height: 56px;\">\r\n<p><b><span lang=\"EN-US\">Evaluation Level<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"33%\" valign=\"top\" style=\"height: 56px;\">\r\n<p><b><span lang=\"EN-US\">Methods and Measures<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"21%\" valign=\"top\" style=\"height: 56px;\">\r\n<p><b><span lang=\"EN-US\">Timeframe<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px;\">\r\n<td width=\"45%\" rowspan=\"2\" valign=\"top\" style=\"height: 136px;\">\r\n<p><b><span lang=\"EN-US\">Level 1: Learners\u2019 reactions<\/span><\/b><\/p>\r\n<p><span lang=\"EN-US\">Participants\u2019 views of their learning experience and opinions about the program<\/span><\/p>\r\n<\/td>\r\n<td width=\"33%\" valign=\"top\" style=\"height: 80px;\">\r\n<p><span lang=\"EN-US\">Participants\u2019 self-reported feedback of IPE learning<\/span><\/p>\r\n<\/td>\r\n<td width=\"21%\" valign=\"top\" style=\"height: 80px;\">\r\n<p><span lang=\"EN-US\">Post-intervention<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"33%\" valign=\"top\" style=\"height: 56px;\">\r\n<p><span lang=\"EN-US\">Qualitative feedback<\/span><\/p>\r\n<\/td>\r\n<td width=\"21%\" valign=\"top\" style=\"height: 56px;\">\r\n<p><span lang=\"EN-US\">Post-intervention<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px;\">\r\n<td width=\"45%\" rowspan=\"2\" valign=\"top\" style=\"height: 136px;\">\r\n<p><b><span lang=\"EN-US\">Level 2a: Modification of attitudes perceptions<\/span><\/b><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"33%\" valign=\"top\" style=\"height: 80px;\">\r\n<p><span lang=\"EN-US\">Participants\u2019 self-reported feedback of IPE learning <\/span><\/p>\r\n<\/td>\r\n<td width=\"21%\" valign=\"top\" style=\"height: 80px;\">\r\n<p><span lang=\"EN-US\">Post-intervention<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 56px;\">\r\n<td width=\"33%\" valign=\"top\" style=\"height: 56px;\">\r\n<p><span lang=\"EN-US\">Qualitative feedback<\/span><\/p>\r\n<\/td>\r\n<td width=\"21%\" valign=\"top\" style=\"height: 56px;\">\r\n<p><span lang=\"EN-US\">Post-intervention<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 80px;\">\r\n<td width=\"45%\" valign=\"top\" style=\"height: 80px;\">\r\n<p><b><span lang=\"EN-US\">\u00a0<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"33%\" valign=\"top\" style=\"height: 80px;\">\r\n<p><span lang=\"EN-US\">Readiness for Interprofessional Learning Scale<\/span><\/p>\r\n<\/td>\r\n<td width=\"21%\" valign=\"top\" style=\"height: 80px;\">\r\n<p><span lang=\"EN-US\">Pre- and post-intervention<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 96px;\">\r\n<td width=\"45%\" valign=\"top\" style=\"height: 96px;\">\r\n<p><b><span lang=\"EN-US\">Level 2b: Acquisition of knowledge\/skills<\/span><\/b><\/p>\r\n<p><span lang=\"EN-US\">Concepts, procedures, principles, and skills<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"33%\" valign=\"top\" style=\"height: 96px;\">\r\n<p><span lang=\"EN-US\">Qualitative feedback<\/span><\/p>\r\n<\/td>\r\n<td width=\"21%\" valign=\"top\" style=\"height: 96px;\">\r\n<p><span lang=\"EN-US\">Post-intervention<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 1: Components of Kirkpatrick\/Barr et al. evaluation framework as applied to TriGen<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: left;\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Figure-1-300x287.png\" alt=\"\" class=\" wp-image-71813 aligncenter\" width=\"455\" height=\"436\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Figure-1-300x287.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Figure-1-768x736.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Figure-1.png 836w\" sizes=\"auto, (max-width: 455px) 100vw, 455px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 1: Flowchart of study components<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">C. Quantitative Measures<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The RIPLS (Parsell &amp; Bligh, 1999) was among the first scales developed for measurement of attitudes towards interprofessional learning. It assesses student readiness for IPE and IPC with other health care professionals and has been reported to be sensitive to differences in the students\u2019 attitude towards IPE (Berger-Estilita et al., 2020). While there are a few studies validating it in Asian countries (China, Indonesia, Japan), none have been performed in Singapore (a multi-ethnic Asian country with English language as a predominant language of instruction (Ganotice &amp; Chan, 2018; Lestari et al., 2016; Li et al., 2018; Tamura et al., 2012).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The RIPLS, a 19-item questionnaire comprising 4 subscales (\u201cTeamwork and Collaboration\u201d; \u201cPositive Professional Identity\u201d; \u201cNegative Professional Identity\u201d and \u201cRoles and Responsibilities\u201d), was administered pre- and post-intervention (McFadyen et al., 2005). Higher RIPLS scores imply greater readiness for interprofessional learning. This study validates the RIPLS in the Singapore context for the first time, then employs it for quantitative evaluation of TriGen. Additionally, separate from the RIPLS, <\/span><span lang=\"EN-GB\">three questions were added as a direct measure of participants\u2019 reaction (Level 1), <\/span><span lang=\"EN-GB\">\u201cI better appreciate the importance of IPC in the care of patients through the programme\u201d, \u201cThe multidisciplinary meetings organised were important for my learning\u201d, and \u201cI would recommend the programme to my friends.\u201d<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">1) Statistical Analysis: <\/span><\/i><span lang=\"EN-GB\">The Shapiro-Wilk test was used to assess if the data followed a normal distribution (Shapiro &amp; Wilk, 1965). <\/span><span lang=\"EN-GB\">Factor analysis was conducted to explore the construct validity of the RIPLS, and Cronbach\u2019s alpha was computed to determine internal consistency. The suitability of the correlation matrix was determined by the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett\u2019s test of sphericity. The numbers of factors retained for the initial solutions and entered into the rotation were determined with the application of Kaiser\u2019s criterion (eigenvalues &gt;1). The initial factor extraction was performed using principal component analysis. Exploratory factor analysis was then conducted based on the RIPLS four-subscale structure.<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">A paired t-test comparing baseline and post-intervention responses was computed for each survey item to determine significant differences (p<\/span><span lang=\"EN-GB\"> \u2264 0.05). One-way ANOVA was performed to assess for demographic factors that correlated with pre-intervention and magnitude of change in RIPLS scores; if it demonstrated an overall difference between groups, post-hoc Tukey\u2019s HSD was performed. <\/span><span lang=\"EN-GB\">For all statistical analyses, the Statistical Package for Social Sciences (SPSS, Version 23.0, Chicago, Illinois) was used.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">D. Qualitative Measures <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Post-intervention qualitative feedback regarding participants\u2019 learning experiences was collected through online surveys. Questions include: What did you learn about interprofessional collaboration? What are your learning points after completing the project? Would you recommend this project to your peers, and what are your reasons? These questions were chosen to better understand participants\u2019 reaction to the programme, their attitudes toward IPE and IPC, and other key learning points they may have. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">1) Thematic Analysis: <\/span><\/i><span lang=\"EN-GB\">All survey participants were encouraged to participate in the qualitative research, with a total of 163 recruited to give written qualitative feedback on the programme. Given the relatively large sample of data, thematic analysis was chosen to explore and interpret the dataset, distilling it into recurring ideas (Braun &amp; Clarke, 2006; Kiger &amp; Varpio, 2020). <\/span><span lang=\"EN-GB\">Analysis was performed on participants\u2019 qualitative descriptions of their learning experiences, with <\/span><span lang=\"EN-GB\">constant comparison analysis used to identify patterns in participants\u2019 responses and develop a coding schema. Two coders independently identified major themes from the text within all transcripts, with reference to the research questions. They discussed and resolved any disagreements. <\/span><span lang=\"EN-GB\">No member checking was performed.<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">A common coding schema was generated and applied to all the transcripts. <\/span><i><span lang=\"EN-GB\"><\/span><\/i><\/p>\r\n<p><i><span lang=\"EN-GB\">E. Ethical Approval<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Ethical approval was obtained from the NUS institutional review board (<\/span><span lang=\"EN-GB\">B-15-272)<\/span><span lang=\"EN-GB\">. Study participation was entirely voluntary and anonymous. Informed consent was taken from participants before data collection commenced, and they were allowed to withdraw from the research at any point in time. No incentives were provided to study participants.<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">226 healthcare undergraduates participated in TriGen from 2015-2018. Response rate for the RIPLS was 79.6%.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. Demographics<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Median age was 21 (range 18-41). 62.2% of participants were female, 37.8% were male. 31.7% were medical students, 12.8% nursing students, 42.2% pharmacy students, 10.0% social work students, and 3.3% therapy students. First- and second-year students comprised 62.2% of participants, while third- to fifth-years comprised 37.8%. 65.0% participated in previous IPE activities. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Construct Validity<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The KMO index was 0.902, indicating sampling adequacy. The chi-square index for Barlett\u2019s test of sphericity was 1919.445 (df171, p&lt;0.001), indicating suitability for factor analysis. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Principal component analysis yielded four components largely consistent with the four-subscale model of the RIPLS (Barr et al., 2005) (Annex 2). However, one item, \u201cI am not sure what my professional role will be\u201d, had a low loading value of 0.285 under the original subscale of \u201cRoles and Responsibility\u201d and a borderline low loading value of 0.459 under the subscale of \u201cNegative Professional Identity\u201d. It was removed from subsequent analyses in view of its poor fit into the theoretical construct (Table 2).<\/span><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\" class=\" aligncenter\" style=\"width: 84.4434%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"38\" valign=\"bottom\" style=\"width: 3.99386%;\">\r\n<p><b><span lang=\"EN-GB\">No<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"bottom\" style=\"width: 25.0384%;\">\r\n<p><b><span lang=\"EN-GB\">Statements<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"bottom\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><b><span lang=\"EN-GB\">Teamwork and Collaboration<\/span><\/b><b><span lang=\"EN-GB\"><\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"bottom\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><b><span lang=\"EN-GB\">Negative Professional Identity<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"bottom\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><b><span lang=\"EN-GB\">Positive Professional Identity<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"bottom\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><b><span lang=\"EN-GB\">Roles and Responsibilities<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Shared learning will help me to think positively about other healthcare professionals.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.794<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Learning with other health and social care students before qualification would improve relationships after qualification. <\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"top\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.781<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">3<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Team-working skills are essential for all health and social care students to learn.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.773<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">4<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Shared learning will help me to understand my own limitations.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.767<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">5<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Communication skills should be learnt with other health and social care students.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.746<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">6<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Learning with other students\/professionals will make me become a more effective member of a health and social care team.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.742<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">7<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">For small group learning to work, students need to trust and respect each other.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.739<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">8<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Shared learning with other healthcare students will increase my ability to understand clinical problems.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.723<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">9<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Patients would ultimately benefit if health and social care students\/professionals worked together to solve patient problems.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.650<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">10<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">It is not necessary for undergraduate health and social care students to learn together.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"top\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.882<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">11<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">I don\u2019t want to waste time learning with other health and social care students.<sup><\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"top\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.854<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">12<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Clinical problem-solving skills can only be learnt with students from my own department.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"top\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.799<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">13<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Shared learning will help to clarify the nature of patient problems.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.658<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">14<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Shared learning before qualification will help me become a better team worker.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.642<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">15<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">I would welcome the opportunity to work on small group projects with other health and social care students.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.614<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">16<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">Shared learning with other health and social care professionals will help me to communicate better with patients and other healthcare professionals.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"top\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.567<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">17<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">The function of nurses and therapists is mainly to provide support for doctors.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"top\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.836<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">18<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">I am not sure what my professional role will be.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.459*<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.285<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"38\" valign=\"top\" style=\"width: 3.99386%;\">\r\n<p><span lang=\"EN-GB\">19<\/span><\/p>\r\n<\/td>\r\n<td width=\"246\" valign=\"top\" style=\"width: 25.0384%;\">\r\n<p><span lang=\"EN-GB\">I have to acquire much more knowledge and skills than other health or social care students.<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" valign=\"top\" style=\"width: 17.8187%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"85\" valign=\"top\" style=\"width: 16.129%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"104\" valign=\"top\" style=\"width: 31.5994%;\">\r\n<p align=\"right\"><span lang=\"EN-GB\">0.517<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 2: Exploratory Factor Analysis of the RIPLS \u2013 Contribution of Items to Each Component<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">*The highest loading value of each item under the four subscale<b>s<\/b> are shown (except for item 18). A loading value of &gt;0.5 was taken to be satisfactory. Item 18, \u201cI am not sure what my professional role will be.\u201d, was deemed borderline satisfactory at a loading value of 0.459 in the subscale Negative Professional Identity. Its loading value was lower at 0.285 in its original subscale Roles and Responsibility.<\/span><\/p>\r\n<div>\r\n<p><i><span lang=\"EN-GB\">C. <\/span><\/i><i><span lang=\"EN-GB\">Internal Consistency<\/span><\/i><\/p>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Cronbach\u2019s alpha is 0.848 for RIPLS total score, suggesting good internal consistency.<\/span><\/p>\r\n<\/div>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">D. Baseline RIPLS Score<\/span><\/i><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.1-300x151.png\" alt=\"\" class=\" wp-image-71821 aligncenter\" width=\"647\" height=\"326\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.1-300x151.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.1-1024x516.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.1-768x387.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.1.png 1485w\" sizes=\"auto, (max-width: 647px) 100vw, 647px\" \/><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.2-300x151.png\" alt=\"\" class=\" wp-image-71822 aligncenter\" width=\"644\" height=\"324\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.2-300x151.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.2-1024x516.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.2-768x387.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-3.2.png 1485w\" sizes=\"auto, (max-width: 644px) 100vw, 644px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 3: Total RIPLS scores<\/span><span lang=\"EN-GB\">. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Subscale scores can be found in Annexes 3 to 6.<\/span><\/p>\r\n<div>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The mean baseline total RIPLS score was 76.6 (95% CI 75.6 \u2013 77.6). There was a baseline difference between faculties (p=0.001), with medical and therapy undergraduates having higher scores as compared to pharmacy students (mean difference 3.85, 0.59\u20137.11, p=0.012 and mean difference 8.83, 0.94\u201316.7, p=0.020, respectively) (Table 3). As for subscales, there was a difference in \u201cTeamwork and Collaboration\u201d baseline scores between years of study, with Year 1\u20132 undergraduates had a higher baseline score of 40.8 (40.0\u201341.5) versus Year 3\u20135 undergraduates with a score of 39.5 (38.6\u201340.4) (p=0.038) (Annex 3). Medical undergraduates had higher baseline scores for the \u201cTeamwork and Collaboration\u201d 41.2 (40.2\u201342.2)) and \u201cPositive Professional Identity\u201d 17.9 (17.4\u201318.5) subscales compared to pharmacy undergraduates 39.3 (38.4\u201340.1) (p=0.034), and 17.0 (16.6\u201317.4) (p=0.036) respectively (Annexes 3-4). Social work undergraduates have the lowest baseline \u201cRoles and Responsibility\u201d score, averaging 4.94 (4.34\u20135.55) compared to all other faculties (Annex 6).<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">E. <\/span><\/i><i><span lang=\"EN-GB\">Change in RIPLS Score Post-Intervention<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">There was no significant difference between the pre- and post-intervention RIPLS total score and the subscale score under the \u201cTeamwork and Collaboration\u201d subscale (Table 3, Annex 3). Under the \u201cPositive Professional Identity\u201d subscale, there was a decrease in post-intervention scores of Year 1-2 students (mean difference -0.500 (-0.931\u2013 -0.069), p=0.023) and students with no participation in activities outside of the faculty (mean difference -0.403 (-0.768 \u2013 -0.037), p=0.031) (Annex 4). Under the \u201cNegative Professional Identity\u201d subscale, there was a decrease in post-intervention score in medical students (mean difference -0.667 (-1.31\u2013 &#8211; 0.020), p=0.44) and social work students (-0.889 (-1.70\u2013 -0.073), p=0.035) (Annex 5). There was an increase in the post-intervention score amongst female students under the \u201cRoles and Responsibility\u201d subscale (mean difference 0.384 (0.065\u20130.703), p=0.019) (Annex 6).<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">F. <\/span><\/i><i><span lang=\"EN-GB\">Individual Item Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Negatively coded statements like \u201cthe function of nurses and therapists is mainly to provide support for doctors\u201d (Item 17) and \u201cI am not sure what my professional role will be\u201d (Item 18) showed significant increases in scores post-intervention (0.23, p=0.005 and 0.17, p=0.016 respectively). Other significant findings include a decrease in scores for the statements \u201cShared learning with other health and social care professionals will help me to communicate better with patients and other healthcare professionals\u201d (Item 13) (-0.14, p=0.013), and \u201cShared learning will help to clarify the nature of patient problems (Item 15) (-0.10, p=0.034) (Table 4).<\/span><\/p>\r\n<\/div>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-1-300x206.png\" alt=\"\" class=\" wp-image-71887 aligncenter\" width=\"597\" height=\"410\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-1-300x206.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-1-1024x705.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-1-768x528.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-1.png 1138w\" sizes=\"auto, (max-width: 597px) 100vw, 597px\" \/> <img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-2-300x106.png\" alt=\"\" class=\" wp-image-71888 aligncenter\" width=\"595\" height=\"210\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-2-300x106.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-2-1024x363.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-2-768x272.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/09\/OA2785-Table-4-2.png 1136w\" sizes=\"auto, (max-width: 595px) 100vw, 595px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 4: RIPLS (Individual items analysis)<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">G. Self-Reported Feedback on Interprofessional Learning<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">91.6% participants agreed they could \u201cbetter appreciate the importance of interprofessional collaboration in the care of patients\u201d. 72.8% said MDMs were important for their learning and 91.9% of respondents would recommend the programme to their friends. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">H. Qualitative Feedback<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">163 of 180 survey respondents participated in the qualitative research (response rate 90.6%).<\/span><span lang=\"EN-GB\"> (Fig 1) <\/span><span lang=\"EN-GB\">34.4% of respondents were male and 65.6% female. 33.1% of respondents were studying Medicine, 12.3% Nursing, 40.5% Pharmacy, 11.0% Social Work and 3.1% Therapy. 54.6% of respondents were in early years of study (Year 1\u20132). 74.8% had previous exposure to IPE. Thematic analysis yielded the following themes:<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">1) Learning and teaching one another: <\/span><\/i><span lang=\"EN-GB\">Healthcare undergraduates found value in learning from one another. They shared knowledge and skills gained from their respective curriculum with one another.<\/span><\/p>\r\n<p>&nbsp;<\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">\u201cI feel more equipped and prepared to teach and learn from other healthcare professionals\u201d <\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">21-year-old female third-year medical student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">\u201cI learnt a lot from my social work team leader and how to consider the social aspects of issues the elderly face\u201d<\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">20-year-old male first-year medical student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">2) Understanding the role of other healthcare professionals: <\/span><\/i><span lang=\"EN-GB\">Healthcare undergraduates learned the role of other healthcare professionals and gained new insights into how different healthcare professionals contributed to the care of the patient. <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">[I have] learn[ed] \u2026 how we can tap on each other[\u2019s] strengths to come up with a care plan for the patients <\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">21-year-old female third-year pharmacy student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">Understanding what medicine, nursing [and] pharmacy does make quite a lot of difference to how we perceive and thus, work with them. <\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">23-year-old female second-year social work student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">3) Understanding one\u2019s own role: <\/span><\/i><span lang=\"EN-GB\">Healthcare undergraduates reported <\/span><span lang=\"EN-GB\">developing a greater understanding of the roles and responsibilities<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">they played as a part of a multi-disciplinary team. <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">I am now more aware of the role and responsibility I have as a healthcare professional.<\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">21-year-old female first-year pharmacy student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">Working in a multi-disciplinary team gave me a feel of how it may be like caring for a patient as a team in my future career.<\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">20-year-old female first-year social work student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">4) Teamwork<\/span><\/i><span lang=\"EN-GB\">: Healthcare undergraduates appreciated the need for collaboration and teamwork within a multi-disciplinary team. They learned about the importance of compromise. <\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">Working with different people, in terms of personality, faculty, etcetera &#8211; I learnt to give and take and be more understanding towards the others.<\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">21-year-old second-year social work student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">It has allowed me to better understand \u2026 how the different professions can come together to better serve the needs of patients. <\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">20-year-old female second-year pharmacy student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">5) Opportunity to meet people from other faculties<\/span><\/i><span lang=\"EN-GB\">: <\/span><span lang=\"EN-GB\">Healthcare undergraduates valued meeting people from other faculties and developing collaborative relationships they would otherwise not have had the opportunity to.<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">I got to know seniors in medicine and peers from pharmacy. <\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">20-year-old female first-year nursing student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: left;\"><i><span lang=\"EN-GB\">It is a very unique experience, having the chance to interact with \u2026 other university students from different healthcare faculties. <\/span><\/i><\/p>\r\n<p align=\"right\" style=\"text-align: right;\"><i><span lang=\"EN-GB\">20-year-old female second-year pharmacy student<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-GB\">\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">6) Factors limiting learning<\/span><\/i><span lang=\"EN-GB\">: <\/span><span lang=\"EN-GB\">Factors limiting learning included time constraints, unmotivated teammates, administrative burden and lack of suitable patients. For the latter, some undergraduates felt that their care was restricted to companionship for patients who were already able to manage their own chronic conditions well and did not require further help from the healthcare undergraduates.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><em><span lang=\"EN-GB\">A. Validation of the RIPLS in Singapore<\/span><\/em><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study validated the RIPLS in the Singapore context. The final model is the same as proposed by McFadyen et al. (2005). without item 18 \u201cI am not sure what my professional role will be\u201d, from \u201cRoles and Responsibility\u201d subscale. The poor fit of this item into this study\u2019s theoretical construct could be because participants are mostly in their pre-clinical years and may not understand professional roles and responsibilities due to their limited on-job experience, a reason also proposed by McFadyen et al. (2005) and Tyastuti et al. (2014). Tyastuti et al. (2014) found this item, along with \u201cI have to acquire much more knowledge and skills than other healthcare students\u201d (item 19) from the same subscale had loading factors of &lt;0.5 and removed the entire \u201cRoles and Responsibility\u201d subscale from the Indonesian version of the RIPLS. Other studies validating the RIPLS also experienced issues with this subscale (Lauffs et al., 2008; Lestari et al., 2016; McFadyen et al., 2005). <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Baseline RIPLS score<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The mean baseline RIPLS score is comparable with that by Chua et al. (2015), another study conducted in Singapore which measured change in the RIPLS after a one-day IPE conference. They also found higher baseline RIPLS scores for medical undergraduates versus other faculties, a finding also noted in this study and another done in a culturally similar country (Lestari et al., 2016). However, this finding seems inconsistent as other studies (Aziz et al., 2011; de Oliveira et al., 2018) have found the contrary. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Chua et al. (2015) also found that prior IPE experience resulted in higher baseline RIPLS scores, a finding not replicated in this study. We hypothesise that while 65.0% of this study\u2019s participants had previous IPE exposure (versus 10.6% in Chua et al. (2015)), the heterogenous nature of IPE programmes they previously participated in may have had differing efficacy in improving IPE attitudes. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study found undergraduates in their later years had a lower baseline \u201cTeamwork and Collaboration\u201d subscale score, versus those in their early years. We postulate that undergraduates with more clinical experience better understand the challenges of IPE in practice, a finding echoed by Judge et al. (2015). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">That <\/span><span lang=\"EN-GB\">pharmacy students, but not medical students, were mandated by their curriculum to fulfil volunteering hours which could explain the former\u2019s lower baseline scores for total RIPLS and subscales \u201cTeamwork and Collaboration\u201d and \u201cPositive Professional Identity\u201d since they are likely less motivated by IPE when choosing to participate.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Social work undergraduates\u2019 low baseline \u201cRoles and Responsibility\u201d score likely reflects their minimal exposure to medical social work unless they elected for healthcare modules in their senior years of study. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">C. Change in Pre- and Post-intervention RIPLS Scores<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Our study did not show a significant difference between the pre- and post-intervention RIPLS total score and the \u201cTeamwork and Collaboration\u201d subscale. Additionally, there was a decrease seen in post-intervention scores under the \u201cPositive Professional Identity\u201d subscale for Year 1-2 students and the \u201cNegative Professional Identity\u201d subscale in medical students and social work students. This is in contrast with the literature, where previous studies involving conferences (Chua et al., 2015) or solitary learning modules (Wakely et al., 2013<\/span><span lang=\"EN-US\">; <\/span><span lang=\"EN-GB\">Zaudke et al., 2016) demonstrated a significant difference in the total RIPLS score pre- and post- intervention. Possible reasons for this are further discussed in section E.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">There was a significant increase in the post-intervention score amongst female students under the \u201cRoles and Responsibility\u201d subscale. Previous studies have suggested that there are gender specific differences in perception towards IPE with female students having a more positive attitude towards IPE (Hansson et al., 2010; Wilhelmsson et al., 2011). In addition, the individual item analysis showed that negatively coded statements relating to the subscale of \u201cRoles and Responsibility\u201d such as \u201cthe function of nurses and therapists is mainly to provide support for doctors\u201d (Item 17) and \u201cI am not sure what my professional role will be\u201d (Item 18) had significant increases in scores post-intervention. This is encouraging and demonstrates the success of the programme in helping students understand the respective roles and responsibility of each profession which is a crucial part of IPE and eventually IPC. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Other significant findings in the individual item analysis include a decrease in scores for the statements \u201cShared learning with other health and social care professionals will help me to communicate better with patients and other healthcare professionals\u201d (Item 13), and \u201cShared learning will help to clarify the nature of patient problems\u201d (Item 15). These findings suggest that the programme can be improved by incorporating more modules on communication between healthcare professionals and shared problem-solving. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">D. Qualitative Feedback<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">While the lack of a significant difference between the pre- and post-intervention RIPLS scores suggest no changes in attitudes, the qualitative data revealed that the majority of undergraduates better appreciated the importance of IPC for patient care and many felt that that MDMs were useful for their learning.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Qualitative analysis revealed five major themes in the undergraduates\u2019 learning pertaining to IPE. Participants learned from and taught each other. Being able to freely learn from and teach one another requires mutual trust and respect which are key elements of collaborative practices (de Oliveira et al., 2018). Participants reported better understanding of their own and other healthcare professionals\u2019 roles; these are recognised as crucial components of collaborative practice (Canadian Interprofessional Health Collaborative, 2010). Undergraduates also shared that they learned about teamwork, specifically, conflict resolution and compromise. Finally, undergraduates appreciated the opportunities to meet fellow undergraduates from different faculties. It has been observed in many successful IPE programmes that informal social interactions are potentially as important as the actual IPE activities (Lie et al., 2016). We observed that the relationships built between participants of the programme often persisted beyond the completion of the programme; these relationships could benefit the institution and healthcare system (Hoffman et al., 2008). <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">E. Possible Reasons Underlying Lack of Improvement in RIPLS Scores<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">First, as mentioned earlier, the RIPLS has been described to have psychometrics issues, with multiple researchers modifying the subscales (Mahler et al., 2015). Second, Schmitz and Brandt (2015) suggested that RIPLS is insensitive to course improvements and to pre- versus post-intervention change in attitudes. We chose the RIPLS at the start of 2014 as it had been widely used and validated and simple to administer, and we also sought to validate it in Singapore for the first time. Unfortunately, few studies on its potential issues had been published at the time to inform the design of this study. Third, the longitudinal nature of the programme may have permitted undergraduates greater insight to the challenges of IPE and realities of collaborating within interprofessional teams, tampering their idealism.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Lestari et al. (2016) described how nursing and midwifery undergraduates had lower RIPLS scores as compared to medical and dentistry undergraduates as they had prior clinical experience and likely observed less than exemplary interactions amongst members of healthcare teams. Similarly, Makino et al. (2013) found that graduates of an IPE programme had a lower mean score on the Modified Attitudes Toward Health Care Teams Scale (ATHCTS) as compared to current students. The authors suggested that the alumni\u2019s negative attitude may be due to their real-world experience. Several structural issues in clinical practice have been identified that contribute to this trend, for example competition between professionals (Tremblay et al., 2010) and power struggles (Paradis &amp; Whitehead, 2015).<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">F. Barriers to IPE<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Undergraduates reported four main barriers: time constraints, unmotivated teammates, administrative burden, unsuitable patients. Other studies including Alexandraki et al. (2017) and West et al. (2016) have also faced time constraints. As this programme is voluntary, undergraduates had to take time off their already packed curriculum to participate, and the selection of volunteers was not a stringent process. Additionally, as participants were contributing to clinical care, documentation of visits is required. Multiple studies showed that physicians deemed documentation and administrative work burdensome and excessive time spent on these may be associated with physicians\u2019 burnout (Patel et al., 2018; Wright &amp; Katz, 2018).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In addressing these barriers, incorporating academic credits for participation, a more stringent selection of participants, streamlining administrative work and prudent choice of patients may be considered. These measures are already being implemented by the programme organisers to improve the programme.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">G. Strengths and Limitations<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The strength of this study lies in the use of both quantitative and qualitative data grounded on an established framework by Kirkpatrick (1959) for the evaluation of a novel experiential IPE programme. The limitations of our study include it being single-institution and that the participants are volunteers which thus form a self-selected group. Hence, the results may not be generalisable. There was also no control arm for the intervention. In addition, there was a large variation in baseline RIPLS score seen in the programme, which can be potentially improved with a more robust study design that controls for baseline differences. <\/span><span lang=\"EN-GB\">Lastly, the use of only a survey for data collection may limit the depth of qualitative data obtained. Further studies could include qualitative interviews.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We <\/span><span lang=\"EN-GB\">validated the RIPLS in Singapore and<\/span><span lang=\"EN-GB\"> demonstrated the feasibility of an interprofessional <\/span><span lang=\"EN-GB\">student-initiated<\/span><span lang=\"EN-GB\"> home visit programme<\/span><span lang=\"EN-GB\">. While there was no significant change in RIPLS scores, the qualitative feedback <\/span><span lang=\"EN-GB\">suggests that there are participant-perceived benefits for IPE after undergoing this programme, even with the perceived barriers to IPE. Future programmes can work on addressing these barriers to IPE. <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Gloria Yao Chi Leung contributed to the conception and design of the work, the acquisition, analysis, and interpretation of data for the work, drafting and revising the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Kennedy Yao Yi Ng contributed to the conception and design of the work, analysis and interpretation of data for the work, drafting and revising the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Yow Ka Shing contributed to the conception and design of the work, the acquisition and interpretation of data for the work, drafting and revising the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Nerice Heng Wen Ngiam contributed to the conception and design of the work, the acquisition of data for the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Dillon Guo Dong Yeo contributed to the conception and design of the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Angeline Jie-Yin Tey contributed to the conception and design of the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Melanie Si Rui Lim contributed to the conception and design of the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Aaron Kai Wen Tang contributed to the conception and design of the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Chew Bi Hui contributed to the conception and design of the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Celine Yi Xin Tham contributed to the conception and design of the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Yeo Jia Qi contributed to the conception and design of the work, drafting the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Lau Tang Ching contributed to the conception and design of the work, critical revision of the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Wong Sweet Fun contributed to the conception and design of the work, critical revision of the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Gerald Choon Huat Koh contributed to the conception and design of the work, interpretation of the data for the work, critical revision of the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Wong Chek Hooi contributed to the conception and design of the work, interpretation of the data for the work, critical revision of the manuscript, approves of the publishing of the manuscript, and agrees to be accountable for the accuracy of the work.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Ethical approval was obtained from the NUS institutional review board (<\/span><span lang=\"EN-GB\">B-15-272)<\/span><span lang=\"EN-GB\">. Study participation was entirely voluntary and anonymous. Informed consent was taken from participants before data collection commenced, <\/span><span lang=\"EN-GB\">and they were allowed to withdraw from the research at any point in time<\/span><span lang=\"EN-GB\">. No incentives were provided to study participants. <\/span><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">According to institutional policy, research dataset is available on reasonable request to the corresponding author.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The authors would like to thank the Tri-Generational HomeCare Organising Committee from 2014 to 2018 for supporting the study. They would like to extend their thanks to the National University of Singapore, Yong Loo Lin School of Medicine, Dean\u2019s Office; the North West Community Development Council; Khoo Teck Puat Hospital, Singapore; Geriatric Education and Research Institute, Singapore. Finally, they would like to thank the volunteers for their generosity and the patients for their hospitality. <\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">National University of Singapore, Yong Loo Lin School of Medicine, Dean\u2019s Office; the North West Community Development Council; Khoo Teck Puat Hospital, Singapore provided funding support for the purchase of medical consumables, refreshments and logistics for the program. <\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">There are no conflicts of interest.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Alexandraki, I., Hernandez, C. A., Torre, D. 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K., Paolo, A., Kleoppel, J., Phillips, C., &amp; Shrader, S. (2016). The impact of an interprofessional practice experience on readiness for interprofessional learning. <i>Family Medicine, 48<\/i>(5), 371\u2013376.<\/span><\/p>\r\n<p><span lang=\"EN-US\"><span lang=\"EN-NZ\"><span lang=\"EN-AU\">*<span lang=\"EN-GB\">Chek Hooi WONG<\/span><br \/>\r\n<\/span><span lang=\"EN-AU\"><span lang=\"EN-GB\">90 Yishun Central,<\/span><br \/>\r\n<span lang=\"EN-GB\">Khoo Teck Puat Hospital,<\/span><br \/>\r\n<\/span><\/span><\/span><span lang=\"EN-US\"><span lang=\"EN-NZ\"><span lang=\"EN-AU\"><span lang=\"EN-GB\">Singapore 768828<\/span><\/span><\/span><\/span><span lang=\"EN-US\"><span lang=\"EN-NZ\"><span lang=\"EN-AU\"><br \/>\r\n<\/span><span lang=\"EN-AU\"><span lang=\"EN-GB\">9 Lower Kent Ridge Rd, Level 10,<\/span><br \/>\r\n<span lang=\"EN-GB\">+65 6807 8001 <\/span><br \/>\r\n<\/span><\/span><\/span><span lang=\"EN-GB\">Email: wong.chek.hooi@ktph.com.sg<\/span><\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":1,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61873],"class_list":["post-71810","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-7-number-4-october-2022"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - 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