Exploring attitudes and barriers towards inter-professional education in healthcare: An educational evaluation of an inter-professional course on human factors


  • Rachel Shute (rachel.shute@nhs.net): Fellow in Medical Education
  • Jenni Hibbert: Deputy Medical Education Lead
  • Francina Cunnington: Medical Education Lead


5JJ Interprofessional education 2


Great Ormond Street Hospital for Children
Postgraduate Medical Education Dept.
London, WC1N 3JH


Inter-professional education (IPE) is high on the UK healthcare education agenda. Despite this, recruiting participants and supporting their attendance at expensive and faculty-intense inter-professional courses (IPC) remains a challenge. Attitudinal factors are believed to significantly impact upon the success of IPE. To gain insight into these factors an educational evaluation was conducted at Great Ormond Street Hospital to explore participants’ attitudes towards IPE before and after attending our IPC on human factors called "Defining Moments...when things go wrong".


Click on 'more detail' for details of the Human Factors course

Summary of Work

Thirteen course attendees, all senior healthcare professionals (doctors, nurses and a manager), completed a bespoke pre and post-course quantitative and qualitative questionnaire which was analysed using Qualtrics software.


Click on 'more detail' to see pre and post course questionnaires given to participants

Summary of Results

Key Findings              

  • Self-selected group: Positive baseline attitudes towards IPE and IP courses across all three professional groups.
  • Consistent improvement in attitudes, immediately post course.
  • Statistically significant improvement in attitude towards IPCs being an “efficient use of resources” and “IPE should be an educational goal of this hospital”.
  • Development of more personalized attitudes towards IPE post course.
    • Advantages noted in first rather than third person
    • Advantages related to their own workplace
  • Identified risks to learning included
    • Nurses: Fears about appearing less knowledgable, being passive members of the group, having their practise challenged
    • Doctors: Fears about relevence of course content to them
  • Concerns about relevance of the course to their professional group persisted for a minority

Click on 'more detail' for results tables and graphs


These findings help us continue to improve the impact of the “Defining Moments” course on inter-professional collaboration and patient care at our hospital.

Identifying barriers to attendance challenged us to

1. Include clearer descriptions of the course content made relevant to all professionals on our advertising

2. Make available pre-course materials to facilitate a shared knowledge base for all participants

3. Improve facilitator awareness of potential inter-professional dynamics during the course.

Take-home Messages


The full reference list and bibliography used for this evaluation can be found below.



Ethical approval for this study was granted by the Institute for Health Research (IHREC Reference 192) through the University of Bedfordshire and by the Ethics committee at Great Ormond Street Hospital.


We would like to thank Ben Betts at HT2 (www.ht2.co.uk) for their expertise in developing the Human Factors serious game.


Lastly we would like to thank all the participants for their honesty and commitment to this study.



"Defining Moments...When things go wrong"

This two-day course offers participants a chance to learn about Human factors and the part they play in our daily lives and work environment. The course involves a combination of a serious game, interactive videos, talks and discussions. Course participants from medical, nursing, allied health professional and managerial backgrounds are all invited to attend. The course faculty includes members from each professional group.

Day 1 begins with an introduction to Human Factors, followed by a serious game, specifically designed to highlight the impact of human factors during a disaster situation.


Photograph of participants playing the serious game.



Phonecall stylized-QuickTime H.264 from HT2 on Vimeo.



Screen shot from the serious game.

Day 2 focuses on human error and offers participants an opportunity to create tools to enable them to share their new Human Factors knowledge to their local teams.



Summary of Work

Summary of Results


Take-home Messages

Anderson, E.S., Thorpe, L.N. and Hammick, M. (2011) 'Interprofessional staff development: Changing attitudes and winning hearts and minds', Journal of Interprofessional Care, 25 (1), pp.11-17.


Atack, L., Parker, K., Rocchi, M., Maher, J. and Dryden, T. (2009) 'The impact of an online interprofessional course in disaster management competency and attitude towards interprofessional learning', Journal of Interprofessional Care, 23 (6), pp.586-598.


Barr, H., Freeth, D., Hammick, M., Koppel, I. and Reeves, S.  (2006) ‘The evidence base and recommendations for interprofessional education in health and social care’, Journal of Interprofessional Care, 20 (1), pp. 75-78.


Billett, S. (2009) ‘Conceptualizing learning experiences: Contributions and mediations of the social, personal and brute’, Mind, Culture and Activity, 16(1), pp.32-47.



CAIPE (2006) Available at: http://www.caipe.org.uk/ (Accessed: 7 September 2013).


Calder, J., (1998) Survey Research Methods, ASME Education Research Booklet No. 6, Association for the Study of Medical Education, Edinburgh.


Carpenter, J., Patsios, D., Szilassy, E. and Hackett, S. (2011) 'Outcomes of short course interprofessional education in parental mental illness and child protection: Self-efficacy, attitudes and knowledge', Social Work Education, 30 (2), pp.195-206.


Coster, S., Norman, I., Murrells, T., Kitchen, S., Meerabeau, E., Sooboodoo, E. and Lynda d’Avray (2008) 'Interprofessional attitudes amongst undergraduate students in the health professions: A longitudinal questionnaire survey', International Journal of Nursing Studies, 45 pp.1667-1681.


Curran, V., Deacon, D. and Fleet, L. (2005) 'Academic administrators' attitudes towards interprofessional education in Canadian schools of health professional education', Journal of Interprofessional Care, 19, pp.76-86.


Curran, V., Mugford, J., Law, R. and MacDonald, S. (2005) 'Influence of an interprofessional HIV/AIDS education program on role perception, attitudes and teamwork skills of undergraduate health sciences students', Education for Health: Change in Learning and Practice (Taylor and Francis Ltd), 18 (1), pp.32-44.


Curran, V., Sharpe, D. and Forristall, J. (2007) 'Attitudes of health sciences faculty members towards interprofessional teamwork and education', Medical Education, 41 (9), pp.892-896.


Curran, V., Sharpe, D., Forristall, J. and Flynn, K. (2008) 'Attitudes of health sciences students towards interprofessional teamwork and education', Learning in Health and Social Care, 7 (3), pp.146-156.


Curran, V., Sharpe, D., Flynn, K. and Button, P. (2010) 'A longitudinal study of the effect of an interprofessional education curriculum on student satisfaction and attitudes towards interprofessional teamwork and education', Journal of Interprofessional Care, 24 (1), pp.41-52.


Curran, V.R., Heath, O., Kearney, A. and Button, P. (2010) 'Evaluation of an interprofessional collaboration workshop for post-graduate residents, nursing and allied health professionals', Journal of Interprofessional Care, 24 (3), pp.315-318.


D’Amour, D., Ferrada-Videla, M., San Martin Rodriguez, L., and Beaulieu, M. (2005), ‘The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks’, Journal of Interprofessional Care, 19 (1), pp. 116-131


Department of Health (2000) A Health Service of all the Talents: Developing the NHS Workforce. London: HMSO


Department of Health and Quality Assurance Agency (2006) Department of Health Phase 2 benchmarking project – final report. Gloucester: Department of Health, London and Quality Assurance Agency for Higher Education.


Department of Health (2011). Governance arrangements for research ethics committees. A harmonized edition. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213753/dh_133993.pdf. (Accessed: 26 August 2013).


Dutton, A. and Worsley, A. (2009) 'Doves and hawks: Practice educators’ attitudes towards interprofessional learning', Learning in Health and Social Care, 8 (3), pp.145-153.


Fallsberg, M.B. and Wijma, K. (1999) 'Student attitudes towards the goals of an inter-professional training ward', Medical Teacher, 21 (6), pp.576-581.


Festinger, L. (1957). A theory of cognitive dissonance. Stanford: Stanford University Press.


Fink, A. and Kosekoff, J. (1985). How To Conduct Surveys. 1st edn. Newbury Park: Sage Publications


Flin, R., O'Connor, P. and Crichton, M. (2008) Safety at the sharp end. 1st Edition. Aldershot: Ashgate Publishing Limited 


Freeth D, Hammick M, Reeves S, Koppel I, Barr H. (2005) Effective interprofessional education: development, delivery and evaluation. London: Blackwell, 2005.


Fuji, K., Paschal, K., Galt, K. and Abbott, A. (2010) 'Pharmacy student attitudes toward an interprofessional patient safety course: An exploratory mixed methods study', Currents in Pharmacy Teaching and Learning, 2 (4), pp.238-247.


Fuller, A. and Unwin, L. (2005) ‘Older and wiser?: workplace learning from the perspective of experienced employees’, Int J of Lifelong Education, 24(1), pp. 21-39.


Gibbon, B., Watkins, C., Barer, D., Waters, K., Davies, S., Lightbody, L. and Leathley, M. (2002) 'Can staff attitudes to team working in stroke care be improved?’, Journal of Advanced Nursing, 40 (1), pp.105-111.


General Medical Council (GMC) (1993) Tomorrows Doctors. Available at: http://www.gmc-uk.org/Tomorrows_Doctors_1993.pdf_25397206.pdf. (Accessed: 14 September 2013)


Hammick, M., Freeth, D., Koppel, I., Reeves, S. and Barr, H. (2007)  ‘A best evidence systematic review of interprofessional education: BEME Guide no.9’ Medical Teacher, 29(8), pp.735-751.


Hayashi, T., Shinozaki, H., Makino, T., Matsuda, T., Koizumi, M., Ogawara, H., Abe, Y., Hayashi, K., Asakawa, Y., Iwasaki, K., Tozato, F., Lee, B., Watanabe, H. and Yasukawa, T. (2012) 'Changes in attitudes toward interprofessional health care teams and education in the first-and third-year undergraduate students', Journal of Interprofessional Care, 26 (2), pp.100-107.


Heinemann, G., Schmitt, M., Farrell, M. and Brallier, S. (1999) 'Development of an Attitudes toward health care teams scale' Evaluation and The Health Professions, 22(1), pp. 123-142.


Hertweck, M., Hawkins, S., Bednarek, M., Goreczny, A., Schreiber, J. and Sterrett, S. (2012) ‘Attitudes toward interprofessional education: Comparing physician assistant and other health care professions students’, J Physician Assist Educ, 23(2), pp.8-15.


Hewstone, M. and Brown, R. (1986). Contact is not enough: an intergroup perspective on the ‘contact hypothesis’. In: Hewstone, M. and Brown, R. (Eds) Contact and conflict in intergroup encounters. Oxford: Blackwell.


Horsburgh, M., Lamdin, R. and Williamson, E. (2001) 'Multiprofessional learning: The attitudes of medical, nursing and pharmacy students to shared learning', Medical Education, 35(9), pp.876-883.


Hyer, K., Fairchild, S., Abraham, I., Mezey, M. and Fulmer, T. (2000) ‘Measuring attitudes related to inter-disciplinary training: revisiting the Heinemann, Schmitt and Farrell 'attitudes towards healthcare teams' scale’, Journal of Inter-professional care, 14(3), pp. 249-258.


Interprofessional Education Collaborative Expert Panel (2011) Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative


Jacobsen, F. and Lindqvist, S. (2009) 'A two-week stay in an interprofessional training unit changes students' attitudes to health professionals', Journal of Interprofessional Care, 23(3), pp.242-250.


Laming, W. (2003) The Victoria Climbie Inquiry Report. House of Commons Health Committee. Printed on 5th June 2003 by order of the House of Commons, London. The Stationary Office Limited. Available at http://www.publications.parliament.uk/pa/cm200203/cmselect/cmhealth/570/570.pdf. (Accessed: 14 August 2013).


Laming, W. (2009) The Protection of Children in England: A Progress Report. Crown Copyright 2009. Available at http://dera.ioe.ac.uk/8646/1/12_03_09_children.pdf. (Accessed: 14 August 2013).


Lapkin, S., Levett-Jones, T. and Gilligan, C. (2013) 'A systematic review of the effectiveness of interprofessional education in health professional programs', Nurse Education Today, 33, pp.90-102.


Lee, B., Celletti, F., Makino, T., Matsui, H., Watanabe, H. (2012) ‘Attitudes of medical school deans toward interprofessional education in Western Pacific Region Countries’, J Interprof Care, 26(6), pp. 479-483.


Lindqvist, S., Duncan, A., Shepstone, L., Watts, F. and Pearce, S. (2005) 'Development of the ‘Attitudes to health professionals questionnaire’ (AHPQ): A measure to assess interprofessional attitudes', Journal of Interprofessional Care, 19 (3), pp.269-279.


Luect, R., Madsen, M., Taugher, M. and Petterson, B. (1990) ‘Assessing professional perceptions: design and validation of an Interdisciplinary Education Perception Scale’, J Allied Health, 19(2), pp.181-191.


Mitchell, B., McCrorie, P. and Sedgwick, P. (2004) 'Student attitudes towards anatomy teaching and learning in a multiprofessional context', Medical Education, 38 (7), pp.737-748.


Morison, S. and Jenkins, J. (2007) 'Sustained effects of interprofessional shared learning on student attitudes to communication and team working depend on shared learning opportunities on clinical placement as well as in the classroom', Medical Teacher, 29 (5), pp.450-456.


Nisbet, G., Hendry, G., Rolls, G. and Field, M. (2008) ‘Interprofessional learning for pre-qualification health care students: an outcomes-based evaluation’, J Interprof Care, 22(1), pp.57-68.


Parsell, G. and Bligh, J. (1999) ‘The development of a questionnaire to assess the readiness of healthcare students for IPL (RIPLS)’, Medical Educator, 33, pp.95-100.


Pirrie, A., Wilson, V., Harden, R. and Elsegood, J. (1999) ‘AMEE Guide No. 12: Multiprofessional education: Part 3 ± promoting cohesive practice in health care’, Medical Teacher, 20 (5), pp.409-416.


Pollard, K. and Miers, M. (2008) 'From students to professionals: Results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the united kingdom', Journal of Interprofessional Care, 22 (4), pp.399-416.


Qualtrics Software (2013). Available at www.qualtrics.com (Accessed: 8 September 2013).


Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Koppel, I., and Hammick, M. (2010) ‘The effectiveness of interprofessional education: Key findings from a new systematic review’ Journal of Interprofessional Care, 24(3), pp. 230-241.


Reeves, S., MacMillan, K. and van Soeren, M. (2010) ‘Leadership within inter-professional health and social care teams: a socio-historical overview of some key trials and tribulations’ J Nurs Management, 18, pp.258-264.


Reeves, S., Tassone, M., Parker, K., Wagner, S. and Simmins, B. (2012) ‘Inter-professional education: An overview of key developments in the past three decades’ Work, 41, pp 233-245.


Refworks Software (2009). Available at www.refworks.com (Accessed: 17th September 2013).


Regmi, K. and Regmi, S. (2010) 'Medical and nursing students attitudes towards interprofessional education in Nepal', Journal of Interprofessional Care, 24 (2), pp.150-167.


Reid, R., Bruce, D., Allstaff, K. and McLernon, D. (2006) 'Validating the readiness for interprofessional learning scale (RIPLS) in the postgraduate context: Are health care professionals ready for IPL?', Medical Education, 40 (5), pp.415-422.


Robben, S., Perry, M., van Nieuwenhuijzen, L., van Achterberg, T., Rikkert, M., Schers, H., Heinen, M. and Melis, R. (2012) 'Impact of interprofessional education on collaboration attitudes, skills, and behavior among primary care professionals', Journal of Continuing Education in the Health Professions, 32(3), pp.196-204.


Saini, B., Shah, S., Kearey, P., Bosnic-Anticevich, S., Grootjans, J. and Armour, C. (2011) 'An interprofessional learning module on asthma health promotion', American Journal of Pharmaceutical Education, 75(2), pp.1-10.


Smith, M. (2001, 2006) ‘Evaluation’ in the Encyclopedia of Informal Education. Available at: www.infed.org/biblio/b-eval.htm. (Accessed: 12 September 2013).


Tanaka, M. and Yokode, M. (2005) ‘Attitudes of medical students and residents towards multidisciplinary team approach’, Medical Education, 39(12), pp.1255-1256.


Tucker, K., Wakefield, A., Boggis, C., Lawson, M., Roberts, T. and Gooch, J. (2003) ‘Learning together: clinical skills teaching for medical and nursing students’, Medical Education, 37(7), pp. 630-637.


Tunstall-Pedoe, S., Rink, E. and Hilton, S. (2003) 'Student attitudes to undergraduate interprofessional education', Journal of Interprofessional Care, 17 (2), pp.162.


Wellmon, R., Gilin, B., Knauss, L. and Inmann Linn, M. (2012) ‘Changes in students attitudes towards inter-professional learning and collaboration arising from a case-based educational experience’ J Allied Health, 41(1), pp.26-34.


Woodward, C. (1988) ASME Medical Education Research Booklet No. 4. Questionnaire construction and question writing for research in medical education. The Association for the Study of Medical Education, Edinburgh, 2000 Edition.


WHO (2011) Framework for action on IPE and Collaborative practice. Available at:http://whqlibdoc.who.int/hq/2010/WHO HRH HPN 10.3 eng.pdf. (Accessed: 9 September 2013).


Zucchero, R., Hooker, E., Harland, B., Larkin, S. and Tunningley, J. (2011) 'Maximizing the impact of a symposium to facilitate change in student attitudes about interdisciplinary teamwork’, Clinical Gerontologist, 34, pp.399-412.





Anderson, E. and Thorpe, L. (2008) 'Early interprofessional interactions: Does student age matter?', Journal of Interprofessional Care, 22 (3), pp.263-282.


Aziz, Z., Lim, C. and Pang, Y. (2011) ‘The attitudes of medical, nursing and pharmacy students to inter-professional learning’, Procedia Social and Behavioural Sciences, 29, pp. 639-645


Conrad, S., Reeves, S., Tassone, M., Parker, K., Wagner, S. and Simmons, B. (2012) 'Interprofessional education: An overview of key developments in the past three decades', Work, 41 (3), pp.233-245.


Forman, D. and Nyatanga, L. (2001) 'The process of developing a research questionnaire to measure attitudes to shared learning', Medical Teacher, 23 (6), pp.595-598.


Goelen, G., De Clercq, G., Huyghens, L. and Kerckhofs, E. (2006) 'Measuring the effect of interprofessional problem-based learning on the attitudes of undergraduate health care students', Medical Education, 40 (6), pp.555-561.


Hale, J., Cahan, M. and Zanetti, M. (2011) 'Integration of basic clinical skills training in medical education: An interprofessional simulated teaching experience', Teaching and Learning in Medicine, 23 (3), pp.278-284.


Kenaszchuk, C., Rykhoff, M., Collins, L., McPhail, S. and Soeren, M. (2012) 'Positive and null effects of interprofessional education on attitudes toward interprofessional learning and collaboration', Advances in Health Sciences Education, 17(5), pp.651-669.


Leipzig, R., Hyer, K., Ek, K., Wallenstein, S., Vezina, M., Fairchild, S., Cassel, C. and Howe, J. (2002) 'Attitudes toward working on interdisciplinary healthcare teams: A comparison by discipline', Journal of the American Geriatrics Society, 50 (6), pp.1141-1148.


McCaffrey, R., Hayes, R., Cassell, A., Miller-Reyes, S., Donaldson, A. and Ferrell, C. (2012) 'The effect of an educational programme on attitudes of nurses and medical residents towards the benefits of positive communication and collaboration', Journal of Advanced Nursing, 68 (2), pp.293-301.


McFadyen, A., Webster, V., Maclaren, W. and O'Neill, M. (2010) 'Interprofessional attitudes and perceptions: Results from a longitudinal controlled trial of pre-registration health and social care students in Scotland', Journal of Interprofessional Care, 24 (5), pp.549-564.


Morison, S., Boohan, M., Moutray, M. and Jenkins, J. (2004)  'Developing pre-qualification inter-professional education for nursing and medical students: Sampling student attitudes to guide development', Nurse Education in Practice, 4 pp.20-29.


Pecukonis, E., Doyle, O. and Bliss, D. (2008) ‘Reducing barriers to interprofessional training: Promoting interprofessional cultural competence’, J Interprof Care, 22 pp.417-428.


Pollard, K., Miers, M. and Gilchrist, M. (2005) 'Second year scepticism: Pre-qualifying health and social care students' midpoint self-assessment, attitudes and perceptions concerning interprofessional learning and working', Journal of Interprofessional Care, 19 (3), pp.251-268.


Punch, K. (2009) Introduction to Research Methods in Education. 1st edn. London: SAGE Publications.


Rieck, S. (2007) 'Critique of 'nurse-physician collaboration: A comparison of the attitudes of nurses and physicians in the medical-surgical patient care setting'', MEDSURG Nursing, 16 (2), pp.119-121.


Siassakos, D., et al (1999) Free communication (oral) presentations: O864 profile of attitudes to safety, teamwork and working conditions in a maternity unit with embedded inter-professional learning.


Silver, I.L. and Leslie, K. (2009) 'Faculty development for continuing interprofessional education and collaborative practice', Journal of Continuing Education in the Health Professions, 29 (3), pp.172-177.


Simin, D., Milutinović, D., Brestovački, B., Simić, S. and Cigić, T. (2010) 'Attitude of health science students towards interprofessional education', Healthmed, 4 (2), pp.461-469.


Thannhauser, J., Russell-Mayhew, S. and Scott, C. (2010) ‘Measures of interprofessional education and collaboration’, Journal of Interprofessional Care, 24(4), pp. 336-349. 


Send ePoster Link