See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/227530164

Developing interprofessional assessment

Article  in  Learning in Health and Social Care · December 2005

DOI: 10.1111/j.1473-6861.2005.00103.x

CITATIONS READS

20 95

4 authors, including:

Susan L Morison Moira Stewart

Queen's University Belfast Queen's University Belfast
25 PUBLICATIONS   742 CITATIONS    44 PUBLICATIONS   571 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

GDP, Specialist, Leader: What do dental students aspire to be? View project

Exploring Nutritional Needs of Older People in Hospital. Changing Ageing Partnership (CAP) View project

All content following this page was uploaded by Susan L Morison on 20 December 2017.

The user has requested enhancement of the downloaded file.

 Original article

Developing interprofessional assessment

Blackwell Publishing, Ltd.

Susan L. Morison PhD PGCE BA1* & Moira C. Stewart MD FRCP FRCPCH2
1 Director, Centre for Excellence in Interprofessional Education (NI), Queen’s University, Belfast (QUB), Belfast, UK
2 Consultant Paediatrician and Senior Lecturer, Department of Child Health, QUB, Belfast, UK

Keywords Abstract
assessment, Undergraduate medical and nursing education should enable the development
communication,
of communication and teamworking skills and of reflective practice, which should
interprofessional
education, teamwork be assessed and continued into professional practice. This study aimed to examine
appropriate methods for the assessment of interprofessional learning of clinical,
teamwork and communication skills for undergraduate students in Paediatrics and
Children’s Nursing and to involve Senior House Officers (SHOs) in this process.
During the 2002/3 academic year, 31 students, four nurse educators, two medical
educators and six SHOs were involved in the development and implementation of a
programme of interprofessional learning and assessment. Objective structured clinical
skills examination (OSCE) and role-play assessment methods were used to explore the
potential to develop common activities and standards for both professions. This study
found that common learning activities and assessment methods acceptable to both
professions could be developed and common standards set. It also concluded that
development and delivery by an interprofessional team is particularly important and
that formative feedback has a vital role to play in the process. Involving SHOs in the
planning and implementation of interprofessional education (IPE) has the potential to
allow its extension into different clinical areas and to meet training requirements at the
postgraduate level.

DoH 2003) and as such should be assessed. Proposals

Introduction to reform and improve training for newly qualified
Learning from Bristol (DoH 2001a) recommended medical practitioners have similarly identified
that medical education and training should pay more a need for a greater focus on team working and
attention to non-clinical aspects of care (including communication skills (DoH 2001b; 2002). Policy
the development of skills) in communicating makers from all areas of healthcare have recognized
with patients and colleagues, and in teamwork and that some form of shared or interprofessional
reflective practice. Moreover, these skills should learning might provide an answer to some of these
*Corresponding author.
Tel. 02890 634107;
be regarded as essential prequalification skills for all problems (CVCP 2000; DoH 2000a,b; 2001b; 2003;
e-mail: s.morison@qub.ac.uk healthcare professionals (NMC 2001; GMC 2002; Finch 2000).

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
 Developing interprofessional assessment 193

Cooper et al. (2004) have drawn attention to the where students benefited from working in small
difficulty of locating interprofessional education groups and learning from a variety of healthcare
(IPE) in traditional disciplinary frameworks, and professionals. The programme was designed to ensure
their arguments are particularly pertinent to the that each profession’s learning outcomes were met,
development of interprofessional assessment. The but there was an emphasis on learning about one’s
assessment methods that predominate in any own and other healthcare professionals’ roles and
discipline are those which reflect its theoretical responsibilities, interprofessional communication
underpinning and where traditional boundaries and teamwork. However, in order for the programme
inevitably are strong and fiercely protected. Using to be sustained it was deemed important to investi-
Medicine and Nursing as an example, although both gate ways in which appropriate assessment could be
undergraduate curricula and assessment methods developed.
have undergone considerable revision in recent
years (Fowell et al. 2000; Watson et al. 2002) the
disciplines’ approaches to assessment clearly reflect
Aim
cultural and philosophical differences. Medicine The aim of this study was to examine appropriate
places great emphasis on the assessment of know- methods for assessment of the interprofessional
ledge acquisition (Fowell et al. 2000) with a strong learning by undergraduate medical and nursing
preference for objective measures, such as multiple- students and to involve Senior House Officers
choice questions and objective structured clinical (SHOs) in this process.
skills examination (OSCE), and less commonly using
methods such as role play, with its emphasis on
active learning (Mackway-Jones & Walker 1999). In
Participants
contrast, nursing places greater emphasis on active A total of 31 students participated in the programme,
learning and assessment to encourage reflective comprising 19 fourth-year undergraduate medical
practice and personal development, and OSCE-type students undertaking their Healthcare of Children
assessments are a relatively recent introduction into module and 12 third-year nursing students from the
this discipline. Developments in interprofessional Children’s Branch. Two of the nursing students and
education must help to bridge the gap between these eight of the medical students were men. As recom-
traditions, and if carried out effectively should also mended by the pilot study (Morison et al. 2003),
acknowledge the implicit underlying philosophical an interprofessional teaching team was established
differences reflected in each profession’s approach to develop and deliver the programme. The team
to curriculum design and delivery. Additionally, consisted of two paediatric nurse specialists, a paedia-
interprofessional assessment must also address the trician, two nurse-lecturers and an IPE co-ordinator.
variation in the requirements and standards of The programme also provided the opportunity to
professional bodies. introduce a total of six SHOs to interprofessional
The study below describes the assessment meth- teaching, assessment, teamwork and communication
ods developed and evaluated for an IPE programme (DoH 2001b; 2002).
in Queen’s University, Belfast (QUB), which had Proposals to inform training of SHOs are currently
been piloted in 2000/1 (Morison et al. 2003; 2004) being implemented with increased emphasis on
and subsequently embedded into the medical ‘competence’ and its assessment. An explicit require-
and nursing curricula. The 8-week programme was ment is to extend and consolidate knowledge, skills,
repeated five times throughout the year for different values and attitudes acquired at undergraduate level.
groups of undergraduate medical and nursing Essential requisites of modern practice, including
students, and was designed for them to learn together teamworking, communication and multiprofessional
about children’s nursing/paediatric medicine in the practice, are embedded in foundation training
classroom and on clinical placement. The clinical area programmes in the early years of postgraduate educa-
was considered as key for interprofessional learning, tion (DoH 2002). The decision to involve SHOs in

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
194 S.L. Morison & M.C. Stewart

this programme provided a potential opportunity the nurse-lecturers, paediatricians and SHOs involved
to meet their training requirements in all these areas in the study. Although students were provided with
and to introduce them to their responsibilities as written instructions on what was required, including
educators in the future. explicit details of how the learning outcomes would
Prior to the commencement of the study, the be assessed, and an overview of diabetes and its
Chairperson of the local Research Ethics Committee management, the team was left to manage and
was consulted and indicated that ethical approval organize their preparation for the assessments.
was not required.

Assessment methods
Methods
Two assessment methods were used to measure
students’ success in achieving the intended learning
Development of learning activities, outcomes
outcomes. One was more commonly used in Medicine
and assessment methods
[(1) below] and the other was more commonly used
Learning activities and outcomes were identified that in Nursing [(2) below]. Both methods enabled students
were relevant to both medical and nursing curricula to practice skills in a realistic, but nevertheless ‘safe’,
and which focused on knowledge, skills and attitudes environment:
common to both professions (Harden 1998; Morison 1 An OSCE was used to assess the students’ clinical
et al. 2004). Assessment methods were selected competence and to ensure that standardization
for their appropriateness to measure the learning was achieved regardless of whether the assessor was
outcomes and not because they were the preferred a nurse specialist, nurse lecturer, paediatrician or
choice of either profession. Additionally, in order SHO. Students were expected to have practiced this
to promote reflection and improve performance task with the diabetic nurse specialists and had been
in the clinical setting, it was deemed essential to given a copy of the assessment criteria (Table 1). The
incorporate interactive feedback into the assessment students performed the clinical skill on a specially
process (Hewson & Little 1998; Mackway-Jones & designed manikin. Students were assessed individu-
Walker 1999; Branch & Paranjape 2002). ally and at the beginning of the assessment each stu-
The programme was delivered during the academic dent was given precise instructions by their assessor.
year 2002/3 to six different groups of students Bottles of insulin, syringes and a sharps’ box were
during the clinical placement component of their provided, but students had to role play hand-washing.
respective modules. The numbers in each group Upon completion of the assessment, immediate
varied between four and six. At the beginning of feedback was provided to each individual student by
each placement, students were given a clinical their assessors. Once all students had completed this
scenario (a child newly diagnosed with insulin- assessment, they were provided with a summary of
dependent diabetes) and were informed that they their group’s strengths and weaknesses in perform-
must work together as a team to learn about this ing this task.
condition in order to plan, prepare and give an 2 Role play was used to assess students’ knowledge
explanation of the condition and its management to of the chronic clinical condition, their ability to
the child’s parents during an assessed role play. The communicate with parents and to work in a team.
team was also to work with the ward-based diabetic The team were required to give an explanation to the
nurse specialists who would provide teaching sessions role-play parents (SHOs), and this included bring-
on a key clinical skill (giving a subcutaneous insulin ing the parents into a room, seating them at a table
injection), and students’ competence in this skill and introducing them to the team members. As
would also be tested. Students were also expected to each individual member of the team would be given
interact with other relevant clinical staff, such as a score, the team had been directed to ensure that
dieticians, to obtain appropriate information to enable each individual member had the opportunity to
them to complete their preparation, as well as with explain some aspect of care to the role-play parents.

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
 Developing interprofessional assessment 195

Table 1 Assessment criteria and rating scale for clinical skills

Jamie is a 7-year-old boy, recently diagnosed as an insulin-dependent diabetic. Please draw up and administer 5 units of short-
acting insulin.
1. Giving a single insulin injection
a. Wash hands 0 1
b. Select correct insulin 0 1
c. Check expiry date on bottle 0 1
d. Select appropriate syringe 0 1
e. Insert needle into insulin bottle and withdraw correct dose 0 1
f. Ensure all air bubbles are removed 0 1
g. Withdraw needle from syringe 0 1
h. Determine site to be injected and ensure it is clean 0 1
i. Pinch up a small amount of skin 0 1
j. Inject at a 90 degree angle, ensuring syringe is held around the barrel and not with thumb on the plunger 0 1
k. Inject insulin smoothly 0 1
l. Once injected relax grip and pressure on the plunger and count for 10 s 0 1
m. Withdraw needle and dispose of safely 0 1
1.1 Rating Scale
0 = Not done 1 = Satisfactory performance
1.2 Additional Discretionary Points
Uncertain/unsafe practice 0
Most points covered, few minor errors 1
Safe, competent practice 2

The SHOs were briefed as to the scenario given to to these skills (Table 2). Rating criteria were similarly
the students, in the use of prompt questions and discussed and agreed by all assessors (Table 3).
in their responses to information given by the Each student was assessed by a group of three
students. Using examples of checklist rating criteria educators, which always included a paediatric nurse
for communication skills (Cohen et al. 1996; specialist, a paediatrician and the IPE co-ordinator.
Donaldson & Topping 1996; NPC Framework 2001) A mean score for each question was calculated
as a starting point, the team developed a checklist of and these were then added to give a total mark and
behavioural indicators (BI) against which to assess finally converted into a percentage score. At the
students’ ability to organize and communicate to end of each assessment session the assessors’ ratings
parents the knowledge they had gained about the were compared and discussed with the assessment
clinical condition, and to work as a team. A checklist team. Once all assessments had been completed
approach was considered to equate well with the and scores and performances reviewed, the assessors
OSCE method being used to assess the clinical skill. met to review the scores and to determine the
In this novel situation, it also provided the inter- cut-off score that would be used to distinguish
professional team of assessors, and the students, with competent from not competent, and no further
a straightforward and specific list of criteria against categorization was made (Talente et al. 2003). This
which they were being measured. process provided assessors from the two professions
The BI were grouped into three categories – clarity with the assurance that they were assessing students
of information, effectiveness of communication from each profession appropriately and objectively,
and teamworking. Prior to the instrument being and that the competent/non-competent cut-off score
used with students, all assessors agreed that the final equated with their professional, subjective judgement
checklist satisfied each profession’s aims with regard (Brown et al. 1997).

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
196 S.L. Morison & M.C. Stewart

Table 2 Assessment checklist

Rating Scale

Quality of information
Behavioural indicator
Explanation is clear, concise and jargon-free and aims and objectives of the topic are clearly stated 0 1 2 3
Ensures that parents/child have understood the explanation and provides them with the opportunity to ask 0 1 2 3
questions
Ensures that all information is appropriate to the parent/child’s needs (e.g. for age, ability and understanding) 0 1 2 3
Uses relevant and appropriate aids to support explanation 0 1 2 3

Effective communication
Behavioural indicator
Effectively ‘opens’ the topic by appropriate use of verbal (introduces self) and non-verbal (eye contact) skills 0 1 2 3
Identifies and responds to verbal and non-verbal cues 0 1 2 3
Listens to questions posed by parents/child and responds appropriately 0 1 2 3
Effectively ‘closes’ the topic by ensuring that ‘doctor/nurse’ and parent/child are satisfied with specific explanation 0 1 2 3
Can effectively communicate all relevant information in the time allocated 0 1 2 3

Professional roles and teamworking

Behavioural indicator
Demonstrates knowledge and understanding of, and respect for, the roles of 0 1 2 3
different members of the multidisciplinary team
Demonstrates ability to work well with different team members 0 1 2 3
Has ensured that all significant aspects of management of the chronic condition 0 1 2 3
have been addressed by a member of the team
Does not duplicate information provided by a colleague 0 1 2 3

Table 3 Rating scale and criteria

The criteria against which students are assessed are described as ‘behavioural indicators’ (BI). Assessors should be able to observe
BI during the presentation. BI will be graded from 0 (no evidence that the BI has been used) to 3 (evidence that the BI has been
used to maximum effect).
Please adhere to the following guidelines when using this rating scale:
0 = Unacceptable.
No evidence of the BI being used or BI used but inappropriately
1 = Poor.
Some evidence of the BI being used appropriately or some evidence BI used inappropriately
2 = Acceptable
Evidence of the BI being used appropriately most of the time and little evidence of BI being used inappropriately.
3 = Good.
Evidence of the BI being used appropriately all of the time and no evidence of inappropriate use
The following example should provide further help.
BI – Explanation is clear, concise and jargon-free and aims and objectives of the topic are clearly stated.
Rating 0 – frequent use of jargon, no clarity to explanation and aims and objectives not explained
1 – some jargon, little clarity to the explanation, aims and objectives attempted but not clear
2 – infrequent use of jargon, majority of the explanation and aims and objectives clear
3 – no jargon, explanation and aims and objectives clear and concise
Please ensure that you familiarize yourself with all of the above before undertaking assessment.

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
 Developing interprofessional assessment 197

Each role play concluded with a debriefing students obtained a score of less than 10. Any
(Mackway-Jones & Walker 1999) on the team per- student who selected the wrong insulin was given a
formance, and included assessors, role-play parents score of 0, regardless of the accuracy of any of the
(SHOs) and students. remaining procedures. This was to ensure that a
student would not be deemed competent on their
aggregate score when their performance would have
Programme evaluation methods
resulted in harm to a ‘real’ patient. Discretionary
Data were collected from both students and SHOs. points were awarded to reflect the student’s holistic
Data triangulation (Pope & Mays 2000; Sim & Wright approach to the skill and to allow recognition of
2000) was employed to help identify common their attitude to the patient/parent in addition to
and conflicting ratings and themes, and thereby their performance of the clinical skill. The assessors
to enhance reliability and validity (Sim & Wright reviewed all of the scores achieved throughout the
2000). It should be pointed out that there is some programme and agreed that a score of less than 10
debate with regard to the role of triangulation in indicated that students had not mastered a sufficient
improving validity (Cohen et al. 2000; Pope & Mays number of the components of this skill (Table 1) and
2000; Sim & Wright 2000), but there is agreement were deemed not competent to perform this procedure
that it does present a more comprehensive picture on a real patient. Students in this category were
of the subject being studied (Pope & Mays 2000). invited to attend further practice sessions with the
A postprogramme questionnaire was developed diabetic nurse specialist.
for students’ evaluation. Demographic data, includ-
ing gender, profession and placement hospital,
Role-play assessment
was requested and the remaining items required
all respondents to indicate the extent to which they The overall score obtained by students ranged
agreed or disagreed with the statement provided. from 53% to 82% (median: 67%) and there was no
A five-point Likert Scale was used for rating. observable difference between the range of scores of
The SHOs evaluated the programme by means of medical and nursing students. Following a final review
a focus group conducted by the IPE co-ordinator. The of all scores achieved throughout the programme
group was asked to discuss what benefits, if any, they (see above), the assessors agreed that students who
thought the undergraduate students had received from obtained a score of less than 60% were not competent
this approach to learning. They were also asked to to communicate clearly and effectively with parents
consider the relevance of the experience to their own and colleagues. This was found to be the case for five
learning needs, the benefits, or otherwise, of being students (16%) who were required to reflect further
involved and the impact of the experience on their own on their strengths and weaknesses and discuss
clinical practice. The focus group was tape recorded this with their medical or nursing tutor.
and transcribed (Kitzinger 2000), and the content
was thematically analysed. The data were also
Programme evaluation
scrutinized by a second person to confirm the iden-
tification of the emergent themes (Pope et al. 2000).
Student evaluation of learning achieved by
the programme
Results Almost 75% of the students agreed that they had
learned to communicate with parents; that they had
OSCE assessment
acquired knowledge of a common clinical condition;
Scores obtained by students ranged from 0 (three that they learned to communicate with other health-
students) to 15 (five students) with a median of 12 care professionals; and that they had learned
and no observable difference between the range of about the role other healthcare professionals play in
scores of medical and nursing students. Six (19%) patient care (Fig. 1).

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
198 S.L. Morison & M.C. Stewart

Fig. 1 Student evaluation of learning achieved.

Teaching and assessing. The SHOs considered that

SHO evaluation of the programme
this experience had provided them with a good
Three key themes emerged from the SHO focus introduction to teaching undergraduates and learning
group: about appropriate teaching methods. They com-
mented that, in general, new doctors had little
Value of role-play approach to learning. SHOs indic- opportunity to teach. They thought that through
ated that they considered the learning experience their participation in the role play they had learned
to be very worthwhile for the students as it helped to identify the variable performances of the students
them to improve their communication skills and, in and to distinguish good from bad. They were
particular, to learn to give an explanation to parents. particularly aware from the role play of the impact on
They commented that, for doctors, providing an parents of inappropriate language or information.
explanation was a very important part of their They suggested that explaining was an effective way
role, particularly as there is an expectation that they of learning as if students could explain clearly and
(doctors) will always be right. Additionally, this simply to parents – even a complicated condition –
approach helped students to learn the importance of it meant that they understood it. They also identified
thorough preparation prior to meeting with patients/ additional instructions that students might be
parents and of using appropriate, jargon-free given to enhance their preparation, teamworking and
language. communication skills. For example, that it might be
In comparison to their own undergraduate useful for students to develop a plan which identified
learning experience, SHOs thought that role play the type of questions they might be asked by parents
was preferable to a ‘question and answer’ approach and then to prepare answers.
which they had found to be intimidating. They also
thought that this approach clearly demonstrated the Interprofessional interaction. They were convinced
importance for students of ‘learning through doing’ that it was important for medical and nursing
and this reinforced the views they had formed as students to learn together as this better reflected
undergraduates, that practice-focused, interactive their future practice. They thought that this
learning experiences were the most effective. experience helped students to understand better the

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
 Developing interprofessional assessment 199

value of working together and to understand more accurately reflects professional practice. The ward
about others’ roles and perspectives. They felt that provided an ideal learning environment for such an
their own understanding had improved in this approach, and comments from the SHOs support
respect and also that they intended to use what they this contention.
had learned in their own practice. In particular, with Although the numbers engaged in these activities
the support of their medical supervisor, they would were relatively small, the results nevertheless show
like to develop a similar teaching intervention using that the interprofessional team of assessors were
a different clinical condition. able to work together to distinguish a standard that
separated competent from non-competent students
from both professions and in both assessments.
Discussion Moreover, teachers and students found the inter-
Identifying appropriate learning outcomes and professional assessments acceptable.
ensuring that subsequent learning activities and The assessment methods were chosen to reflect
assessment methods were aligned were particularly appropriately the interactive nature of the learning
valuable in an interprofessional programme. This activities and were used formatively rather than
facilitated the identification of common learning summatively, to enable students to make mistakes in
requirements and highlighted educational similarities, a safe environment, to reflect on their strengths and
rather than interprofessional differences. The students’ weaknesses and to undertake further practice in the
positive evaluation of the appropriateness of the areas where they were weakest. The OSCE assess-
intended learning outcomes suggests that this ment was particularly effective in identifying areas
aspect of the programme was successful and that where students’ lack of knowledge could have
the programme of learning was acceptable to both dangerous consequences and was also the most
student groups. practicable of the two assessments. Although more
Crucial to the programme’s success was the involve- commonly used in the assessment of medical
ment at all stages – planning, development and students, the OSCE was found to be appropriate for,
delivery – of an interprofessional team that included and acceptable to, both professions. OSCE assess-
expert clinicians and an education specialist. This ment is subsequently being developed in other areas
approach helped to ensure that teachers from both (simulation technology: emergency medicine and
professions (the university and the NHS) felt that nursing) to assess interprofessional activities
they had ownership of the programme (Lloyd-Jones where effective clinical skills and team working are
et al. 1998; Parsell & Bligh 1998). It also provided paramount.
a constructive environment in which teachers could The role-play method of assessment with a focus
engage in dialogue about their own profession’s on ‘explanation’ was particularly effective in helping
assessments and standards, and how these might students to improve their communication and
effectively be deployed for interprofessional purposes. teamwork skills. Through an iterative process, the
The teamwork example of the teachers also served as interprofessional team of assessors were able to
a role model of collaborative practice for students develop a set of criteria against which students from
and SHOs (Spencer & Jordan 2001; Paice et al. both professions could be measured. The results
2002). suggested that this measure was appropriate for
The Bristol enquiry (DoH 2001a) recommended students from both professions. An important
that non-clinical skills, such as communicating with component of the process was that the judgement
patients and colleagues, and engaging in reflective of assessors was used to determine standards.
practice, should be promoted and assessed. How- Without the involvement of representatives from
ever, in everyday practice, non-clinical and clinical both professions it is unlikely that these judgements
tasks are seamlessly combined and therefore, it would have gained interprofessional acceptance.
could be argued, these skills should be taught and The role play was also effective in exposing the
assessed in an integrated manner that more limitations of text-book learning. Students found

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
200 S.L. Morison & M.C. Stewart

that applying theory to practice was not easy and they and skills of their colleagues to help deal with the
learned, through role-play experience, the import- situation. The role play distinguished between
ance of combining effective communication skills effective teams and ‘teams’ who were simply a collec-
and theoretical knowledge. The SHOs, in particular, tion of individuals.
commented on the value of this exercise in helping The SHOs thought that the interactive, practice-
students to learn about using appropriate language focused nature of the learning experience for the
and ensuring that explanations are at an appropriate undergraduate students was particularly valuable
level to optimize parents’ understanding. and preferable to the teaching-through-intimidation
One of the major drawbacks of the role play was model, which is still prevalent in some areas of
its labour intensiveness. However, teachers’ increas- medical education (Lempp & Seale 2004; Stewart
ing familiarity with the process decreased this et al. 2004). As well as recognizing the value of
problem, and the use of a problem-based scenario applying what they had learned through their
and teaching support from the ward-based nurse involvement in the programme to their own clinical
specialists and SHOs also made a positive contribu- practice, the SHOs have subsequently become
tion. It could be argued that the benefits the students involved in developing problem-based scenarios for
gained from this learning experience outweighed the other clinical conditions, such as epilepsy. This sug-
difficulties, but further research would need to be gests that interprofessional learning opportunities
undertaken in different settings to substantiate this. are as important, if not more so, for those already
Another key element in both assessments was in practice. It also suggests that involvement in
the integration of feedback, an essential but often such a programme provides a twofold benefit for
neglected tool for teachers (Hewson & Little 1998; SHOs in that they fulfilled professional require-
Branch & Paranjape 2002). Supportive feedback ments of learning about teamwork and teaching
enabled the students to reflect on their strengths and others, in an interprofessional context, and at the
weaknesses and to discuss with teachers and peers same time gained experience pertinent to their
how they could improve their performance. The own practice – communicating with patients and
inclusion of students, role-play parents (SHOs) colleagues.
and assessors in this discussion also proved valuable,
as it provided the opportunity to examine the
role play from different perspectives. The feedback
Conclusion
discussion provided a learning opportunity and Common learning activities and appropriate assess-
thus enabled the assessment to become part of the ment methods acceptable to students and assessors
learning process. from both professions can be developed and standards
The students’ evaluation of what they had learned set, although development and delivery by an inter-
on the programme is congruent with the learning professional team is essential. Making the inter-
outcomes and assessment results, with most students professional assessments formative, and including
agreeing that they had learned to communicate the opportunity for feedback, discussion and reflec-
with parents and other healthcare professionals, to tion, is also important.
understand the roles played by different healthcare Using a problem-based scenario, having support
professionals in patient care, to appreciate the impor- from SHOs and ward-based specialists, and famili-
tance of teamworking and had gained knowledge arity with the process, can help to ameliorate labour
of a chronic clinical condition. Difficult questions intensiveness. The SHOs who participated in this
from the role-play parents (SHOs), exposed gaps in study are currently refining, developing and testing
the students’ understanding of the clinical condi- the generalizability of this approach by extending it
tion and, importantly, left those students who had to other clinical conditions. Similarly, interprofes-
worked as individuals unable to draw on their team sional OSCE assessments are being developed and
for support. Conversely, those who had worked evaluated in areas such as emergency medicine and
as a team were able to call upon the knowledge nursing where effective clinical skills and teamworking

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
 Developing interprofessional assessment 201

are of prime importance. The findings of this study Department of Health (2001b) Doctors for the Future:
indicate that there is a future for the development of Standing Medical Advisory Committee Advice.
interprofessional assessment. Furthermore, there is DoH, London.
a role for SHOs in undergraduate interprofessional Department of Health (2002) Unfinished Business:
Proposal for the Reform of the Senior House Officer
education. Involving SHOs in the planning and
Grade. TSP, London.
implementation of undergraduate IPE is an effec-
Department of Health (2003) Modernising Medical
tive way to meet their training needs and can help
Careers. DoH, London.
to increase their awareness of the value of inter- Donaldson A.J.M. & Topping K.J. (1996) Promoting peer
professional learning, and communication and team- assisted learning amongst students in further and
working skills. higher education. SEDA, London, Paper 96.
Finch J. (2000) Interprofessional education and team
working: a view from the education providers. British
Acknowledgements Medical Journal 321, 1138–1140.
We would like to thank students, SHOs, diabetic Fowell S.L., Maudsley G., Maguire P., Leinster S.J. &
clinical nurse specialists and Mairead Boohan, QUB Bligh J. (2000) Student assessment in undergraduate
Medical Education Unit. medical education in the United Kingdom, 1998.
Medical Education 34, 1–49.
General Medical Council (2002) Tomorrow’s Doctors.
References GMC, London.
Branch W.T. & Paranjape A.P. (2002) Feedback and Harden R.M. (1998) Effective multiprofessional
reflection: teaching methods for clinical settings. education: a three-dimensional perspective. Medical
Academic Medicine 77, 1185 –1188. Teacher 20, 402–408.
Brown G., Bull J. & Pendlebury M. (1997) Assessing Hewson M.G. & Little M.L. (1998) Giving feedback in
Student Learning in Higher Education. Routledge, medical education. Journal of General International
London. Medicine 13, 111–116.
Cohen D.S., Colliver J.A., Marcy M.S., Fried E.D. & Kitzinger J. (2000) Focus groups with users and providers
Schwartz M.H. (1996) Psychometric properties of a of healthcare. In: Qualitative Research in Health Care
standardized-patient checklist and rating form used to (eds C. Pope & N. Mays), pp. 20–29. BMJ Books,
assess interpersonal and communication skills. London.
Academic Medicine 71, s87–s89. Lempp H. & Seale C. (2004) The hidden curriculum in
Cohen L., Manion L. & Morrison K. (2000) Research undergraduate medical education: qualitative study of
Methods in Education, 5th edn. Taylor & Francis, medical students’ perceptions of teaching. British
London. Medical Journal 329, 770–773.
Committee of Vice Chancellors and principals of the Lloyd-Jones G., Ellershaw J., Wilkinson S. & Bligh J.G.
Universities of the United Kingdom (CVCP) (2000) (1998) The use of multidisciplinary consensus groups
NHS Workforce Planning: CVCP Response Annex 00/96/ in the planning phase of an integrated problem-based
b (3). CVCP, London. curriculum. Medical Education 32, 278–282.
Cooper H., Braye S. & Geyer R. (2004) Complexity and Mackway-Jones K. & Walker M. (1999) Pocket Guide
interprofessional education. Learning in Health and to Teaching for Medical Instructors BMJ Books,
Social Care 34, 179–189. London.
Department of Health (2000a) A Health Service for All Morison S., Boohan M., Jenkins J. & Moutray M. (2003)
Talents: Developing the NHS Workforce. Consultation Facilitating undergraduate interprofessional learning
Document of the Review of Workforce Planning. HMSO, in healthcare: comparing classroom and clinical
London. learning for nursing and medical students. Learning in
Department of Health (2000b) The NHS Plan: a Plan Health and Social Care 2, 92–104.
for Investment, a Plan for Reform. HMSO, London. Morison S., Boohan M., Moutray M. & Jenkins J. (2004)
Department of Health (2001a) Learning from Bristol: Developing pre qualification inter-professional
The Report of the Public Inquiry into Children’s Heart education for nursing and medical students: sampling
Surgery at the Bristol Royal Infirmary 1984 –1995. student attitudes to guide development. Nurse
TSO, London. Education in Practice 4, 20–29.

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
 202 S.L. Morison & M.C. Stewart

National Prescribing Centre (2001)Maintaining Sim J. & Wright C. (2000) Research in Health Care:
Competency in Prescribing. An outline framework to help Concepts, Designs and Methods. Stanley Thornes
nurse prescribers. NPC, Liverpool. Publishers Ltd, Cheltenham.
Nursing and Midwifery Council. (2001) Fitness for Spencer J. & Jordan R. (2001) Educational outcomes and
Practice and Purpose. NMC, London. leadership to meet the needs of modern healthcare.
Paice E., Heard S. & Moss F. (2002) How important are Quality in Health Care 10, ii38–ii45.
role models in making good doctors? British Medical Stewart M.C., Morison S. & Jenkins J. (2004) The hidden
Journal 325, 707–710. curriculum in medical education. BMJ Rapid Response.
Parsell G. & Bligh J. (1998) Educational Principles Available at URL: http://bmj.bmjjournals.com/cgi/
Underpinning Successful Shared Learning. Medical eletters/329/7469/770#85014.
Teacher 20, 522–529. Talente G., Haist S.A. & Wilson J.F. (2003) A model for
Pope C. & Mays N. (2000) Qualitative methods in health setting performance standards for standardized patient
research. In: Qualitative Research in Health Care (eds examinations. Evaluation and the Health Professions 26,
C. Pope & N. Mays), pp. 1–10. BMJ Books, London. 427– 446.
Pope C., Ziebland S. & Mays N. (2000) Analysing Watson R., Stimpson A., Topping A. & Porock D. (2002)
qualitative data. In: Qualitative Research in Health Clinical competence assessment in nursing: a
Care (eds C. Pope & N. Mays), pp. 75–88. BMJ Books, systematic review of the literature. Journal of Advanced
London. Nursing 39, 421– 431.

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202

View publication stats