Do interprofessional education programs produce dissension that destroys them?

We have shown that healthcare professional students attitudes toward interprofessional collaboration improve in association with their work together on interdisciplinary teams in single courses (Van Winkle et al., 2012, 2013). Anecdotally, however, a few students complained that at least one team member from another healthcare professions program did not contribute their share to the success of the team. To test the possibility that these interventions to improve attitudes toward interprofessional collaboration might also have negative effects on some participants attitudes, we examined a new set of data more carefully for both positive and negative changes. Such a negative effect on students attitudes might also have a negative impact on establishment of interprofessional education programs. Ninety five percent of first-year pharmacy students (202 of 213 students) and 100% (n = 96) of first-year prospective health professions students (defined in Van Winkle et al., 2013) completed the newly developed Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC, Hojat et al., 2014) at orientation to their programs in August and September, respectively, 2014 (pre-course administrations of the scale). They then worked together in interdisciplinary learning teams to complete weekly biochemistry workshop exercises and regular discussions concerning the challenges and rewards of healthcare delivery. Eighty one percent of pharmacy students and 91% of prospective health professions students completed the scale again at the end of the 11-week fall academic quarter (post-course administration of the scale). Most students marked their survey forms with personal, four-digit ID codes so that their post-course survey scores could be matched to their pre-course scores for more powerful, paired statistical analyses. Statistical analyses were performed using GraphPad Prism 6 Software, Inc. (LaJolla, CA). This study was reviewed and found to fulfill the criteria for exemption by the Midwestern University Institutional Review Board. Most students became more eager to collaborate after working in teams (p = 0.02, Effect Size (ES) = 0.21, paired t-test for first-year pharmacy students; p < 0.0001, ES = 0.55, paired t-test for prospective health professions students). However, the distributions of survey scores also broadened after postcourse vs. pre-course administration of the scale to pharmacy and prospective healthcare professions students (p < 0.0001, F-tests to compare variances). The postcourse distributions of scores appeared to be composed of at least two populations of students. Thus, the changes in some students survey scores were highly negative statistical outliers of the populations of score changes (Tukey, 1977; Ben-Gal, 2005). These sets of student outliers became much less eager to work with students from other programs (p = 0.0004; ES = 0.98, paired t-test for firstyear pharmacy students; p = 0.004, ES = 0.95, paired t-test for prospective health professions students). While the latter groups of bona fide outliers comprised less than 8% of pharmacy and prospective health professions students in the study, the magnitudes of their negative changes in attitudes were relatively large. The average magnitudes of these negative changes exceeded the increases in mean scores among the remaining majority of students by more than six-fold. In our view, such highly negative experiences among a minority of healthcare professions students working on interdisciplinary teams could disproportionately influence administrators overseeing work toward establishing interprofessional education programs. Those with strongly negative feelings are likely to be much more vocal than students who favor such programs. The later social dynamic would undermine efforts to institutionalize existing pilot programs. In this regard, these students also worked on teams with other healthcare professions students in at least one other course during the same quarter term of 2014.