Introduction
Interprofessional education (IPE) efforts have occurred across the globe, spanning Australia, Canada, Europe, New Zealand, the United Kingdom, and the United States (US), among other countries.1-4 The World Health Organization (WHO) indicates that interprofessional education occurs when “students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”5(p.10) According to national guidance jointly developed by the US-based Health Professions Accreditors Collaborative and the National Center for Interprofessional Practice and Education (National Center), adopting unified terminology, such as the WHO definition, is crucial to the development of quality IPE.6 The Health Professions Accreditors Collaborative and the National Center also recommend the development of a shared understanding of IPE terminology, learning, and measurement to ensure more uniform expectations about the development, implementation, and evaluation of quality IPE.
In 2009, professional associations representing US colleges and schools throughout the health professions formed the Interprofessional Education Collaborative (IPEC) to advance substantive interprofessional learning experiences.7 The founding IPEC associations represented allopathic and osteopathic medicine, dentistry, nursing, pharmacy, and public health. These associations created core competencies for interprofessional collaborative practice to guide curriculum development across health professions schools. IPEC has grown to include 21 members. Its mission is to ensure that health professionals are proficient in the competencies essential for patient-centered, community- and population-oriented, interprofessional collaborative practice. A national competency framework from the Canadian Interprofessional Health Collaborative has guided efforts in Canada, while other countries have developed their own national approaches to advance IPE.1,2
Linking Interprofessional Networks for Collaboration is the IPE-focused Quality Enhancement Plan developed by the University of Texas Health Science Center at San Antonio (UT Health San Antonio).8 Primary goals include increasing IPE knowledge and skills of faculty, staff, and students as well as integrating IPE activities into program curricula and increasing opportunities for student IPE experiences. Having observed local trends emphasizing voluntary IPE that takes place outside the formal curriculum, we will explore the international literature for examples of IPE activities to guide our understanding and shape our approach to IPE development.
Many academic institutions provide voluntary IPE experiences for their learners. According to Stetten et al.,9 service learning is almost always a voluntary activity and, therefore, co-curricular. These activities provide access to care for diverse populations and focus on numerous topics. Most co-curricular IPE (CC-IPE) activities connect service learning with health disparities and inequities, constituting unique learning experiences.10 These IPE experiences enable health professional students to learn more about under-served populations and patients, particularly in relation to social determinants of health.10-12 Commonly referred to as “extracurricular,” these IPE activities can be easily misconstrued in terms of the important role they play in the professional development of students. More specifically, IPE can be devalued13 if it is labeled with the same terminology used to describe activities that are less intimately bound with the professional development of students (eg, voluntary participation in charitable fundraisers or intramural sports).
To address this issue, we assembled a team of faculty and staff advocates who had experience developing voluntarily completed IPE at UT Health San Antonio to explore the question, “How should institutions define IPE activities outside the required curriculum to add value to the professional development of learners and help them achieve IPE competencies?” We then developed a search strategy around this definition, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)14 guidelines to identify, characterize, and classify examples from the peer-reviewed published literature.
As IPE efforts continue to gain momentum, many accrediting bodies for health professions, including dentistry, medicine, and nursing, have integrated IPE into their standards, and have either mandated or strongly encouraged the incorporation of IPE into the curriculum of those professional schools.15-19 Other drivers of IPE include the US-based National Academy of Medicine (formerly the Institute of Medicine) and the development of consensus about IPE-related competencies, such as the reports published by the Canadian Interprofessional Health Collaborative and IPEC.7,20-22 The IPEC core competencies have become a universal goal for learners across the health professions.7 Many academic institutions have begun to build and enhance infrastructure to support these IPEC core competencies. This has been reflected in opportunities both within and outside credit-bearing coursework or other programs that are typically documented on students’ official transcripts.
In recent years, health professions accreditors have begun using the term “co-curricular” to distinguish between activities that augment the professional development of health professions learners in concert with curricular goals and those that do not.15 Currently, there is no universally accepted definition of these activities. We believe that the term “co-curricular IPE” is preferable to “extracurricular IPE” because the latter may unintentionally diminish the value of these activities. We define CC-IPE activities as opportunities that augment learners’ professional development but do not result in a transcript designation, are not part of the formal curriculum, and are purely voluntary. Importantly, we have observed that an IPE activity can be mandated as a course requirement (and thus be transcripted) for one cohort of students, but remain a voluntary activity (and thus not be transcripted) for another cohort of students. Therefore, our definition is applied from the perspective of the student. We leave the term “extracurricular” to refer to activities that are voluntary but do not directly influence interprofessional collaborative practice knowledge acquisition and/or skill development.
Internationally, the field of IPE would benefit from exploring the literature to identify examples that meet our definition. This scoping review will identify, characterize, and classify examples of CC-IPE activities. A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, PROSPERO, JBI Evidence Synthesis, and the JBI Systematic Review Register was conducted. No current or in-progress scoping reviews or systematic reviews on the topic were identified.
In summary, this scoping review will identify literature on CC-IPE activities published in English-language journals. It will offer clarity in an important field of education that currently lacks consensus in its terminology. This will not only improve our existing IPE activities but will also yield information that we will disseminate to inform others locally, nationally, and internationally.
Review questions
- i) What does the literature on CC-IPE reveal in terms of participants, settings, and topics addressed?
- ii) What student learning outcomes have been measured in CC-IPE, and what methods and tools have been used?
- iii) Which IPEC competencies for interprofessional collaborative practice have been targeted in the development and implementation of CC-IPE?
Inclusion criteria
Participants
This review will consider studies that include learners from at least two different health professions involved in CC-IPE activities, where at least one cohort represented pre-licensure students (eg, medical, nursing, pharmacy) who participated voluntarily. We will consider activities that were not transcripted and, most importantly, were based on the individual student's circumstances/experience, not the setting, as CC-IPE activities. All settings will be included, for example, didactic (ie, classroom), simulation, and clinical learning environments.
Concept
This review will consider peer-reviewed studies that explore the concept of CC-IPE in health professions education. Co-curricular IPE activities will be defined as opportunities that augment learners’ professional development but do not result in a transcript designation, are not part of the formal curriculum, and are purely voluntary. Included articles will be classified to summarize characteristics such as targeted IPE competencies, types of learners, settings, topics, and author-reported learning outcomes.
Context
Settings that house CC-IPE activities are hubs of innovation. All manner of IPE activities have been, and can be, first piloted in co-curricular settings. Co-curricular IPE activities augment learners’ professional development as well as their knowledge and skill acquisition. This scoping review will consolidate key information about CC-IPE activities. The information can then be used to guide educators globally to strengthen the development and implementation of CC-IPE.
Types of sources
This scoping review will consider quantitative, qualitative, and mixed methods study designs published in peer-reviewed journals. Reviews, surveys, and opinion papers will not be considered, and a gray literature search will not be conducted.
Methods
The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews.23
Search strategy
The search strategy will aim to locate published primary studies from peer-reviewed journals. An initial limited search of MEDLINE was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles, were used to develop a full search strategy for MEDLINE via PubMed (see Appendix I). The search strategy, including all identified keywords and index terms, will be adapted for each included information source. The reference lists of articles included in the review will be screened for additional papers.
Articles published from 2009 to the present will be considered. This is because 2009 was the year of IPEC's inception in the US, marking a nationwide structured interest in IPE throughout the health professions.7 Only English-language publications will be considered due to the language limitations of the reviewers.
The databases to be searched include MEDLINE (PubMed), CINAHL (EBSCO), Scopus, ERIC (EBSCO), and Academic Search Complete. No relevant publications were found during the preliminary searches of the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, and the JBI Systematic Review Register. Therefore, these databases will be excluded.
Study selection
Following the search, all identified records will be collated and uploaded into EndNote v.X9 (Clarivate Analytics, PA, USA) and duplicates removed. Titles and abstracts will then be screened by two independent reviewers against the inclusion criteria for the review. Potentially relevant papers will be retrieved in full and their citation details imported into Rayyan (Qatar Computing Research Institute, Doha, Qatar). The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of full-text papers that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved with a third reviewer. The results of the search will be reported in full in the final scoping review and presented in a PRISMA flow diagram.24
Data extraction
Data will be extracted by a calibrated independent reviewer using a data extraction tool developed by the reviewers (see Appendix II). The extracted data will include specific details, such as topic, setting, types of students involved, method and tools used to measure student learning outcomes, and IPEC competencies. The draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included paper. Modifications will be detailed in the full scoping review. A second independent reviewer will verify the accuracy of the extracted data. If necessary, a third independent reviewer will adjudicate unresolved discrepancies between the two reviewers.
Data analysis and presentation
Descriptive statistics will be used to characterize the extracted data, which will be presented in a manner that aligns with the objective of this scoping review. We anticipate posters and oral presentations at regional, national, and international meetings that will include diagrammatic, tabular, and other visual representations of data to support the narrative descriptions. Our team also anticipates publication of analyses based on extracted data.
Appendix I: Search strategy
MEDLINE (PubMed)
Initial search conducted on March 3, 2020
Appendix II: Draft data extraction instrument
Please provide your name.
Please list the last name of the first author and the year of publication (eg, Smith, 2020).
Q. 1: Please summarize this CC-IPE activity in 1-2 sentences.
Q. 2: Please select the main health related topic(s) covered in this CC-IPE activity, if any. Check all that apply, specify any not listed, or select “not applicable.”
- ∘ Cardiovascular health (eg, hypertension, heart failure)
- ∘ Cerebrovascular accident (eg, stroke)
- ∘ Diabetes as metabolic health
- ∘ Oral health (eg, periodontal disease)
- ∘ Diet and nutrition
- ∘ Obesity as metabolic health
- ∘ Tobacco-related
- ∘ Not applicable
- ∘ Other, please specify
Q.3: Please select the main patient education topic(s) covered in this CC-IPE activity, if any. Check all that apply, specify any not listed, or select ‘“not applicable.”
- ∘ Fall prevention education (eg, for older adults)
- ∘ Health literacy (eg, oral health literacy)
- ∘ Medication education
- ∘ Not applicable
- ∘ Other, please specify
Q.4: Please select the main social determinants of health topic(s) that were addressed in this CC-IPE activity, if any. Check all that apply, specify any not listed, or select “not applicable.”
- ∘ Access to care
- ∘ Food insecurity
- ∘ Housing insecurity
- ∘ Medication access
- ∘ Poverty
- ∘ Not applicable
- ∘ Other, please specify
Q.5: What kind of CC-IPE activity is this?
- ∘ Pure CC-IPE (eg, no students receive transcript designation)
- ∘ Mixed CC-IPE (eg, some students receive transcript designation, while others do not)
Q.6: Where did this IPE activity take place? Check all that apply or add setting directly if option is not listed.
- ∘ Academic setting: classroom
- ∘ Academic setting: laboratory
- ∘ Academic setting: simulation center
- ∘ Academic setting: conference
- ∘ Community setting: community center
- ∘ Community setting: faith-based setting (eg, church, temple, mosque)
- ∘ Community setting: school
- ∘ Clinical setting: dental clinic
- ∘ Clinical setting: federally qualified health center
- ∘ Clinical setting: hospital
- ∘ Clinical setting: medical clinic
- ∘ Clinical setting: pharmacy
- ∘ Clinical setting: student-run free clinic or equivalent
- ∘ Global health or global education setting
- ∘ Other setting, please specify and use the format of “setting: descriptor” (eg, academic setting: conference)
Q.7: What types of students were involved? Check all that apply and/or specify any not listed.
- ∘ Athletic training
- ∘ Audiology and hearing
- ∘ Chiropractic (dc)
- ∘ Clinical pastoral care
- ∘ Community health worker
- ∘ Dentistry (DDS or DMD)
- ∘ Dental hygiene
- ∘ Dietetics and nutrition
- ∘ Genetic counseling
- ∘ Medical assistants
- ∘ Medical physics
- ∘ Medicine (DO or MD)
- ∘ Medical laboratory sciences
- ∘ Midwifery
- ∘ Nursing (undergraduate)
- ∘ Nursing (graduate)
- ∘ Occupational therapy
- ∘ Optometry
- ∘ Pharmacy
- ∘ Physical therapy
- ∘ Physician assistant
- ∘ Podiatry
- ∘ Psychology (PhD or PsyD)
- ∘ Public health
- ∘ Radiation oncology
- ∘ Respiratory therapy
- ∘ Social work
- ∘ Speech-language pathology
- ∘ Veterinary medicine (DVM)
- ∘ Other, please specify
Q.8: Was the IPE activity developed explicitly to achieve IPEC core competencies? If yes, reply to Q.8A. If no, proceed to Q.9.
Q.8A: Which IPEC core competencies did authors explicitly attempt to address with this IPE activity (eg, the authors prospectively designed the IPE activity to achieve these core competencies)? Check all that apply.
- ∘ Teams and teamwork
- ∘ Roles/responsibilities
- ∘ Interprofessional communication
- ∘ Values/ethics for interprofessional practice
Q.9: Did the authors report outcomes from the IPE activity? If yes, reply to Q.9A and Q.9A.1. If not, proceed to Q.10.
Q.9A: What types of student learning outcomes did the authors report? Check all that apply.
- ∘ Learner's reaction: Kirkpatrick Level 1
- ∘ Modification of attitudes/perceptions: Kirkpatrick Level 2a
- ∘ Acquisition of knowledge/skills: Kirkpatrick Level 2b
- ∘ Behavioral change: Kirkpatrick Level 3
- ∘ Other, please specify
Q.9A.1: What other outcomes did the authors report? Check all that apply and/or specify any not listed. Select all that apply.
- ∘ Educator-related outcomes, please describe
- ∘ Patient-related outcomes, please describe
- ∘ Community-related outcomes, please describe
- ∘ Organization-related outcomes, please describe
- ∘ Other outcomes, please describe
Q.9B: Did the authors report quantitative IPE data in their outcomes assessment? If yes, please reply to Q.9B.1 and Q.9B.2. If not, proceed to Q.10.
Q.9B.1: Did the authors use a validated IPE measurement instrument to generate quantitative outcomes data? If yes, please reply to Q.9B.2. If not, proceed to Q.9B.3.
Q.9B.2: Which of the following IPE measurement instruments did the authors use? Check all that apply and/or specify any not listed.
- ∘ ACE-15 or Assessment for Collaborative Environments
- ∘ AITCS or Assessment of Interprofessional Team Collaboration Scale
- ∘ ATHCT or Attitudes Toward Health Care Team Scale
- ∘ CATS or Communication and Teamwork Skills
- ∘ CPAT or Collaborative Practice Assessment Tool
- ∘ CSACD or Collaboration and Satisfaction About Care Decisions
- ∘ HTVI or Healthcare Team Vitality Instrument
- ∘ ICCAR or Interprofessional Collaborator Assessment Rubric
- ∘ ICCAS or Interprofessional Collaborative Competency Attainment Survey
- ∘ ICS or Interprofessional Collaboration Scale
- ∘ IIC or Index of Interdisciplinary Collaboration
- ∘ IPA or Interprofessional Professionalism Assessment
- ∘ IPAS or Interprofessional Attitudes Scale
- ∘ IPC or Interprofessional Collaboration
- ∘ IP-COMPASS or Interprofessional Collaborative Organization Map and Preparedness Assessment
- ∘ IPEC or Interprofessional Education Collaborative Competency Self-Assessment Tool
- ∘ IPMPC or The Interprofessional Model of Patient Care
- ∘ ISVS or Interprofessional Socialization and Valuing Scale
- ∘ iTOFT or The Individual Teamwork Observation and Feedback Tool
- ∘ ITPPS or Interdisciplinary Team Process and Performance Survey
- ∘ KidSIM Team Performance Scale
- ∘ McMaster-Ottawa Scale
- ∘ OIPC or Observed Interprofessional Collaboration
- ∘ PACT or Performance Assessment for Communication and Teamwork
- ∘ PIVOT or Patient's Insights and Views Observing Teams Questionnaire
- ∘ RCS or Relational Coordination Scale
- ∘ RIPLS or The Readiness for Interprofessional Learning Scale
- ∘ SOS or Safety Organizing Scale
- ∘ SPICE or SPICE-2 or Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education
- ∘ SPICE-R or SPICE-R2 or The Student Perceptions of Interprofessional Clinical Education–Revised
- ∘ TAS or Teamwork Assessment Scale
- ∘ TDM or Team Development Measure
- ∘ TDMQ or Team Decision Making Questionnaire
- ∘ T-MEX or Teamwork Mini Clinical Evaluation Exercise
- ∘ TOSCE or Team Observed Structured Clinical Encounter
- ∘ TPS or Team Performance Scale
- ∘ T-TAQ or Team Assessment Questionnaire
- ∘ T-TPQ or Team Performance Questionnaire
- ∘ TSS or The Team Skills Scale
- ∘ UA-BRS or University of Auckland Behavioural Rating Scale
- ∘ UWE-ELIQ or University of West of England Entry Level Interprofessional Questionnaire
- ∘ Other, please specify
Q9B.3: Please describe the method used to capture quantitative data related to IPE learning outcomes if the authors did not use a validated measurement tool.
Q.10: Did the authors report qualitative data in their IPE outcomes assessment? If yes, please reply to Q.10A. If not, proceed to Q.11.
Q.10A: What formal methodology did the authors use to analyze qualitative data? Check all that apply, or specify methodology used if not listed.
- ∘ Content analysis
- ∘ Thematic analysis
- ∘ None
- ∘ Other, please specify
Q.11: What method did the authors use to capture or collect the qualitative data they reported? Check all that apply or add other method if not listed.
- ∘ Focus group notes from study/project personnel
- ∘ Focus group transcription of conversation
- ∘ Written reflection
- ∘ Written responses to open-ended questions
- ∘ None
- ∘ Other, please specify
Q.12: Is this an ongoing IPE activity that is offered on a regular basis? If yes, please reply to Q.12A. If a one-time event, select “No” and proceed to Q.13.
Q.12A: How frequently is this IPE activity offered?
- ∘ Annually
- ∘ Each semester
- ∘ Multiple times per year
- ∘ Other, please specify
Q.13: Did the authors report anything that could be described as a meaningful or valuable practice? If yes, reply to Q.13A. If not, proceed to Q.14.
Q.13A: Please describe meaningful or valuable practices reported by the authors.
Q.14: Did the authors report anything that could be described as lessons learned or challenges experienced that have implications for the CC-IPE activity? If yes, reply to Q.14A. If not, proceed to Q.15.
Q.14A: Please describe lessons learned or challenges experienced reported by authors
Q.15: Is there anything else noteworthy that you feel was not captured by the questions above? If yes, reply to Q.15A. If not, proceed to Q.16.
Q.15A: Please describe any noteworthy items you feel should be documented.
Q.16: If we wanted to replicate this project at UT Health San Antonio, or modify it to fit our local context, could we? If yes, reply to Q.16A. If not, thank you for completing data extraction for this article.
Q.16A: Please describe how we might replicate this project at UT Health San Antonio, modify it to fit our local context, or use the information in the article to improve upon an existing activity here.
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