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Effect of team-based learning in interprofessional education at a health university

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Objective: This study aimed to examine the effects of interprofessional education (IPE) using team-based learning (TBL). Methods: We analyzed the results of a scale to measure IPE among 449 fourth-year students from seven faculties of a health university in Japan. The students took the Assembly Special Lesson as part of IPE using TBL. Before and after the lesson, the participants completed a questionnaire, which consisted of the IPE Tsukuba Model, to which we added two items. The scale was divided into five domains. We compared the scores using the Wilcoxon signed-rank test. Results: The overall scores of four of the five domains of the IPE evaluation were significantly higher after the lesson than before (P<0.05): "Understanding the role of each profession's specialization" ; "Regarding participation in group work" ; "Thoughts regarding the team in healthcare and welfare" ; and "Feelings about cooperation among different professions." Conclusions: It was evident that the lesson enhanced the students' understanding of the role of other professionals, enabled them to participate in group work, and allowed them to understand the responsibilities of each profession within a team, thereby leading to greater cooperation and better health care. This TBL for IPE was found to be effective by producing valuable changes in perceptions and attitudes toward professional cooperation among students.
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33
Abstract
Objective: This study aimed to examine the e󰮏ects of interprofessional education (IPE) using team-based learning (TBL).
Methods: We analyzed the results of a scale to measure IPE among 449 fourth-year students from seven faculties of
a health university in Japan. The students took the Assembly Special Lesson as part of IPE using TBL. Before and after
the lesson, the participants completed a questionnaire, which consisted of the IPE Tsukuba Model, to which we added
two items. The scale was divided into ve domains. We compared the scores using the Wilcoxon signed-rank test.
Results: The overall scores of four of the ve domains of the IPE evaluation were signicantly higher after the lesson
than before (
P
<0.05): “Understanding the role of each profession’s specialization”; “Regarding participation in group
work”; “Thoughts regarding the team in healthcare and welfare”; and “Feelings about cooperation among di󰮏erent
professions.”
Conclusions: It was evident that the lesson enhanced the students’ understanding of the role of other professionals,
enabled them to participate in group work, and allowed them to understand the responsibilities of each profession
within a team, thereby leading to greater cooperation and better health care. This TBL for IPE was found to be
effective by producing valuable changes in perceptions and attitudes toward professional cooperation among
students.
Keywords: Interprofessional education, Team-based learning, Medical and health care
Introduction
At present, it would be extremely difficult for a single
health-care professional to undertake all aspects of the medical
treatment and care of patients with complex problems;
the importance of interprofessional work has increased.1,2
For that reason, the practice of interprofessional education
(IPE) is necessary in undergraduate curricula.3,4 The Centre
for the Advancement of Interprofessional Education offers
the following definition for IPE: “IPE occurs when two or
more professions learn with, from and about each other to
improve collaboration and the quality of care.”5 Student health
professionals have been found to benet from interdisciplinary
education, with the outcome e󰮏ects being primarily related to
changes in knowledge, skills, attitudes, and beliefs.6
Fujita Health University(FHU) is a general health university
in Toyoake, Japan; it comprises two departments-the School
of Medicine and the School of Health Science-and seven
faculties.7 The School of Health Science consists of the
following faculties: Medical Technology; Nursing; Radiological
Technology; Rehabilitation; Clinical Engineering; and Medical
Management and Information Science. At that university, an
original educational approach termed “assembly” has been
adopted since the institutionʼs founding in 1971. With assembly,
all rst- and second-grade students of the two departments and
seven faculties are reassigned to classes across departmental
boundaries. The purpose of assembly is to provide basic
knowledge about health-care teams to lower-grade students.
However, no such classes were held for upper-grade students,
who had already acquired su󰮐cient ability in patient medical
care. Therefore, a new class―Assembly Special Lesson―was
created as part of IPE to promote teamwork within health care.
With the Assembly Special Lesson, we focused on the
techniques of team-based learning (TBL) within IPE. TBL
o󰮏ers a number of advantages, such as collaboration and active
participation by the learners in the educational process; those
qualities are essential in team medical care.8,9 This educational
technique was developed by Michaelsen in the late 1970s,
when he advocated expanding classes of small numbers of
students to larger classes. Owing to its effectiveness, TBL
has spread rapidly in medical education in recent years.10,11
TBL involves preparation processes, an individual readiness
test, a team readiness test, application exercises, and peer
evaluation as an active learning process. These steps lead to
enhanced judgment and a sense of responsibility at both the
individual and team level; in this way, cooperation within the
team gradually develops. TBL is an e󰮏ective tool for building
cooperation and mutual trust in work groups. Accordingly, it is
very appropriate in practicing IPE.
The TBL program is generally adopted for fewer than 200
students in colleges or minority departments in schools.12-14
Received 22 August, 2016,    Accepted 29 December, 2016
Corresponding author : Sayuri Nakamura, RN, PHN, PhD
Faculty of Nursing, Fujita Health University School of Health Sciences, 1-98
Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
E-mail: sayuri@fujita-hu.ac.jp
E󰮏ect of team-based learning in interprofessional education at a
health university
Sayuri Nakamura, RN, PHN, PhD1, Masatsugu Ohtsuki, MD PhD2, Yoichiro Miki, PhD3,
Tomohiro Noda, PhD4, Shigetaka Suzuki, MT, PhD5, Takami Maeno, MD, PhD6,
Toshikazu Matsui, MD PhD7
1Faculty of Nursing, Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan, 2Department of Clinical General Medicine, Fujita Health
University School of Medicine, Toyoake, Aichi, Japan, 3Dental Education, Kyushu University School of Dentistry, Fukuoka, Fukuoka, Japan, 4Medical Education
Unit, Kochi University School of Medicine, Nankoku, Kochi, Japan, 5Department of Medical Information Processing Science, Fujita Health University, School
of Medicine, Toyoake, Aichi, Japan, 6Center of Planning and Coordination for Medical Education, University of Tsukuba School of Medicine and Medical
Sciences, Tsukuba, Ibaraki, Japan, 7Department of Introduction to Clinical Medicine, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
Team-based learning in IPE
Original Article Open Access
34
However, team medical care is actually practiced by
multidisciplinary professionals. We therefore considered it
necessary to study a TBL program using a large number of
students from various health-care departments. With over
500 students studying at the same site, FHU offers an ideal
environment for implementing IPE. Taking advantage of this
situation, we introduced the Assembly Special Lesson using
TBL.15 Through this methodology, students from different
faculties aimed to learn and collaborate interdependently with
common health goals toward providing the best health care
for patients with complex problems that cannot be solved only
from the perspective of a single profession.
The focus of this study was to confirm the effects of IPE
using TBL at a health university. We examined questionnaire
responses from before and after the Assembly Special Lesson.
Methods
Study subjects
Among 550 fourth-year students from seven faculties (one
faculty of the School of Medicine and six faculties of the School
of Health Sciences) at FHU, we selected 502 students. We
excluded 48 students who did not participate in the Assembly
Special Lesson.
TBL program
For 3 hours each day on October 31 and November 1, 2013,
the Assembly Special Lesson was held at FHU as a type of IPE;
the lesson was conducted on a large scale, with TBL adopted
as the teaching method. We divided the students into 92 xed-
member teams of ve or six individuals prior to the rst TBL
session such that the teams incorporated multidisciplinary
mixtures from the two schools and seven faculties. The
teams were clustered into five classrooms. Two or three
instructors conducted the TBL sessions in each classroom;
as course material, they used “Home Health Care of Stroke
Patients,” which was carefully selected by the Subject Selection
Committee. The members of that committee were instructors
from all faculties who were responsible for the Assembly Special
Lesson. The instructors assigned to present the TBL sessions
had participated in a series of faculty development seminars on
TBL and IPE. Since almost all the students had no previous
experience of TBL, they received orientation from each faculty.
The students received prepared materials about 1 week before
the lesson was held, and they were encouraged to study the
materials so as to take responsibility for their learning.
On both days the lesson was held, TBL was undertaken
using individual readiness assurance tests, team readiness
assurance tests, appeals, instructor feedback, and application
activities. When different opinions were voiced within a
team during the application activities, each member claried
their reasons until the team was able to reach a unanimous
opinion. After the nal application activity on day 2, students
were requested to provide peer feedback through formative
written feedback and summative evaluations of performance.
The feedback sheets, containing gradings by the teams and
anonymized comments from team members, were presented
to all the students for use as reference materials for self-
reection.
Questionnaire survey
We employed a new version of the Interprofessional Education
Tsukuba Model (IPET) scale, which originally consisted of
five domains (38 items).16 We added two items related to
professions that were not included in domain 2 of the original
version of IPET: “Understanding the role of each professionʼs
specialization.” The two items were “I think I understand the
role of a clinical engineer” and “I think I understand the role
of a medical information management o󰮐cer” with respect to
professions related to FHU. So the total number of items was
40. The five domains were as follows: (1) feelings about the
profession I am training for (eight items); (2) understanding the
role of each professionʼs specialization (12 items); (3) regarding
participation in group work (six items); (4) thoughts regarding
the team in healthcare and welfare (10 items); and (5) feelings
about cooperation among different professions (four items).
Each item was measured using a Likert scale with six levels:
1 (strongly disagree); 2 (disagree); 3 (somewhat disagree); 4
(somewhat agree); 5 (agree); and 6 (strongly agree).
We performed forward translation from Japanese to English
of the five domains and 40 items. A native English speaker
who was procient in Japanese collaborated with the developer
of the IPET scale in translating the survey domains and items
for the purposes of this manuscript.
The self-administered survey was conducted before day 1
and at the end of day 2 of the Assembly Special Lesson.
Statistical analysis
Using the Wilcoxon signed-rank test, we compared the
scores for each item and overall for the five domains before
and after the Assembly Special Lesson. We performed all
statistical analyses using SPSS software, version 22.0 (SPSS
IBM Co.). The signicance level was set to 5%.
Ethical considerations
We claried the purpose, method, and content of the study
in a document sent to the participants. We explained to the
subjects that a questionnaire survey would be performed
as part of the study. We also stated that participation in the
research was voluntary, that refusal had no disadvantages, and
that it was possible for the participants to withdraw at any
time-even after having agreed to cooperate. This study was
conducted with the approval of the medical research ethics
review committee of FHU (approval no. 13-209).
N (%)
Sex Male 175 (39.0)
Female 274 (61.0)
Faculty Medicine 95 (21.2)
Medical Technology 79 (17.6)
Nursing 100 (22.3)
Radiological Technology 44 (9.8)
Rehabilitation 87 (19.4)
Clinical Engineering 25 (5.6)
Medical Management and Information
Science 19 (4.2)
Mean ± SD
Age (years) 22.2 ± 1.8
Table 1. Characteristics of study subjects
Fujita Medical Journal 2017 Volume 3 Issue 2
35
Results
Among the 502 students selected, 457 answered the
questionnaire (response rate, 91.0%); after excluding eight
students whose responses were incomplete, we analyzed the
data of 449 students (valid response rate, 98.2%). Table 1 presents
the characteristics of the study subjects. There were 175 male
(39.0%) and 274 female students (61.0%); 95 students were
from the Faculty of Medicine, 79 from Medical Technology,
100 from Nursing, 44 from Radiological Technology, 87 from
Rehabilitation, 25 from Clinical Engineering, and 19 from
Medical Management and Information Science. The average
age of the subjects was 22.2 ± 1.8 years.
The results of the analysis of the IPET questionnaire for the
ve domains appear below.
Domain 1. Feelings about the profession I am training for
Table 2 presents the results for the domain “Feelings about
the profession I am training for.” In this domain, the mean
overall score was 4.37 ± 0.91 before the lesson and 4.39 ± 0.95
after the lesson; we did not observe a significant difference.
However, after the Assembly Special Lesson, some items
showed significantly higher scores than before the lesson
(
P
<0.05). These items were as follows: “I think that I am
suitable for the profession I am training for”; “If I am consulted
by one of my juniors who says that he or she wants to become
a professional, I would recommend the profession I myself
wish to do”; and “I have condence I will work in my chosen
profession in the future.” However, the score for “If I go back
in time to the start of university, I would choose the same eld
of study” was signicantly lower after the Assembly Special
Lesson than before (
P
<0.05).
Team-based learning in IPE
Domain 1: Feelings about the profession I am training for
Items 1–8
Before IPE
score
After IPE
score
N Mean ± SD Mean ± SD
P
value
1. Iʼd like to continue working in the profession I am training for for a long
time in the future. 449 4.95 ± 1.08 4.91 ± 1.10 0.380
2. I think that I am suitable for the profession I am training for. 449 4.07 ± 1.03 4.16 ± 1.06 0.022
3. If I go back in time to the start of university, I would choose the same eld
of study. 449 4.24 ± 1.50 4.14 ± 1.45 0.024
4. If I am consulted by one of my juniors who says that he or she wants to
become a professional, I would recommend the profession I myself wish to do. 449 3.71 ± 1.24 3.87 ± 1.26 0.002
5. I have pride in the profession I am training for. 449 4.68 ± 1.08 4.63 ± 1.09 0.263
6. Iʼd like to learn more about the profession I am training for. 449 4.79 ± 1.02 4.80 ± 1.11 0.438
7. Iʼm satised with my choice of profession. 449 4.56 ± 1.15 4.57 ± 1.16 0.847
8. I have condence I will work in my chosen profession in the future. 449 3.96 ± 1.21 4.06 ± 1.18 0.025
Overall 449 4.37 ± 0.91 4.39 ± 0.95 0.181
Table 2. Comparison of the scores before and after IPE in domain 1
Domain 2: Understanding the role of each professionʼs specialization
Items 1–12
Before IPE
score
After IPE
score
N Mean ± SD Mean ± SD
P
value
1. I think I understand the role of a doctor. 449 3.78 ± 1.06 4.19 ± 1.00 <0.001
2. I think I understand the role of a nurse. 449 3.93 ± 1.17 4.31 ± 1.09 <0.001
3. I think I understand the role of a clinical laboratory technologist. 449 3.46 ± 1.18 3.92 ± 1.18 <0.001
4. I think I understand the role of a pharmacist. 449 3.49 ± 1.02 3.75 ± 1.10 <0.001
5. I think I understand the role of a physical therapist. 449 3.62 ± 1.18 4.07 ± 1.12 <0.001
6. I think I understand the role of an occupational therapist. 449 3.57 ± 1.17 4.02 ± 1.11 <0.001
7. I think I understand the role of a speech therapist. 449 3.25 ± 1.18 3.67 ± 1.16 <0.001
8. I think I understand the role of a radiological technologist. 449 3.45 ± 1.15 3.87 ± 1.11 <0.001
9. I think I understand the role of a nutritionist. 449 3.26 ± 1.03 3.59 ± 1.06 <0.001
10. I think I understand the role of a social worker. 449 2.94 ± 1.15 3.33 ± 1.18 <0.001
11. I think I understand the role of a clinical engineer. 449 3.14 ± 1.17 3.59 ± 1.18 <0.001
12. I think I understand the role of a medical information management o󰮐cer. 449 2.76 ± 1.15 3.33 ± 1.19 <0.001
Overall 449 3.39 ± 0.83 3.80 ± 0.87 <0.001
Table 3. Comparison of the scores before and after IPE in domain 2
36
Domain 2. Understanding the role of each professionʼs specialization
Table 3 shows the results of the domain “Understanding the
role of each professionʼs specialization.” The scores for all items
were significantly higher after the Assembly Special Lesson
than before (
P
<0.05).
Domain 3. Regarding participation in group work
The scores for the domain “Regarding participation in group
work” appear in Table 4. The overall score for the domain was
4.21 ± 0.82 before the lesson and 4.48 ± 0.81 after; the score
after the lesson was signicantly higher than before (
P
<0.001).
The scores for the following items were significantly higher
after the Assembly Special Lesson than before (
P
<0.01): “I
speak to convey my thoughts to the other members”; “I strive
to listen to the opinions of other members”; “I take a exible
attitude when presented with opinions differing from my
own”; “I actively participate in group work as a member of the
group”; and “I strive to advance the group work by cooperating
with other members.”
Domain 4. Thoughts regarding the team in healthcare and welfare
As shown in Table 5, the overall score of the domain
“Thoughts Regarding the team in healthcare and welfare” was
significantly higher after the Assembly Special Lesson than
before (
P
<0.001). It was evident that the score of each item was
signicantly higher after the lesson than before (
P
<0.05) with
the following exceptions: “Team members should treat all team
members as equals”; and “Team members should mutually
support each other.”
Domain 5. Feelings about cooperation among di󰮏 erent professions
Table 6 presents the results of the domain “Feelings
Fujita Medical Journal 2017 Volume 3 Issue 2
Domain 3: Regarding participation in group work
Items 1–6
Before IPE
score
After IPE
score
N Mean ± SD Mean ± SD
P
value
1. I speak to convey my thoughts to the other members. 449 3.76 ± 1.49 4.27 ± 0.97 <0.001
2. I strive to listen to the opinions of other members. 449 4.23 ± 1.70 4.86 ± 0.88 0.001
3. I take a exible attitude when presented with opinions di󰮏ering from my own. 449 4.49 ± 0.89 4.63 ± 0.90 0.001
4. I actively participate in group work as a member of the group. 449 4.13 ± 0.98 4.41 ± 1.06 <0.001
5. I strive to advance the group work by cooperating with other members. 449 4.45 ± 0.93 4.59 ± 0.95 0.009
6. I strive to demonstrate the specialization of my particular profession. 449 4.22 ± 0.92 4.12 ± 1.15 0.071
Overall 449 4.21 ± 0.82 4.48 ± 0.81 <0.001
Table 4. Comparison of the scores before and after IPE in domain 3
Domain 4: Thoughts regarding the team in healthcare and welfare
Items 1–10
Before IPE
score
After IPE
score
N Mean ± SD Mean ± SD
P
value
1. I think it is important that each team member tries to understand the
opinions of other members. 449 5.06 ± 0.92 5.16 ± 0.86 0.025
2. It is important that each team member recognizes and accepts the
di󰮏erences between themselves and other members. 449 4.98 ± 0.87 5.08 ± 0.91 0.027
3. It is important that each participating member shares each patientʼs
problems when making care policies. 449 5.06 ± 0.90 5.17 ± 0.88 0.008
4. It is important to keep the patientʼs desires central when considering a
patientʼs care policy. 449 5.01 ± 0.93 5.16 ± 0.86 0.001
5. It is important that each team member understands the teamʼs goal, has an
awareness of their role in meeting that goal, and works responsibly toward
that goal.
449 5.06 ± 0.87 5.20 ± 0.86 0.001
6. It is important that all team members participate in the discussion. 449 4.95 ± 0.96 5.14 ± 0.90 <0.001
7. Deeper understanding of the patient is made possible by the discussion of
team members. 449 4.92 ± 0.94 5.09 ± 0.90 <0.001
8. It is possible to provide better care for patients by having team discussions. 449 4.97 ± 0.93 5.15 ± 0.89 <0.001
9. Team members should treat all team members as equals. 449 4.96 ± 1.07 5.05 ± 1.01 0.117
10. Team members should mutually support each other. 449 5.17 ± 0.91 5.23 ± 0.89 0.172
Overall 449 5.01 ± 0.79 5.14 ± 0.79 <0.001
Table 5. Comparison of the scores before and after IPE in domain 4
37
about cooperation among different professions.” The overall
score for the domain was signicantly higher after the lesson
than before (
P
<0.01). The scores of the following items were
significantly higher after the lesson than before (
P
<0.05): “I
think that cooperation among many professions leads to better
health care by each profession”; and “I think there are common
areas which any health, medical, and welfare professional
would be able to perform.”
Discussion
The overall scores with four of the five domains in the
IPE evaluation were significantly higher after the Assembly
Special Lesson than before. We concluded that the e󰮏ect of IPE
on each of the ve domains of the IPET questionnaire were as
follows.
The mean overall scores in domain 1 (“Feelings about
the profession I am training for”) did not differ significantly
before and after the lesson. However, the mean scores for
the following items were signicantly higher after the lesson
than before: “I think that I am suitable for the profession I
am training for”; “If I am consulted by one of my juniors who
says that he or she wants to become a professional, I would
recommend the profession I myself wish to do”; and “I have
condence I will work in my chosen profession in the future.”
Students working in teams trust both their own knowledge and
one anotherʼs ability to apply that knowledge e󰮏ectively.10 We
believe these results indicate studentsʼ increased confidence
in their profession as their goal and that they had greater
hope for the future as a result of the Special Assembly Lesson
using TBL. However, the score for “If I go back in time to the
start of university, I would choose the same eld of study” was
significantly lower after the Assembly Special Lesson than
before. This result demonstrates that students may also have
learned the merits of other professions through the classes
using TBL. Studentsʼ perspective of the medical profession
may be expanded through the use of TBL.
With the results for domain 2 (“Understanding the role of
each professionʼs specialization”), the overall scores for all
items were significantly higher after the Assembly Special
Lesson than before. We believed that the students may have
obtained a sense of the role of other occupations as a result of
the lesson through solving the complex problems of patients
in multidisciplinary groups. By means of IPE, students develop
teamwork abilities and can learn from one another.3 Thus,
through IPE at a health university, students may be able to
understand the role of different professional specializations.
At the participating faculties, the various professions toward
which the students were directing their studies were as
follows: doctors, nurses, clinical laboratory technologists,
physical therapists, occupational therapists, radiological
technologists, clinical engineers, and medical information
management o󰮐cers. By being able to relate these professions
to one another, the proper function of each presumably became
clearer to the participating students. We did not include
faculties for pharmacy, speech therapy, nutrition, and medical
social work in the present study, but we supposed that the
Special Assembly Lesson could also be applied to deepen
studentsʼ understanding of the professional roles in those areas.
With domain 3 (“Regarding participation in group work”),
when conducting a discussion as a team, students listened to
the various opinions of other members and they explained
their own opinions. Accordingly, their ways of thinking were
deepened through the two-way communication. TBL typically
provides opportunities for team discussions, such as during
team readiness assurance tests and application exercises. TBL
frequently o󰮏ers the chance for peers to enhance their learning
as teammates talk and listen to one another before arriving
at consensus decisions.17 Thus, with the domain “Regarding
participation in group work,” the scores for the following were
higher after the Assembly Special Lesson than before: “I speak
to convey my thoughts to the other members”; “I strive to
listen to the opinions of other members”; and “I take a exible
attitude when presented with opinions di󰮏ering from my own.”
In a study using the Readiness for Interprofessional Learning
Scale (RIPLS)-a measure for evaluating IPE-it was reported
that the scores for teamwork and collaboration significantly
increased after IPE compared with before18; accordingly, IPE
appears to have the effect of encouraging participation in
group work. In TBL teaching methods, high cognitive ability
is required to make multiple comparisons and discriminations
through analyzing complex information.10 Participation is
encouraged in active discussions to achieve cooperation
among group members. Therefore, the scores for “I actively
participate in group work as a member of the group” and “I
strive to advance the group work by cooperating with other
members” were higher after the Assembly Special Lesson than
before.
In domain 4 (“Thoughts regarding the team in healthcare
Team-based learning in IPE
Domain 5: Feelings about cooperation among di󰮏erent professions
Items 1–4
Before IPE
score
After IPE
score
N Mean ± SD Mean ± SD
P
value
1. I think that cooperation among many professions leads to better care for
both patients and families. 449 5.02 ± 0.96 5.09 ± 0.94 0.088
2. I think that cooperation among many professions leads to better health care
by each profession. 449 4.98 ± 0.95 5.10 ± 0.92 0.011
3. I think there are common areas which any health, medical, and welfare
professional would be able to perform. 449 4.63 ± 0.98 4.92 ± 0.96 <0.001
4. I feel that by sharing goals as part of a professional team, each specialization
gains better awareness of its place and role. 449 4.77 ± 0.97 4.78 ± 1.10 0.700
Overall 449 4.85 ± 0.88 4.97 ± 0.89 0.002
Table 6. Comparison of the scores before and after IPE in domain 5
38
and welfare”), the overall score was higher after the Assembly
Special Lesson. We inferred this meant that students were able
to learn that each profession has a particular responsibility
in healthcare and welfare and that students were also able to
grasp the importance of functioning as a team. The e󰮏ective
use of learning groups clearly requires that individual students
are made accountable for class preparation19; it also means
that teams are able to accomplish more than the sum of the
individual membersʼ contributions.10 In the Assembly Special
Lesson, each student had such responsibility, and students
cooperated with other students from di󰮏erent faculties. Thus,
we considered that through TBL, the students developed
a deeper sense of the importance of working together in a
medical and health team.
With domain 5 (“Feelings about cooperation among
di󰮏erent professions”), the scores of the following items were
significantly higher after the Assembly Special Lesson than
before: “I think that cooperation among many professions
leads to better health care by each profession”; and “I think
there are common areas which any health, medical, and
welfare professional would be able to perform.” Our results
suggest that patient problems are better considered from
many professional viewpoints, thereby leading to better care.
Efforts to improve the quality of care are one of the most
e󰮏ective aspects of IPE.20 We believe better patient care at a
health university to be the goal of IPE. Health practitioners
need to be able to use the knowledge they have personally
acquired and also be able to solve problems by working
e󰮏ectively within a diverse team of health-care professionals
and accessing the teamʼs combined knowledge.21 True team
cohesion develops when learners begin to trust one another.10
When teams conduct problem-solving dialogues, they develop a
synergy that maximizes the likelihood of producing the correct
decision.10,22 In the present study, the student participants
cooperated in teams through TBL when solving patient
problems. TBL helped raise the studentsʼ consciousness about
the importance of cooperation in professional occupations, and
we inferred that TBL led to students feeling that it allowed
them to make a better contribution to health care.
From the above findings, we conclude that IPE with TBL
enhanced the studentsʼ understanding of the role of other
professionals and encouraged active participation by the
students in their group work. IPE with TBL also allowed the
students to understand different professions with a sense of
responsibility and cooperation, leading to better health care at
the health university.
The correlation coe󰮐cient between the IPET scale and the
total RIPLS score was 0.55; thus, criterion-related validity was
secured. Cronbachʼs alpha of each domain was 0.84–0.92, and
so reliability was maintained.16 In our survey, using 40 items
it was added 2 items to the IPET scale, we confirmed the
correlation between the score before and after IPE in the same
subjects. Spearmanʼs rank correlation coefficient was 0.318–
0.658 (
P
<0.01); thus, we confirmed the reproducibility. With
the 40 items it was added 2 items to the IPET, Cronbachʼs
alpha of each domain was 0.78–0.96; therefore, reliability was
maintained. Moreover, there was a significant correlation
between the scores for the original 38-item IPET scale and our
40-item scale in domain 2 and the total score (
P
<0.001); thus,
criterion-related validity was secured.
The present study has some limitations. Since the study was
based on self-assessment, there is the problem of objectivity.
However, except for missing values, the evaluation before and
after the lesson was with the same students; therefore, we
believe that there was no bias in the comparison before and
after the lesson. There was no control group in this study,
which we acknowledge to be an area of weakness and may
a󰮏ect the conclusions we have drawn.
In conclusion, it was suggested that medical and health
students cooperating in teams and using TBL to solve patient
problems enhanced the studentsʼ understanding of the roles
of other professionals and encouraged participation in group
work. Furthermore, it was suggested that the Assembly
Special Lesson underlined the importance of working together
as a team and reinforced feelings of cooperation among the
students. We conclude, therefore, that the health university
students underwent valuable changes in their perceptions and
attitudes toward professional cooperation as a result of IPE
using TBL.
Acknowledgements
The authors wish to thank all the subjects for participating
in our study.
Conict of interest
The authors report no conicts of interest. The authors alone
are responsible for the content and writing of this article.
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Copyright©2017 Sayuri Nakamura, RN, PHN, PhD et al.
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Team-based learning in IPE
... TBL also offers a number of other advantages, such as collaboration and active participation by learners in the education process, which are essential in team medical care [20,21]. Owing to its effectiveness, TBL has spread rapidly in medical education in recent years [22,23], and its effectiveness in IPE has been reported [24]. While PBL is also a useful strategy for IPE [25], it is associated with difficulties with staffing a large number of teachers as tutors, is time consuming and requires schedule adjustments between departments. ...
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