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Nursing and Health Sciences (2014), 16, 321326

Research Article

Promoting interprofessional understandings through online

learning: A qualitative examination
Lisa McKenna, RN, RM, MEdSt, PhD,1 Malcolm Boyle, ADipHSc(Amb Off), MICA Cert, BInfoTech, MClinEpi, PhD,2
Claire Palermo, BSc, MND, MPH, GradCertHealthProfEd, PhD,3 Elizabeth Molloy, BPhysio(Hons), PhD,4
Brett Williams, BAVEd, Grad Cert IntensiveCareParamedicine, Grad Dip EmergHlth, MHlthSc, PhD2 and
Ted Brown, BScOT(Hons), GradCertHealthProfEd, MPA, MSc, PhD5
1
School of Nursing and Midwifery, 4HealthPEER, Departments of 2Community Emergency Health and Paramedic
Practice, 5Occupational Therapy and 3Nutrition and Dietetics, Southern Clinical School, Monash University, Melbourne,
Victoria, Australia

Abstract

Interprofessional education is increasingly a core component of health professional curricula. It has been
suggested that interprofessional education can directly enhance patient care outcomes. However, literature
has reported many difficulties in its successful implementation. This study investigated students perceptions
of participating in an online, Web-based module to facilitate interprofessional education. Three focus groups,
each with 1315 students, from emergency health (paramedic), nursing, occupational therapy, physiotherapy,
and nutrition and dietetics were conducted with students who participated in an online interprofessional
education module at one Australian university. Thematic analysis was employed to analyze interview transcripts. Four themes emerged: professional understanding, patient-centeredness, comparison with other
interprofessional education activities, and overcoming geographical boundaries. Students were overwhelmingly positive about their learning experiences and the value of the module in assisting their understandings
of the roles of other health professionals. Online approaches to interprofessional education have the potential
to enhance learning and overcome geographical and logistical issues inherent in delivering face-to-face
interprofessional education. Furthermore, our design approach allowed students to watch how other health
professionals worked in a way that they were unable to achieve in clinical practice.

Key words

e-learning, focus group, health profession, interprofessional education, online, Web-based.

INTRODUCTION
Interprofessional education (IPE) has received extensive
attention in health professional literature over the past
decade, but dates back to the 1960s (Thistlethwaite, 2012).
IPE has been defined by the World Health Organization
as that which occurs when two or more professions learn
about, from and with each other to enable effective collaboration and improve health outcomes (WHO, 2010, p. 13)
Subsequently, the implementation of interprofessional collaborative practice into curricula for students and health professionals has become an important goal for education
providers and professional organizations, yet IPE implementation can be challenging. In this paper, we report a pilot
activity that sought to develop interprofessional learning
using on online approach.

Correspondence address: Lisa McKenna, School of Nursing and Midwifery, Wellington Road, Monash University, Clayton, Vic. 3800, Australia. Email: lisa.mckenna@
monash.edu
Received 16 June 2013; revision received 19 September 2013; accepted 4 October
2013

2014 Wiley Publishing Asia Pty Ltd.

It has been proposed that the overarching goal of IPE is

to improve patient care outcomes through the promotion of
teamwork and collaboration between various health professionals (Hammick et al., 2007). IPE has been identified as
playing an important role in assisting students develop professional skills not otherwise covered in the curriculum,
such as teamwork (Wamsley et al., 2012), the professional
roles and responsibilities of themselves and other professionals (Jakobsen et al., 2011), effective interprofessional communication skills, centrality of patient to care delivery, and
understanding professional stereotyping (Thistlethwaite,
2012). It has been asserted that these benefits have the potential to enhance patient safety (Aase et al., 2013).
Despite its overall perceived benefits, the implementation
of IPE has been viewed as complex, challenging and frequently frustrating (Matthews et al., 2011). Multiple challenges have been described. These include associated costs
and the time required to establish and run programs (Gilbert,
2005; Hammick et al., 2007; Salfi et al., 2012), finding space
and alignment within individual curricula (Hammick et al.,
2007), logistic issues associated with scheduling and geographical locations (Matthews et al., 2011; Thistlethwaite,
doi: 10.1111/nhs.12105

322

2012; Aase et al., 2013), and having available interprofessional champions to provide leadership and to sustain
ongoing programs (Salfi et al., 2012; Aase et al., 2013).

Online learning approaches

Online, e-learning, or Web-based, approaches to teaching
and learning have become increasingly used in health professional curricula. These approaches to curriculum delivery
have been found to offer benefits of enhanced flexibility and
convenience to learning (Gerkin et al., 2009), or complement
curriculum content (Gresty et al., 2007). An associated
benefit of online learning is that it can assist in overcoming
logistical issues in bringing groups of learners together, thus
overcoming commonly-encountered scheduling difficulties
(Luke et al., 2009; Solomon et al., 2010). Furthermore, online
approaches to learning have been found to increase collaboration between learners, as well as facilitators (Santy et al.,
2009; Solomon et al., 2010; Hoffman & Dudjak, 2012).
Online approaches to facilitate the delivery of IPE have
recently begun to appear in related literature, challenging
assumptions that learners need to be geographically colocated to learn about and with each other. Some of these
studies report findings of projects aimed towards increasing
interprofessional understandings generally (Santy et al.,
2009; Eccott et al., 2012), while others explore specific aspects
of care requiring interprofessional work, such as palliative
care (Ellman et al., 2012). There is evidence to suggest that
online IPE can significantly increase students attitudes
towards working in interprofessional teams (Eccott et al.,
2012). Research also suggests that learners positively receive
online IPE activities. Riesen et al. (2012) employed a blended
learning approach to IPE for graduate nurses, paramedics,
police, and youth workers in Canada using a virtual environment, where each interacted using an avatar, as well as
participating in traditional and virtual workshops. These
researchers reported that learners were satisfied with the
blended approach, and demonstrated significant improvement in interprofessional competence. In their study of
online case conferencing with health and social care workers
to facilitate interprofessional learning in the UK, Santy et al.
(2009) found that learners were pessimistic about participating, but enjoyed their learning experiences. In Canada,
Solomon et al. (2010) found that students reported online
IPE to provide opportunities for them to engage in collaborative problem solving in a team and the importance of
including their own professional perspectives.
As a result of our own personal experiences encountering
difficulties implementing face-to-face IPE, and informed
by the literature, we sought to develop a web-based online
module in which students could engage and develop
interprofessional understandings. In the final product, students worked through a sequence of documents and various
media presentations, with each section having to be completed before moving onto the next. Students started the
educational package by reading through selected documents
defining IPE. They then watched short videos of each participating discipline and their function within the healthcare
system. The main video depicted a scenario of a patient with
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L. McKenna et al.

cardiovascular disease, in which multiple disciplines, including paramedic, occupational therapy, physiotherapy, nursing,
and nutrition and dietetics, oversaw the management of the
patients condition. The situation utilized interactive input
from students to encourage them to communicate with each
other as they dealt with the clinical scenarios that arose as the
patient moved from their home through the emergency
department into the hospital ward and back home after
discharge.
The case was followed by a video of a team approach to
managing a patient in the healthcare system. The final video
included two students being interviewed, who had previously
been involved in IPE, and their views about the benefits to
them and patients. Students could go back and review videos
at any time. Within the module, there was an opportunity for
students to engage with each other through a facilitated discussion group. Clarification of individual discipline roles was
further explored further in focus groups.
The module was undertaken within a seven-day period
prior to evaluating the experience. Quantitative reporting of
student attitudes to the IPE activity has been reported elsewhere (Boyle et al., 2013). In this paper, we report the rich,
qualitative data emerging from focus groups following the
IPE activity.
Through this study, we sought to examine healthprofessional students perspectives on the value of using
online delivery to facilitate interprofessional understandings
and learning.

METHODS
Study design and setting
A qualitative approach was used to investigate the views
of students involved in the IPE learning activity. Qualitative research seeks to describe routine and problematic
moments and meanings in individuals lives (Denzin &
Lincoln, 2005, pp. 34), so was apt for the phenomenon under
exploration.
Undergraduate students, in all years, who were enrolled at
the time of the study in one of five health-related courses at
Monash University (emergency health [paramedic], nursing,
occupational therapy, physiotherapy, and nutrition and
dietetics) were eligible to participate. An announcement
seeking expressions of interest from students to participate
was added to the Moodle site for each course. Responses
from students were coordinated by researchers from each
discipline, with the first two students from each year level of
each course offered the chance to participate in the study.
A self-selected sample of students (n = 46) enrolled in these
courses across all years volunteered to be involved in the IPE
learning activity, and thus the study. Prior to commencing,
students first read the explanatory statement, which outlined
the project, clarified that their participation was voluntary,
and that they could withdraw at any time without reason
being given. Students were then given access to a passwordprotected website where the IPL package was located.
Focus groups (n = 3) were used to investigate views of the
students and their experiences of participating in the learning

Interprofessional and online learning

activity. All (46) students who participated in the IPE learning activity were invited to attend a focus group. Focus group
questions were drafted based on review of the literature and
a process evaluation framework (Hawe et al., 1990). Questions covered the understanding of IPE; experiences of IPE;
and students experiences, attitudes, and learning from the
IPE online learning activity. All researchers reviewed the
interview schedule, with minor edits made to ensure that
the most appropriate data could be obtained.
Questions were used to focus discussions and conversation, rather than as structured questions, as recommended for
qualitative inquiry. Focus groups were conducted in October
2011 by three of the authors. There was overwhelming interest in participating, with 1315 students attending each of the
three focus groups. While the focus groups were oversubscribed, and not numbers that would be considered best practice in focus group discussions, techniques were used by
facilitators to ensure that all participants had opportunities to
contribute to the discussion. Focus groups were digitally
audio-recorded and transcribed verbatim.

Ethical clearance
Ethical approval to conduct the study was obtained from
Monash University Human Research Ethics Committee
prior to the commencement of data collection.

Data analysis
Interview transcripts were analyzed using a thematic
approach informed by Grbich (2009). During the transcription process, participants were allocated pseudonyms, so that
individuals could not be recognized in reporting. Each focus
group transcript was analyzed by three of the authors independently. This involved initial open coding to establish a
coding framework. Codes were then grouped into categories,
and key themes extracted from these broader categories. The
researchers then came together to agree on codes and themes
in order to validate the findings.

RESULTS
The analysis of focus group transcripts revealed four
main themes relating to students learning about IPE through
the online module: professional understanding, patientcenteredness, comparison with other IPE activities, and overcoming geographical boundaries.

Professional understanding
Students reported that the module enhanced their professional understandings, both of their own and the other
health professions. The visual element, through videorecorded clinical scenarios and video-recorded practitioner
interview/debriefing, was praised as contributing to the gains
in understanding:
I thought it was fantastic. Because it sort of gave me an
idea of what I would get to do eventually, and I found

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that really interesting. Because I came into it knowing to

an extent but not know much . . . of what we do. (Nursing
student)
Watching the videos online gave students the opportunity
to observe other health professionals in practice, and this was
widely reported as invaluable and contributed to new appreciations and role understandings:
It makes you go, wow. They (nurses) know so much.
Youd be silly not to appreciate or take in what theyve
said. Because you know it is just a totally different world,
I have no idea. (Occupational therapy student)
I really liked the paramedic one that . . . went through
the whole treatment of the patient and what they did. I
thought that was more beneficial than just having the
professional sitting in the chair, saying this is what I do.
(Physiotherapy student)
Its certainly outlined all the different roles of what the
other . . . occupations in the health profession do, like
OT (occupational therapy), physio. Like with OT, I had
. . . no idea what their job really entailed until I actually
watched. (Nursing student)
I didnt know what an occupational therapist does, and
now I do. (Nutrition/dietetics student)
A few students also discussed learning from watching the
teamwork video, where health professionals worked together
in a patient encounter:
I liked the fact that it went through all of the different
professionals and then . . . went to the end where all of
them were working together and you could see it . . .
piece together. It made a lot more sense than just
reading about all of them doing things separately.
(Nursing student)

Patient-centeredness
One theme that emerged strongly from all of the focus
groups was that the module allowed students to see how the
patient was central to how healthcare team members worked
together to achieve patient care outcomes:
You really clarify the whole thing; youre putting the
patient at the center, not your own image . . . as in that
you have got to put all the allied health-professional
interests toward that patient, rather than just work on
your own what you want you should probably think of
everyone . . . and whats best for the patient. Like it
really brought that home. (Occupational therapy
student)
I think because youre looking at a specific case study, as
well of a patient and his sort of follow through to the
hospital, it made it sort of a story, so it . . . was interesting
as well at the same time. (Nutrition/dietetics student)
Within this context, students recognized the importance of
different team members contributions in the provision of
patient care, and that within the team each was an equal:
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You realize how many . . . it takes a lot of people to . . .

work with the client. (Nursing student)
You realize too that one (health professional) isnt any
more important that the other. That theyre all just as
important, you know, for different reasons. (Nursing
student)
The experience further expanded students understandings
of the scope of practice from other disciplines:
It was in the cardiac rehab. I never thought like they had
a physio. I think it was at one point with the stethoscope
kind of looking at the breathing of the patient, and I kind
of never associated the breathing with the physio before.
I more sort of looked at (the) exercise type thing.
(Nursing student)
It was actually interesting to see how every health professional has an impact on the one client. So at every
stage, like you start with your paramedics to the nurses
and then, and just see the progress the client goes
through. (Nutrition/dietetics student)

Online module versus other IPE activities

Participants were asked to provide their perspectives on the
online nature of the module in comparison to their previous
face-to-face IPE activities. Students reported that the videos
provided allowed them to actually see health professionals
working together in context, rather than learning abstract
content alongside students from other health professions:
IPE in first semester, we did it (for the) first year, this
year. At the beginning, I think everyone went off into
their groups. I noticed . . . the physios would all sit
together and the nurses would all sit together . . . I still
didnt have a great idea of what everyone would do until
I saw the modules and the videos and stuff. (Paramedic
student)
I think this module is better than what we did in like first
semester (classroom-based activities), because it was
more learning about how to work together, rather than
just meeting people who are from those professions and
doing assignments. (Nutrition/dietetics student)
I think the videos I liked more than (classroom-based)
IPE itself . . . IPE . . . helped us get used to each other
and the fact that we all have different, like we all do
different things at uni, but the videos actually told us
what the other people did. We never knew that. (Occupational therapy student)
A number of students discussed how clinical placements
had not provided opportunities to actually watch what other
health professionals did, and the online learning provided
such insights:
Even though we worked 8 h per shift as a nurse, it is
really quite hard for you to have some spare time to look
at what others are actually doing . . . I am just . . . running
with the nurses and they are showering the patients and
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L. McKenna et al.

theyre giving out the medicine. So it would be really

great if we can have some spare time to really sit down
and look at how others are doing their jobs. (Nursing
student)
I sat in IPE for the first few weeks of last semester and I
didnt really understand it, because I didnt know what
the other professions did, and I thought that it would
have been really good to have something like that. It
would have helped a lot. (Nutrition/dietetics student)
Others valued seeing medical staff in their patient care
roles, as during clinical placements they had few opportunities to interact with medical students:
Especially the doctor, the med (medical) students. We
were on placement with other students, OT (occupational therapists), nursing and they were great. You
know often . . . the med students . . . they wouldnt
interact with us. (Physiotherapy student)
Some discipline groups had received formal, structured
IPE learning in their first semesters, and sometimes later, of
their courses. Within the focus groups, some participants discussed their prior experiences and their perceived value:
No one actually told us what an OT (occupational therapist) did or what a nurse did . . . we just went in there and
were kind of like blinded. Like, okay, there are all these
other professions, like what do they actually do? Like
no one actually told us what they did, and being in first
year as well, first semester, I dont think many people
knew what they were actually going to do. (Paramedic
student)
People werent really interested in being there. It was
often on a day where we werent meant to be at the uni.
They put on an extra day, so people were really disinterested. They put it on a time where there were four
assignments due next week. People werent engaged . . .
I dont feel like it was that beneficial. I found a lot of
people actually came out of it going, what was the point
of that? sort of thing. Thats just from like the experiences that I had in first and second year. (Physiotherapy
student)

Overcoming geographical boundaries

One of the benefits reported by students related to the
online program was overcoming challenges associated
with geography. At our university, health courses are delivered on four campuses, as well as many clinical sites. Thus,
geography can be a limitation to any face-to-face IPE activity. The online module was seen as one means for overcoming such challenge. Some students identified that
working interprofessionally in an online context facilitated
their working together better than previous face-to-face
experiences, as highlighted by one physiotherapy student:
In first and second year, (we) did some interprofessional
learning with OT (occupational therapists), and in first
year, I think we do it with the radiography students from

Interprofessional and online learning

(another campus), as well. . . . It was definitely hard at

times, especially with the radiography students who were
off campus to try and put together an assignment with
them . . . and so I dont feel like it worked that well.
(Physiotherapy student)
One student further highlighted the specific benefit for
cross-campus interprofessional learning:
Dietetics is at (another campus), so if there was a classroom situation, like we would have to come down here,
and the likelihood of us probably coming down here
would be maybe slim. I dont know it depends on how
dedicated everyone is, so I guess that online environment did create that we could be involved. (Nutrition/
dietetics student)

DISCUSSION
IPE is increasingly becoming a core requirement for healthprofessional curricula to promote the development of teamwork and interprofessional understandings. Numerous
potential benefits of effective health teamwork have been
asserted, including the provision of better patient care
(Solomon et al., 2010), the effective use of health services
(Mickan, 2005), and improved health outcomes (Mickan,
2005; WHO, 2010). However, curriculum developers often
grapple with the most appropriate approach to such content
delivery and struggle to overcome associated challenges,
including costs, large student numbers, and logistical issues
(Hammick et al., 2007; Bennett et al., 2011). Participants in
the current study reported positively on an online approach,
with an imbedded video scenario where they were able to
watch each member of the team engage in patient care, in
addition to short videos from different health professionals
reflecting on their own roles in practice. Students reported on
the uniqueness of being able to sit and watch others in their
professional roles. This was something they reported that
they were not able to achieve in the context of high-stake
pressures in the clinical environment. They reported having
more respect for other health professionals, and seeing the
patient as central to care, an important outcome of IPE
(Thistlethwaite, 2012). The aspect of actually being able to
see patient-centered care delivery across different professional contexts, which students reported they were not seeing
in clinical placements, is noteworthy. This is a particularly
concerning issue that was not expected to emerge in the
study. It leads to questions about whether current clinical
education models reinforce professional silos if students do
not have the opportunity to develop understandings and
observe the roles of other health professionals in practice,
and how they contribute to overall patient care. This aspect
also leads to questions about current IPE objectives and
effectiveness, and warrants further exploration. Turale (2011)
asserted that the importance of equal partnerships in care
delivery and activities, such as ours, might be one way to
facilitate the development of such partnerships. Classroom
activities that employ video footage, such as those used in our
module, might also facilitate learning about other health professionals and their roles.

325

Our findings reinforced those of other studies (Santy et al.,

2009; Eccott et al., 2012), suggesting that students do not need
to be in face-to-face learning situations for effective IPE to
occur. Online approaches were well received by our students,
and this approach has particular benefits in overcoming some
of the reported challenges in IPE delivery; in particular, logistical and scheduling issues (Hammick et al., 2007; Luke et al.,
2009; Solomon et al., 2010). Students identified that being
able to work with other students from different sites was a
benefit of the module. However, such an approach needs
further consideration and development, including optimal
timing of module delivery and longitudinal evaluation to
determine the impact of the online innovation on knowledge
and skill translation in practice.
Students in this study reported a lack of understanding of
IPE as a negative outcome from prior face-to-face IPE experiences. Many of these had been undertaken in the first
semester of their course, before they sufficiently understood
their own discipline. Students in our study, who had experienced at least one clinical placement, reported that it provided a foundation on which to build further learning. In
their study, Luke et al. (2009) found that students were keen
to learn about the roles of other health professionals, but they
needed to understand their own specific professional role.
Tunstall-Pedoe et al. (2003) found that health professional
students arrived with stereotypical views on entry to university. Curriculum developers often debate where to place IPE
within health professional courses, that is, whether this is best
placed early, before students have developed stereotypical
perceptions, or placed later, when students have developed
their own professional identities (Bradley et al., 2009). Our
findings suggest that there is a need for more research on
the optimal timing of such IPE activities within the wider
curriculum.

Limitations of the study

The study design does have limitations. This pilot was only
conducted with students at one university in Australia. In
the module, students were only presented with one clinical
scenario, and there was limited opportunity for students to
interact with one another online. Further studies would be
needed to explore the broader applicability of such learning. In addition, the students who chose to participate are
likely to have been more engaged because they elected to
be involved.

Conclusions
IPE is increasingly important in health professional
programs. However, incorporating targeted activities
into curricula has been reported as challenging, especially
in terms of logistics and student engagement. The online
delivery of IPE has the potential to overcome some of the
barriers to face-to-face delivery, while still resulting in
effective interprofessional understandings that might not
even be achievable in existing structured clinical practice
placements.
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CONTRIBUTIONS
Study Design: LM, MB, CP, EM, BW, TB.
Data Collection and Analysis: LM, CP, EM.
Manuscript Writing: LM, MB, CP, EM.

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