Abstract

This study aimed to describe the research methods and instruments used in the evaluation of interprofessional education strategies for shared decision making in drug therapy. The types of evaluation employed were categorized according to Kirkpatrick’s adapted model. A scoping review was conducted, following the PRISMA-ScR recommendations. Among the 21 selected studies, there was a predominance of quantitative methods in the evaluation of educational experiences (n=18). Of these, the most common aspect evaluated was “students’ attitudes and perceptions towards interprofessional education and practice” by means of validated instruments (n=13). Ten different instruments were identified and found to be in line with the Interprofessional Education Collaborative competencies. The variety of instruments signals the growing production of knowledge about this topic, but points to the challenge of conducting comparative analyses between educational experiences around the world.

Interprofessional education; Decision making, shared; Evaluation of research programs and tools; Review

Introduction

Pharmacotherapy is one of the most widely used resources in current health care systems in order to prevent, maintain, and recover health status. However, the prescription and inappropriate use of drugs is the origin of great damage to people’s health, requiring interventions to minimize the resulting morbidity and mortality¹1. Instituto para Práticas Seguras no Uso de Medicamentos. Polifarmácia: quando muito é demais? ISMP Brasil [Internet]. 2018 [citado 20 Ago 2022]; 7(3):1-8. Disponível em: https://www.ismp-brasil.org/site/wp-content/uploads/2018/12/BOLETIM-ISMP-NOVEMBRO.pdf
https://www.ismp-brasil.org/site/wp-cont... . The interaction of two or more health professionals in the decision-making process in drug therapy is necessary to improve the health outcomes of patients²2. Institute of Medicine. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington: National Academies Press; 2015. , ³3. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and health-care outcomes (update). Cochrane Database Syst Rev. 2013; (3):CD002213. .

Shared decision making happens when health professionals and patients collaborate, the best evidence is shared, and patient preferences are respected, and patients are considered effective members of the health team⁴4. McCormack J, Elwyn G. Shared decision is the only outcome that matters when it comes to evaluating evidence-based practice. BMJ Evid Based Med. 2018; 23(4):137-9. . In this context, it is important to address shared decision making in drug therapy when training future professionals to work in interprofessional health care.

According to the World Health Organization (WHO), interprofessional education (IPE) “occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”⁵5. Organização Mundial de Saúde. Marco para ação em educação interprofissional e prática colaborativa. Genebra: OMS; 2010. (p. 7). Therefore, the ultimate goal of IPE is to ensure safe and effective health care⁶6. Reeves S. Why we need interprofessional education to improve the delivery of safe and effective care. Interface (Botucatu). 2016; 20(56):185-96. , ⁷7. Gontijo ED, Freire Filho JR, Foster AC. Educação interprofissional em saúde: abordagem na perspectiva de recomendações internacionais. Cad Cuidado. 2019; 3(2):20-38. .

IPE initiatives have been developed in undergraduate health courses in different countries, showing positive results⁸8. Guraya SY, Barr H. The effectiveness of interprofessional education in healthcare: a systematic review and meta-analysis. Kaohsiung J Med Sci. 2018; 34(3):160-5.

9. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39. Med Teach. 2016; 38(7):656-68.

10. Muller JL, Brustulin N, Paz PO, Kaiser DE, Duarte ERM. A prática interprofissional e a formação dos profissionais de saúde: uma revisão integrativa. Saude Redes. 2022; 8 Supl 1:15-35. - ¹¹11. Spaulding EM, Marvel FA, Jacob E, Rahman A, Hansen BR, Hanyok LA, et al. Interprofessional education and collaboration among healthcare students and professionals: a systematic review and call for action. J Interprof Care. 2021; 35(4):612-21. . To assist in the development of these educational activities, 38 key competencies for interprofessional collaborative practice were defined and organized by the Interprofessional Education Collaborative (IPEC), subdivided into four domains: values and ethics; roles and responsibilities; interprofessional communication; and team and teamwork¹²12. Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: report of an expert panel. Washington: IPEC; 2011. , ¹³13. Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: 2016 update. Washington: IPEC; 2016. .

Given the importance of promoting IPE and in order to know more about how interprofessional educational experiences have been implemented, it is also necessary to know how the evaluation of these activities has been conducted in research. In this article, the term evaluation is adopted as the process of gathering evidence that allows judging the effectiveness and value of an educational activity¹⁴14. Reeves S, Boet S, Zierler B, Kitto S. Interprofessional education and practice Guide No. 3: evaluating interprofessional education. J Interprof Care. 2015; 29(4):305-12. .

Peltonen et al .¹⁵15. Peltonen J, Leino-Kilpi H, Heikkilä H, Rautava P, Tuomela K, Siekkinen M, et al. Instruments measuring interprofessional collaboration in healthcare - a scoping review. J Interprof Care. 2019; 34(2):147-61. conducted a scoping review on existing instruments for measuring interprofessional collaboration in healthcare, with a focus on in-service professionals, without a specific look at the evaluation of students-in-training participating in IPE activities.

Based on the above, a scoping review was conducted by our research team to identify studies that describe and evaluate IPE experiences involving aspects of decision making in drug therapy¹⁶16. Detoni KB, André AL, Rezende CP, Furtado BT, Mendonça SAM, Ramalho-de-Oliveira D. Interprofessional education for shared decision making in drug therapy: a scoping review. J Interprof Care. 2022; 1-13. . The present study is a result of this review and has as specific objectives to describe the research methods and instruments employed in the evaluation of such educational experiences from the students’ perspective, as well as to analyze quantitative instruments assessing “students’ attitudes and perceptions toward interprofessional education and practice” regarding collaborative key competencies¹³13. Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: 2016 update. Washington: IPEC; 2016. .

Methodology

A scoping review was conducted, as this type of study is suitable for mapping the available literature in a given research area. All relevant literature is included, regardless of methodological quality, since the objective is precisely to present an overview on a given topic¹⁷17. Cordeiro L, Soares CB. Revisão de escopo: potencialidades para a síntese de metodologias utilizadas em pesquisa primária qualitativa. BIS Bol Inst Saude. 2019; 20(2):37-43. , ¹⁸18. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide: JBI; 2020. Chap. 11, p. 406-51. .

The review protocol was developed using the methodological framework proposed by the Joanna Briggs Institute¹⁸18. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide: JBI; 2020. Chap. 11, p. 406-51. and was registered in the Open Science Framework (osf.io/kfy27). This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)¹⁹19. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMAScR): checklist and explanation. Ann Intern Med. 2018; 169(7):467-73. .

Systematic search and formulation of the research question

A search strategy was prepared using the acronym PCC, where: “P” refers to population; “C” to concept; and “C” to context¹⁸18. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. JBI manual for evidence synthesis. Adelaide: JBI; 2020. Chap. 11, p. 406-51. , with the aim of identifying primary studies that describe and evaluate IPE experiences involving pharmacotherapy decision-making. The results obtained in this review originated two studies; the first, already published, focuses on the teaching and learning approaches used in this context¹⁶16. Detoni KB, André AL, Rezende CP, Furtado BT, Mendonça SAM, Ramalho-de-Oliveira D. Interprofessional education for shared decision making in drug therapy: a scoping review. J Interprof Care. 2022; 1-13. . In this second study, the articles were analyzed to answer the following question: what are the research methods and instruments used to evaluate these experiences in IPE for decision making in drug therapy, from the student’s perspective?

The search process was conducted in seven different databases: MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cochrane Library, PsycInfo, Education Resources Information Center (ERIC), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and Caribbean Health Sciences Literature (LILACS). For each database, a specific strategy was built with the MeSH descriptors or their corresponding DeCs descriptors in English and Portuguese, and the combination of them with their synonyms (search strategies available on the Open Science Framework platform: osf.io/kfy27).

The manual search was conducted by checking the references of all included studies and searching for the last 10 years in the three journals that obtained the highest number of articles retrieved in the search: Journal of Interprofessional Care, Currents in Pharmacy Teaching and Learning, and American Journal of Pharmaceutical Education.

Eligibility Criteria

The following inclusion criteria were used: primary studies with all methodological designs that answered the research question; articles written in English, Portuguese or Spanish, with no restriction regarding publication date. Exclusion criteria: review articles; articles whose population was not composed of at least two or more health and social care undergraduate students; articles that did not address the experience of IPE regarding decision making in drug therapy.

Study selection, data extraction and analysis

The articles identified in the search, after removing duplicates, were gathered in the Rayyan® software²⁰20. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016; 5(210):1-10. . The article selection process was conducted by four independent researchers working in pairs (Kirla Barbosa Detoni and Ariane Lopes André; Cristiane de Paula Rezende and Bárbara Taciana Furtado), in two stages: (1) title and abstract screening; (2) full-text reading. Discrepancies were resolved by consensus and discussion with a fifth reviewer (Simone de Araújo Medina Mendonça).

The data extracted from the selected articles were organized in an Excel® spreadsheet developed by the reviewer team. The reviewer pairs extracted the data independently. In a later step the team jointly discussed the collected information and updated the spreadsheet. Data were collected on the following aspects: a) characteristics of the study (country of origin and year of publication); b) research objectives; c) research methods and instruments used to evaluate the educational experiences; and d) validation of quantitative instruments in the original language and in Brazil.

The results were synthesized in narrative form and a descriptive analysis was conducted, determining absolute and relative frequency measures. The types of evaluation employed in the studies were categorized according to the model adapted from Kirkpatrick²¹21. Barr H, Koppel I, Reeves S, Hammick M, Freeth D. Effective interprofessional education: argument, assumption and evidence. London: Blackwell; 2005. .

The adapted Kirkpatrick model is a slightly modified version of the original model²²22. Kirkpatrick D. Great ideas revisited: revisiting Kirkpatrick’s four-level model. Train Dev. 1996; 50(1):54-9. , expanded with the addition of two evaluation items on levels 2 and 4, which has been suggested by experts in the field of IPE¹⁴14. Reeves S, Boet S, Zierler B, Kitto S. Interprofessional education and practice Guide No. 3: evaluating interprofessional education. J Interprof Care. 2015; 29(4):305-12. . This adapted model presents the following levels of evaluation: reaction, which includes the participants’ perspective on the educational experience (level 1); modification of students’ attitudes and perceptions (level 2a); acquisition of knowledge and skills (level 2b); behavior change, which includes the application of learning in practice (level 3); organizational changes (level 4a); and benefit to patients/users (level 4b).

The contents of the validated quantitative instruments used to evaluate the modification of students’ attitudes and perceptions regarding education and interprofessional practice were analyzed according to the collaborative competencies proposed by IPEC¹³13. Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: 2016 update. Washington: IPEC; 2016. . For this purpose, the full version of these instruments was searched. The items of each instrument were analyzed by the main author and categorized into one of the four domains of IPEC key competencies: values and ethics; roles and responsibilities; interprofessional communication; and team and teamwork. The categorization was done by comparing the content of the instrument items with the description of the competencies and sub-competencies in the official IPEC document (2016 version)¹³13. Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: 2016 update. Washington: IPEC; 2016. . In the following step, meetings were held with Kirla Barbosa Detoni and Simone de Araújo Medina Mendonça for collaborative analysis of the categorization of these items.

Results and Discussion

The search retrieved 5000 publications. From them, 1261 were excluded due to duplicity. A total of 103 articles were selected for full reading, with 42 resulting from the database searches and 61 from the manual search. 21 studies were included in this scoping review ( Figure 1 ). The general characteristics of the studies are described in Frame 1 .

The year of publication of the studies ranged from 1995 to 2020, with 90% (n = 19) of them published after 2010, which shows that interest in the subject has increased in recent years. This review also showed the lack of studies on IPE published in the southern hemisphere. Almost all of the research was conducted in North America (n = 10, 47%) and Europe (n = 9, 43%), as well as Asia (n = 2, 9%) and Oceania (n = 1, 4%).

Evaluating the articles according to the model adapted from Kirkpatrick²¹21. Barr H, Koppel I, Reeves S, Hammick M, Freeth D. Effective interprofessional education: argument, assumption and evidence. London: Blackwell; 2005. , six studies²³23. Robertson KE, Mcdaniel AM. Interdisiplinary professional education: a collaborative clinical teaching project. Am J Pharm Educ. 1995; 59(1):131-6. , ²⁴24. Greene RJ, Cavell GF, Jackson SH. Interprofessional clinical education of medical and pharmacy students. Med Educ. 1996; 30(2):129-33. , ²⁸28. Saunders C, Smith A, Watson H, Nimmo A, Morrison M, Fawcett T, et al. The experience of interdisciplinary peer-assisted learning (PAL). Clin Teach. 2012; 9(6):398-402. , ³⁴34. Monteiro K, Dumenco L, Collins S, Bratberg J, MacDonnell C, Jacobson A, et al. An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills. J Am Pharm Assoc (2003). 2017; 57(2S):S113-7. , ⁴¹41. Sehgal M, Nassetta KR, Bamdas JAM, Sourial M. First do no ‘pharm’: educating medical and pharmacy students on the essentials of medication management. Curr Pharm Teach Learn. 2019; 11(9):920-7. , ⁴²42. Pisano M, Mazzola N, Block L, Ezzo D, Lu C, Coletti DJ. An interprofessional experience in diabetes management for pharmacy and medical students. Curr Pharm Teach Learn. 2020; 12(4):459-64. presented the students’ perspective on the educational experience (level 1), while 15 studies²⁵25. Stewart M, Purdy J, Kennedy N, Burns A. An interprofessional approach to improving paediatric medication safety. BMC Med Educ. 2010; 10(1):1-7.

26. Haddad AR, Coover KL, Faulkner M. Development and incorporation of an interprofessional experience into a geriatric pharmacy elective: the first-year experience. Curr Pharm Teach Learn. 2011; 3(2):116-22.

27. Taylor D, Yuen S, Hunt L, Emond A. An interprofessional pediatric prescribing workshop. Am J Pharm Educ. 2012; 76(6):111.

28. Saunders C, Smith A, Watson H, Nimmo A, Morrison M, Fawcett T, et al. The experience of interdisciplinary peer-assisted learning (PAL). Clin Teach. 2012; 9(6):398-402.

29. Hoti K, Forman D, Hughes J. Evaluating an interprofessional disease state and medication management review model. J Interprof Care. 2014; 28(2):168-70. - ³⁰30. Hardisty J, Scott L, Chandler S, Pearson P, Powell S. Interprofessional learning for medication safety. Clin Teach. 2014; 11(4):290-6. , ³²32. Wang J, Hu X, Liu J, Li L. Pharmacy students’ attitudes towards physician pharmacist collaboration: Intervention effect of integrating cooperative learning into an interprofessional team-based community service. J Interprof Care. 2016; 30(5):591-8. , ³⁵35. Patel K, Desai U, Paladine H. Development and implementation of an interprofessional pharmacotherapy learning experience during an advanced pharmacy practice rotation in primary care. Curr Pharm Teach Learn. 2018; 10(7):990-5.

36. Giuliante MM, Greenberg SA, McDonald MV, Squires A, Moore R, Cortes TA. Geriatric interdisciplinary team training 2.0: a collaborative team-based approach to delivering care. J Interprof Care. 2018; 32(5):629-33.

37. Motycka C, Egelund EF, Gannon J, Genuardi F, Gautam S, Stittsworth S, et al. Using interprofessional medication management simulations to impact student attitudes toward teamwork to prevent medication errors. Curr Pharm Teach Learn. 2018; 10(7):982-9.

38. Kostas T, Thomas J, Thompson K, Poston J, Levine S. Improving medical and pharmacy student confidence in medication management and attitudes about interprofessional collaboration by utilizing an interprofessional module. J Interprof Care. 2018; 32(6):790-3.

39. Chua SS, Lai PSM, Sim SM, Tan CH, Foong CC. Acceptance of interprofessional learning between medical and pharmacy students in a prescribing skills training workshop: pre-post intervention study. BMC Med Educ. 2019; 19(1):101. - ⁴⁰40. Perisin AS, Mestrovica A, Bozicb J, Kacica J, Bukica J, Leskur D, et al. Interprofessional pharmacotherapy workshop: Intervention to improve health professionals’ and students’ attitudes towards collaboration between physicians and pharmacists. J Interprof Care. 2019; 33(5):456-63. , ⁴²42. Pisano M, Mazzola N, Block L, Ezzo D, Lu C, Coletti DJ. An interprofessional experience in diabetes management for pharmacy and medical students. Curr Pharm Teach Learn. 2020; 12(4):459-64. , ⁴³43. Pittenger AL, Goodroad B, Nicol M, Durgin EN, Eveland L, Kaiser R, et al. Interprofessional education within a pilot HIV-care elective course. Am J Pharm Educ. 2019; 83(10):7402. presented the modification of students’ attitudes and perceptions (level 2a). Acquisition of knowledge and skills (level 2b) was demonstrated in seven studies²⁶26. Haddad AR, Coover KL, Faulkner M. Development and incorporation of an interprofessional experience into a geriatric pharmacy elective: the first-year experience. Curr Pharm Teach Learn. 2011; 3(2):116-22.

27. Taylor D, Yuen S, Hunt L, Emond A. An interprofessional pediatric prescribing workshop. Am J Pharm Educ. 2012; 76(6):111. - ²⁸28. Saunders C, Smith A, Watson H, Nimmo A, Morrison M, Fawcett T, et al. The experience of interdisciplinary peer-assisted learning (PAL). Clin Teach. 2012; 9(6):398-402. , ³¹31. Anderson E, Lakhani N. Interprofessional learning on polypharmacy. Clin Teach. 2016; 13(4):291-7. , ³⁴34. Monteiro K, Dumenco L, Collins S, Bratberg J, MacDonnell C, Jacobson A, et al. An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills. J Am Pharm Assoc (2003). 2017; 57(2S):S113-7. , ³⁸38. Kostas T, Thomas J, Thompson K, Poston J, Levine S. Improving medical and pharmacy student confidence in medication management and attitudes about interprofessional collaboration by utilizing an interprofessional module. J Interprof Care. 2018; 32(6):790-3. , ⁴³43. Pittenger AL, Goodroad B, Nicol M, Durgin EN, Eveland L, Kaiser R, et al. Interprofessional education within a pilot HIV-care elective course. Am J Pharm Educ. 2019; 83(10):7402. . The studies did not address the following educational evaluation levels: behavior change (level 3) and organizational changes (level 4a). The benefit for patients/users (level 4b) was contemplated by Branch-Mays et al .³³33. Branch-Mays GL, Pittenger AL, Williamson K, Milone A, Hein E, Thierer T. An interprofessional education and collaborative practice model for Dentistry and Pharmacy. J Dent Educ. 2017; 81(12):1413-20. . Importantly, some studies included educational assessment at more than one level.

Concurrent with the results found in this study, other reviews of the literature indicate that most research in IPE present evaluations referring to levels 1-2b, which focus on outcomes related to student learning in the short term⁹9. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39. Med Teach. 2016; 38(7):656-68. . Overall, these results are appropriate for educators and educational and professional organizations. However, these authors point out that more research is needed to evaluate the changes that IPE can bring in actual clinical practice settings (level 4), including organizational changes and benefits to patients and users, as these outcomes may be more appropriate for national stakeholders such as managers, policy makers, and regulators. The U.S. Institute of Medicine also reinforces the need for research to assess the connection between IPE and its impact on practice, including the impact on patient and population health and outcomes for the health care system as a whole²2. Institute of Medicine. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington: National Academies Press; 2015. .

Two studies used exclusively qualitative evaluation instruments²⁶26. Haddad AR, Coover KL, Faulkner M. Development and incorporation of an interprofessional experience into a geriatric pharmacy elective: the first-year experience. Curr Pharm Teach Learn. 2011; 3(2):116-22. , ⁴¹41. Sehgal M, Nassetta KR, Bamdas JAM, Sourial M. First do no ‘pharm’: educating medical and pharmacy students on the essentials of medication management. Curr Pharm Teach Learn. 2019; 11(9):920-7. and seven employed both qualitative and quantitative evaluation methods²⁵25. Stewart M, Purdy J, Kennedy N, Burns A. An interprofessional approach to improving paediatric medication safety. BMC Med Educ. 2010; 10(1):1-7. , ²⁸28. Saunders C, Smith A, Watson H, Nimmo A, Morrison M, Fawcett T, et al. The experience of interdisciplinary peer-assisted learning (PAL). Clin Teach. 2012; 9(6):398-402. , ³⁰30. Hardisty J, Scott L, Chandler S, Pearson P, Powell S. Interprofessional learning for medication safety. Clin Teach. 2014; 11(4):290-6. , ³¹31. Anderson E, Lakhani N. Interprofessional learning on polypharmacy. Clin Teach. 2016; 13(4):291-7. , ³⁶36. Giuliante MM, Greenberg SA, McDonald MV, Squires A, Moore R, Cortes TA. Geriatric interdisciplinary team training 2.0: a collaborative team-based approach to delivering care. J Interprof Care. 2018; 32(5):629-33. , ³⁹39. Chua SS, Lai PSM, Sim SM, Tan CH, Foong CC. Acceptance of interprofessional learning between medical and pharmacy students in a prescribing skills training workshop: pre-post intervention study. BMC Med Educ. 2019; 19(1):101. , ⁴³43. Pittenger AL, Goodroad B, Nicol M, Durgin EN, Eveland L, Kaiser R, et al. Interprofessional education within a pilot HIV-care elective course. Am J Pharm Educ. 2019; 83(10):7402. . The qualitative data collection methods applied in these studies included: open-ended questions included at the end of quantitative instruments (n = 5)²⁵25. Stewart M, Purdy J, Kennedy N, Burns A. An interprofessional approach to improving paediatric medication safety. BMC Med Educ. 2010; 10(1):1-7. , ²⁸28. Saunders C, Smith A, Watson H, Nimmo A, Morrison M, Fawcett T, et al. The experience of interdisciplinary peer-assisted learning (PAL). Clin Teach. 2012; 9(6):398-402. , ³¹31. Anderson E, Lakhani N. Interprofessional learning on polypharmacy. Clin Teach. 2016; 13(4):291-7. , ⁴¹41. Sehgal M, Nassetta KR, Bamdas JAM, Sourial M. First do no ‘pharm’: educating medical and pharmacy students on the essentials of medication management. Curr Pharm Teach Learn. 2019; 11(9):920-7. , ⁴³43. Pittenger AL, Goodroad B, Nicol M, Durgin EN, Eveland L, Kaiser R, et al. Interprofessional education within a pilot HIV-care elective course. Am J Pharm Educ. 2019; 83(10):7402. ; group reflective feedback (n = 2)²⁶26. Haddad AR, Coover KL, Faulkner M. Development and incorporation of an interprofessional experience into a geriatric pharmacy elective: the first-year experience. Curr Pharm Teach Learn. 2011; 3(2):116-22. , ³⁷37. Motycka C, Egelund EF, Gannon J, Genuardi F, Gautam S, Stittsworth S, et al. Using interprofessional medication management simulations to impact student attitudes toward teamwork to prevent medication errors. Curr Pharm Teach Learn. 2018; 10(7):982-9. and focus groups (n = 1)³⁶36. Giuliante MM, Greenberg SA, McDonald MV, Squires A, Moore R, Cortes TA. Geriatric interdisciplinary team training 2.0: a collaborative team-based approach to delivering care. J Interprof Care. 2018; 32(5):629-33. . Hardisty et al .³⁰30. Hardisty J, Scott L, Chandler S, Pearson P, Powell S. Interprofessional learning for medication safety. Clin Teach. 2014; 11(4):290-6. used multiple data collection methods, including observation, interviews, and focus groups. The qualitative evaluation methods employed were punctual and did not reach the complexity and depth typical of qualitative research. These results, therefore, highlight the need for further and more robust qualitative research to better understand the processes and relationships involved in providing interprofessional educational activities.

All studies that conducted quantitative research to evaluate educational activity employed cross-sectional study design with the application of a structured questionnaire (n = 18). Of these, 16 studies conducted evaluation before and after the educational intervention, and two conducted the questionnaire application only after the intervention²³23. Robertson KE, Mcdaniel AM. Interdisiplinary professional education: a collaborative clinical teaching project. Am J Pharm Educ. 1995; 59(1):131-6. , ²⁴24. Greene RJ, Cavell GF, Jackson SH. Interprofessional clinical education of medical and pharmacy students. Med Educ. 1996; 30(2):129-33. . In fact, among the tools for evaluating IPE activities, structured questionnaires have been the most used⁴⁴44. Abu-Rish E, Kim S, Choe L, Varpio L, Malik E, White AA, et al. Current trends in interprofessional education of health sciences students: a literature review. J Interprof Care. 2012; 26(6):444-51. , possibly because of their easiness of application and data analysis.

Reeves et al .¹⁴14. Reeves S, Boet S, Zierler B, Kitto S. Interprofessional education and practice Guide No. 3: evaluating interprofessional education. J Interprof Care. 2015; 29(4):305-12. published in 2015 a guide to improve the quality of evaluations of IPE initiatives in order to generate more robust evidence. The authors point out that regardless of the type of research (quantitative or qualitative), essential questions should be taken into consideration when planning the evaluation, such as defining the purpose, based on the learning context; the conceptual framework of the project; the academic level of the students, and the formulation of the question that is intended to be answered with this specific evaluation. The authors also highlight the importance of identifying and engaging different stakeholders in the evaluation process.

This review showed that validated quantitative instruments are widely used to evaluate educational experiences. In sum, 12 instruments presented as validated were identified in these studies. Two of them aim to assess students’ “acquisition of specific clinical knowledge and skills” regarding opioid overdose³⁴34. Monteiro K, Dumenco L, Collins S, Bratberg J, MacDonnell C, Jacobson A, et al. An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills. J Am Pharm Assoc (2003). 2017; 57(2S):S113-7. and acquired immunodeficiency syndrome (AIDS)⁴³43. Pittenger AL, Goodroad B, Nicol M, Durgin EN, Eveland L, Kaiser R, et al. Interprofessional education within a pilot HIV-care elective course. Am J Pharm Educ. 2019; 83(10):7402. . Ten instruments aimed to evaluate the modification of students’ attitudes and perceptions regarding interprofessional education and practice, namely:

• AITCS II³⁶36. Giuliante MM, Greenberg SA, McDonald MV, Squires A, Moore R, Cortes TA. Geriatric interdisciplinary team training 2.0: a collaborative team-based approach to delivering care. J Interprof Care. 2018; 32(5):629-33.

• IEPS³⁵35. Patel K, Desai U, Paladine H. Development and implementation of an interprofessional pharmacotherapy learning experience during an advanced pharmacy practice rotation in primary care. Curr Pharm Teach Learn. 2018; 10(7):990-5.

• ISVS²⁹29. Hoti K, Forman D, Hughes J. Evaluating an interprofessional disease state and medication management review model. J Interprof Care. 2014; 28(2):168-70.

• RIPLS²⁵25. Stewart M, Purdy J, Kennedy N, Burns A. An interprofessional approach to improving paediatric medication safety. BMC Med Educ. 2010; 10(1):1-7. , ³⁰30. Hardisty J, Scott L, Chandler S, Pearson P, Powell S. Interprofessional learning for medication safety. Clin Teach. 2014; 11(4):290-6. , ⁴²42. Pisano M, Mazzola N, Block L, Ezzo D, Lu C, Coletti DJ. An interprofessional experience in diabetes management for pharmacy and medical students. Curr Pharm Teach Learn. 2020; 12(4):459-64.

• SATP2C³²32. Wang J, Hu X, Liu J, Li L. Pharmacy students’ attitudes towards physician pharmacist collaboration: Intervention effect of integrating cooperative learning into an interprofessional team-based community service. J Interprof Care. 2016; 30(5):591-8. , ⁴⁰40. Perisin AS, Mestrovica A, Bozicb J, Kacica J, Bukica J, Leskur D, et al. Interprofessional pharmacotherapy workshop: Intervention to improve health professionals’ and students’ attitudes towards collaboration between physicians and pharmacists. J Interprof Care. 2019; 33(5):456-63.

• T-TAQ³⁷37. Motycka C, Egelund EF, Gannon J, Genuardi F, Gautam S, Stittsworth S, et al. Using interprofessional medication management simulations to impact student attitudes toward teamwork to prevent medication errors. Curr Pharm Teach Learn. 2018; 10(7):982-9.

• SPICE³⁸38. Kostas T, Thomas J, Thompson K, Poston J, Levine S. Improving medical and pharmacy student confidence in medication management and attitudes about interprofessional collaboration by utilizing an interprofessional module. J Interprof Care. 2018; 32(6):790-3.

• ICCAS⁴³43. Pittenger AL, Goodroad B, Nicol M, Durgin EN, Eveland L, Kaiser R, et al. Interprofessional education within a pilot HIV-care elective course. Am J Pharm Educ. 2019; 83(10):7402.

• SAIL-10³⁹39. Chua SS, Lai PSM, Sim SM, Tan CH, Foong CC. Acceptance of interprofessional learning between medical and pharmacy students in a prescribing skills training workshop: pre-post intervention study. BMC Med Educ. 2019; 19(1):101.

• UWE²⁷27. Taylor D, Yuen S, Hunt L, Emond A. An interprofessional pediatric prescribing workshop. Am J Pharm Educ. 2012; 76(6):111.

The ten instruments highlighted above were previously validated in the English language literature, with the exception of the one used by Chua et al .³⁹39. Chua SS, Lai PSM, Sim SM, Tan CH, Foong CC. Acceptance of interprofessional learning between medical and pharmacy students in a prescribing skills training workshop: pre-post intervention study. BMC Med Educ. 2019; 19(1):101. , which was developed and validated by the authors themselves. The instruments: AITCS II, IEPS, ISVS, RIPLS and SATP2C were validated for Brazilian Portuguese. The variety of the identified validated instruments shows the growing production of knowledge on the subject. On the other hand, it calls the attention to the challenge of performing comparative analyses between interprofessional educational experiences around the world. It was not the objective of this study to analyze the quality of the validation processes of the instruments.

The items encompassed by the validated instruments that assessed the modification of students’ attitudes and perceptions regarding interprofessional education and practice, highlighted above, were assessed by the authors according to the four domains of collaborative key competencies proposed by IPEC, as described in the methodology ( Frame 2 ).

The domain “team and teamwork” was present in all the instruments evaluated, corresponding to approximately half of the items in the AITCS II (46%), T-TAQ (50%) and RIPLS (53%) scales, and representing 60% of the items in the SPICE scale. The domain “roles and responsibilities” was also contemplated in all instruments and predominated in SATP2C (67%), being less important in T-TAQ (10%) and SAIL-10 (10%).

The domain “interprofessional communication” corresponded to half of the items covered in the ICCAS instrument and approximately 30% in the ISVS and T-TAQ. Items related to this domain were not identified in the SPICE and SATP2C instruments. The domain “values and ethics” was not identified in three instruments (SPICE, ISVS and ICCAS), and the IEPS scale showed the highest proportion of items related to this domain among the instruments evaluated (28%).

The items present in the instruments that were not identified by the authors as belonging to one of the four domains of IPEC collaborative competencies were grouped as “others”. The aspects evaluated by these items refer to general issues such as satisfaction with the educational experiences, recommendation of the activity to other students, and preferences among different teaching methodologies.

The analysis performed on the instruments showed that their items fit the competences described by IPEC, and most of the items evaluated were concentrated in the domains: “team and teamwork” and “roles and responsibilities”. The domain “values and ethics”, in general, was the least evaluated in the instruments. The less prominent group of collaborative competences in the instrument items reflect a logic of care that still focuses mainly on technical issues, which is a strong feature of the training of health professionals. It is important to think about interprofessional work from a perspective that can be used to equalize the power relations between patients and professionals, and also among health professionals. Interprofessionalism should seek to horizontalize relationships, promote better and greater communication with ethics and values such as respect and dialogic capacities.

The tools presented great variability with regard to the domain of the key competence evaluated. Among the tools analyzed, RIPLS has the most items related to the “team and teamwork” domain (53%) and STAP2C has the most items involving the “roles and responsibilities” domain (69%). ICCAS is the instrument that most contemplated the “interprofessional communication” domain, and IEPS the one that most contemplated the “values and ethics” domain. In this sense, we hope that this analysis will help researchers and teachers in the selection of instruments that are more assertive according to the competence that is the focus of that specific educational experience.

This scoping review had some limitations. Some of the included studies provided sparse information, which made data extraction difficult. This issue highlights the need to improve the quality of descriptions in future articles, but at the same time reflects the reality of the publications. Although no gray literature search was performed, this review relied on an extensive literature search in seven electronic databases, in addition to the manual search. As a limitation of the scope review methodology itself, no analysis of the quality of the included studies was performed, since the objective was to present a map of the literature on the subject. Therefore, it was not possible to establish whether the methods and assessment tools employed by the studies were adequate for the interprofessional teaching and learning processes described.

Conclusion

This study allowed the identification of the methods and instruments used in the evaluation of experiences in IPE for decision making in drug therapy, revealing the predominance of the use of quantitative methods. A large number of validated quantitative instruments were identified with a focus on assessing the modification of students’ attitudes and perceptions regarding interprofessional education and practice. Analysis of these instruments, according to the domains of key competencies described by IPEC, showed that the domains of “Team and Teamwork” and “Roles and Responsibilities’ were predominant. The variety of instruments indicates the growing production of knowledge on the subject, but points to the challenge of conducting comparative analysis between educational experiences around the world.

Acknowledgments

We wish to acknowledge Universidade Federal de Minas Gerais (UFMG).

References

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