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Journal of Interprofessional Care
ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: https://www.tandfonline.com/loi/ijic20
Determining the effectiveness of an
interprofessional educational intervention for
teamwork competencies among nursing, physical
therapy, and pharmacy students
Lee Ann Waltz
To cite this article: Lee Ann Waltz (2019): Determining the effectiveness of an interprofessional
educational intervention for teamwork competencies among nursing, physical therapy, and
pharmacy students, Journal of Interprofessional Care, DOI: 10.1080/13561820.2019.1682531
To link to this article: https://doi.org/10.1080/13561820.2019.1682531
Published online: 07 Nov 2019.
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SHORT REPORT
Determining the effectiveness of an interprofessional educational intervention for
teamwork competencies among nursing, physical therapy, and pharmacy students
Lee Ann Waltz
School of Nursing and Health Professions, University of the Incarnate Word, San Antonio, TX, USA
ABSTRACT
Interprofessional education is recognized widely as an essential component to improving patient outcomes
but little progress has beenmade toward understanding the impact of specific educational interventions on
interprofessional competencies. The purpose of this study was to evaluate the effectiveness of a case study
exercise aimed at improving students’ teamwork competencies. A pre and posttest design was used to
evaluate the effectiveness of two approaches to an educational intervention. The treatment group com-
bined nursing, physical therapy, and pharmacy students; the control group involved only nursing students.
The Team Skills Scale (TSS) was used tomeasure interprofessional teamwork competencies and open-ended
questions were used to elicit students’ views. Mean pretest scores were similar for both the treatment and
control groups. Following the intervention, posttest TSS scores were significantly higher for both the
treatment group and control groups. However, posttest scores for the treatment group were significantly
higher than the control group (mean score change 19.2 for treatment group versus 10.0 for control group),
indicating that the face-to-face interaction between students of different professions had a greater impact.
Themes that emerged from the open-ended questions support the quantitative findings, indicating that the
intervention was useful for improving teamwork competencies.
ARTICLE HISTORY
Received 18 July 2018
Revised 18 September 2019
Accepted 14 October 2019
KEYWORDS
Interprofessional education;
teamwork; communication;
collaboration; quantitative
method
In the 2013 report Transforming and Scaling Up Health
Professionals’ Education and Training, the World Health
Organization emphasized that teamwork has increasingly become
the standard in today’s health settings, resulting in the need for all
health professionals to effectively collaborate across disciplines. To
enter the workforce armed with the skills necessary for this model
of practice, interprofessional education (IPE) must be considered
as a means of improving health care members understanding of
each other’s roles, and developing collaborative attitudes and
behaviors (WorldHealthOrganization, 2013).Despitewidespread
recognition of the need for IPE in academic settings, amultitude of
barriers inhibit progress including a lack of partners within insti-
tutions willing to engage in an interprofessional agenda, a need for
faculty development in IPE, and scheduling conflicts
(Interprofessional Education Collaborative, 2011). As educators
have struggled to overcome these barriers, a growing number of
research studies have been conducted to discover the bestmethods
for conducting IPE. While initial research demonstrates that IPE
improves communication and teamwork, more studies are neces-
sary to guide healthcare educators on the value of specific educa-
tional activities. The purpose of this study was to evaluate the
efficacy of two approaches to an educational intervention aimed
at improving students’ interprofessional teamwork competencies.
The study employed a quasi-experimental, pre and posttest
design. Convenience and purposive sampling was used to recruit
baccalaureate nursing, doctoral physical therapy (PT), and doc-
toral pharmacy students from a private university in the south-
west region of the United States. Nursing students were recruited
from a Community Health Nursing, a requisite senior level
course. PT and pharmacy students were recruited to participate
in the study by the physical therapy and pharmacy faculty and
institutionally approved flyers.
Both the treatment and control groups independently par-
ticipated in a case study exercise that involved developing
interprofessional care plans for a geriatric patient who has
recently undergone a below the knee amputation. Prior to the
study, permission was granted to use the case study titled
Interdisciplinary Geriatric Assessment: Mr. Ames, which was
developed by the Center for Interdisciplinary Geriatric
Assessment at the University of Missouri-Columbia (Weston
et al., 2012). The purpose of the case study was to promote an
interprofessional approach for planning and managing treat-
ment of older adults with complex medical, psychological, and
social needs. A packet of information with details regarding
the patient was provided to students for each stage of the case
study, and included assessment information from the disci-
plines of nursing, occupational therapy, physical therapy,
social services, psychological services, podiatry, and respira-
tory therapy. The exercise involved students developing a total
of five interprofessional plans at various stages of treatment
including discharge planning from the inpatient setting, an
inpatient rehabilitation unit, home health services, and transi-
tion back to the family and community. Upon completion of
each care plan, the faculty facilitated a debriefing. The total
CONTACT Lee Ann Waltz waltz@uiwtx.edu 4301 Broadway, San Antonio, TX 78209
JOURNAL OF INTERPROFESSIONAL CARE
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time to complete the entire exercise for both the treatment
and control groups was approximately six hours in one day.
Group assignment
Nursing students were randomized to a treatment or control
group. PT and pharmacy students were assigned to the treat-
ment group. The treatment group consisted of 16 nursing, 6 PT,
and 3 pharmacy students for a total of 25 in the group. Subjects
were placed in groups of 5–6 students to collectively discuss the
case study and develop the plans of care. The case study groups
were comprised of five groups that contained a combination of
2–3 nursing, 1–2 PT, and 0–1 pharmacy students. The 3 phar-
macy students were rotated to a different table following each
round of care plan development so that by the end of the
intervention, all nursing students in the treatment group had
similar amounts of interaction time with the pharmacy students.
The control group consisted of 17 nursing students. The
control group participated in the same exercise, and were
placed in three case study groups of 5–6 students to work
together and develop the interprofessional plans of care.
Data collection
Students completed the Team Skills Scale (Hepburn, Tsukuda, &
Fasser, 1998) before and after the intervention to measure the
effectiveness of the educational intervention in the treatment and
control group. The instrument is comprised of 17 items that are
rated on a 5-point scale designed to measure self-reported team
skills. Summing the scores results in a range of 17 to 85, with
higher scores reflecting greater estimates of team skills.
A demographic data sheet was collected prior to the intervention,
and open-ended questions were collected after the intervention to
elicit students’ views regarding the impact of the activity.
Analysis
IBM SPSS version 22 was used to analyze demographic and
Team Skills Scale (TSS) data. A paired-samples t- test was
conducted to evaluate the impact of the intervention on
students’ scores on the TSS. Assumptions for the use of
a parametric test were assessed by a review of histograms,
Q-Q plots, and Kolmogorov-Smirnov which indicated
approximately normal data. Responses to open-ended ques-
tions were categorized using thematic content analysis.
Ethical considerations
Prior to recruitment of participants, approval for the study
was obtained from the University of Texas Medical Branch
Institutional Board and the University of the Incarnate Word
Institutional Review Board.
Forty-two students completed the study. All students com-
pleted the demographic questionnaire, the Team Skills Scale
(TSS) pretest and posttest, and open-ended questions regard-
ing the value of the educational intervention. Internal
consistency for the TSS was strong, with a Cronbach’s alpha
of .89 for the pretest, and .94 for the posttest. Table 1 presents
post hoc analysis findings for the pre and posttest scores of
the TSS for the treatment and control groups. Mean change
scores were higher in the treatment group (19.2) versus the
control group (10.0). Using Cohen’s guidelines, a large effect
size was noted for both the treatment and control groups.
In the analysis of responses to open-ended questions about
the students’ views regarding the educational intervention,
four themes were shared by both the treatment and control
group: 1) improved understanding of other health professions
roles; 2) importance of working as a team; 3) importance of
communication; and 4) increased appreciation of other health
professions. In the treatment group, an additional theme of
increased confidence about future collaboration with other
health professions was noted, which the students attributed
to a positive experience of interacting with other health pro-
fessions during the activity.
While pretest TSS scores reflected similar teamwork compe-
tencies among students in both the treatment and control
group, posttest TSS scores were significantly higher in the
treatment group. Similar findings have also been noted by
other researchers who detected significant improvement in
subjects exposed to an IPE intervention compared to
a control group (Ruebling et al., 2014; Wang, Shi, Bai,
Zheng, & Zhao, 2015). While the findings reflect that the
intervention resulted in the greatest benefit for students in
the treatment group, the findings also suggest that the virtual
input of other health professions used in the control group
was also beneficial. Limitations of the study include a small
sample size, and representation from only three health profes-
sions within one educational institution. Although the gener-
alizability of the findings is limited, the findings may be useful
to other healthcare educators in planning IPE activities.
While the findings of this study support that face-to-face interac-
tion of health care professions students maximizes confidence in
interprofessional teamwork competencies, it also supports that
virtual exercises involving only one health care profession can be
beneficial. Therefore, when face-to-face interaction is not feasible,
educational interventions that provide virtual interprofessional
input should be considered as an alternative method for develop-
ing teamwork competencies.
Table 1. TSS pre and posttest scores for treatment and control groups (N = 42).
Pretest
mean SD
Posttest
mean SD
Mean
change
Mean
SD
change p
Effect
size
Control
(n = 17)
57.9 9.38 67.9 6.41 10.0 9.1 <.001 1.10
Treatment
(n = 25)
57.0 6.01 76.2 7.2 19.2 8.4 <.001 2.29
Note: nursing student TSS mean pretest scores (n = 16): treatment group 57.3,
control group 57.9. P values (two-tailed) based on paired t-test. Effect size
computed with Cohen’s d.
2 L. A. WALTZ
I would like to express my deep gratitude to the students who partici-
pated in this study, and to my dissertation committee for their support
and guidance. I would also like to thank Richard E. Oliver, Ph.D.,
FASAHP for granting permission to use the Interdisciplinary Geriatric
Assessment Case Study, and Kenneth Hepburn, PhD for granting per-
mission to use the Team Skills Scale.
The author reports no conflicts of interest. The author alone is respon-
sible for the content and writing of this article.
Lee Ann Waltz PhD, RN, CNE is an Assistant Professor at the University
of the Incarnate Word in San Antonio, Texas. Dr. Waltz has been a
Registered Nurse since 1986 in a wide variety of health care settings. Her
background in nursing includes geriatrics, mental health, medical-surgi-
cal, and home health. Dr. Waltz has been teaching in the undergraduate
nursing program at the University of the Incarnate Word since 2007. Her
research interests include interprofessional education and collaboration,
technology in education, and simulation.
Hepburn, K., Tsukuda, R., & Fasser, C. (1998). Team skills scale, 1996. In
K. Siegler, T. Hyer, T. Fulmer, & M. Mezey (Eds.), Geriatric inter-
disciplinary team training (pp. pp. 264–5). New York: Springer.
Interprofessional Education Collaborative. (2011). Core competencies for
interprofessional collaborative practice: Report of an expert panel.
Washington, DC: Author.
Ruebling, I., Pole, D., Breitbach, A. P., Frager, A., Kettenbach, G.,
Westhus, N., … Carlson, J. (2014). A comparison of student attitudes
and perceptions before and after an introductory interprofessional
education experience. Journal of Interprofessional Care, 28(1), 23–27.
doi:10.3109/13561820.2013.829421
Wang, R., Shi, N., Bai, J., Zheng, Y., & Zhao, Y. (2015). Implementation
and evaluation of an interprofessional simulation-based education
program for undergraduate nursing students in operating room nur-
sing education: A randomized controlled trial. BMC Medical
Education, 1–7. doi:10.1186/s12909-015-0400-8
Weston, D., Petterborg, L. J., Oliver, R. E., Baldwin, D. J., Dobey, T.,
Sanford Hargrove, M., … Reid-Arndt, S. (2012). Interdisciplinary
geriatric assessment: Mr. Ames. Retrieved from http://shp.missouri.
edu/vhct/CIGA_Ames/index.html
World Health Organization. (2013). Transforming and scaling up health
professionals’ education and training: World health organization edu-
cation guidelines 2013. Geneva, Switzerland: Author.
JOURNAL OF INTERPROFESSIONAL CARE 3
https://doi.org/10.3109/13561820.2013.829421
https://doi.org/10.1186/s12909-015-0400-8
http://shp.missouri.edu/vhct/CIGA_Ames/index.html
http://shp.missouri.edu/vhct/CIGA_Ames/index.html
- Abstract
Introduction
Methods
Group assignment
Data collection
Analysis
Ethical considerations
Results
Discussion
Conclusion
Acknowledgments
Declaration of Interest
Notes on contributor
References