Introduction

The term “interprofessional practice”, or IPP, emerged in the late 1960s to describe the relationships and communication skills needed for diverse healthcare professionals to work together effectively. Similarly, One Health, or the interconnectivity between animal, environmental, and human health, is a more recent addition to the public health field, becoming a widely adopted paradigm in the early 2000s.¹ As for relevance, both practices have significantly contributed to the contemporary understanding of public health, communication, and research.

In “Impact of Interprofessional Education on Subsequent Practice”, Mark Spencer traced the meanings conveyed by the term IPP and highlighted IPP as the integration of previously discordant fields of study into a new curriculum.² While IPP training can be achieved in various ways, Spencer specifically examined the use of a single, interprofessional education course administered between 1975 and 1981.² Broadly, while the course itself was rarely referenced as of significant importance for participants in their later interprofessional interactions, students who had participated were more likely to successfully engage in IPP-associated behaviors, such as collaborative practice.² Participants’ knowledge growth was evaluated on the basis of positive changes in attitudes and beliefs in relation to IPP. Spencer tentatively framed IPP in a temporal context as a burgeoning and important field, indicating IPP training can help students later in their careers.

As the world has become more specialized and narrowly focused, one of the lessons from studies of IPP has been how vital multisystem thinking and action are in various applications. In “Interprofessional Education in Community Health Contexts: Preparing a Collaborative and Practice-ready Workforce”, the authors found that by increasing medical students' and practitioners’ interactions with diverse communities, they could improve patient outcomes via a better understanding of the social determinants of health and community resource acquisition.³ Similarly, Fifolt et al. utilized an experiential learning simulation to help a group of racially underrepresented college students interested in healthcare professions learn about proper personal protective equipment (PPE) use.⁴ While the primary goals of this exercise were training students for biohazard response and introducing underrepresented students to a hands-on healthcare experience, secondary-level takeaways included participants’ increased abilities to work on a diverse team. ⁴

In an integrative, educational program conducted with healthcare-allied individuals at the Muhimbili University of Health and Allied Sciences, one of Tanzania’s major medical degree-granting universities, interprofessional competence is a foundational principle.⁵ Students cannot graduate without demonstrating the ability to effectively communicate with diverse populations, both as patients and coworkers. In a novel approach to underscore these skills, the university began Interprofessional Day in which participants worked on teams to directly address IPP issues. By completion, all students demonstrated an introductory understanding of IPP, with suggestions for how IPP training events could be expanded and supported in the future. ⁵

       Second to the demonstrated importance of introducing interprofessional education (IPE) into health programs is the evaluation of these specific interventions. Bradley et al. studied the introduction of IPP into varying professional levels and indicated the literary gap in IPE program evaluation. ³ Bradley, and several other subsequent researchers, introduced IPE program evaluation through participant attitudes toward and in agreement with IPP statements. ^1,3,6 In this context, program assessment consistently applies Likert scale questions for evaluation.

Throughout the history of education in healthcare, there has been a consistent recognition of the importance of incorporating IPP into curricula. This recognition dates back to the late 1960s when the concept of IPP first emerged, emphasizing the need for diverse healthcare professionals to work collaboratively and communicate effectively.¹ Over the years, various studies and initiatives have underscored the value of IPP in fostering teamwork, improving patient outcomes, and addressing complex healthcare challenges. This longstanding recognition highlights the enduring commitment to preparing healthcare professionals who can effectively collaborate across disciplines, a fundamental principle that continues to shape contemporary healthcare education.^2-6

In 2016, the Interprofessional Education Collaborative released “Core Competencies for Interprofessional Collaborative Practice” to serve as a basis for introducing and evaluating interprofessional education in health professions.⁷ With an emphasis on the evaluation of IPP, competencies and sub-competencies are inclusively outlined. The four core competencies promote mutual learning, teamwork, and communication relating to success in individual and public health care.⁷ Evaluation and creation of IPP education can also be established through knowledge management (KM). Defined by the major themes of knowledge, organization, process, information, and use, KM is described as the interdisciplinary process of creating, using, sharing, and maintaining an organization’s information and knowledge.⁸ There is demonstrated success surrounding the multidisciplinary practices of IPP and KM in health education. Through KM techniques, programs can attain full educational capability and provide students with the knowledge necessary for a smooth and contributive transition into the public health workforce. KM serves as a framework to systematically organize and manage the wealth of information and expertise within healthcare education, ensuring that it is accessible, up-to-date, and effectively utilized to promote collaborative practices among future healthcare professionals. Through the strategic deployment of KM methodologies, healthcare education programs can enhance their effectiveness in preparing students to meet the evolving challenges of the healthcare industry, ultimately contributing to improved patient care and the advancement of public health.^8,9

Professional collaboration is clearly a central feature of healthcare practice across the globe. Its central tenets, though, and those of One Health—multisystem thinking, strong transdisciplinary communication, and collaborative practice—are more broadly utilized outside the medical and public health fields. With the goal of adapting to the growing complexity of the healthcare field, several researchers have demonstrated success in the introduction of interprofessional learning in an online module format. One study involving undergraduate healthcare students provided participants with five online, asynchronous IPP modules. Levels of knowledge attainment following these modules were measured using quizzes, discussion questions, and case studies. Following the five modules, students demonstrated higher perceived value in IPE. Participants demonstrated value in collaboration, communication, and cohesion among a professional team. Students’ improved perceptions of the importance of core interprofessional tendencies demonstrate the potential success of the incorporation of similar modules in other institutions. ¹⁰  

To wholly establish a linkage between public health and IPP, it is important to distinguish the differences between and recognize the importance of both multidisciplinarity and transdisciplinarity. Multidisciplinary approaches to problem-solving include general references to knowledge from varying disciplines. Transdisciplinary approaches to problem-solving include merging professional knowledge in a previously nontraditional manner.¹¹ Combining these two practices contributes to the ever-growing need for One Health approaches to attaining public health. One Health enables a link between IPP, intercultural communication, and animal and environmental health practices, and likely, is the answer to the extremely complex questions of the future.⁹ Such issues can only be addressed through work collaboratively performed in environmental, veterinary, medical, and public health fields, with necessary deference to varying cultural, racial, and ethnic attitudes towards these topics.¹²

There are several published studies identifying gaps and opportunities in education and knowledge in veterinary and public health programs. A study conducted at the University of Sydney’s School of Veterinary Science outlined the growing complexity of the veterinary public health (VPH) field and the lack of professional skills being introduced into the VPH curriculum.⁹ University of Sydney faculty integrated VPH management as a post-graduate program to bridge the gap between student education and their professional work. The online, asynchronous program integrates animal and human health policy as well as management and communication skills into the training. Success of the program has been demonstrated through student career promotions and student testimonials of smooth transitioning between the academic field and professional workplace.⁹ Another study recognized the need for increased educational training related to disaster management in veterinary curricula in US Veterinary Schools and Colleges.¹³ Following the evaluation of several US veterinary schools, it was concluded that lack of disaster management education can be attributed to poor resource allocation.¹³ Furthermore, a study assessing emergency preparedness in various health professions discovered that there are notable gaps in response capabilities. The researchers proposed that deficiencies in these practices could be resolved through interprofessional collaboration involving healthcare workers and public safety officials.¹⁴

Methods
Survey Design and Distribution

A study of undergraduate, graduate, and professional students at a land-grant university in a midwestern state of the United States (U.S.) was undertaken to assess gaps in knowledge and understanding of IPP. Student participants were surveyed using a pre-training questionnaire followed by the completion of an online, asynchronous training module discussing various IPP scenarios. Participants then completed a post-training survey to determine the impact of the training module on their IPP knowledge and perceptions. The post-training questionnaire also asked participants to identify perceived challenges in meeting IPP standards during the given scenario.

The present study draws from data collected as part of a master’s degree report and extends the analysis to identify recurring patterns and emerging themes that are relevant to IPP and IPE in the context of public health. The survey questionnaire, scenario design, and sampling methodology described in this study were developed specifically for the master’s report.¹⁵

Data was collected from participating university students by an online survey.  Both quantitative and qualitative assessments of the survey data were performed. The voluntary sample population was randomly selected through online distribution channels. The sole inclusion criterion was being a student over 18 years old. The study population consisted of 49 undergraduate students and 17 graduate/professional students pursuing varying degrees (Tables 1 and 2). The study was approved by the university’s Internal Review Board (IRB # 10234). An electronic copy of the survey was distributed via Qualtricsâ, participants provided consent, and submitted their responses anonymously via the online software. Prior to completion of the IPP training modules, participants were asked to quantify their agreement with IPP-related statements (see the “Data Analysis” section) with responses on a Likert scale of “strongly agree,” “somewhat agree,” “neutral,” “somewhat disagree,” and “strongly disagree”. Participants were also asked: “What is your understanding of the phrase ‘interprofessional practice’?” prior to the online IPP training program. Immediately following the IPP training module, participants answered the same questions, in addition to questions relating to one of six IPP scenarios including, “What challenges do you foresee in executing the plan you developed?” and “As the professional in this scenario, what are three strengths in this role that you would bring to an interprofessional team?”. Participants were not provided any example answers for these questions and were asked to type their responses in textboxes in Qualtrics.

IPP Training Scenarios
The IPP scenarios used in this study were developed through a combination of KM techniques including systematic organization and leveraging expertise to ensure comprehensive and realistic scenario representation.^8,9  The randomly assigned scenarios, asking participants to embody the role of a professional such as a doctor, lawyer, teacher, veterinarian, dietitian, or physical therapist, were created with the goal of providing an immersive IPP learning experience. Participants were presented with complex, yet common issues to solve for their client in the hypothetical scenario. The complexity of the scenarios was designed to facilitate interprofessional thinking throughout the remainder of the survey questionnaire.

Data Analysis
For pre- and post-analysis of Likert scale responses, participant attitudes were recorded based on the percentage of agreement with the given IPP statement.² For the Likert statements: “I will not have to work collaboratively or creatively on a diverse team in my future profession (statement 1),” “Interprofessional competency means that all members of a team must have the same knowledge and backgrounds to produce the best outcome from their work (statement 3),” and “Conflict is completely avoidable on a well-functioning interprofessional team (statement 4)” responses of “strongly disagree” and “somewhat disagree” were recorded to indicate a positive attitude toward IPP. For the Likert statement: “Healthcare has routinely demonstrated that teams with better interprofessional communication have better patient long-term outcomes (statement 2)” responses of “strongly agree” and “somewhat agree” were recorded to indicate a positive attitude toward IPP.
For qualitative thematic analysis, survey answers were reviewed by all authors, and codes were assigned for analysis of thematic content with themes related to the IPP competencies created by the Interprofessional Education Collaborative care.⁷ Using the process and themes of KM, gaps in IPP training were identified and accounted for via student responses. To ensure accurate coding and consistent and reliable identification of themes, the authors discussed and agreed on the identified recurring patterns and emerging themes. This method ensures the process of coding is systematic and the coded data collection is consistent. The corrected, typed transcripts, and notes were entered into NVivo12 Plus software (QRS International Ltd., Burlington, MA, USA, 2018) to sort and analyze the data.^16,17 Each participant was only counted once per category (i.e., if they mentioned “communication” three times in the response, they were only counted as one respondent in the summary), but certain responses could contribute to multiple categories (i.e., they mentioned communication and empathy as two of their skills).

Results

Through the pre- and post-training renderings of these IPP statements, sixteen total participants, eight undergraduate and four graduate, did not change their ratings for any statement. Of the 28 (42%) total participants who indicated no understanding of IPP initially, only four (14%) repeated this lack of knowledge by the end of the survey. A total of 77 completed responses were collected, including eleven responses that were incomplete, and therefore, not included. There were 66 completed responses including 17 from graduate and professional students and 49 from undergraduate students (Table 1).

Table 1. Student Programs and Responses.

*The percentage was calculated as the number of responses per student category out of a total of 66 responses.

The undergraduate participants (Table 2) included ten participants in a pre-medical field (pre-nursing, pre-dentistry, pre-physician’s assistant, or pre-surgeon), psychology (9), education (4), biology (3), kinesiology (3), animal science (3), communications (2), architecture (2), business (2), undecided (2), mechanical engineering (2), biochemistry (1), agriculture (1), computer science (1), political science (1), and regional planning (1).

Table 2. Undergraduate Program.

*The percentage was calculated as the number of responses per student category out of a total of 49 responses.

Pre-training survey responses to IPP fact-based statements were used to gauge IPP knowledge prior to completion of the online training module and to compare potential knowledge gained following training. Responses by student program were analyzed based on responses of "strongly agree" and "strongly disagree" to the IPP-related statements (Table 3), culminating in two major groups of students (i.e., undergraduate, and graduate/professional students).