The UK was the first country to approve a COVID-19 vaccine, with the Pfizer/Biontech mRNA vaccine being authorised for use on 2 December 2020. In the subsequent weeks and months, other countries followed suit and the UK moved to approve other vaccines. The UK government outlined an extensive and comprehensive vaccination plan that relied on taking a multidisciplinary approach to its implementation (HM Government, 2021).
IPE is an educational strategy that provides students with structured learning opportunities to foster knowledge, skills and professional attitudes that they would not otherwise acquire in their professional silos (Horsburgh et al, 2001). Frenk et al (2010) suggested that the key to successful IPE is the timing, duration and relevance of sessions in promoting effective collaboration between healthcare practitioners, in order to enable them to respond to the needs of patients within increasingly complex and interdependent healthcare contexts. Khalili (2020) recommended incorporating learning directly relevant to the COVID-19 pandemic, and there is evidence of successful adaptation for online delivery to account for social distancing measures (Kent et al, 2020).
The University of Huddersfield has a successful history of embedding IPE, including workshops on suicide prevention that bring together undergraduate mental health nursing students and pharmacy students (Gorton et al, 2021), workshops on medicines safety for pharmacy and podiatry students (Greenwood et al, 2016), and non-medical prescribing teaching to nursing, physiotherapy and podiatry postgraduates and pharmacy undergraduates (Hemingway et al, 2019; 2020). For some healthcare students, the pandemic has promoted interdisciplinary connectivity helping to facilitate a unified approach to patient care (Jones et al, 2020) and has provided the experience of learning together (Langlois et al, 2020).
The aim of this study was to embed and evaluate the implementation of a virtual IPE workshop for undergraduate nursing and pharmacy students, focused on COVID-19 vaccinations. The objectives were to:
- Design and implement a virtual pilot IPE workshop involving nursing and pharmacy students
- Evaluate students' experience of participating in the session
- Explore the staff facilitator experience.
The premise of the workshop was that IPE may enhance the preparation of healthcare students to understand the vaccine programme, specifically that it could aid students working or volunteering in vaccine centres to gain an awareness of the impact of the programme on the health service more widely and encourage vaccine advocacy. Implementation of the vaccination programme is one example where health professionals, volunteers and strategists have had to rapidly upskill in real time as evidence emerged and changed. IPE focused on this topical priority can enable healthcare students to assimilate credible information to implement in practice, and add to their medicine management role.
Methods
An interdisciplinary team of pharmacy and nursing academics (led by SH and HCG) was convened. Through an iterative process, content was produced to cover the vaccine process (Box 1), with academics leading on aspects that best aligned with their specialty. The content covered issues such as licensing, vaccine preparation and administration, consent and safety issues.
Box 1.Workshop sessions
- Legal basis of administration – patient group direction versus national direction versus patient specific direction. Child nursing lecturer
- Licensing of vaccines. Pharmacy lecturer
- Addressing patient concerns: cultural competency and addressing certain groups. Child nursing lecturer and adult nursing lecturer
- Consent and advocacy, including Gillick competence (children): mental capacity scenario-based example. Child nursing lecturer and learning disabilities lecturer
- Vaccine preparation, storage and ingredients (including cold chain). Pharmacy lecturer
- Administration of vaccines: physical admin. Child nursing lecturer
- Pharmacovigilance and safety monitoring including adverse events – anaphylaxis. Pharmacy lecturer and adult nursing lecturer
The IPE workshop was carried out remotely using Microsoft Teams in January 2021 at the University of Huddersfield. Students were provided with advanced reading to complete prior to the event, which included the most up-to-date guidance on vaccine rollout and specifications available at the time. Final-year undergraduate pharmacy and nursing students from all disciplines (adult, child, mental health and learning disability) were invited to attend. For pharmacy students, there was an expectation to attend, but participation was optional for nursing students, as they were on placement. Students had to complete an online form to sign up and confirm their attendance.
In advance of the workshop, students were provided with a work document to use throughout the workshop. The event included topic-specific sessions each of which had up to eight participants, with the use of PowerPoint presentations and smaller groupwork in virtual break-out rooms. Whole-group plenary sessions were included at the start and end of the workshop, with the rest of the workshop taking place in the pre-defined multidisciplinary break-out rooms. The ten academics facilitating the event ‘visited’ the rooms to maintain momentum: this included providing students with relevant questions and helping them with any queries arising. The final plenary session was led by the academics and included an overview of model answers to these questions, which were also provided electronically to participants. Students were invited to participate in an evaluation survey, and staff facilitators were invited to take part in a reflective focus group.
Ethical approval
Ethical approval was not required for this teaching evaluation.
Student questionnaire
At the end of the workshop, students were invited to provide feedback via an online questionnaire (Table 1) hosted on the Qualtrics platform; this was adapted from a questionnaire previously used by co-authors to evaluate IPE workshops (Hemingway et al, 2019). It was completed anonymously without a request for participants to provide identifiable information beyond which of the two courses they were studying, nursing or pharmacy.
Table 1. Workshop evaluation questionnaire
1. Please select which profession you are a student of:
|
| 2. Prior to the session, where had you gained your knowledge about the COVID-19 vaccine from? |
| 3. Why did you choose to come to the workshop? |
| 4. Please select the extent to which you agree or disagree with the following statements: |
Key K=Knowledge domain, R=Relationships domain
The questionnaire comprised nine 6-point Likert items (strongly disagree, moderately disagree, somewhat disagree, somewhat agree, moderately agree, strongly agree), which were assigned to one of two domains: a Process/Knowledge domain (three items), and a Relationships domain (six items).
Process/Knowledge domain
The first domain refers to the fact that safe and effective nurses and pharmacists need to understand the processes by which medicines are prescribed, supplied and administered. Consequently, to ensure effective implementation of a vaccination programme a collaborative approach is vital (Cooke et al, 2017). Knowledge refers to the fact that nurses and pharmacists must be able to identify and understand the patient's condition. Process and Knowledge aspects were merged into a single construct.
Relationships domain
Relationships refers to benefits of interprofessional referral and work attributed to effective interprofessional collaboration. (Davies and Gidman, 2011). Open-ended questions were included to enable students to describe their experiences of participating in the workshop alongside colleagues from another discipline.
Facilitators focus group
Following the workshop, an informal focus group was conducted via Microsoft Teams with the facilitating staff to elicit their experiences of taking part, with those who did not attend being followed up by email for comment (n=10). The conversation was recorded, and the inbuilt software used to create an initial transcription.
Analysis
Quantitative analysis
Respondents indicated whether they were a nursing or pharmacy student. For all respondents, domain scores were derived from responses to questionnaire items as the sum of the scores of individual items in that domain. Hence the Process/Knowledge domain was scored from 3 to 18 points, with 10.5 representing neutrality; and the Relationships domain was scored from 6 to 36 points, with 21 representing neutrality. Positive perceptions of the workshop were represented by higher scores on both domains.
The scores on each item were summarised descriptively. Data were checked for missing responses or need for imputation. The internal consistency of responses associated with each domain in both questionnaires was assessed using Cronbach's alpha (α) coefficient. The correlation of measures was also assessed. The significance of the difference in scores obtained by the two groups of participants (where recorded) was assessed using independent sample t-tests.
Qualitative analysis
The responses from the open-ended questionnaires and focus group were considered separately. Initially, the interview transcripts were read and re-read by CSO, to aid familiarity. Initial codes were generated by examining the data in full, while focused on the research question (Denzin and Lincoln, 2011; Creswell and Poth, 2018). Responses not directly related to the question were noted down, because they offered context to understanding a participant's experiences and evaluations of the event (Crowe et al, 2015; Creswell and Poth, 2018). Codes were generated, and related ideas were then developed into themes (Denzin and Lincoln, 2011; Creswell and Poth, 2018).
Discussions among the research team (CSO, SH, HCG) led to continuous refining of the identified themes to highlight the entire meanings of the data.
Results
Out of a potential 400 students, 77 attended the voluntary workshop (19% attendance). Of the 77 participants, 44 completed the questionnaire (57%): 23 nursing students (6 adult, 3 child, 6 mental health and 8 learning disability nurses) and 21 pharmacy students.
Reliability analysis revealed very high internal consistency between items in the Process/Knowledge domain (α=0.946); and items in the Relationships domain (α=0.964).
In both disciplines, and across the full cohort, students' mean scores showed positive responses across the two domains (Table 2). Scores indicative of positive perception were reported by 39 out of 44 respondents (88.6%) on the Process/Knowledge domain and by 35 out of 44 respondents (79.5%) on the Relationships domain. There were no significant difference between the two groups (nursing v pharmacy students) on either domain.
Table 2. Summary of scores by student group, and full cohort
| Domain | Mean (SD; range) score | ||
|---|---|---|---|
| Nursing students (n=23) | Pharmacy students (n=21) | All participants (n=44) | |
| Process/knowledge | 14.4 (4.51; 3–18) | 14.7 (4.26; 3–18) | 14.5 (4.34; 3–18) |
| Relationships | 24.5 (7.12; 5–30) | 22.9 (7.41; 5–30) | 23.7 (7.22; 5–30) |
Correlation analyses conducted on the data revealed strong positive correlations between the Process/Knowledge and Relationships domains (R=0.913; 95% bootstrapped confidence interval (CI) 0.794 to 0.967, P<0.001).
Themes emerging from open-ended comments
Three themes were identified from participants' open-ended comments:
- Event design, content and format
- Building interprofessional relationships
- Impact on professional development.
Event design, content and format
Most participants responded positively about the design, content, and format of the workshop, using affirmative words and clauses, such as ‘very good’, ‘great content’, ‘well designed’, ‘engaging’, ‘innovative’, ‘very educational’, ‘brilliant online format’, ‘great idea’. However, some participants reported having difficulties with the format:
‘I think it's very hard to work online, especially with connection and technology issues making it very hard to run the session smoothly.’
Pharmacy student
‘There was a lot of information in a short period of time … I did not have time to write notes, as the slides changed too quickly.’
Nursing student
Specific satisfaction hinged on the provided work document the workshop style, PowerPoint content and break-out rooms:
‘The content was really informative, and I feel more confident in my ability to discuss information regarding the COVID vaccine.’
Nursing student
These positive responses highlighted the effectiveness of IPE among the two groups of healthcare students. However, a few participants felt dissatisfied because they struggled with the technology. Potential improvements suggested by participants included increasing the length of the workshop with greater facilitator input, smoother transition to break-out rooms and having smaller groups, that is with fewer than eight participants. There were also suggestions to deliver the workshop in person, which could be attributed to frustration with the technology, and also to provide some teaching before the breakout-room activities as part of the workshop:
‘Hopefully [it could] be in person and make the break-out rooms clearer with clear facilitators.’
Pharmacy student
Building interprofessional relationships
Most participants acknowledged that the event provided them with the opportunity to meet new individuals from another profession, enabling them to develop interprofessional relationships.
‘Yes, we allocated the task well and according to the expertise of the student.’
Nursing student
The feedback also highlighted the value of shared learning with students validating that this occurred with a ‘good mixture of knowledge and understanding’ where groups worked together interprofessionally:
‘Everybody [was] working in collaboration and contributed.’
Nursing student
The essence of multidisciplinary working was also highlighted:
‘We're all working toward the same goal.’
Pharmacy student
Impact on professional development
Many participants acknowledged that the workshop had positively influenced their professional developments by improving their interprofessional working experiences, improved awareness and preparedness to answer COVID-19 vaccine questions and the desire to get involved in the vaccination programme:
‘I definitely know more about the COVID vaccine, and I am not as worried myself as about getting it [the vaccine]; it [the workshop] provided reliable information and addressed my own anxiety with the COVID vaccine.’
Pharmacy student
Conversely, some responses expressed the view that it was not possible to build these relationships due to the communication difficulties caused by internet disruption, participants' reluctance to answer questions in the groups in the breakout rooms and time constraints.
Staff facilitators' view
Ten staff facilitators participated in an evaluation focus group led by SH (8 in person, and 2 via email): three pharmacy lecturers and seven nursing lecturers (2 adult, 1 children, 2 learning disability and 2 mental health). The focus group highlighted that staff facilitators evaluated the IPE event as effective; they expressed views about how such workshops could be embedded in undergraduate nurse training and would help to enhance interprofessional interactions for both staff and students. Feedback from staff facilitators included:
- The view that sharing information is definitely valuable and creates respect and understanding
- This type of event should be included in the year 3 final placement module – it acknowledged the value of working with colleagues at an important stage in a nursing student's career.
- There was also recognition that some aspects of an IPE event could be improved, for example, there needed to be better organisation of breakout groups within a workshop.
Discussion
The aim of the study was to embed and evaluate the implementation of a virtual IPE workshop for undergraduate nursing and pharmacy students. The focus was on COVID-19 vaccination which, as a contemporary topic, offered the opportunity to inform and engage students, as well as to facilitate a collaborative, problem-solving approach across interprofessional groups. This is an approach that is easily transferable to other current healthcare topics.
Both pharmacy and nursing students reported positive perceptions of the workshop, as measured by the scores on both the Process/Knowledge and Relationship domains, suggesting that the workshop both added to their knowledge of COVID-19 vaccination and built interprofessional networks across the two professional groups. In previous studies, non-medical prescribing students rated their workshop slightly higher than pharmacy students on all domains (Hemingway et al, 2019). However, in a follow-up study (Hemingway et al, 2020), pharmacy students were found to be more positive about the Relationship domain, perhaps due to their familiarity with the prescribing and pharmacology workshop topic, thus valuing the aspect of working together. The current findings, which found no notable differences, suggest the that content in both the Process/Knowledge and Relationship were equally valued by both groups. This could be because both groups had similar baseline knowledge about COVID-19 vaccination, the novel aspect of the workshop would been its collaborative nature centred on a current topic. Using novel or contemporary content, such as the COVID-19 vaccination programme, provides a real-world background, enabling shared learning to be embraced. In such circumstances, students have been found to be wholly interested in the topic and engaged in solving the problems that are presented to them (Garwood et al, 2022).
The study revealed that both student groups would need some preparation to interpreting new evidence, as was essential for the COVID-19 vaccine. In designing the workshops, the assumption was made that nursing students would have better knowledge and skills with regard to injection technique and consent than pharmacy students, and that pharmacy students would have better knowledge regarding the licensing, regulations, formulation and safe monitoring of vaccines (Wilbur and Kelly, 2015). There is a challenge in designing a workshop that facilitates effective outcomes for participants with very different educational and experiential backgrounds, so it is important to take this into account at the design stage and provide content that enables both groups of students to contribute their skills and knowledge (Brock et al, 2013; Thom et al, 2016). The topic of COVID-19 vaccination appeared to be an issue that enabled this (Jones et al, 2020), and thus could help to improve medicines management.
Focus on a relevant pandemic situation was shown by Mahoney et al (2009) to improve teamwork and appreciation of other health professionals' roles, in emergency preparedness training for an influenza pandemic. The workshop provided an opportunity for different groups of health professionals to work together and to share their knowledge and experience.
The quantitative findings from the study correlated with the qualitative student comments and facilitator comments, namely that the workshop enhanced professional development. Interprofessional interactions with all students working collaboratively towards the same goal is the ultimate purpose of IPE (Sy et al, 2020; World Health Organization, 2010). Students expressed increased confidence about the COVID-19 vaccine, in that they felt they were better informed after taking part in the workshop and identified how they could convey this information to the public; they also indicated how they could increase their potential involvement in the implementation of the national vaccination programme (Chan et al, 2021; Ford, 2021) and how their new knowledge could be transferred to future clinical roles (Mahoney et al, 2009; Reeves et al, 2013; Prasad et al, 2020).
The evaluation identified some barriers to effective IPE, including technical issues and the short duration of the workshop, both of which affected student engagement. The key to achieving success via online delivery is getting the content and sequence correct – these need to be tailored to the organisation and to draw on the skills of the facilitator(s) (Piña et al, 2018; Bluteau, 2020). Strategies identified in this study to improve workshop design include allocating more time to group face-to-face activities in the virtual break-out rooms and having an additional 7 facilitators.
Strengths and limitations
This evaluation explored the perspectives of students and staff on their participation in a novel online IPE workshop on COVID-19 vaccination. The content was produced and delivered in real time, as COVID-related evidence emerged and the UK vaccination programme was implemented. Incorporating learning directly relevant to the COVID-19 pandemic, as recommended by Khalili (2020), was evidenced in this study, while also adhering to the social distancing measures that were in effect when the UK was in the midst of the second lockdown.
There are limitations to this work. This is a teaching evaluation and represents a snapshot of student and staff experiences. Participation in the evaluation was voluntary and may have been biased toward people with particularly strong positive and negative view on the rollout of the COVID vaccination programme. The staff focus group was ad hoc, with participants expressing their opinions in front of their peers, which might have influenced the responses. The number of student participants was low. There has been no follow-up to understand how this workshop may have contributed to subsequent practice. In addition, as the vaccine programme was dynamic and evolving, so the content presented in this workshop would require modification for delivery at any subsequent events.
Conclusion
It is feasible to design, deliver and evaluate a topical, online IPE workshop involving pharmacy and nursing students. Focusing on a topical issue, and combining two professional groups who come to a workshop equipped with similar baseline knowledge and with similar access to information, may be more efficacious than choosing professional groups that have similar competencies. Overall, students and staff enjoyed the session and found some aspects potentially beneficial to their practice, notwithstanding the barriers associated with virtual participation. More high-quality longitudinal research is needed in future to provide more understand about the impact of IPE sessions on students' competence and confidence.
KEY POINTS
- The workshop demonstrated that focusing on topical content adds value and interest for students taking part in interprofessional education (IPE)
- Planning and workshop design needs to consider how best to utilise the unique contribution that healthcare students across different disciplines can bring to IPE sessions
- The key to delivering IPE content online successfully depends on the timing of the content
CPD reflective questions
- Think about your interactions with pharmacists in practice. How does this article reflect your experience?
- Consider how interprofessional learning could enhance your learning
- Does learning together with other key stakeholders about medicines offer an optimum way to enhance the skills and knowledge of nurses and other health professionals?