An Interprofessional Education Approach to Teaching Radiation ...

Journal of Medical Imaging and Radiation Sciences

Journal of Medical Imaging and Radiation Sciences 42 (2011) 183-188

Journal de l’imagerie médicale et des sciences de la radiation

www.elsevier.com/locate/jmir

‘‘We Are All Students:’’ An Interprofessional Education Approach to Teaching Radiation Oncology Residents Kieng Tan, MRT(T), MEdab*, Amanda Bolderston, MRT(T), MSc, FCAMRTab, Cathryne Palmer, MRT(T), MScab and Barbara-Ann Millar, MBChBab a b

Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada

ABSTRACT The principal goal of interprofessional education (IPE) is to cultivate collaborative practice for providing patient centered care. Introduction to Radiation Therapy (IRT) is a course designed to introduce radiation oncology residents to the radiation treatment process and the interprofessional nature of the radiation oncology environment. Each resident is paired with a radiation therapy student during the clinical portion of the IRT course. The intent behind the pairing is to facilitate opportunities for IPE and to establish a professional relationship for interprofessional collaboration in the future. The overall outcome of the IPE experience has been positive and beneficial to both groups. Results of the survey examining the residents’ and the radiation therapy students’ perception of their IPE experience within the IRT course showed that they were able to gain insight into each other’s role, as well as learn with and from each other. However, the timing of the IPE experience had some impact on the participants’ ability to reflect on their own practice and share it meaningfully.

RESUM E L’objectif principal de l’Education interprofessionnelle est de cultiver la pratique en collaboration pour fournir aux patients des soins centres. Introduction a la radiotherapie est un cours conc¸u pour presenter le processus de traitement par radiation et le concept interprofessionnel de l’environnement de radiation oncologique aux residents d’onco-radiologie. Chaque resident est jumele avec un etudiant de radiotherapie durant la portion clinique du cours. L’objectif derriere cette approche est de profiter de cette relation interprofessionnelle afin de creer des relations de collaboration futures et faciliter les opportunites d’Education interprofessionnelle. Les resultats d’un sondage portant sur les impressions des residents et des etudiants de radiotherapie par rapport a leur experience d’education interprofessionnelle du cours de radiotherapie montrent qu’ils ont appris beaucoup l’un de l’autre et du r^ole de leur partenaire. Cependant, le choix du moment d’avoir l’experience d’Education interprofessionnelle influence grandement l’habilete du participant a partager et se tourner vers son propre cheminement professionnel.

Introduction

areas, observing on the treatment units and in the treatment planning area. During this clinical placement, each resident is paired with a radiation therapy student. The intent behind the pairing is to facilitate opportunities for interprofessional education (IPE). Both groups of learners will learn with, from, and about each other with emphasis on the radiation therapy student leading the learning opportunities. Although radiation therapy students participate in IPE learning throughout their undergraduate curriculum, they are primarily on the receiving end of knowledge exchange. In general, they are placed into IPE opportunities to equally explore the health care professions of other disciplines and share their own. They are not traditionally the focus of the IPE opportunity. Moreover, they are typically placed into learning activities with other allied health care professionals, their contemporaries, or peers. IRT provides a unique

During the first year of residency, radiation oncology residents are just beginning their specialty education and training. They have minimal exposure to clinical radiation oncology. Introduction to Radiation Therapy (IRT) is a course designed to introduce first-year radiation oncology residents to the radiation treatment process and the interprofessional nature of the radiation oncology environment in a large urban cancer hospital in Toronto. One of the course objectives is to spend time in the radiation therapy department, within clinical * Corresponding author: Kieng Tan, BSc, MEd, RTT, Clinical Coordinator, Radiation Medicine Program, Princess Margaret Hospital / University Health Network, 610 University Avenue, Room 6-103, Toronto, Ontario M5G 2M9, Canada. E-mail address: [email protected] (K. Tan). 1939-8654/$ - see front matter Ó 2011 Published by Elsevier Inc. doi: 10.1016/j.jmir.2011.06.008

opportunity for radiation therapy students to take the lead role in IPE and educate learners within another health care profession that is closely reliant on their own practice and has traditionally been viewed as hierarchically above their own [1]. This article will examine the residents’ and the radiation therapy students’ perception of their IPE experience within the IRT course. Background With increasing knowledge, technology, and specialization, learners have fewer opportunities to interact with other disciplines and professions. They immerse themselves more and more in the knowledge and culture of their own professional groups [2]. Even disciplines that rely on each other for the care of their patients are finding themselves in professional silos, isolated by their training and professional socializations [1]. Failure to communicate with other health care professions involved in the management of the same patient can lead to inadequate care [3]. Good formal and informal communication among health care providers is key to collaborative patient-centered care [4]. However, some professionals are not comfortable speaking up and defining what their roles are, which can lead to a disconnect in understanding [4]. This is particularly evident in hierarchical relationships. Thus, to interact meaningfully with each other and with the patient and/or family, team members must be familiar with the expertise and functions of the others’ roles [2, 4]. The practice of radiation oncology is interprofessionally collaborative across the patient care continuum and involves the participation of a number of professions, which include primarily radiation oncologists, medical physicists, and radiation therapists [5, 6]. Within this interprofessional environment, factors leading to poor team function include ignorance of the roles of other team members, failures of communication and understanding, and disciplinary territoriality [6]. IPE can address these issues through its principal goal of cultivating collaborative practice for providing patientcentered care. The benefits may include an enhanced understanding of the role and contribution of other disciplines, including a familiarity with their basic discipline-specific language and mindset, and improving knowledge and skills needed to work collaboratively [7]. The question then becomes not whether to engage in IPE, but how and when. IPE occurs in a variety of settings, in various learning formats, and at different stages of the learning process. Some educators believe that it should be introduced early in training before students are licensed in their respective professions [8]. Prelicensure exposure to IPE may result in the greatest impact by affecting learners before professional power relations can be cemented. In addition, what appears to be most meaningful to the learner is an IPE experience that is relevant, in an appropriate small-scale format and using interactive teaching strategies [9]. At the University of Toronto (UT), the Centre for Interprofessional Education was first opened in 2006 with 184

a mandate to improve the health of individuals and populations by infusing IP collaborative team practice in all UT health professional education programs [7]. Through curricular renewal in 2007, IPE was integrated throughout the medical radiation sciences (MRS) curriculum. In 2009, UT developed and delivered mandatory IPE curriculum for its 10 health sciences disciplines, including the MRS program and medicine [7]. The integrated IPE curriculum includes opportunities for both classroom and clinically based interprofessional (IP) learning dispersed throughout the didactic and clinical program. In the first year of the undergraduate MRS program, students in the radiation therapy stream are required to complete the following IPE courses: Foundations for Interprofessional Communication and Teamwork, and Foundations of Interprofessional Collaborative Practice in Health Care. During the second year, the students are required to complete Collaborative Patient Care and Interprofessional Collaborative Clinical Simulation [10]. The goal of these courses is to introduce the students to the concept of intra- and interprofessional practice, and to develop communication, feedback, conflict resolution, and reflective skills that will assist in the collaborative nature of IPE [10]. And, in the summer between the first and second years, the radiation therapy students complete an 8-week clinical placement. During this clinical placement, the students are required to complete specific clinical IPE activities. Students enrolled in the Faculty of Medicine since 2009 have been required to complete a similar IPE curriculum, consisting of four core learning activities, including a structured IPE learning component within an already existing clinical placement, and elective IPE learning activities [7]. However, UT medical school graduates now in a residency program may not have received exposure to the IPE curriculum. In an attempt to ensure that all learners at a large Toronto urban cancer hospital, a UT-affiliated clinical site, were exposed to IPE in their education and training curriculum, an initiative was taken to introduce an IP experience to the radiation oncology residency program. The IRT course was viewed as a fitting opportunity. It allowed for a small-scale, one-on-one format in a live and dynamic clinical environment within the context of their profession, thus meaningful and relevant.

Methodology IRT CoursedClinical Component As part of the clinical portion of the IRT course, the residents were required to complete 2.5 hours on a computed tomography (CT) simulator, where radiation treatment planning is initiated, and an additional 2.5 hours on a treatment linear accelerator observing radiation treatment setup, delivery, and care. The radiation therapy students were instructed by the clinical placement supervisor of the IRT course to act as guides or clinical facilitators for the radiation oncology residents. They were to introduce the resident to the radiation

K. Tan et al./Journal of Medical Imaging and Radiation Sciences 42 (2011) 183-188

therapy team and to the patients, demonstrating appropriate professional behaviours at all times. The radiation therapy students were to explain the rationale of the daily activities occurring in the specific clinical areas with a focus on the patient as a partner in the care delivery [11]. The students were to highlight the various stages of an oncology patient’s progress through radiation treatment and the many health care professionals involved in the collaborative care of the patient. Any questions posed by the residents were to be answered by the students to the best of their abilities; however, if the student was unable, the question was to be directed to the radiation therapy staff. The students were also instructed to ask questions of the residents. Although the students would be taking the lead in the knowledge sharing, the IPE experience in the IRT course was intended to be an equal exchange, benefiting both groups of learners. Study Population The study population consisted of all radiation oncology residents enrolled within the IRT course and all radiation therapy students enrolled in a clinical practicum who were assigned to act as clinical facilitators during the residents’ clinical placement. The exclusion criteria: all radiation oncology residents not enrolled within the IRT course and all radiation therapy students not enrolled in a clinical practicum. There were six residents enrolled in the IRT course and, given the requirements of their placement and the limitations of the clinical setting, there were nine corresponding radiation therapy students assigned to the IRT course. The three students in the CT simulator interacted with two residents each, leaving six students with one resident each. Thus the eligible participant population was 15. Data Collection and Analysis One week before the start of the clinical component to the IRT course, the principle investigator (PI) met with the radiation oncology residents and radiation therapy students separately, to discuss possible enrollment within the research study. The purpose and objectives of the study were presented. An opportunity to ask questions and receive answers was provided. After completion of the IRT course, an email was sent to all 15 IRT course participants. The email contained a link to an online survey provided through Survey Monkey, a Letter of Information as an attachment, and instructions regarding the completion of the survey as a confirmation of consent to participate in the study. The survey contained six open-ended questions and two demographic questions about gender and discipline. Five of the six open-ended questions were derived from the MRS Program Interprofessional Education Curriculum objectives. The sixth question was in regard to program improvement. Each question was posed to the resident and the radiation therapy student. The qualitative data were obtained, and responses for each survey question were analyzed individually for content and theme.

Ethics Ethics approval was sought and obtained from the authors’ institution’s Research Ethics Board before proceeding with the study. The Research Ethics Board did not require a consent form to be completed because it was determined that there was no significant demographic information being gathered. In place of the consent form, a Letter of Information was to be given to each potential participant. It outlined the details of the study including the purpose, potential risks, and benefits. It indicated that participation was entirely voluntary and that participants could withdraw at any time without consequences. As well, it stated that by completing the online survey they were consenting to the study. An ethical consideration to be taken into account was the relationship between the PI and the radiation therapy students. The PI was known to the radiation therapy students as a clinical supervisor. Although the radiation therapy students reported to and were evaluated by the PI outside of the study and the students’ participation within the IRT course was not evaluated and had no impact on their success within their undergraduate clinical course. Thus, participation within the study, providing feedback on their experience also had no impact on their success within their undergraduate clinical course. Study participants were informed of this and assured that participation in the study was entirely voluntary and the completion of the survey was anonymous. Results There were 11 responses to the online survey from an eligible participant pool of 15. Of the 11 participants, seven were female and were radiation therapy students. The remaining four study participants were male and were radiation oncology residents. The gender grouping identified, female radiation therapy students and male residents, is somewhat typical of the respective professions. What did you gain from your experiences with the radiation oncology residents/radiation therapy students? Overall, learners from both disciplines found the IPE experience beneficial and supported the concept of interacting with each other. The radiation therapy students were given an opportunity to share and transfer their acquired clinical knowledge to another health care professional. In performing this knowledge transfer, it assisted the radiation therapy students to consolidate their knowledge and better understand their own profession. ‘‘As a radiation therapy student, it was rewarding to be able to relay the knowledge and skills I have acquired to another member in the RT discipline. It provided me with an opportunity to communicate and consolidate my knowledge as well.’’ ‘‘I have gained the opportunity to demonstrate to another health care professional about the daily responsibilities of radiation therapists.’’


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The experiential gain by the radiation oncology residents was not as profound, less specific, but generally more holistic. ‘‘A slight insight to the oncology program and their [radiation therapy] responsibilities towards the patient.’’ ‘‘The importance of teamwork.’’ ‘‘I learned that we are all students at some point in time and that we can learn from each other.’’

How was your experience with the radiation oncology residents/radiation therapy students beneficial in providing an opportunity for interprofessional education and collaboration? Overwhelmingly, all the radiation therapy students viewed their interaction with the residents as a chance for IP education and collaboration. They also felt it was an opportunity to better understand the roles and responsibilities of each profession, where it overlaps, and where there are gaps and areas for collaboration. ‘‘I think it was great, because I think it gave the residents a better idea of what therapists do and I think it will give them a better idea how to collaborate with therapists during their careers.’’ ‘‘I believe the interaction with the radiation oncology resident was beneficial. The therapists on our unit and I were able to bridge the gap between the responsibilities of the radiation oncologist and radiation therapists. When the residents are practicing physicians, they can work with radiation therapists to determine solutions to issues that may be outside their scope.’’

The residents agreed with the overall opportunity for IP education and collaboration; however, they were less expressive in their written comments. They did observe the benefit of establishing the IP relationship early. This may in part be due to witnessing the collaborative nature of the daily interactions of the radiation therapists and their team based approach to care, treatment delivery, and problem solving. ‘‘.because it allowed early exposure to part of the multidisciplinary team in a mutual manner.’’

How were you able to reflect on your practice and communicate it effectively? Comments from the radiation therapy students regarding the IPE experience as an opportunity to reflect on their practice and communicate it effectively were somewhat mixed. The majority of students agreed that they were given an opportunity to take the lead and take ownership in their knowledge and profession. They also recognized the importance of where they were within their training, later in versus earlier on, as a gauge for their knowledge and ability to comfortably share it. ‘‘I think the timing of this event was well planned. I had enough experience and knowledge to be able to take a lead role and effectively communicate with the resident.’’ ‘‘.my clinical experience thus far has helped to solidify my didactic knowledge.’’ 186

However, some students did feel overwhelmed and required the support of the radiation therapy staff to assist with communicating practice knowledge. ‘‘Seeing as how this was the first opportunity I’ve had to act as a preceptor for another in the field of radiation therapy, I found I was a bit overwhelmed at times with questions regarding technicalities of the machine and policies, so was not always able to provide the information that they sought. However, the other members of the RT team were also there and able to fill in the gaps when necessary.’’

Unlike the radiation therapy students, who were approaching the end of their clinical practicum and would soon be practicing professionals, the residents were just starting their education and training. The relatively early stage of their training may have influenced their lack of ability to see the immediate relevance of this IPE experience to their practice. However, one resident did appreciate the future impact it may have. ‘‘.unfortunately at this point it is too early to have this impact practice directly, but it does serve as a good introductory exposure to part of the team and how interactions can be improved down the road.’’ ‘‘With little clinical oncology experience I felt like I sometimes didn’t know what questions to ask or how to best use the time.’’

How were you able to build a foundation for team based and collaborative practice through your interactions with the radiation oncology residents/radiation therapy students? Being open and receptive to understanding the radiation therapist role and responsibilities was viewed by the radiation therapy students as a key indicator that the residents were open to collaborating. ‘‘The radiation oncology resident were very open to understanding what it is that radiation therapists do, and for that reason I found it easy to have a flow of ideas and dialogue between us. This sets the stage for future interactions and collaboration.’’ ‘‘I believe so as the residents now has a better understanding in what the therapists do, i.e., he now understands that radiation therapist have a significant role in patient caredin the future this could prompt him to collaborate with therapists with regards to patient care.’’

The residents viewed the physical inclusion of themselves with the existing team as an indicator for collaboration and team inclusion. ‘‘.this was a good beginning to interprofessional teamwork. My first experience on [the] CT sim[ulator], I was able to work and learn from the whole team as well as see the other side.’’

How were you able to learn with, from and about the radiation oncology residents/radiation therapy students? The radiation therapy students seized the occasion to ask questions and gain a better understanding of the residents


and the role they play within health care. The students also took the opportunity to learn together with the resident in reviewing and solving dilemmas relating to their daily practice. ‘‘The radiation oncology residents were very honest with the amount of information they knew (or didn’t), this honesty made it quite easy to talk to them and learn about their paths as residents.’’ ‘‘The resident was friendly and willing to explain about his program.’’ ‘‘I was able to learn with the radiation oncology resident with the help of the staff. During times when staff were trouble shooting, I was able to learn from it and walk through the steps with the resident at the same time.’’

Radiation oncology residents were able to recognize and appreciate the unique perspective of the radiation therapy students as a learner and as an expert in their field. ‘‘As learners, the radiation therapy students are able to provide a slightly different perspective on the roles of the radiation therapist and the specific skills/knowledge involved.’’ ‘‘These sessions greatly increased my knowledge on the role of the radiation therapist, as well as their licensing, level of expertise in physics and radiation effects and their role in patient care.’’

Discussion The introduction of an IPE experience within the clinical placement of the IRT course proved to be a good venue for introducing two professions that are dependent on each other but may not necessarily have the opportunities to interact closely in the realities of a large institution. The overall outcome of the IPE experience between the radiation therapy students and the radiation oncology residents has been positive and beneficial to both groups. They were able to learn with, from, and about each other with particular emphasis on their professional roles and responsibilities and where they observed an overlap, namely patient care. In essence, they were able to establish the framework for an effective interprofessional team, which is characterized by the knowledge and understanding of each team member’s profession, as well as their ability to appreciate one another’s skills and contributions to patient care [12]. The timing of this IPE experience occurred at an appropriate stage in the radiation therapy students’ education and training. The students had completed all their required didactic courses. They are in their final clinical placement and are a few months away from graduating, writing their certification examination and working professionally. They have reached the point at which their clinical knowledge, skills, and confidence have matured. They are proud and secure in whom they have professionally become and will be [13]. They are ready and eager to share their professional knowledge and practice with others. In addition, the IPE experience was with a neighboring profession dealing with the same patient group, which

made the IPE experience more relevant and easier to engage [13]. They were able to easily converse in their professional language without needing to modify the content or explain the context. If the IPE experience had occurred at an early stage in the radiation therapy students’ education and training it may not have been as successful [8]. The insecurities of being new to clinic and having limited clinical experience to draw upon could have impacted their ability to take the lead in the IPE experience and knowledge transfer. The radiation therapy students appeared to gain the most insight into their own professional identity and were eager to share their views of their professional role within the larger construct of caring for radiation oncology patients. They easily took the lead in the IPE experience, guiding the professional dialogue, offering explanations, and providing answers. This role has traditionally been assigned or assumed by physicians [2, 14, 15]. The residents’ willingness to engage within the IP experience and view themselves with the radiation therapy students as learners may be reflective of the early stage in their education and training and the lack of professionalization that has taken place [2, 8, 14]. The timing of the IPE experience for the radiation oncology residents may not have occurred at the most opportune time. The residents are new to their chosen specialty. They are just beginning their education and training and are not as familiar with the knowledge, practice, or key players that exist in radiation oncology and radiation therapy. Although they encountered some discomfort because of their lack of clinical radiation oncology knowledge and experience, the IPE event remained an excellent opportunity for them to learn from, with and about another professional group without the influence of professional stereotypes [14, 16]. As well, with the limited professional knowledge, there was less need for securing and protecting the knowledge for professional advantage [15]. The professional identity of the residents had not fully cemented and thus they may have been more willing to engage in IPE and learn from a professional group that has been traditionally identified as dependent on their own [16]. The lack of a professional identity may have resulted in the residents being less resistant to sharing leadership in an IP team setting [2]. Conclusions Embedding interprofessional opportunities for learning throughout the undergraduate medical program is critical to establishing the framework for future interprofessional interactions. Participants are familiar with the concept, and thus when introduced in the clinical environment they are more likely to embrace and engage in it fully. In addition, creating multiple opportunities for IPE within the clinical environment is key to maintaining its clinical relevance and momentum. Timing is important in maximizing the benefits of IPE. Ensuring that all participants are at the most appropriate stage in their education and training is critical to achieving full


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engagement and greatest outcomes, especially when bringing together professionals with a natural hierarchy [16]. Careful consideration of the influences of professional stereotyping may dictate the timing for IPE opportunities. It may be more appropriate to introduce learners belonging to the higher echelon to IPE earlier in their education and training, before the influence of stereotypes and at a stage where they can appreciate the IP learning taking place, regardless of who is delivering the knowledge [17]. Conversely, it may be more appropriate to introduce IPE to professional groups lower in the hierarchy later in their education and training when knowledge, skill, and confidence in their professional identity is matured and secured [18]. One of the major challenges to IPE is ensuring that the attitudes of all the health care workers are directed toward a working environment that will provide the best patient care [3]. This means that everyone on the team needs to know their own roles and the roles of the other team members. IRT’s unique interprofessional approach of teaming radiation therapy students with radiation oncology residents in the clinical setting has achieved this. Both the radiation therapy students and the residents have a better understanding of the role each play in the care of their mutual patient and have identified opportunities for collaboration in their future practice. To supplement this IPE experience and further enhance the acknowledged need for IP collaboration in the future, a second IPE experience could be introduced later in the residents’ training when their knowledge base is greater and their capacity to share within the context of radiation oncology has improved. It could facilitate further promotion of collaboration between these two disciplines by providing an additional opportunity to spend time together, to learn and work together in a meaningful way, and to break down the walls of professional silos, socialization, and stereotypes. References [1] Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 2: factors, processes and outcomes. J Interprofessional Care 1, 39–48. [2] Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. J Interprofessional Care 19, 188–196.

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[3] Cook, D. A. (2005). Models of interprofessional learning in Canada. J Interprofessional Care 19, 107–115. [4] Suter, E., Arndt, J., Arthur, N., Parboosingh, J., Taylor, E., & Deutschlander, S. (2009). Role understanding and effective communication as core competencies for collaborative practice. J Interprofessional Care 23, 41–51. [5] Gillan, C., Wiljer, D., Harnett, N., Briggs, K., & Catton, P. (2010). Changing stress while stressing change: the role of interprofessional education in mediating stress in the introduction of transformative technology. J Interprofessional Care 24, 710–721. [6] White, E., & Kane, G. (2007). Radiation medicine practice in the image-guided radiation therapy era: new roles and new opportunities. Semin Radiat Oncol 17, 298–305. [7] Centre for Interprofessional Education, University of Toronto, Toronto, Canada, 2011. Available at: http://www.ipe.utoronto.ca. [8] Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: the learner, the educator and the learning context. J Interprofessional Care 19, 21–38. [9] Rosenfield, D., Oandasan, I., & Reeves, S. (2011). Perceptions versus reality: a qualitative study of student’s expectations and experiences of interprofessional education. Med Educ 45, 471–477. [10] The Michener Institute/University of Toronto, Faculty of Medicine. Medical Radiation Sciences Program Student/Handbook, 2009/2010. [11] D’Amour, D., & Oandasan, I. (2005). Interprofessionality as the field of interprofessional practices and interprofessional education: an emerging concept. J Interprofessional Care 19, 8–20. [12] Curran, V. R., Sharpe, D., Flynn, K., & Button, P. (2010). A longitudinal study of the effect of an interprofessional education curriculum on student satisfaction and attitudes towards interprofessional teamwork and education. J Interprofessional Care 24, 41–52. [13] Wackerhausen, S. (2009). Collaboration, professional identity and reflection across boundaries. J Interprofessional Care 23, 455–473. [14] Reeves, S. (2000). Community-based interprofessional education for medical, nursing and dental students. Health Social Care Community 8, 269–276. [15] Baker, L., Egan-Lee, E., Martimianakis, T., & Reeves, S. (2010). (2010) Relationships of power: implications for interprofessional education. J Interprofessional Care. 25, 98–104. [16] Lewitt, M. S., Ehrenborg, E., Scheja, M., & Brauner, A. (2010). Stereotyping at the undergraduate level revealed during interprofessional learning between future doctors and biomedical scientists. J Interprofessional Care 24, 53–62. [17] Cooke, S., Chew-Graham, C., Boggis, C., & Wakefield, A. (2003). ‘I never realized that doctors were into feelings too’: changing student perceptions through interprofessional education. Learning Health Social Care 2, 137–146. [18] Tunstall-Pedoe, S., Rink, E., & Hilton, S. (2003). Student attitudes to undergraduate interprofessional education. J Interprofessional Care 17, 161–172.
