Examining Longitudinal Patterns in Interprofessional Attitudes and Competencies Among MSW Students: Trajectories of Learning before, during, and after 2-Semester Full-Time Field Placements

Background/Purpose: Patient-centered interprofessional collaborative healthcare improves quality and health equity. Acquiring interprofessional competencies requires early exposure to interprofessional education (IPE) and team-based care. Yet little is known about trajectories of interprofessional growth over time, especially among MSW students, and commonly used IPE measures have limitations including ceiling effects and inflated self-appraisal. The purpose of this study was to employ longitudinal methods to uncover patterns of interprofessional learning among MSW students over three semesters. We hypothesized: (H1) Student interprofessional attitudes improve more during immersive clinical internships than coursework+IPE. (H2) Student pre-clinical self-appraisals are inflated compared to retrospective self-appraisals, which correct for overconfidence.

Methods: MSW students (n=115) in a HRSA Behavioral Health training grant (2017-2021) participated. Mean age was 30.1 (SD=9.8), 93% were women, 13% were Hispanic/Latinx, and racial identities were White (78%), African American (7%), Asian (9%), multi-racial or other (15%). Student backgrounds included rural (42%), first generation college (41%), and economic disadvantage (60%). Clinical training focused on integrated health and behavioral health services and IPE. Students completed questionnaires at four timepoints across three consecutive semesters: prior to advanced coursework+IPE (T1), and before (T2), during (T3), and after (T4) a 2-semester block field placement. Measures included Interprofessional Socialization and Valuing Scale (ISVS-21), and ISVS-21 retrospective pretest assessing pre-clinical attitudes later at T3 and T4. Descriptives were computed in SPSS; ANOVA and Growth Trajectory Modeling were conducted using MPlus which accounts for missingness with full information maximum likelihood. We accounted for nesting by cohort in all analyses.

Results: Repeated measures ANOVA was conducted to compare mean level changes on ISVS scores. ISVS scores differed by time, 𝜒2(3)=32.51, 𝑝< 0.001; with increases from baseline (M_T1=5.65) to each timepoint (M_T2=6.12, M_T3=5.91, M_T4=6.19, p<.001); and from middle to end of field (T3 to T4); but not pre-clinical (T2) to T3 or T4. A latent growth curve model was estimated for ISVS, establishing a linear model, 𝜒2(3)=3.72, 𝑝=0.29 and a significant rate of growth over four timepoints (Slope = 0.473) from T1. Examination of ISVS retrospective pretest scores (students’ re-assessment of pre-clinical) also showed difference in scores by time (re-assessed at T3, 𝜒2(3)=15.93, 𝑝< 0.001; and again at T4, 𝜒2(3)=17.74, 𝑝< 0.001). Students’ recollections of their pre-clinical attitudes that were assessed at T3 (M=3.98) and T4 (M=3.77) were both lower than their original self-appraisal at T2 (M=6.12).

Conclusions/Implications: Findings show greatest changes in interprofessional growth occur during coursework+IPE and during the second semester of field education. Unexpected decline at the end of the first clinical semester suggests that 1-semester of field may be insufficient to solidify interprofessional competencies that recover and increase to highest score after two clinical semesters. Student confidence appears to be inflated pre-clinically, but novel retrospective pretesting allows reassessment of pre-clinical attitudes with the added perspective of time (hindsight) and clinical immersion, thus mitigating a perplexing limitation of IPE measures.