Interprofessional education (IPE) and collaborative practice are increasingly acknowledged as essential for preventing errors and improving patient care while reducing health care costs (Institute of Medicine, 2013, 2015). The hallmark of IPE is interactive, team-based learning (TBL) that promotes interprofessional practice competencies related to values/ethics, roles and responsibilities, communication, and teams/teamwork (Interprofessional Education Collaborative [IEC], 2016).
Faculty tend to teach research and evidence-based practice (EBP) using a single disciplinary perspective, ensuring that students learn the research questions and methods relevant to their discipline. Conversely, interprofessional research and EBP focus on the integration of evidence from multiple disciplines that use a variety of research methods to address complex questions (Repko & Szostak, 2017). Interprofessional research combines theoretical perspectives, expertise, and methods that add to the depth of understanding. Moyers (2016) defines interprofessional EBP as "a dynamic team process that blends the patient's preferences and values, the expertise of practitioners, and multidisciplinary evidence to implement practice changes that challenge current disciplinary paradigms and biases to create an integrated approach to patient care" (p. 5). Engaging students in an interprofessional collaborative research or EBP process strengthens and expands their ability to use multiple sources of evidence and work as a team to improve patient outcomes.
THE PROBLEM/THE INNOVATION
Undergraduate students often experience research and EBP courses as difficult, uninteresting, and irrelevant to practice. Frequently, studies included in these initial classes are divorced from their social, political, and ethical context, which serves to make the content unrelatable. This article describes an interprofessional research methods course designed for nursing, exercise, and nutrition science students that promotes teamwork in addressing a shared research/EBP problem. The identified problem, football and concussions, was selected because of its social relevance, ethical questions, and the availability of many studies from multiple disciplines.
TBL Strategies
The major goal of TBL is to develop team cohesiveness that "involves a specific sequence of activities and feedback designed to quickly change groups of individual students into high performance learning teams in which participants know each other, need each other and hold each other accountable" (Sweet & Michaelsen, 2012, p. 18). The four essential elements of TBL (formation of permanent teams, readiness assurance, application activities, and peer evaluation; Sweet & Michaelsen, 2012) were implemented using concussion in football players as an EBP focus throughout this hybrid, four-credit research methods course.
Formation of Permanent Teams
To ensure team diversity, faculty formed interprofessional student teams of five to six members that lasted the duration of the course. The course began with completion of a team charter and essential agreements, which included principles for respect, ways of interacting, handling conflict, and giving feedback as well as expected levels of participation, class attendance, and division of labor for team assignments. As the physical environment was essential for creating a learning community within each team, classrooms were selected that facilitated forming small groups that enhanced communication and team cohesion.
Readiness Assurance
The purpose of the readiness assurance process is not only to motivate students to come to class prepared but also to provide feedback on their grasp of assigned materials (Sweet & Michaelsen, 2012). Individual preparation was completed through assigned readings from textbooks and a wide variety of professional journals, viewing a segment from the PBS Frontline series "NFL: A League of Denial," and completing an individual assignment or quiz.
The Epstein Educational Enterprises immediate feedback assessment technique (http://www.epsteineducation.com) was used in a three-item weekly team quiz using scratch-off forms. Team members worked to reach consensus in answering questions and received immediate feedback about the correct answer. The team could initiate an appeal process and make a case for answers marked as incorrect, which generated further discussion and learning.
Application Activities and Peer Evaluation
Carefully designed application activities centered on research regarding football and concussions that required teams to make decisions using course concepts. For example, one team assignment focused on a published controversial study with well-known ethical issues. Teams completed an evidence appraisal tool and responded to questions about who conducted the study, their qualifications, whether bias was present in the study, and how they would put together a research team or committee addressing football-related concussions. Faculty served as guides for students in their quest to dissect, research, and solve complex problems (Sweet & Michalesen, 2012).
TBL peer evaluation provides students with both formative and summative feedback from teammates about their contributions to the team and team success. Students completed peer evaluations at midterm and at the end of the course regarding team members' performance in fulfilling essential agreements in the team charter. Aggregate mean scores for each team were graphed and given to students for analysis. Student teams addressed agreements with the highest and lowest ratings and identified actions to enhance teamwork.
ASSESSMENT AND EVALUATION
Several strategies were employed to evaluate the teaching innovation's effectiveness. Student feedback was frequently obtained through the use of the "muddiest point" classroom assessment technique (Angelo & Cross, 1993). Many questions or comments centered on the research process or EBP; these were reviewed by faculty weekly, and "clarification moments" were incorporated at the beginning of each class to address questions.
Comments from students and observations from faculty were also organized by interprofessional practice domains (IEC, 2016). Interprofessional communication was noted through faculty observations during class and interactions between student team members and faculty. Roles and responsibilities were manifested through the team charter with specific roles enacted (team leader, timekeeper, recorder, team researcher, and quality reviewer). Teams and teamwork were evident through completing team assignments in class. Faculty noted that student preparedness significantly affected the teamwork dimension. The values/ethics domain was evident with many students commenting about bias in studies conducted by the football league: "Do you think the power of professional football will continue to overpower the research on concussion?" "How can we continue to encourage children to play contact sports at a young age given the evidence?"
The Readiness for Interprofessional Learning Scale (Parsell & Bligh, 1999) was administered at the beginning and conclusion of the course to assess IPE competencies in students. This tool contains 19 items organized into four subscales (McFayden et al., 2005): teamwork and collaboration, negative professional identity, positive professional identity, and roles and responsibilities. Students score each statement with a level of agreement using a Likert scale of 1 (strongly disagree) to 5 (strongly agree).
Following approval from the university's institutional review board, scores on the Readiness for Interprofessional Learning Scale survey were analyzed using Wilcoxon signed-rank test. Mean scores for each subscale were high, both at the beginning and end of the course, with no significant difference in subscale scores (Table 1). This result was not surprising because the majority of students completed several IPE courses prior to the research methods course; faculty were encouraged that student perceptions remained positive while working in interprofessional teams.
At the end of course, students completed an evaluation that addressed organization of the course, clarity of assignments and syllabus, textbooks, learning activities, and contribution to learning. Results were very positive compared to previous course offerings with respect to: a) consideration of this course to be an important part of the student's program of study, b) usefulness to prepare students for their professional field, c) in-class activities that contributed to student learning, and d) assignments that helped students learn essential content with the integration of knowledge and skills.
DISCUSSION AND CONCLUSION
The ultimate goal of IPE is to engage students in interactive learning that spans the length of their degree program and continues beyond graduation through professional development and continuing education. The topic of concussion in football effectively provided interprofessional learning experiences and a vehicle to integrate evidence from multiple disciplines with social, political, and ethical implications that created more engagement.
TBL provides an opportunity for students to acquire and refine the competencies needed for interprofessional practice. Nurse educators are challenged to collaborate with other health professionals to develop meaningful IPE opportunities for students (National League for Nursing, 2015). Working in teams and using evidence as a foundation for nursing practice are essential skills that will contribute to better patient outcomes.
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