As identified in the first article in this series (Power et al, 2021), opportunities for interprofessional education, where different professions can learn with, from and about each other, are key to fostering collaborative practice and improving the quality of care (Centre for the Advancement of Interprofessional Education, 2002). This article, the sixth in the series on interprofessional education, will focus on the experiences of assessing students undertaking interprofessional education during the COVID-19 pandemic, as well as the adaptations made to this process.
According to the United Nations Educational, Scientific and Cultural Organization (2021), the COVID-19 pandemic affected more than 220 million tertiary level students worldwide. As universities grappled with pivoting to online delivery because of physical distancing requirements, remote or online assessment posed a further significant hurdle. However, this challenging period presented unprecedented opportunities for re-examining and re-imagining assessment approaches. This article will explore examples of assessment types used in interprofessional education during this time and modifications to existing systems, drawing on theory and findings from existing literature and illustrated with case study reports and reflections from academics. Consideration will be given to opportunities for innovation and evidence-informed guidance for future and alternative approaches to student assessment of interprofessional education.
What is assessment and why does it matter?
Assessment is an integral component of teaching and learning with diverse functions and purposes. Its purposes can be distinguished as the ‘assessment of learning’ and ‘assessment for learning’. Assessment of learning focuses on certification and quality assurance to provide accurate information for formal decisions about progress and achievement. Assessment for learning focuses on guiding learning and providing feedback to students and teachers (Schuwirth and van der Vleuten, 2011; Bloxham, 2014). While these purposes are not mutually exclusive, they serve to frame consideration of interprofessional learning assessment during the pandemic.
Assessing interprofessional learning is complex and multifaceted, creating the potential for controversy and tensions between accreditation and compliance with professional and regulatory standards, while supporting the students' motivation and engagement and providing learning feedback for both students and teachers. Regulatory frameworks mandate health and social care professional education programmes to produce graduate practitioners who have the competence and capability to practice effectively in interprofessional collaborative teams. However, Rogers et al (2017) reported a lack of consensus on optimal strategies for guiding the assessment of interprofessional learning, finding tensions between professional body requirements, service requirements and service user expectations. Additionally, there was limited agreement among stakeholders as to what constituted an adequate curriculum, aligning learning outcomes with activities and assessment strategies for interprofessional learning (Rogers et al, 2017).
‘Assessment for learning’ represents a radical shift in thinking, supporting students to learn rather than focusing on certification and quality assurance (Boud and Falchikov, 2007). The implications for changes in assessment practice are considerable, emphasising the formative and diagnostic function of engaging students in assessment. This helps students learn by completing assignments and gaining feedback, and, importantly, introduces ‘assessment as learning’, equipping students for lifelong learning by developing their ability to self-assess and regulate beyond graduation (Boud and Falchikov, 2007; Bloxham, 2014).
Assessment has a major influence on student learning and behaviour, by directing attention to what is important, acting as an incentive for study and influencing what students do and how they do it (Boud and Falchikov, 2007). Assessment in higher education is predominantly used for summative purposes, to determine whether, and to what extent, a learner has acquired sufficient knowledge, skills and capabilities to meet module and programme requirements through the final grades awarded (Knight, 2007; Schuwirth and van der Vleuten, 2011; Bloxham, 2014). Problems with conventional methods for summative assessment, such as high-stakes, end-of-course examinations, exist because they are viewed as something that is done to the students. Learners are passive, with no role other than to subject themselves to the assessment acts of others, to be measured and classified (Boud, 2007; Schuwirth and van der Vleuten, 2011). This approach is incompatible with encouraging students to adopt more active, deeper approaches to learning.
Interprofessional learning assessment may be formative, but it has been argued that students and educators are more likely to value summative assessment that contributes to professional qualifications (Domac et al, 2016; Barr et al, 2017). Rogers et al's (2017) analysis of interprofessional learning assessment outcomes stated that assessment promotes engagement for students who may otherwise pay more attention to uniprofessional learning. Furthermore, combining different types of assessment is recommended for interprofessional learning, such as those that look to both individual learners and their performance within a group or team setting (Rogers et al, 2017). Reflective diaries, learning logs, portfolios and objective structured clinical examinations are examples of assessment methods (Barr et al, 2017).
However, for assessment to be truly effective, curriculum design needs to go further. It is not only a matter of appreciating and responding to the combination of summative assessment of learning and formative assessment for learning. Consideration also needs to be given to developing a range of diversified assessment strategies to capture the complex range of knowledge, skills and capabilities that a healthcare professional is expected to possess. It is also important to build opportunities for feedback on assessment tasks and feedforward to improve performance on similar tasks in the future.
Assessing interprofessional learning: towards best practice
Best practice in assessing interprofessional learning is predicated on constructive alignment between desired learning outcomes, learning activities and how they are assessed (Biggs and Tang, 2011). For effective assessment, programme developers need to examine the contribution that the assessment makes to desired learning outcomes. Assessment tasks vary in the types of learning outcome they are capable of assessing and can be mapped against Bloom's (1956) taxonomy of educational objectives. These include knowledge-based information recall through factual tests (with short answer and multiple-choice questions), performance-based application of professional knowledge, communication and teamwork skills (demonstrated through simulation and objective structured clinical examinations) and analysis and evaluation in reflective practice-based assignments (such as e-portfolios or reflective individual and group blogs) (Hutchings et al, 2013; Bloxham, 2014; Anderson and Kinnair, 2016). The challenge for healthcare programmes when integrating interprofessional education learning outcomes and assessment in the core curriculum is to identify the additional contribution of interprofessional learning. This should not overlap with uniprofessional education learning outcomes, areas and assessments (Anderson and Kinnair, 2016).
Assessment in interprofessional learning can provide programme planning and maintenance information for educators. Pre- and post-session testing assists programme designers in checking learners' prior understanding. This is of particular interest in interprofessional learning, where the extent and nature of knowledge and skills differs between disciplines. Testing also reveals what learners have drawn from the course. This is particularly important in interprofessional learning, as students from different disciplines may have different learning objectives (O'Keefe and Ward, 2018), making it difficult to reconcile the summative, formative and course design dimensions of interprofessional learning assessment.
The role of assessment in warranting or certifying student achievement means that being able to verify the validity and reliability of summative assessments is important (Bloxham, 2014). Achieving best practice in assessment depends on the agreement of standards against which performance of learning can be judged. Much collaborative work has been undertaken to develop interprofessional competency and capability frameworks for use in learning outcomes-focused curricula in healthcare (Frank et al, 2010; Thistlethwaite et al, 2010, 2014; Rogers et al, 2017). However, it has been argued that it is difficult to grade complex higher order learning achievements reliably and validly to warrant the soft skills in the psychosocial domain valued by employers, such as self-efficacy, autonomy, interpersonal relationships and leadership skills (Knight and Yorke, 2003; Knight, 2007; Yorke, 2011).
Translating what is important to assess in interprofessional learning, Rogers et al's (2017) panel of interprofessional education leaders recommended including outcomes in six domains:
- Role understanding
- Interprofessional communication
- Interprofessional values
- Coordination and collaborative decision-making
- Reflexivity
- Teamwork.
However, they also identified that the outcomes were ‘somewhat nebulous’ and difficult to define in order to grant competence to practice (Rogers et al, 2017). Similarly, Domac et al (2016) recognised that despite guidance for assessment of interprofessional competence and capability, it remains challenging to assess interprofessional learning because of ‘diffuse understandings of professionalism’. These include ‘value-based principles for practice, accountability, human professional behaviours such as empathy, compassion and altruism, how to communicate, boundaries to frame practice with service users and team working’ (Domac et al, 2016).
Several writers have examined the social nature of assessment. Yorke (2011) argued that ‘the practice of grading and the cumulation of grades into an overall index of achievement are socially constructed activities that fall a long way short of what is expected of scientific measurement’. Lurie (2012) argues that because interprofessionalism is mainly a social competence, it may be more appropriate to abandon reductionist approaches to measurement and embrace complexity in relation to ‘patterns of human performance in the clinical setting’.
This understanding of the social nature of assessment gives prominence to professional judgement over measurement, while acknowledging the value of the ‘menu-marking approach’ (Yorke, 2011), which uses marking criteria and rubrics, derived from frameworks and standards against which less experienced markers can develop their expertise as assessors. It recognises and values programme teams' professional judgement in steering a middle course through integrating curriculum design and assessment. It also supports the argument that where ‘well-chosen and contextualised, interprofessional competencies can usefully complement the broader attribute descriptions typical of uniprofessional standards and can direct students to the specific areas of learning required’ (Thistlethwaite et al, 2014).
Judgement is not confined to programme planners and assessors. For students to become agents for change, they need assessment that involves cognitive challenge, development of metacognitive capabilities, shaping of identity and building confidence and growth towards active citizenship (Healey et al, 2016; Brown and Sambell, 2020). Best practice in assessment can contribute by nurturing the progression of formative professional judgement on the part of the learner.
Practice-based learning has an integral role in healthcare programmes, despite the challenges of incorporating interprofessional practice learning. Hutchings et al (2022) reported on learning outcomes and competencies required for safe and effective professional practice, while a World Health Organization (WHO, 2022) report called for competency-based learning in practice. The global competency framework for universal health coverage (WHO, 2022) reaffirms the application of knowledge, skills, attitudes and behaviours to performance in the practice context as the means for demonstrating and assessing the mastery of learning outcomes through a set of defined competencies for education programmes. The framework emphasises that knowledge, skills and attitudes are developed interdependently, and that the behaviours required by the health workforce are not learned in isolation, but in the context of tasks and situations for real-world practice. Therefore, there is a need for practice-based authentic integrated assessment capable of assessing multiple aspects of developing competencies.
Developing and valuing well-designed authentic assessment practices, paired with selected interprofessional learning competencies or capabilities, can be transformative to students' lives (Villarroel et al, 2018). This forward agenda for effective interprofessional education assessment aligns with Gordon and Walsh's (2005) argument for embracing capability rather than competence for assessment of interprofessional learning. While both capability and competence are geared to demonstrating progression over time, capability does not stop at a student demonstrating that they can undertake a task successfully. It is defined by Fraser and Greenhalgh (2001) as an integrated application of knowledge where the student or practitioner can adapt to change, develop new behaviours and continue to improve performance in different contexts. Capability is enhanced through feedback on performance and the challenge of unfamiliar contexts. Education for capability must focus on process, supporting learners to construct their own learning goals, receive feedback, reflect, consolidate and avoid goals with rigid and prescriptive content.
In seeking to nurture student learning for the longer term, an interprofessional learning curriculum is needed, where appropriately designed assessment practices are constructively aligned with interprofessional competencies. The idea of integrating and embedding assessment in the learning process is not new; however, the impact of COVID-19 triggered the need for changes in assessment to maintain continuity for students and their qualifications, while managing assessment processes remotely (Brown and Sambell, 2020). Responses and adaptations as a result of the pandemic provided the impetus for rethinking assessment and redressing the balance between assessment of learning and assessment for learning.
Assessment innovations and challenges during the COVID-19 pandemic
The pandemic clearly accelerated transitions to online teaching, learning and assessment. Various terminologies have been used to describe assessment facilitated through technology, including computer-based or aided assessment, online assessment, e-assessment, technology-enhanced assessment and digital assessment (Timmis et al, 2016). The Joint Information Systems Committee (2020) suggested that the UK was behind other countries in the use of e-assessment, with investment required in data systems, infrastructure and staff development. However, given the rapid pivot to online delivery and assessment, and despite the inherent challenges faced by students and staff, examples in the literature and the case studies in this article demonstrate the breadth of creativity and innovation of approach to alternative online assessment in relation to interprofessional education.
In the assessment of healthcare students, Sahu et al (2022) determined the essential e-assessment modes to be knowledge-, performance- and practice-based assessment, using options such as open-ended short answer questions, problem-based questions, viva examinations and recorded objective structured clinical exams. Further examples in the literature include the use of multiple choice questions, self-assessment, projects, portfolios, peer evaluation, quizzes, online discussions and open book examinations (Kearns, 2012; Kumar et al, 2013; Kühbeck et al, 2019; Zagury-Orly and Durning, 2021).
However, as with any form of assessment, e-assessment options need to be selected carefully, according to what they are capable of assessing and mapped against intended learning outcomes. For example, e-assessment using poorly designed multiple-choice questions has been subjected to criticism. Students tend to adopt a surface approach, attempting to recall and reproduce information, rather than adopting a deep approach, seeking to make sense of the learning and apply it to professional practice (Gibbs, 2006; Hutchings et al, 2013). Other examples of e-assessment, some of which have been successfully used in interprofessional learning, include the use of blogs and wikis (Burns et al, 2021). These more discursive and reflective forms of e-assessment, in addition to roleplays, simulation and observations, are deemed capable of assessing students' higher order thinking and practical skills (Timmis et al, 2016; Appiah and Van Tonder, 2018).
For both staff and students, the pivot to online learning presented a challenge in terms of digital literacy and infrastructure. For staff, this was coupled with the skills and confidence required in the use of online pedagogical approaches, and for students, issues with motivation, time management and accessibility (Rajab et al, 2020; Montenegro-Rueda et al, 2021; Sahu et al, 2022). However, if designed and deployed effectively, different forms of e-assessment have the ability to both support and improve student learning. Consideration of optimal methods that are aligned with the nature (whether knowledge-, performance- or practice-based) and level of learning outcomes is nonetheless required. E-assessments have shown significant advantages, including enhanced flexibility in location and time, opportunities for collaboration and peer learning, assessment of problem-solving skills and facilitation of meaningful, timely and accessible student feedback (Timmis, 2016; Appiah and Van Tonder, 2018).
Adaptations and opportunities for innovation should be considered in the assessment of interprofessional education, outlined in this article through case reports and reflections from academics working with a range of professional groups. The case studies were acquired from members of the Centre for the Advancement of Interprofessional Education and their affiliated institutions, who were invited to outline how they had assessed interprofessional education during the pandemic, identifying changes in approach and their impact on students and staff.
Case studies
Case studies from Qatar, England and Scotland highlight adaptations that faculties made in assessing interprofessional learning. In some instances, these raised challenges for students and faculty. However, some adaptations enabled new opportunities to develop future-facing assessment strategies.
Qatar University: cross-faculty assessment
Previous assessment methods
In Qatar University, interprofessional education was integrated in different healthcare curricula, including the pharmacy, health sciences, medicine and dental medicine colleges. Usually, assessment methods varied across colleges. In pharmacy and health sciences, interprofessional education was typically assessed through written reflective accounts. Assessment by portfolio was used in medicine and dental medicine, and pharmacy assessed first year students using multiple choice questions and short written answers. For students required to complete reflective accounts and portfolio tasks, this was undertaken after engagement with an interprofessional education activity in an academic environment, or an interprofessional education activity in clinical placement.
Adaptations for COVID-19 and their challenges
As interprofessional education activities moved to online delivery, several adaptations had to be implemented to ensure continuity (Wetzlmair et al, 2021). Student engagement in online activities varied, as many students were reluctant to use their cameras and some faced technical difficulties. This variation in experience and the absence of assessment influenced student engagement for some participating professions. It was a particular challenge for students who were still required to write a reflective written account following their online experience.
Opportunities for future assessment strategies
The COVID-19 pandemic was an opportunity to reflect on assessment strategies and work towards unifying assessment across the colleges with the aim of ensuring:
- Similar exposure for all health students, allowing equal opportunities for all
- Structured integration and assessment
- Graduating a capable and competent workforce, equipped with the skills to work interprofessionally.
To address this, an interprofessional education passport programme was developed. On completion and fulfilment of its requirements, students received a certificate of passport completion, signed by the vice president for health and medical sciences. Students could add this to their curriculum vitae or portfolio. The purpose of the passport was to:
- Motivate students to attend, participate and engage in activities as part of a structured programme
- Provide a tool to enable students to participate in a progressive manner, tailored to their level of study
- Enable students to meet shared competencies and enhance their understanding of interprofessional education concepts and principles
- Enable students to demonstrate that they met interprofessional education requirements.
The faculty at Qatar University collaboratively designed and implemented a comprehensive assessment strategy to target interprofessional education goals and competencies. All students are now required to complete a minimum of four interprofessional learning activities, with at least one at each level of exposure, immersion and mastery, based on the University of British Columbia interprofessional education model (Charles et al, 2010; El-Awaisi et al, 2017). For each activity, students are required to submit a reflective assignment, as per their assigned course or module, to add to their passport. These assignments are graded by their college using an assessment rubric designed for each level of study, with a score assigned to the course or module.
Glasgow Caledonian University: staff and student digital literacy
Previous assessment methods
The framework developed by Glasgow Caledonian University is similarly based on the exposure to mastery model (Charles et al, 2010). The framework uses a varied and cohesive assessment strategy, which is horizontally and vertically aligned, both in terms of the framework and programme-specific modules.
Adaptations for COVID-19 and their challenges
The first year 11-week module delivered to a range of allied health and social work students focused on professional attributes. Interprofessional groups studied concepts relating to professional requirements, including standards and behaviours, communication, conflict management, reflection, organisational context, cultural competence and personal resilience. Assessment required students to develop an e-portfolio and enter content on a weekly basis, including evidence of core clinical skills such as cardiopulmonary resuscitation, data protection, and infection control. These skills were deemed mandatory and non-completion led to an automatic fail. Additional content related to reflection on aspects such as cultural competence, communication, personal resilience and conflict resolution.
The module team faced challenges because of the need to develop and evidence clinical skills in an online environment. To mitigate these, the team used a variety of pre-existing resources available on the TURAS NHS Education for Scotland digital learning platform (designed to support health and care professionals working in the public sector) and resources developed by the British Resuscitation Council. Written instructions were provided to enable students to access external platforms; however, non-completion of mandatory skills led to many students failing. It became clear that non-completion was primarily because some students were unable to access the platforms. In an attempt to remedy this for future cohorts, mandatory sections are now delivered earlier in the module to enable difficulties to be detected earlier. Additional video content has been developed to illustrate access to external content, which serves to supplement the written instructions.
Digital literacy of both staff and students proved an additional challenge. Staff training was provided and students were given written and video instructions on the functionality of the e-portfolio. Despite this additional support, some students and staff struggled.
Opportunities for future assessment strategies
COVID-19 presented interprofessional education teams with challenges, but conversely enabled them to reflect and review teaching and assessment practice that optimised the digital capacity of students and graduates. The team were familiar with using wikis in interprofessional education modules (Burns et al, 2021) and amended practice to enable students to develop an e-portfolio within a wiki platform. The e-portfolio allowed students to demonstrate the completion of mandatory placement materials, reflective practice and collaborative work on an IT platform. This also allowed students to use the full digital functionality of the platform, enabling them to develop and demonstrate their digital capabilities. This aligns the online teaching and learning approach to policy requirements for a digitally skilled workforce (Scottish Government and COSLA, 2021).
The development team did make assumptions about student and staff digital capabilities, which were found to be limited. This necessitated the development of guidance videos that demonstrated how to make full use of the wiki's digital functionality.
Northumbria University: alternative methods for practice assessment
Previous assessment methods
At Northumbria University, interprofessional education was assessed in practice placement and through module learning outcomes. In practice, students worked with other professionals and core interprofessional competencies were formatively and summatively assessed. Aligned to European Union regulations, nursing students completed a 3-year experience log to capture knowledge and experiences of collaborating with other professions. While assessment differed between health and social care students, all professional, statutory and regulatory bodies required students to demonstrate effective and professional collaboration to promote safe and holistic care.
In addition to practice placement, university programme and module learning outcomes included collaborative and interprofessional practice competence. For example, a second year undergraduate nursing practice module, assessed by formative and summative assessment, included a learning outcome that required students to demonstrate collaborative working skills with professionals, service users and carers, while demonstrating how collaboration improves patient safety.
Adaptations for COVID-19 and their challenges
Academic assessments were largely unaffected by the pandemic as emergency remote teaching enabled learning to continue. All interprofessional assessments were submitted online and emergency assessment regulations were applied.
However, assessment of interprofessional collaborative practice was detrimentally affected by cancelled placements. Additionally, some students were required to shield following government guidance and were unable to attend placements. When opt-in placements were offered as a result of Nursing and Midwifery Council (NMC) changes in the UK, some students opted out or were unable to opt in, and missed their placement. Some students reported additional challenges gaining experiences and being assessed. Therefore, practice assessments had to be achieved in a subsequent placement area.
In March 2020, first year nursing student placements were paused and students were removed from practice environments because of NMC (2020) emergency regulation guidelines. University staff were prevented from visiting students and practice partners in placement environments. This affected the assessment of students' interprofessional competence in practice. To achieve practice competencies, including learning about other professions, a range of virtual online collaborative technology-enabled care services were established. These services provided practice-focused online education, delivered by NHS placement practitioners to students unable to attend placement. In addition, essential teaching could be delivered at university so students followed a comprehensive simulation teaching programme. This enabled achievement of interprofessional competencies that would ordinarily have been achieved in practice placement.
The disruption caused by the pandemic affected students and staff. Staff experienced additional challenges, stress and pressures imposed by supporting students, teaching and finding alternative assessment methods. As a result of time missed from placement, traumatic experiences, shielding or diminished opportunities for development, many students were less confident or required longer to achieve competencies. Programme extensions were required to complete placement hours for registration and several students required supportive action plans to facilitate assessment in practice. Student mental health and wellbeing was affected, resulting in increased occupational health referrals and signposting to student support services. Academic and placement staff spent significant periods of time supporting students, compounded by concern about progression and programme completion. Working at home was problematic for many students, creating challenges developing collaborative practice skills and acquiring the knowledge and experience needed for interprofessional assessments.
The pandemic affected opportunities for interprofessional teaching between regional universities. Medical students from another regional university were unable to join Northumbria students for their undergraduate interprofessional educational programme. A virtual simulation ward was developed, containing a repository of interprofessional roles, to compensate for missed on-campus interprofessional activities (Park and Holland, 2022). Student knowledge and understanding were assessed using a written assignment.
Opportunities for future assessment strategies
Despite the inherent challenges of the pandemic, staff developed a wide range of skills, including the use of digital platforms. They have demonstrated creativity in teaching delivery and assessment design and deployment.
University of Northampton: adaptations and digital readiness
Previous assessment methods
The Faculty of Health, Education and Society at the University of Northampton has a ‘collaborative curriculum’ that is summatively assessed by a shared learning outcome in first, second and third year modules.
- First year: understand the impact of the inter professional role and the individual's responsibilities in the health, education and social care community
- Second year: evaluate differences in interprofessional roles and services and their associated impact on practice and service user experience
- Third year: critically analyse different approaches for collaborating effectively in interprofessional learning in health, education and social care contexts.
Programmes across health, education and social care assess learning outcomes in a variety of ways, including but not limited to reflective accounts (midwifery), portfolios (podiatry, social work), presentations (nursing, occupational therapy) and vivas (paramedic science).
Adaptations for COVID-19 and their challenges
Occupational therapy included the learning outcome in the skills modules in first, second and third year and made several adaptations. In one module, the assessment's group delivery was reconstructed with an online element, through a presentation that included delivery of a group activity in theory. Usually, students would have met as a small group, and others would have participated in the planned activity, but this was not possible and was adapted to more theory-based online delivery.
In another skills module, the poster presentation was adapted for online delivery. Instead of paired delivery in person, students separately recorded presentations using Kaltura Capture software. Students then met with a tutor in a virtual classroom for questions.
For social work, assessments were written assignments, which were not significantly affected by COVID-19. However, the main impact was on teaching delivery, where the biggest challenge was a significant ‘digital divide’ among staff and students in delivering synchronous sessions. Those comfortable with online engagement and learning were minimally affected, but for those who struggled with technology, it was more difficult. These struggles were not primarily related to student motivation, but to digital readiness, specifically technical challenges, such as reliable internet access and headset availability.
Opportunities for future assessment strategies
Since COVID-19 restrictions were lifted, staff and students have returned to campus. Assessment strategies have mainly reverted to their original formats, in line with how programmes had been typically validated. However, COVID-19 provided opportunities for innovation and creativity in designing traditionally face-to-face assessments, such as group or individual presentations. Some adaptations had additional rewards, such as students developing digital capabilities by using Kaltura Capture software to record presentations. Students consolidated their digital confidence and competence through becoming accustomed to interacting online using virtual learning environments, such as Blackboard Collaborate.
Discussion
Assessment is fundamental to education, bringing together a student's entire teaching and learning journey (Montenegro-Rueda et al, 2021). The case studies in this article explored how assessment of interprofessional education was adapted during the COVID-19 pandemic. Reflecting on these experiences, it is possible to consider the key factors that enabled educators to assess interprofessional learning during this challenging time.
Assessment can provide students and teachers with an indication of progress and serve as a vehicle to provide feedback to enhance performance (formative assessment). It can also serve as a means to grade final student performance and determine the extent of the student's learning (summative assessment) (Dixson and Worrell, 2016; Montenegro-Rueda et al, 2021). El-Awaisi et al (2022) identified a need for valid and reliable formative and summative assessment of interprofessional learning. The case studies presented in this article illustrate combinations of both approaches. COVID-19 primarily affected the mode of assessment (knowledge-, performance- and practice-based assessment), causing a shift in methods from in-person to online assessment.
Although each profession has different regulatory bodies and standards for education, the same drivers for interprofessional collaborative practice are inherent to all. These include patient safety and quality delivery of care and can guide common learning outcomes relevant to all health and social care programmes of education. El-Awaisi et al (2022) stated that assessment of interprofessional education should be explicitly mapped to interprofessional education shared competencies. This is in line with Rogers et al's (2017) expert panel consensus recommendations for learning outcomes, which included competencies around teamwork and effective communication in an interprofessional team, with reflection on those concepts and decision-making based on patients' needs (Anderson and Kinnair, 2016). An additional common key factor in the case studies was the importance of learning outcomes in constructive alignment (Biggs and Tang, 2011). Learning outcomes, activities and means of assessment were carefully aligned. In these case studies, the initiatives used common learning outcomes in their learning activities, but there was flexibility for each professional programme of study and how they assessed these outcomes. The pandemic enabled more flexible adaptations where required, yet enabled students to meet learning outcomes.
A thoughtful use of assessment enables programme teams to assess students' performance in specific interprofessional competencies and skills (Kahaleh et al, 2015). This is grounded in an appreciation of the social nature of assessment and gives prominence to professional judgement (Yorke, 2011). Common assessments include written reflections, portfolios and objective structured clinical examinations (Anderson and Kinnair, 2016; Barr et al, 2017), which are feasible during emergency remote teaching. Furthermore, mixed-methods approaches, using carefully designed combinations of assessment methods, appear appropriate for assessing interprofessional education interventions (Kahaleh et al, 2015; Shrader et al, 2017). Assessing the roles of health professional students in an interprofessional team remains challenging even with standardised assessment tools (Kahaleh et al, 2015). The assessments often fail to address the top two of Kirkpatrick's outcomes levels: change in organisational practice and benefits to patients and/or clients (Shrader et al, 2017), a finding reflected by Domac et al (2016) and Rogers et al (2017).
Some students may be required to demonstrate interprofessional outcomes when completing profession-specific assessments; however, procedures, criteria and credits should be consistent across professions and across courses (Wagner and Reeves, 2015). Consideration should be given to avoid over-assessment (Shrader et al, 2017), by introducing validated forms of assessment that do not overlap (Kahaleh et al, 2015). Additionally, for assessment to be successful, it must be authentic, whether delivered online or face to face (Appiah and Van Tonder, 2018; Joint Information Systems Committee, 2020), ensuring that the knowledge, skills and capabilities gained are applicable in the practice or work setting. Ensuring that learning outcomes continue to be robustly assessed, while simultaneously creating an authentic learning experience, is essential. However, as reported by Wetzlmair et al (2021), the shift from in-person to online assessment can prove challenging, as the case studies also demonstrated. Effective replication of face-to-face assessment to a remote learning environment should use more than a ‘lift and shift approach’, and ideally entail a redesign of the entire learning and teaching process.
Assessment adaptations need to be cognisant of the possible ‘digital divide’ among staff and students. Availability and reliability of IT equipment and confidence in its use are important enablers of sustainable online interprofessional education assessment. On the other hand, the challenges acknowledged in the case studies, including lack of confidence in using equipment, varied availability and the reliability or usage of functions such as cameras, can all present significant barriers. This affected the ability to provide equitable, impactful interprofessional learning experiences for students. Interaction and authentic experiences are key to interprofessional collaborative practice in health and social care settings (Barr and Low, 2013; Webb et al, 2019). These challenges also extended to assessment, where challenges with technology affected some higher education institutions' ability to assess interprofessional learning. Further considerations for e-assessment should include consistency, transparency, practicability, accessibility and the emerging challenge of integrity, through the prevention of student academic misconduct and dishonesty (Appiah and Van Tonder, 2018).
There are promising signs of new opportunities for re-examining and reimagining assessment of interprofessional learning, including opportunities for assessing higher order thinking and practical skills, alongside increased flexibility over time and location. Nonetheless, educators need to continue to steer a middle course, cognisant of best practice for assessing interprofessional learning and the impact of the aforementioned considerations on educators and students.
Upcoming article
The next article will focus on the theory behind service user and carer involvement in teaching and learning, providing real-life examples and focusing on the lessons learned to ensure involvement can be achieved.
CPD reflective questions
- How did the COVID-19 pandemic influence the assessment of students undertaking interprofessional education?
- What opportunities and challenges do interprofessional education assessments face post-pandemic?
- What are the key aspects that can be transferred to post-pandemic assessment of interprofessional education?