The COVID-19 pandemic has had a major impact on societies and individuals. Social distancing measures were introduced to stop the spread of the virus and as a result, most levels of teaching and learning transferred from face to face to online. Universities tried to provide ongoing health and social care education through emergency remote teaching while face-to-face teaching and practice-based learning placements were suspended (Sani et al, 2020). This transformation happened unexpectedly and had to be accomplished in a short period of time (Iglesias-Pradas et al, 2021).
As outlined in the first article in this series (Power et al, 2021), interprofessional collaborative practice is essential for providing high-quality, effective healthcare. Globally, universities have introduced interprofessional education for students to learn with, from and about each other to improve quality of care (Centre for the Advancement of Interprofessional Education (CAIPE), 2002; World Health Organization, 2010; Gonzalez-Pascual et al, 2018; Mahajan et al, 2018; Nichols et al, 2020). Like most teaching, the delivery of interprofessional education was affected by the pandemic and the suspension of face-to-face teaching (Langlois et al, 2020). It is valuable to consider how facilitators coped with this shift and ensured the ongoing delivery of interprofessional education. The aim of this second article in the series on interprofessional education is to focus on its delivery during the pandemic. It will provide an international perspective through facilitators' case reports and will reflect on key aspects that had to change, as well as factors that enabled a rapid shift from face-to-face to online interprofessional education. As acknowledged by Khalili (2020), there are challenges and opportunities for interprofessional education during the COVID-19 pandemic. Therefore, this paper will reflect on the lessons learned and offer recommendations to guide future remote and online interprofessional education.
It is possible to consider the 3P (presage, process, and product) model of teaching and learning to reflect on the delivery process of interprofessional education during the COVID-19 pandemic. This model was proposed by Biggs (1993) and discussed within the context of interprofessional education by Freeth and Reeves (2004). ‘Presage’ factors are essential to ensure learning can take place, such as facilitators' and learners' characteristics, and the context for learning and teaching. The ‘process’ involves planning and delivering interprofessional education, and consists of teaching and learning approaches such as remote and online learning and the facilitation style. The final stage refers to ‘product’ factors, such as developing attitudes, perceptions, knowledge, skills, behaviour and impact on practice.
This article focuses on the delivery ‘process’ of interprofessional education in emergency remote teaching. Freeth and Reeves (2004) divide the process into eight categories, which will be discussed throughout the article. These categories are:
- Selecting uni-, multi-or interprofessional education
- Selecting the appropriate stage
- Duration
- Teams versus individual learning
- Remote and online learning
- Opt-in or compulsory learning
- Assessments
- Facilitation.
This article will discuss the delivery process based on findings from existing literature and international experiences from Austria, England, Qatar, and Scotland.
International experiences of emergency remote teaching
The case studies outline key factors that had to change in the delivery process of emergency remote teaching for interprofessional education. This is based on international case studies, which were generated from academics and students from a range of professional groups, including but not limited to adult nursing, children's nursing, dental nursing, health and social care, dietetics and nutrition, physiotherapists, occupational therapists, medicine, pharmacy and midwifery who have had experiences engaging with interprofessional education during the COVID-19 pandemic. The case studies were acquired from members of CAIPE who work globally. They identified key aspects that they had to change in interprofessional education delivery, as well as the enablers and challenges they had experienced.
Austria
In Austria, the case study identified several key aspects that had to change; in-person interprofessional education was suspended, theory-based sessions were offered online (eg teaching healthcare students about roles and responsibilities of professions in the interprofessional team) and interprofessional education sessions that focused mainly on practical experiences were suspended.
The enablers for emergency remote teaching in interprofessional education included that it was more accessible and reduced the need for travel between faculties/locations, IT support and resources were provided by the university and peer support and interprofessional discussion took place via teams chat.
However, there were challenges for emergency remote teaching, which included that meeting other students face to face encourages more sustainable contact than meeting online, practical sessions are not transferable to an online setting and external teaching staff did not get the chance to be as well prepared as staff from the university because of time management and having insufficient time to prepare every external facilitator working for the university.
England
Three case studies were included in England, however, it should be noted that this is a summary of the three and so not all points apply to every site in England. The key aspects that had to change in England were:
- The use of online learning platforms and virtual learning environments
- Changes to staff facilitation (eg additional staff, changes to the facilitation role, staff education and support)
- Written guidance on how to access and use online learning platforms
- Timings of interprofessional education activities had to change, and this varied between universities.
There were several enablers for emergency remote teaching in interprofessional education. There were existing online learning platforms accounts, so there was no need to set up new organisational accounts. Emergency remote teaching offered flexible participation for staff and students, which fit around teaching, homelife, homeschooling and placements. Online learning mitigated logistical considerations such as room bookings. Attendance was high, as students were not required to travel to campus. The interprofessional education lead had a particular interest in e-learning and so the process was not as difficult as it could have been with someone who may not have felt as confident in an online environment.
The challenges for emergency remote teaching in interprofessional education were:
- A 2-week time pressure to convert learning to an online platform because of national lockdown
- Electronically communicating the new format to students: not all students followed instructions/guidance
- Students' levels of digital competence and confidence can vary greatly, which impacts on their ability and confidence to fully engage online
- Students have online learning overload and so may not be motivated to engage with interprofessional education if they see it as an add-on, rather than a mandatory element of their programme of study.
Qatar
In Qatar, the key aspects that had to change were:
- Duration of online interprofessional education: shortened from 3 hours face-to face to 2 hours online
- Use of online platforms: Microsoft Teams
- Introduction of key roles such as coordinator, lead facilitator and facilitators for online learning experiences
- Large group discussions were replaced by small group discussions via video-communication platforms
- Each group was assigned a facilitator to ensure discussion and reflection in small groups
- Chat groups were established for immediate communication between facilitators via WhatsApp.
Enablers and facilitators for emergency remote teaching in interprofessional education included that an existing program was incorporated into the curriculum and an orientation session was given to all the facilitators about technical aspects and facilitating the interprofessional education session virtually. Student and facilitator orientation packs were emailed prior to the sessions and there was an interprofessional education coordinator to deal with all the logistics and arrangements. A lead facilitator was assigned for each activity to oversee the whole process and offer support when needed, while going in between virtual breakout rooms. The lead facilitator recorded a 5 minute introduction introducing the activity, which was screened to all students at the start. The use of ice breakers and the Google Jamboards also facilitated the sessions.
However, there were barriers and challenges, which included the need for more facilitators to ensure one is assigned to each group, the majority of the students did not switch on cameras, there were technical challenges affecting student engagement and healthcare students outside Qatar University were not able to participate.
Scotland
In Scotland, the key aspects that had to change were that in-person teaching was suspended and video-communication platforms were used to deliver interprofessional education. An online session was timetabled for 3 hours instead of an activity that previously ran over 4 days. One member of staff was allocated to two groups and was given guidance to be ‘in the background’ and only interject at the students' request or to provide clarification or guidance if required about the clinical aspects of the case.
The enablers for emergency remote teaching were that engagement from allied health professionals practice supervisors enabled students to log on in practice environments, there was minimal input from staff (even with cameras off, discussion among students was potentially reduced when staff were in the Teams meeting) and this was a multi-faceted case study; there were opportunities to learn with, from and about other professions.
The challenges included that conflicting schedules made it impossible for all healthcare student groups to participate in the emergency remote teaching, and there was a lack of access to laptops/computers. Students trying to access online learning and video-communication platforms via a smartphone or tablet had difficulty viewing the documents used in the discussion.
Summary of the case reports
The process categories affected by the changes to delivery are summarised in Table 1. The mode of delivering interprofessional education sessions had to change in all cases because of the COVID-19 pandemic. Prior to the pandemic, all interprofessional education sessions from the selected case reports were delivered in person, either face-to-face, with students, facilitators, patients and service users in the same physical location or via a blended approach, using online platforms as well as face-to-face teaching. All of the case reports indicated that the interprofessional education sessions transitioned to a fully online learning experience. This shift potentially impacted and affected other factors of the delivery process, such as the duration of interprofessional education sessions, the learning activities and facilitation skills.
Table 1. Key ‘process’ factors that had to change for emergency remote teaching in interprofessional education in Austria, England, Qatar and Scotland
| Country | Interprofessional mix of students | Duration of sessions | Facilitation | Content |
|---|---|---|---|---|
| Austria | Allied health professions (occupational therapists, physiotherapists, dietetics and nutrition, speech and language therapists, radiotherapy), healthcare and nursing and medicine, industrial design, product development, energy, transport, and environmental management | Change from 1-day activity to half-day sessions | Online facilitation of sessions, which were more theory based as opposed to practical, hands-on experience | Students learned about differing professional perspectives and the roles different professions can have across different faculties and institutions |
| England | Adult, children's and dental nursing, early childhood studies, health and social care, learning disabilities, mental health, midwifery, occupational therapy, operating department practitioner, paramedic science, physiotherapy, podiatry and social workers | Activities spanned 1 week, and had a mixture of synchronous online sessions (lasting 2.5 hours) and asynchronous groupwork (instead of a 3-hour workshop) | Online learning offered opportunities to use more innovative learning and teaching approaches. Facilitation and encouraging student participation challenged by students not switching on cameras | Simulation in hospital settings were suspended.Some content was delivered with additional material (workbook, guidelines for participating in online learning environments) |
| Qatar | Biomedical sciences, dental medicine, human nutrition, medicine, pharmacy, physical therapy and public health | Activities shortened from 3 hours (in person) to 2 hours online | Coordinator required for organisation of all the logistics. A lead facilitator oversaw the activity | Students and facilitators joined online interprofessional teams. Large group discussions were replaced with the small group discussions. A video in the beginning outlined the activities |
| Scotland | Students from allied health professions, pharmacy and medicine | Three hours of synchronous online IPE activity (including breaks) occurring 4 times on 4 separate days accommodating approximately 300 students | Minimal input from facilitators ensured the discussion amongst students was not inhibited | After an introduction on interprofessional teamwork, students reviewed case studies of patients in secondary care environments. Further activities covered group discussions on similarities and differences in their professional roles. In a debriefing session, students reflected on key learning points |
Online synchronous teaching and learning often utilised Microsoft Teams, whereas asynchronous teaching and learning processes utilised online platforms such as Blackboard, Google Jamboard, and Padlet. Although various teaching tools and modes of delivery were offered, in two of the case reports (Austria and Scotland), the usual interprofessional mix of the students was not possible when the sessions transitioned to online learning. However, an interprofessional mix of students was still maintained through the students who were able to be involved. In terms of accessibility of student groups, the experiences from England showed that attendance increased at emergency remote teaching interprofessional education sessions in comparison to delivering interprofessional education face to face.
Regarding the duration of interprofessional education sessions, Qatar and England experienced a number of changes. In Qatar, for example, facilitators made the decision to shorten interprofessional education activities from 3 hours face-to-face (as originally organised) to a 2-hour online session. In comparison, some interprofessional education sessions in England extended their interprofessional education to 1 week, with synchronous online sessions and asynchronous group work.
It was apparent that the amount of support required by interprofessional education facilitators increased with the transition from face-to-face to emergency remote teaching. As reported in Qatar and England, additional facilitators and IT support staff were required to ensure all students were assigned to an interprofessional group and to ensure technical problems were resolved as they arose during the interprofessional education activities. Although it was crucial to have facilitators dedicated to each virtual room, their input varied depending on the group activities. For example, in Scotland, the facilitators remained in the background to avoid disrupting the interprofessional group discussions.
According to all the international case studies, emergency remote teaching did not significantly impact on the intended learning outomes nor did the years in which interprofessional education was offeref to students change during and before the COVID-19 pandemic. Various levels of learners participated in interprofessional education and learning outcomes in all the case reports remained the same during emergency remote teaching. Key factors that changed in regards to assessments and tools utilised to demonstrate students' achievements of learning outcomes are beyond the scope of this article but will be discussed in more detail in the sixth article in the series: overcoming barriers. The changes are summarised in Table 1.
Discussion and lessons learned
As highlighted by Langlois (2020), interprofessional education was either offered in the form of emergency remote teaching or suspended during the COVID-19 pandemic. International case reports from Austria, England, Qatar and Scotland have demonstrated that interprofessional education is still possible throughout crisis times and under unusual circumstances. Even though changes had to occur globally within a limited time, facilitators intuitively enabled interprofessional education in an evidence-informed manner.
Remote and online learning
The transition from face-to-face interprofessional education to emergency remote teaching imposed challenges regarding meeting learning outcomes and access to interprofessional education. Although the case reports indicated that the intended learning outcomes remained the same during emergency remote teaching, facilitators had to ensure that those were addressed adequately by the new mode of delivery (Alrasheed et al, 2021). If interprofessional education continues to be offered online or as a hybrid model, evaluation and assessments of the attained learning outcomes are warranted. Nonetheless, the advantages of remote and online learning in interprofessional education should not be overlooked. Literature as well as case reports from England highlight the flexible participation for students and facilitators. Interprofessional education can continue within the curriculum and fit around homelife, homeschooling, and placements (Tang et al, 2018; Seymour-Walsh et al, 2020). The Austrian, English, and Scottish experiences have shown that interprofessional education is accessible to more students, as evidenced by the increase in student numbers (Almendingen, 2021) when offered remotely. First, students who usually would be on placement were able to participate in the interprofessional education sessions. Second, time was saved as students or facilitators did not have to travel to other faculties or locations.
Interprofessional education
Although some challenges occurred, emergency remote teaching in interprofessional education was still possible. Some student groups were not able to attend the interprofessional education sessions, as reported in Austria and Scotland. Furthermore, virtual encounters with other professions were not as sustainable as face-to-face meetings, as indicated by Austrian students and facilitators. However, recent literature and accounts from the case reports suggest that the use of online learning and video communication tools enabled online interactions between various student groups where these would have been otherwise suspended (Alrasheed et al, 2021; Singh and Matthees, 2021). These interprofessional education student groups usually comprise a broad range of health and social care students, such as students of medicine, nursing, physiotherapy, occupational therapy, social work, speech and language therapy, nutrition and dietetics (Reeves et al, 2017; O'Shea et al, 2019; Liaw et al, 2021). The case studies confirm a broad range of health and social care students took part in interprofessional education sessions (Table 1).
Duration of interprofessional education sessions
It has previously been highlighted that online learning can be more time consuming (Jones et al, 2020), with various factors influencing this. First, students taking part in online lectures are more likely to be distracted by other factors such as smartphone, families and friends (Seymour-Walsh et al, 2020). This indicates that content must be repeated frequently and more breaks are necessary. Second, students' engagement in online lectures tends to be limited, therefore expectations must be discussed with students before the lecture starts (Seymour-Walsh et al, 2020). However, the case reports from Qatar and Scotland indicated that online interprofessional education sessions were shortened from 3 to 2 hours and from 4 days to a 3-hour online session respectively. This might be the result of the limited time resources to plan emergency remote teaching in interprofessional education.
Individual and team aspects of learning
Online interprofessional education can enhance communication between students from different healthcare professions and foster better understanding for other professionals' roles. Pre-sessional learning prior to interprofessional education sessions was necessary to ensure that both students as well as facilitators were adapting to the new technologies used. The case studies from England mentioned students' and facilitators' differing levels of digital competencies and confidence. While support with digital technology was available to facilitators (as highlighted in the case reports from Austria and Qatar), students had to adapt to the new online learning tools independently. This required the development of additional resources offered by the universities, such as workbooks and guidelines.
Facilitation
The ideal group size is essential to consider when facilitating group discussions in interprofessional education. Large group discussions have not been proven beneficial in an online learning environment, as the case reports from some English universities and Qatar indicate. International experiences from current literature and the case reports highlight that small groups enhance interprofessional communication and learning (Jaques and Salmon, 2007, Yamashita et al, 2021). In instances where small interprofessional education groups were not already used, this demanded a higher number of facilitators and IT support staff. Experiences from Scotland showed that minimum involvement of facilitators in synchronous learning environments was beneficial to promote group-discussions.
Conclusions
The interprofessional education delivery processes discussed within the case reports enable reflection on the opportunities and challenges that online interprofessional education can offer to learners and facilitators. Globally, facilitators were required to make quick decisions regarding the provision of interprofessional education during the COVID-19 pandemic, with little time to make evidence-informed decisions. However, it is valuable to note that facilitators and students in the case reports intuitively channeled the core principles involved in the process of delivering authentic interprofessional education. In some instances, face-to-face interprofessional education may be necessary, particularly where students need to be in close physical proximity to each other, where a specific context and environment is an important learning outcome, for example, in some simulation-based education. In other situations, delivering interprofessional education in a blended mode by combining face-to-face and online activities may be more appropriate. As highlighted by the Austrian and English case reports in this article, online interprofessional education can reduce travel time for students and facilitators and can overcome the challenge of finding a venue to accommodate a large number of students. It may be useful to offer online interprofessional education when different faculties from different regions or countries are involved.
Despite the challenges of emergency remote teaching in interprofessional education, the case reports suggest that the enablers may outweigh the barriers. This article should serve as motivation for facilitators to plan and deliver interprofessional education and help it to remain a priority during challenging times.
The next article in this series will explore the extent of student experiences in engaging with online interprofessional education at the pre-registration level. The characteristics of online interprofessional education will be described, online teaching and learning activities that target interprofessional education competencies in midwifery education will be identified, and the nuanced experiences of students in online interprofessional education discussed. The article will conclude with ‘learning pearls’ for how to make online interprofessional education more interactive, effective, and relevant, especially in the midst of the changing landscapes of health professions and midwifery education.
Key points
- During the COVID-19 pandemic, interprofessional education transitioned from in-person, face-to-face activities to fully online learning
- The transition impacted the delivery process in various ways and quick decisions had to be made
- Case reports from Austria, England, Qatar and Scotland highlight the changes, enablers and challenges regarding the transition to fully online interprofessional education
- Facilitators and students in the case reports intuitively channeled the core principles involved in the process of delivering authentic interprofessional education
- In some instances, face-to-face education may be necessary, whereas in other situations, delivering interprofessional education in a blended mode may be more appropriate
CPD reflective questions
- How did the COVID-19 pandemic influence the delivery process of interprofessional education?
- What are the key aspects that can be transferred to post-pandemic interprofessional education?
- Why is it essential to reflect on the presage, process, and product factors when thinking of emergency remote teaching in interprofessional education?