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Developing interprofessional assessment

Article  in  Learning in Health and Social Care · December 2005

DOI: 10.1111/j.1473-6861.2005.00103.x

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 Original article

Developing interprofessional assessment

Blackwell Publishing, Ltd.

Susan L. Morison PhD PGCE BA1* & Moira C. Stewart MD FRCP FRCPCH2
1 Director, Centre for Excellence in Interprofessional Education (NI), Queen’s University, Belfast (QUB), Belfast, UK
2 Consultant Paediatrician and Senior Lecturer, Department of Child Health, QUB, Belfast, UK

Keywords Abstract
assessment, Undergraduate medical and nursing education should enable the development
communication,
of communication and teamworking skills and of reflective practice, which should
interprofessional
education, teamwork be assessed and continued into professional practice. This study aimed to examine
appropriate methods for the assessment of interprofessional learning of clinical,
teamwork and communication skills for undergraduate students in Paediatrics and
Children’s Nursing and to involve Senior House Officers (SHOs) in this process.
During the 2002/3 academic year, 31 students, four nurse educators, two medical
educators and six SHOs were involved in the development and implementation of a
programme of interprofessional learning and assessment. Objective structured clinical
skills examination (OSCE) and role-play assessment methods were used to explore the
potential to develop common activities and standards for both professions. This study
found that common learning activities and assessment methods acceptable to both
professions could be developed and common standards set. It also concluded that
development and delivery by an interprofessional team is particularly important and
that formative feedback has a vital role to play in the process. Involving SHOs in the
planning and implementation of interprofessional education (IPE) has the potential to
allow its extension into different clinical areas and to meet training requirements at the
postgraduate level.

DoH 2003) and as such should be assessed. Proposals

*Corresponding author.
Tel. 02890 634107;
e-mail: s.morison@qub.ac.uk
Introduction
Learning from Bristol (DoH 2001a) recommended
that medical education and training should pay more
attention to non-clinical aspects of care (including
the development of skills) in communicating
with patients and colleagues, and in teamwork and
reflective practice. Moreover, these skills should
be regarded as essential prequalification skills for all
healthcare professionals (NMC 2001; GMC 2002;
to reform and improve training for newly qualified
medical practitioners have similarly identified
a need for a greater focus on team working and
communication skills (DoH 2001b; 2002). Policy
makers from all areas of healthcare have recognized
that some form of shared or interprofessional
learning might provide an answer to some of these
problems (CVCP 2000; DoH 2000a,b; 2001b; 2003;
Finch 2000).

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202

Cooper et al. (2004) have drawn attention to the
difficulty of locating interprofessional education
(IPE) in traditional disciplinary frameworks, and
their arguments are particularly pertinent to the
development of interprofessional assessment. The
assessment methods that predominate in any
discipline are those which reflect its theoretical
underpinning and where traditional boundaries
inevitably are strong and fiercely protected. Using
Medicine and Nursing as an example, although both
undergraduate curricula and assessment methods
have undergone considerable revision in recent
years (Fowell et al. 2000; Watson et al. 2002) the
disciplines’ approaches to assessment clearly reflect
cultural and philosophical differences. Medicine
places great emphasis on the assessment of know-
ledge acquisition (Fowell et al. 2000) with a strong
preference for objective measures, such as multiple-
choice questions and objective structured clinical
skills examination (OSCE), and less commonly using
methods such as role play, with its emphasis on
active learning (Mackway-Jones & Walker 1999). In
contrast, nursing places greater emphasis on active
learning and assessment to encourage reflective
practice and personal development, and OSCE-type
assessments are a relatively recent introduction into
this discipline. Developments in interprofessional
education must help to bridge the gap between these
traditions, and if carried out effectively should also
acknowledge the implicit underlying philosophical
differences reflected in each profession’s approach
to curriculum design and delivery. Additionally,
interprofessional assessment must also address the
variation in the requirements and standards of
professional bodies.
The study below describes the assessment meth-
ods developed and evaluated for an IPE programme
in Queen’s University, Belfast (QUB), which had
been piloted in 2000/1 (Morison et al. 2003; 2004)
and subsequently embedded into the medical
and nursing curricula. The 8-week programme was
repeated five times throughout the year for different
groups of undergraduate medical and nursing
students, and was designed for them to learn together
about children’s nursing/paediatric medicine in the
classroom and on clinical placement. The clinical area
was considered as key for interprofessional learning,
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
Developing interprofessional assessment 193
where students benefited from working in small
groups and learning from a variety of healthcare
professionals. The programme was designed to ensure
that each profession’s learning outcomes were met,
but there was an emphasis on learning about one’s
own and other healthcare professionals’ roles and
responsibilities, interprofessional communication
and teamwork. However, in order for the programme
to be sustained it was deemed important to investi-
gate ways in which appropriate assessment could be
developed.
Aim
The aim of this study was to examine appropriate
methods for assessment of the interprofessional
learning by undergraduate medical and nursing
students and to involve Senior House Officers
(SHOs) in this process.
Participants
A total of 31 students participated in the programme,
comprising 19 fourth-year undergraduate medical
students undertaking their Healthcare of Children
module and 12 third-year nursing students from the
Children’s Branch. Two of the nursing students and
eight of the medical students were men. As recom-
mended by the pilot study (Morison et al. 2003),
an interprofessional teaching team was established
to develop and deliver the programme. The team
consisted of two paediatric nurse specialists, a paedia-
trician, two nurse-lecturers and an IPE co-ordinator.
The programme also provided the opportunity to
introduce a total of six SHOs to interprofessional
teaching, assessment, teamwork and communication
(DoH 2001b; 2002).
Proposals to inform training of SHOs are currently
being implemented with increased emphasis on
‘competence’ and its assessment. An explicit require-
ment is to extend and consolidate knowledge, skills,
values and attitudes acquired at undergraduate level.
Essential requisites of modern practice, including
teamworking, communication and multiprofessional
practice, are embedded in foundation training
programmes in the early years of postgraduate educa-
tion (DoH 2002). The decision to involve SHOs in
194 S.L. Morison & M.C. Stewart
this programme provided a potential opportunity
to meet their training requirements in all these areas
and to introduce them to their responsibilities as
educators in the future.
Prior to the commencement of the study, the
Chairperson of the local Research Ethics Committee
was consulted and indicated that ethical approval
was not required.
Methods
Development of learning activities, outcomes
and assessment methods
Learning activities and outcomes were identified that
were relevant to both medical and nursing curricula
and which focused on knowledge, skills and attitudes
common to both professions (Harden 1998; Morison
et al. 2004). Assessment methods were selected
for their appropriateness to measure the learning
outcomes and not because they were the preferred
choice of either profession. Additionally, in order
to promote reflection and improve performance
in the clinical setting, it was deemed essential to
incorporate interactive feedback into the assessment
process (Hewson & Little 1998; Mackway-Jones &
Walker 1999; Branch & Paranjape 2002).
The programme was delivered during the academic
year 2002/3 to six different groups of students
during the clinical placement component of their
respective modules. The numbers in each group
varied between four and six. At the beginning of
each placement, students were given a clinical
scenario (a child newly diagnosed with insulin-
dependent diabetes) and were informed that they
must work together as a team to learn about this
condition in order to plan, prepare and give an
explanation of the condition and its management to
the child’s parents during an assessed role play. The
team was also to work with the ward-based diabetic
nurse specialists who would provide teaching sessions
on a key clinical skill (giving a subcutaneous insulin
injection), and students’ competence in this skill
would also be tested. Students were also expected to
interact with other relevant clinical staff, such as
dieticians, to obtain appropriate information to enable
them to complete their preparation, as well as with
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
the nurse-lecturers, paediatricians and SHOs involved
in the study. Although students were provided with
written instructions on what was required, including
explicit details of how the learning outcomes would
be assessed, and an overview of diabetes and its
management, the team was left to manage and
organize their preparation for the assessments.
Assessment methods
Two assessment methods were used to measure
students’ success in achieving the intended learning
outcomes. One was more commonly used in Medicine
[(1) below] and the other was more commonly used
in Nursing [(2) below]. Both methods enabled students
to practice skills in a realistic, but nevertheless ‘safe’,
environment:
1 An OSCE was used to assess the students’ clinical
competence and to ensure that standardization
was achieved regardless of whether the assessor was
a nurse specialist, nurse lecturer, paediatrician or
SHO. Students were expected to have practiced this
task with the diabetic nurse specialists and had been
given a copy of the assessment criteria (Table 1). The
students performed the clinical skill on a specially
designed manikin. Students were assessed individu-
ally and at the beginning of the assessment each stu-
dent was given precise instructions by their assessor.
Bottles of insulin, syringes and a sharps’ box were
provided, but students had to role play hand-washing.
Upon completion of the assessment, immediate
feedback was provided to each individual student by
their assessors. Once all students had completed this
assessment, they were provided with a summary of
their group’s strengths and weaknesses in perform-
ing this task.
2 Role play was used to assess students’ knowledge
of the chronic clinical condition, their ability to
communicate with parents and to work in a team.
The team were required to give an explanation to the
role-play parents (SHOs), and this included bring-
ing the parents into a room, seating them at a table
and introducing them to the team members. As
each individual member of the team would be given
a score, the team had been directed to ensure that
each individual member had the opportunity to
explain some aspect of care to the role-play parents.

Table 1 Assessment criteria and rating scale for clinical skills
Jamie is a 7-year-old boy, recently diagnosed as an insulin-dependent diabetic. Please draw up and administer 5 units of short-
acting insulin.
1. Giving a single insulin injection
a. Wash hands
b. Select correct insulin
c. Check expiry date on bottle
d. Select appropriate syringe
e. Insert needle into insulin bottle and withdraw correct dose
f. Ensure all air bubbles are removed
g. Withdraw needle from syringe
h. Determine site to be injected and ensure it is clean
i. Pinch up a small amount of skin
j. Inject at a 90 degree angle, ensuring syringe is held around the barrel and not with thumb on the plunger
k. Inject insulin smoothly
l. Once injected relax grip and pressure on the plunger and count for 10 s
m. Withdraw needle and dispose of safely
1.1 Rating Scale
0 = Not done 1 = Satisfactory performance
1.2 Additional Discretionary Points
Uncertain/unsafe practice
Most points covered, few minor errors
Safe, competent practice
The SHOs were briefed as to the scenario given to
the students, in the use of prompt questions and
in their responses to information given by the
students. Using examples of checklist rating criteria
for communication skills (Cohen et al. 1996;
Donaldson & Topping 1996; NPC Framework 2001)
as a starting point, the team developed a checklist of
behavioural indicators (BI) against which to assess
students’ ability to organize and communicate to
parents the knowledge they had gained about the
clinical condition, and to work as a team. A checklist
approach was considered to equate well with the
OSCE method being used to assess the clinical skill.
In this novel situation, it also provided the inter-
professional team of assessors, and the students, with
a straightforward and specific list of criteria against
which they were being measured.
The BI were grouped into three categories – clarity
of information, effectiveness of communication
and teamworking. Prior to the instrument being
used with students, all assessors agreed that the final
checklist satisfied each profession’s aims with regard
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
Developing interprofessional assessment 195
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0
1
2
to these skills (Table 2). Rating criteria were similarly
discussed and agreed by all assessors (Table 3).
Each student was assessed by a group of three
educators, which always included a paediatric nurse
specialist, a paediatrician and the IPE co-ordinator.
A mean score for each question was calculated
and these were then added to give a total mark and
finally converted into a percentage score. At the
end of each assessment session the assessors’ ratings
were compared and discussed with the assessment
team. Once all assessments had been completed
and scores and performances reviewed, the assessors
met to review the scores and to determine the
cut-off score that would be used to distinguish
competent from not competent, and no further
categorization was made (Talente et al. 2003). This
process provided assessors from the two professions
with the assurance that they were assessing students
from each profession appropriately and objectively,
and that the competent/non-competent cut-off score
equated with their professional, subjective judgement
(Brown et al. 1997).
196 S.L. Morison & M.C. Stewart

Table 2 Assessment checklist

Rating Scale

Quality of information
Behavioural indicator
Explanation is clear, concise and jargon-free and aims and objectives of the topic are clearly stated 0 1 2 3
Ensures that parents/child have understood the explanation and provides them with the opportunity to ask 0 1 2 3
questions
Ensures that all information is appropriate to the parent/child’s needs (e.g. for age, ability and understanding) 0 1 2 3
Uses relevant and appropriate aids to support explanation 0 1 2 3

Effective communication
Behavioural indicator
Effectively ‘opens’ the topic by appropriate use of verbal (introduces self) and non-verbal (eye contact) skills 0 1 2 3
Identifies and responds to verbal and non-verbal cues 0 1 2 3
Listens to questions posed by parents/child and responds appropriately 0 1 2 3
Effectively ‘closes’ the topic by ensuring that ‘doctor/nurse’ and parent/child are satisfied with specific explanation 0 1 2 3
Can effectively communicate all relevant information in the time allocated 0 1 2 3

Professional roles and teamworking

Behavioural indicator
Demonstrates knowledge and understanding of, and respect for, the roles of 0 1 2 3
different members of the multidisciplinary team
Demonstrates ability to work well with different team members 0 1 2 3
Has ensured that all significant aspects of management of the chronic condition 0 1 2 3
have been addressed by a member of the team
Does not duplicate information provided by a colleague 0 1 2 3

Table 3 Rating scale and criteria

The criteria against which students are assessed are described as ‘behavioural indicators’ (BI). Assessors should be able to observe
BI during the presentation. BI will be graded from 0 (no evidence that the BI has been used) to 3 (evidence that the BI has been
used to maximum effect).
Please adhere to the following guidelines when using this rating scale:
0 = Unacceptable.
No evidence of the BI being used or BI used but inappropriately
1 = Poor.
Some evidence of the BI being used appropriately or some evidence BI used inappropriately
2 = Acceptable
Evidence of the BI being used appropriately most of the time and little evidence of BI being used inappropriately.
3 = Good.
Evidence of the BI being used appropriately all of the time and no evidence of inappropriate use
The following example should provide further help.
BI – Explanation is clear, concise and jargon-free and aims and objectives of the topic are clearly stated.
Rating 0 – frequent use of jargon, no clarity to explanation and aims and objectives not explained
1 – some jargon, little clarity to the explanation, aims and objectives attempted but not clear
2 – infrequent use of jargon, majority of the explanation and aims and objectives clear
3 – no jargon, explanation and aims and objectives clear and concise
Please ensure that you familiarize yourself with all of the above before undertaking assessment.

© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202

Each role play concluded with a debriefing
(Mackway-Jones & Walker 1999) on the team per-
formance, and included assessors, role-play parents
(SHOs) and students.
Programme evaluation methods
Data were collected from both students and SHOs.
Data triangulation (Pope & Mays 2000; Sim & Wright
2000) was employed to help identify common
and conflicting ratings and themes, and thereby
to enhance reliability and validity (Sim & Wright
2000). It should be pointed out that there is some
debate with regard to the role of triangulation in
improving validity (Cohen et al. 2000; Pope & Mays
2000; Sim & Wright 2000), but there is agreement
that it does present a more comprehensive picture
of the subject being studied (Pope & Mays 2000).
A postprogramme questionnaire was developed
for students’ evaluation. Demographic data, includ-
ing gender, profession and placement hospital,
was requested and the remaining items required
all respondents to indicate the extent to which they
agreed or disagreed with the statement provided.
A five-point Likert Scale was used for rating.
The SHOs evaluated the programme by means of
a focus group conducted by the IPE co-ordinator. The
group was asked to discuss what benefits, if any, they
thought the undergraduate students had received from
this approach to learning. They were also asked to
consider the relevance of the experience to their own
learning needs, the benefits, or otherwise, of being
involved and the impact of the experience on their own
clinical practice. The focus group was tape recorded
and transcribed (Kitzinger 2000), and the content
was thematically analysed. The data were also
scrutinized by a second person to confirm the iden-
tification of the emergent themes (Pope et al. 2000).
Results
OSCE assessment
Scores obtained by students ranged from 0 (three
students) to 15 (five students) with a median of 12
and no observable difference between the range of
scores of medical and nursing students. Six (19%)
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
Developing interprofessional assessment 197
students obtained a score of less than 10. Any
student who selected the wrong insulin was given a
score of 0, regardless of the accuracy of any of the
remaining procedures. This was to ensure that a
student would not be deemed competent on their
aggregate score when their performance would have
resulted in harm to a ‘real’ patient. Discretionary
points were awarded to reflect the student’s holistic
approach to the skill and to allow recognition of
their attitude to the patient/parent in addition to
their performance of the clinical skill. The assessors
reviewed all of the scores achieved throughout the
programme and agreed that a score of less than 10
indicated that students had not mastered a sufficient
number of the components of this skill (Table 1) and
were deemed not competent to perform this procedure
on a real patient. Students in this category were
invited to attend further practice sessions with the
diabetic nurse specialist.
Role-play assessment
The overall score obtained by students ranged
from 53% to 82% (median: 67%) and there was no
observable difference between the range of scores of
medical and nursing students. Following a final review
of all scores achieved throughout the programme
(see above), the assessors agreed that students who
obtained a score of less than 60% were not competent
to communicate clearly and effectively with parents
and colleagues. This was found to be the case for five
students (16%) who were required to reflect further
on their strengths and weaknesses and discuss
this with their medical or nursing tutor.
Programme evaluation
Student evaluation of learning achieved by
the programme
Almost 75% of the students agreed that they had
learned to communicate with parents; that they had
acquired knowledge of a common clinical condition;
that they learned to communicate with other health-
care professionals; and that they had learned
about the role other healthcare professionals play in
patient care (Fig. 1).
198 S.L. Morison & M.C. Stewart
Fig. 1 Student evaluation of learning achieved.
SHO evaluation of the programme
Three key themes emerged from the SHO focus
group:
Value of role-play approach to learning. SHOs indic-
ated that they considered the learning experience
to be very worthwhile for the students as it helped
them to improve their communication skills and, in
particular, to learn to give an explanation to parents.
They commented that, for doctors, providing an
explanation was a very important part of their
role, particularly as there is an expectation that they
(doctors) will always be right. Additionally, this
approach helped students to learn the importance of
thorough preparation prior to meeting with patients/
parents and of using appropriate, jargon-free
language.
In comparison to their own undergraduate
learning experience, SHOs thought that role play
was preferable to a ‘question and answer’ approach
which they had found to be intimidating. They also
thought that this approach clearly demonstrated the
importance for students of ‘learning through doing’
and this reinforced the views they had formed as
undergraduates, that practice-focused, interactive
learning experiences were the most effective.
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
Teaching and assessing. The SHOs considered that
this experience had provided them with a good
introduction to teaching undergraduates and learning
about appropriate teaching methods. They com-
mented that, in general, new doctors had little
opportunity to teach. They thought that through
their participation in the role play they had learned
to identify the variable performances of the students
and to distinguish good from bad. They were
particularly aware from the role play of the impact on
parents of inappropriate language or information.
They suggested that explaining was an effective way
of learning as if students could explain clearly and
simply to parents – even a complicated condition –
it meant that they understood it. They also identified
additional instructions that students might be
given to enhance their preparation, teamworking and
communication skills. For example, that it might be
useful for students to develop a plan which identified
the type of questions they might be asked by parents
and then to prepare answers.
Interprofessional interaction. They were convinced
that it was important for medical and nursing
students to learn together as this better reflected
their future practice. They thought that this
experience helped students to understand better the

value of working together and to understand more
about others’ roles and perspectives. They felt that
their own understanding had improved in this
respect and also that they intended to use what they
had learned in their own practice. In particular, with
the support of their medical supervisor, they would
like to develop a similar teaching intervention using
a different clinical condition.
Discussion
Identifying appropriate learning outcomes and
ensuring that subsequent learning activities and
assessment methods were aligned were particularly
valuable in an interprofessional programme. This
facilitated the identification of common learning
requirements and highlighted educational similarities,
rather than interprofessional differences. The students’
positive evaluation of the appropriateness of the
intended learning outcomes suggests that this
aspect of the programme was successful and that
the programme of learning was acceptable to both
student groups.
Crucial to the programme’s success was the involve-
ment at all stages – planning, development and
delivery – of an interprofessional team that included
expert clinicians and an education specialist. This
approach helped to ensure that teachers from both
professions (the university and the NHS) felt that
they had ownership of the programme (Lloyd-Jones
et al. 1998; Parsell & Bligh 1998). It also provided
a constructive environment in which teachers could
engage in dialogue about their own profession’s
assessments and standards, and how these might
effectively be deployed for interprofessional purposes.
The teamwork example of the teachers also served as
a role model of collaborative practice for students
and SHOs (Spencer & Jordan 2001; Paice et al.
2002).
The Bristol enquiry (DoH 2001a) recommended
that non-clinical skills, such as communicating with
patients and colleagues, and engaging in reflective
practice, should be promoted and assessed. How-
ever, in everyday practice, non-clinical and clinical
tasks are seamlessly combined and therefore, it
could be argued, these skills should be taught and
assessed in an integrated manner that more
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
Developing interprofessional assessment 199
accurately reflects professional practice. The ward
provided an ideal learning environment for such an
approach, and comments from the SHOs support
this contention.
Although the numbers engaged in these activities
were relatively small, the results nevertheless show
that the interprofessional team of assessors were
able to work together to distinguish a standard that
separated competent from non-competent students
from both professions and in both assessments.
Moreover, teachers and students found the inter-
professional assessments acceptable.
The assessment methods were chosen to reflect
appropriately the interactive nature of the learning
activities and were used formatively rather than
summatively, to enable students to make mistakes in
a safe environment, to reflect on their strengths and
weaknesses and to undertake further practice in the
areas where they were weakest. The OSCE assess-
ment was particularly effective in identifying areas
where students’ lack of knowledge could have
dangerous consequences and was also the most
practicable of the two assessments. Although more
commonly used in the assessment of medical
students, the OSCE was found to be appropriate for,
and acceptable to, both professions. OSCE assess-
ment is subsequently being developed in other areas
(simulation technology: emergency medicine and
nursing) to assess interprofessional activities
where effective clinical skills and team working are
paramount.
The role-play method of assessment with a focus
on ‘explanation’ was particularly effective in helping
students to improve their communication and
teamwork skills. Through an iterative process, the
interprofessional team of assessors were able to
develop a set of criteria against which students from
both professions could be measured. The results
suggested that this measure was appropriate for
students from both professions. An important
component of the process was that the judgement
of assessors was used to determine standards.
Without the involvement of representatives from
both professions it is unlikely that these judgements
would have gained interprofessional acceptance.
The role play was also effective in exposing the
limitations of text-book learning. Students found
200 S.L. Morison & M.C. Stewart
that applying theory to practice was not easy and they
learned, through role-play experience, the import-
ance of combining effective communication skills
and theoretical knowledge. The SHOs, in particular,
commented on the value of this exercise in helping
students to learn about using appropriate language
and ensuring that explanations are at an appropriate
level to optimize parents’ understanding.
One of the major drawbacks of the role play was
its labour intensiveness. However, teachers’ increas-
ing familiarity with the process decreased this
problem, and the use of a problem-based scenario
and teaching support from the ward-based nurse
specialists and SHOs also made a positive contribu-
tion. It could be argued that the benefits the students
gained from this learning experience outweighed the
difficulties, but further research would need to be
undertaken in different settings to substantiate this.
Another key element in both assessments was
the integration of feedback, an essential but often
neglected tool for teachers (Hewson & Little 1998;
Branch & Paranjape 2002). Supportive feedback
enabled the students to reflect on their strengths and
weaknesses and to discuss with teachers and peers
how they could improve their performance. The
inclusion of students, role-play parents (SHOs)
and assessors in this discussion also proved valuable,
as it provided the opportunity to examine the
role play from different perspectives. The feedback
discussion provided a learning opportunity and
thus enabled the assessment to become part of the
learning process.
The students’ evaluation of what they had learned
on the programme is congruent with the learning
outcomes and assessment results, with most students
agreeing that they had learned to communicate
with parents and other healthcare professionals, to
understand the roles played by different healthcare
professionals in patient care, to appreciate the impor-
tance of teamworking and had gained knowledge
of a chronic clinical condition. Difficult questions
from the role-play parents (SHOs), exposed gaps in
the students’ understanding of the clinical condi-
tion and, importantly, left those students who had
worked as individuals unable to draw on their team
for support. Conversely, those who had worked
as a team were able to call upon the knowledge
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
and skills of their colleagues to help deal with the
situation. The role play distinguished between
effective teams and ‘teams’ who were simply a collec-
tion of individuals.
The SHOs thought that the interactive, practice-
focused nature of the learning experience for the
undergraduate students was particularly valuable
and preferable to the teaching-through-intimidation
model, which is still prevalent in some areas of
medical education (Lempp & Seale 2004; Stewart
et al. 2004). As well as recognizing the value of
applying what they had learned through their
involvement in the programme to their own clinical
practice, the SHOs have subsequently become
involved in developing problem-based scenarios for
other clinical conditions, such as epilepsy. This sug-
gests that interprofessional learning opportunities
are as important, if not more so, for those already
in practice. It also suggests that involvement in
such a programme provides a twofold benefit for
SHOs in that they fulfilled professional require-
ments of learning about teamwork and teaching
others, in an interprofessional context, and at the
same time gained experience pertinent to their
own practice – communicating with patients and
colleagues.
Conclusion
Common learning activities and appropriate assess-
ment methods acceptable to students and assessors
from both professions can be developed and standards
set, although development and delivery by an inter-
professional team is essential. Making the inter-
professional assessments formative, and including
the opportunity for feedback, discussion and reflec-
tion, is also important.
Using a problem-based scenario, having support
from SHOs and ward-based specialists, and famili-
arity with the process, can help to ameliorate labour
intensiveness. The SHOs who participated in this
study are currently refining, developing and testing
the generalizability of this approach by extending it
to other clinical conditions. Similarly, interprofes-
sional OSCE assessments are being developed and
evaluated in areas such as emergency medicine and
nursing where effective clinical skills and teamworking

are of prime importance. The findings of this study
indicate that there is a future for the development of
interprofessional assessment. Furthermore, there is
a role for SHOs in undergraduate interprofessional
education. Involving SHOs in the planning and
implementation of undergraduate IPE is an effec-
tive way to meet their training needs and can help
to increase their awareness of the value of inter-
professional learning, and communication and team-
working skills.
Acknowledgements
We would like to thank students, SHOs, diabetic
clinical nurse specialists and Mairead Boohan, QUB
Medical Education Unit.
References
Branch W.T. & Paranjape A.P. (2002) Feedback and
reflection: teaching methods for clinical settings.
Academic Medicine 77, 1185 –1188.
Brown G., Bull J. & Pendlebury M. (1997) Assessing
Student Learning in Higher Education. Routledge,
London.
Cohen D.S., Colliver J.A., Marcy M.S., Fried E.D. &
Schwartz M.H. (1996) Psychometric properties of a
standardized-patient checklist and rating form used to
assess interpersonal and communication skills.
Academic Medicine 71, s87–s89.
Cohen L., Manion L. & Morrison K. (2000) Research
Methods in Education, 5th edn. Taylor & Francis,
London.
Committee of Vice Chancellors and principals of the
Universities of the United Kingdom (CVCP) (2000)
NHS Workforce Planning: CVCP Response Annex 00/96/
b (3). CVCP, London.
Cooper H., Braye S. & Geyer R. (2004) Complexity and
interprofessional education. Learning in Health and
Social Care 34, 179–189.
Department of Health (2000a) A Health Service for All
Talents: Developing the NHS Workforce. Consultation
Document of the Review of Workforce Planning. HMSO,
London.
Department of Health (2000b) The NHS Plan: a Plan
for Investment, a Plan for Reform. HMSO, London.
Department of Health (2001a) Learning from Bristol:
The Report of the Public Inquiry into Children’s Heart
Surgery at the Bristol Royal Infirmary 1984 –1995.
TSO, London.
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
Developing interprofessional assessment 201
Department of Health (2001b) Doctors for the Future:
Standing Medical Advisory Committee Advice.
DoH, London.
Department of Health (2002) Unfinished Business:
Proposal for the Reform of the Senior House Officer
Grade. TSP, London.
Department of Health (2003) Modernising Medical
Careers. DoH, London.
Donaldson A.J.M. & Topping K.J. (1996) Promoting peer
assisted learning amongst students in further and
higher education. SEDA, London, Paper 96.
Finch J. (2000) Interprofessional education and team
working: a view from the education providers. British
Medical Journal 321, 1138–1140.
Fowell S.L., Maudsley G., Maguire P., Leinster S.J. &
Bligh J. (2000) Student assessment in undergraduate
medical education in the United Kingdom, 1998.
Medical Education 34, 1–49.
General Medical Council (2002) Tomorrow’s Doctors.
GMC, London.
Harden R.M. (1998) Effective multiprofessional
education: a three-dimensional perspective. Medical
Teacher 20, 402–408.
Hewson M.G. & Little M.L. (1998) Giving feedback in
medical education. Journal of General International
Medicine 13, 111–116.
Kitzinger J. (2000) Focus groups with users and providers
of healthcare. In: Qualitative Research in Health Care
(eds C. Pope & N. Mays), pp. 20–29. BMJ Books,
London.
Lempp H. & Seale C. (2004) The hidden curriculum in
undergraduate medical education: qualitative study of
medical students’ perceptions of teaching. British
Medical Journal 329, 770–773.
Lloyd-Jones G., Ellershaw J., Wilkinson S. & Bligh J.G.
(1998) The use of multidisciplinary consensus groups
in the planning phase of an integrated problem-based
curriculum. Medical Education 32, 278–282.
Mackway-Jones K. & Walker M. (1999) Pocket Guide
to Teaching for Medical Instructors BMJ Books,
London.
Morison S., Boohan M., Jenkins J. & Moutray M. (2003)
Facilitating undergraduate interprofessional learning
in healthcare: comparing classroom and clinical
learning for nursing and medical students. Learning in
Health and Social Care 2, 92–104.
Morison S., Boohan M., Moutray M. & Jenkins J. (2004)
Developing pre qualification inter-professional
education for nursing and medical students: sampling
student attitudes to guide development. Nurse
Education in Practice 4, 20–29.
 202 S.L. Morison & M.C. Stewart
National Prescribing Centre (2001)Maintaining
Competency in Prescribing. An outline framework to help
nurse prescribers. NPC, Liverpool.
Nursing and Midwifery Council. (2001) Fitness for
Practice and Purpose. NMC, London.
Paice E., Heard S. & Moss F. (2002) How important are
role models in making good doctors? British Medical
Journal 325, 707–710.
Parsell G. & Bligh J. (1998) Educational Principles
Underpinning Successful Shared Learning. Medical
Teacher 20, 522–529.
Pope C. & Mays N. (2000) Qualitative methods in health
research. In: Qualitative Research in Health Care (eds
C. Pope & N. Mays), pp. 1–10. BMJ Books, London.
Pope C., Ziebland S. & Mays N. (2000) Analysing
qualitative data. In: Qualitative Research in Health
Care (eds C. Pope & N. Mays), pp. 75–88. BMJ Books,
London.
© 2005 Blackwell Publishing Ltd. Learning in Health and Social Care, 4, 4, 192–202
View publication stats
Sim J. & Wright C. (2000) Research in Health Care:
Concepts, Designs and Methods. Stanley Thornes
Publishers Ltd, Cheltenham.
Spencer J. & Jordan R. (2001) Educational outcomes and
leadership to meet the needs of modern healthcare.
Quality in Health Care 10, ii38–ii45.
Stewart M.C., Morison S. & Jenkins J. (2004) The hidden
curriculum in medical education. BMJ Rapid Response.
Available at URL: http://bmj.bmjjournals.com/cgi/
eletters/329/7469/770#85014.
Talente G., Haist S.A. & Wilson J.F. (2003) A model for
setting performance standards for standardized patient
examinations. Evaluation and the Health Professions 26,
427– 446.
Watson R., Stimpson A., Topping A. & Porock D. (2002)
Clinical competence assessment in nursing: a
systematic review of the literature. Journal of Advanced
Nursing 39, 421– 431.