The Influence of Age and Gender on Perceptions and Knowledge of Medical

Students about The Implementation of Inter-Professional Education

Kharisma Putri Indardi
Jurusan Kedokteran Umum, FKIK, Universtas Muhammadiyah Yogyakarta, Jl.
Brawijaya, Geblagan, Tamantirto, Kec. Kasihan, Bantul, Daerah Istimewa
Yogyakarta

Introduction
In today's era with the development and advancement of health science, health
workers are led to provide quality and high quality health services. The increase and
spread of increasingly complex disease cases (for example: Covid-19, DHF, stroke,
etc.) requires skills and knowledge from various professionals. Therefore, cooperation
between health workers such as doctors, nurses, pharmacists, nutritionists and
physiotherapists is needed in team collaboration to increase patient satisfaction with
health services.
Education is an effort to develop quality health services and create effective
collaboration between professions. Inter-professional Collaboration (IPC) is a forum
in an effort to create effective collaborative practices between professions. Meanwhile,
IPE is educational processes of two or more different disciplines to carry out
interactive learning in enhancing collaboration and service quality, as well as practice
of their respective disciplines (CAIPE, 2002; ACCP, 2009).
Research on the knowledge of students and clinical supervisors to evaluate the
application of IPE in clinical educational settings conducted by Winchester District
Memorial Hospital states that there is high enthusiasm from respondents to the
application of IPE. Then the participants also expressed positive perceptions about the
implementation of IPE. Participants provided several recommendations for the IPE
for the next clinical educational setting (Jelley et al., 2006). In Indonesia, IPE is also
becoming known, this is evident from Indonesia's involvement as a partner in the
Kobe University Inter-professional Education for Collaborating Working Center
(KIPEC) (HPEQ Project, 2011). Currently the development of the IPE curriculum has
not been developed evenly in educational institutions.
IPE is very important, therefore research is needed on the roles and
perspectives of students in developing IPE to support the creation of high quality
health services. Research on the perception of IPE has been carried out by several
researchers, the reference distribution refers to similar studies that have been
previously conducted by Thoha (Fauziah, 2010) asserts that differences in the
characteristics of respondents cause differences in perceiving something, including
perceptions and readiness for IPE. Another systematic review shows that Indonesian
health students have a good perception of IPE as much as 73.62% and students have
good readiness for IPE as much as 79.90% (Sedyowinarso et al., 2011). Interestingly,
Tamás et al. reported that female students were more open to discuss their knowledge
gaps than male students during IPE workshops (Tamás, 2017).
Based on previous IPE research, it is still rare a similar study discussing
significant differences in medical student perspectives on IPE by gender and age.
Starting from several phenomena and facts from the description above, it made
researchers feel interested to find out how significant differences in medical student
perspectives on IPE according to gender and age. It is hoped that this research can
become a reference for FKIK stakeholders to develop IPE to create better outcomes
for FKIK students in collaboration between health workers in improving the quality of
health services.
This study was conducted with the aim of describing how medical students'
perceptions of IPE and analyzing: (a) differences in medical students' perceptions of
IPE based on gender, and (b) differences in medical students' perceptions of IPE
based on age. This study is guided by two questions.
1. What are the significant differences in medical students' perceptions of IPE
based on gender?
2. What is the significant difference between medical students' perceptions of
IPE based on age?
Literature Review
Definition of inter-professional Education (IPE)
IPE is an interdisciplinary education where health professionals learn about
collaboration across disciplines with the aim of developing knowledge, skills and
values in working with other health professions (CIHC, 2008). Interprofessional
education (IPE) is an interactive, group-based learning method that is carried out by
creating a collaborative learning atmosphere to create collaborative practices, and also
to convey understanding of interpersonal, group, organizational and inter-
organizational relationships as a professionalization process (Royal College of
Nursing , 2006). The implementation of IPE for students aims to instill IPE
competencies from an early age in stages, so that when in the field students are
expected to prioritize patient safety and improve the quality of health services
together with other health professions.
Based on these definitions, it can be concluded that IPE can be implemented if
students from various health study programs such as doctor, dentistry, pharmacy,
nurses, therapists and psychologists discuss the concept of health services so that their
quality can be improved for the benefit of patients. Specifically, IPE can be used to
discuss health problems and certain cases so that through interprofessional discussions
solutions can be found and can be applied effectively and efficiently.
Health systems in countries in the world that are highly fragmented are
ultimately unable to solve health problems in the countries themselves (WHO,
2010) .It is then realized that actually solving health problems involves many aspects
of life and requires an integrated contribution from each profession. The application
of IPE is only the first step of the main goal in efforts to improve health services. In
implementing IPE, it makes it easier for students from one discipline to learn from
another discipline. This shared learning can enhance skills and integrated teamwork.
Characteristics of the Ideal IPE Model
The ideal IPE concept was created by equating the paradigm among health
workers. Paradigms between professions that work in harmony will form effective
collaboration in teams that focus on patient well-being. The effectiveness of IPE can
be seen from the ability of the workforce to solve problems and conflicts between
teams. IPE implementation requires a supportive environmental model for its
application. A very effective environmental model for implementing IPE is the real
wold experience, namely the tutorial room or mini hospital. The environment in this
case can be in the form of an environment that supports discussions between health
professionals in solving problems and as a medium for working in teams, such as
discussion rooms and mini hospitals (Lee, 2009). Apart from the environment, role
models are also needed in the application of the IPE concept. The role model here can
be interpreted as a lecturer. When lecturers are able to act well as facilitators, it will
foster mutual respect between professions (Lee, 2009).
Inter-professional education competence
Based on the American Association of Colleges of Nursing, (2011)
competencies that can be achieved in inter-professional education include: values /
ethics that develop in the practice of inter-professional education, roles and
responsibilities, inter-professional communication, and teamwork. Barr (2015)
describes collaboration competencies, namely: 1) clearly understanding the roles,
responsibilities and competences of other professions, 2) working with other
professions to solve conflicts in deciding patient care and treatment, 3) working with
other professions to assess, plan, and monitoring patient care, 4) tolerating differences,
53 misunderstandings and deficiencies of other professions, 5) facilitating
interprofessional meetings, and 6) entering into interdependent relationships with
other health professionals. The competence that is formed with the application of IPE
is expected to enable all students between professions to work together to improve
health services aimed at patient welfare.
IPE learning approach
The IPE learning approach is an important factor that will determine the
success of IPE learning. There are various methods of implementing IPE and there is
no definite method, the methods used change according to the learning needs of the
lecturers. Previous research conducted by Sulistyowati (2019) stated that the IPE
learning method can be applied with the OSCE method, case study discussions,
community practices and extracurricular activities.
Small group discussion and PBL are the methods that are felt to be the best for
classroom learning because this learning system encourages freedom, teamwork, a
more integrated, and in-depth knowledge of science. However, it still has a drawback,
namely that there are several incidents of students between professions that have not
been able to work well in small groups. The lecture method is given as an introduction
to the learning process which is used to increase knowledge only but does not increase
student collaboration skills.
Overview of IPE implementation
IPE is an important component in developing the quality of health services.
Many universities have implemented IPE in their curricula. Several countries that
have implemented IPE are Australia, universities in Europe, America, Canada,
England, Japan, Thailand, the Philippines, and Hong Kong. There were 5 countries
that succeeded in implementing this concept well in 2013, such as Canada, the United
States, India, Brazil and South Africa (WHO, 2013). In European and American
universities there are special departments in the education section of the faculty that
administer IPE independently. The learning method applied was lectures and class
discussions, field trips to deepen their knowledge and conducting group discussions
with certain learning topics (The University of Queensland, 2005).
The benefits of inter-professional education
IPE in the world of health education aims to prepare students in the world of
work to be able to actively contribute in collaboration with other professions in the
field. IPE has an impact on increasing student appreciation and understanding of roles,
responsibilities, and to direct students to think critically and foster professional
attitudes (Galle Rolelei, 2010).
Regarding the development of IPE that has been implemented, all groups
reported positive responses. This positive response states that with the existence of
IPE they experience increased skills, understand the roles of each profession, improve
communication skills in a team, are more effective in taking action, and can make
maximum use of available resources because it is done collaboratively with the
profession other.
The IPE process forms a process of communication, exchange of ideas, a
learning process, until later finding something useful between different health
professional workers in order to solve a problem or to improve the quality of health
(Thistlethwaite, 2010). Students who already understand the IPE concept are expected
to be able to work interprofessionally in a team to improve health services and reduce
the average clinical error and the number of patient deaths.
The barriers of inter-professional education
In reality, IPE still faces various obstacles in its implementation. Several
studies have also stated that the obstacles in implementing IPE are in organization,
implementation, communication, culture or attitudes. According to Sedyowinarso
(2011) the obstacles that occur in implementing IPE are from the ego of each
profession, the variety of bureaucracy and curricula in each health professional
education institution, unclear physical facilities and learning concepts, paradigms of
the health profession, blurred identities and roles of each. profession, there is no
clarity regarding the legal framework for each health profession, as well as culture. It
is very important to overcome these barriers, if they are not immediately overcome
they can affect the quality of health services.
Research Methods
This type of research is quantitative with descriptive analysis design and cross
sectional research design. Quantitative research is systematic scientific research. The
data is given in numerical format and analyzed using statistical methods. Descriptive
design is a theory-based design method created by collecting, analyzing, and
presenting the collected data, while cross-sectional study design is a method of
analyzing data from either a population or a sample at a certain point in time. This
method is used to determine medical students' perceptions of inter-professional
education.
The population used in this study were medical students of UMY class 2019
who were categorized into 4 groups based on the division of practicum groups. Then a
sample of 5 students will be taken from each group. Sampling refers to the
predetermined criteria, namely 2019 FKU UMY students, students who are active in
college, and are willing to become respondents.
The type of instrument used was a questionnaire because of the consideration
of the number of respondents and the types of research that had been done before.
This questionnaire was used to measure the perceptions of UMY medical students
class of 2019 Inter-professional Education. The form of questions from this
questionnaire is a closed item, while the type of measurement scale used is the Likert
scale. The number of questionnaire items used in this questionnaire is 18 statement
items taken from the Interdisciplinary Education Perception Scale (IEPS) by Luecht,
et al. (1990). Luecht, et al. (1990) also explained that in research on the IEPS scale,
there are four components of the perception of IPE consisting of competence and
autonomy, perceptions of the need to work together, evidence of current cooperation,
and understanding of other professions.
The first procedure used to collect data is to ask for approval of the research
proposal by examiners then select potential respondents according to the criteria and
determine the number. After finding the appropriate respondent, you can contact the
respondent to explain and ask for approval of the research being carried out. On the
day of filling out the questionnaire, you can determine the time for filling out the
questionnaire and collecting the questionnaire. Instructs filling out the questionnaire
completely. Finally, processing the data that has been collected. Data processing uses
the SPSS or Microsoft Excel application and includes the editing, coding, and entry
processes (tabulation and analysis).
Result

Characteristics of Respondents

The researcher distributed 40 questionnaires to the students of FK UMY, then

30 completed questionnaires were obtained. After selecting the complete
questionnaires, there were 28 questionnaires to be filled out by 30 students of FK
UMY. In this study, the characteristics of students analyzed are as follows :

a) Gender

39.3 %
60.7 %

Female Male

The graph above shows that most of the respondents who have filled out
the questionnaire are female as many as 60.7% (17 respondent) while the male is
39.3% (11 respondent).
 b) Age

14

12

10

8
Total

0
19 20 21 22
Age

The graph above shows the age of respondents who have filled out the
questionnaire completely, namely 28 respondents, there are 2 people (7.2%) who are
19 years old, 9 people (32.1%) who are 20 years old, 13 people (46.4%) ) who are 21
years old, and 4 people (14.3%) who are 22 years old.

FK Students' Perception of Interprofessional Education

No Item Komponen
Item 1 2 3 4 5 6
1 Individuals in my professions are well- 23 5
trained
2 Individuals in my professions are able to 7 21
work closely with individuals in other
professions
3 Individuals in my professions 22 5 1
demonstrate a great deal of autonomy
4 Individuals in other professions respect 24 4
the work done by my profession
5 Individuals in my professions are very 1 14 11 2
positive about their goals and objectives
6 Individuals in my professions need to 28
cooperate with other professions
7 Individuals in my professions are very 5 19 4
positive about their contributions and
accomplishments
8 Individuals in my professions must 22 6
depend up on the work of people in
other professions
9 Individuals in other professions think 6 22
highly of my profession
10 Individuals in my professions trust each 14 14
other's professional judgment
11 Individuals in my professions have a 20 7 1
higher status than individuals in other
professions
12 Individuals in my professions make 13 15
every effort to understand the
capabilities and contributions of other
professions
13 Individuals in my professions are 2 10 16
extremely competent
14 Individuals in my professions are willing 5 18 3 2
to share information and resources with
other professionals
15 Individuals in my professions have good 8 4 11 5
relations with people in other
professions
16 Individuals in my professions think 7 7 3 7 4
highly of other related professions
17 Individuals in my professions work 2 5 21
well with each other
 18 Individuals in other professions often 12 8 5 3
seek the advice of people in my
professions
n = 28
1. (strongly disagree)
2. (disagree)
3. (somewhat disagree)
4. (somewhat agree)
5. (agree)
6. (strongly agree)

According to the table obtained the following results :

Frekuensi Persentase
Strongly disagree 20 4
Disagree 18 3,6
Somewhat disagree 74 14,8
Somewhat agree 116 23
Agree 177 35,1
Strongly agree 97 19,5
Total 504 100

A total of 35.1% of respondents answered “Agree”', as many as 23% of

respondents chose the answer “Somewhat Agree”, 19.5% of respondents answered
“Strongly Agree”, as many as 14.8 respondents answered “Somewhat Disagree”, as
many as 4% of respondents chose the answer “Strongly Disagree”, and 3.6% of
respondents answered “Disagree”

Distribution of positive and negative perceptions of FK Respondents by Gender

The table below describes the differences in students' perceptions of IPE by

gender :
No Item Gender Positive Negative
Response Response
1 Individuals in my professions are well- Male 11 -
trained
Female 17 -

2 Individuals in my professions are able to Male 4 7

work closely with individuals in other Female 17 -
professions
3 Individuals in my professions Male 11 -
demonstrate a great deal of autonomy Female 17 -

4 Individuals in other professions respect Male 11 -

the work done by my profession
Female 17 -

5 Individuals in my professions are very Male 10 1

positive about their goals and objectives
Female 17 -

6 Individuals in my professions need to Male 11 -

cooperate with other professions Female 17 -

7 Individuals in my professions are very Male 7 4

positive about their contributions and
Female 16 1
accomplishments

8 Individuals in my professions must Male 11 -

depend up on the work of people in Female 17 -
other professions
9 Individuals in other professions think Male 11 -
highly of my profession
Female 17 -

10 Individuals in my professions trust each Male 9 2

other's professional judgment Female 5 12
 11 Individuals in my professions have a Male 1 10
higher status than individuals in other
Female - 17
professions

12 Individuals in my professions make Male 11 -

every effort to understand the
Female 17 -
capabilities and contributions of other
professions

13 Individuals in my professions are Male 5 6

extremely competent
Female 11 6

14 Individuals in my professions are willing Male 11 -

to share information and resources with Female 12 5
other professionals
15 Individuals in my professions have good Male 11 -
relations with people in other Female 9 8
professions
16 Individuals in my professions think Male - 11
highly of other related professions Female 14 3

17 Individuals in my professions work Male 5 6

well with each other Female 16 1

18 Individuals in other professions often Male 2 9

seek the advice of people in my Female 14 3
professions

The data from the table above, most of the female respondents from FK UMY
showed positive responses to all questions, only at points/questions 10,11, 13, 14, and
15 the responses given were mostly negative responses. However, of all female
respondents, they have a positive perception of the importance of working with other
professions. For male respondents from UMY Medical Faculty, the overall response
was positive. However, there are also 1-2 male respondents who gave a negative
response. Overall male respondents still have a positive perception of the importance
of cooperating with other professions.
The most negative perception shows that respondents from the Faculty of
Medicine feel less confident with the work they do in other professions. This is
because medical students perceive that they have more knowledge and skills than
other professions. Therefore, it is important to implement IPE so that students know
more about the role and competence of the profession and increase respect between
professions.
Discussion
Differences in respondent characteristics cause differences in perceiving IPE :
a) Gender
In the gender category, 17 people (60.7%) were female and 11 were male
(39.3%). The respondent taking system was stratified random sampling for the 2019
UMY Medical Faculty students. However, the number of UMY Medical Faculty
students in 2019 was mostly women.
b) Age
The age category of respondents who took part in this study was on average 20
years old with the lowest age being 19 years and the highest age being 22 years.
Students aged 19 years are male students. Meanwhile, 22 year old students are male
students.
The measurement of IPE perception uses 18 valid statement items.
Categorization of perceptions with a rating interval of 1-6 from strongly disagree to
strongly agree. Based on the 2019 UMY medical student survey about IPE, their
perception was good at around 98.7%. The results of the study for gender showed that
female respondents showed a very agree response with IPE, while for male
respondents there were 1-2 respondents who had a negative response. Meanwhile, the
results of the study based on age did not provide a very significant difference because
it did not affect the results, meaning that all participants had a good perception of
IPE.These results indicate that students think that studying IPE can create an
atmosphere in the process of communication and exchange of ideas between health
workers, understanding roles and responsibilities, and directing students to think
critically and foster professional attitudes to find something useful in problem solving.
health problems.
Ateah et. al., (2011) explained that students who are accustomed to learning in
an environment that supports inter professional collaboration will have a good
perception of IPE. According to Morison (2003) students who have a good perception
of IPE during college will be able to improve inter professional relationships in
providing patient health services when they have worked as health professionals.
Conclusion
This study examines the perception of medical students on the application of
IPE and learning. Most of the research respondents were women. The ratio of female
and male respondents is 1.5 : 1. Respondents are medical students of UMY class 2019.
From this study, it is known that 2019 UMY Medical Faculty students gave a positive
response to the application of IPE in learning. This result is also related to whether
there is a significant difference between the results and the gender and age of the
respondents. The data obtained indicate that there is a slight difference in perception
by gender, while for perception by age there is no difference. This is because
differences in the characteristics of respondents cause differences in perceiving
something.
From this research, it can also be concluded that according to the respondents,
namely students of FK UMY, the application of IPE can create a good atmosphere
and communication between health workers. This research is expected to lead
students to think critically and grow a professional attitude at work. The author's
suggestion for further research is to increase the sample of respondents to more
accurate and further research on other factors that can influence perceptions of IPE.
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