4.5.1 The favourable conditions
1. Equal status between members of the group. The subjects who took part in the module
in February 1999 were final year pre-registration students at the same institution who are studying for a specific professional qualification in health. Their status is therefore similar in these respects. However the students were occupational therapists, midwives, nurses, and radiographers and their programmes of study are at different levels. The radiographers and occupational therapists were studying for BSc (Hons) degree’s and were in their 3rd year. The nurses although doing a similar level qualification were only in their 2nd year as 3rd year students were not available (see later under problems 4.6.2 ). The midwives were in the final year of a diploma course. This inherent difference might have had an effect on the perceived status of professions in the group. Although with the range, complexity and current dynamic educational environment these differences might not be perceived as important by the students. In addition the entry qualifications for diploma’s and degree’s is different with again a possible inequality of status being the result. The notion of status is a perceived one and students may have differing views as to which of the professions they feel is higher, lower or similar status. They may be ambivalent to other professions or harbour negative stereotypical views. Other issues, which might influence their perception of status, are gender, previous personal experience, knowledge of differences in salary and working conditions. The way the students will perceive other professions might initially be inequitable but the teaching team, by example, would be able to stress the peer nature of health care work and try to reduce the effect of any perceived differences in status.
2. When an ‘authority’ and/or the social climate are in favour of and promote the
intergroup contact. The ‘authority’ here could be interpreted as the institution or the
interprofessional working and it is clearly stated in the University Mission Statement. The views of the members of staff within the health faculty, where the students mix with others, towards I.P.E. are mixed with some not being convinced of its importance and therefore do not actively promote it. However the staff who will be involved in the delivery of the module will be those who have been involved in earlier initiatives or are new but have opted to be involved. This expressed desire to be part of the I.P.E. programme can be interpreted as a positive sign that the members of staff are in favour of the principles of IPE. Although there may be some who have been asked to be involved by their line managers. However it is envisaged that the majority of staff with whom the students will learn IPE would support the IPE philosophy and spread a positive view to the students.
3. When the contact is of an intimate rather than a casual nature. This favourable
condition can also be considered to affect Pettigrew’s (1998) friendship condition as the more intimate the contact the more likely that friendship might result. The learning strategy that will be utilised for this IPE programme is problem based learning (PBL). This involves small group tutorial work over several weeks and is designed to promote a positive, collective group dynamic. The curriculum development team wanted the students to be in the same group throughout the module so that they would be able to get to know the other students and develop closer relationships. Yet this is counter to the advice of Hewstone et al (1994) who have used the contact theory, arguably successfully, for IPE. These authors state that the consensus from available research evidence suggests that failure to generalise from members of the outgroup to the outgroup in general is a critical weakness in contact theory. Essentially this means that if students learn with only one member of a different professional group they may not see them as a typical member of that group and hence not change their perception of that profession. Therefore I proposed that on this evidence the students should be moved around groups after each trigger, i.e. after 1 week of a four-week programme. Although this would make the encounter less intimate it would enable students of one profession to see students of another as typical members of the outgroup. This decision will need to be re-evaluated after the evaluation of the programme to see if there is any evidence to suggest which course of action should be followed in the future.
4. When the intergroup contact is pleasant or rewarding. The IPE programme will be part
students. Problem-based learning has been described in evaluations as an enjoyable learning method (Vernon and Blake 1993). For some students the IPE module stood outside their normal programme and they were volunteers (see para. 4.6). These participants may benefit from being given a certificate of attendance and be able to put the experience on their CV thus making them more attractive to the labour market. The certificates were sent out to students on conclusion of the module.
5. When members of both groups interact to develop common goals that are higher
ranking in importance than the individual goals of each group. The common goal of all
the healthcare professions is to provide quality healthcare for all patients and clients. However some professional groups have profession specific goals and sometimes-loose sight of the common goal and focus on their own professional contribution. The content of the programme centres on a case study approach in which each profession contributes their skills and knowledge to the benefit of the patient. However this will be carried out alongside other professions so that each will be able to see their contribution to the whole process. It is anticipated that this might engender a feeling within the professions that they are all working towards a common goal.
As Pettigrew suggests that conditions 1, 2, and 5 are the essential conditions along with the co-operative rather than competitive atmosphere. This last essential condition is implied by Amir’s first unfavourable condition. The application of the unfavourable conditions will now be discussed.
4.5.2 The unfavourable conditions
1. When the contact situation produces competition between groups. The goal of the
programme is to develop a team approach to healthcare although it is inevitable that some students will feel in competition to perform better then others. This might be due to natural competitiveness or by a desire to achieve high marks on their degree programme. The IPE programme will need to foster co-operation rather than competition and the facilitators will need to be briefed about how to develop the latter and reduce the former. They might achieve this by stressing the joint goals of the programme, encouraging equal contribution from group members and promoting a valuing of the contributions of the different professions. Carpenter (1995a), using medical and nursing students and Carpenter and
Hewstone (1996) using medical and social work students investigated the degree of co- operation or competitiveness in their studies of IPE programme. They both used interactive learning methods and found that their groups reported a more co-operative than competitive learning environment. These findings were from professions that have quite different underlying philosophies and could be described as having had difficulty in working together in the past. Therefore it is anticipated that there might be less competitiveness within the paramedical students in the group to be included in the pilot as they have more similarities than differences. The degree of co-operation or competitiveness will be incorporated into the evaluation of the pilot module.
2. When the contact is unpleasant, involuntary or tension laden. The educational
experience should be enjoyable if the module runs as planned. As the module is designed as a pilot the students taking part in the module will be voluntary with the exception of the radiography group (see para. 4.6). There is no history of resentment between any of the professions likely to be involved in the Pilot and the learning environment is intended to be an enjoyable and co-operative one. This should reduce the risk of a ‘tension laden’ experience. When the module eventually ran nursing and midwifery students were involved. There is some tension between these professions according to my colleagues in each. This was something that I was mindful of when looking at the evaluation data.
There are several unfavourable conditions that can be linked to one important feature of the programme. That of the ability of the facilitators to promote the favourable and limit the unfavourable conditions.
The 3rd and 4th conditions, When the prestige or the status of one group is lowered as a
result of the contact situation. When members of the group or the group as a whole are in
a state of frustration can be affected by the skill and commitment of the facilitator. If they
sense that there is a situation arising where the status of a group might be affected they should be able to limit the effect of this. Similarly if there appears to be any frustration emerging from the group this should be picked up on at an early stage and the problem dealt with to limit any damage. As can be seem from the discussion of other favourable conditions above the facilitator plays a crucial role in determining the effectiveness of the contact. There will need to be effective training of the facilitators prior to the module and a thorough evaluation of their performance during it.
5. When the groups have moral or ethnic standards which are objectionable to each
other. The professions in the health service each have their own moral code which are
implied by the ethical codes drawn up by the professional body as well as that which is past on through the professional culture. Whilst there are many similar perspectives within these codes there may well be issues upon which professional and individuals disagree. Some of these issues have been incorporated into the curricula used in the past to deliver shared learning (Davidson and Lucas 1995) and MPE (Hughes and Lucas 1997). Issues such as euthanasia demonstrate considerable different views, as does the care for patients from different social and religious backgrounds. There is potential here for some differences to emerge and this will need to be brought to the attention of the facilitators.
6. In case of a majority/minority group, when the members of the minority group are of
a lower status or are lower in any relevant characteristic than the members of the
majority group. It is quite likely that this situation will occur. The numbers of the
professions that will be taking part in this module will be different, as there are unequal numbers of students on the various programmes within the faculty. Therefore there is likely to be a minority/majority group situation. As discussed previously there could well be professionals who view themselves as of a higher or lower status than other professions and some of the students who might be taking part in the module are from different levels of programme e.g. degree or diploma. Therefore it is likely that this unfavourable condition will be present.
Having considered the relationship of these conditions to the pilot IPE module there were still two key questions which have yet to be answered. What effect will any one condition have on the success of the contact? and What effect will a combination of different conditions have? This will need to be revisited when the results of the programme evaluation are known. If the programme can be deemed as successful this last unfavourable conditions that will be present could be described as having a minor effect.