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The potential of the shared identity of ‘novice' to develop a sense of equal status amongst student volunteers from different professional programmes within the IP primary care teams, is a unique finding of this study. Within this study, a novice is defined as a student within the first semester of the first year of their health professional education programme. These students had not yet developed their profession-specific knowledge and skills and this was thought to allow them to see one another as similar. Similarities included being at the beginning of a new profession and career, being new to their programmes of study, concurrently taking similar courses such as anatomy and physiology, having limited profession-specific knowledge, and being new to the clinic and to patient care. These are argued to be important aspects that placed the students on an equal footing. For these novice students, the equal playing field they described was not based upon what the students knew or the professional skills they possessed as suggested by Carpenter and Dickson (2016), but rather upon what they didn't know, about a shared status of not knowing, of being a novice to their profession and to the clinic.

The clinic exposure occurs at a point in time when these novice students have not yet established a strong sense of their professional identity. When students enter their professional programmes they are considered to hold a fledgling professional identity shaped by their expectations of their profession, media accounts of their chosen profession, and their own experiences. Flanagan (1979) describes this as anticipatory socialization to the profession. During profession-specific training, their professional identity becomes moulded and remoulded through a process of professional socialization (Arndt et al. 2009; Cameron 2011; Khalili et al. 2013). This leads students to know what they do, in terms of their profession-specific knowledge and skills, and who they are as a professional. It also establishes their work beliefs, values, roles, and professional culture (Hershey 2007; Newman 2005). Khalili et al. (2013) suggest that anticipatory socialization provides students entering their professional training with a somewhat skewed view of their own and other professions. Their subsequent professional training involving uni-professional socialization with faculty and students from their own professional group (as described as occurring within the specialty clinics) re-frames the students' views of their own profession but in the

absence of interprofessional opportunities students’ views of other professions remain largely unaltered. Khalili et al. (2013) suggest IPE can support the development of an interprofessional identity alongside professional identity.

The students within this study, being within the first months of their professional programmes, had not yet formed a strong professional identity. They described how recognition of their similarities as novice students supported the development of a sense of equal status. Suggesting this early phase in their education may be an appropriate time to focus on similarities between students and their professions rather than emphasising their differences and may provide a window of opportunity for co-developing their professional identity alongside a shared identity as a novice interprofessional team member.

There has been much debate within the field of IPE regarding the appropriate timing of IP learning activities (Elise and Whitehead 2018, Kozmenko et al. 2017). The debate centres around whether IPE should be implemented early in the curriculum before the students establish stereotypical perspectives of other professions (Kozmenko et al .2017), or later when they have a have developed their own professional identity and competencies and can offer more to an interprofessional interaction (Elise and Whitehead 2018; Brewer et al. 2017). Stull and Blue (2016) suggest that early IPE can result in weakened professional identity and declining attitudes towards ones own and other professions. However, there is also support in the literature for the potential of IPE introduced in the early stages of

professional training, prior to students becoming acculturated to their profession, to facilitate interprofessional learning and cultivate interprofessional identity (McNeil et al. 2012; Khalili et al. 2013). Such exposure has been suggested to protect students from developing professional tribalism and adopting specific perspectives and stereotypes of other professions, which are commonly perpetuated by their own profession (Horder 1996). Coster et al. (2008) support this notion that IPE within early professional training can minimize the development of negative biases and perceptions about other professions by shaping interprofessional attitudes at the early stages of student education and professional identity development. Additionally, Cooper et al. (2015) suggest the early introduction of interprofessional activities may increase student confidence in their own professional identity and lead them to value professional difference. This was evident for students who had the opportunity to observe or shadow in a specialty clinic. The experience was reported to challenge stereotypes of the observed profession and increase knowledge and respect for care delivered by other professions and those who were observed, shadowed, or provided consultations believed the experience increased the respect for their profession and elevated its status to an equal footing with other professions in the clinic by challenging stereotypes.

For some students, the experience increased focus on their own profession and reduced attempts to collaborate with other professions. They felt marginalized, excluded, different, and unequal. These negative outcomes were shaped by both a lack of interprofessional opportunities and failed attempts to engage in potential interprofessional activities. These students were clearly seeking interprofessional opportunities and when unable to access them, despite their attempts to do so, they turned their attention to their own profession, and the opportunities provided within the specialty clinics to develop their profession-specific knowledge and skills.

Under these circumstances, the students began to see themselves and their profession as different from the other professions in the clinic. Focussing on the uniqueness and

difference, rather than the similarities between themselves and the other professions. This runs counter to the condition of group members being made aware of both their similarities and differences, which is also identified within contact theory as an important condition to reduce negative intergroup attitudes (Hewstone and Brown 1986). As a result, both the students and the specialty clinics became increasingly focussed on their own profession, developing a strong professional identity without the co-development of a shared

interprofessional identity. This finding is supported by the literature which suggests the development of a strong professional identity can lead individuals to view their profession as different from, or better than, other professions (Baker et al. 2011; Cameron 2011; Khalili et al. 2013) and can interfere with interprofessional collaboration (Cameron 2011). This was clearly the case for students in the specialty clinics.

This focus on difference within the specialty clinic is counter to the focus on similarity and the shared identity of novice evident within the IP primary care teams

Similarities focus early led to IP identity, focus on difference led to professional identity strengthening – suggests early IP exposures should focus on similarity and difference added later.

Tajfel and Turner’s (1986) social identity theory postulates that individuals develop a group identity as a result of socialization into a group. This process involves the identification and categorization of in-groups and out-groups. Individuals are motivated to represent

themselves positively and favour in-groups over out-groups (Haslam et al. 2000). In-groups are ascribed a set of positive characteristics and belonging to an in-group has been

associated with the development of trust and the fostering of group cohesiveness (Turner 1985; Wackerhausen 2009). This was clearly the case for the student leadership team who were reported to have developed a shared team identity and were reaping the benefits of a shared in-group identity, in trust, respect, interdependence, and team cohesion.

A shared in-group identity has also been associated with the development of out-group bias, discrimination, and distrust of members of the out-group. A strong orientation towards one's own professional in-group can potentially result in distrust towards members of out-group professions (Khalili et al. 2013). This can lead to in-profession / out-profession behaviours including favouring members of their own profession and excluding or withdrawing from engaging with members of out-professions (Baker et al. 2011; Cameron 2011; Lloyd et al. 2011). This was demonstrated by students in the specialty clinics who withdrew from interacting with students from other professions. Such withdrawal has been shown to interfere with effective collaboration (Baker et al 2011; Cameron 2011; Lloyd 2011). When individuals become focussed on their own professional practice, limiting their

interprofessional communication (Lloyd et al. 2011) and withdrawing from interactions with other professions, it can result in a loss of understanding of how professions interconnect and how their different roles and responsibilities can combine to ensure better quality care (Khalili et al. 2013). Attention to professional identity at the expense of developing an interprofessional identity has been demonstrated to lead to misconceptions between professions, enhanced negative stereotypes, and the development of prejudices towards out-group professional members (Carpenter and Dickinson 2008; Salvatori et al. 2007). This form of professional socialisation leads to strong association with one’s own professional group and a focus on the differences between professions (Coyle et al. 2011). This supports the findings for students in the specialty clinics who came to see themselves and their profession as unique and different.

6.2.2 Perceived inequality of students in the specialty clinics as