Stereotyping between healthcare students and qualified healthcare professionals, has a long standing history in the IPE and IPW literature. Among the earliest of the non- intervention designs comprised studies by Parker and Chan (1986), Streed and Stoecker (1991) and Kamps et al. (1996). Using the Health Team Stereotyping Scale (HTSS) originally developed in 1957 by Osgood and colleagues, these studies identified the existence of stereotypes and strong in-group favouritism (Turner 1999) between qualified physiotherapists and occupational therapists (Parker and Chan 1986, n=106), and between students of physiotherapy and occupational therapy (Streed and Stoecker 1991, n=84; Kamps et al. 1996, n=744). Considering the findings of their study together with those of Parker and Chan (1986) which revealed existence of the same stereotypes in a sample of qualified professionals, Streed and Stoecker (1991) concluded that stereotypes among undergraduate students appear likely to be carried into professional practice after graduation. Other early studies using the Health Care
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Stereotypes Scale (HCSS) developed by Carpenter (1995a), found similar stereotyping patterns among nursing and medical students (Carpenter 1995a; Rudland and Mires 2005).
These aforementioned studies, albeit with limited sample representation of frontline healthcare professions, and some with relatively small sample sizes, highlighted the existence of negative stereotyping among students during the academic programmes and the subsequent challenges for the pursuit of effective collaborative teamwork. Building on this early evidence, further IPE non-intervention studies saw representation of more frontline healthcare professions in their samples, larger sample sizes, longitudinal designs, and the development of new validated and reliable measures such as the widely used Student Stereotype Rating Scale (SSRQ) (Barnes et al. 2000; Hean et al. 2006a). These studies built upon the early evidence, reinforcing the need for IPE implementation to address stereotyping in the undergraduate years.
Hean et al. (2006a) investigated if students entered their courses with preconceived ideas of other disciplines and if these students perceived professional characteristics to be different between the professions. Their large pioneering study14 involved ten professional disciplines including undergraduate students of nursing, medicine audiology, midwifery, occupational therapy, pharmacy, physiotherapy, podiatry, radiography and social work (n=1256). Using the Student Stereotype Rating Scale (SSRQ), a revised version of the scale originally developed by Barnes et al. (2000), students rated the professions on nine characteristics; academic ability, interpersonal skills, ability to be a team player, leadership ability, ability to work independently,
14 Hean et al. (2006a) present baseline data as part of a longitudinal study (Foster and Macleod Clark
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decision-making ability, professional competence, practical skills, and confidence. Differentiation between the professions was very evident, particularly on the characteristics of interpersonal skills, academic ability and ability to be a team player. There was, however, less differentiation between the professions on the characteristics of professional competence and confidence.
Stereotype profiles emerged in this study clearly representing how these students viewed their colleagues from the different professions on professional characteristics. Nurses were generally credited with good interpersonal skills and ability to be a team player, whereas doctors and pharmacists were seen to have higher academic ability but poorer interpersonal skills and team player ability. Doctors were also seen to have much higher decision-making ability and greater leadership skills than their other healthcare groups. Generally all professions were rated highly on confidence and professional competence. This study resonates with similar findings by Hind et al.
(2003), who found nurses were perceived to have stronger interpersonal skills and team player ability, whereas doctors and pharmacists were rated lower on these attributes. Rudland and Miers (2005) in their study involving first, second, third and fourth year medical students found that medical students considered doctors to be more arrogant and nurses to be more caring, and viewed nurses as having lower academic ability, competence, and status.
Whilst Hean et al.’s (2006a) study used a large student sample and a well validated measure, they selected four professions randomly out of ten to rate the other disciplines. Hence the ratings of all professions are not known. Furthermore, the ratings on each attribute were not a breakdown of ratings attributed by each profession. Noting this limitation, Michalec et al. (2013) took their analysis a stage further to ‘fully dissect’ the
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stereotyped attitudes (pg. 206). All professions were required to rate the other on the SSRQ attributes, and how each profession individually rated all other professions was reported15. In their sample of first year students of medicine, nursing, pharmacy, occupational therapy, physiotherapy, and couple and family therapy (n=638), the rating trend saw each profession rate their own the highest on nearly all characteristics, with the exception of the medical group. This clearly demonstrated positive differentiation and in-group favouritism by five out of six professions thus lending robust support for the tenets of SIT (Tajfel et al. 1971; Turner 1999).
With similar findings to Hean et al. (2006a), the nursing group received highest rating for team player and practical skills and lowest ratings for leadership ability. It was paradoxical that whilst nurses were viewed as very central to the team, they were not considered well positioned to lead the team. They were not alone in low ratings on this attribute with occupational therapy, physiotherapy and most notably pharmacy, also receiving low ratings for leadership. Congruent also with Hean et al. (2006a), the medical and pharmacy students both received relatively low ratings on the interpersonal skills and team player attributes, and received highest for academic ability. A finding of particular interest emerged in this study whereby the medical students rated their own profession lower on all attributes except leadership ability, while all the other professions rated medicine the highest on seven out of the nine attributes (academic ability, professional competence, leadership, work independently, make decisions, practical skills, and confidence). This represents an unusual finding by comparison to other studies. Michalec et al. (2013) interpreted these attitudes among the medical
15 For example: the high ratings obtained for medicine and pharmacy on the attribute of academic ability
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students as either representative of ‘a socially desirable veil of Humility’ (pg. 212), or a feeling of overwhelm among the neophyte student group, as opposed to a true reflection of beliefs about the ability of their profession. Although Michalec et al. (2013) produced a comprehensive study of stereotypes among six healthcare professions by comparison to earlier studies; the authors recognise a number of limitations insofar as only one Higher Education Institution was used, thus reducing generalizability of the findings. Sample sizes by discipline also varied considerably, with couple and family therapy as low as nine participants. Collectively these limitations reduce the generalizability of the results.
Taken together, the findings from these aforementioned studies clearly depict the presence of stereotypes among the attitudes of undergraduate students from a wide variety of disciplines in healthcare education. The underlying premise of SIT (Tajfel 1978; Tajfel 1981) purports that group members favour the participants in their own ‘in- group’ over the other ‘out -group’, and, parallel to this theory, these studies highlighted a natural tendency among healthcare students to rate their own professions higher than others. The ratings attributed to professions on certain characteristics by other professions, are remarkably similar and observable across studies.
A key learning outcome for IPE involves changing negative attitudes between the healthcare professions (Barr et al. 2005). With a wealth of literature demonstrating that healthcare students enter their respective courses with pre-defined stereotypes (Tunstall- Pedoe et al. 2003; Cooke et al. 2003; Hind et al. 2003; Mandy et al. 2004; Rutland and Mires 2005; Lindqvist et al. 2005a; Hean et al. 2006b; Ajjawi et al. 2009; Bradley et al.
2009; Hansson et al. 2010; Ateah et al. 2011; Michalec et al. 2013; Hawke et al. 2013; Cook and Stoecker 2014; Foster and Macleod Clark 2015), it is clear IPE has potentially
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an essential role, but a challenging one, in the moderating of negative attitudes at undergraduate level, to prevent their potentially disabling effect on IPW after graduates enter the workforce.