Nursing and medical students' attitudes and perceptions towards interprofessional education during clinical training in Uganda

Data collection tools

A validated Interprofessional Attitudes Scale (IPAS) was used.¹³ The IPAS assesses attitudes related to the 2011 Core Competencies for Interprofessional Collaborative Practice. The items are based on an existing tool, the Readiness for Interprofessional Learning Scale (RIPLS), and the four domains of the 2011 IPEC Core Competencies for Interprofessional Collaborative Practice. The IPAS was one of the first scales to focus on these core competencies. It consists of 27 items in five subscales: Teamwork, Roles, and Responsibilities; Patient-Centeredness; Interprofessional Biases; Diversity and Ethics; and Community-Centeredness. All items were assessed using a 5-point Likert scale (from “strongly disagree”¹ to “strongly agree”⁵). Additionally, demographic details (age, sex, program of study, and prior IPE experience) were collected.

This tool is particularly relevant for evaluating students’ preparedness for interprofessional education in diverse learning environments. Given that Makerere University and Busitema University have not yet implemented structured interprofessional programs, the IPAS provides a robust framework to measure students’ perspectives on interprofessional collaboration and teamwork. The validity and reliability of the IPAS questionnaire were checked for the Ugandan context before administration. Expert review ensured content validity, while internal consistency reliability was assessed using Cronbach’s alpha.

Data collection process: The researcher trained all research assistants on administering the questionnaire and familiarized them with the instrument. Research assistants received information sheets, consent forms, and survey tools to distribute to clinical students after training. The questionnaire was self-administered, with research assistants available to clarify any queries. Research assistants approached students in classrooms or hospital wards during break times to distribute the questionnaire. The researcher was available to address any challenges during data collection.

Data analysis: Data from the IPAS tool were captured and analysed using STATA 15 software (StataCorp, College Station, TX, USA). Initially, data were cleaned and organized to ensure accurate recording. Descriptive statistics, such as mean and median values, provided an overview of the attitude distribution. Frequencies and percentages of Likert-scale responses were analysed to assess the distribution of attitudes. Measures of variability, such as standard deviation, indicated the degree of consensus among participants.

IPAS scoring and derivation of mean scores

This study utilized a structured questionnaire based on the Interprofessional Attitudes Scale (IPAS), which consists of multiple items organized under key thematic domains: Teamwork, Roles, and Responsibilities; Patient-Centeredness; Inter-professional Biases; Diversity and Ethics; and Community-Centeredness.

Each item was rated using a five-point Likert scale, where 5 represents “Strongly Agree,” 4 represents “Agree,” 3 represents “Neutral (Not Decided),” 2 represents “Disagree,” and 1 represents “Strongly Disagree.”

Derivation of mean scores: To derive the mean score for each individual item, the numerical values assigned to each response were averaged across all participants. This provided a summary measure of the level of agreement or disagreement with each statement, with higher mean scores indicating stronger agreement and more positive attitudes toward the construct being measured.

Domain-level mean scores: For each domain, the item-level scores were first summed for each respondent. The total domain score for each respondent was then averaged across all participants to obtain the domain-level mean score and the corresponding standard deviation (SD).

The composite mean score for each domain reflects respondents’ overall attitudes toward that specific dimension of interprofessional practice. For example, a high mean score in the “Teamwork, Roles, and Responsibilities” domain suggests a strong value placed on interprofessional collaboration. Conversely, a lower mean score in domains such as “Inter-professional Biases” indicates more neutral or negative perceptions toward collaboration with professionals from other disciplines.

Inferential statistics were used to identify significant differences in attitudes based on gender and program of study. Mann–Whitney test was used to compare mean scores between groups, while chi-square tests assessed associations between categorical variables. A p-value of <0.05 was considered statistically significant.

Further exploratory and inferential analyses were conducted. Descriptive statistics, including frequency distributions and measures of central tendency (mean, median), were used to summarize demographic data and attitudes toward interprofessional learning.

Ethical considerations: Participation in the study was voluntary. Written consent was obtained from all students before they received the questionnaire. Students were assigned ID numbers to maintain confidentiality, and no identifying data were collected. Ethical approval was obtained from the Makerere University College of Health Sciences, School of Medicine Research and Ethics Committee (Mak-SOMREC-2021-188). Administrative clearance was sought and received from the respective school deans before data collection.

Domain comparisons

Comparison of overall mean scores by institution

The comparison of overall mean scores between Busitema and Makerere University students revealed significant differences in several variables ( Table 3). Teamwork, roles, and responsibilities had a higher mean score at Busitema (41.9 ± 3.1) than Makerere (40.6 ± 4.4), with a significant p-value of 0.0054. Similarly, patient centeredness was significantly higher at Busitema (23.9 ± 1.5) than Makerere (23.4 ± 2.4, p = 0.0184). Diversity and ethics also showed a significant difference (p = 0.0027), with Busitema students scoring higher (17.6 ± 0.9) than their Makerere counterparts (17.3 ± 1.3). Additionally, community-centeredness was significantly higher at Busitema (28.0 ± 2.3) than Makerere (27.3 ± 3.0, p = 0.0496). However, no significant difference was observed in inter-professional biases (p = 0.0652). These findings suggest that students at Busitema University may have stronger competencies in teamwork, patient-centeredness, diversity, and community engagement compared to those at Makerere University.

Comparison of overall mean scores by course

The comparison of overall mean scores between Bachelor of Medicine and Bachelor of Surgery (MBChB) and Bachelor of Science in Nursing (BScN) students revealed significant differences in inter-professional biases (p = 0.0160) and total score (p = 0.0346). Nursing students had higher mean scores for inter-professional biases (10.8 ± 2.8) compared to medical students (10.0 ± 2.9), suggesting potential differences in perceptions of inter-professional interactions. Similarly, nursing students scored higher on total score (121.8 ± 6.8) than medical students (119.1 ± 9.5). No significant differences were observed in teamwork, roles, and responsibilities (p = 0.1082), patient-centeredness (p = 0.0574), diversity and ethics (p = 0.2482), and community-centeredness (p = 0.5430), indicating comparable competencies in these areas between the two student groups (see Table 4).

Comparison of overall mean scores by gender

The comparison of overall mean scores by gender revealed significant differences in several variables ( Table 5). Female students scored significantly higher than male students in teamwork, roles, and responsibilities (41.7 ± 3.4 vs. 40.6 ± 4.5, p = 0.0074), patient centeredness (23.8 ± 2.1 vs. 23.5 ± 2.2, p = 0.0192), community-centeredness (27.9 ± 2.5 vs. 27.3 ± 2.9, p = 0.0482), and total score (120.6 ± 8.5 vs. 118.9 ± 9.5, p = 0.0345). No significant differences were observed in inter-professional biases (p = 0.3471) and diversity and ethics (p = 0.1785), suggesting that attitudes and perceptions in these areas were similar between male and female students. These findings indicate that female students demonstrated stronger competencies in teamwork, patient-centeredness, and community engagement compared to their male counterparts.

Comparison of overall mean score- Years of study

The comparison of overall mean scores across years of study revealed significant differences in inter-professional biases (p = 0.0024), with Year IV students scoring lower, and community-centeredness (p = 0.0329), where Year IV had the highest mean score ( Table 6). No significant differences were observed in teamwork, roles, and responsibilities, patient centeredness, and diversity and ethics (p > 0.05). These findings suggest that inter-professional biases may decrease in Year IV, while community-centeredness improves, whereas other competencies remain relatively stable across the clinical years of study.

Interprofessional competencies across years of study

The results show significant differences in inter-professional biases and community-centeredness across the years of study. Specifically, Year IV students exhibited lower inter-professional biases and higher community-centeredness compared to those in Years III and V. These findings suggest that fourth-year students, who likely have more exposure to interprofessional learning in clinical settings, have developed more positive attitudes toward collaboration. However, the decline in scores among fifth-year students may reflect a shift toward professional identity formation, which often reinforces discipline-specific roles, a pattern that has been observed in studies from the United States and across other countries.^14–16 This shift could indicate that students begin to prioritize their professional identities as they near graduation, which may limit their openness to interprofessional collaboration.

To maintain positive attitudes toward teamwork and reduce professional silos, IPE activities should be integrated consistently throughout clinical rotations. These activities should encourage ongoing interaction across disciplines, not just in the early stages of training. By ensuring that IPE evolves alongside students throughout their programs, the training will remain relevant and impactful, strengthening interprofessional collaboration as students advance in their clinical years.^17,18

Institutional differences in IPE exposure

Significant differences were also noted between students from Makerere and Busitema Universities. Busitema students scored higher in areas such as teamwork, patient-centeredness, diversity and ethics, and community-centeredness. These differences may be attributed to variations in clinical training environments. Busitema University’s emphasis on community-based learning contrasts with the more hospital-centric training at Makerere University, where discipline-specific hierarchies are more pronounced.

Similar findings have been reported in the United Kingdom, United States and Saudi Arabia, where students engaged in community-based training programs demonstrated stronger interprofessional competencies compared to those trained in hospital settings.^4,5,19,20 Therefore, expanding IPE in hospital environments through structured clinical mentorship and interprofessional ward rounds could help address the disparities between the two institutions.²¹ Additionally, incorporating more community-based placements into Makerere’s curriculum could help foster a more inclusive and collaborative learning environment, similar to what is observed at Busitema.

Discipline-Specific variations in attitudes and perceptions towards IPE

Interprofessional attitudes varied significantly between medical and nursing students, particularly in inter-professional biases and overall scores. Nursing students scored higher in both areas, which suggests that they may have heightened awareness of interprofessional dynamics, possibly due to their experiences in settings where medical professionals are dominant. This increased awareness of interprofessional biases could reflect the hierarchical nature of clinical environments, where medical professionals often take center stage, leading to perceptions of power imbalances in teamwork.²¹

This finding aligns with other studies that show nursing students are often more aware of power imbalances in clinical teamwork.^11,22,23 Addressing these imbalances through interdisciplinary clinical learning experiences such as interprofessional ward rounds, case discussions, and shared clinical assessments could help promote more balanced perceptions of teamwork and improve role recognition across disciplines. Furthermore, integrating these collaborative activities earlier in training may help students enter clinical environments that emphasize collaboration over hierarchy.^24,25

Gender differences in IPE competencies

Emerging evidence suggests that gender influences the development of IPE competencies and collaborative practices.²⁶ IPE aims to challenge traditional hierarchical roles and encourage equitable team dynamic.²⁷ However, cultural norms may still affect how students view and participate in interprofessional education.

In this study, female students demonstrated significantly higher scores in teamwork, patient-centeredness, and community-centeredness than their male counterparts. This finding is consistent with previous research indicating that female students in IPE settings often display better communication and teamwork skills.^24,26 Female students tend to engage more actively in decision-making, consult other professionals, and adopt a collaborative approach, which may be reflective of societal expectations that encourage women to take on more relational roles.²⁸

In contrast, male students often use more directive communication techniques, which align with traditional gender roles that emphasize assertiveness and leadership.^29,30 The non-significant differences observed in inter-professional biases and diversity and ethics suggest that gender does not strongly affect perceptions of interprofessional collaboration in these areas. However, recognizing gender differences in communication and teamwork can help tailor IPE strategies to ensure both male and female students develop strong collaborative skills.²⁹ Future IPE interventions should consider these gendered dynamics and create an environment where all students, regardless of gender, feel equally empowered to participate in collaborative healthcare teams.²⁹

Implications for IPE

The differences observed across student groups highlight the need for intentional IPE strategies that can be adapted to the diverse needs of students. Research has demonstrated that structured IPE programs improve teamwork, reduce professional biases, and enhance patient-centered care.^9,31,32

The higher community-centeredness scores in Year IV students and those from Busitema University suggest that community-based education plays a significant role in strengthening students’ ability to engage with communities. These findings align with similar studies in Uganda, where community-based education has been linked to improved collaborative competencies.³³ Integrating community-based learning into clinical training at both universities could enhance students’ sense of responsibility for community health and reinforce the value of collaboration in achieving broader health goals.

Moreover, the observed gender and discipline-based differences underscore the importance of designing IPE interventions that foster collaboration, mutual respect, and teamwork across gender and professional lines. The higher inter-professional biases among nursing students suggest that interdisciplinary training should specifically address role perceptions and promote more equitable collaboration. Additionally, targeted strategies should be implemented to strengthen teamwork and community engagement among male students, ensuring that all students, regardless of discipline or gender, develop the necessary competencies for effective interprofessional collaboration.

Limitations

The cross-sectional and exploratory design of this study presents certain limitations. Since data were collected from only two universities, the findings provide a snapshot of attitudes toward IPE but may not be fully generalizable to other institutions, particularly private universities with different educational models. Private universities often have varied curricular structures, funding models, and clinical training environments, which could influence students’ perceptions of IPE differently. Future research should incorporate a broader range of institutions to enhance the study’s generalizability.

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