Research ArticleOriginal Research

Faculty Perspective on Interprofessional Education Competencies: Respiratory Therapy Compared to Other Allied Health Professions

Amanda Yarberry Behr, Patricia Marie O’Neal, Dominique Maldonado, Christopher A Truelove and Gianluca De Leo
Respiratory Care October 2022, 67 (10) 1246-1253; DOI: https://doi.org/10.4187/respcare.09791

Abstract

BACKGROUND: Interprofessional Education (IPE) provides a framework for collaborative education between health care specialties to improve patient care. In 2010, the Interprofessional Education Collaborative Expert Panel established the competencies of communication, ethics, roles and responsibilities, and teams and teamwork. Studies have assessed knowledge and attitudes about IPE in several allied health educational programs including respiratory therapy (RT).

METHODS: We compared RT faculty to athletic training (AT), nutrition (NT), occupational therapy (OT), physical therapy (PT), and dental hygiene (DH) faculty. Faculty were asked to rank the IPE competencies according to importance.

RESULTS: RT faculty ranked communication first, then teams and teamwork, roles and responsibilities, and last ethics. A Kruskal-Wallis Dwass-Steel-Chritchlow-Fligner pairwise analysis showed statically significant differences among allied health faculty rankings of IPE competencies. In communication, RT faculty responded statistically higher than AT (P < .001), DH P < .001), NT P < .001), and OT (P = .003). In ethics, RT faculty responded statistically lower than DH (P < .001), NT (P = .01), and PT (P < .001). In roles and responsibilities, RT faculty responded statistically higher than AT (P = .007) and OT (P < .001). In teamwork, RT faculty responded statistically higher than AT (P = .02), DH (P < .001), OT (P = .002), and PT (P < .001).

CONCLUSIONS: RT faculty who teach at different degree levels (associate’s degree programs vs bachelor’s and master’s degree programs) had the same ranking of competencies, but they had a statistically significant difference for teamwork, with associate’s degree faculty ranking teamwork lower than bachelor’s and master’s degree faculty.

Introduction

Interprofessional education (IPE) aims to equip students entering health professions with the skills necessary to work with other disciplines to provide exceptional patient-centered care.1 The National Academy of Medicine declares that health care professionals who work together as a team must clearly understand each other’s roles and communicate effectively to better provide safe, high-quality patientcentered care.2 In 2010, the Interprofessional Education Collaborative Expert Panel established 4 interprofessional competency domains: values/ethics, roles and responsibilities, communication, and teams and teamwork.1 Proficiency in these 4 domains is essential for respiratory therapists whose job duties are collaborative.

Respiratory therapists must interact routinely with physicians, nurses, and a variety of other health care professionals to deliver highly effective treatment and report the most up-to-date patient information. Respiratory therapists provide care in ICUs where the ability to work as part of an interdisciplinary team is critical for patient survival.3

Because of their multidimensional roles and direct involvement as part of the interdisciplinary care team, students of respiratory therapy (RT) are required to engage with interprofessional collaboration training. This training occurs in the academic/clinical environment, where students should receive proper exposure and hands-on training in the clinical learning environment to better nurture and develop practical clinical skills.4 Furthermore, IPE’s true essence comes from students in RT and all other health care programs interacting with other disciplines, being actively engaged in clinical situations, and appreciating each other’s contributions.5,6

Each competency domain is uniquely essential to functioning as a collaborative unit. Previous research studies have sought to either single out one domain’s value over another or attempted to identify ways to improve performance in a specified domain. For example, a study examining the impact of an ethics workshop on interprofessional values addressed the need to determine a course of action that would build students’ confidence in managing ethical situations.7 Another IPE study that used high-fidelity simulation to explore various health professions’ roles and responsibilities reported a mutual increase in knowledge and understanding of the procedures performed among respiratory therapists, nurses, and occupational therapists.8 Following their simulation study, students indicated they would be more inclined to collaborate with members of these professions after gaining a sense of appreciation for each other’s job duties.8 Similarly, in 2004 the Joint Commission declared communication issues to be the primary reason for 72% of neonatal deaths, which prompted a simulation study designed to help identify lapses in communication during high-risk scenarios.9

Additional research discussing the value of teamwork, teambuilding, and leadership development in health care provides evidence to support how collaboration enhances health care outcomes.10 Findings from their study comparing 13 different ICUs indicated that excellent teamwork, carefully designed protocols, and ongoing communication among interdisciplinary teams are the key attributes that lead to the best actual versus expected mortality rates.10 Research shows that IPE/interprofessional collaboration improve the quality and efficiency of care,11 the accuracy of diagnoses,12 and the trajectory of patient outcomes,13 which reinforces the value of each competency domain and the need for continued advancement in IPE.

Multiple research studies demonstrate an overall attitude of positivity and willingness to participate in IPE/interprofessional collaboration among allied health faculty.14-18 Faculty and students of health care programs shared concerns of scarcity of time combined with the feasibility of incorporating additional IPE content into an already packed didactic schedule.16-18 Like the RT programs, most allied health, nursing, and medical programs have incorpora-ted some form of IPE into their curriculum.17 There is limited research to investigate if one competency domain is considered more important than another among faculty in health care professions.19 There is no comparison of the attitudes of different allied health faculty attitudes. Investigating how faculty in different allied health programs perceive the importance of IPE competencies allows us to open conversations about IPE priorities among health care professions. It also helps with providing directions for the implementation of future IPE cross-program training activities. Our study of faculty in RT, occupational therapy (OT), physical therapy (PT), athletic training (AT), dental hygiene (DH), and nutrition (NT) programs fills in the gap in the existing literature to provide faculty perspectives of the ranking of core competencies of IPE/interprofessional collaboration.

After reviewing data from previous research that explored IPE perspectives among allied health professions, this paper aims to (1) compare RT faculty competency preferences with faculty in other allied health professions and (2) determine differences in competency ranking among RT faculty in bachelor’s/master’s and associate-level programs.

QUICK LOOK

Current Knowledge

The goal of interprofessional education (IPE) is to streamline the collaborative efforts of multiple health care disciplines that have a shared interest in a patient’s health and well-being. Introducing students to IPE/interprofessional collaboration as part of their undergraduate curriculum reinforces and refines the skills necessary to effectively collaborate as an interdisciplinary team upon entering the workforce.

What this paper contributes to our knowledge

This study compares respiratory therapy (RT) faculty members’ rankings of the 4 IPE competencies against 5 other allied health programs previously surveyed. RT faculty ranked communication higher and ethics lower than all other allied health programs. Among RT faculty, there was a significant difference in the response of teamwork, with associate’s degree faculty rating teamwork lower than bachelor’s/master’s degree faculty.

Methods

Data were analyzed from previous studies that surveyed the faculty perspectives of 6 allied health professions. Sources included raw data from a specific question that asked faculty to rank the 4 IPE competencies in previous published studies in RT (n = 267, by degree: 186 bachelor’s/master’s and 81 associate’s),17 DH (n = 379),16 NT (n = 146),15 OT (n = 406),14 AT (n = 181) (unpublished data), and PT (n = 116).20 Institutional review board (IRB) approval was granted for each previous study for initial data collection. An IRB review of proposed analysis of the raw data from previous studies was sought and deemed not research and, therefore, required no additional IRB approval. The 4 interprofessional core competencies were defined in the surveys using the definitions provided by the Interprofessional Education Collaborative report1 and were described in the surveys as follows:Ethics and values (E) = “work with individuals of other professions to maintain a climate of mutual respect and shared values.”Roles and responsibilities (R) = “use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.”Communication (C) = “communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.”Teamwork (T) = “apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.”

Faculty were asked to rank the competencies in order of importance. Then we calculated rank data as percentages for the 6 allied health professions surveyed and determined a weighted average for each of the 4 core competencies (E, R, C, T). A value (weight) was assigned to each rank as follows: 4 (first choice), 3 (second choice), 2 (third choice), 1 (fourth choice). We divided the total weight for each competency by the number of faculty members surveyed for that profession. The weighted averages for the 4 core competencies were then compared for the 6 allied health professions and separately by degree for RT.

We evaluated the difference between RT faculty ranking and other allied health faculty ranking of IPE competencies. Additionally, we compared the responses of RT faculty who teach in associate’s degree programs to those RT faculty who teach at the bachelor’s/master’s degree levels.

Additionally, we used the statistical analysis software SAS Studio OnDemand (SAS Institute, Cary, North Carolina) to perform a Shapiro-Wilk normality test to assess normality for all professions’ raw ranking data. Since the data were not normal (P < .05), we used a Kruskal-Wallis test to determine if the data contained significant differences. We also used the Kruskal-Wallis test with Dwass-Steel-Chritchlow-Fligner (DSCF) pairwise comparison to determine if significant differences exist among ranked data for each competency. Additionally, we performed a Kruskal-Wallis test with DSCF pairwise comparison to evaluate if there were significant differences among the ranked data of RT faculty who teach in associate’s degree programs versus bachelor’s/master’s degree programs.

Results

Competency Ranking: RT Versus Other Allied Health Professions

The ranked responses varied among allied health professions. Figure 1 shows the answer rank for each profession. The bars represent what percentage of each profession ranked each competency 1–4 (eg, E1 for ethics ranked as 1; E2 for ethics ranked as 2; E3 for ethics ranked as 3; E4 for ethics ranked as 4). The percentage of each profession is shown rather than the total number to account for each profession’s varied response rate. Aggregate analysis with a Kruskal-Wallis test for nonparametric data revealed a significant difference in IPE competency ranking across all professions (P <.001).

Fig. 1.
Fig. 1.

Interprofessional competency ranking by the percentage of responses for the surveyed faculty of athletic training (AT), dental hygiene (DH), nutrition (NT), occupational therapy (OT), physical therapy (PT), and respiratory therapy (RT). RT is highlighted in gray. A: Ethics (E) ranking, B: communication (C) ranking, C: roles and responsibilities (R) ranking and D: teams and teamwork (T) ranking. Figure keys denote competencies (E, R, C, T) and rank as follows: 1 (first choice), 2 (second choice), 3 (third choice), 4 (fourth choice).

Respiratory therapists ranked ethics last (E4), most often, 49% of the time. Physical therapists ranked ethics last 41% of the time. In Table 1, Kruskal-Wallis test with DSCF pairwise comparison shows that RT faculty ranked ethics significantly lower than the professions of OT (P < .001), DH (P < .001), and NT (P = .02). There was no difference in ethics ranking between RT and AT (P = .059) or PT (P = .84).

Thirty-nine percent of RT faculty ranked communication first. Figure 1 shows that RT faculty were the only group to rate communication first among the competencies by percentage. Thirty-eight percent of RT faculty also ranked communication second. NT faculty ranked communication third, with 38% of faculty choosing C3. All other professions selected communication as second in rank with AT 40%, DH 40%, OT 38%, and PT 31%. In Table 1, the Kruskal-Wallis test with DSCF pairwise comparison shows that RT faculty ranked communication significantly higher than AT (P < .001), DH (P < .001), NT (P < .001), and OT (P = .003). There was not a significant difference for communication ranking between RT and PT (P = .14).

RT faculty ranked roles and responsibilities third most often at 36% and fourth at 28%. AT faculty ranked it first 29% of the time. DH faculty ranked it last most often at 30%. Among NT faculty, the ranking of roles and responsibilities had a 3-way tie between first, second, and fourth at 25.34%, and third was 23.97% of the time. OT faculty ranked roles and responsibilities third and fourth 29% of the time. In Table 2, the Kruskal-Wallis test with DSCF pairwise comparison shows that RT faculty ranked roles and responsibilities significantly higher than AT (P = .007) and PT (P < .001). There was not a significant difference for the ranking of roles and responsibilities between RT and DH (P > .99), NT (P = .28), or OT (P > .99).

RT faculty ranked teamwork second at 33%. The ranking was similar to NT, who ranked teamwork second 32% of the time. DH (29%) and OT (35%) faculty ranked teamwork last most often. RT faculty ranked teamwork higher than AT (P = .01), DH (P <.001), PT (P = .002), and OT (P < .001). There was not a significant difference in teamwork ranking between RT and NT (P = .51).

According to the weighted averages shown in Table 2, RT (3.12), OT (2.94), DH (2.78), AT (2.74), and NT (2.67) all ranked communication first. RT faculty ranked teamwork (2.61) second. PT faculty ranked roles and responsibilities (3.04) first and communication (2.64) second. DH (2.69) and OT (2.64) ranked ethics second. AT (2.63) and NT (2.51) ranked roles and responsibilities second.

View this table:
Table 1.

P Values from the Kruskal-Wallis Dwass-Steel-Chritchlow-Fligner Pairwise Comparison of Respiratory Therapy Faculty Responses Compared to Other Health Care Faculty

View this table:
Table 2

Weighted Average of Faculty Ranking Responses by Competency

Competency Ranking: Associate’s Versus Bachelor’s/Master’s RT Degree Programs

We compared responses from faculty of associate’s degree programs (n = 69) to faculty responses in bachelor’s and master’s degree programs (n = 186). We removed those faculty who belong to programs that offer both associate’s- and bachelor’s/master’s–level programs. In Table 2, weighted data show that both associate’s degree program faculty and bachelor’s/master’s program faculty ranked communication first (associate’s: 3.09; bachelor’s/master’s: 3.14), teamwork second (associate’s: 2.50; bachelor’s/master’s: 2.88), roles and responsibilities third (associate’s: 2.33; bachelor’s/master’s: 2.07), and ethics fourth (associate’s: 2.08; bachelor’s/master’s: 1.90). Figure 2 illustrates the percentage of responses for each competency for the 2 groups. The percentage is used rather than the number of respondents to compare the responses in each group. Communication responses were similar between the 2 groups: associate’s (C1: 38.71%, C2: 36.86%, C3: 19.89%, C4: 4.84%) versus bachelor’s/master’s (C1: 39.13%, C2: 40.58%, C3: 15.94%, C4: 4.35%). Ethics data differed, whereas E1 chosen more by faculty in associate’s programs (E1:23%) versus bachelor’s/master’s (E1:13%). Faculty who teach in associate’s programs were more likely to choose roles and responsibilities second (R2: 21%) versus bachelor’s/master’s (R2: 10%). Teamwork differed between groups, with associate’s more likely to choose teamwork fourth (T4: 22%) versus bachelor’s/master’s (T4: 9%) and less likely to choose teamwork first (T1:19%) versus bachelor’s/master’s (T1: 30%). A Kruskal-Wallis test shows a significant difference between the 2 groups only in teamwork rankings with a P value of .01.21

Fig. 2.
Fig. 2.

Bar graphs representing the percentage of respiratory therapy faculty surveyed to rank the 4 core competencies separated by degree. A: Ethics (E) ranking, B: communication (C) ranking, C: and responsibilities (R) ranking, and D: teams and teamwork (T) ranking by percentage in each group. Figure keys denote competencies (E, R, C, T) and rank as follows: 1 (first choice), 2 (second choice), 3 (third choice), 4 (fourth choice).

Discussion

The comparison of ranked IPE competencies among allied health faculty can be helpful for those involved in designing and implementing collaborative IPE activities. Communication was considered the most important competency domain among RT faculty members. Respiratory therapists require exceptional written and oral communication skills to chart and inform other health care professionals of a patient’s status. Notes related to a patient’s medical condition and any treatment provided must be accurate, detailed, and up to date. Respiratory therapists rely heavily on all interdisciplinary team members to maintain closed-loop communication, especially in the ICU setting, where effective communication among all team members is essential to reducing patient mortality risk.9

According to the weighted data, communication was ranked as the most-important core competency by 5 out of 6 allied health programs, excluding PT (Table 2). Among those 5 that considered communication the most important, RT faculty members ranked communication the highest overall, assigning communication as the first- or the second- most-important competency (Fig. 1, Table 2). This emphasis on the communication competency could be explained by the high-level involvement of respiratory therapists as part of the interdisciplinary care team in an ICU setting. Conversely, the other allied health professions have a more independent role and are most often involved with the patient’s care outside of a critical-care area.

This high-level ranking in communication might also be explained by evaluating the accreditation standards for RT. In the RT program accreditation standards, emphasis is placed on communication with 3 competencies (4.01, 4.03, 4.05) and teamwork that has two (4.02, 4.05).22 Roles and responsibilities and ethics each has one competency in which they are addressed (4.05 and 4.07, respectively).22 Respiratory therapists actively collaborate with nurses and other practitioners to develop treatment plans for their patients. This requires frequent contact to assess and direct care, which makes communication a vital component of respiratory care. The only program to not rank communication the highest was PT. PT faculty ranked roles and responsibilities first and communication second. PT is most often a one-on-one activity performed between the physical therapist and patient. The individual nature of the care might explain their secondary ranking of this domain and preference for roles and responsibilities. Additionally, the accreditation standards for PT contain more references to roles and responsibilities (2C, 6F, and 8F). Notably, programs are required in standard 2C to “describe how the curriculum assessment process considers the changing roles and responsibilities of the physical therapist practitioner.”23

RT faculty ranked teamwork as the second most important competency domain (Table 2). This ranking and appreciation for the teamwork domain might be explained by the critical role respiratory therapists play as part of the interdisciplinary care team. Additionally, respiratory therapists extend the teamwork concept beyond the ICU and into the community. For example, respiratory therapists enlist patients and family members in a patient’s self-management and care once they are discharged.5,6,17,24

Even with a second-place ranking, RT faculty ranked teamwork higher than all other allied health programs surveyed. PT ranked teamwork third, and all other programs ranked teamwork fourth overall (Table 2). Once again, we attributed the ranking of teamwork to the different professions’ independent nature and their lack of involvement in a critical-care setting. Again, this high ranking by RT faculty can be explained by the high level of involvement of respiratory therapists as part of the interdisciplinary team in an ICU setting. Regardless of profession, the critical nature of patients in an ICU requires all members of the care team to work seamlessly together, which involves respecting hierarchies among professionals and having a clear understanding of each other’s roles.

RT faculty ranked ethics as the least important core competency out of the 4 core competencies ranked. Vernon et al17 suggest that ethics was ranked as one of the least important core competencies because the creation of ethical standards and/or guidelines is assumed to be prioritized in areas outside of IPE.

Physical therapists surveyed also ranked ethics as the least important core competency. All other allied health professions ranked ethics as third-most important competency, except for occupational therapists who ranked ethics as the second-most important core competency out of the 4 core competencies. However, no allied health profession surveyed viewed ethics as the most-important core competency, implying the other core competencies are seen as more important. Not upholding ethical standards will affect the patient and health care provider, but not following through in the other interprofessional competencies affects the entire team and the patient.

Ethics plays an important role in RT. The primary ethical role respiratory therapists have is to mitigate the potential suffering of the patient. Respiratory therapists are not responsible for making the end-of-life decisions that they are required to perform. However, it is still beneficial for current and aspiring respiratory therapists to have an adequate understanding of how to handle difficult ethical situations, especially regarding end-of-life issues.

RT faculty ranked roles and responsibilities as the third-most important core competency. Similar results were observed in faculty responses for DH and OT programs. Most PT faculty surveyed ranked roles and responsibilities as the most-important core competency. Roles and responsibilities was ranked as the second-most important core competency among the majority of surveyed AT and NT faculty. Therefore, these allied health professions valued roles and responsibilities as one the more important core competencies for ensuring optimal care and quality of care for patients.

Hierarchies among professionals of an interdisciplinary team are not uncommon and can have adverse effects on communication patterns and effective teamwork.1 Because of demographic diversity, differences in areas of expertise, and levels of professional ability among interdisciplinary team members, a potential source of conflict over leadership may arise.1 Whereas each profession plays an integral role in caring for a patient, respiratory therapists with more years of experience and higher titles are more likely to play a larger role in the team-based care collaboration.

Faculty who teach in bachelor’s and master’s degree programs ranked teamwork higher than faculty who teach in associate’s degree programs. This could be linked to the attitudes of faculty and the roles played by respiratory therapists with more advanced degrees. There is a move to increase the minimum educational standard to a bachelor’s degree level to allow respiratory therapists the ability to practice at the highest level of their credential.25 Those who practice in critical-care settings are encouraged to pursue a master’s or doctoral degree.25

We observe limitations in this study. First, ranking requires the faculty to place a competency in the last position, but that does not mean that the faculty considers it unimportant. Second, the data were collected at different times ranging from RT (March 2016) to PT (March 2019). The number of participants varied among each profession from n = 406 (OT) to n = 116 (PT). These data provide an opportunity to discuss the differences in perception of the competencies to guide further delivery of IPE and review of accreditation standards.

Conclusions

IPE aims to provide a framework for collaboration among professions to improve patient care. RT faculty were the only program to rate communication and teamwork higher than roles and responsibilities and ethics. This ranking can be attributed to the role respiratory therapists have as part of the critical-care team where regular communications and shared patient treatment are vital to successful patient outcomes. Whereas most allied health faculty surveyed valued communication as the most important competency, their ranking of other competencies varied. This varied attitude toward the ranking of IPE does not imply that other competencies are not important. Rather, that care setting may impact the faculty’s perception of the importance of each competency. For example, we observed that RT faculty who teach in bachelor’s/master’s degree programs ranked teamwork higher than those who teach in associate’s degree programs. Future studies in this area could show if faculty in critical-care settings rank the competencies differently than faculty in other settings. This research does not examine the perception of RT practitioners. RT faculty are involved in clinical practice to maintain certification requirements. Another potential area of future study might be to evaluate if there is a difference in the attitudes of RT faculty compared to RT practitioners.

Footnotes

  • Correspondence: Amanda Y Behr MA PhD Candidate, Augusta University, 1120 15th Street, CJ 1101, Augusta, GA 30912. E-mail: abehr{at}augusta.edu

  • The authors have disclosed no conflicts of interest.

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