Exploring Attitudes of Canadian Radiation Oncologists,Radiation Therapists, Physicists, and Oncology NursesRegarding Interprofessional Teaching and Learning

Kaitlin Koo & Lisa Di Prospero & Ruth Barker &

Lynne Sinclair & Merrylee McGuffin & Alita Ng &

Ewa Szumacher

# Her Majesty the Queen in Right of Canada 2014

Abstract The purposes of this exploratory study were toinvestigate the attitudes of radiation oncology professionalsregarding interprofessional (IP) teaching and interprofessionaleducation (IPE), to identify the challenges faced by radiationoncologists who teach within an IP context, and to discovernew strategies to aid professionals teaching IP students. Aquestionnaire was developed through the review of existingliterature on IPE using Medline. The proposed group of ques-tions was selected by educators from different professionsactively involved in IPE. The final revised questionnaireconsisted of three main domains assessing the understandingof IP concepts, attitudes toward IP teaching and learningenvironments, and attitudes toward health-care teams. Anopen-ended comment section was included. The questionnairewas administered to health-care professionals (physicists,

radiation oncologists, and radiation therapists) nationallythrough SurveyMonkey® (electronic survey). A total of 220respondents provided demographic information. Half of theserespondents indicated that they previously received educationrelating to IPE. A high level of agreement was received fornearly all the questions. There were no significant statisticaldifferences among the three different professional respondentgroups for any question. Overall, most of the respondentsdemonstrated a good knowledge and understanding of IPconcepts and advocated IP training and collaboration.

Keywords Interprofessional education (IPE) .

Interprofessional care (IPC) . Attitudes . Learning . Teaching

Introduction

Interprofessional (IP) approaches to patient care are believedto have the potential for improving professional relationships,increasing efficiency, coordination, and ultimately enhancingpatient and health-care outcomes [1]. Interprofessional educa-tion (IPE) occurs when students from two or more professionslearn about from and with each other to enable effectivecollaboration and improve health outcome [2]. IPE enhanceslearners’ understanding of other professions’ roles and respon-sibilities, while fostering mutual respect and understandingbetween members of the health-care team [1].

With budgetary and staffing shortages in recent years, moreeffective and efficient use of health human resources has beenencouraged through governmental and institutional initiativesboth in Canada [3] and internationally. Promotion of IPE andinterprofessional practice (IPP) has been advocated and en-couraged especially in patient care since it helps practitionersto recognize the availability of other resources [4]. In Canada,much effort has been invested into creating a national

This study was presented at the Collaborating Across Borders IVConference on June 12–14, 2013 in Vancouver, BC, Canada.

K. Koo : E. Szumacher (*)Department of Radiation Oncology, Odette Cancer Centre,Sunnybrook Health Sciences Centre, 2075 Bayview Avenue,Toronto, ON M4N 3 M5, Canadae-mail: ewa.szumacher@sunnybrook.ca

L. Di Prospero :M. McGuffinDepartment of Radiation Therapy, Odette Cancer Centre,Sunnybrook Health Sciences Centre, Toronto, Canada

R. Barker : E. SzumacherDepartment of Radiation Oncology, University of Toronto,Faculty of Medicine, Toronto, Canada

L. SinclairCentre for Interprofessional Education, University of Toronto,University Health Network, Toronto, Canada

A. NgTDSB Experiential Learning: Cooperative Education Program atSunnybrook Health Sciences Centre, Toronto, Canada

J Canc EducDOI 10.1007/s13187-014-0614-1

framework that identifies the foundational competency do-mains that underpin IPC and care [5]. The World HealthOrganization (WHO) has recognized IP collaboration, educa-tion, and practice as an innovative strategy that will play animportant role in addressing the global health workforce crisis[4]. The University of Toronto and many other Canadianuniversities are strong advocates for IP initiatives especiallywithin clinical settings evidenced by their mandatory require-ment within health professional curriculum [6].

A recent literature review by Reeves et al. included studiesthat measured the effectiveness of IPE interventions comparedto no educational intervention [7]. Several of the studiesindicated that IPE produced positive outcomes in diabetescare, emergency department culture, and patient satisfaction;collaborative team behavior in operating rooms; managementof care delivered in cases of domestic violence; collaborativeteam behavior and reduction of clinical error rates for emer-gency department teams; and mental health practitioner com-petencies related to the delivery of patient care. Four studiesreported both positive and neutral outcomes; four other studiesreported that IPE interventions did not have an impact onprofessional practice or patient care [7]. Therefore, this reviewconcluded that due to the heterogeneity of the few studiesincluded, a proper assessment of the effectiveness of IPE todraw generalizable inferences about the importance of IPEcould not be concluded.

There are several tools to evaluate outcomes of IPE initia-tives. The current literature evaluating IPE has indicated a lackof established reliability and validity due to the variety ofinstruments used for the assessment of IPE/IPP [8]. With thedevelopment and implementation of IPE activities, much em-phasis has been placed on reporting the learners’ outcomes.However, there are only a few studies that have provided aninsight into the perspectives of IPE facilitators. It has beensuggested that the success of IP collaboration depends primar-ily on the attitudes of different professional groups towardeach other [9]. Health-care professionals come from differentdisciplines and health-care organizations and educational in-stitutions, which results in a variety of teaching and mentor-ship styles during complex health-care situations.

The success of implementing IPEwithin an organization canbe hindered by a number of factors. These factors can bedivided into three main categories (micro, meso, and macro).Each may uniquely challenge the successful development anddelivery of IPE. Firstly, at the micro level, socialization can be achallenge in the successful implementation of IPE; socializationis the process whereby beliefs, attitudes, and behaviors aretransferred from established members of the community tonew members [10]. Secondly, administrative challenges forlearners and faculty that affect the teaching environment andthe role of local leaders would be a barrier at the meso level.Lastly, at the macro level, the need for senior management andgovernment political support could be a potential obstacle [11].

Radiation oncology is an innovative, rapidly changingspecialty that consists of technical and clinical components.It is a discipline that inherently requires continuous collabo-ration with different health professions. In addition, teachingand mentoring of students from different professional groupsis continuing to evolve within radiation oncology training.Based on a previous study by Bennett et al., faculty percep-tions of interprofessional education at an Australianmulticam-pus health faculty, they indicated that the implementation of atruly interprofessional curriculum is challenging [12]. Someof the barriers mentioned that would hinder the developmentof IPE included the need for overt executive leadership com-mitment to IPE. Therefore, there is a need for academicleaders to focus their efforts on building understanding, value,and mutual respect across disciplines, which are essential forembedding IPE into health professional courses [12]. A sec-ond barrier to IPE success was the medical professions pow-erful global status; the power differential between health-care disciplines needs to be recognized if IPE is to betruly shared [12].

This study investigated the attitudes of radiation oncologyprofessionals through the administration of an anonymousquestionnaire. The primary objective of this study was tofurther investigate the attitudes of radiation oncology profes-sionals regarding IPE and IP teaching. The secondary objec-tive for this study was to identify the challenges faced byradiation oncologists, radiation therapist, and physicist whoteach within an IP context. The information collected fromthis study will be fundamental toward exploring new strate-gies to aid radiation oncology professionals who participate inteaching students of other disciplines.

Methods and Procedures

Questionnaire Development

Several stages were involved in the development of the finalquestionnaire. An initial review of the existing literature onIPE was performed using Medline, ERIC, and PubMed data-bases as well as literature evaluating IPE using validatedassessment tools. Some of the validated tools that were incor-porated and modified into the questionnaire included thefollowing: Readiness for Interprofessional Learning Scale(RIPLS) [13], Attitudes Toward Health-Care Teams Scale[14], and Attitudes Toward Interdisciplinary LearningScale [15].

A research investigation team, which consisted of educa-tors representing different professions that are actively in-volved in research concerning IPE, reviewed items withinthe selected validated tools group of questions. The processintentionally used collective input and discussions regardingthe questions’ relevance, content, and comprehension. This

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resulted in the development of a composite questionnairewhich was titled Interprofessional Education PerspectiveQuestionnaire (IEPQ). This tool consisted of three main do-mains: the understanding of IP concepts (UC), attitudes to-ward IP teaching and learning environments (ATL), andattitudes toward health-care teams (AHC). An open-endedcomment section was also incorporated to record any addi-tional comments. The final questionnaire was composed of 44questions with a four-point Likert scale (1=strongly agree and4=strongly disagree).

Pilot Study

A pilot study was conducted to reveal deficiencies in thedesign of the questionnaire and to address the level of clarity,comprehension, content validity, and face validity of the ques-tionnaire. The questionnaire was distributed both electronical-ly and by hard copy to ten IP radiation oncology membersfrom the Sunnybrook Odette Cancer Centre: three radiationoncologists, three radiation therapists, two oncology nurses,and two medical physicists. Since no identifiers were on thesurvey, completion of the survey was indicative of consent asoutlined in the introductory instructions. Upon completion ofthe pilot study, the feedback and comments received from theparticipants were incorporated into the questionnaire. Thequestionnaire was then sent to a subject matter expert fromthe Centre of Interprofessional Education for review; theircomments were also integrated into the questionnaire. Thefinal IPE questionnaire consisted of demographics (Q1–Q15) and three modules: (1) the understanding of IP concepts(Q16, 11 items), (2) attitudes toward IP teaching and learningenvironments (Q17, 21 items), and (3) attitudes toward health-care teams (Q18, 12 items). As with the IEPQ, an open-endedcomment section was also incorporated to record any addi-tional comments (Q19) (Tables 1 and 2).

Participants and Procedure

Using SurveyMonkey® (electronic survey), the questionnairewas distributed to radiation oncologists through the CanadianAssociation of Radiation Oncology (CARO), to radiationtherapists through the Canadian Association of Medical Ra-diation Technologists (CAMRT), and to physicists throughthe Canadian Organization of Medical Physics (COMP). Thedistribution of the questionnaires through e-mail was notaccurate. The exact number of individuals that received thee-mail was not collected since the main objective of this studywas to scan these professional groups and explore their atti-tudes toward IP and IPE. There was also an attempt to distrib-ute the questionnaire to the Canadian Association of Nurses inOncology (CANO); however, due to privacy restrictions lim-iting access to their mailing list, the administration of thequestionnaire was not feasible for these participants.

Data Analysis

Descriptive statistics were used to summarize the data withresponses captured as counts and percentages. A two-partanalysis was conducted to reveal the differences in responsebetween all respondents and the three professional groups ofrespondents. Chi-square analyses (or Fisher’s exact tests forthe case of low expected counts) were used to compare dif-ferences in responses between gender, age, location, profes-sion, experience, and affiliation with an academic center. Allanalyses were carried out using SAS Version 9.1 (SAS Insti-tute, Cary, NC, USA). The data obtained from the open-endedquestions were reviewed by the investigators to identifythemes individually, then by consensus.

Results

Demographics

A total of 220 respondents provided demographic information(Table 1). Most respondents were located in Ontario, Alberta,and British Columbia. From 216 respondents, there were 53physicists (25 %), 39 radiation oncologists (18 %), and 124radiation therapists (57 %). Eighty-five percent of respondentswere affiliated with academic institutions. The majority ofresponders had greater than 20 years in the profession longbefore IPE became a field of study.

Thirty-five percent of respondents indicated that they havepreviously completed courses, workshops, educational ses-sion, presentations, and/or training relating to IPE. Ninetypercent of respondents work in centers that support IPE,90 % believe that IPE is occurring at their center, and94.5 % support the implementation of IPE. Most respondents(92.5 %) think that further education related to IPE would bebeneficial in educating others, and 85.1 % participate in ac-tivities they identified as IPE.

Top Items for All Respondents

A high level of agreement was received for nearly all thequestions under all three domains. Of the 12 items pertainingto the topic of understanding concepts of IP education, prac-tice, and care, the top six items with the highest agreementbetween 96 and 99 % are as follows: (1) respondents felt thatindividuals in their profession must work together with peoplein other professions, (2) working in an IP environment is bestfor the patient, (3) IP teaching and mentorship is important fora student’s education, (4) the majority believed that sharedlearning will help them positively think about other profes-sional, (5) individuals in their profession work well with eachother, and (6) are willing to share information and resourceswith other professions (Table 2).

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Among the 22 items pertaining to the concept of ATL, thefive items with the highest agreement identified were asfollows: (1) nearly all (99 %) of respondents felt that IPEenables students to gain insight about other professions aswell as their own, (2) working in an IP environment is bene-ficial for their own knowledge (99 %) and (3) the studentswhom they mentor (99 %). (4) The majority agreed (96 %)that IPE in the classroom promotes collaboration in the clin-ical setting, and (5) faculty members benefit from lecturingwith faculty members from other disciplines (96 %) (Table 2).

Among the ten items pertaining to the concept of AHC, thetop five items with the highest agreement are as follows: (1)Almost all respondents (99 %) agreed that working in an IPenvironment is beneficial for their own knowledge and (2) thestudents whom they mentor (99 %) and (3) that the teamapproach permits health professionals to meet the needs ofpatients and their family/caregivers (99 %). (4) Nearly allrespondents (99 %) agreed that team meetings foster relation-ships among team members from different disciplines and (5)that working in an IP environment has improved group de-velopment through team learning (98 %) (Table 2).

Summary Scores for All Respondents

The rationale for this study is to address awareness of thechallenges faced while providing IP teaching and how toimplement strategies to better equip radiation oncologists,radiation therapists, oncology nurses, and physicists whoteach IP students in radiation oncology setting. The summaryscores were calculated on a scale of 0 to 100; the higher scorewas indicative of a stronger agreement. The median summaryscores for UC, ATL, and AHC were 76, 64, and 73, respec-tively. Therefore, there was higher agreement on UC andAHC compared to ATL.

Table 1 Respondent demographics

Demographics Number ofrespondents

Percent ofrespondents

Gender

Female 148 67.3

Male 72 32.7

Age in years

20–30 17 7.7

31–40 70 31.8

41–50 79 35.9

51–60 42 19.1

>60 12 5.5

Location in Canada

Alberta 40 18.2

British Colombia 30 13.6

Manitoba 13 5.9

New Brunswick 8 3.6

Newfoundland and Labrador 5 2.3

Nova Scotia 4 1.8

Ontario 91 41.4

Prince Edward Island 8 3.6

Quebec 10 4.5

Saskatchewan 11 5.0

Profession or field

Physicist 53 24.5

Radiation oncologist 39 18.1

Radiation therapist 124 57.4

Number of years in this profession

<5 34 15.5

5–10 41 18.6

11–15 45 20.5

16–20 32 14.6

>20 68 30.9

Affiliation with an academic institution

Yes 153 84.5

No 28 15.5

Support for and IP learning environment

Yes 164 90.6

No 17 9.4

Professions that instructions are provided to

Nurse 84 46.4

Physicist 97 53.6

Radiation oncologist 107 59.1

Radiation therapist 159 87.8

Type of instruction implemented

Clinical 91 50.3

Didactic 18 9.9

Both 72 39.8

IPE occurring at your centre

Yes 155 89.1

No 19 10.9

Table 1 (continued)

Demographics Number ofrespondents

Percent ofrespondents

Support for IPE

Yes 173 99.4

No 1 0.6

Benefits of IPE

Yes 161 92.5

No 13 7.5

Participation in IPE

Yes 148 85.1

No 26 14.9

Completion of training relating to IPE

Yes 61 35.1

No 113 64.9

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Top Items for Three Different Respondent Groups

Ten items from the demographic section were comparedamong respondent groups (physicists, radiation oncologists,and radiation therapists). There were a significantly higherproportion of females in radiation therapy (p>0.001). A lo-gistic regression analysis showed that there was no significantstatistical difference among the three respondent groups afteradjusting for gender.

There was no significant statistical difference among thethree respondent groups for all questions, except for item 7under UC: “Individuals in other professions often seek theadvice of people in my profession” (p=0.0002). Physicistsand radiation oncologists had a higher level of agreement (95and 91 %) compared to radiation therapists (67 %).

Summary Scores for Three Different Respondent Groups

The summary scores were calculated on a scale of 0 to 100;higher scores indicate a stronger agreement. A Kruskal-Wallisnonparametric test revealed that there were no significantstatistical differences among the three respondent groups. Onthe concept of UC, physicists demonstrated the highest levelof agreement (78) compared to radiation oncologists (75) andradiation therapists (75). On the concept of ATL, physicistsdemonstrated a higher level of agreement (67) compared toradiation oncologists (64) and radiation therapists (62). On theconcept of AHC, all respondent groups had the same level ofagreement (73).

Open-ended Comments

An open-ended comment section was incorporated into thequestionnaire to obtain feedback on the questionnaire contentand IPE topics (Table 3). Generally, the questionnaire receivedpositive feedback. Most respondents believe that IP promotesmutual respect and advocate IP training and work environ-ments. Several respondents voiced concerns regarding thepassive roles of students and trainees in IPP, the heavy work-load preventing the participation of radiation therapists andphysicians in IP collaborative work, and the level of involve-ment of certain professions. Other comments highlighted dif-ficulties concerning hierarchical culture such as havingphysician-led initiatives rather than team-based collaboration.

Discussion

This is the first known published study to assess the under-standing and attitudes toward IP within radiation oncology.For this study, the questionnaire used to assess the perspec-tives of these health-care professionals consisted of elementsfrom three different questionnaires. Three questionnaires were

combined to allow for a comprehensive representation of themost important categories that would address our main objec-tives. Based on the demographics collected, there were nosignificant differences noted; however, there were a signifi-cantly higher proportion of females in radiation therapy(p>0.001). This reflects the demographic makeup of the radi-ation therapy population as more females tend to take upradiation therapist positions [16].

Overall, all three respondent groups (physicists, radiationoncologists, and radiation therapists) demonstrated a goodknowledge and understanding of IP concepts; this may beattributed to the IP nature of radiation oncology. A high levelof agreement was achieved among the respondents, and apositive attitude was taken toward collaboration and IPE. Asdescribed in the open-ended comments and reflected in theliterature, most respondents agree that IPP promotes collabo-ration, fosters relationships, and is beneficial to gainingknowledge. One respondent stated, “I feel that interprofes-sional education could increase mutual respect and confidencebetween different health professionals.” The University ofToronto is a strong advocate for IP initiatives [17]; the Uni-versity of Toronto Department of Radiation Oncology is ac-tively engaged in undergraduate, graduate, and postgraduateeducation and training and IPE. Exposure to IP environmentshas a high educational value; in addition, these communica-tion and collaboration skills often extend into the work envi-ronment [18].

The difficulties surrounding hierarchical culture are com-mon barriers to IP education. Whitehead has suggested thatphysician engagements in collaborative processes are hin-dered by specific powers, status, professional socialism, anddecision-making responsibility [19]. More specifically, theclinical settings can be very chaotic and busy for physicians.This could potentially reinforce their sense of self-importanceand lead to limited interest in interaction due to time con-straints that renders teaching less of a priority. Therefore,higher functioning teams are expected to have physicians withlower physician centrality scores. Physician centrality scoresexamine the sharing of authority and leadership among pro-fessionals; higher functioning teams are expected to havelower physician centrality scores, implying that the doctors’authority is detrimental [19]. As such, a physician’s level ofauthority can be detrimental toward the easing of IP teaching.

The open-ended comments returned by our survey aresuggestive of the barriers that are present within the imple-mentation of the IPP. This lack of fluid and consistent imple-mentation of IPE may suggest that physicians may not be thebest leaders for the field of IP learning since they may lackengagement. Oandasan and Reeves suggest that interprofes-sional facilitators will need to shift their way of thinking from“teaching” to learners to “working with” learners [11].Therefore, for interprofessional education to be success-ful, the facilitator needs to accommodate to the

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dynamics of interprofessional learning, optimize learningopportunities, and have a strong understanding of thevalues that each profession brings [11].

Socialization is the concept that when individuals enter aparticular health profession, they have beliefs, understandings,and attitudes of what their profession means to them.

Table 3 Open-ended comments

Profession Comments

1 RO “I think interprofessional learning is a no-brainer.”

2 RT “I feel that interprofessional education could increase mutual respect and confidence between different health professionals.”

3 RT “…I believe that the benefits to IPE are immeasurable, but often limited resources means that opportunities cannot be realizedto their full potential.”

4 RT “Interprofessional collaborative practice and education really needs to happen with ALL members of the care team—physicians included. At this point in the IPCP/E trajectory, physician involvement is limited; or, if it does happen it isstill physician as team leader which may or may not be appropriate.”

5 RT “Certain professions are more open to interprofessional collaboration. Nursing has been a difficult group to work together with.”

6 RT “I think interprofessional education strongly promotes mutual respect and makes the environment better for the patient. Oftenwe work with nurses in the OR at the adjacent hospital and found that initially when this relationship started, some nursesseemed opposed to our being in their environment. Perhaps due to lack of education about our role. This opposition causedmore complications for us and made the flow of procedures more difficult. Since then it has improved, but perhaps it wouldhave been better if there was more interdisciplinary education.”

7 RT “I feel that in the clinical environment the degree of true interprofessional collaboration and education is much less than thetraining programs lead us to believe… Students are educated with IPC or IPE principles and as students they are lead tobelieve that this is the way of things and they can expect this when qualified. Many radiation therapists on the treatmentunits are not able to take part in intercollaborative work, as they can’t be spared to attend… From the day-to-day practice theradiation therapists work alone. I think IPC or IPE is great and hopefully it will happen more and more MRTT’s will have theopportunities to really fully participate.”

8 RT I think the hierarchical culture is very difficult to change and will take a very long time [but] it is worth trying.

9 RT I think this is a great initiative! I look forward to hearing about your results.

10 Not indicated A topic worthy of consideration, Good luck with the study.

MP medical physicist, RO radiation oncologist, RT radiation therapist

Table 2 Summary of results

Statement Number (%) Ranking

Understanding the concepts of interprofessional education, practice, and care

Individuals in my profession must work together with people in other professions 161 (99.38) 1

I think that working in an interprofessional environment is best for the patient 160 (99.38) 1

I believe that interprofessional teaching and mentorship are important for a student’s education 159 (99.38) 1

Shared learning will help me to think positively about other professions 155 (96.88) 4

Individuals in my profession are willing to share information and resources with other professions 155 (95.68) 5

Individuals in my profession work well with each other 155 (95.68) 5

Attitudes toward interprofessional teaching and learning environment

Interprofessional education enables students to gain insight about other professions as well as their own 142 (99.30) 1

I think that working in an interprofessional environment is beneficial for my own knowledge 141 (99.30) 1

I think that working in an interprofessional environment is beneficial to the students whom I mentor 135 (98.54) 3

Interprofessional education in the classroom promotes collaboration in the clinical setting 135 (96.43) 4

Faculty members benefit from lecturing with faculty from other disciplines 131 (96.32) 5

Attitudes toward health-care teams

I think that working in an interprofessional environment is beneficial for my own knowledge 137 (99.28) 1

The team approach permits health professionals to meet the needs of patients as well as their family and caregivers 134 (98.53) 2

I think that working in an interprofessional environment is beneficial to the students whom I mentor 132 (98.51) 3

Team meetings foster relationships among team members from different disciplines 130 (98.48) 4

Working in an interprofessional environment has improved group development through team learning 127 (97.69) 5

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Therefore, these health professionals tend to be trained sepa-rately which impacts the formation of their identity. For ex-ample, as part of their socialization process, medical studentsdevelop a level of competence in which they feel that theymust learn how to be authoritative in professional and inter-professional situations. As a result of their socialization,learners develop certain stereotypes of their own professionas well as other professions, which present particular chal-lenges for implementing interprofessional learning. Therefore,learners need to acknowledge the presence of these stereo-types and the negative impact it has on IPE initiatives. Pro-moting interprofessional education on the socialization pro-cess has the potential to increase opportunities for students tolearn together and collaborate more effectively [20].

Limitations

There are several limitations to the study. Based on the surveymethodology used to conduct the study, several restrictionswere noted. The new composite survey was not extensivelytested for psychometric properties. Based on the scope of theproject, the exploratory nature of the research and the fact thatresults will not be generalized to any other than those whoparticipated, the lack of further tool testing was appropriate.Firstly, there was a relatively low estimated rate of response;an exact response rate was not collected for this study due tothe exploratory nature of this study. Secondly, most of therespondents were from the most populated Canadian prov-inces: Ontario, Alberta, and British Columbia, which arereflective of practice patterns. It is also important to note thatthese organizations provide the best representation of thehealth-care professionals; however, this is not a comprehen-sive list since some of these professionals may not be mem-bers to these organizations.

Selection bias may have been another issue as the respon-dents generally had an interest in IP; as indicated in thedemographics section, half of the respondents had previouslytaken courses or attended presentations relating to IP. Internet-based surveys have been reported to be an attractive alterna-tive to postal or telephone methods. The key advantages ofusing electronic surveys include the ease of implementationand the potential to conduct large-scale surveys.

The University of Toronto is a strong advocate for IPE;however, no insight was obtained from other major institu-tions. Questions regarding potential barriers were not includedin the questionnaire; therefore, factors hindering the imple-mentation of IPP/IPE were not assessed. Comments in theopen-ended comment sections included “survey too long” and“You need a neutral button, I clickedN/A often when I felt thatI neither agreed nor disagreed with the statements”. The open-ended comments indicated that reducing the length of surveyand including a “neutral” option would aid in the reflection of

more accurate answers. These changes may be incorporated toimprove the questionnaire for future studies.

Future directions include repeating the study to obtain theperspectives of nurses and other disciplines that work closelywith patients. Additional input from students and traineesexposed to IP environments would also be beneficial infor-mation to collect. Moreover, conducting an analysis to revealthe variation of IPP/IPE between teaching and nonteachinghospitals is also a topic for consideration. Questions relating tochallenges faced by health-care providers who teach within anIP context need to be included in the questionnaire to assessbarriers obstructing the implementation of IPP/IPE. This mayaid in reducing such barriers and may aid in the developmentof new strategies to facilitate IPE and improve IP team build-ing. The results of this study have also revealed the lack ofspecific objectives to teach others; many of the professionshave indicated that there is a demand for training to bridgethese barriers in IP education.

Conclusion

This exploratory study has provided better insight toward theunderstanding of concepts of IPP/IPE in radiation medicine. Ithas also shown that most health-care professionals demon-strate a positive attitude toward IPE and teamwork and areadvocates of IPP.

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