Maternal and Child Health Journal

, Volume 17, Issue 5, pp 949–958

Effects of Interdisciplinary Training on MCH Professionals, Organizations and Systems

Authors

    • Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
  • Angela Rosenberg
    • Carolina Institute for Developmental Disabilities, Department of Allied Health SciencesUniversity of North Carolina at Chapel Hill
  • Karl Umble
    • North Carolina Institute for Public HealthUniversity of North Carolina at Chapel Hill
  • Linda Chewning
    • Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel Hill
Article

DOI: 10.1007/s10995-012-1078-8

Cite this article as:
Margolis, L.H., Rosenberg, A., Umble, K. et al. Matern Child Health J (2013) 17: 949. doi:10.1007/s10995-012-1078-8

Abstract

We studied the effects of the Interdisciplinary Leadership Development Program (ILDP) on MCH trainees from five MCHB-funded training programs at the UNC-Chapel Hill from the years 2001–2008. Specifically, we examined attitudes/beliefs about interdisciplinary practice and the frequency of use of interdisciplinary skills; identified effects of interdisciplinary training on career choices; and, examined the ways in which graduates used their interdisciplinary skills to effect change in MCH organizations and systems, up to 8 years after completion of training. Using a post-test design, participants in the ILDP were contacted to complete a web-based survey. Non-participating LEND and public health graduates were recruited for comparison. Guided by EvaluLEAD, we designed questions that asked graduates to rate the influence of their programs on their attitudes/beliefs and skills (on 5-point Likert scales), and to describe those influences in some detail in open-ended questions. The 208 respondents represented 59.6 % of the graduates from 2001 through 2008. Model-predicted mean levels of frequency of use of interdisciplinary skilIs was associated with ILDP participation (p = 0.008) and nearly so for interdisciplinary attitudes/beliefs (p = 0.067). There is an association between four domains of systems changes and frequency of skill use: develop/improve a program (3.24 vs. 2.74, p < 0.0001); improve the way an organization works (3.31 vs. 2.88, p < 0.0001); develop/improve a partnership (3.22 vs. 2.83, p < 0.0003); and, develop a policy (3.32 vs. 2.98, p < 0.0013). Graduates used interdisciplinary training to improve outcomes for families and to effect change in MCH systems. MCH leaders should disseminate, more broadly, rigorous assessments of the training intended to develop leadership competencies that underpin effective interdisciplinary practice.

Keywords

Interdisciplinary trainingLeadership trainingInter-professional training

Introduction

Families live in an increasingly complicated world, coping with globalization, demographic shifts such as changing family composition [1], an aging population [2], increasing cultural diversity [3], and growing prevalence of disabilities [4]. At the same time, many basic science and clinical disciplines are becoming more specialized, as knowledge and understanding continue to evolve. Consequently, it is necessary to examine both the ways in which disciplines define the needs of children and families and collaborate to develop strategies to address those needs. Given the multi-faceted aspects of children’s growth and development and the families in which they reside, the professional field of Maternal and Child Health has encouraged the collaboration of many disciplines to promote the well-being of children and families [57]. Understanding and promoting the importance of interdisciplinary education to accomplish effective collaboration must be driven by an evidence base that flows from rigorous research.

This article reports the effects of interdisciplinary education on students who graduated from five MCHB-funded training programs [public health (MPH), social work (MSW/MSPH), nutrition, pediatric dentistry, and Leadership Education in Neurodevelopmental and Related Disabilities (LEND)]. We examine the association between training and attitudes/beliefs about the value of interdisciplinary practice, the frequency with which graduates use interdisciplinary skills, and graduates’ influence on the MCH systems in which they work. We highlight the impact on these outcomes for a sub-set of participants in the MCH Interdisciplinary Leadership Development Program (ILDP), an intensive, focused, year-long curriculum that supplemented their individual program-based learning activities.

Background

Based on a careful study of four systematic reviews [811] on the effects of interdisciplinary training on professional practice and client outcomes, we extracted four concepts–settings, exposure, measurements, outcomes—to guide the design of a rigorous evaluation of interdisciplinary training. Prior studies used a variety of teaching methods, from didactic teaching, case studies and role plays in classrooms to experiential clinical and community placements. Overall, there was a strong trend for studies to measure learner reaction, perceptions and attitudes, and knowledge and skills. A recurrent theme was the paucity of research on the actual impact of interdisciplinary training and care on measurable outcomes [12]. Outcomes were generally self-assessed; few studies used objective external measures. Virtually no studies assessed outcomes over an extended period of time.

Methods

Theoretical Framework and Constructs

Drawing on the systematic reviews [811], we defined interdisciplinary practice as “collaborative practice that combines the insights of several professional disciplines, consumers, and community members—in designing care or programs.” This might occur in a community context, when a health educator, nutritionist and physical therapist design a community/state program to reduce obesity, or in a clinical setting, when an audiologist, social worker, and occupational therapist develop a plan of care for a child with a special need. “Consumers” include patients, family members, or community members assisting with healthcare or public health efforts.

In designing this evaluation, we used EvaluLEAD [13], a framework for developing and evaluating leadership development programs which postulates that such programs may be evaluated partly by looking for discrete, short-term, expected outcomes (such as increases in skills taught), using traditional survey tools (which the authors call “evidential inquiry”). In addition, however, evaluators should look for longer-term outcomes that could not be anticipated which occur as graduates take what they learn in the program and interact with colleagues to lead diverse changes in programs, organizations, coalitions, and policies. These long-term effects, which are not only due to the program, but also influenced by the “open system” in which graduates work, can be discovered by tools such as interviews, case studies, and observations, in what the authors call “evocative inquiry.” Evaluators can combine both approaches to look for individual, organizational, or societal levels of impact from programs.

Another helpful aspect of the EvaluLEAD model is that it draws a distinction between three types of outcomes found at individual, organizational, or societal levels: episodic, developmental, and transformative changes. Episodic changes are changes directly resulting from the program, such as gaining a specific new skill during the program itself. Developmental changes are incremental changes that could be expected, given the content of the program, that occur over time, often with progress mixed with setbacks, and that proceed at varying paces. Transformational changes are fundamental, profound, and often unexpected new directions in factors such as goals, perspectives, behavior, performance, careers, or strategies and policies.

Study Design

This study involved two interdisciplinary interventions. Students from all five programs—LEND, nutrition, pediatric dentistry, public health, and social work—participated in conventional courses and projects with interdisciplinary aspects. For example, public health, social work, and nutrition students work on projects calling upon a variety of disciplines in required public health core courses. Many pediatric dentists took elective rotations in anesthesia, other surgical disciplines, or earned master’s degrees in public health or other academic areas. LEND fellows engage in interdisciplinary clinical assessment teams.

A subset of these students participated in the Interdisciplinary Leadership Development Program (ILDP), consisting of workshops on conflict resolution, cultural competence, minority health, and family-professional collaboration, all building on a three-day leadership intensive workshop which “challenges participants to develop an awareness and understanding of their personal leadership styles and goals through a discussion of leadership models, an analysis of individual and group personality dynamics, and the writing of a leadership plan” [5]. All of the students in three programs—pediatric dentistry, MSW/MSPH, and nutrition—participated in the ILDP, while only some of the participants in two of the programs—LEND and public health—participated in the ILDP. Thus, non-participants from those two programs provided a comparison group to assess the impact of the ILDP.

Because this study was conceived after the learners had already completed their studies within their graduate/residency programs and the ILDP, we used a post-test design, relying on surveys and interviews undertaken 1–8 years after graduates enrolled in the program. We designed questions that asked graduates to rate the influence of their programs on their attitudes/beliefs and use of skills, and to describe those influences in some detail in open-ended questions.

This study was approved by the IRB of the UNC-Chapel Hill.

Population Studied and Sample Selection

The population from which the sample was selected included all graduates of the five participating training programs from the years 2001–2008 and all participants in the ILDP from 2001–2006. The 208 responses represented an overall response rate of 60 % (dentistry 83 %, nutrition 70 %, public health 58 %, social work/public health 56 %, LEND 56 %).

Instruments Used

The study used a web-based survey delivered to graduates via email using the commercially available tool, SurveyMonkey™. We asked both closed-ended and open-ended questions to gather both evidential and evocative types of data. The survey asked questions in three major domains: (1) attitudes/beliefs about interdisciplinary practice, frequency of use of interdisciplinary skills, and the impact of their training on these; (2) work positions and responsibilities after graduation; (3) impacts on the systems of care in which they work, including barriers to interdisciplinary practice.

Variable Creation

Each individual was asked a set of questions relating to her/his attitudes/beliefs about interdisciplinary practice, a set of questions relating to her/his frequency of use of interdisciplinary skills, and assessment of the degree that their program strengthened those attitudes/beliefs and those skills (see “Appendix”). For each of the 8 beliefs items, the survey participant was asked to rate her/his agreement on a 5-point scale. For each of the 14 items relating to practices, survey participants were asked to rate on a 5-point scale how often they have used a particular skill in the previous 3 months. For each of these four sets of outcomes (Attitudes/Beliefs-Agreement, Attitudes/Beliefs-Strengthening, Skills-Frequency, Skills-Strengthening), an outcome variable was created which combined the items within each set. This report addresses Attitudes/Beliefs-Agreement and Skills-Frequency.

Statistical Analysis

A comparison of mean scores by academic program was conducted using Analysis of Variance (ANOVA), and a global F test was used to test for an overall difference in means between at least two of the programs. Pair-wise differences in interdisciplinary beliefs and practices scores were assessed for statistical significance using Tukey’s adjustment for multiple comparisons. Analysis of Covariance (ANCOVA) models were used to assess mean score differences by academic program after adjustment for ILDP participation (and to assess mean score differences by ILDP participation after adjustment for academic program). Within academic program, t tests were used to compare the mean scores by whether a survey respondent participated in the ILDP.

When assessing the relationship between interdisciplinary beliefs and practices scores and scaled responses to other questions (e.g. Program contributions to Skills in Collaborative Practice), Spearman rank correlations were calculated. When comparing proportions of individuals (by ILDP participation) who indicated they have used skills in interdisciplinary collaboration (Yes/No for each skill), Fisher’s Exact tests were used to a obtain p values. All statistical tests were two-sided with alpha = 0.05. Statistical analyses were conducted using SAS 9.2 (SAS Institute, Cary, NC).

Survey qualitative data were analyzed using content analysis methods [14] using Excel® (Microsoft) and Atlas.ti©.

Results

Conceptual Model

Figure 1 displays a conceptual model of the study’s findings. Interdisciplinary training was associated with stronger attitudes/beliefs towards interdisciplinary practice and increased frequency of the use of interdisciplinary skills. Overall, participation in the ILDP enhanced interdisciplinary attitudes/beliefs and use of skills when comparing participants to colleagues in the UNC LEND and MPH programs who were not selected for the ILDP. As shown in the Figure, graduates translated these interdisciplinary skills and practices into systems change, affecting programs, organizations, partnerships and policies.
https://static-content.springer.com/image/art%3A10.1007%2Fs10995-012-1078-8/MediaObjects/10995_2012_1078_Fig1_HTML.gif
Fig. 1

Conceptual model of the evaluation findings through the EvaluLEAD lens

Effects of Training on Attitudes/Beliefs and Use of Skills

The mean scores for attitudes/beliefs about interdisciplinary practice (Table 1) are close to the high end of the scale (“completely agree”). In Table 2, for each of the programs, the mean scores for frequency of skill use were generally close to 3 (“occasionally”).
Table 1

Graduates strongly agreed with statements about the effectiveness and value of interdisciplinary practices

Attitudes/beliefs agreementa

Mean (SD, N)

MPH

4.55 (0.36, 83)

LEND

4.50 (0.33, 49)

Pediatric dentistry

4.43 (0.43, 14)

Nutrition

4.36 (0.34, 12)

MSW/MSPH

4.57 (0.44, 18)

aScale: 1 = Completely disagree, 2 = Disagree 3 = Not sure, 4 = Agree, 5 = Completely agree

Table 2

Graduates used interdisciplinary skills with more than occasional frequency

Skills frequencya

Mean (SD, N)

MPH

3.11 (0.66, 84)

LEND

3.18 (0.76, 43)

Pediatric dentistry

2.79 (0.41, 14)

Nutrition

3.08 (0.44, 11)

MSPH/MSW

3.08 (0.75, 18)

aScale: 1 = Never, 2 = Rarely, 3 = Occasionally, 4 = Often, 5 = Very often

The Influence of the ILDP on Interdisciplinary Attitudes/Beliefs and Skills

Table 3 shows that the ILDP participants reported stronger agreement with interdisciplinary attitudes/beliefs than did their non-participant peers, achieving statistical significance for the LEND participants.
Table 3

Participants in the ILDP tended to agree that interdisciplinary practice was effective and valuable

Attitudes/beliefs agreementa,b

ILDP

Non-ILDP

p value

MPH

4.66 (0.32, 14)

4.53 (0.35, 69)

0.204

LEND

4.59 (0.25, 28)

4.39 (0.39, 21)

0.046

Pediatric dentistry

4.43 (0.43, 14)

 

Nutrition

4.36 (0.34, 12)

 

MSW/MSPH

4.57 (0.44, 18)

 

MPH + LEND

4.61 (0.28, 42)

4.50 (0.36, 90)

0.051

aAll of the students in pediatric dentistry, nutrition, and public health social work participate in the ILDP, so no comparative data are provided

bScale: 1 = Completely disagree, 2 = Disagree 3 = Not sure, 4 = Agree, 5 = Completely agree

Table 4 shows the relationship between ILDP participation and the frequency of use of interdisciplinary skills. Both the LEND and MPH ILDP participants reported more frequent use of interdisciplinary practices than did their non-ILDP counterparts, with the LEND difference statistically significant (p = 0.026).
Table 4

ILDP participants use interdisciplinary skills with greater frequency

Skills frequencya,b

ILDP

Non-ILDP

p value

MPH

3.23 (0.53, 14)

3.08 (0.68, 70)

0.369

LEND

3.41 (0.68, 25)

2.87 (0.78, 18)

0.026

Pediatric dentistry

2.79 (0.41, 14)

 

Nutrition

3.08 (0.44, 11)

 

MSW/MSPH

3.08 (0.75, 18)

 

MPH + LEND

3.35 (0.63, 39)

3.04 (0.70, 88)

0.017

aAll of the students in pediatric dentistry, nutrition, and public health social work participate in the ILDP, so no comparative data are provided

bScale: 1 = Never, 2 = Rarely, 3 = Occasionally, 4 = Often, 5 = Very often

Model-predicted Least Squares means for Analysis of Variance models containing variables for program and ILDP participation allow us to look at the contributions together of each of the two main educational exposures, the home program for each participant (public health, LEND, etc.) and the ILDP and to include in this analysis responses from the three programs for which we did not have explicit comparison groups. While not showing large differences in magnitude (Table 5), the model-predicted mean levels of agreement with interdisciplinary statements was found to be nearly statistically significant for ILDP participation, after controlling for academic program (p = 0.067). Furthermore, attitudes/beliefs about interdisciplinary practice were associated with academic program (p = 0.047), after controlling for ILDP attendance. Table 6 shows the same analysis addressing the frequency of use of interdisciplinary skills. ILDP was associated with frequency of practice of interdisciplinary skills, controlling for academic program (p = 0.008). In summary, controlling for individual program, ILDP participation was associated with increased frequency of use for interdisciplinary practices and to a lesser degree enhanced attitudes/beliefs about interdisciplinary practice.
Table 5

Effects of programs and ILDP on beliefs/attitudes about interdisciplinary practice

Attitudes/beliefs agreement

ILDP

Non-ILDP

p value for ILDP attendance

p value for academic program

LEND

4.49

4.49

0.067

0.047

Nutrition

4.31

   

Pediatric dentistry

4.34

   

MPH

4.55

4.55

  

MSW/MSPH

4.58

   

Scale: 1 = Completely disagree, 2 = Disagree 3 = Not sure, 4 = Agree, 5 = Completely agree

Table 6

Effects of programs and ILDP on frequency of interdisciplinary skills

Skills-frequency

ILDP

Non-ILDP

p value for ILDP attendance

p value for academic program

LEND

3.41

2.87

0.008

0.048

Nutrition

3.08

   

Pediatric dentistry

2.79

   

MPH

3.27

3.06

  

MSW/MSPH

3.08

   

Scale: 1 = Never, 2 = Rarely, 3 = Occasionally, 4 = Often, 5 = Very often

We also asked graduates to rate the ILDP’s influence on four MCH leadership competencies most directly addressed by the program (communication, negotiation and conflict resolution, self-reflection, and cultural competency). In data not shown, the pediatric dentistry, nutrition, and LEND program graduates, on average, responded that the ILDP had improved these abilities in the range between “somewhat” and “a large amount”.

Influences on MCH Systems

In the survey, we asked about the use of interdisciplinary collaboration skills to address four domains of systems: (1) develop or improve a specific program; (2) improve the way an organization works or is structured; (3) develop or improve a partnership; and, (4) develop a policy. In data not shown, the majority of graduates of each program reported having used their interdisciplinary collaboration skills to improve an organization’s structure and functioning, or a partnership (with the only exception being 48 % of LEND graduates influencing an organization). The majority of pediatric dentists and nutrition graduates had also influenced a policy, while fewer graduates of other programs had done so. We assume that this difference is due to the nature of the positions that graduates hold. Nutritionists, for example, often have an immediate connection to programs such as WIC, in which state and local policy development and implementation is ongoing. While pediatric dentists spend the vast majority of their time in direct clinical care, they are called upon, with their specialized knowledge, to participate in state and local policy discussions and program implementation around children’s oral health.

Table 7 shows that for three of the four outcome domains (improve a specific program, improve the way an organization works, develop a partnership), graduates who reported that they had facilitated a change (indicated “yes”) had significantly stronger interdisciplinary beliefs. The relationship is more salient for the frequency of interdisciplinary practices. For each of these four outcome domains, graduates reported more frequent use of interdisciplinary skills when they have reported having made a change than when they have not.
Table 7

Relationship between interdisciplinary beliefs and practices and system change

 

Attitudes/beliefs agreement

Skills frequency

Mean (SD, N)

p value

Mean (SD, N)

p value

Develop or improve a specific program

 Yes

4.55 (0.37, 134)

0.0198

3.24 (0.67, 132)

<0.0001

 No

4.41 (0.33, 45)

 

2.74 (0.51, 44)

 

Improve the way an organization works or is structured

 Yes

4.56 (0.33, 95)

0.0616

3.31 (0.67, 94)

<0.0001

 No

4.46 (0.38, 84)

 

2.88 (0.59, 82)

 

Develop or improve a partnership

 Yes

4.55 (0.37, 126)

0.0237

3.22 (0.68, 124)

0.0003

 No

4.42 (0.32, 51)

 

2.83 (0.57, 50)

 

Develop a policy

 Yes

4.55 (0.34, 69)

0.228

3.32 (0.68, 68)

0.0013

 No

4.49 (0.37, 110)

 

2.98 (0.63, 108)

 

Qualitative analysis showed that graduates used interdisciplinary skills to foster effective working relationships with professionals from multiple disciplines. In many cases, graduates described interdisciplinary practice in their daily approach to their work in organizations or communities. In other cases, graduates described using more formal “partnerships” with other units in the same organization, such as between a nursing school and other parts of a university, or between organizations, such as a partnership between two kinds of organizations to develop and deliver a health program. In some cases, they described coalitions of many organizations that they formed or strengthened. Especially noteworthy is that graduates did not describe these interdisciplinary working relationships, groups, or partnerships as ends in themselves, but rather as means to improving clinical care, population-level programs, and organizations.

The following quote from an MPH graduate shows how she explained intentionally and carefully weighed the “viewpoint, training, personality, and approach” of others in all professional interactions. She also described “initiative” in fostering a new project, and in negotiating between the many engaged parties:

Before approaching any professional experience (i.e. conflict, project, etc.), I try to consider the viewpoint and training that the people with whom I’m working might have. I do not take varying attitudes personally—but instead try to consider one’s background, personality and approach to working in groups…. I have been helping to initiate a $400,000 plan to test a communications technology in rural Northwest Ecuador. The proposal was created with anthropologists, medical doctors, businessmen and public health practitioners from four different countries. All of us approach the project very differently. And it is my role to facilitate and mediate the negotiations.

ILDP and Advanced Skills in MCH Leadership

It is instructive to the field of MCH to view our findings through the lens of the MCH Leadership Competencies. The 12 competencies consist of three components: knowledge, basic skills, advanced skills [6]. Competency 10—interdisciplinary team building—is an obvious outcome that we have identified, but the ILDP has helped students not only to cultivate many competencies, but also at the advanced level. The representative quotes in Table 8 demonstrate advanced performance of skills for seven competencies.
Table 8

Evidence of the development of advanced skills in MCH leadership

MCH leadership competency

Selected advanced skills

Quotes reflecting advanced skills

Self-reflection

Use self-reflection techniques effectively to enhance program development, scholarship and interpersonal relationships

Identify a framework for productive feedback from peers and mentors

Participating in the [ILDP] has been helpful in my development as a leader. It has helped me to reflect on my work and my tendencies in terms of how I operate in group settings. It has helped me to increase my effectiveness by proactively seeking tasks and roles that are aligned to how I best operate and it has also pushed me to be a better manager. [MSW/MSPH ILDP]

Communication

Refine active listening skills to understand and evaluate the information shared by others

In my current work, I manage an interdisciplinary collaboration that implements and evaluates an MCH-related program. Program consumers’ outcomes, a specific program, and a partnership have improved because of my program evaluation efforts and my communication skills. My interdisciplinary skills helped me mostly with the communication piece and understanding how to effect change in a group with varying perspectives, training, and approaches. As such, I was able to present the needed changes in a way that was palatable and respectful and that considered the needs of my colleagues from other disciplines. [MSW/MSPH ILDP]

Negotiation and conflict resolution

Demonstrate the ability to manage conflict in a constructive manner

I do lots of work with partner agencies (the state, other non-profits, etc.). Those relationships can be very challenging, as not only are the partners from multiple disciplines, but also often have different goals/outcomes in mind. I often use general leadership principles from our training as well as the personality training to think about ways to improverelationships, etc. I often find myself fielding calls from other partners to “translate” what others mean when they say or do X. It seems that one thing I gained from the program was the ability to identify barriers, particularly around communication. [MSW/MSPH ILDP]

Cultural competency

Employ strategies to assure culturally-sensitive public health and health service delivery systems

Working with our Spanish interpreters, case manager, and nurses we discussed that Spanish-speaking families seemed to walk-into care more at our clinic but the clinic was seeking to stop taking walk-ins. After formally surveying families we discovered that this was a culturally mediated way to seek care for recent immigrants and worked together to convince clinic administration we should still accept walk-in patients. [MPH non-ILDP]

Developing others through teaching and mentoring

Give and receive constructive feedback about behaviors and performance

The 3-day leadership workshop helped me identify my leadership style and allowed me to capitalize on these strengths, but also helped me identify areas where I need to develop as a leader. This workshop also allowed me to identify leadership styles in others and to brainstorm ways to work together with people who have different work styles. [LEND ILDP]

Interdisciplinary team building

Identify forces that influence team dynamics

Enhance team functioning, redirect team dynamics, and achieve a shared vision

Share leadership based on appropriate use of team member strengths in accomplishing activities and managing challenges for the team

Use knowledge of disciplinary competencies and roles to improve teaching, research, advocacy, and systems of cared

Use shared outcomes to promote team synergy

I am in the middle of re-writing a service design for a rehabilitation program, and must gain internal stakeholder buy-in. I am the only one in my department with an MSPH. I have to get support from data analysts, nurses, project managers, and contracts managers. This involves listening, understanding what motivates others, and speaking “their” language. It also involves “selling” my point of view. [MSW/MSPH ILDP]

Working with communities and systems

Assess the environment to determine goals and objectives for a new or continuing program, list factors that facilitate or impede implementation, develop priorities, and establish a timeline for implementation

Translate mission and vision statements for different audiences, understanding their different cultures, perspectives, and use of language

Use negotiation and conflict resolution strategies with stakeholders when appropriate

Maintain a strong stakeholder group with broad based involvement in an environment of trust and use an open process

[In the MPH program] we had a several classes in which projects involved being out in the community, doing needs assessments, taking surveys, and generally addressing practical issues which necessitated interdisciplinary collaboration…. I’ve worked on some large (National) scale prevention programs in Africa for prevention of mother-to-child transmission as a representative for one of the larger players (PEPFAR). However, we recognize that the actual implementers who make things happen on the ground are the key to the program’s success. We have to bring in government officials, program managers, clinical workers, social workers, other donors, and other relevant partners at every step of the way to ensure not only that the program is cohesive, but also to prevent roadblocks that inevitably threaten in the form of miscommunication, politics and logistical complications. [MPH ILDP]

Discussion

Shared interests in interdisciplinary leadership motivated faculty and staff from five different MCHB-funded training programs at UNC to collaborate in order to learn about other disciplines, but more importantly and fundamentally, to understand effective ways to work together, and to transfer these skills to trainees. Two sentences summarize the results of our project to evaluate the impact of this collaboration on 208 students:
  • Through interdisciplinary courses and projects, and especially through participation in the Interdisciplinary Leadership Development Program, students developed attitudes/beliefs in the value of interdisciplinary practice, gained interdisciplinary skills, and pursued jobs that provided opportunities to use and further develop these skills.

  • Graduates used their attitudes/beliefs and their skills to improve outcomes for families and to effect change in MCH systems involving programs, organizations, partnerships, and policies.

On one level, interdisciplinary training involves increasing the understanding of the expertise that assorted disciplines bring to the setting for those involved in collaborative care. On another level, interdisciplinary training involves developing the capacity to utilize two fundamental insights, independent of discipline, that stem from the following two questions: (1) what are my strengths, weaknesses, preferences, and motivations that inform my ability to work collaboratively?; and, (2) what are the strengths, weaknesses, preferences, and motivations that inform the ability of colleagues to work collaboratively? With the insights that flow from the systematic exploration of these questions as a foundation, our data suggest that students are more likely to develop and use interdisciplinary skills (e.g., communication, conflict management, facilitating relationships, sharing ideas, assembling a functioning team, and etc.), than students who engage in training that brings disciplines together without the same level of intentionality.

The retrospective longitudinal design of this project in which data were gathered from graduates up to 8 years after completion of training enabled us to identify effects of interdisciplinary training well beyond the training experiences themselves. Graduates who reported effects on MCH systems—programs, organizations, partnerships, policies—had stronger attitudes/beliefs about interdisciplinary practice and used interdisciplinary skills more frequently than graduates reporting that they had not brought about changes. The fact that graduates have influenced MCH systems years after completing their training and attribute these effects to the interdisciplinary training that they participated in, underscores the developmental and transformational outcomes of the ILDP. Participants provided 342 responses suitable for EvaluLEAD coding. As is convention for evaluations of training programs, episodic evidence is the most frequent. Two hundred twenty-nine (67 %) comments reported the use of specific skills as a result of the training. Thirty percent of the comments, however, reflected developmental changes, meaning that over time they have continued to appreciate how their interdisciplinary attitudes and skills are evolving and having an impact on professional practice. As expected, transformational changes are rare, with 10 graduates indicating that their interdisciplinary training has fundamentally altered the way they approach their work, even involving basic changes in career trajectories.

Although the design of this study did not involve randomization, three design features strengthen our conclusions. First, we recognized that efforts at interdisciplinary training are prevalent among the four schools—public health, social work, medicine, and dentistry—that host the five training programs that we have studied. Systematic interviews with faculty from these programs and examination of program documents revealed a number of likely reproducible characteristics that reflect the interdisciplinary environment of training. These characteristics included advocacy by true champions of interdisciplinary practice, accountability to interdisciplinary goals, financial and other institutional policies that facilitate collaboration, scheduling flexibility, and a culture of collaboration. The second feature, related to the first, is that graduates were asked to reflect on the characteristics of their programs that motivated interdisciplinary attitudes/beliefs and skills, providing a degree of triangulation to validate these characteristics. For example, on average graduates from all five programs believed that their programs had somewhat influenced their attitudes/beliefs, most notably for pediatric dentistry and LEND. The third feature relates to the ILDP, because this was an intervention with a clearly designed and implemented interdisciplinary curriculum. As such, we were able to draw logical connections between the training and the outcomes reported by the graduates. In addition, and significantly, for two of the training programs—LEND and public health—there were graduates who had been exposed to the ILDP (N = 39) and those who had not (N = 87), providing a reasonably valid comparison group. Indeed, the training programs themselves provide a fair amount of interdisciplinary exposure, so many of the effects we have reported would still result. Nevertheless, the ILDP, especially for LEND participants, showed a “boost” in attitudes/beliefs and the frequency of the use of interdisciplinary skills. One possible explanation for the appearance of a weaker effect on public health graduates is that practice experience is a requirement for admission to the master’s program, so that they may have further developed interdisciplinary attitudes/beliefs and skills prior to enrollment, a question worthy of further exploration.

There are five limitations that we would like to address. First, this study has been conducted at a single university, so it may not be possible to generalize these findings. To address this we asked graduates to report not only the outcomes of interest (attitudes/beliefs and skills), but also their reflections on the role that their training played. The variation and candor in the responses (from “this training program was transformational” to “I came with a strong interdisciplinary background, so I gained little”) suggests that the data may reflect insights that are not unduly biased by the single university site. Related to this limitation is the fact that while graduates reported effects of their training on consumers/families, programs, organizations, partnerships and systems, we did not collect information from the actual recipients. Third, we learned early in the project that interdisciplinary training had many manifestations, so that it was a challenge to discriminate between a group of students with and without exposure to interdisciplinary training. We have been able to analyze two levels of interdisciplinary training, however, the standard exposures in any of the five training programs, on the one hand, and the ILDP on the other. The validity of our findings is strengthened by the fact that in LEND and public health, not all students had the opportunity to participate in the ILDP, so we have been able to analyze differences between ILDP participants and non-participants. A fourth limitation is that our analysis was post hoc at a single time, from 1 to 8 years after completion of training. As noted above, however, participant reflections were quite varied and rich in detail, suggesting a less than substantial effect of this retrospective analysis. Finally, the instruments that we developed to assess attitudes/behaviors and the frequency of skill use were constructed by selecting and revising scales and items from other studies of interdisciplinary training, as well as our own perceptions of important ideas and experiences to capture. While statistical analysis suggests internal validity, these scales require more extensive external validation.

Conclusions: Implications for MCH Leadership Training

The enhanced interdisciplinary attitudes/beliefs and use of skills that we have described do not just happen because professionals from different disciplines are in the room, but are likely a function of engaging trainees in an early “intensive” workshop to establish a core skill set and to build upon this with subsequent workshops that emphasize core MCH competencies. Over the course of the academic year, students develop a culture of collaboration and community of practice surrounding MCH training program(s). Our experience suggests that intentionality, planning, and accountability around interdisciplinary leadership should be an expectation for training programs.

UNC was fortunate to have five MCHB-funded training programs at the time that we embarked on this study. Building on the first implication, campuses with more than one training program should be encouraged or even expected to collaborate on leadership training.

As noted above, interdisciplinary team-building is an explicit MCH leadership competency, but our study is relevant to at least six other competencies. In order to examine the impact of interdisciplinary leadership training, however, it was necessary to develop new instruments to highlight the outcomes of attitudes/behaviors and skills, and ways to characterize the training exposures. It would benefit the MCBH and the training programs to build on these steps to develop instruments for common use.

The real value of this study is not that it has answered the question, “what are the effects of interdisciplinary training on MCH professionals, organizations and systems?” Its importance stems from the fact that we have been able to articulate ways to assess outcomes of interdisciplinary training and to describe and measure interdisciplinary training exposures. While we are pleased that the UNC Interdisciplinary Leadership Development Program appears to have facilitated the growth of interdisciplinary attitudes/beliefs, the frequent use of interdisciplinary skills in practice, and impacts on MCH systems, the next step for MCH leaders is to disseminate more broadly rigorous descriptions and assessments of the training intended to develop leadership competencies that underpin effective interdisciplinary practice.

Acknowledgments

We would like to thank our colleagues, Kathleen Rounds, Jan Dodds, Michael Milano, Bill Vann, and Jessica Lee, whose commitments to interdisciplinary training and practice were essential to the completion of this project. We also express our appreciation for the thoughtful participation of the graduates of our programs. Mike Hussey provided excellent statistical support. This research was supported by HRSA/MCHB grant R40MC08558.

Copyright information

© Springer Science+Business Media, LLC 2012