Interprofessional education in undergraduate health programs: students’ perceptions of a new curriculum implementation

Jéssica Rodrigues da Silva Noll Gonçalves1, Rodrigo Noll Gonçalves2, Saulo Vinicius da Rosa1, Juliana Schaia Rocha1, Samuel Jorge Moysés1, Renata Iani Werneck1

1Pontifícia Universidade Católica do Paraná. Curitiba (PR), Brazil. 2Universidade Federal do Paraná. Curitiba (PR), Brazil.

Introduction

University education reform has increasingly drawn global attention1-3. Internationally relevant documents, such as the “Policy on the Health Workforce for 2030”, guide the urgency of transforming professional training to build more resilient health systems4. The rapid transformations in contemporary societies, notably intensified by the post-pandemic scenario, have increasingly and incisively questioned aspects related to professional training. These changes require training professionals with critical and reflective capacity to act in authentic situations and formulate innovative actions capable of transforming reality5-6. This scenario was intensified by the COVID-19 pandemic, which imposed a global disruption on educational systems, accelerating the use of online technologies and demanding major institutional reorganizations7.

Discussions regarding the need to expand teaching beyond the profession have extended the problematization of teaching methodologies, making integration and interdisciplinarity guiding principles for the training proposal8.

Within this context Interprofessional Education (IPE) emerges, an approach that aims to develop students capable of acting in an integrated and articulated manner with different professionals9. According to the World Health Organization10, IPE “occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes”. This integration promotes the exchange of experiences and knowledge, respect for diversity, enabling the practice of transformative actions, project construction, and permanent dialogue among students and future professionals9.

Learning must be transformative, so as to develop leadership capable of analyzing and synthesizing information for decision-making, adapting global resources to meet increasingly complex health needs11-12. To this end, students need to develop certain interprofessional competencies13-14, which are observable indicators of performance and complex interaction between knowledge, skills, and behaviors15-16. However, it is essential that this teaching approach begins during undergraduate studies, aiming to favor the mutual construction of interprofessional competencies that will be vital for the development of a collaborative health workforce prepared for practice10, capable of adapting global resources to meet increasingly complex health needs11-12.

IPE’s theoretical-conceptual and methodological assumptions have been emphasized in the Brazilian National Curricular Guidelines (In Portuguese, Diretrizes Curriculares Nacionais - DCNs) for health courses, especially in their most recent adjustment proposals17. Despite the growing emphasis on developing these competencies, most Higher Education Institutions (HEIs) resist IPE implementation18. In Brazil, there is still a scarcity of this teaching approach, as observed in systematic reviews on the topic19-20.

Sustaining these initiatives can be inherently complex. International literature, although vast, lacks robust evidence on IPE implementation21. Furthermore, the mere inclusion of IPE in the DCNs does not guarantee its practical effectiveness. Transition critically depends on faculty preparation, which is often insufficient, and on continuous assessment and monitoring procedures, which are essential to prevent IPE from becoming merely a label devoid of practical impact15,22-24. Students’ experience and perception of IPE constitute a valuable resource for determining the potential and limitations of this teaching approach, especially during the process of implementing these curricula25.

Facing this scenario of challenges and aligned with global guidelines for health education reform, the Pontifícia Universidade Católica do Paraná (PUCPR) initiated an excellence project in undergraduate education, instituting the transition from traditional teaching to IPE26. This initiative, which materialized in 2019 with the union of courses from the School of Life Sciences (SLS) in an interprofessional core, demands rigorous monitoring. Given this, the motivation for this study is therefore threefold, aiming to: monitor a strategic curricular transition; fill a national knowledge gap regarding IPE assessment in large Brazilian HEIs; and provide fundamental evidence for the continuous monitoring and sustainability of interprofessional education within the institution.

Given the complexity of this curricular restructuring and fulfilling the requirement of continuous monitoring demanded for IPE’s sustainability, the need arose to assess first-year undergraduate students’ perception. The study aims to unveil their conceptions about the implementation of a new curriculum matrix, with an emphasis on the development of interprofessional competencies.

Method

This case study utilized a qualitative approach, aiming for an in-depth understanding of the study phenomenon. The research was grounded in Social Representation Theory (SRT) assumptions. Developed by Serge Moscovici, this theoretical-methodological framework examines how common-sense knowledge is created, organized, and shared by social groups, being the result of a continuous process of elaboration and communication27. The project was approved by the PUCPR Research Ethics Committee, under Opinion 3,546,600. Students who agreed to participate in the study signed the Informed Consent Form28.

Context

The study was conducted at a non-profit private university in southern Brazil – PUCPR, Curitiba Campus –, founded in March 1959. This study was developed at the SLS, which is responsible for 12 undergraduate courses: agronomy, biotechnology, biological sciences, physical education, nursing, pharmacy, physiotherapy, gastronomy, veterinary medicine, nutrition, dentistry, and psychology. Currently, the SLS offers 11 disciplines that are shared among 11 courses of the school (with the exception of the agronomy course)29-30 (Chart 1).

Chart 1 - Shared disciplines/subjects among the School of Life Sciences courses. Curitiba, Paraná, Brazil, 2021.

Shared discipline

Courses

 

General biochemistry

 

Physical education, nursing, nutrition, physiotherapy, and dentistry

 

Structure and properties of carbon compounds

Biotechnology and pharmacy

Structural genetics and inheritance

 

Dentistry, veterinary medicine, and biological sciences

 

Aggressive and defense agents

Nursing and dentistry

 

Structural and functional aspects of human tissue

Physiotherapy and dentistry

Environment, sustainability, and health

 

Pharmacy, veterinary medicine, physical education, psychology, physiotherapy, and biological sciences

Entrepreneurial attitude

 

Physical education, dentistry, pharmacy, biological sciences, psychology, and nutrition

Scientific reasoning

 

Physical education, biotechnology, and psychology

Interprofessional project: bioethics and human rights

 

Physical education, physiotherapy, biotechnology, biological sciences, and psychology

Professional life planning

 

Biological sciences, physical education, nursing, pharmacy, veterinary medicine, gastronomy, biological sciences, and psychology

 

Human body systems

 

Pharmacy and dentistry

The implementation of a new curriculum occurred in 2019. Thus, initially, the change involved only students who entered in that year. Therefore, only students enrolled in their first or second semester of undergraduate studies in shared SLS courses were invited to participate in the study. The simple random sampling technique without replacement was used for participant selection, ensuring that each individual had the same probability of being selected31-32. Sampling by saturation was used to determine the final sample size and stop the recruitment of new individuals33.

Data collection

Data collection was conducted through an individual, semi-structured interview, conducted remotely, due to the conditions imposed by the pandemic caused by the new coronavirus (SARS-CoV-234) between March and November 2020. According to ROSA and ARNOLDI35, the data collection technique using interviews should be employed when aiming to apprehend in-depth and reliable responses regarding reality. Consequently, it is the method of choice for unveiling social representations about the study topic. Thus, the guiding questions for the study were: “What can you tell me about the implementation of a new curriculum matrix at your HEI?”; and “What is your opinion regarding the interprofessional (shared) disciplines?”.

Firstly, a pilot study was conducted with a software engineering student to test the data collection methods under real fieldwork conditions. From this, it was identified that the script was adequate.

Data analysis

The Discourse of the Collective Subject (DCS) technique was used for data analysis, which allows for retrieving and presenting the social representations of collective thought or opinion, as it seeks to bring forth not only the sense or meaning of the thought, but also the significant form of the discourse. In this way, DCS can act as a “psychoanalytic mirror” of the thought of collectivities and groups, making it a useful tool for interventions that aim to awaken collective consciences and/or initiate dialogues with distinct stances or opinions36.

The technique consists of analyzing statements and other verbal materials that constitute the main corpus, extracting from each the central ideas (CIs) and key expressions (KEs) they refer to. Subsequently, from the material obtained, the various synthesis discourses that form the DCSs are composed37.

Analysis must be preceded by the identification of four methodological figures: KEs, which constitute sections of the discourse that expose the essence of a statement; CI, which describes, in a synthetic, precise, and reliable manner, the meaning of the statements attributed in each discourse; anchoring (AC), which corresponds to the explicit linguistic manifestation of a particular theory, ideology, belief, or value that the subject declares; and DCS, discourse written in the first person singular, composed of the KEs that have similar CIs or ACs38. Complementarily, the DCS can be presented in two ways for didactic purposes: a global (unified) discourse, characterized by a single discourse; and a didactically separated discourse, when the discourse is complex or diverse, and should be contrasted or conflicting (antagonistic).

In summary, at the end of the process, a construct of reality originated by collective thought is obtained39, organized in the form of collective statements, written in the first-person singular, leading to the representation of an amplified content, to express the socially shared representations related to the object of study40.

Discourses were recorded and later individually transcribed using Microsoft Word® software aiming to increase familiarity with the statements expressed by research participants. The subjects were identified with the initial S (student), followed by the interview number. Subsequently, the obtained material was imported and explored using DSCsoft software41. To formulate the DCS, KEs were grouped in a way that they formed a coherent discourse. For this, connectors were used to give meaning to the DCSs. However, great care was taken not to alter the structure of the original discourse.

Results

Sixteen students enrolled in the shared disciplines of SLS participated in the study. Students were composed mainly of female individuals (n=13), with ages ranging between 18 and 24 years (Table 1).

Table 1 - Demographic characteristics of research participants. Curitiba, Paraná, Brazil, 2021.

Variable

Category

n

Sex

 

Female

13

Male

03

Age group

 

18

05

19

06

20

02

21

02

24

01

Course

 

Bachelor in psychology

03

Biotechnology

02

Bachelor in biological sciences

02

Bachelor in physical education

02

Dentistry

02

Pharmacy

02

Veterinary medicine

01

Nutrition

01

Nursing

01

Total

 

16

The data obtained from individual transcriptions, acquired through interviews with students from the shared disciplines of SLS, allowed for the elaboration of several synthesis discourses that formed a construct of reality, originated by collective thought: the DCS. The analysis of the readings and listening of the interviews resulted in a total of three CIs (Table 2). An item that appeared with the highest frequency was “the interaction with people from other courses”. It is noteworthy that, after the first interview, no new CIs emerged, confirming the theoretical saturation of the data.

Subsequently, synthesis discourses are presented in the format of single, complementary, and antagonistic discourses.

Chart 2 - Representation of data obtained from interviews with School of Life Sciences students (meaning attributions regarding the implementation of a new curriculum matrix, with an emphasis on interprofessional competencies). Curitiba, Paraná, Brazil, 2021.

Central idea

Interviews

Total occurrences

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

 

Interaction with people from other courses

x

x

x

x

x

x

x

x

x

 

 

x

x

 

x

x

13

I think about the course next to me

x

 

x

 

 

 

x

 

x

x

x

 

x

x

 

 

08

The professor sometimes ends up focusing only on one course and leaves the other somewhat aside

x

x

 

 

 

 

 

 

x

 

 

 

 

 

x

 

04

Total of new topics for each interview

3

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Central idea A: Interaction with people from other courses

Discourse of the Collective Subject 1

In the beginning, it was very complicated because the interaction and the groups started to merge, so it was very complicated for the whole class. Now we are getting used to it, but at first, it was very difficult to deal with it. Then, in the second semester, in certain (disciplines) that were not so specific, which were more general contents, it worked out [...]. From then on, I really started to understand the proposal of interprofessionality, and from then on, I started to find the PUCPR proposal very interesting and really began to see that it was starting to work out. Anyway, [...] it’s more an exchange of experience along with the subject, you know? It’s good to meet people from other courses.

DCS 1 initially revealed difficulty in interacting with people from other courses, a fact that was overcome during the coexistence in interprofessional disciplines. The discourse also demonstrates that being closer to people from other courses was considered a positive experience for students.

Discourse of the Collective Subject 2

Some interprofessional disciplines are necessary, even for you to create an approximation between the courses. Therefore, [...] I think it’s very important because it’s a way to relate to people from other courses. Besides, I love it because we meet new people, new ways of working with people. [...] they are other mentalities, other people, other courses [...]. [...]students help each other with the assignments; I thought this point was very good.

Complementarily, DCS 2 exposed that contact with people from other areas provided an expansion of the vision regarding the possibilities of work and collaboration with people from other professions.

Discourse of the Collective Subject 3

In my opinion, I would prefer it not to be shared, because I found it a bit confusing to put all the courses together, and sometimes courses that don’t have much in common. So far, if I’m not mistaken, I’ve already taken four or five interdisciplinary subjects. Some I understood the reason and I made an effort to talk to other courses, but, whether we want it or not, I think the whole doesn’t see it the same way, you know? [...]. [...] in some subjects, we strongly felt this division, instead of this interprofessionality [...]subjects were completely divided [...]. It wasn’t an interprofessional classroom. So, I think they must rethink how the grouping system works because I know they try to do interprofessional work with people from different courses and so on, but the distribution is never very equal [...] I don’t think interaction is being very good [...]. I don’t feel like I’m adding anything new to my life; I feel more like I’m being forced to participate.

DCS 3, in an antagonistic discourse, revealed a preference for non-shared disciplines, due to the divergence among courses. Furthermore, there was a report of a division in the classroom and an absence of interprofessionality. Thus, the discourse points to the need to rethink the grouping system of shared disciplines to reduce discrepancies among courses and promote interaction among different professions.

Discourse of the Collective Subject 4

[...] my class is small, it’s easier to interact, ask questions, things like that. But when [...] several courses are put together, I don’t think it’s very nice. Besides, [...] sometimes it hinders things a bit because some semesters are ahead and others are behind, [...] there are those divergences in course schedules [...], some courses are full-time. So, for doing assignments and things like that, sometimes they don’t “match”. Anyway, [...] having too many people in the room, the groups get lost, they divide. It’s a bit complicated.

DCS 4, in an antagonistic discourse, exposed that the grouping of several courses was not interesting, as the excess of students makes interaction difficult among people from different courses and faculty. Furthermore, the divergence in semesters and schedules among students was another reason that hindered the relationship within the shared disciplines.

Central Idea B: I think about the course next to me

Discourse of the Collective Subject 1

It’s cool. I think it’s one of those disciplines that makes us think more about the environment we are in, about the surroundings, about what we can do to change for the better. And especially because they are interprofessional, right? You are there with everyone, you see it from the perspective of dentistry, from the perspective of nutrition [...] Wow! It adds a lot to the knowledge. [...] we end up seeing that there are other possibilities within our field and [...] that our courses have some similarities, and it complements. I thought the experience of having contact with people from other courses was really cool [...]. We had contact with people who are interested in other things, right? It’s good for you to have other people’s vision, because people on the same course sometimes end up having the same views on something, and then a person from another course arrives and can show another side that maybe you don’t know. Furthermore, it’s different, because I believe that when a student goes to the course they chose, they are following only one path, right? But when you see that what you are learning will be shared with everyone in that school, with everyone [...]. So, there we can already see that, in fact, everyone is related and that in the future it will be like that too [...].

Maybe you have a prejudice about the course, then you stop and see, “No! They don’t just do that; they have other areas”. I can work with that person. So, you create contacts, and maybe friendships. Additionally, [...] in the disciplines that are with several courses, I noticed that I developed more [...]. It adds much more value [...], I think about the course next to me. If it’s psychology, I’m going to think with the mind of psychology, I’m going to think, “Ah! psychology thinks this, this, this”. That’s great! So, I’m going to take this into my life too, because I believe this multidisciplinary environment is very important.

The discourse indicates that IPE was successfully anchored in pre-existing and positive categories and values of common sense. Interprofessionality is linked (anchored) to the need for critical and reflective vision (“makes us think more about the environment we are in”), the reduction of stereotypes (“No! They don’t just do that; they have other areas”) and, fundamentally, the inevitability of future professional practice (“everyone is related and that in the future it will be like that too”). This anchoring validates the IPE process for students, making the approach relevant to their future professional practice.

Central idea C: The professor sometimes ends up focusing only on one course and leaves the other somewhat aside

Discourse of the Collective Subject 2

The professor sometimes ends up focusing only on one course and leaves the other somewhat aside. That is, [...] sometimes the professor didn’t know very well how to deal with three courses that were so different within the same classroom. So, sometimes they used examples from one area, and other courses ended up getting a little lost about the example they were presenting. Additionally, [...] many professors didn’t know very well how to deal (with the division of the classroom). So, they themselves treated it as a division. At certain moments they addressed biology, and at other moments they addressed pharmacy. So, this division was very clear, it was always constant. [...] so, it’s more about the professor knowing how to explain it to all the courses that are there, not to be focused only on one. I think the biggest problem was that.

The discourse mentioned the faculty’s difficulty in dealing with courses outside their area of expertise, a situation that contributed to creating a division within the classroom. The examples used in the classroom were directed towards the faculty’s training course, leaving students from other courses unable to understand what was exemplified.

Discussion

The implementation of a new curriculum aims to train professionals connected with innovation and equipped with more comprehensive and integrated competencies, adopting the IPE approach. Given this new curriculum, it is essential to involve the academic community in the assessments to improve the teaching and learning processes. From the analysis of the discourses, it was possible to understand that the implementation of a new curriculum initially consisted of a challenge for students and faculty, marked mainly by the change in the teaching and learning process.

Interaction with people from other courses was initially reported as an obstacle, which was overcome through coexistence in shared disciplines. This experience contributed significantly to broadening students’ vision, beyond their own profession. It also helped in reducing negative stereotypes about other professions. Similarly, authors15 identified, in a synthesis of systematic reviews on IPE, that most studies revealed positive changes in students’ perceptions and attitudes towards other professionals and collaborative work. This will imply training professionals with a multi-professional vision and the necessary competencies to improve the health system. However, the PUCPR experience reveals that this theoretical convergence is not automatic.

The antagonistic discourse revealed a preference for non-shared disciplines, due to the excess of students, the divergence among courses, the existence of a division in the classroom, and the absence of interprofessional interaction. This preference demonstrates a failure in pedagogical implementation and should not be seen merely as an inherent resistance of the student. Negative views were also identified in students’ first IPE experience, such as the lack of contact with people from other courses and the quality of interprofessional experiences42. Consequently, it is important for faculty to develop effective strategies for approximation between different courses so that students genuinely experience the interprofessional learning of learning “about, with, and among”10 the different professions. Thus, there is a need to rethink the grouping system of different professions within shared disciplines, with the objective of obtaining an equal distribution of each course to facilitate interaction among students from different professions. Furthermore, it is important to continue monitoring assessment to understand if this perception occurred only in the first experience.

The faculty’s difficulty in dealing with courses outside their area of expertise was also criticized in the discourse, a fact that contributed to the existence of a division within the classroom. This manifestation should not be interpreted as an intrinsic resistance of students, but rather as a sign that the pedagogical and logistical implementation of IPE faced challenges. This experience, by generating a perception of division instead of promoting interaction, diverges from IPE’s central objectives, indicating that structural and institutional barriers43-44 hindered the realization of the model’s curricular intention, which is a critical point to be considered. Nevertheless, aiming to reduce such obstacles, PUCPR instituted the faculty development center linked to the Educational Advisory, the Center for Teaching and Learning, to promote continuous faculty training. Moreover, the school has a core group of professors (Pedagogical Excellence Center) who monitor the IPE implementation process.

The individual interview was applied instead of the focus group to ensure greater comfort for participants to express their points of view. Additionally, the conditions imposed by the new coronavirus (SARS-CoV-2) contributed to the selection of this interview format. Furthermore, the inclusion of first-year undergraduate students is essential to adjust possible bottlenecks in a new curriculum. Moreover, the continuous monitoring of these students can contribute to measuring the true impact of this teaching approach throughout their professional training and, complementarily, after their entry into the labor market.        

The complexity of integrating students from different professions and the lack or minimal experience of faculty directly impacted the introduction of a new teaching model in HEIs. At this point, it is essential to highlight that the lack of integration among students from different courses may have been influenced by the fact that the institutional system of PUCPR does not have the capacity to mix the courses participating in shared disciplines. Consequently, there was a predominance of certain courses over others. This fact may contribute to the isolation of students who had little representation of their courses in the classroom, weakening the proposed objective of this teaching model. In this regard, Ei-awaisi45 suggests that it is necessary to develop robust IPE teaching and learning strategies and experiences, involving authentic and meaningful situations. Bringing experiences also to interprofessional care, with simulated and real situations, can be important methodologies for interprofessional learning46. Thus, the use of short- and long-term assessments is essential to verify the impact and the need for curricular adjustments related to this teaching approach.

IPE curriculum assessment encompasses intrinsic factors of each institution. Thus, the absence of the medicine course at SLS may characterize a limitation of this study, as it constitutes a strong determinant for the real possibilities of integration in IPE. Here, problems commonly reported in IPE, beyond communicative skills and differences in professional cultures, would certainly appear more clearly, i.e., hierarchies and presumed leadership. Furthermore, the lack of inclusion of faculty in the study, the failure to mix courses by the institutional system and, consequently, the absence of representativeness of all courses that constitute SLS are factors that could contribute to understanding a broader context about the processes involved in the implementation of a new curriculum in the institution.

Educational assessments can help HEIs verify if a certain teaching approach was effective. However, assessments of IPE interventions primarily use outcome-based assessment, which points to changes occurring in the short term47. In contrast, decision-making about these interventions needs to be based on continuous, long-term assessments, to identify whether they should be revised or rejected. Complementarily, they must present institutional support and involve the various interested parties in their assessment processes to achieve success in the implementation and sustainability of these teaching approaches. The absence of this support, or the failure in its logistical and pedagogical articulation, compromises IPE’s long-term sustainability, even in the face of a curricular mandate.

Conclusion

The implementation of a new curriculum initially consisted of a challenge for students and faculty, as IPE is not achieved merely by the coexistence among students from various courses, evidencing the difficulty in adapting to the new teaching model.

The findings reinforce that IPE’s sustainability critically depends on robust institutional support, as the lack of adequate training for a large part of the faculty contributed to the division in the classroom.

In terms of theoretical scope, the results offer crucial empirical evidence in light of SRT by revealing the tension in student representations about IPE. It is observed that, while there is a positive representation about IPE’s potential to reduce stereotypes, this is confronted by the negative representation of practice, characterized by division in the classroom and lack of faculty preparedness. This conflict of representations supports the theoretical argument that IPE’s success is directly linked to the interprofessional competence of the faculty themselves, whose inaction can reproduce single-profession practices and undermine the basis of collaboration. Thus, the study contributes to the advancement of knowledge by demonstrating that the sustainability of IPE demands multi-level institutional support, going beyond curricular requirements.

Such challenges of adaptation and the lack of faculty preparation demand that HEIs invest in strategies that go beyond mere curricular restructuring. Thus, the implications for institutional policies include the need to rethink the course grouping system to ensure equitable representation of courses and intensification of continuous faculty training. Integration between theory and practice, between disciplines and different professions, constitutes a key element to strengthen students’ critical and reflective capacity, promoting transformative interprofessional practices.

Finally, we suggest, for future research, longitudinal follow-up of these students, the inclusion of professors’ perspective, and an analysis of the influence of systemic factors, such as the absence of a medical degree, on the manifestation of hierarchy and presumed leadership problems, which represent the limitations of this study.

This research contributes to the advancement of literature by providing evidence on the challenges of curricular transition in the Brazilian context and offers insights for the planning and execution of IPE in HEIs.

Authors’ contributions

Study conception: Renata Iani Werneck. Data collection: Jéssica Rodrigues da Silva Noll Gonçalves, Rodrigo Noll Gonçalves. Manuscript writing: Jéssica Rodrigues da Silva Noll Gonçalves, Saulo Vinicius da Rosa, Rodrigo Noll Gonçalves. Critical manuscript review: Saulo Vinicius da Rosa, Rodrigo Noll Gonçalves, Samuel Jorge Moysés, Juliana Schaia Rocha. Approval of the final version of the text: Saulo Vinicius da Rosa.

Conflict of interest

The authors have no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

This study was funded in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brazil (finance code 001).

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Corresponding Author

Name: Saulo Vinícios da Rosa

E-mail: sauloviinicius@hotmail.com

© The Author(s) 2026. This work is licensed under Creative Commons Attribution 4.0 International. License text for use: https://creativecommons.org/licenses/by/4.0/