# Evaluating the impact of an interprofessional education intervention on health profession students' perceptions and collaborative competencies in Lebanon: a quasi-experimental study

Iqbal Fahs, Mariam Dabbous, Jihan Safwan, Faten Hamed, Seham Kanaan, Fouad Sakr, Mohamad Rahal

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Iqbal Fahs, Mariam Dabbous, Jihan Safwan, Faten Hamed, Seham Kanaan, et al.. Evaluating the impact of an interprofessional education intervention on health profession students' perceptions and collaborative competencies in Lebanon: a quasi-experimental study. BMC Medical Education, 2025, 25 (1), pp.1477. 10.1186/s12909-025-08082-x. hal-05348578

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# Evaluating the impact of an interprofessional education intervention on health profession students' perceptions and collaborative competencies in Lebanon: a quasi-experimental study

Iqbal Fahs¹,³* , Mariam Dabbous¹,²,⁴, Jihan Safwan¹,²,⁵,⁶, Faten Hamed¹, Seham Kanaan¹, Fouad Sakr¹,² and Mohamad Rahal¹

**Abstract**

**Background** With increasing complexity in patient care, IPE has been proposed to improve interprofessional teamwork and improve outcomes. This study was conducted to evaluate the impact of a structured IPE activity on students' collaborative perceptions and competencies.

**Method** This study employed a quasi-experimental pre-post intervention design to assess changes in perceptions and self-reported competencies using validated tools (SPICE-R2 and ICCAS). The IPE intervention comprised a full day didactic sessions and case studies. Paired-samples t-tests, repeated measures ANOVA, and MANCOVA were utilized to assess changes and identify predictors.

**Results** A total of 182 students (pharmacy: 66.5%, nutrition: 15.9%, and biomedical sciences: 17.6%) were included, with 154 students (84.6%) responding to the postsurvey. The pre-activity total SPICE-R2 score was moderately high (40.81 ± 6.09), and increased significantly to 45.65 ± 5.61 (p < 0.001) post-activity, with all subscales of interprofessional teamwork, roles and responsibilities, and patient outcomes showing significant improvements (p < 0.001). The pre-activity total ICCAS score was moderately high (73.13 ± 7.35), and increased significantly to 87.51 ± 5.25 (p < 0.001) with the greatest gains observed in communication (+ 4.13), conflict resolution (+ 3.04), and team functioning (+ 2.10). Compared with pharmacy students, nutrition students showed greater improvements in both SPICE-R2 (B = 9.193, p < 0.001) and ICCAS (B = 6.605, p = 0.007) scores. Students with prior health education and IPE exposure reported greater improvements in both SPICE-R2 and ICCAS scores (p < 0.05). Conversely, clinical employment significantly predicted lower gains on the SPICE-R2 (B = -3.136, p = 0.047).

**Conclusion** The intervention led to significant improvements in interprofessional collaborative perceptions and competencies. Future longitudinal evaluations are needed to assess sustained impact and transfer to clinical practice.

Full list of author information is available at the end of the article

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© The Author(s) 2025. **Open Access** This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

<footnote>*Correspondence:
Iqbal Fahs
iqbal.fahs@liu.edu.lb</footnote>
**Keywords** Interprofessional education, Collaboration, Perception, Competency, Teamwork, Interprofessional role

**Introduction**

The complexity of patient care along with the increased demand for integrated health services has emphasized collaborative practice between pharmacists and other healthcare providers [1]. Such collaboration aims to improve patient and health system outcomes [2, 3]. Interprofessional collaboration (IPC) involves health-care professionals from different fields working together with patients, families, caregivers and communities to provide high quality care [4]. Interprofessional education (IPE) has been proposed as a strategy to enhance inter-professional teamwork and improve patient outcomes [5–7]. IPE integration into the pharmacy curriculum is mandated by accrediting bodies and supported by professional organizations to ensure that graduates are prepared for collaborative team-based environments [8, 9]. In addition, since 2015, the focus in nutrition and dietetics has also shifted from introducing IPE to strengthening the connection between education with practice [10–12]. This change is now embedded within the essential competencies mandated by multiple dietetics and health organizations [13, 14]. Moreover, although not as direct as a mandate, accrediting agencies for clinical laboratory sciences likewise recognize the importance of IPE [15].

IPE occurs when “students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” [4]. Incorporating IPE into the education and training of health professional students [16, 17], will aid in preparing students with the skills, knowledge, and attitudes needed for team-based collaborative practice [9]. Traditional uni-professional educational models often fail to prepare students for the complexities of collaborative practice [18]. On the other hand, IPE fosters mutual understanding, respect, teamwork, and shared decision making among various health professions [19–21]. Moreover, IPE can strengthen health professional students’ ability to use each other’s knowledge to interpret clinical problems [22].

Research on IPE provides valuable guidance for health-care schools on implementation strategies. A wide-range of IPE activities including didactic sessions, simulations, practice-based learning, and case-based learning have been adopted by academic institutions to foster collaborative skills among healthcare students [6, 7, 19]. The effectiveness of IPE initiatives is assessed by changes in collaborative perceptions and attainment of competencies [23, 24]. These dimensions reflect the students’ attitudes toward teamwork and their readiness for collaborative practice [23, 24]. Several validated instruments have been developed to assess healthcare students’

perceptions and competencies of IPE [25]. Reliable assessment ensures the success of IPE activities in fostering the intended improvements in core competencies including understanding roles, communication, and team-based care [9].

IPE is becoming increasingly acknowledged as an essential component of healthcare education in the Middle East. Rising momentum toward international accreditation standards, heightened recognition of the importance of teamwork in healthcare, and students’ openness to collaborative learning offer promising opportunities for advancing IPE [8, 14]. Qatar University pioneered the integration of IPE into its health curricula through various IPE activities such as case-based discussions and simulations [26]. According to pharmacy, medical, and public health students in Qatar, IPE strengthened their collaborative practice and awareness of diverse professional responsibilities [27]. Moreover, an IPE initiative was conducted in the United Arab Emirates at Mohammed Bin Rashid University of Medicine and Health Sciences participants [28]. The project included medical, nursing, pharmacy, and physiotherapy students, and revealed improved readiness for interprofessional learning and collaboration among the participants [28]. Lebanon has also seen advancements in IPE. An IPE workshop series for medical, pharmacy, nursing, and nutrition students at the Lebanese American University improved participants’ satisfaction and readiness for collaborative learning [29]. Another study at the American University of Beirut revealed enhanced collaborative attitudes among medical, nursing, and public health students [30]. In Lebanon and similar Middle Eastern contexts, the implementation of IPE faces unique challenges. Cultural perceptions of professional roles can hinder equitable collaboration [31]. In addition, structural barriers such as fragmented governance between faculties, limited institutional investment in IPE infrastructure, and shortage of trained facilitators limit consistent delivery [31]. Logistical issues, including conflicting academic calendars and course loads across departments, further complicate joint sessions [31].

At the Lebanese International University (LIU), efforts are underway to systematically embed IPE into the curricula of the Schools of Pharmacy, Nutrition, and Biomedical Sciences (Preclinical laboratory-based undergraduate program). The Bachelor of Pharmacy (BPharm) program is guided by a competency-based framework along with key interprofessional competencies that are consistent with global frameworks (IPEC and WHO) [4, 9]. These competencies are promoted through experiential education, case-based learning, and interprofessional
simulation activities. While several IPE activities and informal collaborations exist across programs, structured and rigorously evaluated IPE interventions remain limited. The curricula of the Schools of Pharmacy, Nutrition, and Biomedical Sciences include some informal IPE elements such as shared workshops, seminars, or simulation-based experiences, however, there is no systematic or structured IPE sequence integrated across all programs. To address this gap, the present study aimed to assess the impact of a structured full-day IPE activity on pharmacy, nutrition, and biomedical sciences students' interprofessional perceptions and self-reported competencies. This activity is one of the first comprehensive, cross-disciplinary interventions bringing together students from all three programs in a unified and intentionally designed format. Changes were measured using two validated tools, the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R2) scale and the Interprofessional Collaborative Competency Assessment Survey (ICCAS) instrument. Findings from this study are intended to inform curricular review, support institutional policy reform, and contribute to the development of sustainable IPE models tailored to the Lebanese academic and healthcare environment.

# Design and methods

## Study design and sampling

The study had a quasi-experimental pre-post intervention design to evaluate the impact of a structured IPE activity on health professional students' perceptions and competencies. The study was conducted at LIU School of Pharmacy during the spring semester of the academic year 2023–2024. A full day interprofessional initiative involving students from pharmacy, nutrition, and biomedical sciences academic programs was organized. Participants were recruited through program announcements and course coordinators. All fifth-year pharmacy students enrolled in the 5-year BPharm program were required to attend the IPE activity as a component of their academic curriculum. In addition, nutrition and biomedical students in the last semester of their 3-year Bachelor programs were invited to participate in the IPE activity. The participation of all students in the study, including pharmacy students, specifically in completing the data collection surveys, was entirely voluntary. Surveys were shared electronically via institutional email one week before (pre-assessment) and one week after the intervention (post-assessment). The participants' responses were matched using anonymous identification codes.

## Ethical approval

This research adhered to the Ethical Guidelines for Life Science and Medical Research Involving Human Subjects and the Declaration of Helsinki. The study was

approved by the Ethical and Research Committee at the Lebanese International University (LIU) under the number 2024ERC-050-LIUSOP. Participation in the study, and in particular completing the data collection surveys, was voluntary. Informed consents were obtained prior to study inclusion where the participants had to agree to participate in the study before survey access. Students were informed that their responses would not affect their grades. The anonymity of respondents and confidentiality were maintained throughout the study. This study was not a clinical trial, so it does not have a clinical trial registration number.

## IPE development and implementation strategy

The structured IPE activity was designed following an informal needs assessment that included faculty input from the schools of Pharmacy, Nutrition, and Biomedical Sciences, review of accreditation standards, and students' feedback. Gaps identified included a lack of structured cross-disciplinary sessions, limited role clarity, and inconsistent collaboration training across disciplines. The implementation strategy emphasized alignment with IPEC competencies [9], integration into the academic calendar, training of facilitators across all departments, and use of validated assessment tools, SPICE-R2 and ICCAS [32–34].

## IPE intervention

The IPE activity was a structured, full-day, multidimensional intervention designed to enhance interprofessional collaboration and core competency development among pharmacy, nutrition, and biomedical sciences students. The IPE activity was designed for final-year undergraduate students, hence, the expected level of interprofessional competency attainment ranged from advanced beginner to competent, as defined by Benner's model and Miller's pyramid [35]. The IPE activity addressed all four IPEC core competency domains: Values and Ethics, Roles/Responsibilities, Interprofessional Communication, and Teams and Teamwork. While the activity was implemented as a single-day intervention, its structure was deliberately mapped to these domains through a combination of role-reflection exercises, interdisciplinary lectures, interactive case-based discussions, and debriefings. Table 1 outlines the detailed schedule, session objectives, facilitators, IPE competencies addressed, IPEC Core Domain, and instructional formats used throughout the activity.

The IPE day commenced with a facilitated interprofessional dialogue and role reflection session, where students explored their own and others' professional identities, expectations, and collaborative roles in patient care. Students then participated in discipline-specific lectures delivered by pharmacy, nutrition and biomedical
<table><caption>**Table 1** Structure and content of the Full-Day interprofessional education (IPE) activity</caption><thead><tr><td>Time</td><td>Session Title</td><td>Facilitator(s)</td><td>Objectives</td><td>IPEC Core Competencies Addressed</td><td>IPEC Core Domain</td><td>Description</td></tr></thead><tbody><tr><td>09:00–10:00</td><td>Interprofessional Dialogue and Role Reflection</td><td>IPE coordinators from all 3 departments</td><td><ul><li>Explore perceptions of professional roles</li><li>Discuss collaboration opportunities</li><li>Build shared understanding</li></ul></td><td><ul><li>Role Clarification</li><li>Interprofessional Communication</li><li>Team Functioning</li><li>Conflict Resolution</li><li>Values and Ethics</li></ul></td><td><ul><li>Roles/Responsibilities</li><li>Interprofessional communication</li><li>Teams and teamwork</li><li>Values and ethics</li></ul></td><td>Guided discussion with anonymous polling, scenario-based prompts, and moderated dialogue to surface expectations and attitudes toward other professions</td></tr><tr><td>10:00–10:45</td><td>Pharmacist's Role in Medication Management and patient Counseling</td><td>School of Pharmacy faculty</td><td><ul><li>Understand pharmacist's role in medication optimization</li><li>Emphasize reconciliation and safety</li></ul></td><td><ul><li>Role Clarification</li><li>Patient-Centered Care</li><li>Conflict resolution</li></ul></td><td><ul><li>Roles/Responsibilities</li><li>Interprofessional communication</li></ul></td><td>Lecture-based session addressing how pharmacists contribute to team-based care in disease management</td></tr><tr><td>10:45–11:30</td><td>Personalized Dietary Planning and Nutritional Assessment</td><td>Nutrition faculty</td><td><ul><li>Describe assessment and intervention in dietary management</li><li>Highlight dietary roles in diseases management</li></ul></td><td><ul><li>Role clarification</li><li>Communication</li><li>Team Functioning</li></ul></td><td><ul><li>Roles/Responsibilities</li><li>Interprofessional communication</li><li>Teams and teamwork</li></ul></td><td>Interactive lecture emphasizing collaboration between nutritionists and other team members in managing diseases</td></tr><tr><td>11:30–12:00</td><td>Break</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>12:00–12:45</td><td>Diagnostic Testing and Laboratory Data Interpretation</td><td>Biomedical Sciences faculty</td><td><ul><li>Interpret lab results</li><li>Understand role in clinical decision-making</li></ul></td><td><ul><li>Communication</li><li>Collaborative Decision-Making</li></ul></td><td><ul><li>Interprofessional communication</li><li>Teams and teamwork</li></ul></td><td>Lecture on diagnostic roles and interpretation of lab findings, emphasizing accurate result communication with clinicians</td></tr><tr><td>12:45–14:00</td><td>Case 1: Elderly Male with Diabetes and Polypharmacy</td><td>Faculty facilitators</td><td><ul><li>Review medications and assess interactions</li><li>Propose dietary changes</li><li>Plan lab follow-up and patient education</li></ul></td><td><ul><li>Patient-Centered Care</li><li>Communication</li><li>Shared Decision-Making</li><li>Role Clarification</li></ul></td><td><ul><li>Roles/Responsibilities</li><li>Interprofessional communication</li><li>Teams and teamwork</li></ul></td><td>Team-based case discussion with mixed-discipline groups (8–10 students); structured worksheet used to propose integrated care plan</td></tr><tr><td>14:00–15:00</td><td>Break</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>15:00–16:15</td><td>Case 2: Young Female with PCOS and Dyslipidemia</td><td>Faculty facilitators</td><td><ul><li>Interpret hormonal and lipid profile</li><li>Coordinate pharmacist-nutritionist care plan</li><li>Resolve conflicting strategies</li></ul></td><td><ul><li>Conflict Resolution</li><li>Team Functioning</li><li>Ethics</li><li>Collaborative Planning</li></ul></td><td><ul><li>Roles/Responsibilities</li><li>Interprofessional communication</li><li>Teams and teamwork</li><li>Values and ethics</li></ul></td><td>Problem-solving and negotiation in interdisciplinary teams; students must agree on a shared management strategy that balances lifestyle and pharmacologic interventions</td></tr><tr><td>16:15–17:00</td><td>Closing Debrief and Shared Reflection</td><td>Lead faculty from all disciplines</td><td><ul><li>Reflect on team experience</li><li>Identify personal and professional growth</li><li>Consolidate learning outcomes</li></ul></td><td><ul><li>Reflection</li><li>Respect for Roles</li><li>Team Communication</li></ul></td><td><ul><li>Roles/Responsibilities</li><li>Interprofessional communication</li><li>Teams and teamwork</li><li>Values and ethics</li></ul></td><td>Oral reflections; verbal sharing of what was learned from other professions and how collaboration evolved throughout the activity</td></tr></tbody></table>

sciences faculty, all attended by the full cohort to promote cross-disciplinary role understanding. After the lectures, students were divided into interprofessional teams of 8 to 10 students and engaged in case-based collaborative learning. Two complex cases, each involving multiple comorbidities were used to simulate real-word scenarios requiring integrated care. Students worked collaboratively to identify pharmacological and nutritional priorities, interpret diagnostic findings, resolve interprofessional disagreements, and develop comprehensive patient-centered management plans. The day concluded

with a group debriefing and oral reflections to consolidate learning and promote critical appraisal of the team-based care experiences.

A total of 19 faculty facilitators (10 from school of pharmacy, 5 from nutrition department, and 4 from biomedical sciences department), with a ratio of 1 facilitator for 10 students, participated in the activity. To ensure consistency and quality across small-group discussions, all facilitators were trained prior to the IPE day. This training included a 1-hour orientation covering the goals of the intervention, expected interprofessional competencies,
and facilitation strategies. Facilitators were provided with a guide that included session objectives, case study summaries, discussion prompts, suggested timelines, and strategies for promoting balanced participation among students from different disciplines.

## Data collection and measures

A survey questionnaire was prepared and administered in English language. It was developed based on previous literature and validated tools that assess IPE perceptions and competencies [32–34, 36]. The questionnaire was reviewed by three faculty members from LIU School of Pharmacy to ensure content validity, clarity, and relevance. The questionnaire was pretested by 5 participants, whose responses were not included in the survey. Minor adjustments were made based on their feedback, resulting in the final version of the survey comprising 3 main sections.

The first section of the data collection sheet retrieved data regarding demographic and educational characteristics such as age, gender, profession, GPA, prior health education (formal academic study in any health-related field prior to the students’ current degree such as diploma or degree in nursing, biology, or public health, etc...), prior teamwork (participation in practice-based health-care teams), prior IPE exposure (practice-based inter-professional experiences involving collaboration across disciplines and not considering the current activity), and prior or concurrent clinical employment (paid employment at a clinical site). The second section included the 10-item SPICE-R2 scale [36]. It assesses perceptions in three domains, including interprofessional teamwork and team-based practice, roles/responsibilities for collaborative practice, and patient outcomes from collaborative practice [36]. Responses were collected on a 5-point Likert scale (1=strongly disagree to 5=strongly agree). The overall SPICE-R2 score was computed by summing the scores of individual items and ranged between 10 and 50. Subscales were also computed by summing the scores of their related individual items. The SPICE-R2 scale displayed high internal consistency with a Cronbach's alpha coefficients of 0.85 pre-test and 0.91 post-test.

The third section included the 21-item ICCAS instrument [33]. This scale evaluates self-reported competencies across six domains, including communication, collaboration, roles/responsibilities, collaborative patient-centered approaches, conflict management/resolution, and team functioning. Responses were collected on a 5-point Likert scale (1=poor to 5=excellent). The ICCAS instrument is a retrospective tool, however, it was validated for utilization as pretest-posttest instrument as well [37]. The overall ICCAS score was computed by summing the scores of all items with a range between 20 and 100. The subscales were computed by summing the

scores of their individual items. The ICCAS scale displayed high internal consistency with a Cronbach's alpha coefficients of 0.76 pre-test and 0.79 post-test.

## Statistical analysis

Data were analyzed using the IBM Statistical Package for Social Sciences program version 25 (IBM-SPSS Statistics 25). A descriptive analysis was performed using absolute frequencies and percentages for categorical variables and means with standard deviations for quantitative variables. Cronbach's alpha was used to test for the internal consistency of the scales used. Bivariate analyses utilized chi-square and independent samples T-test. Paired-samples t-tests were used to assess changes in SPICE-R2 and ICCAS scales and subscales scores, and to assess the changes in mean scores of individual items of the subscales. A repeated measures Analysis of Variance (ANOVA) was used to test the effect of the IPE intervention pre-post assessment within a 2-week interval and across professions. Also, a Multivariate Analysis of Covariance (MANCOVA) was conducted to examine the effects of demographic and educational predictors (prior health education, prior teamwork, prior IPE exposure, clinical employment, age, and GPA) on the change scores of SPICE-R2 and ICCAS while controlling for baseline values. Significance was set at *p* < 0.05, and effect sizes were interpreted using partial eta squared values (η²_p), where a value of around 0.01 was considered a small effect size, around 0.06 indicated a moderate effect size, and values near or above 0.14 represented a large effect size [38].

## Results

### Demographic and educational characteristics of the students

The study included 182 students with a mean age of 22.6 years and an average GPA of 3.29. The majority were females (69.2%) and were enrolled in the pharmacy program (66.5%). Over one-third (36.8%) had prior education in a health-related domain, and 79.7% selected their current major as their first choice. Most participants reported prior teamwork experience (69.2%) and prior IPE exposure (63.7%). Slightly more than half (53.8%) had worked in a healthcare setting before or during their studies. The number of students who responded to the post-activity survey was 154 out of 182 with a response rate of 84.6%. Table 2 summarizes the students' demographic and educational characteristics.

Pharmacy students were significantly older (23.26 ± 2.98 years) compared to their peers in nutrition and biomedical sciences (*p* < 0.001) as shown in Table 3. While no significant difference was observed in prior health-related education (*p* = 0.170), prior teamwork experience was most common among biomedical sciences (78.1%) and
<table><caption>**Table 2** Demographic and educational characteristics of the participants</caption><thead><tr><th>Variable</th><th>Mean ± SD or N (%)<br>N=182</th></tr></thead><tbody><tr><td>Age</td><td>22.60 ± 2.67</td></tr><tr><td>GPA</td><td>3.29 ± 0.47</td></tr><tr><td>Gender</td><td></td></tr><tr><td>• Male</td><td>126 (69.2)</td></tr><tr><td>• Female</td><td></td></tr><tr><td>Profession</td><td></td></tr><tr><td>• Pharmacy</td><td>121 (66.5)</td></tr><tr><td>• Nutrition</td><td>32 (17.6)</td></tr><tr><td>• Biomedical Sciences</td><td></td></tr><tr><td>Current major is the first choice of study</td><td>37 (20.3)</td></tr><tr><td>• No</td><td>145 (79.7)</td></tr><tr><td>• Yes</td><td></td></tr><tr><td>Prior education in a health domain</td><td></td></tr><tr><td>• No</td><td>67 (36.8)</td></tr><tr><td>• Yes</td><td></td></tr><tr><td>Prior team working experiences</td><td></td></tr><tr><td>• No</td><td>126 (69.2)</td></tr><tr><td>• Yes</td><td></td></tr><tr><td>Prior IPE exposure</td><td></td></tr><tr><td>• No</td><td>66 (36.3)</td></tr><tr><td>• Yes</td><td></td></tr><tr><td>Prior or concurrent clinical employment</td><td></td></tr><tr><td>• No</td><td>84 (46.2)</td></tr><tr><td>• Yes</td><td></td></tr></tbody></table>

<table><caption>**Table 3** Comparison of prior experiences and demographics across student groups</caption><thead><tr><th rowspan="2">Variable</th><th colspan="3">Profession<br>M ± SD or N (%)</th><th rowspan="2">P-Value</th></tr><tr><th>Pharmacy<br>N=121</th><th>Nutrition<br>N=29</th><th>Biomedical<br>Sciences<br>N=32</th></tr></thead><tbody><tr><td>Age (years)</td><td>23.26 ± 2.983</td><td>20.55 ± 0.736</td><td>22.00 ± 1.016</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Prior education<br>in a health<br>domain</td><td>78 (64.5)<br>43 (35.5)</td><td>19 (65.5)<br>10 (34.5)</td><td>18 (56.2)<br>14 (43.8)</td><td>0.170</td></tr><tr><td>• No<br>• Yes</td><td></td><td></td><td></td><td></td></tr><tr><td>Prior team<br>working<br>experiences</td><td>35 (28.9)<br>86 (71.1)</td><td>14 (48.3)<br>15 (51.7)</td><td>7 (21.9)<br>25 (78.1)</td><td><strong>&lt;0.001</strong></td></tr><tr><td>• No<br>• Yes</td><td></td><td></td><td></td><td></td></tr><tr><td>Prior IPE<br>exposure</td><td>36 (28.8)<br>85 (70.2)</td><td>18 (62.1)<br>11 (37.9)</td><td>12 (37.5)<br>20 (62.5)</td><td><strong>&lt;0.001</strong></td></tr><tr><td>• No<br>• Yes</td><td></td><td></td><td></td><td></td></tr><tr><td>Prior or con-<br>current clinical<br>employment</td><td>53 (43.8)<br>68 (56.2)</td><td>20 (69.0)<br>9 (31.0)</td><td>11 (34.4)<br>21 (65.6)</td><td><strong>&lt;0.001</strong></td></tr><tr><td>• No<br>• Yes</td><td></td><td></td><td></td><td></td></tr></tbody></table>

pharmacy students (71.1%), but less prevalent in the nutrition group (51.7%; *p* < 0.001). Similarly, pharmacy students reported the highest prior IPE exposure (70.2%) and nutrition students the lowest (37.9%; *p* < 0.001). Prior or concurrent clinical employment was also more common among biomedical sciences (65.6%) and pharmacy students (56.2%) than nutrition students (31.0%; *p* < 0.001).

## Perception of students regarding IPE and collaborative practice (SPICE-R2 Scale)

The pre-activity total SPICE-R2 score was moderately high (40.81 ± 6.09) and ranged from 10 to 50. The subscales showed a relatively high baseline value. There was a generally positive shift in attitudes following the IPE activity with a statistically significant improvement in students' perceptions across the overall SPICE-R2 scale and its three subscales. The total SPICE-R2 score increased from a mean of 40.81 pre-activity to 45.65 post-activity, with a mean change of 4.83 (*p* < 0.001). Table 4 present a comparative analysis of SPICE-R2 overall and subscales scores before and after the IPE activity. There were significant changes in mean scores of all items across all domains (*p* < 0.001) as shown in Table 5. Significant improvements were observed in strong agreement with statements about the value of interprofessional collaboration, understanding of roles, and the positive impact on patient care.

## Attainment of IPE competencies (ICCAS Scale)

The pre-activity total ICCAS score was moderately high (73.13 ± 7.35) on a scale of 20 to 100. Communication, collaboration, roles and responsibilities, and collaborative patient/family-centered approach subscales showed relatively high pre-activity scores. On the other hand, conflict/management resolution and team functioning domains were the lowest at pre-activity level. The overall ICCAS score increased significantly with a mean change of 14.37 (*p* < 0.001). All subscales exhibited statistically significant improvements (*p* < 0.001). The most substantial gains were in communication (mean change = 4.13), conflict management/resolution (mean change = 3.04), and team functioning (mean change = 2.10). Table 6 illustrates the comparison of the ICCAS overall and subscale scores before and after the IPE activity.

Across all domains, individual items showed significant changes in mean scores post-activity (*p* < 0.001) as shown in Table 7. However, more modest improvements were observed in conflict management/resolution and team functioning domains. While students rating themselves excellent in respectfully addressing conflicts increased from 7.7% to 42.2%, a significant proportion still reported only good or fair skills in this area. Likewise, developing care plans and negotiating overlapping
<table><caption>**Table 4** Comparison of the SPICE-R2 scale and subscales before and after the IPE activity</caption><thead><tr><th></th><th>Range<br>Min-Max</th><th colspan="2">Mean ± SD</th><th>Mean<br>change<br>(post-pre)</th><th>p-value</th></tr><tr><th></th><th></th><th>Pre-activity</th><th>Post-<br>activity</th><th></th><th></th></tr></thead><tbody><tr><td>SPICE<br>R2<br>scale</td><td>10–50</td><td>40.81 ± 6.09</td><td>45.65 ± 5.61</td><td>4.83</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Inter-<br>profes-<br>sional<br>team-<br>work<br>and<br>team-<br>based<br>prac-<br>tice<br>sub-<br>scale</td><td>4–20</td><td>17.29 ± 2.36</td><td>18.28 ± 2.28</td><td>1.00</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Roles/<br>re-<br>spon-<br>sibil-<br>ities for<br>col-<br>labor-<br>ative<br>prac-<br>tice<br>sub-<br>scale</td><td>3–15</td><td>11.96 ± 2.13</td><td>12.57 ± 2.06</td><td>0.61</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Pa-<br>tient<br>out-<br>comes<br>from<br>col-<br>labor-<br>ative<br>prac-<br>tice<br>sub-<br>scale</td><td>3–15</td><td>11.95 ± 2.36</td><td>12.74 ± 2.03</td><td>0.79</td><td><strong>&lt;0.001</strong></td></tr></tbody></table>

responsibilities improved but remained with room for further development.

## Comparison of pre- and post-activity SPICE-R2 and ICCAS scores by profession

A repeated measures ANOVA was conducted to assess the effect of the IPE activity on students' perceptions and self-reported competencies (Table 8). The results showed a significant main effect of time on SPICE-R2 scores, F (1, 151) = 58.50, *p* < 0.001, with a partial eta squared (η²ₚ) of 0.279, indicating a moderate to large improvement across all students. Similarly, a significant time effect was found for ICCAS scores, F (1, 151) = 359.33, *p* < 0.001, η²ₚ = 0.704, reflecting a very large improvement in perceived interprofessional competencies after IPE activity.

When analyzing the interaction between time and profession, a significant time-profession interaction was observed for both SPICE-R2 (F (2, 151) = 15.41, *p* < 0.001, η²ₚ = 0.170) and ICCAS (F (2, 151) = 13.42, *p* < 0.001, η²ₚ = 0.151), indicating that the degree of change varied by professional group. The SPICE-R2 scores of pharmacy students moderately increased from 42.02 ± 6.65 to 45.98 ± 4.58 (+3.96). Nutrition students demonstrated the greatest gain, from 36.34 ± 3.99 to 48.17 ± 2.87 (+11.83), with significant differences in both pre- and post-activity comparisons relative to pharmacy students: pre-activity, B = -5.57, *p* < 0.001; post-activity, B = 2.18, *p* = 0.046. Biomedical students had minimal improvement in SPICE-R2 scores (41.37 ± 3.73 to 42.40 ± 8.27, +1.03), with non-significant differences pre-activity (B = -0.64, *p* = 0.582), but a significant decline compared to pharmacy students post-IPE (B = -3.58, *p* = 0.001).

For ICCAS, pharmacy students' scores improved from 72.70 ± 6.90 to 86.91 ± 5.16 (+14.21), while nutrition students again showed the greatest improvement, from 69.20 ± 6.80 to 89.68 ± 5.25 (+20.48). Compared to pharmacy students, nutrition students had significantly lower pre-activity scores (B = -3.50, *p* = 0.017) and significantly higher post-activity scores (B = 2.77, *p* = 0.013). Biomedical students showed a moderate gain in ICCAS scores (77.93 ± 6.70 to 87.28 ± 5.15, +9.35), with significantly higher pre-activity scores than pharmacy students (B = 5.22, *p* < 0.001), but no significant difference post-activity (B = 0.36, *p* = 0.730).

## Multivariate predictors of SPICE-R2 and ICCAS change scores

A MANCOVA (Table 9) was conducted to examine the effects of demographic and educational factors on students' change scores on the SPICE-R2 and ICCAS instruments. Among the predictors, profession was a significant multivariate predictor (Pillai's Trace = 0.136, F (4,284) = 5.161, *p* < 0.001) with a small-to-moderate effect size (Partial η² = 0.068). Compared with pharmacy students, nutrition students showed significantly greater improvements in both SPICE-R2 (B = 9.193, 95% CI [4.887, 13.500], *p* < 0.001) and ICCAS (B = 6.605, 95% CI [1.830, 11.179], *p* = 0.007) scores. In contrast, biomedical sciences students had a significantly lower improvement in ICCAS scores than did pharmacy students (B = -6.523, 95% CI [-12.385, -0.662], *p* = 0.029), whereas the effect on SPICE-R2 change scores was not statistically significant (*p* = 0.204). Additionally, prior education in a health domain showed a statistically significant multivariate effect (Pillai's Trace = 0.087, F (2,141) = 6.685, *p* = 0.002) with a moderate effect size (Partial η² = 0.087). Students with prior education in a health-related field had significantly higher gains on both outcome measures: SPICE-R2 (B = 5.138, 95% CI [2.284, 7.992], *p* = 0.001) and
<table><caption>**Table 5** Perception of students toward IPE before and after the activity</caption><thead><tr><th rowspan="3">SPICE R2<br>Instrument</th><th colspan="5">Pre-activity</th><th colspan="3">Post-activity</th><th rowspan="3">P-value</th></tr><tr><th colspan="4">N (%)</th><th colspan="3">N = 154</th></tr><tr><th>N = 182</th><th>Strongly agree</th><th>Agree</th><th>Neutral</th><th>Disagree</th><th>Strongly disagree</th><th>Strongly agree</th><th>Agree</th><th>Neutral</th></tr></thead><tbody><tr><td colspan="11">Interprofessional teamwork and team-based practice</td></tr><tr><td>Working with students from different disciplines enhances my education</td><td>48 (26.4)</td><td>95 (52.2)</td><td>35 (19.2)</td><td>3 (1.6)</td><td>1 (0.5)</td><td>94 (61.0)</td><td>53 (34.4)</td><td>7 (4.6)</td><td>&lt; 0.001</td></tr><tr><td>Participating in educational experiences with students from different disciplines enhances my ability to work on an interprofessional team</td><td>102 (56.0)</td><td>69 (37.9)</td><td>10 (5.5)</td><td>-</td><td>1 (0.5)</td><td>98 (63.6)</td><td>37 (24.0)</td><td>19 (12.3)</td><td>&lt; 0.001</td></tr><tr><td>Health professional students from different disciplines should be educated to establish collaborative relationships with one another</td><td>98 (53.8)</td><td>64 (35.2)</td><td>19 (10.4)</td><td>-</td><td>1 (0.5)</td><td>107 (69.5)</td><td>29 (18.8)</td><td>18 (11.7)</td><td>&lt; 0.001</td></tr><tr><td>During their education, health professional students should be involved in teamwork with students from different disciplines in order to understand their respective roles</td><td>100 (54.9)</td><td>64 (35.2)</td><td>15 (8.2)</td><td>2 (1.1)</td><td>1 (0.5)</td><td>107 (69.5)</td><td>38 (24.7)</td><td>9 (5.8)</td><td>0.047</td></tr><tr><td colspan="11">Roles/responsibilities for collaborative practice</td></tr><tr><td>My role within an interprofessional team is clearly defined</td><td>61 (33.5)</td><td>92 (50.5)</td><td>28 (15.4)</td><td>-</td><td>1 (0.5)</td><td>89 (57.8)</td><td>56 (36.4)</td><td>9 (5.8)</td><td>0.014</td></tr><tr><td>I have an understanding of the courses taken by, and training requirements of, other health professionals</td><td>82 (45.1)</td><td>72 (39.6)</td><td>22 (12.1)</td><td>5 (2.7)</td><td>1 (0.5)</td><td>92 (59.7)</td><td>43 (27.9)</td><td>19 (12.3)</td><td>&lt; 0.001</td></tr><tr><td>I understand the roles of other health professionals within an interprofessional team</td><td>72 (39.6)</td><td>73 (40.1)</td><td>30 (16.5)</td><td>6 (3.3)</td><td>1 (0.5)</td><td>101 (65.6)</td><td>34 (22.1)</td><td>19 (12.3)</td><td>0.047</td></tr><tr><td colspan="11">Patient outcomes from collaborative practice</td></tr><tr><td>Patient/client satisfaction is improved when care is delivered by an interprofessional team</td><td>111 (61.0)</td><td>59 (32.4)</td><td>10 (5.5)</td><td>1 (0.5)</td><td>1 (0.5)</td><td>109 (70.8)</td><td>36 (23.4)</td><td>9 (5.8)</td><td>&lt; 0.001</td></tr><tr><td>Patient/client-centeredness increases when care is delivered by an interprofessional team</td><td>80 (44.0)</td><td>63 (34.6)</td><td>35 (19.2)</td><td>3 (1.6)</td><td>1 (0.5)</td><td>103 (66.9)</td><td>40 (26.0)</td><td>11 (7.1)</td><td>&lt; 0.001</td></tr><tr><td>Healthcare costs are reduced when patients/ clients are treated by an interprofessional team</td><td>80 (44.0)</td><td>43 (23.6)</td><td>43 (23.6)</td><td>14 (7.7)</td><td>2 (1.1)</td><td>102 (66.2)</td><td>42 (27.3)</td><td>10 (6.5)</td><td>0.014</td></tr></tbody></table>

ICCAS (B = 2.196, 95% CI [1.557, 5.330], p = 0.026). Also, prior IPE experiences showed a statistically significant multivariate effect (Pillai's Trace = 0.151, F (2,141) = 5.290, p = 0.003) with a moderate effect size (Partial η² = 0.070). Students with prior IPE exposure reported greater improvements in SPICE-R2 (B = 1.253, 95% CI [1.185, 3.212], p = 0.007) and ICCAS (B = 0.325, 95% CI [0.182, 2.367], p = 0.012). Moreover, clinical employment showed a statistically significant multivariate effect (Pillai's Trace = 0.131, F (2,141) = 9.315, p < 0.001) with a moderate-to-large effect size (Partial η² = 0.116). Participants with prior or concurrent clinical employment showed significantly lower gains on SPICE-R2 (B = -3.136, 95% CI [-6.848, -0.416], p = 0.047), but the effect on ICCAS change was not significant (p = 0.494). Conversely, other variables including age, GPA, Gender, and prior team work did not have a statistically significant multivariate effect on scores.

Discussion

This study explored the impact of an IPE intervention on health profession students' perceptions and competencies at a Lebanese University. The results provide promising evidence that the IPE activity effectively fostered students' interprofessional collaborative perceptions and competencies.

The choice of validated sensitive tools was central to capturing meaningful changes following the IPE activity. This study utilized validated tools, SPICE-R2 and ICCAS, to assess students' perceptions and self-reported IPE competencies. The SPICE-R2 instrument [32] is a concise validated tool that offers more robust psychometric properties, clearer domain alignment with IPEC competencies, and greater sensitivity to change following short IPE interventions, in comparison to older tools, such as Readiness for Interprofessional Learning Scale (RIPLS) and Attitudes Toward Health Care Teams Scale (ATHCTS) [39, 40]. In addition, the ICCAS tool [33, 34, 37] focuses on behavioral competencies aligned with IPEC domains. Its dual pre/post format helps reduce
<table><caption>**Table 6** Comparison of the ICCAS scale and subscales before and after the IPE activity</caption><thead><tr><th></th><th>Range<br>Min-Max</th><th>Mean ± SD<br>Pre-activity</th><th>Post-activity</th><th>Mean<br>change<br>(post-pre)</th><th>p-value</th></tr></thead><tbody><tr><td>ICCAS<br>scale</td><td>20–100</td><td>73.13 ± 7.35</td><td>87.51 ± 5.25</td><td>14.37</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Communication<br>sub-scale</td><td>5–25</td><td>17.11 ± 2.62</td><td>21.25 ± 1.95</td><td>4.13</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Collaboration<br>sub-scale</td><td>3–15</td><td>12.12 ± 2.40</td><td>13.53 ± 1.50</td><td>1.40</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Roles and<br>responsibilities<br>sub-scale</td><td>4–20</td><td>16.41 ± 2.70</td><td>18.13 ± 1.97</td><td>1.72</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Collaborative<br>patient/family-<br>centered<br>approach</td><td>3–15</td><td>11.44 ± 2.13</td><td>13.35 ± 1.39</td><td>1.90</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Conflict<br>management/<br>resolution<br>sub-scale</td><td>3–15</td><td>9.59 ± 2.16</td><td>12.63 ± 1.23</td><td>3.04</td><td><strong>&lt;0.001</strong></td></tr><tr><td>Team<br>functioning<br>sub-scale</td><td>2–10</td><td>6.44 ± 1.87</td><td>8.59 ± 0.87</td><td>2.10</td><td><strong>&lt;0.001</strong></td></tr></tbody></table>

recall bias and improves sensitivity to change. Compared to other resource-intensive observational tools, ICCAS is a more practical option for capturing students' perceived competency gains [41].

The study revealed a moderately high initial perception of interprofessional collaboration among participants and across all domains of interprofessional teamwork, roles and responsibilities, and patient outcomes. This suggests that even before the activity, students had generally a favorable view of IPE, which could be attributed to curricular emphasis on collaborative practice. The findings from this study demonstrated, as well, a statistically

significant improvement in students' perceptions toward IPE and collaborative practice following their participation in the IPE activity. The results are consistent with prior studies demonstrating the efficacy of IPE interventions in promoting favorable perceptions among health professional students [29, 30, 42–44]. The marked improvement in interprofessional teamwork domain suggests that the intervention was successful in fostering a deeper appreciation for collaborative learning. Similar results were obtained in a quasi-experimental study conducted by Brown et al. in the United States, where the Student Attitude Questionnaire was utilized pre- and post-IPE case studies course to assess the students' perceptions [45]. Students from different health professions (pharmacy, nursing, social work, and allied health sciences) reported significant improvements in various IPE attitudes' domains including perceived value as a team member ($p < 0.001$) [45]. Another study from the United States assessed healthcare students (including pharmacy) perceptions toward an IPE course incorporating cases, lectures, and role plays, using the Readiness for Interprofessional Learning Scale (RIPLS) [46]. The results revealed significantly more positive attitudes toward team collaboration in the intervention group compared to the control group ($p < 0.001$) [46]. Our results align also with Lairamore et al. who demonstrated increased RIPLS scores following a case-based interprofessional intervention across all disciplines [47]. Hence, the findings affirm the effectiveness of IPE activities in enhancing collaborative teamwork attitudes among health professional students.

Our findings revealed a clearer understanding of the students' roles within interprofessional teams with a significant mean change in the perception toward roles and responsibilities for collaborative practice domain following the IPE activity. Prior studies employing case-based IPE learning activities demonstrated as well a significant improvement in students' perceptions toward this domain [45, 46, 48]. A study introduced a longitudinal case-based IPE course series to medical and pharmacy students who collaborated in a student-run clinic [49]. Assessed using SPICE tool, students' perceptions revealed significant improvements in understanding roles and responsibilities, with some uncertainty about their specific roles within the team [49]. This could be attributed to the inclusion of first- and second-year pharmacy and medical students, unlike our study that included senior students. Previous research has demonstrated that senior pharmacy students tend to have a clearer understanding of their roles within interprofessional teams compared to junior students emphasizing the value of integrating IPE early and consistently throughout the pharmacy curricula [50]. Clarity of interprofessional responsibilities is essential to reduce role ambiguity, a
<table><caption>**Table 7** Attainment of IPE competencies before and after the activity</caption><thead><tr><th rowspan="3">The Interprofessional Collaborative Competency Attainment Scale</th><th colspan="4">Pre-activity N (%) N=182</th><th colspan="4">After Post-activity N (%) N=154</th><th rowspan="3">p-value</th></tr><tr><th rowspan="2">Excellent</th><th colspan="3">Very good</th><th rowspan="2">Excellent</th><th colspan="3">Very good</th></tr><tr><th>Good</th><th>Fair</th><th>Poor</th><th>Good</th><th>Fair</th></tr></thead><tbody><tr><td><strong>Communication</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Promote effective communication among members of an interprofessional (IP) team</td><td>14 (7.7)</td><td>49 (26.9)</td><td>33 (18.1)</td><td>45 (24.7)</td><td>41 (22.5)</td><td>58 (37.7)</td><td>59 (38.3)</td><td>22 (14.3)</td><td>15 (9.7)</td></tr><tr><td>Actively listen to IP team members' ideas and concerns</td><td>31 (17.0)</td><td>67 (36.8)</td><td>31 (17.0)</td><td>27 (14.8)</td><td>26 (14.3)</td><td>63 (40.9)</td><td>54 (35.1)</td><td>19 (12.3)</td><td>18 (11.7)</td></tr><tr><td>Express my ideas and concerns without being judgmental</td><td>42 (23.1)</td><td>98 (53.8)</td><td>19 (10.4)</td><td>7 (3.8)</td><td>16 (8.8)</td><td>93 (60.4)</td><td>46 (29.9)</td><td>8 (5.2)</td><td>7 (4.5)</td></tr><tr><td>Provide constructive feedback to IP team members</td><td>42 (23.1)</td><td>100 (54.9)</td><td>22 (12.1)</td><td>8 (4.4)</td><td>10 (5.5)</td><td>91 (59.1)</td><td>41 (26.6)</td><td>12 (7.8)</td><td>10 (5.5)</td></tr><tr><td>Express my ideas and concerns in a clear, concise manner</td><td>37 (20.3)</td><td>92 (50.5)</td><td>19 (10.4)</td><td>12 (6.6)</td><td>22 (12.1)</td><td>78 (50.6)</td><td>56 (36.4)</td><td>15 (9.7)</td><td>5 (3.2)</td></tr><tr><td><strong>Collaboration</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Seek out IP team members to address issues</td><td>65 (35.7)</td><td>60 (33.0)</td><td>31 (17.0)</td><td>20 (11.0)</td><td>6 (3.3)</td><td>90 (58.4)</td><td>60 (39.0)</td><td>4 (2.6)</td><td>-</td></tr><tr><td>Work effectively with IP team members to enhance care</td><td>80 (44.0)</td><td>73 (40.1)</td><td>25 (13.7)</td><td>3 (1.6)</td><td>1 (0.5)</td><td>102 (66.2)</td><td>44 (28.6)</td><td>8 (5.2)</td><td>-</td></tr><tr><td>Learn with, from and about IP team members to enhance care</td><td>55 (30.2)</td><td>67 (36.8)</td><td>48 (26.4)</td><td>9 (4.9)</td><td>3 (1.6)</td><td>70 (45.5)</td><td>71 (46.1)</td><td>13 (8.4)</td><td>-</td></tr><tr><td><strong>Roles and Responsibilities</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Identify and describe my abilities and contributions to the IP team</td><td>67 (36.8)</td><td>87 (47.8)</td><td>24 (13.2)</td><td>3 (1.6)</td><td>1 (0.5)</td><td>96 (62.3)</td><td>52 (33.8)</td><td>6 (3.8)</td><td>-</td></tr><tr><td>Be accountable for my contributions to the IP team</td><td>82 (45.1)</td><td>65 (35.7)</td><td>31 (17.0)</td><td>3 (1.6)</td><td>1 (0.5)</td><td>87 (56.5)</td><td>61 (39.5)</td><td>6 (3.9)</td><td>-</td></tr><tr><td>Understand the abilities and contributions of IP team members</td><td>62 (34.1)</td><td>62 (34.1)</td><td>44 (24.2)</td><td>9 (4.9)</td><td>5 (2.7)</td><td>80 (51.9)</td><td>70 (45.5)</td><td>4 (2.6)</td><td>-</td></tr><tr><td>Recognize how others' skills and knowledge complement and overlap with my own</td><td>44 (24.2)</td><td>103 (56.6)</td><td>28 (15.4)</td><td>4 (2.2)</td><td>3 (1.6)</td><td>89 (57.8)</td><td>60 (39.0)</td><td>5 (3.2)</td><td>-</td></tr><tr><td><strong>Collaborative Patient/Family-Centered Approach</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Use an IP team approach with the patient to assess the health situation</td><td>42 (23.1)</td><td>92 (50.5)</td><td>36 (19.8)</td><td>7 (3.8)</td><td>5 (2.7)</td><td>90 (58.4)</td><td>55 (35.7)</td><td>9 (5.8)</td><td>-</td></tr><tr><td>Use an IP team approach with the patient to provide whole person care</td><td>35 (19.2)</td><td>96 (52.7)</td><td>35 (19.2)</td><td>11 (6.0)</td><td>5 (2.7)</td><td>70 (45.5)</td><td>79 (51.3)</td><td>5 (3.2)</td><td>-</td></tr><tr><td>Include the patient/family in decision-making</td><td>37 (20.3)</td><td>93 (51.1)</td><td>41 (22.5)</td><td>5 (2.7)</td><td>6 (3.3)</td><td>69 (44.8)</td><td>78 (50.6)</td><td>7 (4.5)</td><td>-</td></tr><tr><td><strong>Conflict Management/Resolution</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Actively listen to the perspectives of IP team members</td><td>34 (18.7)</td><td>83 (45.6)</td><td>19 (10.4)</td><td>17 (9.3)</td><td>29 (15.9)</td><td>51 (33.1)</td><td>67 (43.5)</td><td>36 (23.4)</td><td>-</td></tr><tr><td>Take into account the ideas of IP team members</td><td>16 (8.8)</td><td>78 (42.9)</td><td>28 (15.4)</td><td>43 (23.6)</td><td>17 (9.3)</td><td>63 (40.9)</td><td>70 (45.5)</td><td>21 (13.6)</td><td>-</td></tr><tr><td>Address team conflict in a respectful manner</td><td>14 (7.7)</td><td>49 (26.9)</td><td>56 (30.8)</td><td>35 (19.2)</td><td>28 (15.4)</td><td>65 (42.2)</td><td>65 (42.2)</td><td>24 (15.6)</td><td>-</td></tr><tr><td><strong>Team Functioning</strong></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Develop an effective care plan with IP team members</td><td>35 (19.2)</td><td>70 (38.5)</td><td>35 (19.2)</td><td>14 (7.7)</td><td>28 (15.4)</td><td>61 (39.6)</td><td>78 (50.6)</td><td>15 (9.7)</td><td>-</td></tr><tr><td>Negotiate responsibilities within overlapping scopes of practice</td><td>21 (11.5)</td><td>55 (30.2)</td><td>49 (26.9)</td><td>36 (19.8)</td><td>21 (11.5)</td><td>58 (37.7)</td><td>84 (54.5)</td><td>12 (7.8)</td><td>-</td></tr><tr><td>Ability to collaborate professionally compared to the time before the IPE activity</td><td>100 (64.9)</td><td>43 (27.9)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>• Much better now</td><td>11 (7.2)</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>• Somewhat better now</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>• About the same</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>
<table><caption>**Table 8** Comparison of pre- and post-activity SPICE-R2 and ICCAS scores by profession with repeated measures ANOVA</caption><thead><tr><th rowspan="2">Instrument</th><th rowspan="2">Profession</th><th rowspan="2">Pre-activity<br>Mean ± SD</th><th rowspan="2">Post-activity<br>Mean ± SD</th><th rowspan="2">Mean change (post-pre)</th><th colspan="2">Pre-activity</th><th colspan="2">Post-activity</th></tr><tr><th>B<br>[95% CI]</th><th>p-value</th><th>B<br>[95% CI]</th><th>p-value</th></tr></thead><tbody><tr><td rowspan="3">SPICE-R2</td><td>Pharmacy</td><td>42.02 ± 6.65</td><td>45.98 ± 4.58</td><td>+3.96</td><td>Reference</td><td></td><td>Reference</td><td></td></tr><tr><td>Nutrition</td><td>36.34 ± 3.99</td><td>48.17 ± 2.87</td><td>+11.83</td><td>-5.57<br>[-8.08, -3.27]</td><td><strong>&lt;0.001</strong></td><td>2.18<br>[0.056, 4.42]</td><td><strong>0.046</strong></td></tr><tr><td>Biomedical</td><td>41.37 ± 3.73</td><td>42.40 ± 8.27</td><td>+1.03</td><td>-0.64<br>[-2.96, 1.67]</td><td>0.582</td><td>-3.58<br>[-5.74, -1.42]</td><td><strong>0.001</strong></td></tr><tr><td rowspan="3">ICCAS</td><td>Pharmacy</td><td>72.70 ± 6.90</td><td>86.91 ± 5.16</td><td>+14.21</td><td>Reference</td><td></td><td>Reference</td><td></td></tr><tr><td>Nutrition</td><td>69.20 ± 6.80</td><td>89.68 ± 5.25</td><td>+20.48</td><td>-3.50<br>[-6.37, -0.62]</td><td><strong>0.017</strong></td><td>2.77<br>[0.60, 4.95]</td><td><strong>0.013</strong></td></tr><tr><td>Biomedical</td><td>77.93 ± 6.70</td><td>87.28 ± 5.15</td><td>+9.35</td><td>5.22<br>[2.45, 7.99]</td><td><strong>&lt;0.001</strong></td><td>0.36<br>[-1.72, 2.46]</td><td>0.730</td></tr></tbody></table>

<table><caption>**Table 9** Multivariate regression analysis of predictors of changes in SPICE-R2 and ICCAS scores following the IPE activity</caption><thead><tr><th rowspan="2">Predictor</th><th colspan="3">SPICE-R2 Score change</th><th colspan="3">ICCAS Score change</th></tr><tr><th>B</th><th>[95% CI]</th><th>p-value</th><th>B</th><th>95% CI</th><th>p-value</th></tr></thead><tbody><tr><td>Profession: Nutrition vs. Pharmacy</td><td>9.193</td><td>[4.887, 13.500]</td><td><strong>&lt;0.001</strong></td><td>6.605</td><td>[1.830, 11.179]</td><td><strong>0.007</strong></td></tr><tr><td>Profession: Biomedical vs. Pharmacy</td><td>-3.487</td><td>[-8.886, 1.913]</td><td>0.204</td><td>-6.523</td><td>[-12.385, -0.662]</td><td><strong>0.029</strong></td></tr><tr><td>Gender (Male vs. Female)</td><td>0.601</td><td>[-2.306, 3.508]</td><td>0.683</td><td>2.150</td><td>[-1.005, 5.305]</td><td>0.180</td></tr><tr><td>Prior health education (No vs. yes)</td><td>5.138</td><td>[2.284, 7.992]</td><td><strong>0.001</strong></td><td>2.196</td><td>[1.557, 5.330]</td><td><strong>0.026</strong></td></tr><tr><td>First choice major (No vs. yes)</td><td>-0.830</td><td>[-4.200, 2.539]</td><td>0.627</td><td>-2.454</td><td>[-6.112, 1.203]</td><td>0.187</td></tr><tr><td>Prior Teamwork experience (No vs. yes)</td><td>-1.114</td><td>[-4.247, 2.294]</td><td>0.525</td><td>-0.525</td><td>[-4.456, 3.197]</td><td>0.782</td></tr><tr><td>Prior IPE experience (No vs. yes)</td><td>1.253</td><td>[1.185, 3.212]</td><td><strong>0.007</strong></td><td>0.325</td><td>[0.182, 2.367]</td><td><strong>0.012</strong></td></tr><tr><td>Clinical employment (No vs. yes)</td><td>-3.136</td><td>[-6.848, -0.413]</td><td><strong>0.047</strong></td><td>-1.397</td><td>[-5.443, 2.560]</td><td>0.494</td></tr><tr><td>Age</td><td>-0.065</td><td>[-0.711, 0.580]</td><td>0.842</td><td>-0.300</td><td>[-1.001, 0.401]</td><td>0.339</td></tr><tr><td>GPA</td><td>-1.266</td><td>[-5.097, 2.556]</td><td>0.515</td><td>-0.543</td><td>[-4.703, 3.112]</td><td>0.797</td></tr></tbody></table>

known barrier to effective team functioning [51]. This study reported as well greater agreement that interprofessional teams improve patient outcomes along with significant improvement in patient outcomes from collaborative practice subscale post-IPE activity, aligning with previous research [45, 52]. This shift in perception reflects growing recognition among future healthcare providers that collaborative, team-based care is essential for delivering high quality, safe, and patient-centered outcomes [53].

The results of this study demonstrated a moderately high overall pre-activity IPE competency level, as measured by the ICCAS scale. This could be due to the inclusion of interprofessional elements within the schools' curricula. Domains such as communication, collaboration, roles and responsibilities, and collaborative patient/family-centered approach subscales showed relatively high initial scores, suggesting a foundational understanding of these competencies even prior to the IPE activity. Conversely, conflict management/resolution and team functioning domains had the lowest baseline scores. This indicates that students were less confident in handling interprofessional disagreements and effectively negotiating team roles. These areas are known to be more complex and are often considered high order competencies [53].

Our study revealed a significant increase in the overall ICCAS scale and subscales following the IPE activity. These results support the effectiveness of the IPE intervention in enhancing interprofessional competencies. Most improvements were seen in the communication, conflict management/resolution and team functioning, which aligns with previous studies reporting positive shifts in self-assessed competencies post-interventions [54, 55]. Case analysis and collaborative planning are known to cultivate essential skills in communication and teamwork [56]. In addition, the design of the IPE day with active learning formats such as role reflection, interdisciplinary lectures, and complex case-based collaboration, was intentionally aligned with these core competencies. For instance, the role-reflection session encouraged students to explore professional stereotypes and communication preferences, while the two multidisciplinary case discussions required interprofessional teams to negotiate care plans, resolve conflicting approaches, and share decision-making responsibilities. Nonetheless, while conflict management and team functioning showed significant improvement, they remained the lowest-rated domains post-intervention. According to Benner's model and Miller's pyramid, final-year undergraduate students are expected to function at an advanced beginner to competent level [35]. These levels suggest growing
proficiency but not yet the fluency or confidence typi-
cally seen in expert or master-level collaboration. Con-
flict resolution, in particular, demands not only cognitive
understanding but also emotional intelligence, interper-
sonal skills, role negotiation and assertiveness, cultivated
through repeated practice in clinical environments [57].
Moreover, the structure of the activity contributed dif-
ferentially to competency development. While interpro-
fessional communication was emphasized throughout
the day, the conflict resolution element was mainly con-
centrated in the second case discussion. Thus, students
may have had limited opportunities to repeatedly prac-
tice resolving disagreements, possibly explaining the
relatively modest gains in this domain. These findings
suggest that while short multidimensional IPE activi-
ties are valuable, additional experiential learning oppor-
tunities, including longitudinal IPE courses, simulated
conflict scenarios, or joint clinical placements, are likely
needed to more robustly strengthen high-level collabora-
tive competencies like conflict resolution and advanced
team dynamics.

This study demonstrated substantial improvements in SPICE-R2 and ICCAS scales among pharmacy and nutrition students, while biomedical students showed minimal or nonsignificant gains following the participation in the IPE activity. The results are in accordance with previous literature [27, 29, 30, 45, 46, 49, 56], where improvements across different student groups reflects the universal value of IPE regardless of discipline. While pharmacy students had higher baseline scores, the greatest improvements were observed among nutrition students, indicating that the intervention was particularly impactful for those with initially lower perceptions or competencies. This finding aligns with the baseline data, which show that pharmacy students were significantly older and had higher prior exposure to teamwork, interprofessional education, and clinical employment compared to nutrition students. These disparities likely contributed to initially lower perceptions and self-reported competencies among nutrition students, thereby allowing more room for growth during the intervention. Similar patterns were reported by Zaher et al. where nutrition students who initially had lower readiness for interprofessional collaboration showed significant improvements after participating in the IPE program, in contrast to medical students who had higher baseline scores and demonstrated less change [28]. Another study from Hong Kong revealed significant improvement in interprofessional collaboration perception by lower-performing teams compared to the higher-performing teams [58]. Lower performing students articulate a more comprehensive appreciation for the benefits of IPE, are more receptive to new ideas and approaches, and consequently foster a more dynamic learning environment [58]. On the other

hand, biomedical students had minimal improvement in SPICE-R2 scores with non-significant differences pre-activity and a significant decline compared to pharmacy students post-IPE. Also, they exhibited moderate gain in ICCAS scores with significantly higher pre-activity scores than pharmacy students but no significant difference post-activity. This indicates less perceived relevance or engagement of biomedical students with the collaborative components of the intervention. The results support the tailoring of IPE activities to address the specific needs of different professional groups.

Although prior health education did not significantly
differ across groups, further analysis revealed that it was
a significant predictor of greater improvements in both
perceptions and competencies. This could be attributed
to students with foundational knowledge in healthcare
may better appreciate and internalize concepts of inter-
professional collaboration [19]. Students with prior
health education may have entered the activity with
greater awareness of collaborative care models, making
them more capable of grasping and applying interpro-
fessional principles. Furthermore, prior IPE exposures
significantly predicted more gains in perceptions and
competencies. Familiarity with interprofessional learning
environments may enhance responsiveness to further IPE
exposure due to cumulative learning effects or increased
comfort with collaborative engagement [59, 60]. These
students may exhibit more confidence in team-based
scenarios, allowing for deeper engagement during case
discussions and reflection exercises. Conversely, clinical
employment, more common among pharmacy and bio-
medical students, exhibited significantly lower gains on
the SPICE-R2 scale. This could imply that students with
real-world clinical experience may have already formed
attitudes or perceptions leaving less potential for change
[61]. Also, they might be more critical of simplified IPE
activities, perceiving them as less reflective of actual clin-
ical complexities [62]. While IPE benefits learners across
disciplines, the degree of improvement may vary depend-
ing on baseline familiarity with collaborative practice,
professional role identity, and practical exposure. Strate-
gically layering IPE activities throughout the curriculum,
beginning with introductory sessions for less experienced
students and advancing to more complex and clinically
integrated tasks for senior or clinically active students
could offer a more personalized and impactful learning
trajectory.

Lessons learned and proposed curricular enhancements

The positive feedback from students and measurable
improvements in perceptions and self-reported com-
petencies support the relevance of this intervention for
pharmacy, nutrition, and biomedical sciences students.
However, variation in students' baseline IPE exposure
and professional role understanding support the need to introduce IPE earlier in the curriculum. Embedding foundational IPE experiences in the preclinical years would ensure students enter later, case-based activities with shared expectations and baseline skills. In addition, designing the activity across the three departments faced logistic challenges. This revealed the need for centralized planning and administrative support to ensure repeatability. Moreover, training facilitators to manage mixed-discipline teams and promote equitable participation was critical. Hence, developing a faculty developing program on IPE facilitation is now under consideration to enhance consistency and engagement in future activities.

To move beyond one-off interventions, future IPE activities will be integrated into the curriculum through vertical and horizontal alignment. This includes introducing multi-year IPE threads utilizing simulation and case-based methods, and leveraging existing clinical placements for interprofessional learning opportunities. Furthermore, the establishment of an IPE coordination committee composed of faculty from each discipline is being proposed to oversee the design, assessment, and institutionalization of IPE across the university. While the intervention demonstrated significant improvements in students' perceptions and self-reported competencies, its short duration highlights the need for longitudinal IPE models. For these gains to translate into sustained interprofessional collaboration in clinical practice, future efforts must embed IPE throughout the curriculum and include objective assessments in real world settings. These should include interdisciplinary clinical rotations, team-based simulation, and multi-institutional initiatives that reflect Lebanon's diverse and decentralized healthcare landscape. Moreover, longitudinal integration of IPE activities would allow educators to track the progression of interprofessional attitudes and skills over time and assess differential impacts on junior versus senior learners.

## Strengths and limitations

This study had several strengths including its quasi-experimental pre-post design that allows for the evaluation of changes in students' perceptions and competencies following a structured IPE intervention. The use of validated tools (SPICE-R2 and ICCAS) with high internal consistency enhances the reliability of the findings. Also, the rigorous statistical analyses strengthen the validity of the results. However, the study has some limitations including the lack of a control group which limits casual inferences and restricts the ability to attribute observed changes solely to the IPE intervention. A control group was not included due to curricular and ethical considerations, as participation in the IPE activity was mandatory for all fifth-year pharmacy students. This

design decision reflects real-world educational context in which the intervention was embedded. One limitation of this study is the attrition between the pre- and post-intervention responses, with more than 10% of students not completing the follow-up survey. While this level of loss may affect generalizability, statistical comparisons revealed no significant differences in key characteristics between students who completed both surveys and those who did not (Supplementary Table 1). Nonetheless, the possibility of unmeasured confounding due to non-responders cannot be entirely ruled out. In addition, the SPICE-R2 and ICCAS are self-reporting tools and consequently have potential for recall and social desirability biases due to the reliance on students' responses rather than objective competency assessments. Furthermore, the short-term evaluation may not capture sustained changes in attitudes or skills. Moreover, while the IPE activity was well structured, its one-day format may not provide sufficient exposure for long-term competency development.

## Conclusion

The study demonstrated significantly improved collaborative perceptions and self-reported competencies among health profession students following participation in a structured IPE activity. While initial perception scores were already favorable, the activity further strengthened positive attitudes toward teamwork, role clarity, and patient-centered perspectives, aligning with global evidence on IPE effectiveness. The improvements in competencies were significant across all domains, with the largest gains observed in communication, conflict resolution, and team functioning. The intervention demonstrated differential impacts across professional groups, with nutrition students showing the greatest improvements. Factors such as prior health education and prior IPE exposure were positively associated with greater improvements in students' perceptions and competencies, while clinical employment predicted lower gains. The findings support the integration of IPE into the curricula, and highlight the need for longitudinal objective assessments in future research, while advocating for tailored activities that bridge classroom learning with clinical realities.

## Abbreviations

<table><tr><td>ANOVA</td><td>Analysis of variance</td></tr><tr><td>ICCAS</td><td>Interprofessional collaborative competency attainment survey</td></tr><tr><td>IPC</td><td>Interprofessional collaboration</td></tr><tr><td>IPE</td><td>Interprofessional education</td></tr><tr><td>IPEC</td><td>Interprofessional education collaborative</td></tr><tr><td>LIU</td><td>Lebanese international university</td></tr><tr><td>MANCOVA</td><td>Multivariate analysis of covariance</td></tr><tr><td>SD</td><td>Standard deviation</td></tr><tr><td>SPICE-R2</td><td>Student perceptions of interprofessional clinical education-revised</td></tr><tr><td>WHO</td><td>World health organization</td></tr></table>
**Supplementary Information**

The online version contains supplementary material available at https://doi.org/10.1186/s12909-025-08082-x.

Supplementary material 1

**Acknowledgements**

We extend our sincere thanks to the deans, chairpersons, and students of the Bachelor of Pharmacy, the Bachelor of Science in Nutrition and Dietetics program, and the Biomedical Science programs at the Lebanese International University for their valuable contributions and active participation in the IPE day.

**Authors' contributions**

IF conceptualized the study, had the responsibility of the project administration, planned the methodology, and carried out the statistical analyses. IF, MD, JS, FS and MR supervised the project. IF, FH, and SK wrote the manuscript text. All authors reviewed and edited the text, and approved the final manuscript.

**Funding**

This research received no external funding.

**Data availability**

All data supporting the findings of this study are available from the authors upon reasonable request.

**Declarations**

**Ethics approval and consent to participate**

This research adhered to the Ethical Guidelines for Life Science and Medical Research Involving Human Subjects and was approved by the Ethical and Research Committee at the Lebanese International University (LIU) under the number 2024ERC-050-LIUSOP. Informed consents were obtained from all participants prior to study inclusion where the students had to agree to participate in the study before survey access. It was made clear that refusal to participate would not be reflected in the grades awarded. Moreover, this was an observational quasi-experimental study that did not involve any invasive treatment or intervention.

**Competing interests**

The authors declare no competing interests.

**Conflict of interest**

The authors declare no conflict of interest.

**Author details**

Received: 13 May 2025 / Accepted: 26 September 2025

Published online: 22 October 2025

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