Inter-professional Education Competency Scale

Abstract

Contemporary healthcare delivery is fundamentally predicated on multidisciplinary synergy, necessitating the transition from isolated clinical training toward robust interprofessional education (IPE) models. The Inter-professional Education Competency Scale (IPEC Scale) is a multidimensional psychometric self-report instrument engineered to operationalize, assess, and monitor the developmental trajectory of collaborative readiness and core clinical competencies among emerging healthcare professionals. Grounded conceptually in the core competency frameworks established by the Interprofessional Education Collaborative (IPEC) and empirical adaptations by Dow and colleagues, the scale underwent comprehensive cross-cultural adaptation and psychometric validation within a non-Western clinical context by Rasouli, Norouzi, Ramezani, and Hashemi (2024). The inventory comprises 42 items scored across a 5-point Likert scale, structurally distributed across four theoretically delineated subdomains: Values and Ethics (10 items), Roles and Responsibilities (9 items), Inter-professional Communication (11 items), and Team-based Care and Teamwork (12 items). Empirical evaluation within an academic cohort of medical (64.5%) and nursing (35.5%) students confirmed exceptional psychometric properties. Content validity was substantiated by a scale-level Content Validity Index (S-CVI) of 0.87. Exploratory Factor Analysis demonstrated strong sampling adequacy (Kaiser-Meyer-Olkin index of 0.84) and accounted for approximately 52% of total cumulative variance, with individual factor loadings uniformly exceeding 0.70. Confirmatory Factor Analysis demonstrated exceptional model fit: Root Mean Square Error of Approximation (RMSEA) = 0.026, Comparative Fit Index (CFI) = 0.920, Goodness of Fit Index (GFI) = 0.95, Non-Normed Fit Index (NNFI) = 0.95, and a normed chi-square (χ²/df) of 2.38. Internal consistency yielded a global Cronbach’s α of 0.84, complemented by composite reliability coefficients spanning 0.85 to 0.91, alongside Average Variance Extracted (AVE) estimates between 0.64 and 0.76. The scale provides medical educators, health systems researchers, and psychometricians with an empirically grounded instrument to benchmark collaborative readiness, optimize curricular efficacy, and mitigate preventable clinical communication failures.

Keywords

Inter-professional education, Psychometrics, Collaborative practice, Medical students, Nursing students, Factor analysis, Competency assessment, Clinical teamwork, Health professional education, Structural equation modeling

Authors

The cross-cultural adaptation, structural validation, and psychometric operationalization of the 42-item Persian adaptation of the Inter-professional Education Competency Scale was executed by a collaborative team of medical education specialists and clinical psychometric researchers:

• Davood Rasouli — Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
• Azam Norouzi — Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
• Ghobad Ramezani (Corresponding Author: [email protected]) — Education Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
• Akram Hashemi — Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.

The instrument draws foundational heritage from the overarching competency frameworks initiated by the national Interprofessional Education Collaborative and the subsequent measurement paradigms developed by Dow, DiazGranados, Mazmanian, and Retchin (2014) at Virginia Commonwealth University.

Purpose

The primary objective of the Inter-professional Education Competency Scale is to provide an empirically validated, fine-grained diagnostic and evaluative measurement tool designed to quantify self-perceptions of collaborative readiness and actionable competencies among healthcare trainees prior to independent clinical practice. Historically, undergraduate and postgraduate medical, nursing, and allied health educational pathways have functioned within rigid, isolated departmental silos. This insular pedagogy inadvertently cultivates professional tribalism, disjointed communication loops, ambiguity regarding professional scopes of practice, and hierarchical friction. Substantial epidemiological and health services research by the World Health Organization (WHO) and the Institute of Medicine has revealed that interprofessional miscommunication and fragmented teamwork represent primary root causes of preventable medical errors, adverse patient events, and institutional provider burnout.

Despite widespread international accreditation mandates requiring medical institutions to incorporate interprofessional education into their curricula, academic administrators have historically struggled with the operational assessment of these programs. Subjective satisfaction surveys and unstandardized course evaluations fail to measure genuine competency acquisition or latent behavioral shifts. The IPEC Scale addresses this methodological void by offering a structured psychometric architecture that evaluates specific, behaviorally anchored cognitive, affective, and operational domains of interprofessional collaboration. By deploying this instrument, curriculum developers can conduct baseline diagnostic assessments, identify localized competency deficits across distinct health disciplines, and implement targeted educational interventions such as high-fidelity clinical simulations, joint grand rounds, and integrated clinical problem-solving workshops.

Furthermore, in empirical and clinical research settings, the scale serves as an indispensable outcome measure for longitudinal cohort tracking and interventional trials. Researchers can utilize the instrument within pretest-posttest designs or multi-wave longitudinal growth models to determine whether structured clinical rotations or simulation exercises yield statistically significant improvements in team-based efficacy, ethical alignment, and professional boundary comprehension. Additionally, its adaptation across distinct healthcare cultures provides a standardized metric for cross-national benchmarking, enabling comparative health services research between Western healthcare paradigms and emerging health infrastructure environments.

Psychological Construct

The psychological construct assessed by the instrument is Inter-professional Education Competency, operationalized as a multidimensional, integrated constellation of knowledge, cognitive orientations, relational values, and behavioral capabilities required to practice healthcare collaboratively within integrated multidisciplinary teams. Rather than treating collaboration as a static personality trait, the construct is conceptualized as an acquired professional developmental competency characterized by four core latent dimensions:

1. Values and Ethics (10 Items)

This subscale assesses the foundational normative and moral architecture necessary for team-based patient care. It encapsulates the practitioner’s internalized commitment to mutual respect, shared altruism, patient advocacy, cultural humility, and ethical integrity across disciplinary boundaries. High scores reflect an appreciation for the intrinsic value and distinct perspectives contributed by every health profession, a shared commitment to patient-centered confidentiality and dignity, and the ability to navigate complex clinical-ethical dilemmas collaboratively rather than hierarchically. Trainees excelling in this construct demonstrate an active rejection of paternalistic, single-profession dominance in favor of egalitarian, collective accountability for patient welfare.

2. Roles and Responsibilities (9 Items)

This dimension measures cognitive and behavioral clarity regarding professional boundaries, scopes of clinical licensure, and collaborative role interdependency. It evaluates the trainee’s capacity to articulate clearly their own professional capabilities, limitations, and obligations while demonstrating a nuanced comprehension of the complementary functions fulfilled by allied professionals (e.g., how a physician understands the diagnostic, pharmacological, and holistic care contributions of advanced practice nurses, clinical pharmacists, and physical therapists). Construct deficiency in this area manifests as role confusion, scope encroachment, duplicative clinical efforts, or inappropriate omission of patient care interventions due to false assumptions about peer duties.

3. Inter-professional Communication (11 Items)

This subscale evaluates the transactional and relational mechanics of information exchange within multidisciplinary clinical environments. It operationalizes active listening, expressive clarity, non-verbal sensitivity, the avoidance of discipline-specific jargon that alienates team members or patients, and the proactive execution of structured handoffs (such as SBAR: Situation, Background, Assessment, Recommendation). Furthermore, this dimension assesses constructive assertiveness and conflict resolution capabilities—specifically, the willingness to voice critical clinical safety concerns across perceived power gradients without provoking defensiveness, thereby establishing high psychological safety in clinical spaces.

4. Team-based Care and Teamwork (12 Items)

This domain captures the operational translation of collaborative theory into collective clinical action. It measures procedural competence in shared clinical decision-making, adaptive team leadership, situational awareness, task coordination, and distributed cognitive processing during clinical crises and routine care. High scorers understand how to negotiate consensus regarding patient care plans, flexibly adjust workflows in response to evolving patient acuity, integrate disparate diagnostic perspectives, and conduct effective post-event team debriefings to foster continuous clinical quality improvement.

Theoretical Framework

The theoretical framework underlying the Inter-professional Education Competency Scale synthesizes three foundational paradigms from educational psychology, sociology of professions, and organizational dynamics:

1. Social Identity Theory and Contact Hypothesis

The development of professional silos within healthcare is deeply rooted in Social Identity Theory, originally formulated by Henri Tajfel and John Turner. During professional socialization, medical and nursing trainees internalize robust ingroup identities, often accompanied by outgroup stereotyping, professional territorialism, and implicit biases regarding status and competence. The IPEC scale’s theoretical model utilizes Gordon Allport’s Contact Hypothesis as an explanatory mechanism for behavioral transformation. Allport posited that intergroup prejudice and friction diminish under conditions characterized by equal status contact, common overarching goals, intergroup cooperation, and the support of institutional authorities. The scale operationalizes competencies that emerge when educational curricula deliberately construct these conditions, tracking the deconstruction of insular professional identities in favor of a shared, superordinate identity as unified healthcare providers.

2. Situated Learning Theory and Communities of Practice

Jean Lave and Etienne Wenger’s Situated Learning Theory posits that learning is fundamentally an active, contextualized social process occurring within a Community of Practice. In modern healthcare environments, clinical mastery is not merely acquired through didactic memorization of anatomical or pharmacological data, but through ‘legitimate peripheral participation’ alongside diverse colleagues in real-world or simulated clinical encounters. The IPEC Scale evaluates a trainee’s evolution from peripheral, discipline-bound observation to active, integrative participation within the broader clinical community of practice, measuring how effectively they absorb tacit social conventions, reciprocal communication scripts, and shared problem-solving frameworks.

3. Shared Mental Models and High-Reliability Organizing

From organizational psychology and human factors engineering, the scale incorporates the conceptual model of Shared Mental Models (Cannon-Bowers, Salas, & Converse, 1993). In complex, high-stakes environments such as emergency departments, intensive care units, and operating theaters, team success depends on team members holding shared cognitive representations of task requirements, equipment, environmental constraints, and teammate capabilities. The IPEC Scale systematically quantifies whether healthcare students possess the requisite shared mental models regarding roles, ethical duties, and communicative protocols, thereby fulfilling the operational tenets of High-Reliability Organizations (HROs) designed to prevent catastrophic systems failure.

Validity

The psychometric evaluation of the Persian adaptation of the Inter-professional Education Competency Scale implemented a comprehensive, multi-phase validation methodology evaluating content, construct, convergent, and discriminant validity.

Content Validity

Content validity was evaluated by an expert multidisciplinary panel comprising 11 specialists in medical education, nursing education, clinical psychometrics, and health sciences curriculum development. Panel members rigorously reviewed each item for conceptual clarity, cultural appropriateness, translation equivalence, and clinical relevance. Quantification of expert consensus yielded a scale-level Content Validity Index (S-CVI) of 0.87. This exceeds the conventional psychometric threshold of 0.80 established by Polit and Beck, confirming that the scale comprehensively covers the theoretical domains of collaborative competency without extraneous or culturally dissonant constructs.

Construct Validity

Construct validity was demonstrated through complementary exploratory and confirmatory factor analytic designs. Initial exploratory analyses confirmed that the structural associations among the 42 items aligned with the hypothesized theoretical dimensions. Subsequent Confirmatory Factor Analysis (CFA) using structural equation modeling verified the multidimensional four-factor structure. Model adequacy was evidenced by exceptional goodness-of-fit indices: a Root Mean Square Error of Approximation (RMSEA) of 0.026 (substantially below the 0.05 cutoff for superior model fit), a Comparative Fit Index (CFI) of 0.920, a Goodness of Fit Index (GFI) of 0.95, and a Non-Normed Fit Index (NNFI/TLI) of 0.95. The normed chi-square index (χ²/df) yielded 2.38, well within the widely recognized acceptable standard of ≤ 3.0, corroborating that the empirical data closely mirrored the proposed four-factor theoretical model.

Convergent and Discriminant Validity

Convergent validity was evaluated by examining the Average Variance Extracted (AVE) for each latent dimension. Across the four subscales, AVE values ranged between 0.64 and 0.76, comfortably exceeding the standard benchmark of 0.50 established by Fornell and Larcker. This indicates that the latent factors explain more than 60% of the variance observed within their constituent indicator items. Discriminant validity was established using the Fornell-Larcker criterion, verifying that the square root of the AVE for each latent factor was strictly greater than the inter-factor correlation coefficients between that factor and any other latent construct in the measurement model, demonstrating that the four subscales assess distinct, non-redundant facets of collaborative competence.

Reliability

Reliability assessment of the Inter-professional Education Competency Scale established high internal consistency and measurement precision across both global and subscale levels.

Internal Consistency

The scale achieved a global Cronbach’s alpha (α) coefficient of 0.84 when administered to the combined cohort of medical and nursing students. In classical test theory, an alpha coefficient between 0.80 and 0.90 is considered optimal for psychological and educational assessments; it establishes that the items are sufficiently interrelated to capture a cohesive overarching construct while avoiding extreme collinearity or semantic redundancy that artificially inflates coefficients above 0.95.

Composite Reliability

Recognizing the well-documented psychometric limitations of Cronbach’s alpha regarding tau-equivalence assumptions, the researchers computed Composite Reliability (CR) coefficients for each individual subscale within the structural equation framework. The resulting composite reliability values demonstrated outstanding internal consistency across all four latent domains:

• Values and Ethics: CR = 0.88
• Roles and Responsibilities: CR = 0.85
• Inter-professional Communication: CR = 0.89
• Team-based Care and Teamwork: CR = 0.91

Because all composite reliability coefficients comfortably exceeded the conservative threshold of 0.70 (and the stringent threshold of 0.80), the scale demonstrates minimal measurement error variance, providing assurance of score stability and precision when deployed for high-stakes academic benchmarking or longitudinal research.

Factor Analysis

The factorial structure of the 42-item instrument was validated using a rigorous two-step sequential factor analytic protocol comprising Exploratory Factor Analysis (EFA) followed by Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis (EFA)

Prior to extraction, data suitability for dimension reduction was verified. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy yielded an index of 0.84, confirming an adequate sample-to-variable ratio and high shared variance among items. Bartlett’s Test of Sphericity was statistically significant (χ² < 0.001), rejecting the identity matrix null hypothesis and confirming the appropriateness of factor extraction.

Principal Axis Factoring with oblique (Promax) rotation was conducted to permit natural correlation among underlying collaborative competency dimensions. In accordance with the Kaiser criterion (eigenvalues > 1.0) and scree plot inspection, four dominant factors emerged, explaining approximately 52% of the cumulative total variance in student responses. Notably, every one of the 42 items displayed robust, statistically significant factor loadings exceeding 0.70 on its primary latent construct, with negligible cross-loadings (< 0.30) on secondary factors. Consequently, all 42 original items were retained in the final measurement model without requiring item elimination.

Confirmatory Factor Analysis (CFA)

To confirm the empirical tenability of the four-factor structural model, a first-order Confirmatory Factor Analysis was executed using Partial Least Squares Structural Equation Modeling (PLS-SEM) and covariance-based verification. The hypothesized model specified each indicator item loading exclusively onto its designated latent construct (Values and Ethics, Roles and Responsibilities, Inter-professional Communication, or Team-based Care and Teamwork), with covariance paths modeled between the latent factors.

The structural parameter estimates revealed standardized factor loadings ranging from 0.71 to 0.89 across all manifest indicators, establishing that each item serves as an effective psychometric indicator of its target competency construct.

Instrument / Measurement Tool

The formal technical profile and administrative specifications of the instrument are summarized below:

• Instrument Name: Inter-professional Education Competency Scale (IPEC Scale)
• Construct Assessed: Multi-professional collaborative readiness, teamwork behaviors, relational ethics, and communication competencies.
• Test Type: Standardized self-report psychometric rating scale.
• Item Count: 42 items.
• Subscale Breakdown:
  • Values and Ethics: 10 items
  • Roles and Responsibilities: 9 items
  • Inter-professional Communication: 11 items
  • Team-based Care and Teamwork: 12 items
• Response Scale: 42 items, 5-point Likert scale.
• Scoring Protocol: Individual items are rated along the 5-point continuum. Subscale raw scores are derived by calculating the direct sum or arithmetic mean of items within each specific factor. A cumulative composite score can be established by summing all 42 items (theoretical range: 42 to 210), where higher composite and subscale scores denote superior collaborative competence, greater ethical alignment, and elevated preparedness for integrated clinical practice.
• Administration Time: Approximately 10 to 15 minutes.
• Target Population: Undergraduate and postgraduate healthcare trainees, including medical students, nursing students, pharmacy students, and allied health professionals.
• Primary Language of Validation: Persian (translated and adapted from original English core competency frameworks with author consent).

Permissions & Fee and Test Year

The psychometric translation, cultural adaptation, and field validation study of the Persian 42-item Inter-professional Education Competency Scale was formally published in 2024 in BMC Medical Education. The instrument was translated and adapted with explicit permission and consent from the original research team that developed the operationalized IPEC assessment framework (Dow et al., 2014).

The academic validation study published by Rasouli and colleagues is distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0). However, the exact proprietary wording and formalized item inventory of the assessment instrument are maintained under academic research copyright. Researchers, clinical educators, and institutional administrators wishing to reproduce, translate, or deploy the complete instrument for educational research or institutional assessment should contact the corresponding author, Dr. Ghobad Ramezani ([email protected]), or the original developers (Dow et al.) to obtain formal licensing, scoring manuals, and permissions.

References

The academic validation of the Inter-professional Education Competency Scale is supported by the following foundational literature:

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Items of the Scale