The New Generation Project

1. The New Generation Project Am going to talk to you about a part of the researhc we are conducting..Am going to talk to you about a part of the researhc we are conducting..

2. CONTENT OF PRESENTATION CONTEXT THEORY: Link between interprofessional education and stereotyping of other health and social care professionals Defining stereotypes DATA Stereotype data collected in study Sample demographics FINDINGS Hierarchy of ratings of stereotypes on each attribute (central tendency measures) Comparison of central tendency in terms of professional profiles Relationships between measures of central tendency and perceived variability ISSUES FOR DISCUSSION WAY FORWARD

3. CONTEXT Commitment in England to pre-registrationIPE training. New Generation Project: Common Learning. Leading Edge Site Status: Universities of Southampton and Portsmouth partnership. In England, the Department of Health’s commitment to the introduction of pre-registration health and social care undergraduate interprofessional training has lead to the funding of four leading-edge sites to pioneer these programmes. One of these sites is located at the Universities of Southampton/Portsmouth under the auspices of the New Generation Project (NGP). The project culminated in the introduction in October 2003 of an interprofessional programme (Common Learning-CL) that spans students from both universities and pertains to undergraduate students from 10 health/social care disciplines. Common Learning at these sites is an interprofessional programme of learning in which students work together in small groups with a range of other student professions at different points throughout the duration of their training. The objective of the programme is that students learn “with, from and about one another to facilitate collaboration in practice “(CAIPE, 1997). In England, the Department of Health’s commitment to the introduction of pre-registration health and social care undergraduate interprofessional training has lead to the funding of four leading-edge sites to pioneer these programmes. One of these sites is located at the Universities of Southampton/Portsmouth under the auspices of the New Generation Project (NGP). The project culminated in the introduction in October 2003 of an interprofessional programme (Common Learning-CL) that spans students from both universities and pertains to undergraduate students from 10 health/social care disciplines. Common Learning at these sites is an interprofessional programme of learning in which students work together in small groups with a range of other student professions at different points throughout the duration of their training. The objective of the programme is that students learn “with, from and about one another to facilitate collaboration in practice “(CAIPE, 1997).

4. THE LINK BETWEEN INTERPROFESSIONAL EDUCATION AND STEREOTYPING OF OTHER HEALTH AND SOCIAL CARE PROFESSIONALS Contact theory predicts that bringing students together will result in attitude change,(Hewstone et al., 2002 ; Allport, 1954). A longitudinal evaluation of students’ stereotyping will test this prediction. The student groups formed in Common Learning (and created in other programmes also- (Barrett et al., 2003; Carpenter & Hewstone, 1996; Barnes et al., 2000) represent a context in which different professional groups are brought in contact with each other, interact and in which complex identities evolve and structure interprofessional relations. Contact theory (Allport, 1954) proposes that bringing potentially conflicting groups together in this way may result in positive attitude/belief change towards the outgroup (other professional groups in this instance). A change in professional stereotypes would be a typical example of this attitude/belief change. However, attitude/belief change is only achieved if particular conditions are fulfilled (Barnes et al., 2000; Brown et al., 1986; Hewstone & Brown, 1986; Pettigrew, 1998; Allport, 1954)). One of the underlying objectives, therefore, of an interprofessional curriculum is that these conditions be fulfilled in such a way that attitude change is one of the learning outcomes. An internal evaluation of the Common Learning programme is currently in place. With the size of the student data set, range of professions represented and the model of interprofessional education employed, this represents a unique opportunity to develop the evidence base surrounding interprofessional education. Part of the evaluation includes a longitudinal cohort survey of the change in students’ attitudes/beliefs/stereotypes over the duration of Common Learning. The student groups formed in Common Learning (and created in other programmes also- (Barrett et al., 2003; Carpenter & Hewstone, 1996; Barnes et al., 2000) represent a context in which different professional groups are brought in contact with each other, interact and in which complex identities evolve and structure interprofessional relations. Contact theory (Allport, 1954) proposes that bringing potentially conflicting groups together in this way may result in positive attitude/belief change towards the outgroup (other professional groups in this instance). A change in professional stereotypes would be a typical example of this attitude/belief change. However, attitude/belief change is only achieved if particular conditions are fulfilled (Barnes et al., 2000; Brown et al., 1986; Hewstone & Brown, 1986; Pettigrew, 1998; Allport, 1954)). One of the underlying objectives, therefore, of an interprofessional curriculum is that these conditions be fulfilled in such a way that attitude change is one of the learning outcomes. An internal evaluation of the Common Learning programme is currently in place. With the size of the student data set, range of professions represented and the model of interprofessional education employed, this represents a unique opportunity to develop the evidence base surrounding interprofessional education. Part of the evaluation includes a longitudinal cohort survey of the change in students’ attitudes/beliefs/stereotypes over the duration of Common Learning.

5. DEFINING STEREOTYPES “Social categorical judgment(s)…..of people in terms of their group memberships” (p26,Turner, 1999). Stereotyping is a natural human process, used by everyone, that can have both positive and negative outcomes. Making sense of group interactions; means of coping,(Haslam et al., 2002; Kirkham et al., 2002). Danger of oversimplification, self fulfilling prophecy, poor self image and performance. (Kirkham et al., 2002; Takase et al., 2001). Therefore, students will arrive at university with stereotypes that may reflect role perceptions or the perceived personality type attracted to a profession. Nurses: caring, dedicated. Doctors: clever, confident. (e.g. Carpenter, 1995). From a socio-psychological perspective, stereotypes are “social categorical judgment(s)…..of people in terms of their group memberships” (p26,Turner, 1999). Although often seen as innately negative, stereotypes are a valid mechanism whereby people make sense of their interactions with other groups and may be used to guide intergroup behaviours. They are a “necessary evil” to efficiently deal with an outgroup with minimum expenditure of energy (Haslam et al., 2002; Haslam et al., 2000). In the health arena, the functionality of stereotyping has been recognised as means of coping with the demands placed upon the professional by the organisation and client (Kirkham, 2002). However, the oversimplification of what are often complex relationships between the client and the professional, or between professionals themselves, can be dangerous (Kirkham, 2002). If stereotypes are utilised to govern intergroup interaction, false or negative expectations of another groups’ attitudes or behaviours may well be generated and convert into a conflictual reality through a form of self-fulfilling prophecy (Hewstone and Brown, 1986). It may simultaneously impact on the individual’s self image and output. For example, it has been shown that a nurses’ perceptions of the public stereotyping of nursing is related to the development of a self concept, collective self esteem, job satisfaction and performance (Takase et al, 2001). It can be imagined that these events might occur among the different professional groups represented in a health and social care team. However, it may occur equally before practice, during training. Previous evaluations of interprofessional programmes have shown that undergraduate students already hold stereotypes of a variety of health and social care professionals (Carpenter & Hewstone, 1996; Carpenter, 1995a) and do so even as early as at the very beginning of their training (Tunstall-Pedsoe, 2003; Hind et al., 2003). Such findings are not unexpected bearing in mind that the public image of various health and social care professionals documented, ones which students are likely to bring with them on entering training (e.g. Conroy, 2002; Hallam ). However, students are not quite the same population as the public at large, bearing in mind their particular interest in the field and, therefore, deserve separate consideration. Being at the beginning of their training, however, these perceptions have not as yet had the opportunity for further development or confirmation through the socialisation processes that make up professional training. In fact, one of the reasons for the introduction of interprofessional education at an undergraduate level is to combat the formation or reinforcement of negative stereotypes that might occur during this socialisation process (Leaviss ref). Stereotypes may reflect the students’ early perceptions of the role of the different health and social care professionals in future teams (ref). However, research has shown that particular types of personalities are attracted to particular professions (hardigan et al) and students’ ratings may also be based on what they consider to be the typical personality of a particular professional rather than their actual role. It may of course be a combination of both. If it is accepted that the ratings given are a reflection of perceived role, and that stereotypes are a natural cognitive process to which to make meaning of group interaction, then mutual differentiation on the attributes studied is acceptable if not desired (Carpenter/Barnes ref). In other words, nurses recognise and are recognised to be people orientated role and strength and doctors are expected to take final responsibility and leadership roles in the team. The most commonly encountered health professional on which stereotypes are documented appears to be nurses, doctors and social workers (e.g., Carpenter 1995; Hewstone et al., 1994; Pietroni, 1991; Hallam). However, especially as interprofessional programmes develop, and findings are published, other professional stereotypes emerge (e.g. of pharmacists, physiotherapists and dietetic students: Hind; Tunstall-Pedoe-of occupational therapsists –Barnes; of radiographers-Tunstall-Pedsoe). Pietroni (1991), for example, looking at nurses, medics and social workers, asks students to generate what become a diverse range of attributes on these professions. These he classifies into three archetypes: the doctor as hero/warrior/god, the nurse as great mother and the social worker as scapegoat. In a similar exercise, Carpenter (1995) asks students to generate a range of attributes associated with doctors and nurses. These included adjectives such as do-gooders, dithering, arrogant, dedicated, good communicators. Doctors were seen as dedicated, confident, but detached, arrogant and poor communicators. Nurses on the other hand were seen as caring and dedicated, moderately good communicators with a tendency to be do-gooders. Hallam (2000), raising further nursing attributes such as angel and battle axe as adjectives to describe the nursing profession, also comments on the overlap between gender stereotypes and stereotypes held of the professional which persist despite the improved recruitment of men to female dominated professions such as nursing and the dramatic equalisation of the gender ratios of previously masculine dominated professions such as medicine.From a socio-psychological perspective, stereotypes are “social categorical judgment(s)…..of people in terms of their group memberships” (p26,Turner, 1999). Although often seen as innately negative, stereotypes are a valid mechanism whereby people make sense of their interactions with other groups and may be used to guide intergroup behaviours. They are a “necessary evil” to efficiently deal with an outgroup with minimum expenditure of energy (Haslam et al., 2002; Haslam et al., 2000). In the health arena, the functionality of stereotyping has been recognised as means of coping with the demands placed upon the professional by the organisation and client (Kirkham, 2002). However, the oversimplification of what are often complex relationships between the client and the professional, or between professionals themselves, can be dangerous (Kirkham, 2002). If stereotypes are utilised to govern intergroup interaction, false or negative expectations of another groups’ attitudes or behaviours may well be generated and convert into a conflictual reality through a form of self-fulfilling prophecy (Hewstone and Brown, 1986). It may simultaneously impact on the individual’s self image and output. For example, it has been shown that a nurses’ perceptions of the public stereotyping of nursing is related to the development of a self concept, collective self esteem, job satisfaction and performance (Takase et al, 2001). It can be imagined that these events might occur among the different professional groups represented in a health and social care team. However, it may occur equally before practice, during training. Previous evaluations of interprofessional programmes have shown that undergraduate students already hold stereotypes of a variety of health and social care professionals (Carpenter & Hewstone, 1996; Carpenter, 1995a) and do so even as early as at the very beginning of their training (Tunstall-Pedsoe, 2003; Hind et al., 2003). Such findings are not unexpected bearing in mind that the public image of various health and social care professionals documented, ones which students are likely to bring with them on entering training (e.g. Conroy, 2002; Hallam ). However, students are not quite the same population as the public at large, bearing in mind their particular interest in the field and, therefore, deserve separate consideration. Being at the beginning of their training, however, these perceptions have not as yet had the opportunity for further development or confirmation through the socialisation processes that make up professional training. In fact, one of the reasons for the introduction of interprofessional education at an undergraduate level is to combat the formation or reinforcement of negative stereotypes that might occur during this socialisation process (Leaviss ref). Stereotypes may reflect the students’ early perceptions of the role of the different health and social care professionals in future teams (ref). However, research has shown that particular types of personalities are attracted to particular professions (hardigan et al) and students’ ratings may also be based on what they consider to be the typical personality of a particular professional rather than their actual role. It may of course be a combination of both. If it is accepted that the ratings given are a reflection of perceived role, and that stereotypes are a natural cognitive process to which to make meaning of group interaction, then mutual differentiation on the attributes studied is acceptable if not desired (Carpenter/Barnes ref). In other words, nurses recognise and are recognised to be people orientated role and strength and doctors are expected to take final responsibility and leadership roles in the team. The most commonly encountered health professional on which stereotypes are documented appears to be nurses, doctors and social workers (e.g., Carpenter 1995; Hewstone et al., 1994; Pietroni, 1991; Hallam). However, especially as interprofessional programmes develop, and findings are published, other professional stereotypes emerge (e.g. of pharmacists, physiotherapists and dietetic students: Hind; Tunstall-Pedoe-of occupational therapsists –Barnes; of radiographers-Tunstall-Pedsoe). Pietroni (1991), for example, looking at nurses, medics and social workers, asks students to generate what become a diverse range of attributes on these professions. These he classifies into three archetypes: the doctor as hero/warrior/god, the nurse as great mother and the social worker as scapegoat. In a similar exercise, Carpenter (1995) asks students to generate a range of attributes associated with doctors and nurses. These included adjectives such as do-gooders, dithering, arrogant, dedicated, good communicators. Doctors were seen as dedicated, confident, but detached, arrogant and poor communicators. Nurses on the other hand were seen as caring and dedicated, moderately good communicators with a tendency to be do-gooders. Hallam (2000), raising further nursing attributes such as angel and battle axe as adjectives to describe the nursing profession, also comments on the overlap between gender stereotypes and stereotypes held of the professional which persist despite the improved recruitment of men to female dominated professions such as nursing and the dramatic equalisation of the gender ratios of previously masculine dominated professions such as medicine.

6. STEREOTYPE DATA COLLECTED IN STUDY Baseline data from first year pre-registration health and social care students n=1258. Subjects were asked to rate other professions on 9 stereotyped attributes (i.e. heterostereotypes). Two measures: Mean rating on a 1- 5 scale of each attribute (central tendency). Percentage of each professional group to which the rating applies (perceived variability), (Hewstone & Hamberger, 2000). The aim of this paper/presentation is to present the stereotypes held by early pre-registration students of a range of 10 health and social care professionals about to come together in an interprofessional educational programme. The data presented is the baseline of student held stereotypes, the change in which will be monitored over the Common Learning and into practice. The stereotypes given on each profession are compared and contrasted on a variety of attributes, paying particular attention to the consistent hierarchies that are established across the professions at this early stage of training. Following on from this, a presentation of the attribute profile created for each profession is made, comparing and contrasting these profiles. Finally, a second dimension of the stereotype construct, the propensity to stereotype, is considered. The presentation is completed with a discussion of how these findings compare with previous investigations and how they inform the debate around the potential of interprofessional learning. Students were asked to make a judgement on the following attributes of other health and social care professions: academic ability, professional competence, interpersonal skills, being an independent worker, being a team player, decision making, leadership, confidence and practical skills. This was adapted from the stereotype scale used by Barnes et al. (2002). Students were asked to make this judgement on all of the professional groups involved in Common Learning: Audiologists, Medics, Midwives, Nurses, Occupational Therapists, Pharmacists, Physiotherapists, Podiatrists, Radiographers and Social workers. It was decided that the ratings on all attributes on all of the professions involved in Common Learning should be collected. However, putting all questions on all professions in a single questionnaire would have been impractical, producing a tedious and long winded measurement tool. For this reason 4 versions of the questionnaire were created, each version addressing the stereotypes held of two or three different professional groups. The student group was then stratified according to profession, so that 25% of each student group would receive one version of the questionnaire. Therefore, for example, 25% of all doctors would have rated doctors, nurses and midwives; another 25% of the doctors responding would have given ratings on pharmacists, radiographers and podiatrists and so on. The stereotypes assessed in this paper are those that specifically address the ratings students gave of professional groups other than their own (attitudes towards the outgroup-heterostereotypes). If students were making a rating of their own group (attitudes towards the ingroup-autostereotypes) this data was excluded. This was done, as it was anticipated from the literature that attitudes to the outgroup and ingroup are likely to differ (refs). This was confirmed in our analysis where results changed significantly if autostereotype data remained in the analysis (especially when looking at the stereotypes held of nurses in a student cohort that has a very large nursing component). Sample sizes included in each analysis, bearing in mind the above manipulation o f data, therefore range from n=154 when judgements on nurses are being made to n= 306 when smaller professional groups such as midwives are being addressed. Stereotypes have a dual nature, where one component addresses the actual nature or quality of the attribute of the group. For example, doctors as a group are rated highly on the characteristic of academic ability but are more negatively rated on attributes associated with caring or communication skills (Barnes et al., 2000; Carpenter et al., 1995). A second dimension looks at how similar students feel a group is on the particular attribute {Hewstone M, 2000 31 /id}. In other words, the perceived homogeneity of a social group. Doctors, for example, may be given a low rating on interpersonal skills but depending on the familiarity with the group (Haslam..) students may see this rating as applying to a smaller or larger amount of the medical population. This propensity to stereotype or see groups as more homogeneous on a particular characteristic is generally seen as less socially acceptable (Linville quoted in Hewstone). In the questionnaire students were required to make judgements on the two dimensions of stereotypes. They were first asked to rate other health and social care professions on a scale of 1 to 5 on the range of attributes. This dimension is referred to here as the positive/negative nature stereotype dimension (nature). Students were then asked to consider the rating they had provided, and estimate on a scale of 0 to 100% to what percentage of the professional population they felt their ratings applied. For example, if they rate doctors high on academic rigour, do they feel this rating applies to the vast majority of the population or only a small percentage? This dimension is referred to here as the “propensity to stereotype” dimension (propensity). The statistical significance of the differences between mean ratings on both stereotype dimensions and between the attributes on each individual professions was tested using one way Analyses of Variance with a Scheffe post hoc analysis.The aim of this paper/presentation is to present the stereotypes held by early pre-registration students of a range of 10 health and social care professionals about to come together in an interprofessional educational programme. The data presented is the baseline of student held stereotypes, the change in which will be monitored over the Common Learning and into practice. The stereotypes given on each profession are compared and contrasted on a variety of attributes, paying particular attention to the consistent hierarchies that are established across the professions at this early stage of training. Following on from this, a presentation of the attribute profile created for each profession is made, comparing and contrasting these profiles. Finally, a second dimension of the stereotype construct, the propensity to stereotype, is considered. The presentation is completed with a discussion of how these findings compare with previous investigations and how they inform the debate around the potential of interprofessional learning. Students were asked to make a judgement on the following attributes of other health and social care professions: academic ability, professional competence, interpersonal skills, being an independent worker, being a team player, decision making, leadership, confidence and practical skills. This was adapted from the stereotype scale used by Barnes et al. (2002). Students were asked to make this judgement on all of the professional groups involved in Common Learning: Audiologists, Medics, Midwives, Nurses, Occupational Therapists, Pharmacists, Physiotherapists, Podiatrists, Radiographers and Social workers. It was decided that the ratings on all attributes on all of the professions involved in Common Learning should be collected. However, putting all questions on all professions in a single questionnaire would have been impractical, producing a tedious and long winded measurement tool. For this reason 4 versions of the questionnaire were created, each version addressing the stereotypes held of two or three different professional groups. The student group was then stratified according to profession, so that 25% of each student group would receive one version of the questionnaire. Therefore, for example, 25% of all doctors would have rated doctors, nurses and midwives; another 25% of the doctors responding would have given ratings on pharmacists, radiographers and podiatrists and so on. The stereotypes assessed in this paper are those that specifically address the ratings students gave of professional groups other than their own (attitudes towards the outgroup-heterostereotypes). If students were making a rating of their own group (attitudes towards the ingroup-autostereotypes) this data was excluded. This was done, as it was anticipated from the literature that attitudes to the outgroup and ingroup are likely to differ (refs). This was confirmed in our analysis where results changed significantly if autostereotype data remained in the analysis (especially when looking at the stereotypes held of nurses in a student cohort that has a very large nursing component). Sample sizes included in each analysis, bearing in mind the above manipulation o f data, therefore range from n=154 when judgements on nurses are being made to n= 306 when smaller professional groups such as midwives are being addressed. Stereotypes have a dual nature, where one component addresses the actual nature or quality of the attribute of the group. For example, doctors as a group are rated highly on the characteristic of academic ability but are more negatively rated on attributes associated with caring or communication skills (Barnes et al., 2000; Carpenter et al., 1995). A second dimension looks at how similar students feel a group is on the particular attribute {Hewstone M, 2000 31 /id}. In other words, the perceived homogeneity of a social group. Doctors, for example, may be given a low rating on interpersonal skills but depending on the familiarity with the group (Haslam..) students may see this rating as applying to a smaller or larger amount of the medical population. This propensity to stereotype or see groups as more homogeneous on a particular characteristic is generally seen as less socially acceptable (Linville quoted in Hewstone). In the questionnaire students were required to make judgements on the two dimensions of stereotypes. They were first asked to rate other health and social care professions on a scale of 1 to 5 on the range of attributes. This dimension is referred to here as the positive/negative nature stereotype dimension (nature). Students were then asked to consider the rating they had provided, and estimate on a scale of 0 to 100% to what percentage of the professional population they felt their ratings applied. For example, if they rate doctors high on academic rigour, do they feel this rating applies to the vast majority of the population or only a small percentage? This dimension is referred to here as the “propensity to stereotype” dimension (propensity). The statistical significance of the differences between mean ratings on both stereotype dimensions and between the attributes on each individual professions was tested using one way Analyses of Variance with a Scheffe post hoc analysis.

7. DEMOGRAPHICS OF SAMPLE METHODS A questionnaire was administered to the full population of first year students at the beginning of the Common Learning Programme that coincided with the beginning of their first semester of general training. The questionnaire was applied to the full student cohort, which represents an estimated student population of 1449. Following removal of students who had not consented to be part of the study as well as students who may not have been present on the time of data collection, a final sample of 1278 students was collected. METHODS A questionnaire was administered to the full population of first year students at the beginning of the Common Learning Programme that coincided with the beginning of their first semester of general training. The questionnaire was applied to the full student cohort, which represents an estimated student population of 1449. Following removal of students who had not consented to be part of the study as well as students who may not have been present on the time of data collection, a final sample of 1278 students was collected.

8. FINDINGS Hierarchy of ratings of stereotypes on each attribute (central tendency measures) Comparison of central tendency in terms of professional profiles Relationships between measures of central tendency and perceived variability

9. Students were able to differentiate to an even greater degree between professions on the attribute of interpersonal skills (34 significant relationships being found in between the professional groups (Table II c). This may be compared to the academic ability characteristic where 30 differences were demonstrated (still a high level of differentiation, especially if compared to some of the other attributes such as professional competence where only 9 significant relationships are found (Table II b). Midwives, social workers and nurses are rated as significantly the highest on this dimension. Interestingly, pharmacists are seen as having the lowest interpersonal skills, something they share with doctors. However, doctors perhaps are not seen in quite such a poor light, not being seen as different on this dimension from radiographers, podiatrists or audiologists.  Students were able to differentiate to an even greater degree between professions on the attribute of interpersonal skills (34 significant relationships being found in between the professional groups (Table II c). This may be compared to the academic ability characteristic where 30 differences were demonstrated (still a high level of differentiation, especially if compared to some of the other attributes such as professional competence where only 9 significant relationships are found (Table II b). Midwives, social workers and nurses are rated as significantly the highest on this dimension. Interestingly, pharmacists are seen as having the lowest interpersonal skills, something they share with doctors. However, doctors perhaps are not seen in quite such a poor light, not being seen as different on this dimension from radiographers, podiatrists or audiologists.  

10. To establish how students differentiate between the professions on each of the attributes, each attribute was considered individually and the hierarchy of ratings by professional group presented. The hierarchies for the positive/negative nature stereotype dimension are presented in Table I a-h. For simplicity and bearing in mind the large number of significant relationships calculated) only the mean rating for each profession are quoted in these charts. All relationships that reached significance did so at p<0.01unless otherwise stated. The mean ratings in each of the charts have been partitioned into separate blocks. If two professional groups appear in the same block, then the mean rating for each professional group are not significantly different from each other (e.g. in Table I a, podiatrists, nurses, occupational therapists and social workers are rated in a similar fashion on academic ability). Where a particular professional group appears in two or more blocks, this indicates that the rating is not significantly different from any of the professionals that appear in either of these blocks. A podiatrist is, therefore, not rated significantly different from a social worker nor a midwife. Where no block is shared between two professions, this denotes a significant difference between ratings. e.g., social workers and midwives are rated significantly different on academic ability. Information can also be gleaned from these charts on the extent to which student differentiate between professions on the attribute. Further, the mean ratings are classified into three roughly equal categories based on the distribution and range of the ratings. Mean ratings above 4.00 were categorised as high, ratings between 3.50 and 3.99 as medium and ratings < than 3.5 as low. Bearing in mind this information, therefore, Table I a shows that doctors and pharmacists are perceived in the first instance to be of high academic ability and are secondly clearly differentiated from each other and all other professions on this attribute as indicated by the high number of significant differences observed. The other professions are less clearly differentiated, all being given intermediate ratings on academic ability. Podiatrists, occupational therapists, nurses and social workers are rated the lowest on this attribute. These findings concur with those of Barnes et al. (2002), although the Barnes et al. study considers a sample of post registration students. They also find the academic rigour of the doctor (psychiatrist) to be highly rated and significantly more so than community practice nurses social workers and occupational therapists. This pattern is confirmed in earlier students-final year nurses and doctors (Carpenter (1995)-where once again doctors were rated higher than nurses on this particular attribute. Similar findings occur in a comparison of final year social workers and doctors (Hewstone et al. (1994) and with first year pre-registration students (Tunstall Pedsoe (2003)) where a comparisons between, medical, radiography, physiotherapy students were made. To establish how students differentiate between the professions on each of the attributes, each attribute was considered individually and the hierarchy of ratings by professional group presented. The hierarchies for the positive/negative nature stereotype dimension are presented in Table I a-h. For simplicity and bearing in mind the large number of significant relationships calculated) only the mean rating for each profession are quoted in these charts. All relationships that reached significance did so at p<0.01unless otherwise stated. The mean ratings in each of the charts have been partitioned into separate blocks. If two professional groups appear in the same block, then the mean rating for each professional group are not significantly different from each other (e.g. in Table I a, podiatrists, nurses, occupational therapists and social workers are rated in a similar fashion on academic ability). Where a particular professional group appears in two or more blocks, this indicates that the rating is not significantly different from any of the professionals that appear in either of these blocks. A podiatrist is, therefore, not rated significantly different from a social worker nor a midwife. Where no block is shared between two professions, this denotes a significant difference between ratings. e.g., social workers and midwives are rated significantly different on academic ability. Information can also be gleaned from these charts on the extent to which student differentiate between professions on the attribute. Further, the mean ratings are classified into three roughly equal categories based on the distribution and range of the ratings. Mean ratings above 4.00 were categorised as high, ratings between 3.50 and 3.99 as medium and ratings < than 3.5 as low. Bearing in mind this information, therefore, Table I a shows that doctors and pharmacists are perceived in the first instance to be of high academic ability and are secondly clearly differentiated from each other and all other professions on this attribute as indicated by the high number of significant differences observed. The other professions are less clearly differentiated, all being given intermediate ratings on academic ability. Podiatrists, occupational therapists, nurses and social workers are rated the lowest on this attribute. These findings concur with those of Barnes et al. (2002), although the Barnes et al. study considers a sample of post registration students. They also find the academic rigour of the doctor (psychiatrist) to be highly rated and significantly more so than community practice nurses social workers and occupational therapists. This pattern is confirmed in earlier students-final year nurses and doctors (Carpenter (1995)-where once again doctors were rated higher than nurses on this particular attribute. Similar findings occur in a comparison of final year social workers and doctors (Hewstone et al. (1994) and with first year pre-registration students (Tunstall Pedsoe (2003)) where a comparisons between, medical, radiography, physiotherapy students were made.

11. The team player attribute is another characteristics on which students make clearer distinction between the professions (26 significant relationships are calculated) although mainly at the top end of the scale. A similar pattern arose to that demonstrated by the interpersonal skills attribute, i.e., nurses, midwives and social workers are rated highest. However, the levels of differentiation at the lower end of the scale are not as evident as it had been in the interpersonal skills dimension. Although doctors and pharmacists do appear at the bottom of the hierarchy, they reach a medium rating on this characteristic. Further, considering the remaining professions, (excluding nurses, social workers and midwives), doctors and pharmacists can only be significantly distinguished from occupational therapists and physiotherapists (stats….). So although they are felt to be low on interpersonal skills, they are perceived to be in some part willing to be members of a team. Again these findings are in agreement with previous studies of health and social professions. For nurses, for example, Tunstall (2003) finds that nurses are rated highly as good communicators although this had dropped by the end of the interprofessional course in which they were part. Barnes (2002) and Carpenter (1995) find doctors to be rated as poor communicators and finally, Hind (2003) finds other professionals to rate pharmacists significantly less as communicators than they rate themselves. The team player attribute is another characteristics on which students make clearer distinction between the professions (26 significant relationships are calculated) although mainly at the top end of the scale. A similar pattern arose to that demonstrated by the interpersonal skills attribute, i.e., nurses, midwives and social workers are rated highest. However, the levels of differentiation at the lower end of the scale are not as evident as it had been in the interpersonal skills dimension. Although doctors and pharmacists do appear at the bottom of the hierarchy, they reach a medium rating on this characteristic. Further, considering the remaining professions, (excluding nurses, social workers and midwives), doctors and pharmacists can only be significantly distinguished from occupational therapists and physiotherapists (stats….). So although they are felt to be low on interpersonal skills, they are perceived to be in some part willing to be members of a team. Again these findings are in agreement with previous studies of health and social professions. For nurses, for example, Tunstall (2003) finds that nurses are rated highly as good communicators although this had dropped by the end of the interprofessional course in which they were part. Barnes (2002) and Carpenter (1995) find doctors to be rated as poor communicators and finally, Hind (2003) finds other professionals to rate pharmacists significantly less as communicators than they rate themselves.

12. Considering the leadership attribute (Table II d), a fair amount of differentiation between the professions, especially near the top of the rating scale, is observed (23 significant differences are measured). Doctors are seen as clear leaders being rated highly and as significantly different from all other professions (stats). Midwives and social workers are also seen as being able to fulfill this role, ratings reaching a medium level and as significantly different from the remaining professions. Occupational therapists, audiologists, nurses, podiatrists, physiotherapists, pharmacists and radiographers receive low ratings on leadership abilities with no distinction being made between one or the other profession. It appears then that students have entered university expecting doctors to take a leadership role in the health and social care team. Anecdotally, in the newly formed interprofessional student groups, incidences of the medical student taking a leadership role has been evident and where it has not happened, surprise has been shown by fellow students. Although some recognition that midwives and social workers may have some role to play in leadership is evident from these findings, the possibility that other professionals may play a leadership role is not. These findings confirm those elsewhere, that show psychiatrists as high on leadership skills and community practice nurses and occupational therapists as lowly rated (Barnes, 2002). However, there is some disparity around the perceived leadership role of the social worker, whose low leadership skills, in Barnes’ work is not distinguished from those of occupational therapists and nurses.Considering the leadership attribute (Table II d), a fair amount of differentiation between the professions, especially near the top of the rating scale, is observed (23 significant differences are measured). Doctors are seen as clear leaders being rated highly and as significantly different from all other professions (stats). Midwives and social workers are also seen as being able to fulfill this role, ratings reaching a medium level and as significantly different from the remaining professions. Occupational therapists, audiologists, nurses, podiatrists, physiotherapists, pharmacists and radiographers receive low ratings on leadership abilities with no distinction being made between one or the other profession. It appears then that students have entered university expecting doctors to take a leadership role in the health and social care team. Anecdotally, in the newly formed interprofessional student groups, incidences of the medical student taking a leadership role has been evident and where it has not happened, surprise has been shown by fellow students. Although some recognition that midwives and social workers may have some role to play in leadership is evident from these findings, the possibility that other professionals may play a leadership role is not. These findings confirm those elsewhere, that show psychiatrists as high on leadership skills and community practice nurses and occupational therapists as lowly rated (Barnes, 2002). However, there is some disparity around the perceived leadership role of the social worker, whose low leadership skills, in Barnes’ work is not distinguished from those of occupational therapists and nurses.

13. HIERARCHY OF RATINGS ON ATTRIBUTE OF PRACTICAL SKILLS

14. HIERARCHY OF RATINGS ON ATTRIBUTE OF DECISION MAKING

15. HIERARCHY OF RATINGS ON ATTRIBUTE OF INDEPENDENT WORKER

16. HIERARCHY OF RATINGS ON ATTRIBUTE OF CONFIDENCE

18. NB: Profiles appear complementary although share ratings on practical skills and professional competence The profile for doctors (fig 1; Table II a) shows that students see this profession as being particularly strong on academic ability, being rated significantly higher than all other attributes (other than decision making). They are also rated highly on being capable of making decisions, confidence and being independent workers. They are seen as particularly low on interpersonal skills and being team players, however. The profile of nurses (fig 2; Table IIc) shows nurses to be stereotyped as particularly strong on interpersonal skills and being team players as well as their practical skills. They are seen as particularly low on leadership skills, however. The doctor and nurse profiles appear diametrically opposed on many of the scales, specifically in the doctor’s favour for academic ability; leadership abilities, being independent workers, decision making and confidence and in the nurses‘ favour for the attributes of interpersonal skills and being a team player. If it is assumed that stereotypes are to some extent based on perception of role, then the doctors and nurses roles would appear complementary in the eyes of these students. There is some similarity in nursing and doctor profile however, in that similar ratings are received on professional competence and practical skills (although nurses are found to be significantly higher on the latter-see Table Ih).The profile for doctors (fig 1; Table II a) shows that students see this profession as being particularly strong on academic ability, being rated significantly higher than all other attributes (other than decision making). They are also rated highly on being capable of making decisions, confidence and being independent workers. They are seen as particularly low on interpersonal skills and being team players, however. The profile of nurses (fig 2; Table IIc) shows nurses to be stereotyped as particularly strong on interpersonal skills and being team players as well as their practical skills. They are seen as particularly low on leadership skills, however. The doctor and nurse profiles appear diametrically opposed on many of the scales, specifically in the doctor’s favour for academic ability; leadership abilities, being independent workers, decision making and confidence and in the nurses‘ favour for the attributes of interpersonal skills and being a team player. If it is assumed that stereotypes are to some extent based on perception of role, then the doctors and nurses roles would appear complementary in the eyes of these students. There is some similarity in nursing and doctor profile however, in that similar ratings are received on professional competence and practical skills (although nurses are found to be significantly higher on the latter-see Table Ih).

19. NB: Share many attributes-a possible overlap in roles? Very different on others such as leadership The profile for doctors (fig 1; Table II a) shows that students see this profession as being particularly strong on academic ability, being rated significantly higher than all other attributes (other than decision making). They are also rated highly on being capable of making decisions, confidence and being independent workers. They are seen as particularly low on interpersonal skills and being team players, however. The profile of nurses (fig 2; Table IIc) shows nurses to be stereotyped as particularly strong on interpersonal skills and being team players as well as their practical skills. They are seen as particularly low on leadership skills, however. The doctor and nurse profiles appear diametrically opposed on many of the scales, specifically in the doctor’s favour for academic ability; leadership abilities, being independent workers, decision making and confidence and in the nurses‘ favour for the attributes of interpersonal skills and being a team player. If it is assumed that stereotypes are to some extent based on perception of role, then the doctors and nurses roles would appear complementary in the eyes of these students. There is some similarity in nursing and doctor profile however, in that similar ratings are received on professional competence and practical skills (although nurses are found to be significantly higher on the latter-see Table Ih).The profile for doctors (fig 1; Table II a) shows that students see this profession as being particularly strong on academic ability, being rated significantly higher than all other attributes (other than decision making). They are also rated highly on being capable of making decisions, confidence and being independent workers. They are seen as particularly low on interpersonal skills and being team players, however. The profile of nurses (fig 2; Table IIc) shows nurses to be stereotyped as particularly strong on interpersonal skills and being team players as well as their practical skills. They are seen as particularly low on leadership skills, however. The doctor and nurse profiles appear diametrically opposed on many of the scales, specifically in the doctor’s favour for academic ability; leadership abilities, being independent workers, decision making and confidence and in the nurses‘ favour for the attributes of interpersonal skills and being a team player. If it is assumed that stereotypes are to some extent based on perception of role, then the doctors and nurses roles would appear complementary in the eyes of these students. There is some similarity in nursing and doctor profile however, in that similar ratings are received on professional competence and practical skills (although nurses are found to be significantly higher on the latter-see Table Ih).

20.   Midwives are profiled as a profession with high interpersonal and practical skills. If their ratings on each attribute are compared (Table IVc), they fair least well on ratings of academic ability and leadership although these reach medium levels. Social workers are also profiled as having high interpersonal skills, and rated least (although at medium levels) for leadership abilities, academic ability and especially practical skills. Nurses, midwives and social workers appear to share similar profiles. They are very similar in terms of their high ratings on interpersonal skills and team player abilities (figure 3). This similarity may represent a perceived overlap in the caring roles these professions are expected to perform. Midwives and social workers are particularly similar to each other in that students perceive them to have some form of leadership role (in both instances significantly higher rated than nurses Table IId). The similarity in the midwife and social worker profiles continues in that for both midwives and social workers, decision-making and confidence are highly rated, (and again ratings are significantly higher than the nursing mean on this attribute). In terms of academic ability, however, social workers and nurses, are seen as more alike, although only social workers are rated significantly lower than midwives (Table IIa). Social workers also are less significantly well rated on professional competence than midwives although nurses are sufficiently similar to both the other two professions for differences not to reach significance. Nurses and midwives share other similarities in that students perceive nurses and midwives to be have high practical skills, seeing social workers as significantly less equipped on this attribute (Table IIi).Midwives are profiled as a profession with high interpersonal and practical skills. If their ratings on each attribute are compared (Table IVc), they fair least well on ratings of academic ability and leadership although these reach medium levels. Social workers are also profiled as having high interpersonal skills, and rated least (although at medium levels) for leadership abilities, academic ability and especially practical skills. Nurses, midwives and social workers appear to share similar profiles. They are very similar in terms of their high ratings on interpersonal skills and team player abilities (figure 3). This similarity may represent a perceived overlap in the caring roles these professions are expected to perform. Midwives and social workers are particularly similar to each other in that students perceive them to have some form of leadership role (in both instances significantly higher rated than nurses Table IId). The similarity in the midwife and social worker profiles continues in that for both midwives and social workers, decision-making and confidence are highly rated, (and again ratings are significantly higher than the nursing mean on this attribute). In terms of academic ability, however, social workers and nurses, are seen as more alike, although only social workers are rated significantly lower than midwives (Table IIa). Social workers also are less significantly well rated on professional competence than midwives although nurses are sufficiently similar to both the other two professions for differences not to reach significance. Nurses and midwives share other similarities in that students perceive nurses and midwives to be have high practical skills, seeing social workers as significantly less equipped on this attribute (Table IIi).

21.  In the allied health professions, the profile of the occupational therapists shows that although students rate them highest on interpersonal skills and their practical skills, although little distinction exists between these and several of the other attributes. They are most clearly differentiated, however, as not having leadership qualities. In the physiotherapists’ profile they are clearly distinguished as a profession for which practical skills are very evident. They are again rated the least on their leadership skills. Podiatrists are also noted for their practical skills but these ratings cannot be distinguished form their ratings on being an independent worker and professional competence. They are again clearly not seen as leaders. In the allied health professions much of the profiles are shared. In general, they appear to be stereotyped as highly practical (although physiotherapists are seen as significantly more so than occupational therapists-Table IIh) but with lesser leadership skills. They all earn medium ratings for academic ability although physiotherapists are rated significantly higher than occupational therapists (Table II a) They cannot be distinguished from each other on the attributes of professional competence and decision making. Nor are they significantly different on levels of perceived confidence where, although podiatrists just miss a high rating received by the other two professions, the differences are not significant (Table I). The profiles, however, do depart from each other on the interpersonal skills and being a team player attributes. Whilst occupational therapists and physiotherapists are rated highly on interpersonal skills, podiatrists, although receiving a medium rating on this attribute, are significantly lower than the other two allied health professions. A similar trend is observed for the being a team player although the overall ratings for all three professions are in a medium range. This suggests podiatrists are seen as the least people orientated of the three professions. Finally on being an independent worker, physiotherapists and podiatrists appear to be thought of as more able to fulfil this attribute than occupational therapists.In the allied health professions, the profile of the occupational therapists shows that although students rate them highest on interpersonal skills and their practical skills, although little distinction exists between these and several of the other attributes. They are most clearly differentiated, however, as not having leadership qualities. In the physiotherapists’ profile they are clearly distinguished as a profession for which practical skills are very evident. They are again rated the least on their leadership skills. Podiatrists are also noted for their practical skills but these ratings cannot be distinguished form their ratings on being an independent worker and professional competence. They are again clearly not seen as leaders. In the allied health professions much of the profiles are shared. In general, they appear to be stereotyped as highly practical (although physiotherapists are seen as significantly more so than occupational therapists-Table IIh) but with lesser leadership skills. They all earn medium ratings for academic ability although physiotherapists are rated significantly higher than occupational therapists (Table II a) They cannot be distinguished from each other on the attributes of professional competence and decision making. Nor are they significantly different on levels of perceived confidence where, although podiatrists just miss a high rating received by the other two professions, the differences are not significant (Table I). The profiles, however, do depart from each other on the interpersonal skills and being a team player attributes. Whilst occupational therapists and physiotherapists are rated highly on interpersonal skills, podiatrists, although receiving a medium rating on this attribute, are significantly lower than the other two allied health professions. A similar trend is observed for the being a team player although the overall ratings for all three professions are in a medium range. This suggests podiatrists are seen as the least people orientated of the three professions. Finally on being an independent worker, physiotherapists and podiatrists appear to be thought of as more able to fulfil this attribute than occupational therapists.

22. Where the allied professional may be seen as more hands on and therapy orientated, radiographers and audiologists might be expected to share some similarity based on the more technical/technological aspects of their work. For audiologists no single attribute appeared to stand out at the higher end of the ratings, although their professional competence received the highest rating. Again their lack of leadership skills is a very clear stereotype. A similar profile is described for radiographers. These two professions are rated in a very similar way across all attributes with only one of the differences in ratings reaching significance (Table V). They both rated high on professional competence, decision making, being an independent worker and practical skills. They are rated at a medium level for academic ability (although this is only significantly different from their rating on professional competence) and being a team player. Whilst radiographers are rated as a medium on confidence versus the medium rating given audiologists on this attribute, this difference is not a significant one. They both receive a medium rating for interpersonal skills but here audiologists are seen as superior on this characteristic (stats). They are both low on leadership abilities. Where the allied professional may be seen as more hands on and therapy orientated, radiographers and audiologists might be expected to share some similarity based on the more technical/technological aspects of their work. For audiologists no single attribute appeared to stand out at the higher end of the ratings, although their professional competence received the highest rating. Again their lack of leadership skills is a very clear stereotype. A similar profile is described for radiographers. These two professions are rated in a very similar way across all attributes with only one of the differences in ratings reaching significance (Table V). They both rated high on professional competence, decision making, being an independent worker and practical skills. They are rated at a medium level for academic ability (although this is only significantly different from their rating on professional competence) and being a team player. Whilst radiographers are rated as a medium on confidence versus the medium rating given audiologists on this attribute, this difference is not a significant one. They both receive a medium rating for interpersonal skills but here audiologists are seen as superior on this characteristic (stats). They are both low on leadership abilities.

23. CORRELATION BETWEEN MEASURES OF CENTRAL TENDENCY AND PERCEIVED VARIABILITY NB: Normative influences; students do not want to stereotype on negative ratings (Hewstone et al, 2002) A similar set of hierarchies to those illustrated in Table II were created for the propensity to stereotype dimension, i.e. to what percentage of the population they feel their rating of the attribute applies. It was found the pattern of answering shown for this second dimension approximated that shown in the first dimension. An example, of a comparison of the two dimensions can be seen in Table III. The relationship between the dimensions was confirmed through the calculated moderate and significant correlations between the two dimensions (Table IV). This suggests that if students rate a profession highly (positively) on the attribute, they are prepared to state that the rating applies to a larger percentage of that professional population. However, if the profession has been rated less well, then students are less likely to stereotype the profession on this characteristic. This suggests a normative influence when students give ratings on professional stereotypes. This normative phenomenon is reported elsewhere, where the respondents’ need to maintain a self image of fair mindedness is described (Singh et al quoted in Hewstone et al., 2002) and where ingroup favouritism (usually linked with grup interaction) is not found when respondents are forced to rate on negative scales (Mummendey quoted in Hewstone). This normative influence had been clearly demonstrated in piloting of the questionnaire used in the current paper where students who were asked only to respond to the nature dimension of stereotyping. In this instance students showed a strong resistance to the stereotype questions based on its perceived unfairness. When the propensity dimension was introduced, which enables them to qualify their ratings, lesser resistance to the question was apparent.A similar set of hierarchies to those illustrated in Table II were created for the propensity to stereotype dimension, i.e. to what percentage of the population they feel their rating of the attribute applies. It was found the pattern of answering shown for this second dimension approximated that shown in the first dimension. An example, of a comparison of the two dimensions can be seen in Table III. The relationship between the dimensions was confirmed through the calculated moderate and significant correlations between the two dimensions (Table IV). This suggests that if students rate a profession highly (positively) on the attribute, they are prepared to state that the rating applies to a larger percentage of that professional population. However, if the profession has been rated less well, then students are less likely to stereotype the profession on this characteristic. This suggests a normative influence when students give ratings on professional stereotypes. This normative phenomenon is reported elsewhere, where the respondents’ need to maintain a self image of fair mindedness is described (Singh et al quoted in Hewstone et al., 2002) and where ingroup favouritism (usually linked with grup interaction) is not found when respondents are forced to rate on negative scales (Mummendey quoted in Hewstone). This normative influence had been clearly demonstrated in piloting of the questionnaire used in the current paper where students who were asked only to respond to the nature dimension of stereotyping. In this instance students showed a strong resistance to the stereotype questions based on its perceived unfairness. When the propensity dimension was introduced, which enables them to qualify their ratings, lesser resistance to the question was apparent.

25. ISSUES FOR DISCUSSION What are stereotypes actually measuring: role or personality? Profiles show in some cases an overlap in role, in others roles are complementary. But do complementary roles necessarily mean harmony and overlap disharmony? How will stereotypes change over Common Learning.

26. WAY FORWARD Longitudinal work to follow up how Common Learning will make a difference in terms of: the nature of the stereotypes held the propensity to stereotype mutual differentiation The way forward will be to collect exit data rom students and measure their stereotypes at the end of training, We will be specifically looking for changes in the nature of the stereotypess; the change in propensity to stereotype and whethe r mutual differentiation on the attributes has occureed.The way forward will be to collect exit data rom students and measure their stereotypes at the end of training, We will be specifically looking for changes in the nature of the stereotypess; the change in propensity to stereotype and whethe r mutual differentiation on the attributes has occureed.

27. CONTACT DETAILS Dr Sarah Hean Research Programme Coordinator Health Care Innovation Unit Academic Block, Level B Southampton General Hospital Southampton So16 6YD hean@soton.ac.uk