Dynamics in interprofessional learning: a focussed ethnographic study in a student-run dental clinic

Healthcare professionals, including oral healthcare professionals, increasingly collaborate across disciplines to address complex healthcare needs. New Dutch legislation is reshaping tasks, roles, and responsibilities, necessitating changes in collaboration between dental hygienists and dentists. Workplace-based interprofessional education (IPE) is crucial for preparing students for evolving practice. Research on IPE mechanisms in oral healthcare is scarce. This ethnographic study explores mechanisms promoting and hindering workplace-based IPE, focusing on collaborative behaviour and interprofessional learning among students in a student-run dental clinic (SRDC).

We conducted a focused ethnography with third- and fourth-year Bachelor's dental hygiene students and first-, second-, and third-year Master's dental students in a SRDC. Data included 36 h of observations across 20 field observation days, involving 18 dental hygiene and 24 dental students. Additionally, we conducted 31 interviews with 13 dental hygiene and 16 dental students. The data analysis was iterative, with thematic and open coding categorised based on patterns for deeper understanding of the data. We categorised codes under the core competencies of the IPEC framework to identify behaviours in the SRDC. We categorised codes according to the components and sub-triangles of the Cultural-Historical Activity Theory (CHAT) model, exploring their influence on behaviours in the SRDC. The CHAT model was used to analyse interactions and tensions, focusing on the division of labour, rules, and community influence. A combination of these techniques facilitated both descriptive and explanatory data interpretation, with reflective sessions ensuring consensus within the research team.

Students demonstrated collaborative behaviours such as utilising expertise, interaction, shared leadership, and guidance. However, competencies in 'Values and Ethics' and 'Teams and Teamwork' were less emphasised. The CHAT model revealed factors influencing IPE, including student uncertainty, feedback hierarchies, role conflicts, programme requirements, expertise conflicts, task perspectives, supervisory roles, leadership, physical proximity, time constraints, and pre-existing student relationships.

In a SRDC, clear role delineation, reciprocal supervision, and active knowledge exchange foster a productive learning environment, though core competencies develop unevenly. Role ambiguity and integrating from distinct curricula impact collaborative behaviour. Enhancing communication, continuous feedback, and role diversity can optimise collaboration and enhance IPE, improving teamwork and patient outcomes.