The status and outcomes of interprofessional health education in sub-Saharan Africa: A systematic review

ABSTRACT The increasing burden of chronic diseases, and shortage of health care workers especially in Low and Middle Income countries (LMICs) requires greater collaborative working between health professions. There is a growing body of evidence that interprofessional education (IPE) and interprofessional continuous education (IPCE) can improve collaborative practice thus strengthening health care delivery in low resource settings. The World Health Organization (WHO) promotes this educational strategy in these regions as part of wider programs to improve health care. The purpose of this systematic review was to summarize IPE and IPCE activities in sub-Saharan Africa (SSA) and its outcomes; including practice, service and patient outcomes. Standard guidelines for conducting and reporting systematic reviews were followed. The online databases searched included MEDLINE, Embase, Education Resources Information Centre (ERIC), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Science Direct. The Kirkpatrick model was used to classify IPE outcomes reported from literature. Following full text screening, 41 articles were selected for data extraction. It was found that IPE/IPCE is still a relatively new concept in SSA with 93% of studies published after 2012. Furthermore, IPE is concentrated predominantly in undergraduate institutions and mainly implemented to improve collaborative practice and address important public health concerns. Positive reaction and outcomes of IPE/IPCE were reported in terms of change of attitude and perception toward collaborative practice as well as knowledge and skills acquisition. Few studies in SSA sought to understand and measure the outcomes of IPE/IPCE relating to health care practice. More work in this important potential outcome of IPE/IPCE is recommended.


Introduction
The Centre for the Advancement of Interprofessional Education (CAIPE) defines interprofessional education (IPE) as "occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care" (CAIPE, 2002).There is a growing body of evidence showing that effectively delivered interprofessional collaboration can improve health outcomes (Reeves et al., 2017).Consequently, the World Health Organization (WHO) report (2010) recommends adoption of IPE to improve health care delivery through greater collaborative working.This is to maximize the capacity of stretched and under-resourced health systems to deal with the ever increasing burden of disease, especially with the rise of non-communicable diseases (NCDs) in many emerging economies (Bigna & Noubiap, 2019).
The Lancet Commission on health professionals for a new century (Frenk et al., 2010) highlighted that "poor teamwork . . .so-called tribalism of the professions where various professions act in isolation from or even in competition with each other" is hindering the delivery of care and that adoption of IPE is one part of the solution to deal with this "tribalism" (Frenk et al., 2010, p. 1).Reeves et al. (2010) added that health professionals who value input from colleagues of other professional groups and specialties demonstrate enhanced co-operation and collaboration.
There is consequently a growing body of evidence supporting the use of IPE to assist in improving the quality of health delivery and health services outcomes (Reeves et al., 2016).However, much of this evidence is based on studies conducted in high resource settings and according to the Africa Interprofessional Education Network (AfrIPEN) there is limited evidence on IPE and interprofessional collaboration (IPC) from lower-resource settings including sub-Saharan Africa (SSA).This is despite the greater need in such regions where higher prevalence of diseases, limited resources, poverty and scarce workforce are common challenges leading to weak health care collaboration and less effective service delivery (Botma & Snyman, 2019).Another increasingly popular approach to health and wellbeing in SSA is "One health."One health is an approach that brings together multiple professions and disciplines to address challenges related to human, animal and environmental health in a multisectoral approach (Human health, animal health and environmental health).This interprofessional approach aims to design and implement programs, policies, legislation and research for better broad public health outcomes (WHO, 2019).Xyrichis et al. (2018) found that different terms like "interprofessional collaboration", "multidisciplinary coordination", "trans-professional teamwork" and others have been used to describe collaboration in health care teams.Xyrichis et al. (2018) further suggested that detailed evaluation of the nature of collaborations is required in order to consider an intervention as an interprofessional one according to the WHO and CAIPE specifications.Interprofessional interventions can be delivered either during initial professional training (IPE) or to graduated professionals in practice (interprofessional continuous education or IPCE).IPCE focuses on practice based cadres in a form of lifelong learning (Gilbert et al., 2010).IPE was re-explored further in a scoping review (Reeves et al., 2011) with three main forms of interprofessional intervention noted, namely interprofessional education (IPE), interprofessional practice (IPP), and interprofessional organizational (IPO).IPP interventions are activities or procedures embedded and implemented in regular practice to develop collaboration thus the quality of care.IPO interventions are implemented at the organizational level to strengthen collaboration and the quality of care.Reeves et al. clarified that the IPE intervention focuses mainly on pre-qualification (through education systems) while both IPP and IPO are mainly post-qualification interventions that may be considered as a form of IPCE.
Outcomes of both IPE and IPCE can be evaluated using the Kirkpatrick (1959Kirkpatrick ( , 1996) ) model that was adapted and extended by Barr (2000).The extended model includes trainee reaction, learning (knowledge, attitude and skills), behavior in practice, as well as results at the organizational and personal level (patient outcomes).This adapted model has been evaluated by Hammick et al. (2009) and deemed more useful in evaluating outcomes of IPE.
The SSA region suffers significantly greater burden of diseases, both communicable and non-communicable (Gouda et al., 2019) and, at the same time, has a critical shortage of health care providers (Afriyie et al., 2019).As health professions education is reformed in these lowerresource regions and IPE and IPC adopted to address the growing health care challenges, there is a need to understand the current status of IPE and its outcomes in SSA.The aim of this review is to summarize the IPE and IPCE activities in SSA, and the outcomes on health practice, service and patient care.This is intended to enable teaching institutions and health care systems in the region to use IPE and IPCE strategies most effectively in the future to positively impact health care delivery.

Review objectives
The following objectives were set for this review: • To understand the status (what, who, how, where, when) of IPE and IPCE in SSA.

Search strategy
Standard systematic review procedures were followed and the protocol for the review was registered with the International Prospective Register of Systematic Reviews (University of York, 2021).The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) (Moher et al., 2009) informed the search strategy development for this review.
The online databases searched included MEDLINE, Embase, Education Resources Information Centre (ERIC) the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Science Direct.Additionally, citation searching on included studies was performed.A gray literature search was conducted on platforms including the CAIPE, and the African Interprofessional Education Network (AfrIPEN) website as well as Google scholar.No publication timeline restrictions were applied.The literature search was conducted between January 2021 and March 2021, and the search strategy can be found in appendix A.
All identified references were uploaded on a systematic review management software (Rayyan, 2021) allowing duplicate removal and collaboration in the screening of literature.Two members of the research team screened each abstract against the inclusion and exclusion criteria to decide whether the full article should be read.A third member was consulted to address conflicts in the screening process.Similarly, every included full article was screened by at least two researchers before passing it to the final stage of exclusion or inclusion, with a third member in the case of conflicts and discrepancies.

Inclusion criteria
Inclusion criteria for studies were: • Those conducted in the SSA region with full-text available in English language.• Intervention studies (both RCTs and non-randomized).
• Quantitative, qualitative and mixed methods for data collection and analysis.• Those that met the CAIPE definition of IPE (CAIPE, 2002) or those that describe an intervention that met the CAIPE definition in education or practice setting.

Participants
Only students or health care team and collaborators in public or private teaching institutions, hospitals and non-governmental organizations were included in this review.

Interventions
The intervention considered were interprofessional health education or training.

Outcomes
Learner satisfaction or reaction in general, learning (knowledge, attitudes, and skills), behavior in practice as well as results at the organizational and personal levels (patient outcomes).

Exclusion criteria
Exclusion criteria for studies were: • Literature with no full text.
• Studies with described interventions that did not meet the CAIPE IPE definition.
• Studies where no IPE was conducted.
• Studies conducted outside the SSA region.Quality assessment of the included studies were conducted by two reviewers (GFK, AB) and was guided by the Joanna Brigg Institute (JBI) tools (JBI, 2020) for quality assessment, and both quality of study (design and implementation) and quality of information (sampling, ethics, possible bias) were assessed by assigning a score on each component.However, the quality of information was given greater weighting as this review sought to understand and capture as much information as possible on the development and progress of IPE in SSA.
Data extraction forms were developed guided by the best practice medical education (BEME) review (Hammick et al., 2009) and the forms were piloted prior to data extraction.Information extracted from articles included author, title, study design, year of publication, countries of study, IPE details (Aim, professions involved, professional context, duration, setting, provider or funder).Some of the information extracted are presented in Table 1 and narratively.In addition, data on IPE intervention outcomes were also retrieved.Extracted data were pulled together and grouped for a narrative synthesis.Components of the narrative synthesis were the status of IPE and IPCE in SSA and the evaluation of IPE and IPCE in SSA.

Results
The conducted literature search generated 3225 articles, and after de-duplication, 2942 were considered for abstract screening.The screening resulted in 109 articles carried forward for full text screening.Following full text screening, 41 articles were selected for data extraction after meeting the inclusion criteria (Figure 1).The level of agreement among screeners was 87%.
The 41 studies included in the review were published between 1998 and 2021, with 93% (38) of the studies published after 2012.Most IPE interventions in SSA were conducted in South Africa (17,41%), Uganda (7,17%), Rwanda (6,15%), Nigeria (4,8%), Tanzania, Botswana and Malawi (3,7%) each, Mozambique, Zimbabwe, Zambia, Ghana and Kenya have (2,5%) each.Then finally, the Democratic Republic of Congo, Ethiopia and Lesotho combined accounting for 7% of the presented IPE work.Additionally, the analysis showed that 7% (3) of the reported IPE initiatives were the results of collaboration among institutions or professions based in SSA countries and another 7%(3) as extended international collaboration.Reflecting on the quality of included studies, 22% were case studies and did not report much on IPE outcomes.Only 73% quantitative, qualitative and mixed methods studies were considered for IPE outcomes.The average assigned quality score across the included studies was 68% (median 70%, range 37-100%).

The status of IPE in SSA
Most of the IPE work in SSA were concentrated in pre-qualification training (27, 66%) and those in practice as part of IPCE (14, 34%).Patient or case simulation learning and service learning as well as community-oriented learning accounted for 46% (19) of the IPE initiatives in SSA, and classroombased IPE was found in 17% (7), with interactive workshops appearing in 41% (17) of the IPE initiatives in SSA with some studies reporting a mixture of the above learning environments.In addition, IPE initiatives in SSA were mostly driven by Institutions such as Universities (29, 71%) or Hospitals (8, 20%), whilst the rest (4, 10%) were driven by policies (government) or non-governmental organizations.The analysis clarified that 51% (21) of the studies reported to have received funding offered through universities (68%), NGOs (23%) or other sources.
The literature shows that a total of 3238 participants, including facilitators, took part in IPE and IPCE combined.The minimum number of participants in a session was 10 and the maximum was up to 762.The reviewed studies present that the average participants in an IPE and IPCE session was 108 (median = 46).IPE/IPCE facilitators were mainly provided by the organizing or funding institutions.The professions mostly involved in IPE and IPCE considering the number of articles reported on them in the SSA were Medicine (29, 71%), Nursing (29, 71%), Physiotherapy (17,41%), Occupational Therapy (13, 32%), Nutrition and dietetics (13, 32%), Pharmacy (13, 32%), Social workers (11, 27%), and others professions (allied eye health, allied health professions, gynecology, exercise and sports science, speech and language therapy, laboratory, medical archivists, community health workers, biokinetics, medical research, environmental health, education, dentistry and oral health, veterinary medicine, biological sciences, wildlife management, agricultural and forestry sciences, laws and the liberal arts, meteorology, commerce, accounting, computer engineering, chaplaincy and anthropology) were involved in at least one reported IPE/IPCE activities or article.Ninety-two percent of the IPE/IPCE initiatives brought together two to seven professions (mode = 4).

Evaluation of IPE in SSA
The evaluation of IPE initiatives in SSA in this review focused on synthetizing the outcomes of IPE/IPCE initiatives based on the adapted Kirkpatrick model (Barr, 2000;Hammick et al., 2009) of evaluating the outcomes of education and training programs.Data on IPE/IPCE outcomes were extracted from quantitative, qualitative or mixed methods evaluations and details on the outcome measures have been attached with the supplementary document (Appendix B).Most studies touched on the reaction of learners and facilitators, change in perception and attitudes toward learning, knowledge and skills acquisition after an IPE/IPCE session.However, little attention was given to assessing the behavioral change of participants after IPE/IPCE, the outcomes on wider changes in the organization and delivery of care or improvements in health or wellbeing of patients.(Table 2)

Learners' reaction
Learners' reactions were captured in 13 of the included studies and the overall reaction reflected was positive (Buregyeya et al., 2021;O'Carroll et al., 2020;Scrooby et al., 2019).Learners expressed that the learning environment was conducive for them and the interactions with colleagues from other professions enhanced their learning.In addition, learners appreciated each other's role in health care delivery, experience sharing and interactions after IPE sessions (Leshabari et al., 2012;Mpofu et al., 2014;Reitsma et al., 2019;Vostanis et al., 2019).Learners appreciated the process of interprofessional learning using simulation methods and community interactions (Chetty et al., 2020;Davis et al., 2015;Van Wyk et al., 2020).

Modification of perceptions and attitudes
There was a positive change in attitude toward, and perceptions of, IPE in SSA with 18 studies in this review focusing on this component in their outcomes.Some studies (Botma & Labuschagne, 2019;Julie et al., 2016;O'Carroll et al., 2020;Pitout et al., 2016) detailed that learners' perceptions and attitudes to collaborative learning and practice improved.

Acquisition of knowledge and skills
The literature reported acquisition of knowledge and skills through IPE in SSA.The authors (Dressel et al., 2017;Leshabari et al., 2012;Levine et al., 2011) noted that learners both in pre-qualification and those in practice found IPE to be ideal for knowledge and skills improvement in communication, teamwork and quality care enhancement.Some authors expressed that learning through interactive simulations, practical and service learning could contribute to more skills and knowledge retention (Data et al., 2020;Egenberg, Masenga, et al., 2017;Levine et al., 2011;Sagahutu et al., 2021), but this would need further investigation.In addition, IPE facilitated acquisition of knowledge in the new area of "One Health" approach as revealed by Porta (Porta et al., 2020).Table 2. IPE outcomes in SSA (n = 30) classified according to the adapted Kirkpatrick's model (Barr, 2000;Hammick et al., 2009).

•
Participants had a significant improvement in knowledge and skills in interprofessional practice and health care.

•
The opportunity to practice interprofessionally in a rural area exposed students to conditions and situations not often experienced in other placements.

•
Interprofessional collaborative learning improved technical capacity.

•
The scenario-based training and simulation-base curriculum can be implemented in low-resource settings and may contribute to gains in knowledge, clinical skills and teamwork skills.
• IPE enhanced contextualization of the determinants of health, link theory to practice and successful peer learning.

6(20)
• There was reported dynamic and interactive experience beyond classroom activities.
• Increased ability to place the interests of patients and populations at the center of interprofessional health care delivery.

•
Enhanced cultural proficiency of students and faculty promoted interprofessional communication and collaboration. •

•
The development of innovative and accessible service-learning initiatives to help meet the needs of a community or provide easier access to health care services in collaboration with existing services.

•
The educational program provided health care workers with the tools potentially to decrease the morbidity and mortality of cervical cancer in low-resource countries.

•
The program led to provision of primary care and related services to patients and the community.

Change in collaborative behavior
Behavior change consists of transfer of Interprofessional learning to practice for improvements (Barr, 2000).Behavior change is one of the impacts assessed to determine the outcomes of an IPE initiative.The reviewed literature showed a gap in assessment of behavior change in practice after an IPE experience.Some literature (Akoria, 2012;Morton, 2012) revealed that IPE enhances the understanding of cultural differences which improved interactions among team members and the provision of care to patients.In addition, authors (Dressel et al., 2017;Leshabari et al., 2012;Sagahutu et al., 2020) showed that IPE improves the ability to place the patient at the center of care and improves professional and social communication among the team of health care providers and students both on and off duty.

Change in organizational practice
IPE could impact the wider service delivery within an organization, and the adapted Kirkpatrick model (Barr, 2000;Hammick et al., 2009) assesses the outcomes at the organizational level.Some studies (Akoria, 2012;Levine et al., 2011;Morton, 2012) reported that IPE did lead to equipping health care workers with tools for early detection of cervical cancer and innovative strategies to deliver quality health care close to the community.

Benefits to patients
No studies conducted in SSA which examined the outcomes of IPE on patient outcomes were found in the current review.

IPE delivery and growth in SSA
This review demonstrates that academic evaluation of IPE activity has been on-going in SSA since the 1990s with an increase in activity from 2012 onwards.The quality of published studies on IPE in SSA is still low, and this was reflected by the fact that 22% of included studies were case studies or reports and were excluded among studies considered for data on reported IPE outcomes.Most published work is being delivered in the Republic of South Africa (RSA), with an additional significant, but smaller, degree of activity in the East African regions.This concurs with Barr's (Barr, 2015) work on the mapping of IPE globally who noted that delivery of IPE started to become established more generally in SSA after the release of the WHO framework for action on interprofessional education and collaborative practice in 2010 (Gilbert et al., 2010).In RSA however it is clear that IPE has been more consistently implemented since the early nineties (Lazarus et al., 1998)..In SSA, IPE is being delivered mainly as part of pre-qualification undergraduate training and predominantly by universities and hospitals.This is similar to delivery of IPE in other parts of the world such as the Arabic-speaking Middle East countries (El-Awaisi et al., 2016), Europe and the USA where it is being increasingly adopted as a teaching strategy for undergraduates (Gilbert, 2010;Greer et al., 2014).The literature (Barr & Coyle, 2013;Dornan et al., 2011) does, however, point to IPE being equally important for post-graduate education as part of IPCE, although there was very little literature published in this area.
Although IPE is key to enhancing competencies related to collaborative practice (Gilbert et al., 2010) across all health care workers, some professional groups are more exposed to IPE in SSA than others.The professions most engaged include Medicine and Nursing.This makes sense as these cadres are numerically the most common and considered to be at the center of health care provision and therefore collaborative practice (Barr & Coyle, 2013;Loversidge & Demb, 2015).Health professionals other than Medicine and Nursing should, however, ideally also be involved in the future to ensure that education encompasses the whole health care team.Within eye care, this is especially pertinent where inclusive eye health (Mörchen et al., 2018) and primary eye care (WHO, 2018) are currently being promoted in LMICs among community health care workers such as health surveillance assistants.The interprofessional team for eye care is consequently expanding, and IPE will be an important strategy to maximize these new initiatives.
Our review found that the content of IPE in SSA focuses mainly on strengthening non-technical skills such as the improvement of primary health care delivery.In particular existing efforts are predominantly directed toward effective interprofessional team communication and patient or familycentered care.This is an example of the important and focused benefits of IPE as, according to the Canadian National Competencies framework (Canadian Interprofessional Health Collaborative, 2010), these are some of the key competencies that health care providers should have.
IPE in SSA has also been commonly focused on improving service learning and community involvement to address pertinent health problems at the community level.Service learning is defined as a teaching strategy that blends academic instruction with relevant community service (Cashman & Seifer, 2008).Based on our review service learning and communityfocused teaching are popular in RSA compared to other African countries, with the literature highlighting the positive outcomes when conducted interprofessionally (Barr, 2015).
This study suggests that IPE in SSA has been expanding in an appropriate way to address the health needs of the SSA population although at this stage still most published work originating from RSA.This literature review demonstrated that the SSA region is not only focused on dealing with the traditional challenges of infectious diseases such as HIV, Malaria and Tuberculosis but is also increasingly having to manage the growing burden of non-communicable disease (NCDs) too.For instance this review highlighted "One health" which again is an area where IPE is playing an important role in the broader health agenda in SSA improving the wellbeing of people, animals and the environment.
Interestingly, 51% of the studies reported in our review described financial support to implement IPE activities and its evaluation.The sources of funding were mainly scientific grants delivered by universities as well as funding from NGOs.This finding points to the importance of funding in the growth of IPE in SSA with governments as yet not found to be a major funding source to support IPE for IPC development.

Outcomes evaluation of IPE
The metrics used to evaluate the outcomes of IPE focused mainly on change in attitudes, as well acquisition of knowledge and skills among learners but not on changes in patient outcomes, ultimately the end point objective for delivering medical education.Reviewed studies consistently revealed that IPE enabled health sciences learners in SSA to better understand collaboration, role clarification and community involvement in addressing the relevant health problems that they are facing but without reporting on changes to patient health.This finding reemphasizes that IPE should be central in developing patient and community-centered care in SSA but that future studies should focus on additionally measuring changes to longer term health outcomes.
In regard to the reported positive changes in perception and attitudes toward IPE found in this review there could be several different factors influencing this.In addition to the education approach being more interactive, the change in learning environment and community engagement could encourage a positive perception among participants.A systematic review by Hammick et al. (2009) recommended using principles of adult learning in IPE to maximize positive outcomes from teaching initiatives.In addition, the results of the current review show that there was significant knowledge and skills acquisition post IPE interventions, and learners noted preferences for simulation learning and community interactions.The available evidence for IPE in SSA highlights what works and therefore what should be adopted for future delivery of multidisciplinary training in this region.Even though IPE in SSA is still picking up pace and increasingly contributing to solving problems faced by communities, this review showed generally positive outcomes across the four levels of the adapted Freeth/ Kirkpatrick framework.Additionally, the findings in this review complement those of the recent review (Reeves et al., 2016) that looked at presage, process and product factors of IPE especially on the product or outcomes of IPE factor.
Although there is generally very little evidence on the impact of IPE on actual practice (Fung et al., 2015;Reeves et al., 2017), our review found that the understanding of cultural differences in SSA could contribute to improvement in communication and collaboration among teams of care providers with the strong potential for improving health outcomes for individual patients.As positive changes in behavior of practice after exposure to IPE are possible, there is the opportunity to improve quality of health care in SSA by integrating this approach to education more widely in both under and postgraduate health sciences curricula.However, as previously stated more work is needed to understand the outcomes and impact of IPE in delivery of health care, especially in relation to changes in organizational practice and patient outcomes where there is little evidence at present.

Conclusion
This review describes a comprehensive academic evaluation of published work on IPE delivery in SSA.In doing so, the progress and potential for this form of collaborative education to support the development of health care delivery in SSA has been laid out.
The review covers the context and drivers of IPE in SSA, as well as the evidence for the range of outcomes it has generated so far.It is vital for future IPE initiatives to be guided by the existing evidence aligned to the SSA context, so as to build on progress and focus on addressing African health care challenges.Universities and hospitals in SSA have driven the expansion of IPE.However, government-level policy makers as well as NGOs now also need to support this work to establish and promote it more widely to improve health care provision.Specifically, simulation-based and patient-or community-centered IPE has been shown to be preferred way of delivering IPE in the SSA context.However further evaluations are recommended to explore this further as well as its specific impact on health outcomes.Overall IPE is really still in its infancy in SSA, with more initiatives and evaluations needed to understand and measure its benefits on health care practice and patient outcomes.
Review conducted under the Global Challenges Research Fund (GCRF) PhD scholarship at the University of St-Andrews

Notes on contributors
Mr Gatera Fiston Kitema is a community eye health and Disability specialist and Assistant Lecturer at the University of Rwanda.Mr. Kitema is a PhD candidate at the University of St-Andrews looking at interprofessional education for eye health development using the Arclight package.Dr Andrew Blaikie is a Consultant Ophthalmologist in NHS Fife, Senior Lecturer in the Global Health Division team at the University of St Andrews and clinical lead for the Arclight Project.The Arclight Project is a social enterprise that enables teaching institutions and NGOs working in low resource countries to equip, train and empower all grades of health care workers to confidently diagnose and manage eye disease.

Figure 1 .
Figure 1.The PRISMA flow diagram from the systematic review on IPE in the SSA region.
The reactions to the interprofessional education session included: • Opportunity for developing self-growth, collaboration and learning • Appreciation of diversity, traditions, and health needs • Appreciation of each discipline's role in achieving health at the community level • Unity of people and ideas through collaboration to create better solutions for the community • Motivation to better learn and teach about challenging diseases like HIV • Positive problem-based learning, team strengthening and collaborative work • Recommended educational and training approach for practical learning of subjects like anatomy and others Mpofu et al. (2014) Davis et al. (2015) Reitsma et al. (2019) Scrooby et al. (2019) Van Wyk et al. (2020) Buregyeya et al. (2021) Martini and Caceres (2012) Chetty et al. (2020) Kiguli-Malwadde et al. (2020) Leshabari et al. (2012) Vostanis et al. (2019) Ersek et al. (2010) O'Carroll et al. (2020) 2a Modification of perceptions and attitudes 17(57) The synthesized evidence reported that through IPE: • Learning with other professions was beneficial and more thought-provoking • Soft and professional skills could be developed and health care needs could be met with limited resources • Common client-centered outcomes could be achieved • Professional and territorial hierarchies would collapse • Could improve teamwork and good communication • Could promote the understanding of other health care professionals' roles and clinical skills • Positive learning experience and collaboration can be achieved • Positive change in perception of other disciplines could be achieved • Significant educational value and broadened perspectives could be promoted • Could lead to improved work relationships and company culture • Enhanced respect toward colleagues' and other health professional' knowledge and skills • Enhanced self-efficacy and reduced stress • Increased confidence in delivering care to patients Mpofu et al.
IP non-technical skills training improved team dynamics, safer patient care practices, and empowerment.
Laidlaw is currently the Director of the Centre for Healthcare Education Research and Innovation at the School of Medicine, Medical Sciences and Nutrition, University of Aberdeen.Dr Laidlaw has been involved in the training of healthcare professionals for many years, mainly in clinical communication and behavioural sciences Dr Veronica O'Carroll is a Senior Lecturer and Director of Postgraduate Teaching in the School of Medicine, University of St Andrews.She is currently the Programme Director for the Masters in Health Professions Education program.She is an Associate Editor for the Journal of Interprofessional Care and has been a Fellow of the Higher Education Academy since 2008.Dr Jean Baptiste Sagahutu is an Associate Professor of Physiotherapy at the University of Rwanda, College of Medicine and Health Sciences, Physiotherapy Department.He is currently Coordinator of the Postgraduate programme in the School of Health Sciences.His research areas include Disability and Rehabilitation, Interprofessional Education and Collaborative Practice (IPE/IPC).

Table 1 .
Summary of 41 included studies.
Other (Malaria care, Palliative care, Cultural-clinical immersion, Geriatrics care, Physical trauma care, Tuberculosis management, Nontechnical skills development, Eye health care, Infection control)