IMPLEMENTATION OF MULTI-PROFESSIONAL EDUCATION: A SHORT REVIEW OF THE RESEARCH METHODOLOGY AND BIOSTATISTICS COURSE

Background: The faculty of Dentistry Universitas Indonesia (FDUI) has implemented multiprofessional education (MPE) since the academic year of 2012/2013. Some concerns about facilitators and the achievement of students arose. This study aims (1) to describe the curriculum mapping, (2) to elaborate the perception of facilitators regarding the implementation of MPE, and (3) to assess the achievement among non-MPE and MPE groups in a particular subject. Methods: This research used a quantitative and qualitative approach. This research collected the data of achievement, perception of facilitators, and the curriculum in order to assess the implementation of MPE. Results: The curriculum consisted of common subjects or topics. There were some suggestions regarding the facilitators and the curriculum in the implementation of MPE. In line with one-way Annova, the mean score of students among NonMPE (76.52±4.36), MPE_2012 (75.52±4.39), and MPE_2013 groups (75.46±4.66) were not statistically different with p-value = 0.154. Conclusion: The faculty has succeeded in compiling an integrated MPE curriculum. There are opportunities for an improvement in several areas. The academic achievement of MPE students is as good as Non-MPE students. The MPE group’s research proposals seemed to have a spirit of collaboration.


INTRODUCTION
One of the visions of the Faculty of Dentistry Universitas Indonesia (FDUI) is to become the leading Faculty of Dentistry in the field of education, research, and community service with integration and autonomy as its development strategy. 1 To achieve these goals, since 2003, FDUI organized academic education by way of active learning using many approaches such as problem-based learning (PBL), collaborative learning (CoL), questions-based learning (QBL), and others which emphasize student-centered learning that are effective, including students from >2 disciplines working together. 2 Besides that, since the academic year of 2012/2013, FDUI has implemented interprofessional/multiprofessional education (IPE/ MPE).
Interprofessional education (IPE) is defined as "those occasions when students of two or more health care professions learn with, from, and about one another to improve collaboration and the quality of care" (WHO). 3 MPE is defined as "the process by which a group of students in health related fields and with different educational backgrounds are learning together during certain periods of their education" (WHO). 4 There are various perspectives regarding the difference of IPE and MPE. Roodbol mentioned that the concept of MPE features interactive learning as part of interprofessional learning. The difference between IPE and MPE is only in terms of numbers. Interprofessional has two professions while multi professionals have more than two professions. 5 However, some efforts were proposed to distinguish between IPE and MPE "more substantive" than just number. Goldman et al through a sociological approach, mentioned that IPE and MPE represent different educational processes. 6 Barr et al defined "a multiprofessional course when members (or students) of two or more professions learn alongside one another: in other words, parallel rather than interactive learning". They stated that the difference between the two lies in the parallel educational process. 7 8 This curriculum has been implemented since 2013. Therefore, an evaluation or assessment should be conducted in order to improve and maintain the sustainability of this program. There is no evaluation that has been done, whether by comparing with Non-IPE or comparing all IPE batch years.
At the level of preparation and implementation, it is undeniable that there are some concerns regarding MPE. This study aims: (1) to describe the curriculum mapping of FDUI, (2) to elaborate the perception of facilitators about the implementation of MPE, and (3) to assess the achievement among MPE and non-MPE group students (three academic years) in a particular subject. The hypothesis is the achievement of MPE-students would be as good as Non-MPE students.

METHODS
A study that focuses on collecting, analyzing, and mixing both quantitative and qualitative data is commonly defined as a mixed method. 9 This study used a quantitative and qualitative data to assess the implementation of MPE.
The quantitative data which consist of data regarding grades of undergraduate students (N = 311) were collected from FDUI administration office (for Non-MPE students) and official data from The qualitative data which consist of Information regarding the perception of facilitators (n = 41 from 5 faculties) was reviewed from the final report of The RMB module team in 2015. Whereas the information on curriculum mapping was collected from FDUI administration office. The Document review is one of strategy in qualitative approach 10,11 and one of the eligible documents is organizational or institutional reports or summaries. 11 The data from many resources (such as documents) are then organized into major themes, categories, and case examples through content analysis. 12 The analytic procedure encompasses the process of finding, selecting, apprising (to make sense of), and synthesising data included in documents. 11 At the end of the semester, all facilitators were asked to provide opinions and suggestions through a set of open-ended questionnaires on several issues related to the learning of this course. The opinions and suggestions of the facilitators were grouped into the major themes asked in the questionnaire. 11,12 The grouping was based on the scope of implementation which include the curriculum, team teaching, supporting staff, and learning facility. The RMB course was selected in this study with the following considerations: 1. The course had been included in FDUI curriculum before MPE implementation; 2. The availability and accessibility of the data (before and after MPE). The quantitative data regarding the achievement of students were analyzed statistically with One-Way ANOVA using SPSS 23.
This study used secondary data that is not related to informed consent and does not use body or body parts/specimens, therefore only requires permission to use the data which permission has been obtained from related parties.

RESULTS AND DISCUSSION
There were two stages of an undergraduate program at FDUI: 1) Academic Stage (Bachelor of Dental Science) and 2) Professional/Clinical Stage (DDS).
In the academic stage curriculum, there were three main components: the subject encompasses Mandatory Courses from University, Mandatory Courses from Health Science Major (Interprofessional Education), Mandatory Courses from Dental Science Major. In this study, the academic stage, especially the RMB course, would be explored.
Referring to the definition of IPE/MPE, 3,13 the Universitas Indonesia MPE preparation team is required to compile common subjects/topics among five faculties. Based on the team's recommendations, FDUI then compiled a curriculum as shown in Table 1.  15 either to gather five different health professions or internal dynamics in the faculty. From the six common topics identified, four of them were included in the FDUI curriculum before the implementation of MPE. The common topics were ethics and law, communication, basic biomedical sciences, and research methodology and biostatistics. Furthermore, several concerns regarding the students' achievement were raised. "How can they learn "our content" with facilitators and friends from other faculties?" or "how do we ensure that students' achievement will not be different while they learn with facilitators and friends from different faculties?" There were several suggestions on the im plementation of MPE in FDUI. After three years of implementation (2012-2015), several parties involved in the policy-making process as well as those involved in the implementation stage including the facilitators addressed their comments related to the implementation of MPE. The assessment of the implementation of MPE encompassed curriculum (modules and teaching materials), team teaching (team modules, resource persons, and facilitators), administrative personnel, and supporting facilities. The concerns about achievement (score) as previously mentioned will be discussed with the support of objective analysis. should also be evaluated /assessed by their fellow facilitators and the team's module.

Administration & Laboratory Personnel
Always on standby before and after a session.
They have completed their task and the faculty was advised to increase their incentives considering in special circumstances, they were also standby in the Laboratory.

Room
Personnel/ Cleaning Service Always on standby before, during, and after session.
They have completed their task and the faculty was advised to give reward for their assistance.

Infrastructure and Facilities
Discussion and Seminar Room The required rooms were available on schedule. A number of discussion rooms (each for about 20 students) and seminar rooms (each for 200 students) were available.
The rooms with capacity for 50-100 people should be provided.

Laboratory
The required rooms were available on schedule.
The several of other equipment should be provided

Audio Visual Aid
The required AVAs were available on schedule.
There were any AVAs that could not be used/broken. They must be repaired or replaced. Table 2 shows that the themes of suggestions are mainly facilitators and content/curriculum. It means these "areas" should be in our priority. These findings highlight a number of challenges to IPE/MPE, such as cultural changes, curriculum, timetable, and sustainability. 17 In addition, there are also financial issues regarding the reward/honorarium for resource persons and supporting staffs. It is a common issue when implementing the MPE. West et al mentioned such challenges when carrying out IPE activities, including scheduling, logistics, and financial support. 18 Facilitator is one of the main concerns because their role in the learning process is one of the key factors in an active learning process. 19 Their competence and behavior should be assessed beforehand in order to improve their performance and decide which group should they be assigned to, either for team module or faculty. Due to its interactive and constructivist, MPE requires special facilitation skills to engage students in learning from each other. 18 The Interprofessional Facilitation Scale (IPFS) is one of the tools to assess skills in facilitating MPE. Sargent et al has confirmed its validity and reliability. 20 In addition to skills assessment, a follow-up is deemed to improve facilitators' capacity building as Davis et al concluded in their study. 21 As a response regarding students' achievement in MPE courses, a set of student's scores on the RMB course was analyzed by comparing the scores of non-MPE students, MPE students batch 2012, and MPE students batch 2013. Table 3 shows the scores (minimum and maximum) among the three groups are quite similar. Based on the UI grading categories, all the mean scores are in category B+ (75-79). 16 Test homogeneity of variance showed that p value was 0.951 (>0.05) and ANOVA test was eligible to be performed. is not different. The concern regarding students' achievement had been responded to. This kind of analysis is ideally conducted for all courses so that a comprehensive conclusion could be established. As typology for outcomes of interprofessional learning process, acquisition of knowledge/skills is only a level of outcomes. 22 There were still many outcomes that should be assessed with qualified measuring instruments. 22,23 An interesting finding from MPE student groups was their research proposals. The MPE group's research proposals seemed to have a "more collaborative" theme than the non-MPE. A number of proposals either explicitly or implicitly had planned to conduct oral health research with other health professions collaboratively. This phenomenon might be noticed as an achievement even though it was not planned or included in the assessment. It might be reflection of MPE values/competencies as suggested by Steven et al. 24 This is likely triggered by the learning process of the RMB course which brings together students from 5 faculties and learn together in one group. A study in Korea inferred that exposure to collaboration situations through interprofessional education leads to a positive perception of interprofessional learning. 25 The disclosure of this unpredictable positive phenomenon is one of the advantages of the qualitative method. 26 These overarching findings should be interpreted in light of their limitations. First, the available data was limited to the range from batch 2010 to 2013. In addition, only the RMB score was assigned as the reference for student achievement. Second, the scope of assessment was limited to several aspects. Apart from its limitations, this study has several strengths including the use of a mixed approach that allows the disclosure of more comprehensive findings. In addition, this study has revealed important aspects that need attention in the implementation of MPE so that it might be appropriate as a reference for other (dental) schools.

CONCLUSION
The faculty team has succeeded in compiling an integrated MPE curriculum. There are opportunities for improvement in several areas especially for facilitators and curriculum. The academic achievement of MPE students is as good as Non MPE students. The MPE group's research proposals seemed to have a spirit of collaboration.

RECOMMENDATION
A number of follow-up studies for students from batch 2010, 2012, and 2013 should be conducted in order to gather a more comprehensive assessment of MPE. Several improvements should be addressed for better MPE implementation as well as assessment either for facilitators or students.