Does professional and interprofessional identity increase during professional education? A cross-sectional study of Norwegian health- and social care students

Does professional and interprofessional identity increase during professional education? 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A cross-sectional study of Norwegian health- and social care students Ragna Stalsberg, Cathinka Thyness, Hilde Grimstad, Albertina Rusandu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5389892/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Knowledge about the development of professional and interprofessional identity can be used in health & social education institutions to design apt curricula. However, the theoretical assumption for the development lacks solid empirical evidence. The purpose of the study was to examine the development of health & social care students’ professional- and interprofessional identities during professional education. Methods: In this cross-sectional study, all students at all levels from eleven health & social care higher education programmes were included and completed a web-based questionnaire. The Macleod Clark Professional Identity Scale (MCPIS-9) was used to assess both professional and interprofessional identity. Analysis was performed using two-sample t-tests and multivariable regression models. Results: The overall scores of professional and interprofessional identity (range 1-5), were 4.15 and 4.17, respectively. There was a slight but marked increase in professional identity score from the first to the final year of study (0.18—point increase, 95% CI 0.07 to 0.30) and a similar but weaker tendency for interprofessional identity (0.10—point increase, 95% CI -0.01 to 0.21). There was also an increase in professional identity when the three-years bachelor (0.17—point increase, p=0.034) and six-year professional study programmes (0.3—point increase, p=0.022) were analysed separately. However, this was less marked for interprofessional identity (respectively 0.08—point increase, p=0.386 and 0.24— point increase, p=0.049). The professional identity score increased with a mean of .08 point more than interprofessional identity from first to last study year. Conclusion : Across health & social care students, there was a slight but visible increase in professional identity during the professional education. There was a tendency towards the same for interprofessional identity. This limited increase in professional and interprofessional identity during the course of the programmes may be due to the formation of such identity before students start their studies. However, shortcomings in the measurement of identity cannot be ruled out. Educational Psychology Profession identity formation interprofessional identity higher education health & social care students cross-sectional Figures Figure 1 Background Studies among single professions have shown that professional identity and, by inference, interprofessional identity formation, can be expected to develop during professional education [1,2]. However, there is a paucity of studies exploring the evolvement of students’ professional and interprofessional identities during professional education in health & social care. A better understanding of identity development throughout professional education may improve insight into what is considered to be an under-theorised research field [3] and inform stakeholders about the impact of their curricula on identity formation. Professional identity has been defined as ‘the attitudes, values, knowledge, beliefs and skills shared with others within a professional group and the professional role undertaken by the individual’ [4]. It is the outcome of integrating personal values, morals, and attributes with the profession's norms [5,6]. More generally, the concept is expressed as a type of social identity where members of a profession categorize and differentiate themselves from other professionals [7] and think, feel, and behave like members of their own profession [8]. In medical education, a stronger professional identity is associated with several factors, such as academic motivation [9] and higher preparedness for practice [10]. Furthermore, gender, previous work experience in health & social care services, understanding of teamwork, knowledge of the profession, and cognitive flexibility have been found to contribute to professional identity scores among first-year health & social care students [4] although later studies of paramedic students [11] and first-year German medical students [12] did not confirm these findings. The actual evolvement of professional identities and their association with academic progression within higher education is, however, less studied. It could be expected that professional identity increases over time. However, only a slight increase has been identified in previous single-profession studies on Indonesian medical students [9], and in Australian paramedic students [11]. One review even found declining professional identity scores across studies of Chinese nursing students [13]. No cross-sectional studies on professional identity evolvement among students from multiple health & social care educational programmes have been identified. Interprofessional identity formation has been defined as “the development of a robust cognitive, psychological and emotional sense of belonging to an interprofessional community, necessary to achieve shared context-dependent goals” [14]. It is based on a broader circle of group membership consisting of more than one profession and is said to be a concept superordinate to professional identity [15,16]. Underpinned by the interprofessional socialisation framework provided by Khalili et al. [17,18], supported by qualitative findings by Woltenberg et al. [19], it has been suggested that interprofessional identity develops further from professional identity, and thus depends on a prior identification with a specific profession. It has been argued that professional identity formation requires enough time and space to ensure students achieve confidence in practising their profession [20,21] and that a delay in professional identity formation potentially hampers a successful transition from student to practitioner [22]. Nevertheless, a sound professional identity appears to develop in interprofessional learning situations where the students experience and discern their professional roles by interacting with other professional groups [23]. Either way, educational institutions are responsible for nurturing both identities. Thus, knowledge about how they develop during the students’ professional education can be helpful for designing apt curricula. Previous reviews on professional [3] and interprofessional identity [14] have called for studies investigating the assumption that professional and interprofessional identities evolve differently during educational programmes. Hence, the overall aim of the present study was to investigate the development of health & social care students’ professional- and interprofessional identities during professional education in general, and among students in three-year bachelor- and six-year professional study programmes. Methods This was a cross-sectional study that collected data from health & social care students by means of a web-based questionnaire. The study was approved by the privacy officer (Norwegian Agency for Shared Services in Education and Research (SIKT), ref. 701327). All students received written information about the purpose of the study, how data was stored and protected, and that they consented to participate by submitting the questionnaire. The study was also approved by the department managements, including the relevant deans, to assure legitimacy of data collection among students, who tend to be overloaded with invitations to participate in research studies. The data were collected in the spring of 2022. Setting The study was conducted at the Norwegian University of Science and Technology (NTNU), which has a total of 40,000 students across all types of programmes, and 13 different health- & social care study programmes. For most of these programmes, the grade requirements for admission from high school are the highest or among the highest in the country. In total, the health & social care study programmes have approximately 4,800 students. The learning outcomes for all these study programmes follow national regulations. Participants and recruitment The study aimed to include students from all study years from all the health & social care study programmes at NTNU. Programmes with no graduates in 2021 or that did not offer the full programme leading to authorization, were excluded. This meant that two of the 13 study programmes were excluded: paramedic, as the study programme started enrolling students in 2021, and pharmacy, which is only offered as a two-year master's programme for students who hold a bachelor from another institution. The final sample of study programmes consisted of students in audiology, bioengineering, child welfare, medicine, nursing, occupational therapy, physiotherapy, psychology, radiography, social education, and social work. To recruit participants, all eligible students were invited to participate by e-mail with a link to the questionnaire. Some students were provided information and time to complete the questionnaire in a break or immediately after a lecture. A reminder was sent within three weeks. The questionnaire was available for three months because students in different study programmes did not get the information at identical points in time, mainly due to the timing of their practice placements. There are some differences in the amount of interprofessional educational activities across programmes. All 3 rd year students participate in a two-day, on campus activity focusing on learning about other professions and coordination in health and social care. All last-year students participate in an eight-hours collaborative team-based practice placement on interprofessional assessment of a service user. In addition, some study programmes have some minor interprofessional activities. Audiology, bioengineering, psychology, and radiography students have a 7.5 credits (ECTS) interprofessional longitudinal course which includes the two aforementioned activities. These two activities are also part of a joint 3 rd year course of 15 credits (ECTS) for child welfare and social work students. Medicine and psychology students have a 7.5 credits (ECTS) interprofessional teamwork course, which includes all five- and six-year professional study programmes at NTNU. Data Collection and variables The digital questionnaire was made available in the secure survey tool nettskjema.no, developed by the University of Oslo, Norway. The questionnaire consisted of questions about the participants and their parents/guardians, educational characteristics, and a battery of questions for assessment of professional and interprofessional identity. Participant and educational characteristics included age, gender, study programme and year, whether the current study programme was their first priority, whether they had been studying at university level before the current programme, and whether they had worked in health & social care before or during their studies (yes/no). Moreover, questions about whether parents/guardians had been working in health & social care, and whether any of them had any tertiary level education (yes/no), were included in the questionnaire. The length of study programmes was coded as three-years bachelor- (audiology, bioengineering, child welfare, nursing, occupational therapy, physiotherapy, radiography, social education, and social work), and six-year professional study programmes (medicine and psychology). As a variable representing development during professional education, ‘academic progression’ was operationalised by recoding the variable ‘year of study’ (1 st –3 rd year for the bachelor studies or 1 st –6 th year for the six-year programmes of professional studies) into three categories: 1 st year, midway (2 nd year for the three-years bachelor studies, and 2 n –5 th year for the six-year programmes of professional studies), and final year. The battery of questions for assessing students' perceptions of their professional and interprofessional identities was The Macleod Clark Professional Identity Scale (MCPIS-9) [4] using this profession and the health- & social care professions, respectively. MCPIS-9 is a 9-item, 5-point balanced Likert scale with the endpoints 1 (strongly disagree) and 5 (strongly agree). A mean score across the items for those with more than 50% responses was calculated (range 1 to 5), with a higher score indicating higher professional or interprofessional identity. The scale was developed to measure professional identity in health & social care students and has previously been shown to have good psychometric properties [24]. Previous tests have found the MCPIS-9 to have a reliability score (Cronbach’s alpha) of 0.79 [4] and 0.78 [25]. The MCPIS-9 was translated for this study from English to Norwegian through a back and forward process, including three researchers’ individual forward translations followed by joint translation and a backward translation by two external colleagues before adjustments and the final approval from the research group. Analyses As there were only negligible differences between the development of professional and interprofessional identities for the whole sample and students on three-year bachelor's and six-year professional study programmes separately, only a graphical presentation of the analysis of three-year bachelor's and six-year professional study programmes is provided. The characteristics of the whole sample is presented with frequencies, means and standard deviations. The same is done to present scores on each statement and identity score for subgroups. To compare professional and interprofessional identity, two-sample t-tests, presented with mean difference and 95% confidence intervals (95% CI), was used. To analyse the development of professional and interprofessional identity during professional education, we built two multivariate regression models. Here, the dependent variables were professional identity and interprofessional identity; academic progression was the independent variable with adjustment for the variables gender, age, parents/guardians with higher education, parents/guardians working in health & social care , the student worked in health & social care before the study, and the student had study programme as first choice. The results of the multivariable analyses are presented with adjusted coefficients (adj. coeff.) and 95% CIs. The IBM Statistical Package for Social Sciences (SPSS) version 28.0.1.0 (142) was used for all analyses. As there were only negligible differences between the development of professional and interprofessional identities for the whole sample and students on three-year bachelor's and six-year professional study programmes separately, only a graphical presentation of the analysis of three-year bachelor's and six-year professional study programmes is provided. Results In sum, 864 students (approximately one-fifth of the study population) from 11 programmes completed the questionnaire. Their mean age was 23.9 years (standard deviation 4.1, median 23), and three in four were women (Table 2). One in five of the students were in their first year. Students in medicine, physiotherapy and nursing totalled two-thirds of all the respondents. Table 1 Characteristics of responders. N (%) of the responders within each category. N=864 Characteristics N (%) Academic progression - 1 st year student 166 (19.2%) - Midway student (2 nd or 2 nd -5 th year) 416 (48.1%) - Final-year student (3 rd or 6 th year) 278 (32.2%) Gender Women 668 (77.3%) Men 190 (22.7%) Non-binary/no answer 4 (0.2%) Age group - 25 186 (21.5%) Parents/guardians - Have higher education 706 (81.7%) - Work within H&S care 366 (42.4%) The student - Worked in H&S care before studying 453 (52.4%) - The study programme was the first choice 796 (92.1%) Study programme - Audiology 1 (0.1%) - Bioengineering 46 (5.3%) - Child welfare 29 (3.4%) - Medicine 315 (36.5%) - Nursing 101 (11.7%) - Occupational therapy 7 (0.8%) - Physiotherapy 150 (17.4%) - Psychology 43 (5.0%) - Radiography 83 (9.6%) - Social education 62 (7.2%) - Social work 26 (3.0%) Scores on each statement and mean identity score The variation in scores between the statements used to measure professional- and interprofessional identity was small, ranging from 3.6 to 4.6 on the 1–5 scale (Table 3). Similarly, there were only minor differences (maxim difference of 0.2) between each statement on the professional and interprofessional identity scale (Table 3). The mean scores across all statements were 4.15 and 4.17 for professional- and interprofessional identity, respectively. Table 2. Scores for each statement and mean score across all statements for professional and interprofessional identity. Statement s Professional identity Mean (SD) Interprofessional identity Mean (SD) Difference Mean (SD) I feel like I am a member of this profession/the H&S care professions 4.0 (0.79) 4.2 (0.73) -0.19 (0.85) I feel I have strong ties with members of this profession/H&S care professions 3.6 (0.96) 3.6 (0.90) -0.02 (1.01) I am often ashamed to admit that I am studying for this profession/ H&S care professions* 4.5 (0.82) 4.5 (0.73) -0.08 (0.72) I find myself making excuses for belonging to this profession/H&S care professions* 4.4 (0.97) 4.5 (0.75) -0.18 (0.84) I try to hide that I am studying to be part of this profession/ H&S care professions* 4.6 (0.77) 4.6 (0.64) -0.07 (0.70) I am pleased to belong to this profession/H&S care professions 4.4 (0.72) 4.3 (0.75) 0.10 (0.73) I can identify positively with members of this profession/H&S care professions 4.3 (0.73) 4.1 (0.73) 0.15 (0.69) Being a member of this profession is important to me/H&S care professions 3.9 (0.87) 3.8 (0.89) 0.05 (0.73) I feel I share characteristics with other members of the profession/ H&S care professions 3.9 (0.86) 3.8 (0.80) 0.05 (0.75) Mean score across all statements 4.15 (0.54) 4.17 (0.53) -0.02 (0.41) *Statements were phrased negatively but are reversed here to give all the statements the same direction. Description of changes in identity score during professional education There was a slight but marked increase in the students’ professional identity during professional education (0.19 points, p<0.001) and a similar but weaker tendency for interprofessional identity (0.11 points, p=0.075) (Table3). There was a slight difference between the two identity scores, where the interprofessional identity score was highest, except for the final year, where the scores were similar. Table 3. Professional and interprofessional identity scores with difference during professional education (academic progression). Academic progression N Professional identity score (N=860) Mean (95% CI) Interprofessional identity score (N=855) Mean (95% CI) Difference (N=855) Mean (95% CI) 1 st year 166 4.04 (3.95 to 4.12) 4.10 (4.01 to 4.18) -0.06 (-0.13 to 0.01) Midway (2 nd or 2 nd -5 th year) 411 4.13 (4.08 to 4.18) 4.16 (4.11 to 4.21) -0.03 (-0.07 to 0.01) Final year (3 rd or 6 th year) 278 4.23 (4.17 to 4.30) 4.21 (4.15 to 4.28) 0.02 (-0.03 to 0.07) Multivariate analyses of changes in identity score during professional education Adjusted for other variables (gender, age, parents/guardians with higher education, parents/guardians working in health & social care, the student worked in health & social care before the study, and the student had study programme as first choice) the multivariate analyses gave similar results as the descriptive analysis. Last-year students had a mean professional identity score that was 0.18 (95% CI 0.07 to 0.30, p=0.001) higher than the scores of 1st year students (Table 4), while the scores for interprofessional identity was 0.10 (95% CI -0.01 to 0.21, p=0.075) higher (Table 5). Table 4 Multivariate analysis of academic progression and professional identity adjusted for other variables. Characteristics Professional identity Mean score (SD) Adj. coeff. (95% CI) P-value Academic progression - 1 st year 4.04 (0.55) REF - Midway (2 nd or 2 nd -5 th year) 4.13 (0.53) 0.07 (-0.02 to 0.17) 0.138 - Last-year (3 rd or 6 th year) 4.23 (0.52) 0.18 (0.07 to 0.30) 0.001 Adjustment variables Women 4.14 (0.54) -0.03 (-0.11 to 0.06) 0.538 Age group: - Age 21 years and younge r 4.10 (0.50) REF - Age 22-23 4.12 (0.53) 0.05 (-0.15 to 0.05) 0.314 - Age 24-25 4.17 (0.57) -0.01 (-0.11 to 0.11) 0.932 - Age 26 years and older 4.20 (0.55) -0.01 (-0.12 to 0,11) 0.906 Parents/guardians with higher education 4.13 (0.54) -0.07 (-0.16 to 0.02) 0.149 Parents/guardians work in H&S care 4.15 (0.55) 0.02 (-0.06 to 0.09) 0.674 Student worked in H&S care before study 4.18 (0.51) 0.08 (0.00 to 0.15) 0.043 Student had study programme as 1 st choice 4.17 (0.51) 0.36 (0.23 to 0.50) <0.001 Table 5 Multivariable analyses of academic progression and interprofessional identity adjusted for other variables. Characteristics Interprofessional identity Mean score (SD) Adj. coeff. (95% CI) P-value Academic progression - 1 st year 4.10 (0.56) REF - Midway (2 nd or 2 nd -5 th year) 4.16 (0.52) 0.05 (-0.05 to 0.15) 0.320 - Last year (3 rd or 6 th year) 4.21 (0.52) 0.10 (-0.01 to 0.21) 0.075 Adjustment variables Women 4.18 (0.52) 0.07 (-0.02 to 0.15) 0.127 Age group: - Age 21 years and younge r 4.16 (0.49) REF - Age 22-23 4.10 (0.54) -0.09 (-0.17 to 0.01) 0.081 - Age 24-25 4.18 (0.54) -0.01 (-0.12 to 0.10) 0.871 - Age 26 years and older 4.25 (0.55) 0.04 (-0.07 to 0.15) 0.491 Parents/guardians with higher education 4.15 (0.53) -0.06 (-0.16 to 0.03) 0.183 Parents/guardians work in H&S care 4.18 (0.55) 0.03 (-0.05 to 0.10) 0.485 Student worked in H&S care before study 4.17 (0.53) 0.02 (-0.05 to 0.10) 0.538 Student had study programme as 1 st choice 4.19 (0.51) 0.23 (0.10 to 0.36) <0.001 Multivariable analysis of changes in differences in identity score during education The multivariable analysis showed that the professional identity score was 0.08 (95% CI 0.00 – 0.17, p=0.058) higher than the interprofessional identity score when comparing all last year to all 1 st year students (Table 6). Thus, the students’ professional identity score increased by a mean of 0.08 points more than the interprofessional identity score during professional education. Table 6 Multivariable analysis of difference in professional and interprofessional identity. Characteristics Difference between professional and interprofessional identity Mean difference (SD) Adj. coeff. (95% CI) P-value Academic progression - 1 st year -0.06 (0.45) REF - Midway (2 nd or 2 nd -5 th year) -0.03 (0.40) 0.02 (-0.05 to 0.10) 0.568 - Last year (3 rd or 6 th year) 0.02 (0.39) 0.08 ( 0.00 to 0.17) 0.058 Adjustment variables Women -0.04 (0.41) -0.09 (-0.16 to -0.02) 0.008 Age group: - Age 21 years and younge r -0.04 (0.41) REF - Age 22-23 0.01 (0.39) 0.04 (-0.04 to 0.11) 0.338 - Age 24-25 -0.01 (0.41) 0.01 (-0.07 to 0.10) 0.804 - Age 26 years and older -0.05 (0.44) -0.04 (-0.13 to 0.05) 0.336 Parents/guardians with higher education -0.02 (0.42) 0.00 (-0.08 to 0.07) 0.916 Parents/guardians work in H&S care -0.03 (0.39) -0.01 (-0.07 to 0.05) 0.752 Student worked in H&S care before study 0.01 (0.40) 0.06 (0.00 to 0.11) 0.052 Student had study programme as 1 st choice -0.01 (0.39) 0.13 (0.03 to 0.23) 0.013 Identity scores for three-year bachelor- and six-year professional studies As stated in the analysis, when dividing students in three-year bachelor- and six-year professional study programmes, there was no clear difference from the analysis of the whole group together. Therefore, only a graphical presentation of the differences between the two length of studies is provided (Figure 1). Professional identity increased for students in three-years bachelor studies (0.17 points, p=0.034) and six-year professional study programmes (0.30 points, p=0.022). However, this was less clear for interprofessional identity (0.08 points, p=0.386 and 0.24 points, p=0.049, respectively). For both bachelor students and students in the six-year professional study programmes, the interprofessional identity score was higher in the first part of their education, while the professional identity scores were higher at the end. Discussion The professional- and interprofessional identity scores were almost the same among first-year students and only showed a slight increase during professional education. The increase was somewhat larger for the professional than the interprofessional identity score. The same pattern was evident when looking at three-year bachelor- and the six-year professional study programmes separately. Thus, the overall finding was that health & social care students have a high professional and interprofessional identity score from the start, and there are only minor changes curing the professional education with professional identity being the one that increases the most. Professional identity The main finding indicates a small yet noticeable increase in students’ professional identity during professional education. This was also evident when looking at students in the three-years bachelor- and the six-year professional study programmes separately. Similar results have been reported in studies of professional identity in Indonesian medical students [9] and in Australian paramedic students [11]. Both studies applied the same MCPIS-9 scale as in the present study. These studies reported the MCPIS-9 score as the sum of the statements rather than the mean. Among the medical students, there was an increase in identity scores from the early to late study phases (35.75 to 40.7 (p<0.05)), and among the paramedic students, a somewhat smaller increase was found from the first to the last year of study (37.8 to 40.7 (p=0.066)). Studies of nursing students in China included in a review by Mao et al. [13] have reported a decline in professional identity from Freshmen to Senior students. However, restricted access to relevant Chinese journals renders the instruments used in professional identity assessments unknown. The professional identity score was 4.0 on the 1–5 scale among first-year students in our study, which can be considered a high score. The high scores in first-year students might be due to these students having a sense of professional identity before they begin their studies. Adams et al. [4] and Roberts et al. [26] also found that health & social care students report a high level of professional identity when they start their academic professional education, supporting our interpretations. Generally, this could mean that professional identity formation might occur before or during the process when the students decide which study programme to enrol in, as suggested by Kahili [17]. As proposed by Mao et al. [13], it might also be that first-year students have an ideal image of the profession in which they get educated. An alternative explanation to our and other studies’ findings of a relatively high professional identity among first-year students could be that the first-year students answered the questionnaire on professional identity in the spring term, i.e. after they had completed at least half to two-thirds of the first year. If they had completed the questionnaire immediately before or after the first day of their programme and reported a low professional identity, the observed high professional identity would be due to changes during the first part of the first year of studies. Such results would mean that students in their first year of study gain ample professional knowledge, values, and attitudes to identify with their profession almost as much as the soon-to-be graduates. Neither Johnston et al. [11] nor Mao et al. [13] have reported the timing of data collection from first-year students. Roberts et al. [26] collected professional identity data on first-year students at the end of the first semester and found professional identity scores equal to those of first-year students in the present study. These findings give reasons to call for further studies investigating professional identity development during the first year of study. Interprofessional and professional identity The interprofessional identity scores were similar to the professional identity scores, and the topics raised in the discussion above about professional identity are also relevant to interprofessional identity. Thus, repeating them is redundant. However, it is noteworthy that the students’ interprofessional identity score was slightly higher than their professional identity up to the end of the education. Based on the conceptualisation of Reiners [16] and the assumption embedded in the socialisation framework of Kahili et al. [17,18] that interprofessional identity develops further from professional identity, it was reasonable to expect that interprofessional identity scores would be lower than professional identity scores among the first-year students and also show a steeper increase. However, this was not the case even though all students in the present study, including the final stage students, had attended several interprofessional education programmes, which have shown to affect the level of interprofessional identity [18]. An alternative interpretation might be that it is less complicated for students in their first year to ‘identify with a broader circle of group membership consisting of more than one profession’ [16] (i.e. interprofessional identity) than to be able ‘to categorize and differentiate themselves from other professionals’ [7] and ‘think, feel and behave like members of their profession’ [8] (I,e, professional identity). Such an idea would mean that new students have a higher sense of identity with the group of professions rather than the specific profession they have chosen to educate themselves into. Thus, rather than developing an interprofessional identity from a professional identity base, the interprofessional identity is the foundation from which the professional identity develops. Further studies are needed to clarify this. The identity scale used, MCPIS-9, had not been validated for assessing interprofessional identity. However, only modest changes were made to the original statements, with the term profession replaced with health- and social care professions . One possible interpretation is that the insignificant differences in the scores between the two identities could be due to the students not noticing the difference. It could also mean that they consider their profession and the group of professions similar. Still, there were some differences, indicating that the respondents perceived the two versions differently. As discussed above, the timing of the data collection may have influenced the interprofessional identity scores. Although first-year students are early in being socialized into the health and social care professions, their prior knowledge about these professional groups, in addition to the interprofessional learning programmes, may have shaped a level of interprofessional identity that makes it difficult to distinguish them from advanced students in terms of interprofessional identification. Strengths and limitations The present study is the first cross-sectional study providing quantitative data on changes in both students professional and interprofessional identity during professional education. It is also the largest study, with students from all study years of eleven health & social care study programmes. The results are therefore important to increase the knowledge of health & social care students’ development of professional and interprofessional identity during professional education. The measurement used, the MCPIS-9 scale, has been validated and used in several studies. Still, it can be questioned if it is sensitive to change as only slight differences have been found between first and final-year students in all identified studies. The arguments for the measurement being sensitive to change despite studies finding only slight differences, would be that the students’ identity is stable during professional education. Thus, more research is needed, including the use or development of other measures. This cross-sectional study investigated the professional and interprofessional identity of different groups of students, which could mean that the observed differences could be due to a cohort effect. I.e., that students who were in their last year of study also would have scored higher on identity if they were asked as first year students compared to those who were in their first year when they participated. A longitudinal study that follows the same students during their whole education could thus yield different results and avoid the cohort effect. Conclusions Across health & social care students from eleven different professional educational programmes, there was a slight yet noticeable increase in the students’ professional identity during professional education and a tendency for the same for interprofessional identity. Still, the professional identity score showed a minor but steeper increase during professional education compared to the interprofessional identity score. These findings can be due to the students having a relatively high professional and interprofessional identity before starting a health or social care study programme. However, shortcomings, such as a lack of sensitivity to change in measuring identity, cannot be ruled out. Declarations The study was assessed as not subject to notification by the Norwegian Regional Committees for Medical and Health Research Ethics ((REK) ID: 423598). The study was approved by the Norwegian Agency for Shared Services in Education and Research ((SIKT), ref. 701327)). All students received written information about the study, and that we had obtained informed consent to participate by submitting the digital questionnaire. Ethics approval and consent to participate The study was approved by the privacy officer (Norwegian Agency for Shared Services in Education and Research (SIKT), ref. 701327). Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions The study was conceived and designed by RS, CT, HG, AR, BA, RJ, and AS. Data collection were organised by RS, HG, AR, BA, and RJ. Initial analyses were performed by CT; further analyses were undertaken by RS and AS. The manuscript was drafted by RS and AS. Subsequent drafts were commented on by CT, HG, AR, BA, RJ. All authors have approved the final manuscript. References Arndt J, King S, Suter E, Mazonde J, Taylor E, Arthur N. Socialization in health education: Encouraging an integrated interprofessional socialization process. J Allied Health. 2009 Mar 1;38(1):18-23. Holden MD, Buck E, Luk J, Ambriz F, Boisaubin EV, Clark MA, Mihalic AP, Sadler JZ, Sapire KJ, Spike JP, Vince A. Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education). Acad Med. 2015 Jun 1;90(6):761-7. Cornett M, Palermo C, Ash S. Professional identity research in the health professions—a scoping review. Adv Health Sci Educ. 2023;28(2):589-642. Adams K, Hean S, Sturgis P, Clark JM. Investigating the factors influencing professional identity of first‐year health and social care students. Learn Health Soc Care. 2006 Jun;5(2):55-68. Wilson I, Cowin LS, Johnson M, Young H. Professional identity in medical students: pedagogical challenges to medical education. Teach Learn Med. 2013;25(4):369-73. Wald HS. Professional identity (trans) formation in medical education: reflection, relationship, resilience. Acad Med. 2015;90:701-6. McNeil KA, Mitchell RJ, Parker V. Interprofessional practice and professional identity threat. Health Sociol Rev. 2013;22(3):291-307. Coster S, Norman I, Murrells T, Kitchen S, Meerabeau E, Sooboodoo E, d’Avray L. Interprofessional attitudes amongst undergraduate students in the health professions: A longitudinal questionnaire survey. Int J Nurs Stud. 2008;45(11):1667-81. Wasityastuti W, Susani YP, Prabandari YS, Rahayu GR. Correlation between academic motivation and professional identity in medical students in the Faculty of Medicine of the Universitas Gadjah Mada Indonesia. Educ Med. 2018;19(1):23-9. Chaou CH, Yu SR, Chang YC, Ma SD, Tseng HM, Hsieh MJ, Fang JT. The evolution of medical students’ preparedness for clinical practice during the transition of graduation: a longitudinal study from the undergraduate to postgraduate periods. BMC Med Educ. 2021;21(1):1-9. Johnston T, Bilton N. Investigating paramedic student professional identity. Australas J Paramed. 2020;17. Faihs V, Heininger S, McLennan S, Gartmeier M, Berberat PO, Wijnen-Meijer M. Professional identity and motivation for medical school in first-year medical students: a cross-sectional study. Med Sci Educ. 2023;33(2):431-41. Mao A, Lu SE, Lin Y, He M. A scoping review on the influencing factors and development process of professional identity among nursing students and nurses. J Prof Nurs. 2021;37(2):391-8. Tong R, Brewer M, Flavell H, Roberts L. Professional and interprofessional identities: a scoping review. J Interprof Care. 2020:1-9. Reinders JJ. Task shifting, interprofessional collaboration and education in Oral Health Care [Doctoral dissertation]. 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Learn Health Soc Care. 2006;5(3):142-54. Baker L, Egan-Lee E, Martimianakis MA, Reeves S. Relationships of power: implications for interprofessional education. J Interprof Care. 2011;25(2):98-104. Schwertner RM, Pinkston D, O’Sullivan P, Denton B. Transition from student to physical therapist: Changes in perceptions of professional role and relationship between perceptions and job satisfaction. Phys Ther. 1987;67(5):695-701. Carpenter J, Dickinson H. Interprofessional education and training. Policy Press; 2016. Matthews J, Bialocerkowski A, Molineux M. Professional identity measures for student health professionals – a systematic review of psychometric properties. BMC Med Educ. 2019;19(1):308. Cowin LS, Johnson M, Wilson I, Borgese K. The psychometric properties of five Professional Identity measures in a sample of nursing students. Nurse Educ Today. 2013;33(6):608-13 Roberts LD, Davis MC, Radley-Crabb HG, Broughton M. Perceived relevance mediates the relationship between professional identity and attitudes towards interprofessional education in first-year university students. J Interprof Care. 2018;32(1):33-40. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5389892","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":377280314,"identity":"f08313e5-5da4-4264-bc12-0e9b5c09be27","order_by":0,"name":"Ragna Stalsberg","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYFADdgY2ECVHtAYJBmaIFmMIRYqWxAZCWszbj1978IOhro6/mf3Zg497atO3y/cek2DcYYNTi8yZnHLDHobDEhKHecwNZzw7nruzjS9NgvFMGh4H5aRJ8DAckGA4zMMmzXPgWO6GYzxmEoxth3Fr4X+TJvmHoU5C/jD7M+k/B46lGxDUIpF+TJqHgVnC4DCDmTTDgZoEIrS8YZOWMTgsuRHkl54DBww3HMsxtkhsw+MX/vRnkm8q6vjljrc/e/DjQJ28weEzhjc+tuEOMQYGHgMGBgM4D+qeBDwagAnlATKvDq/aUTAKRsEoGJkAANKxTXYBScDJAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-9611-1615","institution":"NTNU","correspondingAuthor":true,"prefix":"","firstName":"Ragna","middleName":"","lastName":"Stalsberg","suffix":""},{"id":377280315,"identity":"ee375d12-b3ec-4866-9a31-b3868ddf7368","order_by":1,"name":"Cathinka Thyness","email":"","orcid":"","institution":"NTNU","correspondingAuthor":false,"prefix":"","firstName":"Cathinka","middleName":"","lastName":"Thyness","suffix":""},{"id":377280316,"identity":"941d3331-7ad3-4d22-b156-3a049e8fbe37","order_by":2,"name":"Hilde Grimstad","email":"","orcid":"","institution":"NTNU","correspondingAuthor":false,"prefix":"","firstName":"Hilde","middleName":"","lastName":"Grimstad","suffix":""},{"id":377280317,"identity":"76a32f05-2492-4070-95ca-fbb20402dee6","order_by":3,"name":"Albertina Rusandu","email":"","orcid":"","institution":"NTNU","correspondingAuthor":false,"prefix":"","firstName":"Albertina","middleName":"","lastName":"Rusandu","suffix":""},{"id":377280318,"identity":"81cd0734-d5e4-4fef-ba2f-7982e8c11789","order_by":4,"name":"Beate Andre","email":"","orcid":"","institution":"NTNU","correspondingAuthor":false,"prefix":"","firstName":"Beate","middleName":"","lastName":"Andre","suffix":""},{"id":377280319,"identity":"1b6abb20-9763-440f-9501-f7663046c9e3","order_by":5,"name":"Randi Juul","email":"","orcid":"","institution":"NTNU","correspondingAuthor":false,"prefix":"","firstName":"Randi","middleName":"","lastName":"Juul","suffix":""},{"id":377280320,"identity":"f5878c36-a0c7-4a75-ad62-ccbe511122fa","order_by":6,"name":"Aslak Steinsbekk","email":"","orcid":"","institution":"NTNU","correspondingAuthor":false,"prefix":"","firstName":"Aslak","middleName":"","lastName":"Steinsbekk","suffix":""}],"badges":[],"createdAt":"2024-11-04 17:08:00","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5389892/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5389892/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68899752,"identity":"106d6a45-8fa1-46c2-8efd-c9bc53163144","added_by":"auto","created_at":"2024-11-13 09:25:24","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":93378,"visible":true,"origin":"","legend":"\u003cp\u003eMean professional and interprofessional identity scores by study years for the three- and six-year studies.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5389892/v1/274157980e5cd78952c43f3e.jpg"},{"id":68899767,"identity":"eb6b0ba3-73e0-48e0-95a7-6e76bf8fb4bb","added_by":"auto","created_at":"2024-11-13 09:25:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":984571,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5389892/v1/0bf3bcb9-39fb-4b3d-bb98-b44c5c32445f.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"Does professional and interprofessional identity increase during professional education? A cross-sectional study of Norwegian health- and social care students","fulltext":[{"header":"Background","content":"\u003cp\u003eStudies among single professions have shown that professional identity and, by inference, interprofessional identity formation, can be expected to develop during professional education\u0026nbsp;[1,2]. However, there is a paucity of studies exploring the evolvement of students\u0026rsquo; professional and interprofessional identities during professional education in health \u0026amp; social care. A better understanding of identity development throughout professional education may improve insight into what is considered to be an under-theorised research field\u0026nbsp;[3]\u0026nbsp;and inform stakeholders about the impact of their curricula on identity formation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProfessional identity has been defined as \u0026lsquo;the attitudes, values, knowledge, beliefs and skills shared with others within a professional group and the professional role undertaken by the individual\u0026rsquo;\u0026nbsp;[4]. It is the outcome of integrating personal values, morals, and attributes with the profession\u0026apos;s norms\u0026nbsp;[5,6]. More generally, the concept is expressed as a type of social identity where members of a profession categorize and differentiate themselves from other professionals\u0026nbsp;[7]\u0026nbsp;and think, feel, and behave like members of their own profession\u0026nbsp;[8].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In medical education, a stronger professional identity is associated with several factors, such as academic motivation\u0026nbsp;[9]\u0026nbsp;and higher preparedness for practice\u0026nbsp;[10]. Furthermore, gender, previous work experience in health \u0026amp; social care services, understanding of teamwork, knowledge of the profession, and cognitive flexibility have been found to contribute to professional identity scores among first-year health \u0026amp; social care students\u0026nbsp;[4]\u0026nbsp;although later studies of paramedic students\u0026nbsp;[11]\u0026nbsp;and first-year German medical students\u0026nbsp;[12]\u0026nbsp;did not confirm these findings. The actual evolvement of professional identities and their association with academic progression within higher education is, however, less studied. It could be expected that professional identity increases over time. However, only a slight increase has been identified in previous single-profession studies on Indonesian medical students\u0026nbsp;[9], and in Australian paramedic students\u0026nbsp;[11]. One review even found declining professional identity scores across studies of Chinese nursing students\u0026nbsp;[13]. No cross-sectional studies on professional identity evolvement among students from multiple health \u0026amp; social care educational programmes have been identified.\u003c/p\u003e\n\u003cp\u003eInterprofessional identity formation has been defined as \u0026ldquo;the development of a robust cognitive, psychological and emotional sense of belonging to an interprofessional community, necessary to achieve shared context-dependent goals\u0026rdquo;\u0026nbsp;[14]. It is based on a broader circle of group membership consisting of more than one profession and is said to be a concept superordinate to professional identity\u0026nbsp;[15,16]. Underpinned by the interprofessional socialisation framework provided by Khalili et al.\u0026nbsp;[17,18], supported by qualitative findings by Woltenberg et al.\u0026nbsp;[19], it has been suggested that interprofessional identity develops further from professional identity, and thus depends on a prior identification with a specific profession.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt has been argued that professional identity formation requires enough time and space to ensure students achieve confidence in practising their profession\u0026nbsp;[20,21]\u0026nbsp;and that a delay in professional identity formation potentially hampers a successful transition from student to practitioner\u0026nbsp;[22]. Nevertheless, a sound professional identity appears to develop in interprofessional learning situations where the students experience and discern their professional roles by interacting with other professional groups\u0026nbsp;[23]. Either way, educational institutions are responsible for nurturing both identities. Thus, knowledge about how they develop during the students\u0026rsquo; professional education can be helpful for designing apt curricula. Previous reviews on professional\u0026nbsp;[3]\u0026nbsp;and interprofessional identity\u0026nbsp;[14]\u0026nbsp;have called for studies investigating the assumption that professional and interprofessional identities evolve differently during educational programmes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHence, the overall aim of the present study was to investigate the development of health \u0026amp; social care students\u0026rsquo; professional- and interprofessional identities during professional education in general, and among students in three-year bachelor- and six-year professional study programmes.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a cross-sectional study that collected\u0026nbsp;data from health \u0026amp; social care students by means of a web-based questionnaire. The study was approved by the privacy officer (Norwegian Agency for Shared Services in Education and Research (SIKT), ref. 701327). All students received written information about the purpose of the study, how data was stored and protected, and that they consented to participate by submitting the questionnaire. The study was also approved by the department managements, including the relevant deans, to assure legitimacy of data collection among students, who tend to be overloaded with invitations to participate in research studies. The data were collected in the spring of 2022.\u003c/p\u003e\n\u003ch2\u003eSetting\u003c/h2\u003e\n\u003cp\u003eThe study was conducted at the Norwegian University of Science and Technology (NTNU), which\u0026nbsp;has a total of 40,000 students across all types of programmes, and 13 different\u0026nbsp;health- \u0026amp; social care study programmes. For most of these programmes, the grade requirements for admission from high school are the highest or among the highest in the country. In total, the\u0026nbsp;health \u0026amp; social care study programmes have approximately 4,800 students.\u0026nbsp;The learning outcomes for all these study programmes follow national regulations.\u003c/p\u003e\n\u003ch2\u003eParticipants and recruitment\u003c/h2\u003e\n\u003cp\u003eThe study aimed to include students from\u0026nbsp;all\u0026nbsp;study years\u0026nbsp;from all the health \u0026amp; social care study programmes at NTNU. Programmes with no graduates in 2021 or that did not offer the full programme leading to authorization, were excluded. This meant that two of the 13 study programmes were excluded: paramedic, as the study programme started enrolling students in 2021, and pharmacy, which is only offered as a two-year master\u0026apos;s programme for students who\u0026nbsp;hold a bachelor from another institution. The final sample of study programmes consisted of students in audiology, bioengineering, child welfare, medicine, nursing, occupational therapy, physiotherapy, psychology, radiography, social education, and social work.\u003c/p\u003e\n\u003cp\u003eTo recruit participants, all eligible students were invited to participate by e-mail with a link to the questionnaire. Some students were provided information and time to complete the questionnaire in a break or immediately after a lecture. A reminder was sent within three weeks. The questionnaire was available for three months because students in different study programmes did not get the information at identical points in time, mainly due to the timing of their practice placements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere are some differences in the amount of interprofessional educational activities across programmes. All 3\u003csup\u003erd\u003c/sup\u003e year students participate in a two-day, on campus activity focusing on learning about other professions and coordination in health and social care. All last-year students participate in an eight-hours collaborative team-based practice placement on interprofessional assessment of a service user. In addition, some study programmes have some minor interprofessional activities. Audiology, bioengineering, psychology, and radiography students have a 7.5 credits (ECTS) interprofessional longitudinal course which includes the two aforementioned activities. These two activities are also part of a joint 3\u003csup\u003erd\u003c/sup\u003e year course of 15 credits (ECTS) for child welfare and social work students. Medicine and psychology students have a 7.5 credits (ECTS) interprofessional teamwork course, which includes all five- and six-year professional study programmes at NTNU.\u003c/p\u003e\n\u003ch2\u003eData Collection and variables\u003c/h2\u003e\n\u003cp\u003eThe digital questionnaire was made available in the secure survey tool nettskjema.no, developed by the University of Oslo, Norway. The questionnaire consisted of questions about the participants and their parents/guardians, educational characteristics, and a battery of questions for assessment of professional and interprofessional identity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipant and educational characteristics included age, gender, study programme and year, whether the current study programme was their first priority, whether they had been studying at university level before the current programme, and whether they had worked in health \u0026amp; social care before or during their studies (yes/no). Moreover, questions about whether parents/guardians had been working in health \u0026amp; social care, and whether any of them had any tertiary level education (yes/no), were included in the questionnaire.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe length of study programmes was coded as three-years bachelor- (audiology, bioengineering, child welfare, nursing, occupational therapy, physiotherapy, radiography, social education, and social work), and six-year professional study programmes (medicine and psychology).\u003c/p\u003e\n\u003cp\u003eAs a variable representing development during professional education, \u0026lsquo;academic progression\u0026rsquo; was operationalised by recoding the variable \u0026lsquo;year of study\u0026rsquo;\u0026nbsp;(1\u003csup\u003est\u003c/sup\u003e\u0026ndash;3\u003csup\u003erd\u003c/sup\u003e year for the bachelor studies or 1\u003csup\u003est\u003c/sup\u003e\u0026ndash;6\u003csup\u003eth\u003c/sup\u003e year for the six-year programmes of professional studies) into three categories: 1\u003csup\u003est\u003c/sup\u003e year, midway (2\u003csup\u003end\u003c/sup\u003e year for the three-years bachelor studies, and 2\u003csup\u003en\u003c/sup\u003e \u0026ndash;5\u003csup\u003eth\u003c/sup\u003e year for the six-year programmes of professional studies), and final year.\u003c/p\u003e\n\u003cp\u003eThe battery of questions for assessing students\u0026apos; perceptions of their professional and interprofessional identities was The Macleod Clark Professional Identity Scale (MCPIS-9) [4] using \u003cem\u003ethis profession\u003c/em\u003e and \u003cem\u003ethe\u0026nbsp;\u003c/em\u003e\u003cem\u003ehealth- \u0026amp; social care professions,\u003c/em\u003e respectively. MCPIS-9 is a 9-item, 5-point balanced Likert scale with the endpoints 1 (strongly disagree) and 5 (strongly agree).\u0026nbsp;A mean score across the items for those with more than 50% responses was calculated (range 1 to 5), with a higher score indicating higher professional or interprofessional identity. The scale was developed to measure professional identity in health \u0026amp; social\u0026nbsp;care students and has previously been shown to have good psychometric properties\u0026nbsp;[24]. Previous tests have found the MCPIS-9 to have a reliability score (Cronbach\u0026rsquo;s alpha) of 0.79\u0026nbsp;[4]\u0026nbsp;and 0.78\u0026nbsp;[25]. The MCPIS-9 was translated for this study from English to Norwegian through a back and forward process, including three researchers\u0026rsquo; individual forward translations followed by joint translation and a backward translation by two external colleagues before adjustments and the final approval from the research group.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAnalyses\u003c/h2\u003e\n\u003cp\u003eAs there were only negligible differences between the development of professional and interprofessional identities for the whole sample and students on three-year bachelor\u0026apos;s and six-year professional study programmes separately, only a graphical presentation of the analysis of three-year bachelor\u0026apos;s and six-year professional study programmes is provided.\u003c/p\u003e\n\u003cp\u003eThe characteristics of the whole sample is presented with frequencies, means and standard deviations. The same is done to present scores on each statement and identity score for subgroups. To compare professional and\u0026nbsp;interprofessional identity, two-sample t-tests, presented with mean difference and 95% confidence intervals (95% CI), was used.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo analyse the development of professional and interprofessional identity during professional education, we built two multivariate regression models. Here, the dependent variables were professional identity and interprofessional identity; academic progression was the independent variable with adjustment for the variables gender, age, parents/guardians with higher education, parents/guardians working in health \u0026amp; social care , the student worked in health \u0026amp; social care before the study, and the student had study programme as first choice. The results of the multivariable analyses are presented with adjusted coefficients (adj. coeff.) and 95% CIs. The IBM Statistical Package for Social Sciences (SPSS) version 28.0.1.0 (142) was used for all analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs there were only negligible differences between the development of professional and interprofessional identities for the whole sample and students on three-year bachelor\u0026apos;s and six-year professional study programmes separately, only a graphical presentation of the analysis of three-year bachelor\u0026apos;s and six-year professional study programmes is provided.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn sum, 864 students (approximately one-fifth of the study population) from 11 programmes completed the questionnaire. Their mean age was 23.9 years (standard deviation 4.1, median 23), and three in four were women (Table 2). One in five of the students were in their first year. Students in medicine, physiotherapy and nursing totalled two-thirds of all the respondents.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1\u0026nbsp;Characteristics of responders. N (%) of the responders within each category. N=864\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cp\u003eAcademic progression\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003csup\u003est\u0026nbsp;\u003c/sup\u003eyear student\u0026nbsp;\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e166 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Midway student (2\u003csup\u003end\u003c/sup\u003e or 2\u003csup\u003end\u003c/sup\u003e-5\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e416 (48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Final-year student (3\u003csup\u003erd\u003c/sup\u003e or 6\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e278 (32.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eWomen\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e668 (77.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMen\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e190 (22.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNon-binary/no answer\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e4 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cp\u003eAge group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026lt;21\u0026nbsp;\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e219 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;22-23\u0026nbsp;\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e271 (31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;24-25\u0026nbsp;\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e184 (21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026gt;25\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e186 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cp\u003eParents/guardians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Have higher education\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e706 (81.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Work within H\u0026amp;S care\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e366 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cp\u003eThe student\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Worked in H\u0026amp;S care before studying\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e453 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;The study programme was the first choice\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e796 (92.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e\n \u003cp\u003eStudy programme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Audiology\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e1 (0.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Bioengineering\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e46 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Child welfare\u0026nbsp;\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e29 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Medicine\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e315 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Nursing\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e101 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Occupational therapy\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e7 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Physiotherapy\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e150 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Psychology\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e43 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Radiography\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e83 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Social education\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e62 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75.7576%;\"\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Social work\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.2424%;\"\u003e\n \u003cp\u003e26 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eScores on each statement and mean identity score\u003c/h2\u003e\n\u003cp\u003eThe variation in scores between the statements used to measure professional- and interprofessional identity was small, ranging from 3.6 to 4.6 on the 1\u0026ndash;5 scale (Table 3). Similarly, there were only minor differences (maxim difference of 0.2) between each statement on the professional and interprofessional identity scale (Table 3). The mean scores across all statements were 4.15 and 4.17 for professional- and interprofessional identity, respectively.\u003c/p\u003e\n\u003cp\u003eTable 2. Scores for each statement and mean score across all statements for professional and interprofessional identity. \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatement\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional identity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterprofessional identity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifference\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI feel like I am a member of this profession/the H\u0026amp;S care professions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.0 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.2 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.19 (0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI feel I have strong ties with\u0026nbsp;members of this profession/H\u0026amp;S care professions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.6 (0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.6 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.02 (1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI am often ashamed to admit that I am studying for this profession/ H\u0026amp;S care professions*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.5 (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.5 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.08 (0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI find myself making excuses for belonging to this profession/H\u0026amp;S care professions*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.4 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.5 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.18 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI try to hide that I am studying to be part of this profession/ H\u0026amp;S care professions*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.6 (0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.6 (0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.07 (0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI am pleased to belong to this profession/H\u0026amp;S care professions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.4 (0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.3 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.10 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI can identify positively with members of this profession/H\u0026amp;S care professions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.3 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.1 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBeing a member of this profession is important to me/H\u0026amp;S care professions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.9 (0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.8 (0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.05 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI feel I share characteristics with other members of the profession/ H\u0026amp;S care\u0026nbsp;professions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.9 (0.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.8 (0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.05 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003escore\u003c/em\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;across all statements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e4.15 (0.54)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e4.17 (0.53)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e-0.02 (0.41)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Statements were phrased negatively but are reversed here to give all the statements the same direction.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eDescription of changes in identity score during professional education\u003c/h2\u003e\n\u003cp\u003eThere was a slight but marked increase in the students\u0026rsquo; professional identity during professional education (0.19 points, p\u0026lt;0.001) and a similar but weaker tendency for interprofessional identity (0.11 points, p=0.075) (Table3). There was a slight difference between the two identity scores, where the interprofessional identity score was highest, except for the final year, where the scores were similar.\u003c/p\u003e\n\u003cp\u003eTable 3. Professional and interprofessional identity scores with difference during professional education (academic progression).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9003%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic progression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.97674%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2625%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional identity score (N=860)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4319%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterprofessional identity score (N=855)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifference\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=855)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9003%;\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.97674%;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2625%;\"\u003e\n \u003cp\u003e4.04 (3.95\u0026nbsp;to\u0026nbsp;4.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4319%;\"\u003e\n \u003cp\u003e4.10 (4.01\u0026nbsp;to\u0026nbsp;4.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e-0.06 (-0.13\u0026nbsp;to\u0026nbsp;0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9003%;\"\u003e\n \u003cp\u003eMidway (2\u003csup\u003end\u003c/sup\u003e or 2\u003csup\u003end\u003c/sup\u003e-5\u003csup\u003eth\u003c/sup\u003e year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.97674%;\"\u003e\n \u003cp\u003e411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2625%;\"\u003e\n \u003cp\u003e4.13 (4.08\u0026nbsp;to\u0026nbsp;4.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4319%;\"\u003e\n \u003cp\u003e4.16 (4.11\u0026nbsp;to\u0026nbsp;4.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e-0.03 (-0.07\u0026nbsp;to\u0026nbsp;0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9003%;\"\u003e\n \u003cp\u003eFinal year (3\u003csup\u003erd\u003c/sup\u003e or 6\u003csup\u003eth\u003c/sup\u003e year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.97674%;\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2625%;\"\u003e\n \u003cp\u003e4.23 (4.17\u0026nbsp;to\u0026nbsp;4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.4319%;\"\u003e\n \u003cp\u003e4.21 (4.15\u0026nbsp;to\u0026nbsp;4.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.4286%;\"\u003e\n \u003cp\u003e\u0026nbsp;0.02 (-0.03\u0026nbsp;to\u0026nbsp;0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eMultivariate analyses of changes in identity score during professional education\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eAdjusted for other variables (gender, age, parents/guardians with higher education, parents/guardians working in health \u0026amp; social care, the student worked in health \u0026amp; social care before the study, and the student had study programme as first choice) the multivariate analyses gave similar results as the descriptive analysis. Last-year students had a mean professional identity score that was 0.18 (95% CI 0.07 to 0.30, p=0.001) higher than the scores of 1st year students (Table 4), while the scores for interprofessional identity was 0.10 (95% CI -0.01 to 0.21, p=0.075) higher (Table 5).\u003c/p\u003e\n\u003cp\u003eTable 4 Multivariate analysis of academic progression and professional identity adjusted for other variables.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 56.5657%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean score (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj. coeff. (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic progression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e- 1\u003csup\u003est\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.04 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e- Midway (2\u003csup\u003end\u003c/sup\u003e or 2\u003csup\u003end\u003c/sup\u003e-5\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.13 (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e0.07 (-0.02\u0026nbsp;to\u0026nbsp;0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e- Last-year (3\u003csup\u003erd\u003c/sup\u003e or 6\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.23 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e0.18 (0.07\u0026nbsp;to\u0026nbsp;0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjustment variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.14 (0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e-0.03 (-0.11\u0026nbsp;to\u0026nbsp;0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003eAge group:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e- Age 21 years and younge\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.10 (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e- Age 22-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.12 (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e0.05 (-0.15\u0026nbsp;to\u0026nbsp;0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e- Age 24-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.17 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e-0.01 (-0.11\u0026nbsp;to\u0026nbsp;0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003e- Age 26 years and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.20 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e-0.01 (-0.12\u0026nbsp;to\u0026nbsp;0,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003eParents/guardians with higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.13 (0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e-0.07 (-0.16\u0026nbsp;to\u0026nbsp;0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003eParents/guardians work in H\u0026amp;S care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.15 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e0.02 (-0.06\u0026nbsp;to\u0026nbsp;0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003eStudent worked in H\u0026amp;S care before study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.18 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e0.08 (0.00\u0026nbsp;to\u0026nbsp;0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 43.4343%;\"\u003e\n \u003cp\u003eStudent had study programme as 1\u003csup\u003est\u003c/sup\u003e choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.1818%;\"\u003e\n \u003cp\u003e4.17 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.2323%;\"\u003e\n \u003cp\u003e0.36 (0.23\u0026nbsp;to\u0026nbsp;0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.1515%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 Multivariable analyses of academic progression and interprofessional identity adjusted for other variables.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 57%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterprofessional identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean score (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj. coeff. (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic progression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e- 1\u003csup\u003est\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.10 (0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e- Midway (2\u003csup\u003end\u003c/sup\u003e or 2\u003csup\u003end\u003c/sup\u003e-5\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.16 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e0.05 (-0.05\u0026nbsp;to\u0026nbsp;0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e- Last year (3\u003csup\u003erd\u003c/sup\u003e or 6\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.21 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e0.10 (-0.01\u0026nbsp;to\u0026nbsp;0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjustment variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.18 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e0.07 (-0.02\u0026nbsp;to\u0026nbsp;0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003eAge group:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e- Age 21 years and younge\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.16 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e- Age 22-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.10 (0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e-0.09 (-0.17\u0026nbsp;to\u0026nbsp;0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e- Age 24-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.18 (0.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e-0.01 (-0.12\u0026nbsp;to\u0026nbsp;0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003e- Age 26 years and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.25 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e0.04 (-0.07\u0026nbsp;to\u0026nbsp;0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003eParents/guardians with higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.15 (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e-0.06 (-0.16\u0026nbsp;to\u0026nbsp;0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003eParents/guardians work in H\u0026amp;S care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.18 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e0.03 (-0.05\u0026nbsp;to\u0026nbsp;0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003eStudent worked in H\u0026amp;S care before study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.17 (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e0.02 (-0.05\u0026nbsp;to\u0026nbsp;0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42%;\"\u003e\n \u003cp\u003eStudent had study programme as 1\u003csup\u003est\u003c/sup\u003e choice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22%;\"\u003e\n \u003cp\u003e4.19 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24%;\"\u003e\n \u003cp\u003e0.23 (0.10\u0026nbsp;to\u0026nbsp;0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eMultivariable analysis of changes in differences in identity score during education\u003c/h2\u003e\n\u003cp\u003eThe multivariable analysis showed that the professional identity score was 0.08 (95% CI 0.00 \u0026ndash; 0.17, p=0.058) higher than the interprofessional identity score when comparing all last year to all 1\u003csup\u003est\u003c/sup\u003e year students (Table 6). Thus, the students\u0026rsquo; professional identity score increased by a mean of 0.08 points more than the interprofessional identity score during professional education.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;6\u0026nbsp;Multivariable analysis of difference in professional and interprofessional identity.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifference between professional and interprofessional identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean difference (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj. coeff. (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic progression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e- 1\u003csup\u003est\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.06 (0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e- Midway (2\u003csup\u003end\u003c/sup\u003e or 2\u003csup\u003end\u003c/sup\u003e-5\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.03 (0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.02 (-0.05\u0026nbsp;to\u0026nbsp;0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e- Last year (3\u003csup\u003erd\u003c/sup\u003e or 6\u003csup\u003eth\u003c/sup\u003e year)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.02 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.08 ( 0.00\u0026nbsp;to\u0026nbsp;0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjustment variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.04 (0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.09 (-0.16\u0026nbsp;to\u0026nbsp;-0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eAge group:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e- Age 21 years and younge\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.04 (0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eREF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e- Age 22-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.01 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.04 (-0.04\u0026nbsp;to\u0026nbsp;0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e- Age 24-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.01 (0.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.01 (-0.07\u0026nbsp;to\u0026nbsp;0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e- Age 26 years and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.05 (0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.04 (-0.13\u0026nbsp;to\u0026nbsp;0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eParents/guardians with higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.02 (0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.00 (-0.08\u0026nbsp;to\u0026nbsp;0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eParents/guardians work in H\u0026amp;S care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.03 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.01 (-0.07\u0026nbsp;to\u0026nbsp;0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStudent worked in H\u0026amp;S care before study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.01 (0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.06 (0.00\u0026nbsp;to\u0026nbsp;0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStudent had study programme as 1\u003csup\u003est\u0026nbsp;\u003c/sup\u003echoice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.01 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.13 (0.03\u0026nbsp;to\u0026nbsp;0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003eIdentity scores for three-year bachelor- and six-year professional studies\u003c/h2\u003e\n\u003cp\u003eAs stated in the analysis, when dividing students in three-year bachelor- and six-year professional study programmes, there was no clear difference from the analysis of the whole group together. Therefore, only a graphical presentation of the differences between the two length of studies is provided (Figure 1).\u003c/p\u003e\n\u003cp\u003eProfessional identity increased for students in three-years bachelor studies (0.17 points, p=0.034) and six-year professional study programmes (0.30 points, p=0.022). However, this was less clear for interprofessional identity (0.08 points, p=0.386 and 0.24 points, p=0.049, respectively). For both bachelor students and students in the six-year professional study programmes, the interprofessional identity score was higher in the first part of their education, while the professional identity scores were higher at the end.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe professional- and interprofessional identity scores were almost the same among first-year students and only showed a slight increase during professional education. The increase was somewhat larger for the professional than the interprofessional identity score. The same pattern was evident when looking at three-year bachelor- and the six-year professional study programmes separately. Thus, the overall finding was that health \u0026amp; social care students have a high professional and interprofessional identity score from the start, and there are only minor changes curing the professional education with professional identity being the one that increases the most.\u003c/p\u003e\n\u003ch2\u003eProfessional identity\u003c/h2\u003e\n\u003cp\u003eThe main finding indicates a small yet noticeable increase in students’ professional identity during professional education. This was also evident when looking at students in the three-years bachelor- and the six-year professional study programmes separately.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilar results have been reported in studies of professional identity in Indonesian medical students\u0026nbsp;[9]\u0026nbsp;and in Australian paramedic students\u0026nbsp;[11]. Both studies applied the same MCPIS-9 scale as in the present study. These studies reported the MCPIS-9 score as the sum of the statements rather than the mean. Among the medical students, there was an increase in identity scores from the early to late study phases (35.75 to 40.7 (p\u0026lt;0.05)), and among the paramedic students, a somewhat smaller increase was found from the first to the last year of study (37.8 to 40.7 (p=0.066)). Studies of nursing students in China included in a review by Mao et al.\u0026nbsp;[13]\u0026nbsp;have reported a decline in professional identity from Freshmen to Senior students. However, restricted access to relevant Chinese journals renders the instruments used in professional identity assessments unknown.\u003c/p\u003e\n\u003cp\u003eThe professional identity score was 4.0 on the 1–5 scale among first-year students in our study, which can be considered a high score. The high scores in first-year students might be due to these students having a sense of professional identity before they begin their studies. Adams et al.\u0026nbsp;[4]\u0026nbsp;and Roberts et al.\u0026nbsp;[26]\u0026nbsp;also found that health \u0026amp; social care students report a high level of professional identity when they start their academic professional education, supporting our interpretations. Generally, this could mean that professional identity formation might occur before or during the process when the students decide which study programme to enrol in, as suggested by Kahili\u0026nbsp;[17]. As proposed by Mao et al.\u0026nbsp;[13], it might also be that first-year students have an ideal image of the profession in which they get educated.\u003c/p\u003e\n\u003cp\u003eAn alternative explanation to our and other studies’ findings of a relatively high professional identity among first-year students could be that the first-year students answered the questionnaire on professional identity in the spring term, i.e. after they had completed at least half to two-thirds of the first year. If they had completed the questionnaire immediately before or after the first day of their programme and reported a low professional identity, the observed high professional identity would be due to changes during the first part of the first year of studies. Such results would mean that students in their first year of study gain ample professional knowledge, values, and attitudes to identify with their profession almost as much as the soon-to-be graduates. Neither Johnston et al.\u0026nbsp;[11]\u0026nbsp;nor Mao et al.\u0026nbsp;[13]\u0026nbsp;have reported the timing of data collection from first-year students. Roberts et al.\u0026nbsp;[26]\u0026nbsp;collected professional identity data on first-year students at the end of the first semester and found professional identity scores equal to those of first-year students in the present study. These findings give reasons to call for further studies investigating professional identity development during the first year of study.\u003c/p\u003e\n\u003ch2\u003eInterprofessional and professional identity\u003c/h2\u003e\n\u003cp\u003eThe interprofessional identity scores were similar to the professional identity scores, and the topics raised in the discussion above about professional identity are also relevant to interprofessional identity. Thus, repeating them is redundant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, it is noteworthy that the students’ interprofessional identity score was slightly higher than their professional identity up to the end of the education. Based on the conceptualisation of Reiners\u0026nbsp;[16]\u0026nbsp;and the assumption embedded in the socialisation framework of Kahili et al.\u0026nbsp;[17,18]\u0026nbsp;that interprofessional identity develops further from professional identity, it was reasonable to expect that interprofessional identity scores would be lower than professional identity scores among the first-year students and also show a steeper increase. However, this was not the case even though all students in the present study, including the final stage students, had attended several interprofessional education programmes, which have shown to affect the level of interprofessional identity\u0026nbsp;[18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAn alternative interpretation might be that it is less complicated for students in their first year to ‘identify with a broader circle of group membership consisting of more than one profession’\u0026nbsp;[16]\u0026nbsp;(i.e. interprofessional identity) than to be able ‘to categorize and differentiate themselves from other professionals’\u0026nbsp;[7]\u0026nbsp;and ‘think, feel and behave like members of their profession’\u0026nbsp;[8] (I,e, professional identity). Such an idea would mean that new students have a higher sense of identity with the group of professions rather than the specific profession they have chosen to educate themselves into. Thus, rather than developing an interprofessional identity from a professional identity base, the interprofessional identity is the foundation from which the professional identity develops. Further studies are needed to clarify this.\u003c/p\u003e\n\u003cp\u003eThe identity scale used, MCPIS-9, had not been validated for assessing interprofessional identity. However, only modest changes were made to the original statements, with the term \u003cem\u003eprofession\u003c/em\u003e replaced with \u003cem\u003ehealth- and social care professions\u003c/em\u003e. One possible interpretation is that the insignificant differences in the scores between the two identities could be due to the students not noticing the difference. It could also mean that they consider their profession and the group of professions similar. Still, there were some differences, indicating that the respondents perceived the two versions differently.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs discussed above, the timing of the data collection may have influenced the interprofessional identity scores. Although first-year students are early in being socialized into the health and social care professions, their prior knowledge about these professional groups, in addition to the interprofessional learning programmes, may have shaped a level of interprofessional identity that makes it difficult to distinguish them from advanced students in terms of interprofessional identification.\u003c/p\u003e\n\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\n\u003cp\u003eThe present study is the first cross-sectional study providing quantitative data on changes in both students professional and interprofessional identity during professional education. It is also the largest study, with students from all study years of eleven health \u0026amp; social care study programmes. The results are therefore important to increase the knowledge of health \u0026amp; social care students’ development of professional and interprofessional identity during professional education.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe measurement used, the MCPIS-9 scale, has been validated and used in several studies. Still, it can be questioned if it is sensitive to change as only slight differences have been found between first and final-year students in all identified studies. The arguments for the measurement being sensitive to change despite studies finding only slight differences, would be that the students’ identity is stable during professional education. Thus, more research is needed, including the use or development of other measures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study investigated the professional and interprofessional identity of different groups of students, which could mean that the observed differences could be due to a cohort effect. I.e., that students who were in their last year of study also would have scored higher on identity if they were asked as first year students compared to those who were in their first year when they participated. A longitudinal study that follows the same students during their whole education could thus yield different results and avoid the cohort effect.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAcross health \u0026amp; social care students from eleven different professional educational programmes, there was a slight yet noticeable increase in the students\u0026rsquo; professional identity during professional education and a tendency for the same for interprofessional identity. Still, the professional identity score showed a minor but steeper increase during professional education compared to the interprofessional identity score. These findings can be due to the students having a relatively high professional and interprofessional identity before starting a health or social care study programme. However, shortcomings, such as a lack of sensitivity to change in measuring identity, cannot be ruled out.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe study was assessed as not subject to notification by the Norwegian Regional Committees for Medical and Health Research Ethics ((REK) ID: 423598). The study was approved by the Norwegian Agency for Shared Services in Education and Research ((SIKT), ref. 701327)). All students received written information about the study, and that we had obtained informed consent to participate by submitting the digital questionnaire.\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the privacy officer (Norwegian Agency for Shared Services in Education and Research (SIKT), ref. 701327).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eThe study was conceived and designed by RS, CT, HG, AR, BA, RJ, and AS. Data collection were organised by RS, HG, AR, BA, and RJ. Initial analyses were performed by CT; further analyses were undertaken by RS and AS. The manuscript was drafted by RS and AS. Subsequent drafts were commented on by CT, HG, AR, BA, RJ. All authors have approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eArndt J, King S, Suter E, Mazonde J, Taylor E, Arthur N. Socialization in health education: Encouraging an integrated interprofessional socialization process. J Allied Health. 2009 Mar 1;38(1):18-23.\u003c/li\u003e\n \u003cli\u003eHolden MD, Buck E, Luk J, Ambriz F, Boisaubin EV, Clark MA, Mihalic AP, Sadler JZ, Sapire KJ, Spike JP, Vince A. Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education). Acad Med. 2015 Jun 1;90(6):761-7.\u003c/li\u003e\n \u003cli\u003eCornett M, Palermo C, Ash S. Professional identity research in the health professions\u0026mdash;a scoping review. Adv Health Sci Educ. 2023;28(2):589-642.\u003c/li\u003e\n \u003cli\u003eAdams K, Hean S, Sturgis P, Clark JM. Investigating the factors influencing professional identity of first‐year health and social care students. Learn Health Soc Care. 2006 Jun;5(2):55-68.\u003c/li\u003e\n \u003cli\u003eWilson I, Cowin LS, Johnson M, Young H. Professional identity in medical students: pedagogical challenges to medical education. Teach Learn Med. 2013;25(4):369-73.\u003c/li\u003e\n \u003cli\u003eWald HS. Professional identity (trans) formation in medical education: reflection, relationship, resilience. Acad Med. 2015;90:701-6.\u003c/li\u003e\n \u003cli\u003eMcNeil KA, Mitchell RJ, Parker V. Interprofessional practice and professional identity threat. Health Sociol Rev. 2013;22(3):291-307.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCoster S, Norman I, Murrells T, Kitchen S, Meerabeau E, Sooboodoo E, d\u0026rsquo;Avray L. Interprofessional attitudes amongst undergraduate students in the health professions: A longitudinal questionnaire survey. Int J Nurs Stud. 2008;45(11):1667-81.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWasityastuti W, Susani YP, Prabandari YS, Rahayu GR. Correlation between academic motivation and professional identity in medical students in the Faculty of Medicine of the Universitas Gadjah Mada Indonesia. Educ Med. 2018;19(1):23-9.\u003c/li\u003e\n \u003cli\u003eChaou CH, Yu SR, Chang YC, Ma SD, Tseng HM, Hsieh MJ, Fang JT. The evolution of medical students\u0026rsquo; preparedness for clinical practice during the transition of graduation: a longitudinal study from the undergraduate to postgraduate periods. BMC Med Educ. 2021;21(1):1-9.\u003c/li\u003e\n \u003cli\u003eJohnston T, Bilton N. Investigating paramedic student professional identity. Australas J Paramed. 2020;17.\u003c/li\u003e\n \u003cli\u003eFaihs V, Heininger S, McLennan S, Gartmeier M, Berberat PO, Wijnen-Meijer M. Professional identity and motivation for medical school in first-year medical students: a cross-sectional study. Med Sci Educ. 2023;33(2):431-41.\u003c/li\u003e\n \u003cli\u003eMao A, Lu SE, Lin Y, He M. A scoping review on the influencing factors and development process of professional identity among nursing students and nurses. J Prof Nurs. 2021;37(2):391-8.\u003c/li\u003e\n \u003cli\u003eTong R, Brewer M, Flavell H, Roberts L. Professional and interprofessional identities: a scoping review. J Interprof Care. 2020:1-9.\u003c/li\u003e\n \u003cli\u003eReinders JJ. Task shifting, interprofessional collaboration and education in Oral Health Care [Doctoral dissertation]. Groningen, the Netherlands: University of Groningen; 2018.\u003c/li\u003e\n \u003cli\u003eReinders JJ, Krijnen WP, Goldschmidt AM, van Offenbeek MA, Stegenga B, van der Schans CP.\u0026nbsp;Changing dominance in mixed profession groups: putting theory into practice. Eur J Work Organ Psychol. 2018;27(3):375-86.\u003c/li\u003e\n \u003cli\u003eKhalili H, Orchard C, Laschinger HKS, Farah R. An interprofessional socialization framework for developing an interprofessional identity among health professions students. J Interprof Care. 2013;27(6):448-53.\u003c/li\u003e\n \u003cli\u003eKhalili H, Orchard C. The effects of an IPS-based IPE program on interprofessional socialization and dual identity development. J Interprof Care. 2020:1-11.\u003c/li\u003e\n \u003cli\u003eWoltenberg LN, Ballard JA, Gnonhossou DA, Norton JC, Burkhart PV, Kuperstein J. Interprofessional identity development within a brief shadowing experience: An exploratory case study. J Interprof Care. 2019:1-10.\u003c/li\u003e\n \u003cli\u003eWakefield A, Boggis C, Holland M. Team working but no blurring thank you! The importance of team work as part of a teaching ward experience. Learn Health Soc Care. 2006;5(3):142-54.\u003c/li\u003e\n \u003cli\u003eBaker L, Egan-Lee E, Martimianakis MA, Reeves S. Relationships of power: implications for interprofessional education. J Interprof Care. 2011;25(2):98-104.\u003c/li\u003e\n \u003cli\u003eSchwertner RM, Pinkston D, O\u0026rsquo;Sullivan P, Denton B. Transition from student to physical therapist: Changes in perceptions of professional role and relationship between perceptions and job satisfaction. Phys Ther. 1987;67(5):695-701.\u003c/li\u003e\n \u003cli\u003eCarpenter J, Dickinson H. Interprofessional education and training. Policy Press; 2016.\u003c/li\u003e\n \u003cli\u003eMatthews J, Bialocerkowski A, Molineux M. Professional identity measures for student health professionals \u0026ndash; a systematic review of psychometric properties. BMC Med Educ. 2019;19(1):308.\u003c/li\u003e\n \u003cli\u003eCowin LS, Johnson M, Wilson I, Borgese K. The psychometric properties of five Professional Identity measures in a sample of nursing students. Nurse Educ Today. 2013;33(6):608-13\u003c/li\u003e\n \u003cli\u003eRoberts LD, Davis MC, Radley-Crabb HG, Broughton M. Perceived relevance mediates the relationship between professional identity and attitudes towards interprofessional education in first-year university students. J Interprof Care. 2018;32(1):33-40.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Profession, identity formation, interprofessional identity, higher education, health \u0026 social care, students, cross-sectional","lastPublishedDoi":"10.21203/rs.3.rs-5389892/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5389892/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Knowledge about the development of professional and interprofessional identity can be used in health \u0026amp; social education institutions to design apt curricula. However, the theoretical assumption for the development lacks solid empirical evidence. The purpose of the study was to examine the development of health \u0026amp; social care students’ professional- and interprofessional identities during professional education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eIn this cross-sectional study, all students at all levels from eleven health \u0026amp; social care higher education programmes were included and completed a web-based questionnaire. The Macleod Clark Professional Identity Scale (MCPIS-9) was used to assess both professional and interprofessional identity. Analysis was performed using two-sample t-tests and multivariable regression models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe overall scores of professional and interprofessional identity (range 1-5), were 4.15 and 4.17, respectively. There was a slight but marked increase in professional identity score from the first to the final year of study (0.18—point increase, 95% CI 0.07 to 0.30) and a similar but weaker tendency for interprofessional identity (0.10—point increase, 95% CI -0.01 to 0.21). There was also an increase in professional identity when the three-years bachelor (0.17—point increase, p=0.034) and six-year professional study programmes (0.3—point increase, p=0.022) were analysed separately. However, this was less marked for interprofessional identity (respectively 0.08—point increase, p=0.386 and 0.24— point increase, p=0.049). The professional identity score increased with a mean of .08 point more than interprofessional identity from first to last study year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Across health \u0026amp; social care students, there was a slight but visible increase in professional identity during the professional education. There was a tendency towards the same for interprofessional identity. This limited increase in professional and interprofessional identity during the course of the programmes may be due to the formation of such identity before students start their studies. However, shortcomings in the measurement of identity cannot be ruled out.\u003c/p\u003e","manuscriptTitle":"Does professional and interprofessional identity increase during professional education? A cross-sectional study of Norwegian health- and social care students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-13 09:25:19","doi":"10.21203/rs.3.rs-5389892/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c51c2dfe-0c27-4d97-aa46-5bcdfb44633e","owner":[],"postedDate":"November 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40166173,"name":"Educational Psychology"}],"tags":[],"updatedAt":"2024-11-13T09:25:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-13 09:25:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5389892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5389892","identity":"rs-5389892","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}