116 Chapter 7 by compressing the range of data and reducing variability among participants' scores. As a result, it is challenging to detect differences or changes in the variable of interest, potentially leading to inaccurate conclusions. Consequently, ceiling effects can obscure the relationships between variables and limit the overall interpretability and generalizability of the results. Another limitation is the self-measurement tools that are used in this thesis. Although we found significant differences between the intervention and the controlled group in attainment of interprofessional competencies, the outcome is perceived attainment of competencies, not the actual performance in clinical practice. Self-measurement tools, while convenient and accessible, have a potential for bias; individuals may unintentionally or intentionally misreport data due to memory lapses, social desirability, or misunderstanding of the questions in the measurement tools. This can lead to inaccurate or unreliable data, which undermines the validity of the findings. There's also the challenge of participant compliance: not all participants may follow the measurement protocols accurately or consistently. Future research should focus on finding tools to measure actual interprofessional competencies of students in clinical practice. Several factors challenge measuring actual performance in clinical practice. Who should observe and judge student’s performance? And when observing, the observers’ paradox could be an issue. This is the situation in which the subject being observed is unintentionally influenced by the presence of the observer. How should we observe authentic behaviour? The ICCAS is a self-measurement tool, but it is also proposed to be suitable for observation and assessment in clinical practice to observe students by others than themselves. Other methods can also be considered, such as a 360-degree feedback, or video feedback after filming student’s behaviour or debriefings in which students participate. Last but not the least, the studies in this thesis were built around a small classroom intervention at one specific educational facility. We don’t know if the same results could be attained with other interventions and facilities, and with real patients in clinical practice. However, in our studies we found effects comparable to the literature about IPE, for example similar barriers and facilitators as in other research, so there seems to be some transferability to other settings. Nevertheless, it would be interesting to investigate whether the same results could be obtained in other settings. Implications & recommendations Research always raises questions for further research. In this paragraph suggestions for further research are given.
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