70 Chapter 4 students as well. This is reflected by the reduction of hierarchy in Level 3. Apparently, students feel a difference in status, considering the way they describe the feeling of ‘hierarchy’. The way students think and feel about hierarchy in clinical practice – and thus linking social capital as a result of IPE – was a remarkable finding, since there were no questions about hierarchy in the interviews. Yet many students talked about it immediately when asked about their experiences with IPC. Finally, at Level 4, some students even experience that, if they know more about each other and/or there is less hierarchy, patient care will improve. Although several quotes of students at all four levels indicate that they experience some form of ‘getting ahead’, this last level is the most desirable form, because patient care actually improves. Bonding social capital was the only form of social capital that did not appear in our interviews. This is coherent with the definition of ‘bonding social capital’: ties between individuals with that are close and strong, such as family or close friends. Furthermore, students in this study did not have a long-term relationship with each other, and thus strong and close ties could not be established. However, even though the relationships were not ongoing or longitudinal, students still experienced growth in bridging and linking social capital. This can occur because of the ‘capital’-nature of social capital: students can reinvest it in new interprofessional groups. When evaluating the other barriers and facilitators to IPC of students in clinical practice, there were also similarities found with previous studies. Visser et al. (2017) stated in a review study about barriers and facilitators to IPE that ‘feeling intimidated by doctors’ is a barrier, which is similar to the barrier ‘hierarchy’ in IPC. ‘Feelings of urgency because of a patient crisis’ is described as a facilitator by Visser et al. (2017). This seems similar to our facilitator ‘responsibility for patient’ in IPC, regarding the fact that a real patient in need – instead of a paper case description in classroom setting – stimulates students to take collaboration more seriously. The barriers and facilitators to IPC in this study can also be compared to the factors Olde Bekkink et al. (2018) found for residents in the emergency department: personal, system, interpersonal and training. The ‘personal’ factor bears a resemblance to ‘personal’ in this study, while ‘system’ is similar to this study’s ‘organisational’ factor. ‘Interpersonal’ does have similarities to ‘perceived hierarchy’ in our study, since hierarchy was one of the interpersonal factors found in the study of Olde Bekkink et al. (2018). In our study, ‘perceived hierarchy’ was the only interpersonal factor that was found. The last factor ‘training’ in the study by Olde Bekkink et al. (2018) obviously differs from our fourth factor of ‘the feeling of responsibility for a patient’. The similarity between the two factors is that students or residents described the two factors as being missed: for students there was no responsibility for a real patient in an educational setting, and for residents there was a lack of training in IPC. Students pointed these two factors out as, if present, facilitating better IPC.
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