Interprofessional collaboration is essential for healthcare systems due to the recent global shift from the traditional patient-doctor relationship to collaborative and team-oriented approaches to patient care.¹ To enhance collaboration in future health care systems, it is necessary to increase exposure to formalized interprofessional education (IPE) across health professions during training. By definition, IPE is said to occur "when two or more professions learn with, from and about each other to improve collaboration and the quality of care".² While interprofessional collaboration is an expected competency, many undergraduate healthcare educational programs lack adequate IPE experiences.³ More recently, medical schools around the world have been incorporating it in various ways in their curricula.⁴ However, questions remain about how and when is best to educate and train students for interprofessional collaboration.

We are focusing on community-based medical education as an opportunity to uncover the potential of interprofessional collaboration. Since medical students can obtain the necessary knowledge, skills, and attitudes for medical procedures in community health care, this environment offers many opportunities for interprofessional learning.^5-8

In order to incorporate community-oriented IPE into the curriculum for medical education, the degree of preparation of a medical student's interprofessional learning in all school years must first be clarified. The Readiness for Interprofessional Learning Scale (RIPLS), developed by Parsell and Bligh,⁹ was adapted in this study and has been broadly adopted to evaluate attitudes among healthcare students toward interprofessional collaboration.^10-13 Students' attitudes toward interprofessional learning seem to be affected by multiple factors, such as generation atmosphere, current curriculum, social factors, and so on. Therefore, it is not appropriate to assess their attitudes in a single one year-survey.^3,14,15 To avoid bias due to a single year, and students were surveyed annually for three years. Differences in their attitudes in each school year as they progress through the medical curriculum should be clarified by a repeated cross-sectional study.

This study aims to investigate the readiness of medical students for interprofessional learning over three academic years and the relationship between students' attitudes toward interprofessional learning and their interest in community medicine prior to incorporating community-oriented interprofessional education into the curriculum.

There is no doubt that physicians must have the ability to collaborate with other professionals as members of the health care team. For that reason, IPE is required for medical students, and is required to be incorporated into the curriculum for medical education. In this study, a survey was given annually for three years to investigate the medical students' readiness for interprofessional learning and the relationship between students' attitude toward interprofessional learning and their interest in community medicine. Most previous studies have compared RIPLS scores before and after teaching a specific curriculum and shown an increased RIPLS after IPE. The present study was not a survey of short-term results before and after a special program, but a longitudinal survey across all school years. A student's attitude toward interprofessional learning can be influenced by several factors, so a one-year survey alone may reflect a student's transitory trends. In this study, to avoid bias due to a single year, three academic years of data were collected and analyzed together.

We found that the RIPLS score of students in year 1 was highest, followed by year 6, year 5, year 3, year 4, and year 2. Immediately after admission to medical school, students tend to be open-minded to various disciplines. This mindset in year 1 may partially explain the positive attitude towards interprofessional learning. A previous report has shown a decline in RIPLS scores after IPE from medical school matriculation.¹⁷ It has been maintained that IPE may reinforce negative beliefs about the value of learning from other health professionals.¹⁷ Research has found that students in various healthcare professions enter the university with stereotypical views of one another.¹⁸ For medical students, especially undergraduates, year 1 involves transitioning into adulthood and dealing with professional identity formation.¹⁹ This may be the reason why the RIPLS score decline in year 2. However, it is reported that RIPLS scores partially increase during the curriculum.²⁰ In our study at Nagasaki University, expectations for interprofessional collaboration are believed to have increased since year 2 by adopting the IPE program

from the lower school year. In addition to the above, participation in clinical training from year 4 may be another reason. This study showed that the RIPLS score among medical students correlates with student interest in community medicine. Students at Nagasaki University could imagine community-based medical care and comprehensive medical care on remote islands as community medicine. The change in interest in community medicine in each school year parallels the RIPLS score. However, statistically, the correlation between them is moderate in year 4 and above.

Walker and colleagues determined that there is a greater opportunity to collaborate with other professionals in community settings.²¹ Community-based clinical learning environments constitute a rich resource, whereby students can create constructive and transformative interprofessional learning experiences. In that way, students can learn the importance of collaborating with other health professionals in community-based medical education.²² Reinforcing our IPE program in a rural setting could also have an impact on students with lower interest in interprofessional learning.

The present study has several limitations. First, there is a social desirability bias. Students in the first year tend to answer questions in a manner that will be viewed favorably by others. Second, we conducted this study at a single institution. However, our student population is overall representative of most medical school populations because we follow the model core curriculum in Japan.

The curricula of medical schools are constantly being updated. It may be difficult to examine how a particular educational program could affect the attitudes of medical students with all curricula. Successive RIPLS observations could be used to assess the effectiveness of IPE throughout the curriculum. IPE programs should be adjusted to meet the demands of different students in different years of medical education and should help enhance future interprofessional collaboration.

To increase interest in community medicine, medical schools should consider the introduction of community-oriented interprofessional education into the curriculum in year 1. Community-based medical education has the potential to improve attitudes towards interprofessional cooperation in the future, which will hopefully contribute to improved patient care and increased professional satisfaction for all members of the health care team.