Embedded Facilitators to Subtly Guide Learners during Sequential Variations of Complex Interprofessional Acute Care Simulations
Purpose: Use of simulation for interprofessional education (IPE) is expected to increase.(1) There are many challenges to achieving the learning objectives of high fidelity IPE simulations. Complex simulations are challenging for students. Application of content and technical skills should cover lifespan, diagnosis and other possible clinical problem-solving contexts with sufficient repetition to achieve learning goals. Students may not recall content, notice significant events or follow the simulation authors’ pre-conceived path. There are few published papers that describe experiences with methods that overcome these issues. The purpose of this simulation method is to provide subtle, inferred facilitation using embedded instructor facilitators during sequential variation of IPE simulations to achieve consistent learning objectives.
Methods/Description: During simulations, facilitators typically observe performance and then guide debriefing. If facilitators prompt or redirect during a simulation, it is often out of role, decreasing the fidelity of the simulation. To provide in-role, subtle prompting, facilitators were embedded into the simulation as either nurses, occupational therapists, clinical instructors, patients, or patient family members/care givers.
Simulations were coauthored by the interprofessional group of educators. Learning goals focused on monitoring change of health status and function during early mobilization, reporting changes and taking appropriate action with team members.
Over the 5 years of these simulations, there have been approximately 400 2nd year physical therapy student participants. Variations have included age of the patient: 2-years, teens, and adults up to 76-years. Medical diagnoses have included burns, stroke, asthma, Guillain Barre syndrome, total knee replacement, spontaneous pneumothorax, fractured fibula, and spina bifida. Patient problems included fall risk, orthostatic hypotension, chest tube function, discharge, dyspnea and distress. The TeamSTEPPS format was used for healthcare professional interactions.(2)
To keep engagement and participation of students high, there were groups of three students at each station. The students completed 3 stations of 35 minutes sequentially, out of a possible 4 stations.
Evaluation of sessions included verbal debriefing, student written reflections and facilitator feedback.
Results/Outcomes: Feedback, reflection and debriefing of students, facilitators and instructors confirmed previous studies of physical therapy student IPE simulations - that the majority were satisfied with the learning experiences and reported increased self-efficacy in interdisciplinary healthcare contexts.(3,4) In particular, Hadley et al. noted that faculty and facilitators noted improvement in student communication skills.(5)
Specific to the purpose of these simulations, Darrah et al., suggested that offering an experience only once may result in limited changes.(6) Students and facilitators in the current series noticed improved monitoring and reporting of patient status, problem solving with team members, including patients and caregivers, and confidence over the three simulations.
Conclusions/Relevance to the conference theme: Embedding facilitators in a variety of roles during high fidelity simulations provides a seamless guidance system to prompt and redirect students to achieve learning goals. Repetition of learning objectives with variation in context results in student self-efficacy in fulfilling their clinical roles according to both facilitators and learners. These methods should be studied more systematically to determine the optimal process to achieve student guided learning during IPE simulations.