We won’t be silos Anymore! How A Multi-Patient Interprofessional Simulation is Designed to Change Practice
Interprofessional education (IPE) is recommended as a standard in the education of pre-healthcare professionals. Research demonstrates that purposefully integrating training programs for interprofessional education (IPE) may produce better patterns of communication and collaboration among healthcare team members.1-3 Furthermore, the Institute of Medicine (IOM) Committee on Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes/Board on Global Health identified four major areas of need related to “evaluating the impact of IPE on collaborative practice and patient outcomes.” The four major areas identified were: 1) More closely aligning the education and health care delivery systems; (2) Developing a conceptual framework for measuring the impact of IPE;(3) Strengthening the evidence base for IPE; and (4) More effectively linking IPE with changes in collaborative behavior.4 While previous studies have made advances towards discovering the effectiveness of interprofessional clinical simulation, many aspects have not yet been explored. Clinical simulations create a simulated medical situation in which healthcare pre-professionals are required to make decisions as they would in a real-life clinical situation. The development of an interprofessional approach to these simulations allows for the various disciplines to collaborate in treating the simulated patient. Clinical reasoning can be defined as a process by which healthcare providers collect cues, process information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process.5 Clinical reasoning skills can be developed at the individual level or in a group setting such as occurs during interprofessional rounds at a patient’s bedside.6 Healthcare professionals that train alongside one another in carefully developed patient care scenarios can learn to communicate more effectively with those outside of their profession, increase their knowledge of the others’ scope of practice and gain confidence in advocating and making decisions for their patients. The purpose of this study was to explore IP education through the use of a multi-patient clinical bedside rounding simulation involving health professional students from ten disciplines. Each patient case was designed to facilitate clinical reasoning skills for each profession. Attitude toward teamwork and communication, confidence and understanding roles was explored.
Methods and/or Description of Project
This was a descriptive study using a mixed-method design. Over 400 health professions students from Nursing, Respiratory Therapy, Medical Dietetics, Physical Therapy, Occupational Therapy, Speech Language Pathology, Pharmacy, Medicine, and Acute Care Nurse Practitioner programs completed a pre- and post-simulation survey to examine attitudes, confidence and the understanding of the other professions’ roles. The simulation was a 2.5 hour experience which involved interprofessional rounds and collaborative care of two complex patients. The objectives of the experience were to create a climate of mutual respect and understanding, understand the roles and responsibilities of the other professions participating in the simulation develop inter-professional communication skills, and develop a multidisciplinary team plan of care to improve patient outcomes across the lifespan. One patient, played by a standardized patient who is mechanically ventilated following a motor vehicle accident, represented a post/op trauma case. The other patient, played by a standardized patient, represented a post-operative transfemoral amputation with multiple chronic conditions and a complicated social background. A third patient case was recently added as well to allow for more diversity in patient presentation. This third case is a homeless individual that has been admitted with a diagnosis of ascites. Students in respiratory therapy, occupational therapy, pharmacy, and medical dietetics also repeat the experience as a peer teacher for more novice students in their program. Peer teaching as a model for teaching and learning has been found to be effective in several environments such as lab and the clinical realm. Our research team continues to explore the peer teaching and learning method in interprofessional clinical simulation by publishing a recent study that illustrated this peer teaching model as beneficial to both the peer teacher and the peer learner. A large group debriefing session follows the simulation which was recorded.
Six months were spent planning the simulation objectives, patient cases and all of the necessary logistics which culminated in a series of simulations that began in November 2012. Participation in the simulations reflected a positive change in attitude. Post survey items indicated statistically significant (p<0.05) improvement. Additionally, participants noted increased confidence on the post simulation survey (p<0.05). Increased collaborative care and more interprofessional interactions were noted after first rounds. Using inductive analysis, four themes were identified from the final simulation debriefing sessions; understanding roles, seeing the big picture, increased trust, and opinions about simulation.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
Interprofessional education has demonstrated a strategy to better prepare students for the clinical setting. This study reinforces results from the literature that illustrate attitudes, teamwork and communication improved following clinical simulation. This study contributes evidence utilizing a broader scope of represented professions and unique multi-patient scenarios. This simulation study demonstrates how physical therapy education along with other healthcare disciplines is changing from a traditional model of lecture and lab to a more realistic environment where students can experience the way healthcare can and should be delivered to provide the most effective, efficient and safe patient care in the clinical setting. This simulation experience continues to grow with a total of 10 professions now participating and over 2,000 students who have completed this IPE to date.
1. McCulloch, P, Rathbone, J & Catchpole, K. (2011). Interventions to improve teamwork and communications among healthcare staff. British Journal of Surgery. 98(4), pp 469-479.
2. Reeves, S, Perrier, L, Goldman, J, Freeth, D, Zwarenstein, M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database of Systematic Reviews 2013, Issue 3 Art No: CD002213.
3. Vazirani, S, Hays, RD, Shapiro, MF, Cowan, M. (2005) Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. American Journal of Critical Care, 14(1), 71-76.
4. IOM (Institute of Medicine). 2015. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: The National Academies Press.
5. School of Nursing and Midwifery Faculty of Health University of Newcastle. Clinical Reasoning Instructor Resources. 2009. http://www.utas.edu.au/__data/assets/pdf_file/0003/263487/Clinical Reasoning-Instructor-Resources.pdf. Access on 4/9/2017.
6. Gorman SL, Ryan JM. How clinical reasoning can and should impact interprofessional communication to address behaviors that hinder acute care practice. J Acute Care Phys Ther. 2014;5(1):18-29.
Learners will be able to:
1. Discuss different approaches to case development that facilitate clinical reasoning skill building.
2. List strategies to infuse innovative teaching concepts into interprofessional simulation including: safety initiatives, peer teaching, and incorporation of multiple professions.
3. Discuss how a well-designed simulation case can impact attitudes and communication skills from an interprofessional perspective.
An interprofessional panel presentation with opportunity throughout the presentation to interact and dialogue with the panel presenters about case development in order to facilitate clinical reasoning skills.
Introduction (5 minutes)
Simulation Structure Overview/Case presentation of 3 cases (15 minutes)
Discussion of case development with in- depth look at how clinical reasoning is interwoven throughout the 3 different case scenarios for each discipline (45 minutes)
Discussion on peer teaching elements (10 minutes)
Question and answer (10 minutes)
Wrap and assessment (5 minutes)