A Model for Simulation-Based Interprofessional Team Learning
By Brian Patterson, BS, MD/MPH Candidate
In April 2014, students from Wright State University (WSU)’s Boonshoft School of Medicine and College of Nursing and Health teamed up with pharmacy students from Cedarville University—all based in Ohio—to participate in an extracurricular activity they hoped would herald a new approach to their combined curriculums.
Working in interprofessional teams, the students engaged in several high-fidelity manikin-based simulation experiences. The event was well documented and further quantified with a voluntary, IRB-approved, pre- and post-simulation survey given to students and faculty. The baseline attitudes (pre-simulation) toward interprofessional education (IPE) and simulation-based training were positive overall. Post-simulation survey results demonstrated statistically significant positive changes in attitude regarding IPE and simulation-based exercises. The experience was a success, and the participating students and faculty were eager to further develop IPE events with the intent of integrating this approach into the curriculum in the future. Currently, the three schools are collaborating to create their first IPE curriculum elective.
Students in the local WSU chapter of the Institute for Healthcare Improvement (IHI) Open School took it upon themselves to develop the IPE simulation lab, and they have further pursued the topic in semiannual interprofessional meetings. The chapter leaders’ intent is to expose students to the ideas of quality improvement (QI) and inspire them to become involved in their own QI projects. The IPE simulation lab is considered a step forward in undergraduate medical education and is an ongoing QI project. Additionally, the university has developed an Interdisciplinary Healthcare Council (IHC) focused on discussions resulting from the diversity of perspectives of the many schools and professions represented across campus. Student members of the WSU Open School chapter appreciate the value of QI and feel strongly about the need to develop and implement an interdisciplinary approach to undergraduate medical education. This article describes a foundational understanding of the importance of IPE and elaborates on current developments at WSU initiated by members of the Open School.
Background
Many believe that an interprofessional approach to healthcare is fundamental to its future and integral to the successful treatment of patients. Furthermore, an interprofessional learning environment more closely mirrors real-life situations and current healthcare practice. Although it is reasonable to assume that an undergraduate, interprofessional learning environment better prepares medical students for the transition to internship and residency, research to support that premise is limited (Al-Elq, 2010; Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Singleton & Green-Hernandez, 1988). The interdisciplinary approach to teaching and learning is evolving; medical school programming and interdisciplinary team interactions are slowly replacing more traditional didactic, lecture-based learning methods. Uniting healthcare professions, not only across campus but also among academic institutions, has potential to better prepare all students—with benefits for all patients—as well as to develop teamwork among future practicing healthcare professionals.
For medical school students, the transition from undergraduate programs to internship presents many challenges. Interns face new, more robust roles in patient care, increased responsibility in decision-making, and long, intense work hours. They are also required to learn and apply large volumes of new information that can directly impact the quality of patient care. Studies have shown, however, that many medical school graduates do not feel adequately prepared to address these essential challenges and responsibilities.
Studies indicate that students in the health professions who have been trained using an interprofessional approach are more likely to become collaborative team members (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; MacDonnell, Rege, Misto, Dollase, & George, 2012). Additionally, they are more likely to show respect and positive attitudes toward each other and work together more effectively toward improving patient outcomes. An integral part of IPE lies in understanding the other professions, as well as one’s own role within the healthcare team (Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011).
Other concurrent developments in medical education, such as simulation-based exercise, can be used to augment concepts of IPE. Although simulation is a relatively new component of medical education, it has been used for years in other high-risk professions, such as aviation and aerospace (Al-Elq, 2010). Simulation-based teaching and learning can be an important curriculum tool, connecting theory with practice and allowing students and professionals to acquire skills through deliberate practice without detriment to the patient (Al-Elq, 2010). It offers a safe and less stressful learning environment for students, allowing them to develop and practice a wide variety of skills and procedures. Simulation also provides the opportunity for immediate assessment and feedback and for repetition as needed, all of which can help strengthen and improve skills without increasing risk for patients. The implementation and use of simulation in medical education has proven to be an effective teaching method to fill educational gaps. Additional benefits of simulation activities include improved interpersonal communication, teamwork, leadership, decision-making, and stress management; the ability to prioritize tasks under pressure; and enhanced clinical competence (Flanagan, Nestel, & Joseph, 2004). Using manikins in high-fidelity simulation-based learning in nursing education has been shown to be effective as a teaching and learning method (Cant & Coopers, 2010). It is, therefore, reasonable to conclude that simulation-based exercise may be an ideal platform for launching IPE endeavors.
The value of cultivating and developing these important qualities and skills when establishing a surgical or medical team seems obvious. Strong communication skills, respect, and good connections among team members are critical for successful patient care. Physicians are not only important members of the healthcare team, they must be able to move easily from the role of leader to being a contributing team member and back again, while maintaining an understanding of all roles and responsibilities on the team.
Hypothesis
IPE is becoming more widely integrated into healthcare professional education (Berg, Wong, & Vincent, 2010; Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Stewart, Kennedy, & Cuene-Grandidier, 2010). Many schools introduce IPE to their undergraduate health profession students at an early stage, often in the first year of the program (Berg, Wong, & Vincent, 2010; Bridges, Davidson, Odegard, Maki, & Tomkowiak, 2011; Rosenfield, Oandasan, & Reeves, 2011). Students value IPE, but there are a number of challenges associated with initial engagement, and many schools are unsure how to approach this interdisciplinary integration (Fernandez, Parker, Kalus, Miller, & Compton, 2007; Leonard, Shuhaibar, & Chen, 2010; MacDonnell, Rege, Misto, Dollase, & George, 2012). An interprofessional simulation lab was developed to help identify the benefit of using this educational tool in undergraduate education. Currently, WSU’s Boonshoft School of Medicine and the College of Nursing and Health both use simulation, but have not yet integrated an undergraduate interdisciplinary approach.
As this was the first exercise at WSU involving interprofessional groups composed completely of undergraduates, a survey was used for data collection to support a continuous improvement process by establishing baseline perceptions and identifying strengths and weaknesses of the interdisciplinary simulation. The focus of the study was to validate the hypothesis that students from all health professions will have a baseline positive attitude toward IPE and will show a statistically significant increase in Likert-scale measurement in their attitudes toward both IPE and simulation-based education following a set of simulation-based team training encounters.
Procedure
To facilitate an interdisciplinary learning environment and improved treatment and clinical problem-solving through communication across healthcare disciplines, the Open School chapter at WSU, in conjunction with WSU faculty, designed a simulation lab experience to include multiple health professions. The organizers found value in creating an interdisciplinary learning environment to facilitate and foster team structure, leadership, situation monitoring, mutual support, and communication. Open School chapter members also found value in QI, documenting their endeavors and improving their processes. Based on a premise of using a simulation experience to connect theory and practice and an interdisciplinary approach, an Interprofessional Simulation Lab IRB-approved research survey was developed to identify attitudes and perceptions of healthcare professional students and faculty members regarding interdisciplinary team-learning and simulation-based activities. The purpose of the experience was to unite medical, nursing, and pharmacy students in a cooperative effort to improve the delivery of healthcare. The simulation lab included students from the WSU Boonshoft School of Medicine and College of Nursing and Health and the Cedarville School of Pharmacy.
The goal of the Interdisciplinary Simulation Lab survey was to measure the attitudes and perceptions of healthcare professional students and faculty with regard to: 1) interdisciplinary team-learning, and 2) simulation-based team-learning activities. Data was used to assess the success of the simulation lab as a platform for IPE and for QI in planning future interdisciplinary collaborations.
Undergraduate students in medicine, nursing, and pharmacy were recruited at the beginning of the simulation lab, and a statement was read aloud explaining that the survey was voluntary, anonymous, and confidential. The survey asked students to identify their school and year; no other personal information was requested. The survey utilized a Likert scale for responses. Students and faculty members were asked to complete one survey at the beginning of the simulation and a second survey at the end. They were instructed to return both surveys to the same numbered envelope, as this pairing of data provided greater flexibility for statistical analysis, namely paired t-test analysis. The anonymous data allowed the investigators to look at baseline attitudes (pre-simulation) toward team training and simulation as well as the impact of simulation-based sessions (post-simulation) on those attitudes.
Results
Overall, students in all three participating health professions demonstrated positive attitudes toward IPE and simulation training. Results from four out of six survey questions demonstrated a statistically significant positive increase in differences between pre-simulation and post-simulation survey. The other two survey questions did not show a significant increase, likely due to very positive baseline attitudes. Baseline responses indicated a strongly positive attitude towards IPE. In comparison to pre-simulation survey responses, post-simulation responses demonstrated statistically significant increases in students’ experience and perceived value of high-fidelity healthcare clinical simulation. Additionally, there were statistically significant increases in students’ perceived value of interdisciplinary team training and its importance in the future of medical education. In essence, the survey results indicate positive baseline attitudes toward IPE that could be further enhanced through participation in IPE simulation-based exercises.
Discussion
Through the Interprofessional Simulation Lab survey, the Open School chapter was able to substantiate and emphasize a clear message to students and faculty at WSU and the Cedarville School of Pharmacy regarding the perceived importance of IPE and the success of an IPE pilot project. The event and data collected provided chapter leaders with a platform to convey this message to the administration, as well as to use in future Open School meetings on campus. The message on campus has been further augmented through audio/visual materials borrowed from IHI, as well as student testimonials. Chapter leaders have been pleased with the questions, attentiveness, and participation of the audiences. Many students seem to take a strong interest in the subject. The events are well attended and vital to the success of the Open School chapter and the implementation of IPE and QI through awareness, education, and recruitment. The Open School chapter at WSU plans to continue the IPE Simulation Lab event annually, which is also currently in the process of being integrated into the curriculum. This study provides a model of one method for integrating IPE into curricula for healthcare professionals.
Personal Note on Clinical Application in Surgery
As a fourth-year medical school student and chapter leader of the Open School at WSU, I wholeheartedly support this work and collaborative effort. I will soon be applying to general surgery residency programs, and I have found my interprofessional experiences invaluable in shaping my perspective of my future career.
Successful surgical care requires a team approach to best practice by a variety of healthcare professionals. The surgical team includes the surgeon, nurses, anesthesiologist, clinical nurse specialists, and surgical techs, as well as social workers, pharmacists, physical therapists, occupational therapists, registered dietitians, respiratory therapists, the patient and family, and others (Epstein, 2014). Developing a good surgical team includes emphasizing leadership and communication. The central theme in the surgical theater is safe, effective care of the patient. An interdisciplinary team approach to surgery can greatly enhance the surgical outcome for the patient. Using an interdisciplinary approach to learning makes us all better healthcare workers; the patient always benefits from this cooperation.
My experiences with the IPE simulation lab, Interdisciplinary Healthcare Council, and interprofessional meetings of the Open School chapter have profoundly influenced my view of healthcare delivery. I appreciate from firsthand experience the importance of training in teams and the value of IPE simulation. I believe that due to these experiences, I will be a more proficient and effective surgical intern. I have a better understanding and appreciation for my professional colleagues and staff, my situational awareness skills have been augmented, and my communication skills have been greatly enhanced. I have dedicated significant time to these projects and endeavors in an attempt to change medical education for the better. I entered the field of medicine to treat patients to my fullest capacity and provide the best possible healthcare. I believe that commitment to an IPE curriculum should be a primary objective of any institution responsible for educating medical professionals. I am pleased with the overwhelmingly positive responses at my home institution and the relative ease of implementing such objectives, especially considering the significant barriers that exist to curriculum reform. Along with my collaborating colleagues, I hope to leave a humble legacy that will perpetuate and inspire future students and faculty members to embrace a new frontier in interprofessional medical education, for ourselves and especially for our patients.
Acknowledgments
Special thanks to invaluable faculty and student collaborators Raymond P. Ten Eyck, MD, MPH, FACEP; Sherrill Smith, PhD, RN, CNL, CNE; Douglas Anderson, PharmD, DPh; Dean Parmelee, MD, FAACP, DFARA; Brittani Purkeypile, BSN, RN; and Bethany Sibbitt, BS, PharmD candidate.
Brian Patterson is a fourth-year medical student at the Wright State University Boonshoft School of Medicine in Dayton, Ohio. He is a native Ohioan and attended Otterbein College, majoring in biochemistry and chemistry with a minor in life science. Patterson enjoys running, music, and art, and has coached Special Olympics track for many years. Patterson is also a member and chapter leader of the IHI Open School, which offers professionals and students online training in quality improvement and patient safety. Learn more at ihi.org/openschool. Patterson may be contacted at patterson.89@wright.edu.
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