A scoping review to understand simulation used in interprofessional education

Leveraging Community Engagement and Human-Centered Design to Develop Multilevel Implementation Strategies to Enhance Adoption of a Health Equity Intervention

Background Health equity intervention implementation (which promotes positive health outcomes for populations experiencing disproportionately worse health) is often impeded by health-equity-specific barriers like provider bias; few studies demonstrate how to overcome these barriers through implementation strategies. An urgent health equity problem in the U.S. is the mental health of transgender youth. To address this, we developed Gender-Affirming Psychotherapy (GAP), a health equity intervention comprising best-practice mental health care for transgender youth. This paper details the identification of implementation determinants and the development of targeted strategies to promote provider adoption of GAP. Methods This study represents part of a larger study of mental health provider adoption of GAP. Here we describe the first 2 stages of the 3-stage community-engaged and human-centered design process - Discover, Design/Build, and Test - to identify implementation determinants of adoption and develop implementation strategies with transgender youth, their parents, and mental health providers. This process involved collecting data via focus groups, design meetings, usability testing, and champion meetings. Data were analyzed using rapid and conventional content analysis. Qualitative coding of implementation determinants was guided by the Health Equity Implementation Framework, and implementation strategy coding was facilitated by the ERIC Implementation Strategy Compilation. Results We identified 15 determinants of GAP adoption, and all were specific to the transgender population (e.g., inclusive record system, anti-transgender attitudes). Seventeen implementation strategies were recommended and 12 were developed, collectively addressing all identified determinants. Most strategies were packaged into an online self-paced mental health provider training (implementation intervention) with 6 training tools. Additional inner setting strategies were designed to support training uptake (e.g., mandate training) and GAP adoption (e.g., change record system). Conclusions Community-engaged and human-centered design methods can identify health equity intervention implementation determinants and develop targeted strategies. We highlight five generalizable takeaways for health equity implementation scientists: (1) implementer bias may be a key barrier, (2) experience with the health equity population may be an important facilitator, (3) stakeholder stories may be an effective training tool, (4) inner setting-level implementation strategies may be necessary, and (5) teaching implementers how to build implementation strategies can overcome resource-constraints. Trial registration: NCT05626231.

Evaluating the use of virtual simulation training to support pharmacy students' competency development in conducting dispensing tasks

BACKGROUND

The incorporation of digital health technologies in undergraduate teaching, such as the MyDispense program, provides a simulated opportunity to support students' competency development in dispensing tasks.

OBJECTIVE

This study aimed to evaluate the impact of using MyDispense, an online pharmacy simulation platform, on pharmacy students' self-reported reaction, learning, and accuracy in performing dispensing tasks.

METHODOLOGY

16 MyDispense cases simulating real-practice scenarios from prescription dispensing and verification to patient counseling were created for 55 professional year 1 pharmacy students as part of a professional skills course. A pre-post survey, nestled on Kirkpatrick's Model of Training Evaluation, was conducted on participants in the cohort to evaluate how the incorporation of MyDispense supported their development of dispensing tasks. A virtual formative assessment was also done using MyDispense to compare students' self-reported accuracy with faculty assessment scores to evaluate how MyDispense can support students' knowledge and metacognitive abilities in dispensing.

RESULTS

The study showed an increase in students' confidence after using MyDispense, which led to an increase in the "learning" level of Kirkpatrick's Model. However, small changes were observed in other levels and sublevels of Kirkpatrick's Model. A notable discrepancy was observed between students' self-assessment scores and faculty assessment scores, with students overestimating their performances. Correlation analysis showed a weak relationship between students' self-assessment scores and the learning level of Kirkpatrick's Model.

CONCLUSION

This study highlights the positive impact of MyDispense on pharmacy students' confidence in dispensing. However, virtual simulation training may be best incorporated when students have exposure to experiential training placements, to maximize the learning outcomes and knowledge in dispensing processes.

A methodology to evaluate the effectiveness of interprofessional education strategies based on the Medical Research Council (MRC) framework among vocational healthcare students in China

Interprofessional education (IPE) is rapidly becoming a core element of health professions preparation programs worldwide, but the effectiveness of different IPE strategies and their impacts in different regions and populations remain unclear, especially in the vocational education setting. This article describes the overall research design including the development, testing and preliminary evaluation of the IPE education interventions for Chinese vocational healthcare students, following the procedure outlined in the UK Medical Research Council (MRC) framework for developing and implementing complex interventions in healthcare. The objective is to develop and adapt role-based IPE strategies and evaluate their feasibility and effectiveness on interprofessional competencies of vocational healthcare students in China, with nursing students being our focus.•This study adopts a mixed-methods approach to develop two IPE strategies related to role interaction (role-taking and role-playing) in comparison to one conventional IPE strategy (pure group discussion) and investigate the different effectiveness in vocational healthcare students' attitudes to IPE, perception of professional roles, and interprofessional collaborative competencies by three valid scales.•The study is divided into four stages: development, feasibility testing, evaluation and final experimental verification.•This study helps provide scientific and appropriate IPE strategies for vocational healthcare educators, so as to improve the interprofessional learning and collaborative ability of vocational healthcare students.

Simulation-Based Teaching and Learning in Respiratory Care Education: A Narrative Review

Simulation-based pedagogy has become an essential aspect of healthcare education. However, there is a significant gap in the literature regarding the application of simulation-based modalities in respiratory care education. This review aims to address this gap by providing insight into the theory and current uses of simulation, its effectiveness in respiratory care education, and strategies to enhance faculty development. The study utilizes a narrative synthesis approach to review relevant literature and provide a comprehensive understanding of the topic. The research involved comprehensive searches of electronic databases, including PubMed and Google Scholar, to identify relevant literature, encompassing original articles, reviews, and other pertinent content, focusing on simulation-based teaching and learning in respiratory care education published between 1990 and 2022. Findings suggest that simulation-based education is an effective tool for improving respiratory care education and can enhance the clinical skills of learners. The study concludes by discussing the future of simulation in respiratory care education and the potential benefits it may offer.

Descriptive Analysis of Student Diagnostic and Documentation Skill Development in a low Fidelity Simulation in Psychiatric Nurse Practitioner Education

Introduction

Nursing educators face challenges in helping registered nurses prepare to be psychiatric nurse practitioners. Nursing educators must consider the variation of students' skill sets, experience levels, and the shortage of preceptors. Simulations can help overcome limited clinical sites and standardize skill acquisition. High-fidelity simulations can be helpful but are labor-intensive and expensive. Low-fidelity simulations are adaptable to fit the learning needs of psychiatric nurse practitioner students but little research has evaluated these simulations.

Objective

This paper evaluates a series of low-fidelity interventions used to help students learn diagnostic criteria, treatment decisions, and documentation.

Methods

A retrospective descriptive analysis was performed on the results of all students in five cohorts in a psychiatric nurse practitioner course (n=68) on 45 low-fidelity online simulations over five years during the course on advanced psychiatric nursing of adults. Diagnostic notes were graded on four criteria by a psychologist or a psychiatric nurse practitioner. A representative sample of grades on eight notes were analyzed for this manuscript. Survey responses from the students in one cohort were obtained to evaluate their confidence levels and perceptions of simulation utility and responses were analyzed using descriptive and qualitative methods.

Results

The overall mean of description, detail, completeness, and professionalism increased from 7.6 (out of 10) to 9 over the semester with statistically significant improvements in all four areas. The strongest correlation was between detail and completeness and the weakest correlation was between professionalism and description. Students reported that they found significant value in the low-fidelity simulation exercises.

Conclusion

This analysis demonstrates one of the first efforts to analyze low-fidelity simulations for psychiatric nurse practitioner students. The data indicate these simulations can help students improve their confidence and skills in several areas.

Early stages of learning in interprofessional education: stepping towards collective competence for healthcare teams

BACKGROUND

Interprofessional education (IPE) is a core element of many health professional education curricula. To date the focus of much research has been on student perceptions of, and attitudes towards, the learning experience. Little is known about the impact of early IPE experience on how students understand and learn about effective interprofessional teamwork.

METHODS

This qualitative study involved first year university students enrolled in health professions degrees and investigated their descriptions of interprofessional teamwork through graphic elicitation and interviews. Participants were enrolled in a large-scale interprofessional unit (subject) in the university.

RESULTS

The data were analysed through the lens of a tool that classifies dimensions of interprofessional activity. The findings indicated the majority of students had what was classified as a Stage 1 (or 'nascent') understanding of integration between work practices and a Stage 2 (or 'emerging') understanding of the dimensions of interprofessional teamwork which were commitment, identity, goals, roles and responsibilities, and interdependence.

CONCLUSIONS

Based on the findings, the stages for a learning trajectory for interprofessional education are proposed and each stage is mapped to dimensions of interprofessional activity. A number of pedagogical strategies are suggested in order to move students through this two-stage model of learning and ensure their readiness for interprofessional teamwork as health professionals.

Importance of Interprofessional Education for Occupational Therapy

The purpose of this position statement is to provide recommendations for educators on best practices to embed interprofessional education (IPE) into today's occupational therapy curricula, whether entry level or postprofessional, to bridge academic and clinical learning environments.

Development of Team Behavior Skills and Clinical Lactation Competence Among Medical Students Engaging in Telesimulations with Standardized Patients

Objective: The aims of this pilot feasibility study were to determine if telesimulations with standardized patients (SPs) wearing high-fidelity breast models impact students' team behavior and clinical competence in lactation support. Materials and Methods: Medical students (N = 19) completed five telesimulations: Cases 1, 2, 5 in a team, 3 as individual, and 4 randomized. SPs used the Formative Assessment Rubric (FAR) to evaluate interpersonal and clinical competence. Collaboration skills within team-based telesimulations (Cases 2 and 4) were rated using the Interprofessional Collaborator Assessment Rubric (ICAR). Satisfaction data were collected from a focus group and written evaluation. Descriptive statistics were calculated for FAR, ICAR, and written evaluations. Appropriate nonparametric tests were used to measure FAR and ICAR differences over time or between team and individual telesimulations and the relationship between FAR and ICAR scores. Content analysis was used to generate themes from focus group data. Results: Learners' interpersonal and lactation-specific competence improved over time (p = 0.003 and 0.009, respectively). Learners were able "to accept responsibility for their actions" more but spent less time "seeking perspectives from peers" in Case 4 compared with Case 2 (p = 0.01 and p < 0.001, respectively). Themes from the focus group related to the value of team telesimulations to learn clinical lactation skills and learn about one's role in a team. Learners agreed they developed clinical lactation skills (>4.5/5-pt). Conclusions: Opportunities to work collaboratively in telesimulations with a SP prepare learners for professional collaborations to effectively care for breast/chestfeeding dyads.

Leveraging Interprofessional Education to Improve Physician/Laboratory Cooperation and Patient Outcomes

Pathology and laboratory medicine are integral parts of the healthcare team. While this fact is uncontested, efforts to integrate medical laboratory science (MLS) students into interprofessional education (IPE) activities with medical students have been scarce. We contend here that now is the optimal time to explore IPE with medical and MLS students and that doing so will provide significant benefits to students as well as their future patients. Neglecting to capitalize on this opportunity will result in continued interprofessional barriers.

Evaluation of Nursing Students' Experiences in an Interprofessional Simulated Disaster Exercise

BACKGROUND

Disaster simulation exercises provide a unique opportunity for nursing students to experience interprofessional collaboration. The limited study of interprofessional education using disaster simulation has focused on two to three health disciplines. In reality, teams comprise members from multiple disciplines in health care and emergency management.

METHOD

A simulated disaster was held at a community college in Toronto, Canada. A total of 121 nursing students participated in the event, alongside students and providers from six health care and emergency management professions. A survey was used to evaluate nursing students' experiences.

RESULTS

Nursing students (n = 78) reported a high level of satisfaction, and 90% reported the simulation demonstrated the importance of inter-professional practice. Two themes arose from participants' comments: communicating with patients and collaborating with health care and emergency management providers.

CONCLUSION

There is a need for follow-up to evaluate the impact of this event on nursing students' future practice. [J Nurs Educ. 2021;60(8):445-448.].

Meeting pharmacy educational outcomes through effective use of the virtual simulation MyDispense

INTRODUCTION

One of the challenges of pharmacy schools worldwide is the need to link theoretical training with the mastery of practical skills. A virtual pharmacy simulation, MyDispense, developed by the Faculty of Pharmacy and Pharmaceutical Sciences at Monash University, enables students to practice the skills of a professional pharmacist, from novice to highly advanced, in a safe virtual environment that is web-based and highly accessible. The free online simulation allows students to undertake scenarios where patients can present with prescription or self-care requirements, and are also challenged with validation tasks requiring them to check the work of virtual colleagues for accuracy, legality, and medicine safety.

COMMENTARY

This commentary describes the use of a virtual simulation, MyDispense, in enhancing didactic instruction, complementing experiential education, and the challenges of the virtual simulation to pharmacy educators. MyDispense is now deployed to 186 schools of pharmacy across 34 countries to over 25,000 students worldwide who have completed over 963,000 exercises globally.

IMPLICATIONS

The severe acute respiratory syndrome 2 (aka COVID-19) pandemic presents challenges to pharmacy education requiring many educators to switch to remote online learning. Simulation programs, such as MyDispense, help to replicate aspects of pharmacy practice and can be used creatively to meet course needs. The use of MyDispense is an excellent example of pharmacy educators collaborating globally and learning from each other to improve student learning.

Interprofessional simulation to promote teamwork and communication between nursing and respiratory therapy students: A mixed-method research study

BACKGROUND

Collaboration and teamwork are vitally important for safe patient care. Experiential learning through interprofessional simulation helps prepare students for the expansive requirements of today's complex healthcare environment.

PURPOSE

To develop and evaluate an interprofessional simulation educational activity to promote teamwork and communication between respiratory therapy and nursing students.

DESIGN

A mixed method design employing surveys, observation, and focus groups with educators and students was used. Thirty-six students from two institutions in Western Canada participated in this study. Data was analyzed using descriptive statistics and content analysis.

RESULTS

Baseline assessment revealed students were most familiar and comfortable with team functioning and communication interprofessional competencies, familiar but uncomfortable with collaborative leadership, conflict resolution, patient-centered care, and role clarification competencies. Correlation between communication and teamwork and collaborative leadership suggests these competencies play an important role in students' ability to enact more complex skills, such as conflict resolution competency. Overall, participants were highly satisfied and shared invaluable insights for improving this simulation experience in the future.

CONCLUSION

This evaluation study demonstrated feasibility of interprofessional simulation and its potential to enhance acquisition of interprofessional competencies. A future study will incorporate additional disciplines, such as medicine and pharmacy, applying a controlled evaluation design.

Integration of a Virtual Dispensing Simulator "MyDispense" in an Experiential Education Program to Prepare Students for Community Introductory Pharmacy Practice Experience

BACKGROUND

Technology is increasingly used to enhance pharmacy education. We sought to evaluate student learning and preparedness for community introductory pharmacy practice experiences (IPPEs) after implementation of "MyDispense" into experiential education.

METHODS

Both first-year pharmacy students and assigned community IPPE preceptors were eligible. Students were stratified based on previous community pharmacy experience (< or ≥ 50 h), then randomized to complete MyDispense exercises before IPPE (group A) or after 24-32 h of IPPE (group B). We evaluated preceptors' assessment of student readiness using a 6-item Likert scale survey and students' readiness and opinion of MyDispense using an anonymous 9-item survey. Descriptive statistics were used to characterize data. The Mann-Whitney U test was used to compare groups and a p-value < 0.05 was considered statistically significant.

RESULTS

Of 177 eligible students, 155 were randomized and 56 completed study. Group A included 32 students; 56.3% had prior community practice experience. Group B included 24 students; 50% had prior community practice experience. Forty-eight preceptors were enrolled. Students who completed exercises before rotation received higher preceptor scores for patient counseling of self-care and of medications (p < 0.05 for both). Students self-assessed their counseling skills lower than all other skills; 30.4% and 42.9% of students felt mostly or always prepared to counsel for self-care and medications, respectively. Students found MyDispense straightforward, realistic, and appreciated the ability to practice in a safe, electronic, community pharmacy, patient-care environment.

CONCLUSION

Simulation-based software, such as MyDispense, can enhance learner understanding of the prescription fill and counseling process in a community pharmacy practice setting.

Assessing Application-Based Breastfeeding Education for Physicians and Nurses: A Scoping Review

BACKGROUND

Physicians and nurses are expected to support breastfeeding mothers. However, there is a lack of standardized lactation education throughout training programs and hospitals. As a result, providers lack the necessary confidence and skills to guide mothers throughout the breastfeeding experience. The hands-on nature of breastfeeding management demands the implementation of application-based learning tools to improve skills retention and patient breastfeeding outcomes.

RESEARCH AIM

In this scoping review, we aimed to critically assess the types of application-based breastfeeding management learning tools reported within medical and nursing professions and the evaluation methods of learner and patient outcomes.

METHODS

The authors searched the literature to identify peer-reviewed articles published between 2000 and 2018 with medical or nursing students, residents, or professionals as the target learner group in an application-based educational intervention. Both authors independently assessed the content in the resulting articles, with specific focus on teaching methods, curricular development, and the learning outcomes reported within each study.

RESULTS

Ten articles matched the inclusion criteria and were included in the final review, including five studies from the medical field and five from the field of nursing. Use of real patients was a common method for application-based skills training, followed by role playing and use of standardized patients. Teaching and evaluation methods varied widely across the studies.

CONCLUSION

The results align with existing literature in finding a dearth of high-quality studies assessing breastfeeding education among physicians and nurses. The variability in teaching and evaluation methods indicates a lack of standardization in breastfeeding education between institutions.

High-fidelity simulation-based education in pre-registration healthcare programmes: a systematic review of reviews to inform collaborative and interprofessional best practice

Simulation-based education (SBE) is recognized as an effective interprofessional teaching and learning method. Whilst there is a large volume of research evidence concerning elements of SBE there is a lack of clarity concerning foundational principles of best practice. This is important for educators wishing to utilize high-quality SBE to deliver interprofessional education. The aim of this review is to synthesize review evidence of SBE best practice in a broad range of pre-registration healthcare programs and contextualize findings in light of relevant educational theory. A systematic search of PubMed, Scopus, Medline/Ovid, British Nursing Index, and the Cochrane Library databases was undertaken in February 2020. Data extraction and quality evaluation were undertaken by two authors. Fifteen reviews were included. In addition to identifying barriers and enablers to implementation, three interdependent themes regarding SBE best practice were found: curriculum level integration and planning (curriculum level integration, the opportunity for deliberate repeated practice, distribution, and sequencing); simulation design and delivery (clearly defined learning outcomes and benchmarks, pre-brief, multiple learning strategies, interactivity and individualized learning, feedback, and debrief); and resources (facilitator competency, controlled environments). These themes broadly align with the social constructivist theory of experiential learning whereby structured opportunities to learn via concrete experience, reflective observation, abstract conceptualization, and active experimentation are provided through effective planning, design, and delivery of SBE. Interdependencies suggest that integration of SBE at curriculum-level enables planning and implementation of best practice principles which are associated with effective learning, which also inform and facilitate the availability of adequate simulation resources.

Students as patients: A systematic review of peer simulation in health care professional education

CONTEXT

Evidence supports the substitution of both clinical placement time and traditional educational activities with simulation-based education (SBE). However, lack of resources can be a barrier to SBE implementation. Peer simulation provides an alternative to simulated patient (SP)-based SBE by educating students to portray patient roles. This diversifies learning experiences for students using SBE and may decrease costs.

OBJECTIVES

This study aimed to determine the impact of students portraying the roles of patients in a simulation-based learning environment (peer simulation) on learning outcomes in entry-level health care professional students.

METHODS

Seven databases were searched (from inception to 8 May 2019) using terms including 'peer simulation,' 'role-play' and 'simulated/standardised patient.' The studies included described a health care professional student SBE interaction involving peer simulation. Data were extracted by two independent investigators. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and Critical Appraisal Skills Programme (CASP). A descriptive analysis was completed and meta-analysis conducted in instances in which outcomes could be pooled.

RESULTS

A total of 12 studies met the inclusion criteria. Constructs measured by the studies included communication, empathy, self-efficacy and confidence. Five randomised controlled trials compared peer simulation with the use of SPs and demonstrated greater or equivalent patient empathy gains in peer simulation. Meta-analysis determined no difference in communication capabilities between the two groups. Students perceived peer simulation as comparably valuable and frequently superior to other forms of learning. This review was unable to determine effective design features of peer simulation initiatives.

CONCLUSIONS

Students were positive about peer simulation, but there has been limited evaluation of learning outcome attainment. Significant heterogeneity was observed; studies were diverse in design, outcome measures and the training provided for peer patients. Peer simulation positively influences student communication and development of patient empathy and offers an alternative to learning with SPs. Further rigorous research is required to understand the impact of peer simulation for a broader range of learning outcomes and to confirm the impact of this developing educational approach.

Developing a Framework for Population Health in Interprofessional Training: An Interprofessional Education Module

Interprofessional education (IPE) is based on the concept that health professional students are best trained on the skills, knowledge, and attitudes that promote population health when they learn with and about others from diverse health science fields. Previously, IPE has focused almost exclusively on the clinical context. This study piloted and evaluated an IPE learning experience that emphasizes population health in a sample of public health undergraduate students. We hypothesized that students who completed the 2-hour online asynchronous module would better understand the value of public health's role in interprofessional teams, the benefit of interprofessional teamwork in improving health outcomes, and the value of collaborative learning with other interprofessional students. Students engaged in pre- and post-training assessments and individual reflections throughout the module. Sixty-seven undergraduate public health students completed the module and assessments. After completion, a greater proportion strongly agreed that students from different health science disciplines should be educated in the same setting to form collaborative relationships with one another (19 vs. 39% before and after completion, respectively). A greater proportion also strongly agreed that care delivered by an interprofessional team would benefit the health outcomes of a patient/client after the training (60 vs. 75% before and after, respectively). Mean scores describing how strongly students agreed with the above two statements significantly increased post-training. A greater proportion of students strongly agreed that incorporating the public health discipline as part of an interprofessional team is crucial to address the social determinants of health for individual health outcomes after taking the training (40 vs. 55% before and after, respectively). There was little change in attitudes about the importance of incorporating public health as part of an interprofessional team to address social determinants of health for population health outcomes, which were strongly positive before the training. Most students reported being satisfied with the module presentation and felt their understanding of interprofessional practice improved. This training may be useful for students from all health disciplines to recognize the benefits of engaging with and learning from public health students and to recognize the important role of public health in interprofessional practices.