Taking a closer look at undergraduate acute care interprofessional simulations: lessons learnt

Learning better together? A scoping review of in-person interprofessional undergraduate simulation

BACKGROUND

Given the increasing complexity of contemporary clinical practice, there has never been a more important time to provide interprofessional educational (IPE) activities across the learning continuum to develop collaborative practice. From the outset of health professional training, it is crucial that students not only develop their own professional skills but also gain an awareness of the capabilities of other healthcare professionals and how best to work collaboratively. Despite simulation being a common teaching modality in many undergraduate curricula, little is known about the range of interprofessional activities within these settings. Therefore, this study aims to address the following research question: What is known about undergraduate in-person (IP) simulation-based education (SBE)?

METHODS

We conducted a scoping literature review, adhering to the PRISMA-ScR extension guidelines, and used the Arksey and O'Malley framework. Our search covered three electronic databases: Web of Science (WOS), MEDLINE, and Embase. We utilised Covidence systematic review software to assist in screening articles. To support data charting, we developed a data extraction tool and employed both qualitative and quantitative techniques through numerical and thematic analysis to ensure a comprehensive representation of our data.

RESULTS

A total of 97 studies were included, with most publications originating from the USA, UK, and Australia. Two main themes emerged regarding the impact of IP SBE at an individual level: confidence and role identification. Several themes related to the impact on teams included knowledge of other professional roles/values, communication, and teamwork. The studies identified various barriers and enablers to simulation, particularly logistical barriers and financial challenges associated with complex technologically enabled simulation. Faculty collaboration and resources were reported as primary enablers in facilitating the delivery of simulation activities.

CONCLUSIONS

The impact of IP-SBE on learners and interprofessional teams is predominantly positive, with reported benefits including increased confidence, enhanced role identification, and improved communication and teamwork skills. However, challenges such as logistical barriers and resource constraints highlight the need for collaborative faculty efforts and adequate infrastructure to support IP-SBE implementation. Despite the growing interest in IP-SBE, there remains a notable lack of standardised reporting on simulation design and debriefing processes in both teaching practice and research.

A Scoping Review of Interprofessional Simulation-Based Team Training Programs

SUMMARY STATEMENT

Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.

Enhancing the effectiveness of interprofessional education in health science education: a state-of-the-art review

BACKGROUND

In order to foster effective collaboration and improve healthcare outcomes, students from multiple health professions engage in interprofessional education (IPE), learning together and from each other. Existing literature explores the effectiveness of IPE within health sciences but presents varied findings. The purpose of this study is to The effectiveness of IPE is defined as the four levels of training evaluation delineated by Kirkpatrick: reaction, learning, behavior, and results. Affecting factors are defined as elements directly influencing IPE effectiveness, while intermediating factors are influenced by these affecting factors, subsequently impacting overall IPE effectiveness.

METHODS

A state-of-the-art review was conducted using medical databases PubMed, MEDLINE, PsycINFO, Web of Science, and Scopus. Search terms included: (interprofessional learning) OR (interprofessional education) AND (higher education) within the time frame of 2017 to 2022. The methodological quality of the included studies was assessed using Joanna Briggs Institute checklists for quasi-experimental and qualitative studies. Study features were evaluated using a coding scheme, and qualitative analysis of the included studies was performed.

RESULTS

Fifty-four studies met the inclusion criteria after screening. Qualitative analysis revealed four affecting factors: 1) Community-based learning approach, 2) Problem-based learning approach, 3) Experiential learning approach, and 4) Technology-based learning approach. Intermediating factors included student and team characteristics, such as boundary crossing, team leadership, readiness, educational discipline and background, and interprofessional attitudes. Additionally, educational design characteristics, like intervention duration, facilitation, and authenticity of learning experiences, served as intermediating factors. Organizational characteristics, such as organizational culture and logistics, were identified as further intermediating factors.

CONCLUSION

This study provides insight on factors affecting and intermediating IPE effectiveness, vital in the design of IPE programs. Based on the findings we formulated six practical tips to enhance IPE effectiveness.

Interprofessional simulation of acute care for nursing and medical students: interprofessional competencies and transfer to the workplace

BACKGROUND

Teamwork and communication are essential tools for doctors, nurses and other team members in the management of critically ill patients. Early interprofessional education during study, using acute care simulation, may improve teamwork and communication between interprofessional team members on the long run.

METHODS

A comparative sequential quantitative-qualitative study was used to understand interprofessional learning outcomes in nursing and medical students after simulation of acute care. Students were assigned to a uni- or interprofessional training. Questionnaires were used to measure short and long term differences in interprofessional collaboration and communication between the intervention and control group for nursing and medical students respectively. Semi-structured focus groups were conducted to gain a better understanding of IPE in acute simulation.

RESULTS

One hundred and ninety-one students participated in this study (131 medical, 60 nursing students). No differences were found between the intervention and control group in overall ICCAS scores for both medical and nursing students (p = 0.181 and p = 0.441). There were no differences in ICS scores between the intervention and control group. Focus groups revealed growing competence in interprofessional communication and collaboration for both medical and nursing students.

CONCLUSIONS

Interprofessional simulation training did show measurable growth of interprofessional competencies, but so did uniprofessional training. Both medical and nursing students reported increased awareness of perspective and expertise of own and other profession. Furthermore, they reported growing competence in interprofessional communication and collaboration in transfer to their workplace.

Essential Elements of Preregistration Nursing Interprofessional Simulation Training

BACKGROUND

Internationally, interprofessional simulation (IPS) training increasingly is being included in nursing curricula. This systematic review examined the elements of IPS training that prepare nursing students for clinical practice.

METHOD

Five databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], ProQuest, PubMed, Scopus, and Google Scholar) were searched for articles published from 2000 through 2020. Search terms included interprofessional, interdisciplinary, collaboration, collaborative care, teamwork, undergraduate nursing, and simulation. Thematic analysis of included studies was conducted using Braun and Clarke's (2006) six-phase approach.

RESULTS

Twenty-one studies were included. Five key themes emerged: (1) foster safe learning spaces, (2) realism matters, (3) effective debriefing is essential, (4) communication and teamwork increase patient safety, and (5) learning about scopes of practice and roles enables better care.

CONCLUSION

IPS training provides nursing students with learning opportunities that can fundamentally shape their capacity to work effectively in interprofessional and multi-disciplinary settings. [J Nurs Educ. 2023;62(1):28-35.].

Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine

BACKGROUND

Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication.

METHODS

Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016-2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students.

RESULTS

Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment.

CONCLUSIONS

Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.

Developing Healthcare Team Observations for Patient Safety (HTOPS): senior medical students capture everyday clinical moments

BACKGROUND

Aviation has used a real-time observation method to advance anonymised feedback to the front-line and improve safe practice. Using an experiential learning method, this pilot study aimed to develop an observation-based real-time learning tool for final-year medical students with potential wider use in clinical practice.

METHODS

Using participatory action research, we collected data on medical students' observations of real-time clinical practice. The observation data was analysed thematically and shared with a steering group of experts to agree a framework for recording observations. A sample of students (observers) and front-line clinical staff (observed) completed one-to-one interviews on their experiences. The interviews were analysed using thematic analysis.

RESULTS

Thirty-seven medical students identified 917 issues in wards, theatres and clinics in an acute hospital trust. These issues were grouped into the themes of human influences, work environment and systems. Aviation approaches were adapted to develop an app capable of recording real-time positive and negative clinical incidents. Five students and eleven clinical staff were interviewed and shared their views on the value of a process that helped them learn and has the potential to advance the quality of practice. Concerns were shared about how the observational process is managed.

CONCLUSION

The study developed an app (Healthcare Team Observations for Patient Safety-HTOPS), for recording good and poor clinical individual and team behaviour in acute-care practice. The process advanced medical student learning about patient safety. The tool can identify the totality of patient safety practice and illuminate strength and weakness. HTOPS offers the opportunity for collective ownership of safety concerns without blame and has been positively received by all stakeholders. The next steps will further refine the app for use in all clinical areas for capturing light noise.