"[horizontal ellipsis](W)idespread adoption of a model of interprofessional education across the learning continuum is urgently needed. An ideal model would retain the tenets of professional identity formation while providing robust opportunities for interprofessional education and collaborative care. Such a model also would differentiate between learning outcomes per se and the individual, population, and system outcomes that provide the ultimate rationale for ongoing investment in health professions education. And it would take into account the many enabling or interfering influences on learning and these more distal outcomes" (Institute of Medicine [IOM], 2015, p. xii)
In our previous columns exploring the use of simulation to enhance interprofessional education (IPE), we discussed the interprofessional teamwork (IPT) IOM core competencies (utilize informatics, employ evidencebased practice, apply quality improvement, and provide patient-centered care), and how they can help us develop and frame interprofessional (IP) simulations (IOM, 2003). We also challenged nursing professional development (NPD) specialists, who are in the forefront of leading the IPE charge in the practice setting, to thoughtfully consider ways to measure the impact of IPE on patient outcomes.
In this issue, we focus on the importance of integrating IPT competencies to IPE and better aligning them to patient-centered care and outcomes. Too often, the focus placed on the assessment of knowledge, skills, and attitudes (KSAs) of the learners drowns out the importance of also linking the KSAs of our learners to the IPT core competencies and to the eventual patient outcome. According to the recent 2015 IOM report, despite many advances in simulation science and simulation activities, definitive evidence linking IPE to desirable intermediate and final outcomes is severely lacking (IOM, 2015, p. 6).
The lack of "definitive evidence" does not in any way suggest that IPE is without merit. Indeed, the growing body of scientific evidence overwhelmingly supports the claim that IPE through simulation has been transformative in its positive impact on improvements in IP collaboration, leadership development, communication, and team dynamics. What this IOM report underscores is the importance of linking IP competencies and goals to patient-centered care. So the question is, how can we better achieve this goal through simulation? How can NPD specialists advance IPT simulation education while, at the same time, highlight profession-specific core competencies and link them to patient outcomes?
One approach is by way of using a strategy we refer to as "debriefing from the learner's point of view." In an IPT setting, it is expected that individuals from the different professions may have differing expectations and goals pertaining to the simulation. However, by emphasizing the importance of the IPT core competencies, this strategy attempts to draw the differing professions into a shared mental model by focusing on IP team performance and the team's eventual success and failure to provide patient-centered care. Thus, the perspectives are individual but channeled through the lens of the team performance and with the patient outcome in sight. This format highlights the possibility of structuring the debrief session to incorporate essential core competencies to the assessment of the KSAs of each individual.
This debriefing strategy still encourages the learner to visualize, assess and reflect on their individual performances. It differs, however, from the common approach of debrief which formulates the questions based on what the learner felt "went well and could be improved" to how effectively the team "demonstrated various IPT competencies and its direct impact on the delivery of patient-centered care."
For example, one may begin by asking, "How did the use of informatics influence the team's performance? How did this impact patient outcome?" or "What evidence-based practice did the team employ? How did this impact patient outcomes?" This approach highlights three things that are often overlooked during simulation debriefing. First, this emphasizes the importance of the core competencies that are shared by all professions. Second, it encourages each learner to reflect on their individual professional perspectives and to relate them to the IP setting. Third and finally, it introduces the concept that the focus of IP training is to improve team performance so that the goal of improved patient-centered care and outcome is achieved, not only individual satisfaction with their performance or the learning activity.
This brings up some difficult but relevant questions we need to ask of ourselves. For example, are we designing simulations that challenge our learners to show their proficiency with IP core competencies? Do we document how well they progress individually and as teams? Do we educate our learners to IP competencies and consistently emphasize the importance of IPT training? Are we using IP terms with learners and bringing IP discussion to the forefront as much as possible? How well do we debrief the learners on their IP skills development and reinforce its importance to patient outcomes when we facilitate simulation activities?
In addition to the IOM core competencies for IPT, the Core Competencies for Interprofessional Collaborative Practice were developed in 2011 by an expert panel consisting of several associations of preprofessional healthcare programs (Core Competencies for interprofessional collaborative practice, 2011). These broad competency domains include specific competencies that each student must demonstrate in order to make the transition from academia to the complex healthcare practice environment. Table 1 below provides an overview of the domains, competencies, and their importance to IPT training and team development. It also includes sample debriefing questions to assist the NPD specialist to begin integrating simulation-based IPT training into their educational curriculum.
In this column, we have focused on ways to develop debriefing strategies to assist the learner to improve their IP skills. Our next column will look at ways to frame debriefing strategies from the lens of the patient. It goes without saying that the main reason why we engage in IP training is to improve the quality of care provided to our patients.
Are you developing and implementing various strategies for teaching IP in the practice setting? What successes have you achieved with IP simulation and debriefing IP teams? Please email us at mailto:[email protected] and mailto:[email protected] to continue to conversation.
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