Collaboration, Effective Communication, Interdisciplinary Education, Interprofessional Education, Medical Education, Nursing Education, Physician Assistant Education, Simulation Best Practices



  1. Alfes, Celeste M.
  2. Rutherford-Hemming, Tonya
  3. Schroeder-Jenkinson, Casey M.
  4. Lord, Cynthia Booth
  5. Zimmermann, Elizabeth


Abstract: A 12-week program was developed to educate nursing, medicine, and physician assistant faculty on the principles and best practices of simulation. The goal was to facilitate team building and collaborative practice through the implementation of an interprofessional (IP) simulation experience for students. Workshops focused on IP communication involving seminar-based instruction, discussion, and the progressive development of an IP simulation based on a National League for Nursing Advancing Care Excellence for Seniors scenario. During the final session, students participated in the simulation while faculty evaluated and revised the scenario to best meet the needs of students from the three disciplines.


Article Content

Interprofessional education (IPE) has been identified by health care and accreditation organizations as a high priority initiative that is necessary to improve the overall safety and quality of patient care (American Association of Colleges of Nursing, 2015; World Health Organization [WHO], 2015). Health care students typically work in isolation from other health care disciplines but are expected to collaborate with other disciplines in the clinical arena after graduation.


Simulation, an interactive experiential learning strategy, is an excellent venue to provide opportunities for interprofessional (IP) learners to develop, practice, and refine skills such as communication and collaboration within the context of a patient care scenario. However, before students can be afforded simulated learning opportunities, faculty need to be trained using the evidence-based practices associated with this unique teaching method.


The purpose of this project was to educate faculty from the university's schools of nursing, medicine, and physician assistant (PA) programs on the principles and best practices of simulation (INACSL Standards Committee, 2016) in an effort to begin facilitating teamwork, collaborative practice, and the development of an IP simulation experience for students. With the anticipated opening of an IPE Health Education Campus in 2019, it was determined that faculty from all health sciences programs would need to collaborate in the development of IP learning activities. A faculty team was brought together to investigate, share, and develop the university's first IP simulation experience, which was formally introduced in spring 2017 and piloted as part of the university's first IPE course.



At an IPE retreat held at the university the previous summer, faculty acknowledged that, although IPE experiences existed within the university, a cohesive and comprehensive curriculum was needed. It was further determined that simulation was not being used to its potential for IPE. To move forward effectively, faculty decided to focus on three key areas for IPE development as identified by the deans of nursing, medicine, dentistry, and applied social science: 1) communication skills training, 2) technology, and 3) learning how to train interprofessionally in a collaborative practice setting.


The team planned a series of four faculty workshops based on the the Interprofessional Education Collaborative Expert Panel (2011) competencies: medical knowledge, interpersonal communication skills, patient care, professionalism, value and ethics, roles and responsibilities, teamwork, practice-based learning and improvement, and systems-based practice. Each workshop was designed to educate faculty in developing a portion of an effective simulation experience. Workshops of approximately four hours were offered over a 12-week period in fall 2015 and spring 2016.


Session 1 focused on writing the objectives and refining the patient scenario; session 2 focused on how to be an effective facilitator; and session 3 focused on effective debriefing. A dry run of the simulation was conducted during session 4. Simulation, IPE, and standardized patient (SP) experts representing nursing, medicine, and physician assistants were invited from the university. Each session used a seminar and discussion format to highlight the standards of best practices in simulation.


The faculty team was composed of three faculty from nursing, one from medicine and two from the PA program. Faculty were given time to implement the best practices of simulation at each workshop by continually building an IPE simulation focused on collaborative practices and communication. At the end of the workshop series, an IPE simulation utilizing SPs was fully developed with faculty trained in best practices to implement the university's first IPE simulation experience.


The team elected to use a simulation scenario from the National League for Nursing, modified to fit the group of IP students. The scenario chosen was the Millie Larsen Advancing Care Excellence of Seniors (ACE.S) simulations 1 and 2 (Reese, 2015). This scenario was complex, allowing the faculty team to incorporate a variety of health care professionals in the simulation. Using the well-constructed simulation template allowed faculty to easily modify and align learning objectives. The debriefing method chosen for the simulation was Promoting Excellence and Reflective Learning in Simulation (PEARLS; Eppich & Cheng, 2015). PEARLS, which is grounded in empirical inquiry, integrates self-assessment, focused discussion, and directive feedback to provide a structured framework adaptable for simulations focused on clinical decision-making, teamwork training, and IP collaboration. A consultant with expertise in PEARLS was brought in for a four-hour training session that enabled faculty to learn and develop their debriefing skills using this framework.



The six faculty members from the IPE team facilitated the dry-run simulation with six student volunteers: two third-year BSN students, two first-year PA students, and two first-year medical students. Students provided consent prior to the simulation and completed media release forms to allow for videotaping. Student participants had little to no previous exposure to IPE experiences.


The students were placed in two teams of three, with one student from each discipline. Each team had the opportunity to both participate in and observe a simulation session. A 20-minute prebriefing was conducted to introduce students to each others' professions, the learning objectives, and the timing of the experience. One faculty member was assigned the role of faculty preceptor in charge of directing students in a 10-minute huddle before meeting the patient.


Students were given 15 minutes to interact as an IP team and elicit a full history from their professional standardized patient. After the interaction, the student team had 10 minutes to orally present their patient to their faculty preceptor. All six students participated in a 25-minute debriefing and completed a confidential, de-identified 10-item faculty-developed written survey. The 10 items were open-ended questions that encouraged the students to provide feedback with specific examples about their feelings, team effectiveness, communication styles, level of engagement, respect of peers, perceived barriers, and potential impact on future practice.


All six students strongly agreed that the simulation experience was valuable, and all either strongly agreed or agreed that the simulation helped them gain insight into the roles of other health professions. Utilizing descriptive statistics, 67 percent strongly agreed that the goals of the simulation were clear and achieved, 83 percent strongly agreed they felt safe in honestly communicating during the debriefing, and 67 percent strongly agreed the session provided them with insight and communication skills they will utilize in the future. The students were asked to write one sentence describing what they learned during the simulation experience. Anecdotal themes included the importance of working as a team of professionals to provide the best care for patients, respecting and valuing members of the team, and adapting to other team members' communication styles.


Members of the faculty team felt the collaborative process exceeded their expectations, and feedback was consistent among the three disciplines. Themes included the importance of clinical realism and utilizing an authentic case, gaining insight and valuing their colleagues' role, and the empowerment and genuine support received from faculty colleagues,. Faculty were invigorated by students' enthusiasm for the experience and encouraged by their request to incorporate IPE experiences throughout the curriculum.



It is essential for students in the health professions "to learn about, from and with each other" (WHO, 2015) so that they can function effectively in clinical practice. Accrediting bodies from nursing, medicine, physician assistant, dentistry, and social work have made IPE an accreditation requirement. Learning about other professions is not sufficient, and accreditation requirements now mandate that students work and learn together. The challenge is to create learning experiences in collaborative care that will actually lead to changes in behavior. Equally important is preparing faculty to facilitate learning experiences that promote IP collaboration. By using simulation strategies with SPs, health professions educators bring learners together in a practical and meaningful way. In addition to educating participating faculty on principles and best practices of simulation and the development of an IP simulation experience, this project helped inform and enhance existing curricula and IP initiatives at the university.


Incorporating IPE experiences early in the curriculum promotes experiential learning that prepares students for collaborative practice in the community and clinical settings. By bridging gaps in faculty development, the professions will develop a strong collaborative foundation for the future and facilitate the transition to a new health education campus, ensuring effective IP student practice at the bedside, and ultimately improving the overall quality and safety of patient care.




American Association of Colleges of Nursing. (2015). Interprofessional education (IPE). Retrieved from


Eppich W., & Cheng A. (2015). Promoting excellence and reflective learning in simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare, 10(20), 106-115.


INACSL Standards Committee (2016), December. INACSL standards of best practice: SimulationSM Simulation design. Clinical Simulation in Nursing, 12(S), S5-S12.


Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Author.


National League for Nursing. (2015). Millie Larson. Advancing Care Excellence for Seniors. Retrieved from


Reese C. (2015). Millie Larsen [National League for Nursing Advancing Care Excellence for Seniors]. Retrieved from


World Health Organization. (2015). Framework for action on interprofessional education and collaborative practice. Retrieved from