The Institute of Medicine's (2011)Future of Nursing report calls for an increase in interprofessional collaboration among health care professionals. Working in teams where care is coordinated allows individuals the ability to work to the fullest extent of their license and education and therefore produce improved patient outcomes. The World Health Organization (2010) defines interprofessional education (IPE) as a learning experience that "occurs when students from two or more professions, learn about, from, and with each other" (p. 13). Patient safety is of paramount importance, and effective interprofessional communication is one way to ensure that positive patient outcomes are achieved (Institute of Medicine, 2011).
A goal of IPE is to develop in practitioners the knowledge, skills, and attitudes needed to reflect a coordinated team approach. Weiss, Tilin, and Morgan (2018) recommended creating a "community of practice" where ideas, information, and resources are shared by all participating in the IPE experience. For nursing programs located on nonacademic health center campuses, IPE can be viewed as quite a challenge.
Recognizing the importance of IPE experiences for our students, the deans of the College of Nursing at the University of Alabama in Huntsville (UAH CON) and the University of Alabama in Birmingham School of Medicine, Huntsville campus, made a joint commitment to invest time and resources in producing effective IPE experiences, along with the Auburn University School of Pharmacy. This article describes our efforts to bring students from nursing, medicine, and pharmacy at three different institutions together for IPE experiences and achieve IPE team behaviors and competencies.
GRADUATE INTERPROFESSIONAL EXPERIENCE
The state-of-the-art UAH CON Learning and Technology Resource Center (LTRC) features a 10,615-square foot simulation center with a mock hospital and seven high-fidelity simulation laboratories with audio-video management systems. The LTRC also features seven collaboration stations for documentation, a Pyxis medication room, five medical-surgical suites, one intensive care unit suite, one home health laboratory, a four-bed obstetric/pediatric suite, and four telehealth robots. Two months prior to the IPE experience, three simulation scenarios were developed by nursing, medicine, and pharmacy using simulation design best practices (Lioce et al., 2015). The one-hour simulations lasted 20 minutes and involved 40 minutes of interprofessional faculty-facilitated bedside debriefing for participants.
The IPE collaboration and negotiations began with a tour of the LTRC for deans and faculty at all three programs. The stakeholders agreed to cohost training and review simulation scenarios with faculty from the advance practice nursing, medicine, and pharmacy programs. All stakeholders participated in testing the scenarios and made revisions to clarify objectives, collaborate on expected performance measures and learning outcomes, and streamline debriefing.
Simulation objectives, supported by the literature on IPE experiences with a focus on teamwork and communication (LeFlore, Bond, Anderson, Baxley, & Diaz, 2017), were outlined as follows: 1) demonstrate effective teamwork; 2) demonstrate therapeutic and confidential communication; 3) recognize the signs and symptoms of the particular disease process; 4) write an appropriate intervention note, assessment, and plan; and 5) write an appropriate set of orders. Faculty agreed that, in addition to clinical objectives, it was imperative to add a formative learning objective regarding documentation after each simulation. This was executed in a progressive manner, beginning with faculty role-modeling in the first simulation to independent work by students in the third.
The IPE day agenda consisted of a group prebriefing, six participant rotations, a group debriefing, and a faculty-staff debriefing. The prebriefing included faculty and staff introductions; an icebreaker that focused on the scope of practice for each professional role; and an overview of the agenda, objectives, teams, performance measures, and resources. Participants were placed in interprofessional groups by their faculty and sat with their group while completing the icebreaker. There were 20 medical students, 16 nurse practitioner students, and 4 pharmacy students.
Each rotation, facilitated by three interprofessional faculty, consisted of clinical skill stations and three high-fidelity simulation cases. No participant preparation was assigned, and only faculty knew the types of cases that would be presented. All participants received a simulation-specific team orientation immediately prior to receiving report on the simulated patient.
DISCUSSION
Effective lessons were learned via this IPE experience. Through the utilization of simulation technology, faculty members from each respective school (nursing, medicine, and pharmacy), LTRC staff members, and nurse practitioner, pharmacy, and medical student participants were able to communicate collectively and function together. Objectives 1 and 2, addressing teamwork and therapeutic communication, were met. The students commented on how important it was to have all disciplines present in the simulations.
Although positive outcomes were achieved, areas in need of improvement were also identified and discussed so that future IPE collaborations could be made more effective. The positive aspects of the educational experience began with the utilization of the existing LTRC facility and the high-fidelity simulators and task trainers. All student participants were able to take part in three faculty-led simulation scenarios. They all had the opportunity to practice assessing a simulated patient case, making a diagnosis, and developing treatment plans. Based on faculty comments, all students excelled in recognizing the signs and symptoms of disease processes and completed the required documentation; objectives 3, 4, and 5 were met.
The student participants rotated through low-fidelity simulation stations that addressed breast, pelvic, and prostate exams; auscultation techniques; sterile technique; and patient hand-off. Each station provided hands-on opportunities and instruction by experienced medical and nurse practitioner faculty. The student participants returned to demonstrate the skill and took part in a question and discussion segment with faculty to further facilitate collaborative learning.
The opportunity for students to learn from interdisciplinary faculty members was received with positive remarks during the debrief session. Students from the three disciplines indicated they were better able to recognize the unique roles of each profession and appreciated the expertise that individual faculty members integrated into the simulations (Delunas & Rouse, 2014). One participant summarized the overall event by saying, "This was an excellent experience and eye opening."
The interaction with pharmacology faculty was identified as having great benefit for nursing and medical student participants during the case scenario simulations. Having access to this level of expertise enabled all participants to make better decisions regarding the prescribing of medication and developing treatment plans.
One obstacle encountered had to do with scheduling. The summer semester for each school varied, with nurse practitioner students having a 10-week semester, medical students having an 8-week semester, and pharmacy students having a session of 5 weeks only. All disciplines demonstrated flexibility with their scheduling, but it was clear that arranging dates for the next academic year would require scheduling well in advance. Following the debriefing of the IPE experience with students, all faculty met to further debrief on the overall experience and discuss future dates. All disciplines verbalized the importance for their students of participating in IPE experiences and noted that it is not necessary to be in an academic health sciences center for IPE to be successful.
CONCLUSION
This innovative partnership demonstrated that collaboration among different institutions can be successful in establishing IPE experiences that enhance interprofessional communication, knowledge, and skills. What made this collaboration successful and innovative was the recognition by the three institutions of the importance of IPE in each respective curriculum and their willingness to work as partners. Having a state-of-the-art simulation center at the CON made it possible to have realistic, collaborative health training scenarios. Being located in a nonacademic health science center should never be a deterrent for creating innovative interprofessional learning opportunities.
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