Innovative interprofessional learning activities within health professional programs are vital to prepare graduates to provide safe, effective, team-based care (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). However, students in health profession programs rarely interact with others outside their discipline, which can leave them unprepared for practice and put patients at risk for harm (Institute of Medicine, 2015). Developing creative, meaningful, and effective interprofessional education (IPE) activities can be challenging for educators (NASEM, 2021). Simulation, which provides a safe learning environment that promotes communication and teamwork among health professionals, has demonstrated positive results (NASEM, 2021).
Faculty at our institution developed a creative, interactive approach to interprofessional learning experiences that has enabled students from different disciplines to learn from one another and collaborate in the development of patient care plans. To maximize resources, we developed a large-classroom simulation incorporating a variety of media formats. Simulation in the large classroom setting has been successfully utilized in nursing education (Carson & Harder, 2016; Rode et al., 2016). This article highlights the development, implementation, and evaluation of an interprofessional simulation for a large classroom setting.
SIMULATION VIA VIDEO
The simulation was created by faculty from nursing, pharmacy, and social work to model the core competencies for interprofessional collaborative practice (Interprofessional Education Collaborative, 2016). The objectives were for students to be able to: 1) understand how to communicate with other health professionals in a collaborative manner and 2) recognize the impact of teamwork on patient-centered care. We used the International Nursing Association for Clinical Simulation and Learning (2016) Standards of Best Practice: SimulationSM to guide the development and implementation of the simulation.
Prebriefing, led by a nursing faculty member well versed in simulation, included the establishment of ground rules, learning objectives, orientation to the activity, and expectations. Students were seated in teams with one or more students from each discipline. They introduced themselves to other team members and briefly described their roles and educational preparation.
The facilitators began the simulation by introducing the patient as follows: "Your patient is Mr. John Brown. He is a 78-year-old widower, living on his own since his wife died nine months ago. He has an elevated blood pressure and Type 2 diabetes that has been poorly controlled for the last two years. He has two children, one of whom lives in town and the other lives out of state." In the first video, which was recorded in a simulation laboratory and designed to mimic a patient's home, Mr. Brown is confused and encounters multiple safety hazards. He demonstrates an unsteady gait, drops medications on the floor, and trips on his rug. The video ends with Mr. Brown falling asleep on his couch after eating doughnuts.
After the video, facilitators asked questions to guide discussion about each discipline's role in the scenario, concerns about the patient, priorities for patient care, and potential barriers to improving the patient's situation. Once the teams addressed these topics, a large-group discussion took place to examine responses. All students identified several patient safety concerns regarding Mr. Brown's environment and medication management.
Faculty facilitators provided the following information before the second video: "Mr. Brown's daughter is angry and does not understand what is going on with her father. She calls his primary care provider's office to obtain an appointment. Mr. Brown's daughter informs the nurse at the office that her father says that he takes his medications, but when she visits, he has not taken his medications for three days. She is also concerned about his safety and choice of foods." In this video, Mr. Brown and his daughter are in a simulation suite that mimics a clinic exam room. Health care professionals from nursing, medicine, pharmacy, and social work enter the room together but do not introduce themselves nor state their discipline. The daughter dominates the conversation and becomes agitated, complaining that her father takes multiple medications, is forgetful, and is not eating properly. The health care professionals appear disinterested. After about five minutes, they exit the room to discuss the next steps. The video demonstrates conflict within the team regarding roles and responsibilities for patient care.
At the conclusion of the video, teams were provided three open-ended questions focused on teamwork, collaboration, and communication. After the teams addressed the questions, the facilitators and all students discussed the scenario. At this point, students began to recognize patterns in their responses. Nursing students focused on safety, pharmacy students focused on medication adherence, and social work students focused on lack of social support. Most importantly, students noted that their varied approaches to the patient's care made them a stronger, more effective team and allowed them to develop a better, holistic plan of care.
After discussion, the students watched a third video. Here, the scenario was similar to the second video, but this time, the interprofessional team entered the room, introduced themselves, and demonstrated teamwork and collaboration throughout the patient encounter. After the team members completed their interview and assessment, they worked together to develop a plan of care for Mr. Brown. Following the video, students worked in teams to discuss what went well, what could have been improved, and how teamwork and collaboration impacted patient care. They then joined together for a large-group discussion about the video, and faculty from all disciplines transitioned to large-group debriefing. Students were encouraged to reflect on the situation and how health care professionals can work together to develop and execute an effective plan of care.
EVALUATING THE LEARNING EXPERIENCE
Before and after the learning experience, all students completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), a 20-item Likert scale tool developed to assess students' perceptions of working on an interprofessional team (Archibald et al., 2014). As the social work group was small, data are reported for nursing and pharmacy students only; 96 students (nursing, 34; pharmacy, 62) completed the pretest, and 76 completed the posttest. Pre-post data were compared using independent t-tests. This study received exempt institutional review board approval.
Results of the ICCAS survey indicated that there were statistically significant improvements in combined nursing and pharmacy students' responses in the areas of communication (t = 6.8, p < .001), collaboration (t = -5.93, p < .001), roles and responsibility (t = -6.55, p < .001), conflict management (t = -5.64, p < .001), patient-centered care (t = -6.23, p < .001), and team function (t = -6.17, p < .001). No significant differences were found in any area between nursing and pharmacy students. Students' comments regarding the experience during debriefing were positive, with students stating the learning experience was exceptional because they gained greater understanding about the roles and responsibilities of other disciplines when working on an interprofessional team and how each discipline enriches the development of a holistic care plan. They verbalized that the simulation helped improve their collaboration and communication skills with other students.
DISCUSSION AND CONCLUSION
Our findings were congruent with the literature, with simulation shown to be an effective method to improve students' perceptions of and preparation for interprofessional practice (Granheim et al., 2018; Horsley et al., 2018; Labrague et al., 2018). The students in our programs had limited opportunities to interact with other disciplines prior to this experience. They valued and enjoyed the time spent with students from other programs and found the experience to be fun and interactive. As the small sample from one large public institution was a limitation and the groups were self-selected, with self-reported data, we recommend further study.
Integrating IPE in health care education can be key to preparing health care professionals to deliver safe, effective care (NASEM, 2021). This innovative activity provided a unique opportunity for students to collaborate with others to develop a plan of care and understand the importance of each discipline's contribution to the interprofessional team. The method maximized the resources of faculty time and classroom space to allow students to participate in simulated interprofessional activities. This creative approach may be useful for other programs that aim to provide valuable simulated IPE experiences but need to use flexible, cost-effective methods to offer experiences for all students.
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