Impact of a student virtual interprofessional simulation

INTRODUCTION

Health science students are trained in their academic programs to be competent in their profession, but once they enter the workforce, they will be expected to work in a team for optimal patient care.^[1] Interprofessional education (IPE) is important because it fosters collaboration, communication, coordination, networking, and teamwork, thereby minimizing patient errors and maximizing patient quality of care.^[2] Furthermore, other positive outcomes from interprofessional collaboration include patient’s quicker functional recovery, less complications, improved quality of life, reduced length of hospital stay, decreased morbidity, and fewer hospitalizations.^[1] For the healthcare provider and organizations, the interprofessional team approach improves job satisfaction and quality of work with lower costs. The rapid increase of older adults and the rise in healthcare costs have created the need for healthcare professionals to be efficient in working together to deliver quality care.^[1]

IPE is defined as two or more professions working together to understand each other, and learning with and from each other, while collaborating toward achieving shared outcomes.^[3,4] The interdisciplinary framework allows patient care to be supported by each professional contributing their perspective to the interprofessional team.^[5] IPE becomes more critical towards addressing healthcare professionals’ educational silos by effectively training students on how to cooperatively deliver quality care, while enabling students to develop their own professional identities.^[5] IPE allows students to address barriers created by student attitudes, perceptions, level of skill, and the power dynamics of working in a team.^[6] Students need to be given learning opportunities to work collaboratively, break out of their professional silos, and develop a positive attitude about other healthcare professions.^[7] Without IPE in the healthcare profession curriculum, students will start their professional career with interprofessional barriers of misunderstanding of each other’s language, problem-solving approaches, and values.^[7,14]

The research purpose of our study was to determine the effect of an IPE simulation on changing student attitudes in the areas of teamwork, roles and responsibilities, patient centeredness, interprofessional biases, diversity and ethics, and community centeredness for students in physician assistant studies (PAS), nursing, nutrition, and social work (SW). We hypothesized that student attitudes would improve for all students and would vary by students’ future profession based on a single IPE simulation.

MATERIAL AND METHODS

Study design

This study utilized a prospective, pre-post cohort design with a single IPE simulation intervention between the pre-test and post-test. This occurred during the Spring 2021 semester and Spring 2022 semester. Students signed a consent to participate in the study, completed the Interprofessional Attitude Survey (IPAS)^[8] as a pre-test, engaged in the single IPE simulation, repeated the IPAS as a post-test, and completed a feedback form at the end of the simulation [Figure 1]. This study was approved by the Institutional Review Board in November 2020 and funded by the BHWET grant. Study was conducted in Spring 2021 and Spring 2022.

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Figure 1:

Study design of the virtual interprofessional education simulation.

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This IPE simulation activity was a virtual mock interprofessional team meeting with students from PAS, Nursing, Nutrition, and SW. The goal of the activity was to promote the skills of communicating their plan of care between professions. The learning objectives were taken from the core competencies of the Interprofessional Collaborative Practice in (1) Work with individuals of other professions to maintain a climate of mutual respect and shared values. (Values/Ethics for Interprofessional Practice), (2) Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of patients and to promote and advance the health of populations. (Roles/Responsibilities), (3) Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease (Interprofessional Communication), (4) Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable. (Teams and Teamwork), (5) Work with individuals of other professions to maintain a climate of mutual respect and shared values (Values/Ethics for Interprofessional Practice).^[9]

Before the IPE simulation, students were expected to complete pre-work assignments. As a part of the pre-work, students were expected to read through the mock patient chart in Docucare (Lippincott^®, Wolters Kluwer) and read about the role/responsibilities of the Various Healthcare Professionals. Additionally, Nutrition students had to review Pediatric Standards of Practice: Information on how to calculate pediatric needs, plot the patient on the growth chart for the patient, calculate calorie and protein need, determine a plan of care, and decide what information to discuss with the team and what to discuss with the mother of the patient. Nursing students reviewed the pre-reading assignments, watched the assigned videos, and completed questions to prepare them for their participation in an interprofessional team meeting and family meeting simulation. They were expected to develop and communicate a treatment plan for a patient. SW students were given pre-reading articles and were expected to review the patient chart. PAS students reviewed the patient chart and determined the plan of care for the patient.

During the IPE simulation meeting, the students’ task was to discuss with each other the specifics of the pediatric failure to thrive case using the medical chart and their discipline-specific treatment plans. Students were asked to volunteer to participate in the research and complete the Interprofessional Attitudes Scale (IPAS) online pre-survey before the interprofessional team meeting. This interprofessional team discussion occurred for 15 min, followed by a 15 min team meeting with the actor’s mother of the simulated patient. Finally, there was a debriefing session for 30 min. The debriefing included questions about how they felt about the simulation experience, what went well, what they would do differently, what they learned, and what they will use in their practice. After the debriefing, those who volunteered to participate in the study were invited to fill in the IPAS online post-survey and feedback form.

RESULTS

The students who participated were a combination of both undergraduate and graduate students. Of all the 237 students who participated in this simulation, a total of 77 students completed both the pre- and post-survey. Graduate students who participated in this study were 2^nd-year SW (n = 34; 44%), 2^nd-year nutrition (n = 10; 13%), and 1^st-year PAS (n = 8; 10%). Nursing students (n = 25; 33%) were the undergraduate students at the junior level. This was students’ first experience with interprofessional simulation. Before this IPE simulation, nursing and PAS had experience doing simulations for skills assessment with their own discipline. Sixty-eight percent of students were not included in the study data analysis because they chose not to or forgot to complete the post-survey. Students were allowed 1 week before the simulation to complete the pre-survey and 2 weeks following the simulation to complete the post-survey and feedback form. Demographic information was not collected to protect the anonymity of our subjects.

The IPAS survey results showed a statistically significant difference in student attitudes and total scores of pre- and post-survey based on a single IPE simulation [Table 1]. There was no difference by program type in the Interprofessional Attitudes Survey total score. Although not statistically significant, Nursing and Nutrition students scored higher on the pre-test total score, while the post-test showed equal scores across Nursing, Nutrition, and SW.

In the area of Teamwork, Roles, and Responsibilities subscale, there was a statistical increase in student attitudes based on the total score of pre- and post-survey. There was no difference by program type in student attitudes about Teamwork, Roles, and Responsibilities. However, Nursing and SW students showed a greater increase in scores for Teamwork, Roles, and Responsibilities compared to the other professions. There was no statistically significant difference in student attitudes on the IPAS survey subscales focused on Patient Centeredness. Interprofessional Biases, Diversity and Ethics, and Community Centeredness from the intervention of IPE simulation based on the total score of pre and post-survey. Student attitudes did not vary by program type for Patient Centeredness, Interprofessional Biases, Diversity and Ethics, and Community Centeredness. Based on their post activity feedback form, students identified some major themes of the simulation they enjoyed most [Table 2]. The major learning themes that emerged were the significance of collaborating together in an interprofessional team meeting, learning the roles and responsibilities, understanding the perspectives of the other disciplines, and communicating effectively with the team and patient.

DISCUSSION

The present study determined the effect of a single IPE simulation on interprofessional attitudes. This single IPE simulation was chosen since interprofessional student coursework has not yet been embedded extensively in the curriculum. This single IPE also was also meant to satisfy the grant and accreditation requirements for the PAS, RN, RD, and SW programs. Consistent with other studies, our study findings showed significant improvements in student attitudes from all four professions only in the area of Teamwork, Roles, and Responsibilities. Students learned how to work together as a part of a team and gained knowledge of the other healthcare professions. Wang et al. results showed a significant increase in the Roles and Responsibilities subscale of the Readiness for Interprofessional Learning Scale following an IPE activity for medical, pharmacy, and nursing students building stronger role identity and effective communication across professions.^[10] An important IPEC competency for effective interprofessional practice is knowledge of the roles and responsibilities of healthcare professionals. Thus, the lack of understanding about other professionals’ roles on the healthcare team can impede interprofessional collaboration. The ideal training for collaborative practice is to provide exposure and interaction for students in healthcare programs to learn professional roles, cultures, and contributions of team members.^[10,14] Interprofessional teamwork can be enhanced by allowing more socialization between professions, increasing appreciation of the roles of other healthcare professionals.^[11] The principles of collaborative practice are advocated by the World Health Organization (WHO), suggesting that effective communication in an interprofessional team depends on the team members’ knowledge of the roles and responsibilities of other health professionals. The WHO emphasizes the importance of IPE to develop knowledge and practical skills in a clinical setting, incorporating the principles of patient-centered care.^[11] Benefits of IPE training include improving one’s career working in an interdisciplinary team through enhanced mutual respect and trust, knowledge of roles and responsibilities, effective communication, and enhanced job satisfaction. Benefits to patients include reduced patient hospital stays and fewer medical errors.^[12-14]

Our study showed strong reliability and validity for the use of the IPAS survey. The IPAS survey aligned closely with the core competencies from the IPEC, which served as our learning objectives for the IPE simulation. Limitations of this study were that students were unequal in number across professions. In addition, students were at different stages in their programs, with varying knowledge and skill levels. Nursing students were undergraduate level, while nutrition, PA, and SW students were graduate. A control group was not included in this study. A recommendation for future research would be to integrate IPE education into the curricula of all four programs and research students’ IPE-related attitudes, communication, teamwork, and knowledge about other healthcare professionals, investigating changes from the beginning to the end of their academic programs. Barriers in planning the IPE included faculty engagement in preparing their students and preparing themselves for the debriefing sessions. Potential future research could be to examine the changes in student attitudes following formal faculty training on debriefing.

CONCLUSION

This research provides insight into the impact of incorporating IPE on nursing, nutrition, PA, and SW students’ attitudes in the areas of teamwork, roles and responsibilities, patient centeredness, interprofessional biases, diversity and ethics, and community centeredness. Our study confirmed a significant change in student attitudes regarding teamwork and roles and responsibilities. This change occurred across all four professions and did not vary by discipline. The intervention of an IPE virtual simulation resulted in improved student appreciation of collaborative team practice in improving communication, solving patient problems, becoming a better team member, and understanding their own limitations. Improved familiarity with healthcare professional roles, professional stereotypes, and workplace culture can help to facilitate positive change for improved team collaboration.^[13] It is clear from this study that a single IPE simulation was a valuable learning experience and helped to break down professional silos between nursing, nutrition, SW, and PAs. Additional practice of interprofessional communication and teamwork during students’ education can facilitate collaborative practice in their professional careers. Future research is recommended to identify the impact of multiple IPE teamwork activities throughout students’ academic programs on their attitudes and their interprofessional collaborative knowledge and skills.