Immersive clinical simulation in undergraduate health care interprofessional education : knowledge and perceptions

Background: Interprofessional simulation at the undergraduate level has been tested but is still very scarcely used due to curriculum and logistical issues. Over a 3-year period we have conducted extracurricular immersive simulation sessions for multiprofessional groups of final year healthcare students. Methods: Following ethical approval, a series of scenarios requiring various combinations of healthcare professionals' inputs were designed for students attending the simulation sessions on offer. Another team of faculty were involved in the creation of a questionnaire to test students on discipline specific knowledge and about their perception of multidisciplinary working. Students recruited to the study were semi-randomly selected to either a control or experimental group which determined whether they completed the knowledge questionnaire prior to or after simulation exposure. Results: Participants were 237 students from Adult/Children/Learning Disability/Mental Health Nursing, Paramedic, Radiography, Physiotherapy, and Pharmacy. Questionnaire data analysis showed that experimental group students reported a higher perceived level of knowledge of other professions and were more confident about working as part of a multidisciplinary team than control group students (P<0.05). Although positive for both groups, experimental group students expressed greater appreciation for pre-qualification interprofessional learning opportunities. The experimental group outscored the control group by 3.23 percentage points on the discipline knowledge questionnaire (p<0.05). Conclusions: The study shows that even limited interprofessional simulation exposure enabled students to acquire knowledge of other professions and develop a better appreciation of interprofessional learning. Discussions during the debriefings highlighted the fact that interprofessional training is important and valued by students, especially if it is well contextualized and facilitated through the exposure to realistic scenarios.Peer reviewedSubmitted Versio

Are undegraduate healthcare students learning about each other from multiprofessional scenario-based simulation training?

Introduction: During initial training, students have few opportunities to practise alongside students from other disciplines other than in a classroom setting (1). Simulation offers an ideal context to provide clinical experience in a safe and controlled environment (2). This project explores whether simulation improves trainees’ knowledge of other healthcare discipline roles and skills. Methods: Following ethical approval, final year healthcare students were invited to a 3-hour multiprofessional simulation session. A series of scenarios were developed with advice from relevant discipline specific professionals to represent a traditional patient care pathway. Students from 3-4 disciplines were invited to form groups of 12 to 16. During each session students were randomly selected to fill in a questionnaire with 40 questions to test their knowledge of different healthcare disciplines. Half of the students filled in the questionnaire before the simulation experience (Control group) and the other half after (Experimental group). Two scenarios were run per session, followed by debriefing, giving students the opportunity to observe and be involved in a case. Students could attend more than one session, but only completed the questionnaire on the first occasion. The students were only assessed on the questions of the 3-4 disciplines represented in their session (12-16 questions). In addition students were asked questions regarding their view of multidisciplinary training using a 5-point Likert scale (1=strongly disagree, 5=strongly disagree). Results: 87 questionnaires were collected. 43 control group students (Questionnaire before simulation) and 44 experimental group students (Questionnaire after simulation). Participants were: Adult (n=42)-Children (n=4)-Learning Disability (n=9) Nurses, Paramedics (n=12), Radiographers (n=20), Physiotherapists (n=8). Both groups were comparable in terms of gender, discipline and age representation. 13 sessions were run with 7 participants on average and at least 3 disciplines represented. Knowledge of the disciplines represented was reliably different between the control and experimental groups (Control 73.9%, 95% CI 70.9-76.9; and Experimental 78.5%, 95% CI 75.1-81.9, p=0.04). In addition there were reliable differences between the groups in their view of multidisciplinary training; confidence about working as part of a multidisciplinary team was 3.28 (SD=0.77, Control) and 3.82 (SD=0.79, Experimental), p=0.002; the perception of their knowledge of what other healthcare professionals can or cannot do was 2.93 (SD=0.86, Control) and 3.41 (SD=0.95, Experimental), p=0.015; their view that learning with other healthcare students before qualification will improve their relationship after qualification was 3.93 (SD=1.14, Control) and 4.39 (SD=0.78, Experimental), p=0.032; their opinion about interprofessional learning helping them to become better team worker before qualification was 3.93 (SD=1.26, Control) and 4.39 (SD=0.78, Experimental), p=0.045. Conclusions/Discussion: Although the difference is relatively small, the results demonstrate that students gained confidence and knowledge about the skills and role of other disciplines involved in their session. Through simulation, the positivism of students about different aspects of multidisciplinary learning has significantly improved. The aim is now to formally include this session within their curriculum. The main challenges have been voluntary student attendance, timetabling issues due to the number of disciplines involved in each session, and higher than expected staff to student ratio due to poor attendance.Peer reviewe

Undergraduate students' view of multidisciplinary working over a 3-year study on interprofessional simulation learning

Introduction: Interprofessional simulation training at undergraduate level has been tested (1) but is still very scarce due to curriculum and logistical issues. Our simulation specialists worked with staff from most health disciplines within the University to develop a range of scenarios relevant to students that are involved in the final year Interprofessional Education module (2). Data collected from students' during sessions between 2007-2010 with some support from the Higher Education Academy (UK) and a University Learning and Teaching Enhancement award is presented. Hypothesis: Interdisciplinary simulation will improve students' perception of multidisciplinary working when comparing data collected over 3 years, pre and post high-fidelity simulation (3) exposure. Methods: 30 multidisciplinary simulation sessions were conducted with a total of 237 students from Adult/Children/Learning Disability/Mental Health Nursing, Paramedic, Radiography, Physiotherapy, and Pharmacy. During any session, each student was involved in one of 2 scenarios as part of a small team with 3-4 disciplines and using actors, simulated patients and SimMan/SimBaby, and remotely observed the other scenario tackled by their peers. Depending on whether they were allocated to the control or experimental group, students were answering 5 questions about interprofessional working before or after the simulation session using a Likert scale (1=strongly disagree, 5=strongly agree). This study was granted ethical approval as part of a larger educational project. Results: The statements and responses were: I am confident about working as part of a multidisciplinary team (3.46 SD=0.86, Control; 3.94 SD=0.81, Experimental; p=0.000); working as part of a multidisciplinary team would make me feel anxious (2.60 SD=1.09, Control; 2.30 SD=1.04, Experimental; p=0.033); I feel I know what other professionals can and cannot do (2.99 SD=0.89, Control; 3.27 SD=0.84, Experimental; p=0.013); learning with other healthcare students before qualification improves relationships after qualification (4.09 SD=1.13, Control; 4.27 SD=0.83, Experimental; p=0.167); interprofessional learning before qualification helps me become a better team worker (4.02 SD=1.14, Control; 4.35 SD=0.82, Experimental; p=0.011). Discussion/Conclusion: A supportive atmosphere, realistic scenarios, students' involvement, and the correct environment are important factors to fully immerse the participants. The results show that there are differences between the groups' responses to the questions. Experimental group students answered all questions with a more positive attitude towards multidisciplinary working and this was statistically significant for all but one statement. Despite the small intervention (2 scenarios/debriefings), students felts significantly more confident about working as part of a multidisciplinary team. Introducing multiprofessional simulation pre-qualification was a valuable experience and could help students develop teamworking skills4 and feel more confident in the clinical setting.Peer reviewe

Results from a 3-year study on interprofessional simulation learning

Introduction: Students often learn and acquire clinical experience in uni-professional groups; however simulated practice now offers an ideal context to provide students interprofessional experience in a safe and controlled environment. Hypothesis: Exposure to simulation will improve students' knowledge of other healthcare discipline roles and skills. Methods: Over 3 years, and following research ethical approval, 237 undergraduate volunteer students were involved in small groups to one of 30 3-hour interprofessional simulation sessions (1) using simulated patients and SimMan/SimBaby in a pre-hospital and clinical settings. Each session had 3-4 disciplines (Adult/Children/Learning Disability/Mental Health Nursing, Paramedic, Radiography, Physiotherapy, and Pharmacy) and each student observed and took part in one long and relevant student-lead, high-fidelity scenario (2) . Half the students were randomly selected to fill in a 40-item questionnaire testing their knowledge of other disciplines before the simulation (Control group) and the others after (Experimental group). Students were assessed on the questions of the disciplines represented in their session. The scenarios were designed based on the disciplines of the students attending each particular session and the scenario designers did not have specific knowledge of the questionnaire contents. Results: Both groups of students were comparable in terms of discipline mix, age, and gender. The results of the knowledge questionnaire for the control and experimental groups of students were respectively 72.69% (95% CI 70.64-74.73) and 75.92% (95% CI 73.73-78.10) based on the questions relating to the disciplines represented in each session. A t-test was used to compare the mean scores for which the p-value was 0.03. The relatively small score advantage of the experimental group over the control group is statistically significant when looking at the relevant subset of questions. As expected, there is almost no difference in scores between the two groups if the comparison is made over the questions from all the disciplines, that is even if they were not represented within the scenarios of a particular session. Discussion/Conclusion: The comparative analysis shows that students gained knowledge of other disciplines thanks to the scenarios and despite them not being necessarily addressing points raised by the pre-set questions about the different disciplines. Discussions during the debriefings highlighted the fact that inter-disciplinary training is important and valued by students. Despite the challenges, introducing it in the undergraduate curriculum should facilitate its implementation as Continuing Professional Development once these students become qualified healthcare professionals (3). We need to find a strategy to timetable these sessions in the students' curriculum when it is convenient for multiple disciplines to take part.Peer reviewe

Undergraduate multiprofessional training : are students ready for it?

Intorduction: Multidisciplinary simulation training at undergraduate level is still very scarce due to curriculum and logistical issues. Over the last couple of years, HICESC has worked with staff from most health departments to develop scenarios relevant to a range of disciplines that are involved in the final year Interprofessional Education module1. This abstract reports the students’ feedback from a series of sessions run in 2007-2008 with support from the Higher Education Academy and a University Learning and Teaching Enhancement award. Methods: 15 multidisciplinary simulation sessions were conducted with a total of 95 students from Adult/Children/Learning Disability Nursing, Paramedic Sciences, Radiography and Physiotherapy and a team of 6 faculties. Each student was involved as part of a small team in one long high-fidelity scenario2 with 3-4 disciplines and using actors, simulated patients and SimMan. Students also remotely observed another scenario tackled by their peers and were asked to document their observations based on CRM principles on a white board so it could be used as a discussion basis during the debriefing. Students filled in a pre and post-simulation questionnaire about the session using a 5-point Likert scale. Results: Most students (77.78%) were not familiar with the concepts of simulation and were quite anxious about the simulation (3.6/5). Being constantly observed can be distressing. Over three quarters of the students said the scenarios were realistic (3.99/5), which helped them to forget the cameras, instructors and their peers. They reported their performance was not really affected by the fact they were being observed (2.29/5). Concerning the difficulty to treat the mannequin as a real patient, the answers are very spread because it relies to a certain degree on the students’ sense of imagination. In general students thought the mannequin’s response to treatment was realistic (3.81/5). Even if students’ perception of knowledge of their own discipline role and skills was very high (4.73/5) and poorer about other disciplines (2.68/5), they reported simulation allowed them to learn more about their own discipline (3.82/5) and the other disciplines (3.91/5). Students said they leant from the debriefing sessions (4.39/5) and that it enhanced their technical knowledge (4.25/5). 80.16% of the students thought that seeing themselves on video would allow them to reflect better. They requested that 3-4 multiprofessional simulation sessions per year should be part of the Interprofessional Education module. Discussion: Simulation sessions are always enjoyed by students but on this occasion the feedback was even more positive (4.59/5) because it was multidisciplinary. Patient simulators are reported as being very useful in addition to learning from real patients. Students thought the simulation improved their clinical skills and knowledge. A supportive atmosphere, a realistic scenario and environment are important factors to fully immerse the participants. Introducing multiprofessional simulation pre-qualification was a valuable experience and could help students develop teamworking skills and feel more confident in a crisis situation.Peer reviewe

Acquisition of knowledge of other healthcare disciplines through simulation

Introduction : Students have few opportunities to practise alongside other disciplines. Simulation offers an ideal context to provide experience in a safe and controlled environment to junior trainees. This project explores whether simulation improves trainees’ knowledge of other healthcare discipline roles and skills. Methods: 95 students were involved in small groups to one of fifteen 3-hour multi-professional simulation sessions1 using simulated patients and SimMan in the community or emergency department. Each session had 3-4 disciplines (Adult/Children/Learning Disability Nursing, Paramedic, Radiography, Physiotherapy) and each student observed and took part in one long and relevant high-fidelity2 scenario. Half the students were randomly selected to fill in a 40-item questionnaire testing their knowledge of other disciplines before the simulation (Control group) and the others after (Experimental group). Students were assessed on the questions of the disciplines represented in their session. Results: A t-test was used to compare the mean scores of both groups. The hypothesis to test is m1=m2 versus m1≠m2 with m1= control group mean score and m2= experimental group mean score. The p-value is 0.0195 with m1=73.80 and m2=78.81: the t-test rejects the hypothesis of equality of the means. Experimental group marks are significantly higher than control group marks (Fig.1). Conclusions: Students gained knowledge of other disciplines thanks to the scenarios. They are better prepared to enter the inter-professional healthcare workforce. Discussions during the debriefings highlighted the fact that multi-disciplinary training is important. Introducing it in the undergraduate curriculum should facilitate its implementation as Continuing Professional Development once these students become qualified healthcare professionals3.Peer reviewe