Interprofessional Simulation-Based Education - The Operations Side

10/06/2016

Blog post by SimGHOSTS President Scott Crawford

Interprofessional Simulation-Based Education - The Operations Side

 

Photos by Chris Espinos

Why do we train in an interprofessional education (IPE) simulation environment ? Healthcare, in addition to being one of the largest expenses in our country, is one that involves the coordination of an extraordinary number of resources to deliver that care. Simulation pedagogy talks about breaking down the silos of training, but those silos extend beyond the simulation center. Establishing and building communication is perceived as the solution to many of the medical errors we see in headlines about patient safety and patient care. The direct effects to patient care are multifactorial and difficult to assess directly, but IPE training is well perceived by participants and allows for engagement in a manner not usually available.[i]

The Joint Commission in 2007 reported that staff communication was the primary cause of 65% of hospital sentinel events between 1995 and 2005[ii]. Communication breakdown is often between disciplines or systems for healthcare delivery. Silos don’t just exist within the simulation center during standard training, they exist within the hospital, clinics and between specialties and support services. The concept of trust and appropriately describing the reasoning for providing care in the manner it is delivered still needs to be improved.

Written documentation seems like the appropriate area to improve this type of communication and should improve outcomes, but practitioners including nurses and physicians feel as though they are drowning already, with some reports suggesting that “For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours are spent on EHR and desk work within the clinic day.”[iii]

Here is the area where medical educators hope IPE simulation will carry the greatest impact. The direct personal face-to-face interaction between physicians, nurses, pharmacists and everyone else involved with providing care must exist during training to be carried over into practice. Whether this involves the simulation lab or a carefully constructed in-situ event, these individuals must be brought together. Clear communication and a culture where cutting corners is both not tolerated and can be addressed without reciprocity are a must within our healthcare system.

 

Our institution just conducted the largest IPE simulation activity ever performed on our campus. We sought to address the relationship between the care for diabetes and pregnancy near El Paso at the U.S.-Mexico border. This undertaking took 10 months of planning and involved 178 learners from 10 different medical programs, including resident physicians, nurses, pharmacists and sonographers. Twelve independent simulation scenarios were written to address specific components of the interplay between these specialties and repeated over three days. Although the content creation alone was an enormous undertaking to develop up-to-date referenced information for each of these specialties, even the educators most involved with simulation did not fully understand the availability of equipment or the expectations with the rapid simulation-based sessions like those required for this encounter. Appropriate use of moulage, equipment setup and operation, and logistics for directing this many individuals through all stations required an immense knowledge of simulation operations. Educational technologies, A/V infrastructure to adapt to the specific needs of each station and a general understanding of educational methods to encourage facilitators to allow guided reflection by learners and avoid the tendency to perform lecture-based educational activities are just some of the areas where these individuals were able to intervene.

In the end we created a robust and engaging simulation atmosphere where participants learned from one another how each of them impacts the care of mother and baby in the setting of diabetes in pregnancy. This care extended from early ultrasound identification of fetal anomalies, to counseling about diabetic medication use, to how to appropriately manage complications from diabetes during pregnancy, and finally to perinatal complications for those patients who have not received optimum care.

There is no way that this type of activity can be performed without the engagement and availability of knowledgeable staff behind the scenes to allow educators to focus on content delivery and researchers to focus and understand how this type of educational activity can impact delivery of healthcare.

As a technical expert, I felt an immense sense of accomplishment when learners were able to demonstrate appropriate use of equipment required for care that they have never before seen, and felt engaged with the scenario. As an educator, I knew, beyond what could ever be captured by a Likert scale, the utility of this method of education when a pharmacist, ER physician, and obstetrician each shared one piece of knowledge during a scenario that allowed each to connect the dots and create a complete picture for the need to identify early asymptomatic bacteriuria, to provide the correct antibiotics, all with the goals to prevent premature contractions and preterm labor.

Two separate teams worked to achieve this success on our campus. This is another example of an interprofessional experience. The technicians and other simulation specialists made suggestions to methods for content delivery and logistics to educators that enhanced the learning opportunities for all participants. I can confidently say that without this careful interplay, the sessions would not have been conducted to create the success that we were able to experience. A special thank you to Karla Salamanca, Eddie Luevano CHSOS, Laurence Rascon CHSOS and Hector Aranda CHSOS for their tireless support of this activity.

[i] Zhang, C., Thompson, S., & Miller, C. (2011). A review of simulation-based interprofessional education. Clinical Simulation in Nursing, 7(4), e117-e126.

[ii] https://www.jointcommission.org/assets/1/6/2007_Annual_Report.pdf

[iii] Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. [Epub ahead of print 6 September 2016]