http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, Early Online: 1–4 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2015.1027336
SHORT REPORT
Perceptions of interprofessional clinical simulation among medical and nursing students: A pilot study Catherine Anne Shanahan and Joy Lewis
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
School of Osteopathic Medicine in Arizona, A. T. Still University, Mt. Orab, OH, USA
Abstract
Keywords
Interprofessional education (IPE) is a well-supported concept in medical education and a priority for leadership. How students experience IPE is unclear. This pilot study evaluated how medical and nursing students perceived and experienced IPE. Ten medical and 10 nursing students participated in a clinical simulation-based IPE exercise with 2 medical and 2 nursing students per group. Participants completed the KidSIM ATTITUDES questionnaire before and after the exercise. Students gave verbal feedback during the post-exercise debrief. Statistical analyses showed perceptions of the group became more positive with the exercise. With statistical significance across all the domains (relevance of IPE and simulation, communication, situation awareness, and roles/responsibilities), verbal comments were positive. A single clinical simulation-based IPE exercise improved perceptions of IPE among these students. These results provide further impetus to continue to study IPE for medical and nursing students. The findings also support the inclusion of IPE in medical education.
Clinical simulation, curriculum, interprofessional education, medical students, nursing students
Introduction Interprofessional collaboration is essential for safe, high-quality, patient-centered care. This concept is enthusiastically supported by hospital administrators, health care professional societies, the Institute of Medicine and the Interprofessional Education Collaboration Expert Panel (IPEC, 2011). In order to set the stage for interprofessional collaboration, interprofessional education (IPE) should be incorporated into health professional education programs (Reese, Jeffries, & Engum, 2010). There is debate regarding the most effective approach to IPE. There is no standard of practice with respect to teaching approach, duration of activities or optimal professional mix for the IPE of health professionals. However, there is evidence that IPE activities using experiential learning via clinical simulation are effective (Baker et al., 2008). In addition, it has been suggested that IPE activities were perceived more positively with small groups when compared with large group activities, where students were supported by regular, integrated interprofessional activities (Rosenfield, Oandasan, & Reeves, 2011). As educators strive to develop and incorporate IPE experiences into curricula, guidance is needed on how to evaluate them. These evaluations need to include not only collaboration, teamwork, leadership and the communication aspects of the experience but also the learning modality used. There are numerous evaluative tools available. While many have shown internal validity in their ability to measure various aspects of learner perceptions of and
Correspondence: Catherine Anne Shanahan, School of Osteopathic Medicine in Arizona, A. T. Still University, 612 South High St., Mt. Orab, OH 45154, USA. E-mail: [email protected]
History Received 23 April 2014 Revised 10 December 2014 Accepted 5 March 2015 Published online 17 June 2015
attitudes toward IPE, most have not evaluated the learning modality used for the IPE experiences (Sigalet, Donnon, & Grant, 2012). Drawing from these tools, Sigalet et al. (2012) developed a questionnaire that covers domains evaluated by existing tools and evaluates clinical simulation as the learning modality for the experience. The questionnaire presents positive statements related to IPE, participants are asked their level of agreement using a 5-point Likert scale. Higher scores represent more positive attitudes. Since clinical simulations have been found to be effective learning modalities for IPE experiences (Baker et al., 2008), we employed the questionnaire developed by Sigalet et al. (2012). Validated for clinical simulation in critical care and emergency settings, this tool covers participants’ perceptions in five domains: relevance of IPE; relevance of simulation; communication; situation awareness; and roles and responsibilities. It has been reported that the tool has good internal validity when compared with other interprofessional questionnaires (Sigalet et al., 2012). The purpose of this article is to report a pilot study that described the perceptions of medical and nursing students of a clinical simulation-based IPE experience and to identify student characteristics related to these perceptions.
Background The study enrolled 10 third-year medical students and 10 senior associate degree nursing students. The IPE experience was required for the medical student orientation. The nursing instructors solicited volunteers for a ‘‘clinical simulation experience’’ from those starting their final year of nursing school. The intervention was conducted with five groups of four students
2
C. A. Shanahan & J. Lewis
J Interprof Care, Early Online: 1–4
Table I. Pre- and post-IPE simulation factor scores.
Domains (items)
Pre-test (n ¼ 20) Mean (SD)
Relevance of IPE (7 items# 1–4,28–30) Relevance of simulation (5 items #5–7,9,16) Communication (8 items #8,10–15,18) Situation awareness (4 items# 17,19–21) Roles and responsibilities (6 items# 22–27) Total (30 items)
29.80 21.30 35.40 16.40 25.05 127.95
(3.21) (1.89) (2.93) (1.70) (2.44) (10.62)
Post-test (n ¼ 20) Mean (SD) 33.70 23.85 38.50 19.00 28.55 143.65
(1.98) (2.01) (2.14) (1.49) (2.19) (8.86)
p Valuea 50.0001 50.0001 0.0005 50.0001 50.0001 50.0001
a
Paired t-test, a p value of 50.01 is considered significant for this study.
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
(two nursing and two medical). The students participated in a clinical simulation experience using a human patient simulator. The medical student instructors and the nursing instructors worked together to develop and administer this IPE experience.
Methods The study employed a pre-/post-intervention design. Data were collected from each student prior to the simulation exercise included: age, gender, years and type of clinical work experience, discipline, education level and past IPE experience. The students were asked to not discuss the simulation experience with others. The simulations took place at the community college simulation lab; all the groups had the same scenario. All of the participants had some past experience with clinical simulation. Before and after the clinical simulation, participants took the questionnaire. The questionnaires were numbered and linked to a participant to enable comparisons (pre and post). These names and numbers were entered into a password protected Excel spreadsheet. The pre-/post-questionnaire data were entered into an encrypted, password protected, Excel spreadsheet by number. Hard copies of the questionnaires were kept in a locked filing cabinet. A debrief session with students and faculty immediately followed each session. Student comments were written down but kept anonymous. The anonymous pre-/post-responses were analyzed using paired t-tests. The results were stratified based on gender, discipline and clinical experience. Ethical considerations This project was deemed exempt by the local Institutional Review Board (IRB). The IRB did not require written consent but did require a letter be given to each participant that stated the focus of the study, time commitment to complete the survey, assurance that information would be de-identified and that participation was voluntary. A letter inclusive of the requirements was given to all of the participants.
Results All 20 participants in the simulation completed the pre- and postquestionnaire and debrief. There were 13 females and 7 males, 50% were between the ages of 20 and 30 years with two participants over age 40 years. As shown in the table, questions were grouped by domain. Pre- and post-answers were compared using paired t-tests and all the domains showed statistically significant increases (Table I). Analysis of factor score by gender, discipline and previous clinical experience, showed no significant changes. In relation to open-ended questions, the students were overwhelmingly positive about the experience. Some expressed appreciation for the small size of the groups. Others expressed that at first roles were unclear. ‘‘I wanted to make a suggestion
but did not think I was allowed to’’, stated a nursing student. Despite the initial awkwardness, there was the sense of ultimately gaining consensus and using ‘‘we’’ versus ‘‘I’’ when communicating. While some nursing students were apprehensive, concerned about their knowledge level; many medical students were impressed with the nursing students’ level of clinical knowledge and experience. ‘‘I was not comfortable giving orders’’ expressed one of the medical students. The participants stated that the experience was valuable, ‘‘liked the simulation better with medical students there, more realistic’’ and requested more similar sessions.
Discussion The results suggest possible positive changes in perceptions after an IPE clinical simulation exercise. This is consistent with other work that showed clinical simulation to be an effective and wellreceived IPE modality (Baker et al., 2008). Students reported finding clinical simulation relevant and realistic. Additionally, clinical simulation encourages students to think and to take action. Thus, students may be able to define their own roles and responsibilities while working together in an interprofessional manner. This approach may also encourage interprofessional faculty to lead by example since the development of simulation exercises for IPE often requires interprofessional educators to model collaborative behavior (Baker et al., 2008). Feedback supported the concept that IPE clinical simulations are well received when delivered in small groups (Rosenfield et al., 2011). Limitations include a small sample size. The lack of significant change related to gender, discipline and past clinical experience may be due to this. Also, there is selection bias with nursing students being volunteers. In summary, this study provides some positive perceptions about the use of interprofessional clinical simulation. Participating students and faculty are enthusiastic about integrating IPE into curricula and are now ambassadors for IPE. Enthusiasm for IPE may wane over time (Bradley, Cooper, & Duncan, 2009). Future research should evaluate how to make this positive change sustainable. Frequency and timing of IPE and disciplines to include need further clarification. This study shows that IPE is valued by students, additional IPE training is desired. Future research could replicate this study with more participants.
Acknowledgements We would like to thank the participating students, Southern State Community College, Melanie Foxx and Bruce Fugate.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the writing and content of the paper.
DOI: 10.3109/13561820.2015.1027336
Interprofessional clinical simulation among medical and nursing students
References
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
Baker, C., Pulling, C., McGraw, R., Dagnone, J., Hopkins-Rosseel, D., & Medves, J. (2008). Simulation in interprofessional education for patient-centered collaborative care. Journal of Advanced Nursing, 64, 372–379. Bradley, P., Cooper, S., & Duncan, F. (2009). A mixed-methods study of interprofessional learning of resuscitation skills. Medical Education, 43, 912–922. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional education collaborative practice. Washington D.C.: Interprofessional Education Collaborative.
3
Reese, C., Jeffries, P., & Engum, S. (2010). Using simulations to develop nursing and medical student collaboration. Nursing Education Perspectives, 31, 33–49. Rosenfield, D., Oandasan, I., & Reeves, S. (2011). Perceptions versus reality: a qualitative study of students’ expectations and experiences of interprofessional education. Medical Education, 45, 471–477. Sigalet, E., Donnon, T., & Grant, V. (2012). Undergraduate students’ perceptions of and attitudes toward a simulation-based interprofessional curriculum. Society for Simulation in Healthcare, 7, 353–358.
SHORT REPORT
Perceptions of interprofessional clinical simulation among medical and nursing students: A pilot study Catherine Anne Shanahan and Joy Lewis
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
School of Osteopathic Medicine in Arizona, A. T. Still University, Mt. Orab, OH, USA
Abstract
Keywords
Interprofessional education (IPE) is a well-supported concept in medical education and a priority for leadership. How students experience IPE is unclear. This pilot study evaluated how medical and nursing students perceived and experienced IPE. Ten medical and 10 nursing students participated in a clinical simulation-based IPE exercise with 2 medical and 2 nursing students per group. Participants completed the KidSIM ATTITUDES questionnaire before and after the exercise. Students gave verbal feedback during the post-exercise debrief. Statistical analyses showed perceptions of the group became more positive with the exercise. With statistical significance across all the domains (relevance of IPE and simulation, communication, situation awareness, and roles/responsibilities), verbal comments were positive. A single clinical simulation-based IPE exercise improved perceptions of IPE among these students. These results provide further impetus to continue to study IPE for medical and nursing students. The findings also support the inclusion of IPE in medical education.
Clinical simulation, curriculum, interprofessional education, medical students, nursing students
Introduction Interprofessional collaboration is essential for safe, high-quality, patient-centered care. This concept is enthusiastically supported by hospital administrators, health care professional societies, the Institute of Medicine and the Interprofessional Education Collaboration Expert Panel (IPEC, 2011). In order to set the stage for interprofessional collaboration, interprofessional education (IPE) should be incorporated into health professional education programs (Reese, Jeffries, & Engum, 2010). There is debate regarding the most effective approach to IPE. There is no standard of practice with respect to teaching approach, duration of activities or optimal professional mix for the IPE of health professionals. However, there is evidence that IPE activities using experiential learning via clinical simulation are effective (Baker et al., 2008). In addition, it has been suggested that IPE activities were perceived more positively with small groups when compared with large group activities, where students were supported by regular, integrated interprofessional activities (Rosenfield, Oandasan, & Reeves, 2011). As educators strive to develop and incorporate IPE experiences into curricula, guidance is needed on how to evaluate them. These evaluations need to include not only collaboration, teamwork, leadership and the communication aspects of the experience but also the learning modality used. There are numerous evaluative tools available. While many have shown internal validity in their ability to measure various aspects of learner perceptions of and
Correspondence: Catherine Anne Shanahan, School of Osteopathic Medicine in Arizona, A. T. Still University, 612 South High St., Mt. Orab, OH 45154, USA. E-mail: [email protected]
History Received 23 April 2014 Revised 10 December 2014 Accepted 5 March 2015 Published online 17 June 2015
attitudes toward IPE, most have not evaluated the learning modality used for the IPE experiences (Sigalet, Donnon, & Grant, 2012). Drawing from these tools, Sigalet et al. (2012) developed a questionnaire that covers domains evaluated by existing tools and evaluates clinical simulation as the learning modality for the experience. The questionnaire presents positive statements related to IPE, participants are asked their level of agreement using a 5-point Likert scale. Higher scores represent more positive attitudes. Since clinical simulations have been found to be effective learning modalities for IPE experiences (Baker et al., 2008), we employed the questionnaire developed by Sigalet et al. (2012). Validated for clinical simulation in critical care and emergency settings, this tool covers participants’ perceptions in five domains: relevance of IPE; relevance of simulation; communication; situation awareness; and roles and responsibilities. It has been reported that the tool has good internal validity when compared with other interprofessional questionnaires (Sigalet et al., 2012). The purpose of this article is to report a pilot study that described the perceptions of medical and nursing students of a clinical simulation-based IPE experience and to identify student characteristics related to these perceptions.
Background The study enrolled 10 third-year medical students and 10 senior associate degree nursing students. The IPE experience was required for the medical student orientation. The nursing instructors solicited volunteers for a ‘‘clinical simulation experience’’ from those starting their final year of nursing school. The intervention was conducted with five groups of four students
2
C. A. Shanahan & J. Lewis
J Interprof Care, Early Online: 1–4
Table I. Pre- and post-IPE simulation factor scores.
Domains (items)
Pre-test (n ¼ 20) Mean (SD)
Relevance of IPE (7 items# 1–4,28–30) Relevance of simulation (5 items #5–7,9,16) Communication (8 items #8,10–15,18) Situation awareness (4 items# 17,19–21) Roles and responsibilities (6 items# 22–27) Total (30 items)
29.80 21.30 35.40 16.40 25.05 127.95
(3.21) (1.89) (2.93) (1.70) (2.44) (10.62)
Post-test (n ¼ 20) Mean (SD) 33.70 23.85 38.50 19.00 28.55 143.65
(1.98) (2.01) (2.14) (1.49) (2.19) (8.86)
p Valuea 50.0001 50.0001 0.0005 50.0001 50.0001 50.0001
a
Paired t-test, a p value of 50.01 is considered significant for this study.
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
(two nursing and two medical). The students participated in a clinical simulation experience using a human patient simulator. The medical student instructors and the nursing instructors worked together to develop and administer this IPE experience.
Methods The study employed a pre-/post-intervention design. Data were collected from each student prior to the simulation exercise included: age, gender, years and type of clinical work experience, discipline, education level and past IPE experience. The students were asked to not discuss the simulation experience with others. The simulations took place at the community college simulation lab; all the groups had the same scenario. All of the participants had some past experience with clinical simulation. Before and after the clinical simulation, participants took the questionnaire. The questionnaires were numbered and linked to a participant to enable comparisons (pre and post). These names and numbers were entered into a password protected Excel spreadsheet. The pre-/post-questionnaire data were entered into an encrypted, password protected, Excel spreadsheet by number. Hard copies of the questionnaires were kept in a locked filing cabinet. A debrief session with students and faculty immediately followed each session. Student comments were written down but kept anonymous. The anonymous pre-/post-responses were analyzed using paired t-tests. The results were stratified based on gender, discipline and clinical experience. Ethical considerations This project was deemed exempt by the local Institutional Review Board (IRB). The IRB did not require written consent but did require a letter be given to each participant that stated the focus of the study, time commitment to complete the survey, assurance that information would be de-identified and that participation was voluntary. A letter inclusive of the requirements was given to all of the participants.
Results All 20 participants in the simulation completed the pre- and postquestionnaire and debrief. There were 13 females and 7 males, 50% were between the ages of 20 and 30 years with two participants over age 40 years. As shown in the table, questions were grouped by domain. Pre- and post-answers were compared using paired t-tests and all the domains showed statistically significant increases (Table I). Analysis of factor score by gender, discipline and previous clinical experience, showed no significant changes. In relation to open-ended questions, the students were overwhelmingly positive about the experience. Some expressed appreciation for the small size of the groups. Others expressed that at first roles were unclear. ‘‘I wanted to make a suggestion
but did not think I was allowed to’’, stated a nursing student. Despite the initial awkwardness, there was the sense of ultimately gaining consensus and using ‘‘we’’ versus ‘‘I’’ when communicating. While some nursing students were apprehensive, concerned about their knowledge level; many medical students were impressed with the nursing students’ level of clinical knowledge and experience. ‘‘I was not comfortable giving orders’’ expressed one of the medical students. The participants stated that the experience was valuable, ‘‘liked the simulation better with medical students there, more realistic’’ and requested more similar sessions.
Discussion The results suggest possible positive changes in perceptions after an IPE clinical simulation exercise. This is consistent with other work that showed clinical simulation to be an effective and wellreceived IPE modality (Baker et al., 2008). Students reported finding clinical simulation relevant and realistic. Additionally, clinical simulation encourages students to think and to take action. Thus, students may be able to define their own roles and responsibilities while working together in an interprofessional manner. This approach may also encourage interprofessional faculty to lead by example since the development of simulation exercises for IPE often requires interprofessional educators to model collaborative behavior (Baker et al., 2008). Feedback supported the concept that IPE clinical simulations are well received when delivered in small groups (Rosenfield et al., 2011). Limitations include a small sample size. The lack of significant change related to gender, discipline and past clinical experience may be due to this. Also, there is selection bias with nursing students being volunteers. In summary, this study provides some positive perceptions about the use of interprofessional clinical simulation. Participating students and faculty are enthusiastic about integrating IPE into curricula and are now ambassadors for IPE. Enthusiasm for IPE may wane over time (Bradley, Cooper, & Duncan, 2009). Future research should evaluate how to make this positive change sustainable. Frequency and timing of IPE and disciplines to include need further clarification. This study shows that IPE is valued by students, additional IPE training is desired. Future research could replicate this study with more participants.
Acknowledgements We would like to thank the participating students, Southern State Community College, Melanie Foxx and Bruce Fugate.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the writing and content of the paper.
DOI: 10.3109/13561820.2015.1027336
Interprofessional clinical simulation among medical and nursing students
References
J Interprof Care Downloaded from informahealthcare.com by Nyu Medical Center on 07/02/15 For personal use only.
Baker, C., Pulling, C., McGraw, R., Dagnone, J., Hopkins-Rosseel, D., & Medves, J. (2008). Simulation in interprofessional education for patient-centered collaborative care. Journal of Advanced Nursing, 64, 372–379. Bradley, P., Cooper, S., & Duncan, F. (2009). A mixed-methods study of interprofessional learning of resuscitation skills. Medical Education, 43, 912–922. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional education collaborative practice. Washington D.C.: Interprofessional Education Collaborative.
3
Reese, C., Jeffries, P., & Engum, S. (2010). Using simulations to develop nursing and medical student collaboration. Nursing Education Perspectives, 31, 33–49. Rosenfield, D., Oandasan, I., & Reeves, S. (2011). Perceptions versus reality: a qualitative study of students’ expectations and experiences of interprofessional education. Medical Education, 45, 471–477. Sigalet, E., Donnon, T., & Grant, V. (2012). Undergraduate students’ perceptions of and attitudes toward a simulation-based interprofessional curriculum. Society for Simulation in Healthcare, 7, 353–358.
