Breaking Bad News: Confronting Interdisciplinary Bias

Purpose:  A critical component of safe patient care in today’s health care system is effective teamwork. Teams composed of members from various health care disciplines depend upon successful interprofessional collaboration under stressful conditions to achieve desired health outcomes.  The purpose of Phase I of this multifaceted project was to bring together healthcare students from multiple disciplines – including nursing, medicine, and pharmacy: a) to collaborate on planning and implementing an approach to managing a challenging patient care situation, and b) to identify their own biases,  challenges, and successes with interprofessional communication.

 Methods:  In teams of 3, one from each discipline, students are asked to engage in a two-stage simulated patient family encounter, and then participate in a debriefing discussion with clinical educators from each discipline. Prior to the simulation, team members have ten minutes to learn about each other’s discipline and professional culture. The simulated scenario, using Standardized Patient (SP) Model, involves a serious medication error.  Educators provide a description of the error and each team member’s responsibility for the error. The patient has survived and has been transferred to the medical intensive care unit.  The task for the team is to discuss the error with the patient’s family member.  The team has ten minutes to plan how they will approach the family member.  In the next stage, the team has a 15-minute meeting with the family member during which a trained actor (SP) portrays a family member who is emotional, either angry or sad, about the error that has occurred.   During the debriefing phase, the clinical educators attempt to elicit perceptions of responsibility for the error, in a safe environment, and encourage students to discuss the challenges of the interdisciplinary experience. 

 Results:  During the debriefing, students were able to recognize the expertise each profession brings to patient care delivery, to openly demonstrate respect and trust for the other members of their team, and to clearly identify what they would do differently ‘next time. The students often reported a greater appreciation at the breadth of knowledge held by their colleagues in other professions.  Additionally, they reported several points of identification with each other that often resulted in a higher degree of respect and trust for the other disciplines. The students acknowledged that an increase in trust and respect for each other would lead to improved patient outcomes.  Finally, students reported greater comfort in communicating with their team members about patient care and potential errors following the simulation when compared to before the collaboration.

 Conclusion:

The simulated experience was useful, in that it gave the students from different disciplines and three different universities an opportunity to identify interdisciplinary biases that each had towards one another. This led to an understanding of how to conquer the biases and provided a pathway towards improved communication strategies, which will indirectly promote patient safety and improved patient outcomes.