Enhancing Interprofessional Education through Technology-Supported Simulation: Lessons Learned

Purpose: Although advances have been made the U.S. healthcare system continues to rely heavily on the silo model of education and practice. Students learn about their profession and practitioners provide care at their level of training, but often for only one disease and without the knowledge or understanding of the complementary roles of other healthcare professions in patient care. Therefore, patients with multiple chronic conditions receive fragmented care affecting cost, safety, effectiveness, quality of life, and mortality. Practitioners must be trained to collaborate in interprofessional (IP) teams. This cannot happen without each person becoming aware of the roles and responsibilities of others. Well-integrated IP teams increase patients’ physical functioning, well-being, perceptions of control, self-efficacy, quality of life, satisfaction with services, and reduce healthcare costs. The purpose of the course and learning outcomes evaluation was to assess self-reported perceptions of effectiveness of the simulation in meeting course objectives, including synthesis of IP collaborative practice concepts.

A team-based approach to learning stresses shared leadership, fostering growth in the skills needed to be effective drivers of healthcare change. Most IP course and capstone simulations are face-to-face, with a focus on acute care and critical decision-making. The innovation of this course and capstone event was the ability for virtual attendance by distance students during a technology-supported simulation learning experience; thus providing early IP education to crystalize application of didactic content from the online portion of this blended platform approach. The skill set acquired from the course included competencies established by the Interprofessional Education Collaborative (IPEC) and TeamSTEPPS® for primary care.

Critical steps for the success of technology-supported teleconferencing include early communication, advanced planning and practice, and access to proper equipment. Technology support was essential to connect virtual students during simulation and debriefing, and to stream debriefing to overflow rooms.

Methods: This semester long IP course included nursing, medicine, nutrition, and social work students. It combined online didactic material, unfolding case studies, and culminated with a technology-supported simulated capstone experience utilizing standardized patients. The format ensured inclusion of communication, values and ethic, roles and responsibilities, teamwork, and embedded four TeamSTEPPS® skills of (leadership, situation monitoring, mutual support, and communication).

Students used a mobile app to connect to telehealth carts with built-in teleconferencing devices. Test calls were completed in advance to troubleshoot connection issues, ensure call reliability, and assess audio/video quality. Several sessions were needed to establish connections, confirming the importance of advanced planning. Even after a mock session there were unexpected complications.

To stream the debriefing session into another room, a room with a built-in teleconferencing system served as the base-room.  Multiple cameras and microphones covered the room and a telehealth cart connected the audio/visual system to the destination room.

Results: Thirty students attended the event, and eighteen students responded to the non-required survey. The majority of students reported a positive simulation experience and learning expectations were met (88.9%). Students reported that the technology-supported simulation was effective in meeting course objectives, including synthesis of IP collaborative practice concepts (66.7%), enhanced knowledge of professional roles (66.7%), and a better understanding of how working within an IP team improves rural healthcare (66.7%). Specific to IPEC objectives, they reported the event was effective in meeting objectives related to core competencies (88.9%), collaboration (83.3%), professional roles (72.2%), and teamwork (83.3%).

Conclusion: There were many lessons learned from this experience. Unexpected problems that could have been avoided included (1) a remote student connected into the simulation session mid-stream causing some disruption, but this is like real life behavior; (2) students in the second session may have had an advantage because they have time to get to know each other and to plan roles before starting the simulation session, while students in the first session were immediately ushered into the simulation without the orientation time; (3) use of standard release form was not sufficient;

 Revisions to the course and the simulation experience should include: (1) stream simulation into additional rooms to be viewed by other students and faculty, (2) students should have the opportunity to watch all recorded sessions at a later time; (3) revise student release forms to allow use of photos/videos in portfolio.