training for tomorrow: the simulated interprofessional rounding experience at musc donna kern, md...
TRANSCRIPT
Training for Tomorrow: Training for Tomorrow: The Simulated Interprofessional The Simulated Interprofessional Rounding Experience at MUSCRounding Experience at MUSC
Donna Kern, MD
Associate Dean for Curriculum- Clinical Sciences , COM
Assistant Director, MUSC Healthcare Simulation Center
Nancy Duffy, DNP, RN, CEN, CNE
Director of the Undergraduate Program, CON
Assistant Director, MUSC Healthcare Simulation Center
Matt Gillespie, BLA, and Jimi Horne, AAS, NREMT-P
MUSC Healthcare Simulation Center
ObjectivesObjectives
Describe a simulation-based interprofessional (IP) activity designed to improve the learners’ understanding of collaborative care
Discuss drivers and barriers to implementing this activity
Simulated Interprofessional Rounding Simulated Interprofessional Rounding Experience (SIRE) Experience (SIRE)
Developed in 2009 as a collaboration between Medicine and Pharmacy
Part of MUSC’s QEP- the Creating Collaborative Care Initiative
Addition of Physician assistant students in 2010 and Nursing students in 2011
Simulated Interprofessional Rounding Simulated Interprofessional Rounding Experience (SIRE) ObjectivesExperience (SIRE) Objectives
Describe the role of multiple health professionals in the patient care team
Demonstrate evidence-based communication (TeamSTEPPS) Demonstrate collaborative, patient-centered team care Identify medication interactions and errors Demonstrate effective disclosure of an error to the patient Assess an unstable patient accurately and efficiently Manage an unstable patient Plan the discharge of a patient with an interprofessional team Clinical case-specific objectives….
SIRE DescriptionSIRE Description
Clinical teams are created with 5 members:– 2 Pharmacy students (Year 3)– 1 Medical student (Year 4)– 1 Nursing student (Upper level) – 1 PA student (Year 1)
SIRE DescriptionSIRE Description
All teams participate in 3 activities:1. Communication Skills Workshop based on the
TeamSTEPPS curriculum
2. Week 1 Simulation Case: GI Bleed in pt with INR of 9
3. Week 2 Simulation Case: Pneumonia with sepsis
All students have participated in a formal IP Day Error Disclosure Workshop - approximately 1 year prior to SIRE.
Communication Skills WorkshopCommunication Skills Workshop
Large group lecture on TeamSTEPPS model– Communication tools:
Brief, Huddle, SBAR, Situation Monitoring (CUS words)
Teams skills training– Paper chain exercise– Simulation practice session
Part 1 (60 minutes) Unstable Patient
– Team works collaboratively to care for a simulated patient with an ACUTE condition
Part 2 ( 30 minutes) Discharge Planning
3 mins Instructions given and team members assign roles; learners review the patient chart individually; no discussion is permitted
2 mins Team holds a brief outside patient’s room
5 mins Nursing student conducts initial patient assessment and reports SBAR to team
25 mins Team enters and conducts patient interview/assessment, evaluation and management of patient; all orders are recorded on board
25 mins IP faculty debrief the students
PharmD and MD Faculty Teaching Pair observes students from PharmD and MD Faculty Teaching Pair observes students from the control room and role plays the voice of the simulated patient.the control room and role plays the voice of the simulated patient.
At the conclusion of the simulation, faculty debriefed the team At the conclusion of the simulation, faculty debriefed the team and facilitated discussion of the learning objectives and the and facilitated discussion of the learning objectives and the team performance.team performance.
Structure of Simulations Structure of Simulations
Part 2 (30 minutes) Discharge Planning
– Team works collaboratively to care for a simulated patient with an ACUTE condition
10 mins Team creates plan for discharge
10 mins Discusses plan with patientDiscloses medication error (if this has not already occurred- patient will prompt discussion.
10 mins IP faculty debrief the students
Advantages of Simulation in SIREAdvantages of Simulation in SIRE
Provides “clinical” environment for applied learning when real clinical environments do not have space for IP learners
Makes it possible to teach skills (safely) that are not part of the traditional role of the students (who are viewed as “recorders” or worse….observers)
Achieves “highly visible” learning that makes it difficult for students to hide knowledge, skill, attitude deficits
Allows capture of learner/team performance and reflection
Barriers Barriers
Academic calendars!! Required for some learners vs. optional for other
learners Training level of learners Identifying and training interprofessional faculty Finding space for training such a large number of
students
SummarySummary
Overall, all students are very positive about the SIRE experience.
PharmD students report slightly greater gain in learning and appreciation for IPE activities– Received better curricular preparation for activity
Decreased confidence in certain aspects of clinical management.– Simulation reveals deficiencies in student application of
clinical knowledge.
StudyStudy
Validated checklist was developed for assessing clinical performance in simulation
Formal assessment of team skills
Do team skills predict clinical outcomes? Yes. Published results of translation of simulation
clinical performance to clinical outcomes
ReferencesReferences
Institute of Medicine. Health professions education: A bridge to quality. Washington, DC: National Academy Press. 2003.
UK Center for Advancement of Interprofessional Education (CAIPE). http://www.caipe.org.uk/index.php?&page=define
Shrader S, Kern D, Zoller J, Blue A. Interprofessional Teamwork Skills as Predictors of Clinical Outcomes in a Simulated Healthcare Setting. Journal of Allied Health 2013; 42(1):e1-6.
Shrader S, McRae L, King IV W, Kern.D. A Simulated Interprofessional Rounding Experience in a Clinical Assessment Course. American Journal of Pharmaceutical Education 2011; 75 (4) Article 61.
TeamSTEPPS http://teamstepps.ahrq.gov/