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/