High Fidelity Simulation in Interprofessional Education: A how-to approach to creating and sustaining effective professional learning Linda Honan, PhD, MSN, CNS-BC, Yale School of Nursing On behalf of Yale Interprofessional Longitudinal Experience Team October 3, 2017 Collaborations Across Boarders VI Yale Interprofessional Longitudinal Clinical Experience S L I D E 1
Yale Interprofessional Education Faculty Team (2016-2017) School of Yale Medicine Team 2016-17 School of Nursing Physician Associate Program Eve Colson, MD* Barry Wu, MD, FACP Linda Honan, PhD, MSN, CNS-BS, RN, ANEF Deborah Fahs, DNP, MSN, FNP-C, RN Rosana Gonzalez-Colaso, PharmD, MPH David Brissette, MMSc, PAc Matthew Goldenberg, MD, MSc Ami Marshall, MSN, APRN Elizabeth Roessler, MMSc, PAc John Encandela, PhD * Macy Foundation Faculty Scholar Patrice O Neill-Wilhelm, MSN, APRN Virginia Sherrick, MSN, APRN, FNP-BC, RN-BC No Conflicts of Interest S L I D E 2
Background We successfully piloted an Interprofessional Longitudinal Clinical Experience (ILCE) at Yale University for three years and implemented our (ILCE) course in 2016-2017. S L I D E 3
Who are we? 251 students from the School of Medicine (SOM), Physician Associate (PA) program and the School of Nursing (SON) Simulation exercises: history taking physical examination clinical reasoning teamwork oral presentation patient safety S L I D E 4
Measurement S L I D E 5
Example: Objective Structured Clinical Exam (OSCE) 31 ILCE, 31 matched controls, matched by program and sex, MD students were further matched by whether they were MD or MD/PhD 8 LCE, 8 matched control teams 8 blinded evaluators who watched videos of OSCE Global rating scale S L I D E 6
OSCE Results, Pilot 2 Late April-early May, 2015 7 ILCE IP teams, 7 matched teams (32/32 students) 1 (most desirable) to 5 (least desirable) range of means Inter-rater reliability: k =.61 Clinical Skills: Average of Means Sum of Means ILCE 2.43 17.04 Non-ILCE 2.61 18.27 Difference = 1.23 p = 0.20 Teamwork: Average of Means Sum of Means ILCE 1.90 13.33 Non-ILCE 2.52 17.66 Difference = 4.3 p =.0001 S L I D E 7
Results Simulations were: the best part of the ILCE practical complimented the skills we are applying at clinical sites teambuilding activities S L I D E 8
Heavy lifting Objectives 1) Describe the structural aspects that should be considered when implementing experiences in HFS for medical, APRN, and PA students with faculty from each program. 2) Learn from the successes and pitfalls observed in implementing simulation in an interprofessional program. 3) Discuss how to develop targeted simulation learning objectives. S L I D E 9
Structural Aspects Time, time, time Content Course sequencing Objectives Taking on too much Serendipity Data, data, data S L I D E 10
Developing objectives History taking Physical Examination Oral reporting Teamwork Safety S L I D E 11
Pitfalls Traveling time Clearly delineate the objectives of simulation Timing Trajectories All hands on deck S L I D E 12
Safety < 20% students noted bed height on session one, which improved to 69% by session two. 68% noted allergy history at session one, which increased to 90% on session two. 81% of students gave water to our simulated patient (NPO patient), 21% on simulation two. S L I D E 13
Successes from student perspective S L I D E 14
Workarounds Flexibility It takes a village S L I D E 15
Tools S L I D E 16
Conclusion History taking and physical examination Evaluation Feedback S L I D E 17
S L I D E 18
Questions??? S L I D E 19
References Fahs, D. B., Honan, L., Gonzales-Colaso, R., Colson, E., (2017). Interprofessional education development: Not for the faint of heart. Advances in Medical Education and Practice, 2017(8), 329-336, doi: 10.2147/AMEP.133426 Pellico L. H., Fahs, D. B., Talwalkar, J., & Kayingo, G., (2015). Interprofessional learning: Perceptions of first year health students. Journal of Nursing Education and Practice, 5(6), 39-49. Talwalker, J. S, Fahs D. B., Kayingo G, Wong R, Jeon S, Honan L. Readiness for interprofessional learning among healthcare professional students. (2016). Int J of Med Ed.7:144-148 Wong, R.L., Fahs, D.B., Talwalkar, J.S., Colson, E.R., Desai, M.M., Kayingo, G., Balanda, M., Luczak, A.G., & Rosenthal, M.S. (2016). A longitudinal study of health professional students attitudes towards interprofessional education at any American university. Journal of Interprofessional Care, 30(2):191-200. doi: 10.3109/13561820.2015.1121215. S L I D E 20
Images Images Source Slide 9 https://www.google.com/search?tbm=isch&source=hp&biw=750&bih=547&q=pitfalls&oq=pitfalls&gs_l=im g.1.0.0l10.1977.3501.0.5289.10.10.0.0.0.0.124.952.0j8.8.0...0...1.1.64.img..2.8.947.0..35i39k1.6dngnfvh6g#imgrc=bfhga1exkmvjbm: Slide 6 Slide 9 Slide 10 Slide 12 Slide 14 Slide 15 Slide 16 http://www.picquery.com/heavy-lifting_uzbareengmqpoax6cymgi2hqwebohtw9del*oof6xau/ https://www.searchencrypt.com/images?eq=jkujzjzysgj56jgha6xmbq%3d%3d https://www.searchencrypt.com/images?eq=5dkvuzvd%2b5pnifdk6youva7m8cdj%2bjiewm4otko64b k%3d https://www.flickr.com/photos/jakobbg/2788390342/ http://www.apartmenttherapy.com/diy-bench-three-becomes-one-ki-15576 https://www.google.com/search?tbm=isch&source=hp&biw=750&bih=547&q=ask+questions&oq=ask+ques tions&gs_l=img.3..0l10.2067.4640.0.6586.15.15.0.0.0.0.106.1102.11j1.12.0...0...1.1.64.img..3.12.1101.0.p- Kgq8m1eb0#imgrc=bzg3HAkhZ2k3bM: S L I D E 21