- Email: [email protected]
Multidisciplinary, Team-Based Learning: The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLE©) Approach
Clinical Simulation in Nursing (2013) 9, e171-e178
www.elsevier.com/locate/ecsn
Featured Article
Multidisciplinary, Team-Based Learning: The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) Approach Carolynn Masters, PhD, RN, CARNa,*, Valerie O’Toole Baker, RN, ACNS, BCb, Holly Jodon, MPAS, PA-Cc a
Dean, Morosky College of Health Professions and Sciences, Gannon University, Erie, PA 16541 Assistant Professor, Villa Maria School of Nursing, Gannon University, Erie, PA 16541 c Assistant Professor, Physician Assistant Program, Gannon University, Erie, PA 16541 b
KEYWORDS collaborative practice; interdisciplinary; interprofessional education; multidisciplinary; progressive scenario; simulation; team-based learning
Abstract: Students in health profession programs are traditionally educated in ‘‘silos’’ throughout their program of study caring for patients in Episodic periods of time. Upon graduation, they are expected to function as part of the health care team, collaborating with others to care for patients from the initial point of contact to discharge. This article describes the Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) approach. The objective is to provide students from multiple disciplines the opportunity to collaboratively care for a patient from the initial point of contact through discharge following Agency for Health Care Research and Quality (AHRQ) TeamSTEPPS and best practice guidelines in a simulated learning environment. Cite this article: Masters, C., O’Toole Baker, V., & Jodon, H. (2013, May). Multidisciplinary, team-based learning: The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLE) approach. Clinical Simulation in Nursing, 9(5), e171-e178. doi:10.1016/j.ecns.2011.11.007. Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Background Health profession students have traditionally been educated within the confines of a discipline-specific curriculum with little exposure to communicating and working with other disciplines. Health profession students do learn about the roles and responsibilities of health care team members, but because of limitations imposed by protocol at the clinical site, students are not often afforded the opportunity to
* Corresponding author: [email protected] (C. Masters).
communicate directly with other members of the health care team. However, these same students upon graduation are expected to perform as part of a larger systemdthat of a highly functional health care team. In response to this concern, the faculty of Gannon University’s Morosky College of Health Professions and Sciences developed and implemented the Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) approach (Figure 1). The SIMPLE Approach is a multidisciplinary, team-based methodology that promotes collaboration and prepares graduates for the challenges of the real world. In the SIMPLE approach, students
1876-1399/$ - see front matter Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ecns.2011.11.007
Multidisciplinary, Team-Based Learning: The SIMPLE Approach from multiple disciplinesdnursing, physician assistant, and respiratory caredare introduced to the concept of collaborative practice early in the educational process. Accomplished through five phases, they become proficient in their unique role in patient care and progress to participation in multidisciplinary learning activities focusing on the collaborative Key Points care of patients with com Multidisciplinary leaplex issues. In this final rning activities can phase, students start from be used to promote the initial point of contact team work and proupon admission and progress vide students with the throughout the stages of opportunity to collabcare, including treatment oratively care for and discharge. Students colpatients. laborate and apply best prac A culture of multidistice guidelines following the ciplinary learning can Agency for Health Care be created with dediResearch and Quality cated and committed (AHRQ) TeamSTEPPS, faculty. a teamwork system design, Health profession stuto care for patients in a nondents benefit from threatening environment learning together. (Agency for Health Care Research and Quality, 2011). The purpose of this article is to provide the reader with a description of a curricular design that outlines the groundwork and strategies required to implement simulated team-based learning activities. For this model, interdisciplinary describes two disciplines and multidisciplinary refers to three disciplines. With recent changes in nomenclature, this article will further clarify how the SIMPLE approach incorporates interprofessional education, in which the primary goal is ‘‘to prepare all health profession students for deliberately working together with the common goal of building a safer and better patient-centered community/population oriented U.S. health care system’’ (Interprofessional Education Collaborative Expert Panel, [IECEP], 2011).
Review of the Literature Interprofessional collaborative practice, health professionals from multiple disciplines working together as a team, is the cornerstone to providing safe, high quality, effective patient-centered care (IECEP, 2011). Health profession educators have an obligation to prepare workforce-ready graduates who can assume the roles and responsibilities of interdisciplinary team members. Essential core competencies have been identified for health profession educators to prepare practitioners for interprofessional collaborative practice (IECEP, 2011). One way to achieve this goal is to engage students in interprofessional education, which occurs ‘‘when students from two or more professions learn about, from, and with each other
e172
Figure 1 The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) approach. The three circles denote the disciplines of nursing, physician assistant, and respiratory care. The white center is the ‘‘sweet spot,’’ the place where content overlaps in all three disciplines. This is where the disciplines come together to participate interprofessional collaborative patients-centered care. Used with permission Ó Jodon, Masters & Baker, Gannon University, 2011.
to enable effective collaboration and improve health outcomes’’ (WHO, 2010, p. 7). Health profession curricula are changing from traditional isolated learning silos (Robertson & Bandali, 2008) to curricula that provide more interactive learning between and among individuals from various health professions; however, innovative strategies must be developed and implemented in health profession curricula that advance the skills and competencies necessary for interprofessional collaborative practice. Strategies such as multidisciplinary, team-based learning activities that promote effective communication, teamwork, and critical thinking can be used to promote collaborative practice. Multidisciplinary, team-based learning involves individuals from various disciplines coming together in a collaborative and comprehensive manner for a common purpose (Dillon, Noble, & Kaplan, 2009). The beneficial outcome of multidisciplinary, team-based learning lies in the ability of students to collaboratively manage a patient throughout the continuum of care. To plan and provide collaborative care, students need to recognize the unique contribution of each member of the health team and coordinate information and processes from multiple disciplines into a holistic plan of care for the patient. Through working in teams or multidisciplinary groups, students learn how to effectively communicate and gain a greater understanding of multiple professional roles and responsibilities (Lett, 2008). Participation in patient simulation experiences has been found to be an effective and efficient tool to enhance the learning process (Baker et al., 2008; Decker et al., 2008; Jeffries, Woolf, & Linde, 2003). Simulation provides opportunities for students to gain valuable exposure to patient
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach situations and practice skills in a safe environment. Simulation has traditionally been used to train students for the care of the patient in single, static episodes of critical events. However, as practitioners, they are faced with situations that are often dynamic and unfolding that requires the provision of comprehensive continuous care for patients and their families. The literature supports the use of simulation and teambased learning in improving students’ knowledge of team and communication skills, their attitudes towards working as a team, and their ability to identify effective team skills (Robertson, Kaplan, Atallah, Higgins, Lewitt, & Ander, 2010; Tucker, Wakefield, Boggis, Lawson, Roberts, & Gooch, 2003). Studies have shown that simulationenhanced interprofessional education involving students from a variety of health professions better prepared the students to enter professional practice and ultimately led to improved patient care (Bandali, Parker, Mummery, & Preece, 2008; Robertson & Bandali, 2008). The American Association of Critical Care Nurses (2005) recommends that members of the health profession team have access to educational programs that develop critical communication skills. Students should be educated in a culture that encourages team training. The literature has supported use of simulated learning activities that promote interaction of students from various disciplines. A result of these simulated learning activities and reflective practice is that students learn with, from, and about one another (Bandali et al., 2008). Bender and Buckner (2005) developed interdisciplinary teaching models for nursing, physical therapy, and occupational therapy students. Participation in these comprehensive, coordinated, patient-centered modules allowed students to gain a better understanding of their shared roles and responsibilities in caring for patients. Professional socialization should begin at the start of a student’s educational experience. Attitudes toward collaboration develop as a student is socialized to their specific discipline as well as the entire health team (Dillon, Noble, & Kaplan 2009). Multidisciplinary educational processes of students provide the foundation for collaboration throughout professional practice.
Background Gannon University is a private, Catholic Diocesan University with an enrollment of approximately 4,200 undergraduate and graduate students. The University is organized into three colleges, one of which is known for health profession education, the Morosky College of Health Professions and Sciences (MCHPS). Within the MCHPS, there are seven health profession programs, including nursing, physician assistant, respiratory care, radiologic sciences, occupational therapy, physical therapy, and sport and exercise science. In 2007, Gannon University acquired and renovated a 100,000 square foot building to locate all health profession programs within a single facility. Unifying the programs in one building
e173 was part of the University’s strategic plan to foster a collaborative learning environment where students in the health professions may work together. One of the primary goals of the University’s strategic plan was to create synergy and collaboration between and among students of the various educational programs. In 2009, a state-of-the-art patient simulation center was constructed to assist in accomplishing this goal. The Center provides the technological resources and experiential education that readily facilitates multidisciplinary collaboration and interprofessional education. Gannon University’s Patient Simulation Center is a 5,800 square foot facility that was built to emulate the real-world environment of health care. The center consists of an emergency/trauma room, operating room, a seven-bed multiskills room, a pediatric room, an adult examination room, and a labor and delivery suite. The center is equipped with 14 high- and medium-fidelity patient simulators, virtual intravenous training stations, a computer laboratory, debriefing rooms, and is enhanced with integrated audiovisual recording capability and real-time viewing access.
In the Beginning With the creation of the patient simulation center in mind, the dean of the Morosky College of Health Professions and Sciences had the vision to introduce interprofessional learning activities and identified educational content common to all health profession programs. Gannon’s Multidisciplinary Curriculum Model was developed, which includes effective team communication, vital signs, code blue, trauma, and asthma (Figure 2). This model introduced the MCHPS faculty to interprofessional education, and they recognized the need to prepare students to function as a member of the health care team upon graduation. As a result a commitment was made, in the strategic plan of the college, to provide interprofessional learning experiences for students via the patient simulation center. It was decided that basic to complex health care skills could be threaded with interprofessional education, from freshmen level through to graduation. This would serve to achieve the ultimate goal of having students from multiple health professions work side by side and effectively as a team to care for patients with complex needs. To further accomplish this goal, faculty champions from each of the seven health profession disciplines were identified, trained, and provided the support necessary to incorporate simulation learning into their disciplinespecific curricula. These faculty champions incorporated simulation into the educational experiences of their respective programs. Subsequently, a decision was made to start multidisciplinary learning activities with three of the seven health profession programsdnursing, physician assistant, and respiratory care. The initial focus was on multidisciplinary care of the patient with asthma, which was content common to all three disciplines.
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach
e174
Figure 2 Diagram of the seven health profession disciplines at Gannon University and curricula content that are common across all seven. These activities are used to develop multidisciplinary team-based learning involving students from the various disciplines. Used with permission Ó Masters, Gannon University, 2008.
Laying the Groundwork: Preparing Students for the SIMPLE Approach Health profession students were introduced to professional roles and basic communication techniques in a freshmen seminar course. To engage students in interprofessional educational activities early on, faculty champions arranged schedules so that as the students progressed through their educational programs they were introduced to basic assessment skills via interprofessional simulation laboratory experiences. This was the students’ first opportunity to interact one-on-one with members from another discipline. The curricula of each discipline then progressed to presenting theory and practice, relevant to that discipline, for the care of the patient with simple health needs and students began to experience basic episodic scenario simulation education. Once this was accomplished, students progressed within their discipline to gain knowledge and understanding of the care and treatment of patients with complex health care needs. The content areas described above were divided into four phases and incorporated, to varying degrees, in all of the health profession curricula, but most comprehensively in three disciplines: nursing, physician assistant, and respiratory care. The faculty champions from these three disciplines agreed that although the concept and importance of team-based care was present in all program-specific curricula; there were no opportunities for students to participate in the collaborative care of patients. Faculty purposefully built upon the previous four phases, which took their students through progressive, foundational learning activities, to prepare them for multidisciplinary, team-
based learning activities. Lead faculty from nursing, physician assistant, and respiratory care met weekly throughout the semester to plan a step-wise process for implementing the fifth phase of the SIMPLE approachd working together as a multidisciplinary team in the complex care of a patientdwhich occurred near the completion of the students’ curricula, during their final year of study.
Curriculum Implementation Phase I: Professional Socialization All students at Gannon University are required to take a first-year seminar during their freshmen year. Students in the health professional programs are assigned to majorspecific seminar courses. The first-year seminar provides an opportunity to introduce students to effective communication skills, the professional roles and responsibilities of their profession, and those of the other members of the health care team. The various health profession disciplines are introduced, guest speakers are invited, and case studies are presented that articulate the roles of each profession. Students in the nursing, physician assistant, and respiratory care seminars are introduced to the concept of teamwork and collaborative practice through explanation and discussion of the TeamSTEPPS logo. TeamSTEPPS is a teamwork system designed for health care professionals developed by the AHRQ to promote patient safety (Agency for Health Care Research and Quality, 2011). The four primary teamwork skills of leadership, communication, situation monitoring, and mutual support are reviewed; as are the
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach concepts of knowledge, performance, and attitudes. Participation in the seminar promotes professional socialization and enables students to begin their educational process with a sound knowledge base for their unique role in patient care while gaining an appreciation for team-based care.
Phase II: Learning Together To further enhance communication among health profession students, traditional barriers of discipline-specific education are broken down by student participation in interprofessional physical assessment skill laboratory activities conducted in the patient simulation center. First, the theory component is presented within discipline-specific curriculum by the respective faculty. Topics presented include basic physical assessment skills, such as vital signs, heart sounds, and breath sounds. After the theory presentation, students from two disciplinesdnursing and physician assistant or nursing and respiratory caredmeet in the patient simulation center. They are divided into interprofessional groups consisting of pairs of studentsdone from each disciplinedand proceed through stations facilitated by faculty from the two disciplines. These faculty members model collaborative practice by working together to facilitate hands-on learning experiences. At this point, communication is informal as students learn with and from one another in a safe environment. By learning with one another and working with faculty from a profession other than their own, traditional educational barriers of discipline-specific education are broken down, providing a foundation for mutual respect and appreciation among health profession students.
Phase III: Basic Discipline-Specific Roles Before a health care provider can function as an effective member of the health care team, they must be competent in their unique role function. Curricula in the health professions follow a model of patient care that begins with simple disease processes and progresses to complex, multisystem disease processes. In phase III, students remain within their discipline and are taught content and specific role function regarding care of the patient with simple disease processes. Students learn the theory of best practice guidelines for the care of patients in the classroom setting, care for patients in the clinical area, and move to completing basic episodic scenarios in the patient simulation center. The scenarios involve only students from one discipline with the purpose being to focus on what they, as a professional, are expected to perform. To facilitate an understanding of collaborative practice, faculty members from each discipline present The Pocket Guide: TeamSTEPPS; Strategies & Tools to Enhance Performance and Patient Safety and students are provided with a copy for use throughout their program of studies. At this time students are also introduced to and practice the use of introduction, situation, background, assessment, and recommendation (ISBAR) communication, an augmented standardized method of communication (Zafian & Janskly, 2011).
e175
Phase IV: Complex Discipline-Specific Roles In phase IV, students continue to remain within their discipline and proceed to the care of patients with more complex acute disease processes. The purpose of this phase is to provide students with the knowledge and skills required to effectively care for a patient with advanced needs. During this phase, students learn the theory of best practice guidelines for the care of patients with complex disease processes in the classroom and apply the theory in the care for these patients in the clinical setting. Students, as a single discipline, complete complex progressive scenarios in the patient simulation center. The complex progressive scenarios are designed to provide students with an opportunity to care for patients from initial point of contact through discharge, which is not possible during the clinical experience because of time constraints. The complex progressive scenarios start with students caring for a patient with a simple version of a disease process, progressing to a complex version of the disease process, and ending with the discharge of the patient. In this way, students are able to review content learned in the care of patients with simple disease processes and progress through complex to discharge needs of the patient. At the conclusion of phase IV, students develop a professional identify and possess a clear understanding of their role in the provision of collaborative care for patients. Students also have increased communication skills and confidence in their ability to perform skills. These students are comfortable in their unique role in the care of patients and are now ready and prepared to participate in teambased learning activities involving multiple disciplines.
Phase V: The Culmination of the SIMPLE Approach Phases I through IV laid the groundwork necessary to effectively execute the implementation of phase V of the SIMPLE approach. The purpose of the SIMPLE approach is to have students from multiple disciplines collaborate to provide comprehensive, continuous care for patients in a safe learning environment. The ultimate goal is to prepare students to practice effectively in the real world setting as a highly functional member of the health care team providing safe, quality, patient-centered care. The primary objectives of the SIMPLE approach are to: Have students understand professional roles to promote collaboration; Increase student competence and confidence; Improve effective communication between and among disciplines; Develop a sound understanding of the continuum of care from point of contact through discharge, including assessment, intervention, implementation, interdisciplinary consultation, and patient teaching.
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach
e176
Box 1. The Multidisciplinary Care of the Patient with Asthma Participants: Students from the physician assistant, nursing, and respiratory care programs. Episode 1: Emergency department Patient: Adult with acute exacerbation of asthma. Nursing student: Assesses patient and provides care based on standard protocol and best practice guidelines. Patient states he/she has not followed the asthma management regimen because of a lack of funds to purchase required medications. Patient does not have an adequate understanding of the importance of compliance with the medication regimen. The patient no longer responds to the protocol guidelines, a report using ISBAR is called to the physician assistant student. Physician assistant student: Performs a history and physical assessment and collaborates with the nursing student regarding a course of action to take. A decision is made to have the patient receive a breathing treatment instituted by the respiratory care student. Respiratory care student: Performs an assessment and based on the needs of the patient suggests a slight change regarding the specifics of the treatment to best meet the needs of the patient. Patient: Stabilizes and is transferred to an inpatient medical unit. Episode 2: Medical unit, 10 hours after admission Nursing student: Assesses patient and determines that a breathing treatment is needed. Nursing student and respiratory care student: Together review the standing orders for the breathing treatment and identify an area in need of clarification. They contact the Physician Assistant student to clarify the order. Physician assistant student clarifies the order. Nursing student is unfamiliar with the equipment required to provide the breathing treatment and asks the respiratory care student to review the use of equipment. Episode 3: Medical unit, 2 days after admission. Physician assistant student: Assesses the patient then meets with the nursing and respiratory care students outside of the patient’s room to discuss the patient’s discharge needs. The three students identified a need to have a home health referral and case management follow up to ensure patient compliance with the regimen and to address financial restrictions the patient was under related to obtaining the prescribed medications. Students collaborated to determine which member of the team will provide specific components of patient teaching and discharge instructions. Respiratory care student teaches the patient how to use a peak flow meter. Nursing student teaches the patient how to document and respond to the peak flow log. Physician assistant student teaches the patient about medications to be taken at home as well as follow up care. Sequenced debriefing occurs throughout and at the end of the scenario. One example of the SIMPLE approach in action is the learning activity called ‘‘The Multidisciplinary Care of the Patient with Asthma.’’ Box 1 details the multidisciplinary progressive scenario. At this point, upper-level students from three disciplinesdnursing, physician assistant, and respiratory caredare brought together in the patient simulation center and assigned to teams of three. Each team is given the challenge of caring for a patient who is admitted to the emergency department with an acute asthmatic exacerbation. The students must be able to rapidly and accurately assess the patient, communicate their findings, intervene appropriately, and continuously re-evaluate the situation. Essentially, they must function as a highly effective team to ensure safe patient outcomes.
Traditionally, debriefing consists of group discussion sessions that follow simulation activities. The sessions provide opportunities for students to review what was done during the simulation scenario, to discuss with one another what they could have been done differently or more effectively, and what they have learned (Cantrell, 2008). In the SIMPLE approach, sequenced debriefing is used. Discipline-specific faculty lead the debriefing process for discipline-specific interventions as needed and when natural breaks in the scenario occur. In this way, role-specific content is evaluated by a clinical expert for that discipline. All faculty members participate in debriefing students regarding collaborative practice, including communication techniques and teamwork.
Debriefing Outcomes The process of debriefing is recognized as an essential component of simulation learning. Debriefing fosters the development of clinical reasoning and judgment skills through reflective learning processes (Dreifuerst, 2009).
Students who participated in the SIMPLE approach and the students who viewed the scenarios via video recording reported in their course evaluations an overall positive
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach learning experience. Students stated they felt more comfortable using ISBAR communication and more confident in their ability to provide a comprehensive and effective patient report. Students stated they had a greater understanding and respect for the importance of each team member’s role by participating in the multidisciplinary progressive teambased learning activities. Students also mentioned that before this experience, they did not have the opportunity to collaboratively care for a patient for more than static periods of time during their scheduled clinical. By participating in the SIMPLE approach, students were provided the opportunity to care for a patient across the continuum of care from initial point of contact through discharge following best practices guidelines while collaborating with other members of the health care team. Another positive outcome of the multidisciplinary, teambased learning approach was the awareness that took place regarding the appreciation for clinical expertise acquired by students from three different educational levels. The physician assistant students are in a master’s program, the nursing students are in a baccalaureate program, and the respiratory care students are in an associate degree program. Students often rate the clinical expertise of another person based on their level of education. It can be incorrectly assumed that the higher level of education an individual has completed the more comprehensive their knowledge base is for the general care of patients. Students commented that participation in the SIMPLE approach allowed them to experience firsthand the high level of expertise each student had regarding their unique role in the care of a patient regardless of the degree being earned. Students also commented on the crossover between all health care professionals’ knowledge base, particularly in the area of physical assessment. Students were not aware of the fact that all health care providers who participated in care of the patient performed their own assessment of the patient. Another interesting finding included student comments regarding faculty interaction and collaboration throughout the SIMPLE approach. When implementing the SIMPLE approach, faculty from all disciplines modeled interprofessional behavior, respect, and cooperation, valuing input from others. Students commented that they thought that each discipline-specific faculty member was the content expert for all aspects of patient care and that they were surprised to see faculty collaborate. Faculty evaluation of the SIMPLE approach was extremely positive. Increased student proficiency in use of ISBAR and general communication skills was observed by faculty. There was also a noticeable change in student attitude toward recognition and appreciation of each member’s unique contributions in the care of the patient from initial point of contact to discharge. Before this experience, students had limited experience interacting with other members of the health team. Participation in the SIMPLE approach broke down communication barriers among and between students from varying health profession programs and encouraged enhanced cooperative teamwork.
e177
Challenges As students in the health professions move beyond their freshman year, there is consistency between the disciplines as to the skills and content taught; however, there exists considerable diversity as to where in the curriculum each of the disciplines incorporate content and learning experiences essential to their profession. When examining the curricula of the three disciplines, it was noted that all three taught physical assessment skills, but all at varying times. For example, physical assessment is taught in the senior level of the 5-year physician assistant master’s program, in the sophomore year of the baccalaureate nursing program, and in the first year of the associate degree respiratory care program. Scheduling a common time when students from multiple disciplines were available to participate in the SIMPLE approach was a challenge, even though all health profession students have classes located in the same building. By having faculty champions who were committed to the SIMPLE approach, adjustments were made in schedules to make this important learning experience happen. Another challenge was overcoming the notion that use of the SIMPLE approach required more time in curricula that are already burdened with large volumes of content in a limited timeframe. Rather than adding to the respective curricula, faculty reviewed current curricula and rearranged content so that the teamwork, cooperation, and collaboration contentdwhich was already included in the individual course content of the three programsdwas now implemented when using the SIMPLE approach. Rather than simply talking about the benefits of collaboration and cooperation, students were able to experience firsthand the process of multidisciplinary collaboration in the care of a patient across the continuum of care.
Future Direction The SIMPLE approach will be broadened to include students from other health profession programs, such as physical therapy, radiologic sciences, and occupational therapy. The type of patient scenarios will be expanded to include care of the patient with a variety of complex health problems. Although student satisfaction and faculty perception of the SIMPLE approach have been reviewed, formal evaluation of the SIMPLE approach will be studied.
Conclusion Effective teamwork is essential to achieving patient safety. Health profession educators have an obligation to prepare workforce-ready graduates who are prepared to assume their roles and responsibilities as a highly effective team member. To enhance collaborative practice, health profession curricula need to provide interprofessional
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach educational experiences for students starting at the first year of study. Ideally, it would progress to multidisciplinary experiences before graduation that integrate strategies that build the necessary teamwork skills of communication, collaboration, and respect.
Acknowledgments This work was supported in part by the Emerging Learning and Integrated Technologies Education (ELITE) Faculty Development Program, University of Pittsburgh School of Nursing Grant U1KHP0838 from the Division of Nursing and the Office of Health Information Technology, Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS). The authors would especially like to thank John M. O’Donnell, CRNA, MSN, DrPH, University of Pittsburgh School of Nursing.
References Agency for Health Care Research and Quality. (2011). TeamSTEPPS: National implementation. Retrieved June 1, 2011 from http://teamstepps. ahrq.gov/. American Association of Critical Care Nurses. (2005). AACN standards for establishing and sustaining healthy work environments: A journey to excellence. Aliso Viejo, CA: American Association of Critical Care Nurses. Baker, C., Pulling, C., McGraw, R., Damon-Dagone, J., HopkinsRosseel, D., & Medves, C. (2008). Simulation in interprofessional education for patient-centered collaborative care. Journal of Advanced Nursing, 64(4), 372-379. Bandali, K., Parker, K., Mummery, M., & Preece, M. (2008). Skills integration in a simulated and interprofessional environment: An innovative undergraduate applied health curriculum. Journal of Interprofessional Care, 22(2), 179-189.
e178 Bender, D., & Buckner, S. (2005). Interdisciplinary patient care skills module. Journal of Nursing Education, 44(6), 291-292. Cantrell, M. A. (2008). The importance of debriefing in clinical simulations. Clinical Simulations in Nursing, 4(2), 19-23. Decker, S., Sportsman, S., Puetz, L., & Billings, L. (2008). The evolution of simulation and its contribution to competency. The Journal of Continuing Education in Nursing, 39(2), 74-80. Dillon, P., Noble, K., & Kaplan, L. (2009). Simulation as a means to foster collaborative interdisciplinary education. Nursing Education Research, 30(2), 87-90. Dreifuerst, K. (2009). The essentials of debriefing in simulation learning: A concept analysis. Nursing Education Perspectives, 30(2), 108-114. Interprofessional Education Collaborative Expert Panel. (2011). Core compententcies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative Expert Panel. Jeffries, P. R., Woolf, S., & Linde, B. (2003). Technology-based vs. traditional instruction. A comparison of two teaching methods for teaching the skill of performing a 12 lead EKG. Nursing Education, 24(2), 70-74. Lett, D. (2008). The new architecture of medical education. Canadian Medical Association Journal, 178(1), 17-19, Retrieved August 2011 from www.cmaj.ca/content/178/1/17.2.full. Robertson, J., & Bandali, K. (2008). Bridging the gap: Enhancing interprofessional education using simulation. Journal of Interprofessional Care, 22(5), 499-508. Robertson, B., Kaplan, B., Atallah, H., Higgins, M., Lewitt, M., & Ander, D. (2010). The use of simulation and a modified TeamSTEPPS curriculum for medical and nursing students team training. Simulation in Healthcare, 5(6), 332-337. Tucker, K., Wakefield, A., Boggis, C., Lawson, M., Roberts, T., & Gooch, J. (2003). Learning together: Clinical skills teaching for medical and nursing students. Medical Education, 37(7), 630-637. World Health Organization (WHO). (2010). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization. Retrieved June 2011 from http://whqlibdoc.who. int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf. Zafian, R., & Jansky, L. (2011). ISBAR: Adding an extra step in handoff communication. Retrieved March 2011 from http://www.strategiesfornursemanagers.com/content/222773.cfm.
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
www.elsevier.com/locate/ecsn
Featured Article
Multidisciplinary, Team-Based Learning: The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) Approach Carolynn Masters, PhD, RN, CARNa,*, Valerie O’Toole Baker, RN, ACNS, BCb, Holly Jodon, MPAS, PA-Cc a
Dean, Morosky College of Health Professions and Sciences, Gannon University, Erie, PA 16541 Assistant Professor, Villa Maria School of Nursing, Gannon University, Erie, PA 16541 c Assistant Professor, Physician Assistant Program, Gannon University, Erie, PA 16541 b
KEYWORDS collaborative practice; interdisciplinary; interprofessional education; multidisciplinary; progressive scenario; simulation; team-based learning
Abstract: Students in health profession programs are traditionally educated in ‘‘silos’’ throughout their program of study caring for patients in Episodic periods of time. Upon graduation, they are expected to function as part of the health care team, collaborating with others to care for patients from the initial point of contact to discharge. This article describes the Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) approach. The objective is to provide students from multiple disciplines the opportunity to collaboratively care for a patient from the initial point of contact through discharge following Agency for Health Care Research and Quality (AHRQ) TeamSTEPPS and best practice guidelines in a simulated learning environment. Cite this article: Masters, C., O’Toole Baker, V., & Jodon, H. (2013, May). Multidisciplinary, team-based learning: The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLE) approach. Clinical Simulation in Nursing, 9(5), e171-e178. doi:10.1016/j.ecns.2011.11.007. Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Background Health profession students have traditionally been educated within the confines of a discipline-specific curriculum with little exposure to communicating and working with other disciplines. Health profession students do learn about the roles and responsibilities of health care team members, but because of limitations imposed by protocol at the clinical site, students are not often afforded the opportunity to
* Corresponding author: [email protected] (C. Masters).
communicate directly with other members of the health care team. However, these same students upon graduation are expected to perform as part of a larger systemdthat of a highly functional health care team. In response to this concern, the faculty of Gannon University’s Morosky College of Health Professions and Sciences developed and implemented the Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) approach (Figure 1). The SIMPLE Approach is a multidisciplinary, team-based methodology that promotes collaboration and prepares graduates for the challenges of the real world. In the SIMPLE approach, students
1876-1399/$ - see front matter Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ecns.2011.11.007
Multidisciplinary, Team-Based Learning: The SIMPLE Approach from multiple disciplinesdnursing, physician assistant, and respiratory caredare introduced to the concept of collaborative practice early in the educational process. Accomplished through five phases, they become proficient in their unique role in patient care and progress to participation in multidisciplinary learning activities focusing on the collaborative Key Points care of patients with com Multidisciplinary leaplex issues. In this final rning activities can phase, students start from be used to promote the initial point of contact team work and proupon admission and progress vide students with the throughout the stages of opportunity to collabcare, including treatment oratively care for and discharge. Students colpatients. laborate and apply best prac A culture of multidistice guidelines following the ciplinary learning can Agency for Health Care be created with dediResearch and Quality cated and committed (AHRQ) TeamSTEPPS, faculty. a teamwork system design, Health profession stuto care for patients in a nondents benefit from threatening environment learning together. (Agency for Health Care Research and Quality, 2011). The purpose of this article is to provide the reader with a description of a curricular design that outlines the groundwork and strategies required to implement simulated team-based learning activities. For this model, interdisciplinary describes two disciplines and multidisciplinary refers to three disciplines. With recent changes in nomenclature, this article will further clarify how the SIMPLE approach incorporates interprofessional education, in which the primary goal is ‘‘to prepare all health profession students for deliberately working together with the common goal of building a safer and better patient-centered community/population oriented U.S. health care system’’ (Interprofessional Education Collaborative Expert Panel, [IECEP], 2011).
Review of the Literature Interprofessional collaborative practice, health professionals from multiple disciplines working together as a team, is the cornerstone to providing safe, high quality, effective patient-centered care (IECEP, 2011). Health profession educators have an obligation to prepare workforce-ready graduates who can assume the roles and responsibilities of interdisciplinary team members. Essential core competencies have been identified for health profession educators to prepare practitioners for interprofessional collaborative practice (IECEP, 2011). One way to achieve this goal is to engage students in interprofessional education, which occurs ‘‘when students from two or more professions learn about, from, and with each other
e172
Figure 1 The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLEÓ) approach. The three circles denote the disciplines of nursing, physician assistant, and respiratory care. The white center is the ‘‘sweet spot,’’ the place where content overlaps in all three disciplines. This is where the disciplines come together to participate interprofessional collaborative patients-centered care. Used with permission Ó Jodon, Masters & Baker, Gannon University, 2011.
to enable effective collaboration and improve health outcomes’’ (WHO, 2010, p. 7). Health profession curricula are changing from traditional isolated learning silos (Robertson & Bandali, 2008) to curricula that provide more interactive learning between and among individuals from various health professions; however, innovative strategies must be developed and implemented in health profession curricula that advance the skills and competencies necessary for interprofessional collaborative practice. Strategies such as multidisciplinary, team-based learning activities that promote effective communication, teamwork, and critical thinking can be used to promote collaborative practice. Multidisciplinary, team-based learning involves individuals from various disciplines coming together in a collaborative and comprehensive manner for a common purpose (Dillon, Noble, & Kaplan, 2009). The beneficial outcome of multidisciplinary, team-based learning lies in the ability of students to collaboratively manage a patient throughout the continuum of care. To plan and provide collaborative care, students need to recognize the unique contribution of each member of the health team and coordinate information and processes from multiple disciplines into a holistic plan of care for the patient. Through working in teams or multidisciplinary groups, students learn how to effectively communicate and gain a greater understanding of multiple professional roles and responsibilities (Lett, 2008). Participation in patient simulation experiences has been found to be an effective and efficient tool to enhance the learning process (Baker et al., 2008; Decker et al., 2008; Jeffries, Woolf, & Linde, 2003). Simulation provides opportunities for students to gain valuable exposure to patient
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach situations and practice skills in a safe environment. Simulation has traditionally been used to train students for the care of the patient in single, static episodes of critical events. However, as practitioners, they are faced with situations that are often dynamic and unfolding that requires the provision of comprehensive continuous care for patients and their families. The literature supports the use of simulation and teambased learning in improving students’ knowledge of team and communication skills, their attitudes towards working as a team, and their ability to identify effective team skills (Robertson, Kaplan, Atallah, Higgins, Lewitt, & Ander, 2010; Tucker, Wakefield, Boggis, Lawson, Roberts, & Gooch, 2003). Studies have shown that simulationenhanced interprofessional education involving students from a variety of health professions better prepared the students to enter professional practice and ultimately led to improved patient care (Bandali, Parker, Mummery, & Preece, 2008; Robertson & Bandali, 2008). The American Association of Critical Care Nurses (2005) recommends that members of the health profession team have access to educational programs that develop critical communication skills. Students should be educated in a culture that encourages team training. The literature has supported use of simulated learning activities that promote interaction of students from various disciplines. A result of these simulated learning activities and reflective practice is that students learn with, from, and about one another (Bandali et al., 2008). Bender and Buckner (2005) developed interdisciplinary teaching models for nursing, physical therapy, and occupational therapy students. Participation in these comprehensive, coordinated, patient-centered modules allowed students to gain a better understanding of their shared roles and responsibilities in caring for patients. Professional socialization should begin at the start of a student’s educational experience. Attitudes toward collaboration develop as a student is socialized to their specific discipline as well as the entire health team (Dillon, Noble, & Kaplan 2009). Multidisciplinary educational processes of students provide the foundation for collaboration throughout professional practice.
Background Gannon University is a private, Catholic Diocesan University with an enrollment of approximately 4,200 undergraduate and graduate students. The University is organized into three colleges, one of which is known for health profession education, the Morosky College of Health Professions and Sciences (MCHPS). Within the MCHPS, there are seven health profession programs, including nursing, physician assistant, respiratory care, radiologic sciences, occupational therapy, physical therapy, and sport and exercise science. In 2007, Gannon University acquired and renovated a 100,000 square foot building to locate all health profession programs within a single facility. Unifying the programs in one building
e173 was part of the University’s strategic plan to foster a collaborative learning environment where students in the health professions may work together. One of the primary goals of the University’s strategic plan was to create synergy and collaboration between and among students of the various educational programs. In 2009, a state-of-the-art patient simulation center was constructed to assist in accomplishing this goal. The Center provides the technological resources and experiential education that readily facilitates multidisciplinary collaboration and interprofessional education. Gannon University’s Patient Simulation Center is a 5,800 square foot facility that was built to emulate the real-world environment of health care. The center consists of an emergency/trauma room, operating room, a seven-bed multiskills room, a pediatric room, an adult examination room, and a labor and delivery suite. The center is equipped with 14 high- and medium-fidelity patient simulators, virtual intravenous training stations, a computer laboratory, debriefing rooms, and is enhanced with integrated audiovisual recording capability and real-time viewing access.
In the Beginning With the creation of the patient simulation center in mind, the dean of the Morosky College of Health Professions and Sciences had the vision to introduce interprofessional learning activities and identified educational content common to all health profession programs. Gannon’s Multidisciplinary Curriculum Model was developed, which includes effective team communication, vital signs, code blue, trauma, and asthma (Figure 2). This model introduced the MCHPS faculty to interprofessional education, and they recognized the need to prepare students to function as a member of the health care team upon graduation. As a result a commitment was made, in the strategic plan of the college, to provide interprofessional learning experiences for students via the patient simulation center. It was decided that basic to complex health care skills could be threaded with interprofessional education, from freshmen level through to graduation. This would serve to achieve the ultimate goal of having students from multiple health professions work side by side and effectively as a team to care for patients with complex needs. To further accomplish this goal, faculty champions from each of the seven health profession disciplines were identified, trained, and provided the support necessary to incorporate simulation learning into their disciplinespecific curricula. These faculty champions incorporated simulation into the educational experiences of their respective programs. Subsequently, a decision was made to start multidisciplinary learning activities with three of the seven health profession programsdnursing, physician assistant, and respiratory care. The initial focus was on multidisciplinary care of the patient with asthma, which was content common to all three disciplines.
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach
e174
Figure 2 Diagram of the seven health profession disciplines at Gannon University and curricula content that are common across all seven. These activities are used to develop multidisciplinary team-based learning involving students from the various disciplines. Used with permission Ó Masters, Gannon University, 2008.
Laying the Groundwork: Preparing Students for the SIMPLE Approach Health profession students were introduced to professional roles and basic communication techniques in a freshmen seminar course. To engage students in interprofessional educational activities early on, faculty champions arranged schedules so that as the students progressed through their educational programs they were introduced to basic assessment skills via interprofessional simulation laboratory experiences. This was the students’ first opportunity to interact one-on-one with members from another discipline. The curricula of each discipline then progressed to presenting theory and practice, relevant to that discipline, for the care of the patient with simple health needs and students began to experience basic episodic scenario simulation education. Once this was accomplished, students progressed within their discipline to gain knowledge and understanding of the care and treatment of patients with complex health care needs. The content areas described above were divided into four phases and incorporated, to varying degrees, in all of the health profession curricula, but most comprehensively in three disciplines: nursing, physician assistant, and respiratory care. The faculty champions from these three disciplines agreed that although the concept and importance of team-based care was present in all program-specific curricula; there were no opportunities for students to participate in the collaborative care of patients. Faculty purposefully built upon the previous four phases, which took their students through progressive, foundational learning activities, to prepare them for multidisciplinary, team-
based learning activities. Lead faculty from nursing, physician assistant, and respiratory care met weekly throughout the semester to plan a step-wise process for implementing the fifth phase of the SIMPLE approachd working together as a multidisciplinary team in the complex care of a patientdwhich occurred near the completion of the students’ curricula, during their final year of study.
Curriculum Implementation Phase I: Professional Socialization All students at Gannon University are required to take a first-year seminar during their freshmen year. Students in the health professional programs are assigned to majorspecific seminar courses. The first-year seminar provides an opportunity to introduce students to effective communication skills, the professional roles and responsibilities of their profession, and those of the other members of the health care team. The various health profession disciplines are introduced, guest speakers are invited, and case studies are presented that articulate the roles of each profession. Students in the nursing, physician assistant, and respiratory care seminars are introduced to the concept of teamwork and collaborative practice through explanation and discussion of the TeamSTEPPS logo. TeamSTEPPS is a teamwork system designed for health care professionals developed by the AHRQ to promote patient safety (Agency for Health Care Research and Quality, 2011). The four primary teamwork skills of leadership, communication, situation monitoring, and mutual support are reviewed; as are the
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach concepts of knowledge, performance, and attitudes. Participation in the seminar promotes professional socialization and enables students to begin their educational process with a sound knowledge base for their unique role in patient care while gaining an appreciation for team-based care.
Phase II: Learning Together To further enhance communication among health profession students, traditional barriers of discipline-specific education are broken down by student participation in interprofessional physical assessment skill laboratory activities conducted in the patient simulation center. First, the theory component is presented within discipline-specific curriculum by the respective faculty. Topics presented include basic physical assessment skills, such as vital signs, heart sounds, and breath sounds. After the theory presentation, students from two disciplinesdnursing and physician assistant or nursing and respiratory caredmeet in the patient simulation center. They are divided into interprofessional groups consisting of pairs of studentsdone from each disciplinedand proceed through stations facilitated by faculty from the two disciplines. These faculty members model collaborative practice by working together to facilitate hands-on learning experiences. At this point, communication is informal as students learn with and from one another in a safe environment. By learning with one another and working with faculty from a profession other than their own, traditional educational barriers of discipline-specific education are broken down, providing a foundation for mutual respect and appreciation among health profession students.
Phase III: Basic Discipline-Specific Roles Before a health care provider can function as an effective member of the health care team, they must be competent in their unique role function. Curricula in the health professions follow a model of patient care that begins with simple disease processes and progresses to complex, multisystem disease processes. In phase III, students remain within their discipline and are taught content and specific role function regarding care of the patient with simple disease processes. Students learn the theory of best practice guidelines for the care of patients in the classroom setting, care for patients in the clinical area, and move to completing basic episodic scenarios in the patient simulation center. The scenarios involve only students from one discipline with the purpose being to focus on what they, as a professional, are expected to perform. To facilitate an understanding of collaborative practice, faculty members from each discipline present The Pocket Guide: TeamSTEPPS; Strategies & Tools to Enhance Performance and Patient Safety and students are provided with a copy for use throughout their program of studies. At this time students are also introduced to and practice the use of introduction, situation, background, assessment, and recommendation (ISBAR) communication, an augmented standardized method of communication (Zafian & Janskly, 2011).
e175
Phase IV: Complex Discipline-Specific Roles In phase IV, students continue to remain within their discipline and proceed to the care of patients with more complex acute disease processes. The purpose of this phase is to provide students with the knowledge and skills required to effectively care for a patient with advanced needs. During this phase, students learn the theory of best practice guidelines for the care of patients with complex disease processes in the classroom and apply the theory in the care for these patients in the clinical setting. Students, as a single discipline, complete complex progressive scenarios in the patient simulation center. The complex progressive scenarios are designed to provide students with an opportunity to care for patients from initial point of contact through discharge, which is not possible during the clinical experience because of time constraints. The complex progressive scenarios start with students caring for a patient with a simple version of a disease process, progressing to a complex version of the disease process, and ending with the discharge of the patient. In this way, students are able to review content learned in the care of patients with simple disease processes and progress through complex to discharge needs of the patient. At the conclusion of phase IV, students develop a professional identify and possess a clear understanding of their role in the provision of collaborative care for patients. Students also have increased communication skills and confidence in their ability to perform skills. These students are comfortable in their unique role in the care of patients and are now ready and prepared to participate in teambased learning activities involving multiple disciplines.
Phase V: The Culmination of the SIMPLE Approach Phases I through IV laid the groundwork necessary to effectively execute the implementation of phase V of the SIMPLE approach. The purpose of the SIMPLE approach is to have students from multiple disciplines collaborate to provide comprehensive, continuous care for patients in a safe learning environment. The ultimate goal is to prepare students to practice effectively in the real world setting as a highly functional member of the health care team providing safe, quality, patient-centered care. The primary objectives of the SIMPLE approach are to: Have students understand professional roles to promote collaboration; Increase student competence and confidence; Improve effective communication between and among disciplines; Develop a sound understanding of the continuum of care from point of contact through discharge, including assessment, intervention, implementation, interdisciplinary consultation, and patient teaching.
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach
e176
Box 1. The Multidisciplinary Care of the Patient with Asthma Participants: Students from the physician assistant, nursing, and respiratory care programs. Episode 1: Emergency department Patient: Adult with acute exacerbation of asthma. Nursing student: Assesses patient and provides care based on standard protocol and best practice guidelines. Patient states he/she has not followed the asthma management regimen because of a lack of funds to purchase required medications. Patient does not have an adequate understanding of the importance of compliance with the medication regimen. The patient no longer responds to the protocol guidelines, a report using ISBAR is called to the physician assistant student. Physician assistant student: Performs a history and physical assessment and collaborates with the nursing student regarding a course of action to take. A decision is made to have the patient receive a breathing treatment instituted by the respiratory care student. Respiratory care student: Performs an assessment and based on the needs of the patient suggests a slight change regarding the specifics of the treatment to best meet the needs of the patient. Patient: Stabilizes and is transferred to an inpatient medical unit. Episode 2: Medical unit, 10 hours after admission Nursing student: Assesses patient and determines that a breathing treatment is needed. Nursing student and respiratory care student: Together review the standing orders for the breathing treatment and identify an area in need of clarification. They contact the Physician Assistant student to clarify the order. Physician assistant student clarifies the order. Nursing student is unfamiliar with the equipment required to provide the breathing treatment and asks the respiratory care student to review the use of equipment. Episode 3: Medical unit, 2 days after admission. Physician assistant student: Assesses the patient then meets with the nursing and respiratory care students outside of the patient’s room to discuss the patient’s discharge needs. The three students identified a need to have a home health referral and case management follow up to ensure patient compliance with the regimen and to address financial restrictions the patient was under related to obtaining the prescribed medications. Students collaborated to determine which member of the team will provide specific components of patient teaching and discharge instructions. Respiratory care student teaches the patient how to use a peak flow meter. Nursing student teaches the patient how to document and respond to the peak flow log. Physician assistant student teaches the patient about medications to be taken at home as well as follow up care. Sequenced debriefing occurs throughout and at the end of the scenario. One example of the SIMPLE approach in action is the learning activity called ‘‘The Multidisciplinary Care of the Patient with Asthma.’’ Box 1 details the multidisciplinary progressive scenario. At this point, upper-level students from three disciplinesdnursing, physician assistant, and respiratory caredare brought together in the patient simulation center and assigned to teams of three. Each team is given the challenge of caring for a patient who is admitted to the emergency department with an acute asthmatic exacerbation. The students must be able to rapidly and accurately assess the patient, communicate their findings, intervene appropriately, and continuously re-evaluate the situation. Essentially, they must function as a highly effective team to ensure safe patient outcomes.
Traditionally, debriefing consists of group discussion sessions that follow simulation activities. The sessions provide opportunities for students to review what was done during the simulation scenario, to discuss with one another what they could have been done differently or more effectively, and what they have learned (Cantrell, 2008). In the SIMPLE approach, sequenced debriefing is used. Discipline-specific faculty lead the debriefing process for discipline-specific interventions as needed and when natural breaks in the scenario occur. In this way, role-specific content is evaluated by a clinical expert for that discipline. All faculty members participate in debriefing students regarding collaborative practice, including communication techniques and teamwork.
Debriefing Outcomes The process of debriefing is recognized as an essential component of simulation learning. Debriefing fosters the development of clinical reasoning and judgment skills through reflective learning processes (Dreifuerst, 2009).
Students who participated in the SIMPLE approach and the students who viewed the scenarios via video recording reported in their course evaluations an overall positive
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach learning experience. Students stated they felt more comfortable using ISBAR communication and more confident in their ability to provide a comprehensive and effective patient report. Students stated they had a greater understanding and respect for the importance of each team member’s role by participating in the multidisciplinary progressive teambased learning activities. Students also mentioned that before this experience, they did not have the opportunity to collaboratively care for a patient for more than static periods of time during their scheduled clinical. By participating in the SIMPLE approach, students were provided the opportunity to care for a patient across the continuum of care from initial point of contact through discharge following best practices guidelines while collaborating with other members of the health care team. Another positive outcome of the multidisciplinary, teambased learning approach was the awareness that took place regarding the appreciation for clinical expertise acquired by students from three different educational levels. The physician assistant students are in a master’s program, the nursing students are in a baccalaureate program, and the respiratory care students are in an associate degree program. Students often rate the clinical expertise of another person based on their level of education. It can be incorrectly assumed that the higher level of education an individual has completed the more comprehensive their knowledge base is for the general care of patients. Students commented that participation in the SIMPLE approach allowed them to experience firsthand the high level of expertise each student had regarding their unique role in the care of a patient regardless of the degree being earned. Students also commented on the crossover between all health care professionals’ knowledge base, particularly in the area of physical assessment. Students were not aware of the fact that all health care providers who participated in care of the patient performed their own assessment of the patient. Another interesting finding included student comments regarding faculty interaction and collaboration throughout the SIMPLE approach. When implementing the SIMPLE approach, faculty from all disciplines modeled interprofessional behavior, respect, and cooperation, valuing input from others. Students commented that they thought that each discipline-specific faculty member was the content expert for all aspects of patient care and that they were surprised to see faculty collaborate. Faculty evaluation of the SIMPLE approach was extremely positive. Increased student proficiency in use of ISBAR and general communication skills was observed by faculty. There was also a noticeable change in student attitude toward recognition and appreciation of each member’s unique contributions in the care of the patient from initial point of contact to discharge. Before this experience, students had limited experience interacting with other members of the health team. Participation in the SIMPLE approach broke down communication barriers among and between students from varying health profession programs and encouraged enhanced cooperative teamwork.
e177
Challenges As students in the health professions move beyond their freshman year, there is consistency between the disciplines as to the skills and content taught; however, there exists considerable diversity as to where in the curriculum each of the disciplines incorporate content and learning experiences essential to their profession. When examining the curricula of the three disciplines, it was noted that all three taught physical assessment skills, but all at varying times. For example, physical assessment is taught in the senior level of the 5-year physician assistant master’s program, in the sophomore year of the baccalaureate nursing program, and in the first year of the associate degree respiratory care program. Scheduling a common time when students from multiple disciplines were available to participate in the SIMPLE approach was a challenge, even though all health profession students have classes located in the same building. By having faculty champions who were committed to the SIMPLE approach, adjustments were made in schedules to make this important learning experience happen. Another challenge was overcoming the notion that use of the SIMPLE approach required more time in curricula that are already burdened with large volumes of content in a limited timeframe. Rather than adding to the respective curricula, faculty reviewed current curricula and rearranged content so that the teamwork, cooperation, and collaboration contentdwhich was already included in the individual course content of the three programsdwas now implemented when using the SIMPLE approach. Rather than simply talking about the benefits of collaboration and cooperation, students were able to experience firsthand the process of multidisciplinary collaboration in the care of a patient across the continuum of care.
Future Direction The SIMPLE approach will be broadened to include students from other health profession programs, such as physical therapy, radiologic sciences, and occupational therapy. The type of patient scenarios will be expanded to include care of the patient with a variety of complex health problems. Although student satisfaction and faculty perception of the SIMPLE approach have been reviewed, formal evaluation of the SIMPLE approach will be studied.
Conclusion Effective teamwork is essential to achieving patient safety. Health profession educators have an obligation to prepare workforce-ready graduates who are prepared to assume their roles and responsibilities as a highly effective team member. To enhance collaborative practice, health profession curricula need to provide interprofessional
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5
Multidisciplinary, Team-Based Learning: The SIMPLE Approach educational experiences for students starting at the first year of study. Ideally, it would progress to multidisciplinary experiences before graduation that integrate strategies that build the necessary teamwork skills of communication, collaboration, and respect.
Acknowledgments This work was supported in part by the Emerging Learning and Integrated Technologies Education (ELITE) Faculty Development Program, University of Pittsburgh School of Nursing Grant U1KHP0838 from the Division of Nursing and the Office of Health Information Technology, Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS). The authors would especially like to thank John M. O’Donnell, CRNA, MSN, DrPH, University of Pittsburgh School of Nursing.
References Agency for Health Care Research and Quality. (2011). TeamSTEPPS: National implementation. Retrieved June 1, 2011 from http://teamstepps. ahrq.gov/. American Association of Critical Care Nurses. (2005). AACN standards for establishing and sustaining healthy work environments: A journey to excellence. Aliso Viejo, CA: American Association of Critical Care Nurses. Baker, C., Pulling, C., McGraw, R., Damon-Dagone, J., HopkinsRosseel, D., & Medves, C. (2008). Simulation in interprofessional education for patient-centered collaborative care. Journal of Advanced Nursing, 64(4), 372-379. Bandali, K., Parker, K., Mummery, M., & Preece, M. (2008). Skills integration in a simulated and interprofessional environment: An innovative undergraduate applied health curriculum. Journal of Interprofessional Care, 22(2), 179-189.
e178 Bender, D., & Buckner, S. (2005). Interdisciplinary patient care skills module. Journal of Nursing Education, 44(6), 291-292. Cantrell, M. A. (2008). The importance of debriefing in clinical simulations. Clinical Simulations in Nursing, 4(2), 19-23. Decker, S., Sportsman, S., Puetz, L., & Billings, L. (2008). The evolution of simulation and its contribution to competency. The Journal of Continuing Education in Nursing, 39(2), 74-80. Dillon, P., Noble, K., & Kaplan, L. (2009). Simulation as a means to foster collaborative interdisciplinary education. Nursing Education Research, 30(2), 87-90. Dreifuerst, K. (2009). The essentials of debriefing in simulation learning: A concept analysis. Nursing Education Perspectives, 30(2), 108-114. Interprofessional Education Collaborative Expert Panel. (2011). Core compententcies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative Expert Panel. Jeffries, P. R., Woolf, S., & Linde, B. (2003). Technology-based vs. traditional instruction. A comparison of two teaching methods for teaching the skill of performing a 12 lead EKG. Nursing Education, 24(2), 70-74. Lett, D. (2008). The new architecture of medical education. Canadian Medical Association Journal, 178(1), 17-19, Retrieved August 2011 from www.cmaj.ca/content/178/1/17.2.full. Robertson, J., & Bandali, K. (2008). Bridging the gap: Enhancing interprofessional education using simulation. Journal of Interprofessional Care, 22(5), 499-508. Robertson, B., Kaplan, B., Atallah, H., Higgins, M., Lewitt, M., & Ander, D. (2010). The use of simulation and a modified TeamSTEPPS curriculum for medical and nursing students team training. Simulation in Healthcare, 5(6), 332-337. Tucker, K., Wakefield, A., Boggis, C., Lawson, M., Roberts, T., & Gooch, J. (2003). Learning together: Clinical skills teaching for medical and nursing students. Medical Education, 37(7), 630-637. World Health Organization (WHO). (2010). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization. Retrieved June 2011 from http://whqlibdoc.who. int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf. Zafian, R., & Jansky, L. (2011). ISBAR: Adding an extra step in handoff communication. Retrieved March 2011 from http://www.strategiesfornursemanagers.com/content/222773.cfm.
pp e171-e178 Clinical Simulation in Nursing Volume 9 Issue 5