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Assessment of interprofessional perceptions and attitudes of health professional students in a simulation laboratory setting
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Currents in Pharmacy Teaching and Learning 5 (2013) 167–174
Research
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Assessment of interprofessional perceptions and attitudes of health professional students in a simulation laboratory setting Michelle M. Bottenberg, PharmD, BCPSa,*, Jane E. DeWitt, BS, MS, PhDb, Geoffrey C. Wall, PharmD, FCCP, BCPSa, Anisa Fornoff, PharmDa, Nora Stelter, PharmDa, Denise Soltis, RPhc, Darla Klug Eastman, PharmD, BCPSa a b
Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, Des Moines, IA Social and Administrative Sciences, Drake University College of Pharmacy and Health Sciences, Des Moines, IA c Drake University College of Pharmacy and Health Sciences, Des Moines, IA
Abstract Objective: To describe the interprofessional perceptions and attitudes of medical, pharmacy, and nursing students from separate universities involved in a human patient simulation laboratory experience. Methods: A survey instrument was administered to medical, pharmacy, and nursing students to determine if interprofessional simulation labs alter participants’ attitudes and perceptions of each other. Results: Surveys completed by 163 students were analyzed. Some significant differences in perceptions existed between medical and pharmacy students. Review of student comments contributed to understanding survey responses. Conclusions: This interprofessional interaction in a simulation laboratory was perceived by health professional students from different universities to be a beneficial experience. Implementation of a similar interprofessional simulation could be considered by other colleges and schools of pharmacy, especially with those who are not part of a large, academic health center. r 2013 Elsevier Inc. All rights reserved. Keywords: Interprofessional; Assessment; Simulation
Introduction The concept of interprofessional education (IPE) has become an area of growing importance in health professional education. With the increasing prevalence of chronic diseases, advancements in healthcare technology, and mounting complexity of healthcare delivery, the need for coordination and integration of clinical care through a multidisciplinary approach has become essential.1 To address this issue, the Institute of Medicine (IOM) has called for a redesign of the health professions education process to provide healthcare
* Corresponding author: Michelle M. Bottenberg, PharmD, BCPS, Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Ave, Des Moines, IA 50311-4505. E-mail: [email protected]
professionals, both in the academic setting and in practice, the knowledge, skills, and attitudes to work effectively in a multidisciplinary environment.2 Additionally, in the IOM’s To Err is Human: Building a Safer Health System report, many healthcare errors were blamed on the ‘‘y historical lack of interprofessional cooperation and effective communication.’’ The report suggests that by improving interprofessional collaboration, the goal of reducing patient errors by 50% in five years is achievable.3 Evidence that interprofessional learning improves health outcomes and patient safety is slowly building and has already been shown to be effective in reducing clinical error, improving collaborative team behavior, and supporting team culture.4 Additionally, the 2007 Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy aligned with the IOM report recommending that
1877-1297/13/$ – see front matter r 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cptl.2012.12.004
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graduates must be competent to deliver patient-centered care and to communicate and collaborate with patients, their care givers, physicians, nurses, and other healthcare providers.5 Specifically, standard 12 encourages curricular development surrounding the provision of patient-centered care within an interprofessional healthcare team. More recently, a joint report representing the major associations in medical, pharmacy, nursing, dental, and public health education concerning the critical need for interprofessional education was released.6 Among the core competencies listed in this document as crucial to educational activities between health professions includes interprofessional communication strategies, teamwork and consensus building, delineation of roles in the healthcare team and the ethics of such activities. Multiple definitions of IPE have been proposed, but there is a growing consensus that it represents joint learning by practitioners or students of more than one profession to enhance collaborative practice.7 Key components of IPE are that practitioners or students are to learn with, from, and about each other to improve collaboration and the quality of patient care. Active experiential, reflective, and contextual learning approaches associated with adult learning have been found to facilitate interprofessional learning.7 One way to achieve this is through patient simulation. Human patient simulators offer a high degree of realism, particularly when integrated into simulated scenarios, because of their advanced and responsive computerized physiological functions. Learners must integrate a full range of knowledge, attitudes, and skills to respond effectively to the situation.8 Patient simulation is being used by medical and nursing schools, but has yet to be introduced formally into many schools of pharmacy curricula. Over the past few years, several reports of simulation in pharmacy education have been published, but the reports on the use of human patient simulation (HPS) are limited.9–14 However, these reports will probably start to increase as the ACPE Standards have recently encouraged the use of simulation as an active learning technique. Simulation can now be part of a program’s required 300 hours of introductory pharmacy practice experiences, as well.5 Many of these IPE endeavors are being piloted at large, academic health centers where various health professions students are involved from the same institution. This research project presents an experience from students of health professions from different universities in an attempt to foster IPE activities. The objective of this study was to describe the interprofessional experience of medical, pharmacy, and nursing students involved in a private medical school’s simulation laboratory and to evaluate descriptive data gathered from our survey entitled: ‘‘A Survey Assessing Interprofessional Perceptions and Attitudes of Health Professional Students in a Simulation Laboratory Setting.’’ (Appendix 1) The hypothesis was that the students would have a positive attitude regarding their interprofessional simulation laboratory experience, and additionally that it would positively affect their perceptions of other healthcare professionals.
Methods The simulation laboratory, located at a private, osteopathic medical school, provides medical, nursing and pharmacy students the opportunity to work together to build skills in assessing and treating a wide range of cases on lifelike mannequins in a simulated clinical environment. These mannequins exhibit human physiologic functions such as blood pressure, reactive pupils, working tear ducts, and heart and lung sounds. Participants were a convenience sample of second year (M2) and third year (M3) medical students from the medical school, third year (P3) and fourth year (P4) pharmacy students from a local college of pharmacy, pharmacy residents from a local teaching hospital, and both bachelor’s and advanced degree nursing students (BSN and ADN) from a local community college. The supervising academic physicians at the simulation laboratory approached other health professions academic institutions in order to foster more interprofessional experiences. Pharmacy students have been participating in simulation sessions since 2009, at about the same time as ACPE simulation standards were being implemented. Although the integration of pharmacy and medical students in the simulation lab was not a direct result of the accreditation guidelines, the goals of the pharmacy faculty in having student pharmacists participate in these exercises aligned well with these standards. In general, team composition consisted of four medical students and two pharmacy students, while occasionally, two nursing students participated as well. Assignment to the teams and the cases was dependent upon student scheduling and was not purposeful. The majority of cases were simulated acute emergency room clinical situations. Some examples include acute coronary syndrome, panic attack, acute kidney injury/hyperkalemia, subdural hematoma, and diabetic ketoacidosis. In response to the patient case, interprofessional student teams perform many common procedures on the mannequin, such as administering medications, starting an IV, assessing vitals, and performing surgical procedures. Teams evaluate patient cases in the simulation lab for 20–30 minutes. Following the simulation, students participate in a 30–60 minute discussion session with faculty from the different academic institutions. Although each patient-case scenario has differing overall objectives, the pharmacy students were responsible to provide drug information to team members on items such as dosages and adverse effects and to help identify and resolve drug-therapy problems. Medical objectives included decisions on which laboratory tests to request, which imaging studies to order, and what treatments should be initiated. Additional objectives addressed team dynamics and improved communication strategies. A research team of faculty from the college of pharmacy and the medical school was created to assess the health professional students’ interprofessional perceptions and
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attitudes in the simulation laboratory setting. To examine this issue, the research team conducted a literature search using these terms: interprofessional; student; attitudes; survey; student attitudes; and interdisciplinary healthcare. A 24-item survey was constructed (Appendix 1). Questions were adopted from previously published surveys found during the literature search, including the Index of Interdisciplinary Collaboration, the Attitudes Toward Health Care Teams Scale, the RIPLS tool, and the Interdisciplinary Education Perception Scale.8,15–18 The survey was designed as a post-assessment survey to be administered upon completion of a student’s simulation lab experience. A pre-assessment survey was not administered to avoid bias; however, pre-assessment questions were built into the post-assessment survey to address this concern. The first three questions gathered demographic information. One negative question was inserted to examine how it correlated with other responses. The study was approved by both institutions’ Institutional Review Boards. Immediately after students completed their simulation lab session and informed consent was obtained, the paper survey was administered. Students were asked to complete the survey only once. No compensation was provided for completion of the survey. Completed surveys were collected by simulation laboratory staff. Study participants Surveys were administered over the Spring semester from February to May 2010 only to interprofessional groups that contained pharmacy students. Informed consent was received by the participants and instructions were emphasized that the survey was to be filled out only once per student after completing the patient case. A total of 210 M2 students and 110 P3 students were eligible to participate. However, not all medical students had the opportunity to participate with pharmacy students, and it was optional for pharmacy students to attend during the Spring semester due to scheduling conflicts. Additionally, this experience was optional for P4 students who were with participating faculty members, as well as pharmacy residents from a local PGY1 residency program. All students who participated in the interprofessional simulation consented to complete the survey, indicating a 100% response rate. The survey included a demographic question which allowed student participants to indicate their program and/ or year of study from 12 possibilities. While a few nursing students completed the survey, most of the students were second year medical students, and P3, and P4 students, as shown in Table 1. Results There were 171 surveys completed, with no missing data. All participants who were offered the survey completed it. Due to the small number of nursing responses,
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Table 1 Simulation laboratory participants Status
N
%
M2 P3 P4 Pharmacy resident ADN nursing student TOTAL
118 24 19 2 8 171
69.0 14.0 11.1 1.2 4.7 100.0
they were omitted for the purposes of analysis, and the remaining responses were collapsed to two categories: Medicine and Pharmacy. There were 163 responses remaining: 118 Medicine (72.4%) and 45 Pharmacy (27.6%). The average age for the 171 participants was 24.8 years (range 22–49). The 163 subjects included in the analysis had an average age of 24.6 years (range 22–37). Data from completed survey forms were compiled and entered into an Excel spreadsheet by the principal investigator. Data were then downloaded to SPSS 19.0 for analysis. Responses were based on a standard Likert scale, with 1 ¼ Strongly Disagree and 5 ¼ Strongly Agree. Significance was set a priori at .05. Statistical difference between groups was confirmed using 2 2 contingency tables and a chi-square statistic. The overall response medians, along with those for the Medicine and Pharmacy subjects, for the 14 items on the survey are shown in Table 2. Results supported the hypothesis that students would have a positive attitude toward the interprofessional simulation laboratory experience. An overall median score of 4.84 indicated overwhelming agreement to the item stating, ‘‘The interprofessional component of the simulation lab adds value to my training.’’ Likewise, students’ response to the statement, ‘‘Learning with other students will help me to become a more effective member of the healthcare team,’’ resulted in a median of 4.89 and indicated student agreement. Student responses indicated that the experience had a positive impact on their understanding of the contributions of other healthcare professionals based on the statement, ‘‘This experience improved my understanding of the contributions of healthcare professionals in other disciplines,’’ which had a median of 4.71. However, the median responses of 3.57 and 3.55 to the statements, ‘‘This experience changed my attitude about the competency of other healthcare professionals,’’ and ‘‘The students from other disciplines contributed more to the patient’s care than I expected,’’ may demonstrate that the simulation experience had a limited impact on the students’ perception of other healthcare professionals. Statistically significant differences between medicine and pharmacy respondents were identified for six survey items. For each of those items, the median response from the medical students was more positive than the pharmacy
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Table 2 Overall, medicine, and pharmacy response medians and chi-square results* Overall Medicine Pharmacy w median median median p-value 4. The participants worked well together.
4.58
4.68
4.27
12.673 .005*
5. Working in teams unnecessarily complicates things most of the time.
1.34
1.34
1.32
.699 .951
6. The interprofessional component of the simulation lab adds value to my training.
4.84
4.88
4.73
4.619 .032*
7. This experience improved my understanding of the contributions of healthcare professionals in other disciplines.
4.71
4.72
4.68
.545 .762
8. I believe that individuals in my profession make an effort to understand the capabilities and contributions of other professions.
4.31
4.30
4.34
2.364 .500
9. I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession.
4.17
4.25
4.00
12.970 .005*
10. This experience will help improve the quality of patient care.
4.84
4.90
4.65
13.935 .003*
11. A team’s primary purpose is to assist physicians in achieving treatment goals for patients.
4.33
4.27
4.45
4.113 .391
12. This experience changed my attitude about the competency of other healthcare professionals.
3.57
3.50
3.71
4.647 .325
13. The students from other disciplines contributed more to the patient’s care than I expected.
3.55
3.63
3.37
6.621 .157
14. Individuals in my profession must depend upon the work of people in other professions.
4.77
4.84
4.50
14.229 .003*
15. Individuals in other professions often seek the advice of people in my profession.
4.40
4.62
4.03
24.618 .000*
16. Working with individuals from other disciplines leads to patient outcomes that we could not achieve alone.
4.79
4.81
4.73
2.605 .457
17. Learning with other students will help me to become a more effective member of the healthcare 4.89 team.
4.90
4.86
2.456 .293
* Questions 1 through 3 are demographic data and are reported elsewhere.
student response. The significant items were as follows: ‘‘The participants worked well together’’ (p ¼ .005); ‘‘The interprofessional component of the simulation lab adds value to my training’’ (p ¼ .32); ‘‘I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession’’ (p ¼ .005); This experience will help improve the quality of patient care’’ (p ¼ .003); ‘‘Individuals in my profession must depend upon the work of people in other professions’’ (p ¼ .003); and ‘‘Individuals in other professions often seek the advice of people in my profession’’ (p ¼ .000). All participants were encouraged to write additional comments regarding their experience at the end of the survey. While these comments were not analyzed, the
content was reviewed. Both pharmacy and medical students expressed generally positive responses to the experience with wording like, ‘‘Great experience,’’ ‘‘Great activity,’’ or ‘‘Definitely a positive experience.’’ More specifically, some comments centered on the interprofessional aspect: ‘‘I learn a lot more working with other healthcare professionals’’ and ‘‘It was a valuable experience to work with other healthcare members.’’ In addition, some commented on the general aspect of group or teamwork in a positive way.
Discussion To our knowledge, this is the first study that has examined the attitudes of pharmacy students and other health
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professions from different universities collaborating in a simulation laboratory environment. Simulation laboratory exercises are increasingly used in physician training programs. Such programs have been shown to improve clinical skills and knowledge in such diverse areas as resuscitation training, respiratory physiology, performing phlebotomies, and general physical exam skills.19–22 McGaghie, in an extensive review of simulation training for medical students notes that a core feature of such experiences is ‘‘team training’’.23 Although pharmacists or other healthcare professionals are not specifically mentioned in this review, the goals the author lists for evidence-based practice and best practices including emphasize teamwork over task work, reviewing team processes for optimal patient care, and coaching to emphasize professional and teambased behavior are goals that both intra- and interprofessional training should aspire to. This study can be viewed in the context of development of a learning activity that strives for these best practices, but without the implicit connection that a college of pharmacy and medicine in the same academic medical center may have. Although this research project would largely be considered a descriptive study, outcome data were included as a point for future research.24 Fernandez et al. reported on the use of high-fidelity HPS in pharmacy education and found favorable reception by students in preparation for clinical rotations.11 A review of the literature found few publications examining facets of the simulation laboratory on teaching outcomes, including any work examining the attitudes of simulation laboratory participants concerning other disciplines after multidisciplinary training. This is understandable as simulation laboratories can be resource intensive and many colleges of pharmacy may not have access to such equipment—especially in colleges that are not located within an academic medical center. Thus, this research project assessing attitudes of pharmacy and medicine students (who attend two different private universities) after a simulation laboratory experience is unique. In general, the results demonstrated positive overall perception of pharmacy and medical students toward each other and multidisciplinary training. The cohort of medicine and pharmacy students possessed a high level of respect and willingness to participate in multidisciplinary patient care exercises. After the simulation lab experience, both medicine and pharmacy students believed their teams worked well together and improved the quality of patient care. Interestingly, medical students responded more positively to the notion that other professionals make an effort to understand their profession as compared to the pharmacy students (question 9, ‘‘I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession’’). Although there was not a difference between the two groups with regards to question 7 (‘‘This experience improved my understanding of the contributions of healthcare professionals in other disciplines’’), it was interesting to note that several of the M3 students rated this low and included written comments
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discussing how they already had a high opinion of the other members of the healthcare team and so this experience did not really alter that. The medical students may have had previous experience with interprofessional simulations with nursing students, so it is unknown how this may have affected the results. Additionally, it was interesting to note that the pharmacy students were less favorable to the idea that the participants worked well together as shown in question 4 (‘‘The participants worked well together’’). One theory to support this finding could be that this was only the second time in the Sim Lab for the pharmacy students as compared to the medical students who were in it several times a semester. This potentially could have placed the medical students more at ease within the group due to their previous experience. Another theory is that the pharmacy students may not have been comfortable enough to vocalize their ideas or thoughts without being asked directly. This concept would be interesting to explore with further research. The results of this research project are similar to other studies assessing the use of simulation in pharmacy education. A scan of the pharmacy education literature did examine the attitudes of medicine and pharmacy students similar to the one we describe in a study by Shrader et al. involving interprofessional student teams consisting of pharmacy, medical, and physician assistant students in a large, academic health center.14 The authors describe how they implemented a simulated interprofessional rounding experience using human patient simulators in a clinical assessment course, which was viewed as a positive experience by a majority of the students involved. Additionally, their study found significant improvement in interprofessional attitudes after students completed the experience, although the finding was primarily seen within the pharmacy student group, while the medical/physician assistant student group demonstrated minimal improvement. In addition, Scott et al. examined attitudes in interdisciplinary ambulatory settings and showed the interdisciplinary team approach as a constructive experience that had a positive impact on attitudes of non-pharmacy students towards pharmacists.25 Fernandez et al. used HPS to introduce students ‘‘to interdisciplinary team skills and reinforce pharmacotherapeutics.’’ Students responded favorably and preferred HPS to classroom teaching.11 Westberg et al. looked at interprofessional standardized patient experiences (ISPE) as a means to provide ‘‘an opportunity for pharmacy students to collaborate with students from other health professions early in the curriculum.’’26 Students were surveyed pre and post the experience and asked to describe the roles of other healthcare providers. Students enjoyed the experience and found that ISPE expanded their understanding of other healthcare providers’ roles. Damon Dagnone et al. surveyed nursing and medical students and medical residents after they completed interdisciplinary exercises that aimed to teach communication and teamwork within ACLS training in a high-fidelity
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simulation laboratory.15 The survey demonstrated that all students and residents found the interprofessional session to be valuable and gave them a better understanding of the different roles of an ACLS team. Our study found similarly high ratings, but is different in that the education within our simulations was not explicitly intended to develop teamwork roles. It is also noteworthy that Dagnone’s study did not involve pharmacy students or pharmacy residents and so did not address the attitudes of or toward pharmacists.
some selection bias. It would have been beneficial to have obtained more data from the nursing students for comparison as well, but the small number of nursing students participating in the interprofessional simulation did not allow for a meaningful comparison of this professional group. Finally, both medical and pharmacy students have additional experiential requirements and work experience that may have also impacted the attitudes of those involved, and may have affected any pre-simulation survey results.
Limitations
Conclusions
This research project has several limitations. First, there is no pre–post survey data. The purpose of this study was to examine the interplay of working in a simulation laboratory on attitudes, perceptions, and interprofessional interactions. A pre–post survey design may have captured the overall impact of simulation laboratory on the outcomes. However, a pre-survey was declined as this would have biased the participants with the simulation experience. Medical students are graded on their interprofessional work and a presurvey may have ‘‘tipped them off’’ on what they should gain from the experience. For example, if the students filled out a pre-survey and knew they were going to be assessed on communication and working together interprofessionally, this could then lead them to act differently during the case. Additionally, there were not equal groups of each of the health professions’ students represented during the experience or in the final sample, which may have influenced the results. The visit to the simulation laboratory was not required of pharmacy students, so this could have led to
This interprofessional interaction in a simulation laboratory was perceived by health professional students from different universities to be a beneficial experience. In general, both medicine and pharmacy students had positive responses in all categories of the survey. Although small statistically significant differences were found between groups, all students from both disciplines deemed the simulation laboratory a positive experience. In particular, future research could be conducted in regards to the difference found with question 4, the participants worked well together. Additionally, this project engaged faculty and motivated them to push for more interprofessional interaction within the curricula. Based on these positive interactions, the medical school faculty members have asked for increasing participation with pharmacy students and pharmacy faculty with the intent of enhancing future learning opportunities. Implementation of a similar interprofessional simulation could be considered by other colleges and schools of pharmacy, especially with those who are not part of a large, academic health center.
Appendix 1: Survey A Survey Assessing InterprofessionalPerceptions, and Attitudes of Health Professional Students in a Simulation Laboratory Setting This is a survey for health professional students who have been involved in a simulation lab experience together. Complete this survey only once this year. STOP if you have previously completed this survey.
1. Your status: M2 & Medical Resident & BSN Nursing Student &
M3 & Pharmacy Resident & PA Student &
P3 & PN Nursing Student & DPM Student &
P4 & ADN Nursing Student & DPT Student &
2. Your age: ________ 3. Case title __________________________ Strongly Disagree
Somewhat Disagree
Neutral
Somewhat Agree
Strongly Agree
4. The participants worked well together.
1
2
3
4
5
5. Working in teams unnecessarily complicates things most of the time.
1
2
3
4
5
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Strongly Disagree 1
Somewhat Disagree 2
Neutral
7. This experience improved my understanding of the contributions of healthcare professionals in other disciplines.
1
8. I believe that individuals in my profession make an effort to understand the capabilities and contributions of other professions.
173
3
Somewhat Agree 4
Strongly Agree 5
2
3
4
5
1
2
3
4
5
9. I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession.
1
2
3
4
5
10. This experience will help improve the quality of patient care.
1
2
3
4
5
11. A team’s primary purpose is to assist physicians in achieving treatment goals for patients.
1
2
3
4
5
12. This experience changed my attitude about the competency of other healthcare professionals.
1
2
3
4
5
13. The students from other disciplines contributed more to the patient’s care than I expected.
1
2
3
4
5
14. Individuals in my profession must depend upon the work of people in other professions.
1
2
3
4
5
15. Individuals in other professions often seek the advice of people in my profession.
1
2
3
4
5
16. Working with individuals from other disciplines leads to patient outcomes that we could not achieve alone.
1
2
3
4
5
17. Learning with other students will help me to become a more effective member of the healthcare team.
1
2
3
4
5
6. The interprofessional component of the simulation lab adds value to my training.
Comments:
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References 1. Page RL II, Hume AL, Trujillo JM, Leader WG, Vardeny O, Neuhauser MM, et al. Interprofessional education: principles and application. A framework for clinical pharmacy. Pharmacotherapy. 2009;29(3):145e–164e. 2. Institute of Medicine. Committee on the Health Professions Education Summit. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press; 2003. 3. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001. 4. Reeves S, Zwarenstein M, Goldman J, et al. Cochrane Database Syst Rev. 2008;23:1. 5. Accreditation Council for Pharmacy Education. Accreditation standards. /http://www.acpe-accredit.org/pdf/S2007Guide lines2.0_ChangesIdentifiedInRed.pdfS; Accessed December 17, 2012. 6. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC: Interprofessional Education Collaborative; 2011. 7. Barr H. Interprofessional Education: today, yesterday, and tomorrow. Learning and Teaching Support Network Centre for Health Sciences and Practice from the UK Centre for Advancement of Interprofessional Education, London, UK http://www.caipe.org.uk. 8. Baker C, Pulling C, McGraw R, Dagnone JD, Hopkins-Rosseel D, Medves J. Simulation in interprofessional education for patient-centered collaborative care. J Adv Nurs. 2008;64(4): 372–379. 9. Seybert AL, Laughlin KK, Benedict NJ, Barton CM, Rea RS. Pharmacy student response to patient-simulation mannequins to teach performance-based pharmacotherapeutics. Am J Pharm Educ. 2006;70(3): Article 48. 10. Chaikoolvatana A, Goodyer L. Evaluation of a multimedia case-history simulation program for pharmacy students. Am J Pharm Educ. 2003;67 Article 16. 11. Fernandez R, Parker D, Kalus JS, Miller D, Compton S. Using a human patient simulation mannequin to teach interdisciplinary team skills to pharmacy students. Am J Pharm Educ. 2007;71(3): Article 51. 12. Seybert AL, Kobulinksy LR, McKaveney TP. Human patient simulation in a pharmacotherapy course. Am J Pharm Educ. 2008;72(2): Article 37.
13. Marken PA, Zimmerman C, Kennedy C, Schremmer R, Smith KV. Human simulators and standardized patients to teach difficult conversations to interprofessional health care team. Am J Pharm Educ. 2010;74(7): Article 120. 14. Shrader S, McRae L, King WM, Kern D. A simulated interprofessional rounding experience in a clinical assessment course. Am J Pharm Educ. 2011;75(4): Article 61. 15. Dagnone JD, McGraw RC, Pulling CA, Patteson AK. Interprofessional resuscitation rounds: a teamwork approach to ALCS education. Med Teach. 2008;30:e49–e54. 16. Horsburgh M, Lamdin R, Williamson E. Multiprofessional learning: the attitudes of medical, nursing, and pharmacy students to shared learning. Med Educ. 2001;35:876–883. 17. Leipzig RM, Hyer K, Ek K et al. Attitudes toward working on interdisciplinary healthcare teams: a comparison by discipline. J Am Geriatr Soc. 2002;50:1141–1148. 18. Ragucci KR, Steyer T, Wager KA, West VT, Zoller JS. The presidential scholars program at the Medical University of South Carolina: an extracurricular approach to interprofessional education. J Interprof Care. 2009;23(2):134–147. 19. Ten Eyck RP, Tews M, Ballester JM, Hamilton GC. Improved fourth-year medical student clinical decision-making performance as a resuscitation team leader after a simulation-based curriculum. Simulation Healthc. 2010;5:139–145. 20. Kuebler WM, Mertens M, Pries AR. A two-component simulation model to teach respiratory mechanics. Adv Physiol Educ. 2007;31:218–222. 21. Scerbo MW, Bliss JP, Schmidt EA, Thompson SN. The efficacy of a medical virtual reality simulator for training phlebotomy. Hum Factors. 2006;48:72–84. 22. Karnath B, Frye AW, Holden MD. Incorporating simulators in a standardized patient exam. Acad Med. 2002;77:754–755. 23. McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003–2009. Med Educ. 2010;44:50–63. 24. Cook DA, Bordage G, Schmidt HG. Description, justification and clarification: a framework for classifying the purposes of research in medical education. Med Educ. 2008;42:128–133. 25. Scott DM, Montagne M, Hakanson N, Schwanke RW. The development and evaluation of an interdisciplinary health training program: a pharmacy perspective. Am J Pharm Educ. 1983;47:42–48. 26. Westberg SM, Adams J, Thiede K, Stratton TP, Bumgardner MA. An Interprofessional activity using standardized patients. Am J Pharm Educ. 2006;70(2): Article 34.
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Research
http://www.pharmacyteaching.com
Assessment of interprofessional perceptions and attitudes of health professional students in a simulation laboratory setting Michelle M. Bottenberg, PharmD, BCPSa,*, Jane E. DeWitt, BS, MS, PhDb, Geoffrey C. Wall, PharmD, FCCP, BCPSa, Anisa Fornoff, PharmDa, Nora Stelter, PharmDa, Denise Soltis, RPhc, Darla Klug Eastman, PharmD, BCPSa a b
Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, Des Moines, IA Social and Administrative Sciences, Drake University College of Pharmacy and Health Sciences, Des Moines, IA c Drake University College of Pharmacy and Health Sciences, Des Moines, IA
Abstract Objective: To describe the interprofessional perceptions and attitudes of medical, pharmacy, and nursing students from separate universities involved in a human patient simulation laboratory experience. Methods: A survey instrument was administered to medical, pharmacy, and nursing students to determine if interprofessional simulation labs alter participants’ attitudes and perceptions of each other. Results: Surveys completed by 163 students were analyzed. Some significant differences in perceptions existed between medical and pharmacy students. Review of student comments contributed to understanding survey responses. Conclusions: This interprofessional interaction in a simulation laboratory was perceived by health professional students from different universities to be a beneficial experience. Implementation of a similar interprofessional simulation could be considered by other colleges and schools of pharmacy, especially with those who are not part of a large, academic health center. r 2013 Elsevier Inc. All rights reserved. Keywords: Interprofessional; Assessment; Simulation
Introduction The concept of interprofessional education (IPE) has become an area of growing importance in health professional education. With the increasing prevalence of chronic diseases, advancements in healthcare technology, and mounting complexity of healthcare delivery, the need for coordination and integration of clinical care through a multidisciplinary approach has become essential.1 To address this issue, the Institute of Medicine (IOM) has called for a redesign of the health professions education process to provide healthcare
* Corresponding author: Michelle M. Bottenberg, PharmD, BCPS, Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, 2507 University Ave, Des Moines, IA 50311-4505. E-mail: [email protected]
professionals, both in the academic setting and in practice, the knowledge, skills, and attitudes to work effectively in a multidisciplinary environment.2 Additionally, in the IOM’s To Err is Human: Building a Safer Health System report, many healthcare errors were blamed on the ‘‘y historical lack of interprofessional cooperation and effective communication.’’ The report suggests that by improving interprofessional collaboration, the goal of reducing patient errors by 50% in five years is achievable.3 Evidence that interprofessional learning improves health outcomes and patient safety is slowly building and has already been shown to be effective in reducing clinical error, improving collaborative team behavior, and supporting team culture.4 Additionally, the 2007 Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy aligned with the IOM report recommending that
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graduates must be competent to deliver patient-centered care and to communicate and collaborate with patients, their care givers, physicians, nurses, and other healthcare providers.5 Specifically, standard 12 encourages curricular development surrounding the provision of patient-centered care within an interprofessional healthcare team. More recently, a joint report representing the major associations in medical, pharmacy, nursing, dental, and public health education concerning the critical need for interprofessional education was released.6 Among the core competencies listed in this document as crucial to educational activities between health professions includes interprofessional communication strategies, teamwork and consensus building, delineation of roles in the healthcare team and the ethics of such activities. Multiple definitions of IPE have been proposed, but there is a growing consensus that it represents joint learning by practitioners or students of more than one profession to enhance collaborative practice.7 Key components of IPE are that practitioners or students are to learn with, from, and about each other to improve collaboration and the quality of patient care. Active experiential, reflective, and contextual learning approaches associated with adult learning have been found to facilitate interprofessional learning.7 One way to achieve this is through patient simulation. Human patient simulators offer a high degree of realism, particularly when integrated into simulated scenarios, because of their advanced and responsive computerized physiological functions. Learners must integrate a full range of knowledge, attitudes, and skills to respond effectively to the situation.8 Patient simulation is being used by medical and nursing schools, but has yet to be introduced formally into many schools of pharmacy curricula. Over the past few years, several reports of simulation in pharmacy education have been published, but the reports on the use of human patient simulation (HPS) are limited.9–14 However, these reports will probably start to increase as the ACPE Standards have recently encouraged the use of simulation as an active learning technique. Simulation can now be part of a program’s required 300 hours of introductory pharmacy practice experiences, as well.5 Many of these IPE endeavors are being piloted at large, academic health centers where various health professions students are involved from the same institution. This research project presents an experience from students of health professions from different universities in an attempt to foster IPE activities. The objective of this study was to describe the interprofessional experience of medical, pharmacy, and nursing students involved in a private medical school’s simulation laboratory and to evaluate descriptive data gathered from our survey entitled: ‘‘A Survey Assessing Interprofessional Perceptions and Attitudes of Health Professional Students in a Simulation Laboratory Setting.’’ (Appendix 1) The hypothesis was that the students would have a positive attitude regarding their interprofessional simulation laboratory experience, and additionally that it would positively affect their perceptions of other healthcare professionals.
Methods The simulation laboratory, located at a private, osteopathic medical school, provides medical, nursing and pharmacy students the opportunity to work together to build skills in assessing and treating a wide range of cases on lifelike mannequins in a simulated clinical environment. These mannequins exhibit human physiologic functions such as blood pressure, reactive pupils, working tear ducts, and heart and lung sounds. Participants were a convenience sample of second year (M2) and third year (M3) medical students from the medical school, third year (P3) and fourth year (P4) pharmacy students from a local college of pharmacy, pharmacy residents from a local teaching hospital, and both bachelor’s and advanced degree nursing students (BSN and ADN) from a local community college. The supervising academic physicians at the simulation laboratory approached other health professions academic institutions in order to foster more interprofessional experiences. Pharmacy students have been participating in simulation sessions since 2009, at about the same time as ACPE simulation standards were being implemented. Although the integration of pharmacy and medical students in the simulation lab was not a direct result of the accreditation guidelines, the goals of the pharmacy faculty in having student pharmacists participate in these exercises aligned well with these standards. In general, team composition consisted of four medical students and two pharmacy students, while occasionally, two nursing students participated as well. Assignment to the teams and the cases was dependent upon student scheduling and was not purposeful. The majority of cases were simulated acute emergency room clinical situations. Some examples include acute coronary syndrome, panic attack, acute kidney injury/hyperkalemia, subdural hematoma, and diabetic ketoacidosis. In response to the patient case, interprofessional student teams perform many common procedures on the mannequin, such as administering medications, starting an IV, assessing vitals, and performing surgical procedures. Teams evaluate patient cases in the simulation lab for 20–30 minutes. Following the simulation, students participate in a 30–60 minute discussion session with faculty from the different academic institutions. Although each patient-case scenario has differing overall objectives, the pharmacy students were responsible to provide drug information to team members on items such as dosages and adverse effects and to help identify and resolve drug-therapy problems. Medical objectives included decisions on which laboratory tests to request, which imaging studies to order, and what treatments should be initiated. Additional objectives addressed team dynamics and improved communication strategies. A research team of faculty from the college of pharmacy and the medical school was created to assess the health professional students’ interprofessional perceptions and
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attitudes in the simulation laboratory setting. To examine this issue, the research team conducted a literature search using these terms: interprofessional; student; attitudes; survey; student attitudes; and interdisciplinary healthcare. A 24-item survey was constructed (Appendix 1). Questions were adopted from previously published surveys found during the literature search, including the Index of Interdisciplinary Collaboration, the Attitudes Toward Health Care Teams Scale, the RIPLS tool, and the Interdisciplinary Education Perception Scale.8,15–18 The survey was designed as a post-assessment survey to be administered upon completion of a student’s simulation lab experience. A pre-assessment survey was not administered to avoid bias; however, pre-assessment questions were built into the post-assessment survey to address this concern. The first three questions gathered demographic information. One negative question was inserted to examine how it correlated with other responses. The study was approved by both institutions’ Institutional Review Boards. Immediately after students completed their simulation lab session and informed consent was obtained, the paper survey was administered. Students were asked to complete the survey only once. No compensation was provided for completion of the survey. Completed surveys were collected by simulation laboratory staff. Study participants Surveys were administered over the Spring semester from February to May 2010 only to interprofessional groups that contained pharmacy students. Informed consent was received by the participants and instructions were emphasized that the survey was to be filled out only once per student after completing the patient case. A total of 210 M2 students and 110 P3 students were eligible to participate. However, not all medical students had the opportunity to participate with pharmacy students, and it was optional for pharmacy students to attend during the Spring semester due to scheduling conflicts. Additionally, this experience was optional for P4 students who were with participating faculty members, as well as pharmacy residents from a local PGY1 residency program. All students who participated in the interprofessional simulation consented to complete the survey, indicating a 100% response rate. The survey included a demographic question which allowed student participants to indicate their program and/ or year of study from 12 possibilities. While a few nursing students completed the survey, most of the students were second year medical students, and P3, and P4 students, as shown in Table 1. Results There were 171 surveys completed, with no missing data. All participants who were offered the survey completed it. Due to the small number of nursing responses,
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Table 1 Simulation laboratory participants Status
N
%
M2 P3 P4 Pharmacy resident ADN nursing student TOTAL
118 24 19 2 8 171
69.0 14.0 11.1 1.2 4.7 100.0
they were omitted for the purposes of analysis, and the remaining responses were collapsed to two categories: Medicine and Pharmacy. There were 163 responses remaining: 118 Medicine (72.4%) and 45 Pharmacy (27.6%). The average age for the 171 participants was 24.8 years (range 22–49). The 163 subjects included in the analysis had an average age of 24.6 years (range 22–37). Data from completed survey forms were compiled and entered into an Excel spreadsheet by the principal investigator. Data were then downloaded to SPSS 19.0 for analysis. Responses were based on a standard Likert scale, with 1 ¼ Strongly Disagree and 5 ¼ Strongly Agree. Significance was set a priori at .05. Statistical difference between groups was confirmed using 2 2 contingency tables and a chi-square statistic. The overall response medians, along with those for the Medicine and Pharmacy subjects, for the 14 items on the survey are shown in Table 2. Results supported the hypothesis that students would have a positive attitude toward the interprofessional simulation laboratory experience. An overall median score of 4.84 indicated overwhelming agreement to the item stating, ‘‘The interprofessional component of the simulation lab adds value to my training.’’ Likewise, students’ response to the statement, ‘‘Learning with other students will help me to become a more effective member of the healthcare team,’’ resulted in a median of 4.89 and indicated student agreement. Student responses indicated that the experience had a positive impact on their understanding of the contributions of other healthcare professionals based on the statement, ‘‘This experience improved my understanding of the contributions of healthcare professionals in other disciplines,’’ which had a median of 4.71. However, the median responses of 3.57 and 3.55 to the statements, ‘‘This experience changed my attitude about the competency of other healthcare professionals,’’ and ‘‘The students from other disciplines contributed more to the patient’s care than I expected,’’ may demonstrate that the simulation experience had a limited impact on the students’ perception of other healthcare professionals. Statistically significant differences between medicine and pharmacy respondents were identified for six survey items. For each of those items, the median response from the medical students was more positive than the pharmacy
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Table 2 Overall, medicine, and pharmacy response medians and chi-square results* Overall Medicine Pharmacy w median median median p-value 4. The participants worked well together.
4.58
4.68
4.27
12.673 .005*
5. Working in teams unnecessarily complicates things most of the time.
1.34
1.34
1.32
.699 .951
6. The interprofessional component of the simulation lab adds value to my training.
4.84
4.88
4.73
4.619 .032*
7. This experience improved my understanding of the contributions of healthcare professionals in other disciplines.
4.71
4.72
4.68
.545 .762
8. I believe that individuals in my profession make an effort to understand the capabilities and contributions of other professions.
4.31
4.30
4.34
2.364 .500
9. I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession.
4.17
4.25
4.00
12.970 .005*
10. This experience will help improve the quality of patient care.
4.84
4.90
4.65
13.935 .003*
11. A team’s primary purpose is to assist physicians in achieving treatment goals for patients.
4.33
4.27
4.45
4.113 .391
12. This experience changed my attitude about the competency of other healthcare professionals.
3.57
3.50
3.71
4.647 .325
13. The students from other disciplines contributed more to the patient’s care than I expected.
3.55
3.63
3.37
6.621 .157
14. Individuals in my profession must depend upon the work of people in other professions.
4.77
4.84
4.50
14.229 .003*
15. Individuals in other professions often seek the advice of people in my profession.
4.40
4.62
4.03
24.618 .000*
16. Working with individuals from other disciplines leads to patient outcomes that we could not achieve alone.
4.79
4.81
4.73
2.605 .457
17. Learning with other students will help me to become a more effective member of the healthcare 4.89 team.
4.90
4.86
2.456 .293
* Questions 1 through 3 are demographic data and are reported elsewhere.
student response. The significant items were as follows: ‘‘The participants worked well together’’ (p ¼ .005); ‘‘The interprofessional component of the simulation lab adds value to my training’’ (p ¼ .32); ‘‘I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession’’ (p ¼ .005); This experience will help improve the quality of patient care’’ (p ¼ .003); ‘‘Individuals in my profession must depend upon the work of people in other professions’’ (p ¼ .003); and ‘‘Individuals in other professions often seek the advice of people in my profession’’ (p ¼ .000). All participants were encouraged to write additional comments regarding their experience at the end of the survey. While these comments were not analyzed, the
content was reviewed. Both pharmacy and medical students expressed generally positive responses to the experience with wording like, ‘‘Great experience,’’ ‘‘Great activity,’’ or ‘‘Definitely a positive experience.’’ More specifically, some comments centered on the interprofessional aspect: ‘‘I learn a lot more working with other healthcare professionals’’ and ‘‘It was a valuable experience to work with other healthcare members.’’ In addition, some commented on the general aspect of group or teamwork in a positive way.
Discussion To our knowledge, this is the first study that has examined the attitudes of pharmacy students and other health
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professions from different universities collaborating in a simulation laboratory environment. Simulation laboratory exercises are increasingly used in physician training programs. Such programs have been shown to improve clinical skills and knowledge in such diverse areas as resuscitation training, respiratory physiology, performing phlebotomies, and general physical exam skills.19–22 McGaghie, in an extensive review of simulation training for medical students notes that a core feature of such experiences is ‘‘team training’’.23 Although pharmacists or other healthcare professionals are not specifically mentioned in this review, the goals the author lists for evidence-based practice and best practices including emphasize teamwork over task work, reviewing team processes for optimal patient care, and coaching to emphasize professional and teambased behavior are goals that both intra- and interprofessional training should aspire to. This study can be viewed in the context of development of a learning activity that strives for these best practices, but without the implicit connection that a college of pharmacy and medicine in the same academic medical center may have. Although this research project would largely be considered a descriptive study, outcome data were included as a point for future research.24 Fernandez et al. reported on the use of high-fidelity HPS in pharmacy education and found favorable reception by students in preparation for clinical rotations.11 A review of the literature found few publications examining facets of the simulation laboratory on teaching outcomes, including any work examining the attitudes of simulation laboratory participants concerning other disciplines after multidisciplinary training. This is understandable as simulation laboratories can be resource intensive and many colleges of pharmacy may not have access to such equipment—especially in colleges that are not located within an academic medical center. Thus, this research project assessing attitudes of pharmacy and medicine students (who attend two different private universities) after a simulation laboratory experience is unique. In general, the results demonstrated positive overall perception of pharmacy and medical students toward each other and multidisciplinary training. The cohort of medicine and pharmacy students possessed a high level of respect and willingness to participate in multidisciplinary patient care exercises. After the simulation lab experience, both medicine and pharmacy students believed their teams worked well together and improved the quality of patient care. Interestingly, medical students responded more positively to the notion that other professionals make an effort to understand their profession as compared to the pharmacy students (question 9, ‘‘I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession’’). Although there was not a difference between the two groups with regards to question 7 (‘‘This experience improved my understanding of the contributions of healthcare professionals in other disciplines’’), it was interesting to note that several of the M3 students rated this low and included written comments
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discussing how they already had a high opinion of the other members of the healthcare team and so this experience did not really alter that. The medical students may have had previous experience with interprofessional simulations with nursing students, so it is unknown how this may have affected the results. Additionally, it was interesting to note that the pharmacy students were less favorable to the idea that the participants worked well together as shown in question 4 (‘‘The participants worked well together’’). One theory to support this finding could be that this was only the second time in the Sim Lab for the pharmacy students as compared to the medical students who were in it several times a semester. This potentially could have placed the medical students more at ease within the group due to their previous experience. Another theory is that the pharmacy students may not have been comfortable enough to vocalize their ideas or thoughts without being asked directly. This concept would be interesting to explore with further research. The results of this research project are similar to other studies assessing the use of simulation in pharmacy education. A scan of the pharmacy education literature did examine the attitudes of medicine and pharmacy students similar to the one we describe in a study by Shrader et al. involving interprofessional student teams consisting of pharmacy, medical, and physician assistant students in a large, academic health center.14 The authors describe how they implemented a simulated interprofessional rounding experience using human patient simulators in a clinical assessment course, which was viewed as a positive experience by a majority of the students involved. Additionally, their study found significant improvement in interprofessional attitudes after students completed the experience, although the finding was primarily seen within the pharmacy student group, while the medical/physician assistant student group demonstrated minimal improvement. In addition, Scott et al. examined attitudes in interdisciplinary ambulatory settings and showed the interdisciplinary team approach as a constructive experience that had a positive impact on attitudes of non-pharmacy students towards pharmacists.25 Fernandez et al. used HPS to introduce students ‘‘to interdisciplinary team skills and reinforce pharmacotherapeutics.’’ Students responded favorably and preferred HPS to classroom teaching.11 Westberg et al. looked at interprofessional standardized patient experiences (ISPE) as a means to provide ‘‘an opportunity for pharmacy students to collaborate with students from other health professions early in the curriculum.’’26 Students were surveyed pre and post the experience and asked to describe the roles of other healthcare providers. Students enjoyed the experience and found that ISPE expanded their understanding of other healthcare providers’ roles. Damon Dagnone et al. surveyed nursing and medical students and medical residents after they completed interdisciplinary exercises that aimed to teach communication and teamwork within ACLS training in a high-fidelity
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simulation laboratory.15 The survey demonstrated that all students and residents found the interprofessional session to be valuable and gave them a better understanding of the different roles of an ACLS team. Our study found similarly high ratings, but is different in that the education within our simulations was not explicitly intended to develop teamwork roles. It is also noteworthy that Dagnone’s study did not involve pharmacy students or pharmacy residents and so did not address the attitudes of or toward pharmacists.
some selection bias. It would have been beneficial to have obtained more data from the nursing students for comparison as well, but the small number of nursing students participating in the interprofessional simulation did not allow for a meaningful comparison of this professional group. Finally, both medical and pharmacy students have additional experiential requirements and work experience that may have also impacted the attitudes of those involved, and may have affected any pre-simulation survey results.
Limitations
Conclusions
This research project has several limitations. First, there is no pre–post survey data. The purpose of this study was to examine the interplay of working in a simulation laboratory on attitudes, perceptions, and interprofessional interactions. A pre–post survey design may have captured the overall impact of simulation laboratory on the outcomes. However, a pre-survey was declined as this would have biased the participants with the simulation experience. Medical students are graded on their interprofessional work and a presurvey may have ‘‘tipped them off’’ on what they should gain from the experience. For example, if the students filled out a pre-survey and knew they were going to be assessed on communication and working together interprofessionally, this could then lead them to act differently during the case. Additionally, there were not equal groups of each of the health professions’ students represented during the experience or in the final sample, which may have influenced the results. The visit to the simulation laboratory was not required of pharmacy students, so this could have led to
This interprofessional interaction in a simulation laboratory was perceived by health professional students from different universities to be a beneficial experience. In general, both medicine and pharmacy students had positive responses in all categories of the survey. Although small statistically significant differences were found between groups, all students from both disciplines deemed the simulation laboratory a positive experience. In particular, future research could be conducted in regards to the difference found with question 4, the participants worked well together. Additionally, this project engaged faculty and motivated them to push for more interprofessional interaction within the curricula. Based on these positive interactions, the medical school faculty members have asked for increasing participation with pharmacy students and pharmacy faculty with the intent of enhancing future learning opportunities. Implementation of a similar interprofessional simulation could be considered by other colleges and schools of pharmacy, especially with those who are not part of a large, academic health center.
Appendix 1: Survey A Survey Assessing InterprofessionalPerceptions, and Attitudes of Health Professional Students in a Simulation Laboratory Setting This is a survey for health professional students who have been involved in a simulation lab experience together. Complete this survey only once this year. STOP if you have previously completed this survey.
1. Your status: M2 & Medical Resident & BSN Nursing Student &
M3 & Pharmacy Resident & PA Student &
P3 & PN Nursing Student & DPM Student &
P4 & ADN Nursing Student & DPT Student &
2. Your age: ________ 3. Case title __________________________ Strongly Disagree
Somewhat Disagree
Neutral
Somewhat Agree
Strongly Agree
4. The participants worked well together.
1
2
3
4
5
5. Working in teams unnecessarily complicates things most of the time.
1
2
3
4
5
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Strongly Disagree 1
Somewhat Disagree 2
Neutral
7. This experience improved my understanding of the contributions of healthcare professionals in other disciplines.
1
8. I believe that individuals in my profession make an effort to understand the capabilities and contributions of other professions.
173
3
Somewhat Agree 4
Strongly Agree 5
2
3
4
5
1
2
3
4
5
9. I believe that individuals in other professions make an effort to understand the capabilities and contributions of my profession.
1
2
3
4
5
10. This experience will help improve the quality of patient care.
1
2
3
4
5
11. A team’s primary purpose is to assist physicians in achieving treatment goals for patients.
1
2
3
4
5
12. This experience changed my attitude about the competency of other healthcare professionals.
1
2
3
4
5
13. The students from other disciplines contributed more to the patient’s care than I expected.
1
2
3
4
5
14. Individuals in my profession must depend upon the work of people in other professions.
1
2
3
4
5
15. Individuals in other professions often seek the advice of people in my profession.
1
2
3
4
5
16. Working with individuals from other disciplines leads to patient outcomes that we could not achieve alone.
1
2
3
4
5
17. Learning with other students will help me to become a more effective member of the healthcare team.
1
2
3
4
5
6. The interprofessional component of the simulation lab adds value to my training.
Comments:
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