- Email: [email protected]
Simulation as an Effective Strategy for Interprofessional Education
Clinical Simulation in Nursing (2017) 13, 624-627
www.elsevier.com/locate/ecsn
Research Brief
Simulation as an Effective Strategy for Interprofessional Education Margaret Costello, PhD, RN*, James Huddleston, DPT, Josephine Atinaja-Faller, MSN, RN, Kathrina Prelack, PhD, RN, Amanda Wood, RN, Jillian Barden, RN, Sylvana Adly, RN, MS Simmons College of Nursing and Health Sciences, Boston, MA 02115, USA KEYWORDS interprofessional education; simulation; quantitative research; interprofessional care; teamwork; interprofessional communication; Interprofessional Attitudes Survey (IPAS); Interprofessional Education Collaborative (IPEC)
Abstract: Interprofessional simulation provides healthcare professions students an opportunity to collaborate in a team. The purpose of this study was to examine student perspectives of an interprofessional simulation lab experience within the fields of nursing, physical therapy, nutrition, and social work. A pre-post design was employed, using the validated Interprofessional Attitudes Survey Interprofessional Education Collaborative tools to determine if there were any perceived changes in interprofessional competency and attitudes about interprofessional simulation experience. Following the simulation there were significant changes in students’ attitudes in areas of cultural competence, understanding of roles, interprofessional communication and teamwork. Interprofessional simulation is a teaching strategy that shows great promise for promoting teamwork among the healthcare professions. Cite this article: Costello, M., Huddleston, J., Atinaja-Faller, J., Prelack, K., Wood, A., Barden, J., & Adly, S. (2017, December). Simulation as an effective strategy for interprofessional education. Clinical Simulation in Nursing, 13(12), 624-627. http://dx.doi.org/10.1016/j.ecns.2017.07.008. Ó 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Background According to the Institute of Medicine, nearly 100,000 deaths occur annually from preventable medical errors. Many of these preventable errors are attributed to ineffective communication and collaboration between health care providers (Kohn, Corrigan, & Donaldson, 2000). Moreover, studies show that improved patient, staff, and organizational satisfaction and patient outcomes result when care is
The author declares no conflict of interest. * Corresponding author: [email protected] (M. Costello).
provided in an interdisciplinary, collaborative way (Korner et al., 2016; Tsakitzidis et al., 2016). In order to decrease the frequency of these preventable incidents and improve patient outcomes and satisfaction, patient-centered teams involving multiple disciplines would be more effective than care providers working in isolation from each other. Introducing interprofessional education to health professions studies encourages collaboration and communication between health care professionals and increases their readiness to work collaboratively with other professions during their education (World Health Organization [WHO], 2013). ‘‘Interprofessional education occurs when students from two or more professions learn about, from, and with
1876-1399/$ - see front matter Ó 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ecns.2017.07.008
Simulation for Interprofessional Education
625
each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team’’ (WHO, 2013). One barrier to interprofessional teamwork discussed in the literature emphasizes that education programs for Key Points health care professionals An interprofessional often do not address collabsimulation study oration (Park, Hawkins, explored nursing, nutriHamlin, Hawkins, & tion, physical therapy Bamdas, 2014). and social work stuLearning together imdents attitudes, beliefs, proves the ability of health and knowledge tocare students to apply their wards interprofessional knowledge and skills and put collaboration, utilizing them into practice as protools which measure fessionals in the workplace the interprofessional to treat their patients more core competencies as effectively (Park et al., recommended by 2014). In 2009, six national IPEC. associations of schools of The study which health professions formed a included 122 intercollaborative to promote professional students, and encourage constituent found that following efforts that would advance an interprofessional substantive interprofessional simulation experience learning experiences. The students had a change goal was to help prepare in attitudes regarding future health professionals cultural competence, for enhanced team-based roles and relationcare of patients and improve ships, interprofespopulation health outcomes. sional communication The collaborative representand teamwork. ing dentistry, nursing, medi Simulation is an effeccine, osteopathic medicine, tive teaching strategy pharmacy, and public health to provide experience convened an expert panel of in communication representatives from each of interprofessional teamthe six sponsor professions work and collaboration. to create core competencies for interprofessional collaborative practice, to guide curriculum development and to make recommendations for interprofessional learning experiences in order to help prepare health professions students for patient-centered team-based care (Interprofessional Education Collaborative [IPEC], 2016). These competencies include topics of values, ethics, roles, responsibilities, interprofessional communication, and teamwork (IPEC, 2016). Simulation instruction has been endorsed by the WHO as an effective method of assisting health professionals to learn how to effectively work in teams (WHO, 2013). Using simulation on a routine basis for health professions students ‘‘can teach [them] about each other’s professions and solidify the skills necessary to productively collaborate’’ as well as ‘‘help students to retain
and build upon skills to increase their ability to deliver safe, quality care’’ (Snelling & Jenkins, 2016). Simulation instruction has also been found to support the building of confidence, clinical judgment, knowledge, and competence within students (Fisher & King, 2013). A systematic review of over 700 qualitative and quantitative simulation research studies found that simulation-based education contributes to students’ learning when integrated into pre-licensure nursing curricula (Cant & Cooper, 2017). Interestingly, a review of the literature revealed few interprofessional studies that studied utilizing the core competencies. One study we reviewed found that following an interprofessional simulation of nursing and social work students that attitudes toward interprofessional learning became significantly more positive (Murphy & Nimmagadda, 2015). To meet the needs of the changing health care landscape, with a focus on interprofessional practice, we developed an interprofessional simulation laboratory experience including nursing, nutrition, physical therapy, and social work students. Previously at our institution, simulation as a method of instruction was utilized in nursing education primarily. Our study examines student attitudes, beliefs, and knowledge toward interprofessional collaboration, utilizing tools that measure the interprofessional core competencies as recommended by IPEC.
Sample One hundred twenty-two nursing (33), physical therapy (38), nutrition (29), and social work (22) students at a small four-year liberal arts college in the northeast participated in a study designed to assess the relationship between student perspectives before and after completing a two and one half hour, community health, interprofessional simulation workshop. The simulation was required as part of the students’ individual professional course of study. Although students were required to participate in the simulation class, they were not required to participate in the data collection process.
Method The study was approved by the colleges institutional review board. Prior to the workshop, consenting students completed the IPEC Competency Survey Instrument that is designed to evaluate health profession student’s selfreported ability on each interprofessional core competency and the Interprofessional Attitudes Survey (IPAS) that is designed to assess student attitudes of interprofessional education. Both tools are based on the interprofessional core competencies. The IPEC Competency Survey Instrument is also a validated tool (Cronbach’s alpha coefficients: 0.96-0.98), and includes four categories: values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork. Subscales include shared learning (9), patient interaction (5),
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12
Simulation for Interprofessional Education
626
prejudices in the workplace (3), cultural competence (4), and working with the community (6) (Dow, DiazGranados, Mazmanian, & Retchin, 2014). Each category includes several items that are rated on a five-point Likert scale based on the respondent’s personal feelings and educational experiences related to their perceived ability for each item. The IPAS is a validated tool (Cronbach’s alpha coefficients: 0.62-0.92) that consists of 27 items in five subscales: teamwork, roles and responsibilities, patient centeredness, interprofessional biases, diversity and ethics, and community centeredness (Norris et al., 2015). Each question utilized a five-point Likert scale based on the respondent’s feelings and personal experiences regarding interprofessional education and collaboration. After completing the presurveys, students took part in one of 24, two and one-half hour simulation experience scheduled over three consecutive weeks. One faculty from each discipline participated in each session except for social work whose designated representative was unable to participate due to unexpected time challenges. The simulation scenario involved a Hispanic older woman recently discharged from the hospital with a history of a recent fall, cardiac disease, and diabetes. She was discharged with a referral for home care services, including nursing, dietary, and physical therapy. A social worker was consulted because she lives alone and has few social supports. The sequence of events for the simulation included a 30-minute prebrief team meeting with all participants and faculty, a 15-minute nursing visit, a 15-minute team meeting after the nurses’ visit with all the team members, followed by a 15-minute visit each by physical therapy, nutrition, and social work. All patient visits were visible on a TV screen outside the simulation area by all other team members. The session concluded with another 15 minutes meeting with all team members and a 30-minute debrief with team members and faculty. The overall objectives of the simulation were to provide an experience in teamwork and collaboration among students from the four health care professions, introduce students to the interprofessional core competencies, and determine if there were any perceived changes in competency abilities and attitudes about IPE. Post data collection occurred over a three-week period as students completed their sessions. Unmatched information from the two pre and post surveys was analyzed using Statistical Analysis Software Package (SPSS) to assess possible relationships between the preliminary data and postsimulation surveys. First, demographic information was analyzed based on participant responses from the preliminary survey. Next, responses to the IPEC and IPAS tools were examined to determine a possible relationship between the simulation experience and student perceptions of interprofessional education and collaboration with their peers. Nonparametric one-sample Wilcoxon signed ranks tests compared the posttest subscale medians with the pretest subscale medians.
Results There was 100% enrollment in the study. Of the 122 participants, 98% reported that they had never been involved with an interprofessional simulation. The IPAS survey preand postsimulation scores were analyzed based on their subscales. The median changes of the patient interaction subscale and the cultural competence subscales were significantly higher post simulation (p < .001). Although median scores increased following the simulation exercise with all the other subscales, these changes were not significant. In analyzing the IPEC data, the median scores for the roles and responsibilities and the teams and teamwork subscales were significantly higher post simulation (p < .001) and the median score of the interprofessional communication subscale was significantly higher post simulation (p ¼ .001). The postsimulation median score of the values and ethics subscale was higher than the presimulation medium test scores, suggesting an increase in mutual respect in the interprofessional climate; however, this finding was not statistically significant.
Discussion Utilizing two well-studied tools, the IPEC and IPAS, we determined there were significant changes in students’ preand postsimulation attitudes about IPE (see Tables 1 and 2). The change in pre- and postcultural competence suggests that following the simulation exercise, there may have been an increase in the student’s ability to consider the unique role of cultural competence in patient care, as well as the expertise of other members of the team; this finding is consistent with a study that revealed that social workers did have greater cultural awareness following a simulation experience (Murphy & Nimmagadda, 2015). The higher postsimulation score for the roles and responsibilities subscale may indicate a positive change in the knowledge of one’s own role and those of other professions. The higher postsimulation score for the Interprofessional Communication Subscale may suggest increased awareness of communication that is supportive of a team approach in patient care. Students in our study also demonstrated an increase in the postsimulation score for the teams and teamwork scales that may indicate that students had a greater understanding of how to perform effectively as a member of an interprofessional team after participating in the simulation. Limitations of the study include unmatched samples Table 1
Median IPAS Rank Scores
IPAS Subscale
Median Rank (p Value)
Patient interaction Cultural competence
5.000 (p ¼ .00) 5.000 (p ¼ .00)
Note. IPAS ¼ Interprofessional Attitudes Survey.
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12
Simulation for Interprofessional Education Table 2
627
Median IPEC Rank Scores
IPEC Subscale
Median Rank (p Value)
Roles and responsibilities Interprofessional communication Teams and teamwork
4.222 (p ¼ .000) 4.273 (p ¼ .001) 4.000 (p ¼ .00)
Note. IPEC ¼ Interprofessional Education Collaborative.
and lack of between-group comparisons among the different professions.
Conclusion The core competencies for interprofessional collaborative practice have been identified under the singular domain of interprofessional collaboration, encompassing the topics of values and ethics, roles, and responsibilities, interprofessional communication, and teams and teamwork. Having nursing, physical therapy, and nutrition and social work students work together during a simulation exercise offers a unique collaborative educational experience for students to meet the core competencies of interprofessional education and to prepare them to better integrate into clinical teams when entering the workforce. This collaborative interprofessional practice may have the effect of ultimately improving patient care. Future research should evaluate the effect of interprofessional simulation education on patient outcomes.
References Cant, R. P., & Cooper, S. J. (2017). Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Education Today, 49, 63-71. http://dx.doi.org/10.1016/j.nedt.2016.11.015. Dow, A. W., DiazGranados, D., Mazmanian, P. E., & Retchin, S. M. (2014). An exploratory study of an assessment tool derived from the competencies
of the Interprofessional Education Collaborative. Journal of Interprofessional Care, 28(4), 299-304. http://dx.doi.org/10.3109/13561820.2014.8 91573. Fisher, D., & King, L. (2013). An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient. Journal of Advanced Nursing, 69(11), 23752388. http://dx.doi.org/10.1111/jan.12174. Interprofessional Education Collaborative (IPEC). (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Author. Retrieved from https://ipecollaborative.org/uploads/ IPEC-2016-Updated-Core-Competencies-Report__final_release_.PDF Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press. Korner, M., Butof, S., Muller, C., Zimmerman, L., Becker, S., & Bengal, J. (2016). Interprofessional teamwork and team interventions in chronic care: A systematic review. Journal of Interprofessional Care, 30(1), 15-28. http://dx.doi.org/10.3109/13561820.2015.1051616. Murphy, J. I., & Nimmagadda, J. (2015). Partnering to provide simulated learning to address Interprofessional Education Collaborative core competencies. Journal of Interprofessional Care, 29(3), 258-259. http: //dx.doi.org/10.3109/13561820.2014.942779. Norris, J., Carpenter, J. G., Eaton, J., Guo, J.-W., Lassche, M., Pett, M. A., & Blumenthal, D. K. (2015). Development and construct validation of the interprofessional attitudes scale. Academic Medicine: Journal of the Association of American Medical Colleges, 90(10), 1394-1400. http://doi.org/10.1097/ACM.0000000 000000764. Park, J., Hawkins, M., Hamlin, E., Hawkins, W., & Bamdas, J. A. (2014). Developing positive attitudes toward interprofessional collaboration among students in the health care profession. Educational Gerontology, 40(12), 894-908. http://dx.doi.org/10.1080/03601277.201 4.908619. Snelling, M., & Jenkins, P. (2016). Interprofessional collaboration simulations. Journal of the New York State Nurses Association, 44(2), 53. Tsakitzidis, G., Timermans, O., Callewaert, N., Verhoeven, V., LopezHartmann, M., Truijen, S., ., & Van Royen, P. (2016). Outcome indicators on interprofessional collaboration interventions for elderly. International Journal of Integrated Care, 16(2), 5, pp. 1e17 http://dx. doi.org/10.5334/ijic.2017. World Health Organization (WHO). (2013). Transforming and scaling up health professionals’ education and training. World Health Organization Guidelines. Retrieved from http://apps.who.int/iris/bitstream/ 10665/93635/1/9789241506502_eng.pdf
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12
www.elsevier.com/locate/ecsn
Research Brief
Simulation as an Effective Strategy for Interprofessional Education Margaret Costello, PhD, RN*, James Huddleston, DPT, Josephine Atinaja-Faller, MSN, RN, Kathrina Prelack, PhD, RN, Amanda Wood, RN, Jillian Barden, RN, Sylvana Adly, RN, MS Simmons College of Nursing and Health Sciences, Boston, MA 02115, USA KEYWORDS interprofessional education; simulation; quantitative research; interprofessional care; teamwork; interprofessional communication; Interprofessional Attitudes Survey (IPAS); Interprofessional Education Collaborative (IPEC)
Abstract: Interprofessional simulation provides healthcare professions students an opportunity to collaborate in a team. The purpose of this study was to examine student perspectives of an interprofessional simulation lab experience within the fields of nursing, physical therapy, nutrition, and social work. A pre-post design was employed, using the validated Interprofessional Attitudes Survey Interprofessional Education Collaborative tools to determine if there were any perceived changes in interprofessional competency and attitudes about interprofessional simulation experience. Following the simulation there were significant changes in students’ attitudes in areas of cultural competence, understanding of roles, interprofessional communication and teamwork. Interprofessional simulation is a teaching strategy that shows great promise for promoting teamwork among the healthcare professions. Cite this article: Costello, M., Huddleston, J., Atinaja-Faller, J., Prelack, K., Wood, A., Barden, J., & Adly, S. (2017, December). Simulation as an effective strategy for interprofessional education. Clinical Simulation in Nursing, 13(12), 624-627. http://dx.doi.org/10.1016/j.ecns.2017.07.008. Ó 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Background According to the Institute of Medicine, nearly 100,000 deaths occur annually from preventable medical errors. Many of these preventable errors are attributed to ineffective communication and collaboration between health care providers (Kohn, Corrigan, & Donaldson, 2000). Moreover, studies show that improved patient, staff, and organizational satisfaction and patient outcomes result when care is
The author declares no conflict of interest. * Corresponding author: [email protected] (M. Costello).
provided in an interdisciplinary, collaborative way (Korner et al., 2016; Tsakitzidis et al., 2016). In order to decrease the frequency of these preventable incidents and improve patient outcomes and satisfaction, patient-centered teams involving multiple disciplines would be more effective than care providers working in isolation from each other. Introducing interprofessional education to health professions studies encourages collaboration and communication between health care professionals and increases their readiness to work collaboratively with other professions during their education (World Health Organization [WHO], 2013). ‘‘Interprofessional education occurs when students from two or more professions learn about, from, and with
1876-1399/$ - see front matter Ó 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ecns.2017.07.008
Simulation for Interprofessional Education
625
each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team’’ (WHO, 2013). One barrier to interprofessional teamwork discussed in the literature emphasizes that education programs for Key Points health care professionals An interprofessional often do not address collabsimulation study oration (Park, Hawkins, explored nursing, nutriHamlin, Hawkins, & tion, physical therapy Bamdas, 2014). and social work stuLearning together imdents attitudes, beliefs, proves the ability of health and knowledge tocare students to apply their wards interprofessional knowledge and skills and put collaboration, utilizing them into practice as protools which measure fessionals in the workplace the interprofessional to treat their patients more core competencies as effectively (Park et al., recommended by 2014). In 2009, six national IPEC. associations of schools of The study which health professions formed a included 122 intercollaborative to promote professional students, and encourage constituent found that following efforts that would advance an interprofessional substantive interprofessional simulation experience learning experiences. The students had a change goal was to help prepare in attitudes regarding future health professionals cultural competence, for enhanced team-based roles and relationcare of patients and improve ships, interprofespopulation health outcomes. sional communication The collaborative representand teamwork. ing dentistry, nursing, medi Simulation is an effeccine, osteopathic medicine, tive teaching strategy pharmacy, and public health to provide experience convened an expert panel of in communication representatives from each of interprofessional teamthe six sponsor professions work and collaboration. to create core competencies for interprofessional collaborative practice, to guide curriculum development and to make recommendations for interprofessional learning experiences in order to help prepare health professions students for patient-centered team-based care (Interprofessional Education Collaborative [IPEC], 2016). These competencies include topics of values, ethics, roles, responsibilities, interprofessional communication, and teamwork (IPEC, 2016). Simulation instruction has been endorsed by the WHO as an effective method of assisting health professionals to learn how to effectively work in teams (WHO, 2013). Using simulation on a routine basis for health professions students ‘‘can teach [them] about each other’s professions and solidify the skills necessary to productively collaborate’’ as well as ‘‘help students to retain
and build upon skills to increase their ability to deliver safe, quality care’’ (Snelling & Jenkins, 2016). Simulation instruction has also been found to support the building of confidence, clinical judgment, knowledge, and competence within students (Fisher & King, 2013). A systematic review of over 700 qualitative and quantitative simulation research studies found that simulation-based education contributes to students’ learning when integrated into pre-licensure nursing curricula (Cant & Cooper, 2017). Interestingly, a review of the literature revealed few interprofessional studies that studied utilizing the core competencies. One study we reviewed found that following an interprofessional simulation of nursing and social work students that attitudes toward interprofessional learning became significantly more positive (Murphy & Nimmagadda, 2015). To meet the needs of the changing health care landscape, with a focus on interprofessional practice, we developed an interprofessional simulation laboratory experience including nursing, nutrition, physical therapy, and social work students. Previously at our institution, simulation as a method of instruction was utilized in nursing education primarily. Our study examines student attitudes, beliefs, and knowledge toward interprofessional collaboration, utilizing tools that measure the interprofessional core competencies as recommended by IPEC.
Sample One hundred twenty-two nursing (33), physical therapy (38), nutrition (29), and social work (22) students at a small four-year liberal arts college in the northeast participated in a study designed to assess the relationship between student perspectives before and after completing a two and one half hour, community health, interprofessional simulation workshop. The simulation was required as part of the students’ individual professional course of study. Although students were required to participate in the simulation class, they were not required to participate in the data collection process.
Method The study was approved by the colleges institutional review board. Prior to the workshop, consenting students completed the IPEC Competency Survey Instrument that is designed to evaluate health profession student’s selfreported ability on each interprofessional core competency and the Interprofessional Attitudes Survey (IPAS) that is designed to assess student attitudes of interprofessional education. Both tools are based on the interprofessional core competencies. The IPEC Competency Survey Instrument is also a validated tool (Cronbach’s alpha coefficients: 0.96-0.98), and includes four categories: values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork. Subscales include shared learning (9), patient interaction (5),
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12
Simulation for Interprofessional Education
626
prejudices in the workplace (3), cultural competence (4), and working with the community (6) (Dow, DiazGranados, Mazmanian, & Retchin, 2014). Each category includes several items that are rated on a five-point Likert scale based on the respondent’s personal feelings and educational experiences related to their perceived ability for each item. The IPAS is a validated tool (Cronbach’s alpha coefficients: 0.62-0.92) that consists of 27 items in five subscales: teamwork, roles and responsibilities, patient centeredness, interprofessional biases, diversity and ethics, and community centeredness (Norris et al., 2015). Each question utilized a five-point Likert scale based on the respondent’s feelings and personal experiences regarding interprofessional education and collaboration. After completing the presurveys, students took part in one of 24, two and one-half hour simulation experience scheduled over three consecutive weeks. One faculty from each discipline participated in each session except for social work whose designated representative was unable to participate due to unexpected time challenges. The simulation scenario involved a Hispanic older woman recently discharged from the hospital with a history of a recent fall, cardiac disease, and diabetes. She was discharged with a referral for home care services, including nursing, dietary, and physical therapy. A social worker was consulted because she lives alone and has few social supports. The sequence of events for the simulation included a 30-minute prebrief team meeting with all participants and faculty, a 15-minute nursing visit, a 15-minute team meeting after the nurses’ visit with all the team members, followed by a 15-minute visit each by physical therapy, nutrition, and social work. All patient visits were visible on a TV screen outside the simulation area by all other team members. The session concluded with another 15 minutes meeting with all team members and a 30-minute debrief with team members and faculty. The overall objectives of the simulation were to provide an experience in teamwork and collaboration among students from the four health care professions, introduce students to the interprofessional core competencies, and determine if there were any perceived changes in competency abilities and attitudes about IPE. Post data collection occurred over a three-week period as students completed their sessions. Unmatched information from the two pre and post surveys was analyzed using Statistical Analysis Software Package (SPSS) to assess possible relationships between the preliminary data and postsimulation surveys. First, demographic information was analyzed based on participant responses from the preliminary survey. Next, responses to the IPEC and IPAS tools were examined to determine a possible relationship between the simulation experience and student perceptions of interprofessional education and collaboration with their peers. Nonparametric one-sample Wilcoxon signed ranks tests compared the posttest subscale medians with the pretest subscale medians.
Results There was 100% enrollment in the study. Of the 122 participants, 98% reported that they had never been involved with an interprofessional simulation. The IPAS survey preand postsimulation scores were analyzed based on their subscales. The median changes of the patient interaction subscale and the cultural competence subscales were significantly higher post simulation (p < .001). Although median scores increased following the simulation exercise with all the other subscales, these changes were not significant. In analyzing the IPEC data, the median scores for the roles and responsibilities and the teams and teamwork subscales were significantly higher post simulation (p < .001) and the median score of the interprofessional communication subscale was significantly higher post simulation (p ¼ .001). The postsimulation median score of the values and ethics subscale was higher than the presimulation medium test scores, suggesting an increase in mutual respect in the interprofessional climate; however, this finding was not statistically significant.
Discussion Utilizing two well-studied tools, the IPEC and IPAS, we determined there were significant changes in students’ preand postsimulation attitudes about IPE (see Tables 1 and 2). The change in pre- and postcultural competence suggests that following the simulation exercise, there may have been an increase in the student’s ability to consider the unique role of cultural competence in patient care, as well as the expertise of other members of the team; this finding is consistent with a study that revealed that social workers did have greater cultural awareness following a simulation experience (Murphy & Nimmagadda, 2015). The higher postsimulation score for the roles and responsibilities subscale may indicate a positive change in the knowledge of one’s own role and those of other professions. The higher postsimulation score for the Interprofessional Communication Subscale may suggest increased awareness of communication that is supportive of a team approach in patient care. Students in our study also demonstrated an increase in the postsimulation score for the teams and teamwork scales that may indicate that students had a greater understanding of how to perform effectively as a member of an interprofessional team after participating in the simulation. Limitations of the study include unmatched samples Table 1
Median IPAS Rank Scores
IPAS Subscale
Median Rank (p Value)
Patient interaction Cultural competence
5.000 (p ¼ .00) 5.000 (p ¼ .00)
Note. IPAS ¼ Interprofessional Attitudes Survey.
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12
Simulation for Interprofessional Education Table 2
627
Median IPEC Rank Scores
IPEC Subscale
Median Rank (p Value)
Roles and responsibilities Interprofessional communication Teams and teamwork
4.222 (p ¼ .000) 4.273 (p ¼ .001) 4.000 (p ¼ .00)
Note. IPEC ¼ Interprofessional Education Collaborative.
and lack of between-group comparisons among the different professions.
Conclusion The core competencies for interprofessional collaborative practice have been identified under the singular domain of interprofessional collaboration, encompassing the topics of values and ethics, roles, and responsibilities, interprofessional communication, and teams and teamwork. Having nursing, physical therapy, and nutrition and social work students work together during a simulation exercise offers a unique collaborative educational experience for students to meet the core competencies of interprofessional education and to prepare them to better integrate into clinical teams when entering the workforce. This collaborative interprofessional practice may have the effect of ultimately improving patient care. Future research should evaluate the effect of interprofessional simulation education on patient outcomes.
References Cant, R. P., & Cooper, S. J. (2017). Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Education Today, 49, 63-71. http://dx.doi.org/10.1016/j.nedt.2016.11.015. Dow, A. W., DiazGranados, D., Mazmanian, P. E., & Retchin, S. M. (2014). An exploratory study of an assessment tool derived from the competencies
of the Interprofessional Education Collaborative. Journal of Interprofessional Care, 28(4), 299-304. http://dx.doi.org/10.3109/13561820.2014.8 91573. Fisher, D., & King, L. (2013). An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient. Journal of Advanced Nursing, 69(11), 23752388. http://dx.doi.org/10.1111/jan.12174. Interprofessional Education Collaborative (IPEC). (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Author. Retrieved from https://ipecollaborative.org/uploads/ IPEC-2016-Updated-Core-Competencies-Report__final_release_.PDF Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press. Korner, M., Butof, S., Muller, C., Zimmerman, L., Becker, S., & Bengal, J. (2016). Interprofessional teamwork and team interventions in chronic care: A systematic review. Journal of Interprofessional Care, 30(1), 15-28. http://dx.doi.org/10.3109/13561820.2015.1051616. Murphy, J. I., & Nimmagadda, J. (2015). Partnering to provide simulated learning to address Interprofessional Education Collaborative core competencies. Journal of Interprofessional Care, 29(3), 258-259. http: //dx.doi.org/10.3109/13561820.2014.942779. Norris, J., Carpenter, J. G., Eaton, J., Guo, J.-W., Lassche, M., Pett, M. A., & Blumenthal, D. K. (2015). Development and construct validation of the interprofessional attitudes scale. Academic Medicine: Journal of the Association of American Medical Colleges, 90(10), 1394-1400. http://doi.org/10.1097/ACM.0000000 000000764. Park, J., Hawkins, M., Hamlin, E., Hawkins, W., & Bamdas, J. A. (2014). Developing positive attitudes toward interprofessional collaboration among students in the health care profession. Educational Gerontology, 40(12), 894-908. http://dx.doi.org/10.1080/03601277.201 4.908619. Snelling, M., & Jenkins, P. (2016). Interprofessional collaboration simulations. Journal of the New York State Nurses Association, 44(2), 53. Tsakitzidis, G., Timermans, O., Callewaert, N., Verhoeven, V., LopezHartmann, M., Truijen, S., ., & Van Royen, P. (2016). Outcome indicators on interprofessional collaboration interventions for elderly. International Journal of Integrated Care, 16(2), 5, pp. 1e17 http://dx. doi.org/10.5334/ijic.2017. World Health Organization (WHO). (2013). Transforming and scaling up health professionals’ education and training. World Health Organization Guidelines. Retrieved from http://apps.who.int/iris/bitstream/ 10665/93635/1/9789241506502_eng.pdf
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12