Simulation faculty and staff development: An interprofessional, online approach

Journal Pre-proof Simulation faculty and staff development: An interprofessional, online approach Laura T. Gantt, Walter C. (Skip) Robey, Tracy Langston, Laura Bliley

PII:

S2405-4526(19)30114-4

DOI:

https://doi.org/10.1016/j.xjep.2019.100310

Reference:

XJEP 100310

To appear in:

Journal of Interprofessional Education & Practice

Received Date: 29 May 2019 Revised Date:

27 September 2019

Accepted Date: 17 December 2019

Please cite this article as: Gantt LT, (Skip) Robey WC, Langston T, Bliley L, Simulation faculty and staff development: An interprofessional, online approach, Journal of Interprofessional Education & Practice (2020), doi: https://doi.org/10.1016/j.xjep.2019.100310. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc.

Simulation Faculty and Staff Development: An Interprofessional, Online Approach

Laura T. Gantt, PhD, RN, CEN, NE-BC, CHSE Associate Dean and Professor East Carolina University College of Nursing Greenville, NC [email protected]

Walter C. (Skip) Robey, MD, FACEP, CHSE

Assistant Dean for Simulation and Clinical Associate Professor Office of Clinical Simulation East Carolina University Brody School of Medicine Greenville, NC

Tracy Langston, MSN, RNC-NIC, RN-BC Education Specialist, Nursing Center for Learning and Performance Vidant Medical Center Greenville, NC

Laura Bliley, MSN, RN Assistant Director, Nursing & Allied Health Education Eastern Area Health Education Center Greenville, NC

Declarations of interest: None

1 1

Abstract:

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Two academic healthcare programs and a university-affiliated hospital were faced with increasing

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demands for faculty and staff knowledge in support of expanded use of simulation-based education.

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While a few authors have published recommendations and innovations for faculty development in

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simulation programs,1 best practices have yet to be determined. 2,3 Through collaboration by

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simulation program administrators and educators at the College of Nursing, the School of Medicine, and

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the hospital, an online program was developed for use by multiple disciplines and facilities. An online

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approach allows for standardization of simulation faculty development across three entities. Faculty

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and staff were incentivized by the ability to receive continuing education credits. The online self-

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directed program includes 10 modules with a learner pretest and posttest. Comparisons of pre- and

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post-test scores have shown knowledge improvements. Through post-course surveys, learners have

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indicated favorable responses to the online program. In order to implement this type of online

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approach to simulation faculty development, a stable web-based learning platform is required. For more

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information about the course, the lead author may be contacted at XXXX.

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Format: The online simulation educator course consists of 10 modules with pretest, posttest, and

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module quizzes for 8 of 10 modules. Within the program, learners are asked about their personal

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objectives at the beginning and whether they accomplished those at the end of the course. The Eastern

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Area Health Education Center (Eastern AHEC), which hosts the program on its learning platform,

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requires a learner evaluation to be completed before issuing the continuing education certificate, to

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assure that the data is obtained.

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Target audience:

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East Carolina University (ECU) is home to a Health Sciences Division (HSD) which includes the Brody

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School of Medicine and separate Colleges of Nursing, Allied Health and Dental Medicine. ECU’s HSD is

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affiliated with Vidant Medical Center, a 900+ bed Level I Trauma Center. Recognizing that simulation

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faculty and staff education was needed across several health sciences institutions and the hospital,

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faculty and staff from the Brody School of Medicine (BSOM), College of Nursing (CON) and Vidant

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Medical Center’s (VMC) Center for Learning and Performance met to develop an interprofessional online

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course to provide basic education for those involved in simulation for healthcare education. University

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employees who are involved in the education of students are considered faculty, though there are

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support personnel who are in staff positions. In the medical center, those who provide education are in

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staff positions.

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The Society for Simulation in Healthcare’s (SSH) Teaching/Education Accreditation Standards Companion

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Document 4 defines a simulation or key educator as someone who is regularly involved with simulation

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education within a program. To be an accredited simulation program through SSH, simulation educators

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must be deemed qualified to do so through experience and simulation-related training. In addition,

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many Boards of Nursing have educational requirements for nurse educators involved in simulation

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activities with students, particularly if simulation is used as a replacement for clinical hours.5 In order to

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apply to become a Certified Healthcare Simulation Educator (CHSE) through SSH, a candidate must have

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a bachelor’s degree or apply for equivalency through experience and training. Our university’s colleges

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and schools require at least a master’s degree to be considered for an instructor position in an academic

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program.

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The goal of the simulation course development was to standardize the simulation education for faculty

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and staff across the ECU HSD and hospital, in part, because the simulation programs within ECU’s Brody

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School of Medicine and College of Nursing wished to pursue accreditation through SSH. The course was

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eventually called Introduction to Basic Simulation for Faculty and Staff.

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Objectives:

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The objectives set for the participants were that they would: 1) have an understanding of standards of

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best practice in simulation, 2) recognize basic steps in planning and creating a simulation scenario, 3) be

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able to describe types of simulation modalities and technology, 4) be able to discuss the importance of a

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pre-briefing plan, 5) be able to define realism and fidelity as related to simulation, 6) be able to

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differentiate between debriefing models, 7) be familiar with simulation evaluation tools, 8) be able to

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describe team training concepts using simulation, and 9) demonstrate improvement in knowledge from

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the pre-test to the post-test. Each of these objectives corresponded with a specific module within the

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course. In addition, participants were asked to identify personal objectives for taking the course and

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asked whether they had met their objectives at the end of the course. The outcome measures for the 9

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objectives were: 1) an improvement in average pretest and post-test scores for all participants by at

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least 10%; 2) that 90% of participants would state that their personal goals have been met.

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Activity description

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The online simulation educator course consists of 10 modules. Each of the modules represents content

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that is fundamental to the use of simulation in education. Course concepts and educational guidelines

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were based on Standards of Best Practice: Simulation described by the International Nursing Association

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for Clinical Simulation and Learning 6 and the SSH Accreditation of Healthcare Simulation Standards. 4

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The course begins with a series of documents that outline which parts of the course are required for

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either nursing or medicine faculty and staff (see Appendix A). There is a pretest at the beginning of the

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course and a posttest at the end with quizzes for reinforcement of content after most modules. The

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online, self-directed study modules can be completed in 2-4 hours depending on the learner’s previous

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experience with simulation-based education. Initially, additional credit was awarded for the program,

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but when queried, learners with less simulation experience stated that they completed the course in

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approximately 4 hours. There have been some participants in the course with extensive simulation

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experience.

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The course was first offered via the university’s learning platform in May of 2018 to 26 CON faculty and

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five simulation lab staff. The second iteration of the course was offered in August of 2018 and was

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completed by an additional 11 CON faculty. During the fall of 2018, the course moved to the Eastern

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Area Health Center (EAHEC) learning platform and was made available to Vidant Medical Center staff in

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addition to CON and BSOM faculty. Since this change, fifteen additional CON faculty, twelve BSOM

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faculty, two BSOM staff, and 25 VMC staff have completed the course.

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Through an agreement with the university and VMC, EAHEC hosts the course on their learning platform

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and provides continuing education credits for nurses and physicians. Except for one paramedic and a

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simulation center business manager, all of the participants who have taken the course were either

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physicians or nurses. As noted by other authors, 7 offering health professional education credits may

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have improved course enrollment for our program.

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Assessment

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To date, 96 learners have completed the course. The majority of these (58%) have been from the

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College of Nursing, most likely because it was first to pursue accreditation through SSH. Credentials of

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the learners have included MDs, RNs, DNPs, CNMs, PhDs, EMTs, EMT-Ps and others.

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Scores on quizzes, the pretest and posttest were all calculated on a 100-point scale. For learners from

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all disciplines since inception of the course, the average overall pretest score was 81% with a range of

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50% to 100%. For the posttest, the average overall score was 95% with a range of 60% to 100%. The

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increase in pretest to posttest score was 14%, exceeding the outcome measure. For each objective, the

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participants either agreed or strongly agreed (92.19% – 98.44%) that each objective was met. The

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percent of participants that agreed or strongly agreed that their personal goals were met was 97.9%,

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also exceeding the outcome measure. For the group from VMC, the average pretest score was 81% and

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the average posttest score as 93%. For BSOM, the average pretest score was 82% and the posttest

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score average was 91%. For learners from the CON, the average pretest score was 80% and the average

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posttest score was 96%.

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Evaluation

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Based on requirements by the Accreditation Council for Continuing Medical Education (ACCME) and

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American Nurses Credentialing Center (ANCC), the course has been reviewed for content currency by

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the authors of this paper and by nurse planners at EAHEC. Course review and revisions are planned for

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April 2020.

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As each participant successfully completes the course posttest, EAHEC sends the program evaluation

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link to them. Post-course surveys completed by participants have been favorable. EAHEC also maintains

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data related to participant course evaluations and shares this on a periodic basis with course faculty.

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One hundred percent of participants strongly agreed or agreed that their overall expectations of the

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activity were met. Ninety-eight percent strongly agreed or agreed that the information presented

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would enhance their practice; the other 2% were neutral. Only one participant has stated that their

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personal learning objectives in taking the course were not met; this participant is experienced in

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simulation and found the course too elementary. Participants have made suggestions for improvements,

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including better videos and more of them, shorter content with reduced redundancy, more PowerPoint

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slides, and fewer materials to download.

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Impact:

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Methods for providing simulation education for faculty and staff are frequent topics at simulation

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conferences throughout the country. In addition, challenges around how to deliver this education are

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also discussed in simulation journals and texts. Recent literature, however, contains few descriptions

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about programs for faculty and staff or comparisons between types of programs. Our program

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represents one approach to educating faculty and staff about simulation and beginning the educator

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credentialing process for simulation center accreditation. The unique aspects of our program are the

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online and self-directed format, and that it is interprofessional and provides continuing education

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credits. By providing a detailed overview of our program including information on content and data on

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outcomes, we hope to address the many questions we have had concerning the composition and

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delivery methods for the course. We also hope to further the conversation about how best to design

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and deliver educational content about simulation to faculty and staff.

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Plack et al. 8 proposed a model for how graduates of a faculty development program interact with and

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impact work group and processes. It is our hope that formalizing educational materials with the goal of

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creating a shared understanding of simulation education will have a positive effect on faculty

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interactions and student outcomes, particularly as we work together in other faculty and student

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educational programs.

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The simulation literature contains a number of studies that have shown that focused faculty

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development is needed for debriefing skills. 2,9 Currently we offer a more intensive face-to-face,

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interactive debriefing workshop to simulation faculty who have already completed the Introduction to

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Basic Simulation for Faculty and Staff. Because of the workload and scheduling challenges associated

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with such faculty development courses, discussions about offering this and other courses in an online

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format are ongoing. A need for a faculty course on assessment of learning outcomes has also been

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identified.

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Required Materials:

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The deployment of this program requires a stable web-based learning platform which may be accessed

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by multiple types of learners from different sites. When dealing with an interprofessional program,

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reaching consensus on format, a course outline, and the amount of time to be dedicated by participating

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faculty and staff can be challenging. The online course is hosted by the EAHEC learning platform in

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order to provide access to multiple users from different organizations. All authors on this manuscript

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have access to the course documents and references that were used to put the program together. A

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notebook containing a complete set of documents was assembled at BSOM for reference; creating such

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a reference could cut down on time participants might need to download documents. Some

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participants, however, prefer to download, save, and print documents for future reference.

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References

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1. Gore, T, Singh, OB. Development of a Foundations of Simulation Teaching Course for Nurse Educators. Nurs Educ Perspect 2019; 40(3): 179–180. doi: 10.1097/01.NEP.0000000000000347

160 161 162 163 164 165 166 167 168 169 170 171 172

2. Jeffries PR, Dreifuerst KT, Kardong-Edgren S, Hayden J. Faculty development when initiating simulation programs: Lessons learned from the National Simulation Study. J Nurs Regul. 2015;5:17-23. 3. Nehring WM, Wexler T, Hughes F, Greenwell, A. Faculty development for the use of high-fidelity patient simulation: a systematic review. Int J Health Sci Educ 2013;1(1):4. 4. Society for Simulation in Healthcare Accreditation of Healthcare Simulation Standards Teaching/Education Accreditation Standards Companion Document, Standard 3a. https://www.ssih.org/Portals/48/Accreditation/Companion%20Documents/TeachingEducation%20Companion%20Document-PROVISIONAL.pdf Accessed August 29th, 2019.

5. North Carolina Board of Nursing Board of Nursing. Resources for program directors: Simulation guidance. North Carolina Board of Nursing website. https://www.ncbon.com/education-resources-forprogram-directors-simulation-guidance. Accessed May 20th, 2019. 6. INACSL Standards of Best Practice: SimulationSM Clin Simul Nurs. 2016;12:S5-S50. 7. Peterson DT, Watts PI, Epps CA, White ML. Simulation Faculty Development: A Tiered Approach. Simul Healthc. 2017;12:254-259. 8. Plack MM, Goldman EF, Wesner M, Manikoth N, Haywood Y. How learning transfers: A study of how graduates of a faculty education fellowship influenced the behaviors and practices of their peers and organizations. Acad Med. 2015;90:372-378.

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9. Waznonis AR. Simulation debriefing practices in traditional baccalaureate nursing programs: National survey results. Clin Simul Nurs. 2015;11:110-119.

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10. INACSL Standards of Best Practice: SimulationSM Simulation Operations Clin Simul Nurs. 2017;13:681-687. 11. McMullen, M, Wilson, R, Fleming, M, et al. Debriefing-on-demand: A pilot assessment of using a “pause button” in medical simulation. Simul Healthc. 2016; 11(3):157-163.

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12. Cheng, A., Grant, V., Robinson, T, et al. The promoting excellence and reflective learning in simulation (PEARLS) approach to healthcare debriefing: A faculty development guide. Clin Simul Nurs. 2016;12(10):419-428.

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14. Gantt, LT The Clark Simulation Evaluation Rubric: Use with ADN and BSN Students. Nurs Educ Perspec. 2010; 31 (2):101-106.

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13. Rudolph, JW, Simon, R, Dufresne, RL, Raemer, DB. There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simul Healthc. 2006; 1(1): 49-55.

15. Leighton, K, Mudra, V, Gilbert, G. Development and psychometric evaluation of the facilitator competency rubric. Nurs Educ Perspec. 2018; 39(6), e3-e9. 16. Guise, JM., Deering, SH, Kanki, BG, et al. Validation of a tool to measure and promote clinical teamwork. Simul Healthc. 2008; 3(4): 217-223. 17. Agency for Healthcare Research and Quality. (2013) TEAMSTEPPS 2.0 Pocket Guide. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculumtools/teamstepps/instructor/essentials/pocketguide.pdf AHRQ Pub. No. 14-0001-2. Accessed May 20, 2019. 18. Agency for Healthcare Research and Quality. (2016) Healthcare Simulation Dictionary. https://www.ahrq.gov/sites/default/files/publications/files/sim-dictionary.pdf AHRQ Publication No. 16(17)-0043. Accessed May 20, 2019. 19. National League for Nursing. Simulation Faculty Development Toolkit. https://sirc.nln.org/pluginfile.php/18733/mod_page/content/23/Faculty%20DevelopToolkitFINAL%2002 -16.pdf Accessed May 20, 2019.

Appendix A:

Index of Modules and Documents

Below is a listing of modules and documents arranged in order of those that should be completed by College of Nursing faculty and staff OR Brody School of Medicine faculty and staff.

College of Nursing Concepts Integration Labs

Brody School of Medicine Clinical Sim Ctr

Introduction and Overview Introduction to & Overview of Course Content

Introduction and Overview Introduction to & Overview of Course Content BSOM Faculty Development Initiative Overview Course Pretest Index of Modules and Documents Forms ECU BSOM Clinical Simulation Center Request Form Standards of Simulation INACSL Simulation Standards6,10 Quiz on Simulation Standards Scenario and Task Training Design Simulation Design Template Video on Scenario Design for Team Simulation Annie Sutton PE Scenario (Example, completed with directions) Annie Sutton PE Scenario (Example, completed) SOM Technical Skill Format Algorithm Quiz on Scenario & Task Training Design Simulation Modalities and Technology Simulation Modalities and Technology BSOM CSC SimMan 3G Set-up BSOM CSC Camera and Recoding Set-up Quiz on Modalities Briefing and Prebriefing Simulation Briefing and Pre-briefing PPT BSOM Prebriefing Script Educational Components of a Simulation Scenario

Course Pretest Index of Modules and Documents Forms ECU CON Editable Lab & Equipment Form Standards of Simulation INACSL Simulation Standards 6,10 Quiz on Simulation Standards Scenario and Task Training Design Simulation Design Template Video on Scenario Design for Team Simulation Annie Sutton PE Scenario (Example, completed with directions) Annie Sutton PE Scenario (Example, completed) BSOM Technical Skill Format Algorithm Quiz on Scenario & Task Training Design Simulation Modalities and Technology Simulation Modalities and Technology

Quiz on Modalities Briefing and Prebriefing Simulation Briefing and Pre-briefing PPT

Prebrief Script (example) Quiz on Briefing and Debriefing Realism and Fidelity Realism in Simulation PPT Realism and Fidelity Definitions Quiz on Realism and Fidelity Debriefing Debriefing Overview with Definitions PPT Video on Debriefing Robey Facilitated Debrief Format Debriefing with/without Video Tip Sheet Pause Method of Debriefing Tip Sheet 11 PEARLS Debrief Card/Information 12 13 Advocacy Inquiry Debriefing Tip Sheet Quiz on Debriefing Evaluation Instrument & Rubric Overview The Clark Clinical Simulation Rubric 14 Simulation Experience Evaluation Leighton Facilitator Competency Rubric 15 Quiz on Evaluation of Simulations Team Training and Interprofessional Education Team Training Introduction Guise Clinical Teamwork Scale 16 TEAMSTEPPS Pocket Guide 17 Quiz on Team Training Simulation Resources Healthcare Simulation Dictionary 18 19 NLN Simulation Faculty Development Toolkit ECU CON Available Equipment List ECU CON Master Scenario List

Quiz on Briefing and Debriefing Realism and Fidelity Realism in Simulation PPT Realism and Fidelity Definitions Quiz on Realism and Fidelity Debriefing Debriefing Overview with Definitions PPT Video on Debriefing Robey Facilitated Debrief Format Debriefing with/without Video Tip Sheet Pause Method of Debriefing Tip Sheet 11 PEARLS Debrief Card/Information 12 13 Advocacy Inquiry Debriefing Tip Sheet General Simulation Scenario Learning Objectives Example Quiz on Debriefing Evaluation Instrument & Rubric Overview The Clark Clinical Simulation Rubric 14 Simulation Experience Evaluation Leighton Facilitator Competency Rubric 15 Quiz on Evaluation of Simulations Team Training and Interprofessional Education TEAMSTEPPS Introduction Guise Clinical Teamwork Scale 16 TEAMSTEPPS Pocket Guide 17 Quiz on Team Training Simulation Resources Healthcare Simulation Dictionary 18 19 NLN Simulation Faculty Development Toolkit BSOM Guidelines for Use of Clinical Simulation Facility BSOM Simulation Equipment Resource Inventory BSOM Simulation Clinical Case Scenario Library