Educators are heeding the call for more interprofessional learning opportunities, where medical, nursing and pharmacy students and other members of the healthcare team learn from and with each other.
“We’re trying to improve the amount of teamwork and make it more realistic with what they are going to experience in clinical practice,” said Mike Jacobs, DNS, RN, director of the University of South Alabama simulation program in Mobile, which provides interdisciplinary simulation two to three times a week to medical, nursing, pharmacy and allied students. Training starts during the first semester and continues throughout the curriculum. Scenarios include a death and dying, cardiac arrest, respiratory failure, delivering bad news and admitting mistakes.
“They can see the decision-making processes that each discipline goes through in order to care for a patient,” Jacobs said. “It allows them to see not only what another discipline’s responsibilities are and how their responsibilities may overlap. It lets everyone see where they fit into the puzzle.”
That leads to better communicators and team members and ultimately, improved patient care, Jacobs said. The schools have found students perform better during clinical rotations after simulation.
“We have seen culture clashes decline due to these simulations,” Jacobs said. When students start interdisciplinary learning from the beginning of their education and realize faculty are supportive, students consider teamwork the norm, according to Jacobs.
Preparing for a paradigm shift
The University of Virginia School of Nursing in Charlottesville began introducing interprofessional simulation training about six years ago and expanded with grant funding. Dorothy Tullmann, PhD, RN, CNL, associate professor of nursing at the University of Virginia School of Nursing, reported the students give the experience high marks. Nursing and medical school faculty members oversee two scenarios — rapid response and difficult conversations in the ICU — for fourth-year nursing students.
“People are supportive, but the logistics of making it happen are challenging,” Tullmann said. For instance, the training takes place on Tuesday morning, a clinical day for the nursing undergraduates, who are excused from clinicals that day. Additionally, Tullmann described an uneasy “guest culture” in the lab, related to the professions’ long-standing cultures.
“We’re changing the culture to ‘We are a team, participating together to learn with each other and from each other,’” Tullmann said. “We are getting them used to the paradigm shift during their education rather than waiting until they get out.”
Students work with licensed teams
Simulation represents an important component of nursing school learning at Oregon Health & Science University in Portland. Last-quarter students in an integrated practicum course participated in sepsis scenarios with members of the MICU healthcare team. Senior nursing students also participate in interprofessional code-responder simulation training to learn how to deal with emergency situations.
“It gives them an opportunity to see how the teams work together in an interprofessional training,” said Alycia Tutsch, MN, RN, CCRN, OHSU clinical instructor and simulation specialist. The students observe how the teams communicate and deal with complex situations and participate in the debriefings.
The program also gives OHSU staff an opportunity to observe students, who often apply for jobs at the facility. Tutsch reported no pushback from physicians. “We believe there will be an increase in these opportunities for students,” Tutsch said.
Simulations with actors
Three times per year, the Goldfarb School of Nursing at Barnes-Jewish College, St. Louis College of Pharmacy and Washington University School of Medicine, Occupational Therapy and Physical Therapy, all in St. Louis, bring students together in the simulation lab with standardized patients portrayed by actors, to participate in two case scenarios. The days are built into students’ schedules.
Shirley Thorn, PhD, RN, associate dean for practice engagement, health systems and organizational leadership program director at Goldfarb, said it improves therapeutic communication and team skills and encourages shared decision making.
“The idea of engaging in more and more interprofessional activities is increasing,” Thorn said. “When you have the team environment working well, patients feel more comfortable and get more involved in their own care.”