Effective Use of Inter Professional Use of Simulator Based Learning
Inter Professional Use of Simulators
Inter-professional simulation (IPS) includes both educators and learners from two or more professions who join to create interactive and collaborative learning activities that replicate real-world situations (Gaba, 2007; Zhang, Thompson, & Miller, 2011) Simulation activities can occur in a wide array of settings, including simulation centers, in situ, and virtual settings such as Second Life. Various health care simulation formats include immersive simulations, human patient simulators, standardized patients, and serious games. The goal of IPS is to further develop knowledge, communication, and clinical skills, and enhance attitudes that yield competent team performance (Gaba, 2007; Institute of Medicine [IOM], 2003).
Implementation of Inter-Professional Use of Simulators
Regardless of setting and format, simulation is increasingly being viewed as a facilitating technology that transcends traditional educational boundaries and allows students in pre-licensure and postgraduate health care programs to acquire the competencies needed for inter-professional practice (Zhang et al., 2011). The necessity of numerous roles in a simulation scenario naturally lends itself to inter-professional collaboration. Nursing and medicine are the two professions included most frequently in IPS (Zhang et al., 2011).Although each profession must educate students in preparation for their future roles, it is considered essential that team members understand the roles of each of the other team members.
Simulation of health care practice allows participants to question their perceptions of these roles brought from previous exposure, culture, and media (National League for Nursing [NLNJ, 2012). Considerable efforts in standardization of structure and process for successful inter-professional health care simulation are underway.The Society for Simulation in Health care (SSH) is a multi-professional organization that promotes excellence in inter-professional health care education, practice, advocacy, and research through a variety of simulation modalities (SSH, 2011).
SSH has had a rigorous accreditation program for simulation centers since 2008 (SSH, 2011). The SSH has developed both beginning and advanced levels of certification for educators using simulation. Both the levels of certification criteria include elements of inter-professional collaboration. Certification is open to all health care professionals (SSH, 2014).In nursing, six competencies of Quality and Safety Education for Nurses (OSEN) have been defined as patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety. and informatics (Cronenwett et al., 2007), IPS is essential to the integration of these patient safety competencies in education and practice, particularly the competencies of teamwork and collaboration and quality improvement.
Although there are natural and structural inclinations for inter-professional collaboration in simulation, significant barriers remain in implementation. Scheduling participants from different programs or professions who have varied schedules is a continuous challenge. Perhaps the most-cited obstacle to IPS is limited resources. This broad category includes the costs of simulation and how that should be shared among the professions, as well as a lack of recognition by administration of the work load necessary to execute IPS (Gough, Hellaby, Jones, & Mackinnon, 2012; NLN, 2012 ). Other barriers include faculty and administration resistance to change and proximity to other health care programs (NLN, 2012).
Health care educators in academe and practice are finding ways around the obstacles of IPS. Two highly successful IPS programs focused on medical and nursing students (Liaw et al, 2014; Paige et al. 2014), Paige et al. (2014) implemented a high-fidelity, interprofessional simulated operating room (OR) experience with undergraduate nursing students, nursing anesthesia students, and medical students. This quasi-experimental study looked at self-efficacy and teamwork before and after simulation experiences. Overall, students tend to overestimate their practice of team-based behaviors. Statistically significant improvement in self-efficacy and team performance after IPS intervention were reported (Paige et al. 2014).
The authors concluded that high fidelity IPS of the OR improves students team-based attitudes and performance. Liaw et al. (2014) developed a program of IPS (Sim-IPE) aimed to improve communication between nursing and medical students. In their Sim-IPE program, communication strategies, such as Situation, Background, Assessment, Recommendation (SBAR) and Check-Back, were implemented in handover reporting of a deteriorating patient (Liawet al., 2014). Self confidence, perception of inter-professional learning, and satisfaction with the simulation were measured Statistically significant increases in confidence and perception for both medical and murder students along with overall satisfaction in the simulation program were reported (Liaw et al., 2014 ).
SSH promotes IPS and offers accreditation to organizations that implement simulation (SSH, 2011) as well as certification for simulation educators of all health care professions (SSH, 2014). Inadequate resources, primarily costs, and educator workload remain sufficient obstacles to many institutions that desire the implementation of IPS.
Implementation In Health Education
Implications to health care are obvious. IPS offers academic health care educators an early opportunity to develop students self-efficacy, team performance (Paige et al., 2014), self-confidence, communication skills, and appreciation for inter-professional team-work (Liaw et al., 2014). Health care educators in the practice setting are implementing IPS opportunities to foster competence and excellence in health care teams. It is believed that this systematization of IPS will revolutionize professional practice and lead to marked advancements in patient safety (Liaw et al. 2014)
Outcomes of Inter Professional Use of Simulators
The 10M (2010) urges a further increase in the use of simulation as a training tool for teaching health care physicians, especially in the areas of team training. While the anecdotal and empirical evidence supports this shift in education and training of health care providers, several cautions should be noted. First, Milton (2013) advises that nursing educators have an obligation to carefully incorporate nursing theory based curricula with IPS and never compromise theoretical core beliefs of nursing.
Second, while some mention the challenge of finding appropriate places in nursing curriculum to insert IPE opportunities (NLN, 2012), it is a transformation in thinking and planning that will integrate IPE simulation into nursing curriculum as naturally as it occurs in professional practice. Third, the NIN (2012) recommends careful attention to matching student levels across the various programs in order to maximize success of IPS. Simultaneously educators in practice and academe are building a body of knowledge regarding IPS Initially, the use of an evaluation framework to define outcomes and a quality improvement model to structure designing and testing could provide the scientific foundation for systematically measuring the effectiveness of IPS (Zhang et al. 2011).
Further, multi site longitudinal research studies are required to provide evidence of the transfer ability of skills developed during IPS to patient care, as well as the overall impact on both education and health care (Gough et al, 2012). With the current state of IPS knowledge, high-quality mixed and multi method approaches should be encouraged to provide a richer picture and more robust analyzes of IPS interventions and outcomes (Gough et al, 2012).
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