INTERPROFESSIONAL LEARNING BYADVANCED CLINICAL SIMULATION

1. Facultat de Farmàcia. Universitat de València2. Facultat d’Infermeria i Podologia. Universitat de València.3. Facultat de Medicina i Odontologia. Universitat de València.

Garrigues, Teresa M1, Casal-Angulo, Carmen2, Mifsut-Rodríguez, Luis3, Carrión, Carmen1, Chorro, Javier3,

Fernández-Garrido, Julio2

INTERPROFESSIONAL LEARNING (IP)

Many adverse events relate tocommunication difficulties between themembers of the interprofessional team(Reader, Flin, & Cuthbertson, 2007)

The health professions' educationalprograms face the challenge ofincorporating this IP into the curriculumto prepare students to worktogether to build better, safer, patient-centered care (WHO)

INTERPROFESSIONAL LEARNING (IP)

Two or more health professions learning interactivelyabout, from and with each other, all with the common goal ofenabling effective collaboration and improving patienthealth outcomes (WHO, 2010)

INTERPROFESSIONAL LEARNING (IP)

Four competences wereidentified as essentials:

Sharing values/ethics,

Assumingrole/responsibility,

Communication

Teamwork.

INTERPROFESSIONAL EDUCATION COLLABORATIVE, 2016

ADVANCED CLINICAL SIMULATION (ACS)

ACS is a technique that uses asituation or environmentcreated to allow persons toexperience a representation of areal healthcare event for thepurpose of practice, learning,evaluation, testing or to gainunderstanding of systems orhuman actions.

HCS facilities at Faculty of Nursing

ADVANCED CLINICAL SIMULATION (ACS)

ACS uses a simulator (e.g. mannequin, standardized patient,virtual or computer model, procedural model) as anyrepresentation used during training or assessment that behavesor operates like a given system and responds to the user’sactions (Council for the Accreditation of Healthcare Simulation Programs, 2013)

HCS facilities at Faculty of Medicine

OBJECTIVES

¡ To measure the student satisfaction with this activity

¡ To test the student perception of ACS as a learningtechnique for the acquisition of non-technical skills(teamwork, effective communication and leadership)

¡ To assess the impact of this clinical practice onstudents outcomes

To gather evidences on the learningefficiency of IP-ACS by pilotexperiences

CLINICAL CASES INTHE SIMULATEDCRITICAL ROOM

OBJECTIVE:TO SAVE LIFES

TEAMWORK

¡ PARTICIPANTS:

ü 6 staff members of the Faculties ofMedicine, Nursing and Pharmacy

ü Volunteer students from:

¡ Medicine (6th year, n = 21)¡ Nursing (4th year, n = 20)¡ Pharmacy (5th year, n = 30)

¡ FACILITES: Clinical box withmannequin, connected to controlsystem in the next room and video andsound recording systems, classroomwith screen

METHODOLOGY

METHODOLOGY

Staff from thethree faculties

workedcollaboratively

to developclinical

scenarios andagree learningoutcomes forthe sessions

Casedesign

Casepresenta

tion

ACS(video)

Peerevaluation

DebriefingEvaluation

ClinicalSimulationfacilities

Information about the case:A 73-year-old woman, allergic to NSAID and to metamizole, with a history of HTA,hypothyroidism, a ruptured disc herniated 10 years before, depressive syndrome andtotal right hip prosthesis operated 6 years ago.

She went to the hospital for right hip pain and was diagnosed with dislocation of theright hip prosthesis. She entered the area of traumatology and surgery wasscheduled. The day after the intervention, the patient presented a febrile peak andpositive urine cultures to Escherichia coli and Enterococcus sp.

Linezolid was prescribed. Simultaneously, opioids (25μ / 72h of transdermal fentanyland 50mg / 8h of tramadol) and paracetamol 1g / 8h were prescribed as an analgesictreatment.

METHODOLOGY

METHODOLOGY

A 6 student team wasformed (2 from everydegree) and workedtogether to solve theclinical case in thesimulation room for 15minutes.

The outcome depends onthe interaction andcollaborative work ofthem.

SIMULATION DEBRIEFING EVALUATION

METHODOLOGY

The team was observed by peers who filled out a check-list oftechnical and non-technical skills.

SIMULATION DEBRIEFING EVALUATION

Alumno Evaluador:Alumnos que realizan

el caso:

PUNTOS CRITICOSSISTEMATICA SI NO INCORRECTO OBSERVACIONES

Identificación PacienteMotivo de la urgenciaValoración del nivel de concienciaMonitorización de constantes vitales

Grupo ENFERMERIA

Monitorización constantes y reevaluación paciente

Administración fármacosAdministración oxigenoSoporte vital avanzado. Administración fármacos,

colaboración vvaaGrupo MEDICINAEvaluación pacienteManejo vía aéreaSoporte vital avanzado. Toma de decisiones.Grupo FARMACIAReconocimiento interacción medicamentosaPauta tratamiento eficaz ante dicha interacción

TECHNICAL SKILLS

- Identify signs and symptoms of anadverse reaction to medication

- React to medication adverse effects- Recommend alternative therapies

METHODOLOGY

SIMULATION DEBRIEFING EVALUATION

Gestos (habilidades no técnicas) SI NO Regular (explicar porqué)

OBSERVACIONES

Presentación al paciente

Tranquiliza al paciente

Aplica medidas de seguridad del paciente

Comunicación con el paciente y/o sus familiaresComunicación eficaz equipo

Conocimiento del entorno

Designación lider (Liderazgo)

Prioriza las intervenciones de forma efectivaPetición de ayuda

Coordinación equipo (Distribucion cargatrabajo)

Amticipación y planificación (transferenciacorrecta)

Usar toda la información disponibleMovilización de todos los recursos disponibles

COMENTARIOS QUE SE QUIERA AÑADIR:

METHODOLOGY

NONTECHNICAL SKILLS

- Leadership- Team coordination

- Effective use of information

SIMULATION DEBRIEFING EVALUATION

Discussevents

Ask forpersonalemotions

Rereadthe case

Summarize

METHODOLOGY

Debriefing

SIMULATION DEBRIEFING EVALUATION

The group also has to identify the ideal performance to havebetter outcomes for the patient

METHODOLOGY

During the debriefing, thefacilitator emphasizes the useand importance of non-technical skills such asteamwork, effectivecommunication andleadership as learningobjectives.

SIMULATION DEBRIEFING EVALUATION

METHODOLOGY

The completesession was video-recorded, includingdebriefing, to beused in otherlearning contexts

Evaluation was conducted by a survey at the end of thesession with several items with a Likert type test

SIMULATION DEBRIEFING EVALUATION

RESULTS

STUDENT’S SATISFACTION WITH IP DURING PREGRADCOURSES

Likert scale: Useless-Very important (1-5)

0

10

20

30

40

50

60

70

80

90

Medicine Nursing Pharmacy

This activity will have an impact onthe future relationships at work

Very important Important

I’ve neverimagined how

much pharmacistsknow!

Nurses aretrained to

observe everysymptom

RESULTS

STUDENT’S PERCEPTION OF ACS AS ALEARNING TECHNIQUE

0

20

40

60

80

100

120

Medicine Nursing Pharmacy

Clinical simulation is effective as learning technique

Very important Important

As we can makedecissions with impacton the patient we pay

more attention!!

It should beused since thebegining of the

degree!

RESULTS

PERCEPTION OF LEARNING OUTCOMES OFNONTECHNICAL SKILLS

0

20

40

60

80

100

120

Medicine Nursing Pharmacy

This activity helps me to learn how be moreefficient in a health team

Very important Important

The leader has to ensureeveryone is clear about

what they are required todo

Commitment isessential in health

teams

…safetydepends on

communication

CONCLUSIONS

¡ Students support this type of activities as very relevant in theirlearning process

¡ Students consider that this activity leads to theacknowledgement of the importance of teamwork andcommunication

¡ The necessary assistance for the acquisition of clinical skillspromotes both the transdisciplinary work and the respect andrecognition of other professions’ role

¡ By using simulation in a controlled environment undersupervision, IPL leads to deeper learning, towards betterpatient care outcomes.

ACKNOWLEDGEMENTS

¡