Integrating Health Education
Co-authors: Evan R. Gooberman, MPHc & Alexander S. Krengel, MPHc
Results
Background
In a 2014 survey of Drexel University graduate-level students, 87% responded that there is a
need for more interdisciplinary collaboration in their curricula (1). 75% of these respondents said the best way to create progress in the health system was to encourage more collaboration, indicating that each profession shares the responsibility of improving the system.
Teams of interdisciplinary care providers are critical for integrated service delivery models
(2). Such teams are better equipped to comprehensively address quality, access, cost of care
(”The Triple Aim”), and complex patients and populations. More collaborative and interdisciplinary team approaches are needed, which means appropriate training must be provided to
students and professionals going into this complex environment.
To address this unmet need, a pilot interprofessional health simulation was designed with
student-faculty collaboration. In October, 2014, this full-day pilot ran 16 students through 6
different simulation scenarios at the Drexel University College of Medicine. Students from
public health, medicine, law, and health informatics participated, gaining new perspectives and
building on their understanding and skills in the health fields, as indicated by survey results (3).
The participants provided feedback and indicated that the event was successful and should be
reiterated.
The Interprofessional Health Simulation reviewed in this report was held in the evening of
April 9, 2015 at the Drexel University College of Nursing & Health Professions Simulation
Center. The simulation consisted of three clinically and three non-clinically based scenarios
with 27 participants from various health disciplines throughout Philadelphia.
“This was entirely different from any experience I have had – the incorporation of
patient encounters was crucial in understanding the collaborative nature of the field,
understanding roles and areas to further pursue.”
Program Design
“For me, the pharmaceutical scenario was best because I had no clue what was going
on. I totally relied on my teammates for their knowledge and support and was able
to step away from being embarrassed about not knowing something.”
To ensure the highest degree of knowledge and experience, graduate, professional, fifthyear BSN, and accelerated BSN students were the target audience
for the simulation. Students within the Drexel University
School of Public Health, College of Nursing &
Health Professions, College of Medicine, Law School
and College of Business were invited via direct emails
or emails sent by deans and faculty members.
Invitations were also sent via faculty to nursing
students at the University of Pennsylvania and
Thomas Jefferson University.
Scenarios were developed iteratively with specific
learning goals for each field invited. A detailed facilitation
guide was developed to capture these learning goals and the overall objectives of the event.
Participants were assigned representatively to teams of six or seven people and engaged
in team-building activities to create a comfortable environment and rapport. Each team participated in two clinical scenarios and one non-clinical scenario lasting one hour each:
Scenario Type
Description
Clinical
Emergency Department: Occupational injury resulting in fractured femur (Standardized Patient [SP])
Clinical
Trauma Bay: Patient with superficial knife wounds, accompanied by wife (2 SPs); Simulataneous
patient with critical gunshot wounds (Sophisticated Mannequin), accompanied by police officer (SP)
Clinical
Rural Family Practice Office: Adult special needs patient, accompanied by mother (2 SPs)
Non-Clinical Table-Top Team of pharmaceutical executives balancing priorities with a drug development pipeline
Power of Attorney discrepancy with a same-sex married couple in a state that does not recognize gay
marriage and a devout Jehovah's Witness mother
Team of advisors to the President of the US evaluating and recommending improvements to the US
Non-Clinical Table-Top
Health Insurance System
Non-Clinical Table-Top
At the end of the clinical scenarios, participants and facilitators debriefed the scenario and
discussed the specific learning goal, challenges and how they overcame these. All participants
met together for a final debrief about the successes, challenges and suggestions for future collaboration.
The pilot simulation showed that there was a need for an increased amount of unstructured
social time, for participants to form strong relationships and create a foundation for future collaboration. Following the debrief, all participants and facilitators were invited to an off-site net-
working reception.
Discussion
Participant Characteristics
16
Participants
Score Ave Before (SE) 77.3 (24.1)
Score Ave After (SE) 82.1 (22.9)
100
Score Mode Before
100
Score Mode After
1.50
Work Exp. Med (Yrs)
0.00
Working Exp. Mode (Yrs)
0.79
Other IPE (0 - 1: No-Yes)
1.00
Other IPE Mode
MD
RN
Other
3
5
3
68.8 (27.9)
73.2 (23.4)
71.4 (24.3)
83.0 (23.4)
78.0 (26.4)
85.8 (12.4)
75
100
75
100
100
75
0.50
0.00
0.00
0.00
0.00
0.00
0.50
0.80
0.50
0.00
1.00
0.00
Before
MPH
0
Emergent Themes
Communication
Roles
Business & Law
Experience
different
viewpoints
50%
38%
38%
29%
Problem-solving
with limited Still need a wider
information
perspective
38%
1
3
4
38%
Overall Competency Score
Before and After Simulation
After = 81.9
Before = 75.2
74
76
78
80
82
84
Transformed Score (0 - 100)
“I was really able to see the areas in which I excelled in the healthcare field.
I saw how I could step in where there were gaps. I was able to adapt.”
“The second clinical scenario was exhilarating, it flew by
and I learned so much about myself and other roles.”
Mean (95% CI)
Competency Group
2
After
Field of Study
Response Breakdown
t
p-value
Before
After
Overall Knowledge
Values & Ethics
Roles & Responsibilities
Teamwork
75.2 (73.3; 77.2)
61.0 (57.2; 64.8)
82.5 (78.8; 86.2)
71.5 (66.5; 76.4)
83.2 (79.4; 86.9)
81.9 (80.2; 83.6)
68.2 (64.1; 72.3)
87.0 (83.8; 90.1)
82.0 (78.1; 85.8)
87.7 (85.1; 90.3)
-5.10
-2.57
-1.81
-3.34
-1.98
<.0001
0.0107
0.0718
0.0010
0.0493
Communication
82.3 (78.1; 86.5)
89.0 (85.9; 92.0)
-2.54
0.0118
Overall Score
Evaluation Methods
A survey with quantitative and qualitative items was developed to evaluate the effectiveness and meaningfulness of the interprofessional health simulation, and to establish a framework for continued development of co-curricular competency building events for the
population of interest.
Quantitative items were developed directly from the Interprofessional Education
Collaborative’s (IPEC) report: Core Competencies for Interprofessional Collaborative Practice
and supplemented with 7 questions regarding general competency and knowledge within the
health fields (4). Utilizing reliability estimates from the pilot survey in October, 2014, 28
total Likert-type items (5 scales) were randomized. The survey was blindly administered to
participants in-person before and after the simulation. Independent sample t-tests were
performed within each competency scale and on overall competency.
Qualitative items focused on four major dimensions: 1) Participant characteristics and
future goals; 2) Reasons for participation; 3) Reflections on the experience; 4) Future hopes
for interprofessional experiences. Preliminary thematic analysis was conducted to identify
and estimate the frequency of emergent ideas.
Acknowledgments
Leland “Rocky” Rockstraw, PhD, RN
Kathleen Ryan, MD, FACP
Cheryl A. Hanau, MD, FACP
Brenna Aumaier, MPHc
John Cornele, MSN, RN, CEN, EMT-P
Arlene Solnick, MSN, RN
Rajeev Mavath, MD, MPHc
The findings suggest that the interprofessional health simulation is an effective way to
build competency in future health professionals. The survey is attitudinal in nature and
though suggestive, its validity in measuring competency or changes therein is questionable.
Ideally these competencies would be measured by evaluation that is more objective such as
examination or observation.
Despite these findings, however, we recognize that competency building is not an overnight process. It requires frequent practice and long-term commitment. The participant
sample group was both small and not representative of the population of interest, detracting
somewhat from the design and intentions of the simulation. With an increased sample of
students from each program invited, we might be able to identify competency-area deficits
within groups that could provide insight into areas for program-specific and interprofessional training needs.
The evaluation methods lend themselves to issues with self-report biases. The distribution
of responses at the outset of the simulation suggest social desirability bias; there may also
be context effects. Ideally surveys would be administered to a random, representative group
of students prior to the simulation and follow-up surveys administered in the week following the event to mitigate these context and placebo effects and compare to a control group.
Poor response rates in this population complicated such administration.
Results from the qualitative portion of the survey indicate students are interested in
being challenged, gaining wider perspective, and improving communication. Maybe most
compelling is that all participants indicate they would encourage colleagues to participate in
the future, with a modal response of: “You can’t miss it!” and the rest responding:
“You should go.”
Future Steps
• Draw more widely from health professions using effective communications strategies
• Formalize interprofessional student and faculty workgroup with the goal of
developing co-curricular and curricular programs with a shared vision of health
• Ensure University support for integrative, interdisciplinary initiatives in
practice- and problem-based programs
• Create an accountable system such as a formal curricular experience
(credit or non-credit bearing)
• Disseminate simulation format amongst Philadelphia and other US universities
• Establish interprofessional competency certification program with
formal, longitudinal evaluation
• Grow the movement for collaboration and integrative education across health fields
4 IPEC Core Competencies
for Interprofessional
Collaborative Practice:
1.
2.
3.
4.
Values & Ethics
Roles & Responsibilities
Communication
Teamwork
References
1: AS Krengel, A Landicho, A Sheridan, V Doshi, A Magdalinski & Y Greene. (2014) Roundtable on American Health Delivery:
An Interdisciplinary Collaboration in Health.*
2: L Jansen (2008). Collaborative and Interdisciplinary Health Care Teams: Ready or Not?
3: E Gooberman & AS Krengel. (2014). Multidisciplinary Health Simulation: Piloting collaboration through clinical &
non-clinical simulation.
4: Interprofessional Education Collaborative [IPEC] (2011). Core Competencies for Interprofessional Collaborative Practice.