Integration of Interprofessional Education and Culture into Advanced Practice Simulations

"To be culturally competent is to be willing to learn about the differences and to acknowledge them"- a qualitative study on Polish medical students' attitudes towards cross-cultural competence development

BACKGROUND

Changes in Polish demographic data with a growing number of culturally and linguistically diverse patients stipulate new directions in medical education to prepare future physicians to work effectively across cultures. However, little is known about Polish medical students' willingness to gain cross-cultural knowledge and skills, desire to get engaged in interactions with patients from diverse cultural backgrounds, expectations and needs concerning cross-cultural training as well as challenges they face in the path to cultural competence.

METHODS

Therefore, in this study, we conducted and thematically analysed fifteen semi-structured interviews with medical students to broaden our understanding of medical students' perception of cross-cultural competence enhancement.

RESULTS

The conducted thematic analysis allowed for the development of four themes, which showed that Polish medical students perceived skills and knowledge necessary to facilitate culturally congruent care as indispensable to form quality patient-doctor relations, believed that lack of cultural sensitivity may lead to dangerous stereotype formation and insufficient competence may be the source of stress and anxiety resulting in confusion and lack of confidence. Finally, numerous suggestions have been made by participants on how to improve their cross-cultural competence. Students emphasized, however, the role of medical education with active and experiential learning methods, including simulation-based training, in the process of equipping them with the knowledge and skills necessary to provide best quality care to culturally diverse patients.

CONCLUSIONS

Our analysis indicated that Polish medical students seem to hold positive attitudes towards cultural competence development and view it as an important component of physician professionalism.

Interprofessional Simulation as an Educational Tool to Assess Cultural Competence Among Health Professions Students

BACKGROUND

The concept of collaborative practice within health professions is viewed as "best practice." Poor collaboration can adversely affect patient safety. Interprofessional (IP) teamwork skills can be developed and nurtured through the health professionals' education; however, many barriers exist, which deter this from occurring. A lack of cultural diversity exposure within the healthcare setting can result in treatment disparities and place the patient at risk. One healthcare area that has gained considerable interest is the practitioners' understanding of multiculturalism and how cultural competence subsequently influences health disparities.

OBJECTIVES

This study examined the application of culturally complex clinical simulation scenarios that intentionally integrated IP teamwork and hypothesized that participants' understanding of cultural competence would improve.

METHODS

Participants were junior-level nursing, bachelor-level social work, graduate-level occupational therapy, and PharmD students (N = 180) who participated in an IP simulation exercise composed of culturally complex clinical scenarios performed by trained standardized patients designed to demonstrate underrepresented populations with diverse religious/spiritual, sexual orientation, racial/ethnic, socioeconomic, psychosocial, and geographic characteristics. Survey tools included an adapted Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) and the Cultural Awareness Assessment Tool (CAAT). Descriptive statistical analyses were conducted to describe the sample population with the use of inferential statistics to analyze the MAKSS and CAAT scores using a statistical significance level of 0.05. Data were analyzed using SPSS v25 using paired t tests to compare pretest-posttest results.

RESULTS

Results showed that there was a statistically significant increase in MAKSS and CAAT scores from presimulation to postsimulation. The findings also suggest that participation in this type of exercise may have increased self-assessment of cultural awareness and multicultural awareness, knowledge, and skills among health professions students.

CONCLUSIONS

This study described the planning and execution of a large multiple scenario simulation event that involved 180 students spanning 5 healthcare disciplines. Findings demonstrated that the IP simulation event improved the students' self-assessment of multicultural awareness, knowledge, and skills as well as their own cultural awareness. The exploration of cultural competence and humility should be a priority for simulation-based learning.

Health care students' perceptions about learning of affective interpersonal communication competence in interprofessional simulations

BACKGROUND

Health professionals need interpersonal communication competence (ICC) in their work with patients and other professionals. Interprofessional simulation provides health care students with an opportunity to practice communication skills in a safe and authentic environment.

OBJECTIVE

The purpose of this study was to describe the perceptions of health care students of interprofessional simulations in acquiring affective interpersonal communication competence (AICC).

DESIGN

This study was conducted using the quantitative descriptive research method.

SETTINGS

The data were collected from health care students participating in interprofessional simulations at a university of applied sciences in Finland using a questionnaire titled Student questionnaire on a multiprofessional simulation exercise. The health care students included nursing, physical therapy and practical nursing students.

PARTICIPANTS

This study was participated by 149 health care students with a response rate of 41.2%.

METHODS

The quantitative data were analysed using the SPSS 24.0 for Windows statistical software. Frequencies, percentages, averages, and standard deviation were used to describe the data. Two mean sum variables were formed using factor analysis from the variables describing AICC.

RESULTS

The students' perceptions of learning AICC (attitude, motivation, emotions) in interprofessional simulations were largely positive; for example, the simulations reduced prejudice against, and increased appreciation of, other occupational groups. Even though the interprofessional simulations were sometimes perceived as stressful, stress could also be a positive source of learning and effectively fostered personal understanding of others in a team.

CONCLUSION

Interprofessional simulations increased knowledge of the activities of other professional groups for students in different fields of education. This encourages them to work together after completing their education and entering the workforce. Knowledge of the simulation process and the creating a safe learning environment also promoted students' AICC.

Development and validation of interprofessional learning assessment tool for health professionals in continuing professional development (CPD)

Introduction

Interprofessional learning (IPL) is increasingly recognized as a promising strategy in addressing the burgeoning challenges in healthcare. Its assessment remains to be perplexing and requires accurate measurements. Thus, this study intended to develop a valid and reliable reflective tool in assessing IPL as a Continuing Professional Development (CPD) outcome.

Methods

A one-group post-posttest pre-experimental design with tool development was employed to establish the validity and reliability of the “Inventory of Reflective Vignette–Interprofessional Learning” (IRV-IPL). This tool was developed from an extensive literature review and designed with three segments to assess interprofessional competencies before, after, and what if scenarios using vignettes. After it was validated by education experts (n = 5) and written consent forms were signed by the participants, the IRV-IPL was pilot tested among healthcare professionals (n = 10) for analysis and improvement. During the actual implementation, it was administered to healthcare professionals (n = 45) who participated in a university-provided CPD event. Collected data underwent validity and reliability testing.

Results

IRV-IPL generated excellent internal consistency (α = 0.98), and across all segments of collaboration (α = 0.96), coordination (α = 0.96), cooperation (α = 0.96), communication (α = 0.97), and commendation (α = 0.98). Items exhibited significantly positive large correlations (r > 0.35, p < 0.05) in all segments showing beneficial measures for postdictive validity in recalling prior interprofessional competencies, and predictive validity in estimating interprofessional learning as an outcome of CPD and alternative interventions.

Conclusion

This study provided a piece of groundwork evidence on the use of IRV-IPL as a reflective assessment tool for interprofessional learning in CPD contexts. Further studies are essential to explore the educational utility of IRV framework in crafting relevant assessments and to establish construct validity of IRV-IPL using exploratory and confirmatory factor analyses.

Effect of the Diverse Standardized Patient Simulation (DSPS) Cultural Competence Education Strategy on Nursing Students’ Transcultural Self-Efficacy Perceptions

Introduction: Standardized patient simulation can be an effective strategy to foster cultural competence education. Methodology: Guided by the Cultural Competence and Confidence Model, this grant-funded, longitudinal, one-group, pretest and posttest study used the Transcultural Self-Efficacy Tool (TSET) to examine the effect of the Diverse Standardized Patient Simulation (DSPS) cultural competence education strategy on students’ ( n = 53) transcultural self-efficacy. Developed by following recommended guidelines and standards, the DSPS had content validity review. It aimed to improve students’ knowledge, skills, and attitudes with regard to providing culturally competent nursing care. The statistical methods included t-tests, McNemar’s test, correlation analyses, and Mann–Whitney U-test. Results: The DSPS influenced statistically significant changes (increase) in students’ transcultural self-efficacy perceptions ( p < .05). All students regardless of background benefited from formalized cultural competence education. Discussion: Evidence-based strategies such as the DSPS can offer a valuable guide for educators to foster cultural competence education.

Training future clinicians: An interprofessional approach to treating tobacco use and dependence

The high prevalence of smoking among persons with mental illness and co-occurring substance use disorders has not changed in the past decade despite a decline in smoking among the general population. Interprofessional collaborative care offers clinicians the opportunity to engage their patients in tobacco cessation treatment that is coordinated and comprehensive. Investigators applied a 1-group, pre/post-test design with qualitative and quantitative descriptive analyses to estimate the impact of an interprofessional tobacco education program on perceived self-efficacy and self-reported counseling abilities of graduate nursing, social work, and pharmacy (PharmD) students (N = 36; nursing, n = 13, n = 9 PharmD, n = 14 social work) to treat tobacco dependence among this subpopulation of smokers, and to assess their perceptions of interprofessional education. All participants completed a 2-h web-based module, a 3-h classroom training, a simulation with a standardized patient, and a group audio-recorded debriefing session with faculty. Emergent themes from qualitative analyses were valuing simulations, demystifying disciplines, reflecting on and critiquing practice, and lessons learned. Participants' perceived self-efficacy, self-rated counseling ability, intention to ask about tobacco use, and intention to provide counseling for tobacco cessation increased significantly. Teaching students an interprofessional team approach appears to be effective in enhancing counseling abilities and self-efficacy and may positively influence health professions students' perceptions of interprofessional education. Larger studies are recommended to validate the results of this pilot study.

Using Simulation for Clinical Practice Hours in Nurse Practitioner Education in The United States: A Systematic Review

OBJECTIVES

The National Organization for Nurse Practitioner Faculty (NONPF) does not allow simulation to be used in lieu of traditional clinical hours. The NONPF cites a lack of empirical evidence related to learning outcomes with simulation as rationale for its stance. The purpose of this systematic review was to search, extract, appraise, and synthesize research related to the use of simulation in Nurse Practitioner (NP) education in order to answer the two following questions: 1) What research related to simulation in NP education has emerged in the literature between 2010 and April 2015?, and 2) Of the research studies that have emerged, what level of Kirkpatrick's Training Evaluation Model (1994) is evaluated?

DESIGN

This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

DATA SOURCES

A literature search was completed in PubMed and CINAHL using a combination of medical subject headings, or Mesh terms, as well as keywords to retrieve non-indexed citations.

REVIEW METHODS

The inclusion criteria for this review were broad in order to disseminate information on future research needed. The review considered studies related to NP education that included any form of simulation intervention, e.g. role-playing and standardized patients. The review considered studies that described original research, but no other design restrictions were imposed. The review was limited to studies published in the English language.

RESULTS

The database search strategy yielded 198 citations. These results were narrowed down to 15 studies based on identified inclusion criteria.

CONCLUSIONS

There is a lack of empirical evidence in the literature to support using simulation in lieu of direct patient care clinical hours in NP education. The evidence in this systematic review affirms NONPF's statement. Five years after the inception of NONPF's position statement, research to support learning outcomes with simulation in nurse practitioner education remains lacking. There is a need to produce rigorous scientific studies in the future in order to provide quantitative support to allow simulation to be counted as clinical hours in NP programs.