Team-based clinical simulation in radiation medicine: value to attitudes and perceptions of interprofessional collaboration

Interprofessional education in cancer care - a scoping review

BACKGROUND

Comprehensive cancer care requires effective collaboration by interprofessional healthcare teams. The need to develop educational initiatives to improve interprofessional collaboration is increasingly recognised. However, there is no agreement regarding the interprofessional competencies required for effective cancer care leading to much variation on the focus of research, planning and managing change. A scoping review was conducted to identify the current status of IPE in cancer care and to summarise the results of previous research in order to guide the development of interprofessional education in cancer care.

METHODS

The JBI Scoping Review guidelines were used to guide the process of the review. A search of the available literature was conducted in CINAHL, MEDLINE (Ovid), PubMed, PsycInfo, Scopus databases from January 2012 to March 2023 to investigate IPE for health professional clinicians working in cancer care.

RESULTS

Of the 825 initial references and 153 studies imported for screening, a total of 28 studies were included in the final review. From those studies, seven focused on the need for IPE and interprofessional competence for oncology healthcare professionals, four reviewed existing IPE programs and 17 described the development and evaluation of interprofessional education. Findings show variation and lack of concept definitions underpinning research in IPE in cancer care settings. Variation also exists in the range of research activities in IPE, most notably related to communication, teamwork and the development of interprofessional practice. The evaluation of impact of IPE is mainly focused on health care professionals' self-evaluation and general feedback. Impact on patient care was only evaluated in one study.

CONCLUSIONS

Based on the results, interprofessional education research in the field of cancer care is limited in Europe. Thus, there is a significant increase in publications in the last five years. A more systematic focus on the theoretical framework and definition of concepts would be of value. Research and programme development should be based on a shared understanding on what constitutes the interprofessional competences and IPE. Programmes to develop interprofessional practice should be developed and implemented systematically with inclusion of validated assessment methods, and evaluated and improved regularly.

A simulated clinic to build interprofessional and authentic learning opportunities for shaping future practice in medical radiation professionals

BACKGROUND

Simulation based learning provides an opportunity to increase student readiness prior to clinical placement. Cross disciplinary learning facilitates interprofessional competency building and improved student appreciation of other health professions, which adds another learning dimension to simulated scenarios. This paper outlines the approach to facilitating an interdisciplinary simulated clinic, where experiences were mapped to common professional capabilities.

METHODS

After mapping skill sets and professional capabilities common to both Nuclear Medicine and Radiation Therapy, a mock clinic was planned to address common objectives. The aims of the activity were to prepare students for upcoming clinical placement and to build knowledge and skills in the interprofessional environment. All students were allocated roles of both the health care professional and the patient and introduced to the concept of interprofessional learning in a pre-brief session. During the simulated clinic phase students experienced the other modality through the patient perspective as well as practicing the clinician role within their own modality. Following the simulation students came together for a de-brief session. The activity was evaluated using both online polling and pre and post paper-based surveys.

RESULTS

A total of 28 students participated in the simulation: 17 in radiation therapy and 11 in nuclear medicine. All participants agreed that the mock clinic was valuable preparation for clinical placement. Twenty-four completed pre and post surveys, revealed a collective improvement in several measures of interprofessional understanding and application. Free text polled responses in the de-brief session highlighted value for practicing communication, realistic physical resemblance to the real-life scenarios and time pressures.

CONCLUSION

When two disciplines were combined in the simulated clinic, students learnt about each other's profession together. Evaluation showed positive improvements in both clinical readiness and interprofessional learning. Simulated tasks in healthcare education bought many benefits in preparing students for the workplace and in this example, enabled common objectives of interprofessional practice to be met.

Interprofessional education (IPE) in medical radiation science: A scoping review

INTRODUCTION

Interprofessional education (IPE) in medical radiation education is designed to enhance both student and longer-term patient outcomes. This scoping review aims to provide an overview of the available evidence and examine the effectiveness of IPE strategies used to enhance the development of medical radiation science (MRS) students.

METHODS

Medline, CINAHL, Cochrane Library and Emcare were searched for articles which employed an experimental study design to quantitatively assess the effectiveness of IPE for MRS students. Two reviewers screened and extracted relevant data independently. Critical appraisal was conducted using the JBI critical appraisal tool.

RESULTS

Eighteen studies were included in this review. Diverse approaches to IPE were discovered, particularly in terms of the method of delivery, setting and duration of interventions. MRS students interact with many professions, particularly medical doctors and nurses. All studies which employed a control arm demonstrated statistically positive findings favoring IPE intervention(s). In pre-post studies, most IPE interventions reported significant positive differences after IPE was implemented. This entailed an enhanced perceived knowledge and understanding of other professions, and ability to undertake their role in the team.

CONCLUSION

IPE was shown to be effective in enhancing students' perceptions and attitudes and to a limited extent, improve knowledge acquisition. Future research should assess long-term effects and patient-related outcomes.

IMPLICATIONS FOR PRACTICE

IPE in a variety of formats demonstrates positive results for MRS students; however, interventions which are longer-term, conducted in small groups, and performed earlier in the educational pathway, may demonstrate greater effectiveness.

Near-Peer Teaching in Radiation Oncology: a Proof of Principle Study for Learning Treatment Planning

Radiotherapy techniques are expanding in range and complexity; therefore, protecting learning environments where residents nurture treatment planning skills is critical. The evidence base for 'near-peer' teaching (NPT), where professionals at a similar career stage assist in each other's learning, is growing in hospital-based disciplines, but has not been reported in radiation oncology. The feasibility of a resident-led teaching programme for developing treatment planning skills was investigated herein with quality improvement (QI) methodology. Following consultation with attendings (n = 10) and all residents (n = 17) at the two cancer centres in the region, a regular NPT session focused on planning skills was initiated at the largest centre, with video-linking to the second centre. Tutorials were case-based and pitched at the level of qualifying examinations. Plan-Do-Study-Act (PDSA) cycles were designed based on primary and secondary improvement drivers derived by group consensus among residents, with tutorials adopted accordingly. Participation, content, and satisfaction were monitored for 20 months. Six PDSA cycles reformed the tutorial format, leading to logistical and pedagogical benefits including interprofessional contributions and enhanced interactivity. Tutorials occurred on 85% prescribed occasions (n = 45) during the subsequent 18-month follow-up, with 25 distinct tumour sites featured. Resident participation and satisfaction increased, independent of resident seniority. Tutorials were paused for the first 2 months of the SARS-CoV-2 pandemic only. A high-quality and cost-effective regional, trainee-led teaching programme on treatment planning was feasible and cost-effective in this study.

Fostering Undergraduate Medicine, Nursing, and Pharmacy Students' Readiness for Interprofessional Learning Using High Fidelity Simulation

Background

Interprofessional education is directly linked to high-quality patient care, however, it remains unclear whether senior undergraduate medicine, nursing, and pharmacy students are ready for interprofessional education using high fidelity human patient simulators.

Purpose

The purpose of this study was to explore student’s readiness for interprofessional learning and determine whether participation in high fidelity interprofessional education resulted in higher levels of readiness for interprofessional learning.

Methods

An interventional program starting with a pre-test before the program and a post-test after the program ends were designed with 24 students. The students were assigned to seven interprofessional teams. Each team participated in a high fidelity interprofessional education module designed to teach the clinical management of an adult patient experiencing acute anaphylaxis. The Readiness for Interprofessional Learning Scale (RIPLS) was used as the pre and post-test instrument.

Results

Prior to participation, students reported a high level of readiness for interprofessional learning, but that readiness significantly improved after participation, including more positive attitudes towards teamwork, enhanced communication skills, and improved respect and trust for team members.

Conclusions

The findings from this study show a higher level of readiness for high fidelity interprofessional learning using human patient simulators among senior undergraduate medicine, nursing, and pharmacy students. These findings support the integration of high fidelity interprofessional education into undergraduate medicine, nursing, and pharmacy undergraduate education programs.

Radiotherapy-specific interprofessional learning through simulation

INTRODUCTION

Interprofessional learning (IPL) is a vital aspect of training in radiation oncology professions, yet is rarely delivered to those professionals who work most closely together in clinical practice. Scenario-based learning using simulation facilities provides a unique opportunity to facilitate this learning and this project aimed to determine the impact and value of this initiative.

METHODS

Small groups comprising post-graduate diploma pre-registration therapeutic radiographers, medical physics trainees and radiation oncology registrars were challenged with 4 plausible and challenging radiotherapy scenarios within an academic simulation centre. Pre- and post-event completion of the "Readiness for Interprofessional Learning Scale" measured impact and a Likert-style survey gathered feedback from participants.

RESULTS

The session increased participants' teamwork and collaboration skills as well as strengthening professional identities. Participants reported high levels of enjoyment related to collaborative working, communication and observing other professionals deploying their technical skills and specialist knowledge.

CONCLUSION

Although beneficial, simulated scenarios offering equal opportunities for engagement across the professions are challenging to plan and timetabling issues between the 3 groups present significant difficulties. The safe environment and unique opportunity for these groups to learn together was particularly well received and future oncology-specific simulated scenario sessions are planned with larger cohorts.

IMPLICATIONS FOR PRACTICE

Simulated scenario training can be used to improve team working across the radiotherapy interprofessional team and may have wider use in other specialist interdisciplinary team development.

Interprofessional education: evaluation of a radiation therapy and medical physics student simulation workshop

INTRODUCTION

Interprofessional education (IPE) involves two or more professions engaged in learning with, from and about each other. An initiative was undertaken to explore IPE for radiation therapy (RT) and medical physics (MP) students through a newly developed workshop based around simulated learning. The aims of this study were to explore RT and MP students' perceptions of working as part of a collaborative team and of their own and the other group's professional roles. Student perceptions of the simulation education tool, the virtual environment for radiotherapy training (VERT) system, were also investigated.

METHODS

RT and MP students were invited to participate in a 4-hour interprofessional workshop. Pre- and post-workshop surveys were employed to collect demographic data, students' perceptions of interdisciplinary education (interdisciplinary education perception scale (IEPS)) and workshop evaluation (bespoke questionnaire).

RESULTS

Fifteen students attended the workshop (RT, n = 8; MP, n = 7). Thirteen pre- and post-questionnaires were returned (Pre-questionnaire: RT, n = 6, response rate, 75%; MP, n = 7, response rate, 100%; post-questionnaire: RT, n = 7, response rate, 87.5%; MP, n = 6, response rate 85.7%). For both student groups combined, IEPS scores ranged from 64 to 108 and 71 to 108 in the pre- and post-questionnaires, respectively, with insignificant differences in the mean scores post-intervention (Z = -1.305, P = 0.192). Satisfaction with VERT as a simulation tool was high for both student groups.

CONCLUSIONS

The interprofessional student workshop served to promote interprofessional collaboration for RT and MP students. VERT was reported as an appropriate education tool for this purpose, enabling access to virtual clinical equipment common to both student groups. It is suggested that IPE continues to be offered and investigated in RT and MP students, in order to improve effective interprofessional strategies which may enrich future professional collaboration.

Diagnostic radiographers working in the operating theatre: An action research project

INTRODUCTION

Failures in interprofessional communication are well-documented and are an established cause of medical error and negative health outcomes. Socio-historical issues like imbalances in power and status are particularly prevalent in the operating theatre environment, adding complications to interprofessional working. Simulation, used in healthcare education, may impact positively on interprofessional working.

METHODS

The aim of this action research study was to develop, pilot and run a simulation experience for Diagnostic Radiography (DRAD) students. Action research was used to structure this study. The first phase of the action research was to look at the problem; this was undertaken using critical incident technique. Findings from the critical incident technique influenced the simulation event. A focus group was held immediately after the event for reflection. A second simulation using a cohort of 48 students and a reflection after a period of three months formed the second round of the project. The simulation took place in a hi-fidelity simulated operating theatre. Thematic content analysis was undertaken of the focus group, data from the critical incident technique, and the reflections.

RESULTS

The findings are discussed under the themes; identification, clarity, preparation, and the expert. Identification and lack of clarity in communication were seen as an important issue in the operating theatre. Lack of preparation of the working environment was also highlighted. Lack of confidence in the operating theatre inhibits interprofessional working.

CONCLUSION

Simulation can help prepare students for working in the operating theatre. Realism is important as is scheduling the event to ensure maximum benefit.