Exploring the role of power during debriefing of interprofessional simulations

Capability to identify and manage critical conditions: effects of an interprofessional training intervention

BACKGROUND

The burden of critical illness is a global issue. Healthcare systems often fail to provide essential emergency and critical care for deteriorating patients, and the optimal strategy for ensuring safe care is not fully known. This study aimed to explore the capability to identify and manage critical conditions and to evaluate how an interprofessional training intervention that included theory as well as high-fidelity simulation (proACT) in the short and long term affected the capability.

METHODS

A questionnaire study was performed. A cross-sectional survey of all in-hospital nurses and physicians in a Swedish region (n538) and a longitudinal cohort of participants entering the proACT course during a six-month period (n99) were included. Descriptive and comparative statistics were generated. Additionally, qualitative content analysis was performed for free text answers.

RESULTS

The findings demonstrated that the intervention improved the individual healthcare professionals' competence with a sustained effect over time. The coverage of proACT trained staff increased from 13.2% to 26.5%, but no correlation was observed with workplace conditions that support safe care. Collaboration and workplace climate were perceived to be mainly positive, but for safer care, an overall need for improved competence and staffing was emphasized.

CONCLUSIONS

The present study confirms previously identified issues and the need for improvements in the care of critically ill patients in general hospital wards. It supports the notion that a training intervention, such as proACT, can increase the capability to identify and manage patients with critical conditions. All healthcare professions increased the competence. Hence, more effort is needed to enable staff of all professions to participate in such training. Studies of interventions cover higher number of trained staff in the setting are warranted to clarify whether the training can also improve workplace conditions that support safe care of deteriorating and critically ill patients.

A Scoping Review of Interprofessional Simulation-Based Team Training Programs

SUMMARY STATEMENT

Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.

Comparing reflection levels between facilitator-led and student-led debriefing in simulation training for paramedic students

BACKGROUND

Simulation in healthcare attempts to create relevant representations of patient encounters. It provides experiential learning, bridging typical classroom activities and clinical practice. This study aims to investigate whether the principle of Peer-Assisted Learning can be used in simulation by letting simulation-experienced paramedic students prepare, deliver, and debrief their own simulations, with minimal faculty assistance. This could be a way to support student learning by being involved in teaching, and it might at the same time optimise the cost-effectiveness of simulation-based training.

METHODS

This observational non-inferiority study compared reflection levels between facilitator-led and student-led simulation and debriefing, between scenario types, and compared the number of turns in which students are involved in both settings. Third-year Bachelor in Paramedic Science students' debriefings were filmed and transcribed. The degree of reflection in students' statements was rated according to a modified version of Fleck's analytical framework of reflection levels, assigning scores from lowest (R0 description) to highest (R4 critical reflection). Facilitator-led and student-led debriefings were compared using chi-square tests. Scenarios were also analysed according to type (paediatric emergencies and complex assessments) regardless of who led the simulation.

RESULTS

Ten facilitator-led and 12 student-led debriefings were analysed. Students gave 682 (49%) contributions in the facilitator-led debriefings, and 702 (51%) contributions in student-led debriefings. Comparison of reflection levels between facilitator-led and student-led debriefings was respectively: R0-level 32.7% vs 33.8%, R1-level 44.0% vs 44.3%, R2-level 14.7% vs 17.1%, R3-level 0.1% vs 1.3%, and R4-level 0.1% vs 0.1%. There were no statistically significant differences in reflection levels between facilitator-led and student-led debriefings (p = 0.178). Comparing the reflection levels between the scenarios on "paediatric emergencies" and "complex assessments", the results were respectively: R0-level 35.4% vs. 31.7%-level, R1-level 45.3% vs. 43.3%-level, R2-level 13.4% vs. 17.8%, R3-level 0.5% vs. 0.9%, and R4-level 0.0% vs. 0.3%. These differences were statistically significant (p = 0.010). No significant differences in engagement were found between debriefings led by a student or a facilitator, when measuring the number of turns in the conversations.

CONCLUSIONS

Facilitator-led and student-led debriefings resulted in equivalent reflection levels amongst students. Student-led simulation is potentially a cost-effective supplement to regular simulation within a healthcare degree program. Since complex scenarios provided higher reflection levels than paediatric, scenario design might influence reflection levels.

Fostering Adaptive Expertise Through Simulation

Technology-enhanced simulation has been used to tackle myriad challenges within health professions education. Recently, work has typically adopted a mastery learning orientation that emphasizes trainees' sequential mastery of increasingly complex material. Doing so has privileged a focus on performance and task completion, as captured by trainees' observable behaviors and actions. Designing simulation in these ways has provided important advances to education, clinical care, and patient safety, yet also placed constraints around how simulation-based activities were enacted and learning outcomes were measured. In tracing the contemporary manifestations of simulation in health professions education, this article highlights several unintended consequences of this performance orientation and draws from principles of adaptive expertise to suggest new directions. Instructional approaches grounded in adaptive expertise in other contexts suggest that uncertainty, struggle, invention, and even failure help learners to develop deeper conceptual understanding and learn innovative approaches to novel problems. Adaptive expertise provides a new lens for simulation designers to think intentionally around how idiosyncrasy, individuality, and inventiveness could be enacted as central design principles, providing learners with opportunities to practice and receive feedback around the kinds of complex problems they are likely to encounter in practice. Fostering the growth of adaptive expertise through simulation will require a fundamental reimagining of the design of simulation scenarios, embracing the power of uncertainty and ill-defined problem spaces, and focusing on the structure and pedagogical stance of debriefing. Such an approach may reveal untapped potential within health care simulation.