Changing workplace-based education norms through 'collaborative intentionality'

Changing the conversation: impact of guidelines designed to optimize interprofessional facilitation of simulation-based team training

BACKGROUND

Interprofessional simulation-based team training (ISBTT) is commonly used to optimize interprofessional teamwork in healthcare. The literature documents the benefits of ISBTT, yet effective interprofessional collaboration continues to be challenged by complex hierarchies and power dynamics. Explicitly addressing these issues during ISBTT may help participants acquire skills to navigate such challenges, but guidelines on how to do this are limited.

METHODS

We applied an educational design research approach to develop and pilot structured facilitator guidelines that explicitly address power and hierarchy with interprofessional teams. We conducted this work in a previously established ISBTT program at our institution, between September 2020 and December 2021. We first reviewed the literature to identify relevant educational theories and developed design principles. We subsequently designed, revised, and tested guidelines. We used qualitative thematic and content analysis of facilitator interviews and video-recording of IBSTT sessions to evaluate the effects of the guidelines on the pre- and debriefs.

RESULTS

Qualitative content analysis showed that structured guidelines shifted debriefing participation and content. Debriefings changed from physician-led discussions with a strong focus on medical content to conversations with more equal participation by nurses and physicians and more emphasis on teamwork and communication. The thematic analysis further showed how the conversation during debriefing changed and how interprofessional learning improved after the implementation of the guidelines. While power and hierarchy were more frequently discussed, for many facilitators these topics remained challenging to address.

CONCLUSION

We successfully created and implemented guidelines for ISBTT facilitators to explicitly address hierarchy and power. Future work will explore how this approach to ISBTT impacts interprofessional collaboration in clinical practice.

'They mirror what they see': A constructivist grounded theory study of simulation culture in four professional domains in Ireland

PURPOSE

In simulation-based education (SBE), educators integrate their professional experiences to prepare learners for real world practice and may embed unproductive stereotypical biases. Although learning culture influences educational practices, the interactions between professional culture and SBE remain less clear. This study explores how professional learning culture informs simulation practices in healthcare, law, teacher training and paramedicine.

METHODS

Using constructivist grounded theory, we interviewed 19 educators about their experiences in designing and delivering simulation-based communication training. Data collection and analysis occurred iteratively via constant comparison, memo-writing and reflexive analytical discussions to identify themes and explore their relationships.

RESULTS

Varied conceptualizations and enactments of SBE contributed to distinct professional learning cultures. We identified a unique 'simulation culture' in each profession, which reflected a hyper-real representation of professional practice shaped by three interrelated elements: purpose and rationale for SBE, professional values and beliefs, and educational customs and techniques. Dynamic simulation cultures created tensions that may help or hinder learning for later interprofessional practice.

CONCLUSION

The concept of simulation culture enhances our understanding of SBE. Simulation educators must be mindful of their uni-professional learning culture and its impacts. Sharing knowledge about simulation practices across professional boundaries may enhance interprofessional education and learners' professional practice.

Exploring nurses' role in guiding residents' workplace learning: A mixed-method study

INTRODUCTION

Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions.

METHODS

This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using anova. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions.

RESULTS

Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p < .001). Themes suggest that nurses and residents could be divided into two groups: (i) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care and (ii) respondents who saw the guiding role as limited and emphasised the distinct fields of expertise between nurses and physicians.

CONCLUSIONS

Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalise on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care.

The effect of continuing interprofessional education on improving learners' self-efficacy and attitude toward interprofessional learning and collaboration

We aimed to assess the effect of continuing interprofessional education on collaborative self-efficacy, attitude toward the team, and interprofessional learning in workplace-based learning situations. This was a quasi-experimental study conducted in two educational hospitals. Two hundred and ten participants including nursing and medicine from general medicine, internal medicine, and emergency medicine, entered the study and were categorized in the census's intervention group (n = 97) and control group (n = 113). Continuing interprofessional education interventions included interprofessional rounds and workshops. Attitudes toward the team and interprofessional learning and collaborative self-efficacy were assessed using the Readiness for Interprofessional Learning, Attitudes Toward Health Care Teams, and Interprofessional Collaborator Assessment. Participants' attitude toward the team (p-value <.001), attitude toward interprofessional learning (p-value <.001), and interprofessional collaborative self-efficacy (p-value <.001) were significantly improved compared to participants' scores in the control group. Integrating the principles of continuing education, interprofessional education, and workplace-based learning provided an effective learning situation through interactive relationships and active collaboration of participants. The findings revealed a significant educational effect of the intervention on attitude toward interprofessional learning and the team, and a small effect on self-efficacy of interprofessional collaboration.