Discharge Day: A Case-Based Interprofessional Exercise About Team Collaboration in Pediatrics

Interprofessional education for healthcare professionals. A BEME realist review of what works, why, for whom and in what circumstances in undergraduate health sciences education: BEME Guide No. 83

AIM

To provide an evidence-informed program theory (PT) for Interprofessional Education (IPE) that adds to the knowledge base of how IPE in undergraduate health sciences education works.

METHODS

We undertook a realist review of the literature and synthesis of the evidence combined with stakeholder experience. Our initial program theory (IPT), built around development, delivery and evaluation of IPE interventions, was tested and refined following an in-depth search of the literature and consultation with stakeholders. The literature (2010-2022) was selected based on the realist criteria of relevance and rigor, as well as on conceptual richness of the studies.

RESULTS

Our PT is built upon 124 CMOs (Context of IPE interventions, Mechanisms that fired within that context, and IPE Outcomes), from 58 studies. Our PT comprises an array of elements found in the Context, including traits and behavioral displays of students and facilitators, and discusses four Mechanisms (feeling responsible, feeling enthusiastic/excited, feeling safe to take risks, and feeling ready), which are likely to lead to outcomes related to the Interprofessional Education Collaborative (sub)competencies.

DISCUSSION

Results were linked to learning theories to further build our understanding. The PT can serve as a guide for the development, delivery, and evaluation of IPE interventions.

Use of qualitative methods to optimize collaborative practices by highlighting differences in perceptions between professionals: an example of patient education

Interprofessional working must be approached within health promotion interventions using systematic methods to identify areas of suboptimal collaboration. We designed a qualitative study with a purposive sample of seven French therapeutic patient education programs. Semi-structured individual interviews were conducted with 14 healthcare providers and seven clinician leaders (coordinators) involved in patient education. We used the same interview guide and thematic grid regardless of the professional's profile to compare their perceptions on elements affecting outcome, participation and sustainability of programs. Healthcare providers and coordinators addressed non-convergent issues at both ends of a continuum from a micro-level nested in the program delivery to a macro-level corresponding to the structured implementation and sustainability of the program. Meso-level issues featured convergent perspectives. Our methodology could be used at the level of health services in a health system to provide a complete recovery of stakeholders' perspectives (without "blind spots" from one stakeholder or another). In our study, we focused on patient education in the French health system and pointed out possible considerations to optimize the functioning of programs. Such considerations include specific training plan development, encouraging reflection on the content and use of initial assessment, leading sessions in pairs to save on work time, and communication on the ins and outs of organizational imperatives that require healthcare providers' contributions.

Training to Transition: Using Simulation-Based Training to Improve Resident Physician Confidence in Hospital Discharges

Introduction

Hospital discharge is a highly critical and complex process that is prone to medical errors, poor communication, and ineffective synchronization of transitional teams. Improving safety during postacute care transitions has become a national focus. Simulation-based training is an underutilized method of instruction for medical resident transitions of care education.

Methods

As an integral part of a transitions curriculum, 36 PGY 1 residents from internal medicine and transitional year residency programs underwent a discharge simulation utilizing a trained simulated participant (SP) and a lay caregiver. The objective of the training was to implement a simulation-based education intervention to improve transition practices and discharge communication in graduate medical education. A faculty observer used a case-specific discharge rubric to standardize feedback to the resident and observed the resident navigate the electronic medical record (EMR) for discharge orders. Pretest and posttest surveys assessing resident attitudes and confidence regarding specific areas of the discharge process were distributed to all participating residents for completion.

Results

Thirty-six internal medicine and transitional year residents (100%) completed an observed discharge simulation with an SP and a separate encounter with the EMR discharge navigator. All 36 residents (100%) completed the pretest survey, and 23 (63%) completed the postsurvey evaluation. Postsurvey results showed residents agreed (92%, p < .05) that the simulation increased their confidence in safely discharging a patient.

Discussion

Simulation encounters are an effective adjunct to postacute care transition education.

Pyramid of Discharge Needs: A Simple Framework on Discharge Planning for Medical Students and Residents

Medical students and residents often have difficulty with discharge planning and determining appropriate post-hospitalization level of care. As the discharge planning process can be complex, physicians in-training often do not engage until late into the hospitalization or near day of discharge. This paper offers a simple pyramid construct that categorizes common discharge needs into 4 areas or tiers. As the topic of discharge planning is not formally taught in medical education, most trainees learn through experience and by trial and error. Using a simple pyramid and a basic flow chart to guide students and residents, the discharge planning process can be introduced as soon as possible during the hospitalization.

Leveraging Podcasts to Introduce Medical Students to the Broader Community of Health Care Professionals

INTRODUCTION

Safe, patient-centered, and cost-effective care requires effective collaboration within interprofessional teams. Education programs for health care professionals are often siloed, providing students with limited interprofessional education (IPE) opportunities to learn from, with, and about other professions. Podcasts offer a novel approach to facilitate IPE, allowing for asynchronous conversations with interprofessional colleagues.

METHODS

We developed four podcasts with various health care professionals for 135 preclinical medical students preparing to transition into clinical rotations. The podcasts were coupled with an hour-long interactive session with the podcast interviewees conducted via videoconference. The curriculum explored the distinct education paths, roles, and responsibilities of various health care disciplines. Strategies for communicating effectively with and learning from interprofessional team members were emphasized.

RESULTS

There were 197 unique downloads of the podcasts, and 95 students attended the interactive session. Most students reported that the podcasts and follow-up live session enhanced their learning (100% and 98% of students who completed the postcurriculum survey, respectively). Responses to the postcurriculum survey revealed students learned strategies for engaging in productive interprofessional conversations, the importance of leveraging the distinct roles and responsibilities of diverse health professionals, the value of learning from other health professionals, and the use of respectful language.

DISCUSSION

This IPE curriculum built around podcasts enhances medical student learning and represents an innovative approach to improving access to IPE in a virtual learning environment. This modality can be adapted to meet the needs of a wide spectrum of learners and can be coupled with in-person learning.

Interprofessional Education Without Limits: A Video-Based Workshop

INTRODUCTION

Interprofessional collaboration improves patient outcomes. Many institutions lack access to learners from other health care professions, limiting the feasibility of many published interprofessional curricula. We created a video-based workshop to fill the need for an introductory interactive interprofessional activity for third-year medical students (MS 3) in their internal medicine clerkship, in which other health care students and standardized patients were not readily accessible.

METHODS

This session introduced medical students to the interprofessional model of care through a video workshop. Learners engaged in reflective observation as a video presented a physician interviewing a patient. The training and roles of interprofessional providers were discussed with the aid of video demonstrations. Learners completed postworkshop and postmedicine clerkship surveys with responses indicated using a Likert scale (1 = strongly disagree, 5 = strongly agree).

RESULTS

Sixty-seven MS 3s participated in this workshop; postworkshop survey response rate was 82%. Of students who responded to the surveys, 87% agreed that the video increased their understanding of when it would be beneficial to consult interprofessional team members. Students' confidence in interacting with interprofessional team members improved from a mean of 3.0 before the workshop to 3.7 after the workshop. At the end of the medicine clerkship, 71% indicated that the video improved their ability to work with interprofessional team members at least moderately.

DISCUSSION

This video-based workshop improved students' self-rated understanding of interprofessional team members' roles and increased their confidence interacting with other members of the interprofessional health care team.