Interprofessional communication skills training to improve medical students' and nursing trainees' error communication - quasi-experimental pilot study

BACKGROUND

Interprofessional communication is of extraordinary importance for patient safety. To improve interprofessional communication, joint training of the different healthcare professions is required in order to achieve the goal of effective teamwork and interprofessional care. The aim of this pilot study was to develop and evaluate a joint training concept for nursing trainees and medical students in Germany to improve medication error communication.

METHODS

We used a mixed-methods, quasi-experimental study with a pre-post design and two study arms. This study compares medical students (3rd year) and nursing trainees (2nd year) who received an interprofessional communication skills training with simulation persons (intervention group, IG) with a control group (CG). Both cohorts completed identical pre- and post-training surveys using the German Interprofessional Attitudes Scale (G-IPAS) and a self-developed interprofessional error communication scale. Descriptive statistics, Mann-Whitney-U-test and Wilcoxon-test were performed to explore changes in interprofessional error communication.

RESULTS

A total of 154 were medical students, and 67 were nursing trainees (IG: 66 medical students, 28 nursing trainees / CG: 88 medical students, 39 nursing trainees). After training, there were significant improvements observed in the "interprofessional error communication" scale (p < .001) and the "teamwork, roles, and responsibilities" subscale (p = .012). Median scores of the subscale "patient-centeredness" were similar in both groups and remained unchanged after training (median = 4.0 in IG and CG).

CONCLUSIONS

Future studies are needed to find out whether the training sustainably improves interprofessional teamwork regarding error communication in acute care.

Measuring LEND Core Competencies Using Trainee Follow-Up Surveys

OBJECTIVES

Measuring the value-added impact of Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) training on trainees' leadership and career trajectories is necessary to understand program efficacy. In the current study, we leveraged an existing ex post facto design to develop and test a new measure of LEND competencies and compare outcomes of LEND trainees and comparison peers.

METHODS

We developed the LEND Outcomes Follow-Up Survey using a multi-step, mixed methods process. A series of focus groups and consultations with key stakeholders identified eight important LEND leadership outcomes: (1) interdisciplinary work; (2) advocacy; (3) intersectional approach; (4) systems perspective; (5) life course perspective; (6) leadership; (7) engagement with maternal and child health populations; and (8) research experience. We developed and piloted this novel survey to measure these LEND leadership outcomes. We used data collected from this novel measure and an existing survey that is used nationally by LEND, to compare the outcomes of 43 LEND trainees and 30 comparison peers at two years post completion of LEND training.

RESULTS

We found that, compared to comparison peers, LEND trainees: (1) worked with a greater number of disciplines; (2) were more likely to be engaged in advocacy; (3) were more likely to utilize a systems perspective in their work; (4) were more likely to work with maternal and child health populations; and (5) were more likely to have experience conducting research.

CONCLUSIONS

Our findings suggested that LEND training improves LEND leadership outcomes at two years post-completion of LEND training.

Evaluation of the feasibility of a video-transmitted surgical ward round: a proof of concept study

BACKGROUND

Surgical ward rounds are key element to point-of-care interprofessional postoperative treatment and technical and communicational aspects are relevant for the patient's safety and satisfaction. Due to COVID-19 restrictions, the training opportunity of experiencing a face-to-face surgical ward round was massively hampered and thus, we developed a digital concept. This study aims to investigate the feasibility of video-transmitted ward rounds integrating surgical and communicational aspects with live streaming from wards. Further, medical students were asked for their satisfaction and their subjective learning success.

METHODS

The proof-of-concept study consisted of self-reported subjective evaluation of competences in ward round skills. Qualitative feedback was collected to gain deeper insight and students' empathy was rated by using the student version of the Jefferson Empathy Scale (JES).

RESULTS

One hundred three medical students participated. The students were satisfied with the video-transmitted ward round (M = 3.54; SD = 1.22). In the subjective evaluation students' ward round competencies rose significantly (p < .001, Mpre = 3.00, SD = 0.77; Mpost = 3.76, SD = 0.75). The surgeon was rated as empathic (M = 119.05; SD = 10.09). In the qualitative feedback they named helpful aspects like including an expert for communication. However, they preferred the face-to-face setting in comparison to the digital concept.

CONCLUSIONS

It was feasible to implement a video-transmitted ward round within a pandemic. The format worked technically, was well-accepted and also led to a subjective rise in the students' competencies. Video-transmitted ward rounds may be integrated to support the medical education, though, they cannot replace the face-to-face setting.

Attitudes of health care professionals towards interprofessional teamwork in Ashanti Region, Ghana

BACKGROUND

Interprofessional collaboration ensures that high-quality health care is provided leading to improved health outcomes and provider satisfaction. Assessing the attitudes of health care professionals towards teamwork in Ghana is novel.

OBJECTIVE

To examine the attitudes of health care professionals towards interprofessional teamwork and assess specific attributes influencing these attitudes in the Ashanti region, prior to implementing an in-service interprofessional HIV training programme.

METHODS

A cross-sectional pre-training online survey using a modified Attitudes Toward Health Care Teams Scale was conducted among health care practitioners undergoing a two-day interactive interprofessional HIV training in Kumasi and Agogo from November 2019 to January 2020. Trainees were diverse health professional cadres selected from five hospitals in the Ashanti region of Ghana. Data was summarised using the mean and standard deviation for continuous variables, and frequencies and percentages for categorical variables. An exploratory factor analysis was conducted to categorise the 14 items of the modified attitudes scale. The Wilcoxon rank-sum (Mann-Whitney) and Kruskal-Wallis tests were used to test the mean attitude difference among the demographic characteristics. Statistical significance was set at p < 0.05.

RESULTS

Altogether, 302 health professionals completed the survey. The ages ranged from 20-58 years, mean age 27.96 years (standard deviation 5.90 years). Up to 95% of the trainees agreed with the 14 statements on the modified attitudes scale. Three factors were identified; "quality of care", "team efficiency", and "time constraint" with Cronbach's alpha measures of 0.73, 0.50, and 0.45 respectively. The overall mean attitude score was 58.15 ± 6.28 (95% CI, 57.42-58.88). Attitude of health care professionals towards interdisciplinary teams for patient care varied significantly by age (p = 0.014), health profession cadre (p = 0.005), facility (p = 0.037), and professional experience (p = 0.034).

CONCLUSION

Strengthening in-service interprofessional training for health practitioners especially early career professionals in the Ashanti region would be valuable.

Our Patients Need Empathy Training across Healthcare Professions

Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.

[Evaluation of simulation-based training program intended to improve interprofessional communication skills of community pharmacy and general medicine students]

OBJECTIVES

The objective of this work is to assess the impact of a simulation session on the ability of pharmacy and medicine students in general practice to communicate in the resolution of patient-facing situations.

METHODS

The evaluation of the impact of the session on the representation of the professions used a questionnaire to be completed before and after the session by the students. The evaluation of the impact of the session on the perception of communication and associated skills was based on an audio recording of the debriefings, which, after transcription and thematic analysis, was used as a preliminary analysis for the drafting of a questionnaire proposed the following year. This questionnaire focused on the issues of interprofessional communication and on the seminar process.

RESULTS

During the 2018 and 2019 seminars, 518 students attended, 39% were pharmacy students (n=201) and 61% were medical students (n=317). The majority of medical students initially responded that physician-pharmacist communication was confraternal and rare. More pharmacy students felt that the quality of the physician-pharmacist relationship was poor. However, there was a marked improvement for all students on this aspect of communication after the seminar. Both groups also generally agreed that this relationship could be improved.

CONCLUSIONS

The evaluation shows that an interprofessional simulation program improves the ability of pharmacy and general practice students to communicate in patient-facing situations.

Task-based training to prevent surgical site infection: A formative evaluation

Background

Lack of evidence-based training constitutes a serious impediment to preventing surgical site infections in low-middle income countries (LMIC). The purpose of this study was to design and implement an infection prevention training programme and investigate how it might work in an LMIC. Intended for healthcare professionals working in operating rooms, the programme was based on current instructional design principles of interprofessional, task-based learning. The second aim was to carry out a formative evaluation exploring participants' and facilitators' perceptions and experiences of the training.

Methods

In undertaking this design-based research, we used a mixed-methods approach. The four session training was attended by anaesthesia and surgical trainees, registered nurses, technologists and included a video showing best practices, role plays, and peer-group reflection. We evaluated the programme through questionnaires, focus-group interviews with participants, written reflections by participants, and individual interviews with facilitators. Quantitative analysis was complemented by thematic analysis of focus-group and interview transcripts, reflections, and observer notes.

Results

Our analysis revealed that participants had positive attitudes towards the training. They felt they had learned a lot from each other and the facilitators offered them the opportunity to interact with each other. Trainees especially valued the video presentation as it inspired them to revise old concepts and presented an excellent practical example of infection prevention in their specific setting.

Conclusion

The training seemed to bridge the gap between knowledge and practice. However, direct observation of procedural skills and peer feedback could further reduce the gap, by enhancing the transfer of knowledge to practice.

A model to evaluate interprofessional training effectiveness: feasibility and five-year outcomes of a multi-site prospective cohort study

OBJECTIVES

Assessing the impact of interdisciplinary training programs is highly desirable and needed. However, there are currently no established methods to prospectively assess long-term outcomes of trainees compared to individuals who did not receive training. Our objective was to test the feasibility of a longitudinal, prospective cohort design to evaluate training outcomes, and to use this method to evaluate Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) training outcomes.

METHODS

LEND trainees were matched to comparison peers and followed annually for up to five years using a pre-existing outcomes survey. We assessed study feasibility using recruitment and retention data over five years. We then looked at preliminary efficacy of LEND training in LEND trainees compared to comparison peers using the pre-existing outcomes survey.

RESULTS

Overall, 68.3% of eligible trainees participated in the Outcomes Study across five years, and 66.0% were matched to comparison peers. On average, 84.4% of LEND trainees and 79.9% of comparison peers completed the outcomes survey annually. Attrition was low at 0.9% for LEND trainees and 2.6% for comparison peers over five years. LEND training demonstrated preliminary efficacy in promoting leadership development: LEND trainees began their careers engaged in more leadership activities than comparison peers, and the rate of growth in their participation in leadership activities was greater.

CONCLUSIONS

The design used to assess outcomes is a feasible approach that can be widely used to assess training program outcomes. Analyses suggest that LEND training is efficacious in increasing involvement in leadership activities over time after graduation.

Interprofessional Education in Child and Adolescent Mental Health: A Scoping Review

To identify elements of effective interprofessional education (IPE) within child and adolescent mental health (CAMH), we conducted a scoping literature review. A search of four databases revealed 32 studies that met inclusion criteria describing IPE interventions regarding CAMH. Studies included a range of medical, mental health, allied health, educational, and community professionals in clinical, school-based, and community-based settings. The majority of studies have focused on autism or general child mental health. Outcomes were generally positive but skewed toward attitudinal and knowledge-based measures. Practice-based interventions tended to support higher levels of educational outcomes, including behavioral, patient-level, or systems-level changes.

Protocol for two-arm pragmatic cluster randomized hybrid implementation-effectiveness trial comparing two education strategies for improving the uptake of noninvasive ventilation in patients with severe COPD exacerbation

Background

COPD is the fourth leading cause of death in the US, and COPD exacerbations result in approximately 700,000 hospitalizations annually. Patients with acute respiratory failure due to severe COPD exacerbation are treated with invasive (IMV) or noninvasive mechanical ventilation (NIV). Although IMV reverses hypercapnia/hypoxia, it causes significant morbidity and mortality. There is strong evidence that patients treated with NIV have better outcomes, and NIV is recommended as first line therapy in these patients. Yet, several studies have demonstrated substantial variation in the use of NIV across hospitals, leading to preventable morbidity and mortality. Through a series of mixed-methods studies, we have found that successful implementation of NIV requires physicians, respiratory therapists (RTs), and nurses to communicate and collaborate effectively, suggesting that efforts to increase the use of NIV in COPD need to account for the complex and interdisciplinary nature of NIV delivery and the need for team coordination. Therefore, we propose to compare two educational strategies: online education (OLE) and interprofessional education (IPE) which targets complex team-based care in NIV delivery.

Methods and design

Twenty hospitals with low baseline rates of NIV use will be randomized to either the OLE or IPE study arm. The primary outcome of the trial is change in the hospital rate of NIV use among patients with COPD requiring ventilatory support. In aim 1, we will compare the uptake change over time of NIV use among patients with COPD in hospitals enrolled in the two arms. In aim 2, we will explore mediators’ role (respiratory therapist autonomy and team functionality) on the relationship between the implementation strategies and implementation effectiveness. Finally, in aim 3, through interviews with providers, we will assess acceptability and feasibility of the educational training.

Discussions

This study will be among the first to carefully test the impact of IPE in the inpatient setting. This work promises to change practice by offering approaches to facilitate greater uptake of NIV and may generalize to other interventions directed to seriously-ill patients.

Trial registration

Name of registry: ClinicalTrials.gov

Trial registration number: NCT04206735

Date of Registration: December 20, 2019

An interprofessional experience in diabetes management for pharmacy and medical students

BACKGROUND AND PURPOSE

The 2016 Standards of the Accreditation Council for Pharmacy Education state that curricula must include opportunities for interprofessional education (IPE). This report describes a collaborative effort between a pharmacy program and a school of medicine to develop, implement, and evaluate an interprofessional workshop focused on collaborative disease management.

EDUCATIONAL ACTIVITY AND SETTING

A medical school course in diabetes management was identified as optimal for an IPE approach. One class session was designed to highlight the advantages of team-based care in diabetes management and describe the roles of members of an interprofessional healthcare team. Students were divided into groups to discuss cases and demonstrate diabetic device counseling. Students were surveyed before and after the IPE experience to examine their attitudes towards interprofessional learning.

FINDINGS

We obtained matched pre and post-evaluations from 168 participants (138 medical students and 30 pharmacy students). Learner attitudes were positive overall, and improved from pre-test (M = 80.28, SD = 10.29) to post-test (M = 82.83, SD = 9.40, F = 14.92, df = 1, p < .001), suggesting more favorable attitudes to interprofessional learning after completing the class. Multivariate analysis indicated a significant main effect for learner profession, suggesting pharmacy students had more positive attitudes to interprofessinal learning both before and after the workshop.

SUMMARY

Adding an IPE dimension to an existing medical school course had a positive impact on student perceptions of interprofessional practice, particularly for the pharmacy students who could demonstrate the value of their role on a team for patient care.

Call the On-Call: a study of student learning on an interprofessional training ward

Interprofessional training wards are designed to train students' team and communication competences. Such wards are generally highly valued clinical placements by undergraduate students; however, evidence in the literature suggests that medical students experience a lack of profession-specific tasks on these wards. Moreover, students lack structured training in the complexities of everyday communication where different health professions rarely are present together in stable teams. This paper reviews one strategy to train students in interprofessional communication while letting students perform profession-specific tasks. A qualitative study with ethnographically-collected data was conducted among three interprofessional student teams over three two-week periods, mixing field observations (75 h), interviews (n = 16), and field notes (45 pages). The findings show that students gained insights into new aspects of their professional roles and an appreciation of clear and open interprofessional communication over the telephone. Learning was facilitated through being confronted with new situations and discussing these experiences with each other over time. Call the On-Call as a pedagogic activity provided not just medical students, but also nursing students with new types of profession-specific tasks on the interprofessional training ward.

Interprofessional training for the delivery of community health services in Mexico: the experience of Partners in Health

Interprofessional training in health is scarce in Mexico. Partners in Health (CES in Spanish), is the branch of an international civil society organization that provides health services to poor and rural populations. CES runs a set of ten health centers in Chiapas, Mexico, in partnership with the local Ministry of Health. A key component of the provision strategy is to train healthcare providers, mainly medical and nursing students in their final year of training, to create healthcare teams that work together while fostering their individual capacities. CES offers a diploma on Global Health and Social Medicine, where medical and nursing students -also called pasantes- interact to discuss jointly the effects of global and social determinants of health in local communities, as well as specific clinical topics. A qualitative study including interviews and nonparticipant observations was undertaken to identify initial achievements and challenges of the experience. CES has achieved important benefits related to teamwork as well as clinical capacities of individuals as healthcare providers. However, challenges have emerged: differences in social origin, personal development expectations, professional identity and institutional roles hinder team cohesion. Consequently, CES has introduced adjustments to reduce the negative impact of these differences. Although the training model needs further development, the possibility of transferring some of its good practices to non-CES scenarios should be seriously considered by health authorities.

Bridging the training-practice gap in interprofessional student supervision

BACKGROUND

Workforce recruitment and retention issues are common in highly dispersed regions such as Queensland in Australia. Provision of student placements in these non-metropolitan areas is one way of promoting staff recruitment. However, healthcare professionals in these areas face a number of challenges in accessing training opportunities including student supervision training. Funding was made available to develop and run a series of targeted, evidence-based, interprofessional student supervision workshops in non-metropolitan Queensland.

METHODS

Workshop participants were health professionals from both public and private health service providers in Queensland. Using a pre-post design, anonymous data were collected through surveys administered before and after workshop participation. Descriptive statistics were used to analyze participant information. Free text responses were categorized using an iterative process to identify prevalent themes.

RESULTS

A total of 147 participants attended nine face-to-face workshops and provided data. Allied health participants represented 70% of the population, with the remainder largely from nursing, medicine and dentistry. There was a positive shift in self-reported level of confidence in student supervision following training. Of the participants 143 (97%) reported that they acquired new skills and knowledge from training. A number of enablers of and barriers to translation of learning to practice following interprofessional student supervision training were identified.

CONCLUSIONS

Targeted interprofessional student supervision training is valuable and can increase participants' self-reported level of confidence in student supervision. It is recommended that health organizations promote a culture of providing positive student placement experiences in order to maximize future workforce opportunities.

Crossing the quality chasm: it takes a team to build the bridge

The paradigm shifts in healthcare delivery now more than ever call for interdisciplinary teamwork to deliver the best patient care. The lessons from the Institute of Medicine's To Err Is Human: Building a Safer Health System report are painful but elucidate the problems with training and working in silos and the consequent inconsistent communication between healthcare providers. We review the literature regarding interprofessional training and describe some strategies and innovations. This article proposes that healthcare professional schools embed interprofessional education into the curriculum to meet the challenges of providing high-quality, efficient, and safe patient care.