Board #108 - Research Abstract Using Reflective Writing to Assess Impact of an Inter-Professional Cardio-Pulmonary Workshop for Medical, Nursing and Respiratory Therapy Students (Submission #8645)

Abstract

Hypothesis Modern healthcare is delivered in teams; however, healthcare education has lagged behind practice in providing opportunities for students to learn the skills required to function effectively as a member of an inter-professional (IP) team. Educators are challenged to create effective training activities that expose students to communication skills and allow the opportunity to practice these skills. The outcome of these activities should be students who use these skills in the clinical environment to improve patient care. This highlights a second set of challenges – creating training curricula that effectively transfer these skills from the simulation lab into actual clinical practice, and developing metrics to assess the transfer of training.Our hypothesis is that reflective writing can be used to assess the impact of an IP training curriculum on the students’ application of communication skills in the clinical environment. Methods We developed a simulation-based curriculum for nursing, respiratory (RT), and medical (med) students around critical care topics. In one station, students engaged in faculty facilitated group problem-solving for ventilator alarms, exam and transfer of a ventilated patient. The second station involved immersive simulation in which IP student teams assessed and managed a patient with a cardiac arrhythmia. Within the technical skills training, nursing and medical faculty co-led discussion and demonstration of interprofessional team skills including closed-loop communication, flattened hierarchy, anticipatory behavior, role clarity, and shared mental model. Curriculum effectiveness was evaluated through post workshop survey and participant reflective essays addressing an example of how the skills were applied in practice. 3 independent trained reviewers used qualitative content analysis to identify themes in each of the essays. Differences were resolved through discussion and consensus. Results One-hundred nursing, 20 med, and four RT students participated. Fortynine nursing and 17 med students filled out post surveys. One-hundred nursing and 20 med students completed reflective writing. We coded 20 randomly sampled nursing essays and 20 medical student essays. 65/67 students rated the workshop as good or excellent in teaching teamwork skills. Nursing and med student reflective writing themes were similar. We observed different Kirkpatrick levels of impact in the essays, including multiple levels in a single essay. 75% of students described applying at least one new teamwork skill in clinical practice, and 60% of these students observed an improved patient, team or personal outcome as a result of skill use, including improved efficiency and quality of care, fewer errors and increased confidence. 35% observed a teamwork skill in a team member, and 64% described new knowledge or awareness. The dominant skills used or observed were closed-loop communication, role clarity, and flattened hierarchy. Conclusion This IP simulation-based workshop was well rated by students, who felt this format effectively taught teamwork skills. A single exposure to these skills has incomplete transfer into clinical practice for these undergraduate learners. The reflective writing pieces were completed within one month of training, but we expect that if teamwork skills haven’t been practiced by then, they are not likely to be used without additional training or structured opportunities to practice. Additional measures of participants’ teamwork skills in the lab and in practice would help better understand the correlation between self-reflection and actual effectiveness of teamwork skills in an individual. While much of team training research has been focused on practicing providers, interventions at the early clinical or pre-clinical levels may prove more effective. More work is needed to understand the “dosing” and “frequency” required for effective teamwork skills acquisition and transfer to practice. Disclosures None