Interprofessional Simulation Training Research Articles

Improving quality through simulation; developing guidance to design simulation interventions following key events in healthcare

Simulation educators are often requested to provide multidisciplinary and/or interprofessional simulation training in response to critical incidents. Current perspectives on patient safety focus on learning from failure, success and everyday variation. An international collaboration has led to the development of an accessible and practical framework to guide the implementation of appropriate simulation-based responses to clinical events, integrating quality improvement, simulation and patient safety methodologies to design appropriate and impactful responses. In this article, we describe a novel five-step approach to planning simulation-based interventions after any events that might prompt simulation-based learning in healthcare environments. This approach guides teams to identify pertinent events in healthcare, involve relevant stakeholders, agree on appropriate change interventions, elicit how simulation can contribute to them and share the learning without aggravating the second victim phenomenon. The framework is underpinned by Deming’s System of Profound Knowledge, the Model for Improvement and translational simulation. It aligns with contemporary socio-technical models in healthcare, by emphasising the role of clinical teams in designing adaptation and change for improvement, as well as encouraging collaborations to enhance patient safety in healthcare. For teams to achieve this adaptive capacity that realises organisational goals of continuous learning and improvement requires the breaking down of historical silos through the creation of an infrastructure that formalises relationships between service delivery, safety management, quality improvement and education. This creates opportunities to learn by design, rather than chance, whilst striving to close gaps between work as imagined and work as done.

Interprofessional Paediatric High-Fidelity Simulation Training: A Mixed Methods Study of Experiences and Readiness among Nursing and Medical Students.

Training in communication skills between nursing and medical students during interprofessional paediatric emergency simulation training represents a significant aspect of safe patient care. Evidence highlights that poor communication in paediatric emergency scenarios jeopardises patient safety. Through realistic simulations, students practice the communication strategies of crisis resource management (CRM), such as "closed-loop communication", "speaking up", and "team time-out". In this study, we aimed to evaluate the impact of interprofessional simulation on enhancing teamwork and communication skills. Additionally, we sought to assess the occurrence of contexts for the three CRM communication strategies during simulations. Employing a mixed methods research design, the analysed students completed pre- and post-simulation online questionnaires. To measure attitudes towards interprofessional collaboration, we used the German version of the University of West England Interprofessional Questionnaire (UWE-IP_german), and to measure interprofessional attitudes, we used the Greifswald Questionnaire for the Measurement of Interprofessional Attitudes (Greif Mie), also in German, for both pre- and post-simulation. For qualitative video analysis, we utilised Grounded Theory Methodology (GTM). Following simulation training, we observed a significant improvement (p > 0.001) in the subscale "attitude towards interprofessional learning" of the UWE-IP_german among nursing and medical students. Medical students consistently exhibited a significantly (p < 0.001) more positive attitude towards other professionals in both the pre- and post-simulation assessments. Overall, all the students expressed satisfaction with the interprofessional simulation training. In the qualitative selective coding process, the central phenomenon "participation" could be identified in the coding paradigm. This study presents substantial evidence of the learning impact of interprofessional paediatric simulation training on nursing and medical students.

High-consequence infectious diseases: the conception and development of a multi-disciplinary, interprofessional simulation training programme

High-consequence infectious diseases (HCIDs) represent a group of acute infectious diseases with the potential to impact healthcare systems and public health profoundly. Effective management requires a system-based strategy focused on early detection, initiation of infection prevention and control measures, and appropriate use of personal protective equipment (PPE). Inadequate training in the safe use of HCID PPE, and lack of familiarity with key processes such as HCID waste and spills management, exacerbates the risk posed to healthcare workers (HCWs). Enhanced training opportunities are required to ensure that staff are equipped with the necessary knowledge and capabilities to protect themselves from pathogen exposure and infection. To create a bespoke interprofessional HCID simulation training programme. A detailed learning needs analysis was undertaken, which identified multiple areas amenable to educational intervention. A full-day HCID simulation programme was developed, providing HCWs the opportunity to practice and gain proficiency in various domains. Six interprofessional participants took part in the HCID simulation programme pilot. All six (100%) participants felt that the stated learning objectives had been achieved, and five and one participants found the programme to be extremely useful (83%) or very useful (17%), respectively. Following refinement based on pilot feedback, a further six courses have been run for 38 participants, of whom 97% found the programme to be extremely useful or very useful. The development of a training intervention in the low-frequency, high-risk field of HCIDs had a positive impact. Given the disproportionate impact on HCWs at times of HCID outbreaks, more investment is needed to keep the workforce upskilled.

Healthcare Students’ Anxiety, Cognitive Load, and Trait-mindfulness during Interprofessional obstetric Simulation Training

Background Simulation anxiety can hinder healthcare students' learning. Trait-mindfulness may help reduce learners' anxiety and improve their cognitive load during simulation training. However, the relationship between healthcare students' anxiety, trait mindfulness, and cognitive load has not been studied together during undergraduate interprofessional obstetric emergency simulation training. Methods This observational correlational research examined the relationship between healthcare students' anxiety, trait-mindfulness, and cognitive load. Furthermore, it examined whether healthcare students' trait-mindfulness can moderate the effect of anxiety on cognitive load during undergraduate interprofessional obstetric emergency simulation training. Forty-six undergraduate medical and nursing students were enrolled in this study. Each participant (in a team of 3 to 4) completed one postpartum hemorrhage scenario. The French versions of the State-Trait Anxiety Inventory (STAI-Y; Gauthier &amp; Bouchard, 1993), the Mindfulness Attention Awareness Scale (Germann et al., 2009), and Paas’s cognitive load scale (Paas, 1992) were used to measure anxiety, trait-mindfulness, and cognitive load, respectively. Results The study results show a positive correlation between healthcare students’ state-anxiety and cognitive load. Additionally, healthcare students’ mindfulness moderated the effect of state-anxiety on cognitive load during simulation training. Discussion As a personality trait, healthcare students’ mindfulness is associated with reduced simulation anxiety and improved cognitive load during obstetric emergency simulation training. Besides the learning tasks and simulation environment characteristics, simulation instructors should consider healthcare students’ anxiety and mindfulness to optimize their cognitive load during simulation training. Conclusion The study demonstrated that healthcare students’ trait mindfulness mitigates the magnitude of simulation anxiety on cognitive load during emergency simulation training. It suggests further examining healthcare students’ personality traits to detect potential interactions of their traits with the simulation learning process.

A MODEL FOR TEACHING STUDENTS AGE-FRIENDLY CONCEPTS USING VIRTUAL INTERPROFESSIONAL SIMULATION

Abstract Achieving effective Age-Friendly Health Systems requires teaching the future healthcare workforce how to consistently use the 4Ms framework in the care of older adults: What Matters, Medication, Mentation, and Mobility. Effective interprofessional teamwork is key to operationalizing this model. We describe here a virtual interprofessional student simulation training that demonstrates the importance of teamwork in addressing each of the 4Ms concepts and, importantly, how inattention to one ‘M’ can lead to ineffective care. Our training prepares learners with online didactic pre-work followed by a virtual simulation experience where interprofessional groups of students simulate a team care planning meeting. The case demonstrates how ‘what matters most’ to the patient (i.e., providing care for her husband who has dementia) impacts each of the other Ms. Specifically, she is taking medications inappropriately, has symptoms of depression, and will not undergo recommended surgery to correct mobility issues due to concerns about who will care for her husband. We have conducted this training with 548 undergraduate and graduate students representing medicine, nursing, pharmacy, social work, nutrition/dietetics, counseling, physical, occupational and speech therapy. 95% of students rated the simulation experience positively. There was statistically significant improvement in appreciation for teamwork (p&amp;lt; 0.001), evidence-based practice (p&amp;lt; 0.001), and inclusion of the patient and caregiver perspectives (p&amp;lt; 0.001) comparing pre and post simulation survey results. These results indicate a positive impact on student’s preparedness to incorporate 4Ms principles into their future practice, thus advancing both Age Friendly and Dementia Friendly Health System initiatives.

Interprofessional obstetric simulation training improves postpartum haemorrhage management and decreases maternal morbidity: a before-and-after study.

To determine the impact of the Obstetric Simulation Training and Teamwork (OB-STaT) curriculum on postpartum haemorrhage (PPH) rates and outcomes. Before-and-after study. Maternity care hospitals within the USA. Patients who delivered between February 2018 and November 2019. Interprofessional obstetric teamwork training (OB-STaT) conducted at each hospital. Electronic medical records for deliveries were reviewed for 6 months before and after conducting OB-STaT at participating hospitals. The PPH rate (blood loss of ≥1000 ml), uterotonic medications used, tranexamic acid use, blood product transfusion, hysterectomy, length of stay and composite maternal morbidity (postpartum haemorrhage, hysterectomy, transfusion of ≥4 units of blood products and intensive care unit admission for PPH). A total of 9980 deliveries were analysed: 5059 before and 4921 after OB-STaT. The PPH rates did not change significantly (5.48% before vs 5.14% after, p = 0.46). Composite maternal morbidity decreased significantly by 1.1% (6.35%-5.28%, p = 0.03), massive transfusions decreased by 57% (0.42%-0.18%, p = 0.04) and the mean postpartum length of stay decreased from 2.05 days (1.05 days SD) to 2.01 days (0.91 days SD) (p = 0.04). Following OB-STaT, haemorrhage medication use increased by 36% (14.8%-51.2%, p = 0.03), the use of tranexamic acid for PPH treatment almost doubled (2.7%-4.8%, p < 0.001) and the rate of hysterectomy significantly increased (0%-0.1%, p = 0.03). Although the PPH rates did not decrease, OB-STaT significantly improved maternal morbidity, decreased massive transfusions, and improved PPH management by increasing the utilization of uterotonic medications, tranexamic acid and hysterectomy.

Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation.

Planned home or birth center births sometimes require emergency transfers to a hospital. Poor communication among members of the birth care team during a transfer can lead to unfavorable outcomes for the birthing person and newborn. To improve the quality of birth transfers in Utah, the Utah Women and Newborns Quality Collaborative partnered with the LIFT Simulation Design Lab to develop and pilot an interprofessional birth transfer simulation training. We engaged community stakeholders to identify learning objectives and co-design the simulation trainings using principles of participatory design. We conducted 5 simulation trainings featuring birth transfers during a postpartum hemorrhage. The LIFT Lab evaluated the trainings to determine if they were feasible, acceptable, and effective. Measures included a post-training form asking participants to evaluate the quality of the training and a 9-question pre- and post-training survey measuring changes in participants' self-efficacy regarding components of birth transfer. The changes were assessed for significance using a paired t test. A total of 102 participants attended the 5 trainings; all health care provider groups were well represented. Most participants felt the simulations were similar to real situations and would benefit others in their professions. All participants said the trainings were a good use of their time. Following the training, participants had significantly higher levels of self-efficacy regarding their ability to manage birth transfers. Birth transfer simulation trainings are an acceptable, feasible, and effective method for training interprofessional birth care teams.

Trauma Team High-Fidelity Simulation Training in a Rural Level III Trauma Center: An Interprofessional Experience.

Emergency department trauma resuscitation requires teamwork and high-stakes clinical decision-making. Rural trauma centers with low trauma activation volumes must ensure that resuscitations are efficient and safe. The purpose of this article is to describe the implementation of high-fidelity, interprofessional simulation training to foster trauma teamwork and role identification for trauma team members responding to trauma activations in the emergency department. High-fidelity, interprofessional simulation training was developed for members of a rural Level III trauma center. Subject matter experts created trauma scenarios. An embedded participant led the simulations using a guidebook that outlined the scenario and learner objectives. The simulations were implemented from May 2021 through September 2021. Postsimulation survey results identified that participants found training with other professions valuable and that knowledge was gained. Interprofessional simulations enhance team communication and skills. Combining interprofessional education with high-fidelity simulation creates a learning environment that optimizes trauma team function.

Out of textbook and [almost] into the clinic: Case simulation in integrated care training.

A growing recognition of the need for specialized training to prepare health care providers to work in integrated care (IC) settings requires innovative methods to educate learners. There is an opportunity to provide IC trainees with relevant experiential opportunities to practice these techniques using simulation-based learning, a well-established training approach in medical education. This pilot study sought to examine the feasibility of using simulation-based learning in the interprofessional training of Marital and Family Therapy (MFT) and Family Nursing Practitioner (FNP) trainees in relevant integrated care competencies. Participants included 26 learners (21 MFT and five FNP). The case simulation event involved students completing a video telehealth clinical encounter involving a warm handoff. Clinical faculty observed trainees, completed a checklist designed specifically for the event, and provided feedback directly after the event. Trainees reported high satisfaction with the use of simulation-based learning. Observational coding revealed that trainees successfully implemented many elements of a warm handoff, however, aspects involving interprofessional communication, brief intervention, and follow-up planning appeared more challenging. Increased utilization of interprofessional case simulation training in masters and doctoral level behavioral health programs could help accelerate the development of a competent integrated care workforce. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Virtual safety: using online simulation to prepare trainees for their community safeguarding roles

Conducting child protection medical assessments (CPMA) where there are concerns of non-accidental injury (NAI) is a key clinical skill for paediatricians and part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum [1]. Child Protection (CP) simulation training was commissioned following trainee feedback around unpreparedness when carrying out CPMA. The COVID-19 pandemic forced delivery of online CP simulation. Initial learners were paediatric trainees; with newly qualified school nursing and health visiting colleagues in subsequent delivery; allowing for multi-professional learning in the simulated environment. The session aims were to: - increase familiarity with professional conversations in the CP context - formulate an evidence-based opinion in cases of suspected NAI - rehearse discussing outcomes of CPMA with parents/carers and social workers We rehearsed, modified, and then, using Zoom as a synchronous platform, with a trained simulated patient (SP) and faculty as role players created three 10-minute community-based CP scenarios for a twice-yearly programme. Pre-course information and a pre-briefing explained the online limitations and opportunities, including how we co-create psychological safety, the option of a wellbeing ‘wobble’ room, also outlining the Diamond debriefing model [2]. Pre- and post-course surveys were sent to the 18 participants. Likert scale ratings on confidence and anxiety levels when approaching a CP medical; familiarity with and likelihood of using the HEADSSS tool [3] was analysed using paired T-test probability. 94% (17/18) had no previous CP simulation experience. Confidence in carrying out CPMA increased post-simulation (p= 0.00418) Anxiety going into the CPMA decreased post-simulation (p=0.00624). 44% were familiar with HEADSSS tool pre-course and 94% were more likely to use it post-course (Likert rating 4or5). Confidence in expressing concerns to parent/carer rose from 11% to 82.3% post-course (Likert rating 4or5). Free text learning points included ‘Use what you can agree on (parent and doctor) as a foundation for developing rapport.’ ‘… very useful in preparation for community.’ ‘… very helpful in giving me more confidence in carrying out medicals.’ ‘Never undertaken a simulation with an actor, it felt real (I was surprised)’, ‘interesting to share learning… as practitioners have different perspectives.’ Despite sensitivity of the subject and the emotive realism brought by the SP’s, psychological safety was achieved in this online interprofessional CP simulation training through detailed preparation in course design and faculty preparedness. The pilot was successful in preparing participants to fulfil their safeguarding role. Online training continues to be a synchronous induction for 2022. 1. RCPCH. Progress curriculum. Royal College of Paediatrics and Child Health 2018. 2. Jaye P, Thomas L, Reedy G. The Diamond: a structure for simulation debrief. The Clinical Teacher. 2015; 12(3):171–175. 3. Cohen E, Mackenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health. 1991;12(7):539–44.

Interprofessional simulation training for perinatal mental health: A mixed methods study

AbstractObjectiveTo determine the effectiveness of high‐fidelity interprofessional simulation on improving self‐efficacy of healthcare staff caring for individuals with perinatal mental health (PNMH) problems.MethodsThis study employed a mixed methods, quasi‐experimental intervention design. Participants were 240 doctors, nurses, midwives, and other clinical and nonclinical healthcare professionals recruited to partake in the study during their time undertaking the course. The course took place in a simulation centre, re‐creating high fidelity scenarios of a woman's pathway of treatment in perinatal mental health care. The course consisted of six simulated scenarios using trained actors to portray patients with common perinatal mental health presentations. Participants each took part in and observed at least 1–2 scenarios and all subsequently engaged in reflective group debriefs.Main Outcome MeasuresThe Human Factor Skills for Healthcare Instrument (HFSHI), measuring self‐efficacy in human factors skills, and a scale developed for this study—the Course Specific Question Scale (CSQ)—to measure changes in knowledge, skills and confidence on course‐specific learning objectives were used for pre‐ and post‐data. A post‐course evaluation form was used for gathering qualitative data on learning and course experience.ResultsParticipants expressed improvements in interprofessional collaboration, emotional awareness, reflection, communication and attitudes towards perinatal mental health following the course. Improvements in self‐efficacy alongside skills, knowledge and confidence regarding perinatal mental health care were also found.ConclusionsFindings suggest potential benefits of simulation training for perinatal mental health to improve self‐efficacy, knowledge and clinical practice. More research is needed to fully assess interprofessional simulation training in PNMH and the long‐term impact of training on clinical practice.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses.

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

Strategy to Develop a Common Simulation Training Program: Illustration with Anesthesia and Intensive Care Residency in France

Phenomenon : The urgency of having fair and trustworthy competency-based assessment in medical training is growing. Simulation is increasingly recognized as a potent method for building and assessing applied competencies. The growing use of simulation and its application in summative assessment calls for comprehensive and rigorously designed programs. Defining the current baseline of what is available and feasible is a crucial first step. This paper uses anesthesia and intensive care (AIC) in France as a case study in how to document this baseline. Approach : An IRB-approved, online anonymous closed survey was submitted to AIC residency program directors and AIC simulation program directors in France from January to February 2021. The researcher-developed survey consisted of 65 questions across five sections: centers' characteristics, curricular characteristics, courses' characteristics, instructors' characteristics, and simulation perceptions and perspectives. Findings : The participation rate was 31/31 (100%) with 29 centers affiliated with a university hospital. All centers had AIC simulation activities. Resident training was structured in 94% of centers. Simulation uses were training (100%), research and development (61%), procedural or organizational testing (42%), and summative assessment (13%). Interprofessional full-scale simulation training existed in 90% of centers. Procedural training on simulators prior to clinical patients' care was performed “always” in 16%, “most often” in 45%, “sometimes” in 29% and “rarely” or “not” in 10% of centers. Simulated patients were used in 61% of centers. Main themes were identified for procedural skills, full-scale and simulated patient simulation training. Simulation activity was perceived as increasing in 68% of centers. Centers expressed a desire to participate in developing and using a national common AIC simulation program. Insights : Based on our findings in AIC, we demonstrated a baseline description of nationwide simulation activities. We now have a clearer perspective on a decentralized approach in which individual institutions or regional consortia conduct simulation for a discipline in a relatively homogeneous way, suggesting the feasibility for national guidelines. This approach provides useful clues for AIC and other disciplines to develop a comprehensive and meaningful program matching existing expectations and closing the identified gaps.

Efficacy of interprofessional sport concussion simulation training for health care students and teacher candidates

This paper presents a simulated telehealth interprofessional (IP) meeting. Students from athletic training, nursing and teacher preparation programs participated in this simulation. The main objective of the learning activity was for students to conduct an IP team meeting using a collaborative approach in the context of concussion management. In this report, we also discuss how the simulation changed student self-efficacy in interprofessional team collaboration. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was used to retrospectively measure students' reflections of their competencies pre- and post-simulation. Quantitative data indicated that the greatest improvement was in the students' ability to work effectively with IP team members to enhance care and to understand team members’ abilities and contributions. Qualitative data also showed that students reported being able to collaborate with other professionals was the most helpful part of the simulation.

Influence of presence in an inter-professional simulation training of the emergency caesarean section: a cross-sectional questionnaire study

PurposeEmergency training using simulation is a method to increase patient safety in the delivery room. The effect of individual training concepts is critically discussed and requires evaluation. A possible influence factor of success can be the perceived reality of the participants. The objective of this study was to investigate whether the presence in a simulated emergency caesarean section improves subjective effect of the training and evaluation.MethodsIn this observation study, professionals took part in simulated emergency caesarean sections to improve workflow and non-technical skills. Presence was measured by means of a validated questionnaire, effects and evaluation by means of a newly created questionnaire directly after the training. Primary outcome was a correlation between presence and assumed effect of training and evaluation.Results106 participants (70% of course participants) answered the questionnaires. Reliability of the presence scale was good (Cronbach’s alpha 0.72). The presence correlated significantly with all evaluated items of non-technical skills and evaluation of the course. The factor “mutual support” showed a high effect size (0.639), the overall evaluation of the course (0.395) and the willingness to participate again (0.350) a medium effect. There were no differences between the professional groups.ConclusionThe presence correlates with the assumed training objectives and evaluation of the course. If training is not successful, it is one factor that needs to be improved.

Abstract 12580: An Interprofessional Approach to Standardizing Family Care During Code Blue Events

Introduction: The development of a standardized practice for family care during resuscitation (FPDR) events was identified as an area for quality improvement at a large academic hospital. Healthcare Chaplains were identified as ideal Family Facilitators for FPDR due to their professional training in therapeutic communication and existential crisis management as well as their current practice of responding to all Code Blue events. An interprofessional workgroup developed guidelines to delineate the role of Chaplain as Family Facilitator in Code Blue events and created an interprofessional education simulation (IPE-sim) training curriculum for their dissemination. Methods: The workgroup, which included an acute care nurse practitioner in the nursing faculty, a palliative care physician, and the director of Chaplain Services, conducted a thorough review of FPDR literature, analyzed data on Chaplain care provided at Code Blue events over the past 9 years, and entered into dialogue with stakeholders regarding FPDR. The group authored guidelines which were adopted as an addendum to the institution’s existing Code Blue policy. The workgroup collaborated with the Code Blue team to develop simulation training events to ensure proper application of the new guidelines. Results: This work resulted in the addition of FPDR guidelines to the Code Blue policy and the creation of a FPDR flowchart that standardized the Chaplain role in Code Blue events by delineating a communication process as well as FPDR inclusion and exclusion criteria. The implementation of this work was facilitated through three 4-hour IPE-sim training sessions. Conclusions: Standardized FPDR guidelines pertaining to the role of Chaplain as Family Facilitator improve patient- and family-centered care. Institutional FPDR guidelines should be created by an interprofessional team and vetted by multidisciplinary stakeholders. Simulation-enhanced IPE prepares Chaplains and teams for FPDR and can improve interprofessional collaboration during Code Blue events.

Exploring transformative learning for trainee pharmacists through interprofessional simulation: a constructivist interview study

BackgroundThe expanding roles of UK pharmacists have prompted substantial changes to the initial pharmacy education and training, including increasing recognition of the value of learning alongside other professional groups in acute settings. Interprofessional immersive simulation training appears to represent a useful educational tool to meet the evolving needs of the profession, but the impact of such training on workplace behaviour and relationships has not been explored. This study aimed to explore how interprofessional simulation training facilitates transformative learning in pre-registration pharmacists.MethodsAcross three different locations in Scotland, pre-registration pharmacists were paired with medical students to participate in immersive simulation scenarios with post-scenario debriefs. Pre-registration pharmacists were individually interviewed shortly after their simulation session, using a semi-structured interview schedule based on the transformative learning framework. Transcripts were analysed using template analysis, with Mezirow’s phases of perspective transformation forming the initial coding template.ResultsFifteen interviews following five simulation sessions at three different sites were undertaken. Phases 1–6 of the transformative learning framework all resonated with the pre-registration pharmacists to varying degrees. Two prominent threads became evident in the data: a change in participants’ perceptions of risk, and deepened understanding of their role within an acute context. These themes were woven throughout phases 2–6 of the transformative learning framework.ConclusionsInterprofessional immersive simulation training involving acute clinical scenarios has been found to be helpful for pre-registration pharmacists and can foster transformative learning. Through this powerful process, they developed new ways to see the world, themselves and their professional relationships. Positive future actions and roles were planned. As the patient-facing roles of pharmacists expand, educational practices that translate into meaningful change to workplace behaviour and relationships become increasingly important. Carefully constructed interprofessional immersive simulation training should be utilised within pharmacy education more widely.

Developing an emergency robotic undocking protocol using simulation

Emergent undocking of the surgical robot is a high-acuity low-frequency event that requires knowledge and proficiency to optimize patient safety. Simulation was used to codify sequential processes, roles, and responsibilities. This quality improvement project aimed to develop a protocol for use during emergent undocking of the surgical robot. A pre-post interventional design was used. One pre- and two post-intervention simulation performances of interprofessional teams were observed during intraoperative crisis events. Educational sessions provided instruction on roles and responsibilities and emergent undocking procedures. Interprofessional simulation training sessions allowed staff to refine and practice emergent robotic undocking. Timed endpoints notably improved. Participant confidence in the emergent undocking of the surgical robotic improved. Adherence initially improved then declined to pre-intervention levels. Project outcomes showcase the utility of emergent robotic undocking procedures, and demonstrate the effectiveness of conducting simulations to codify and refine the process of emergency robotic undocking. • Interdisciplinary simulation activities allowed assessment of team performance. • Repeated simulation scenarios improved emergent robotic undocking processes. • Mean times for vital signs identification decreased from 40 s to 20 s. • Undocking speed decreased by 46 s after two simulation periods. • Interprofessional in-situ simulation exercises led to improved confidence scores.

Pre-registration nursing and occupational therapy students’ experience of interprofessional simulation training designed to develop communication and team-work skills: A mixed methods study

To bridge the gap between university and the clinical environment, the university where this study was conducted incorporated interprofessional simulation sessions into the curricula for pre-registration nursing and occupational therapy students. The purpose of the study was to evaluate the effectiveness of simulation training to support the development of students’ interprofessional communication and teamwork skills. Study participants were first-year students. A mixed methods study design was used that included: (1) a cross-sectional survey, (using the Interprofessional Education Collaborative Competency Self-Assessment tool), before and after the simulation session; and (2) two focus groups with students and one with academic staff. A total of 91 students and 5 staff participated. All students increased their self-perceived skills in interprofessional interactions. Two major themes were identified: ‘Communication and Teamwork’, with four sub-themes, (1) ‘Significance of Communication in teamwork’; (2) ‘Learning about, from and with each other’; (3) ‘Professional role identification and collaborative practice’; and (4) ‘Clinical leadership facilitated collaboration’ and ‘Lessons learnt from the simulation session’, with three subthemes: (1) ‘enhanced preparation for clinical placement’; (2) ‘the experience of interacting with a simulated patient’; and (3) ‘holistic patient care’. The results from the study demonstrated that interprofessional simulation sessions are an effective approach to introducing and developing collaborative clinical practice.

Performativity, identity formation and professionalism: Ethnographic research to explore student experiences of clinical simulation training.

Developing professional identity is a vital part of health professionals' education. In Auckland four tertiary institutions have partnered to run an interprofessional simulation training course called Urgent and Immediate Patient Care Week (UIPCW) which is compulsory for Year Five medical, Year Four pharmacy, Year Three paramedicine and Year Three nursing students. We sought to understand student experiences of UIPCW and how those experiences informed student ideas about professional identity and their emergent practice as health professionals within multidisciplinary teams. In 2018, we commenced ethnographic research involving participant observation, field notes, interviews, photography and observational ethnographic film. A total of 115 students participated in this research. The emergent findings concern the potentially transformative learning opportunity presented within high fidelity multi-disciplinary simulations for students to develop their professional identity in relation to peers from other professions. Our work also exposes the heightened anxiety and stress which can be experienced by students in such interdisciplinary simulations. Student experience suggests this is due to a range of factors including students having to perform in front of peers and staff in such simulation scenarios when their own professional identity and capabilities are still in emergent stages. Staff-led simulation debriefs form a critical success factor for transformative learning to be able to occur in any such simulations so that students can reflect on, and move beyond, the emotion and uncertainty of such experiences to develop future-focused concepts of professional identity and strategies to support effective interprofessional teamwork.