When medical students enter the “Patient Safety Room of Horrors” in the University of Vermont Clinical Simulation Laboratory – a mock inpatient room rigged with a number of safety “errors” – they rely on their physician training when surveying for potential problems, like a missing patient name on an IV bag. Nursing students are likely to notice slightly different problems – a bed rail that’s down, for example – and pharmacy students come out of the room with yet another list of risks. But by going through this exercise together – rather than in isolation – these students are gaining a critical skill: how to solve problems collaboratively.
The point of the exercise, says UVM Director of Clinical Simulation Ted James, M.D., is to not only reinforce patient safety best practices, but to drive home the value of a team-based approach to health care. When the participants reconvene after their trip through the “room of horrors” and compare notes, they can realize – and appreciate – the different perspectives they all bring to a patient’s bedside.
“You’re going to see more as a team,” says James, adding that learning this early on – and having it continually reinforced throughout the span of a career – leads to a healthcare system that is better able to prevent errors that lead to bad outcomes. And as more and more patients seek care for chronic and complex conditions, and health care evolves to embrace new models like accountable care organizations and patient-centered medical homes, teamwork and effective communication become ever-more critical.
The question – “How do you improve teamwork?” – takes center stage.
Enter the UVM/ Clinical Simulation Lab, and a series of interprofessional education (IPE) activities in development and already underway. The 9,000-square-foot lab in UVM’s Rowell Building has proven to be a valuable resource for gathering nurses, doctors, pharmacists, and other healthcare professionals in the same room to practice teamwork and communication in situations that mimic what they may encounter in the clinic or the hospital.
Most IPE activities are designed to help participants arrive at a “shared mental model” of the patient care situation, says James. Working through a scenario, then sitting together for a post-session debrief about how the situation played out, helps participants to understand the skill sets and viewpoints each person brings to the table. It also reinforces the need and the benefit of “practicing mutual support.”
This education happens at all levels: From medical students and residents to fellows and attending physicians, with support from a team of professionals in the Simulation Lab led by Cate Nicholas, M.S., P.A., Ed.D., director of simulation education and operations.
A health profession student curriculum addressing patient safety and quality improvement, using simulation and IPE as a key teaching and learning tools has been established at UVM, and shows promise for changing the culture of safety and promoting a team-based approach to patient-centered care. IPE is built into a week-long Bridge during the third-year Clerkships of the Vermont Integrated Curriculum (VIC). Most recently, the course included a total of 150 pharmacy, nursing and medical students. Students complete an online patient safety module from the Institute of Healthcare Improvement prior to entering the course, and then participate in team-based simulation scenarios, including the room of horrors.
Course evaluations have been strong. Findings reported in a 2014 Association of American Medical Colleges’ Integrating Quality meeting conference poster presentation authored by James and a team of six faculty members in the College of Medicine, College of Nursing and Health Sciences, and Albany School of Pharmacy, showed that students uniformly appreciated the opportunity for early interaction with members of the health care team outside of their own profession and viewed such opportunities as important for their professional training. Additional IPE coursework for the first and second year of the VIC is in the works as well.
A mock page program, developed by James and Celia Cohen, M.S.N., R.N., an educator in the Nursing Education and Research Department at Fletcher Allen Health Care, with support from the John and Nancy Frymoyer Fund for Medical Education, focuses on interprofessional communication skills between a nurse and the on-call physician. The program features scenarios where a nursing student is required to evaluate a standardized patient under distress before calling a physician – who could be an attending faculty member, a resident or a medical student – to discuss patient management. Forty medical students, 90 nursing students and 30 novice nurses completed the most recent program.
According to James, the feedback was very positive. One student shared “It’s different to actually do the simulation than to just think about how you would answer a nurse’s question and to do it on the spot," and another said “I found it useful to practice thinking on my feet through this modality of clinical simulation. I would like to have more exposure to these kinds of exercises.”
IPE in the Simulation Lab also extends to residents, fellows and physicians. Hematology-oncology fellows recently completed simulation-based team training along with the hematology-oncology nurses, focused on cancer care scenarios. When patients experience complications like anemia, delirium, or chemotherapy extravasation (accidental leakage into the surrounding tissue), the team works together to solve the problem and, like all simulation exercises, meets to debrief.
On August 6 and 7, 2014, the Simulation Lab hosts a workshop to train faculty to develop their own IPE sessions using simulation. Previous workshops like this one have led to a number of team training and IPE programs at Fletcher Allen and the College of Medicine, James says.
The work UVM and Fletcher Allen are doing around IPE is finding a wider audience. James has been invited to serve as faculty for the Harvard Macy Institute’s 2015 program for educators in health professions course in January, where he will deliver a presentation on simulation-based IPE work. The Cambridge, Mass-based organization attracts healthcare professionals from around the world interested in developing educational projects and leading activities at their home institutions.