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A quasi-experimental controlled trial examining the role of inter-professional training using resuscitation simulation Paul Bradley 1 Peninsula Medical.

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Presentation on theme: "A quasi-experimental controlled trial examining the role of inter-professional training using resuscitation simulation Paul Bradley 1 Peninsula Medical."— Presentation transcript:

1 A quasi-experimental controlled trial examining the role of inter-professional training using resuscitation simulation Paul Bradley 1 Peninsula Medical School, Universities of Exeter & Plymouth,UK Simon Cooper & Fiona Duncan Faculty of Health & Social Work, University of Plymouth, UK Funded by ceppl – Full report at: http://www.plymouth.ac.uk/files/extranet/docs/HSW/CEPPL%20Int erprofessional%20Skills%20Learning%20Report.pdf Research questions o Does inter-professional skills training influence attitudes, leadership, team work and skills performance? o Is there a difference in attitudes, leadership, team work and skills performance between medical and nursing students? Background o Interprofessional learning (IPL) is a much vaunted contemporary issue in modern healthcare education o Tomorrow’s Doctor required: o “the mastery of skills required to work within a team, and where appropriate, assume the responsibilities of a team leader, requiring an understanding and appreciation of the roles, responsibilities and skills of nurses and other health care workers” o ‘Interprofessional Education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ CAIPE Why resuscitation training? o Resuscitation Council (UK) sanctioned resuscitation training in the UK is frequently undertake in interprofessional settings with faculty from various disciplines. The Immediate Life Support (ILS) is a one-day Resuscitation Council (UK) approved course o ILS was chosen as a feasible intervention o National standard o Agreed validated assessment tools Study design o A quasi-experimental trial using non- equivalent before-after design: students were assigned to interprofessional (IP) and uniprofessional (UP) groups based on geographical location o Mixed methods were utilised to explore quantitative and qualitative perspectives Setting & Sample 53 2 nd year medical students (MS; n=25) and student nurses (SN; n=28) Inter-professional (Plymouth) ILS versus uniprofessional (Exeter) ILS One day Immediate Life Support course measuring: o Skills – airway, Basic Life Support, defibrillation ratings o Leadership and team work ratings o Video recorded simulated team scenarios Data collection tools Performance ratings - quantitative o Leadership using the Leadership Behaviour Description Questionnaire - LBDQ o Team work using the Emergency Team Dynamics - ETD o Skills performance using Resuscitation Team Tasks – RTT Focus groups – qualitative o 5 uniprofessional focus groups (3-4 months after the training) Video recording o At the end of each day individual and team performance was assessed in a video recorded resuscitation scenario o One camera recorded data from the foot of the bed and a second from the side o All students were asked to lead a different scenario with the help of their respective teams o Run in the same sequence by all the assessment teams, after a random selection of student assessment order Performance Results o No difference between multi and uniprofessional groups in any of the performance ratings o However, in the sub groups medical students : o had higher leadership ratings in all settings (p=.01) and o led more dynamic (p=.039) and o efficient teams (the tasks) (p=.021) o A linear regression model showed profession of the student to be the main predictor of leadership score o ‘Good’ multiprofessional groups were as ‘good’ as unprofessional groups despite being less familiar with each other. o The IPL element seems to add a ‘buzz’ to the performance Opinions and attitudes to IPL Opportunities and desires Tribal affiliations and preconceptions Curriculum issues IPL opportunities and desires Teamwork and communication Realistic training Role and perspective “getting that other viewpoint... understand how to communicate … to get the best result for the patient” (IPMS). “… once you get into practice you know the interactions, you know the different relationships and … it would make a difference in the way you approach each other” (IPSN). “I think realistically when you have to in the real situation you’d meet those kind of people anyway, they’d be around so it makes it more realistic if they were training with you” (UPMS). “I think we would get a different viewpoint … It gives you the opportunity to realise your strengths and weaknesses” (IPMS) “I think it would help to banish any stereotypes both the nurses and the medical students might have of each other” (IPMS). Tribal affiliations & preconceptions My Tribe Professional relations Hierarchy Intimidation “but you just feel there’s a barrier straight away because we’re separated. You know segregation between medics and nurses and it just seems to last doesn’t it” (IPSN) “I immediately felt a bit anxious when I knew we were going to be working along side medics. I didn’t feel that we were on the same hierarchical level” (UPSN), “if I was with say a group of doctors I’d feel intimidated and maybe wouldn’t speak out as much as I would in a group of people that I feel comfortable with“ (UPSN). “I think we’ve got such a strong group dynamic now that wouldn’t really mix with other students no matter who they are” (UPSN). Curriculum issues Timing Experiences Topics “any clinical activity which doctors and nurses are expected to do when they are qualified” (UPSN), “from the start. If you mix it from the start then you don’t have any of that us and them at all, it’s like we’re all in it together” (IPMS). “we couldn’t tell them anything about what it is like to be nurses ‘cos we didn’t have a clue” (UPSN) Focus groups o Broad support for inter-professional learning (IPL) o Perceived benefits for: o Teamwork and communication o But concerns about o Professional identity o Hierarchical inequities and o Feelings of intimidation (nurses) Conclusions o The mixed methods study design has enabled new insight into the effectiveness of interprofessional learning in undergraduate resuscitation training o Short ‘one off’ interventions are feasible in the undergraduate setting even in the relatively junior years o Team performance outcomes in resuscitation appear not to be reduced in interprofessional settings o There are benefits from interprofessional learning in terms of attitudes and perceptions o Further work is required to establish the generalisability of the current findings Emergent focus group themes Address for correspondence: Prof Paul Bradley John Bull Building Derriford Plymouth, UK PL6 8BU paul.bradley@pms.ac.uk


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