Training for Tomorrow: The Simulated Interprofessional Rounding Experience at MUSC Donna Kern, MD Associate Dean for Curriculum- Clinical Sciences, COM Assistant Director, MUSC Healthcare Simulation Center Nancy Duffy, DNP, RN, CEN, CNE Director of the Undergraduate Program, CON Assistant Director, MUSC Healthcare Simulation Center Matt Gillespie, BLA, and Jimi Horne, AAS, NREMT-P MUSC Healthcare Simulation Center

Objectives Describe a simulation-based interprofessional (IP) activity designed to improve the learners’ understanding of collaborative care Discuss drivers and barriers to implementing this activity

Simulated Interprofessional Rounding Experience (SIRE) Developed in 2009 as a collaboration between Medicine and Pharmacy Part of MUSC’s QEP- the Creating Collaborative Care Initiative Addition of Physician assistant students in 2010 and Nursing students in 2011

Simulated Interprofessional Rounding Experience (SIRE) Objectives Describe the role of multiple health professionals in the patient care team Demonstrate evidence-based communication (TeamSTEPPS) Demonstrate collaborative, patient-centered team care Identify medication interactions and errors Demonstrate effective disclosure of an error to the patient Assess an unstable patient accurately and efficiently Manage an unstable patient Plan the discharge of a patient with an interprofessional team Clinical case-specific objectives….

SIRE Description Clinical teams are created with 5 members: –2 Pharmacy students (Year 3) –1 Medical student (Year 4) –1 Nursing student (Upper level) –1 PA student (Year 1)

SIRE Description All teams participate in 3 activities: 1.Communication Skills Workshop based on the TeamSTEPPS curriculum 2.Week 1 Simulation Case: GI Bleed in pt with INR of 9 3.Week 2 Simulation Case: Pneumonia with sepsis All students have participated in a formal IP Day Error Disclosure Workshop - approximately 1 year prior to SIRE.

Communication Skills Workshop Large group lecture on TeamSTEPPS model –Communication tools: Brief, Huddle, SBAR, Situation Monitoring (CUS words) Teams skills training –Paper chain exercise –Simulation practice session

Part 1 (60 minutes) Unstable Patient –Team works collaboratively to care for a simulated patient with an ACUTE condition Part 2 ( 30 minutes) Discharge Planning 3 minsInstructions given and team members assign roles; learners review the patient chart individually; no discussion is permitted 2 minsTeam holds a brief outside patient’s room 5 minsNursing student conducts initial patient assessment and reports SBAR to team 25 minsTeam enters and conducts patient interview/assessment, evaluation and management of patient; all orders are recorded on board 25 minsIP faculty debrief the students

PharmD and MD Faculty Teaching Pair observes students from the control room and role plays the voice of the simulated patient.

At the conclusion of the simulation, faculty debriefed the team and facilitated discussion of the learning objectives and the team performance.

Structure of Simulations Part 2 (30 minutes) Discharge Planning –Team works collaboratively to care for a simulated patient with an ACUTE condition 10 minsTeam creates plan for discharge 10 minsDiscusses plan with patient Discloses medication error (if this has not already occurred- patient will prompt discussion. 10 minsIP faculty debrief the students

Advantages of Simulation in SIRE Provides “clinical” environment for applied learning when real clinical environments do not have space for IP learners Makes it possible to teach skills (safely) that are not part of the traditional role of the students (who are viewed as “recorders” or worse….observers) Achieves “highly visible” learning that makes it difficult for students to hide knowledge, skill, attitude deficits Allows capture of learner/team performance and reflection

Barriers Academic calendars!! Required for some learners vs. optional for other learners Training level of learners Identifying and training interprofessional faculty Finding space for training such a large number of students

Summary Overall, all students are very positive about the SIRE experience. PharmD students report slightly greater gain in learning and appreciation for IPE activities –Received better curricular preparation for activity Decreased confidence in certain aspects of clinical management. –Simulation reveals deficiencies in student application of clinical knowledge.

Study Validated checklist was developed for assessing clinical performance in simulation Formal assessment of team skills Do team skills predict clinical outcomes? Yes. Published results of translation of simulation clinical performance to clinical outcomes

References Institute of Medicine. Health professions education: A bridge to quality. Washington, DC: National Academy Press UK Center for Advancement of Interprofessional Education (CAIPE). Shrader S, Kern D, Zoller J, Blue A. Interprofessional Teamwork Skills as Predictors of Clinical Outcomes in a Simulated Healthcare Setting. Journal of Allied Health 2013; 42(1):e1-6. Shrader S, McRae L, King IV W, Kern.D. A Simulated Interprofessional Rounding Experience in a Clinical Assessment Course. American Journal of Pharmaceutical Education 2011; 75 (4) Article 61. TeamSTEPPS