In our past columns on interprofessional education (IPE) and simulation, we explored creative ways to link interprofessional (IP) competencies to patient-centered care. We offered several ideas on how to achieve this by changing the point of reference of the debrief from that of the instructor and learners' objectives to that of the patient's objectives. We conclude this IPE series with a "simulated question and answer" session that addresses several questions from our readers and offers parting thoughts from the authors regarding the future of simulation for IPE and training.

CWP: Okay, Mary, here's a question from Bob in Florida. "I'm having trouble getting physicians to participate in the IPE sessions at my hospital. Is this normal? What suggestions would you have for someone in my similar circumstance?"

MEH: Chan, that is a good question. I think many of us have experienced challenges with fully engaging our physician colleagues in IP simulation education. I have observed that many physicians are interested in participating in simulations, though not necessarily with other professions. Often, this has to do with the technical skills that they need to practice and master, which I can definitely appreciate. For example, they need to be proficient at airway management, central line insertion, and other invasive procedures. Though there are certainly components of working with other team members on these techniques, physicians need to be able to focus on their responsibilities and ensure their own proficiency. As nursing professional development (NPD) practitioners, we need to support this aspect of simulation and reframe the question from "how do I get physicians to participate" to "how can I make IPE relevant to all involved?" Increasing the relevance of IP simulation scenarios takes a good bit of work, experimentation, and willingness to collaborate with other professions to maximize the educational experience.

It is also important to recognize that, although NPD practitioners can be excellent simulation facilitators, having other professions help with the teaching and debriefing can go a long way in gaining engagement from everyone on the team, regardless of profession. Partnering with other professions for these educational activities demonstrates positive IP role modeling and can help others see its benefits.

MEH: Chan, as you view this dilemma from a physician perspective, what other thoughts do you have on how to increase physician engagement and participation? What practical suggestions do you have for NPD practitioners to add relevance to their simulation scenarios so that physicians find maximum benefit from participating?

CWP: Mary, I think you brought up several excellent points. First and foremost, when an IPE is being considered, it is essential for NPD practitioners to consider which professions need to be present and how each member will benefit from the participation. When dealing with the physician community, it is important to point out the increasing emphasis on effective communication, team leadership, and error reduction. Simulated code response training lends itself well to developing key elements of effective communication and team leadership. Since many physicians are required to maintain competence in key procedures, an interprofessional team (IPT) training session can be developed around potential complications and/or errors that occur during the handoff upon completion of the procedure. This would allow the physicians to gain from their psychomotor training, and to learn how to anticipate and address potential complications that can occur. It's amazing how effective communication can be when everyone is engaged and in complete agreement with the eventual goal of the simulation training.

CWP: Mary, here's a question from Jan in Texas. "I do not have a high-fidelity simulator but would like to do realistic IPE sessions involving code response to an arrested patient. Do you have any suggestions?"

MEH: Chan, that's unfortunate that our reader does not have a high-fidelity simulator, but that is not uncommon. Many facilities do not provide an adequate budget for simulation space, equipment, or dedicated simulation staff. NPD practitioners must then find creative ways to deliver IPE simulation sessions with few or no resources. The good news is that one does not need a high-fidelity simulator to conduct successful IPE or training. For example, if conducting an in situ code response training, one should instantly have access to a simple monitor system including blood pressure, pulse, and pulse oximetry devices. The additional things needed are basic equipment for the hands-on training portion for CPR and the defibrillator with the appropriate safety features. If the hospital has implemented CPR feedback devices, this would be a great place to use it to assess the quality of CPR by measuring the depth, rate of chest compressions, and compression continuity, for example, time off chest.

For those who wish to add greater realism, they may consider involving a standardized patient (SP) to portray a distraught family member. This member could demand that they be present during the resuscitation. This is a great way to incorporate an ethical dilemma to an already stressful situation.

MEH: Chan, what other low-cost methods have you used to implement IPE sessions?

CWP: Mary, as you have alluded to earlier, physicians are very enthusiastic about the opportunity to practice high-risk but low-frequency procedures such as intubation, central line access, intraosseous access, and needle thoracostomy. By simple introduction of a procedural task trainer and making the life-saving procedure one of the critical points of the resuscitation, you can encourage greater engagement from the physician community and instantly gain IP participation, thereby achieving higher relevance to the healthcare facility. None of this requires a high-fidelity simulator.

MEH: Okay, Chan, we have heard from many readers that there is a growing emphasis on IP training in the practice setting as NPD practitioners continue to branch out beyond nursing education. What advice would you offer NPD practitioners who desire to improve the quality and relevance of their IP educational offerings?

CWP: Mary, if you asked me this question 15 years ago when I began my simulation career, I would have told you that in order to improve the quality and relevance of any type of training you need to increase the realism through better use of technology and to improve the quality of the debrief to include real time performance data. While I still believe these things to be true, I'm reminded of a quote from one of my favorite authors and satirists Malcolm Muggeridge, who said, "All new news is old news happening to new people." I gather the latest "how to's" on how to be an effective teacher or how to create an effective curriculum is similarly old news in principle, but seems new because it is being endorsed by a new generation of educators. That said, I'd like to share with our readers the brilliant thoughts I gleaned from a lecture given by Dr. David E. Kern in 2014 about adult learners. And yes, this is the Dr. Kern, author of the Kern's six-step curriculum development model (Kern, Thomas, & Hughes, 1998). Here's what he shared about adult learners. If our NPD practitioners can keep the following six things in mind as they develop their IPE curriculum, I think they will fare well.

1. Adult learners are interested in concepts and principles.

2. Adult learners like to solve problems, not learn facts.

3. Adult learners want to use what they've learned soon after learning it.

4. Learning is best in their own pace.

5. Motivation increases when they set their own learning objectives.

6. Adult learners like to know how they're doing: crave feedback.

(http://qatar-weill.cornell.edu/cpd/event/Curriculum%20Development%20Half-Day%20W)

As we have previously discussed, I think simulation-based IPE naturally incorporates Principles 1, 2, 3, 6, and potentially even 5. Without a doubt, simulation can be a powerful tool and technique leveraged for meaningful education.

CWP: Mary, what are your thoughts and insights on this?

MEH: Chan, I think you have hit the nail on the head with this explanation. Sometimes just going back to the basic tenets of teaching is all that is necessary to propel us forward. If there is anything that I have learned in my career as an NPD practitioner and simulationist, it is that simulation success is not about the equipment, the space, or the newest and greatest technology. It is about the people involved, including the learners, facilitators, and ultimately the patients, as they are the reason that we are in this line of work.

CWP: Mary, well said. As we conclude this IP simulation series, we will be delving into other areas of simulation, as it relates to the practice environment and ways that NPD practitioners can incorporate simulation into their teaching. As always, please e-mail your questions, reflections, and suggestions for topics to mailto:[email protected] and mailto:[email protected].

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