The Institute of Medicine (IOM) has issued several reports with regard to patient safety, communication, and team training (IOM, 2000, 2003). Numerous health profession organizations, including nursing organizations, have responded to the IOM calls by collaboratively creating a set of core interprofessional competencies (Interprofessional Education Collaborative Expert Panel [IPEC], 2011). The goal of interprofessional education (IPE) is to increase interprofessional team communication with the expectation that patient outcomes will improve. The aim of this study is to determine whether interprofessional team communication is related to team performance in a simulation with nursing and medical students.
LITERATURE REVIEW
Studies investigating linkages between student interprofessional team communication and outcomes are lacking. A key issue in establishing the team communication-outcome connection is the measurement of teamwork behaviors, particularly in a relatively new investigatory field like IPE.
Because of the trajectory of tool development, studies on IPE and teamwork have historically involved the measurement of student perceptions, attitudes, and self-efficacy. More recent tool development and testing have been conducted on direct observational measures in teamwork and team communication. Tools such as the Team Performance Observation Tool (Agency for Healthcare Research and Quality, 2012) and the Indiana University Simulation Integration Rubric (IUSIR; Reising, Carr, Tieman, Feather, & Ozdogan, 2015) have facilitated the extraction and recording of behaviorally based observations to determine competency levels in teamwork and team communication. For example, using the Team Performance Observation Tool, a study found that providing teamwork education improved performance in an interprofessional trauma scenario (Baker et al., 2015). Despite the increasing availability of reliable and valid behaviorally based tools, no studies were found in health education professions literature that investigated the relationship between student interprofessional team communication and simulated procedure performance.
METHOD
In a secondary analysis of a larger interprofessional simulation study, a retrospective, correlational design was used to determine if there is a relationship between team communication scores and team procedural scores. Human subjects approval was obtained for the secondary analysis.
In an innovative, longitudinal program, nursing students and medical students are formed into teams that persist for a two-year period. The students are junior and senior bachelor of science in nursing students and first- and second-year medical students. Teams take part in a range of interprofessional activities including team training, standardized patients, direct practice, and high-fidelity simulation.
Each simulation scenario is tailored to the educational levels of students and contains concepts that are similar across the nursing and medical school curricula. Both curricula certify students in Advanced Cardiac Life Support in the senior year for nursing and the second year for medicine.
Participants and Setting
Two high-fidelity simulation scenarios were analyzed for this study: 1) an asthma scenario involving teams of junior nursing and two-year medical students (n = 36) and 2) an advanced scenario of diagnostic reasoning and Advanced Cardiac Life Support involving teams of senior nursing and second-year medical students (n = 32).
Nursing students were predominantly female (>90 percent), Caucasian (>90 percent), and in their first degree program. Medical students were predominantly male (>60 percent), Caucasian (>60 percent), and in their first post-bachelor degree graduate program.
All activities took place on the residential campus of a large Midwestern university. The nursing and medical programs have been engaged in IPE since 2008 and interprofessional practice since 2015.
Tools
Each simulation is rated on three separate categories: individual communication, team communication, and procedure performance. Individual and team communication scores are rated using the IUSIR, which has six individual communication items and six team communication items. A rating of 1 for each item represents novice behaviors; a rating of 5 denotes expert performance.
The six team communication items were used for this study; possible scores ranged from 6 to 30. A single team communication score was computed for each team for reliability and validity in the same student population as a part of a larger study. Reliability for the team portion of the IUSIR is .79 (Reising et al., 2015).
In addition, a procedure rubric was developed for each simulation to address the key care expected to be delivered during the scenario; it contains such items as history and physical assessments, facilitating diagnostics, and administering correct treatments. Similar to the team communication score, there is one procedure score for the team. The procedure rubrics have undergone minor modifications over time and have been subjected to review by content experts in nursing, medicine, and simulation. The minimum score for the procedure performance is 1, and the maximum score is 10.
Procedure
Each team engages in a simulation that lasts approximately 20 minutes, followed immediately by a 10-minute debriefing. The IUSIR and procedure scoring is completed, and the tools are then also used for debriefing purposes. Students receive the IUSIR ahead of the simulation but do not receive the procedure rubric.
A secondary analysis of a larger simulation study was conducted for this study. The scores from one rater were used for the purposes of this analysis. Team communication and procedure scores for both scenarios were correlated using SPSS.
RESULTS
The IUSIR team scores ranged from 18 to 30 (M = 25.54, SD = 3.44). The procedure scores ranged from 6 to 10 (M = 8.54, SD = .798). Pearson product-moment correlation coefficient was computed to assess the relationship between team communication scores and procedure scores. The results demonstrate a significant, positive correlation between the two variables, r(68) = .628, p = .000.
DISCUSSION
The results of this study demonstrate that improved interprofessional team communication was related to improved procedural performance, which translated to improved patient care in the simulation setting. Similar to the Baker et al. (2015) study, this study suggests that deliberate training in team communication in health professions education does improve team communication and team performance. Furthermore, this study extends the influence of team training to include improvements in patient care in a simulated setting.
The core IPEC competencies (2016), advanced by health professions organizations, consist of four domains: values/ethics for interprofessional practice, roles/responsibilities, interprofessional communication, and teams/teamwork. The IUSIR measures components of the interprofessional communication and teams/teamwork domains. This study links key interprofessional competencies to improvements in simulated patient care for interprofessional teams.
Findings support the IOM Interprofessional Learning Continuum model, which advances a methodology by which IPE contributes to learner outcomes that include performance in practice (IOM, 2015). In the model, learner outcomes are linked with health and system outcomes such as population health and cost-effectiveness. Training in interprofessional communication and teamwork in health professions students provides a "jump start" to preparing future practitioners in collaborating for more holistic, quality, comprehensive, cost-effective patient care, a necessity in today's value-based purchasing environment. Limitations to this study include the use of a single rater and a single site. Although two different scenarios were evaluated, both were similarly constructed to create an environment conducive to collaboration between nursing and medical students.
CONCLUSION
This study demonstrates the powerful message echoed in the IOM reports: That team communication does matter and can improve patient safety. Simulation is an effective means to recreate practice situations that promote the development of team communication skills in order to improve patient care. By presenting students the link between their communication development and positive patient care outcomes, the importance of the interprofessional competencies development during their health education programs is emphasized.
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