Members of clinical teams can hold stereotyped views of one another that can form barriers to interprofessional cohesion and collaboration. Interprofessional education (IPE) is often championed as a way of teaching individuals to be better team players through the adoption of collaborative attitudes and behaviours. However, the potentially detrimental effects of IPE are not well understood. This study used the social identity approach (SIA) as a lens to explore the impact of interprofessional simulation on the identities and professional relationships of trainee pharmacists and medical students.
Across three different locations in Scotland, trainee pharmacists were paired with medical students to participate in immersive simulation scenarios with post-scenario debriefs. Participants were individually interviewed shortly after their simulation session, using a semi-structured interview schedule based on SIA. Transcripts were analysed using template analysis, with sub-categorizations of SIA forming the initial coding template.
Twenty-five interviews were undertaken across both groups. The interprofessional simulation session effectively challenged pre-existing stereotypes. For the trainee pharmacists, the alteration of self-stereotypes influenced motivation through self-enhancement and, in turn, altered group norms via the promotion of genuine collaboration and joint decision-making. However, social comparisons focussed on status remained prominent.
This study has shown that interprofessional simulation can effectively challenge and alter stereotypes (including self-stereotypes), but social comparisons may be less easy to overcome in this context. As it continues to be embedded within healthcare education, the limitations of IPE must be better understood to ensure that the potential value of such opportunities is maximized.
Healthcare systems improvement using simulation and debriefing is an increasingly employed, yet underutilized quality improvement tool to enable user-centred design. This approach allows users to experience real-life systems and processes through simulation and then provide feedback on how a system supports them within their role. Understanding this interaction of people and their systems is critical to safe, quality, reliable and efficient care and bridges the gap between how we think a system is working and how it is working.
This novel project was collaboratively developed and led by simulation, human factors and patient safety experts and used existing organizational safety data to target further high-risk safety threats surrounding administering, cross-checking and labelling blood products for transfusion. A system-focused simulation-based approach was used to identify system issues for a large healthcare organization’s transfusion policy redesign. A Failure Mode and Effects Analysis (FMEA) was then used to apply a risk score to the findings from the simulation user feedback to inform a large high-risk policy redesign.
Multiple recommendations were provided to the participating units and policy and procedure redesign teams surrounding environmental issues, standards, interpretation and usability of the policy.
Our collaborative patient safety, simulation and human factors project was successful in proactively identifying both active and latent factors contributing to adverse events and identifying recommendations using FMEA methodology to improve patient safety, including revisions to the physical space within the lab, and the provincial blood transfusion policy and procedure.
Previous research suggests that gender bias is pervasive in health care and has deleterious effects on treatment outcomes for patients. When developing and improving training on gender bias, we need to further our understanding of how such topics arise and are sustained in conversations between healthcare professionals (HCPs). The aim of this study is to analyze the influence of patient gender in HCP decision-making by analyzing how they surface, discuss and manage topics around gender.
An ethnomethodological qualitative study using discursive psychology and conversation analysis was implemented to examine 10 simulation debriefs in a specialized mental healthcare simulation centre in London. Video footage was obtained from mental health simulation training courses on bias in clinical decision-making, involving HCPs from mixed healthcare professions. Following transcription of selected segments, the debriefs were analyzed and repeated patterns of interaction were captured in distinct themes.
Four main themes were identified from the data, indicating some of the ways in which conversations about gender are managed: collaboration (to encourage discussion), surprise (when unexpected topics arose), laughter (to diffuse tense situations) and silence (demonstrating careful thinking). Patients with mental health conditions were perceived differently in terms of treatment decisions due to existing gender biases.
The persistence of gender bias that may result in discrimination in health care with negative consequences attests to the need for greater awareness and training development at various levels to include an intersectional approach.
Debra Nestel is Professor of Simulation Education in Healthcare, Monash University, and Professor of Surgical Education, Department of Surgery, University of Melbourne, Australia. Debra was previously Editor-in-Chief (EIC), BMJ Simulation and Technology Enhanced Learning (STEL), and founding EIC, Advances in Simulation. She is program lead for the Graduate Programs in Clinical Simulation (Monash University) and the Graduate Programs in Surgical Education (University of Melbourne). Debra leads a national faculty development program for simulation practitioners – NHET-Sim (www.nhet-sim.edu.au). In 2021, Debra received the award of Member of the Order of Australia for her service to healthcare simulation. She has received other national awards for her work in healthcare simulation and a Presidential Citation from the Society for Simulation in Healthcare. Debra has published over 200 peer-reviewed papers in health professions education, edited books on simulated patient methodology (2015), healthcare simulation (2017), surgical education (2019) and research methods for healthcare simulation (2019) https://www.researchgate.net/profile/Debra_Nestel
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ASPiH conference 2023: Sustainable Simulation. 6th to 8th November 2023 at the Hilton Metropole Hotel in Brighton, UK.
Writing retreat for healthcare simulation researchers (October 17, 18 and 20, 2023 in Honolulu, Hawai’i)
This NHS E SE Regional Conference to “Optimise Simulation” offers opportunities to present and share simulation activity with e-Posters, short oral presentations, workshops, and collaborative networking.
On the 7th December 2022, the Faculty of Health Sciences at the Australian Catholic University (ACU) ran its 12th Simulation Health Education Showcase. The Simulation Showcase is built on the philosophy of collaboration, which is why for the last 12 years, it has been delivered in partnership with the Australian and New Zealand Laerdal Medical team and offered free to all attendees. The theme this year was Innovation and inclusion for continuing learner centred simulation which was reflected by the attendee representation from nine health disciplines, from both industry and academia.
Michelle Kelly (Professor of Nursing at University of South Australia) recently delivered a keynote presentation at the 12th ACU Simulation in Health Education Showcase in Melbourne.
Simulation-based education (SBE) is “massively on the rise, highly technological, but under-theorised”. A cross-institutional team in Scotland was recently awarded a Scottish Medical Education Research Consortium (SMERC) grant to explore questions relating to how SBE sits within its wider ecosystem.
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