1. Emma Kientz, MS, APRN-CNS, CNE
Improving Interprofessional Communication Skills with Standardized Patient Simulations
Emma Kientz, MS, APRN-CNS, CNE
Site Coordinator - Tulsa
Assistant Professor of Nursing
University of Oklahoma
Fran and Earl Ziegler College of Nursing
March 2016

2. Disclosures
The presenter has no relevant financial relationships with any commercial interests to disclose
No disclosures

3. Acknowledgements John Carlson, MS John Gaudet MPH
Julie Miller-Cribbs MSW, PHD
Dr. Sarah Passmore
Dr. James Tomasek
Jeana Wilcox PhD, RN, CNS, CNE

4. Train in Silos, Work as Teams
How are health care professionals
supposed to make the transition?

5. Problem and Significance
If Interprofessional collaboration is a goal of health care provider training, one must understand effective methods of training that results in collaborative professionals.
Author review of 35 articles
Only 5 involved actual or simulated clinical experiences
Determining how actual or simulated clinical experiences impact attitudes, and consequently actions, related to interprofessional education is necessary to build evidence-based teaching strategies for health professions students.
Because perceptions and attitudes affect behavior, it is important to understand the perceptions and attitudes surrounding student engagement in learning activities.

6. Research Question
Do attitudes and perceptions of communication and teamwork of an interprofessional team change following exposure to an interprofessional learning experience?

7. Sample 110 Health Professions Students Medicine (35) Nursing (43)
Social Work (32)

8. Specific Aims
Specific Aim 1: To compare change in attitudes toward working in health care teams pre- and post- simulated interprofessional standardized patient encounter.
Hypothesis 1a: There will be improved attitudes toward working in health care teams following participation in a simulated interprofessional standardized patient encounter.
Hypothesis 1b: The attitude changes will vary depending on the future profession of the students involved.
Recently, a new national health professions accreditors collaborative formed to stimulate interprofessional engagement in health professions education programs. The National Center for Interprofessional Practice and Education is still in its infancy, created in October The center provides a repository of literature related to Interprofessional practice and education.

9. Specific Aims
Specific Aim 2: To compare readiness for interprofessional learning pre- and post- simulated interprofessional standardized patient encounter.
Hypothesis 2a: There will be improved readiness for interprofessional learning following participation in a simulated interprofessional standardized patient encounter.
Hypothesis 2b: The readiness for interprofessional learning will vary depending on the future profession of the students involved.

10. Project Description
Students from three professional groups were brought together for a half-day seminar and interprofessional simulation
Consent forms and Pre surveys for attitudes and readiness for working in Interprofessional teams were administered
Introduction to Oklahoma child abuse reporting laws
Interprofessional standardized patient simulation
Post surveys and debriefing
Baker, C., Pulling, R., McGraw, R, Dagone, J, Hopkins-Rosel, D. (2008). Simulation in interprofesional education for patient centered collaborative care. Journal of Advanced Nursing 64(4)

11. Surveys ATHCT: Attitudes Toward Health Care Teams Scale
20 item tool with 6 point scale
Cronbach’s alpha = .87*
RIPLS: Readiness for Interprofessional Learning Scale
19 item tool with 5 point scale
Cronbach’s alpha = .90*
* Chronbach's alpha as reported in literature

12. Simulation
Interprofessional faculty group created simulation scenario, pre-scenario reading assignments, standardized patient training, and debriefing questions

13. Data Analysis Quasi-experimental Research Design
OUHSC IRB approval (2014) and extension (2015)
Random assignment: 10 simulation groups
Pre-intervention differences between groups evaluated by General Linear Models
Group differences in improvement after intervention tested by logistic regression
Comparisons were adjusted for non-independence among members of simulation groups
2014 and 2015 data were combined for analysis

14. Attitudes Results
Specific Aim 1: To compare change in attitudes toward working in health care teams pre- and post- simulated interprofessional standardized patient encounter.
Consistent with literature, there was no significant difference between observers and simulation participants.

15. Attitudes Results continued
Hypothesis 1a: There will be improved attitudes toward working in health care teams following participation in a simulated interprofessional standardized patient encounter.
Overall, 35% of students improved the mean score on the Attitudes Toward Health Care Teams Survey following the interprofessional simulation.
Pre-test difference by gender (Logisitc Regression, p=.017, n=108)
Change score difference by gender (logistic regression, p=.449, n=103)

16. Attitudes Results continued
Hypothesis 1b: The attitude changes will vary depending on the future profession of the students involved.
Pre-test difference by profession (logistic regression, n=108)
Medicine-Nursing (p=.007)
Medicine-Social Work (p=.002)
Nursing-Social Work (p=.365)
Change score difference by profession (logistic regression, n=103)
Medicine-Nursing (p=.004)
Medicine-Social Work (p=.011)
Nursing-Social Work (p=.724)
Overall, there was a 60% increase in student opinion that physicians are “team-oriented” following the simulation experience. Most of the movement was from medical students (85% scored physicians as “team players” following the simulation).

17. Readiness Results
Specific Aim 2: To compare readiness for interprofessional learning pre- and post- simulated interprofessional standardized patient encounter.
Consistent with literature, there was no significant difference between observers and simulation participants.

18. Readiness Results
Hypothesis 2a: There will be improved readiness for interprofessional learning following participation in a simulated interprofessional standardized patient encounter.
Overall, 64% of students improved the mean score on the Readiness for Interprofessional Learning Scale following the interprofessional simulation.
Women increased more than men (p=.017, n=104)

19. Readiness Results
Hypothesis 2b: The readiness for interprofessional learning will vary depending on the future profession of the students involved.
Pre-test difference by profession (logistic regression, n=108)
Medicine-Nursing (p=.006)
Medicine-Social Work (p=.002)
Nursing-Social Work (p=.292)
Change score difference by profession (logistic regression, n=104)
Medicine-Nursing (p=.123)
Medicine-Social Work (p=.126)
Nursing-Social Work (p=.578)

20. Future Research Directions
Investigate effect of learning in teams on making appropriate clinical decisions
Only about 10% of groups reached the decision to report potential abuse within the allotted simulation timeframe.
Only about 20% of groups asked patient wearing sunglasses to remove those glasses before conducting the patient interview.

21. Questions?

22. References
Baker, C., Pulling, R., McGraw, R, Dagone, J, Hopkins-Rosel, D. (2008). Simulation in interprofesional education for patient centered collaborative care. Journal of Advanced Nursing 64(4)
Hall, P. (2005). Interprofessional Teamwork: Professional cultures as barriers. Journal of Interprofessional Care, (May),
Heinemann, G., Schmitt, H., Farrell, M. & Brallier, S. (1999). Development of an Attitudes Toward Health Care Teams Scale. Evaluation and the Health Professions, March 22(1),
Lidskog, M., Lofmark, A. & Ahlstrom, G. (2008). Learning About Each Other: Students’ conceptions before and after interprofessional education on a training ward. Journal of Interprofessional Care, 22(5),