Bridging gaps between silos of care with simulation and telehealth

According to the World Health Organization, a siloed approach to healthcare education has fostered a culture of poor interdisciplinary collaboration and teamwork. Adverse events relate directly to fragmented teamwork. For example, many medical errors can be attributed to suboptimal communication. High quality healthcare practices and excellent patient outcomes are the result of efficient, accurate, and respectful communication. Students learn those skills best when education is interdisciplinary and collaborative.

Interprofessional education (IPE) also teaches students to develop and practice strategic teamwork and is an excellent tool for enhancing positive interprofessional attitudes. Its premise? Students who learn from one another, about one another, and with one another develop competencies needed to work together, which lead to better care and improved outcomes.

Traditional IPE involves one or more faculty members—aided by PowerPoint and other instructional tools—leading groups of students in classroom discussion of case-based scenarios. Although traditional IPE is effective in developing critical team-based problem-solving skills, other approaches, such as simulation, are useful for augmenting the experience.

Comparative studies have shown that simulation, an experiential form of deliberate practice that uses live patient actors or high-fidelity mannequins to facilitate development and mastering of skills, is superior to traditional educational methods. Applied to interprofessional education, simulation promotes interdisciplinary collaboration, fosters communication skills, and protects patients. Schools using IPE with simulation prepare students for working on interprofessional teams that deliver better patient care.

Challenges and solutions
Barriers to incorporating simulation into interprofessional education include lack of administrative support, multiple needs of learners, shortage of qualified faculty members, and insufficient opportunity for structured post-experience reflection. Many IPE programs demonstrate that it is difficult to entice students from various disciplines to come together at the same time and place to solve case-based scenarios. When IPE is coupled with simulation in rural areas, the challenges are even greater if there are not enough students from a variety of disciplines to conduct meaningful IPE experiences.

One solution is telehealth technology. Telehealth allows patients and healthcare professionals to access specialty providers through virtual networks. One format, remote patient monitoring—also known as “remoting in”—enables live two-way, real-time interactive communication between a practitioner and a distant patient.

Telehealth increases rural access to care and improves rural health in many ways. Used for consultations, it saves time and money because neither the patient nor the provider has to travel long distance. Equipping students with telehealth skills is crucial for those who will work in rural areas because primary practitioners in those settings often need to coordinate patient care with multiple specialists. Simulation-based IPE augmented with telehealth tools provides students the opportunity to acquire technology skills they will use in a rural setting while addressing issues inherent to working with rurally located patients. Telehealth-based simulation also allows students to remote-in from off-campus.

During my time as an educator focused on best practices, my students often expressed a desire for more opportunities to work on interprofessional teams. When students work with other disciplines, they witness firsthand the roles that others play and how each contributes to the patient care experience. Telehealth-facilitated IPE fosters interdisciplinary respect by allowing students to visualize other roles in action. For example, during a telehealth-facilitated IPE simulation on our rural campus, remotely located medical students reported that the robot enhanced their ability to understand and appreciate the expertise of other professions, as they could see and hear interventions implemented by nurses and pharmacists in the scenario room.

My journey with IPE
As a nurse who worked in teaching hospitals for the first half of my career, I always valued the interprofessional team rounding I experienced. I could see how each discipline contributed to improved patient care. When I transitioned to academia, I wanted to teach my students the importance of collaborative teamwork and how communication skills contribute to positive outcomes. After 15 years as an educator, I am convinced that simulation is one of the best ways to acquire and sharpen these skills, so I incorporate it into each of my clinical nursing courses. Without jeopardizing patient safety, students can make mistakes, learn from them, and translate their new knowledge to future patient care encounters 

In working with traditional IPE and interacting with students from a variety of healthcare disciplines—from those with very little clinical background to those who are clinically proficient—I have observed that the latter tend to lead the conversation while those just beginning their studies contribute only minimally. To address this, I deliberately recruit interdisciplinary students in their third or fourth year of clinical rotations to participate in simulation-based, telehealth-facilitated IPE experiences.

During these scenarios, students can fully apply their discipline-related knowledge to the case at hand. Afterward, students comment that the exercise enhanced overall group learning and individual understanding of each other’s roles. To get the most of their IPE experiences, students should be at similar levels of clinical education. This allows them to contribute at their level of expertise and maximize their experience.

IPE effects on nursing
Helping nursing students develop the soft skills needed to become effective team players is very important. By designing and implementing simulation scenarios that require clarity of communication, active listening, and ability to resolve conflict, educators are better able to teach the difficult art of communication and bridge gaps between silos of care. 

For nursing students to become proficient communicators and understand roles of other members on the healthcare team, they need to practice with other students. Simulation-based IPE is an excellent way to practice, gain experience, and learn about other healthcare roles. Nursing students acquire much-needed confidence when peers preparing to practice in other disciplines recognize the value they bring to each patient encounter. RNL

Ann Scott, DNP, RN, CCRN-K, CNE, is clinical assistant professor at the University of South Carolina College of Nursing in Columbia, South Carolina, USA.

Editor’s note:
Ann Scott will present “Simulation-Based Interprofessional Education in a Rural Setting: Development and Evaluation of a ‘Remote-In’ Telehealth Scenario” on Sunday, 22 July 2018, at Sigma’s 29th International Nursing Research Congress in Melbourne, Australia. Register here for congress.

Check out these additional articles by presenters at the 29th International Nursing Research Congress.