A mixed methods study of interprofessional learning of resuscitation skills

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A mixed methods study of interprofessional
learning of resuscitation skills
AMEE 2008, 30 August - 3 September 2008, Prague,
Czech Republic

• Paul Bradley
• Peninsula College of Medicine and Dentistry,
  Universities of Exeter Plymouth
• Simon Cooper
• Fiona Duncan
• Faculty of Health Social Work, University of
  Plymouth

Funded by ceppl Full report at http//www.plymo
uth.ac.uk/files/extranet/docs/HSW/CEPPL20Interpro
fessional20Skills20Learning20Report.pdf
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Background

• Interprofessional learning (IPL) is a much
  vaunted contemporary issue in modern healthcare
  education
• Tomorrows Doctor required
• the mastery of skills required to work within a
  team, and where appropriate, assume the
  responsibilities of a team leader, requiring an
  understanding and appreciation of the roles,
  responsibilities and skills of nurses and other
  health care workers
• Interprofessional Education occurs when two or
  more professions learn with, from and about each
  other to improve collaboration and the quality of
  care CAIPE

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Previous work

• Examples of IPL in a variety of settings
• Simulated ward
• Clinical education/training ward
• Clinical skills facilities
• Classroom
• Parameters studied
• Evaluation
• Attitude
• Perceptions
• Systematic review could not find a single study
  that used a randomised control trial, a
  before-and-after or interrupted time series
  design that demonstrated inter-professional
  learning influenced clinical performance1

1Zwarenstein M. Reeves S. Barr H. Hammick M.
Koppel I. Atkins J. Interprofessional education
effects on professional practice and health care
outcomes. The Cochrane Library, Issue 2. Oxford.
Update Software 2001
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Research questions

• Does inter-professional skills training influence
  attitudes, leadership, team work and skills
  performance?
• Is there a difference in attitudes, leadership,
  team work and skills performance between medical
  and nursing students?

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Resuscitation training

• Resuscitation Council (UK) sanctioned
  resuscitation training in the UK is frequently
  undertake in interprofessional settings with
  faculty and candidates from various disciplines
• Immediate Life Support (ILS) is a one-day
  Resuscitation Council (UK) approved course
• ILS was chosen as a feasible intervention
• National standard
• Agreed validated assessment tools

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Study design

• A quasi-experimental trial using non-equivalent
  before-after design students were assigned to
  interprofessional and uniprofessional groups
  based on geographical location

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Study design
E-mail invitation al all Year 2 Medical (170) and
Nursing Students (45)
Random selection of participants (54)
5 Medical students
5 medical students
13 nursing students
30 mixed professional groups
Plymouth
Exeter
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Setting Sample

• 53 2nd year healthcare students
• Medical (25)/nursing students (28)
• Inter-professional (Plymouth) v uniprofessional
  (Exeter)
• One day Immediate Life Support course measuring
• Skills airway, Basic Life Support,
  defibrillation ratings
• Leadership and team work ratings
• Video recorded simulated team scenarios

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Data collection tools

• Readiness for interprofessional learning scale
  (RIPLS) pre- (100), post- (100) and at 3-4
  months follow-up (81)
• Performance ratings
• Leadership
• (Leadership Behaviour Description Questionnaire -
  LBDQ)
• Team work
• (Emergency Team Dynamics - ETD)
• Skills performance
• (Resuscitation Team Tasks - RTT)
• 5 uniprofessional focus groups (3-4 months)
• (Cronbachs alpha gt 0.82)

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Video recording

• At the end of each day individual (and team
  performance) was assessed at a video recorded
  resuscitation scenario
• One camera recorded data from the foot of the bed
  and a second from the side
• All students were asked to lead a different
  scenario with the help of their respective teams
• The scenarios were based on the Resuscitation
  Council ILS course scenarios
• Run in the same sequence by all the assessment
  teams, after a random selection of student
  assessment order

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Focus groups

• Focus group sizes and structure

• Focus group analysis

• 5 groups
• 2 UP nursing students (6,7)
• 1 UP medical students (6)
• 1 IP nursing students (6)
• 1 IP medical students (5)

• Discussions were audio-recorded and transcribed
  verbatim
• Independently read and reread
• Identification of key codes and categories
• Identified category clusters and relationships
• Discussion leading to overarching themes and sub
  themes.

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Demographics
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RIPLS results

• Medical student and nursing students had
  significant differences for Roles and
  Responsibilities
• Uniprofessional groups showed no significant
  change in any scores over the course of 3 data
  collection points
• Interprofessional groups scores improved
  significantly for TWC and IP immediately post
  intervention but not at follow-up 3-4 months
  later
• Interprofessional groups had significantly higher
  scores than uniprofessional groups for TWC and IP
  at all three data collection points

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Comparison of RIPLS score by profession
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Comparison of RIPLS scores
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Comparison of RIPLS scores
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Performance Results

• No difference between inter- and uniprofessional
  groups in any of the performance ratings
• However in the sub groups
• Medical students had higher leadership ratings in
  all settings (p 0.01) and
• led more dynamic (p0.039)
• and efficient teams (the tasks) (p0.021)
• A linear regression model showed profession of
  the student to be the main predictor of
  leadership score

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Performance Results

• Good interprofessional groups were as good as
  uniprofessional groups despite being less
  familiar with each other.
• The IPL element seems to add a buzz to the
  performance

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Focus group
Opinions and attitudes to IPL
Opportunities and desires
Tribal affiliations and preconceptions
Curriculum issues
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IPL opportunities and desires
Teamwork and communication
Realistic training
Role and perspective
I think we would get a different viewpoint It
gives you the opportunity to realise your
strengths and weaknesses (IPMS) I think it
would help to banish any stereotypes both the
nurses and the medical students might have of
each other (IPMS).
getting that other viewpointunderstand how to
communicate to get the best result for the
patient (IPMS). once you get into practice
you know the interactions, you know the different
relationships and it would make a difference in
the way you approach each other (IPSN).
I think realistically when you have to in the
real situation youd meet those kind of people
anyway, theyd be around so it makes it more
realistic if they were training with you (UPMS).
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I think weve got such a strong group dynamic
now that wouldnt really mix with other students
no matter who they are (UPSN).
but you just feel theres a barrier straight
away because were separated. You know
segregation between medics and nurses and it just
seems to last doesnt it (IPSN)
Tribal affiliations preconceptions
My Tribe
Professional relations
I immediately felt a bit anxious when I knew we
were going to be working along side medics. I
didnt feel that we were on the same hierarchical
level (UPSN),
Hierarchy
if I was with say a group of doctors Id feel
intimidated and maybe wouldnt speak out as much
as I would in a group of people that I feel
comfortable with (UPSN).
Intimidation
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Curriculum issues
we couldnt tell them anything about what it is
like to be nurses cos we didnt have a clue
(UPSN)
Experiences
Time
Topics
any clinical activity which doctors and nurses
are expected to do when they are qualified
(UPSN),
from the start. If you mix it from the start
then you dont have any of that us and them at
all, its like were all in it together (IPMS).
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Focus groups

• Broad support for inter-professional learning
  (IPL)
• Perceived benefits for
• Teamwork and communication
• But concerns about
• Professional identity
• Hierarchical inequities
• And feelings of intimidation (nurses)

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Limitations

• A relatively small numbers
• Involved two professional groups only
• A collaborative study involving two closely
  co-located institutions
• No follow-up of resuscitation skills learning

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Conclusions

• The study design and mixed methods approach has
  enabled new insights into the effectiveness of
  interprofessional learning in undergraduate
  resuscitation training
• Short one off interventions are feasible in the
  undergraduate setting even in the relatively
  junior years
• Team performance outcomes in resuscitation appear
  not to be reduced in interprofessional settings
• There are benefits from interprofessional
  learning in terms of attitudes and perceptions
• Such courses may not support long term change in
  attitude unless repeated or extended
• Further work is required to establish the
  generalisability of the current findings

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Any Questions?
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paul.bradley_at_pms.ac.uk