Organisation/Management

Points to consider include:

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  Organisational/educational lead buy-in

  
  
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  Funding (equipment)

  
  
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  Participant and Faculty time

  
  
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  Location

  
  
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  Training requirements

While acknowledging that the learner should be central to devising any educational material or intervention, organisational support, especially from senior management of all professional groups participating, is crucial to the successful, sustained implementation of interprofessional simulation-based education (Reeves et al., 2007). The scale of the simulation intervention determines which personnel should be involved. This could range from local leaders (shift coordinator and consultants) on the day of the simulation activity, to, for larger programmes, requiring sustainability and increased resources, it could include educational leads from each profession (e.g. college tutors, lead nurses/matrons) and departmental/directorate managers.

Clarity from the outset regarding funding for simulation equipment, faculty time and training time for learners is paramount and will aid the simulation design and set realistic learning outcomes. Consideration for the location of the simulation, space and medical equipment are explored in Chapter 2. When testing systems, actual in situ space, processes and equipment should be used. Consider performing simulation on days of reduced clinical work (e.g. clinical governance days) when clinical areas are less likely to be in use. When considering equipment and drugs to be used in the simulation, remember that patient safety is paramount, and when using simulated equipment in an in situ environment, facilitators must be meticulous to leave nothing behind at the end of the session.

Having secured time for faculty and learners, the organisational focus must now shift to the learners’ training requirements. This needs careful consideration and planning when endeavouring to engage the interprofessional team in its entirety.

Spending time considering these organisation/management issues will promote long-term sustainability of simulation activities in the busy workplace.

Participants

Points to consider include:

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  Scenario theme

  
  
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  Professional group/role

  
  
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  Composition of participants

  
  
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  Level of experience/training requirements

  
  
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  Remote senior support

The participant (Thistlewaite et al., 2010) set-up of the simulation is crucial to the scenario/programme design. In order to promote effective interprofessional interaction and increase set-up fidelity (Bland et al., 2014), the composition and number of participants need to closely match that of the simulated clinical team. Over-representation of any one professional group can skew the interprofessional learning (Reeves et al., 2007).

When planning the scenario theme, consider which participant groups would be involved in actual clinical settings. For example, a placental abruption with fetal bradycardia scenario would require midwifery, obstetric, anaesthetic and neonatal teams to be present, depending on the progression of the simulation and learning objectives.

Knowledge of learning requirements and level of experience/skill set of participants is key for scenario design and facilitation. Complex simulations are likely to require different levels of experience within professions, if a fully interprofessional learning experience is to be created (see ‘Theories and Practice’ below). Consider the availability of remote senior support (for all professional groups) that can be called upon during the simulation, providing advice by telephone or attending in person.

Facilitators/Faculty

Points to consider include:

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  Professional representation

  
  
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  Number

  
  
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  Roles

  
  
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  Training and faculty development

The composition of facilitators (faculty) needs careful thought. Ideally, this should mirror the professional representation of the participants, so as to maintain credibility during facilitation and debriefing of the simulation. Consider the number of facilitators that you will need; this will be influenced by the size of the participant team. Establish facilitators’ roles from the outset, including pastoral, emotional support for high-intensity scenarios. Training and continuing professional development, in both facilitation and debriefing practices, is crucial (Purva et al., 2016). This is particularly important for new faculty members. Regular peer feedback will enable faculty development. Technical faculty may also be required, if this skill set is not within the existing faculty.

Theories and Practice

IPE requires collaborative practice (Sargeant, 2009), engaging professionals to acquire the knowledge, skills and attitudes to work together for a common goal (Oandasan and Reeves, 2005; Sargeant, 2009). IPE is built on social and experiential learning. In order to construct interprofessional simulation-based education in healthcare, two specific theoretical learning perspectives are useful to consider (Sargeant, 2009): social constructivism and complexity theory.

Social constructivism (Lantolf and Thorne, 2006) places the emphasis on participants exploring a situation and applying an individual’s prior knowledge to make sense of the clinical context – the interactivity between the participants and the influence of situational factors upon their behaviour and application of knowledge (Sargeant, 2009). Complexity theory is particularly important in the healthcare setting, where there are multiple, unpredictable system components that may have an impact on a participant’s behaviour in a setting (Sargeant, 2009; Sweeney and Griffiths, 2002).

Congruent with these learning theories are the following practices, which should be incorporated into the simulation design:

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  Vygotsky’s zone of proximal development (Vygotsky, 1978; McLeod, 2012), where less-competent participants may develop from their more skilful peers, by using ‘scaffolding’ (Wood, 2001) – assistance that matches the specific needs of the participant at that time. In simulation practice, this could be highlighting a guideline or aide-memoire for the participants to work through as the clinical case becomes more complex.

  
  
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  Situated and authentic learning (deliberate community of practice) (Lave and Wenger, 1991; Sargeant, 2009), where learning is seen as a social activity within a particular environment (e.g. learning within a healthcare team through interpersonal interaction) and where practitioners work together to learn and collaboratively create new knowledge about a situation, e.g. awareness of a practice guideline, patient-specific information.

  
  
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  Mentoring (Gibbons et al., 2002) between junior and senior colleagues, which occurs naturally in the workplace.

In order to create a common platform for learning and decrease cognitive load (Paas et al., 2003), a ‘flipped-classroom’ approach (Missildine et al., 2013), whereby information pertaining to an aspect of the simulation is given to participants prior to the event (e.g. a guideline/algorithm), can help facilitate and improve interprofessional learning. For example, if a difficult airway scenario is to be simulated, the unit guideline for this is given to participants beforehand and is available during the simulation.

With a less-experienced group of participants, a more behavioural learning approach may be required, which would require more input from the faculty. One or more members may need to act as confederates, otherwise known as embedded participants (INACSL Standards of Best Practice: Simulation^SM: INACSL Standards Committee, 2016), to guide the participants through a given scenario to achieve the learning objectives. In this case, it is still important that any confederate assists the participants to engage in the simulation, promoting active learning, directing them to the prior agreed learning objectives in a collaborative manner.

Design Characteristics/Learning Objectives

Points to consider include:

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  Learning objectives for all IP team members

  
  
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  Technical vs. non-technical factors

  
  
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  Fidelity

  
  
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  Space/equipment availability

  
  
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  Cues

  
  
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  Support mechanisms

It is important that the learning objectives are relevant to all participant groups involved, achievable in the set time frame and convey the process by which they are to be achieved. Focus on no more than four objectives for any given simulation, covering both technical and non-technical (human factor) skills. Within these learning objectives there may be technical issues for different participant groups that require discussion, but the main focus of interprofessional simulation should be around how the professional groups interact with each other, the surroundings and the clinical issue. This needs to be conveyed in the learning objectives.

With the learning objectives in mind, consider the design characteristics of the simulation. The fidelity of the set-up – the degree to which the simulation replicates the real event and/or workplace – should address physical, environmental and psychological components (Lopreiato, 2016) of the simulation design. Physical fidelity, ‘the degree to which the simulation looks, sounds and feels like the actual situation’ (or the ‘in-situ’ nature of simulation), creates a high sense of realism, allowing participants to suspend disbelief on entering the simulation (Lopreiato, 2016). The use of monitored high-fidelity manikins, from which the participants are able to elicit clinical signs, along with using equipment identical to that used in clinical practice, increases the authenticity of the simulation – the participants’ subjective interpretation/response to a constructed simulation (Bland et al., 2014). However, increasing the manikin fidelity does not automatically lead to an increase in authenticity and perceived participant learning (Bland et al., 2014). Using low-fidelity manikins, with additional moulage, in an otherwise high-fidelity environment (clinical room, with familiar equipment, following departmental system processes) can still create an authentic learning experience. A similar experience can be gained from the use of a high-fidelity manikin in a mocked-up training room, using the appliances and equipment seen in clinical practice. The design features should not detract from participants being able to achieve their learning objectives. See Chapter 5 for more information regarding fidelity.

Having an appropriate participant set-up, matching that in clinical practice, with the ability to summon senior assistance, by means of phone/bleep/crash buzzer, during the simulation further increases the environmental fidelity. Ensuring the departmental system processes are adhered to during the simulation aids the authenticity of the simulation experience and interprofessional learning. To promote psychological fidelity, each participant should perform their usual professional role and act within their clinical competencies.

The complexity of the simulation has to be appropriate to the clinical setting and participants involved (Motola et al., 2005; Reeves et al., 2007), and where the simulation is likely to extend beyond the participants’ clinical capabilities, the faculty must ensure that appropriate scaffolding is in place. Senior support or supplementary information may be provided as a ‘flipped-classroom’ pre-simulation. Cues from the faculty may include altering the simulator parameters, in real time (ensuring realism of the simulated events), or questions and statements of clarification to the participants where visual cues cannot be recreated (e.g. colour or movement of a manikin).