Interprofessional education using simulation of an overnight inpatient ward shift.

In healthcare it is rare for professionals to practice together before they practice together. Nightmare Night Care is an annual interprofessional voluntary event for health sciences students in nursing, medicine and pharmacy to come together for a simulated hospital overnight ward shift. The purpose of this study was to investigate the interprofessional knowledge, skills and attitudes the students learn from this experience. Students responded to surveys before (n = 45) and after the event (n = 11) regarding their understanding of the goals of interprofessional education (IPE), roles and responsibilities of other professions, and what they learned from this event. Responses demonstrated that students are eager to learn in interprofessional settings and that IPE events may aid in building understanding and communication between professions. IPE events are an opportunity to allow students to learn about each other; however, they must occur frequently, and must include an orientation on role clarification if they are to have an effect on changing preconceived stereotypes of the other professions.

Keywords: night shift; patient care team; simulation; students; Interprofessional education

Health care professionals are required to work in collaborative teams to optimize quality of care and patient safety, yet in health sciences curricula, there is controversy about how to teach teamwork in an interprofessional environment. Interprofessional education (IPE) favorably improves perceptions among health professions students (e.g. Ateah et al., [2]; Kowitlawakul et al., [6]) and early IPE can prevent the development of negative attitudes and improve teamwork (e.g. Hood et al., 2014).

One annual event in the repertoire of IPE events at the University of Manitoba, Canada, is Nightmare Night Care (NMNC), a volunteer, simulated 12-h night. The event began in the Faculty of Nursing in 2006, and medical and pharmacy students were added in 2010. The event included a formal orientation for all selected students. Junior medical (Year 1) and nursing (Year 2) students performed the role of standardized patients, senior students in nursing (Years 3 and 4), medicine (Year 2) and pharmacy (Year 4) performed their respective professional roles. Graduate medical residents (Years 1 and 2) performed the role of ward attending physicians and academic staff from all three faculties served as mentors. The shift included interprofessional ward rounds, simulated patient records and staged patient events. There was a debriefing session with faculty in the morning prior to students' departure.

The purpose of this article is to present findings from a study of the 2013 event which aimed to investigate students' understanding of IPE, how the NMNC affects their perceptions of other professions and how they work together.

A non-experimental pre-test–post-test survey design was used for this study. Convenience sampling was used from the IPE event participants.

All nursing, medical and pharmacy students (n = 995) were recruited to both the activity and the study by E-mail invitation. Participation was limited by facility size. Forty-five participants were randomly selected from interested students.

The pre-event survey asked questions about preconceived perceptions about IPE. Participants responded to four questions using a 10-point Likert scale (10 = strongly agree), and five open-ended questions regarding their perceptions of the roles of other health professions, expectations for the event, and perceived value of IPE. The post-event survey was E-mailed to participants ∼1 month after the event. It included four questions using the same Likert scale and seven open-ended questions. The questions were designed to determine whether the event changed perceptions about professional roles and working with other health professions. Additional targeted questions were asked of the senior students as health care providers and junior students as the standardized patients.

A research assistant not involved in the event collated the data. The authors independently evaluated the open-ended questions and then reached consensus regarding emerging themes.

Survey data was analyzed for descriptive statistics using SPSS software (version 20; SPSS Inc., Chicago, IL). The open-ended questions were manually coded and analyzed independently by each authors and then sorted into category schemes. Consensus regarding themes was reached.

Ethics approval was obtained from the University of Manitoba's Research Ethics Board. Students were asked to sign consent forms and complete a pre-event survey at the orientation session. Identification codes were generated to ensure anonymity.

A total of 45 students responded to the pre-event survey, 12 from medicine, 23 from nursing and 10 from pharmacy. The mean scores are presented in Table I.

Table I. Pre-/post-event mean knowledge/attitudes scores.

2 Scale of 1–10, with 10 = strongly agree.

Responses to the open-ended questions showed that students participated in order to understand the experience of being a patient, to learn with other healthcare students and to practice clinical skills. Responses regarding preconceived ideas of other professions included perceptions of physicians as smart, but poor listeners and team-players; nurses as patient-centric and hard-workers; and pharmacists as very knowledgeable, but less consulted. Several questions focused on the participants' understanding of IPE and its value in patient care. Responses were synchronous across professions regarding the definition of interprofessional, and students found IPE beneficial as it provided experience in communication, collaboration and teamwork. Students understood that interprofessional care provides higher quality patient care.

Eleven students responded to the post-event survey, five from medicine and six from nursing (Table I). Responses to the open-ended questions showed that students valued the experience of being a patient, the ability to collaborate with other professions and learning the roles of other health professions. A nursing student stated that students enjoyed "working and laughing with students from all of the different faculties". Difficult parts of the event were trying to coordinate care during busy times and being awake in the middle of the night.

Participants were asked via open-ended questions if the experience changed any preconceived biases regarding other professions. Students reported that they had a better understanding of how the professions interact and the role of each profession in a clinical setting. Students were asked also how they thought this experience would impact their future career. Students reported more confidence in working in a team and a better understanding of the role of the other professions. They indicated that they had a better understanding of the patient experience, the value of interprofessional communication and the importance of each team member.

Healthcare providers and "patients" were asked targeted questions. Healthcare providers were asked how working in a team affected their ability to provide patient care. Students overwhelmingly thought that being part of the team improved their ability to care for their patients. One student suggested that by nature of being in a student role, they were more open to receive help from others. "Patients" repeatedly expressed that effective communication was necessary for a strong interprofessional team. In response to general comments, students indicated that they wanted more orientation on how to work together prior to the event.

The pre-event survey results indicated that students are eager and willing to learn from other professions, to learn outside the classroom and to appreciate the patient experience. Other simulation-based interprofessional initiatives have demonstrated efficacy in team-based learning, and the ability to improve students' knowledge, attitudes and skills toward interprofessional teamwork (Brennan, Olds, Dolansky, Estrada, & Patrician, [4]; Sigalet, Donnon, & Grant, [7]) and are rated positively by students involved (Alinier et al., [1]; Baker et al., [3]).

The question regarding preconceived ideas about other professions likely represented general assumptions and stereotypes of each of the three participating professions. The simulation event did not appear to change many perspectives; however, the post-survey sample size was small. Responses to the pre-event survey described medical professionals as knowledgeable, smart, poor listeners and poor team players. Nursing professionals were viewed overall as being patient-centered, caring and hard-working, while pharmacy professionals were either unknown or best known for their vast knowledge of drugs. The post-event survey revealed similar stereotypes; however, participants indicated they now had a better understanding of how the professions interact and the role of each profession in a clinical setting.

Overall, students appreciated the opportunity to work together in a simulated clinical setting before entering a real-life situation. The NMNC provided a safe environment where students felt comfortable to learn about, with and from each other. The event also provided students with the opportunity to learn how an inpatient ward runs, how it feels to work through the night, and the challenges of direct patient care, or of being a patient. Several students commented that despite the orientation provided, they would have preferred a more detailed orientation to understand how they were supposed to work together during the NMNC. This study highlights the importance of encouraging interprofessional collaboration at the student level. Possible future events are planned to be more frequent and include an orientation that discusses the roles of each profession and how students are expected to fulfill these roles. Planning is underway to include more activities during this simulation event that consciously require students to interact with each other.

A limitation of the study was the low response rate for the post-event survey. Use of a more accessible electronic survey format (such as REDCap or Survey Monkey, which require less effort on the part of the participant compared to surveys attached to E-mail) may enhance the post-event response rate in the future. Another limitation was that the author-constructed survey tool was not formally tested for reliability or validity prior to implementation. While it was evaluated for face validity, the tool would need to be formally tested for reliability and validity if it were to be used again. A third limitation was the small sample that the facilities would allow due to space restrictions. Many additional students interested in the simulation event were unable to participate. Consequently, the pre-event survey sample size was also limited. In the future, collating data from multiple IPE events would give a better representation of responses. Finally, the students who attend these events are likely those who are more interested in IPE, thus the responses may reflect this subgroup of students.

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

This work was partially supported by the University of Manitoba Start-Up Funds program.