Interprofessional Standardized Patient Exercise (ISPE): The Case of “Paul Harris”
|Case||9011||1||October 4, 2011|
Effective interprofessional education (IPE) enhances collaboration among healthcare professionals by engaging participants in authentic tasks, settings and roles. Using these guiding principles, this Interprofessional Standardized Patient Exercise (ISPE) was created to provide health professional students with a structured learning experience in working as an interdisciplinary health care team. The SP case of Paul Harris involves multiple complex chronic medical conditions and was designed to be relevant to many health professions. At our University, participants were 2nd and 3rd year students from five health professional schools: dentistry, medicine, nursing, pharmacy, and physical therapy. Students worked in interprofessional teams to interview the SP and create an integrated care plan. Faculty facilitators from each school were present to observe the students and to lead debriefing sessions. The exercise takes approximately 4 hours. This case would also be relevant to other health professional students, including nutritionists, physician assistants, and social workers.
Staves J, Hossaini M, Kroon L, Lindsay C, Newlin B, O’Brien B, Topp K, Wamsley M. Interprofessional Standardized Patient Exercise (ISPE): The Case of “Paul Harris”. MedEdPORTAL; 2011. Available from: www.mededportal.org/publication/9011
- Students will demonstrate the ability to effectively communicate and collaborate with other healthcare professionals.
- Students will demonstrate the ability to efficiently interview and assess a patient with chronic illness, showing empathy, and sensitivity to a patient’s cultural and personal needs.
- Students will develop a comprehensive care plan to meet the patient’s healthcare needs in collaboration with other healthcare professionals.
- Students will describe the role of other healthcare professionals in caring for a patient with chronic illness.
- Team, Interview (MeSH), IPE
- Communication & Interpersonal Skills
- Interpersonal & Communication Skills
- Interprofessional Collaboration
- Medical Knowledge
- Patient Care
- Systems-based Practice
- Clinical Sciences
- Clinical Skills/Doctoring
- Communication Skills
- Evaluation of Clinical Performance
- Health Education
- Personal Characteristics/Attitudes
- Professional School
- Allied Health Student
- Dental Student
- Medical Student
- Nursing Student
- Pharmacy Student
- Public Health Student
- Professional School Post-Graduate Training
- Standardized Patient
Authors & Co-Authors
UCSF School of Dentistry
Mehran Hossaini, DMD
UCSF School of Dentistry
UCSF School of Pharmacy
Bridget O’Brien, MS, PhD
UCSF School of Medicine
Maria Wamsley, MD
UCSF School of Medicine
Lisa Kroon, PharmD, CDE
UCSF School of Pharmacy
Barbara Newlin, RN, MN, ANP
UCSF School of Nursing
Kimberly Topp, PhD
UCSF School of Medicine
Effectiveness and Significance
In 2009-2010, we successfully implemented the Interprofessional Standardized Patient Exercise (ISPE) at our institution. 101 students participated, from the schools of dentistry, medicine, nursing, pharmacy, and physical therapy. We evaluated students’ attitudes toward interprofessional team-based care by administering the Attitudes Toward Health Care Teams (ATHCT) validated survey to students pre- and post-ISPE. The survey uses a 6-point Likert Scale (1=strongly disagree, 6=strongly agree). Students’ attitudes improved on 2 of the 3 subscales of the survey, Team Value (pre-mean=4.87, SD=.50, post-mean=5.13, SD=.53, p<.001) and Team Efficiency (pre-mean=4.41, SD=.64, post-mean=4.72, SD=.64, p<.001). Attitudes toward Physicians’ Shared Role in interprofessional teams did not change significantly (p=.29).
We also surveyed students and faculty about their satisfaction with the ISPE, which was high: faculty would recommend the exercise for students in their profession (mean=5.67 on a 6-point scale, SD=1.05) and students would recommend the ISPE to a fellow student (mean=5.34, SD=.89).
Perceived achievement of the goals of the ISPE was evaluated through focus groups (one focus group for each profession). Students in all five focus groups reported appreciation for the opportunity to learn about other profession and to educate others about their own professional role.
These findings contribute to the growing body of literature on efforts to generate positive attitudes toward interprofessional collaboration early in training, which may influence students’ ability to be active and effective members of healthcare teams.
Special Implementation Guidelines or Requirements
The Paul Harris case is an interprofessional standardized patient exercise (ISPE) designed to provide health professional students with a structured learning experience in working as an interdisciplinary health care team. The SP case involves multiple complex chronic medical conditions, and was designed to be relevant to many health professions. At our University, participants were from five health professional schools: dentistry, medicine, nursing, pharmacy, and physical therapy. All students were in their 3rd year, except for the nurse practicioner students, who were in their 2nd year of a two-year program. Faculty facilitators from each school were present for the ISPE to observe the students and to lead debriefing sessions. This case would also be relevant to other health professional students, including nutritionists, physician assistants, and social workers. Details of the case can easily be adjusted based on which health professions are available (ex: dental history can be simplified if no dental students are participating). Prior to the ISPE, a detailed Faculty Facilitator Guide was distributed to all faculty facilitators, and Student Orientation Materials were distributed to all student participants. The ISPE itself took approximately 4 hours to complete. The schedule of events is as follows: 1.Student Orientation, led by faculty facilitators. Includes time for students fill out the Attitudes Towards Health Care Teams (ATHCT) survey. (15 min) Note: The ATHCT survey is a validated 21-item instrument that we used to evaluate the impact of our ISPE on student attitudes towards working in interprofessional teams (Heinemann, Schmitt, & Farrell, 1999). Use of this survey is not essential to the curriculum. 2.Team Huddle: Students meet in their interprofessional teams of 4-5 students (1 student from each participating school if possible). Together they read the Patient Presenting Information and Student Instructions (includes a brief summary of the SP’s chief complaint, vital signs, medications, lab results, and imaging). It is important to emphasize to students that this is an opportunity for them to strategize about the team’s approach to the patient, their individual roles and how to capitalize on the collective skills of the group rather than repeat parts of the history, physical examination or information sharing that other group members have already performed. At our institution, we ask students to decide in which order they will interview the SP as we have found this promotes more discussion amongst team members. (20 min) 3.SP Interviews: Students take turns individually interviewing the SP (performing a history, physical examination and information sharing relevant to their profession) while the other team members observe (remotely on video monitors, using two-way mirrors, or seated quietly in the encounter room). (15 min per interview, with 5 min break between each interview during which the SP fills out a Patient/Provider Interaction Evaluation Form.) During the 5 minute break between interviews, the student who just completed the interview fills out a brief Post-interview Exercise to help them organize the information they gathered during their interview. Students are also encouraged to discuss the case in their interprofessional teams and further strategize during these breaks. 4.Team Plan: Students meet in their interprofessional team to develop a joint care plan for their patient using the Interprofessional Team Care Plan Template. (20 min) 5.Debriefing Session: The interprofessional team meets with 1-2 faculty facilitators to briefly present their care plan, and to discuss the interprofessional experience. We recommend combining two interprofessional teams for the debriefing session, to increase the variety of student and faculty perspectives. There is an ISPE Faculty Facilitator Guide to orient the faculty in advance to the experience and provide them with suggested questions to help guide the debriefing session discussion. Faculty may choose to hand out copies of the Sample Team Care Plan at the end of the debriefing session. (50 min) 6.Evaluation: After the debriefing sessions, students again fill out the ATHCT (Note: this is optional and was used to compare student attitudes towards interprofessional teams before and after ISPE participation at our institution), as well as a Student Satisfaction Survey. Faculty complete a Faculty Satisfaction Survey. If desired, student focus groups can be conducted at a later date to discuss the effectiveness of the ISPE. We recommend organizing the focus groups by profession, to encourage honest discourse. We constructed the patient profile to be a 58-year old man with no particular ethnicity, height, or weight. Recruited standardized patients will need to undergo training prior to the exercise. We set up one four-hour training module before the ISPE, which entailed a review of case details, practice with the patient-provider interaction evaluation form and role-play of the case with an experienced SP trainer and faculty members from several health professions.
We recognize that other institutions have different combinations of health professional training programs, and while this case was developed with our five schools in mind (dentistry, medicine, nursing, pharmacy, and physical therapy), we believe the case is complex enough that it could easily be adapted for a variety of other healthcare professional students, including social workers, nutritionists, and counselors.
During the pilot year of the ISPE at our institution, some professional students (nursing, pharmacy, and physical therapy) volunteered to participate, while participation was mandatory for the other students. While our data did not show significant differences in pre-ISPE attitudes between students for which the exercise was voluntary vs. required, we would nonetheless suggest striving for a consistent approach in choosing participants (either all voluntary or all mandatory).
It is important that student participants be at similar points in their clinical training. At our institution, the third-year pharmacy student participants had limited previous direct patient care experience, and they reported feeling somewhat overwhelmed by the exercise. We therefore subsequently invited fourth-year pharmacy students to participate in the exercise instead, with improved student satisfaction.
In piloting the ISPE, it was challenging to effectively integrate the dentistry students into the exercise. This was in part due to the difficulty of creating an authentic simulation for dental students without allowing them to actually perform the full intra-oral exam. We have attempted to address this issue by briefing the dental students ahead of time about what portions of the exam they can perform, providing the students will detailed and authentic records (including pictures and xrays), and expanding the SP’s dental history.
During the faculty-facilitated debriefing session at the end of the exercise, there is a tendency for students to become focused on the details of medical management of the patient, rather than discussing their experiences with interprofessional collaboration. It is important that the facilitator(s) reminds the students that the main point of the debriefing session is to discuss interprofessional teamwork. It may help to inform students that they will be receiving a sample Team Care Plan at the end of the exercise that will discuss medical management in more detail.
Having support of the leadership of all schools and interprofessional faculty on the ISPE planning team was essential for our program’s success. Logistical challenges to implementing an ISPE include securing necessary funding, scheduling the exercise, finding time for IPE in each school’s curriculum and recruiting students and faculty. In order to meet these challenges, it is critical that school leadership be in support of IPE. In addition, involving students in the planning an implementation of the ISPE can enhance excitement about the exercise, help with recruitment of participants, and facilitate the long-term sustainability of the initiative.
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