The Journal of Continuing Education in Nursing

Original Article 

Interprofessional Educator Development Course for Simulation

Evelyn Stephenson, DNP, RN, RNC-NIC, NNP-BC, CHSE; Julie Poore, DNP, RN, CHSE; Bobbi J. Byrne, MD; Jennifer Dwyer, MSN, RN-BC, CHSE, FNP; David Ebert; Greg Hasty, LPN, CHSE, CHSOS; Karen Schroedle, BA; Joseph Turner, MD; Dylan Cooper, MD

Abstract

As interprofessional teams and interprofessional practice become the norm in health care, there is an increasing need for interprofessional educator development to prepare health care students and staff for these new roles. This article describes the development, implementation, and results of an Interprofessional Educator Development Course (IPEDC) for simulation that was created to train clinical educators, practicing professionals, and academic faculty from all health care professions in simulation methodology. The authors, working across disciplines and professions, describe the benefits, limitations, and outcomes of this approach and explain how they met the needs of the involved stakeholders. [J Contin Educ Nurs. 2019;50(10):463–468.]

Abstract

As interprofessional teams and interprofessional practice become the norm in health care, there is an increasing need for interprofessional educator development to prepare health care students and staff for these new roles. This article describes the development, implementation, and results of an Interprofessional Educator Development Course (IPEDC) for simulation that was created to train clinical educators, practicing professionals, and academic faculty from all health care professions in simulation methodology. The authors, working across disciplines and professions, describe the benefits, limitations, and outcomes of this approach and explain how they met the needs of the involved stakeholders. [J Contin Educ Nurs. 2019;50(10):463–468.]

Simulation is a means of providing hands-on instruction in a safe environment that imitates the actual practice environment. Simulation educators must be able to establish a simulated real-world environment and develop cases where the learners can make clinical decisions, communicate within an interprofessional team, and evaluate their performance. The power of simulation rests in moving beyond cognitive learning directly into a practice setting, to one that blends learning in a safe environment where the learner can be exposed to scenarios that occur both frequently and infrequently in practice. When the goal is to use simulations to develop students and staff for interprofessional practice, an interprofessional team of faculty must write new simulations or redesign others to add interprofessional roles to the scenarios, the implementation of the simulation, and in the debriefing and evaluation of the learning outcomes. To this end, our academic health care center has created the Interprofessional Educator Development Course (IPEDC), which is now the standard for teaching interprofessional practice with a simulation. This article describes the substance and approach used in the IPEDC course.

Background

The simulation literature supports educator training in simulation techniques and strategies (Alexander et al., 2015; INACSL Standards Committee, 2016; Lemoine, Chauvin, Broussard & Oberleitner, 2015). These authors found inconsistent or nonexistent training opportunities for educators, and training, when present, was limited to reviewing literature, observing others, or attending a workshop. Most training was provided by vendors selling simulation equipment and was limited to equipment management and maintenance (Kardong-Edgren, Willhaus, Bennett, & Hayden, 2012). Given the capital expense of the equipment, it is paradoxical that little funding is made available for optimizing simulation as a learning strategy. Yet, standards for training exist, such as those promulgated by the INACSL. The call by Alexander et al. (2015) for educator development and the use of standards became the foundations for our IPEDC course.

Davidson and Rourke (2012) suggested that successful educator development begins with an introduction to simulation equipment and resources during the initial orientation. Peterson, Watts, Epps, and White (2017) recommended that educator development in simulation provide an early introduction to simulation and tiered instruction. This provides a clear developmental direction for educators as they progress through five stages of training (Introduction to Simulation Education; Scenario Development; Running a Simulation; Debriefing; and Assessment, Research, and Sustainability). The tiered approach allows for educators to gain simulation expertise at a reasonable and steady pace. Although recommendations for educator development in simulation are growing in the literature, few articles address interprofessional educator development initiatives.

The Simulation Center at our academic health science center is a collaborative partnership between the school of medicine, school of nursing, and the health care system that provides simulations for a wide variety of health care providers. The center space is over 30,000 square feet and contains a virtual hospital with five patient rooms, complete with a unit secretary station, an operating suite, an intensive care unit room, an emergency department room, a delivery suite, an ambulance bay, flex space, classrooms, a skills laboratory, and a 10-room virtual clinic. Educators in the center provide simulation-derived validation of procedural and communication skills, along with competency for patient assessment, prioritization, and decision making.

As a challenge to our group of educators, we wanted standardized core competencies to be shared by all faculty engaged in the 1,000 events per year that our interprofessional groups sponsored. Twenty percent of the more than 100,000 learner-hours provided annually involve interprofessional experiences. Evaluative data, which included a review of the literature, a needs assessment, and discussions with stakeholders, suggested that many clinical educators and faculty demonstrated gaps in their ability to provide consistent, meaningful, quality simulations. The educator team identified five goals for the new IPEDC:

  • Improve the quality of simulation education and assessment for learners.
  • Centralize educational resources and standardize training for simulation educators and facilitators from all professions.
  • Develop a core group of educators from various professions trained to deliver consistent and quality experiences.
  • Improve interprofessional educator collaboration.
  • Align with the Standards of Best Practice: Simulation (INACSL, 2016), achieving consistency in the learning experience for all participants.

Steps Involved for Course Development

The IPEDC curriculum was developed by an interprofessional team, using standards previously noted. We determined that the content would be orchestrated in five modules: introduction to simulation as an educational strategy; scenario development to meet learning outcomes; conducting the simulation; conducting a postsimulation debriefing; and leadership in simulation assessment, research, and sustainability. These five training modules would achieve the following goals: to improve educator readiness and confidence in using simulation for learner readiness for practice, ensure cross-disciplinary competencies in faculty engaged in simulation, improve cross-disciplinary consistency in approaches to simulation, enhance collaboration between and among the disciplines, and model national standards. Table 1 identifies the didactic content and presenting educators for each session.

Interprofessional Educator Development Course in Simulation Education Course Content

Table 1:

Interprofessional Educator Development Course in Simulation Education Course Content

To improve attendance by all professions, the planning group decided that each session would be no more than 2 to 3 hours in length. The modules were offered monthly in the afternoon and were developed and facilitated by an interprofessional expert educator team.

The planning group decided to use local simulation experts to deliver material in an effort to highlight local talent, improve accessibility to experts, and contain costs. The group identified local education experts from each partner institution (i.e., the health care system, medicine, and nursing) with the following qualities: significant simulation experience, passion for education, and comprehension of the best practices in simulation. Using local experts was beneficial for several reasons. First, each educational session was offered more than one time to develop the necessary numbers of educators required to support the curricula and meet the varied educational objectives. Health care schools and clinical institutions hire many faculty and clinical educators each year; thus, ongoing orientation and education is necessary. Next, using local experts from the partnership modeled interprofessional team cooperation that was ideal in the education of the interprofessional audience. The planning team also felt that this would aid in interprofessional curricular integration. Another reason for using members of the partnership was to be able to offer nursing continuing education (CE) contact hours or continuing medical education (CME) hours to members of each of the professions in accordance with the requirements of each of their respective accrediting bodies. At our institution, we could offer the contact hours at no charge to participants. The cost for the contact hours was absorbed by the school of medicine. Finally, if a team of local experts provided the content, they would be available for ongoing consultation and simulation development to newly trained educators.

Each of the educators involved in developing and teaching the course content, donated their time with the understanding that the rewards would be realized through improved quality of simulation. Dates for the IPEDC training were chosen during simulation center downtime, which resulted in availability of classroom and simulation space with no interruption of simulation education for students or health professionals who train at the center. The cost of handouts was absorbed by the simulation center operational budget as part of their organizational mission. Attendees were not charged a fee to participate in the IPEDC. Simulation centers planning to develop similar courses need to consider the cost of curriculum development, presenters, handouts, training space, and personnel to assist with technology.

Course Content

As one of the most studied educational pedagogies, simulation education resources are rapidly changing. In the development of five course modules, recent peer-reviewed publications and online educational materials served as resources for the content. The INACSL and the Society for Simulation in Healthcare offer several resources. The five course sessions (Table 1) are described below.

Introduction to Simulation Education

The topics in this module include a brief history of simulation, definitions of simulation terms, descriptions of best practice, and a review of adult learning theory. The history was brought to life with discussions and a picture of the first flight simulator and the first human simulator. How the toy maker Laerdal was approached to make the first Resusci Anne® was also a part of the historical account. Finally, local simulation experts from multiple professions participate in a question-and-answer panel to share simulation experiences and discuss how to engage other faculty.

Scenario Development

Module 2 details the factors that need to be included in simulation development. Participants are allotted time to work on developing their own simulation with the help of the expertise of the presenting facilitators. Although the entire scenario was not completed during the session, feedback and assistance was provided by the facilitators as requested via e-mail. Topics for discussion included types of simulations that may be written, the availability of different templates, the need to match the correct type of simulation for the learning outcomes and objectives, and use of standardized and simulated patients.

Running a Simulation

This module discusses important elements in the running of a simulation, as well as interactive discussions of potential difficulties that may be encountered. Live simulations and videos were used to demonstrate some of the obstacles that might be encountered, as well as solutions to common problems. Demonstrations of effective, well-run simulations, as well as poorly run simulations that did not meet learning objectives, are shared as learning objects.

Debriefing

Module 4 focuses on developing the skills important in debriefing. Facilitators lead an interactive discussion on providing feedback and the various theoretical models of debriefing. An experienced simulation facilitator conducts a debriefing with occasional pauses to highlight certain debriefing techniques. Included in the presentation were clips from popular children's movies that include simulation and debriding to keep the conversation light and lively. Participants then have the opportunity to practice their emerging debriefing skills for novice facilitators or refine debriefing techniques for more experienced facilitators.

Assessment, Research, and Sustainability

The final module includes an overview of the strengths and challenges of using simulation as an assessment tool. Learners participate in exercises that score cases on a standardized assessment tool. Additional discussions involve the introduction the concept of using simulation as a research tool, initial steps necessary for a simulation-based scholarly project, and factors to consider to create a sustained simulation program.

Program Evaluation Data

In the initial 2 years of the IPEDC, module 1 was presented four times, whereas the other modules were each presented twice. A total of 86 educators, facilitators, and administrators attended the IPEDC, to include faculty from nine professions and 14 different organizations. Table 2 identifies attendance per session over a 2-year period. The majority attended one to two sessions (average of 1.5 sessions per attendee), with the introduction sessions gathering the greatest total attendance (Figure 1).

Interprofessional Educator Development Course Attendance by Profession and Organization Over 2 Academic Years

Table 2:

Interprofessional Educator Development Course Attendance by Profession and Organization Over 2 Academic Years

Total Interprofessional Educator Development Course (IPEDC) attendance per session over 2 academic years.

Figure 1.

Total Interprofessional Educator Development Course (IPEDC) attendance per session over 2 academic years.

Sixty-nine percent of attendees completed a written nursing CE or CME evaluation. On a Likert scale of 1 to 5, the average scores on CE evaluations were 4.85, 4.88, and 4.98; CME evaluations at 4.70, 4.65, and 4.67. Table 3 summarizes learner evaluation data. Qualitative feedback focused on session format, structure, and content. The comments included a desire for electronically shared presentation slide decks for sessions, a desire for more hands-on practice, and specific information for the care and maintenance of equipment. Comments also focused on the course providing appropriate strategies for beginning educators.

Attendee Feedback Over 2 Academic Years and Participants' Voluntary Completion of Either CME or CE Evaluation

Table 3:

Attendee Feedback Over 2 Academic Years and Participants' Voluntary Completion of Either CME or CE Evaluation

Lessons Learned to Move Forward

The success of the IPEDC is largely attributed to the fact that the planning group shared a common philosophy regarding the structure and development of the program. Planners developed the IPEDC with the desire to have consistency for all educator participants in an effort to create a safe learning environment for their learners. Using best practice guidelines for simulation ensured that this goal was accomplished regardless of the background or simulation role of each course participant.

The decision to use an interprofessional team was important because of the diverse audience to be served. Attendees represented nine different professions from 14 different organizations (Table 2). One half of these organizations were from outside of the academic health sciences center, as we invited any health care educator statewide who was interested in learning more about simulation.

The team was also challenged to develop educational materials to address a variety of learning needs of the educators who were participating in this program. Although simulation itself is a hands-on experience, some of the foundational content needed to be taught in a lecture. To better engage learners during lecture, facilitators incorporated photographs and videos. Group discussion also played a significant role in the learning experience. All participants wore name tags, so facilitators addressed them directly when asking for comments, questions, or suggestions.

Using educational technology is a common barrier for many educators. Participants attending the IPEDC had varying levels of technological skills. The IPEDC only covered very basic technology as the educators who run simulation at this center are always fortunate to have a technician with them during an event.

Common to many interprofessional initiatives, scheduling was a challenge. Finding dates and times that worked for those in both academic and practice settings proved to be difficult. The team hoped to offer the IPEDC at a time that was convenient for all disciplines, but unfortunately the schedules were vastly different and this forced the team to target one primary group and hope that other disciplines could have some representation. The initial course was a multiday session consisting of a half-day workshop on each of the five modules. Most participants attended only one or two of the five total sessions. Many health care educators have multiple scheduling conflicts due to both clinical and academic commitments. In an attempt to improve attendance and based on feedback, the IPEDC changed the format to a 1-day course. A disadvantage of condensing the material to a 1-day format was the loss of depth of topic coverage. The team thought this was acceptable because the interprofessional educational team was local and easily accessible for further consultations.

Each attendee was asked to provide an evaluation at the end of each attended session for the purpose of course content and program improvement. The decision was made to provide paper-and-pencil CE or CME evaluations due to the variety of professionals attending. Sixty-nine percent of attendees completed a written CE or CME evaluation. The nursing CE evaluation asked attendees to rate their ability to identify, describe, develop, and use the information presented from the individual session they attended. The CME evaluation for the physicians asked attendees to rate the extent to which the program met their professional expectations and need, provided supporting materials or tools that were helpful to their practice, and provided the opportunity to learn interactively. From these evaluations and the information gained, the team made changes in the content delivery. An identified need from this experience was to have a mechanism for one evaluation to satisfy all health care professions' CE documentation requirements. For the purpose of data collection and analysis, the team has now moved to one evaluation form that satisfies both CE and CME requirements.

Course evaluation data also identified the need to develop advanced training as a next step for attendees. This is especially true of the debriefing sessions. Participants asked for more time to practice (e.g., perhaps as Sim 2.0) and to refine their craft and new skills. To meet these requests, advanced courses are in the planning phase.

Summary

As simulation education continues to expand in the health care curriculum, there is an increasing need for clinical educator and faculty development. The IPEDC offers an opportunity to educate individuals from many health care professions with the standards of best practice in simulation. Evaluation and feedback from participants is critical for continuing quality improvement of course offerings to address the ever-changing needs of health care educators.

References

  • Alexander, M., Durham, C.F., Hooper, J.I., Jeffries, P.R., Goldman, N., Kardong-Edgren, S. & Tillman, C. (2015). NCSBN simulation guidelines for prelicensure nursing programs. Journal of Nursing Regulation, 6(3), 39–42. doi:10.1016/S2155-8256(15)30783-3 [CrossRef]
  • Davidson, K.M. & Rourke, L. (2012). Surveying the orientation learning needs of clinical nursing instructors. International Journal of Nursing Education Scholarship, 9, 3. doi:10.1515/1548-923X.2314 [CrossRef]
  • INACSL Standards Committee. (2016). INACSL standards of best practice: SimulationSM facilitation [Supplemental material]. Clinical Simulation in Nursing, 12, S16–S20. doi:10.1016/j.ecns.2016.09.007 [CrossRef]
  • Kardong-Edgren, S., Willhaus, J., Bennett, D. & Hayden, J. (2012). Results of the national council of state boards of nursing national simulation survey: Part II. Clinical Simulation in Nursing, 8, E117–E123. doi:10.1016/j.ecns.2012.01.003 [CrossRef]
  • Lemoine, J.B., Chauvin, S.W., Broussard, L. & Oberleitner, M.G. (2015). Statewide interprofessional faculty development in simulation-based education for health professions. Clinical Simulation in Nursing, 11, 153–162. doi:10.1016/j.ecns.2014.12.002 [CrossRef]
  • Peterson, D.T., Watts, P.I., Epps, C.A. & White, M.L. (2017). Simulation faculty development: A tiered approach. Simulation in Health-care, 12, 254–259. doi:10.1097/SIH.0000000000000225 [CrossRef]

Interprofessional Educator Development Course in Simulation Education Course Content

SessionTopicEducator Presenting
1Introduction to simulation educationMedicine, nursing, paramedicine, education
2Scenario developmentNursing, medicine
3Running a simulationNursing, medicine, education, paramedicine
4DebriefingMedicine, nursing
5Assessment, research, and sustainabilityEducation, medicine

Interprofessional Educator Development Course Attendance by Profession and Organization Over 2 Academic Years

Profession/OrganizationTotal No. of Attendees (N = 86)
Profession
  Nursing39
  Medicine23
  Paramedicine9
  Education5
  Administration4
  Dentistry3
  Physical therapy1
  Social work1
  Veterinary1
Organizationa
  School of medicine32
  Health center23
  School of nursing11
  EMS3
  Dental school3
  VA hospital2
  East campus2
  Neighboring university 12
  Engineering2
  Neighboring university 22
  Chamberlain Nursing1
  Center for IPE1
  Neighboring hospital 11
  Neighboring hospital 21

Attendee Feedback Over 2 Academic Years and Participants' Voluntary Completion of Either CME or CE Evaluation

Attendee EvaluationAverage on 5-Point Likert Scalea (± SD)
CME evaluations (N = 46)
  The program met my professional expectations and needs.4.69 (0.51)
  The program provided supporting materials or tools that are helpful to my practice.4.65 (0.53)
  The program included opportunities to learn interactively.4.67 (0.56)
CE evaluations (N = 41)
  The objectives reflected the overall purpose/goal of this program.4.85 (0.42)
  I would recommend this program to others with the same educational background and experience.4.87 (0.40)
  Content was presented without bias to drugs or commercial support.4.98 (0.16)
Authors

Dr. Stephenson is Clinical Associate Professor, Science of Nursing Care, Mr. Ebert is Simulation Coordinator, Encouraging Learning, Innovation & Technology Excellence (ELITE) Center, Indiana University School of Nursing, Ms. Dwyer was Education Specialist, C.O.R.E. Essentials, and IU Health Liaison, Dr. Poore is Manager, Mr. Hasty is Simulation Coordinator, Ms. Schroedle is Standardized Patient Educator, The Simulation Center at Fairbanks Hall, Indiana University Health, Dr. Byrne is Associate Professor of Clinical Pediatrics in the Section of Neonatal-Perinatal Medicine, Director of the Neonatal Resuscitation Program Outreach Education, Department of Pediatrics, Dr. Turner is Assistant Professor of Clinical Emergency Medicine, Assistant Program Director, Department of Emergency Medicine, Indiana University School of Medicine, and Dr. Cooper is Professor of Clinical Emergency Medicine, Director of Simulation Education, Department of Emergency Medicine, Indiana University School of Medicine, and Director, The Simulation Center at Fairbanks Hall, Indiana University Health, Indianapolis, Indiana.

†:

Deceased.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Evelyn Stephenson, DNP, RN, RNC-NIC, NNP-BC, CHSE, Clinical Associate Professor, Science of Nursing Care, Indiana University School of Nursing, 600 Barnhill Drive, NU 431, Indianapolis, IN 46202; e-mail: estephe@iu.edu.

Received: July 16, 2018
Accepted: June 10, 2019

10.3928/00220124-20190917-08

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