Simulated Patients, Real IPE Lessons When you bring together students from three disciplines to treat virtual patients, interprofessional learning gets real. Features
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Features  |   November 01, 2016
Simulated Patients, Real IPE Lessons
Author Notes
  • Carol C. Dudding, PhD, CCC-SLP, is vice president for standards, credentials and clinical education of the Council of Academic Programs in Communication Sciences and Disorders, and director of the speech-language pathology online master’s program at James Madison University in Harrisonburg, Virginia. She is an affiliate of ASHA Special Interest Groups 10, Higher Education; 11, Administration and Supervision; and 18, Telepractice. duddincc@jmu.edu
    Carol C. Dudding, PhD, CCC-SLP, is vice president for standards, credentials and clinical education of the Council of Academic Programs in Communication Sciences and Disorders, and director of the speech-language pathology online master’s program at James Madison University in Harrisonburg, Virginia. She is an affiliate of ASHA Special Interest Groups 10, Higher Education; 11, Administration and Supervision; and 18, Telepractice. duddincc@jmu.edu×
  • Linda Hulton, PhD, RN, is professor of nursing and the coordinator of the Doctor of Nursing Practice (DNP) Program at James Madison University. hultonlj@jmu.edu
    Linda Hulton, PhD, RN, is professor of nursing and the coordinator of the Doctor of Nursing Practice (DNP) Program at James Madison University. hultonlj@jmu.edu×
  • Anne L. Stewart, PhD, LCP, is a professor of graduate psychology at James Madison University and a licensed psychologist. stewaral@jmu.edu
    Anne L. Stewart, PhD, LCP, is a professor of graduate psychology at James Madison University and a licensed psychologist. stewaral@jmu.edu×
  • Maria deValpine, PhD, RN; Joy Harnage, PhD, DNP; and Sharon Strang Zook, DNP, APRN, FNP-BC, at James Madison University also contributed to this article.
    Maria deValpine, PhD, RN; Joy Harnage, PhD, DNP; and Sharon Strang Zook, DNP, APRN, FNP-BC, at James Madison University also contributed to this article.×
Article Information
Professional Issues & Training / Attention, Memory & Executive Functions / Features
Features   |   November 01, 2016
Simulated Patients, Real IPE Lessons
The ASHA Leader, November 2016, Vol. 21, 52-59. doi:10.1044/leader.FTR2.21112016.52
The ASHA Leader, November 2016, Vol. 21, 52-59. doi:10.1044/leader.FTR2.21112016.52
Multiple debilitating strokes have left Ronnie, 73, struggling to communicate and swallow. His wife, Elizabeth Ann, now bears the burden of constantly caring for him at home—with some morning assistance from their son.
Elizabeth Ann feels the strain as Ronnie requires ever more intensive care. Now it’s up to a team of future speech-language pathologists, psychologists and nurse practitioners to figure out the best plan of care for Ronnie and his family. Except that Ronnie and his family aren’t real. They’re virtual characters in the simulated world of “Second Life”—and this simulated case is giving students at James Madison University (JMU) hands-on training in coordinating treatment.
Interprofessional education (IPE) is gaining traction as interprofessional teaming increasingly defines our services and shapes our strategic planning. There’s no denying that we need to teach professionals-in-training how to work with professionals in other fields to achieve better outcomes for clients, as called for by—among others—the World Health Organization, the Institute of Medicine and ASHA’s Strategic Pathway to Success.
Yet for all the buzz about IPE and interprofessional practice (IPP)—also known as interprofessional collaborative practice—many are left wondering what this service model actually looks like. How do we know if we are actually doing true interprofessional teaming? How do we best prepare professionals to do it? And how do we navigate the challenges?
At JMU, our collaboration among the departments of communication sciences and disorders, nursing, and psychology explored these questions, with students consulting with faculty and each other on complex cases involving patients with multiple chronic conditions, such as brain injury, congestive heart failure and stroke.
What we’ve found is that there’s nothing like a real-life situation to provide insight into another professional’s perspective—but that to truly make IPE work, you need to navigate a number of logistical, cultural, attitudinal and evaluation challenges. We’ll share here what we’ve learned so far, and what we still hope to learn.
What IPE looks like
What defines IPE isn’t always clear. For instance, some may question whether having students from different professions attend the same lectures counts as IPE. Others claim that for an activity to qualify as IPE, it must include opportunities for students, faculty and practitioners to learn “from and with each other.”
To meet the benchmark of collaboration in IPE, programs are offering students the opportunity to engage in co-treatment with other professionals in the clinic setting. Some departments, like ours at JMU, are using simulation experiences so that students can practice collaboratively with no risk to actual patients (see these related Leader articles: “Way to Grow,” and “Simulating Patient Communication Strategies.” Such simulations may employ standardized patients (people acting as patients), mannequins and virtual reality experiences.
In our IPE project, teams of students interacted with avatars representing patients and family members in clinical settings via “Second Life,” an online virtual environment. Each case was based on a client who presents with a chronic disease and experiences a mental health component. Students ultimately met with actual patients in a real-world setting as a final test of their IPE skills.

“Each case was based on a client who presents with a chronic disease and experiences a mental health component.”

Our IPE experience
Held over three semesters and involving our nursing, graduate clinical psychology and graduate speech-language pathology programs, our project also involved an instructional designer and professor of art history. The project was part of a federal Health Resources and Services Administration training grant that supports cultivating interprofessional competencies of students training to work with patients with multiple chronic conditions, such as Alzheimer’s disease, congestive heart failure and stroke.
Informing our instructional design was the evidence-based Leicester Model of Interprofessional Education (see sources), which emphasizes a patient-centered approach and team-based curriculum. Students in clinical psychology, doctorate of nursing practice and graduate communication sciences disorders came together as part of an orientation workshop. They were placed into six teams of five students, with at least one member of each discipline on a team. Over the semester the team completed web-based modules to learn and apply core IPE competencies (see sidebar below).
Toward the end of the first semester, teams worked together on the web-based case of Ronnie (described in this article’s opening paragraphs), an elderly man who experiences multiple strokes. The teams applied core IPE competencies as they developed a patient-centered treatment plan. They worked on the plans virtually in online meeting rooms, then presented their findings at face-to-face meetings with all teams present.
In the second semester, teams signed up to participate in one of four simulations. Each simulation involved a patient and family member dealing with a chronic condition (such as stroke), mental health issue (such as depression) and a speech-language or swallowing condition (such as dysphagia). Teams again were charged with developing a patient-centered treatment plan, but this time they presented the plan to the patient and family using avatars in Second Life. The faculty role-played the patient and family members, challenging the team with real-life issues. The other teams observed the simulations. All participated in a debriefing conducted in Second Life.
The third semester culminated in a modified Health Care Team Challenge event, in which students, faculty and volunteer patients worked together to develop recommendations for patient care. Once again, teams were challenged to implement IPE core competencies as they communicated among the team and with volunteer patients. Speech-language pathology students recommended follow-up for undiagnosed concerns related to voice and swallowing. Team members reflected individually and as a team on each of the four competencies. Students were debriefed on the process.
How well did the project work? Based on students’ and our own evaluations, the project was successful in increasing students’ IPE-related skills and values. As the project progressed, students reported new knowledge of client resources, demonstrated growth in their knowledge of their own and others’ roles, and demonstrated an increase in IPE communication skills. Students also spoke of a strengthened desire to work interprofessionally.
Even though the project was carefully designed and implemented, a number of challenges were also noted.
Transcending challenges
IPE is distinctly different from traditional training models, so it’s not surprising that difficulties arose. Here are some of the major challenges we encountered.
Differences between disciplines in requirements for clinical training. Although acknowledging that IPE/IPP experiences were of value, the speech-language pathology students—unlike students in the other professions—could not count the IPE/IPP experiences, such as treatment planning, toward required practicum hours. This restriction affected their level of participation. We modified the final semester activity to allow the speech-language pathology students to obtain practicum hours for the activity.
Lack of awareness of roles. Students acknowledged limited awareness of the roles of other disciplines on their teams. This lack of knowledge may be due to current methods of training students in our discipline-specific silos. There is a risk of profession-centrism in which some may feel their chosen profession is more important to the team than others. We witnessed team power dynamics, with one discipline assuming a leadership role. These challenges were addressed throughout the project as students gained knowledge and skills in the core competencies.

“Student differences in clinical experience led to an imbalance in power and participation. We responded by incorporating discussions about power differentials, team dynamics and communication strategies.”

Student differences in clinical experience. Student participants ranged from first-year graduate students with little clinical experience to active practitioners seeking an advanced degree. This diversity offered a unique learning opportunity, but also led to an imbalance in power and participation. This experience is not unique to our project. We responded by incorporating discussions about power differentials, team dynamics and communication strategies. We offered additional support to the first-year graduate students, outside of the team environment, to increase their confidence to fully participate within the team.
Difficulties with scheduling. An oft-cited obstacle to IPE is scheduling faculty and students. The faculty team from this project has a weekly face-to-face meeting. Scheduling students for online and face-to-face events was another challenge, as some worked full time as hospital administrators while others were placed at full-time internships throughout the region. We scheduled face-to-face meetings at times when students were required to be on campus for other reasons, and used technology to allow students to meet online at mutually agreed-upon times. The Second Life simulations, while accessible from any computer, were scheduled for evenings and weekends. We used telepresence technology to allow a student to participate in the Health Care Challenge event from several states away.
Maintaining student engagement. The JMU faculty recognized that implementing a three-semester project was ambitious. Student attrition made it hard to maintain teams over the course of the project. For some, participation was required as part of a course; for others, it was voluntary. This arrangement led to some lower engagement and higher drop-out among certain groups. To overcome this challenge, we awarded an IPE certificate to students who participated in all three semesters.

“As we travel this interprofessional road together, we need to keep the ultimate goal of improving outcomes for those we serve as our inspiration for moving beyond the challenges.”

Identifying appropriate IPE evaluation tools. It is important for any IPE project to measure its success using valid tools, but such tools have yet to be developed for our population of students. Many existing IPE scales are intended for undergraduate students, not graduate students, and often measure student perception and self-report. We found that some tools were not sensitive enough to measure changes in behavior.
Facing and tackling these various IPE challenges has resulted in deep learning among faculty and students. IPE serves not only to strengthen our knowledge of other professions but expands our understanding of the value of chosen career paths. As we travel this interprofessional road together, we need to do so with a full understanding of both the rewards and challenges of IPE, keeping the ultimate goal of improving outcomes for those we serve as our inspiration for moving beyond the challenges.
Editor’s note: Sample the JMU IPE virtual cases in this video. Or explore a 2016 ASHA e-book on IPE/IPE, which includes case-based examples.
Interprofessional Case: For Better or For Worse

Goal/Purpose

Participants will develop a patient-centered home care program for Ronnie, 73, who has speaking and swallowing problems following several strokes. The team will address the level of care required and support Ronnie’s wife and son in providing care in the home.

Expected outcomes

  • Establish a home care program for the patient and family.

  • Use the SBAR (Situation, Background, Assessment, Recommendation) tool for team communication.

  • Identify perceived or real barriers to receiving assistance in the home.

  • Support the wife and family in caring for Ronnie.

Debriefing points
  • What are the ethical issues related to this case?

  • How can the team best support his wife?

  • What do you see as the main challenges ahead for this family?

  • Were you satisfied with the performance of the team?

IPE Core Competencies

A number of professional organizations with accrediting responsibilities, including ASHA, have adopted the Interprofessional Education Collaborative Core Competencies to guide interprofessional education. The four domains of competencies include:

  • Values/ethics for interprofessional practice: Work with individuals of other professions to maintain a climate of mutual respect and shared values.

  • Roles/responsibilities: Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.

  • Interprofessional communication: Communicate with patients, families, communities and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.

  • Teams and teamwork: Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver and evaluate patient-/population-centered care and population health programs and policies that are safe, timely, efficient, effective and equitable.

Sources
Anderson, E., & Lennox, A. (2009). The Leicester model of interprofessional education: Developing, delivering, and learning from student voices for 10 years. Journal of Interprofessional Care, 23(6), 557–573. [Article] [PubMed]
Anderson, E., & Lennox, A. (2009). The Leicester model of interprofessional education: Developing, delivering, and learning from student voices for 10 years. Journal of Interprofessional Care, 23(6), 557–573. [Article] [PubMed]×
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs. 27(3), 759–769. [Article] [PubMed]
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs. 27(3), 759–769. [Article] [PubMed]×
Richardson, B., Gersh, M., & Potter, N. (2012). Health care team challenge: A versatile model for interprofessional education. MedEdPORTAL Publications, 2012(8), 9287.
Richardson, B., Gersh, M., & Potter, N. (2012). Health care team challenge: A versatile model for interprofessional education. MedEdPORTAL Publications, 2012(8), 9287.×
Thistlethwaite, J., & Moran, M. (2010). Learning outcomes for interprofessional education (IPE): Literature review and synthesis. World Health Organization Study Group on Interprofessional Education and Collaborative Practice. Journal of Interprofessional Care, 24(5), 503–513. [Article] [PubMed]
Thistlethwaite, J., & Moran, M. (2010). Learning outcomes for interprofessional education (IPE): Literature review and synthesis. World Health Organization Study Group on Interprofessional Education and Collaborative Practice. Journal of Interprofessional Care, 24(5), 503–513. [Article] [PubMed]×
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November 2016
Volume 21, Issue 11