Students in health and human services professions train for a variety of real-life scenarios, but what does one do after witnessing a fellow care provider make an error in treatment? How do you diplomatically point out the fault of another team member and disclose the mistake to the patient? And could those answers come from using simulation as a learning tool?
These were the questions raised in one of four interprofessional education (IPE) 2018-2019 seed grant projects funded through the University of Maryland, Baltimore’s (UMB) Center for Interprofessional Education (CIPE) and shared with faculty at a Nov. 13 symposium in the President’s Boardroom at the Saratoga Building.
The difficult subject of error disclosure was the focus of “Simulation-Based Curriculum for Patient-Centered Communication for Medical and Nurse Practitioner Students” presented by Wan-Tsu W. Chang, MD, assistant professor, University of Maryland School of Medicine (UMSOM). Three other teams also presented the results of their 13-month, interprofessional education and interprofessional care projects that receive seed grants of $5,000 to $15,000.
The proposed project aims to evaluate current communication skills among medical and nurse practitioner students with simulated patients and use a focused, multidisciplinary intervention to improve their communication skills. The pilot project used a scenario of error disclosure involving nurse practitioner and medical students on their emergency medicine rotation. The project’s results will be used to guide further simulation-based interprofessional initiatives in health care communication.
Five nurse practitioner students and four medical students participated in the project. “This particular simulation scenario is of a medical error that led to a poor outcome,” Chang explained. In the scenario, a patient arrives at the emergency department with symptoms of anaphylaxis, a life-threatening allergic reaction. A standardized actor playing the role of a nurse incorrectly administers a medication, putting the patient at severe risk of myocardial infarction. Students participating in the project had to learn how to disclose the error to the patient and how to counsel their team member who made the error.
After the students completed the scenario, they attended an interprofessional lecture on best practices for error disclosure. A similar simulation scenario was repeated several weeks later to gauge how much students had improved from their first experience.
“There are many actions that we hoped our students would perform and improve on,” Chang said. Students were evaluated on whether they explained the mistake to the patient and to the nurse clearly, showed empathy about the mistake, answered questions openly about the sequence of events, did not inappropriately minimize the error, described possible consequences of the mistake, discussed next steps to management, and offered the nurse resources for coping with making the error.
“Overall, their performance did improve,” Chang said. One graph in Chang’s PowerPoint presentation compared how students did disclosing the error to the patient with disclosing the error to the nurse.
“They definitely did a lot better in disclosing the error to the patient, which was a little surprising,” Chang said.
David B. Mallott, MD, associate dean for medical education at UMSOM and co-director of CIPE, thanked the teams of faculty members on hand to present their projects. CIPE, directed by Jane M. Kirschling, PhD, RN, FAAN, dean of the University of Maryland School of Nursing, is a national leader in providing interprofessional education for health, law, and human services professionals that is grounded in best practices for educational innovation and assessment.
“All of you should take great pride in being part of a group of people who are, in fact, trying to change things, to try to look at different models, to try to figure out how we might best serve our students,” Mallott said. “And so, for that, as a representative from the Center for IPE here on campus, I want to thank you all for taking that plunge. The center is very happy to have found a group of very talented people and we give out our money with a fair amount of rigor.”
Before introducing UMB President Jay A. Perman, MD, Mallott thanked him for making interprofessional education a priority at UMB.
“I somehow think that he won't lose sight of either this campus or the IPE initiative, whatever they do to the title in front of his name,” Mallott said of Perman, who will take over as chancellor of the University System of Maryland on Jan. 6, 2020.
“You are terribly important to me in doing this work,” Perman told the teams of faculty members, adding that he expects to make IPE a priority systemwide.
“When I was interviewed for the position, and when I was asked, what are the sorts of things you're going to emphasize, I said, ‘Well, we have a good running start on interprofessional education at UMB and I expect to make that one of my pillars as chancellor,’” Perman said. “The sister campuses, the other 11, they are interested and they can benefit in this work as well. So I'm just going to take what you're doing here and go one flight up. Give me the goods.”
Here are the IPE 2018-2019 seed grant projects and team members:
“Simulation-Based Curriculum for Patient-Centered Communication for Medical and Nurse Practitioner Students”
Danya Khoujah, MBBS, FAAEM, FACEP — School of Medicine
Wan-Tsu Chang, MD — School of Medicine
Veronica Quattrini, DNP, FNP-BC — School of Nursing
“Maryland Area Health Education Center (AHEC): AHEC Scholars Pilot”
Richard Colgan, MD — School of Medicine
Mary Jo Bondy, DHEd, PA-C — Graduate School
Margaret Hammersla, PhD, CRNP-A — School of Nursing
Allison Robinson, MPH — School of Medicine
“Enhancing Interprofessional Training on Advance Care Planning Using Standardized Patients”
Leah Millstein, MD — School of Medicine
John Cagle, PhD, MSW — School of Social Work
Amanda Agarwal, LCSW-C — University Health Clinic
John Allen, MD — School of Medicine
Danielle Baek, MD — School of Medicine
Melissa Bellin, PhD, LCSW — School of Social Work
Steven Eveland, MBA, RN, CHPN — University of Maryland Medical System
Terra Hill, MSW, LGSW — University of Maryland Medical System
Mei Ching Lee, PhD, RN, CHPR — School of Nursing
Barbara Perez Marquez, MFA — School of Medicine
Debra Wiegand, PhD, RN, CCRN, CHPN, FAHA, FPCN, FAAN — School of Nursing
“A Better Way to Manage Pain: An Interprofessional Student Symposium on Pain Management and Mitigating Risk for Opioid Misuse and Addiction”
Roy Film, PT, MPT, DPT, OCS, FAAOMPT — School of Medicine
Katherine Fornili, DNP, MPH, RN, CARN, FIAAN — School of Nursing
Joseph Liberto, MD — School of Medicine
Meredith J. McHugh, LMSW, PhD — School of Medicine
Mary Lynn McPherson, PharmD, MA, MDE, BCPS, CPE — School of Pharmacy
Leah Sera, PharmD, MA, BCPS — School of Pharmacy
Christopher Welsh, MD — School of Medicine