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Large scale extended ward interprofessional simulation
131 Plays5 months ago
Mel is joined by Robyn Dickie ( nurse, Senior Lecturer, Chair Teaching and Learning & Coordinator - Education and Innovation for the School of Nursing, Midwifery and Paramedicine at ACU), and Alison Blunt (physiotherapist, lecturer and National Lead Specialised Learning Environments and Simulation Coordination for School of Allied Health at ACU). Alison and Robyn discuss there large-scale (>2000 students) interprofessional simulation activity.
Here is link to the co-debriefing paper Robyn was discussing Understanding interprofessional co-debriefing practices within large scale ward-based simulation - ScienceDirect
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Transcript
Intro
Introduction and Guest Introduction
00:00:40
Melanie Barlow
All right, welcome to another episode of Simulation Happy Hour. And I am joined today by Robin Dickie who's a senior lecturer in nursing and also the chair of teaching and learning across the School of Nursing, Midwifery and Paramedicine at Australian Catholic University.
00:00:58
Melanie Barlow
And Alison Blunt, who is a lecturer in physio and also the national specialised learning environments and simulation coordinator for allied health at Australian Catholic University. Welcome.
00:01:11
Robyn
Thanks for having me.
00:01:12
Alison
Hi.
00:01:13
Melanie Barlow
Pleasure.
Overview of Interprofessional Simulation Program
00:01:14
Melanie Barlow
So today we're going to talk about extended ward based interprofessional simulation. so a big event you do every year across seven ish campuses nationally. So what is an extended ward based IP simulation?
00:01:33
Robyn
That's a great question, Mel. It is very complicated question. Immersive simulation. So essentially what we do at ACU for our final or penultimate year students is that we have created a ward that runs over six shifts essentially and students move in and out in roles of that shift.
00:01:58
Robyn
And essentially, it goes over three days and nursing students are there for the whole of the three days. And students have the opportunity to be the registered nurse. So not being a student nurse, but being a registered nurse. And then our allied health colleagues join us for a shift and they also get to be in the role of physio speech pathologists. So it is very complex because there's eight different patients that the students have to interact with.
00:02:30
Robyn
They have to do all of the usual tasks, but we're also looking for that interprofessional collaboration. So it's very great. Like it's a great learning opportunity for the students, but it is quite complex and logistically challenging to run, which I'm sure we'll unpack.
00:02:47
Robyn
But yeah, I think the benefits far outweigh all of those challenges.
00:02:54
Alison
Yeah, and it really for the students is their first taste if they haven't been on a clinical placement yet of a realistic world.
00:02:54
Melanie Barlow
That sounds huge. Go Alison. Yeah.
00:03:03
Alison
So we can present them with simulated environments to practice their, I guess, their context specific skills in a very limited sense. It's almost like in a one little room with one client.
00:03:17
Alison
they can practice those kinds of interactions. But until you bring in all the other parts of the ecosystem, all the other members of the hospital healthcare team, it's not very realistic for what they can expect when they go on a clinical placement environment.
00:03:31
Alison
For example, the allied health students, instead of walking in and being presented with a patient in the immersive sim is they have to find their patient. They have to talk to whoever else is looking after their patient. They have to organize themselves in a environment where other stuff is going on.
00:03:46
Alison
So they really have more of much, much more of a cognitive load and have to practice those cognitive processes that they will need to do in the real world in order to apply what they've learned from us within their disciplines.
Student Experiences and Challenges
00:03:59
Alison
And those elements, I think, as clinical educators and experienced clinicians, you really take for granted that students can just walk in and get started in a realistic ward or a real ward, whereas they have real challenges with knowing when to interrupt or approach other members of the healthcare team, knowing who people are, just those basic interactions before they even start with the client are the things that can really throw them.
00:04:23
Alison
So this immersive world, this immersive ward is a really great way for them to actually practice those those basic introductions and the things that they'll be faced with when they get onto a real ward for the first time.
00:04:34
Melanie Barlow
Great, because in nursing, obviously third years have been out on prac, but allied health students do their practical experiences towards the end of their qualification.
00:04:38
Robyn
hmm
00:04:44
Alison
Yeah.
00:04:44
Melanie Barlow
So they may not have been out there yet.
00:04:46
Alison
Yeah. And at the moment, there's some differences in where this experience is located for the allied health students. So we have speech pathology, occupational therapy and physiotherapy participating in this immersive sim experience and the speech pathology and physiotherapy students haven't yet been on a clinical placement.
00:05:06
Alison
but the occupational therapy students have been on a couple of clinical placements. I hope I've got that correct with my other discipline colleagues.
00:05:12
Robyn
Yeah.
00:05:12
Melanie Barlow
Thank you.
00:05:13
Robyn
i
00:05:14
Alison
So, and you can even see that slight difference between them, even though they're they're novices, just actually having been in a real world, they just understand where to put themselves and you know a lot better how to introduce themselves.
00:05:28
Alison
But the ones who haven't even been on a real clinical experience yet, it can take a lot more time to get settled in the simulation and to get started. And once they get started, they they're pretty good and they're into it. But that I guess that first period of the simulation, they're just trying to work out how to put themselves in how to insert themselves into this situation.
00:05:50
Alison
not not even just what to do about their patient care, but but how do I actually just enter the simulation if they haven't been in a real ward before? And it's it's a really useful thing to sit back and to observe as as a teacher. Yeah.
00:06:02
Melanie Barlow
Excellent. So what inspired development of such a large scale interprofessional simulation? Like who wanted to take that on, Robin?
00:06:14
Alison
yeah
00:06:15
Robyn
So for those who know me, I always love a challenge and this was a really awesome challenge. So we were at a stage in the nursing curriculum where we were reviewing the curriculum.
00:06:27
Robyn
We had some opportunities through curriculum review to look at what we were offering third year final semester students and What i have been doing as part of my PhD studies is looking at students' transition to clinical play practice, but also really focusing more on their behavioural skills. So communication, teamwork, interprofessional collaboration.
00:06:52
Robyn
In a past life, I also was the interprofessional collaborator. education curriculum developer for another university. So I had some opportunities to work with other disciplines in the past and had seen the value in that.
Real-World Simulation Tasks and Learning Outcomes
00:07:07
Robyn
And so when we were looking at adapting a simulation from Edith Cowan University, we there was this thought of, oh, well, they get actors or volunteers to role play different disciplines.
00:07:22
Robyn
And so we were, that's what was proposed. And I was in a meeting and I said, why would you get people to role play? We've got students on every campus. Why wouldn't you make that authentic?
00:07:33
Robyn
And a few people were like, the logistics of that. ACU has six campuses, which nursing is located on. But within those six campuses, the allied health makeup is very different.
00:07:47
Robyn
And so the logistics of that was just too overwhelming for people to sort of think about. But I really pushed for it because what I want students to be able to do, whether on placement, is to be able to, as Alison said, go up to their buddy nurse and be able to have a really good conversation with them, to be able to contact a doctor and not be scared about doing that, to be able to identify errors or to, you know, when
00:07:54
Melanie Barlow
I should it in the school.
00:08:17
Robyn
maybe stock has run out for pharmacy to be able to call pharmacy. And so i wanted to build all of these things that often when you're on clinical placement, the the staff around you protect you from all of those things that you have to do as a graduate registered nurse.
00:08:34
Robyn
And so was like, no, I'm going to put all of those things in so that they actually have to do that. So i suppose my inspiration to make it as big as it is, is that I want our graduates to be safe, confident and competent when they go on to their final placement. And it gave them an opportunity to identify areas for improvement.
00:09:01
Robyn
So we don't teach anything new. they The expectation is that they have all of these skills, but it really highlights to them and to me as their teacher to go, o we haven't taught that very well.
00:09:13
Robyn
in second year of second semester. So we'll need to look at the curriculum for that. Or, wow, they do these things really well. And how are they doing them so well? what are So unpacking that for me was really important as well. So, yeah, my driver is always what is the best result for the students? And then, of course, the outcome sequentially to that is patient safety.
00:09:39
Melanie Barlow
Fantastic. So I imagine both for nursing and allied health, so physio, speech, occupational therapy, there were some challenges and you've spoken about some of those, but what was the challenge, I guess, to make it authentic?
00:10:02
Alison
We were lucky that we have the authentic environments but we had to bring more than just the hardware and the walls and the beds and the oxygen.
00:10:11
Alison
like that Those kind of environments really help the students to to learn and to see, I guess, what what to expect when they come to that.
00:10:18
Robyn
you
00:10:21
Alison
But they also set up the interactions that they have interprofessionally. So we were lucky to have the environments, which is great. But the environments are only part of the picture. The actually having authentic other professionals there, like Robin said, is really important. Like why would you, you know, in scenarios with physio students, I played the nurse, I portrayed the nurse or I portrayed the patient. It would be so much better if we had a nursing student to portray the nurse. I really agree with what Robin said there.
00:10:47
Alison
And a lot of times we do filter the experience for the students and say, okay, so what would happen if your patient had pain or what would happen if, you know you couldn't proceed because they had pain and they could come up, a student could come up with the idea of, well, I would go and talk to the nurse about pain relief, but actually doing that in an environment where we have a simulation ward and you have a medication room off the ward and just like on a real ward, a lot of the times you have to come find the nurse because they're not standing there waiting for duty, waiting for an allied health student to turn up and say, hello, I'm here.
00:11:16
Robyn
Okay.
00:11:17
Alison
And you know this is what we would like to do, please. that the actual, they had to go and find a nurse in the medication room. And one of the big comments that I found really interesting from the physiotherapy students was, oh my God, nurses are so busy.
00:11:29
Alison
you know And how I just got to wait, you can see them standing there. And so i'm just gonna wait until the nurse is finished. And I had to sort of prompt and say, well, the nurses will never be finished. They will always be moving from one task to the next.
00:11:41
Alison
So if your patient needs pain relief before you can proceed with an assessment, you're gonna have to go and find them in the medication room. And there was this real like, oh, can I do that? So having the authentic environments, but having the authentic players moving around in the environments was really crucial rather than just talking about them. So they could experience that discomfort.
00:12:02
Alison
So they felt safe because they're doing it on campus. They know it's not real patients. They know it's a learning experience, but they did have a lot of discomfort around these interprofessional interactions. Not that they didn't think that they could do what they'd been trained to do or that they would get a bad reaction from another student.
00:12:21
Alison
In that way, it helped to make it a lot safer than approaching, you know a real nurse with 30 years experience is quite terrifying for a junior allied health person. But to actually go up to another nursing student, but still that, like there were these barriers between, oh, can I do that, you know, because I had to physically take myself to another part of the ward rather than have, a facilitator portraying a nurse who was standing right there nodding at them saying yes yes I can do that for you.
00:12:46
Robyn
Thank you.
00:12:46
Alison
So they were some of the really powerful things about making it authentic and it was easy enough to do we just we just had to sort of set it up that way and a lot of those interactions and learnings I think in this simulation particularly in the first year or two Robin I don't know if you'd agree we we we got some unintentional good things out of it and we we got some I guess interprofessional interactions they come under communication and task management and negotiation which were a lot deeper than I thought there would be.
00:13:16
Alison
So I felt that those sorts of things really increased the authenticity, the fact that you had everybody moving around like a play or like an improv, more like that, and people had to be comfortable with that improv element of it but they were some of the really powerful learnings for authenticity I think.
Simulation Design and Implementation
00:13:33
Robyn
I think too, and yes, it was definitely unintentional, but I think he was designed to be have these intentional fears embedded within for students to encounter.
00:13:44
Alison
Yeah.
00:13:47
Alison
Mm-hmm.
00:13:47
Robyn
So i think in terms of the way that we thought about the types of patients, where the patients would be located in the ward, the I think we were very intentional about what that would be.
00:14:01
Robyn
So, in terms of making it authentic, we had to think about the resourcing that we had and I'm sure we'll talk about what we would love in the future, but the reality was that we had to run it on the budget that we already had allocated for those units.
00:14:21
Robyn
So there wasn't a significant amount of budget that was going to sustain it long term. So of course we have the setup budget, but that was only for the first year. And then after that, there was nothing.
00:14:33
Robyn
So in terms of the design, i had to think about, well, How am I going to get these patients to have peaks and troughs of activity, interactions with different health professionals, deliberate errors to make sure that there was some interactions between whether it was faculty role-playing doctors, because we don't have doctors here at ACU, so we had to role-play those roles.
00:15:02
Robyn
But I think it was very, I think we thought about it a lot. I know I definitely thought about it, probably wait much for a good year to go, oh, if i change if I tweak that a little bit, that'll mean that that person will have to go and talk to a doctor about an insulin
00:15:10
Alison
yeah
00:15:23
Robyn
And then they'll have to do a phone order for an insulin order and they'll have to use a different form for that. And so i was trying to think about all of the different interactions that they might have.
00:15:36
Robyn
i think also thinking about what other disciplines bring. So the beginning in that first iteration of it, we had huge amounts of notes for students to read, particularly from an allied health perspective.
00:15:51
Robyn
And we just found that that was really overwhelming. The students were spending a lot of time just reading the notes, which is something that they probably would have done in the clinical environment before they went and saw a patient.
00:16:02
Robyn
But that wasn't the purpose of the simulation. The purpose of the simulation was for them to interact with a patient, to do a task within an interprofessional collaborative setting. So that adjustment was needed to occur.
00:16:17
Robyn
But that was also a bit challenging to give that feedback. one and But what was really helpful is because we had co-professional observation and debriefing, that people actually saw that in action.
00:16:29
Robyn
So it wasn't just me as a nurse saying, hey, your allied health notes are really, really long.
00:16:32
Alison
Thank you.
00:16:34
Robyn
There was an opportunity for allied health staff members to go, oh, wow, they just spent time reading the chart and they didn't really get an opportunity to do what we wanted them to do. I think the other thing around the authenticity was considering the learning objectives. So we were pretty clear on what we wanted it to achieve.
00:16:54
Robyn
So there was the interprofessional learning objectives overall for the extended experience. And then each patient had their own learning objectives for interprofessional collaboration. And then within that, there was discipline specific learning objectives. So I think from a curriculum design perspective, i think it was very intentional of what we wanted to achieve within that, in the within the environments that we were working in. So absolutely agree. Like we're very lucky at ACU across the six campuses that we were working in, that we have these environments.
00:17:29
Robyn
Although those environments were very different on every campus. So adjusting that as well to be really flexible and say, hey, you know, in Canberra, you've got five beds, five beds, another room and another room. So yours isn't going to look like what I can run in Brisbane or that someone else can run in Melbourne or Ballarat. So it was just something like the fidelity was really tricky, but rewarding when everyone came back and said, oh, yeah, these students had this experience and that experience.
00:17:58
Alison
Mm-hmm.
00:17:59
Melanie Barlow
So logistically, so you said you thought about it for a year. So how many times have you run it and how what structures have you got in place to make it happen and to bring this together and to make it not only interprofessional in running but interprofessionally designed?
00:18:21
Robyn
So with just finished our third iteration. So it's been running for three years, which is fantastic for us to keep going. The structures, we have a nursing lead, out which is me, and then there's an allied health lead. And that's changed a couple of times, but we've Alison, you were the allied health lead for one year and another person, Nick, was the allied health lead this year. And but they Nick had also been involved since the conception as well. So the leads have been involved in the conception from the beginning and and the running of it from the beginning.
00:18:59
Robyn
And then within that structure, then we have a campus-based structure. So there'll be a nursing person and an allied health person. So it doesn't matter which discipline from allied health, just someone to so lead it on that campus.
00:19:14
Robyn
And so they look after really the, the campus-based requirements, which is, you know, all of the equipment, all that sort of, just the nuances to set it up in their environment.
00:19:23
Alison
Thank you.
00:19:28
Robyn
Uh, I'm in charge of making sure that the equipment lists are correct, which seems like okay. And you'd think after three years, you'd have it down pat. But even like last week, one of my team members said, oh, you need to revise this because we were missing this, this, this, and this.
00:19:46
Robyn
And everyone each year wants to add something different. So we realized after the first year that our dying patient didn't have palliative care, OBS charts. So we're constantly thinking about how we can adapt to make it more authentic.
00:20:01
Robyn
But in terms of the structure, there's sort of the operational people. So Alison and I are quite operational, but then there's a steering group that sits on top of that. that's led by Professor Elizabeth Jacob.
00:20:15
Robyn
And so we're part of that as well. So essentially, if I need anything, I go to Beth and say, hey, I need equipment here. Can you support that? So yeah, it's been it's been really great. I think we've been really lucky. i think the people who have chosen to be involved and to be the leads of this are actually really motivated to to do well in this. So I think we've been, I think I've been very lucky with my nursing team and I can't, you know, everyone has just been so supportive.
00:20:50
Robyn
Lots of feedback, but so supportive.
00:20:52
Alison
mr smith said
00:20:53
Melanie Barlow
that's great So I can imagine this is quite, well, a bit daunting for the students. Like how how do you prepare them?
00:21:05
Melanie Barlow
What's the briefing, pre-briefing kind of
Pre-Briefing and Student Preparation
00:21:07
Alison
oh that That's changed a little bit over the three years as well too. I think in the first year we were doing lots of evaluation where we sort of had to strike a balance between giving the students enough information to have some idea of what they were walking into without priming them too much about what we were looking for them to say in their feedback afterwards or what we were looking for from the experience.
00:21:07
Melanie Barlow
processes?
00:21:32
Alison
So we pre-brief at a few different levels. So there's sort of operational pre-brief information that the students get before they arrive, which is a combination of delivered sort of with verbal feedback and you know to the students classes and through their learning management system about what to expect.
00:21:51
Alison
When they come, there's a lot of information for them to read on the learning management system around the logistics. And we've had to change a little bit over the years with that as well too. With tertiary students, they don't often look at their learning management system information, their canvas, even though we keep directing them there.
00:22:02
Melanie Barlow
thank
00:22:07
Alison
So there was, I think, kind of like a 50-50. Some, you know, maybe half the students turned up very prepared and knew exactly what their patients' names would be ready to go. and the others turned up and were like, what are we doing again?
00:22:17
Alison
So we we provided enough information for them to know it would be a simulated experience, which students really enjoy simulation and all their self-feedbacks, their evaluations of other courses, their preclinical units before they come to this interprofessional simulation is they are asking for more simulation, so they want it. they They turn up primed to be ready to enjoy it and to get something positive out of it, the majority of them, and are ready ready to jump in. But they feel apprehensive.
00:22:46
Alison
Sometimes it's a balance in that pre-briefing of helping them to acknowledge there will be uncomfortable moments and they may feel apprehensive without wanting to tell them to be apprehensive. So there's pre-briefing beforehand, you know, in the weeks beforehand about the experience. There's the pre-briefing that they get when they actually turn up. So the pre-briefing just like for simulated learning activity, which is delivered by the facilitators or the lead facilitators It includes information about you know things that are in a good quality pre-brief, like around orientation to the environment, psychological safety procedures, who who are the the people and the players will be and what their roles will be.
00:23:26
Alison
But in that pre-briefing, that's for the first time that the discipline students are actually meeting each other. And it's also sometimes the first time that the inter interprofessional facilitators are meeting each other as well too.
00:23:37
Alison
So it's got these meta levels of you know the students interprofessionally walking into something new, as well as us as the educators into professionally walking into something new. And a lot of the facilitators are not full-time staff at ACU. So they are clinical educators from real environments or they're some of the casual teachers like me who work clinically as well as teach students.
00:24:00
Alison
So it's it's lots of different levels that that we prepare them for that. And, you know, it's also been a challenge of in the logistics trying to get the amount of pre-briefing right. You don't want half the simulation experience time to be pre-briefing and getting started because when the time runs out, they're like, oh, sometimes they were just finishing off a task or they they needed to find, you know, that they all feel like that they need more time.
00:24:25
Robyn
Yeah, I think this it's interesting the way Alison describes it because Allied Health, there was, when we were first starting, Allied Health wanted to give the students all the information. So it was very much like really setting them up for success. And I think success looks different in different ways.
00:24:47
Robyn
So I felt like there was this kind of desire that the students would come in very prepared and they'd feel really comfortable doing it. And my kind of view is completely opposite to that, is that Sometimes when you go into a clinical environment, things are messy and you've got to find things out.
00:25:04
Robyn
And for nursing students, particularly in their final semester, they're going on to their final six-week placement.
00:25:04
Melanie Barlow
uh,
00:25:11
Robyn
I didn't want to give them all the information. I wanted them to know that they would be being a registered nurse on a ward, looking after patients, mixed patients. So we had a mix of surgical, medical patients.
00:25:25
Robyn
and mental health patients in a regional hospital and that's what you were going to be looking after. So there was a bit of toing and froing, I think, between our teams of like, this is what we need and I'm like, oh, we don't need that.
00:25:33
Alison
like Yeah.
00:25:38
Alison
I don't even think that that's necessarily the discipline thing, Robyn.
00:25:38
Robyn
So,
00:25:41
Alison
I think that that really reflected where the students were in their studies.
00:25:43
Robyn
Yeah.
00:25:44
Alison
So if the nursing students were finishing and graduating in six months' time and had done a number of clinical placements, then certainly they they are they are ready to be challenged and they're already used to walking into environments where they don't quite know what's going to happen.
00:25:49
Robyn
Yeah. Yeah.
00:25:57
Robyn
Yeah.
00:25:58
Alison
From the speech pathology and physio perspective, they're third year students, so they're a whole 12 months behind.
00:26:02
Robyn
Yeah.
00:26:04
Alison
And you wouldn't think 12 months makes such a difference, but at this stage in their undergraduate course, it really does.
00:26:10
Robyn
Yeah.
00:26:10
Alison
You can tell the difference between a final year student and a second to final year student, regardless of the discipline, in terms of their problem solving skills and their willingness to be uncomfortable and how much time it took them and you know scaffolding and prompting and hand-holding it took to get them started.
00:26:21
Melanie Barlow
Oh.
00:26:24
Robyn
yeah
00:26:27
Alison
So I think that that an interesting thing about this experience is that, yes, they're coming from four different disciplines, but also they're coming from four different stages in their course.
00:26:36
Robyn
Yep. No.
00:26:38
Alison
So what they have done before really plays into how ready they were to get started. But I don't think it affected their performance overall, but certainly you could see in that first settling period, the first sort of 50% of the simulation activity, when you're scanning around, you could see which students were having trouble getting started and which weren't. And it it really did reflect, I think, whether they had a clinical placement before or not.
00:27:02
Alison
They all found it a valuable experience, but how comfortable they were to be uncomfortable
00:27:05
Robyn
yeah
00:27:08
Alison
was different according to whether they'd had a simulated clinical placement before.
00:27:12
Robyn
Yeah. So I think, Mel, to your question, i don't know that there's a hard and fast rule about what pre-briefing and briefing you should because I do you think if you're having such a complex simulation, meeting the lead needs of the learner will look very different.
00:27:13
Melanie Barlow
Yeah.
00:27:19
Melanie Barlow
Yeah.
00:27:20
Alison
a
00:27:29
Melanie Barlow
yeah
00:27:29
Robyn
So I think being open to that and not being wedded that every student should have all of this information is important because you are, as Alison said, addressing the needs of the student at the time. So...
00:27:41
Robyn
Yeah, pre-briefing look different.
00:27:45
Melanie Barlow
So it's interesting because Alison, you said before, it it occurs on lots of different levels, like faculty are meeting for the first time, students are meeting for the first time.
00:27:53
Alison
hey
00:27:56
Melanie Barlow
It's predominantly, I think, you know, it's set within a nursing unit. So there's...
00:28:02
Alison
And in a nursing ward, like home base for the nursing students, so on at least our campus,
00:28:05
Melanie Barlow
Yes. Yes.
00:28:10
Alison
I think it's different potentially across different campuses in ACU, but the the actual simulation wards that the experience took place in were the wards where the nursing undergraduate students had done all their clinical skills before, whereas the allied health students hadn't even used those actual sim rooms. They had been in sim rooms before, but in a different building.
00:28:29
Alison
So just the difference of
00:28:31
Alison
changing the actual location.
00:28:31
Robyn
Thank you.
00:28:33
Alison
It was like going to someone else's house as opposed to going to your house. So how comfortable you feel to extend yourself and to be uncomfortable and just the eyes glancing around the room to try and find out where things were.
00:28:48
Alison
does make a difference to how readily you can get started and how comfortable you feel initially, I think. So we teach a lot of our practical skills in the simulation wards at ACU for all the health disciplines.
00:28:52
Melanie Barlow
Yeah.
00:28:59
Alison
But they, yeah, these rooms were not the rooms that a lot of the students had been in before. So that made a difference, I think, to, you know, readiness to get started. And in the pre-briefing, needing an actual orientation to the ward Just like you know I've been a physiotherapist for 25 years, I'm pretty comfortable walking into hospital wards.
00:29:19
Alison
But I remember when I was a locum, walking into a hospital ward in a different hospital, it does take time to get settled and to work out who's who. who And the uniforms as well too was and was another thing as well too, working out who was who. Unfortunately, all our allied health students wear the same uniform and all the nursing students wear their own uniform. So it was clear to see who was allied health and who was nursing.
00:29:41
Alison
But to work out who was who in the zoo took took a little bit of time. So there's this balance in going back pre-briefing, I think, to wanting to give the information, but not wanting to give the information and the time that took up time for doing other interactions.
00:29:58
Alison
so And when you've when you've got a limited amount of time, you had to you know we And that's some of the jiggling around, I think, of pre-briefing over the last three years, Robin, has been like we've wanted to preload information before they come so that they've got more time to actually do their interactions rather than be walking around looking for charts and reading charts and things like that in the simulation.
00:30:07
Robyn
Yeah. Yeah.
00:30:13
Robyn
you
00:30:19
Robyn
yeah
00:30:20
Melanie Barlow
Cool. So not just pre-briefing, but also facilitation and debriefing. How does that work?
Facilitator Roles and Interprofessional Collaboration
00:30:27
Melanie Barlow
inter-professionally and when faculty are used to only looking after their own discipline and now they're working with someone from another discipline who they may not know, how do you navigate not only the priorities for the students but the priorities in what that faculty do together?
00:30:51
Robyn
Yeah, it's a, it's, it is a really a difficult conundrum that we've tried hard to address. So we do a,
00:31:02
Robyn
For faculty, we do a pre-briefing and really highlight the expectations that is this is about interprofessional practice. we Whilst we're interested in safe practice, so if a student does something that is completely unsafe, the discipline should be able to call out that behaviour.
00:31:18
Robyn
But really, we're interested in the way that they talk to each other, collaborate with each other. negotiate, prioritise, all of, they're the things that we're looking at. And I think that's really hard if you are not used to those types of simulations and you've just been teaching nursing students how to draw IV antibiotics for the last six months.
00:31:40
Robyn
So reframing that and reorientating people to the purpose of the simulation was incredible. is our ever-ending goal but I also think
00:31:50
Melanie Barlow
oh
00:31:55
Robyn
it's really we role model that behavior so I always when I like I flit around for three weeks I do teach but I i do a lot of making sure that that
00:31:59
Alison
Mm-hmm.
00:32:07
Robyn
that people are talking to each other and that, you know, oh hi, you're a speech pathologist. I've never met you before. You know, I'm Robin, I'm from nursing because often I found that the facilitators weren't collaborating.
00:32:20
Robyn
They were sort of observing from different perspectives rather than having those, that interaction at the beginning to say, hey, I'm this person and, you know, finding a little bit about them, each other and then
00:32:26
Melanie Barlow
oh
00:32:32
Melanie Barlow
Which is so interesting, right?
00:32:32
Alison
Hmm.
00:32:33
Melanie Barlow
Because I'm no doubt in the debrief, they'll be debriefing the students how they interacted, yet they weren't interacting themselves.
00:32:34
Alison
Hmm.
00:32:39
Robyn
Yeah. Yeah.
00:32:41
Alison
Hmm.
00:32:42
Robyn
And I think it's because we're so used to just looking at what our discipline is. And I think we have this idea that I'm here for nursing or I'm here for allied health. And so,
00:32:53
Robyn
I think that's improved over the years, but I definitely think in the first iteration, it was quite challenging. If the facilitators hadn't done any interprofessional education before, they were very focused on even their own own discipline.
00:33:08
Robyn
So it might have been you're a physiotherapist looking at allied health and the whole sim, but there was a lot of nuances about I want to talk about this physiotherapy action and what they should have done and what they shouldn't have done. It's like, whoa, that's important. That's probably a conversation after the debrief with that particular student, but that's not the purpose of this.
00:33:31
Robyn
So it is really challenging. And I think it comes back to like your personality of and getting the right people to be facilitating these simulations, but also setting them up for success.
00:33:44
Alison
Mm-hmm.
00:33:46
Robyn
So we're we've adapted manual. So there's like a big thing that they can read that supports the running of the simulation. We received some feedback that some of the events, so there's little events for each patient wasn't comprehensive enough.
00:34:01
Robyn
So we've really done a lot of tweaking of documents to support that. And initially we were kind of like, here's the allied health things that you need to worry about. And here's the nursing things that you need to worry about.
00:34:14
Robyn
And now we just give everyone everything. And that helps them to understand, oh, well, this is what's going to be happening for the nursing students right now. and this is what's going to be required for the allied health students so that the facilitators have that information. So that was a lesson learned.
00:34:29
Robyn
After the
00:34:30
Melanie Barlow
Mm-hmm.
00:34:30
Alison
I really agree. I think that, like you said, Robin, I think it was important to have the right facilitators, the right people, and to keep emphasising, even though they knew they were in an interprofessional sim, that they had to debrief it and act it in an interprofessional way.
00:34:44
Alison
That it was nice when you didn't know what discipline the facilitators were, whether they were nursing or allied health or someone like. And I didn't know all of the stuff. So it it was it was nice when it was surprising to not know where your facilitator's background was.
00:34:58
Alison
when you saw the way that they interacted. It it shouldn't, you know, we we should be able to give them advice about general things and about safe practice in particularly, but you didn't want to necessarily skew things, not skew, but it it functioned best as a quality interprofessional experience if it was facilitated with a real interprofessional mindset.
00:35:22
Robyn
Thank you.
00:35:22
Alison
So, you know, when I was facilitating it and being the ESP of the ward manager or something like that. I'd have speech pathology students say, we haven't got the right thickened fluids, we need level two, we've only got level three.
00:35:35
Alison
I say, would you like me to call the kitchen for you? And they're like, oh, okay, that'd be great. And who are you? and say, oh, you know, I'm the the whoever. So it's good, I think, if your facilitators do work into professionally themselves. So if they are a skills teacher for a particular discipline in academia and have been that for a while, that was harder for them to shift, I think.
00:35:54
Alison
But if you are still clinically working and you, you know, i'm I'm not in any other discipline than what I am, but I've observed a lot over the years.
00:35:54
Robyn
Hmm.
00:36:03
Alison
So having, I guess, what we wanted from facilitators was some simulation experience and approachability and attitude to be able to function in an improv and immersive scenario and not be too rigid about what they had to teach and what they had to give feedback on and to have a little bit of a a step back hands-off approach so that you weren't jumping in and being a skills teacher because that really affected the flow of things but to actually have an attitude that they were there for all of the students whatever they needed for their generic skills it didn't really matter whether you put your hand on the person's arm here or there to help them up out of bed and it didn't really matter if you were
00:36:40
Alison
a nurse or a physio or a speech pathology student sitting a patient in the chair to do a swallowing assessment. So, you know, you were trying to facilitate all elements of that activity to happen rather than being a teacher of a particular discipline.
00:36:51
Robyn
Thank you.
00:36:53
Alison
And sometimes she did see it's very hard. We go into our mindsets and we're we're trained that way to be, you know, the the clinician that we are. But I think we really had to keep emphasising, you know, A, the fluidity and the style of the immersive sim, which, as Robin said, has a lot of planning and ducks with feet going crazy under the water underneath to make it look so fluid.
00:37:16
Alison
but also to be you know not in your own role, your discipline role as a facilitator as well. So we we we tried to emphasize that over, but we also consciously looked at that, I think, when we were asking certain people to to be our facilitators as whether they would feel comfortable with that flexibility.
00:37:35
Melanie Barlow
Cool. So I know last year you, and we'll put the link to the paper in the show notes, but you studied the co-debriefing practices.
00:37:42
Robyn
We did.
00:37:42
Melanie Barlow
So not just co-debriefing, but interprofessional co-debriefing.
00:37:47
Alison
Mm-hmm.
00:37:47
Melanie Barlow
What are some challenges? I mean, i think you've spoken about some, but the particular learnings from that?
00:37:54
Robyn
I think, and I learned this from the great Jenny Rudolph many years ago, around holding learning objectives too tightly. And I think some of our facilitators really wanted to hold on to what they should be saying rather than or or get directing the students to say, talk about certain things rather than letting them talk about their goals.
00:38:17
Robyn
authentic interprofessional experiences. So i think one of the things that we notice is is the setup well before you enter debriefing that, and we've talked about how, you know, people need to talk to each other and the facilitators need to be flexible in their roles.
00:38:37
Robyn
And what we found was that those who felt that that they were doing that often may not have had great outcomes in their debrief.
00:38:41
Alison
music
00:38:49
Robyn
So often we think we're really good at debriefing, And so we report that we're really good at debriefing, but observationally, as expert observers, we felt that the interprofessional aspects weren't as good as what they could be.
00:39:07
Robyn
So yeah, co-debriefing is a tricky one, particularly from IPE perspective is because People are really keen to talk about what their discipline needs rather than thinking bigger.
00:39:17
Melanie Barlow
Yeah.
00:39:20
Robyn
So, know, we have explored these ideas of having two tiers of debriefing, just the constraints that we have in our own environments around room availability and and what value adds that for students.
00:39:35
Robyn
That's something that we're open to discuss moving forward.
00:39:38
Melanie Barlow
yeah
00:39:39
Robyn
But I do think the co-debriefing relationship that people need to form at the beginning of the pre-briefing needs to be modelled throughout so that they do get that authentic co-debriefing practice.
00:39:54
Alison
so
00:39:55
Robyn
Often people just debrief the way that they debrief doing a clinical procedural skill rather than thinking about how to open up a question and direct it to a whole group of 14 or so students.
00:40:10
Robyn
So I think it was that direction to the whole group rather than to a specific discipline can be challenging as well.
00:40:18
Melanie Barlow
Yeah. I think it was holding to their discipline-specific objectives for each patient rather than looking at what the interprofessional objectives were for the simulation in its entirety kind of thing.
00:40:31
Robyn
Yeah.
00:40:33
Alison
Thank
00:40:36
Alison
you.
00:40:36
Robyn
Yeah. And I think that just comes down to they they want this there the students and i mean like nursing students, they want nursing students to achieve x Y and z by the end of their 18 hours contact time in the simulation.
00:40:51
Melanie Barlow
uh,
00:40:52
Robyn
So i do and I do appreciate why people would go down that path. For the nursing students, we were lucky in the fact that the first, the morning shifts, the first three hours of each day were with our interprofessional colleagues.
00:41:07
Robyn
And then we had the opportunity just with nursing. So we tried to do it like a ward where we're Allied Health aren't usually there at eight o'clock at night. so So it was so okay for us to be able to have that. So using things like car parks to say, hey, that's a really good nursing point, but let's talk about that in our next debrief was a way that we tried to get students to, we're not dismissing what you're saying, but we we will talk about that later.
00:41:36
Robyn
So hum
00:41:37
Melanie Barlow
Good.
00:41:37
Alison
Thank you.
00:41:38
Robyn
Yeah, there are strategies to do that, but it it is, it takes experience.
00:41:38
Melanie Barlow
Excellent.
00:41:41
Robyn
And I think we expect a lot from our facilitators to be able to debrief. So I think for the listeners, co-debriefing interprofessionally is a skill that really needs to be developed and mentored, observed.
00:41:57
Robyn
You should be debriefing debriefings. giving people feedback. And that takes a lot of time. So i must say, logistically, we have not done that. And that's something that I would love to do in the future.
00:42:09
Alison
It was so complex to debrief on on several levels.
00:42:10
Melanie Barlow
Yeah.
00:42:12
Alison
There was just the fact that you were debriefing something where there was a lot going on. You know, three two or three hours of activity is a lot more challenging than debriefing just a simple, you know, scenario.
00:42:22
Robyn
Seven minutes in.
00:42:22
Melanie Barlow
Yes.
00:42:24
Alison
There's so many people. There's so many people who want to say things. There's the dynamics of such a big group. There's co-debriefing, even if they were from the same profession, just managing that relationship and that working cohesively.
00:42:36
Alison
And then you add in the inter interprofessional co-debrief,
00:42:37
Melanie Barlow
yeah
00:42:39
Alison
of two facilitators who just met each other today. So it it was a lot to ask and it's I can't really think of a more complex. you me
00:42:47
Melanie Barlow
Yeah.
00:42:47
Robyn
I love it.
00:42:48
Melanie Barlow
And it was safe.
00:42:49
Alison
and So scenario so we we expected a lot and we we, you know, trusted our facilitators to do their very best with that. But I think that they you know some some some were very confident with that, some some were not as confident with that and just had to go and did their best.
00:43:03
Melanie Barlow
yeah
00:43:04
Alison
And I think as long as people had good intentions and the students you know were managed safely, they all got something out of it.
00:43:08
Melanie Barlow
and it was safe
00:43:11
Alison
But I think this is a big area where We want to continue to improve and to learn and to and you know to know a bit more and to be able to put steps in place or frameworks in place for our debriefers to be able to do that skillfully and to build their skill.
00:43:28
Melanie Barlow
Absolutely.
00:43:28
Robyn
Yep.
00:43:29
Melanie Barlow
So I guess to start wrapping up though, what are some outcomes you've seen for the students? Like what has been the impact for them? Have you evaluated? what's What are you seeing?
00:43:44
Alison
There was a lot of data that was taken for evaluation and I think Robin can probably talk to that better than me. I've had individual conversations with students that and I've taken some short interviews and videos of students straight after the simulation with their consent to capture their feelings of how they felt afterwards and what they would say to their peers or what they had said to their peers after the experience.
00:44:06
Robyn
Thank you.
00:44:06
Alison
And I guess that anecdotal feedback was was really useful about it was a great tester, it was a great taster as well too of what clinical placement might be. It was challenging in lots of different ways for them, but overall that it was a worthwhile experience to do and that they recommended that their future students were to were to
Impact on Student Readiness and Industry Feedback
00:44:27
Alison
do this.
00:44:28
Alison
And when I've mentioned this to colleagues who are actually clinically clinical educators in the environment, they're like, wow, what a great thing to do. And that they all agreed that students needed experiences like this before they come on to real clinical placements.
00:44:41
Alison
And that this was something that really would add value, but that, gosh, what a challenge to get the students you know to to do this, to set up this realistic world before they hit the real world.
00:44:48
Robyn
Yeah.
00:44:52
Alison
So I think that that is, I guess, I talk more, I guess, to the value or the experiences that students had by actually being part of this. But there were a lot of, there was a lot of data taken around attitudes and changes pre and post, wasn't there, Robin?
00:45:07
Alison
So there was...
00:45:08
Robyn
Yeah, there was.
00:45:08
Alison
Hmm.
00:45:09
Robyn
But for anyone who's done a lot of interprofessional education research, as I have done, those tools are not very sensitive. So, in fact, despite the...
00:45:21
Robyn
giving us feedback afterwards, qualitatively, quantitatively, there wasn't a lot of change, statistically different significant change in students' attitudes or perceptions around the benefit of interprofessional education.
00:45:35
Robyn
And there's lots of there's lots of literature about ceiling scores and those sorts of things for these tools. So I think when they were designed 20 years ago, when IP wasn't really a thing,
00:45:43
Alison
Yep.
00:45:45
Robyn
Now to lots of students have IPE experiences and feel really comfortable with teamwork and and sort of the sub themes within those our tools, I think.
00:45:58
Robyn
it's hard for us to evaluate that. But what we do see is that some students really love it and there's a subset of nursing students who hate it and they're often the students who have already worked as a nurse, so enrolled nurses, kind of don't feel that it value adds anything.
00:46:01
Melanie Barlow
Uh...
00:46:17
Robyn
And I think one of the things that I would like to do 2026 iteration is identify the and give them a more leadership role.
00:46:28
Robyn
So they can do all the tasks and they're quite good at the time management, but I would really like them to have some challenging interactions as a leader.
00:46:37
Robyn
So that's something that our student evaluation of teaching and learning has shown me, is that the ENs don't really like it and they think it's a bit of a waste of time, whereas The students who are undergraduate, haven't worked in a nurse in a nursing role before, really value that.
00:46:57
Robyn
Most importantly, industry really love it. So they see a difference in our students and the preparedness for their so there final placement.
00:47:08
Robyn
A way that we're facilitating that is that because they get to see what they know and don't know, their goals for the placement are really explicit. So that our students come with not, I just want to learn everything about neuroscience nursing.
00:47:24
Robyn
They actually come in with really specific goals because they've had 18 hours of simulated experience where they can go, actually, I'm really bad at drawing up or administering blood.
00:47:37
Robyn
they They're not very good at that. Or... maybe I don't know how to do an ECG really quickly. Like I can do it, but it takes me 20 minutes and that's not going to save someone's life in an acute chest pain situation. So they have more specific goals. And so our industry partners are like, wow, they are much more prepared for communicating with staff members to escalating things.
00:48:02
Robyn
So yeah, I think for me, getting that feedback really from our industry partners, that is actually what I was trying to achieve. The students will like or hate anything, right?
00:48:11
Melanie Barlow
Amazing.
00:48:14
Robyn
So I'm kind of, and the students who give feedback are usually on the edges.
00:48:18
Alison
Mm-hmm.
00:48:19
Robyn
and So they're usually the 1% on either time.
00:48:19
Alison
like the
00:48:19
Melanie Barlow
yes
00:48:21
Robyn
So I don't necessarily take all of that, you know, with a glass of wine, but definitely think that the industry response and and as Alison said, the facilitators who work clinically with us,
00:48:31
Melanie Barlow
yeah
00:48:35
Robyn
are really excited about this. so
00:48:38
Melanie Barlow
Well, it's all about what we do as preparedness for practice, right? And
Research and Reflections
00:48:41
Melanie Barlow
so if you're demonstrating that, that's amazing.
00:48:42
Robyn
Yeah. Yeah.
00:48:44
Melanie Barlow
I'm getting feedback for that.
00:48:44
Robyn
yeah Yeah. so we do have a study at one of my colleagues we've followed up on a number of graduates students who had finished their final placement to see what they thought of that.
00:48:56
Robyn
So we did a couple of focus groups. So that paper is almost ready for submission as well.
00:49:01
Melanie Barlow
Amazing.
00:49:02
Robyn
Yeah.
00:49:04
Melanie Barlow
Now, I have one important question for you.
00:49:06
Robyn
Oh, yep.
00:49:08
Melanie Barlow
So this is simulation happy hour, Alison and Robin. So if you could attend happy hour anywhere in the world, where would that be and what would you be having?
00:49:23
Alison
Well, I think my body knows it's happy hour, even though it's, 11 o'clock in the morning because my stomach's been rumbling through this whole recording. If you hear little, hmm, noises, it's a good thing.
00:49:35
Alison
Happy hour makes me hungry and thirsty. I think I'd be having a nice icy cold limoncello sitting on the rocks beside a beach on the Amalfi Coast eating something nice and salty.
00:49:42
Melanie Barlow
oh
00:49:46
Melanie Barlow
Oh,
00:49:48
Alison
Is that specific enough for you?
00:49:50
Robyn
Yeah, i was thinking i was thinking Bellini's at Positano, but you've kind of taken my thing.
00:49:50
Melanie Barlow
yes. Take me there.
00:49:51
Alison
Hmm.
00:49:55
Melanie Barlow
Oh.
00:49:55
Alison
Oh, you'll be just at the beach up for me. I'll be an Otrani.
00:50:01
Robyn
Yeah, Positano is probably too expensive for me.
00:50:03
Alison
Yeah, you know, and I can't do positive. Oh, my gosh.
00:50:07
Robyn
i
00:50:07
Melanie Barlow
well i'
00:50:08
Robyn
Anything with a view.
00:50:09
Melanie Barlow
go with either of you
00:50:11
Robyn
Anything with a view. Like, i yeah, and I love a cocktail.
00:50:14
Melanie Barlow
Fantastic.
00:50:16
Robyn
Yeah.
00:50:17
Melanie Barlow
Well, thank you for joining us and sharing that significant, huge and logistically nightmare
00:50:26
Robyn
It's a nightmare, but I love it.
00:50:26
Melanie Barlow
project.
00:50:29
Alison
hit
00:50:29
Robyn
I wouldn't wouldn't have it any other way.
00:50:29
Melanie Barlow
Yes. And that I'm sure there's a massive project team that you're representing.
00:50:36
Robyn
Yes.
00:50:37
Melanie Barlow
so
00:50:37
Robyn
Yes. Yes.
00:50:39
Alison
You know, I was trying to think in my head when you were talking earlier, Robin, about how many people we're talking about.
00:50:43
Robyn
Yeah.
00:50:43
Alison
It's at least 12. So they're across Australia, they're across different disciplines, they are across different experience as well too.
00:50:49
Robyn
Yeah.
00:50:52
Alison
So they've all got teaching experience, clinical practice experience, and some have simulation experience and are from the simulation special interest groups at ACU and others were from the interprofessional education groups across ACU.
00:51:06
Robyn
Yeah.
00:51:07
Alison
So we we all came together as as as a big working party, didn't we? Bringing a whole range of different skills.
00:51:11
Robyn
Yeah. Yeah.
00:51:13
Alison
so
00:51:13
Robyn
I think also, and a big shout out to technical services.
00:51:14
Alison
It was a real group effort.
00:51:18
Melanie Barlow
Yes.
00:51:19
Robyn
So this doesn't happen without them and the the people who rock up and teach for the 18 hours or three hours, they're the ones that actually make it happen.
00:51:25
Melanie Barlow
Yes.
00:51:25
Alison
Yes.
00:51:28
Robyn
So there's probably about 100
00:51:31
Alison
Mm.
00:51:31
Robyn
that make this happen.
00:51:33
Alison
Mm.
00:51:34
Robyn
And yeah, I mean, we were very blessed to win a VC Excellent Award in our first year of running it.
00:51:40
Alison
Mm.
00:51:40
Robyn
So, you know, we're kicking goals and we'll continue to kick goals.
00:51:43
Alison
any
00:51:45
Robyn
The ball gets a bit heavier every year, just with more people wanting to be involved. And yeah, it's really fun.
00:51:51
Melanie Barlow
Yeah, more disciplines, which is amazing.
00:51:52
Alison
Thanks, Mel. Bye-bye.
00:51:55
Robyn
And so if you're ever in ACU land on any campus, call out and come and watch us. We from June to first week of August every year.
00:52:02
Alison
oh
00:52:08
Melanie Barlow
All right. Thank you.
00:52:09
Robyn
Thanks, guys.
00:52:10
Alison
thanks so
00:52:10
Robyn
Thanks, Mel.
00:52:10
Melanie Barlow
so yeah
00:52:11
Alison
but bye