Señalamiento de los objetivos

Paradigms of educational philosophy were noted in the results, nursing students strongly spoke of education in terms of experience, reflecting the majority of their undergraduate study still takes place in a workplace setting. Medical students also actively reflected on experience but challenged experience ‘for the sake of it’, pharmacy students tended to talk of education in classroom setting due to their reduced exposure in undergraduate study.

Participants reported the simulation made them think about decisions or exposed them to situations which they had not encountered before. This suggests that the simulation forces students to reason at the higher levels of Bloom’s taxonomy (68). This effect was reported both due to the technology itself and the design of the teaching session (Figure 4.10):

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N010: I think it makes you think then when you’re doing the different roles. It puts into perspective what’s expected of people.

Res: Do you think the role reversal is a valuable thing then?

D010: Yeah.

N010: It also makes you think that when you’re asking for something, you have to be aware of people’s time restraints and what they’ve got going on.

Figure 4.10 Role reversal facilitating deep levels of thought

The technology itself modified participants classroom paradigms of how to prescribe, with students actively acknowledging they had to think of the best way of tackling a problem.

“There’s not always one way of doing something there are multiple ways. P

This was augmented by delays between prescribing and onset of action of the drug which again made students reflect upon and reconsider their prescribing decisions:

“When he got better but then got worse so then it made you think, ‘Oh well what have we done wrong?’ and it made you re think where you could have gone wrong.” [P011]

Participants also reflected on the need for critical thinking in the simulation which was aided by observation of a patient’s vital signs Figure 4.11).

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P015: I think especially if it’s like outside of like say NICE guidelines which most cases in hospital you have to give another drug so, kind of like puts critical thinking into it.

P013: here you can see how your choices directly affect the patient if that makes sense?

N004: …which is something which makes you question whether it’s because the antibiotics aren’t working, they haven’t given long enough…

Figure 4.11 Interaction detailing the advantages of immediate feedback with respect to drug choice

Evidence of paradigm experience

Participants suggested that the simulation could have acted as a paradigm experience an event that they would never forget in future. When it was explained how the virtual patient died, students stated this would be something they always remember. This was supported by pharmacy students reporting key learning points from a similar event with an avatar in their previous studies.

P014: [referring to previous experience] I think I gave him vancomycin.

P016: And that was a shorter session as well.

Res: Yeah and you remember that still?

P015: Yeah.

Res: That you gave him vancomycin and he went red, you know what he’s showing there is it’s kind of quite a powerful learning experience for you then.

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P011: We aren’t going to forget that now, what oxygen we give now.

P014: Yeah, yeah.

P016: Never give anyone 100% [oxygen] again [laughs].

Figure 4.12 Students speaking about previous paradigm experiences and their similarity to the simulation

Again pharmacy students tended to bemoan their lack of experiential learning whereas nurses framed their learning in terms of it.

Res: Yeah, absolutely I mean one thing I wrote down today is nurses have a lot of grounded knowledge so, you’ve seen things before and you’re confident in dealing with them whereas pharmacy students as a whole…you know what to prescribe but you don’t know what happens if you know what I mean?

P023: Yeah initially N004 knew how to stabilise the patient, we never [yeah] I mean when the patient comes in we don’t really know what to do we just know like what drugs they’re on and what drugs to give.

N004: I think it shows like realistically because I think in all of our training who are on the same course we all got different placements so we know different things…but I’m sure some of you have been on medical wards a lot more than I have so could deal with a long term effect but maybe not the immediate.

P014: No, so people pharmacy students wouldn’t have so much experience you know it’s rare on the placements. This is a better way really because I’ve only had about one or two and they were one-week placements.

156 4.3.4 Future Use

Participants believed the technology would be suitable for many different types of clinical situation.

“Yeah, …you could apply it to anything.” [P011]

They also envisaged its use in inherently different ways where rather than speaking to a patient, participants could speak to another healthcare professional.

“What about talking to the doctor? But I don’t know, like if you have like speaking to the doctor so like you have a list of questions like, ‘Why can’t we prescribe this? Can we change it?’” [P014]

When specifically questioned regarding the mobile use of the technology, most participants agreed that it would be educationally beneficial. One participant raised the possibility of students disengaging with this format due to competing timetable pressures, exactly the scenario it was designed to avoid.

“My only like thing with that mobile app is we have so much stuff to do I don’t know whether it would be overlooked if it wasn’t like timetabled to come in and physically have to be

somewhere.” [N006]

Overall the simulation appeared to be of educational benefit for students both in terms of teaching practical skills required in the management of COPD and for improving collaboration and communication between professional groups.

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4.4 Theme 3 Collaboration

4.4.1 Teamwork

The simulation and technology naturally facilitated teamwork and collaboration between participants. They relied on each others’ knowledge and experience and deferred to each other as appropriate to derive a good outcome for the patient. When directly asked ‘what makes a good team?’ participants gave a number of roles and characteristics which they believed important for any team. These included a leadership, respect, good listening skills, communication, rising above conflict, and awareness of one’s own role.

“You’re not going to get on with everyone in the team and so if you’ve got conflict, I think you have to not let it affect the team. There are loads of different personalities and you do experience that with the hospital staff, don’t you?” [D010]

“Oh yeah, you clash with people, don’t you? We’re there for the patients at the end of the day

and the treatment that we do is for the patient. If we don’t get on whilst we’re doing it, then we do what you ask and vice versa. I suppose it’s about having that mutual respect for everybody and everybody’s role. Everybody is important in what they do and without each other, we wouldn’t be able to do what we do. PHARMACIST SAYS NOTHING…. ” [N010]

Pharmacy students tended to concentrate more on generic qualities in their responses whereas nursing and medical students related responses to their experience of working in teams in a care setting, thus producing more nuanced and pragmatic tips for good team working.

Good examples of teamwork were often observed in the form of ‘helpful knowledge’ shared between participants, relating directly to the ‘learning from’ portion of the CAIPE definition of IPE (169). Even when attempting to role play another professional in the group participants

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tended to revert to their own profession if they had knowledge which would help the management of the patient.

“At this moment there has been a high level of collaboration between students. N010 & P030 have been quieter and less forthcoming than D010 who is guiding the others through the process of diagnosis. D010 has certainly reverted to type.” [Observational data]

If participants were uncomfortable making a diagnosis or suggesting a treatment, a much more collaborative and shared decision was taken between participants in the group (Figure 4.14).

D010: “would we not just give penicillin if he has a bit of a rash?

N010: “I wouldn’t feel comfortable prescribing penicillin

D : “I’m worried he might have a weird anaphylactic reaction

Figure 4.14 Example of collaborative decision making process

Participants actively acknowledged the shared decision making process but then vocalised whether or not they felt competent to take part in the decision. Participants stipulated where they viewed their own competency ending, and any safety nets they would deploy to check another’s decision.

“I think in terms of like deciding to prescribe it was like a collaborative thing. But for me…I don’t usually get involved in what drug to prescribe over another,…that’s not my decision so, I sort of left that to these guys pharmacists because as long as they’re not allergic to it as far as I’m concerned if its doing the right thing then I would just give it.” [N006]

159 4.4.2 Communication

Participants viewed good communication skills as being essential for collaboration amongst healthcare professionals. Face to face conversations were regarded as the most effective method of achieving a solution, with a number of benefits such as solving errors in real time cited.

“Yeah, because even if you bleep a doctor on the ward, you’ll see them and tell them your problem and then they’ll come round. You then kind of expand on your problems a bit more and then they go and see the patient visually to then decide on a treatment plan. I don’t know. It’s like taking it away from all being together to just going via an app.” [N010]

Participants also cited problems with miscommunication if people do not communicate in a face to face setting:

“In a group like this, if a person says something that devalues the actual problem, they might be corrected, …if people work individually they can take different directions altogether. Definitely, if it’s done in a group where everyone can see each other, it’s way better, I suppose.” [P030]

Participants also related this to the simulation itself citing the benefits of face to face meetings over mobile technology mediated virtual environments:

“I think going back a little bit I think it was definitely best to keep it as scheduled sessions because I think like a big thing of IPE is that communication aspect, like talking to each other, finding out what other people would think of a scenario before you process it.” [P026]

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Pharmacy students were observed to actively avoid communication if they felt unable to answer a direct question. This behaviour could be categorised as evasive and distraction (Figure 4.15).

D010: to P “What would you recommend for H.influenzae?

P010: Does not respond for some time “not sure

D010 then struggles with a drug name, looks to P010 for help [P010 slightly ignores this request]

D010: What drugs would you give him? If cephalosporins caused that, what would you give him? It’s just interesting to know what we would do? LONG PERIOD OF SILENCE]

Figure 4.15 Examples of pharmacy students actively avoiding communication where they are unsure of the answer

When questioned about the key learning outcomes of the scenario one participant responded with the suggestion that the main aim was to teach collaboration, suggesting the technology would be a useful format for future interprofessional learning.

“ in response to a question re main learning outcome] I think just the general collaboration of different disciplines.” [N003]