WITH THE SUPPORT AND INPUT OF : Association for Simulated Practice in Healthcare (ASPiH) • Association for Standardized Patient Educators (ASPE) • Australian Society for Simulation in Healthcare (ASSH) • Brasilian Association for Simulation in Health (Abrassim) • Canadian Network for Simulation in Healthcare (CNSH) • Dutch Society for Simulation in Healthcare (DSSH) • International Nursing Association for Clinical Simulation in Learning (INACSL) • International Pediatric Simulation Society (IPSS) • Japan Society for Instructional Systems in Healthcare (JSISH) • Korean Society for Simulation in Healthcare (KoSSH) • Latin American Association for Clinical Simulation (ALASIC) • New Zealand Association for Simulation in Healthcare (NZASH) • Pan Asia Society for Simulation in Healthcare (PASSH) • Polish Society of Medical Simulation (PSMS) • Portuguese Society for Simulation (SPSim) • Russian Society for Simulation Education in Medicine (ROSOMED) • Society in Europe for Simulation Applied to Medicine (SESAM) • Spanish Society of Clinical Simulation and Patient Safety (SESSEP) A project of the Society for Simulation in Healthcare

BackgroundWith the recent emphasis on implementation of interprofessional education (IPE), simulation can be a successful and impactful pedagogy to train health profession learners. Simulation allows opportunities to practice decision-making and working in teams in a realistic and safe environment. Participants learn with and about other professions and have the chance to clarify roles within their team. Simulation-enhanced IPE can present challenges for faculty. This article seeks to provide insight into key aspects of interprofessional simulation to maximize its successful implementation.MethodsOur team has identified key lessons learned in how we successfully implemented IPE using simulation. We have collectively overcome challenges and barriers as we have implemented simulation-based IPE at our university.ResultsTo implement effective simulation-enhanced IPE, teams should consider an overall need assessment, curriculum integration, logistical plans, faculty development, a structured prebrief and debrief plan, and a process for evaluation.ConclusionsAlthough IPE is an important component of training for future health care providers, simulation can be an effective strategy for implementation of interprofessional activities. However, it is essential to consider key aspects to ensure a quality and consistent experience for learners.

To the Editor: We appreciate the comments of Kumar et al1 in their response to our article, Peterson et al.2 We agree that mentorship, a customized education plan, and incentives are each essential in simulation faculty development. We would like to take the opportunity to highlight each of these within the context of our tiered faculty development program. Mentorship is certainly important in developing expertise in any area. Many formal and informal mentoring relationships are fostered even within our structure. Faculty participating in our certification plan may choose their mentor or may ask for help in finding a mentor who is a good match for their content area or area of interest. Our structure also supports mentorship in that we provide suggested, evidence-based tools for use in giving feedback. We agree with the authors that mentees often carry a heavy load of clinical, administrative, and personal responsibilities leading them to need additional support in finding constructive ways to mentor their peers. In our experience, this structure provides the support needed for effective mentoring. We also agree that a customized education plan can be valuable and is an alternate approach for programs without an existing structure. However, it is our assertion that an “informal” approach as suggested by the authors could result in profound variability that could have a detrimental impact on the learning environment for those who participate in simulation activities. We recognize that the creation of a tiered faculty development program may be difficult at some institutions; however, we believe that our structure as presented provides ample room for customization and meeting the needs and/or requirements of other institutions. Our tiered and structured plan is inclusive of all levels of involvement. Entry level simulationists are encouraged and welcome, and the plan creates a path for advancement if they wish to continue. We have partnered with more than 1000 simulation facilitators in the past 4 years, and each has had very different experiences in their development as simulationists. The content of our tiered program merely serves as a core set of institutional priorities and assumptions about simulation best practices that allow us to provide our learners (>21,000 in 2017 facilitated through our office alone) with a recognizable, stable learning environment across seven health schools and the health system within which we operate. Examples of “structured educational components” as mentioned by the authors (ie, discussing peer-reviewed articles, recommending national meeting attendance, networking) are also accomplished at our institution but through a series of regular monthly gatherings. We also agree that incentivization is vital to building a cadre of competent and skilled simulationists within any institution. One way this can be accomplished is by working with promotion and tenure committees to ensure that this work is recognized. We strongly encourage all individuals who participate in our development plan to include their simulation faculty development training on their curriculum vitae to be recognized. Many of the simulationists at our institution have received university-wide teaching awards and are viewed as expert educators in their fields. We also offer continuing education credits for each of the simulation faculty development workshops offered within our program. In addition to the incentives mentioned previously, our university has also developed a simulation fellowship program as well as a Master of Science in Healthcare Simulation for those who desire to gain additional expertise in a more formalized way. In conclusion, we have not found a structured and tiered approach to simulation faculty development to be a barrier. We find that it actually helps legitimize the work we do in simulation and provides a welcome path for those who want to participate in high-quality simulation activities. Dawn Taylor Peterson, PhD Department of Medical Education School of Medicine Department of Health Services Administration School of Health Professions Office of Interprofessional Simulation for Innovative Clinical Practice University of Alabama at Birmingham Birmingham, AL [email protected]Penni I. Watts, PhD, RN, CHSE-A University of Alabama at Birmingham School of Nursing Birmingham, ALChad A. Epps, MD Center for Healthcare Improvement and Patient Simulation The University of Tennessee Health Science Center Memphis, TNMarjorie Lee White, MD, MPPM, MA, CHSE Departments of Pediatrics and Medical Education School of Medicine Department of Health Services Administration School of Health Professions Office of Interprofessional Simulation for Innovative Clinical Practice University of Alabama at Birmingham Birmingham, AL

Statement During the last decade, the use of electronic health records (EHRs) in clinical settings has risen sharply. Many clinical education programs have not incorporated the use of electronic documentation into their curriculum. It is important to incorporate technologies that will be used in real-world settings into educational clinical simulations to better prepare students for clinical practice and promote patient safety. Electronic documentation can be harder to teach to students because it requires a more in-depth orientation on how to use the electronic documentation system and because health care organizations often give students limited or no access to the documentation system. This review will include a discussion on the benefits and disadvantages of using educational EHRs, barriers and facilitators to implementing educational EHRs, and best practices for incorporating educational EHRs into current educational curriculums.

Summary Statement During the last decade, the use of electronic health records (EHRs) in clinical settings has risen sharply. Many clinical education programs have not incorporated the use of electronic documentation into their curriculum. It is important to incorporate technologies that will be used in real-world settings into educational clinical simulations to better prepare students for clinical practice and promote patient safety. Electronic documentation can be harder to teach to students because it requires a more in-depth orientation on how to use the electronic documentation system and because health care organizations often give students limited or no access to the documentation system. This review will include a discussion on the benefits and disadvantages of using educational EHRs, barriers and facilitators to implementing educational EHRs, and best practices for incorporating educational EHRs into current educational curriculums.

Summary Statement Simulation faculty development has become a high priority for the past couple of years because simulation programs have rapidly expanded in health systems and universities worldwide. A formalized, structured model for developing quality facilitators of simulation is helpful to support and sustain this continued growth in the field of simulation. In this article, we present a tiered faculty development plan that has been implemented at a university in the United States and includes the essentials of faculty development. We discuss the rationale and benefits of a tiered faculty development program as well as describe our certification plan. The article concludes with lessons learned throughout the process of implementation.

Summary Statement Simulation faculty development has become a high priority for the past couple of years because simulation programs have rapidly expanded in health systems and universities worldwide. A formalized, structured model for developing quality facilitators of simulation is helpful to support and sustain this continued growth in the field of simulation. In this article, we present a tiered faculty development plan that has been implemented at a university in the United States and includes the essentials of faculty development. We discuss the rationale and benefits of a tiered faculty development program as well as describe our certification plan. The article concludes with lessons learned throughout the process of implementation.

The complex health care needs of today's society require health care professionals to work as a collaborative team. Safe, quality health care depends on the ability of the health care team to cooperate, communicate, and share skills and knowledge appropriately. Interprofessional education provides a collaborative approach for the development and mastery of these competencies. Simulation-based experiential learning is recognized as an effective way to promote interprofessional education teamwork.

Background: Interprofessional education is not a new concept but is one that has become critical as the healthcare industry is held more accountable for costs, quality and outcomes. Healthcare is being transformed by a focus on patient-centered care and the increasing complexity of care. The need for collaborative and interdependent professional teamwork is essential to meet these demands. As educational institutions, we are tasked to develop practitioners who are competent in working on teams and who are responsible and committed to providing care to individuals in a manner that fosters collaboration and improved outcomes.

Objectives Hospital administrators are individuals that provide oversight and leadership within healthcare organizations. In the current and future healthcare environment, it is increasingly important for hospital administrators to understand the roles of all disciplines and to understand how to effectively communicate with key stakeholders. To be successful, hospital administrators must work collaboratively with physician leaders, clinical and non-clinical professional staff, and external constituents, such as Board members. The goal of this case was to expose Masters’ of Science in Health Administration students to clinical scenarios they will potentially face in the future. By using simulated cases, the goal is for students to have the opportunity to interact with members of the healthcare team including physicians, nurses, respiratory therapists, patients and families. The MSHA students were integrated into an existing interprofessional student curriculum which included nursing, medical and respiratory therapy students. Description This study took place in the Pediatric Simulation Center located at Children’s of Alabama and the Simulation Center located at the University of Alabama at Birmingham Hospital, both of which are located in Birmingham, Alabama. There were three simulated cases used that included exposure to the following situations: 1) A DNR/DNI patient whose family member insisted on intubation against the patient’s wishes after the patient became unconscious; 2) A pediatric patient, whose parent was a Jehovah’s witness, that desperately needed blood after experiencing inflected head trauma; and 3) A medical error involving a patient who was given 100 units of insulin instead of 10 units. Data were collected using program evaluations completed immediately at the conclusion of each simulation experience by the participating health administration students. Evaluations were collected from a total of 18 health administration students. Each evaluation contained statements about the simulation experience with the options of agree, neutral, or disagree. Participants were also asked to describe what they believed was most beneficial about the experience and what they feel could be improved. Conclusion All of the participants felt that their simulation experience was a valuable learning experience and the majority of participants felt that the experience will improve their care of patients in the future. Many of the students commented that these cases also helped them realize how important it is to have interdisciplinary communication and collaboration. Simulations were the most valuable to MSHA students when there were defined questions relating to legal issues because these cases had higher engagement of administrators. When asked about improvements, the recurring themes included clarification of the role of the administrator in the case, as well as having an actual administrator in the debriefing session following each simulation who could provide clearer answers as to proper ways to deal with each situation. Seventeen of the 18 students agreed that they would recommend this case series to others and several commented that having more than one opportunity to participate in simulations would be beneficial. Reference l. Cooper JB, Singer SJ, Hayes J, Sales M, Vogt JW, Raemer D, Meyer GS. Design and evaluation of simulation scenarios for a program introducing patient safety, teamwork, safety leadership, and simulation to healthcare leaders and managers. Simul Healthc 2011 Aug;6(4):231-8. Disclosures None

Simulation is effective at improving healthcare students' knowledge and communication. Despite increasingly interprofessional approaches to medicine, most studies demonstrate these effects in isolation. We enhanced an existing internal medicine curriculum with immersive interprofessional simulations. For ten months, third-year medical students and senior nursing students were recruited for four, 1-hour simulations. Scenarios included myocardial infarction, pancreatitis/hyperkalemia, upper gastrointestinal bleed, and chronic obstructive pulmonary disease exacerbation. After each scenario, experts in medicine, nursing, simulation, and adult learning facilitated a debriefing. Study measures included pre- and post-tests assessing self-efficacy, communication skills, and understanding of each profession's role. Seventy-two medical students and 30 nursing students participated. Self-efficacy communication scores improved for both (medicine, 18.9 ± 3.3 pretest vs 23.7 ± 3.7 post-test; nursing, 19.6 ± 2.7 pretest vs 24.5 ± 2.5 post-test). Both groups showed improvement in "confidence to correct another healthcare provider in a collaborative manner" (Δ = .97 medicine, Δ = 1.2 nursing). Medical students showed the most improvement in "confidence to close the loop in patient care" (Δ = .93). Nursing students showed the most improvement in "confidence to figure out roles" (Δ = 1.1). This study supports the hypothesis that interdisciplinary simulation improves each discipline's self-efficacy communication skills and understanding of each profession's role. Despite many barriers to interprofessional simulation, this model is being sustained.

Introduction/Background The value of interprofessional simulation is increasingly being documented. Our group sought to develop a multi-patient, multi-professional extended simulation session for laboratory science, medicine, nursing and respiratory therapy participants. The intent of the simulation was to challenge learners with significant complexity to allow for critical thinking, prioritization and team-based communication challenges. We created a very difficult afternoon in the intensive care unit (ICU) setting. Methods A multi-professional team including laboratory sciences, medicine, nursing and respiratory therapy developed a four patient ICU based extended time simulation experience. Patient profiles were created by the simulation team. A timeline and set of expected actions was carefully crafted. The patient record was created and included nursing documentation on ICU based flow sheet as well as timed laboratory results. The patients that were in the mock ICU included a recent transfer from the floor with presumed septic shock who develops a transfusion related lung injury reaction, an expected new admit from the emergency department with chronic obstructive pulmonary disease who needs bipap, a patient who recently received a tracheostomy and who is weaning off the respirator and a recent transfer from the floor with respiratory distress who is currently being evaluated for a pulmonary embolus. The nursing students arrived before the other learners and received check out from confederate nurses who were going off shift and had time to complete their assessments. The respiratory participants were briefed about available equipment and respiratory plan of care. Seven nurses, four laboratory students, two medical residents, one medical student and three respiratory therapy students participated in the simulation. Over 15 faculty members and confederates were present to assist with scenario flow, manikins management and debriefing. The entire scenario lasted 75 minutes and the debriefing was completed in stages, with a portion at the bedside, a portion with the entire group and additional discipline specific debriefing. Evaluation data included general evaluation which was solicited both in writing and in the form of a focus group. Participants were overwhelmingly positive about the experience. They highlighted the opportunity to practice the care of patients with other healthcare team members. Nursing students in particular had suggestions for improving the fidelity of the situation. Faculty involved provided feedback for future sessions. The faculty after action review focused on both discipline specific improvements, as well as overall opportunities for clarification. For example, for nursing and respiratory requested standardization of medications and supplies in a format that is more consistent with an actual ICU setting. The physicians reported that the fact that they were needed in many locations added to the realism but would have preferred to have the standard checkout sheet that they use in actual practice. Laboratory science students, who were located off site, would prefer to be closer to the action. Conclusion To our knowledge, this represents the first collaboration of these four disciplines in a multi-patient simulation scenario focusing on prioritization of multiple patients. The activity was well received; however, the quality of the simulation experience was likely related to the high proportion of faculty to students. Additional work is needed to streamline this educational effort to allow for widespread implementation. Reference ©1. Scherer et al. Interprofessional Simulation to Foster Collaboration between Nursing and Medical Students Clinical Simulation in Nursing (2013) e1-e9. Disclosures None.

This article explores the evolution and history of interprofessional education (IPE) using healthcare simulation (HCS). The evolution described here demonstrates an achievement of patient safety efforts as a consequence of the historical roots of healthcare and highlights HCS as a progressive method synergistic with IPE. This paper presents a descriptive review that covers the HCS and IPE literature, indicating factors that led to the use of HCS in IPE. Understanding the history of simulation-enhanced IPE provides healthcare educators with fertile ground to support future IPE. A number of benefits in using HCS to address common challenges to IPE are outlined, including natural relevance and engagement for learners, faculty attraction to its use, and the opportunity to explore socio-historical issues in teams. Several promising directions for future research are suggested.

Departments of *Clinical and Diagnostic Sciences †Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama Reprints: Chad Epps, MD, Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, e-mail: [email protected]

Background This pilot study evaluated the effect of videotape-facilitated human patient simulator (HPS) practice and guidance on clinical performance indicators. Method Nursing and nurse anesthetist students in the treatment group (n = 20) participated in HPS practice and guidance using videotape-facilitated debriefing, and the control group (n = 20) participated in HPS practice and guidance using oral debriefing alone. Results Students in the intervention group were significantly more likely to demonstrate desirable behaviors concerning patient identification, team communication, and vital signs. The role students played in the simulation significantly impacted their performance. When scores of both the intervention and control groups were combined, team leaders, airway managers, and nurse anesthetists had higher mean total performance scores than crash cart managers, recorders, or medication nurses. Conclusion Video-facilitated simulation feedback is potentially a useful tool in increasing desirable clinical behaviors in a simulated environment.