- Open Access
Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine
BMC Medical Education volume 22, Article number: 204 (2022)
Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication.
Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016–2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students.
Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment.
Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.
Interprofessional communication is defined by the Interprofessional Education Collaborative (IPEC) as ‘the ability to communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease’ and is one of the four IPEC competencies . Interprofessional communication aids in preparing health professionals for collaborative practice, allowing them to communicate their readiness to work together . Ineffective interprofessional communication amongst health professionals leads to errors, delayed treatment, misdiagnosis, and adverse events, all of which result in poor patient outcomes [1,2,3,4,5]. Communication failures are reported to be the cause of 56% of intraoperative and postoperative complications . The need for improved communication is a priority in healthcare and the World Health Organization promotes interprofessional healthcare learning as an approach to address communication to improve patient safety and patient outcomes [1, 6, 7]. Improved interprofessional communication and training in clinical settings results in fewer reported adverse events, fewer counting errors in the operating room, improved performance, and probable savings in healthcare costs [3, 8]. In intensive care settings, improved communication during interprofessional rounds has been shown to decrease adverse events by enhanced interprofessional teaching and coordination of patient care .
Accrediting bodies throughout the health professions, such as the Liaison Committee on Medical Education (LCME), Commission on Dental Accreditation, Commission on Collegiate Nursing Education, and the Accreditation Council for Pharmacy Education, along with their counterparts from the Health Professions Accreditors Collaborative, recognize that communication failures amongst health professionals is a problem. As a result, a large proportion of accreditors have included requirements for interprofessional communication-focused education in their standards and guidelines [10,11,12,13,14,15]. The LCME, which maintains accreditation authority for medical colleges and schools in the United States and Canada, emphasizes the importance of interprofessional education (IPE) by including a requirement that core curriculum within medical schools must prepare students to function collaboratively on teams inclusive of other health professionals with specific instruction in interprofessional communication and interprofessional care .
Instruction devoted to interprofessional communication is common and is being incorporated into health professionals’ education using a variety of approaches, including online modules, case studies, workshops, and simulations [16, 17]. Interprofessional communication workshops with clinical scenarios using communication tools such as Strategies and Tools to Enhance Performance and Patient Safety curriculum (TeamSTEPPS™) have shown to increase confidence and perceived competence in conflict resolution [17,18,19]. Training in small group role-play of clinical cases, small group discussions, and presentations positively improved scores on the Global Interpersonal Communication Competence Scale (GICC-15), a tool with established validity evidence for measuring communication among health professionals, showing that students’ overall communication competency can increase with practice . Communication courses are another highly utilized means to positively impact health professional learners’ interpersonal and interprofessional communication self-efficacy beliefs [21, 22]. Hagemeier et al. described an interprofessional communication development skills course for pharmacy, nursing, and medical students that improved students’ interpersonal and interprofessional communication self-efficacy beliefs (i.e., belief in one’s ability to succeed in a situation) after an eight-module course .
Simulation has been shown to be one of the most effective forms of health professions education . Opportunities exist to leverage the effectiveness of simulation to advance learning objectives focused on interprofessional communication to meet LCME standards and achieve interprofessional communication-focused IPEC competencies [16, 23]. Liaw et al. combined a standardized patient (SP) and patient simulator for a clinical scenario to provide variation and heightened realism for an interprofessional team in the case of a deteriorating patient, showing increased confidence in communication for health professional learners . A SP is defined as “a person trained to consistently portray a patient or other individual in a scripted scenario for the purposes of instruction, practice, or evaluation” . Standardized patients are commonly used to teach communication skills and their use has been shown to lead to significant increases in self-reported communication skills [19, 26,27,28]. Fidelity in simulation is defined as “the degree to which the simulation replicates the real event and/or workplace; this includes physical, psychological, and environmental elements” . High-fidelity simulation refers to extremely realistic simulation experiences that provide a high level of interactivity and realism for the health professionals [29, 30]. Simulation centers are widespread and growing in health professions education, providing an opportunity to develop large-scale IPE simulations that involve an optimized number and combination of students at the appropriate level of training for interprofessional practice [24, 31, 32]. These settings, also referred to as clinical skills centers, are commonly used as a location for high-fidelity simulation specifically with SPs and SP training programs, leveraging dedicated staff and examination rooms in a controlled environment in medical education [33, 34]. The Association of American Medical Colleges reports that increased activities for medical students in a simulation center result in increased repetitive opportunities for learning clinical skills and assessment throughout the medical curriculum . Simulation centers have been used to develop early interprofessional teamwork and communication skills in medical and nursing students which may possibly affect professional practice and subsequent patient safety .
Despite growing expectations across health professions education for longitudinal IPE, IPE activities occur most frequently as single events, thus limiting the goals of modifying health professionals’ behaviors and potentially improving patient outcomes [14, 15, 36]. The importance of longitudinal studies, commonly defined as taking place over at least one year, has been recognized . Longitudinal IPE studies have shown improvement in perceptions and skills amongst health professional learners but are lacking in number [36, 38,39,40].
The introduction of interprofessional communication in simulation activities in undergraduate medical education may lead to improved interprofessional communication beyond medical education, though further descriptions of these simulation activities is needed. In this secondary analysis of a scoping review conducted on simulation-based IPE, we aimed to determine the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center that explicitly identified increasing competence in interprofessional communication as a desired outcome. We sought to identify co-learners, other targeted IPEC competencies, and intended learning outcomes using the Kirkpatrick’s Expanded Outcomes Typology . We also sought to compile practical considerations reported by authors, including barriers to successful execution.
A complete description of our scoping review protocol, conducted in accordance with JBI guidelines for scoping reviews (i.e., PRISMA-ScR), has been previously published . In summary, we searched PubMed directly and used the EBSCO platform to search CINAHL Plus and ERIC databases with results limited to the year 2016. Our scoping review was designed to inform the following research questions: In what contexts has simulation IPE been implemented, in regard to learner type, setting, topics, level of fidelity, and resources used? Which IPEC competencies for interprofessional collaborative practice have been included in the design of simulation IPE? What student learning, educator-related, and patient-related outcomes have been measured and reported in the design of simulation IPE? What are the facilitators and barriers to simulation IPE?
These research questions were intentionally broad in order to gather a general and expansive view of the literature. Inclusion criteria included study participants, concept, context and types of data sources. Studies published in peer-reviewed literature that reported on simulation activities involving two or more types of undergraduate or graduate health professional learners in the simulation environment that were delivered in academic settings, clinical settings, community settings, or other settings and included either quantitative, qualitative, or mixed methods were included.
In total, 165 peer-reviewed articles met inclusion criteria, and a 31-item data extraction tool linked to our four research questions was applied. The complete data extraction tool has been previously published with the protocol; examples of data extracted included types of learners (by profession), settings, IPEC competencies targeted, learning outcomes, and reported assessment/evaluation strategies . Data extraction was completed by an individual team member. A second team member independently reviewed and confirmed the accuracy of extracted data. Identified discrepancies were resolved by these individuals with a third team member available to adjudicate unresolved discrepancies.
Kirkpatrick’s Expanded Outcomes Typology was used to categorize learning outcomes, commonly utilized in educational training and simulation as a method of evaluating and categorizing outcome criteria of educational training [41, 43, 44]. Kirkpatrick’s original four-level model classifies learning into reaction, learning, behavior, and results . This was later expanded with an explicit aim of application to IPE, as a mechanism to demonstrate the opportunities for IPE across the learning continuum as learners move from preclinical curricula and clinical learning environments into practice. The Kirkpatrick model includes levels and sublevels [41, 45]:
Level 1: Learner’s reaction
Level 2a: Modification of attitudes/perceptions
Level 2b: Acquisition of knowledge/skills
Level 3: Behavioral change
Level 4a: Change in organizational practice
Level 4b: Benefits to patients, families, and communities
Additional research questions were developed to guide secondary analyses of the complete scoping review dataset. This secondary analysis was conceived to inform strategies to address LCME accreditation requirements and was organized around the following research question: What existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education? Guided by this question, a sub-dataset was developed from the original by identifying studies describing simulation IPE activities that (1) took place in dedicated simulation centers, (2) targeted the IPEC interprofessional communication domain, and (3) involved undergraduate medical students.
Of the 165 articles that met inclusion criteria for our scoping review, 144 were excluded from the secondary analysis because they did not meet all three criteria; therefore, 21 articles published between 2016–2020 were included (Table 1). Simulation IPE activities covered a variety of topics, including mental health, cardiovascular health, oral health, medication errors, end-of-life care, discharge planning, inpatient and outpatient care, transitions of care, and emergency care. The majority of simulation IPE activities were categorized as high-fidelity (76%, 16/21). Standardized patients were utilized in 71% (15/21) of activities; 29% (6/21) utilized mannikins only. Thirty-three percent (7/21) were categorized as hybrid activities, utilizing more than one resource or equipment for the activity, to include virtual reality, mannikins, simulated health records, and SPs. Ten percent (2/21) were longitudinal simulation IPE activities. Medical students most commonly worked with nursing students (undergraduate and graduate) in identified simulation IPE activities (90%, 19/21), followed by pharmacy students (43%, 9/21). Less commonly reported were partnerships with occupational therapy and physical therapy (19%, 4/21); dentistry and dietetics/nutrition (each 14%, 3/21); physician assistant, social work, and speech language pathology (each 10%, 2/21); midwifery, operating department practitioner, psychology, public health, and respiratory therapy (each 5%, 1/21).
The majority (76%, 16/21) of activities reported modification of attitudes/perceptions (Kirkpatrick Level 2a) as the primary learning outcome; 48% (10/21) reported assessment of learners’ reactions (Kirkpatrick Level 1); 38% (8/21) reported assessment of knowledge and/or skill acquisition (Kirkpatrick Level 2b); and 29% (6/21) reported assessment of behavioral change (Kirkpatrick Level 3) (Fig. 1).
In addition to IPEC competencies dedicated to interprofessional communication, authors also explicitly attempted to address IPEC competencies focused on teams/teamwork in 86% (18/21) of activities, followed in frequency by roles/responsibilities (48%, 10/21) and values/ethics for interprofessional practice (29%, 6/21). The majority (90%, 19/21) of activities captured quantitative data related to IPE learning outcomes using an assessment tool with established validity evidence in IPE (57%, 12/21), survey, or locally developed tool . The majority (67%, 14/21) of included articles reported capturing qualitative data to inform IPE outcomes assessment, as well. Standardized communication tools such as Situation, Background, Assessment and Recommendation (SBAR), Identify, Situation, Background, Assessment and Recommendation (ISBAR) and TeamSTEPPS were utilized in 33% (7/21) of the simulation IPE activities.
Author-reported challenges included scheduling limitations when combining different health professional learners, time demands on faculty, geographic challenges due to different school locations, technologic complications with online activities, and lack of control groups to facilitate comparative analyses. Mismatches in learner cohort sizes resulted in disproportionate numbers of one type of learner compared to another in several simulation IPE activities, as well as mismatches of different types of learners according to learning level (e.g., novice, intermediate, advanced).
In this study, we found significant variability in terms of health-related topics taught and instruction methods employed during simulation IPE activities focused on interprofessional communication in simulation centers. However, high-fidelity simulations emerged as a predominant method of instruction, with the majority utilizing SPs. Standardized patients are considered the highest fidelity simulators and are used frequently to teach communication and interpersonal skills within undergraduate health professional curricula to improve transfer to the clinical learning environment [67, 68]. Standardized patients provide a clear benefit over role play in an authentic, yet ‘safe’ first experience in clinical interactions, while also providing professional feedback from the perspective of the patient [26, 69,70,71]. Performance feedback from SPs is considered a reliable source for assessing communication skills in educational programs [69, 71, 72]. Standardized patients are frequently used to increase the fidelity of interprofessional communication-focused simulation IPE activities, consistent with our findings. The addition of SPs can further increase the fidelity of simulation activities that do not currently utilize them; however, costs associated with utilizing SPs can be a limitation [26, 70].
We limited our focus to simulation IPE activities that were located in simulation centers based on the assumption that characteristics common to this setting – controlled environment, skilled staff, SPs, mannikins, and robust infrastructure/equipment – would inform efforts to target higher-level learning outcomes along the Kirkpatrick continuum. Interestingly, our results demonstrated that most simulation IPE targeted lower-level learning outcomes despite taking place in simulation centers. Furthermore, we postulate that 62% (13/21) of the simulation IPE activities identified in our study can be completed outside of a simulation center; thus, many of these simulation IPE activities can likely be transferred to classroom, hospital, or clinic settings.
Another interesting finding from our study is the identified lack of simulation IPE developed to span the entire continuum of Kirkpatrick levels (Fig. 1), with only 9.5% (2/21) of articles demonstrating this approach [55, 56]. The authors of these studies note challenges associated with this approach, including cost, logistics, schedules, faculty availability, and location of learners. A recommendation for achieving success in simulation IPE based on these two studies includes ensuring diversification of the types of modalities and/or pedagogical strategies employed, such as using video, telephone, workshops, and online simulations. By diversifying modalities and strategies, higher-level learning outcomes can be achieved with lower fidelity simulation IPE activities and less resources. In addition, less physical space is required for the activity at one given time and may not need to be located in a simulation center. Including video, telephone, or online simulations also eliminates the need for students to be geographically localized together .
Bok et al. described the characteristics of prevailing interprofessional communication programs for medical students in a scoping review from 2000–2018, identifying the indications and content of the programs, what training and evaluation methods each program used with the outcomes, and challenges experienced in 73 articles . A content and thematic analysis was performed and themes/categories related to each of the four levels of Miller’s Clinical Assessment Framework/Pyramid were described [38, 73]. We chose to characterize activities in our review using Kirkpatrick’s model as it is used frequently in medical education and is recommended within consensus guidelines for quality IPE, though Kirkpatrick’s Expanded Outcomes Typology has been compared to Miller’s Pyramid [14, 74,75,76]. Similar to Bok et al., we found significant variability in the assessment of simulation IPE activities in our analysis, with the majority targeting learners’ reactions and modification of attitudes/perceptions, both considered lower-level outcomes. In another review, Abu-Rish et al. reported on qualitative, quantitative, and mixed method IPE studies published over five years that focused on IPE skills and/or competencies with an assessment of IPE effectiveness, which included 22 simulation IPE studies . Abu-Rish et al. highlighted several similar patterns identified in our analysis; for example, assessments predominantly targeted lower-level learning outcomes and the majority of instructional designs featured one-time events .
Numerous IPE measurement tools, teamwork assessment tools, and simulation assessment tools used in activities identified in our review were utilized (Table 2). These assessment tools have documented validity evidence in IPE assessment, though we recognize that the validity of the tool is dependent on the context . Studies that utilized one of these tools aimed to measure the same outcome of the original study of validation, such as attitudes or IPEC competencies, but did not always use the same groups of learners or setting. Some tools assessed simulation by observation to include IPE competencies but were not specific to IPE competencies. Our analysis validates much of what Bok et al., Abu-Rish et al., and others have reported, but Bok et al. and Abu-Rish et al. found that few programs utilized tools with established validity evidence in the assessment, whereas we found that the majority of simulation IPE activities used tools with established validity evidence [27, 36, 38]. Other studies have found that there is a lack of simulation IPE that is assessed with tools with validity evidence . Our findings differ while simultaneously highlighting that tools with prior validity evidence should be used in a similar context and should continue to undergo the process of validation, thus adding to the literature .
The dearth of longitudinal simulation IPE activities in our study is consistent with what others have observed . Longitudinal IPE activities with longitudinal follow-up of outcomes have shown improved interprofessional skills, communication, performance, and behaviors [39, 40, 47, 48]. More longitudinal IPE activities are needed in addition to longitudinal assessment to identify whether outcomes are long-term and if they ultimately lead to improved patient outcomes [36, 38, 47, 48]. Also congruent with our results were the difficulties and barriers to simulation IPE activities identified by authors, such as scheduling, mismatches of students at various levels of training, and lack of funding, faculty, staff and administrative support . We agree there is significant diversity in the structure/content, objectives, and assessment of simulation IPE activities centered around interprofessional communication for medical students and a longitudinal approach to developing these activities should be prioritized [36, 38, 39].
The combination of modalities such as online activities and use of mannikins, SPs, and virtual reality in simulation IPE activities were limited in our review, as well as in the review by Bok et al. . Benefits to hybrid activities include the elimination of logistical and resource barriers in a hybrid model to improve access to successful IPE [55, 62, 77]. Combining modalities in a longitudinal simulation IPE approach would also allow for repeated IPE interactions between learners with less dependence on space and time constraints, which would provide more opportunities for longitudinal IPE activities . Students exposed to multiple IPE experiences across different settings have reported an increased impact on knowledge, skills, and attitudes than a single isolated IPE activity [55, 56, 78, 79]. By augmenting an SP encounter with a simulated electronic medical record review, for example, health professional learners can gain additional practical experience with added realism . Our review documented the combined use of mannikins and SPs most frequently in hybrid activities; however, and importantly, we found that most of these hybrid IPE simulation could be completed outside of simulation centers and that they could be modified to attain higher-level learning outcomes along the Kirkpatrick continuum. IPE simulation activities should attempt to combine multiple teaching modalities for high-fidelity activities focused on interprofessional communication.
In our analysis, health professional learners identify the need for effective interprofessional communication. Simulation IPE, regardless of the type of modality used, can be used effectively to improve interprofessional communication based on the intended learning outcome and this seems to be independent of the location of the simulation. Reising et al. demonstrated that interprofessional communication improves performance . This knowledge, combined with our results, should motivate medical educators to develop simulation IPE activities aimed at improving medical students’ capacity for team-based care through improved interprofessional communication [3, 8, 9, 47]. Based on our findings and recommendations of the Health Professions Accreditors Collaborative and the National Academy of Medicine, we also recommend greater use of the Kirkpatrick Expanded Outcomes Typology to drive the design and assessment of longitudinal simulation IPE activities that target higher-level learning outcomes, such as skill acquisition and behavior change [14, 41].
This secondary analysis of a scoping review identified 21 articles published after 2016 that described simulation IPE activities involving medical learners in a simulation center and focused on interprofessional communication. While differences across these articles emerged regarding healthcare topics addressed, assessment tools utilized, learning outcomes measured, IPEC competencies targeted, and the types and combinations of health professional learners involved, several commonalities were identified that are instructive for medical educators throughout the world. We can draw from these commonalities and from those few studies included that have responded to calls from the IPE community to develop longitudinal IPE activities. To strengthen IPE simulation focused on interprofessional communication, we recommend that medical educators deliberately incorporate (1) hybrid instructional methods to bypass logistic hurdles, (2) longitudinal approaches to achieve higher-level learning outcomes, and (3) assessment tools with established validity evidence to measure those outcomes. Informed by our findings, this strategy will improve the skills and teamwork behaviors of medical students to improve patient care and outcomes.
Availability of data and materials
Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. Interprofessional Education Collaborative, Washington, DC; 2011. Available from: https://www.aacom.org/docs/default-source/insideome/ccrpt05-10-11.pdf.
The Joint Commission Sentinel Event Data Root causes by event type: 2004–2014. Updated 2015. Accessed 31 May 2021. http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2014.pdf.
Reader TW, Flin R, Cuthbertson BH. Communication skills and error in the intensive care unit. Curr Opin Crit Care. 2007;13(6):732–6. https://doi.org/10.1097/MCC.0b013e3282f1bb0e PMID: 17975399.
Kohn LT, Corrigan J, Donaldson MS. To err is human: Building a safer health system. Washington, DC: National Academy Press; 2000.
Eggertson L. On the Same Team? Nurs-Physician Comm Can Nurs. 2012;108(5):28–32.
Australian Commission on Safety and Quality in Health Care, 2012. Safety and Quality Improvement Guide Standard 6: Clinical Handover. October 2012. Accessed 3 June 2021. https://www.safetyandquality.gov.au/sites/default/files/migrated/Standard6_Oct_2012_WEB.pdfUpdated
World Health Organization Framework for action on interprofessional education & collaborative practice. Updated September 2010. Accessed 10 June 2021. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice
Rivers RM, Swain D, Nixon WR. Using aviation safety measures to enhance patient outcomes. AORN J. 2003;77:158–62.
Jain M, Miller L, Belt D, King D, Berwick DM. Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change. Qual Saf Health Care. 2006;15(4):235–9. https://doi.org/10.1136/qshc.2005.016576.PMID:16885246;PMCID:PMC2564008.
Functions and Structure of a Medical School Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Updated March 2021. Accessed 25 May 2021. https://lcme.org/wp-content/uploads/filebase/standards/2021-22_Functions-and-Structure_2021-04-16.docx
Commission on Dental Accreditation. Updated July 1, 2020. Accessed 10 Aug 2021. https://www.ada.org/~/media/CODA/Files/predoc_standards.pdf?la=en
Commission on Collegiate Nursing Education. Updated 2018. https://www.aacnnursing.org/Portals/42/CCNE/PDF/Standards-Final-2018.pdf. Accessed 10 Aug 2021.
Accreditation Council for Pharmacy Education. Updated February 2015. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf. Accessed 10 Aug 2021.
Guidance on Developing Quality Interprofessional Education for the Health Professions. Health Professions Accreditors Collaborative and the National Center for Interprofessional Practice and Education. Updated February 2019. https://healthprofessionsaccreditors.org/wp-content/uploads/2019/02/HPACGuidance02-01-19.pdf. Accessed 1 July 2021.
Health Professions Accreditors Collaborative Interprofessional Education Standards Survey. Updated December 2020. 10 Accessed Jul 2021. https://healthprofessionsaccreditors.org/wp-content/uploads/2020/12/HPAC_Survey_Dec_18_2020.pdf
Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: An integrative review. Nurse Educ Pract. 2016;19:36–40. https://doi.org/10.1016/j.nepr.2016.04.005 Epub 2016 May 3 PMID: 27428690.
Keller KB, Eggenberger TL, Belkowitz J, Sarsekeyeva M, Zito AR. Implementing successful interprofessional communication opportunities in health care education: a qualitative analysis. Int J Med Educ. 2013;4:253–9. https://doi.org/10.5116/ijme.5290.bca6 Published 2013 Dec 22.
AHRQ: Agency for Healthcare Research and Quality. Rockville, MD: US Department of Health and Human Services; 2013.TeamSTEPPSTM: National implementation; 2013 [Cited 10 June 2013]; Updated 2013. Accessed 15 July 2021. http://teamstepps.ahrq.gov
Sargeant J, MacLeod T, Murray A. An interprofessional approach to teaching communication skills. J Continuing Educ Health Prof. 2011;31(4):265e267. https://doi.org/10.1002/chp.20139.
Kim SJ, Kwon OD, Kim KH, Lee JE, Lee SH, Shin JS, et al. Investigating the effects of interprofessional communication education for medical students. Korean J Med Educ. 2019;31(2):135–45. https://doi.org/10.3946/kjme.2019.125 Epub 2019 May 30. PMID: 31230436; PMCID: PMC6589613.
Hagemeier NE, Hess R, Hagen KS, Sorah EL. Impact of an Interprofessional Communication Course on Nursing, Medical, and Pharmacy Students’ Communication Skill Self-Efficacy Beliefs. Am J Pharm Educ. 2014;78(10):186. https://doi.org/10.5688/ajpe7810186.
Solomon P, Baptiste S, Hall P, Luke R, Orchard C, Rukholm E, et al. Students’ perceptions of interprofessional learning through facilitated online learning modules. Med Teach. 2010;32(9):e391–8. https://doi.org/10.3109/0142159X.2010.495760.
Barnsteiner JH, Disch JM, Hall L, Mayer D, Moore SM. Promoting interprofessional education. Nurs Outlook. 2017;55(3):144e150. https://doi.org/10.1016/j.outlook.2007.03.003.
Liaw SY, Zhou WT, Lau TC, Siau C, Chan SW. An interprofessional communication training using simulation to enhance safe care for a deteriorating patient. Nurse Educ Today. 2014;34(2):259–64. https://doi.org/10.1016/j.nedt.2013.02.019 Epub 2013 Mar 19 PMID: 23518067.
INACSL Standards Committee. INACSL standards of best practice: Simulation glossary. Clin Sim Nurs. 2016;12(S):S39–47.
Solomon P, Salfi J. Evaluation of an interprofessional education communication skills initiative. Educ Health (Abingdon). 2011;24:616.
Marion-Martins AD, Pinho DLM. Interprofessional simulation effects for healthcare students: A systematic review and meta-analysis. Nurse Educ Today. 2020;94:10456810. https://doi.org/10.1016/j.nedt.2020.104568. Epub 2020 Aug 22 PMID: 32932058.
Dennis D, Furness A, Duggan R, Critchett S. An Interprofessional Simulation-Based Learning Activity for Nursing and Physiotherapy Students. Clin Simul Nurs. 2017;13(10):501–10.
Lopreiato J O. Healthcare Simulation Dictionary. Rockville, MD: Agency for Healthcare Research and Quality; October 2016. AHRQ Publication No. 16(17)-0043.
Meakim C, Boese T, Decker S, Franklin AE, Gloe D, Lioce L, et al. Standards of Best Practice: Simulation Standard I: Terminology. Clin Simul Nurs. 2013;9(6S):S3–11. https://doi.org/10.1016/j.ecns.2013.04.001.
Salas E, Shuffler ML, Thayer AL, Bedwell WL, Lazzaea EH. Understanding and improving teamwork in organisations: A scientifically based practical guide. Hum Resour Manage. 2015;54(4):599–622. https://doi.org/10.1002/hrm.21628.
Anderson E, Bennett S. Taking a closer look at undergraduate acute care interprofessional simulations: lessons learnt. J Interprof Care. 2019. https://doi.org/10.1080/13561820.2019.1676705.
Jahanshir A, Bahreini M, Banaie M, Jallili M, Hariri S, Rasooli F, et al. Implementation a Medical Simulation Curriculum in Emergency Medicine Residency Program. Acta Med Iran. 2017;55(8):521–4 PMID: 29034649.
Talwalkar JS, Cyrus KD, Fortin AH. Twelve tips for running an effective session with standardized patients. Med Teach. 2020;42(6):622–7. https://doi.org/10.1080/0142159X.2019.1607969.
Corbett E Jr. The AAMC Project on the Clinical Education of Medical Students Clinical Skills Education. 2006.
Abu-Rish E, Kim S, Choe L, Varpio L, Malik E, White AA, et al. Current trends in interprofessional education of health sciences students: A literature review. J Interprof Care. 2012;26(6):444–51. https://doi.org/10.3109/13561820.2012.715604.
Caruana EJ, Roman M, Hernández-Sánchez J, Solli P. Longitudinal studies. J Thorac Dis. 2015;7(11):E537–40. https://doi.org/10.3978/j.issn.2072-1439.2015.10.63.PMID:26716051;PMCID:PMC4669300.
Bok C, Ng CH, Koh JWH, Ong ZH, Ghazali HZB, Tan LHE, et al. Interprofessional communication (IPC) for medical students: a scoping review. BMC Med Educ. 2020;20(1):372. https://doi.org/10.1186/s12909-020-02296-x.PMID:33081781;PMCID:PMC7574565.
Shrader S, Griggs C. Multiple Interprofessional Education Activities Delivered Longitudinally Within a Required Clinical Assessment Course. Am J Pharm Educ. 2014;78(1):14. https://doi.org/10.5688/ajpe78114.
Ward LD, Bray BS, Odom-Maryon TL, Richardson B, Purath J, Woodard LJ, et al. Development, implementation and evaluation of a longitudinal interprofessional education project. J Interprofessional Educ Pract. 2016;1(3):35–41.
Committee on Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes; Board on Global Health; Institute of Medicine. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes. Washington (DC): National Academies Press (US); 2015 Dec 15. Available from: https://www.ncbi.nlm.nih.gov/books/NBK338360/https://doi.org/10.17226/21726
Lemke KC, Velasquez ST, Bland L, Lopez E, Ajtai R, Ford LA, et al. Simulation interprofessional education in health professions education: a scoping review protocol. JBI Evid Synth. 2021;19(11):3058–72. https://doi.org/10.11124/JBIES-20-00487 PMID: 34374688.
Johnston S, Coyer FM, Nash R. Kirkpatrick’s Evaluation of Simulation and Debriefing in Health Care Education: A Systematic Review. J Nurs Educ. 2018;57(7):393–8. https://doi.org/10.3928/01484834-20180618-03 Published Online: June 18, 2018.
Kirkpatrick DL. Evaluation of training. In: Craig RL, editor. Training and Development Handbook. New York: McGraw Hill; 1976.
Cox M, Cuff P, Brandt B, Reeves S, Zierler B. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. J Interprof Care. 2016;30(1):1–3. https://doi.org/10.3109/13561820.2015.1111052.
Reising DL, Carr DE, Gindling S, Barnes R, Garletts D, Ozdogan Z. Team Communication Influence on Procedure Performance: Findings From Interprofessional Simulations with Nursing and Medical Students. Nurs Educ Perspect. 2017;38(5):275–276. https://doi.org/10.1097/01.NEP.0000000000000168. PMID: 28562460.
Oxelmark L, NordahlAmorøe T, Carlzon L, Rystedt H. Students’ understanding of teamwork and professional roles after interprofessional simulation-a qualitative analysis. Adv Simul (Lond). 2017;8(2):8. https://doi.org/10.1186/s41077-017-0041-6.Erratum.In:AdvSimul(Lond).2019Feb5;4:1.PMID:29450009;PMCID:PMC5806292.
Partecke M, Balzer C, Finkenzeller I, Reppenhagen C, Hess U, Hahnenkamp K, Meissner K. Interprofessional Learning - Development and Implementation of Joint Medical Emergency Team Trainings for Medical and Nursing Students at Universitätsmedizin Greifswald. GMS J Med Educ. 2016;33(2):Doc32. https://doi.org/10.3205/zma001031 PMID: 27280143; PMCID: PMC4895854.
Horsley TL, Reed T, Muccino K, Quinones D, Siddall VJ, McCarthy J. Developing a Foundation for Interprofessional Education Within Nursing and Medical Curricula. Nurse Educ. 2016;41(5):234–8. https://doi.org/10.1097/NNE.0000000000000255 PMID: 26963036.
Jakobsen RB, Gran SF, Grimsmo B, Arntzen K, Fosse E, Frich JC, Hjortdahl P. Examining participant perceptions of an interprofessional simulation-based trauma team training for medical and nursing students. J Interprof Care. 2018;32(1):80–8. https://doi.org/10.1080/13561820.2017.1376625 Epub 2017 Oct 6 PMID: 28985089.
Sincak C, Gunn J, Conroy C, Komperda K, Van Kanegan K, Krumdick N, Lee M, Kanjirath P, Lempicki K, Heinking K, Spiegel J. Transformation of an Online Multidisciplinary Course into a Live Interprofessional Experience. Am J Pharm Educ. 2017;81(5):94. https://doi.org/10.5688/ajpe81594.PMID:28720922;PMCID:PMC5508093.
Reed T, Horsley TL, Muccino K, Quinones D, Siddall VJ, McCarthy J, Adams W. Simulation Using TeamSTEPPS to Promote Interprofessional Education and Collaborative Practice. Nurse Educ. 2017;42(3):E1–5. https://doi.org/10.1097/NNE.0000000000000350 PMID: 27922901.
Sehgal M, Nassetta KR, Bamdas JAM, Sourial M. First do no “pharm”: Educating medical and pharmacy students on the essentials of medication management. Curr Pharm Teach Learn. 2019;11(9):920–7. https://doi.org/10.1016/j.cptl.2019.05.006 Epub 2019 May 31 PMID: 31570130.
Andersen P, Coverdale S, Kelly M, Forster S. Interprofessional simulation: Devel- oping teamwork using a two-tiered debriefing approach. Clin Simul Nurs. 2018;20:15–23. https://doi.org/10.1016/j.ecns.2018.04.003.
Shrader S, Kostoff M, Shin T, Heble A, Kempin B, Miller A, et al. Using Communication Technology to Enhance Interprofessional Education Simulations. Am J Pharm Educ. 2016;80(1):13. https://doi.org/10.5688/ajpe80113.PMID:26941439;PMCID:PMC4776291.
Ragucci KR, Kern DH, Shrader SP. Evaluation of Interprofessional Team Disclosure of a Medical Error to a Simulated Patient. Am J Pharm Educ. 2016;80(8):138. https://doi.org/10.5688/ajpe808138.PMID:27899834;PMCID:PMC5116790.
Kusnoor AV, Gill AC, Hatfield CL, Ordonez N, Dello Stritto R, Landrum P, Teal CR, Ismail N. An Interprofessional Standardized Patient Case for Improving Collaboration, Shared Accountability, and Respect in Team-Based Family Discussions. MedEdPORTAL. 2019;4(15):10791. https://doi.org/10.15766/mep_2374-8265.10791.PMID:30800991;PMCID:PMC6354797.
Carpenter AM, Hirthler MA, King CJ. Interprofessional Collaborative Practice: Use of Simulated Clinical Experiences in Medical Education. J Am Osteopath Assoc. 2018;118(4):235–42. https://doi.org/10.7556/jaoa.2018.048 PMID: 29582058.
Wen A, Wong L, Ma C, Arndt R, Katz AR, Richardson K, Deutsch M, Masaki K. An interprofessional team simulation exercise about a complex geriatric patient. Gerontol Geriatr Educ. 2019;40(1):16–29. https://doi.org/10.1080/02701960.2018.1554568 Epub 2018 Dec 4. PMID: 30513067.
Liaw SY, Ooi SW, Rusli KDB, Lau TC, Tam WWS, Chua WL. Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes. J Med Internet Res. 2020;22(4): e17279. https://doi.org/10.2196/17279.PMID:32267235;PMCID:PMC7177432.
Brashers V, Erickson JM, Blackhall L, Owen JA, Thomas SM, Conaway MR. Measuring the impact of clinically relevant interprofessional education on undergraduate medical and nursing student competencies: A longitudinal mixed methods approach. J Interprof Care. 2016;30(4):448–57. https://doi.org/10.3109/13561820.2016.1162139 Epub 2016 Jun 7 PMID: 27269441.
King TS, Schubert C, Pittman O, Rohrig L, McClerking C, Barthelmas T. Use of an Academic Electronic Health Record with an Interprofessional Simulation for Advanced Practice Nursing Students. Nurs Educ Perspect. 2021;42(4):259–61. https://doi.org/10.1097/01.NEP.0000000000000621 PMID: 32079908.
Haber J, Hartnett E, Allen K, Crowe R, Adams J, Bella A, Riles T, Vasilyeva A. The Impact of Oral-Systemic Health on Advancing Interprofessional Education Outcomes. J Dent Educ. 2017;81(2):140–8 PMID: 28148604.
Karpa K, Graveno M, Brightbill M, et al. Geriatric assessment in a primary care environment: a standardized patient case activity for interprofessional students. MedEdPORTAL. 2019;15:10844. https://doi.org/10.15766/mep_2374-8265.10844.
Lau Y, Chee DGH, Ab Hamid ZB, Leong BS-H, Lau ST. Interprofessional simulation based advanced cardiac life support training: video-based observational study. Clin Simul Nurs. 2019;30(C):16–24.
Cook DA, Brydges R, Ginsburg S, Hatala R. A contemporary approach to validity arguments: a practical guide to Kane’s framework. Med Educ. 2015;49(6):560–75. https://doi.org/10.1111/medu.12678 PMID: 25989405.
Maran NJ, Glavin RJ. Low- to high-fidelity simulation - a continuum of medical education? Med Educ. 2003;37(Suppl 1):22–8. https://doi.org/10.1046/j.1365-2923.37.s1.9.x PMID: 14641635.
Hargie O, Dickson D, Boohan M, Hughes K. A survey of communication skills training in UK schools of medicine: present practices and prospective proposals. Med Educ. 1998;32:25–34.
Gude T, Grimstad H, Holen A, Anvik T, Baerheim A, Fasmer OB, et al. Can we rely on simulated patients’ satisfaction with their consultation for assessing medical students’ communication skills? A cross sectional study. BMC Med Educ. 2015;15:225.
Pilnick A, Trusson D, Beeke S, O’Brien R, Goldberg S, Harwood RH. Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review. BMC Med Educ. 2018;18(1):267. https://doi.org/10.1186/s12909-018-1381-1.PMID:30453956;PMCID:PMC6245918.
Williams B, Song JJY. Are simulated patients effective in facilitating development of clinical competence for healthcare students? A scoping review. Adv Simul. 2016;1(1):6.
Siassakos D, Bristowe K, Hambly H, Angouri J, Crofts JF, Winter CR, et al. Team Communication with Patient Actors, Simulation in Healthcare. J Soc Simul Healthcare. 2011;6(3):143–9. https://doi.org/10.1097/SIH.0b013e31821687cf.
Cruess RL, Cruess SR, Steinert Y. Amending Miller’s pyramid to include professional identity formation. Acad Med. 2016;91(2):180–5.
Dubrowski A, Morin MP. Evaluating pain education programs: An integrated approach. Pain Res Manage. 2011;16(6):407–10.
ten Cate O, Snell L, Carraccio C. Medical competence: the interplay between individual ability and the health care environment. Med Teach. 2010;32(8):669–75. https://doi.org/10.3109/0142159X.2010.500897 PMID: 20662579.
Mehay R, Burns R. Miller’s Pyramid of Clinical Competence. The Essential handbook for GP training and education. London: Radcliffe Publishing Limited; 2009. Chapter 29: Assessment and Competency. p414.
Lazinski MJ, Ross L, Wolf S, Finck M, Cherry L. Interprofessional Education at a Distance: The Hybrid Interprofessional Education Model. Internet J Allied Health Sci Prac. 2021:19(3):Article 15.
D’Eon M. A blueprint for interprofessional learning. J Interprof Care. 2005;19(2):49–59.
Thistlewaite J. Interprofessional education: a review of context, learning and the research agenda. Med Educ. 2012;46(1):58–70.
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Velásquez, S.T., Ferguson, D., Lemke, K.C. et al. Interprofessional communication in medical simulation: findings from a scoping review and implications for academic medicine. BMC Med Educ 22, 204 (2022). https://doi.org/10.1186/s12909-022-03226-9
- Interprofessional education
- Interprofessional communication
- Medical education