Elaine Gill

Offering antenatal sickle cell and thalassaemia screening in primary care: A pre–post evaluation of a brief type of communication skills training

OBJECTIVE To evaluate brief communication skills training for healthcare professionals (HCPs) in offering antenatal sickle cell and thalassaemia (SCT) screening in primary care. DESIGN Descriptive study within a cluster randomised controlled trial in 17 inner city practices. METHODS 126 HCPs were invited to attend a training session. Outcome measures were: attendance; perceived usefulness of training; comfort and confidence in offering screening; offering screening at pregnancy confirmation consultations; gestational age at test uptake. RESULTS 62% (78/126) HCPs attended training and 61 completed both pre- and post-training questionnaires. There were 49 new joiners and locums not in post at the start of the trial. After training, HCPs reported greater comfort [4.8 vs 5.4, p = 0.05] and confidence [4.6 vs 5.6, p<0.001] in offering screening. Pregnant women consulting trained HCPs were offered screening more frequently and at an earlier gestational age than those consulting untrained HCPs (75% vs 44%, χ(2) = 122, p<0.001; 91.5 days (attending training) vs 98.5 days (did not attend training) vs 101.8 days (new joiners and locums), F = 8.49, df 1069,2 p = 0.001). CONCLUSION Brief communication skills training for HCPs in offering antenatal SCT screening in primary care is feasible and can be effective. PRACTICE IMPLICATIONS Ways of maximising HCP attendance in training sessions requires consideration.

Simulation-based training for “front-of-house” staff in psychosis services

Staff communication skills are key to improving patients’ experience of healthcare, from the point of first contact with services to treatment end. To date, training initiatives to improve communication have prioritised the clinical workforce, rather than allied and support staff. In this study we evaluated the impact of simulation-based communication training for “front-of-house” staff (receptionists and administrators) working in specialist psychosis services. Forty-three staff completed the two-day training. Before and after training, staff rated the importance of communication skills in their role (Attitude), their understanding of psychosis (Knowledge), and their workplace satisfaction (Satisfaction). Attendees repeated the measures at follow-up (6–12 months post-training; n = 11), alongside a behavioural communication skills task, and were compared to a group of non-attenders (n = 12). Pre–post improvements were evident on all measures, reaching significance for Knowledge (medium effect). Improvements were mostly maintained in the 26% of attendees completing follow-up assessments. At follow-up, attendees scored significantly higher than non-attenders on Attitude and Knowledge (large effects), marginally higher on skills, but lower on Satisfaction. The workshops improved staff understanding of psychosis and the importance of communication in their roles. The impact of the training on service users’ satisfaction with services should now be evaluated in a controlled trial.

0131 The ontological shift – the influence an interprofessional full patient simulation session can have on a medical students’ learning

Background Undergraduate full patient simulation (FPS) is commonplace. FPS course evaluations show that clinical knowledge and skills are improved. But what do the students really take away from the experience? Methodology Final year medical, nursing and midwifery students participated in an interprofessional FPS course. A phenomenological approach1 and analysis2 explored ‘meaning’ and transfer of learning into their clinical practice. The ontological shift is one of the resulting themes. Outcomes The students described a change in the way they observed and participated in their clinical placements post the FPS experience. Student GK explores these issues: GK Because I had a really good experience and I learnt from it, I went back to the ward, and I was remembering, actually, do you know what? Yes, I can see, that’s why I was looking at the nurses, I was looking at the F1, and the nursing interaction as well. And we had a deteriorating patient, and the other F1s, the other student wasn’t there. And I offered to help, obviously, and I saw how it worked. I saw how the nurses worked, and I thought it was really good. I guess you don’t realise it until you’ve been put into that situation. Key changes described include: Observing the doctors role differently Observing the interaction between healthcare professionals Using other healthcare professionals as a learning resource Increased confidence to participate in clinical activities Conclusions An ontological shift can be deemed to have occurred when the subject starts thinking about an ‘entity’ in a new way and categorises it differently. The students describe new ways (for them) of observing practice and behaviours in the clinical arena and re-conceptualise clinical problems, thereby seeing the clinical world in a new light – an ontological shift. References Moustakas C. Phenomenological research methods. London: Sage Publications, 1994 Creswell, JW. Qualitative inquiry and research design; choosing among five approaches. London: Sage Publications, 2007

0215 Learning To Work Together: How Interprofessional Simulation Enables Undergraduate Medics In The Their Understanding Of Interprofessional Practice

Background/context Full patient simulation provides a safe learning environment that lends itself well to interprofessional learning with a chance for post-experience debriefing of both technical and non-technical skills.1 However, little work has been done to investigate the learning that occurs during these interactions, and how it effects students’ on-going professional behaviour.2 Methodology This study employs phenomenology,3,4 a qualitative inquiry approach, to explore the learning that occurs in and after an interprofessional full-patient simulation course for final year undergraduate medical and nursing students. Results/outcomes Analysis of interviews, which explore the students’ experiences and sense-making in the simulation setting, showed that three key themes emerged relating specifically to the important contributions of the interprofessional aspect of the course. These effects were: An increase in the sociological fidelity of the simulation An experiential learning opportunity to engage first-hand in teamworking in clinical practice A greater understanding of the nurse’s role, knowledge and abilities as a result of the simulation Conclusions and recommendations These results specifically argue for the contribution of the interprofessional aspect of the course to the medical students’ simulation experience in respect to working with and understanding their nursing colleagues. This study adds to Sharma et al’s5 claim that increasing the sociological fidelity of a simulation can increase the quality of non-technical skill learning—and therefore a corresponding transferability into interprofessional practice. We also highlight that there remains a large gap in medical undergraduate training on understanding nurses’ role, knowledge and abilities; simulation can help address this through both experiential learning in the simulated scenario and in the post-simulation debriefs. We argue that these important benefits from delivering undergraduate simulation in an interprofessional manner outweigh any potential added expense and logistical issues. References Palaganas JC, Epps C, Raemer DB., A history of simulation-enhanced interprofessional education. Journal of interprofessional care, 2014. 28(2): p. 110–5 Tofil NM, et al. Interprofessional simulation training improves knowledge and teamwork in nursing and medical students during internal medicine clerkship. Journal of Hospital Medicine, 2014. Published online 13/1/14 Moustakas C. Phenomenological Research Methods1994, London: Sage Publications Creswell JW. Qualitative Inquiry and Research Design; Choosing Among Five Approaches.2007, London: Sage Publications Sharma S, et al. Interprofessional simulated learning: the need for ‘sociological fidelity’. Journal of interprofessional care 2011. 25(2): p. 81–3