Samuel Lapkin

A systematic review of the effectiveness of interprofessional education in health professional programs

OBJECTIVE The objective of this systematic review was to identify the best available evidence for the effectiveness of university-based interprofessional education for health students. BACKGROUND Currently, most health professional education is delivered in a traditional, discipline specific way. This approach is limited in its ability to equip graduates with the necessary knowledge, skills and attitudes for effective interprofessional collaboration and for working as part of a complex health care team. Interprofessional education is widely seen as a way to improve communication between health professionals, ultimately leading to improved patient outcomes. INCLUSION CRITERIA The review included all randomised controlled trials and quasi-experimental studies in which two or more undergraduate or post-graduate health professional groups are engaged in interprofessional education. REVIEW METHODS A three-stage comprehensive search of ten electronic databases as well as grey literature was conducted. Two independent reviewers assessed each paper prior to inclusion using the standardised critical appraisal instruments for evidence of effectiveness developed by the Joanna Briggs Institute. RESULTS Nine published studies consisting of three randomised controlled trials, five controlled before and after studies and one controlled longitudinal study were included in the review. CONCLUSION Students attitudes and perceptions towards interprofessional collaboration and clinical decision-making can be potentially enhanced through interprofessional education. However, the evidence for using interprofessional education to teach communication skills and clinical skills is inconclusive and requires further investigation. IMPLICATIONS FOR RESEARCH Future randomised controlled studies explicitly focused on interprofessional education with rigorous randomisation procedures, allocation concealment, larger sample sizes, and control groups, would improve the evidence base for interprofessional education.

Examining the impact of high and medium fidelity simulation experiences on nursing students' knowledge acquisition.

AIM This paper describes a study that measured and compared knowledge acquisition in nursing students exposed to medium or high fidelity human patient simulation manikins. BACKGROUND In Australia and internationally the use of simulated learning environments has escalated. Simulation requires a significant investment of time and money and in a period of economic rationalisation this investment must be justified. Assessment of knowledge acquisition with multiple choice questions is the most common approach used to determine the effectiveness of simulation experiences. METHOD This study was conducted in an Australian school of nursing; 84 third year nursing students participated. A quasi-experimental design was used to evaluate the effect of the level of manikin fidelity on knowledge acquisition. Data were collected at three points in time: prior to the simulation, immediately following and two weeks later. RESULTS Differences in mean scores between the control (medium fidelity) and experimental (high fidelity) groups for Tests 1, 2 and 3 were calculated using independent t tests and were not statistically significant. Analysis of covariance (ANCOVA) was conducted to determine whether changes in knowledge scores occurred over time and, while an improvement in scores was observed, it was not statistically significant. CONCLUSION The results of this study raise questions about the value of investing in expensive simulation modalities when the increased costs associated with high fidelity manikins may not be justified by a concomitant increase learning outcomes. This study also suggests that multiple choice questions may not be the most appropriate measure of simulation effectiveness.

A cross-sectional survey examining the extent to which interprofessional education is used to teach nursing, pharmacy and medical students in Australian and New Zealand Universities

The current status of interprofessional education (IPE) in Australian and New Zealand universities is largely unexamined despite its generally acknowledged benefit. Data are also limited about the use of IPE in teaching medication safety to nursing, pharmacy and medical students. For this reason a web-based cross-sectional survey was used to gather information from Australian and New Zealand universities offering nursing, pharmacy or medical programs. Responses were received from 31 of the 43 (72%) target universities. Eighty percent of the participants indicated that they currently offer IPE experiences, but only 24% of these experiences met the accepted definition of IPE. Of the participants who offer IPE as defined by Center for the Advancement of Interprofessional Education, only 50% use it to teach medication safety. Timetabling restrictions and lack of appropriate teaching and learning resources were identified as the main barriers to implementation of IPE. All participants reported that staff development, multi-media and e-learning resources would be beneficial to IPE initiatives and the teaching of medication safety. Innovative approaches will be needed to overcome the barriers and facilitate the uptake of quality IPE more broadly. Web-based and e-learning options promise a possible way forward, particularly in the teaching of medication safety to nursing, pharmacy and medical students.

A systematic review of speech recognition technology in health care

BackgroundTo undertake a systematic review of existing literature relating to speech recognition technology and its application within health care.MethodsA systematic review of existing literature from 2000 was undertaken. Inclusion criteria were: all papers that referred to speech recognition (SR) in health care settings, used by health professionals (allied health, medicine, nursing, technical or support staff), with an evaluation or patient or staff outcomes. Experimental and non-experimental designs were considered.Six databases (Ebscohost including CINAHL, EMBASE, MEDLINE including the Cochrane Database of Systematic Reviews, OVID Technologies, PreMED-LINE, PsycINFO) were searched by a qualified health librarian trained in systematic review searches initially capturing 1,730 references. Fourteen studies met the inclusion criteria and were retained.ResultsThe heterogeneity of the studies made comparative analysis and synthesis of the data challenging resulting in a narrative presentation of the results. SR, although not as accurate as human transcription, does deliver reduced turnaround times for reporting and cost-effective reporting, although equivocal evidence of improved workflow processes.ConclusionsSR systems have substantial benefits and should be considered in light of the cost and selection of the SR system, training requirements, length of the transcription task, potential use of macros and templates, the presence of accented voices or experienced and in-experienced typists, and workflow patterns.

Interprofessional education for the quality use of medicines: designing authentic multimedia learning resources.

It is claimed that health care students who learn together will be better prepared for contemporary practice and more able to work collaboratively and communicate effectively. In Australia, although recognised as important for preparing nursing, pharmacy and medical students for their roles in the medication team, interprofessional education is seldom used for teaching medication safety. This is despite evidence indicating that inadequate communication between health care professionals is the primary issue in the majority of medication errors. It is suggested that the pragmatic constraints inherent in university timetables, curricula and contexts limit opportunities for health professional students to learn collaboratively. Thus, there is a need for innovative approaches that will allow nursing, medical and pharmacy students to learn about and from other disciplines even when they do not have the opportunity to learn with them. This paper describes the development of authentic multimedia resources that allow for participative, interactive and engaging learning experiences based upon sound pedagogical principles. These resources provide opportunities for students to critically examine clinical scenarios where medication safety is, or has the potential to be compromised and to develop skills in interprofessional communication that will prepare them to manage these types of situations in clinical practice.

The effectiveness of debriefing in simulation-based learning for health professionals: A systematic review

Background Simulation is defined as a technique used to replace or amplify real experiences with guided experiences that evoke or replace substantial aspects of the real world in a fully interactive manner. The use of simulation for educational purposes began decades ago with the use of low‐fidelity simulations and has evolved at an unprecedented pace. Debriefing is considered by many to be an integral and critical part of the simulation process. However, different debriefing approaches have developed with little objective evidence of their effectiveness. Objectives The aim of this review was to identify, appraise and synthesise the best available evidence for the effectiveness of debriefing as it relates to simulation‐based learning for health professionals. Inclusion criteria Types of participants This review included any health professional participants regardless of gender, age or profession. Types of intervention(s)/phenomena of interest Studies that evaluated the use of debriefing for the purpose of simulation‐based learning were included. Types of studies The review included randomised controlled trials. Types of outcomes Outcome measures included objectively measured outcomes such as situational awareness, communication skills, teamwork, knowledge acquisition, and performance of psychomotor skills as assessed by validated instruments such the Anaesthesia Non‐Technical Skills Scale, the Emergency Response Performance Tool, and the Clinical Simulation Tool. Search strategy A three‐stage comprehensive search strategy was utilised to search across ten electronic databases. English language studies published between January 2000 and September 2011 were considered for inclusion. Methodological quality Two independent reviewers assessed the methodological quality of each study selected for retrieval using standardised Joanna Briggs Institute critical appraisal tools. Data collection Data were extracted from studies using the standardised data extraction tool from the Joanna Briggs Institute Data synthesis Meta‐analysis was not possible because of the different outcomes, control groups and interventions in the selected studies. Findings are therefore presented in narrative form. Results Ten randomised controlled trials involving various debriefing methods were eligible for inclusion in this review. The methods of debriefing included: post simulation debriefing, in‐simulation debriefing, instructor facilitated debriefing and video‐assisted instructor debriefing. In the included studies there was a statistically significant improvement pre‐test to post‐test in the performance of technical and nontechnical skills such as: vital signs assessment; psychomotor skills; cardiopulmonary resuscitation; task management; team working; and situational awareness, regardless of the type of debriefing conducted. Additionally, four of the studies reported improvement in these outcomes without the use of video playback during debriefing. In one study the effect of the educational intervention was evident 6‐9 months after the initial simulation experience. Conclusions The results of this systematic review support the widely held assumption that debriefing is an important component of simulation. It is recommended therefore that debriefing remain an integral component of all simulation‐based learning experiences. However, the fact that there were no clinical or practical differences in outcomes when instructor facilitated debriefing was enhanced by video playback is an important finding since this approach is currently considered to be the ‘gold standard’ for debriefing.

The effectiveness of interprofessional education in university-based health professional programs: A systematic review

Executive summary Background: A key responsibility of universities is to prepare health professional graduates for their roles as effective members of the health care team. Currently, most university‐based health professional education is delivered in a traditional, discipline specific way. This approach is limited in its ability to equip graduates with the necessary knowledge, skills and attitudes for effective interprofessional collaboration and for working as part of a complex health care team. Interprofessional education occurs when learners from two or more professional groups learn about, from and with each other. The fundamental premise of interprofessional education is that if health professional students learn together they will be better prepared for interprofessional collaboration ultimately leading to improved patient outcomes. Objective ‐The objective of this systematic review was to identify the best available evidence for the effectiveness of university‐based interprofessional education. Inclusion criteria ‐The review included all randomised controlled trials and quasi‐experimental studies that assessed the effectiveness of interprofessional education in university‐based health professional programs. All studies that included two or more undergraduate or post‐graduate health professional groups engaged in interprofessional education were considered. Outcome measures included objectively measured or self‐reported educational outcomes and/or professional competencies related to interprofessional education as assessed by validated instruments such as the Readiness for Interprofessional Learning Scale and the Interdisciplinary Education Perception Scale. Search strategy: A three‐stage comprehensive search strategy was utilised to search across ten electronic databases. English language studies published between January 2000 and February 2011 were considered for inclusion. Methodological quality: Two independent reviewers assessed the methodological quality of each study selected for retrieval using standardised Joanna Briggs Institute critical appraisal tools. Data collection and synthesis: Data were extracted from studies using the standardised data extraction tool from the Joanna Briggs Institute. Meta‐analysis was not possible because of the different outcomes, control groups and interventions of the selected studies; and the findings are therefore presented in narrative form. Results: Nine published studies consisting of three randomised controlled trials, five controlled before and after studies and one controlled longitudinal study were eligible for inclusion in this review. Four studies reported significant improvement in attitudes and perceptions of interprofessional education. In addition, five studies reported a mixed set of outcomes related to interprofessional education interventions. Conclusions Implications for Practice Students attitudes and perceptions towards interprofessional collaboration and clinical decision making can be potentially enhanced through interprofessional education. However, the evidence for using interprofessional education to teach interprofessional communication skills and clinical skills such as resuscitation to health professions students is inconclusive and needs further investigation Implications for Research Future randomised controlled studies explicitly focused on interprofessional education with rigorous randomisation procedures and allocation concealment; larger sample sizes; and more appropriate control groups, would improve the evidence base of interprofessional education.

The effectiveness of interventions designed to reduce medication administration errors: a synthesis of findings from systematic reviews

AIM The aim of this overview was to examine the effectiveness of interventions designed to improve patient safety by reducing medication administration errors using data from systematic reviews. BACKGROUND Medication administration errors remain unacceptably high despite the introduction of a range of interventions aimed at enhancing patient safety. Systematic reviews of strategies designed to improve medication safety report contradictory findings. A critical appraisal and synthesis of these findings are, therefore, warranted. METHODS A comprehensive three-step search strategy was employed to search across 10 electronic databases. Two reviewers independently examined the methodological rigour and scientific quality of included systematic reviews using the Assessment of Multiple Systematic Reviews protocol. RESULTS Sixteen systematic reviews were eligible for inclusion. Evidence suggest that multifaceted approaches involving a combination education and risk management strategies and the use of bar code technology are effective in reducing medication errors. CONCLUSION More research is needed to determine the benefits of routine double-checking of medications during administration by nurses, outcomes of self-administration of medications by capable patients, and associations between interruptions and medications errors. IMPLICATIONS FOR NURSING MANAGEMENT Medication-related incidents must be captured in a way that facilitates meaningful categorisation including contributing factors, potential and actual/risk of harm and contextual information on the incident.

Organisational interventions for promoting person-centred care for people with dementia

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective: To determine the effectiveness of organisation‐wide interventions to implement person‐centred care for people with dementia, in relation to reduction of behavioural symptoms such as agitation and depression, improvement in quality of life and functional capabilities, alterations in the use of restraint (physical and/or chemical) and reduction in adverse events. Secondary objective: To identify the variety, quality, and feasibility of person‐centred care approaches for people with dementia, with specific reference to organisational factors which promote and constrain the implementation of person‐centred care.

Generation Y Health Professional Students’ Preferred Teaching and Learning Approaches: A Systematic Review

Generation Y or Millennials are descriptors for those born between 1982 and 2000. This cohort has grown up in the digital age and is purported to have different learning preferences from previous generations. Students are important stakeholders in identifying their preferred teaching and learning approaches in health professional programs. This study aimed to identify, appraise, and synthesize the best available evidence regarding the teaching and learning preferences of Generation Y health professional students. The review considered any objectively measured or self-reported outcomes of teaching and learning reported from Generation Y health professional student perspectives. In accordance with a previously published Joanna Briggs Institute Protocol, a three-step search strategy was completed. Two research articles (nursing and dental hygiene students) and three dissertations (nursing) were critically appraised. All studies were crosssectional descriptive studies. A range of pedagogical approaches was reported, including lecture, group work, and teaching clinical skills. Based on the Joanna Briggs Institute levels of evidence, reviewers deemed the evidence as Level 3. Some generational differences were reported, but these were inconsistent across the studies reviewed. There is, therefore, insufficient evidence to provide specific recommendations for the preferred educational approaches of health professional students and further research is warranted.