Background
The goal of the Accreditation Council for Graduate Medical Education (ACGME) CLER program is to optimize the clinical learning environment for trainees, including improving interprofessional practice. It is unclear how to best prepare interns for interprofessional practice. A prior needs assessment of residents and staff nurses at the University of Chicago on this topic highlighted the importance of “orienting interns from day 1” to the importance of these skills. This study describes the development, implementation, and evaluation of an interprofessional interactive role play for incoming interns during Graduate Medical Education (GME) Orientation.
Methods
Incoming interns from all specialties were required to participate in this exercise during New Intern Orientation. Interns were divided into groups of 10 to participate in a 30-minute interprofessional 3-character role-play (nurse, intern, patient) and subsequent discussion with nurse and physician facilitators. The role-play highlighted the difficulty communicating surrounding the potential discharge of a patient. An interprofessional team of educators developed the case, facilitator guide, and discussion checklist. All participants and facilitators were surveyed post-exercise and participants again 30 days into internship. Descriptive statistics were used to summarize the data.
Results
Of the 32 interprofessional facilitators, half (16) were nurses and half (16) were physicians. All facilitators found the role-play simulation to portray a realistic scenario, were satisfied with the discussion, and felt their opinions were valued. Of the 133 incoming interns surveyed, nearly all (91%, 121) reported receiving prior IPE training, and three-quarters (76%, 101) were satisfied with their training. Over three-quarters (84%, 112) felt the role-play scenario was realistic. Most (86%, 114) interns were satisfied with their performance, and nearly all (94%, 125) were satisfied with the post-case discussion. Almost all (93%, 124) interns reported they would be more thoughtful of how they interact with health professionals. Qualitative comments from participants included: “I enjoyed having nurses and physicians represented,” “loved including nurses,” “This was a great way to open up discussion with attendings, new interns, and nurses,” “very useful- favorite thing from orientation so far,” “the attending and nurse were great and made the session very interesting,” and “would love to have more representation of other groups like PT, nutrition.” Thirty days into internship, 128 interns were re-surveyed and over half (52%, 69) reported that they were communicating more effectively with interprofessional team members as a result of the role play.
Conclusions
In this first rendition of an interprofessional interactive role play for incoming interns, satisfaction of interns and physician and nursing facilitators was very high. Nurse facilitators felt their opinions were valued, which was supported by robust qualitative comments from interns. Over half of interns reported this exercise improved their ability to effectively communicate with interprofessional team members during internship. Although the actual impact on patient care of this short exercise is unclear, the return on investment to GME is high with high learner and facilitator satisfaction and high levels of commitment to change. Future work should reinforce these skills as well as ascertain whether this exercise results in improved interprofessional communication.