Journal of Interprofessional Care

ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijic20

Interprofessional education and collaboration: A

simulation-based learning experience focused on
common and complementary skills in an acute
care environment

S. Cunningham, L. Foote, M. Sowder & C. Cunningham

To cite this article: S. Cunningham, L. Foote, M. Sowder & C. Cunningham (2017):

Interprofessional education and collaboration: A simulation-based learning experience focused on
common and complementary skills in an acute care environment, Journal of Interprofessional Care,
DOI: 10.1080/13561820.2017.1411340

To link to this article: https://doi.org/10.1080/13561820.2017.1411340

Published online: 21 Dec 2017.

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 JOURNAL OF INTERPROFESSIONAL CARE
https://doi.org/10.1080/13561820.2017.1411340

SHORT REPORT

Interprofessional education and collaboration: A simulation-based learning

experience focused on common and complementary skills in an acute care
environment
S. Cunninghama, L. Footeb, M. Sowderb, and C. Cunninghamc
a
Department of Physical Therapy, Radford University, Roanoke, Virginia, USA; bClinical Simulation Center, Radford University, Roanoke, Virginia,
USA; cClinical Simulation Center, Radford University, Roanoke, Virginia, USA
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ABSTRACT ARTICLE HISTORY

The purpose of this mixed-methods study was to explore from the participant’s perspective the Received 5 June 2017
influence of an interprofessional simulation-based learning experience on understanding the roles and Revised 11 September 2017
responsibilities of healthcare professionals in the acute care setting, interprofessional collaboration, and Accepted 27 November 2017
communication. Participating students from two professional programs completed the Readiness for KEYWORDS
Interprofessional Learning Scale (RIPLS) prior to and following the simulation experience to explore the Interprofessional education;
influence of the simulation experience on students’ perceptions of readiness to learn together. A mixed methods;
Wilcoxon signed rank analysis was performed for each of the four subscales of the RIPLS: shared learning phenomenology; roles;
(<.001), teamwork and collaboration (<.001), professional identity (.042), and roles and responsibilities survey; teamwork
(.001). In addition, participating students were invited to participate in focus group interviews to discuss
the effectiveness of the simulation experience. Three key themes were discovered: interprofessional
teamwork, discovering roles and responsibilities, and increased confidence in treatment skills. The
integration of interprofessional education through a simulation-based learning experience within the
nursing and physical therapy professional programs provided a positive experience for the students.
Simulation-based learning experiences may provide an opportunity for institutions to collaborate and
provide additional engagement with healthcare professions that may not be represented within a single
institution.

Introduction Background
The Framework for Action on Interprofessional Education and Program design
Collaborative Practice emphasised that the introduction of
The curricula of both professional programs were reviewed to
teamwork for students should begin within interprofessional
determine the students’ knowledge base and optimal place-
education (IPE) (WHO, 2010). Simulation has been shown to
ment of the simulation experience. This review identified
be an effective learning method to promote interprofessional
students with similar background knowledge for participation
collaboration within healthcare teams (Hammick, Freeth,
in the simulation experience and allowed the instructional
Koppel, Reeves, & Barr, 2007; Palaganas, Epps, & Raemer,
methods to be customised to the students’ levels of expertise.
2014). However, few studies have investigated the incorpora-
Students were identified within the first clinical year of the
tion of physical therapy students into simulations with other
nursing program and second year of the physical therapy
healthcare professionals (Lefebvre, Wellmon, & Ferry, 2015;
graduate program based on parallel curriculum components
Shoemaker et al., 2011). These studies have been limited to
for the introduction of acute patient care.
emergent situations and practice in critical care environ-
ments. However, in practice, health professionals often colla-
borate within less formal teams with a focus on meeting the Simulation design
rehabilitation and discharge needs of the patient. In 2015, the
A 3-hour simulation experience was developed to allow stu-
Center for Simulation at Radford University developed a
dents to engage in clinical scenarios representing a variety of
simulation experience for physical therapy and nursing stu-
patient diagnoses in an acute care environment. The simula-
dents. The purpose of this study was to explore from the
tion took place prior to clinical experiences. The focus of the
participant’s perspective the influence of an interprofessional
scenarios included: (1) anticipation of possible complications
simulation experience on understanding the roles and
and patient care needs based on the patient diagnosis and past
responsibilities of healthcare professionals in the acute care
medical history, (2) safe performance of essential skills for
setting, interprofessional collaboration, and professional
patient care, (3) communication and collaboration with other
identity.

CONTACT Shala Cunningham scunningham4@radford.edu Department of Physical Therapy, Radford University, 101 Elm Ave, 8th floor, Roanoke, VA 24013,
USA.
© 2017 Taylor & Francis
 2 S. CUNNINGHAM ET AL.

health professionals, and (4) improved understanding of the Data collection

roles of healthcare providers in the acute care environment.
A mixed-methods research design was utilised to determine
Three scenarios were utilised to segment the complex task of
the influence of the experience. The Readiness for
patient care in an inpatient environment: (1) trauma second-
Interprofessional Learning Scale (RIPLS) was chosen to obtain
ary to a motor vehicle accident, (2) pneumonia, and (3) open
baseline data and measure student perceptions regarding IPE
appendectomy. During the scenarios, students discussed the
following the simulation experience. The original RIPLS was
common skills in their profession and provided their unique
developed to measure student preparedness for IPE within
perspectives of implications of the care provided. The students
each of the four domains outlined by McFadyen et al., (2005).
collaborated to provide care and perform interventions with
The RIPLS was revised based on a Rasch analysis and the
each patient.
subscales were renamed (Williams, Brown, & Boyle, 2012).
Multiple opportunities were provided to perform each skill,
The new subscales include shared learning, teamwork and
ensuring all students experienced kinesthetic learning. Effective
collaboration, professional identity, and roles and responsibil-
communication and collaboration with patient care was the
ities. The revised scale was utilised in this study.
main focus of the debriefing. Students also reflected on the skills
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In addition to completion of the RIPLS, focus group inter-

performed and how each profession complemented the other to
provide patient-centred care. The students performed patient
care at the bedside in groups consisting of one physical therapy
student and three nursing students. Table 1 provides the com-
mon skills identified in the simulation experience.
Methods
Participants
Participants included students from three institutions. Over a
6-week period, 20 physical therapy students and 63 nursing
students took part in the simulation experience. To ensure all
groups had students from both professions, a third-year phy-
sical therapy student (not included in the outcomes) volun-
teered to participate in the scenarios. All students indicated
this was their first experience with IPE.
views were performed at the end of the academic semester to
explore the students’ perceptions regarding the experience. All
students involved in the simulation were invited to participate
in the focus group interviews. Six focus groups were per-
formed over a 2-week period. Participation in each group
ranged between 6 and 10 students. Focus groups were com-
posed of students from a single profession. Interviews were
performed by two of the researchers within each of the pro-
fessional programs. An interview guide was utilised. All inter-
views were recorded and transcribed for accuracy.
Data analysis
IBM SPSS 22 was utilised for quantitative data analysis. A
Wilcoxon signed rank analysis was performed for each of the
four subscales on the RIPLS prior to and following the simu-
lation experience. The level of statistical significance was set at

Table 1. Common skills for physical therapy and nursing students within the simulation experience.
General skills:
Electronic Health Record (EHR) utilisation; Work Station on Wheels (WOW) orientation; Paper chart utilisation; Supply cart orientation
Station 1 Station 2: Station 3:
Left radius fracture right tibial fracture Pneumonia with history of asthma Appendectomy with secondary intention healing
Skills: Skills: Skills:
● Heart sounds Auscultation ● Anterior lung sounds ● Bowel sound auscultation
● 5-lead ECG setup ● Positioning for improved air exchange: Head ● Jackson Pratt (JP) drain assessment
● Heart rhythm assessment elevation ● Catheter assessment
● Blood pressure ● Pulse oximetry ● Sequential compression device (SCD) placement and removal
● Respiratory rate ● Nasal cannula placement ● Incentive spirometry—cues and setting
● Pulse palpation ● Use of portable oxygen tank ● Sterile dressing change
● Movement of unstable fracture ● Humidifier setup on flow meter
● Environment preparation for transfers ● Appropriate cues for nebulizer use
and gait
Assessment: Assessment: Assessment:
● Pain assessment ● Prioritising treatment versus assessment ● Wound assessment
● Radiograph and radiology report ● Imaging interpretation
interpretation
Knowledge: Knowledge: Knowledge:
● Signs and symptoms of compartment ● Importance of humidifier with airway ● Laboratory interpretation platelet count haematocrit WBC
syndrome excretions differential BMP
● Signs and symptoms of hypovolemia ● Medication recognition ● Pharmacokinetics of drug excretion
versus pain ● Adverse reactions of steroid treatment
● Medication recognition ● Insulin sliding scale
● Signs and symptoms of respiratory distress
 JOURNAL OF INTERPROFESSIONAL CARE 3

p < .05. The qualitative data were analysed using the descrip-
tive phenomenology approach. Primary coding was per-
formed by the investigators using the constant comparative
method. Thick descriptions and narratives of the study parti-
cipants were provided to inform the themes. To ensure cred-
ibility of the themes, data also underwent analyst triangulation
to avoid selective perception.
The findings were reviewed by a peer, who has experience
in qualitative research, for verification that the findings accu-
rately represent the data.
Ethical considerations
This study was approved by the Institutional Review Board of
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But we worked really well together. We were shocked at what each
other can do and couldn’t do and so we just kinda worked
together.
I think it helped us learn the roles of other professionals. It is one
thing to discuss it and another to see it in a real case and under-
stand it.
I feel like you have a closer connection knowing what they can
and cant do. And you have more respect.
Students reported increased confidence following participation
in patient care skills with the high fidelity human simulator.
The boot camp simulation design assisted learning through
reinforcement of knowledge within a case scenario:
It was nice to practice it without feeling pressure or judgment. I

Radford University. Consent was obtained and the rights of
the participants were protected throughout the study.
Results
All physical therapy students (n = 20) and 60 nursing
students participated in completing the RIPLS. The stu-
dents demonstrated a statistically significant improvement
in all four the RIPLS subscales. Table 2 presents the results
for each subscale.
During focus group interviews, students from both pro-
fessions (n = 52) discussed the influence of the simulation
experience on the promotion of teamwork and communi-
cation across the professions. Three main themes were
discovered: interprofessional teamwork, discovering roles
and responsibilities, and increased confidence in treatment
skills.
Within the theme of teamwork, students described assist-
ing each other with patent care and drawing upon each
other’s knowledge. In addition, students gained valuable
insight concerning each others’ perspectives on the patient’s
impairments:
I liked that we were answering the questions together. The areas
where I felt weaker, the nursing students were able to provide
helpful input and the answers. It was nice to also be able to
comment on the questions that were more PT related and share
my knowledge.
It was more of the communication that I felt was important and
how our unique perspectives about the patient would impact the
other professions assessment.
Students discussed the discovery of each other’s professional
roles and responsibilities through the experience. By develop-
ing a better understanding of the other professions’ assess-
ment and treatment procedures, the teams developed respect
for each others’ unique role in patient care:
feel more confident in offering to assist with these things.
I learned a lot in three hours. I mean I knew it, but I was not
confident in performing it.
Discussion
Early integration of IPE in a clinical environment allowed
students to explore roles and responsibilities of healthcare
professionals through active learning. As compared to other
studies incorporating physical therapy into IPE through simu-
lation (Lefebvre et al., 2015; Shoemaker et al., 2011), the roles
of each profession were not well defined by the patient pre-
sentation. This allowed for common skills to be emphasised
and the flexibility within the healthcare team members role to
be explored.
Concerns have been raised over the validity of the RIPLS
(Schmitz & Cullen, 2015). The RIPLS was chosen based on the
novice experience of the students and their limited exposure
to IPE. Furthermore, the improvement on the RIPLS sub-
scales was supported by the themes from the focus group
interviews. The RIPLS subscale of professional identity indi-
cated the least amount of change; however, the students were
in the first semester of each professional school’s acute care
curriculum with limited exposure to their professions full
scope of practice.
The focus groups used for the interviews were composed of
students from a single profession, which may have limited the
discussion and resulting themes.
Concluding comments
Using simulation experiences for IPE may provide an oppor-
tunity for institutions to collaborate and provide additional
engagement with healthcare professions that may not be
represented within a single institution. Further development

Table 2. Wilcoxon signed rank analysis for each RIPLS subscale.

Presimulation Postsimulation
RIPLS subscale Minimum Maximum Median Mean SD Minimum Maximum Median Mean SD p value
i. Shared Learning 18 45 45.0 41.8 5.6 36 45 45.0 43.5 2.9 <.001
ii. Teamwork and collaboration 10 15 14.0 13.6 1.5 3 15 15.0 13.7 2.2 <.001
iii. Professional Identity 12 20 18.0 18.3 1.8 15 20 20.0 19.1 1.4 .042
iv. Roles and responsibilities 3 15 11.5 9.9 3.7 3 15 12.0 11.5 3.1 .001
RIPLS: 5-point scale (1 indicating strongly disagree to 5 indicating strongly agree) to assess the readiness of healthcare students for IPE.
Scores for items in subscale iii and iv were reversed due to the negative phrasing of statements.
 4 S. CUNNINGHAM ET AL.
of interprofessional simulations and exploration of best prac-
tice is necessary to fully integrate collaborative clinical experi-
ences throughout the curriculum.
Declaration of interest
The authors report no conflicts of interest. The authors alone are
responsible for the content and writing of this article.
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