The Use Of Trauma Interprofessional Simulated Education (TIPSE) To

the use of trauma interprofessional simulated education (tipse) to enhance role awareness in the emergency department setting abstract

The use of Trauma Interprofessional Simulated Education (TIPSE) to
enhance role awareness in the Emergency Department setting
Abstract
Interprofessional Simulation-based Education (IPSE) is common in
medicine and nursing curricula however, less evident in diagnostic
radiography. Previous work suggests graduate radiographers are
unprepared in terms of trauma knowledge and experience. A trauma IPSE
programme as a joint venture between two universities was developed.
Our aim was to explore the views of radiography, nursing and medical
students regarding preparedness for trauma practice. Second-year
student radiographers (n=39), nursing (n=10) and medical (n=5)
students were invited to participate in trauma simulations. Pre- and
post-scenario questionnaires were completed and quantitative analysis
undertaken. Prior to IPSE, the majority of students were unprepared to
manage trauma. Post-scenario significantly more felt prepared to
undertake their role in the team and had better understanding of their
and other professions’ roles in trauma (P<0.01). IPSE is an effective
means of preparing undergraduate students in understanding both their
and other professional’s roles within the trauma team.
Keywords: Trauma, Interprofessional Education, Simulation,
Radiography, Nursing, Medicine
Introduction
Interprofessional education is fundamental in healthcare curricula due
to the need to train effectual healthcare teams (Gough, Hellaby,
Jones, & MacKinnon, 2012). One method of instruction is
interprofessional simulation-based education (IPSE).
IPSE occurs when two or more professions engage autonomously in
realistic scenarios to learn with, from and about each other, in a
controlled manner (Aliner et al., 2008). Whilst IPSE is common in
medicine and nursing curricula it is less evident in other
undergraduate professions including radiographers (Gough et al., 2012;
Aliner et al., 2008). A recent study found that even limited
simulation exposure provided students with understanding of other
health professions (Alinier et al., 2014). Due to the time-sensitive,
multifarious nature of the trauma setting, successful patient outcomes
are reliant on effective communication and teamwork (Miller, Crandall,
Washington & McLaughlin, 2012). Radiography often plays a crucial part
in the early management of trauma patients as X-ray images conducted
as an adjunct to the primary survey by radiographers allow rapid
identification of life threatening conditions. Therefore it is
disconcerting that Mackay, Anderson, & Hogg (2008) report that
graduate radiographers are ill prepared in terms of trauma-team
knowledge and experience with implications for the delivery of
efficient, quality diagnostic imaging.
Background
To bridge this deficit, faculty from two Scottish universities
developed in situ Trauma IPSE (TIPSE). Our aim was to explore nursing,
medical and radiography students’ perspectives with regards to their
preparedness for dealing with ‘trauma situations’. The main objectives
were to increase IPSE, and prepare students for professional practice
in trauma.
In pairs or triads radiography students were given a simulated
scenario, using SimMan 3G Trauma (Laerdal), along with nursing and
when available medical students. All scenarios involving ‘trauma
radiography’ were led by a qualified Emergency Department physician
with specialists in both nursing and trauma radiography over a
three-week period. All sessions were performed ‘in situ’ within the
resuscitation room of the hospital to enhance simulation fidelity.
Methods
This study employed a prospective, cohort intervention comparing pre-
and post-scenario knowledge/perspectives.
Data collection
All second-year undergraduate radiographers plus a convenience sample
of undergraduate nursing students from a variety of year groups from
one Scottish university and penultimate-year medical students from the
other university were invited to participate. Participants completed
paired pre- and post-scenario questionnaires consisting of 5-point
Likert rating scale. In total, 54 students were recruited (39
radiography, 10 nursing, 5 medical). No students had participated in ‘in
situ’ simulation previously.
Data analysis
Likert-scale data was imputed into SPSS v22 with paired pre- and
post-scenario scores compared using Wilcoxin paired tests.
Ethical considerations
Ethical approval for this study was granted via the National Research
Ethics Service.
Results
Analysis indicated that prior to completing the simulation, only eight
of the students ‘felt prepared’ to deal with trauma (Likert score 4)
with a mean Likert-score of 2.5 (Table 1). Post-scenario results
demonstrated a rise in the mean score to 3.7 with most students
feeling ‘more prepared’ to deal with trauma (Likert scores 4+5, n =
38, P<0.01). Just over half of the students (n=28) believed that they
‘understood their professions role in the trauma team’ prior to the
scenario. This number increased post-scenario to 49 with a mean change
in Likert-score of 0.9 (P<0.01).

In the pre-questionnaire the majority (76%) indicated ‘uncertainty as
to others responsibilities within the team (Likert scores 1-3), with
the cohort returning a mean Likert-score of 2.9. This mean score
increased to 4.1 post-scenario, providing a statistically significant
rightward shift in students’ understanding of others’ responsibilities
within the trauma team (P<0.01) (Table 1). Interestingly 13 students
(24%) felt unprepared to act in a multidisciplinary trauma team
(Likert scores 1+2) prior to the scenario, which dropped to only one
student (<2%) post-scenario (P<0.01). There did not appear to be any
major differences when analysing individual professional groups.
However, the numbers in the medical and nursing groups are too small
to make any meaningful group-wise comparison.
Discussion
Our data suggests undergraduate healthcare students feel unprepared to
work in a major trauma environment. In relation to radiographic
practice, this finding is consistent with Mackay et al. (2008), who
found graduate radiographers lacked confidence in major trauma and
recommended that trauma simulation be integrated into undergraduate
programmes. After participation in TIPSE, undergraduate healthcare
students felt markedly more prepared for facing major trauma, with a
significant difference seen in student perceptions of their role in
relation to the trauma team post-scenario. This suggests an enhanced
readiness for practice in trauma, highlighting TIPSE’s positive
learning effects.
Alinier et al., (2014) agree that IPSE facilitates knowledge and
understanding of other health professions’ roles that is well
supported in the literature as a vital element in an effective team.
Our post-scenario results found a significant positive shift in
students’ perceptions regarding major trauma and the roles of other
healthcare professionals in this environment.
Miller et al. (2012) found that whilst teamwork and communication in
the trauma setting improved through in situ simulations, this outcome
was not sustained and they recommended a continuum of simulations
maintaining interprofessional collaboration. This raises logistical
and resource issues, for example high student numbers and increasing
service demand can preclude organisation of authentic simulation
(Buckley et al., 2012; Alinier et al., 2014). It could be argued, in a
patient safety dominated climate, that sustainability of IPSE is a
necessity in providing an effective collaborative workforce receptive
to modern healthcare needs.
The authors acknowledge that there were a number of limitations
connected to this study. Firstly the questionnaires were distributed
to the students for completion at the beginning and end of each
scenario, when knowledge of trauma was still fresh in the students’
minds. Secondly, for the purposes of the study a limited convenience
sample of students from two participating universities was used, with
the majority being radiography undergraduates, while those from the
medical and nursing professions were less represented. Thirdly, though
a 5 point Likert scale was used for the data collection the
questionnaires used within the study were not validated prior to
analysis. However, the study’s primary intention was to specifically
focus on trauma radiography during an IPSE due to the previously
reported lack of radiographer confidence within the trauma setting
(MacKay et al., 2008).
Concluding comments
This study suggests that TIPSE can impart knowledge of the trauma team
and prepare students, in particular radiographers, for clinical
practice. Further work planned includes longitudinal follow up to
ascertain if this intervention delivered at this point in their
curricula improves graduate radiographers preparedness for practice,
and qualitative analysis of challenges participants encountered in
trauma team simulations.
Declaration of Interest
The authors report no declarations of interest. The authors are
responsible for the writing and content of this paper.
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