The Center for Innovative Clinical Practice gives students a real experience and faculty a research tool
Daniel Allison was caught off-guard. His patient, lying in a hospital bed and complaining of searing pain in her extremities and right hip, refused to cooperate with his treatment plan. Thinking fast, Allison remembered that the patient liked to play Bingo, and that there were game cards in the clinic. So he played with her, buying enough time to formulate and offer up a Plan B.
“I wasn’t as prepared as I thought I was,” says Allison, a fourth-term Master of Occupational Therapy student. “It was definitely a wake-up call.” Then the patient stood up, showing no pain at all. This wasn’t a miracle—it was part of a simulation taking place in the new Center for Innovative Clinical Practice on the San Marcos, California, campus.
The facility, which opened in May, spans nearly 7,000 square feet and offers an immersive learning environment with state-of-the-art medical tools and resources. The center includes a 16-bed patient ward, a dedicated area for OT education, two patient assessment rooms, a complex simulation room, a 25-seat observation and debriefing room, and an Activities of Daily Living lab with a kitchen, bedroom, dining room, closet, bathroom, and living room.
INTEGRATED INTO THE CURRICULUM
Mock treatment has long been part of health education, but the center is unique in its scope and goals for integration into the curriculum. “Many university simulation labs are designed for students in many medical fields and are used mainly for medical student scenarios and testing,” says Dawn Zwart, simulation coordinator. “Our center is designed specifically for OT and PT students, and starting with their first trimester they will use it to put into practice information from labs and lectures, applying critical thinking and communication with patients.”
Since occupational and physical therapy students will be working together as graduates, they will be learning together in the center during their classes. Simulations are particularly well suited to practicing interprofessional collaboration because they can go beyond skill-building to focus on communication between healthcare providers as well as interactions with patients.
Though Allison spent several days preparing for the simulation, no amount of homework or textbook studying could ready him for the quick thinking he needed to do on the spot.
“What we learn in the classroom setting, we can let it sink in,” he says. “But when you’re put into the simulation, it’s a lot different.”
Where in the past a student might learn the steps required to safely move a patient, “the thinking behind what they were doing was only lightly addressed,” says Maureen “Mo” Johnson, instructor in the Master of Occupational Therapy program. “Now they can learn what to do when things don’t go as planned.”
Says Allison: “Making the simulations as real as possible makes us think on our feet and puts us a step ahead.”
The center provides a real-life experience without the real-life stakes, which is comforting, Allison says. “It was good to know that it was practice, with other students playing the role of patient.”
For another simulation, Allison took on the part of a patient who had suffered a stroke and could not move the left side of his body.
“I would fall over to the left side with no warning,” he says. “I’d pretend I was fine, and then when the students turned away I’d fall over. They learned that they needed to have a hand on the patient.”
Allison learned a lot from this role, too. “It definitely gave me some perspective on how patients may feel,” he says. “I realized that the patient is more than his chart. A lot of times it’s mental as well as physical.”
“These kinds of experiences increase memory retention,” says Dr. Susan Saxton who as senior vice president of innovation and emerging strategies spearheaded the center. “Students can work on professional behaviors. We can enhance their academic progression and better identify students who can use additional assistance before they go out for internships or fieldwork.”
Another benefit of the simulations at the center, according to students and faculty, is the debriefing process. Though debriefing is not a new concept in the medical field, it is novel for OT and PT, Johnson says.
“Simulation debriefing was made for first responders, surgeons, nurses, anesthesiologists,” Johnson says. “We’re not those. We’re therapists. So we’re changing the whole environment of the simulation to fit therapy. And we’re one of the few places in the world that is doing it right now.”
During a typical debriefing, students gather around a table and view a recording of the simulation, then discuss what went well and what could be improved.
“This allows for critical thinking as health science practitioners,” Johnson says. “It’s not a lecture; it’s a debrief. We can talk about how it felt, why they made certain choices. There’s no right or wrong. They’d never felt there was this kind of safe way to express themselves.”
The students realize that “it’s not just about talking at the patient,” she says. “It’s about being in the moment and thinking on your feet. Students explore the thinking and the problem-solving and then go back and practice it again and again.”
In the debriefing, “everyone comes out of character, and everyone has the opportunity to speak about what they liked and didn’t like,” Allison says. “You gain a perspective you wouldn’t have otherwise.”
The ability to record scenarios using Simulation IQ from Education Management Solutions opens up tremendous opportunities for students and faculty. The innovative audiovisual technology being installed will allow faculty to record simulations that they can then post online for Flex or residential students to watch asynchronously. Faculty can even mark sections of the video so that students focus on a specific skill or communication technique being used with a mock patient. Because the recordings will be housed on the web, students from other campuses or even other schools in the Laureate International Universities network could benefit from a scenario created by a faculty member with specific expertise.
The center has been so popular in California that the university is opening new centers for the spring term on the St. Augustine and Austin campuses. A fourth center will open as part of the new permanent Miami campus in summer.
Among the innovative ideas in the works is a community functions room that could include a mock ATM or bank teller window, as well as a grocery store aisle, to help occupational therapy students prepare people for daily activities associated with independent living. The Austin campus is leading the way with a movement science lab that takes technology used to train athletes, such as treadmills and pressure plates, and applies them to rehabilitation, helping clinicians better observe how patients are moving and how it affects them physically. The campuses are also working on simulating an outpatient clinic with treatment tables, weights, parallel bars, and other equipment to expose students to scenarios in a setting they are likely to encounter during clinical education and as graduates.
The Center for Innovative Clinical Practice has already inspired several faculty members to add to the scant knowledge on how simulations impact student learning in occupational and physical therapy. Here a few of them share their early research ideas.
TOPIC: Effects of Simulation Based Learning on Clinical Education
RESEARCHER: Dr. Nicole Rodriguez ’12, Flex DPT Instructor and Academic Coordinator of Clinical Education
ABSTRACT: Preparing students for successful clinical experiences is important to their success in the program and as graduates. By researching how exposure to simulation labs affects physical therapy student anxiety, motivation, and preparedness, we can help inform faculty members on how to best instruct and prepare these doctoral students to perform optimal patient care, both during their internships and after graduation.
TOPIC: Debriefing Sessions
ABSTRACT: With a qualitative design, we can better understand the perceptions of faculty about what happens in their debriefing sessions and how debriefing sessions affect the learning experiences of occupational therapy and physical therapy students. Also, with an online training module for faculty development on debriefing students following their experiences in the center, faculty would be able to review the kinds of debriefing processes and select the one most appropriate for their simulation.
TOPIC: Using Simulation to Enhance Interprofessional Education Among OT and PT Students
ABSTRACT: We can investigate how simulation and technology can enhance interprofessional education among first-year OT and PT students by engaging them in immersive simulation scenarios and skills techniques. Students would self-reflect and evaluate interprofessional communication and collaboration among fellow classmates. The data would measure outcomes and increase opportunities for developing interprofessional roles and coordinating patient care.