Background This descriptive study measured the effectiveness of and participants' satisfaction with an interprofessional simulation education workshop as a teaching strategy for health care professionals. Method Health care professionals completed a 1-day clinical simulation workshop on interprofessional collaboration, after which they had the opportunity to fill out 4 evaluative instruments

1. Featured Article
Interprofessional Simulation: An Effective
Training Experience for Health Care Professionals
Working in Community Hospitals
Dawn Prentice, RN, PhDa
, Karyn Taplay, MSN, RNCa
,
Elizabeth Horsley, RN, BScN, BAa
, Sue Payeur-Grenier, RNb
, Dan Belford, RRTb
a
Brock University, St. Catharines, Ontario L2S 3A1, Canada
b
Niagara Health System, St. Catharines, Ontario L2R 5K3, Canada
KEYWORDS
interdisciplinary
training;
simulation;
teaching methods;
hospital;
collaboration;
interprofessional
communication
Abstract
Background: This descriptive study measured the effectiveness of and participants’ satisfaction with
an interprofessional simulation education workshop as a teaching strategy for health care professionals.
Method: Health care professionals completed a 1-day clinical simulation workshop on interprofessional
collaboration, after which they had the opportunity to fill out 4 evaluative instruments.
Results: One hundred sixty-three participants completed the questionnaires. The majority were regis-
tered nurses (73.6%). Subscale scores were calculated for 3 of the instruments, with the mean ranging
from 3.99 to 4.61 out of a possible maximum rating of 5. Content analyses of the participants’ comments
resulted in 6 themes: (a) simulation as a learning experience, (b) the learning environment, (c) inter-
professional collaboration learning continuum, (d) cohesiveness, (e) adapting to change, and (f) im-
proved patient outcomes.
Conclusions: Simulation was highly rated as an effective teaching strategy for interprofessional
collaboration. Staff expressed satisfaction with simulation as a teaching strategy.
Cite this article:
Prentice, D., Taplay, K., Horsley, E., Payeur-Grenier, S., & Belford, D. (2010, Month). Interprofessional
simulation: An effective training experience for health care professionals working in community
hospitals.
Ó 2010 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier
Inc. All rights reserved.
Introduction
Simulation is a teaching strategy that is gaining popularity in
nursing and in other allied health professions. Simulation
technology provides the opportunity to develop realistic sce-
narios for many different levels of learners, from undergrad-
uate to postgraduate, in a safe environment (Morgan &
Cleave-Hogg, 2002). Simulation activities can facilitate cog-
nitive skills, critical thinking, and clinical reasoning and en-
hance psychomotor performance (Grady et al., 2008).
Following a simulation experience, learners are often given
the opportunity to debrief. Throughout the debriefing pro-
cess, learners reflect on the experience and receive feedback.
In addition to practical applications, simulation experi-
ences provide learners with an opportunity to integrate
knowledge, apply it, and examine the results of theirCorresponding author: dprentice@brocku.ca (D. Prentice).
1876-1399/$ - see front matter Ó 2010 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ecns.2010.03.001
Clinical Simulation in Nursing (2010) -, ---
www.elsevier.com/locate/ecsn
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2. actions (Baker et al., 2008). Learning can occur during the
simulation or the debriefing or when knowledge is trans-
ferred from the simulation to the clinical setting (Bradley
& Postlethwaite, 2003). The concept of simulation for pro-
moting interprofessional practice was born of the need to
support staffing changes and facilitate the adoption of an in-
terprofessional collaborative
model of care. This model
of care was implemented in
a local health care system
consisting of seven commu-
nity hospitals. The health
care system introduced four
registered respiratory thera-
pists, working to full scope,
into the registered nurses’
rotation to support the inter-
professional collaborative
care model. In tandem with
these changes, the health
care system participated in
the Health and Human Re-
sources Demonstration Site
Project funded by the On-
tario Ministry of Health
and Long-Term Care Nurs-
ing Secretariat. This initia-
tive focused on the
development of best prac-
tice staffing approaches and
interprofessional collabora-
tion (IPC) education initiatives to build capacity for sus-
tainable human resources planning. Three key
interprofessional care core competencies were developed
as part of this initiative: (a) interpersonal and communica-
tion skills, (b) client- and family-centered care, and (c) col-
laborative practice.
Interprofessional workshops were implemented to pro-
vide health care professionals with the knowledge and
skills to learn about working collaboratively on interpro-
fessional teams. The interprofessional project team from
the local health care system partnered, with the nursing
faculty from the local university, to develop, implement,
and evaluate the workshops. Simulation was chosen as
a teaching strategy for three reasons: (a) it provides a safe
environment in which learners can make decisions and
evaluate outcomes without risk to patients (Bradley & Post-
lethwaite, 2003), (b) it had previously been used for con-
tinuing education with this population and was perceived
as a positive learning experience, and (c) the project team
wanted the staff members to experience learning in an ac-
ademic environment outside their typical work setting.
The effectiveness of using high-fidelity simulation for
interprofessional student education has been previously
reported (Baker et al., 2008; Fernandez, Parker, Kalus, Miller,
& Compton, 2007; Mikkelsen Kyrkjebø, Brattebø, & Smith-
Strøm, 2006). However, there is a paucity of research about
the use of clinical simulation for educating health care profes-
sionals. Thus, the purpose of this descriptive study was to
measure the effectiveness and satisfaction of simulation as
a teaching strategy for health care professionals.
Development and Implementation of the Simula-
tion Scenarios
The interprofessional practice leader from the health care
system and the university nursing lab coordinator de-
veloped the scenarios for use with a high-fidelity human
patient simulator. The interprofessional practice leader is
a registered respiratory therapist and experienced advance
cardiac life support instructor who brought clinical exper-
tise to the simulation design. The lab coordinator was
responsible for programming the scenarios and setting up
the simulations to create a realistic environment. The
opening sequence for each scenario was preprogrammed;
however, patient parameters were adjusted throughout the
scenarios in response to participants’ actions.
Three scenarios were developed, two adult and one infant.
Although the focus was IPC, scenarios that dealt with critical
or traumatic situations were chosen as the background to al-
low staff to apply concepts of IPC to situations that mirror
what they encounter in their practice. Prior to the start of
the simulations, participants were informed that this was
a learning session. They were assured that it was not a test
and that they would not be graded on their clinical skills. Fa-
cilitated debriefing sessions were conducted after each sce-
nario by the interprofessional practice leader, the project
manager, and three clinical educators, all of whom had expe-
rience in debriefing techniques. The debriefing questions
were developed by the facilitators on the basis of the core
competencies of interprofessional care and included guided,
open-ended, and reflective questions. The purpose of the de-
briefing was to promote the exchange of ideas and foster an
open and supportive learning environment.
Ethics Clearance
Ethics clearance was obtained from both the university ethics
review board and the ethics review board for the health care
system. Prior to commencement of the workshops, staff
members from the clinical areas involved were given a letter
of information about the study and an invitation to participate.
As participation was voluntary, implied consent was obtained
if the participants chose to complete the surveys.
Method
This descriptive study incorporated four quantitative ques-
tionnaires and qualitative content analysis of the partici-
pants’ comments on the workshop evaluation. The four
questionnaires included (a) the 20-item Simulation Design
Key Points
Clinical simulation is
an effective teaching
strategy used in inter-
professional student
education.
Practicing health care
professionals expressed
satisfaction with simu-
lation as a teaching
strategy for interprofes-
sional collaboration.
Further research is
needed to determine
whether clinical simula-
tion is an ongoing effec-
tive teaching strategy to
teach interprofessional
collaboration to practic-
ing health care
professionals.
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3. Scale, (b) the 16-item Educational Practices in Simulation
Scale, (c) the 13-item Student Satisfaction and Self-
Confidence in Learning, and (d) the 9-item Interprofes-
sional Education and Clinical Simulation Workshop Eval-
uation. The questionnaires were administered to the
participants at the end of the workshop, after all debriefing
sessions were completed. Demographic information (age,
gender, professional designation, years of experience, and
highest level of education completed) was also obtained.
The first three instruments were developed and tested for
the National League for Nursing (NLN; Jeffries Rizzolo,
2006), and permission was obtained to use them for this
study. Each instrument uses a 5-point Likert-type scale,
with responses ranging from strongly agree to strongly dis-
agree. Jeffries and Rizzolo (2006) reported good reliability
for the first three scales, with Cronbach’s alpha subscales
between .86 and .96. In original tests of the Simulation De-
sign Scale, Cronbach’s alpha was .92 for presence of fea-
tures and .96 for importance of features. Cronbach’s
alpha for the Educational Practices in Simulation Scale
was .86 for presence of specific practices and .91 for the
importance of specific practices. Cronbach’s alpha for the
Student Satisfaction and Self-Confidence in Learning In-
strument subscales was .94 and .87, respectively (Jeffries
Rizzolo, 2006). The only modification to the tool was
the substitution of the word learner for student. The Inter-
professional Education and Clinical Simulation Workshop
Evaluation questionnaire was developed by one of the in-
vestigators (KT) at the request of the project team. The
questionnaire, which used a 5-point Likert-type scale with
responses ranging from not at all to excellent, solicited infor-
mation about the overall objectives of the workshop and
asked specific questions related to the content presented. Ad-
ditionally, the questionnaire had three open-ended questions:
How has the workshop caused you to think about interpro-
fessional collaboration? What did you enjoy about the work-
shop? What changes would you recommend? There was also
an opportunity for participants to provide comments. Given
that this was a workshop evaluation, it was not pilot tested.
Sample
The workshops were mandatory for staff and took place in
the university’s nursing simulation lab during a 2-week
period. All staff who attended the workshops were invited
to participate in the study. Participants included registered
respiratory therapists, registered nurses, registered practical
nurses, social workers, personal support workers, dietitians,
and pastoral care givers. The majority of participants were
registered nurses. This was expected because the usual
composition of acute care units consists of a high number
of nurses. The participants represented five of the seven
hospital sites within the local health care system. Each ses-
sion consisted of 16 to 20 participants. At least three facil-
itators were present at each workshop, and they took turns
facilitating the debriefing sessions.
Data Analysis
Data were analyzed with SPSS Version 16. Descriptive
statistics were obtained for the demographic variables and
the Interprofessional Education and Clinical Simulation
Workshop Evaluation questionnaire. Individual subscale
scores were calculated for each of the three NLN ques-
tionnaires. For example, the Simulation Design Scale was
divided into five subscales, and the scores were calculated
for each subscale, with a score of 1 indicating strongly dis-
agree with the statement and a 5 indicating strongly agree
with the statement.
The Educational Practices in Simulation Scale and the
Simulation Design Scale had a not applicable option for
each item. To facilitate scoring of the subscales, the not ap-
plicable option was converted to a missing designation, and
this score was replaced with the mean score of the particu-
lar item on the subscale. If 20% or more items were missing
from a questionnaire, the questionnaire was not included in
the analysis (Tabachnick Fidell, 1989). To maximize the
sample size, all other data were used, which accounts for
the differences in sample size among the subscales. The
Simulation Design Scale and the Educational Practices in
Simulation Scale also had a ranking component for each
of the items on the questionnaire, in which responses
ranged from 1 ¼ not important to 5 ¼ very important. Fre-
quency counts were calculated for these items.
Content analysis (Graneheim Lundman, 2004) was
used to examine the data from the three open-ended ques-
tions on the Interprofessional Education and Clinical Sim-
ulation Workshop Evaluation questionnaire. Initially open
coding was conducted independently by each of the inves-
tigators. Once this was completed, the investigators met and
collectively decided on nine codes. All data were then reex-
amined individually by the principal investigators and allo-
cated to the specific codes. Analysis continued among the
principal investigators, and each piece of coded data was
compared for consistency. Any outlier results were dis-
cussed, mutually agreed on, and then allocated to the suit-
able code. Data that could not be coded within the coding
system were further examined, resulting in an additional
code. All data were then reexamined in light of the new
code. Analysis continued, resulting in six themes, as well as
areas for improvement. Investigator triangulationas suggested
byLoiselle,Profetto-McGrath,Polit,andBeck(2004)wasim-
plemented to enhance credibility. Investigator triangulation
was achieved by the two principal investigators’ and the co-in-
vestigator’s collecting and analyzing the data.
Results
Demographic
A total of 167 staff members from the health care system
participated in the Interprofessional Education and Clinical
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4. Simulation workshop. Of those, 163 completed the ques-
tionnaires, yielding a response rate of 97.6%. The majority
of participants were female (88%) and registered nurses
(73.6%). Registered respiratory therapists accounted for 9%
of the participants, registered practical nurses 7%, social
workers 4%, other allied health staff 4%, and health care
aides 3%. Almost two thirds of participants were between
the ages of 36 and 55 (65.7%), and more than half reported
a college diploma as the highest level of education
completed.
Mean subscale scores for the five subscales within the
Simulation Design Scale ranged from 4.06 to 4.35 out of
a possible 5, indicating that the respondents agreed with the
statements on the questionnaire (Table 1). This scale also
had a ranking of not important to very important for each
item on the scale. Overall, the items had an 83% or greater
ranking of important to very important. The lowest ranked
item discussed goal setting for the patient, and this item
may not be relevant for this particular setting or population
and may account for the lower ranking.
Mean subscale scores for the Educational Practices in
Simulation Scale shows the mean score for each of the four
subscales was at least 4 (agree with the statement; Table 2).
The subscales ranged from 4.08 to 4.61. The collaboration
subscale had the highest mean score, 4.61. All items on the
Educational Practices in Simulation Scale were ranked as
important or very important by 80% or more of respon-
dents. Of the two highest ranked items, the first item was
in the collaboration subscale; 92.4% ranked ‘‘I had the
chance to work with my peers during the simulation’’ as
important or very important. Similarly, 91.7% ranked
‘‘The simulation offered a variety of ways in which to learn
the material’’ as important or very important. The mean
subscale scores for the Learner Satisfaction and Self-
Confidence in Learning Scale indicated the satisfaction
with current learning subscale was 4.15, and the mean score
for the self-confidence in learning subscale was 3.99
(Table 3).
Results of the Interprofessional Education and Clinical
Simulation Workshop Evaluation showed that 73% of the
participants reported that the stated learning objectives
were met for the day and 74% reported that this workshop
helped enhance their learning using simulation.
Qualitative Findings
Six major themes emerged from the qualitative analysis:
simulation as a learning experience, the learning environ-
ment, IPC learning continuum, cohesiveness, adapting to
change, and improved patient outcomes. The respondents
also identified seven areas for improvement: (a) logistics,
(b) simulation, (c) more information requested, (d) the
evaluation tools, (e) interprofessional diversity, (f) the
addition of more professionals, and (g) ideas for future
educational days.
Simulation as a Learning Experience
The majority of the responses viewed the simulation
learning experience as positive. One participant stated,
‘‘The simulation lab allowed me to experience the scenar-
ios presented in a very realistic way, unlike previous
manikins’’. Many participants simply stated that the most
enjoyable aspect of the workshop was simulation. Simula-
tion as a teaching strategy resonated with the majority of
the participants.
The Learning Environment
The overarching sentiment of this theme spoke to the
satisfaction expressed by the majority of participants about
the learning environment. The location, atmosphere, and
the use of technology to enhance learning were among
some of the aspects receiving positive comments. Although
most comments were positive, one participant stated
‘‘didn’t understand the whole point of the day,’’ and another
wrote ‘‘not too sure how SIM lab enhanced why we were
here. Could be better facilitated elsewhere. SIM lab
distracts [from] the real reason we’re here. It’s not clinical
skills.’’ Follow-up from these comments could include
assessing the participants’ understanding of IPC and
eliciting what participants would like to learn about IPC,
such as scope of practice, roles, communication, or conflict
resolution. As the goal of the project was to introduce an
interprofessional model of practice, some of the content
related to the components of that model may have been
better introduced in an alternative learning environment
prior to having the team of interdisciplinary professionals
come together for a simulation.
Table 1 Mean Subscale Scores for the Simulation Design
Scale
Subscale N M SD
Objectives and information 156 4.06 .69
Support 154 4.20 .66
Problem solving 153 4.06 .67
Feedback/guided reflection 152 4.35 .64
Fidelity (realism) 154 4.22 .76
Table 2 Mean Subscale Scores for the Educational Practices
in Simulation Scale
Subscale N M SD
Active learning 157 4.23 .61
Collaboration 157 4.61 .62
Diverse ways of learning 159 4.08 .82
High expectations 159 4.19 .88
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5. Learning Continuum
The data represented a continuum of responses. Some
participants said the workshop offered new learning about
IPC, some said it reminded them about or reinforced the
concept of IPC, and some said it produced no change
(‘‘I have always practiced this way’’). The new learning
that was shared by the participants included the importance
of IPC and a better understanding of the extent to which
professionals from different areas can work together.
The majority of the data supported the reminding and
reinforcing section of the IPC learning continuum. A
heightened awareness of IPC was articulated by several
participants, and other comments supported IPC as a pro-
cess. Additionally, participants shared their views of IPC
prior to the workshop, acknowledged that the workshop
served to reinforce what they already knew, and suggested
actions as a result of their recent learning.
The concept of a learning continuum was further supported
by the remaining responses, in the already doing it category. A
few participants provided comments to suggest that they were
already practicing IPC. One participant stated ‘‘same as al-
ways treat people the way you want to be treated.’’ Responses
ranged from IPC as new learning, to reminding or reinforcing,
through to indicating there was no change in their idea of IPC.
Further analysis of an IPC learning continuum could be
achieved by comparing the years of experience of the profes-
sionals with where they were on the continuum.
Cohesiveness
Teamwork was a significant component within this theme.
The word teamwork, as well as the concept of teamwork,
was repeatedly shared. Participants expressed that this
workshop caused them to ‘‘reinforce’’ or ‘‘rethink’’ the
concept of teamwork, and one suggested, ‘‘We need to
work as a team, not on an individual basis.’’
Another element within the theme of cohesiveness was
appreciation of oneself within the team, as well as an
appreciation of the whole team. Several participants stated
that the most enjoyable aspect of the workshop was
‘‘sharing’’ and ‘‘working’’ as a team.
Adapting to Change
As with any change, actual or anticipated, voluntary or
required, various responses are elicited. This was reflected
in the development of this theme. One participant stated
‘‘that it’s coming, we better get ready.’’ A few participants
realized that changing to an interprofessional model of care
is ‘‘the wave of the future,’’ and others indicated that this
educational workshop served to alleviate some fears and
offer some support for the future.
Improved Patient Outcomes
Although much of the data pointed to themes about IPC and
the actual learning experience, the themes of cohesiveness
and improved patient outcomes speak to potential outcomes
of adopting an IPC model of care. Improved patient
outcomes are a goal for all health care professionals and
were clearly articulated by the participants of this study. As
one participant commented, this workshop ‘‘helped me
understand the degree to which we can support each other
for better patient outcomes.’’
Discussion
An interprofessional model of care was mandated by senior
administration in the health system. The anticipation of
resistance to this change created a quandary for the
interprofessional project team members. They searched
for the best method to introduce and implement this new
model. As this workshop was one of the first steps in the
implementation process, a positive learning experience was
desired. The results from the NLN questionnaires indicate
that simulation was an effective strategy for teaching IPC,
and staff was satisfied with simulation as a teaching
strategy. Although the findings from this study are similar
to those of other studies that have reported simulation to be
a useful strategy for team training in acute care areas such
as the operating room (Shapiro et al., 2004) and the emer-
gency department (Paige et al., 2007), there is a paucity of
studies related to the effectiveness of this type of teaching
strategy for health care professionals. Because this work-
shop was the first component in the introduction of a new
model of patient care, the desire was to create a positive
learning environment and facilitate the change process.
This study revealed that simulation was highly rated by
the participants as a positive learning experience. There-
fore, simulation could be used as a teaching strategy for
health care professionals when one is implementing
change. Further research is warranted to determine whether
simulation as a teaching strategy can facilitate the change
process among health care professionals and whether sim-
ulation is an effective way to teach practicing health care
professionals.
The findings from the content analysis indicate that
participants viewed improved patient outcomes as a positive
aspect of adopting an IPC model. Emphasizing improved
patient outcomes of care as a result of implementing an IPC
Table 3 Mean Subscale Scores for the Learner Satisfaction
and Self-Confidence in Learning Questionnaire
Subscale N M SD
Satisfaction with current
learning
159 4.15 .57
Self-confidence in learning 158 3.99 .69
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6. model may help facilitate this change for those practice
settings planning to introduce this model in the future. To
understand what constitutes improved patient outcomes,
further research with the staff is necessary. This research
may help articulate the specific patient outcomes that can
be improved as a result of integrating an IPC model of care.
To the best of the researchers’ knowledge, the NLN
instruments have been used only in academic settings and
only with students. We purposely chose to use these
instruments with health care professionals in order to
determine their effectiveness in a different population. In
reviewing comments from the participants, we found there
was some duplication of items across the instruments. In
addition, some of the items on the instruments may not be
appropriate for nonacademic settings. Further research with
these instruments is suggested in order to ascertain
modifications that might eliminate some of the duplication
and make the instruments more suitable to various health
care disciplines.
Participants used the Interprofessional Education and
Clinical Simulation Workshop Evaluation questionnaire to
suggest several areas for improvement of future simula-
tions. One suggestion was to develop scenarios that are less
‘‘crisis focused.’’ Another recommendation was to create
different scenarios that provide greater opportunity to
simulate team collaboration. An additional suggestion
was to have a more diverse representation of health
professionals, including physicians. When future educa-
tional workshops using simulation are planned, these
suggestions should be considered.
Limitations
There are several limitations to this study that may affect the
generalizability of the results. A convenience sample was
used, and the data were collected from one health care system
at one time. Moreover, with a self-report survey, there is
always a chance of a reporting bias (Polit Beck, 2004).
During the presentation on simulation, a small number
of participants mentioned that they had minimal exposure
to interdisciplinary learning or simulation training; how-
ever, this information was not tracked formally in our study.
Prior exposure to simulation may have influenced satisfac-
tion scores.
Conclusion
This study was an innovative use of simulation and a novel
approach to interprofessional education. Additionally, the
simulation workshop provided the context to integrate the
key interprofessional care core competencies: interpersonal
and communication skills, client- and family-centered care,
and collaborative practice in a safe or nonthreatening
learning environment. Although the results from this study
showed that simulation was an effective teaching strategy
for staff members to learn about IPC and that staff was
satisfied with simulation as a teaching strategy, further
multisite health system research within the province and
across the country is necessary to improve generalizability
of the results. Given that the majority of the participants
were nurses, future research should include a more diverse
representation of professionals In addition, information
related to prior exposure to interdisciplinary learning or
simulation training needs to be collected.
It would be interesting to evaluate staff satisfaction with
IPC 1 year after the respiratory therapists have been in-
tegrated into the health care team. Finally, further develop-
ment, implementation, and evaluation of interprofessional
scenarios need to be conducted in order to advance the use of
simulation as a teaching strategy for IPC.
Acknowledgments
This study was supported by Health Force Ontario,
Ministry of Health and Long-Term Care Nursing Secretar-
iat Demonstration Site Project for Nursing Human Re-
sources Planning.
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