Can situational judgement tests (SJTs) help medical students overcome barriers to interprofessional communication?

1. Can situational judgement tests (SJTs) help medical students overcome barriers to interprofessional communication? Evaluating SJTs as an interprofessional educational tool. By Frances Varian Final Year Medical Student f.l.varian@warwick.ac.uk

2. Aims Background Methodology Results Conclusions Questions Introduction Varian and Cartwright (2012)

3. How SJTs overcome barriers to interprofessional communication. Tips for facilitating SJTs as an effective teaching tool. “I see myself as a trainee doctor now rather than a medical student…SJTs have highlighted practicing to be an FY1, rather than just learning about medicine.” Aims

4. “Through interdisciplinary education, health care professionals learn collaboratively within and across their disciplines in order to gain the knowledge, skills, and values required to work with other health care professionals.” Canadian Interprofessional Health Collaborative (2007) What are the barriers to interprofessional communication? Uni-professional education which enhances ‘exclusivity’ Attitudes which fuel rivalry between disciplines Role-modelling of negative attitudes or behaviours (McNair 2005) Background

5. Year 1 – Health in the Community, IPLP Year 2 – Learning from Lives, IPLP Year 3 – Ward-based clinical experience Year 4 – Clinical experience, SJTs IPE at Warwick

6. You are working on ITU and taking bloods from a patient when you accidently stick yourself with the needle when removing it from the patient. You had followed infection control guidelines and were wearing gloves but you see your finger bleeding underneath. You quickly squeeze it and clean it and put a dressing on it. You go to look on the system for anything on the patient’s HIV/Hepatitis status but there is nothing. The patient is unconscious. What should you do? Choose the THREE most appropriate options from the following list: A. Ring the lab to request urgent viral serology on the blood forms for HIV and Hepatitis status B. Ring occupational health C. Go down to A&E to get some anti-retrovirals to start immediately D. Fill in a CAE form for the stick injury E. Ask if you can go home because you are so worried F. Wait to see if the patient wakes up G. Bleep your registrar to explain the situation H. Explain to one of the nurses what has happened A Situational Judgement Test

7. B. Ringing occupational health is appropriate they will be able to tell you immediately the protocol for stick injuries. D. Filling in a CAE form is appropriate as when you go to occupational health, they will ask whether you have filled this in. G. Bleeping your registrar to explain the situation is appropriate as you will have to go to occupational health, thereby leaving ITU. You should always notify a senior of a serious incident - as in this case - so they can make the appropriate arrangements such that neither you nor the patient’s safety is compromised. A. Requesting viral serology is not appropriate as the patient has not consented to having these investigations and it would not be in their best interests to have them done. If they were in ITU for an illness in which HIV status could benefit their treatment then this could be considered. You however would not request this; it would have to be under senior authority. C. Going to A&E for anti-retrovirals is not appropriate during working hours. Occupational health will be able to give you the appropriate advice and treatment. If in the event occupational health cannot be contacted, you should go to A&E where an appropriate risk assessment and management can be carried out. E. Asking if you can go home is not appropriate as this would avoid, rather than help, this situation. F. Waiting to see if the patient wakes up to ask for their permission for serology is not appropriate. The patient is unconscious and therefore you have no idea when they will wake up. You should act quickly and promptly after a stick injury to reduce the risk to yourself as far as possible. H. Explaining to one of the nurses what has happened is not a preferred option as you should inform your senior before the nurses. The nurse’s priority is largely patient safety whereas a senior colleague will be able to analyse the situation and manage the team to best support your needs and ensure the patient’s best interests are considered. Answer: BDG

8. Qualitative evaluation final year medical students 100 questionnaires pre- and post-SJT 2 scales: Pre-Q 10-point Likert scale, Post-Q 4-point scale Minimum of 16 SJT questions completed One-hour teaching session discussing SJT material facilitated by FY1s 2 focus groups of 7 participants each Methodology

9. Initial average 8.7/10 scaling the importance of learning about other healthcare professionals roles. 73% placed increased importance. Initial average 9.2/10 on the importance of teamwork as an FY1. 60%placed increase importance. Initial average 6.6/10 on having a good understanding of different roles of healthcare professionals. 80% felt this was improved. Initial average 5.7/10 in knowing which team member was most appropriate to ask for help for any given situation. 88% felt knowledge was improved . “Talking to the team has been helpful as before I was quite focussed on being a doctor and everything a doctor is doing but you need to know about other people and their roles too.” Barrier 1: Over-coming uni-professional knowledge

10. Initial average 6/10 for actively seek out knowledge of other professionals’ roles on the wards. 73% felt this was improved. Initial average 8/10 in feeling comfortable about seeking help from others. 70% felt this was improved. “They have given me an excuse to ask questions rather than feeling like a busy body.” “I have become more aware of different roles of healthcare professionals, asking more questions to registrars, nurses, pharmacists about their role in the structure of the team … it has definitely caused me to ask more questions on the wards” Barrier 2: Attitudes which fuel rivalry

11. Initial average 5.9/10 on daily expectations of the FY1 job role. 92% improved expectations. Initial average 6.2/10 on confidence practicing as an FY1 knowing what is expected. 65% felt more confident. Initial average 6.4/10 for the amount they reflect on difficult situations in clinical experience. 85% felt they were more likely to reflect “Practicing SJTs made me realise I lacked knowledge of what is expected of FY1s. Since then I’ve been taking more notice of what they actually do, asking questions and advice.” Barrier 3: Role-modelling of negative attitudes

12. “I no longer sit back and watch, now I actually think about what they are doing, what should have been done … without the exam, I would not be doing that at this stage.” “They are a great in combination with clinical experience” “The fact that SJTs are there has got me thinking about being proactive, about asking questions, thinking about different roles and what you should do in different situations” Test or Tool?

13. Rating the session 7/10: 89% felt SJT teaching gave value beyond skills learning on the wards 94% enjoyed the session 94% valuable for learning SJTs as an educational tool

14. 3 top tips for facilitating SJTs as an educational tool: Use real-life experiences of situations Group discussion Include relevant guidance Educational Tool

15. SJTs are uniquely positioned to enhance learning SJTs overcome barriers to interprofessional communication SJTs are a valuable educational tool Interprofessional communication can be maximised if facilitated by a group discussion Summary and Conclusions

16. Questions?

17. Canadian Interprofessional Health Collaborative (CIHC) (2007) Interprofessional Education and Core Competencies: literature review. Canada: CHICpis, pp1-18 Finch, J.(2000) Interprofessional education and teamworking: a view from the education providers. BMJ; 321 (7269): 1138-1140 de Meijer, L.A.L. and Born, M. Ph. (2009) The situational judgement test: Advantages and disadvantages. In M. Born, C.D. Foxcroft & R. Butter (Eds.), Online Readings in Testing and Assessment, International Test Commission. McDaniel MA, Morgeson FP, Finnegan EB, Campion MA, Braverman EP. (2001) Use of situational judgment tests to predict job performance: a clarification of the literature. J ApplPsychol ;86:730-40. McNair, RP (2005). The case for educating health care students in professionalism as the core content of interprofessional education. Medical Education; 39 (5): 456–464 Varian, F. Cartwright, L. (2012) The situational judgement test at a glance. Oxford: Wiley-Blackwell. References