Simulations and shared decisions

Initial situation

The Interprofessional Simulation Center (CiS) offers a longitudinal program integrated into the curricula of the University of Geneva’s Faculty of Medicine (UNIGE), the Haute Ecole de Santé de Genève (HEdS), the HES-SO of Geneva and the Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO). This program consists of 3 training modules and interprofessional activities in internship.

These modules are offered to 7 different programs (Nursing, Midwifery, Physiotherapy, Medical Radiology, Nutrition & Dietetics, Medicine and Pharmacy). Students in the HEdS programs take one module during each year of their Bachelor’s degree, while medical and pharmaceutical students take one module every two years during their Bachelor’s and Master’s degrees.

The first module is proposed over a whole week (read the related project) to the 7 courses. Module 2 takes place over half a day (read the related project). Module 3 takes place over two half-days. It is essentially about participating in simulated practices in interprofessional teams.

Project implementation

Students are divided into groups of 7-8. Each student brings the specific skills acquired during their training and shares their professional practices by delineating individual roles and responsibilities in the proposed activities.

The main objectives of this module are to teach students to position themselves within an interprofessional team, to share, plan and coordinate interventions with other professions with reference to leadership (designated, situational, or shared). They must know how to transmit relevant, concise, clear, and timely information between team members, including the patient and his/her family. They must be able to implement strategies and use appropriate tools to manage differences and resolve conflicts in a collaborative manner. They need to contribute to and obtain informed consent from the care receiver or family member in chronic or palliative care situations by establishing a partnership in decision-making.

There are 14 different scenarios that run concurrently over a full week to allow 450 students to complete two half days of simulation. 12 scenarios reproduce acute or chronic care situations and students practice with computer-controlled mannequins or with Simulated Patients.

Two scenarios were co-created with partner patients. This original approach allows to represent as closely as possible the patients’ perspective and to benefit from their feedback on the students’ team performance.

The first of the two scenarios was created with three people with disabilities/moderate mental handicap and autism. The goal for the students was to evaluate the patient’s capacity for discernment and self-determination when deciding to amputate a toe. The patient refuses the amputation, and the students are required to interact as a team with the patient to make the best decision.

The second scenario deals with bedside communication. The goal for students is to integrate a patient as a real partner in decision making. They must be able to deal with the history and the environment of the person being treated, since the patient keeps all the information concerning her own life.

This half-day simulation is organized according to a precise procedure recorded in a document provided to the tutors who accompany the students. This document lists the different stages of the half-day session, the instructions given to the students as well as the elements of the patient’s medical file. After a short Powerpoint introduction, the students watch two video sequences presenting an interview between the patient and two professionals. They analyze these sequences using a “shared decision” observation grid.

In a second phase, a nursing student and a medical student will replay this same scene according to precise instructions to practice shared decision making. The simulation lasts fifty minutes. It is interspersed with debriefings. The particularity of this debriefing is that it is co-animated with the patient who gives feedback on the partnership / shared decision. She is a full member of the teaching team. The tutors must therefore decide on their co-animation.

Finally, in the last stage, all the participants move to the simulation room. The patient settles into her bed. The students must then transmit information to each other using the IPASS tool (Identification, Patient, Actions, Strategy, Synthesis). The simulation ends when the group has worked through the IPASS in its entirety. The tutors have 45 minutes to lead the students towards this objective.

The evaluation of the module is based on the involvement and professionalism of the students in the simulated practice and the debriefing according to an evaluation grid filled in by the tutors.

Thoughts and advice

The responsables of interprofessional training note the logistical complexity of organizing this week, but the great interest it represents, both for the students and for the trainers.

The integration of patient partners in the design of the simulation scenarios is a very rich innovation, which allows students to have direct access to patient feedback on their experience in the team.

Student feedback

In their evaluation of the 2022-2023 module, students noted the following: 91.8% of students felt they had gained knowledge about interprofessional collaboration and 94.8% felt they had achieved their objectives. Students also appreciated meeting real patients: “meeting the patients in the disability simulation was great and it brought us closer to the reality of the field”.