Simulations and shadowing

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 students in medicine and pharmacy take one module every two years during their bachelor’s and Master’s degrees.

While the first module is proposed over a whole week (read the related project) to the 7 programs, the second module takes place over half a day.

Project implementation

In this module, students learn to analyze interprofessional collaboration situations experienced by health care professionals, patients, and their families in a particular care setting. The aim is to identify the interprofessional competencies that promote (when present) and limit (when missing or deficient) collaborative practice, quality, and safety of care. Learners share their professional practices by delineating individual roles and responsibilities.

With this in mind, the activities proposed in this module are either simulation scenarios or a life-size simulation (ValTra).

The simulation scenarios are carried out in groups of 7-8 students accompanied by 2 tutors. The tutorage is composed of clinicians from different professions and who have been trained in interprofessional debriefing who come to share their experiences and play the role of collaboration model.

These simulation scenarios are conducted on Thursday afternoons throughout the academic year, depending on the availability of the various fields. They take place in different locations (CiS, HES, Roseraie). The groups are gathered in a simulation room which generally has two parts: one part in which the simulation takes place and another part from which the simulation can be observed by other students and the trainers, thanks to a video retransmission system. The simulation scenario is usually composed of several sequences, which allows students to take turns and take an active role in the simulation. An acute care case, for example, involves resuscitation in pediatrics. Students are asked to perform neonatal resuscitation following an infant’s convulsions. It is the tutor who makes the dummy react according to the actions performed by the student.

A case of chronic care leads for example to meet a patient with a tattoo representing a purulent wound with a bandage. She would be referred by her attending doctor for a specialized consultation with a doctor and a nurse. Two students are assigned to take the anamnesis in the simulation room. The peers observe in the other room. Then, the whole group debriefs on what was done with the tutor on the professional and collaborative aspects. Depending on the case, the group can designate a student to follow up with the patient. The tutor intervenes at each step and each debriefing. He/she can suggest replaying the scenario depending on the learners’ behavior: lack of empathy, lack of integration of the patient, lack of elements, etc. This reflective part is the most important key of the simulation because it allows for discussion of what was successful or unsuccessful in the management and collaboration between the professionals in order to draw lessons that can be applied to future practice.

Students participating in these simulations must also complete a shadowing activity. This involves following patients (with or without their relatives) or professionals (from their own profession and/or other professions) as their shadows during interprofessional activities (IP colloquium, IP coordination meeting, management of a complex IP situation, incident or error…). A report of the activity must then be written.

The alternative to simulations and shadowing is participation in the “ValTra” training module in Val-de-Travers, which takes place every year over a weekend. This large-scale, ultra-realistic simulation is carried out by 7 ambulances, 2 Mobile Emergency and Resuscitation Services (SMUR), 6 fire department vehicles, 1 emergency call centre and a hospital set up from scratch. In order to be as close as possible to reality, all the exercises are the result of scenarios invented by the ambulance teaching staff. The scenarios are staged with the help of extras who are made up to simulate injuries. One year, for example, students were able to participate in a simulated chemical plant explosion. The military responded to decontaminate the site and decontamination kits were issued to the victims. The participating cohort was integrated into the system and handled the triage of victims transported to the field hospital. Following the weekend, students are expected to produce a report of their experience in a free form (film, poster, etc.).

The evaluation of the module is based on the involvement and professionalism of the students in the simulated practice and debriefing.

Thoughts and advice

The assessment of the team responsible for interprofessional education underlines the difficulty of matching the academic agendas of seven training programs. This requires good will on both sides to successfully plan and maintain these interprofessional simulations in the programs.

Furthermore, the match between students’ experience levels at this stage of their education is not perfect. Medical and pharmacy students have less clinical experience than other health students. This must be explained at the time of the simulations so as not to create a feeling of incapacity and powerlessness among the less experienced students.

Once these obstacles are overcome, the results are very positive. It allows clinicians from different disciplines to meet and brainstorm on the situations they experience daily in their practice settings and to agree on the messages delivered to students during the simulations.

The students appreciate the simulation modality more than the shadowing one. The simulations make sense because they reproduce aspects of real life. The meaning of shadowing is less clear to the students, even though a number of them have discovered aspects of the work of other health professionals that were not known.

Student feedback

In the evaluation carried out in the year 2021-2022, 96% of the students felt that they had been able to identify, in collaboration with other professionals and the patients, the therapeutic and care objectives of the simulated situation. They said that they were able to define their competencies, roles and responsibilities in patient care (82.1%) and to identify the professional competencies of the different actors involved (86.3%). They also felt capable of transferring the skills they had acquired to their future clinical placements (87.2%). The students also noted that the tutors helped them identify what needed to be improved in order to progress (89.7%) and that they were respectful and appropriate in their remarks (92.7%). It should be noted that while health students do an interprofessional module every year, medical students only do it every other year, which they feel is insufficient: “For the question in part 4 “Simulation as preparation for the internship”, I put 1-2 points out of 4 and no more because I think this kind of simulation is really useful and can really prepare us for our future internships, but we should do more than 1 in 4 years. . if we did more, definitely I could have put 4 points (totally agree).”