Stronger together: learner reactions on a team-based, interprofessional first death simulation experience.

Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.

Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain.

OBJECTIVES: To improve diagnostic ability, educators should employ multifocal strategies. One promising strategy is self-explanation, the purposeful technique of generating self-directed explanations during problem-solving. Students self-explain information in ways that range from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. In a previous phase of research, unique ways that family nurse practitioner (NP) students self-explain during diagnostic reasoning were identified and described. This study aims to (a) explore relationships between ways of self-explaining and diagnostic accuracy levels and (b) compare differences between students of varying expertise in terms of ways of self-explaining and diagnostic accuracy levels. Identifying high-quality diagnostic reasoning self-explanation types may facilitate development of more refined self-explanation educational strategies. METHODS: Thirty-seven family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern university diagnosed three written case studies while self-explaining. During the quantitative phase of a content analysis, associational and comparative data analysis techniques were applied. RESULTS: Expert students voiced significantly more clinical and biological inference self-explanations than did novice students. Diagnostic accuracy scores were significantly associated with biological inference scores. Clinical and biological inference scores accounted for 27% of the variance in diagnostic accuracy scores, with biological inference scores significantly influencing diagnostic accuracy scores. CONCLUSIONS: Not only were biologically focused self-explanations associated with diagnostic accuracy, but also their spoken frequency influenced levels of diagnostic accuracy. Educational curricula should support students to view patient presentations in terms of underlying biology from the onset of their education.

Ways that nurse practitioner students self-explain during diagnostic reasoning.

OBJECTIVES: An important step in mitigating the burden of diagnostic errors is strengthening diagnostic reasoning among health care providers. A promising way forward is through self-explanation, the purposeful technique of generating self-directed explanations to process novel information while problem-solving. Self-explanation actively improves knowledge structures within learners' memories, facilitating problem-solving accuracy and acquisition of knowledge. When students self-explain, they make sense of information in a variety of unique ways, ranging from simple restatements to multidimensional thoughts. Successful problem-solvers frequently use specific, high-quality self-explanation types. The unique types of self-explanation present among nurse practitioner (NP) student diagnosticians have yet to be explored. This study explores the question: How do NP students self-explain during diagnostic reasoning? METHODS: Thirty-seven Family NP students enrolled in the Doctor of Nursing Practice program at a large, Midwestern U.S. university diagnosed three written case studies while self-explaining. Dual methodology content analyses facilitated both deductive and qualitative descriptive analysis. RESULTS: Categories emerged describing the unique ways that NP student diagnosticians self-explain. Nine categories of inference self-explanations included clinical and biological foci. Eight categories of non-inference self-explanations monitored students' understanding of clinical data and reflect shallow information processing. CONCLUSIONS: Findings extend the understanding of self-explanation use during diagnostic reasoning by affording a glimpse into fine-grained knowledge structures of NP students. NP students apply both clinical and biological knowledge, actively improving immature knowledge structures. Future research should examine relationships between categories of self-explanation and markers of diagnostic success, a step in developing prompted self-explanation learning interventions.

SP safety, autonomy and healthcare simulation practice in the COVID-19 era.

This letter expands upon the three tenets of the Healthcare Simulation Manifesto-comprehensive safety, collaborative advocacy, and ethical leadership. To do this, we will discuss two key terms: 'essential' and 'autonomy' in relation to safety for standardized/simulated patients (SPs). In this time of crisis, simulationists must move the boundary of skills training previously accepted as safe for human beings, and leverage technology to ensure the highest level of safety achievable for our SPs.

How metaphorical framings build and undermine resilience during change: A longitudinal study of metaphors in team-driven planned organizational change.

Change is a constant feature of organizing and one that requires resilience, or the ability to effectively face challenges. Although research demonstrates important findings about resilience during chaotic change like crises, less is known about resilience in mundane situations like planned change. This study explores team-driven planned organizational change, offering insights about how team members metaphorically frame change how their framing fluctuates over time relative to perceptions of team success. Our three theoretical contributions extend theory about metaphors and organizational change, showing how negative framings of change are endemic to teams, regardless of perceived success; generate knowledge about resilience in organizing by showing how metaphors both build and undermine resilience; and extend applied theory about stakeholder participation in bureaucratic organizations.

Interprofessional Healthcare Student Training in the Care of Sexual Assault Patients Utilizing Standardized Patient Methodology.

BACKGROUND: The medical assessment of sexual assault (SA) is challenging because SA patients are often hesitant to disclose their medical needs, which puts them at further physical and psychological risk, and because of provider unease in conducting SA examinations. This challenge is compounded by a lack of provider training. OBJECTIVES: The study goals were to develop an interprofessional simulation event that would foster SA interview skills, foster effective communication with SA patients, and increase learner confidence in assessing SA patients. METHODS: Participants were senior-year school of medicine (n = 165) and advanced practice registered nursing (n = 30) students (N = 195) who were enrolled in a mandatory Military Sexual Assault Assessment and Treatment course, along with data provided by trained standardized patients (SPs, n = 16) who participated in the simulation event and in assessments of learners. Measures included the Sexual Assault Interview Skills Checklist, the Essential Elements of Communication, and the Confidence in SA Assessment scale. Data were analyzed using analysis of variance and t tests at the P < 0.05 threshold. RESULTS: Postsimulation Sexual Assault Interview Skills Checklist and Essential Elements of Communication scores demonstrated an acceptable level of competence according to both students and SPs. Confidence in SA assessment rose significantly from presimulation to postsimulation. Before simulation, medical students were significantly lower than nursing students, but the simulation event closed the confidence in SA assessment gap. CONCLUSIONS: This interprofessional simulation event resulted in SA interview competence, communication skills competence, and improved confidence scores. Combined, these findings support the efficacy of simulation to train emerging healthcare providers to properly assess SA.

Cumulative Risk on the Oxytocin Receptor Gene (OXTR) Predicts Empathic Communication by Physician Assistant Students.

In the relationship between patients and health care providers, few communicative features are as significant as the providers' ability to express empathy. A robust empirical literature describes the importance of physician communication skills-particularly those that convey empathy-yet few studies have examined empathic communication by physician assistants, who provide primary care for an increasing number of Americans. The present study examines the empathic communication of physician assistant students in interactions with standardized patients. Over a 6-month period, each student conducted three clinical interviews, each of which was evaluated for empathic communication by the patients, the students' clinical instructors, and third-party observers. Students also provided saliva samples for genotyping six single-nucleotide polymorphisms on the oxytocin receptor gene (OXTR) that are linked empirically to empathic behavior. Consistent with recent research, this study adopted a cumulative risk approach wherein students were scored for their number of risky alleles on the single-nucleotide polymorphisms. Results indicated that cumulative risk on OXTR receptor gene predicted lower patient empathy scores as rated by instructors and observers, but not by standardized patients.

Empathy Between Physician Assistant Students and Standardized Patients: Evidence of an Inflation Bias.

PURPOSE: Empathic communication with patients is an essential component of quality primary care. This study examines the ability of physician assistant (PA) students to communicate empathically in clinical interviews with standardized patients. METHODS: In their first year of training, PA students conducted 3 clinical interviews with standardized patients over a 6-month period in 2014, during the second half of their didactic year. Each interview was evaluated for empathy by 4 individuals: the students themselves, their standardized patients, their clinical instructors, and third-party observers. RESULTS: Students consistently rated their empathic abilities more favorably than did patients, clinical instructors, or observers, with mean differences ranging from 0.56 to 1.92 and averaging 1.09 on a 9-point scale. Students' evaluations were most dissimilar from those of patients (difference M = 1.12) and most similar to those of observers (difference M = 1.06). The assessments of all 4 raters varied over time: students rated themselves as significantly more empathic in April (time 2) than in July (time 3) of their didactic year. Patients rated students as significantly less empathic in January of the didactic year (time 1) than at time 2 and as significantly more empathic at time 2 than time 3. Instructors rated students as significantly less empathic at time 1 than at either time 2 or time 3. Finally, observers rated students as significantly more empathic at time 1 than at either time 2 or time 3. CONCLUSIONS: PA students consistently overestimate their empathic abilities during their first year of training. Given the importance of empathy in clinical care, increased didactic efforts focused on developing and conveying empathy may be warranted in PA education.