Dr. Karen J. Panzarella is an Associate Professor at D’Youville, in Buffalo NY and a Certified Healthcare Simulation Educator and TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) master trainer. Her research focuses on the use of healthcare simulation for collaborative practice.

Panzarella

Dr. Heather Ferro is a Clinical Assistant Professor of Occupational Therapy and a TeamSTEPPS master trainer. She has been an OT for 23 years and has worked interprofessionally across the continuum of health care.

James Cypert is the Director of Interprofessional Education and Simulation. A master trainer in TeamSTEPPS, he brought 25 years’ experience in information technology and education and has become an innovative voice in the pursuit of integrating technology into classrooms.

Dr. Kirsten Butterfoss is a Clinical Associate Professor, D'Youville School of Pharmacy and is a clinical pharmacist at a skilled nursing facility in Buffalo, NY. She is a member of the D'Youville College Interprofessional Education Committee and is a TeamSTEPPS master trainer. Her involvement with the interprofessional education committee includes curricular development and debriefing.

Colleen Koszelak is a Clinical Assistant Professor and Director of Nursing Simulation. She specializes in neonatal intensive care and was instrumental in establishing the School of Nursing simulation program and is a master trainer in TeamSTEPPS.

Nominated for their outstanding work as Patient Safety Advocates, the nominator said: “These individuals are champions for patient safety. They devote time and energy into training over 500 health professional students per year from eight different disciplines in simulation groups of 12-14 with eight different professions. They are master trainers in TeamSTEPPS and are currently conducting a research study that trained 27 health professional students (from eight disciplines) in TeamSTEPPS and developed an additional two hour “Targeted Team Strategies” for active practice of TeamSTEPPS strategies and are looking at this effect in their performance in interprofessional simulation scenarios. This is their story.

Interprofessional students participating in Targeted Team Strategies. All Images: D'Youville Simulation.
Interprofessional students participating in Targeted Team Strategies. All Images: D'Youville Simulation.

The Benefits of Training Health Professional Students in TeamSTEPPS Prior to Graduation

The D’Youville master trainers use TeamSTEPPS to enhance collaboration across curricula.

Patient safety should be at the forefront of an institute of higher education that graduates over 500 health care providers each year. D’Youville is noted for offering degrees in eight health professional programs on a small urban campus in Buffalo, New York. The advent of a school of pharmacy at D’Youville brought accreditation standards for interprofessional education. To address these standards, a team of five interdisciplinary faculty attended the inaugural Interprofessional Collaborative in Dulles, Washington in 2012. During the event, the team decided the best approach for students from different disciplines to learn together would be participating in something fun, meaningful and applicable to real life clinical care. They started by using medical simulation.

A small grant was secured and used to build two simulation rooms at D’Youville’s chiropractic clinic and provide faculty training in the areas of curriculum writing, facilitating, and debriefing. During a two-day summer retreat a dozen faculty came together from the various health profession programs and created four simulation scenarios about a patient, “Chris Dulles.” During the simulations, learners from each of the health profession programs followed Chris for a year across his continuum of care. The faculty wrote embedded challenges into the curriculum for the learners to problem solve and respond, including: drug seeking behavior, signs of a new stroke, an overbearing spouse, and discharge planning concerns (Panzarella et. al, 2013). This set of scenarios was implemented in the spring interprofessional education (IPE) curriculum in 2013 and has been delivered to over 500 health profession students (‘learners’) each year since. Student learners attend an evening four-hour simulation experience and represent eight different health profession programs: chiropractic, dietetic, nursing, nurse practitioner, occupational therapy (OT), pharmacy, physical therapy (PT), and physician assistant (PA) (DeMarco et. al, 2015). Excitement from faculty and positive feedback from the student learners led to the recruitment and development of 25 faculty from the eight health profession programs to facilitate the spring curriculum.

In 2015, a second grant was secured and used for a second retreat of additional faculty to create a fall IPE simulation curriculum, “Tom” and “Martha,” which has been delivered to over 300 interprofessional students each year since 2015. Tom, a Vietnam veteran, and Martha, a retired nurse, are simulated patients who are undergoing elective surgery. In the scenario, Tom is having a lumbar laminectomy in one week and Martha is scheduled for a total hip replacement. Students meet in their interprofessional groups on three occasions (seven hours of contact time) throughout the semester. The first two hour meeting is called the “Round Robin.” During this event, learners pair up with a student from a different health profession and meet Tom and Martha preoperatively in an outpatient setting to conduct an interview. In addition, learners participate in a skills demonstration commonly used within (and unique to) their profession. The second meeting, a four-hour simulation session, learners meet Martha and Tom the day after their surgeries in an acute care hospital and deal with embedded challenges of medication changes, detoxification and domestic violence. Although D’Youville does not have a medical school, the curricular team created a simulated physician and medical student role. During the simulation, student learners also interact with Martha in a home care setting and deal with challenges of infection control and dietary/digestive concerns (Butterfoss et. al, 2018). The final simulation event (one contact hour) is offered at the end of the fall semester. All learners who participated in the IPE program throughout the semester come together as one united team to meet Tom and Martha “one year later” and ask about the patients’ successes, challenges, and current needs. Student learners also listen to real life stories from a community veteran and a survivor of domestic violence. Currently over 30 faculty, from the eight health profession programs, participate in facilitating and debriefing the fall and spring curriculum.

Both fall and spring interprofessional curricula challenge learners to communicate with their healthcare team. Communication challenges are embedded throughout the scenarios to have learners display collaborative care with their colleagues, patient, and the patients’ family members. Although many opportunities are presented, it is rare that learners communicate with their healthcare team optimally as evidenced on video recordings. Only after targeted debriefing to address performance gaps, is some improvement demonstrated in subsequent scenarios. Learners have heard communication strategies such as ‘SBAR’ or ‘Handoffs’ in a didactic lecture, but many are not familiar with and none have had opportunities to practice these strategies in a simulated setting.

In spring of 2018, five key players in IPE became master trainers in TeamSTEPPS. Following this training, the core team presented the material at a rehabilitation symposium at a local trauma hospital and were convinced that TeamSTEPPS is an effective program that needs to be implemented at D’Youville in conjunction with the existing IPE curricula. Through this added training, the goal is to prepare students to become assertive leaders of collaborative practice. Following the symposium, the master trainers made a strong effort to gain buy-in across the D’Youville campus and presented customized one-hour overview of TeamSTEPPS at faculty meetings, staff development days, and to the president’s council. The excitement around the topic grew quickly across the campus as people heard the presentation. In the summer of 2018, the five master trainers planned a research study to collect data that would provide evidence regarding the value of this training for students.

The study, “Enhancing Interprofessional Simulation Utilizing Targeted Team Strategies” was conducted fall of 2018 and examined the effects of TeamSTEPPS training in addition to the existing fall IPE simulation curriculum “Tom and Martha”. The experimental group of 27 student learners (three PA, six OT, four PT, four pharmacy, six nursing, two dietetic and two chiropractic) was split into two groups. Each group completed eight hour online training of TeamSTEPPS. In addition, they participated in two hours of targeted team strategies that master trainers had created to provide practice with team building and use of key strategies from TeamSTEPPS. This group was compared to a random selection of matched students who also participated in the fall IPE simulation curriculum and served as the control group.

The experimental and control groups are being analyzed via the video recordings of the four-hour IPE simulation sessions for achievement of learning objectives related to the TeamSTEPPS competencies by counting how many times the student learners utilized the tools and strategies of TeamSTEPPS. The experimental groups completed a pre- and post-assessment on teamwork knowledge, attitudes, and skills. Levels of patient satisfaction were compared via feedback from the simulated patients for both groups. Initial analysis shows a positive trend toward the groups that received TeamSTEPPS training and targeted team strategies in addition to the IPE simulation curriculum.

D’Youville is planning construction of a 50,000 square foot health professions HUB to open in the fall of 2020 and will include a community clinic, workforce development, and simulation. The initial planning committees seemed segregated in their utilization of space and programing, prompting an urgent need to get everyone on the same page with the vision of the HUB and the future of D’Youville. The core team of master trainers presented the idea of using TeamSTEPPS as a platform to unify the vision and suggested a retreat, similar to the retreats that were used to build the IPE simulation curricula. D’Youville’s president, Dr. Lorrie Clemo, endorsed the team’s idea and empowered the team to plan the retreat. The event was planned and had 50 committed volunteers (staff, faculty, and administrators) to attend the two-day “mystery” retreat. The mystery retreat required each participant to read “Our Iceberg is Melting” by John Kotter and to reflect on several key questions prior to attending.

Participants in the “Save Our Iceberg” retreat, Dr. Karen Panzarella out-stretched arms.
Participants in the “Save Our Iceberg” retreat, Dr. Karen Panzarella out-stretched arms.

On December 11 & 12, 2018 the D’Youville “Save Our Iceberg” retreat was held in Niagara Falls, Canada. With the goal of creating a sense of urgency, the retreat opened with a simulation, unbeknownst to the participants, that had D’Youville’s president announcing that spring enrollment was lower than expected and although 50 participants were scheduled to attend the retreat, the budget could only support 30 participants and therefore 20 volunteers were needed to stay back and would be given the opportunity to attend a future retreat. The realism was powerful as participants asked, “can we hold it here on campus so we all can participate”. This was the first experience debriefing 50 people at once during a D’Youville simulation and it was a huge success! From here the participants were taken on an exhilarating jet boat ride through the lower rapids of Niagara Falls. The remainder of the retreat was devoted to a customized version of TeamSTEPPS training called, “D’You TEAM” and included didactic, videos and targeted team strategies. The retreat culminated with implementing change through culture transformation and design work with the architects of the HUB project. At the closing ceremony, each participant was awarded a penguin pin and empowered to be a change agent (this was accomplished once again through a planned simulation). During the simulation, one of the faculty who attended was wearing her penguin pin and another employee of D’Youville asked about it. The focus of the interaction was communication about the shared vision generated through the retreat, including the faculty member revealing that her mystery roommate was President Clemo! The preliminary feedback is very positive and as one participant reported, “The retreat brought together a diverse group of individuals from across the D'Youville campus. I enjoyed meeting people that I do not normally have the opportunity to interact with and hearing their different perspectives.” 

References

1. Butterfoss, K, Panzarella, K, Whelan, M., Ferro, H., Dunn, B., Case, A., Stewart, M., Verni, C.,Duszkiewicz, A., Cieri, N., and DeMarco, L. “Transitions of Care From Pre-Operative to Community Care through Interprofessional Simulation, Journal of interprofessional care, resubmitted November 2018.

2. DeMarco L, Panzarella K, Ferro H, Pownall L, Case A, Nowakowski, P, Stewart M, Duszkiewicz A, Verni C, Kennedy M, Cieri N, Dowd C, Dunford D. Outcomes of an Interprofessional Simulation Curriculum. Journal of Applied Research in Higher Education 2015:7(2)453-468.

3. Panzarella K, Rivers L, Brigh, B, Whelan M, Butterfoss K, Russ L, Case A, Brian S, Ferro H, DeMarco L, Dunford D, Schmitz K, Kittleson H, Kennedy M, Brzykcy D, Pownall L, Reddington M. Using Actors as Simulated Patients for Interprofessional Education. Medical Science Educator 2013:October23(3S).

Originally published in Issue 1, 2019 of MT Magazine.