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Clinical Simulation in Nursing (2017) 13, 624-627
Research Brief
Simulation as an Effective Strategy for
Interprofessional Education
Margaret Costello, PhD, RN*, James Huddleston, DPT,
Josephine Atinaja-Faller, MSN, RN, Kathrina Prelack, PhD, RN,
Amanda Wood, RN, Jillian Barden, RN, Sylvana Adly, RN, MS
Simmons College of Nursing and Health Sciences, Boston, MA 02115, USA
quantitative research;
interprofessional care;
Attitudes Survey
Collaborative (IPEC)
Abstract: Interprofessional simulation provides healthcare professions students an opportunity to
collaborate in a team. The purpose of this study was to examine student perspectives of an interprofessional simulation lab experience within the fields of nursing, physical therapy, nutrition, and social
work. A pre-post design was employed, using the validated Interprofessional Attitudes Survey Interprofessional Education Collaborative tools to determine if there were any perceived changes in interprofessional competency and attitudes about interprofessional simulation experience. Following the
simulation there were significant changes in students’ attitudes in areas of cultural competence, understanding of roles, interprofessional communication and teamwork. Interprofessional simulation is a
teaching strategy that shows great promise for promoting teamwork among the healthcare professions.
Cite this article:
Costello, M., Huddleston, J., Atinaja-Faller, J., Prelack, K., Wood, A., Barden, J., & Adly, S. (2017,
December). Simulation as an effective strategy for interprofessional education. Clinical Simulation in
Nursing, 13(12), 624-627.
Ó 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier
Inc. All rights reserved.
According to the Institute of Medicine, nearly 100,000
deaths occur annually from preventable medical errors.
Many of these preventable errors are attributed to ineffective
communication and collaboration between health care providers (Kohn, Corrigan, & Donaldson, 2000). Moreover,
studies show that improved patient, staff, and organizational
satisfaction and patient outcomes result when care is
The author declares no conflict of interest.
* Corresponding author: (M. Costello).
provided in an interdisciplinary, collaborative way (Korner
et al., 2016; Tsakitzidis et al., 2016). In order to decrease
the frequency of these preventable incidents and improve
patient outcomes and satisfaction, patient-centered teams
involving multiple disciplines would be more effective
than care providers working in isolation from each other.
Introducing interprofessional education to health professions studies encourages collaboration and communication
between health care professionals and increases their readiness to work collaboratively with other professions during
their education (World Health Organization [WHO],
2013). ‘‘Interprofessional education occurs when students
from two or more professions learn about, from, and with
1876-1399/$ - see front matter Ó 2017 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Simulation for Interprofessional Education
each other to enable effective collaboration and improve
health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a
member of the collaborative practice team’’ (WHO, 2013).
One barrier to interprofessional teamwork discussed in the
literature emphasizes that
education programs for
Key Points
health care professionals
An interprofessional
often do not address collabsimulation
oration (Park, Hawkins,
explored nursing, nutriHamlin,
tion, physical therapy
Bamdas, 2014).
and social work stuLearning together imdents attitudes, beliefs,
proves the ability of health
and knowledge tocare students to apply their
wards interprofessional
knowledge and skills and put
collaboration, utilizing
them into practice as protools which measure
fessionals in the workplace
the interprofessional
to treat their patients more
core competencies as
effectively (Park et al.,
2014). In 2009, six national
associations of schools of
The study which
health professions formed a
included 122 intercollaborative to promote
professional students,
and encourage constituent
found that following
efforts that would advance
an interprofessional
substantive interprofessional
simulation experience
learning experiences. The
students had a change
goal was to help prepare
in attitudes regarding
future health professionals
cultural competence,
for enhanced team-based
roles and relationcare of patients and improve
interprofespopulation health outcomes.
sional communication
The collaborative representand teamwork.
ing dentistry, nursing, medi Simulation is an effeccine, osteopathic medicine,
tive teaching strategy
pharmacy, and public health
to provide experience
convened an expert panel of
representatives from each of
interprofessional teamthe six sponsor professions
work and collaboration.
to create core competencies
for interprofessional collaborative practice, to guide
curriculum development and to make recommendations for
interprofessional learning experiences in order to help prepare
health professions students for patient-centered team-based
care (Interprofessional Education Collaborative [IPEC],
2016). These competencies include topics of values, ethics,
roles, responsibilities, interprofessional communication, and
teamwork (IPEC, 2016).
Simulation instruction has been endorsed by the WHO as an
effective method of assisting health professionals to learn how
to effectively work in teams (WHO, 2013). Using simulation on
a routine basis for health professions students ‘‘can teach [them]
about each other’s professions and solidify the skills necessary
to productively collaborate’’ as well as ‘‘help students to retain
and build upon skills to increase their ability to deliver safe,
quality care’’ (Snelling & Jenkins, 2016). Simulation instruction has also been found to support the building of confidence,
clinical judgment, knowledge, and competence within students
(Fisher & King, 2013). A systematic review of over 700 qualitative and quantitative simulation research studies found that
simulation-based education contributes to students’ learning
when integrated into pre-licensure nursing curricula (Cant &
Cooper, 2017). Interestingly, a review of the literature revealed
few interprofessional studies that studied utilizing the core competencies. One study we reviewed found that following an interprofessional simulation of nursing and social work students that
attitudes toward interprofessional learning became significantly
more positive (Murphy & Nimmagadda, 2015).
To meet the needs of the changing health care landscape,
with a focus on interprofessional practice, we developed an
including nursing, nutrition, physical therapy, and social
work students. Previously at our institution, simulation as a
method of instruction was utilized in nursing education
primarily. Our study examines student attitudes, beliefs,
and knowledge toward interprofessional collaboration, utilizing tools that measure the interprofessional core competencies as recommended by IPEC.
One hundred twenty-two nursing (33), physical therapy
(38), nutrition (29), and social work (22) students at a small
four-year liberal arts college in the northeast participated in
a study designed to assess the relationship between student
perspectives before and after completing a two and one half
hour, community health, interprofessional simulation workshop. The simulation was required as part of the students’
individual professional course of study. Although students
were required to participate in the simulation class, they
were not required to participate in the data collection
The study was approved by the colleges institutional
review board. Prior to the workshop, consenting students
completed the IPEC Competency Survey Instrument that is
designed to evaluate health profession student’s selfreported ability on each interprofessional core competency
and the Interprofessional Attitudes Survey (IPAS) that is
designed to assess student attitudes of interprofessional
education. Both tools are based on the interprofessional
core competencies. The IPEC Competency Survey
Instrument is also a validated tool (Cronbach’s alpha
coefficients: 0.96-0.98), and includes four categories:
values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork. Subscales
include shared learning (9), patient interaction (5),
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12
Simulation for Interprofessional Education
prejudices in the workplace (3), cultural competence (4),
and working with the community (6) (Dow, DiazGranados,
Mazmanian, & Retchin, 2014). Each category includes
several items that are rated on a five-point Likert scale
based on the respondent’s personal feelings and educational experiences related to their perceived ability for
each item. The IPAS is a validated tool (Cronbach’s alpha
coefficients: 0.62-0.92) that consists of 27 items in five
subscales: teamwork, roles and responsibilities, patient
centeredness, interprofessional biases, diversity and ethics,
and community centeredness (Norris et al., 2015). Each
question utilized a five-point Likert scale based on the respondent’s feelings and personal experiences regarding
interprofessional education and collaboration.
After completing the presurveys, students took part in
one of 24, two and one-half hour simulation experience
scheduled over three consecutive weeks. One faculty from
each discipline participated in each session except for
social work whose designated representative was unable to
participate due to unexpected time challenges. The simulation scenario involved a Hispanic older woman recently
discharged from the hospital with a history of a recent fall,
cardiac disease, and diabetes. She was discharged with a
referral for home care services, including nursing, dietary,
and physical therapy. A social worker was consulted
because she lives alone and has few social supports. The
sequence of events for the simulation included a 30-minute
prebrief team meeting with all participants and faculty, a
15-minute nursing visit, a 15-minute team meeting after the
nurses’ visit with all the team members, followed by a
15-minute visit each by physical therapy, nutrition, and
social work. All patient visits were visible on a TV screen
outside the simulation area by all other team members. The
session concluded with another 15 minutes meeting with all
team members and a 30-minute debrief with team members
and faculty.
The overall objectives of the simulation were to provide
an experience in teamwork and collaboration among students from the four health care professions, introduce
students to the interprofessional core competencies, and
determine if there were any perceived changes in competency abilities and attitudes about IPE. Post data collection
occurred over a three-week period as students completed
their sessions. Unmatched information from the two pre and
post surveys was analyzed using Statistical Analysis Software Package (SPSS) to assess possible relationships between the preliminary data and postsimulation surveys. First,
demographic information was analyzed based on participant
responses from the preliminary survey. Next, responses to
the IPEC and IPAS tools were examined to determine a
possible relationship between the simulation experience and
student perceptions of interprofessional education and
collaboration with their peers. Nonparametric one-sample
Wilcoxon signed ranks tests compared the posttest subscale
medians with the pretest subscale medians.
There was 100% enrollment in the study. Of the 122
participants, 98% reported that they had never been involved
with an interprofessional simulation. The IPAS survey preand postsimulation scores were analyzed based on their
subscales. The median changes of the patient interaction
subscale and the cultural competence subscales were significantly higher post simulation (p < .001). Although median
scores increased following the simulation exercise with all
the other subscales, these changes were not significant. In
analyzing the IPEC data, the median scores for the roles
and responsibilities and the teams and teamwork subscales
were significantly higher post simulation (p < .001) and
the median score of the interprofessional communication
subscale was significantly higher post simulation
(p ¼ .001). The postsimulation median score of the values
and ethics subscale was higher than the presimulation medium test scores, suggesting an increase in mutual respect
in the interprofessional climate; however, this finding was
not statistically significant.
Utilizing two well-studied tools, the IPEC and IPAS, we
determined there were significant changes in students’ preand postsimulation attitudes about IPE (see Tables 1 and 2).
The change in pre- and postcultural competence suggests
that following the simulation exercise, there may have
been an increase in the student’s ability to consider the
unique role of cultural competence in patient care, as
well as the expertise of other members of the team; this
finding is consistent with a study that revealed that social
workers did have greater cultural awareness following a
simulation experience (Murphy & Nimmagadda, 2015).
The higher postsimulation score for the roles and responsibilities subscale may indicate a positive change in the
knowledge of one’s own role and those of other professions.
The higher postsimulation score for the Interprofessional
Communication Subscale may suggest increased awareness
of communication that is supportive of a team approach in
patient care. Students in our study also demonstrated an increase in the postsimulation score for the teams and teamwork scales that may indicate that students had a greater
understanding of how to perform effectively as a member
of an interprofessional team after participating in the simulation. Limitations of the study include unmatched samples
Table 1
Median IPAS Rank Scores
IPAS Subscale
Median Rank (p Value)
Patient interaction
Cultural competence
5.000 (p ¼ .00)
5.000 (p ¼ .00)
Note. IPAS ¼ Interprofessional Attitudes Survey.
pp 624-627 Clinical Simulation in Nursing Volume 13 Issue 12
Simulation for Interprofessional Education
Table 2
Median IPEC Rank Scores
IPEC Subscale
Median Rank (p Value)
Roles and responsibilities
Interprofessional communication
Teams and teamwork
4.222 (p ¼ .000)
4.273 (p ¼ .001)
4.000 (p ¼ .00)
Note. IPEC ¼ Interprofessional Education Collaborative.
and lack of between-group comparisons among the
different professions.
The core competencies for interprofessional collaborative
practice have been identified under the singular domain of
interprofessional collaboration, encompassing the topics of
values and ethics, roles, and responsibilities, interprofessional communication, and teams and teamwork.
Having nursing, physical therapy, and nutrition and
social work students work together during a simulation
exercise offers a unique collaborative educational experience for students to meet the core competencies of
interprofessional education and to prepare them to better
integrate into clinical teams when entering the workforce.
This collaborative interprofessional practice may have the
effect of ultimately improving patient care. Future research
should evaluate the effect of interprofessional simulation
education on patient outcomes.
Cant, R. P., & Cooper, S. J. (2017). Use of simulation-based learning in
undergraduate nurse education: An umbrella systematic review. Nurse Education Today, 49, 63-71.
Dow, A. W., DiazGranados, D., Mazmanian, P. E., & Retchin, S. M. (2014).
An exploratory study of an assessment tool derived from the competencies
of the Interprofessional Education Collaborative. Journal of Interprofessional Care, 28(4), 299-304.
Fisher, D., & King, L. (2013). An integrative literature review on preparing
nursing students through simulation to recognize and respond to the
deteriorating patient. Journal of Advanced Nursing, 69(11), 23752388.
Interprofessional Education Collaborative (IPEC). (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Author. Retrieved from
Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human:
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Korner, M., Butof, S., Muller, C., Zimmerman, L., Becker, S., & Bengal, J.
(2016). Interprofessional teamwork and team interventions in chronic
care: A systematic review. Journal of Interprofessional Care, 30(1),
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Norris, J., Carpenter, J. G., Eaton, J., Guo, J.-W., Lassche, M.,
Pett, M. A., & Blumenthal, D. K. (2015). Development and
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Park, J., Hawkins, M., Hamlin, E., Hawkins, W., & Bamdas, J. A.
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Snelling, M., & Jenkins, P. (2016). Interprofessional collaboration simulations. Journal of the New York State Nurses Association, 44(2), 53.
Tsakitzidis, G., Timermans, O., Callewaert, N., Verhoeven, V., LopezHartmann, M., Truijen, S., ., & Van Royen, P. (2016). Outcome
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