Adapting the Communication and Teamwork Skills Assessment to Assess Pre-licensure Health Care Student Team Performance in Simulation- Enhanced Interprofessional Education

Literature demonstrates a lack of structured reporting of interprofessional (IPE) education activities and challenges objectively measuring team performance. The purposes of this article are: to provide a structured description of a simulation-enhanced IPE project focusing on pre-licensure health care student team performance; and, to describe how the Communication and Teamwork Skills (CATS) assessment was adapted to assess teamwork and communication skills during student team simulations. METHODS Simulated case scenarios were conducted with teams consisting of nursing, respiratory therapy, and medical students. The CATS tool was adapted for use in IPE simulations by adding two statements that globally assessed frequency and quality of teamwork. Individual items from the CATS tool guided assessment of overall team performance. Faculty assessors piloted the tool by discussing tool components and assessing several sample cases together. Faculty assessors then scored each simulation individually and the adapted CATS tool was assessed for interrater reliability. RESULTS The team assessed sixty-eight cases (n=68). Thirty-four (n=34) cases were rated by three of the faculty and thirty-four (n=34) were rated by two faculty. Inter-rater reliability for frequency of communication was .808 and .789 for quality of communication. CONCLUSION This project suggests that an adapted version of the CATS assessment tool can be used to reliably assess communication performance of health care student teams during a simulated acute care case. In addition, the planning team hopes that the project can be replicated to develop a model of IPE that is sustainable and feasible within other academic or health care settings. Received: 03/31/2017 Accepted: 04/02/2018 © 2018 Masters, et al.. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & Adapting the Communication ORIGINAL RESEARCH 3(3):eP1159 | 2 Introduction Educators are challenged to infuse core competencies related to teamwork and communication into curricula to ensure pre-licensure health care students are prepared to function in interdisciplinary teams (Institute of Medicine [IOM], 2003; IOM, 2010; Interprofessional Education Collaborative Panel [IPEC], 2016). A key concept associated with this work is interprofessional education (IPE). According to The World Health Organization (2010), IPE occurs “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” (p. 13). One strategy to teach IPE competencies is simulation, which provides a controlled and safe environment for students to practice their teamwork and communication skills (Decker et al., 2015; National League for Nursing [NLN], n. d.). Integration of IPE into pre-licensure health care education has gained momentum over the past several years in an effort to improve patient care outcomes. Students can work towards this goal through development of mutual respect and improved understanding of other disciplines’ expertise (IPEC, 2016). A large-scale literature review focusing on pre-licensure health care IPE identified 83 studies that had been published between 2005 and 2010 (Abu-Rish et al., 2012). The Interprofessional Education Collaboration was founded in 2009 to “prepare future health professionals for enhanced team-based care of patients and improved population health outcomes” (IPEC, 2016, p. 1). This organization supports health care educators through establishment of core IPE competencies, IPEC Faculty Development Institutes, and a newly created IPEC-PORTAL with free, high-quality teaching materials. Today, membership includes professional education institutions representing fifteen diverse health care professions. Accreditation agencies and healthcare organizations such as the NLN, Society for Simulation in Health Care, American Association of Colleges of Nursing, International Nursing Association for Clinical Simulation and Learning, and Institute for Healthcare Improvement have endorsed Sim-IPE as an effective mechanism to teach IPE (Decker et al., 2015; NLN, n. d.). Sim-IPE takes place when “participants and facilitators from two or more professions are engaged in a simulated health care experience to achieve shared or linked objectives and outcomes” (Decker et al., 2015, p. 294.). There has been an increase in published Sim-IPE studies over the past 10 years, with reports of positive outcomes for students elicited through both informal and formal evaluation. Palaganas, Brunette, and Winslow (2016) suggests that students enjoyed the realism, practice, debriefing, reflection, relevancy, and opportunities for feedback associated with Sim-IPE. Students also perceived improvement in their knowledge, skills, and behaviors related to teamwork, communication, and collaboration. Pre-licensure IPE and Sim-IPE activity has increased, but concerns have been identified with the existing work. One weakness reported in the literature is a perceived lack of rigor in outcome assessment including limited psychometric testing and inadequate psychometric development of existing tools (Abu-Rish et al., 2012; Decker et al., 2015; Palaganas et al., 2016). Recent literature reviews found that the majority of IPE Implications for Interprofessional Practice • An adapted Communication and Teamwork Skills (CATS) assessment tool demonstrated initial reliability in assessing pre-licensure health care student team performance in simulation-enhanced interprofessional education (Sim-IPE). • Dissemination of interprofessional education (IPE) utilizing a standardized format may foster replication of similar projects in academic and health care settings. • Long-term commitment is required by educators to facilitate high-quality, sustainable IPE experiences for students in health care programs. H IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu.edu/hip 3(3):eP1159 | 3 and Sim-IPE studies did not address reliability and validity of measurement tools (Abu-Rish et al., 2012; Palaganas et al., 2016). Another criticism of current efforts to evaluate IPE is limited measurement of team performance skills, with the majority of tools and studies focused on assessing participants’ knowledge, attitudes, and perceptions about IPE concepts and practice (National Center for Interprofessional Practice and Education, n.d.). This finding is consistent with the literature in that only 9.6% of IPE studies developed and implemented observational ratings for assessing students’ communication and teamwork skills (Abu-Rish et al., 2012). Tools that measure team performance are available (Agency for Healthcare Research and Quality [AHRQ], n.d.; Chiu et al., n.d.; Frankel, Gardner, Maynard, & Kelly, 2007; Kiesewetter & Fischer, 2015; Malec et al., 2007). However, it is difficult to identify an appropriate and reliable tool to use in pre-licensure IPE that quantitatively measures communication and teamwork skills and is simple to use. A second concern associated with IPE projects is inconsistency and lack of description when disseminating findings. Standardized methods of reporting, including focus on IPE preparation, activities, and outcomes, was strongly encouraged to address these shortcomings (Abu-Rish et al., 2012; Olson & Bialocerkowski, 2014; Palaganas et al., 2016). Suggestions for specific variables to be included when reporting are: theoretical or conceptual framework, intervention design, simulation scenarios and modality, demographics of students and faculty, teaching strategies, frequency and duration of IPE intervention, faculty development, validation of measurement tools, institutional leadership support, barriers and facilitators, and community partnerships (Abu-Rish et al., 2012; Olson & Bialocerkowski, 2014; Palaganas et al., 2016). An example of a standardized method for reporting IPE, entitled the Replicability of Interprofessional Education (RIPE) tool, can be viewed in Table 1. The objective of standardized reporting is to foster replication and encourage comparison of IPE initiatives with the ultimate goal of improving rigor of IPE and Sim-IPE research. Integration of IPE into pre-licensure health care curricula is essential to prepare students for the realities of practice. However, IPE research must meet rigorous scientific standards and be replicable in academia and practice. Thus, the goals of this article are: To utilize RIPE guidelines to describe a pre-licensure Sim-IPE project between a community hospital and private college focusing on team performance To describe adaptation of the CATS assessment for use as an assessment tool for pre-licensure health care student team performance