May 29, 2015

Evan Gooberman & Alex Krengel

Drexel University School of Public Health

Masters of Public Health Candidates

“If we want to keep making drugs, we should go with the higher return on investment.”

“Only if we are deciding based on cost and risk.”

“Agreed, we also have to account for the potential population health impact.”

Students chimed, huddled around a table. On the evening of April 9^th, "Building Broader Connections" Day of National Public Health Week, this team of six was asked to act as pharmaceutical industry executives balancing resources to prioritize multiple drug development pathways. In the second ever Interprofessional Health Simulation, thirty students and professionals from Public Health, Nursing, Medicine, Music Therapy and Business gathered together at the Drexel University College of Nursing and Health Professions Simulation Center. They worked together in small teams, to solve complex health-related problems.

The goal of the event is to develop everyone’s capacity for interprofessional collaboration, defined by five key attributes within the fields of health: overall knowledge and competency, values and ethics, rules and responsibilities, communication and teamwork.  Due to the complexity within the many fields of health, the simulation was designed with the belief that developing these attributes will help future professionals develop shared understanding and accountability and work collaboratively to recognize the nuances of our communities, create better systems and provide better services to achieve the outcomes we desire.

To move toward this goal, participants were placed into one of four interdisciplinary teams, with participants from various backgrounds working together. Each team engaged in three of the six scenarios that were developed: three clinically-based, and three non-clinically-based table-top scenarios. Within the clinical scenarios, participants cared for their patients as if they were in a real healthcare setting.

In one such scenario, participants entered an Emergency Department setting and discovered their patient, a man in his 30s who complained of severe pain in his leg, which was being caused by a fracture in his femur. The healthcare team collected a history, revealing that he was injured at work, which led to conversations about occupational injuries and workplace safety. For another scenario, the team elected three members to be a physician, a nurse, and a medical assistant, while the rest of the ream observed remotely. This small care team was placed in a rural community and had to address a multitude of health conditions with an adult with special needs and her mother. Without local specialists, the team then had to create a coordinated care plan and chart the life course of the patient, which was ultimately discussed in the full team debrief.

The third and possibly most exciting scenario took place in a trauma bay. Participants entered, finding two patients: one the victim of a stabbing in stable condition and visited by his wife; the other was accompanied by a police officer, had a gunshot wound and was in critical condition. The team had to deal with treating both patients simultaneously, and then experienced added difficulty when the wife discovered that the patient next-door with gunshot wounds was the perpetrator of her husband’s stabbing. The participants rose to this occasion, handling each situation calmly and with professionalism. After each simulation, teams and facilitators sat down for a debrief to discuss the simulation, major challenges, learning points and future objectives.

The non-clinical scenarios focused on broader health topics, such as the American health insurance system, business interests, and law and ethics. For one scenario, participants stepped into the role of a hospital ethics committee and reviewed the case of two married men, one of whom was severely injured while they were visiting a state that does not recognize same-sex marriage. This led to discrepancies with Power of Attorney, especially when the mother arrived and wanted to refuse a blood transfusion for her son, since she raised him as a Jehovah’s Witness. As previously mentioned, the next was a group of executives at a pharmaceutical company making decisions about alternative pipeline candidates their research and development team should pursue and consequently market. The final scenario resembled House of Cards, as the President of the US wanted to provide more jobs and pay for the initiative by cutting funding from Medicare, Medicaid, and Social Security. Teams analyzed the US health insurance system and made recommendations to the president.

At its culmination, participants and facilitators shared their reflections, challenges, and ah-ha moments from the evening, before continuing to a network reception. This was a key point of the event because after working with each other for a couple of hours, participants were really able to get to know each other on a personal level, establishing a foundation for future collaborations.

The simulation was viewed as a success in many respects. While filling out the post-survey for the simulation, everyone indicated that they would recommend the program to their colleagues in the future. It was evident that participants in the Interprofessional Health Simulation learned a great deal about others' roles in health and how to effectively collaborate with one another. (Survey results indicate significant improvement in the key attributes the simulation was designed to grow.) These future health professionals are now better prepared for their careers in which success will be determined by their ability to work with colleagues from various disciplines.