Simulation exercise gets future doctors and nurses talking

In medicine, a breakdown in communication can have serious—even deadly—consequences.

"About 70 percent of medical errors that occur in health care are due to communication failures," says Mary Dolansky, PhD, RN, assistant professor at Case Western Reserve University's Frances Payne Bolton School of Nursing.

The School of Nursing and School of Medicine are working together to keep patients safer by training future doctors and nurses to communicate more effectively.

"Doctors and nurses are trained to communicate differently and to focus on different aspects of a patient," says Nicole Cruver, a secondyear nursing student who participated in a live simulation exercise at the university's Mt. Sinai Skills and Simulation Center designed to improve communication in health care settings. "The whole point of the exercise was to be introduced to how the other pool communicates. It's learning to speak the same language."

Cruver, along with other nursing and medical students, attended the simulation exercise to learn and practice SBAR (Situation, Background, Assessment and Recommendation)—a technique designed to convey only the most critical information for efficient communication between health care professionals. The communication tool is used by University Hospitals Case Medical Center and has been adopted by the Department of Defense to use while caring for injured troops.

The exercise was made possible by a grant from the Institute for Healthcare Improvement/Macy Foundation initiative to strengthen medical and nursing collaborative education. The session consisted of introductory video training to provide context and basic instruction on the SBAR method, as well as more hands-on training. Students broke .20

into interprofessional teams, assessing volunteers posing as patients and practicing communicating the situation and developing a plan using SBAR.

The advantages of simulation exercises are enormous, says Daniel B. Ornt, MD, vice dean for education and academic affairs at the School of Medicine. "You can create reproducible, consistent experiences that are impossible to do in the actual health care environment, and you can do it in a way that is absolutely safe because there are no real patients." Simulations also offer the opportunity to debrief and evaluate the experience, which is particularly useful in team building, he adds. Cruver and the other student participants discussed the communication barriers they encountered during the exercise and how they can learn from their mistakes.

Students were enthusiastic about the value of the training. "It's such a good idea to start working together early on—to really start ingraining the idea that we're working together as a team toward the same goal," says third-year medical student Maura Manion, who also participated in the exercise.

The nursing and medical schools plan to continue SBAR training and simulation exercises through the recently formed Interprofessional Learning Exchange and Development (I-Lead) Program. (See page 22 to learn more.) This four-year project is funded by a $640,000 grant from the Josiah Macy Jr. Foundation, a New York-based privately endowed philanthropy that supports programs designed to improve the education of health professionals in the interest of public health.

"Experiential learning really is the key," says Dolansky. "And in simulation, there's just nothing like it. You can read things, you can work on case studies, but until you get in and do it, you don't internalize it."