Reliance on, and Benefit of, Each Other

One of the clearest ways in which students demonstrated good team working behaviour was by relying on each others’ knowledge base and acknowledging their individual limitations.

The concept of the “experienced student was introduced by students all had completed at least three years of study by the time of the intervention). Students offered the opinion this was vital to good interprofessional teamwork, because they would be aware of their own and others strengths and weaknesses.

“I think it’s only because like you said, we’re well into our training now and we already know what everyone’s limitation is to a certain degree. Obviously some will take the role in certain areas; some will take a step back and forth because they’re relying on other people’s

experience and they can do it.” [N001]

“Everyone kind of knows their role a little bit more and responds to that. They get what they have to do. Obviously if you’re in a group you reflect on that.” [P001]

These experienced students, tended to take a lead in tasks where their knowledge was more complete, or where they considered themselves to be competent. This could be misconstrued as stereotypical behaviour, however this behaviour tended to improve collaboration and

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consequently improve the care of the virtual patient. Accurate evidence for this behaviour was provided by the independent observer as seen in Figure 3.5 below:

P001 - Prescribes drugs.

N001 Takes down obs.

D002 Provides an explanation for the current obs levels and recommends keeping an eye on them.

P002 and P003 - consulting each other and the BNF.

P002 Directed towards D001 and D003 ‘So do you want me to find an alternative drug?’

N002 Reads and notes down obs levels.

D001 and D003 Examine X-ray and consult reach other on assessing it, then explaining to the group what it shows.

Figure 3.5 Independent observation of students acting within their competency

This was summarised by the independent observer noting that there was a clear role of each profession in each group. The nurse consistently focused on observations, pharmacists on drugs and doctors on the physical examination and overall knowledge of the situation. Each member of the team was able to defer based on their professional knowledge, relying on each other especially when it was an acute critical simulation. Students in the second group fell in their ‘roles’ more quickly than the first group, possibly because the pharmacy and medical students had someone to confer with intraprofessionally.

In contrast to the separate yet complimentary roles referred to by the independent observer; physiotherapy lecturers referred to some overlap in the roles between themselves and nurses. This was tempered by the assertion that each profession would approach a problem in a differing manner:

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“Again overlap with nursing because they too understand the need for mobilising patients and changing position. But not perhaps have the same emphasis and priority as physiotherapy students” [PY02]

Many examples of explicit reliance on each other were revealed by the research,

demonstrated by the response of both student and lecturer participants. These normally took the form of direct questions regarding an aspect of care as can be seen in Figure 3.6 below.

D003 Directed at P “How much paracetamol do we give?”

P002 and P003 [Consult each other and give advice]

N002 - “But his obs may come down with that, what else can we give him?” Uses her experience and knowledge to demonstrate that it is inappropriate, but still relies on pharmacists’ further knowledge about alternatives.

Figure 3.6 Conversation between participants demonstrating explicit reliance on each others’ knowledge.

Lecturers positively demonstrated this behaviour in their group as the nursing lecturer specifically asked the pharmacist about the dose of a medication. Students also reflected on their reliance on each other in the focus groups, showing solidarity to each other by identifying their own weaknesses:

“yeah, there were certainly parts I’d have no idea about, like X-rays or mechanical ventilation. If you showed me an X-ray I wouldn’t know what to look for.” [P003]

“sort of likewise on drugs as well, dosing and stuff.” [D001]

This reliance manifested itself in a positive manner where students started to learn with, from and about each other, by directly asking each other the significance of findings which were being related to the group. This possibly could have detracted from patient care, but it improved the learning experience for students.

114 D003 Reads out abdominal exam.

P002 ‘Cool. So what does that mean?’

D003 and D001 Explain abdominal exam.

D003 ‘We really need to do something now’.

Figure 3.7 Conversation demonstrating explicit learning from and with each other

This inquisitiveness between different professional groups was cited as a benefit of the experience by students:

“Yeah I think it’s good because we’re obviously working with different professions and you think about what tests you need to do that other people would be interested in. You get an idea of what everyone is looking for as well as what you should look for.” [D002]

This reliance on each other expressed itself fruitfully when it was articulated that the different professions share a collective responsibility for patient care:

“Everybody makes mistakes so actually you need your whole team with the knowledge, skill and insight” [PY02]

Students were asked if they thought the app would be suitable for use in a uniprofessional group e.g. for pharmacists only. The response to this was positive but they believed they would struggle if the simulation was presented in the same format as for an interprofessional group. This idea could be furthered if a professions lack of knowledge in certain areas could be ameliorated by further information being interpreted or presented in a different manner.

“If you were to do it as a group, say on the same course then you might realise ‘I don’t know that’. That’s why I’d need such and such a body to come in and help. It makes you more aware.” [D003]

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“You could maybe run it where you had everyone from one course…could you give them the information that they would not have” [P002]

This demonstrates students’ belief that they need the expertise of their colleagues whilst dealing with virtual patients.