YPSILANTI – The team of future health care professionals approached the patient. They had some bad news to deliver.
“You’ve had a little bit of an amputation,” one said gently.
The patient, whose stated name was “Julia” and had lost her foot, wasn’t happy.
“A little bit of an amputation?” she asked, indignant. “What the (heck) is that?”
She was a homeless woman, an alcoholic with memory problems who had been found in a Detroit alley and had suffered frostbite, forcing the amputation of her foot, an outcome she had trouble understanding.
A team of professionals—a nurse, a social worker and an orthotics and prosthetics specialist, attempted to communicate and draw her out while starting to assemble a plan to discharge her in several weeks.
When they entered the hospital room, she fell and first needed to be helped up onto the bed.
Then came the questions and demands, staccato-style, laced with anger and confusion and hallucinations:
“Where am I?”
“God, what happened to my foot?”
“Why can’t I stand?”
“Get me my foot back! How am I supposed to get around? Can’t you just warm it up?”
“What is that under my bed?”
The well-intentioned health care team seemed young and somewhat inexperienced, and for good reason. They were students in graduate, health-based programs at Eastern Michigan University, part of more than 200 soon-to-be professionals participating in a second annual day of scenario practice and review with simulated patients Nov. 16 at the simulation facilities at nearby St. Joseph Mercy Ann Arbor Hospital and in Eastern’s Rackham Hall.
The day’s program, which combined students from a variety of health programs that included orthotics and prosthetics, physician assistant, nursing, occupational therapy, health administration, clinical lab science, athletic training and social work, is part of a powerful emphasis and culture at the EMU College of Health and Human Services (CHHS) on interprofessional education (IPE) – the idea that patients benefit most from integrated care that blends the efforts of professionals from various areas.
“Patient and client needs demand that professionals from many different disciplines work together to provide the best care possible,” says Christine Karshin, associate dean of the college. “Simulation-based education, used in a collaborative practice, is of great value for learners outside their own disciplines. It better prepares students to meet the complexities of today's health care workplace.”
Indeed, a 2015 national report on malpractice risks in communications found that communications breakdowns figured in 30 percent of all malpractice claims filed between 2009 and 2013. Further, 37 percent of all high-severity injury cases (including death) involved a communication failure, the report said.
Students took part in either morning and afternoon simulations, running through two scenarios: when they first encounter the patient after surgery and then three weeks later, shortly before discharge. After viewing a video of the simulation in small groups, students and Eastern faculty gathered in a classroom to share impressions and insights.
The students learned skills crucial to effective and integrated patient care, skills that ensure the team remain on the same page. Those included the call out (repeating instructions for clarity), briefing (preplanning outside before talking to the patient) and huddling (to discuss how to respond to new or unexpected circumstances).
Suggestions for improving one’s approach to a patient focused on establishing the best, most sympathetic communication possible by perhaps slowing down the conversation, by approaching the patient one health professional at a time and or having one person do most of the talking.
With such recommendations came a powerful realization: Whatever your plan, it can often quickly dissolve. Expect the unexpected.
Julia, one of a variety of simulated patients interacting with the students that day, said she “tried to portray the despair someone on the outside would feel,” confused and resentful after finding she had lost a foot. And if someone hadn’t yet spoken in the simulation, Julia would prompt them, challenging the student to say something.
Despite the simulated conditions, “it still felt real,” she said of each scenario.
Professors Linda Myler and Kathy Seurynck, co-directors of nursing and IPE simulation at EMU and organizers of the day’s program along with Jacob Lindquist, a professor of orthotics and prosthetics, led the discussions.
“Having this day is very, very valuable for (the students) to be able to see what other people do (in such a setting),” Seurynck says. “To talk to other students in their profession – we’re hoping this carries on to their practice.”
Myler notes that the partnership with St. Joe’s and Eastern is distinct because most simulation centers are located primarily at the educational institution.
“This day allows us to get students who have never been there before into the hospital patient care setting,” she said. “This simulation fulfills some of the standards we want to actually give students before they enter their practice. EMU students can set themselves apart by noting they’ve participated in such an inter-professional simulation.”
Sidney Phan, an EMU nursing student, said the day vividly displayed what health care professionals from other areas can do for patients. “Each discipline has a different but valuable way of communicating with a patient,” she said.
EMU has undertaken such efforts with the help of a $500,000 estate gift from Donald F.N. Brown, which helped the college establish an Inter-professional Faculty Scholars Conference and other educational activities.
For more on the nature of the event, see the video of this year’s inter-professional education day.
About Eastern Michigan University
Founded in 1849, Eastern is the second oldest public university in Michigan. It currently serves more than 19,000 students pursuing undergraduate, graduate, specialist, doctoral and certificate degrees in the arts, sciences and professions. In all, more than 300 majors, minors and concentrations are delivered through the University's Colleges of Arts and Sciences; Business; Education; Health and Human Services; Technology, and its graduate school. EMU is regularly recognized by national publications for its excellence, diversity, and commitment to applied education. For more information about Eastern Michigan University, visit the University's website.