Interprofessional Education Through Standardized Patients (SPs) and Team Objective Structured Clinical Examinations (TOSCEs)
Background: Literature has shown that interprofessional team-based care and standardized patients (SPs) significantly improve students’ retention of knowledge and perceptions compared to other forms of simulation. To enrich student experience and foster student success, the aim of developing this piloted Team Objective Structured Clinical Examinations (TOSCEs) was to design and implement interprofessional, structured clinical encounters and examinations with facilitator, peer, and SP formative feedback.
Methods: Five standardized, interprofessional patient-centered cases were written, peer-evaluated, and each utilized 32 times each to conduct 160 standardized patient TOSCEs over the course of 8 hours at 30 minutes per event. Case topics included medical interviewing, medication reconciliation, transitions of care, primary care, and medical emergencies. All cases intentionally integrated factors that contribute to health disparities and social determinants of health. A maximum of 3 students from 4 disciplines were grouped with one of 11 different SPs per TOSCE. Learning objectives and outcomes were grounded in IPEC’s four core competencies. Discipline-specific objectives were also devised and aligned with knowledge, skills, and behaviors. Upon TOSCE completion, SPs provided real-time verbal feedback and facilitators and peer observers provided documented feedback via a Qualtrics® survey. Additionally, student self-evaluation on attainment of interprofessional competence and improvement in cultural sensitivity were captured through pre-/post-event surveys using the validated Revised Interprofessional Collaborative Competencies Attainment Survey (ICCAS) and Cultural Awareness Sensitivity Tool (CAST).
Results: A total of 321 students consented, completed the pre-surveys, and participated in 1 to 4 TOSCEs. Of those, 90% also completed the post-surveys (n=289; dental hygiene=19, nursing=19, pharmacy=182, physician assistant=69). Overall, results demonstrated a statistically significant attainment of interprofessional collaborative competence (t(288)=16.72, p< 0.001), as well as an improvement in cultural awareness and sensitivity upon TOSCE participation (t(274)=4.39, p< 0.001).
Conclusion: Creating IPE experiences with multiple disciplines that include interactive cases with SPs poses a challenge of coordination and timing. However, when successfully implemented, they offer invaluable learning experiences with particular focus on communication and teamwork. TOSCEs provide interactive patient-centered experiences where students can practice how disciplines work together to assess patients and formulate care plans. Communication and teamwork are core skills health care students will utilize on clinical rotations and once in professional practice. Experiences that allow students to practice these skills in real-time provide better preparation for rotations.
Reflections/Implications: Incorporating TOSCEs requires advanced planning and adequate resources, including both time and financial commitment; but with preparation, they offer valuable experiences for students to improve communication and teamwork skills.