As noted in the last blog entry (see May 2, 2011), the use of interprofessional simulation based on psychological conceptions of non-technical skills tends also to emphasise the individual as the site of the ‘problem’ and ‘solution’ to communication and collaboration. As a result, there appears to be a disconnect between the theoretical and methodological approach underpinning simulation – that emphasises individual skill acquisition – without adequately acknowledging the subsequent complex clinical context in which individual practitioners must perform their newly acquired collaborative skills. One could also posit that current interprofessional simulated learning brings the notion of interprofessionalism back to an issue of ‘correcting’ the individual to become more ‘team’ oriented and ‘collaborative’, thereby exacerbating culturally held, highly valued and behaviorally expressed notions of individualism which can exist within some professions. This would seem fundamentally in tension with the premise of interprofessionalism which is a relational one. It is not just grounded within uni-dimensional ideas of effective communication, but within an understanding of one’s role in relation to others that are pertinent to a given health care task, with an appreciation of the context in which it occurs.
The application of a sociological approach can also encourage a reconsidering of the notion of ‘non-technical’ (collaborating, negotiating and communicating) skills, which within the simulation literature are usually demoted to ‘soft’ and secondary to clinical skills. Not only are collaborating and negotiating processes essential to effective interprofessional practice, they are also complex technical activities in their own right. They involve the integration of a complicated range of skills, attitudes and behaviours, which require a firm understanding as to how factors such as imbalances of authority and influence, differing educational backgrounds, disparate ways of constructing professional identity, gender and socio-economic inequalities, can affect and often undermine interprofessional interactions.
It seems therefore that whilst the simulation literature is acknowledging the importance of using an interprofessional approach, the best way to incorporate such an approach and empirically study its impact on collaboration, teamwork and patient care, is still unknown.
Whilst recognising the issues affecting interprofessional collaboration in healthcare are complex, historical, and culturally and socially engrained, we strongly believe that such issues must be addressed if meaningful and relevant team-focused, rather than individually-focused, training programs are to become a reality. Incorporating the ever-present, but seldom explicitly addressed sociological issues (e.g. power, hierarchy, professional boundaries, gender) into interprofessional team training simulations will certainly be no easy task. Operationalizing concepts which are complex and nuanced will be challenging, but if our ultimate goal is to improve interprofessional collaboration in clinical practice to enhance patient care, then this is a necessary next step.
The introduction of ‘sociological fidelity’ will inevitably have many implications for the design and practice of interprofessional simulated learning. Undoubtedly, scenarios will become more complex to produce. As a result, rich qualitative data gathered from various clinical settings will be needed to ensure that the interprofessional scenarios are truly contextual and provide an effective reflection of the lived realities of different professionals. The aim of such scenario development is to reveal and explore real life interprofessional tensions, hierarchies and boundaries, and thus facilitators will need to anticipate potential consequences of sometimes difficult discussions which may emerge during the enactment of the scenarios. Despite these additional challenges, the use of sociological theory in the development of interprofessional scenarios, combined with careful assessment and evaluation, will improve the quality of interprofessional simulation-based education.
(Scott Reeves, Editor-in-Chief)
For more information read: Sharma, Boet, Kitto & Reeves – Journal of Interprofessional Care, Vol. 25, pages 81-83.