Seeing vs Doing: A Comparison of Participants and Observers During a Novel Interprofessional Discharge Simulation

Background:
Interprofessional communication and teamwork are important aspects of medical training. Medical students are rarely taught in clinical simulations that involve students from more than one profession. The objective of this study was to develop and implement a novel discharge OSCE, to enable medical students to practice discharging a patient with a chronic disease while incorporating effective communication with other healthcare professionals.

Methodology:
This is a single-center, survey-based study evaluating a novel discharge objective structured clinical exam (D-OSCE) created for second year medical students. Students were instructed in AHRQ’s IDEAL model for patient-centered discharge (Introduce, Discuss important parts of the discharge, Educate, Assess for understanding and Listen). They were also taught about the importance of interprofessional collaboration through a discharge panel with a physical therapist, social worker, nurse, and pharmacist. The instructions highlighted that to successfully complete the D-OSCE, students should discharge the standardized patient, but also to initiate a phone call to physical therapy during the simulation when needed. Standardized patients were instructed to act surprised that they were going home that day and express concerns about their mobility and that they feel that the physical therapist needs to be consulted. All experiences were rated by both the standardized patient and a dedicated faculty. One student acted as the discharge student, while 3 others observed. We compared student participants and the observers, in regards to their understanding of the roles of other healthcare professionals, preparedness for interacting with other healthcare professionals, and discharging patients.

Results:
63 second-year medical students participated (16 participants, 47 observers). The participants had a higher percentage who agreed or strongly agreed that they were prepared to interact with other professionals in the hospital discharge process (14/16 or 80%) as compared to the observers (28/47 or 60%, p=0.07). The participants reported a high level of preparedness for conducting a patient discharge (15/16 or 94% vs 26/47 or 55%, p=0.008).

Conclusions:
Compared to student observers, student participants in a discharge OSCE requiring interdisciplinary communication was associated with increased preparedness to interact with an interprofessional team as well as a higher level of preparedness for discharging a patient.