Online Survey
23 students (15 MD, 7 RN, 1 PA) analyzed 14 cases taken from the CSBL’s IPE courseware (Table 2). The cases covered a range of healthcare settings (e.g. obstetrics, emergency, internal medicine) and medical conditions. Students were asked to identify words they perceived as inclusive vs. exclusive. In total, 290 terms (28% of total word count) were identified as healthcare language (inclusive or exclusive), 285 terms as inclusive, and 196 terms as exclusive by at least one participant (Table 3). 4 terms were classified as healthcare terminology by 100% of participants, although no terms were classified unanimously as inclusive or exclusive
(Appendix A-C). Of the 290 total words identified, 113 words were classified as healthcare terminology, 46 as inclusive, and 17 as exclusive by >50% of participants (Figure 1).
Focus Group
22 students (14 MD, 7 RN, 1 PA) participated in focus groups following participation in the IPE simulation workshops (see Table 2). Participants shared perspectives that highlighted both the challenges and benefits of introducing terminology in early IPE experiences. They shared insights from their clinical experiences and made comparisons between these experiences and the current workshop. Several key themes emerged from the focus group discussion.
Theme #1 – Abbreviations and acronyms as a form of complex healthcare language
When prompted to reflect on their experiences with healthcare language, many participants pointed to the heavy use of abbreviations in the clinical setting. Abbreviations were largely regarded as a barrier to interprofessional and interdisciplinary communication, particularly when the same abbreviation had multiple meanings depending on the clinical setting or profession. Rather than improving the efficiency of communication, students felt that abbreviations resulted in a greater amount of time spent attempting to decipher the language and ensure the term is interpreted correctly.
One of the (cases) said ROM…I was like, "Oh, that's probably ruptured membranes," but, is it? And having to take the time to search the rest of the chart data, to see if that's what I'm thinking it is, probably takes longer than someone just actually writing out ruptured membranes.
I don’t remember what it was, but it was a three letter kind of thing. And to the nursing students it meant one thing and to the medical students it meant a completely different thing, but it was the exact same three letters. It’s really interesting that we have things like that, and for people that work so close together, that we have such confusing terminology…it obviously can lead to a lot bigger issues.
Theme #2 – Unfamiliar terminology: product of being an early learner or exclusionary?
Participants found it challenging to decide whether a term was exclusionary as they were unsure of whether to attribute it to a lack of clinical experience or professional differences.
One specific example I could think of was about the MAR... I'm only three months into my program, so I have no idea what it was, but it was interesting hearing how much each type of professional used it, and under what context they did.
However, two individuals commented specifically on the potential value of encountering exclusionary, profession-specific terminology in early IPE experiences, explaining that as long as it continues to exist in the workplace, it might be beneficial to gain exposure to it early on.
I think as long as it's continued in hospital…until it's fully changed I think it is beneficial to have here because realistically, as it will continue to be used in hospital, it does help to put this into clinical setting now, whether we fully believe if it should be used or not long term.
Theme #3 – Simulation as a safe space
Participants commented on the comfortable, safe nature of this early simulation-based IPE experience. They felt that it was easier to ask for help from facilitators and peers and learn complex terminologies compared to in the clinical setting. They appreciated that this was a setting devoted to learning, where mistakes could be made without consequences and in the absence of patient care responsibilities.
This is a learning space. I think one of the facilitators actually mentioned that explicitly. She was like "This is a safe space. You're not expected to know everything and that's okay, just ask."
Participants drew comparisons to clinical settings where they commonly encounter new medical jargon but find it difficult to ask for help, due to the fast-paced environment where stakes are higher, and where healthcare professionals may play a role in evaluation of the individual. In the clinical setting, students were more likely to conduct an internet search in order to learn terminology, rather than asking for help.
A lot of times during horizontals, you don't get the chance to ask questions, because everyone's really busy with their own thing. So I think it's really helpful to learn about it in more of an academic setting as opposed to a clinical setting.
Theme #4 – Value of complex terminology as a desirable difficulty in early IPE
Participants pointed out the additional cognitive effort required in integrating complex terminology early, and the ways in which it could be challenge learning.
I just felt like it took me a lot of effort to read everything, internalize it, and then regurgitate it. And then to have to decipher it on top of all that.
However, participants pointed out specific benefits of utilizing healthcare terminology, perhaps terminology with even greater complexity what is taught in their respective programs, in early IPE experiences. They appreciated that the cases were reflective of their real clinical experience.
I definitely don't think that the cases should be dumbed down, even though I'm in first year and I don't know a lot, but it's just because, they weren't so complicated that we couldn't get the big picture, or the main points at all. Even though there are some words that we didn't know, the big picture is very clear in each case, and because we read these cases, thought about it, and thought about how to do the hand-over in this slightly stressful situation, I don't think I'm gonna forget any of the new terms I learned here. So I think it's actually beneficial to have it a little bit more advanced than what we're learning in school.
At the end of each discussion, the participants were prompted to address the question of when in one’s training would it be most optimal to introduce complex healthcare terminology in the interprofessional setting. The individuals who responded to this question and engaged in discussion suggested that it should be introduced as early as possible, perhaps even prior to any clinical exposure.
I actually think that people should do it as many times throughout their schooling as possible, because what you get in first year is gonna be very different than what you get in second year…it's gonna be very, very different, what you're able to take away and maybe contribute to other members in your group of varying learning levels as well.