The aim of this study was to evaluate the feasibility of the collaborative learning module and to evaluate its effect from the learners’ perspectives. The study was designed as a mixed methods study using qualitative and quantitative data in a pre/post evaluation.
Theoretical and didactic framework:
The course development was conducted using the Program to Enhance Relational and Communication Skills (PERCS) as a didactic framework. The PERCS pedagogy is based on the concepts of validating clinicians’ existing relational capacities, emphasizing moral dimensions of care, suspending hierarchy, and creating a safe learning environment [43, 44]. Another important element is the use of simulated patients (SP) portraying the roles of patients and family members. The SP have received special training to assist with debriefing and give participants direct feedback on their communication styles and approaches [45, 46]. We chose PERCS as a framework as it combines important elements of relational learning with the opportunity to facilitate interprofessional discourse in the context of interprofessional education. The learning objectives are displayed in Table 1.
Learning objectives of the course
After the seminar the participants can
♣ explain the importance of language barriers for the quality of care in medicine and nursing care,
♣ work effectively with interpreters,
♣ get to explain the relevance of interprofessional cooperation and
♣ describe the professional roles of colleagues from other professions
Description of the intervention:
The course is designed as a three-hour seminar. It is part of a longitudinal interprofessional curricular thread at the Faculty of Medicine Freiburg . The data presented here were collected from winter term 2016/2017 to summer term 2018. Both medical and nursing students learn at University Hospital in Freiburg, Germany. In Germany, medical training is a six-year-program. The participating medical students are all in the final year of training in which they are part of care teams and work under supervision of senior medical staff. The training as a nurse takes three years. The participants are in their 2nd and 3rd year of training in which practical assignments and theory units alternate. Both professions have had first experiences in patient contact at the time of the course. The interprofessional teaching team consists of a paediatrician with expertise on social paediatrics and language barriers, a medical psychologist with a focus on research on communication, the head of the local interpreter pool, as well the trainer for the simulated patients who also has a background in nursing. The language of instruction is German. The participants were invited to the course by email. Participation was voluntary.
Content and Structure of the course (see Fig. 1):
The participants learn about the relevance of language barriers in medicine and nursing in terms of quality of care and patient safety. Important topics include the frequency of language barriers, the diversity of languages spoken in Germany, the ethics of language barriers regarding equal treatment, legal aspects regarding the validity of informed consent conversations.
Groupwork and discussion
In a subsequent exercise, participants are invited to share their own experiences in the context of the topic and to develop ideas on how to recognize and overcome language barriers in everyday clinical practice. The results are visualized and serve as a starting point for the following discussion focusing on differences and similarities among participants’ experiences. During this group discussion, the participants also learn about different variants of interpreting (telephone interpreting, professional vs. non-professional interpreters) and the respective advantages and disadvantages associated with the different options and the potentially resulting problems.
Practical exercise / simulation
Next, participants have the opportunity to practice an enacted, interpreted conversation with a non-German native speaking SP and the linguistically appropriate interpreters. SP cases include informing a mother about the HPV vaccination of her daughter or taking the history of a toddler with gastroenteritis and a diaper rash who is presented in the emergency department by his grandmother (see appendix). The SPs are trained to portray these cases authentically. We offered the case studies in Russian, Turkish, Spanish and Portuguese. Thus, participants experience the similarities and differences between an interpreter-mediated and a language-concordant conversation. We offered two simulations per teaching session in which we used different cases. The simulation interviews can either be done by a participant alone or as an interprofessional team consisting of a medical student and a student of paediatric nursing. The participants are instructed to focus not only on the medical issue at hand (e.g. differential diagnoses of gastroenteritis or data regarding the incidence of HPV-associated diseases) but are also encouraged to address the psychosocial cues offered by the SPs.
Debriefing and feedback
After the simulations, participants of the role-play engage in a debriefing exercise with the SPs, the group and course leaders . On the one hand, this discussion serves as feedback for participants regarding their performance. On the other hand, special features which emerged during the simulation are being reflected in the group for a more general discussion. Typical topics include the introduction of interpreters in the conversation with patients, the seating arrangement in interpreter-supported conversation or the use of short phrases during the conversation. After participating in or witnessing the simulation, participants are also able to ask interpreters questions e.g. regarding their interpretation of role-neutrality. In this way, participants engage in an interprofessional, reflective discussion about behavioural and context factors which should be considered by medical and nursing staff in order to optimize the quality of the interaction with interpreters and patients.
Evaluation: The intervention was evaluated by participants in a pre-post design using both online and paper/pencil questionnaires. Questionnaires were based on previously published PERCS surveys and the Freiburg Questionnaire for Interprofessional Learning Evaluation (“FILE”) and included questions on demographic characteristics. The items from PERCS surveys focus on the learner’s experience of the workshop (5 closed and 5 open questions). The FILE is an instrument for the self-assessment of different aspects of interprofessional competencies. It comprises 21 items and includes the following scales: relevance of interprofessionality (10 items), understanding of one’s role (5 items), ability to work in a team (6 items), team competence (5 items). The items are rated on a five-point Likert scale (1 = very good, 5 = insufficient) .
Analysis: The evaluation was carried out by means of descriptive statistics (absolute and relative frequencies, group comparisons by T-test, Bonferroni correction) as well as an orienting qualitative content analysis of the free text answers . For the statistical analysis we used SPSS (version 25.0 and 27.0, Armonk, NY: IBM Corp.).