Analysis of Learner Questions Posed During Project DOCC Simulation Experiences (1090-003587) (Research Abstract Oral: Simulation Methodology)
Start time: Tuesday, January 26, 2021, 8:00 AM End time: Tuesday, January 26, 2021, 9:00 AM Session Type: Research Abstracts (Completed Studies)
There is a growing need for a comprehensive approach to caring for medically complex children in primary care settings since more infants are surviving prematurity, complex congenital heart disease, childhood cancer, and a growing number of genetic diseases. Parents of medically complex children often become stressed and confused by daily demands of coordinating care between specialists, therapies and community with no real sense of someone “driving the bus”. The patient centered medical home (PCMH) has data supporting its impact on reducing disparities in healthcare and is based on the relationship between the patient, community, and healthcare workers (Mielenz, Allegrante, & Rowe, 2016). With this in mind, our research question was: Do the questions being asked by medical residents and health professional students during Project DOCC simulation exercise knowledge of the patient centered medical home model?
The simulation exercise emerged as an adaptation of the 1994 Project DOCC (Delivery of Chronic Care) national curriculum that was designed by parents of children with special healthcare needs. This parent-led simulation training experience was conducted as an Inter-professional Education opportunity for 1) 3rd and 4th year medical students; 2) medical residents; 3) pharmacy students; and 4) nursing students. The simulation exercise had multiple phases: 1) pre-simulation data collection; 2) team activity; 3) pre-briefing; 4) simulation/parent interview; 5) debriefing session; 6) post test data collection. Each parent interview was recorded via video and audio. Questions posed by learners were transcribed and categorized based on the PCMH model. The dependent variable is the focus of the questions asked, as they relate to the PCMH model. Time allowed during the parent interview, size of interview groups, and the team activity were independent variables throughout the study.
Data was analyzed by categorizing each question into qualities of a PCMH as defined by The American Academy of Pediatrics (i.e. Accessible, Patient/Family Centered, Continuous, Comprehensive, Coordinated,Compassionate, and Culturally Effective). Our results indicated that a number of factors go into the quality of questions the learner’s ask. The evaluation of five DOCC simulations from 2019-2020 indicated successes and declines in initiative taken by students when questioning parents. After implementing the team activity during the third simulation cohesiveness, leadership, and questions appropriateness increased among the team. Higher quantities of questions falling under the categories of Patient/Family Centered and Compassionate were asked across every simulation. The presence of a resident increased the quantity and quality of questions asked across all disciplines of the team. There are more findings to share about what was effective and ineffective as a learning tool.
The results of this project indicated that students’ understanding of a PCMH did expand after participating in the simulation per questions asked and pre/post test results. Every question was able to be categorized into a PCMH quality, however, there were some limitations. When students were given less time with parents, asked to question multiple parents, or a medical resident was not present the quantity and quality of questions declined. It was learned that there is a particular team dynamic that encourages certain types of questions. These findings have positive implications for the healthcare simulation community as they identify specific areas of success in Project DOCC that will amplify the understanding of the young medical professionals involved and provide something they can carry with them throughout their careers as they interact with medically fragile families.