Theory guided interprofessional simulation

Oral Presentation 1
Dr Sarah O'Hare, Dr Richard Conn, Prof Gerard Gormley

Theory guided interprofessional simulation: Designing an in-situ simulation programme to enhance transformative agency and enable organisational change

INTRODUCTION
The critical nature of emergencies requires General Practice (GP) practices to provide a prompt patient-centred collaborative approach. In-situ simulation (ISS) is documented as an acceptable and feasible way to train for high acuity, low opportunity scenarios such as emergencies. Existing GP ISS research is individually focused and often atheoretical. Cultural historical activity theory (CHAT) is useful as a methodological framework for the vital task of studying practice-based learning in complex learning environments(1). Transformative agency by Double Stimulation (TADS), a concept associated with CHAT, provides new opportunities for education to structure, analyse and interpret collective change.

OBJECTIVES
Guided by CHAT principles an interprofessional team participated in a longitudinal programme of ISS “SimLab” relating to GP paediatric emergencies. We sought to understand how the SimLab mediated transformative agency in responding to paediatric emergencies.

METHODS
Workshop (I) involved a “mocked-up” paediatric ISS. Afterwards, participants were provided with a summary of recognised best practice, researchers facilitated participants in identifying workplace activity to CHAT framework and identified contradictions. In Workshop (II), through collaborative activity participants identified accumulated historical tensions and devised a future model to resolve contradictions(2). Workshop (III) involved a different ISS followed by a discussion to explore if the changes had enhanced their emergency response. The study applied qualitative data collection methods including focus group recordings, video footage and participant reflection diaries to gain detailed accounts of participants’ experiences. Analysis used TADS as a theoretical framework to identify, quantify, trace and understand manifestations of transformative agency.

OUTCOMES
CHAT enabled a deeper exploration of the complex relationship of ISS and real-world clinical practice(3). Two months later a follow up interview demonstrated that many elements of their newly modelled systems had become stable in their organisational structures and were considered an enhancement on previous practice. Participants exhibited six types of expressions of transformative agency; resisting, criticising, explicating, envisioning and committing to actions which evolved through collective activity over the course of the SimLab(4). Agentive actions centred around: re-envisioning the role of non-clinical staff; acknowledging the limitations of individualised approaches; formalising emergency care responses; and recognising the need to reforming delivery of emergency training.

CONCLUSIONS 
This study presents a CHAT-informed ISS programme which scaffolded the process of TADS, enabling participants to exhibit transformative agency and develop systemic solutions. We propose further research applying this approach in other contexts, further evaluating the pedagogic potential of ISS as a mediator of organisational change.