Assessing Team Collaboration between Nurse Practitioner and Master's-Level Social Work Students Via an Interprofessional Team Objective Structured Clinical Examination (ITOSCE)

Background and Purpose

Objective structured clinical examinations (OSCEs) have been widely used in health professions education and are increasingly utilized to assess competencies among nurse practitioner students (NP) and master of social work students (MSW).  The Interprofessional Team OSCE (ITOSCE) is a modified version in which students work in teams to care for a simulated patient. For this project, an ITOSCE was created to provide NP and MSW students with an opportunity to demonstrate clinical assessment skills and team collaboration techniques. The ITOSCE model was evaluated in terms of its association with changes in students’ level of confidence in their collaborative abilities and their mastery of various collaborative skills.

Methods

Two ITOSCE scenarios were developed that featured complex patients whose medical symptoms were exacerbated by psychosocial issues; local actors served as standardized patients and were trained to play the role of each client. During the ITOSCE, NP students first completed a 30-minute health assessment and then handed off to the MSW student for follow up. The MSW student conducted a 30-minute psychosocial assessment, and the two disciplines met again to discuss their respective clinical impressions and identify approaches for an integrated care plan. All segments of the ITOSCE were digitally recorded as a basis for student feedback and evaluative analysis.

A pre-post test research design was used. Students’ confidence in their collaborative skills was assessed before and after completing the ITOSCE using the Team Skills Scale (TSS); students’ mastery of collaborative skills as demonstrated in digitally recorded interactions was evaluated via relevant components of the Interprofessional Collaborator Assessment Rubric (ICAR). Relevant ICAR items included those evaluating communication, collaboration, team functioning, and conflict management. Given a non-normal sampling distribution, the Wilcoxon Signed Ranks Test was used to assess changes in students’ confidence levels. ICAR results were examined via simple frequency counts across students.

Results

Forty-five students participated in the ITOSCE; 20 students completed the TSS at both pre-test and post-test, representing a 44 percent response rate. Statistically significant gains in students’ confidence level were evident in two areas:  functioning effectively as an interdisciplinary team member and actively participating in team meetings. Students felt the least confident in their knowledge of care principles for effective team contributions and most confident in their ability to treat team members collegially. Digital recordings of 13 nursing and social work teams, representing 30 students working in either dyads or triads, were analyzed via ICAR. Although the majority of students scored either “mastery” or “competent” on each item, reviewers noted some students used a directive approach, authoritatively telling their partner(s) what to do rather than discussing the case collaboratively; this skill limitation was not captured via ICAR.

Conclusions and implications

Participation in the ITOSCE was associated with increased confidence in team skills and virtually all students demonstrated effective collaborative skills as measured via ICAR. However, the inability of the selected ICAR items to detect subtle differences in students’ demonstrated collaborative competencies was a limitation. Future research with instruments that better capture subtleties in students’ performance is indicated.