Part 1: Online Survey
23 students (15 MD, 7 RN, 1 PA) analyzed 14 IPE workshop cases covering a range of healthcare settings and disciplines (Table 2). Terms coded as inclusive and exclusive healthcare terminology were graphically represented in word clouds (Figure 1). Students identified 290 healthcare terms (28% of total word count), with 285 coded as inclusive, and 196 coded as exclusive by at least one participant (Table 3). Only 4 terms were classified as healthcare terminology by all participants, and no terms were classified unanimously as inclusive or exclusive (Appendix A-C). More than 50% of participants classified 113 words as healthcare terminology, 46 as inclusive, and 17 as exclusive (Figure 2). When RN students were compared with PA and MD students, no differences were noted in the identification or classification of terminology (Appendix A-C).
Part 2: Focus Group
22 students (14 MD, 7 RN, 1 PA) participated in two focus groups (Table 2), sharing both the challenges and benefits of introducing terminology in early IPE experiences. They described their early clinical experiences and made comparisons between these experiences and the current workshop. Four themes emerged.
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 different meanings in different settings. Rather than improving the efficiency of communication, students felt that abbreviations increased the amount of time spent deciphering and interpreting the term 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.
– RN student
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.
– RN student
Theme #2 – Unfamiliar terminology: product of being an early learner or exclusionary?
Participants found it challenging to label terms exclusive as they were unsure whether their unfamiliarity was due to a lack of clinical experience or lack of use of the terms by their profession.
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.
– MD student
Two individuals commented on the value of encountering exclusive terminology in early IPE experiences, explaining that if terms – even exclusive terms – are used in the workplace, then knowing them was helpful.
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.
– Unknown profession
Theme #3 – Simulation as a safe space
Participants noted that simulation was a safe setting to learn terminology. It was easier to ask for help from facilitators and peers compared to the clinical setting. They acknowledged that the sessions were focused on their learning, without the pressure 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."
– RN student
Participants drew comparisons to clinical settings where they commonly encountered unfamiliar terminology but found it difficult to ask for help, due to the fast-pace and perception that questions might adversely impact their assessment. As a result, students were more likely to conduct an internet search to learn terminology in the workplace, 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.
– MD student
Theme #4 – Value of complex terminology as a desirable difficulty in early IPE
Participants pointed out the additional cognitive effort required in integrating healthcare terminology, and the ways in which it could 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.
– PA student
However, participants pointed out specific benefits of utilizing healthcare terminology in early IPE experiences. They appreciated that cases reflected authentic clinical experiences.
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.
– MD student
Participants believed that healthcare terminology should be introduced as early as possible, even prior to 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.
– PA student