Simulated Patient as Co-facilitators: Benefits and Challenges of the Interprofessional Team OSCE (Submission #9350).

Hypothesis: The quality of care for chronic patients depends on the collaborative skills of the healthcare providers.1,2 The literature lacks reports of the use of simulation to teach collaborative skills in non-acute care settings. We posit that simulation offers benefits for supporting the development of collaborative practice in non-acute settings. We explored the benefits and challenges of using an Interprofessional Team - Objective Structured Clinical Examination (IT-OSCE) as a formative assessment tool. IT-OSCE is an intervention which involves an interprofessional team of trainees interacting with a simulated patient (SP) enabling them to practice collaborative skills in non-acute care settings.5 A simulated patient are people trained to portray patients in a simulated scenario for educational purposes.6,7 Since interprofessional education (IPE) ultimately aims to provide collaborative patient-centered care.8,9 We sought to promote patient-centeredness in the learning process. Methods: The IT-OSCE was conducted with four trios of students from different professions. The debriefing was co-facilitated by the SP with a faculty. The participants were final-year students in nursing, physiotherapy and medicine. Our research question focused on the introduction of co-facilitated (SP and faculty) debriefing after an IT-OSCE: 1) What are the benefits and challenges of involving the SP during the debriefing? and 2) To evaluate the IT-OSCE, an exploratory case study was used to provide fine grained data 10, 11. Three focus groups were conducted - two with students (n=6; n=5), one with SPs (n=3) and one with faculty (n=4). Audiotapes were transcribed for thematic analysis performed by three researchers, who found a consensus on the final set of themes. Results: The thematic analysis showed little differentiation between SPs, student and faculty perspectives. The analysis of transcripts revealed more particularly, that the SP's co-facilitation during the debriefing of an IT-OSCE proved to be feasible. It was appreciated by all the participants and appeared to value and to promote patient-centeredness in the learning process. The main challenge consisted in SPs feedback, more particularly in how they could report accurate observations to a students' group rather than individual students. Conclusion: In conclusion, SP methodology using an IT-OSCE seems to be a useful and promising way to train collaborative skills, aligning IPE, simulation-based team training in a non-acute care setting and patient-centeredness. We acknowledge the limitations of the study, especially the small sample and consider the exploration of SP-based IPE in non-acute care settings as strength. Future studies could consider the preparation of SPs and faculty as co-facilitators. References: 1. Borrill CS, Carletta J, Carter AJ, et al. The effectiveness of health care teams in the National Health Service. Aston centre for Health Service Organisational Research. 2001. 2. Reeves S, Lewin S, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. Oxford: Wiley-Blackwell; 2010. 3. Issenberg S, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning - a BEME systematic review. Medical Teacher. 2005;27(1):10-28. 4. McGaghie W, Petrusa ER, Gordon DL, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Medical Education. 2010;44(1):50-63. 5. Simmons B, Egan-Lee E, Wagner SJ, Esdaile M, Baker L, Reeves S. Assessment of interprofessional learning: the design of an interprofessional objective structured clinical examination (iOSCE) approach. Journal of Interprofessional Care. 2011;25(1):73-74. 6. Nestel D, Layat Burn C, Pritchard SA, Glastonbury R, Tabak D. The use of simulated patients in medical education: Guide Supplement 42.1 - Viewpoint. Medical teacher. 2011;33(12):1027-1029. Disclosures: None (C) 2014 by Lippincott Williams & Wilkins, Inc.

Determinants of school efficiency : The case of primary schools in the State of Geneva, Switzerland

The public primary school system in the State of Geneva, Switzerland, is characterized by centrally evaluated pupil performance measured with the use of standardized tests. As a result, consistent data are collected among the system. The 2010-2011 dataset is used to develop a two-stage data envelopment analysis (DEA) of school efficiency. In the first stage, DEA is employed to calculate an individual efficiency score for each school. It shows that, on average, each school could reduce its inputs by 7% whilst maintaining the same quality of pupil performance. The cause of inefficiency lies in perfectible management. In the second stage, efficiency is regressed on school characteristics and environmental variables;external factors outside of the control of headteachers. The model is tested for multicollinearity, heteroskedasticity and endogeneity. Four variables are identified as statistically significant. School efficiency is negatively influenced by (1) the provision of special education, (2) the proportion of disadvantaged pupils enrolled at the school and (3) operations being held on multiple sites, but positively influenced by school size (captured by the number of pupils). The proportion of allophone pupils; schools located in urban areas and the provision of reception classes for immigrant pupils are not significant. Although the significant variables influencing school efficiency are outside of the control of headteachers, it is still possible to either boost the positive impact or curb the negative impact. Dans le canton de Genève (Suisse), les écoles publiques primaires sont caractérisées par un financement assuré par les collectivités publiques (canton et communes) et par une évaluation des élèves à l'aide d'épreuves standardisées à trois moments distincts de leur scolarité. Cela permet de réunir des informations statistiques consistantes. La base de données de l'année 2010-2011 est utilisée dans une analyse en deux étapes de l'efficience des écoles. Dans une première étape, la méthode d'analyse des données par enveloppement (DEA) est utilisée pour calculer un score d'efficience pour chaque école. Cette analyse démontre que l'efficience moyenne des écoles s'élève à 93%. Chaque école pourrait, en moyenne, réduire ses ressources de 7% tout en conservant constants les résultats des élèves aux épreuves standardisées. La source de l'inefficience réside dans un management des écoles perfectible. Dans une seconde étape, les scores d'efficience sont régressés sur les caractéristiques des écoles et sur des variables environnementales. Ces variables ne sont pas sous le contrôle (ou l'influence) des directeurs d'école. Le modèle est testé pour la multicolinéartié, l'hétéroscédasticité et l'endogénéité. Quatre variables sont statistiquement significatives. L'efficience des écoles est influencée négativement par (1) le fait d'offrir un enseignement spécialisé en classe séparée, (2) la proporition d'élèves défavorisés et (3) le fait d'opérer sur plusieurs sites différents. L'efficience des écoles est influencée positivement par la taille de l'école, mesurée par le nombre d'élèves. La proporition d'élèves allophones, le fait d'être situé dans une zone urbaine et d'offrir des classes d'accueil pour les élèves immigrants constituent autant de variables non significatives. Le fait que les variables qui influencent l'efficience des écoles ne soient pas sous le contrôle des directeurs ne signifie pas qu'il faille céder au fatalisme. Différentes pistes sont proposées pour permettre soit de réduire l'impact négatif soit de tirer parti de l'impact positif des variables significatives.

Determinants of school efficiency : The case of primary schools in the State of Geneva, Switzerland

Purpose The purpose of this paper is (1) to measure school technical efficiency and (2) to identify the determinants of primary school performance. Design/methodology/approach A two-stage Data Envelopment Analysis (DEA) of school efficiency is conducted. At the first stage, DEA is employed to calculate an individual efficiency score for each school. At the second stage, efficiency is regressed on school characteristics and environmental variables. Findings The mean technical efficiency of schools in the State of Geneva is equal to 93%. By improving the operation of schools, 7% (100 - 93) of inputs could be saved, representing 17'744'656.2 Swiss francs in 2010. School efficiency is negatively influenced by (1) operations being held on multiple sites, (2) the proportion of disadvantaged pupils enrolled at the school and (3) the provision of special education, but positively influenced by school size (captured by the number of pupils). Practical implications Technically, the determinants of school efficiency are outside of the control of the headteachers. However, it is still possible to either boost the positive impact or curb the negative impact. Potential actions are discussed. Originality/value Unlike most similar studies, the model in this study is tested for multicollinearity, heteroskedasticity and endogeneity. It is therefore robust. Moreover, one explanatory variable of school efficiency (operations being held on multiple sites) is a truly original variable as it has never been tested so far.