Research on the application effect of inter-professional training program for newly enrolled medical staff in operating room based on digital information technology

Abstract

Background

The operating room environment demands high levels of teamwork and interprofessional collaboration, yet current training programs often lack sufficient opportunities to develop these essential skills. Few studies have explored the impact of Interprofessional Education (IPE) based on digital information technology in improving the collaboration and learning among newly enrolled medical staff in the operating room.

Objectives

This study aimed to design, implement, and evaluate a digital information technology-based IPE training program for newly enrolled medical staff in the operating room. The evaluation focused on the effects of the program on the participants’ expertise, operational knowledge, team communication skills, and application of these skills in clinical practice.

Methods

Sixty-eight newly enrolled medical staff from surgical departments in a tertiary hospital in Shanxi province were included in this study from January 2021 to December 2022. The participants engaged in an IPE training curriculum that utilized digital information technology, featuring courses and case studies specifically tailored to the operating room environment. Post-training assessments included evaluation of test scores of expertise course, evaluation of surgical simulation operations (operational knowledge and communication), and the International Interprofessional Collaboration Competency Attainment Survey (ICCAS). The effectiveness of the training was assessed by evaluating improvements in communication skills, application of practical knowledge, and teamwork in surgical contexts.

Results

Expertise course evaluation and reflection revealed that the new enrolled medical staff in the operating room had a deep understanding of the knowledge. At the same time, they are better able to understand and master the nursing mode in the process of different professional surgery, and said that they would like to cooperate with surgeon and anesthesiologist during the surgical operation. The score of the Interprofessional Collaborative Competency Attainment Survey (ICCAS) increased significantly (P < 0.05), indicating that the communication and collaboration skills of the new enrolled medical staff in operating room were further improved, and that they were more familiar with the patient-centered teamwork mode.

Conclusions

This study provides a valuable reference for the design and implementation of IPE programs based on digital information technology in the operating room. It highlights the importance of such programs in enhancing the understanding and cross-disciplinary communication skills for newly enrolled medical staff, ultimately improving patient care through better teamwork.

Introduction

The ability of doctors and nurses to work closely together in the operating room is key to successful surgery. Completing surgery requires a multidisciplinary approach and teamwork [17]. A higher proportion of medical staff in the operating room can result in lower clinical surgical cooperation capabilities [30]. Operating Room (OR) managers need to strengthen training, enrich the training methods, and create a supportive environment in the standardized training for newly enrolled nurses to improve their care practice abilities and ensure the quality of critical operations [13]. Medical education in newly enrolled nurses play a pivotal role in cultivating nursing professionals. Traditional teaching methods, however, are increasingly insufficient in meeting the evolving demands of current medical education [13].

Interprofessional education (IPE) in health professional education is crucial for nurturing a collaborative practice-ready workforce to ensure patient-centered care and safety [11]. IPE occurs through formal interprofessional teaching sessions where two or more professions can learn with each other to improve collaboration and quality of patient care [31]. The Interprofessional Education Collaborative (IPEC) has identified four core competencies of interprofessional collaboration that can be developed through IPE: (1) values and ethics for interprofessional practice; (2) roles and responsibilities; (3) interprofessional communication; and (4) teams and teamwork [17]. Many studies demonstrated that IPE provides opportunities for communication and collaboration among different disciplines, helping to gain knowledge and skills, change attitudes, and improve clinical competency for better patient care in fields such as oncology, endocrinology, and pulmonology [6, 7, 19]. However, traditional interdisciplinary education is limited by time and space in hospital. Due to the epidemic of COVID-19, more social activities have been moved online, such as online education and learning. Online education and communication have provided convenience and opportunities for training newly medical staff [39, 20, 10]. However, to date there are few reported studies on the effectiveness of interprofessional training programs for newly enrolled medical staff in operating room based on digital information technology [38].

The aim of this study is to describe an implementation science approach translating an IPE training model based on digital information into medical and nursing curriculums, and to evaluate the implementation outcomes using Proctor’s conceptual framework. This study provides health managers with important insights into the IPE based on digital information educational program and implementation science, and aims to improve the quality of training for newly enrolled medical staff.

Methods

Study design

A mixed-methods study design was used, combining pretest-posttest approach and focus group discussions (FGDs) (The results of FGDs in this paper consist only of the quantitative data.) to evaluate students’ perceived effects of IPE in the operating room using digital information technology.

Participants and setting

From January 1, 2021, to December 31, 2022, 68 enrolled clinical staff members (31 nurses, 7 anesthetists, 22 surgeons, 8 pharmacists) from a tertiary hospital, Shanxi Provincial People’s Hospital, were invited to participate in the study. A traditional sampling process was not employed. Instead, all newly enrolled medical staff were required to participate in the IPE training course. (This study did not employ traditional sampling methods to collect data for three reasons: the small number of new recruits, the purpose of training all newly employed clinical staff, and the need to assess the economic impact.) [22]. All staffs signed an informed consent form. The courses pertained to various disciplines (Pharmacy, anesthesiology, nursing, and surgery) and generally included pre-clinical, clinical and compulsory training cycles. The courses were primarily delivered through online lectures, complemented by practical sessions and surgical case discussions based on digital information technology. The main course learning outcomes were: (1) to gain knowledge about the focus and approach of other healthcare professionals when examining a complex patient in a simulated operation; (2) to perform an interprofessional assessment of a patient; and (3) to reflect on the value of interprofessional collaboration during the procedure.

Teaching support

The teaching and training team monitored students’ participation and provided instructional guidance, including supportive strategies for technical problems. Team members included a course director, four online instructors (The course director for this initiative is a distinguished professional hailing from the hospital’s Training Center. The instructional faculty, which includes specialists such as a surgeon, anesthesiologist, pharmacist, and nurse, were meticulously selected from among professionals holding the rank of associate director or superior within premier in tertiary A hospital. These professionals have self-volunteered to participate in this education guidance, further underscoring their commitment to the initiative.), and an engineer from the information technology department. The engineer was responsible for training team members and students on the simulation platform’ s operation. All faculty members collaborated to discuss and decide on the practical contents, including the selection of operation cases. They considered and assessed the operational challenges of the digital information platform during activity design.

Procedures

The IPE training program primarily consists of two parts. The first part of the training was delivered over a 12-week period, with participants engaging in 10 h of training per week. This included 5 h of online theoretical instruction. A total of 68 newly enrolled medical staff used an online system to participate in the course, which focused on theoretical instruction for operating room nurses.

The second part of the training involved surgical operation simulation, serving as the primary method for operation practice. This simulation focused on interprofessional cooperative scenarios (Inclusion criteria for scenarios included relevance to operating room practice and the ability to highlight key interprofessional competencies. Exclusion criteria involved scenarios that were either too specialized or not directly applicable to the operating room context.). Before conducting the simulation exercises, instructors with extensive clinical experience in the operating room were selected. These instructors had over 10 years of experience and held titles of deputy senior or higher. A dedicated scenario simulation teaching team was formed, comprising surgeons, anesthesiologists, and instructors. This team collaboratively developed scripts for the simulated surgery scenarios, selecting three typical cases for simulation. The cases were arranged in order of increasing complexity: the first involved an appendectomy, the second focused on cholecystitis surgery, and the third dealt with surgical cooperation for hemorrhagic shock due to liver and spleen rupture. The simulation cases also included unexpected situations and common errors, such as gauze loss, block breaks, and needle fractures. Following each simulation exercise about two hours, 1 h of classroom-based surgical case discussions was conducted to reflect on the scenarios, address challenges encountered, and reinforce learning. we utilized the Kirkpatrick Model to develop Proctor’s Conceptual Framework, focusing on three specific levels: Reaction, Learning, and Behavior. These levels were selected to systematically evaluate the effectiveness of the interprofessional training program (A detailed scheme of the training program is illustrated in Fig. 1) [8, 3].

Fig. 1

Flow of research activities diagram developed by the authors for this study

Instruments

General information

General information about participants was collected, including their age, sex, major, grade, and experience related to digital information and IPE.

Surgery-related knowledge

A test was used to evaluate participants’ knowledge of surgery, consisting of ten multiple-choice questions, including both single-answer and multiple-answer questions. The questions were developed jointly by the faculty team and two clinical surgery specialists, based on the surgery competency framework [12]. The total teaching time was 120 h, including 100 h for core courses (The 30 h of related nursing courses are exclusive to nurses, while all staff members are required to complete the 70 h of core courses.) and 20 h for basic courses (All newly enrolled staff are required to complete the training.) (Table 1).

Table 1 Contents of the virtual simulation-based interprofessional education activity for rehabilitation nursing

Participants’ feedback

A comprehensive questionnaire (S1) was developed to assess various aspects of the feedback of the IPE program, including participants’ satisfaction, the effectiveness of the digital platform and Perceived effectiveness of online tools for IPE. Participant satisfaction with the IPE program was measured using the Interprofessional Education Perception Scale (IEPS), which comprises 18 items rated on a 5-point Likert scale [21, 33]. The usability of the digital information platform was assessed through the System Usability Scale (SUS), a 10-item questionnaire using a 5-point Likert [4, 5]. To evaluate the perceived effectiveness of online tools for IPE, the e-Learning Systems Success (ELSS) scale was utilized, featuring 34 items rated on a 7-point Likert scale [32]. A pilot study (n = 10) was conducted to ensure the clarity and comprehensiveness of the questionnaire, resulting in minor adjustments to item wording. Reliability analysis revealed high internal consistency for all scales (Cronbach’s α ranging from 0.88 to 0.94). Content validity was established through expert review, while construct validity was supported by confirmatory factor analysis, demonstrating good fit indices for all scales. The Chinese versions of these instruments, translated and culturally adapted following established guidelines [5], were employed in this study, exhibiting psychometric properties comparable to their original English counterparts [34, 16].

Data collection

The Learning Through online platform was utilized to administer pre-test and post-test questionnaires to participants [29]. Pre-test data collection included demographic information and baseline scores for the Interprofessional Collaborative Competency Attainment Survey (ICCAS) [26], the Interprofessional Education Perception Scale (IEPS), and the e-Learning Systems Success (ELSS) scale [1, 35]. Throughout the program, the online platform recorded participants’ course engagement data, including time spent on modules, completion rates, and performance on embedded assessments.

Post-test data collection, conducted immediately after the final session, comprised the ICCAS, IEPS, and ELSS scales to measure changes in interprofessional competencies, perceptions, and e-learning effectiveness, respectively. The System Usability Scale (SUS) was also administered at this time to evaluate the usability of the digital platform [14]. Additionally, participants’ feedback on the overall IPE experience was gathered through open-ended questions.

To ensure unbiased data collection, two research team members who were not involved in the facilitation of the online-based IPE sessions were responsible for the data collection process. These team members sent e-questionnaires via a secure chat group, provided clear instructions for completion, and were available to address any queries from participants. They also conducted follow-up reminders to maximize response rates. All data were collected electronically, ensuring accuracy and reducing the risk of transcription errors. The online platform’s built-in features allowed for real-time data validation, prompting participants to complete any missing items before submission. This approach minimized incomplete responses and enhanced the quality of the collected data.

Statistical analysis

SPSS Version 22 [25] was used for data analysis. Descriptive statistics were employed to present participants’ general characteristics and feedback results as measurable values and percentages. Pre- and post-test scores were expressed as means and standard deviations (mean ± SD) if normally distributed. Paired t-tests were used to calculate statistical significance between pre- and post-test scores, and “effect size” value was represented by Cohen’s d value. ANOVA were were used to calculate statistical significance between pre- and post-test scores among 4 groups. All statistical tests were two-tailed, and the significance level was set at 0.05. Differences between pre-test and pro-test scores on the ICCAS (knowledge of surgery and interprofessionl collaboration) were used to evaluate the effectiveness of the online-based program.

Results

Participant characteristics

Newly enrolled clinical staff were included in this study, including 31 nurses (45.6%), 7 anesthetists (10.3%), 22 surgeons (32.4%) and 8 pharmacists (11.8%). Finally, participants were organized into eight study groups. Seven of the eight groups respectively had an anesthetist and a pharmacist, four nurses, and three clinical surgeons. The last group consisted of the remaining members, including one pharmacist, one surgeon, and three nurses. The median age of participants was 24 years. All participants completed the questionnaires before and after the activity. Of the 68 participants, 69.1% were female and 30.9% were male. A majority, 77.9%, had prior training experiences with digital information, while 22.1% did not. Only 4.4% of participants had previous experience with Interprofessional Education (IPE), and 95.6% had none. Notably, none of the participants had experience with IPE based on digital information. After completing the online specialized courses, all scores were above 90, and there were no statistically significant differences in the expertise assessment scores across different professional background, gender, experiences with digital learning, experiences with IPE (P>0.05).The characteristics of the participants and their expertise scores are shown in Table 2.

Table 2 Characteristics of the participants (N = 68)

Effect of surgical IPE on operation knowledge and team communication

All participants completed the presimulation and postsimulation tests. The newly enrolled clinical staffs had statistically significant higher scores for in both operational knowledge and communication compared to their presimulation scores (Table 3). After attending the IPE, anesthetists, surgeons, and pharmacists continued to have significantly higher post-test scores than the nurses, except for communication scores. Nonetheless, as shown in Table 4, all groups showed significant improvements in their post-test scores for operation knowledge and communication after attending the surgical IPE. And we also found that the operational knowledge acquired and communication skills improved among the newly enrolled clinical staff were maintained after 5 months of follow-up.

Table 3 Summary of mean scores before and after IPE training (mean ± SD)

Table 4 Comparison of the pretest and posttest mean scores within the newly enrolled clinical staff (mean ± SD)

The results of the ICCAS pre-IPE and post-IPE total and subscales are presented in Fig. 2 demonstrating the changes in the subscales after IPE. All ICCAS subscales demonstrated a statistically significant improvement in newly enrolled clinical staff’s self-reported interprofessional competencies (P < 0.05). In the post-IPE training survey, all trainers were asked, ‘Compared to before the learning activities, would you say your ability to collaborate interprofessionally is: ‘much worse now’ to “much better now” on a five-point Likert-type scale. All students who attended the IPE training reported either ‘somewhat better’ or ‘much better’.

Fig. 2

Mean values of ICCAS subscales before and after among newly enrolled clinical staff

Post-activity feedback

Participant feedback about the IPE training based on digital information is summarized in Table 5. Each participant’s average response score from the raw questionnaire was rescaled to a 1–5 range. These rescaled scores were then categorized into four intervals. The number of participants in each category was counted and converted to percentages based on the total number of participants (N = 68).

Most (94.14%) participants felt satisfied or very satisfied with the overall training activity, and 73.53% thought the shared digital information easy or very easy to use. The vast majority (75.00%) perceived the digital information as an effective or very effective method for IPE. In terms of suggestion, 25 newly enrolled clinical staffs gave comments. Half of them described their learning experience using adjectives such as “meaningful” and “precious.” Some noted that they needed more time to become familiar with the operation because of the differences between each practice case. Some expressed a desire for more opportunities to practice using the digital information platform with faculty guidance before the formal sessions. Of course, a minority advised that more typical operation cases should be simulated during training based on the digital information platform. It is noteworthy that the dissatisfied participant with overall satisfaction was a nurse, and the nine who experienced difficulties regarding the ease of shared IPE platform use were all newly enrolled nurses. Regarding those who judged the use of digital information for IPE ineffective, six were pharmacists, one was a nursing staff member, and the other an anesthesiologist.

Table 5 Participant feedback on the digital information-based interprofessional education (N = 68)

Discussion

The present study found that IPE training improved expertise knowledge, operational knowledge and communication among newly enrolled clinical staff and that these gains were maintained after 5 months of follow-up. All ICCAS subscales demonstrated a statistically significant improvement in newly enrolled clinical staff’s self-reported interprofessional competencies. Participants’ feedback about the IPE training based on digital information is summarized that indicated satisfaction with the program, and they hope many expressing a desire for more extensive IPE training opportunities.

The results demonstrated the potential impacts of digital information-based IPE training activity on participants’ acquisition of operational knowledge. This observation is consistent with Saaiq et al. [27], who concluded that medical knowledge was increased among healthcare students after digital teaching on IPE training. In addition, a descriptive qualitative study also supported the benefits of virtual IPE in developing knowledge of interprofessional competencies for students from different health professions [36]. In this study, we utilized a straightforward online test to assess participants’ expertise and operational knowledge, which effectively reflected both high levels of expertise and significant improvements in operational skills. Ensuring a solid foundation of theoretical knowledge is essential for surgical practice. However, seamless cooperation among medical staff is crucial for the successful completion of the operation.

Therefore, we evaluated communication scores of pre-simulation and post-simulation of surgery, and we also conducted the ICCAS teamwork ability score test before and after IPE and found that communication, collaboration, responsibilities, a collaborative patient-centered approach, conflict management, and team functioning scores increased significantly across all seven dimensions. Similar findings were reported in another study involving 99 students from 3rd to 5th-year undergraduate and 2nd-year graduate entry healthcare programs [9]. A Canadian study also found that IPE significantly enhanced the perceived ability of practice supervisors for interprofessional collaboration among third-year undergraduate nursing students [2]. However, most studies focus on IPE for students, not newly enrolled clinical staff [28, 24, 15]. Training at this stage is particularly crucial for future careers, especially in surgical coordination, which directly determines the smooth completion of operations [18]. A qualitative study also found that newly recruited medical staff who participated in IPE-based activities performed well in surgical simulations, were satisfied with the IPE, and suggested incorporating such activities more frequently in the operating room [17].

Separate interviews were conducted with those new employees who were dissatisfied, experienced difficulties, or found the training ineffective. We found that one nursing staff member was dissatisfied due to difficulty, mainly because some of the surgical knowledge was quite complex. However, they were interested in it and felt it would be beneficial for their future surgical work. Therefore, it is recommended that instructors provide additional guidance and clarification. The primary issue with ineffectiveness was observed among pharmacists, who felt that pharmacy-specific content required separate learning and was not suitable for interprofessional education (IPE). It is suggested that this aspect be improved in the future. This indicates the need to focus on and strengthen interdisciplinary education in the future, particularly among anesthetists, pharmacists, nurses, and clinical surgeons [37].

In the post-epidemic era, online education has proven highly effective in overcoming barriers of time and space, allowing for training and learning anytime and anywhere [23]. We also observed these advantages in the digital information-based IPE. While our study provides important insights into IPE training using digital tools, it is limited by a small sample size, which may affect generalizability, and by a focus on short-term outcomes without assessing long-term impacts. Additionally, reliance on self-reported data could introduce bias. Future research should involve larger, more diverse samples, employ longitudinal designs to evaluate long-term effects, utilize objective data collection methods, and explore new digital tools like virtual reality to enhance training outcomes.

In summary, this study offers a reference for designing and implementing IPE courses based on digital information technology. It enhances the understanding of newly enrolled medical staff in the operating room, increases their experience with cross-professional communication, and highlights the value of such communication. This provides valuable training experience for operating room managers.