Interprofessional collaborative reasoning by residents and nurses in internal medicine: Evidence from a simulation study

Abstract

Clinical reasoning has been studied in residents or nurses, using interviews or patient-provider encounters. Despite a growing interest in interprofessional collaboration, the notion of collaborative reasoning has not been well studied in clinical settings. Our study aims at exploring resident-nurse collaborative reasoning in a simulation setting. We enrolled 14 resident-nurse teams from a general internal medicine division in a mixed methods study. Teams each managed one of four acute case scenarios, followed by a stimulated-recall session. A qualitative, inductive analysis of the transcripts identified five dimensions of collaborative reasoning: diagnostic reasoning, patient management, patient monitoring, communication with the patient, and team communication. Three investigators (two senior physicians, one nurse) assessed individual and team performances using a five-point Likert scale, and further extracted elements supporting the collaborative reasoning process. Global assessment of the resident-nurse team was not simply an average of individual performances. Qualitative results underlined the need to improve situational awareness, particularly for task overload. Team communication helped team members stay abreast of each other’s thoughts and improve their efficiency. Residents and nurses differed in their reasoning processes, and awareness of this difference may contribute to improving interprofessional collaboration. Understanding collaborative reasoning can provide an additional dimension to interprofessional education.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Collaborative reasoning: a team’s process of reaching a shared mental model about the patient’s problem and its management.

Mason L. 1996. Collaborative reasoning on self‐generated analogies: conceptual growth in understanding scientific phenomena. Educ Res Eval. 2:309–350.

Notes on contributors

K. S. Blondon, MD, PhD, is an internist at the University Hospitals of Geneva. She studies interprofessional collaboration and conflicts, physician handoffs.

F. Maître, RN, is a head nurse of a ward in Internal Medicine at the University Hospitals of Geneva, and has interests in quality improvement, in particular interprofessional collaboration and conflicts.

V. Muller-Juge, MSc, is an education scientist working in the Unit of Development and Research in Medical Education and the Unit of General Internal Medicine and Pediatrics at the University of Geneva and conducts research on interprofessional collaboration and conflicts at the University of Geneva, Switzerland.

N. Bochatay, MSc, is a sociologist and anthropologist working in the Unit of Development and Research in Medical Education at the University of Geneva and conducts research on interprofessional collaboration and conflicts.

S. Cullati, PhD, is a sociologist, studies interprofessional collaboration and conflicts, and works in the Quality of Care Service at the University Hospitals of Geneva.

P. Hudelson, PhD, is an anthropologist who conducts research on interprofessional collaboration and conflicts, and works in the Department of Primary Care at the University Hospitals of Geneva.

N. V. Vu, PhD, is a professor emeritus of the Unit of Development and Research in Medical Education at the University of Geneva. She studies interprofessional collaboration and conflicts.

G. L. Savoldelli, MD, MEd, is an associate professor in Anesthesiology at the University Hospitals of Geneva, and works in the Unit of Development and Research in Medical Education at the University of Geneva. He conducts research on interprofessional collaboration and conflicts.

M. R. Nendaz, MD, MHPE, is a full professor in Internal Medicine at the University Hospitals of Geneva, and Director of the Unit of Development and Research in Medical Education at the University of Geneva. He is leading research in interprofessional collaboration, conflicts and clinical reasoning.

Additional information

Funding

The study was funded by the Fondation Ernst et Lucie Schmidheiny (ME 8676) and the Projet de Recherche et de Développement, Direction médicale, Hôpitaux Universitaires de Genève (PRD 2010-II-5). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.