Exploring Cognitive Bias Using a Simulation Enhanced IPE Activity

Hi, everyone. Welcome. We’ll give just another minute here while everyone’s filing in before we get started.

All right, well, we’ll go ahead and get started. This morning Hi, everyone. Thank you for joining us for Reaction I’m Kelly Fitzgerald, and I’m looking forward to today’s presentation Doctor Carman Turkelson is joining us from the University of Michigan School of Nursing Simulation Center. And Leslie Smith and Julia Hollenbeck are joining us from the University of Michigan, Flint for this session exploring cognitive bias using a simulation enhanced IPE activity.

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And we will have a roundtable discussion after where you can ask your questions to our presenters today. So if you do have questions, go ahead and add those to the Q&A window

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We will answer as many as we possibly can during that roundtable discussion after.

I will go ahead and turn the time over to our presenters, now. Thank you so much.

Thank you Kelly very much and thank you for having us.

I just want to say hi from Michigan and go blue. I saw in the comments everyone was saying where they were from. So we finally got some good weather here today.

One day we had about another three inches of snow. Saturday, it’s supposed to be close to 80, so typical Michigan weather for us. So today, we’re going to talk about exploring cognitive bias using a simulation enhanced IPR activity.

Our research team was like Kelly mentioned Doctor Carmen Turkelson is in our nursing school of nursing. Leslie Smith is in the Department of Physical Therapy and myself, Julie Hollenbeck, Program Director for Radiation Therapy. So the purpose of our simulation interprofessional experience was to explore cognitive bias with a focus on situational awareness.

We took a simulation House of Horrors sim and that focused on situational awareness and then we decided to use it as an IPE to help students possibly identify cognitive bias. So we asked ourselves two questions when we built this and put this together for the students. By bringing students together from different professions, nursing, physical therapy, and radiation therapy in a Sim-IPE, could we help them identify cognitive bias.

And then would they be able to explore ways that they could reduce cognitive bias and hopefully improve patient outcomes? So from there, I am going to give this to Dr. Turkelson to discuss our methods.

Thank you, Julie. And thank you everyone for having us today. We’re really excited to be here. And like Julie, I’m looking at the chat and seeing it looks like so many people are in warmer areas than we are.

But there’s hope like she said. We’re–

you can advance the slide, Julie, really excited to share this Sim-IPE activity this is one of several IPE activities that we do that are simulation based within our different schools.

So as Julie mentioned, I’m from the School of Nursing. Leslie and Julia from the College of Health Sciences and Leslie representing physical therapy and Julie representing radiation therapy.

And as Julie mentioned, this project originally started with nursing. So my nursing students did what I called the house of horrors. And in talking to Leslie, I learned that her students were doing something very similar called the house of horrors but for PT students.

And that’s how together, our team started having these conversations and asking these questions well, what would it look like if we made this an IPE activity? And how would the perceptions or situational awareness between the PT, nursing, and radiation therapy differ? And you know, Julie mentioned situational awareness. So I just want to make sure we’re all on the same page with that. That’s our understanding of an environment.

And so our conversations were well as a nurse, my understanding of the environment may look different than the understanding of a radiation therapist or even a physical therapist. And then we were also looking at different types of cognitive biases or ways that maybe our line of thinking could be wrong. We all know that all of us have biases, conscious and unconscious biases. And some of those can lead us to making the wrong decisions.

So we were specifically looking at a couple of different types of cognitive biases such as overconfidence, the bandwagon theory, and confirmation biases as a couple of examples that we were specifically interested in. We took a convenient sample of our learners, so students from undergraduate nursing and undergraduate radiation therapy and physical therapy to create this IPE program. We used a specific theoretical model to guide the development of this program.

And as I mentioned, we do multiple Sim-IPE activities that are embedded throughout the curriculum in all of these programs. So this activity was one of several IPE related activities that our students will participate in over the course of their curriculum. So I don’t want you to think that this was the only introduction or activity that was interprofessional that they were involved in.

And the idea behind Ericsson’s model is that you need repeated exposure in order to develop expertise. And we really embrace that model our faculty that do IPE and that all of our students need repeated opportunities for exposure, repeated opportunities for interprofessional learning and guidance from experts in order to develop and attain those core IPEC competencies.

You can advance the slide, Julie.

So this project involved–

we broke it down into really three phases. So there were some pre-learning activities that all of the students had to complete before they came to on-campus Sim-IPE, or House of Horrors IPE as we called it. And then you can see that Sim-IPE activity itself included a few activities. And I’ll go into those in detail in a minute.

And then the third component included a reflective writing assignment that the learners or the students did on their own after participating in that Sim-IPE activity.

You can advance the slide.

So that first phase that for the pre-learning activities, we felt it was important that the learners come to that Sim-IPE session with a little bit of knowledge and a little bit of understanding about what we were trying to achieve.

We use a learning management system called Blackboard. We’re shifting to Canvas in the fall of this year. But that’s just basically the learning platform that we’re using. And all of us had our individual courses.

So we all posted, Leslie, Julie, and I within our respective courses the pre-learning material for the students to complete before they came. That was posted on Blackboard. And it included a short video on what cognitive bias was.

And then we also included videos on each of the professions. So for my nursing students, there were two videos, one related to what it means to be a physical therapist and one related to radiation therapy.

For Leslie’s students, she posted a nursing video and radiation therapy and Julie’s students, they had the PT and the nursing videos. And that was really just so that the students could learn and understand a little bit about each of the professions. And I do want to say, and I’ll let Leslie and Julie comment on their students. But my students were in the second semester of the nursing program.

So they really had just started their clinical activities and really probably didn’t know a lot about the other professions just yet. So those videos were to help with that. And then we also asked them to read an article on cognitive bias in health leaders, which kind of outlines how cognitive bias can impact patient outcomes and patient safety.

Next slide.

So the second phase, so the pr-learning activity was like their ticket to the Sim-IPE event was them coming to campus for a one hour Sim-IPE.

And that included multiple activities, as you can see, were packed into that hour.

There was a pre-briefing, then the actual house of horrors course activity. We also did some team perception activities. And then we had a debriefing included in that. And again, I’ll go into each of these in a minute.

Logistically, we ended up having 39 undergraduate nursing students, 57 physical therapy students, and 16 radiation therapy students. So you can see one of the challenges with any IPE activity, of course, is getting all the learners there on the same two days, which we did this over two days but also trying to make sure that we have representation from each of the different professions in our groups.

We tried to create a schedule so that at least two of the programs were represented. Because you can see there’s a huge variation in the numbers of radiation students compared to physical therapy and even nursing. So we decided that at a minimum, we wanted to have at least 2 of the programs represented. We ended up bringing 9 to 11 students at a time for these one hour sessions. And then once they were there, they were broken into 2 smaller groups of 4 to 6 students.

And again, we were making every effort to make sure that those smaller groups of students represented at least two professions. So we didn’t want four nursing students altogether or four physical therapy students all together. The whole idea this was an interprofessional activity.

Next slide.

So the pre-briefing, that’s when we all gather together in a small kind of conference area so this is the 9 to 11 students all coming together. We’re introducing ourselves. We had two faculty facilitators at each of the sessions and again, trying to represent each two professions in our facilitators, too. So it wasn’t just a nursing or a PT faculty or radiation therapy. Two of us were there for all of the sessions.

And we introduced ourselves. We had the students introduce themselves. We obtained consent because this was an IRB based project. And we were collecting data from the students.

And students could opt out if they wanted to in terms of allowing us to use the reflections for the data collection. They could not opt out of participating in the activity because it was considered part of our coursework, non-graded. But they could opt out of allowing us to use their reflections. And I don’t think really any of them did that.

But we distributed all that paperwork. And then part of the pre-briefing had us breaking that group of 9 to 11 students into two smaller interprofessional groups. And we kind of did this randomly. If I’m remembering right, I think we asked them like what’s your favorite color? And if people said red, two people said red, then they were on a team together or pink, then you were on the red team. And so it really kind of organically brought them together.

We also went through the House of Horrors activity guidelines. And so they were going to go into a room where they were going to see a lot of different errors. They were not going to be able to talk to any of their teammates. So that again, they were in a group of four to six. They would go in there with their clipboards and their paper. And they are going to write down as many errors as they could find in the five minutes that they were in that room.

They could not talk to each other. They could lift up things. They could move things. They could walk around. But the one key thing was not to talk to anybody else while they were in that room. So we went through those guidelines.

And then we split them up. So one group went into the house of horrors, and the other group stayed with the facilitators.

Next slide.

So let’s talk about that house of horrors a little bit more so you can see in the slide here, a picture of what that room looked like. And again, as I said, when I started this for me, I think is one of my favorite IPE activities because we get to make the room look as dangerous and unsafe as possible. And so Julie, Leslie, and I and our Sim techs, we went in there and just made a huge mess of things, as you can see.

And we made sure too, because again, I’m a nurse, right? And I’ve been a nurse for 28 years. So I see things through a nursing lens.

And Leslie and Julie see things from their PT and radiation therapy lens. So we wanted to make sure the safety errors and the things that we built into that room didn’t just represent what a nurse would be looking for but also what a PT and radiation therapist might be looking for.

So we had errors with related to the medications, which might be more nursing related. We had safety. You can see the bed rails down. It’s in high position, which was related to physical therapy. We had radiation therapy where the markings were wrong.

So we made sure to include multiple errors. And I think we had 40 or 50 errors at least in that room that were safety related errors. Again, each team, and you can see in this picture there’s five students there, had five minutes in the room.

You can see they’ve got their clipboards and they’re just supposed to write down as many errors as they can find in that 5 minute time without talking to each other. They can move stuff around. They could walk around the room. But they could not talk to each other.

And we also asked them once they were done, writing down as many things as they saw wrong to identify their top three. So each of those five students left the room thinking that they had their top three when they left the room.

Now, the other group of students remained with the facilitator. And they participated in team perception activities. During that same five minutes that the one groups in the House of horrors room, another group was watching two videos related to cognitive bias. And you might have seen these videos before. One is with the people passing the basketball and the gorilla comes in. And do you see the gorilla or not?

So we gave the students some different instructions. First we gave them no instruction and just had them watch the video. And then the second team perception video, we actually gave them assigned tasks. So you watch the person with the white shirt. And you watch the person with the pink shirt.

And so we saw how well you did or they did when no instructions were given and there were no people assigned to specific tasks versus team members being assigned a specific task. And then we had some discussion about that.

Next slide.

After, so we had to flip the group. So one group was in House of Horrors. One group was doing the videos. And then we swapped. Once both groups had completed both activities, we all came together and did a group debriefing. And we broke them back into their groups and had them then discuss their top three safety errors that they found during that House of Horrors experience. From there, we wanted them as a team to come up and collaborate together and agree on the top three safety errors in that room.

And as you can imagine, there was quite a bit of discussion happening there. And I know many students shared with us that they hadn’t even thought of some of the things that the other professions were bringing up.

We also discussed as a group as each team shared what were their top three and why did they choose those top three? What made them a priority over others? So we had a lot of really good discussion around how the group selected their top three and agreed on those. And then we also had some more discussion on those team perception videos.

At the end of that, we collected the data sheets.

OK, next slide.

And then the students, once they were done, they left. And they completed a reflective activity. I think we gave them a week to upload this in our different courses. And there were some specific questions we asked them to address. So we wanted them to answer how cognitive bias and situational awareness would apply to their work in a health care setting?

And then we wanted them to also try to provide us with an example of cognitive bias that they may have experienced or witnessed while they were in their clinical setting or clinic. And then last, we wanted them to come up with a solution that might help resolve or make themselves more aware of cognitive biases in the future.

All right. So I’m going to take over from the results my name is Leslie Smith and like Carman has said and Julie, I’m physical therapy faculty.

Next slide.

So overall, we had 112 students. We did have 113 that participated. So only one student did not provide consent. But we did have consent from 112 students, which included 39 nursing students, 57 DPT students, and 16 radiation therapy students.

Because physical therapy and radiation therapy is a yearly cohort, and nursing is a bi-yearly cohort, there was a comparison, convenient comparison group for us to look at because we only did this once a year. So there was a nursing cohort that didn’t do it as an IPE. But it just gave us an opportunity to do a comparison group when we looked at our data.

Next slide.

So the results of the safety errors, so when the individual students filled out their all of the safety errors, and then they had to make a determination on their own what was the three most what they thought were the most important safety errors during their semi-PE.

Just under a third of them identified exposed bodily fluids within the room to be the most important. And then medications not properly secured. And you can see the percentages there for each of those.

And then a number of students also thought the mess in the room.

There was clutter everywhere in the room, like stuff on the floor, stuff on the bed. It just, it was not very neat. And I think often, that can be very distracting to somebody. And I think that they focused on the mess and weren’t may be able to see. We don’t know for sure, but maybe not able to see some of the other things because of that distraction.

And then we had the teams like Carmen said during the debriefing as they had discussions as a team. And they had to as before they left, as a team, they had to decide what their top three were. And so in our data, we had 12 teams total that had like the 11 to 14 students that agreed on the three most important safety errors. So oxygen not connected, which was nobody’s individual top three. Or had a few, but it wasn’t in the top three anyway, but obviously pretty important that the patient’s oxygenation might be impacted.

They stuck with those exposed bodily fluids and the position of the bed being in a high position.

And then the patient identification came out. Somebody thought, wow, that’s really important. I didn’t even notice that the patients, what the patient charts said and what the patient’s armband said were different. And think an IV bag had a different patient name even. And so not everybody picked up on that.

Go ahead and switch slides.

And like I said, we had that comparison group. And so with the comparison group, it was only nursing students. And their individually were medications, mess on the floor in the room, and the bed in the high position, so some of the same things that we saw with our IPE group. And then as a team, they identified the medications as number one, then oxygen and patient identification.

So if we kind of look at all these together, next slide, you can kind of see how these all kind of compare. So I don’t think I have a pointer. But the top three, individual, you can see where exposed body fluids, medication, and mess on the floor, that was with a team, an IPE team. And when we looked at nursing only, medications was 73% of them said medications. And when we think about that, physical therapists don’t deal with medications and neither do radiation therapists.

So we don’t really–

we’re not going to focus probably on the medications. But the RN students, that’s a big part of their job. So of course, that makes sense that when for as individuals, medication was a big issue. The mess on the floor, again, I think that’s just so distracting that I think everyone was able to identify that and then the bed in the high position for the nursing students only.

When we looked at the teams, though, this is I think, where it kind of got a little bit closer. So a team, an IPE team identified oxygenation as the most important whereas the nursing group, and only by a little bit more, but like 2/3, it’s that medication. Their focus was more on that medication where only half of them put oxygenation. So and I do think that that’s the difference between the IPE group and what they think is more important as a team and nursing only group.

So next slide.

And then we did some qualitative analysis of both groups, both the Sim-IPE group and the comparison group from those reflective papers that Carman was talking about. And so from both of the groups, we had 92.7%

of the students that were able to identify a cognitive bias that they have observed in the clinical setting. They didn’t always name it exactly the way that we named it. We actually looked at their description of it and named it ourselves.

Sometimes they were able to name it exactly. But they were able to identify that yes, in the clinic, I have seen confirmation bias. Or I have seen these types of biases. And they would describe it in the paper. And then what we did was we said, “Yes, this is definitely a cognitive bias.” And 92.7% students identified and were able to describe something they’ve seen in the clinic that they would describe as a cognitive bias.

Interestingly enough, a lot of our nursing students described patients that were drug seeking in the emergency room or on the floor. And their preceptors maybe didn’t, they didn’t think that the patient really had pain. So I thought that was interesting. We saw that a lot. But we didn’t see that with the other two professions. The most common cognitive bias was the overconfidence and the confirmation bias.

All right, next slide. OK, from both groups, we asked could you think of a solution? So that last question that Carmen mentioned, is there a way that we as a team could reduce these cognitive bias? And 55% of the students who participated in the study group were able to link one of the interprofessional teams and teamwork as a solution. So over half we’re able to say when you have multiple people working together, you get different perspectives. And they were able to link that to reducing cognitive biases as an option.

With the comparison group, only 7% because they didn’t do this activity with an interprofessional team. So my thought is that they probably weren’t thinking about it in that frame. OK, Julie?

OK, we’ll finish with discussion.

So as Leslie mentioned, we did notice a change. So from whether it was the Sim-IPE group or the nursing comparison group, their individual safety errors changed when they were able to come together as a group.

We also, like Leslie mentioned, noticed that the individual safety errors and the ordering of what one group or one profession thought was more of a safety error than another profession. We did notice a little bit of a change in trend with that.

We were able to determine that the IPEC core competencies when we asked the students during that reflective writing sample to discuss if they’ve ever seen a cognitive bias in the clinical setting if they could describe it, and then what were some ways that they could help reduce cognitive bias? The Sim-IPE group was able to do that more successfully. 55% of them said something in regards to the IPEC core competencies.

So 25 students wrote that interprofessional teams and teamwork would help with reducing cognitive bias. 18 spoke of interprofessional communication, 12 recognizing roles and responsibilities, and 6 recognizing values and ethics.

This was different than the nursing comparison group where only six nursing students identified those IPEC core competencies.

3 mentioned interprofessional teams and teamwork. And the other 3 mentioned interprofessional communication to help reduce cognitive bias. And like Leslie said, it’s probably because they were in a group of their own profession.

I believe Carman did mention limitations to this study. This was a convenient sample.

We just used it from our university. So we didn’t have a representative sample of other health care students at other institutions.

Also, we don’t know if this will help with–

if this has any clinical carry over. So what the students noticed and recognized in a classroom simulation experience, would they then recognize it in a clinical setting?

So future directions for us, we’d like to again, maybe look at other types of classroom activities to see if we could add and build more IPE work with other health care professions. We would like to also look at testing the validity of the Sim-IPE activity by having clinical partners participate. We also found it interesting as both Carman and Leslie mentioned the sort of trends of the safety errors for each of the professions.

Our data sheets, correct me if I’m wrong, but I believe our data sheets didn’t have an ability for them to circle whether they were an RN student, a PT student, or an RT student. So I think moving forward, we’d like to see if we could see trends professionally with their top three safety years. We are also open and would love to have other professions join us in the Sim-IPE and then also looking at doing a video analysis, the cognitive bias video analysis.

So in conclusion, the students recognized their professional cognitive bias to the activity as demonstrated by their responses to what they identified in the House of Horror simulation room.

Most students had already seen cognitive bias situations occurring in the clinical setting and were able to recognize those bias.

The top two were overconfidence and confirmation bias. Many students recognized the Sim-IPE as an opportunity to improve communication, teamwork, and understanding each other’s roles and responsibilities as it relates to situational awareness.

And then also, when watching the videos, students that were assigned instructions were better able to identify the subtle changes.

So Carman spoke to this during phase two when they watched the videos, the gorilla video. And then we had another video where two women were having a conversation. And if the students were assigned a task or something to do like watch the person in the white shirt or count how many times the dark shirt gets the basketball, we noticed that we assigned roles to that group that they were able to pick up on those changes versus when we just simply instructed the students to watch the videos.

And these are our references. And as of right now, that is the end of our presentation.

Thank you so much. We are just thrilled to have you here today and appreciate you taking time out to share the study with us.

We are going to go ahead and jump into our roundtable discussion. That will be here on the same Zoom link.

All the same housekeeping still applies. But just as a quick reminder, use the chat window if you want to share your thoughts or resources. And then any questions that you’d like answered, go ahead and put in the Q&A box.

If you want to have a specific question in there answered that someone else put in, go ahead and click the thumbs up icon so that you can upvote that question.

And we’ll go ahead and dive into the first one. There’s two similar questions mostly about the students. Were all of these students undergrad? And if so, what level were these student sophomores, juniors, seniors, or were they mix level?

So the nursing students were undergraduate in our traditional program. We have traditional and accelerated students. So they were in our traditional program second semester. So they are really early on in their program. And then I’m going to let Julie and Leslie answer with regard to their students.

The radiation therapy students are undergraduate as well. The junior and senior year of a bachelor’s degree, they are cohorted in a radiation therapy program.

We had juniors who were in their second semester in their second semester clinic. And then we also had seniors in their last semester, which would’ve been their fifth semester of clinical.

For the physical therapy students, they were their graduate students in a doctorate of physical therapy program. And they were all in their second year, second semester, so about halfway through their professional program.

Great, thank you. And the next question is, did you find that the students who saw the awareness videos first before entering the simulation that their awareness of the surroundings and errors identified was they were more able to identify what was wrong when compared to the student who did a simulation first and then watched the awareness videos?

That is a great question. [LAUGH]

I don’t think we actually dived into the data at that level.

I’ll let Leslie and Julie jump in, but definitely something that we would be interested in looking at before. But just to make sure the videos really had nothing to do with the safety or they were the, it’s the gorilla video. So but it did maybe open their eyes to the fact that they could be going into a patient room with some preconceived notions based on their professional training up until that point.

But I think that’s a really interesting thing to consider. And like Julie, said one of the things we learned is that we probably should have had a little more information on our data collection sheets so we could have done that analysis.

And the only thing that I would add is I think that when we looked at the videos were not the main purpose of our study. It was kind of filler time. And it just kind of added to their understanding of how people see things differently and some people see the gorilla and some people don’t. And so we didn’t really think to really look at that until after we did it for the first year. Then we were like, we really need to dive more into that because those videos were very interesting, the reaction that we got from the students. And some of them did reflect on it as well.

It was like Carmen and Leslie said, it was more of an enhancement of the fact that as humans, we use cognitive bias all day every day. It’s just part of how our brain works.

So instead of just telling them that, we kind of wanted to show them that and demonstrate that to them through these videos that you could be watching and very intently staring at the screen and watching these people pass this basketball back and forth and not even see a person dressed in a gorilla suit skirting right through them and beating their chest. So it kind of maybe hopefully made them more aware of the fact that we all experience these cognitive bias.

Interesting, thank you. All right, next question, did you publish this study? There’s a couple of people looking to read it and possibly include it in their schools.

Actually yes, in the spring of 2022, so it just got published in the Radiation Therapist Journal. So it is published. And yeah, we’d be happy for you to read that.

Great. All right, another question here, they said how long did you need to prepare prior to actual day of simulation?

That’s a good question, too.

So our team has been doing IPE for quite a while, Sim-IPEs.

And so we maybe had a little bit of an advantage. And like I said, too, we had been individually kind of doing this House of Horror. So we already had the basic premise in terms of how the room might look and how long the students would be in there. But we had multiple team meetings where we discussed what the day would look like, what the pre-learning activities would look like, what pre-briefing.

We actually created facilitator pre-briefing guides so that if that somebody different was doing the pre-briefing that we were making sure that we were consistent. Because there’s three of us, right? And we actually recruited some other faculty to help with the facilitation. And so this ensured that everybody was getting the same information from the debriefing standpoint. And everybody was on the same page in what would happen during the one hour time with the learners.

In terms of setting up the room, it’s actually pretty fun. It doesn’t take that long to make a lot of errors in the room. And I have to sim techs, and they assisted with that. And I just let them kind of come up with a lot of the different errors. And then like I said, Julie, Leslie, and I went in there and added some of our own things, too. In fact, we were so good at creating a room that had multiple safety errors and looked horrible that there was a tour in between our sessions.

And somehow, they weren’t supposed to go into that room. But they went into that room. And they actually reported to the dean that oh my gosh, there was this horrible thing happening in your Sim Center.

And so I kind of had some explaining to do to the dean that no, that was actually as a learning activity. But the person doing the tour wasn’t guided by one of our Sim Center teams. I don’t know, sometimes we have people just walking through our Sim Center and anyway, so we had to do some–

we learned that, too, to make sure that we were telling everybody that we were doing these House of Horror activities.

But the room set up really doesn’t take that much time. And there’s obviously from the sim simulation piece, there’s not a lot. You don’t have to develop mannequin actions and things like that. So that part makes it a little easier.

That’s great. All right, another question here is what other types of IPE simulations do you offer are than the House of Horrors?

Well, so we do multiple Sim-IPEs.

So we’ve done the House of Horrors.

And Leslie, you can jump into in case I missed one. We have a community health telehealth Sim-IPE.

We have a cardiac Sim-IPE.

We have a discharge planning Sim-IPE.

And we have a neuro Sim-IPE. and when I say cardiac and neuro that’s just our way of knowing that that scenario is more of a cardiac focused scenario and more of a neuro stroke type scenario.

And we do those at different times of the year based on where the students are in the program. So for example, the neuro IPE activity is going to be at a time when the learners that are participating in that have access to that kind of stroke related content for example or cardiac related content. So did I miss any mostly?

I think those are the ones that are simulation based. We also do other IPEs with the physical therapy and the radiation therapy do a breast cancer case IPE.

The physical therapy students also will do a–

they do an IPE with orthotics and prosthetic students along with PAOT looking at the needs of patients that have had amputations or that need orthotics. And they also do a IPE with occupational therapy early on just learning the difference between PT and OT.

And we just did one ventilator, right?

Early mobililty.

Early mobility with a ventilator, and I think we’ve done one end of life, an IPE end of life. The reason that we’re kind of struggling is because obviously, with the pandemic, some of our IPE activities were placed on hold during the pandemic. And enough last fall was actually the first time we were able to resume some of our face-to-face IPE. So it seems like so long ago. Even this. Hous of Horrors, the last time we did it was in 2019 because of the COVID pandemic restrictions.

So we’re getting back up to speed in terms of going back to the things that we’ve done. And it’s amazing how you try to remember all the things that we were doing before the pandemic and how much it changed life.

Great, thank you so much. Well, we will go ahead and start wrapping up here. If anyone has any more questions, feel free to put them in the Q&A box. Before we wrap up here, Carman and Julie and Leslie, is there anything else that you’d like to add?

Well, I just appreciate the opportunity to share some of the good work that we’re doing and the importance of not just cognitive bias and teams and teamwork and but really across the board in health care to try to improve outcomes.

Yeah, I agree with Leslie. We’re really excited to be here today and to share this. We feel like this is one of our more unique IPE related activities. And it really does focus on patient safety. If you think about the fact that half of the students could have missed or not felt that oxygen not being connected was not a priority, that was surprising to all of us.

And so it really highlighted to us how perhaps this could make a difference in the clinical setting. And as Julie said, we don’t have any hard data that suggests that is true or not. But that is what excites us and keeps us continuing to do this work is the hope that we can change behaviors and change practice and ultimately improve patient safety and outcomes.

I agree with both what Leslie and Carmen said. Thank you so much for having us.