Surgical Team Assessment Training: improving surgical teams during deployment

Military Medical Simulations-Scoping Review

INTRODUCTION

The military employs a wide variety of training paradigms to prepare a ready medical force. Simulation-based training is prominently used in the military for all roles of care to provide the knowledge, skills, and abilities needed to render care from the battlefield to the hospital. The purpose of this scoping review is to synthesize the body of research in military healthcare simulation, highlight trends in the literature, and identify research gaps.

MATERIALS AND METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis process, the databases of PubMed, Google Scholar, and targeted conferences were searched for articles focused on simulation-based training in the military healthcare community. Inclusion criteria required that the studies assessed a healthcare simulation intervention and had military participants. Data were gathered on population parameters (branch of service and provider level) as well as study parameter (simulation modality, medical domain, and outcome measures). Outcome measures were categorized according to the Kirkpatrick model of training evaluation.

RESULTS

A total of 43 articles met inclusion criteria. Article summaries and descriptive data on the participant populations and study parameters are provided in Tables 1, 2, and Supplementary Table S1.

CONCLUSIONS

Participant populations were inclusive of all the services and roles of care, suggesting appropriate representation of the broad military healthcare community. The majority of literature has studied physical simulations, such as manikins or task trainers. Few studies employed augmented or virtual reality as the training intervention, likely because of the nascency of the technology. Trauma care was the focus of 65% of the studies; this is attributable to the criticality of trauma care within battlefield medicine and casualty response. Related to study outcomes, participant reactions, such as usability and user acceptance, and immediate learning outcomes were heavily studied. Retention and behavioral changes were rarely studied and represent a significant research gap. Future research assessing mixed reality technologies would be beneficial to determine whether the technology warrants inclusion in programs of instruction. Finally, studies with outcome measures including long-term knowledge and skills retention, behavioral change, or patient outcomes are strongly recommended for future research.

Experience and training needs of nurses in military hospital on emergency rescue at high altitude: a qualitative meta-synthesis

BACKGROUND

Nurses play an important role in the treatment of war wounds on the plateau, and they face multiple challenges and a variety of needs in their caregiving process. This study aimed to systematically integrate and evaluate qualitative research data to understand the altitude emergency rescue experience and training needs of nurses in military hospitals and provide them with targeted assistance.

METHODS

We critically assessed the study using the Joanna Briggs Institute Critical Assessment Checklist for Qualitative Research. Extraction, summarization and meta-synthesis of qualitative data. Cochrane Library, PubMed, Embase, FMRS, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database, and China Biomedical Database (CBM) were searched for relevant studies published from the establishment of the database to May 2023. Additionally, we conducted a manual search of the references of the identified studies. Registered on the PROSPERO database (CRD42024537104).

RESULTS

A total of 17 studies, including 428 participants, were included, and 139 research results were extracted, summarized into 10 new categories, and formed 3 meta-themes. Meta-theme 1: mental state of military nurses during deployment. Meta-theme 2: the experience of military nurses during deployment. Meta-theme 3: training needs for emergency care.

CONCLUSIONS

Emergency rescue of high-altitude war injuries is a challenging process. Leaders should pay full attention to the feelings and needs of military nurses during the first aid process and provide them with appropriate support.

The effectiveness of simulation-based training on the competency of military nurses: A systematic review

BACKGROUND

Simulation is an integral component of healthcare education and military training. There is substantial evidence demonstrating the effectiveness of simulation-based training in nursing and the military; however, its effectiveness for military nurses has not been established in systematic reviews.

OBJECTIVE

To evaluate the effectiveness of simulation-based training on the competency of military nurses and provide guidance for future research on the training of military nurses.

DESIGN

A scoping literature review of PRISMA was used to guide the review.

METHODS

Six databases (PubMed, CINAHL, EMBASE, PsycINFO, Embase, and the Cochrane Library) were searched for English articles. The following search terms were used in different combinations: simulation, simulate, military, army, nurses, competency, training, and education. Our database search began in 2000 and ended in February 2022. Additionally, we conducted a manual search of the references of the identified studies.

RESULTS

In this review, ten studies published between 2008 and 2021 were included, nine were from the United States and one was from the United Kingdom. The results showed that simulation-based interventions were effective in military nurse competency training, including individual knowledge, skills, abilities and thinking, team communication and collaboration abilities, competency enhancement and maintenance. Simulations can effectively train the competencies of newly graduated military nurses, nurses during daily work, and in preparing nurses during deployment.

CONCLUSION

Existing studies on simulation-based training of military nurses are limited. Additional research is needed to assess other competency training for military nurses, pre-deployment training, and training using other simulation methods. It is important to find suitable simulation training methods for the different competencies required of military nurses.

A Systematic Review of Trauma Crew Resource Management Training: What Can the United States and the United Kingdom Learn From Each Other?

OBJECTIVE

Crew Resource Management (CRM) training incorporates methods such as simulation, debrief, and teamwork training to emphasize human factors skills. This systematic review aimed to assess differences in CRM between UK and USA trauma personnel.

DESIGN

A structured search of the databases MEDLINE and Embase in addition to unstructured reference review and Google Scholar search was undertaken without time restraint to identify articles describing CRM training courses of trauma personnel. Predetermined criteria for inclusion included comprehensive reports of CRM training in trauma personnel with participant assessment. Articles were analyzed for course details and descriptions, Kirkpatrick domains and levels utilized, and measure items and outcomes.

RESULTS

Twenty-nine full-text articles (24 USA, 5 UK) met predetermined criteria. UK-based CRM had a heavy emphasis on doctors while USA-based CRM reached a range of multidisciplinary civilian and military professionals. UK-based CRM focused on skills outcomes using pre- and post-training questionnaires, whereas USA-based training focused on behavior and nontechnical skills utilizing validated standardized measures. CRM-based training, and particularly courses incorporating simulation and multidisciplinary methods, resulted in significantly improved preparedness for trauma, emergency skills, and clinical behavioral change.

CONCLUSIONS

CRM training has the potential to give significant benefits to participant learning, teamwork behaviors, and clinical care outcomes. The USA appears to utilize a focused multidisciplinary and human factors approach to trauma training, which could be adopted by UK institutions to improve cohesive team performance and patient care.

Multidisciplinary Simulation-Based Team Training for Trauma Resuscitation: A Scoping Review

OBJECTIVE

Simulation-based training as an educational intervention for healthcare providers has increased in use over the past 2 decades. The simulation community has called for standardized reporting of methodologies and outcomes. The purpose of this review was to (1) summarize existing data on the use of simulation-based team training for acute trauma resuscitation, and (2) describe differences in training methodologies, outcomes reporting, and gaps in the literature to inform research priorities.

DESIGN

We performed a scoping review of Ovid Medline, Embase, Cochrane Library, CINAHL, Web of Science, ERIC, and Google Scholar for studies evaluating simulation-based team training for acute trauma resuscitation. Full-text review was performed by 2 reviewers and variables related to study design, training methodology, outcomes reported, and impact of training were abstracted.

RESULTS

Forty-seven out of 3,911 screened studies met criteria for inclusion. Only 2 studies were randomized. The most frequent design was a pre-post study (64%). Eleven studies did not report their simulated scenario design. Interventions occurred most frequently in a laboratory-based setting (45%). Simulation-based training was associated with greater knowledge (n = 5/6), higher nontechnical skills (n = 12/13), greater number of resuscitation tasks completed (n = 10/13), and faster time to resuscitation task completion (n = 11/11). No differences in patient outcomes were found (n = 3/3).

CONCLUSIONS

Simulation-based training for trauma resuscitation is associated with improved measures of teamwork, task performance and speed, knowledge, and provider satisfaction. Type of reported outcomes and training methodologies are variable. Standardized reporting of training methodology and outcomes is needed to address the impact of this intervention.

Effective Surgical Teams: An Integrative Literature Review

It is imperative to understand the factors that contribute to effective surgical teams. The aim of this integrative review was to evaluate the aids and barriers for perioperative teams in functioning effectively, preventing adverse events, and fostering a culture of safety. The literature search was undertaken of 15 databases, which resulted in 70 articles being included. It was found perioperative teamwork was not widely understood. Findings indicated barriers to effective surgical teams comprised of confusion in tasks and responsibilities, existing hierarchies and prevailing misconceptions and understanding among team members. Although numerous quality initiatives exist, the introduction of protocols and checklists, team effectiveness in the perioperative setting is still insufficient and challenges in establishing effective surgical teams continue. Further research is recommended to obtain a comprehensive perception of environmental influences and barriers surgical teams encounter in the delivery of safe quality care.

Utilization profile of the Canadian-led coalition Role 2 Medical Treatment Facility in Iraq: the growing requirement for multinational interoperability

Background

The Canadian Armed Forces deployed a Role 2 Medical Treatment Facility (R2MTF) to Iraq in November 2016 as part of Operation IMPACT. We compared the multinational interoperability required of this R2MTF with that of similar facilities previously deployed by Canada or other nations.

Methods

We reviewed data (Nov. 4, 2016, to Oct. 3, 2017) from the electronic Disease and Injury Surveillance Report and the Daily Medical Situation Report. Clinical activity was stratified by Global Burden of Diseases category, ICD-10 code, mechanism of injury, services used, encounter type, nationality and blood product usage. We reviewed the literature to identify utilization profiles for other MTFs over the last 20 years.

Results

In total, 1487 patients were assessed. Of these, 5.0% had battle injuries requiring damage-control resuscitation and/or damage-control surgery, with 55 casualties requiring medical evacuation after stabilization. Trauma and disease non-battle injuries accounted for 44% and 51% of patient encounters, respectively. Other than dental conditions, musculoskeletal disorders accounted for most presentations. Fifty-seven units of fresh frozen plasma and 64 units of packed red blood cells were used, and the walking blood bank was activated 7 times. Mass casualty activations involved coordination of health care and logistical resources from more than 12 countries. In addition to host nation military and civilian casualties, patients from 15 different countries were treated with similar frequency.

Conclusion

The experience of the Canadian R2MTF in Iraq demonstrates the importance of multinational interoperability in providing cohesive medical care in coalition surgical facilities. Multinational interoperability derives from a unique relationship between higher medical command collaboration, international training and adherence to common standards for equipment and clinical practice.

The Role of High-Fidelity Team-Based Simulation in Acute Care Settings: A Systematic Review

Introduction  High-fidelity team-based simulation has been identified as an effective way of teaching and evaluating both technical and nontechnical skills. Several studies have described the benefits of this modality in a variety of acute care settings, but a lack of standardized methodologies has resulted in heterogeneous findings. Few studies have characterized high fidelity simulation across a broad range of acute care settings and integrated the latest evidence on its educational and patient impact.

Methods  The MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were searched for empirical studies from the last 10 years, investigating high fidelity team-based simulation in surgical, trauma, and critical care training curricula.

Results  Seventeen studies were included. Interventions and evaluations were comprehensively characterized for each study and were discussed in the context of four overarching acute care settings: the emergency department/trauma bay, the operating room, the intensive care unit, and inpatient ad hoc resuscitation teams.

Conclusions  The use of high-fidelity team-based simulation has expanded in acute care and is feasible and effective in a wide variety of specialized acute settings, including the emergency department/trauma bay, the operating room, the intensive care unit, and inpatient ad hoc resuscitation teams. Training programs have evolved to emphasize team-based, multidisciplinary education models and are often conducted in situ to maximize authenticity. In situ simulations have also provided the opportunity for system-level improvement and discussions of complex topics such as social hierarchy. There is limited evidence supporting the impact of simulation on patient outcomes, sustainability of simulation efforts, or cost-effectiveness of training programs. These areas warrant further research now that the scope of utilization across acute care settings has been characterized.

Interprofessional education involving didactic TeamSTEPPS® and interactive healthcare simulation: A systematic review

The didactic portion of TeamSTEPPS®, which focuses on teaching teamwork and communication, coupled with interactive simulation methods provides a unique interprofessional education (IPE) learning environment. Across the literature there are a wide variety of such programs described, but there is not a consensus on the most effective methodology. A systematic review was therefore undertaken to synthesize, critically appraise, and evaluate existing literature on IPE programs that utilize didactic TeamSTEPPS in conjunction with interactive healthcare simulation. EBSCO and PubMed databases were searched from inception through March 2017 using predetermined inclusion and exclusion criteria. The initial search yielded 66 articles which was reduced to 42 peer-reviewed publications after duplicates were removed. An additional 2 articles were identified via hand search. Therefore, 44 articles were identified and reviewed and 11 studies met all inclusion criteria. Critical appraisal was performed using The Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. The outcome measures associated with each program as well as specifics of the didactic portion and interactive healthcare simulation are further explored in this review. It is anticipated that the findings from this systematic review will aid in the development of future evidence-based interprofessional programs.

Interprofessional education in graduate medical education: survey study of residency program directors

BACKGROUND

The overarching purpose of this study is to examine the current trends in interprofessional education (IPE) within graduate medical education in the Unites States.

METHODS

A survey was sent to program directors across with different specialties between March and April 2016. The survey was completed by 233 out of 1757 program directors, which represents a response rate of 13.3%.

RESULTS

IPE is currently being used by over 60% of the GME program directors that completed the survey. The median number of IPE hours is 60. Classroom learning (70.8%) and team-based approaches (70.1%) to patient care are the two most common forms of IPE. The two most prevalent reasons for implementing IPE are improving collaboration (92.2%) and communication (87%). More than half of the program directors agreed or strongly agreed that lack of time both for teachers (54.4) and for residents (51.5%) are barriers to IPE. About one third of the respondents whose programs do not include IPE are interested in implementing some IPE in the future.

CONCLUSION

IPE in its varying formats has been implemented as a training model by many residency programs. Further studies are needed to explore the comparative effectiveness of the different modalities of IPE.

Training Tools for Nontechnical Skills for Surgeons-A Systematic Review

OBJECTIVE

Development of nontechnical skills for surgeons has been recognized as an important factor in surgical care. Training tools for this specific domain are being created and validated to maximize the surgeon's nontechnical ability. This systematic review aims to outline, address, and recommend these training tools.

DESIGN

A full and comprehensive literature search, using a systematic format, was performed on ScienceDirect and PubMed, with data extraction occurring in line with specified inclusion criteria.

SETTING

Systematic review was performed fully at King's College London.

RESULTS

A total of 84 heterogeneous articles were used in this review. Further, 23 training tools including scoring systems, training programs, and mixtures of the two for a range of specialities were identified in the literature. Most can be applied to surgery overall, although some tools target specific specialities (such as neurosurgery). Interrater reliability, construct, content, and face validation statuses were variable according to the specific tool in question.

CONCLUSIONS

Study results pertaining to nontechnical skill training tools have thus far been universally positive, but further studies are required for those more recently developed and less extensively used tools. Recommendations can be made for individual training tools based on their level of validation and for their target audience. Based on the number of studies performed and their status of validity, NOTSS and Oxford NOTECHS II can be considered the gold standard for individual- and team-based nontechnical skills training, respectively, especially when used in conjunction with a training program.

Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center

PROBLEM

Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired.

METHODS

Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities.

RESULTS

Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care.

IMPLICATIONS FOR PRACTICE

Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential.

'A band of brothers'-an exploration of the range of medical ethical issues faced by British senior military clinicians on deployment to Afghanistan: a qualitative study

AIMS

To identify and explore features of ethical issues that senior clinicians faced as deployed medical directors (DMDs) to the British Field Hospital in Afghanistan as well as to determine the ethical training requirements for future deployments.

METHOD

A qualitative study in two phases conducted from November 2014 to June 2015. Phase 1 analysed 60 vignettes of cases that had generated ethical dilemmas for DMDs. Phase 2 included focus groups and an interview with 13 DMDs.

FINDINGS

Phase 1 identified working with limited resources, dual conflict of meeting both clinical and military obligations and consent of children as the most prevalent ethical challenges. Themes found in Phase 2 included sharing clinical responsibilities with clinicians from other countries and not knowing team members' ways of working, in addition to the themes from Phase 1.

DISCUSSION

This study has drawn together examples of scenarios to form a repository that will aid future training. Recommendations included undertaking ethics training together as a team before, during and after deployment which must include all nationalities who are assigned to the same operational tour, so that different ethical views can be explored beforehand.

Segurança do paciente no ambiente cirúrgico: tradução e adaptação cultural de instrumento validado

Resumo Objetivo Traduzir e adaptar o Safety Attitudes Questionnaire/Operating Room Version para a língua portuguesa. Métodos Pesquisa metodológica de adaptação transcultural que empregou as etapas: tradução, síntese, retrotradução, avaliação por comitê de juízes, pré-teste, submissão e avaliação dos relatórios pelos autores do instrumento original. A validação de conteúdo foi realizada mediante as equivalências semântica, idiomática, conceitual, experiencial e de conteúdo. Participaram 12 juízes e o índice de concordância correspondeu a ≥ 80%. Resultados As etapas de tradução e retrotradução foram consideradas adequadas e na avaliação da síntese pelos juízes foi indicada alteração em 41 itens, do total de 137. Em relação ao processo de validação das equivalencias realizado pelos juízes, o consenso geral do instrumento obteve 84,1% de equivalência, 9,3% de não equivalência e 6,6% de indecisos. No pré-teste, o tempo médio de preenchimento correspondeu a 16,5 minutos. Conclusão O processo de tradução e adaptação apresentou adequação quanto à validade de conteúdo mediante os índices obtidos nas equivalências e compreensão pelos sujeitos, e foi aprovado pelos autores.